Fisiología de la ventilación mecánica no invasiva

Fabio Andrés Varón V., MD., Ángela María Giraldo M., MD.

Resumen


La ventilación mecánica no invasiva se refiere a la entrega de ventilación a los pulmones utilizando técnicas que no requieren una vía aérea endotraqueal. La aplicación de presión positiva en ventilación no invasiva se remonta a la década de 1930, cuando los estudios de Barach demostraron que la presión positiva continua en la vía aérea, podría ser útil en el tratamiento del edema pulmonar agudo. Pero solo hasta 1980 se desarrollaron investigaciones administrando presión positiva a través de una boquilla con lo cual se obtuvieron resultados positivos con descenso en los niveles de PaCO2 y mejoría de la oxigenación en pacientes con EPOC y ASMA, sin embargo los resultados no fueron homogéneos por lo que se desestímulo su uso. Hoy se conoce que esta disparidad en los resultados se debió al corto tiempo de la ventilación mecánica no invasiva, de tan sólo 10 a 15 minutos tres o cuatro veces al día, demasiado breve para obtener buenos resultados. En paralelo, esta se utilizó en pacientes con enfermedad neuromuscular en el Centro de Rehabilitación de Goldwater en Nueva York, pero el uso de diferentes interfaces hizo que la técnica no presentara una adecuada adaptación en el grupo de pacientes (2). Sólo hasta 1985 se produjo una proliferación de su uso con la introducción de presión positiva continua en la vía aérea para el tratamiento de la apnea obstructiva del sueño. Hoy se han confirmado los beneficios en diversas entidades clínicas (3).


Palabras clave


ventilación no invasiva; trabajo muscular; constantes de tiempo; capacidad residual funcional; PEEP.

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Referencias


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DOI: http://dx.doi.org/10.30789/rcneumologia.v28.n1.2016.161

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