Manejo de la exacerbación aguda severa de EPOC

Management of severe acute exacerbations of COPD.

Contenido principal del artículo

Eder Cáceres, MD.
Rubén Duenas, MD.
Marcela Poveda, MD.
Ricardo Buitrago, MD.

Resumen

La EAEPOC (Exacerbación Aguda de Enfermedad pulmonar Obstructiva Crónica) es un motivo de consulta frecuente en los servicios de urgencias y cuando es severa usualmente requiere el manejo en una unidad de cuidados intermedios o intensivos donde se garantice un adecuado monitoreo del paciente y la provisión de asistencia ventilatoria. Se realizó una revisión de la literatura acerca de la evaluación, manejo y seguimiento de la EAEPOC severa haciendo énfasis en los fundamentos e indicaciones de la VMNI y en la evaluación del paciente una vez se ha instaurado esta terapia la cual es en la actualidad la primera opción en pacientes con EAEPOC en inminencia de o en falla ventilatoria hipercápnica y ha mostrado beneficios significativos en la recuperación y supervivencia. Es importante junto a la evaluación clínica la toma de gases arteriales en estos pacientes que permitirán un enfoque inicial y servirán posteriormente como guía en la toma oportuna de decisiones.

Palabras clave:

Descargas

Los datos de descargas todavía no están disponibles.

Detalles del artículo

Biografía del autor/a (VER)

Eder Cáceres, MD., Universidad de La Sabana. Bogotá, Colombia.

Residente Cuidado Intensivo Universidad de La Sabana. Bogotá, Colombia.

Rubén Duenas, MD., Clínica Shaio. Bogotá, Colombia

Neumologo Clínica Shaio. Bogotá, Colombia

Marcela Poveda, MD., Clínica Shaio. Bogotá, Colombia.

Cardiologa Intensivista. Clínica Shaio. Bogotá, Colombia.

Ricardo Buitrago, MD., Clínica Shaio. Bogotá, Colombia.

Cardiologa Intensivista. Clínica Shaio. Bogotá, Colombia.

Referencias (VER)

Rodríguez-Roisin R. Toward a concensus definition for COPD exacerbation. Chest. 2000;117;398S-401S

Garcia-Aymerich J, Barreiro E, Farrero E, Marrades RM, Morera J, Antó JM. Patients hospitalized for COPD have a high prevalence of modifiable risk factors for exacerbation (EFRAM study). Eur Respir J. 2000 Dec;16(6):1037-42.

Bahadori K, FitzGerald JM, Levy RD, Fera T, Swinston J. Risk factors and outcomes associates with chronic obstructive pulmonary disease exacerbations requiring hospitalization. Can Res J. 2009; 168: 71-79

Rothberg M., Pekow P., et al. Antibiotic Therapy and Treatment Failure in Patients Hospitalized for Acute Exacerbations of Chronic Obstructive Pulmonary Disease. JAMA, May 26, 2010.

Daniels JM, Snijders D, de Graaff CS, Vlaspolder F, Jansen HM, Boersma WG. Antibiotics in addition to systemic corticosteroids for acute exacerbations of chronic obstructive pulmonary disease. Am J Respir Crit Care Med. 2010 Jan 15.

Anthonisen NR, Manfreda J, et al. 1987. Antibiotic therapy in exacerbations of chronic obstructive pulmonary disease. Ann Intern Med, 106:196–204.

Siddiqi A., Sethi S.. Optimizing antibiotic selection in treating COPD exacerbation. International Journal of COPD 2008:3(1) 31–44.

Schuetz P., D. Leuppi, Tamm M., Short versus conventional term glucocorticoid therapy in acute exacerbation of chronic obstructive pulmonary disease. REDUCE trial. Swiss Med Wkly. 2010;140.

ATS/ ERS Task Force. Eur Respir J 2004; 23: 932–946

Nava S., Hill N.. Non-invasive ventilation in acute respiratory failure. Lancet . 2009; 374: 250–59.

Carrera M., Marín J., Antón A. A controlled trial of noninvasive ventilation for chronic obstructive pulmonary disease exacerbations. Journal of Critical Care (2009) 24, 473.e7–

e14 .

G U Meduri, N Abou-Shala, R C Fox, C B Jones, K V Leeper and R G Wunderink. Noninvasive face mask mechanical ventilation in patients with acute hypercapnic respiratory failure. Chest. 1991;100;445-454

British Thoracic Society Standards of Care Committee. Noninvasive ventilation in acute respiratory failure. Thorax 2002;57:192–211.

Masip J. Ventilación no invasiva en el edema agudo de pulmón. Hipertensión. 2008;25(1):16-22

Esmond G., Mikelsons C.. Non invasive respiratory support techniques. 1a edición. Oxford, UK. Blackwell Publishing. 127–152

Des Jardins T. Cardiopulmonary anatomy and physiology. 4th edition. Columbia. USA. Delmar/Thomnson learning. 63 – 115.

Levitzky M. Pulmonary Physiology. 7th edition. Mc Graw Hill’s ed. USA. Cap. 3.

Khilnani G., Banga A. Noninvasive ventilation in patients with chronic obstructive airway disease. International Journal of COPD 2008:3(3) 351–357

Mckenzie I. Core Topics in mechanical ventilation. 1st edition. Cambridge. Cambridge University Press. 32–53.

Elliot M. Non invasive mechanical ventilation. Medicine. 2004. 99–102.

Antro C, Merico F, Urbino R, Gai V. Non-invasive ventilation as a first-line treatment for acute respiratory failure: «real life» experience in the emergency department. Emerg Med J. 2005 Nov;22(11):772-7

Kaya A,Çiledag A, Çayli I, Önen Z, et al. Associated factors with non-invasive mechanical ventilation failure in acute hypercapnic respiratory failure. Tüberküloz ve Toraks Dergisi. 2010; 58(2): 128-134

Ferrer M, Sellarés J, Valencia M, Carrillo A. Non-invasive ventilation after extubation in hypercapnic patients with chronic respiratory disorders: randomised controlled trial. Ann Intern Med. 2010 Feb 16; 152(4): JC-24.

Khilnani GC, Saikia N, Banga A, Sharma SK. Non-invasive ventilation for acute exacerbation of COPD with very high PaCO(2): A randomized controlled trial. Lung India. 2010 Jul;27(3):125-30.

Prasad SB, Chaudhry D, Khanna R. Role of noninvasive ventilation in weaning from mechanical ventilation in patients of chronic obstructive pulmonary disease: an Indian experience. Indian J Crit Care Med. 2009 Oct;13(4):207-12

Carrera M, Marín JM, Antón A, et al. A controlled trial of noninvasive ventilation for chronic obstructive pulmonary disease exacerbations. J Crit Care. 2009 Sep;24(3):473.e7-14.

Purro A, Appendini L, Polillo C, et al. Mechanical determinants of early acute ventilatory failure in COPD patients: a physiologic study. Intensive Care Med. 2009 Apr;35(4):639-47.

Joosten SA, Koh MS, Bu X, et al. The effects of oxygen therapy in patients presenting to an emergency department with exacerbation of chronic obstructive pulmonary disease. Med J Aust. 2007 Mar 5;186(5):235-8.

Mohan A, Premanand R, Reddy LN, et al. Clinical presentation and predictors of outcome in patients with severe acute exacerbation of chronic obstructive pulmonary disease requiring admission to intensive care unit. BMC Pulm Med. 2006 Dec 19;6:27.

Delclaux C, L’Her E, Alberti C. JAMA. Treatment of acute hypoxemic nonhypercapnic respiratory insufficiency with continuous positive airway pressure delivered by a face mask: A randomized controlled trial. 2000 Nov 8;284(18):2352-60.

Citado por