PROTOCOLO DE VENTILACIÓN PROTECTORA EN PACIENTES OBESOS: ESTRATEGIAS PARA LA OPTIMIZACIÓN DE LA FUNCIÓN PULMONAR Y REDUCCIÓN DE COMPLICACIONES
Resumen
La obesidad impone alteraciones severas en la mecánica respiratoria, convirtiendo el manejo ventilatorio en cuidados intensivos en un desafío clínico sujeto a gran variabilidad asistencial. El objetivo de este estudio fue desarrollar un protocolo de ventilación mecánica protectora para pacientes obesos críticos. Método: Se trata de un estudio metodológico aplicado, fundamentado en una revisión narrativa de la literatura (2020-2025). Las evidencias sustentaron la creación de un protocolo institucional para el Hospital Municipal Ronaldo Gazolla (RJ), orientado a la estandarización del cuidado multiprofesional. Resultados: El protocolo desarrollado establece conductas decisivas: preoxigenación obligatoria con Ventilación No Invasiva (VNI); posicionamiento en Beach Chair o Trendelenburg reverso para alivio de la presión intraabdominal; obligatoriedad del cálculo del volumen corriente (6-8 mL/kg) por el peso predicho utilizando la altura de la rodilla o cúbito; monitorización rigurosa de la driving pressure; titulación individualizada de la PEEP; indicación de pronación como rescate; e institución profiláctica inmediata de VNI post-extubación. Conclusión: El instrumento traduce la complejidad fisiopatológica en un algoritmo práctico a pie de cama. En un escenario de rutina intensiva y diferentes niveles de expertise del equipo, el protocolo actúa como barrera contra fallas empíricas, reduciendo la variabilidad del cuidado, mitigando el riesgo de Lesión Pulmonar Inducida por Ventilador (VILI) y allanando el camino para la mejora de los resultados clínicos.
Biografía del autor/a
Fisioterapeuta Residente em Atenção em Terapia Intensiva.
Fisioterapeuta Residente em Atenção em Terapia Intensiva.
Fisioterapeuta Residente da atenção em Terapia Intensiva.
Fisioterapeuta Residente da atenção em Terapia Intensiva.
Fisioterapeuta Residente em Atenção em Terapia Intensiva.
Graduanda de Fisioterapia.
Fisioterapeuta. Mestre em Modelos de Decisão e Saúde. Doutor em Empidemiologia em Saúde Pública Ensp/FIOCRUZ.
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