Ventilación asistida por presión vs. ventilación mandatoria intermitente sincronizada. Efectos hemodinámicos en pacientes críticos

Pressure support ventilation vs. synchronized intermittent mandatory ventilation. Hemodynamic effects on critically ill patients

Contenido principal del artículo

Carmelo Dueñas
Carlos García Del Río
Martín Carvajal
Gloria Olmos Ruiz
Patricia Vélez

Resumen

Introducción: en los últimos años han aparecido varias publicaciones acerca de los efectos hemodinámicos de la ventilación asistida por presión (VAP). Ningún estudio ha comparado los efectos fisiológicos de la VAP con los de la ventilación mandatoria intermitente sincronizada (VMIS) en el mismo paciente.
Objetivo: establecer si existe diferencia en los efectos hemodinámicos de la VAP y de la VMIS en cuidado intensivo.
Diseño: experimento clínico cruzado (aleatorizado-controlado).
Pacientes y métodos: de junio de 1993 a mayo de 1995, 31 pacientes ingresaron al estudio. Fueron sometidos a ventilación mecánica por ventilación asistida (VAC) o VMIS de manera no premeditada, durante la fase de estabilización. Antes del destete del ventilador, aleatoriamente, se asignaron a VAP o VMIS por 2 horas, tomándose medidas hemodinámicas. Luego permanecieron en VAC 1 hora y seguidamente se sometieron por 2 horas al método contrario al usado en las primeras 2. Se mantuvo VC de 10 cc/kg, FIO2 de 40% y PEEP de 4. Las variables estudiadas fueron frecuencia cardíaca, frecuencia respiratoria, tensión arterial, diuresis, presión ven osa central, presión capilar pulmonar, índice cardíaco, aporte de O2 , consumo de oxígeno, resistencias vasculares sistémicas y pulmonares, SaO2 , SvO2 y distensibilidad.
Los resultados obtenidos son presentados en 2 subgrupos según la enfermedad: Grupo 1: respuesta inflamatoria sistémica (SDRIS) y Grupo 11: falla cardíaca severa. El análisis estadístico fue hecho con promedios, desviación estándar y prueba T de student.
Resultados: no hubo diferencias significativas entre los 31 pacientes. Tampoco al dividirlos en SDRIS y falla cardíaca, salvo que estos últimos pacientes tuvieron mejor índice cardíaco con VAP que con VMIS. Ventilatoriamente fue evidente una mejor distensibilidad en todos los grupos con VAP.
Conclusión: la VAP puede considerarse como método de elección para pacientes con falla cardíaca severa que requieran ventilación mecánica.

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Biografía del autor/a (VER)

Carmelo Dueñas, Unidad de Cuidado Intensivo. Hospital Bocagrande. Cartagena, Colombia.

Universidad de Cartagena, Unidad de Cuidado Intensivo. Hospital Bocagrande. Cartagena, Colombia.

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