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2006, Número 4

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Med Crit 2006; 20 (4)


Asistencia mecánica ventilatoria de largo plazo en la Unidad de Terapia Intensiva: definición, causas y pronóstico

Cerda GP, Olvera GC, Aguirre SJ, Franco GJ, Elizalde GJ, Martínez SJ

Idioma: Español
Referencias bibliográficas: 26
Paginas: 157-163
Archivo PDF: 76.43 Kb.


RESUMEN

Objetivo: Identificar las causas de asistencia mecánica ventilatoria de largo plazo (AMVLP) en la UTI y caracterizar su pronóstico.
Diseño: Prospectivo y observacional
Lugar: UTI de un hospital de tercer nivel.
Intervenciones: Ninguna.
Mediciones y resultados principales: 39 pacientes con AMVLP (edad media 59.4 ± 26) se agruparon en: pacientes con insuficiencia respiratoria aguda en pulmones previamente sanos (categoría I), y en pulmones con neumopatía crónica preexistente (categoría II). Se obtuvieron datos demográficos, APACHE II, duración de AMV, necesidad de traqueostomía y tiempo de realización, necesidad de AMV no invasiva (AMVni) postextubación inmediata, egresados con y sin AMV, mortalidad y días de estancia hospitalaria y sobrevida después de 1 mes de egreso. Los pacientes de la categoría I requirieron menor AMVni (27 vs 54%, p ‹ 0.01), tuvieron mayor éxito de retiro de la AMV (58 vs 0%, IC 95% 0.1-1, p ‹ 0.001), menor mortalidad hospitalaria (31% vs 75%, IC 95%, 1.3-5, p ‹ 0.01) y mayor sobrevida al mes del egreso (62% vs 0%, p ‹ 0.01). No hubo otras diferencias estadísticas significativas.
Conclusiones: La AMVLP en pacientes con neumopatía crónica, debe valorarse y puede no justificarse, ya que no demostró reducir la mortalidad a corto ni a largo plazo.


REFERENCIAS (EN ESTE ARTÍCULO)

  1. Gracey DR, Nassens SM, Viggiano RW, Koening GE, Silverstein MD, Hubmayr RD. Outcome of patients cared for in ventilator-dependent unit in general hospital. Chest 1995;107:494-9.

  2. Seneff MG, Wagner D, Thompson D, Honeycutt C, Silver MR. The impact of long-term acute-care facilities on the outcome and cost of care for patients undergoing prolonged mechanical ventilation. Crit Care Med 2000; 28:342-50.

  3. Quality of Life After Mechanized Ventilation in the Elderly Study Investigators. 2-month mortality and functional status of critically in adult patients receiving prolonged mechanical ventilation. Chest 2002;121:549-58.

  4. Make BJ, Hill NS, Goldberg AK et al. Mechanical ventilation beyond the intensive care unit. Report of a consensus conference of the American College of Chest Physicians. Chest 1998;113:289-344.

  5. Gracey DR, Viggiano RW, Naessens SM, Hubmayr RD, Silverstem MD, Koenig GE. Outcomes of patients admitted to a chronic ventilator-dependent unit in an acute-care hospital. Mayo Clin Proceedings 1992;67:131-6.

  6. Gracey DR, Naessens JM, Krishan I, Marsh HM. Hospital and post-hospital survival in patients mechanically ventilated for more then 29 days. Chest 1992;101:2114.

  7. MacIntyre NR, Thalman J. Ventilación mecánica de largo plazo. En: Mechanical Ventilation (MacIntyre NR, Branson R, eds.). McGraw-Hill, Philadelphia, Pennsylvania. USA 2002:380-8.

  8. Scheinhorn DJ, Antoinian BM, Catlin SL. Weaning from prolonged mechanical ventilation: The experience at a regional weaning center. Chest 1994;105:534-9.

  9. Scheinhorn DJ, Chao DC, Stearn-Hassenpflug M, LaBree LD, Heltsley DJ. Post-ICU mechanical ventilation: treatment of 1,123 patients at a regional weaning center. Chest 1997;111:1654-9.

  10. Elpern EH, Larson R, Douglass P, Rosen RL, Bone RC. Long-term outcomes for elderly survivors of prolonged ventilator assistance. Chest 1989;96:1120-4.

  11. Goldberg AI. Outcomes of home care for life-supported persons: long-term oxygen and prolonged mechanical ventilation. Chest 1996;109:595-6.

  12. Portier F, Defouilloy C, Muir JF. Determinants of immediate sur among chronic respiratory insufficiency patients admitted to an intensive care unit for acute respiratory failure. A prospective multicenter study. The French 13. Task Group for Acute Respiratory Failure in Chronic Respiratory Insufficiency. Chest 1992; 101:204-10.

  13. Jeffrey AA, Warren PM, Flenley DC. Acute hypercapnic Respiratory Failure in patients with chronic obstructive lung disease: Risk factors and use of guidelines for management. Thorax 1991;47:34-40.

  14. Seneff MG, Wagner DP, Wagner RP, Zimmerman JE, Knaus WA. Hospital and 1-year survival of patients admitted to intensive care units with acute exacerbation of chronic obstructive pulmonary disease. JAMA 1995; 274:1852-7.

  15. Murphy SL. Deaths: Final data for 1998. Natl Vital Rep 2002;48:1-15.

  16. Adams AB, Shapiro R, Marini JJ. Changing prevalence of chronically ventilator-assisted individuals in Minnesota: increased, characteristics and the use of noninvasive ventilation. Respir Care 1998;43:643-9.

  17. AARC Consensus Group: Non-invasive positive pressure ventilation. Respir Care 1997;42:364-9.

  18. Scheinhorn DJ, Hassenpflug M, Artinian BM, LaBree L, Catlin JL. Predictors of weaning after 6 weeks of mechanical ventilation. Chest 1995;107:500-5.

  19. Tobin MJ, Yang KL. A prospective study on indexes predicting the outcome of trials of weaning from mechanical ventilation. N Engl J Med 1991;324:1445-50.

  20. Nevins ML, Epstein SK. Weaning from prolonged mechanical ventilation. Clin Chest Med 2001;22:13-33.

  21. Heffner JE. The role of tracheostomy in weaning. Chest 2001;120:477S-81S.

  22. Sethi JM, Siegel MD. Mechanical ventilation in chronic obstructive lung disease. Clin Chest Med 2000;21:799-818.

  23. Branson RD, MacIntyre NR. Dual-control modes of mechanical ventilation. Respir Care 1996;41:294-302.

  24. Grant JP. Nutrition care of patients with acute and chronic respiratory failure. Nutr Clin Pract 1994;9:11-7.

  25. Bassili HR, Deitel M. Effect of nutritional support on weaning patients off mechanical ventilators. JPEN J Parenter Enteral Nutr 1981:161-3.

  26. Chelluri L, Mendelsohn AB, Belle SH et al. Hospital costs in patients receiving prolonged mechanical ventilation: Does age have an impact? Crit Care Med 2003; 31:1746-51.




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