Recomendações para a atuação dos fisioterapeutas nos casos de oxigenação por membrana extracorpórea (ECMO)*
Recommendations for physiotherapy in patients on Extracorporeal Membrane Oxygenation (ECMO)*
Natália Coronel de Lima Lages, Karina Tavares Timenetsky
Resumo
A Oxigenação por Membrana Extracorpórea (ECMO) é indicada quando o paciente desenvolve falência respiratória hipoxêmica refratária às estratégias convencionais de resgate, muito comum nos pacientes acometidos pela COVID-19. A manutenção de determinadas condições por 72 horas, tais como a relação da pressão parcial de oxigênio com a fração inspirada de oxigênio (PaO2 /FiO2 ) < 100 mmHg, complacência estática < 10 ml/ cmH20 e/ou pH < 7,2 com pressão parcial de dióxido de carbono (PaCO2 ) > 60 mmHg tem sido utilizadas, por centros especializados, como critérios para indicação precoce de ECMO nesses pacientes. A ventilação mecânica dos pacientes em ECMO deve sempre objetivar proteção pulmonar e diafragmática e a estratégia ventilatória deve ser individualizada. A mobilização e os exercícios terapêuticos devem ser implementados precocemente nestes pacientes, sendo considerados procedimentos seguros quando respeitadas as recomendações. A indicação de fisioterapia deve levar em consideração os ajustes da ECMO no momento da intervenção.
Palavras-chave
Abstract
Extracorporeal Membrane Oxygenation (ECMO) is indicated for acute hypoxemic respiratory failure refractory to conventional rescue therapies, a condition commonly observed in COVID-19 patients. Criteria such as a partial pressure of oxygen to inspired oxygen fraction ratio (PaO2 /FiO2 ) < 100 mmHg, static lung compliance < 10 ml/cmH20 and/or pH < 7.2 with a partial pressure of carbon dioxide (PaCO2 ) > 60 mmHg for at least 72 hours, have been used by some specialists for early indication of ECMO in these patients. Mechanical ventilation during ECMO must be individualized and should focus on lung and diaphragmatic protection. Mobilization and therapeutic exercises should be implemented early in these patients and both are considered safe procedures, if safety recommendations are followed. Physiotherapy prescription should take into account the ECMO settings at the time of the intervention.
Keywords
Referências
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