TRATAMIENTO Y PRONOSTICO DE LA ENFERMEDAD PULMONAR OBSTRUCTIVA CRONICA AGUDIZADA GRAVE





TRATAMIENTO Y PRONOSTICO DE LA ENFERMEDAD PULMONAR OBSTRUCTIVA CRONICA AGUDIZADA GRAVE

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La mortalidad de los pacientes con enfermedad pulmonar obstructiva crónica que requieren hospitalización por exacerbación de su enfermedad, oscila entre 3% y 4%, pero asciende hasta 61% para aquellos que requieren ingreso en UCI y ventilación mecánica invasiva.
anon9.jpg Autor:
José Manuel Añon Elizalde,
Columnista Experto de SIIC

Institución:
Servicio de Medicina Intensiva Hospital Virgen de la Luz Cuenca, España


Artículos publicados por José Manuel Añon Elizalde,
Recepción del artículo
20 de Abril, 2004
Aprobación
15 de Septiembre, 2004
Primera edición
23 de Noviembre, 2004
Segunda edición, ampliada y corregida
7 de Junio, 2021

Resumen
La enfermedad pulmonar obstructiva crónica (EPOC) es una de las causas más frecuentes de mortalidad y morbilidad en todo el mundo. Se caracteriza por una limitación al flujo aéreo que no es totalmente reversible, es habitualmente progresiva y asociada a una respuesta inflamatoria anómala de los pulmones a partículas nocivas o gases. Los pacientes con EPOC experimentan agudizaciones de su enfermedad, las cuales han sido definidas como un empeoramiento mantenido de las condiciones basales del paciente más allá de las variaciones diarias, de comienzo agudo y que necesita un cambio en la medicación habitual. Entre 50% y 75% de ellas son de causa infecciosa. La mayoría de las recomendaciones terapéuticas para el tratamiento de la agudización de la EPOC en la UCI derivan de consensos de expertos. El tratamiento inicial incluye oxígeno, broncodilatadores, corticoides sistémicos y antibióticos. Aquellos pacientes con agudización grave o que no responden al tratamiento conservador necesitarán ventilación mecánica con presión positiva, la cual puede administrarse de forma no invasiva a través de mascarilla o de forma invasiva a través de intubación endotraqueal. La mortalidad de los pacientes hospitalizados con agudización oscila entre 3% y 4%, pero asciende hasta 61% para aquellos que requieren ingreso en UCI y ventilación mecánica invasiva. Aunque ciertas variables fisiológicas se asocian al pronóstico, no existe hoy un método fiable para identificar pacientes con alto riesgo de muerte.

Palabras clave
Enfermedad pulmonar obstructiva crónica, pronóstico, tratamiento, ventilación mecánica


Artículo completo

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Abstract
Chronic obstructive pulmonary disease (COPD) is a major cause of morbidity and mortality throughout the world. COPD is a disease state characterized by airflow limitation that is not fully reversible. The airflow limitation is usually both progressive and associated with an abnormal inflammatory response of the lungs to noxious particles or gases. Patients with COPD experience acute exacerbations of their airway disease. Although definitions of acute exacerbations vary, recently the following definition has been proposed: a sustained worsening of the patient's condition, from the stable state and beyond normal day-to-day variations that is acute in onset and necessitates a change in regular medication in a patient with underlying COPD. Bronchial infections are important causes (50-75%) of acute exacerbations. Most therapeutic recommendations for managing patients in the ICU with acute exacerbations of COPD derive from expert consensus. Initial management includes supplemental oxygen, bronchodilators, antibiotics and systemic corticosteroids. For those patients with a severe exacerbation or without response to the farmacologic treatment, mechanical ventilation may be used. Ventilatory support can be provided by a face mask in the form of noninvasive positive pressure ventilation or by tracheal intubation with invasive mechanical ventilation. The mortality of patients hospitalized for an acute exacerbation is 3% to 4%, but in-hospital mortality climbs up to 61% for patients who requiere ICU admission and invasive mechanical ventilation. Although certain physiologic characteristics are associated with a higher likelihood of inpatient mortality, there is currently no reliable method for identifying patients at high risk of mortality.

Key words
Chronic obstructive pulmonary disease, prognosis, therapeutics, mechanical ventilation


Clasificación en siicsalud
Artículos originales > Expertos de Iberoamérica >
página   www.siicsalud.com/des/expertocompleto.php/

Especialidades
Principal: Cuidados Intensivos, Neumonología
Relacionadas: Cardiología, Fisiatría, Medicina Interna



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