Castilla-Castilla CMC, Vidales-Roque LB, Pérez-Durán J, Tena-Reyes D, Tapia-Rombo CA

Language: Spanish
References: 25
Page: 638-643
PDF size: 127.52 Kb.

ABSTRACT

Background: Atelectasis is a decrease of lung volume caused by airway obstruction or pressure on the external part of the lung. It is common after surgery and extubation. The purpose of this investigation was to determine factors related with alectasis following extubation in preterm neonates with a weight under 1250 g who were referred to a neonatal intensive care unit.
Methods: The study was conducted in neonates admitted to a neonatal intensive care unit requiring mechanically assisted ventilation. Preterm neonates born at 28 to 36 weeks’ gestation and with 0 to 28 days’ extrauterine life, with mechanically assisted ventilation for at least 24 hours, and that when undergoing planned extubation had a weight under 1250 g were included. Two comparative groups were formed: group A, with alectasis after extubation; group B, without alectasis after extubation.
Results: As factors associated with alectasis after extubation, reintubation in two or more occasions and cycling higher than 20 per minute, which were statistically relevant, were identifi ed.
Conclusions: In addition to previous general measures to prevent alectasis, extubation with ventilation not higher tan 20 cycles per minute should be programmed and reintubation should be avoided as much as possible.

REFERENCES

1. Tapia-Rombo CA, Domínguez-Martínez R, Saucedo- Zavala VJ, Cuevas-Uriostegui ML. Factores de riesgo para la presencia de complicaciones de la asistencia mecánica ventilatoria en el recién nacido. Rev Invest Clin. 2004;56(6):700-11.

2. Tapia-Rombo CA, Rodríguez-Jiménez G, Ballesteros- del Olmo JC, Cuevas-Uriostegui ML. Factores de riesgo asociados a complicaciones de la asistencia mecánica ventilatoria en el recién nacido prematuro. Gac Med Mex. 2009;145(4):273-83.

3. Gattinoni L, Pesenti A. The concept of baby lung. Int Care Med. 2005;31(6):776-84.

4. International Consensus Conferences in Intensive Care Medicine. Ventilator-associated lung injury in ARDS. Am J Respir Crit Care Med. 1999;160(6): 2118-24.

5. Webb HH, Tierney DF. Experimental pulmonary edema due to intermittent positive pressure ventilation with high infl ation pressures: protection by positive end-expiratory pressure. Am Rev Respir Dis. 1974;110(5):556-65.

6. Schnapp LM, Chin DP, Szafl arski N, Matthay MA. Frequency and importance of barotraumas in 100 patients with acute lung injury. Crit Care Med. 1995; 23(2):272-78.

7. Slutsky AS. Lung Injury caused by mechanical ventilation. Chest. 1999;116(1 Suppl):9S-15S.

8. Pingleton SK. Barotrauma in acute lung injury: Is it important? Crit Care Med. 1995;23(2):223-4.

9. Hamilton PP, Onayemi A, Smyth JA, Gillan JE, Cutz E, Froese AB, et al. Comparison of conventional and high-frequency ventilation: Oxygenation and lung pathology. J Appl Physiol Environ Exerc Physiol. 1983; 55(1 Pt 1):131-8.

10. Gattinoni L, Caironi P, Carlesso E. How to ventilate patient with acute lung injury and acute respiratory distress syndrome. Curr Opin Crit Care. 2005;11(1): 69-76.

11. Slutsky AS. Ventilator-induced lung injury: From barotraumas to biotrauma. Respir Care. 2005;50:646-59.

12. Ranieri VM, Giunta F, Suter PM, Slutsky AS. Mechanical ventilation as a mediator of multisystem organ failure in acute respiratory distress syndrome. JAMA. 2000;284(1):43-4.

13. Imai Y, Parodo J, Kajikawa O, de Perrot M, Fischer S, Edwards V, et al. Injurius mechanical ventilation and end-organ epithelial cell apoptosis and organ dysfunction in an experimental model of acute respiratory distress syndrome. JAMA. 2003;289(16): 2104-12

14. López-Candiani C, Soto-Portas LC, Gutiérrez-Castrellón P, Rodríguez-Weber MA, Udaeta-Mora E, et al. Complicaciones de la ventilación mecánica en neonatos. Acta Pediatr Mex. 2007;28(2): 63-8.

15. Alanís S, López V, Rodríguez I, Ábrego V. Uso de alfadornasa en el manejo de atelectasia de difícil resolución en recién nacidos. Rev Mex de Pediatr. 2003;70(3):143-5.

16. Al-Alalyan S, Dyer D, Khan B. Chest physiotherapy and post-extubación atelectasis in infants. Pediatr Pulmonol. 1996:21(4):227-30.

17. Hernández E, Furuya MEY. Enfermedades respiratorias pediátricas. México: Manual Moderno; 2002.

18. Merkus PJ, de Hoog M, Van Gent R, de Jongste JC. DNase treatment for atelectasis in infants with severe respiratory syncytial virus bronchiolitis. Eur Resp J. 2001;18(4):734-7.

19. Young MJ, Bresnitz EA, Strom BL. Sample size nomograms for interpreting negative clinical studies. Ann Intern Med. 1983;99(2):248-51.

20. Tapia-Rombo CA, Galindo-Alvarado AM, Saucedo- Zavala VJ, Cuevas-Uriostegui ML. Factores predictores de falla en la extubación en recién nacidos de pretérmino. Gac Med Mex. 2007;143(2):101-8.

21. Tapia-Rombo CA, de León-Gómez N, Ballesterodel- Olmo JC, Ruelas-Vargas C, Cuevas-Uriostegui ML, Castillo-Pérez JJ. Factores predictores para falla en la extubación en dos o más ocasiones en el recién nacido de pretérmino. Rev Invest Clin. 2010; 62(5):412-23.

22. Tapia-Rombo CA, Córdova-Muñiz NE, Ballesterosdel- Olmo JC, Aguilar-Solano AMG, Sánchez-García L, Gutiérrez-González GA, et.al. Factores predictores para la producción de displasia broncopulmonar en el recién nacido pretérmino. Rev Invest Clin. 2009;61(5):466-75.

23. Davis GM, Bureau MA. Mecánica de la pared del tórax y pulmonares en el control de la respiración en el neonato. Clin Perinatol 1987;3:575-603.

24. Noguez-Prieto F. La insufi ciencia respiratoria en la sala de cuidados intensivos. En: Arellano-Penagos M. Cuidados intensivos en pediatría. Segunda edición. México: Nueva Editorial Interamericana; 1981.

25. Cuevas-Schacht F, Ortega-Iglesias J, Sosa-de Martínez MC, Garrido-Galindo C, Pérez-Fernández L. Broncoscopia en pacientes pediátricos con atelectasia persistente. Acta Pediatr Mex. 2005;26(2):62-66.