medigraphic.com
ISSN 2448-8909 (Impreso)

2015, Número 4

<< Anterior Siguiente >>

Med Crit 2015; 29 (4)


Ventilación pulmonar ultraprotectora en insuficiencia respiratoria aguda, un nuevo concepto

Carrillo-Esper R, Pérez CÁA

Idioma: Español
Referencias bibliográficas: 30
Paginas: 234-239
Archivo PDF: 212.04 Kb.


RESUMEN

El síndrome de insuficiencia respiratoria aguda (SIRA) es una afección grave que presenta el enfermo en estado crítico, esto es condicionado a la respuesta inflamatoria del agente etiológico en la barrera endotelio-epitelial pulmonar inducida por inflamación, cuyo resultado condiciona aumento de la permeabilidad vascular y disfunción del agente tensoactivo con lo que se producen grados variables de colapso y consolidación alveolar. Con la finalidad de disminuir el daño inducido por ventilación mecánica, se han elaborado diferentes estrategias. La estrategia más aceptada y avalada por evidencia científica es la ventilación de protección pulmón. En los últimos años, la presencia de removedores de CO2 extracorpóreos sin el uso de bombas arteriovenosas se han desarrollado y probado para su uso clínico, su uso permite la remoción de CO2 con una mejoría moderada de la oxigenación. Una estrategia con ventilación mecánica con volumen corriente ultrabajo (3 mL/kg de peso predicho) en combinación con los dispositivos de extracción de CO2 podrían reducir la lesión pulmonar asociada con la ventilación en comparación con el manejo protector actual. Aún se debe determinar si esta estrategia mejorara la sobrevida de los enfermos con SIRA.


REFERENCIAS (EN ESTE ARTÍCULO)

  1. Tremblay LN, Slutsky AS. Ventilator-induced lung injury: from the bench to the bedside. Intensive Care Med. 2006;32:24-33.

  2. Pinheiro de Oliveira R, Hetzel MP, dos Anjos-Silva M, Dallegrave D, Friedman G. Mechanical ventilation with high tidal volume induces inflammation in patients without lung disease. Crit Care. 2010;14:R39.

  3. Slutsky AS, Ranieri VM. Ventilator-induced lung injury. N Engl J Med. 2013;369:2126-2136.

  4. Chiumello D, Carlesso E, Cadringher P, Caironi P, Valenza F, Polli F, et al. Lung stress and strain during mechanical ventilation for acute respiratory distress syndrome. Am J Respir Crit Care Med. 2008;178:346-355.

  5. Roan E, Waters CM. What do we know about mechanical strain in lung alveoli? Am J Physiol Lung Cell Mol Physiol. 2011;301:625-635.

  6. Chiumello D, Carlesso E, Cadringher P, Caironi P, Valenza F, Polli F, et al. Lung stress and strain during mechanical ventilation for acute respiratory distress syndrome. Am J Respir Crit Care Med. 2008;178:346-355.

  7. Protti A, Cressoni M, Santini A. Lung stress and strain during mechanical ventilation: any safe threshold? Am J Respir Crit Care Med. 2011;183:1354-1362.

  8. Gattinoni L, Protti A, Caironi P, Carlesso E. Ventilator-induced lung injury: the anatomical and physiological framework. Crit Care Med. 2010;38:539-548.

  9. Needham DM, Colantuo E, Mendez-Tellez PA, Dinglas VD, Sevransky JE, Dennison-Himmelfarb CR, et al. Lung protective mechanical ventilation and two year survival in patients with acute lung injury: prospective cohort study. BMJ. 2012;344:e2124.

  10. Kilpatrick B, Slinger P. Lung protective strategies in anaesthesia. Br J Anaesth. 2010;105 Suppl 1:i108-116.

  11. Ventilation with lower tidal volumes as compared with traditional tidal volumes for acute lung injury and the acute respiratory distress syndrome. The Acute Respiratory Distress Syndrome Network. N Engl J Med. 2000;342:1301-1308.

  12. Retamal J, Libuy J, Jiménez M, Delgado M, Besa C, Bugedo G, et al. Preliminary study of ventilation with 4 ml/kg tidal volume in acute espiratory distress syndrome: feasibility and effects on cyclic recruitment derecruitment and hyperinflation. Crit Care. 2013;17:R16.

  13. Terragni PP, Rosboch G, Tealdi A, Corno E, Menaldo E, Davini O, et al. Tidal hyperinflation during low tidal volume ventilation in acute respiratory distress syndrome. Am J Respir Crit Care Med. 2007;175:160-166.

  14. Azzam ZS, Sharabi K, Guetta J, Bank EM, Gruenbaum Y. The physiological and molecular effects of elevated CO2 levels. Cell Cycle. 2010;15:1528-1532.

  15. Peltekova V, Engelberts D, Otulakowski G, Otulakowski G, Uematsu S, Post M, et al. Hypercapnic acidosis in ventilator-induced lung injury. Intensive Care Med. 2010;36:869-878.

  16. Rubenfeld GD, Cooper C, Greg-Carter RT, Thompson BT, Hudson LD. Barriers to providing lung-protective ventilation to patients with acute lung injury. Crit Care Med. 2004;32:1289-1293.

  17. Bein TH, Weber F, Philipp A, Prasser C, Pfeifer M, Schmid FX. A new pumpless extracorporeal interventional lung assist in critical hypoxemia/hypercapnia. Crit Care Med. 2006;4:1372-1379.

  18. Ohtake S, Kawashima Y, Hirose H, Matsuda H, Nakano S, Kaku K, et al. Experimental evaluation of pumpless arteriovenous ECMO with polypropylene hollow-fiber membrane oxygenator for partial respirator y support. Trans Am Soc Artif Intern Organs. 1983;29:237-241.

  19. Novalung-GmbH iLA membrane ventilator® compendium of evidence. 2009.

  20. Jayroe JB, Alpard SK, Wang D, Deyo DJ, Murphy JA, Zwischenberger JB. Hemodynamic stability during arteriovenous carbon dioxide removal for adult respiratory distress syndrome: a prospective randomized outcomes study in adult sheep. Asaio J. 2001;47:211-214.

  21. Conrad SA, Zwischenberger JB, Grier LR, Alpard SK, Bidani A. Total extracorporeal arteriovenous carbon dioxide removal in acute respirator y failure: a phase I clinical study. Intensive Care Med. 2001;27:1340-1351.

  22. von Mach MA, Kaes J, Omogbehin B, Sagoschen I, Wiechelt J, Kaiser K, et al. An update on interventional lung assist devices and their role in acute respirator y distress syndrome. Lung. 2006;184:169-175.

  23. Dembinski R, Hochhausen N, Terbeck S, Uhlig S, Dassow C, Schneider M, et al. Pumpless extracorporeal lung assist for protective mechanical ventilation in experimental lung injury. Crit Care Med. 2007;35:2359-2366.

  24. Iglesias M, Jungebluth P, Petit C, Matute MP, Rovira I, Martínez E, et al. Extracorporeal lung membrane provides better lung protection than conventional treatment for severe postneumonectomy non cardiogenical acute respirator y distress syndrome. J Thorac Cardiovasc Surg. 2008;135:1362-1371.

  25. Muellenbach RM, Kredel M, Wunder C, Küstermann J, Wurmb T, Schwemmer U, et al. Arteriovenous extracorporeal lung assist as integral part of a multimodal treatment concept: a retrospective analysis of 22 patients with ARDS refractory to standard care. Eur J Anaesthesiol. 2008;25:897-904.

  26. Bein T, Weber-Carstens S, Goldmann A, Müller T, Staudinger T. Lower tidal volume strategy (≈3 ml/kg) combined with extracorporeal CO2 removal versus conventional protective ventilation (6 ml/kg) in severe ARDS: the prospective randomized Xtravent-study. Intensive Care Med. 2013;39:847-856.

  27. Costa E, Amato M. Ultra-protective tidal volume: how low should we go? Crit Care. 2013;17:127.

  28. Young D, Lamb SE, Shah S, MacKenzie I, Tunnicliffe W, Lall R, et al. High-frequency oscillation for acute respiratory distress syndrome. N Engl J Med. 2013;368:806-813.

  29. Moerer O, Quintel M. Protective and ultra-protective ventilation: using pumpless interventional lung assist (iLA). Minerva Anestesiol. 2011;77:537-544.

  30. Gattinoni L, Carlessoa E, Langer T. Towards ultraprotective mechanical ventilation. Curr Opin Anesthesiol. 2012;25:141-147.




2020     |     www.medigraphic.com