aproximarnos de manera más real a estimar variables predictoras

advertisement
Evaluación de la ventilación mecánica no invasiva en pacientes con insuficiencia respiratoria aguda
aproximarnos de manera más real a estimar variables
predictoras de fracaso.
CONCLUSIONES
La VMNI reafirma su rol como estrategia para el manejo
de la IRA, evitando la intubación en el 75% de los
pacientes de esta serie.
Es necesario establecer estadísticamente un punto de
corte para la relación PaO2/FiO2 para aportar precozmente a la toma de decisiones en el manejo de pacientes
con IRA.
Las variables IPAP y FC, podrían aportar información valiosa para determinar el momento de término de
la VMNI e iniciar la ventilación mecánica invasiva. Sin
embargo es necesario enrolar un número mayor de
pacientes y posterior análisis por subgrupos.
REFERENCIAS
1.
Antonelli M, Conti G, Rocco M, Bufi M, De Blasi R, Vivino G,
Gasparetto A et al. A comparison of non-invasive positive-pressure
ventilation and conventional mechanical ventilation in patients
with acute respiratory failure. N Engl J Med 1998; 339: 429-35.
2.
Carlucci A, Richard JC, Wysocki M, Lepage E, Brochard L.
Noninvasive versus conventional mechanical ventilation: An
epidemiologic study. Am J Respir Crit Care Med 2001; 163: 874-80.
3.
Guerin C, Girard R, Chemorin C. Facial mask noninvasive
mechanical ventilation reduces the incidence of nosocomial
pneumonia. A prospective epidemiological survey from a single
ICU. Intensive Care Med 1997; 23: 1024-32.
4.
American Thoracic Society. International Consensus Conferences
in Intensive Care Medicine: noninvasive positive pressure
ventilation in acute respiratory failure. Am J Respir Crit Care Med
2001; 163 (1): 283-91.
immunosuppressed patients with pulmonary infiltrates, fever, and
acute respiratory failure. N Engl J Med 2001; 344: 481-7.
12. Antonelli M, Conti G, Bufi M, Costa M, Lappa A, Rocco M,
Gasparetto A, Meduri G. Noninvasive ventilation for treatment of
acute respiratory failure in patients undergoing solid organ
transplantation: a randomized trial. JAMA 2000; 283: 235-41.
13. Brochard L, Mancebo J, Wysocki M, Lofaso F, Conti G, Rauss A,
Simonneau G et al. Noninvasive ventilation for acute
exacerbations of chronic obstructive pulmonary disease. N Engl J
Med 1995; 333: 817-22.
14. Lightowler JV, Wedzicha J, Elliott M, Ram F. Noninvasive positive
pressure ventilation to treat respiratory failure resulting from
exacerbations of chronic obstructive pulmonary disease:
Cochrane systematic review and meta-analysis. BMJ 2003; 326
(7382): 185-9.
5.
Mehta S, Hill N. Noninvasive ventilation: State of the art. Am J
Respir Crit Care Med 2001; 163: 540-77.
15. Keenan SP, Sinuff T, Cook DJ. Which patients with acute
exacerbation of chronic obstructive pulmonary disease
benefit from noninvasive positive-pressure ventilation? A
systematic review of the literature. Ann Intern Med 2003; 138:
861-70.
6.
Brochard L, Isabey D, Piquet J. Reversal of acute exacerbations of
chronic obstructive lung disease by inspiratory assistance with a
face mask. N Engl J Med 1990; 323: 1523-30.
16. Keenan SP, Sinuff T, Cook DJ. Does noninvasive positive pressure
ventilation improve outcome in acute hypoxemic respiratory
failure? A systematic review. Crit Care Med 2004; 32: 2516-23.
7.
Hill N, Brennan J, Garpestad E, Nava S. Noninvasive ventilation in
acute respiratory failure. Crit Care Med 2007; 35 (10): 1-6.
17.
8.
Masip J, Betbesé AJ, Páez J, Vecilla F, Cañizares R, Padró J et al.
Noninvasive pressure support ventilation versus conventional
oxygen therapy in acute cardiogenic pulmonary edema. Lancet
2000; 356: 2126-32.
9.
Pang D, Keenan SP, Cook DJ, Sibbald WJ. The effect of positive
pressure airway support on mortality and the need for intubation
in cardiogenic pulmonary edema: a systematic review. Chest
1998; 114: 1185-92.
10. Park M, Sangean MC, Volpe M, Park M. Randomized, prospective
trial of oxygen, continuous positive airway pressure, and bilevel
positive airway pressure by face mask in acute cardiogenic
pulmonary edema. Crit Care Med 2004; 32: 2407-15.
11. Hilbert G, Gruson D, Vargas F, Valentino R, Gbikpi-Benissan G,
Dupon M, Reiffers J, Cardinaud JP. Noninvasive ventilation in
Antonelli M, Conti G, Moro ML, Esquinas A, González-Díaz G,
Confalonieri M, Pelaia P, Principi T, Gregoretti C, Beltrame F 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: 1718-28.
18. Wysocki M, Tric L, Wolff MA, Millet H, Herman B. Noninvasive
pressure support ventilation in patients whith acute respiratory
failure. Chest 1995; 107: 761-8.
19. Hess D, Fessler HE. Should noninvasive positive-pressure
ventilation be used in all forms of acute respiratory failure?
Respiratory Care 2007; 52 (5): 568-81.
20. Elliott M, Confalionieri M, Nava S. Where to performe noninvasive
ventilation? Eur Respir J 2002; 19: 1159-66.
21. Antonelli M, Conti G, Esquinas A, Montini L, Maggiore SM, Bello G,
Rocco M, Maviglia R, Pennisi MA, González-Díaz G, Meduri GU. A
multiple-center survey on the use in clinical practice of non-
REVISTA CHILENA DE MEDICINA INTENSIVA. 2010; VOL 25(1): 15-22
21
Download