Ventilación espontánea en ventilación mecánica invasiva
Spontaneous ventilation in invasive mechanical ventilation Un pulmón dual

Contenido principal del artículo

Autores/as

Andrés Gonzalo Bravo Díaz

Marcela Libreros Arciniegas

Resumen

Introducción: El uso de la ventilación mecánica invasiva (VMI) convencionalmente con modos controlados y uso de sedantes conlleva a un aumento de complicaciones y eventos indeseados como la disfunción diafragmática al inhibir la ventilación espontanea. Este artículo revisara la viabilidad de la ventilación espontanea en VMI partiendo de la actividad muscular inspiratoria como mecanismo fisiológico para la ventilación pulmonar, los cambios al ser remplazado por un mecanismo donde la ventilación es generada por la VMI, la interacción entre los dos mecanismos “pulmón dual” y sus efectos a nivel pulmonar. La evidencia disponible se encuentra en SDRA con ventajas y desventajas, se propone estrategias de evaluación, monitoria, regulación del impulso y esfuerzo inspiratorio que facilite la ventilación espontanea durante la VMI. Método: Se realizó una revisión documental en 4 fases: 1. Búsqueda de información, 2. Selección de publicaciones, 3. Procesamiento y análisis de la información seleccionada, 4. Redacción del documento. Conclusión: La ventilación espontánea en VMI es viable al reducir la incidencia de la debilidad muscular y podría disminuir la estancia en UCI. En estudios en SDRA el “pulmón dual” presenta más ventajas que desventajas y se reconoce su utilidad en SDRA leve o moderado. Hacen falta estudios en situaciones clínicas menos complejas y más comunes en UCI o pulmones sanos donde podría encontrarse más ventajas. Se sugiere realizar la evaluación del momento clínico y fisiopatológico, monitorear la VMI, monitorear y regular el impulso respiratorio y el esfuerzo muscular enfocándose en los principios de protección pulmonar y diafragmática.  

Detalles del artículo

Citas

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