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2012, Número 4

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Rev Hosp Jua Mex 2012; 79 (4)


Posición prono, más que una estrategia en el manejo de pacientes con síndrome de insuficiencia respiratoria aguda

Hernández-López GD, Mondragón-Labelle T, Torres-López L, Magdaleno-Lara G

Idioma: Español
Referencias bibliográficas: 35
Paginas: 263-270
Archivo PDF: 459.98 Kb.


RESUMEN

En el tratamiento del síndrome de insuficiencia respiratoria progresiva aguda grave (SIRPA) se recomienda la ventilación mecánica con volúmenes corrientes bajos y presión positiva al final de la espiración (PEEP). Sin embargo, hay pacientes que persisten hipoxémicos y obligan a utilizar alternativas terapéuticas para mejorar la oxigenación arterial; el tratamiento con posición prono (PP) es una de ellas. En etapas iniciales, el SIRPA se caracteriza por una alteración difusa y homogénea de la permeabilidad vascular, con edema y aumento del peso pulmonar, lo cual favorece el desarrollo de atelectasias por la transmisión vertical de fuerzas gravitatorias al comprimir las regiones pulmonares más dependientes. En los pacientes con asistencia ventilatoria mecánica, el estrés y la distensión pulmonares son los principales factores determinantes de la lesión pulmonar inducida por la ventilación mecánica (LPIVM). En el SIRPA grave temprano la PP con optimización de la PEEP reduce el riesgo de lesión pulmonar inducida por el ventilador (LPIVM), al disminuir el estrés y la distensión del parénquima pulmonar durante la ventilación mecánica. Durante el manejo de pacientes bajo asistencia mecánica respiratoria colocados en posición prono ocurren tres fenómenos que favorecen el intercambio de gases: desviación de la ventilación, desviación del flujo sanguíneo y el debilitamiento de la pared torácica. La PP favorece también el reclutamiento alveolar de zonas colapsadas.


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