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2015, Número 1

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Gac Med Mex 2015; 151 (1)


Estrategias ventilatorias ante el niño con síndrome de distress respiratorio agudo e hipoxemia grave

Donoso FA, Arriagada SD, Díaz RF, Cruces RP

Idioma: Español
Referencias bibliográficas: 70
Paginas: 75-84
Archivo PDF: 126.60 Kb.


RESUMEN

En esta revisión se recogen los conceptos fundamentales del uso de ventilación mecánica (VM) en niños con síndrome de distress respiratorio agudo (SDRA) e hipoxemia refractaria. Se discuten conceptos de VM protectora y potencial de reclutamiento (PR), y se examinan las opciones ventilatorias y/o maniobras destinadas a optimizar el tejido pulmonar no aireado –maniobra de reclutamiento alveolar (MRA), titulación de la presión positiva al final de la espiración (PEEP), ventilación de alta frecuencia oscilatoria (VAFO) y ventilación con liberación de presión de la vía aérea (APRV)– u orientadas a corregir la alteración ventilación/perfusión (V/Q) –uso de decúbito prono–, y como única medida farmacológica se discute el uso de relajantes neuromusculares. En la práctica, el concepto de VM protectora implica efectuar un ajuste individualizado de la PEEP y del volumen corriente (VT). El uso de maniobras de reclutamiento alveolar y titulación decreciente de la PEEP puede mejorar la función pulmonar en pacientes con SDRA. Ante escenarios de fracaso de VM se debe considerar el inicio precoz de la VAFO. El posicionamiento en prono de forma temprana y prolongada puede mejorar el intercambio gaseoso, en espera de un mejor control de la causa que motivó la VM.


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