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2017, Número 4

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Med Crit 2017; 31 (4)


Retiro de la ventilación mecánica

Hernández-López GD, Cerón-Juárez R, Escobar-Ortiz D, Graciano-Gaytán L, Gorordo-Delsol LA, Merinos-Sánchez G, Castañón-González JA, Amezcua-Gutiérrez MA, Cruz-Montesinos S, Garduño-López J, Lima-Lucero IM, Montoya-Rojo JO

Idioma: Español
Referencias bibliográficas: 44
Paginas: 238-245
Archivo PDF: 172.54 Kb.


RESUMEN

La mayoría de los pacientes que requieren ventilación › 24 horas y mejoran pueden ser extubados tras la primera prueba de ventilación espontánea. El reto es mejorar la desconexión de los pacientes que fracasan. El retiro de la ventilación mecánica es un elemento esencial en el cuidado de los pacientes críticamente enfermos. Se revisa el proceso de liberar al paciente del soporte mecánico y de la cánula endotraqueal. El tiempo empleado en el proceso de destete representa de 40 a 50% de la duración total de la ventilación. Se recomienda: 1) Prever tres grupos en función de la dificultad y duración del destete, 2) Retiro lo más pronto posible, 3) Utilizar la prueba de ventilación espontánea para determinar si los pacientes pueden ser extubados con éxito, 4) La prueba inicial debe durar 30 minutos en respiración en tubo en T o con bajos niveles de soporte, 5) La presión de soporte y los modos de ventilación AC deben preferirse cuando han fracasado en la primera prueba, 6) Considerar ventilación no invasiva en pacientes seleccionados para acortar la duración de la intubación, pero no debe usarse de forma rutinaria como herramienta para el fracaso de la extubación.


REFERENCIAS (EN ESTE ARTÍCULO)

  1. Wunsch H, Linde-Zwirble WT, Angus DC, Hartman ME, Milbrandt EB, Kahn JM. The epidemiology of mechanical ventilation use in the United States. Crit Care Med. 2010;38:1947-1953.

  2. Esteban A, Anzueto A, Frutos F, Alía I, Brochard L, Stewart TE, et al. Characteristics and outcomes in adult patients receiving mechanical ventilation: a 28-day international study. JAMA. 2002;287:345-355.

  3. Brochard LL, Martin SG, Blanch L, Pelosi P, Belda JF, Jubran A et al. Clinical review: Respiratory monitoring in the ICU a consensus of 16. Critical Care. 2012;16:219.

  4. Jackson M.; Strang T.; Rajalingam Y. A practical approach to the difficult to wean patient. JICS. 2012;13(4):327-331.

  5. Peñuelas O, Frutos-Vivar F, Fernández C, Anzueto A, Epstein SK, Apezteguía C, et al. Characteristics and outcomes of ventilated patients according to time to liberation from mechanical ventilation. Am J Respir Crit Care Med. 2011;184:430-437.

  6. Roussos CS, Macklem PT. Diaphragmatic fatigue in man. J Appl Physiol Respir Environ Exerc Physiol. 1977;43:189-197.

  7. Vassilakopoulos T, Roussos CS, Zakynthinos S. The immune response to resistive breathing. Eur Respir J. 2004;24:1033-1043.

  8. Seely AJ, Bravi A, Herry C, Green G, Longtin A, Ramsay T, et al. Do heart and respiratory rate variability improve prediction of extubation outcomes in critically ill patients? Crit Care. 2014;18(2):R65.

  9. Cook TM, Woodall N, Frerk C. Major complications of airway management in the UK: Results of the Fourth National Audit Project of the Royal College of Anaesthetists and the Difficult Airway Society. Part 1: anaesthesia. Br J Anaesth. 2011; 106: 617-631.

  10. Radhi S, Guerra D, Alalawi R, Raj R, Nugent K. Cuff leak tests at the time of extubation correlate with voice quality assessment. ICU Director. 2012;3:27.

  11. Cavallone LF, Vannucci A. Review article: extubation of the difficult airway and extubation failure. Anesth Analg. 2013;116:368-383.

  12. MacRae GM. Closed claims studies in anesthesia: a literature review and implications for practice. AANA J. 2007;75(4):267-275.

  13. Rose L, Blackwood B, Egerod I, Haugdahl SH, Hofhuis J, Isfort M, et al. Decisional responsibility for mechanical ventilation and weaning: an international survey. Crit Care. 2011;15:R295.

  14. Popat M, Mitchell V, Dravid R, Patel A, Swampillai C, Higgs A. Difficult Airway Society Guidelines for the management of tracheal extubation. Anaesthesia. 2012;67:318-340.

  15. Epstein SK, Ciubotaru RL, Wong JB. Effect of failed extubation on the outcome of mechanical ventilation. Chest. 1997;112:186-192.

  16. Cavallone FL, Vannucci A. Extubation of the difficult airway and extubation failure. Anesth Analg. 2013;116:368-383.

  17. Mabrouk AA, Mansour FO, Abd El-Aziz A, Elhabashy MM, Alasdoudy AA. Evaluation of some predictors for successful weaning from mechanical ventilation. Egyptian Journal of Chest Diseases and Tuberculosis. 2015;64(3):703-707. http://dx.doi.org/10.1016/j.ejcdt.2015.03.021

  18. Thiruppathi Chockalingam. Weaning and extubation. J Lung Pulm Respir Res. 2015;2(3):00043.

  19. McConville FJ, Kress PJ. Weaning patients from the ventilator. N Engl J Med. 2012;367:2233-2239.

  20. Truwit JD, Marini JJ. Validation of a technique to assess maximal inspiratory pressure in poorly cooperative patients. Chest. 1992;102(4):1261-1219. doi: 10.1378/chest.102.4.1216.

  21. Kuhlen R, Hausmann S, Pappert D, Slama K, Rossaint R, Falke K. A new method for P0.1 measurement using standard respiratory equipment. Intensive Care Med. 1995;2(7):554-560.

  22. MacIntyre NR. The ventilator discontinuation process: an expanding evidence base. Respir Care. 2013;58(6):1074-1086.

  23. Burns MS, Fisher CH, Tribble SS, Lewis R, Merrel P, Conaway MR, et al. Multifactor clinical score and outcome of mechanical ventilation weaning trials: burns wean assessment program. Am J Crit Care. 2010;19:431-439.

  24. Beigmohammadi MT, Hussain-Khan Z, Samadi S, Mahmoodpoor A, Fotouhi A, Rahimiforoushani A, et al. Role of hematocrit concentration on successful extubation in critically ill patients in the intensive care units. Anesth Pain Med. 2016;6(1):e32904. doi: 10.5812/aapm.32904.

  25. Lai YC, Ruan SY, Huang CY, Kuo PH, Yu CJ. Hemoglobin levels and weaning outcome of mechanical ventilation in difficult-to-wean patients: a retrospective cohort study. PLoS ONE. 2013;8(8):e73743. doi: 10.1371/journal.pone.0073743.

  26. MacIntyre NR, Cook DJ, Ely EW Jr, Epstein SK, Fink JB, Heffner JE y col. Evidence-based guidelines for weaning and discontinuing vetilatory support: a collective task force facilitated by the American College of Chest Physicians; the American Association for Respiratory Care; and the American College of Critical Care Medicine. Chest. 2001;120(6 Suppl):375S-395S.

  27. Figueras J, Weil MH. Increases in plasma oncotic pressure during acute cardiogenic pulmonary edema. Circulation. 1977;55:195-199.

  28. Dres M, Teboul JL, Anguel N, Guerin L, Richard C, Monnet X. Extravascular lung water, B-type natriuretic peptide, and blood volume contraction enable diagnosis of weaning-induced pulmonary edema. Crit Care Med. 2014;42:1882-1889.

  29. Anguel N, Monnet X, Osman D, Castelain V, Richard C, Teboul JL. Increase in plasma protein concentration for diagnosing weaning-induced pulmonary oedema. Intensive Care Med. 2008;34:1231-1238.

  30. Teboul JL, Monnet X, Richard C. Weaning failure of cardiac origin: recent advances. Crit Care. 2010;14:211. doi: 10.1186/cc8851.

  31. Pecanha-Antonio A, Souza-Castro P, Schulz L, Maccari J, Oliveira R, Teixeira C, et al. Lung ultrasound findings predict weaning failure from mechanical ventilation. Crit Care. 2014;18(Suppl 1):P298. doi: 10.1186/cc13488.

  32. DiNino E, Gartman EJ, Sethi JM, McCool FD. Diaphragm ultrasound as a predictor of successful extubation from mechanical ventilation. Thorax. 2014;69(5):423-427. doi: 10.1136/thoraxjnl-2013-204111.

  33. Schmidt AG, Girard DT, Kress PJ, Morris EP, Daniel R, Ouellette RD, et al. Liberation from mechanical ventilation in critically ill adults. Chest. 2017;151(1):160-165.

  34. Schmidt GA, Girard TD, Kress JP, Morris PE, Ouellette DR, Alhazzani W, et al. Liberation from mechanical ventilation in critically ill adults: an official American College of Chest Physicians/American Thoracic Society clinical practice guideline. Chest. 2017;151:166-165.

  35. Girard TD, Kress JP, Fuchs BD, Thomason JW, Schweickert WD, Pun BT, et al. Efficacy and safety of a paired sedation and ventilator weaning protocol for mechanically ventilated patients in intensive care (Awakening and Breathing Controlled trial): a randomised controlled trial. Lancet. 2008;371:126-134.

  36. Blackwood B, Alderdice F, Burns K, Cardwell C, Lavery G, O’Halloran P. Use of weaning protocols for reducing duration of mechanical ventilation in critically ill adult patients: Cochrane systematic review and meta-analysis. BMJ. 2011;342:c7237.

  37. Liu Y, Wei LQ, Li GQ, Wang H, Yu-Hua Zhang YH, et al. A decision-tree model for predicting extubation outcome in elderly patients after a successful spontaneous breathing trial. Anesth Analg. 2010;111:1211-1218.

  38. Girard TD, Alhazzani W, Kress JP, Ouellette DR, Schmidt GA, Truwit JD, et al. An official American Thoracic Society/American College of Chest Physicians clinical practice guideline: liberation from mechanical ventilation in critically ill adults: rehabilitation protocols, ventilator liberation protocols, and cuff leak tests. Am J Respir Crit Care Med. 2017;195:120-133.

  39. Zhang B, Qin YZ. Comparison of pressure support ventilation and T-piece in determining rapid shallow breathing index in spontaneous breathing trials. Am J Med Sci. 2014;348:300-305.

  40. Haas CF, Loik PS. Ventilator discontinuation protocols. Respir Care. 2012;57(10):1649-1662.

  41. Ouellette RD, Patel SM, Girard DT, Morris EP, Gregory A, Schmidt AG, et al. Inspiratory pressure augmentation during spontaneous breathing trials, protocols minimizing sedation, and noninvasive ventilation immediately after extubation. Chest. 2017;151(1):166-180.

  42. Bolzan WD, Solangen G, Faresin GS, et al. Endotracheal tube cuff pressure assessment maneuver induces drop of expired tidal volume in the postoperative of coronary artery bypass grafting. J Cardiothoracic Surg. 2012;7:53.

  43. Perren A, Brochard L. Managing the apparent and hidden difficulties of weaning from mechanical ventilation. Intensive Care Med. 2013;39:1885-1895.

  44. Fisher MM, Raper RF. The “cuff-leak” test for extubation. Anaesthesia. 1992;47(1):10-12.




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