Ventilación no invasiva en una unidad de medicina intensiva
Estudio prospectivo observacional
Palabras clave:
VENTILACIÓN NO INVASIVA, RESPIRACIÓN ARTIFICIAL, INSUFICIENCIA RESPIRATORIA, ENFERMEDAD AGUDA, ESTUDIOS PROSPECTIVOSResumen
La ventilación no invasiva (VNI) se utiliza con buenos resultados en la insuficiencia respiratoria con los objetivos de evitar la intubación traqueal y la ventilación invasiva. Sus indicaciones se han extendido a nuevas situaciones clínicas aunque en ocasiones la evidencia no permite hacer recomendaciones definitivas.
Objetivos: describir los usos y resultados clínicos de la VNI.
Metodología: estudio clínico, prospectivo y observacional en una unidad de medicina intensiva (UMI) durante un año.
Resultados: la VNI se utilizó en 141/771 casos, representando el 18,3% de los egresos en el período de estudio. En 11,7% se aplicó como tratamiento inicial (VNI-Inicial), mientras que en 6% se utilizó luego de un período de ventilación invasiva (VNI-Pos VI). En este último grupo se utilizó en diferentes situaciones: a) como puente para el destete de ventilación invasiva; b) para prevenir la insuficiencia respiratoria posextubación, o c) para el tratamiento de la insuficiencia respiratoria posextubación. El éxito global de la técnica fue de 70% en ambos grupos, siendo la mortalidad en la UMI de 10% para el grupo VNI-Inicial y de 4,3% en el grupo VNI-Pos VI. En el Grupo Fracaso se observó mayor severidad por APACHE II, tiempo de estadía y mortalidad en la UMI.
Conclusiones: la VNI es de uso frecuente para el tratamiento de la insuficiencia respiratoria del paciente crítico como alternativa a la intubación traqueal y para el manejo respiratorio posventilación invasiva. Un mayor conocimiento acerca de las distintas aplicaciones de la VNI puede contribuir a mejorar los resultados clínicos del paciente crítico.
Citas
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(24) Fernandez R, Baigorri F, Artigas A. Noninvasive ventilation in patients with “do-not-intubate” orders: medium-term efficacy depends critically on patient selection. Intensive Care Med 2007; 33(2):350-4.
(25) Esteban A, Ferguson ND, Meade MO, Frutos-Vivar F, Apezteguia C, Brochard L, et al; VENTILA Group. Evolution of mechanical ventilation in response to clinical research. Am J Respir Crit Care Med 2008; 177(2):170-7.
(26) Esteban A, Frutos-Vivar F, Muriel A, Ferguson ND, Peñuelas O, Abraira V, et al. Evolution of mortality over time in patients receiving mechanical ventilation. Am J Respir Crit Care Med 2013; 188(2):220-30.
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(28) Ferrer M, Sellarés J, Valencia M, Carrillo A, Gonzalez G, Badia JR, et al. Non-invasive ventilation after extubation in hypercapnic patients with chronic respiratory disorders: randomised controlled trial. Lancet 2009; 374(9695):1082-8.
(29) Chandra D, Stamm JA, Taylor B, Ramos RM, Satterwhite L, Krishnan JA, et al. Outcomes of noninvasive ventilation for acute exacerbations of chronic obstructive pulmonary disease in the United States, 1998-2008. Am J Respir Crit Care Med 2012; 185(2):152-9.
(30) Nava S, Hill N. Non-invasive ventilation in acute respiratory failure. Lancet 2009; 374(9685):250-9.
(31) Antonelli M, Conti G, Moro ML, Esquinas A, Gonzalez-Diaz G, Confalonieri M, et al. Predictors of failure of noninvasive positive pressure ventilation in patients with acute hypoxemic respiratory failure: a multi-center study. Intensive Care Med 2001; 27(11):1718-28.
(32) Santos Solari MC, Hurtado Bredda FJ, Neme J, Rivara Urrutia DA, Píriz H. Ventilación con presión positiva no invasiva en la insuficiencia respiratoria aguda. Paciente Crít 1996; 9(1):5-17.
(33) Neme J, Gutiérrez AM, Santos MC, Berón M, Ekroth C, Arcos JP, et al. Efectos fisiológicos de la ventilación no invasiva en pacientes con EPOC. Arch Bronconeumol 2007; 43(3):150-5.
(34) Burns KE, Meade MO, Premji A, Adhikari NK. Noninvasive ventilation as a weaning strategy for mechanical ventilation in adults with respiratory failure: a Cochrane systematic review. CMAJ 2014; 186(3):E112-22.
(35) Glossop AJ, Shephard N, Bryden DC, Mills GH. Non-invasive ventilation for weaning, avoiding reintubation after extubation and in the postoperative period: a meta-analysis. Br J Anaesth 2012; 109(3):305-14.
(2) Bersten AD, Holt AW, Vedig AE, Skowronski GA, Baggoley CJ. Treatment of severe cardiogenic pulmonary edema with continuous positive airway pressure delivered by face mask. N Engl J Med 1991; 325(26):1825-30.
(3) Bott J, Carroll MP, Conway JH, Keilty SE, Ward EM, Brown AM, et al. Randomised controlled trial of nasal ventilation in acute ventilatory failure due to chronic obstructive airways disease. Lancet 1993; 341(8860):1555-7.
(4) Kramer N, Meyer TJ, Meharg J, Cece RD, Hill NS. Randomized, prospective trial of noninvasive positive pressure ventilation in acute respiratory failure. Am J Respir Crit Care Med 1995; 151(6):1799-806.
(5) Mehta S, Jay GD, Woolard RH, Hipona RA, Connolly EM, Cimini DM, et al. Randomized, prospective trial of bilevel versus continuous positive airway pressure in acute pulmonary edema. Crit Care Med 1997; 25(4):620-8.
(6) Masip J, Roque M, Sánchez B, Fernández R, Subirana M, Expósito JA. Noninvasive ventilation in acute cardiogenic pulmonary edema: systematic review and meta-analysis. JAMA 2005; 294(24):3124-30.
(7) Brochard L, Mancebo J, Wysocki M, Lofaso F, Conti G, Rauss A, et al. Noninvasive ventilation for acute exacerbations of chronic obstructive pulmonary disease. N Engl J Med 1995; 333(13):817-22.
(8) Plant PK, Owen JL, Elliott MW. Early use of non-invasive ventilation for acute exacerbations of chronic obstructive pulmonary disease on general respiratory wards: a multicentre randomised controlled trial. Lancet 2000; 355(9219):1931-5.
(9) Keenan SP, Powers CE, McCormack DG. Noninvasive positive-pressure ventilation in patients with milder chronic obstructive pulmonary disease exacerbations: a randomized controlled trial. Respir Care 2005; 50(5):610-6.
(10) Pastaka C, Kostikas K, Karetsi E, Tsolaki V, Antoniadou I, Gourgoulianis KI. Non-invasive ventilation in chronic hypercapnic COPD patients with exacerbation and a pH of 7.35 or higher. Eur J Intern Med 2007; 18(7):524-30.
(11) Confalonieri M, Potena A, Carbone G, Porta RD, Tolley EA, Umberto Meduri G. Acute respiratory failure in patients with severe community-acquired pneumonia: a prospective randomized evaluation of noninvasive ventilation. Am J Respir Crit Care Med 1999; 160(5 Pt 1):1585-91.
(12) Carrillo A, Gonzalez-Diaz G, Ferrer M, Martinez-Quintana ME, Lopez-Martinez A, Llamas N, et al. Non-invasive ventilation in community-acquired pneumonia and severe acute respiratory failure. Intensive Care Med 2012; 38(3): 458-66.
(13) Ferrer M, Esquinas A, Leon M, Gonzalez G, Alarcon A, Torres A. Noninvasive ventilation in severe hypoxemic respiratory failure: a randomized clinical trial. Am J Respir Crit Care Med 2003; 168(12):1438-44.
(14) Soroksky A, Stav D, Shpirer I. A pilot prospective, randomized, placebo-controlled trial of bilevel positive airway pressure in acute asthmatic attack. Chest 2003; 123(4): 1018-25.
(15) Soma T, Hino M, Kida K, Kudoh S. A prospective and randomized study for improvement of acute asthma by non-invasive positive pressure ventilation (NPPV). Intern Med 2008; 47(6):493-501.
(16) Antonelli M, Conti G, Esquinas A, Montini L, Maggiore SM, Bello G, et al. A multiple-center survey on the use in clinical practice of noninvasive ventilation as a first-line intervention for acute respiratory distress syndrome. Crit Care Med 2007; 35(1):18-25.
(17) Nava S, Ambrosino N, Clini E, Prato M, Orlando G, Vitacca M, et al. Noninvasive mechanical ventilation in the weaning of patients with respiratory failure due to chronic obstructive pulmonary disease: a randomized, controlled trial. Ann Intern Med 1998; 128(9):721-8.
(18) Ferrer M, Esquinas A, Arancibia F, Bauer TT, Gonzalez G, Carrillo A, et al. Noninvasive ventilation during persistent weaning failure: a randomized controlled trial. Am J Respir Crit Care Med 2003; 168(1):70-6.
(19) Trevisan CE, Vieira SR; Research Group in Mechanical Ventilation Weaning. Noninvasive mechanical ventilation may be useful in treating patients who fail weaning from invasive mechanical ventilation: a randomized clinical trial. Crit Care 2008; 12(2):R51.
(20) Nava S, Gregoretti C, Fanfulla F, Squadrone E, Grassi M, Carlucci A, et al. Noninvasive ventilation to prevent respiratory failure after extubation in high-risk patients. Crit Care Med 2005; 33(11):2465-70.
(21) Ferrer M, Valencia M, Nicolas JM, Bernadich O, Badia JR, Torres A. Early noninvasive ventilation averts extubation failure in patients at risk: a randomized trial. Am J Respir Crit Care Med 2006; 173(2):164-70.
(22) Keenan SP, Powers C, McCormack DG, Block G. Noninvasive positive-pressure ventilation for postextubation respiratory distress: a randomized controlled trial. JAMA 2002; 287(24):3238-44.
(23) Esteban A, Frutos-Vivar F, Ferguson ND, Arabi Y, Apezteguía C, González M, et al. Noninvasive positive-pressure ventilation for respiratory failure after extubation. N Engl J Med 2004; 350(24):2452-60.
(24) Fernandez R, Baigorri F, Artigas A. Noninvasive ventilation in patients with “do-not-intubate” orders: medium-term efficacy depends critically on patient selection. Intensive Care Med 2007; 33(2):350-4.
(25) Esteban A, Ferguson ND, Meade MO, Frutos-Vivar F, Apezteguia C, Brochard L, et al; VENTILA Group. Evolution of mechanical ventilation in response to clinical research. Am J Respir Crit Care Med 2008; 177(2):170-7.
(26) Esteban A, Frutos-Vivar F, Muriel A, Ferguson ND, Peñuelas O, Abraira V, et al. Evolution of mortality over time in patients receiving mechanical ventilation. Am J Respir Crit Care Med 2013; 188(2):220-30.
(27) Canadian Critical Care Trials Group/Canadian Critical Care Society Noninvasive Ventilation Guidelines Group; Keenan SP, Sinuff T, Burns KE, Muscedere J, Kutsogiannis J, Mehta S, et al. Clinical practice guidelines for the use of noninvasive positive-pressure ventilation and noninvasive continuous positive airway pressure in the acute care setting. CMAJ 2011; 183(3):E195-214.
(28) Ferrer M, Sellarés J, Valencia M, Carrillo A, Gonzalez G, Badia JR, et al. Non-invasive ventilation after extubation in hypercapnic patients with chronic respiratory disorders: randomised controlled trial. Lancet 2009; 374(9695):1082-8.
(29) Chandra D, Stamm JA, Taylor B, Ramos RM, Satterwhite L, Krishnan JA, et al. Outcomes of noninvasive ventilation for acute exacerbations of chronic obstructive pulmonary disease in the United States, 1998-2008. Am J Respir Crit Care Med 2012; 185(2):152-9.
(30) Nava S, Hill N. Non-invasive ventilation in acute respiratory failure. Lancet 2009; 374(9685):250-9.
(31) Antonelli M, Conti G, Moro ML, Esquinas A, Gonzalez-Diaz G, Confalonieri M, et al. Predictors of failure of noninvasive positive pressure ventilation in patients with acute hypoxemic respiratory failure: a multi-center study. Intensive Care Med 2001; 27(11):1718-28.
(32) Santos Solari MC, Hurtado Bredda FJ, Neme J, Rivara Urrutia DA, Píriz H. Ventilación con presión positiva no invasiva en la insuficiencia respiratoria aguda. Paciente Crít 1996; 9(1):5-17.
(33) Neme J, Gutiérrez AM, Santos MC, Berón M, Ekroth C, Arcos JP, et al. Efectos fisiológicos de la ventilación no invasiva en pacientes con EPOC. Arch Bronconeumol 2007; 43(3):150-5.
(34) Burns KE, Meade MO, Premji A, Adhikari NK. Noninvasive ventilation as a weaning strategy for mechanical ventilation in adults with respiratory failure: a Cochrane systematic review. CMAJ 2014; 186(3):E112-22.
(35) Glossop AJ, Shephard N, Bryden DC, Mills GH. Non-invasive ventilation for weaning, avoiding reintubation after extubation and in the postoperative period: a meta-analysis. Br J Anaesth 2012; 109(3):305-14.
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2015-06-30
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Villarino C, Benavides B, Giordano Álvaro, Nin N, Hurtado J. Ventilación no invasiva en una unidad de medicina intensiva: Estudio prospectivo observacional. Rev. Méd. Urug. [Internet]. 30 de junio de 2015 [citado 21 de noviembre de 2024];31(2):103-11. Disponible en: https://revista.rmu.org.uy/index.php/rmu/article/view/212
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