Ultrasonido para el diagnóstico diferencial de la patología pulmonar en el paciente crítico

Ultrasound for the diagnosis of pulmonary disease in the critically ill patient

Contenido principal del artículo

María Camila Arango-Granados
Virginia Zarama Córdoba

Resumen

Durante los últimos años, la ecografía se ha convertido en una herramienta diagnóstica de primera línea para el enfoque y el manejo del paciente críticamente enfermo y es considerada hoy día uno de los pilares en la evaluación integral de todos los pacientes. Se ha demostrado que el ultrasonido mejora el rendimiento diagnóstico de la patología pulmonar y de la falla respiratoria aguda. Su utilidad radica en la capacidad de realizar el estudio a la cabecera del paciente, sin irradiación, de manera inmediata por el mismo médico tratante, sumado a la capacidad diagnóstica para identificar condiciones tales como el edema pulmonar cardiogénico y no cardiogénico, describir los patrones de ocupación alveolar y consolidación pulmonar, caracterizar y cuantificar el derrame pleural y diagnosticar la presencia de neumotórax. Adicionalmente, de la mano de una ecografía cardíaca enfocada, aumenta el rendimiento diagnóstico tempranamente en el tromboembolismo pulmonar con compromiso de ventrículo derecho (VD) o la falla cardíaca descompensada. En esta revisión se ilustran los hallazgos ultrasonográficos más importantes en el diagnóstico diferencial de la patología pulmonar y se revisa la evidencia disponible sobre su rendimiento diagnóstico. Es indiscutible la utilidad de esta herramienta para el abordaje del paciente crítico en las unidades de cuidados intensivos (UCI) o en los servicios de emergencias. Su prontitud, el buen rendimiento diagnóstico y la oportunidad de inicio temprano de terapias específicas obligan a los clínicos que manejan pacientes críticos a incorporar el ultrasonido en la práctica diaria.

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