Resumen
En la última década se ha establecido que la ventilación no invasiva (VNI) con presión de soporte (PS) es una técnica de primera línea en los pacientes con insuficiencia respiratoria aguda (IRA) grave secundaria a enfermedad pulmonar obstructiva crónica. Sin embargo, en el edema agudo de pulmón cardiogénico (EAP) no había evidencia de su efectividad. Por ello se planteó un estudio aleatorizado con pacientes afectados de EAP grave para comparar la VNI (con PS y presión positiva al final de la espiración [PEEP]) y la oxigenoterapia convencional. Los resultados evidenciaron mejoría más rápida y significativa de la IRA y reducción de la tasa de intubación orotraqueal (IOT) del 33% al 6%. En concordancia con otros estudios, los pacientes con hipercapnia fueron los que más se beneficiaron de esta técnica. Analizando posteriormente todos los pacientes con EAP tratados de forma convencional en nuestro centro en los últimos 5 años, comprobamos que la acidosis severa (pH < 7.25) y la presión arterial sistólica baja (< 140 mm Hg) al ingreso, entre otras, eran variables independientes predictoras de la necesidad de IOT. Por tanto, aunque todos los pacientes con EAP puedan beneficiarse de la VNI con PS y PEEP, existen criterios de riesgo que permiten detectar los casos más severos, en los que su utilización puede resultar esencial.
Palabras clave
Ventilación no invasiva, presión de soporte
Clasificación en siicsalud
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página www.siicsalud.com/des/des031/02d10002.htm
Especialidades
Principal: Cuidados Intensivos
Relacionadas: Cardiología, Medicina Interna
Patrocinio y reconocimiento
A los doctores Antonio Jordi Betbesé, Francisco Vecilla, Rosario Cañizares, Josep Ballús, Teresa Catá y Josep Anton Ferreres, por su colaboración; y a los equipos de enfermería de Urgencias y de la UVI de nuestro hospital, especialmente este último, sin el cual no habría sido posible la realización del estudio original.
Artículo completo
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Abstract
In the last decade, non-invasive ventilation (NIV) with pressure support (PS) has been established as a first line treatment in patients with severe acute respiratory failure (ARF) secondary to chronic obstructive pulmonary disease. However, there was no evidence about its efficacy in the acute cardiogenic pulmonary edema (APE). Therefore, a prospective randomized study was planned to compare NIV with PS and PEEP with conventional oxygen therapy. The results of the study clearly demonstrated a faster and significative improvement in ARF and a reduction in the intubation rate from 33% to 6%. Hypercapnic patients were those who showed the maximum benefit in accordance to other studies. Analysing all patients with severe APE admitted to our institution in the last 5 years, we found out that severe acidosis (pH < 7.25) as well as low systolic blood pressure (< 140 mm Hg) were independent variables predictive of the necessity of intubation. Thus, although all patients with APE may benefit with the use of NIV with PS and PEEP, there are some risk criteria allowing the detection of the most severe cases in whom the use of NIV may be essential.
Key words
Non-invasive ventilation, pressure support
Bibliografía del artículo
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