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1998, Número 3

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Med Crit 1998; 12 (3)


Trabajo respiratorio según el grado de sensibilidad de disparo por flujo en pacientes con ventilación en soporte por presión

Osorio BJA, Franco GJ, Martínez SJ, Elizalde GJJ

Idioma: Español
Referencias bibliográficas: 27
Paginas: 95-101
Archivo PDF: 122.17 Kb.


RESUMEN

Objetivo. Evaluar el efecto del disparo por flujo (flow-by, Fb) sobre el trabajo respiratorio impuesto (WOBp) en la ventilación por soporte de presión (PSV), como herramienta para el destete.
Diseño. Estudio de serie de casos.
Lugar. Una UCI de un hospital de enseñanza de la Ciudad de México.
Pacientes. Se incluyeron doce pacientes (ocho hombres y cuatro mujeres, edad media 62.9 ± 14.4 años) con ventilación mecánica prolongada o de difícil retiro.
Intervenciones. Se utilizó Fb con flujo base (Vb) de 12 L/min y se determinó el WOBp con un monitor pulmonar Bicore a diferentes grados de sensibilidad de disparo (Vtr): 6, 3 y 1 L/min; y a dos niveles diferentes de PSV: alto (nivel al iniciar la modalidad espontánea) y bajo (nivel previo a la extubación).
Resultados. En PSV alto (15.3 33.7 cmH2O) los WOBp con Vtr de 6, 3 y 1 fueron 0.19 0.3 J/L, 0.15 0.28 J/L, y 0.12 0.27 J/L, respectivamente. En PSV bajo (5.8 1.1 cmH2O), los WOBp con Vtr de 6, 3 y 1 fueron 1.26 0.5, 1.05 0.42 y 0.79 + 0.4 J/L, respectivamente. Se encontró diferencia estadística de los WOBp (p < 0.05) en bajo nivel de PSV, entre Vtr de 6 (1.26 0.5 J/L) y 1 (0.79 0.4 J/L).
Conclusiones. El WOBp desciende con menores grados de Vtr. Sugerimos el uso del Vtr más bajo (1 L/min) en pacientes de difícil destete.


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