Resumen
En la �ltima d�cada se ha establecido que la ventilaci�n no invasiva (VNI) con presi�n de soporte (PS) es una t�cnica de primera l�nea en los pacientes con insuficiencia respiratoria aguda (IRA) grave secundaria a enfermedad pulmonar obstructiva cr�nica. Sin embargo, en el edema agudo de pulm�n cardiog�nico (EAP) no hab�a evidencia de su efectividad. Por ello se plante� un estudio aleatorizado con pacientes afectados de EAP grave para comparar la VNI (con PS y presi�n positiva al final de la espiraci�n [PEEP]) y la oxigenoterapia convencional. Los resultados evidenciaron mejor�a m�s r�pida y significativa de la IRA y reducci�n de la tasa de intubaci�n orotraqueal (IOT) del 33% al 6%. En concordancia con otros estudios, los pacientes con hipercapnia fueron los que m�s se beneficiaron de esta t�cnica. Analizando posteriormente todos los pacientes con EAP tratados de forma convencional en nuestro centro en los �ltimos 5 a�os, comprobamos que la acidosis severa (pH < 7.25) y la presi�n arterial sist�lica 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 m�s severos, en los que su utilizaci�n puede resultar esencial.
Palabras clave
Ventilaci�n no invasiva, presi�n de soporte, edema agudo de pulm�n.
Clasificaci�n en siicsalud
Art�culos originales> Expertos de Iberoam�rica>
p�gina www.siicsalud.com/des/des031/02d10002.htm
Especialidades
Principal: Terapia Intensiva
Relacionadas: Cardiolog�a, Cl�nica M�dica
Enviar correspondencia a:
Dr. Josep Masip Utset, Unidad de Vigilancia Intensiva. Hospital Creu Roja de Barcelona. Consorci Sanitari Creu Roja de Catalunya (CSCRC). c/ Dos de Maig 301, 08024 Barcelona, Espa�a.
Patrocinio y reconocimiento
A los doctores Antonio Jordi Betbes�, Francisco Vecilla, Rosario Ca�izares, Josep Ball�s, Teresa Cat� y Josep Anton Ferreres, por su colaboraci�n; y a los equipos de enfermer�a de Urgencias y de la UVI de nuestro hospital, especialmente este � ltimo, sin el cual no habr�a sido posible la realizaci�n del estudio original.
Art�culo completo
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Extensi�n:
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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, altho ugh 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, acute cardiogenic pulmonary edema.
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