Asistencia ventilatoria no invasiva en el tratamiento inicial de la insuficiencia respiratoria aguda

  • Ana Graciela França Círculo Católico de Obreros del Uruguay, CTI. Jefe. Médico Intensivista
  • Carlos Ignacio Formento Círculo Católico de Obreros del Uruguay. Médico Intensivista
  • Soledad Olivera Médico Residente de Medicina Intensiva
  • Alejandro Ebeid Bocchi Círculo Católico de Obreros del Uruguay, Coordinador de CTI. Médico Intensivista
Palabras clave: RESPIRACIÓN ARTIFICIAL, INSUFICIENCIA RESPIRATORIA, ENFERMEDAD AGUDA

Resumen

Introducción: la ventilación mecánica invasiva connota riesgo de neumonía y daño traumático de vía aérea. La ventilación no invasiva (VNI) demostró beneficios en insuficiencia respiratoria aguda (IRA), en enfermedad pulmonar obstructiva crónica (EPOC) y en edema agudo pulmonar cardiogénico (EAP), pero disparidad en la insuficiencia respiratoria hipoxémica no EAP. 
Objetivos: evaluar VNI en IRA hipoxémica e hipercápnica como tratamiento inicial. Respuesta, evolución, riesgo de fracaso y muerte. 
Material y método: estudio de cohorte prospectivo que incluyó a adultos inmunocompetentes tratados con VNI. Período: enero de 2011 a julio de 2013. Fueron pacientes ingresados en UCI-CI polivalente de 16 camas con IRA hipercápnica: presión arterial de anhídrido carbónico (PaCO2) ≥45 mm Hg, y pH ≤7,35 y >7,25, o hipoxémica: presión arterial de oxígeno (PaO2) con máscara de oxígeno >80 y ≤150 mmHg. Se excluían si había: indicación de intubación inmediata, depresión sensorial, inestabilidad hemodinámica, broncoplejía. 
Resultados: fueron 61 pacientes, 62 ± 14 años (edad media ± 1 desvío estándar). Apache II 15 ± 5,5. Hubo 36 pacientes con IRA hipoxémica, fracasaron 9 (25%) y fallecieron 7 (19%); con IRA hipercápnica fueron 25 pacientes, fracasaron 5 (20%) y fallecieron 4 (16%). Los que fracasaron tuvieron una internación más prolongada, p=0,01, mayor incidencia de infecciones respiratorias, p=0,009, y extrarrespiratorias, p=0,03. Los factores independientes de riesgo relacionados a fracaso y muerte (regresión logística) fueron:
. Fracaso: cada incremento unitario de la frecuencia respiratoria (FR) en primera hora de VNI, odds ratio (OR) 2,2 (IC 95% 1,4-3,5).
. Muerte: fracaso de la VNI, OR 19,5 (IC 95% 4,0-94,6). 
Conclusiones: cada incremento de la FR en la primera hora de VNI duplica el riesgo de fracaso y este multiplica por 20 la probabilidad de muerte.

Citas

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Publicado
2014-09-30
Cómo citar
1.
França AG, Formento CI, Olivera S, Ebeid Bocchi A. Asistencia ventilatoria no invasiva en el tratamiento inicial de la insuficiencia respiratoria aguda. Rev. Méd. Urug. [Internet]. 30 de septiembre de 2014 [citado 12 de agosto de 2020];30(3):168-7. Disponible en: http://revista.rmu.org.uy/ojsrmu311/index.php/rmu/article/view/241
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