Puga TMS, Parellada BJ, Hernández PW, Pérez PF, Quiñones ZA, Ruiz SLO

Language: Spanish
References: 26
Page: 70-86
PDF size: 226.44 Kb.

ABSTRACT

Introduction: The plan of study of the career of medicine doesn't contemplate the acquisition of knowledge on the mechanical ventilation for that reason the doctors are in disadvantage when they should face this type of patients, either in the intensive municipal areas in our country or being part of an internationalist mission, for example the centers of integral diagnosis in Venezuela. Objective: Proposing algorithms practical guides for the application of the mechanical ventilation in the intensive municipal areas and the centers of integral diagnosis. Method: Study of development type that included a wide bibliographical revision and the creation of a group of expertst hat did 16 recommendations based on 5 blocks of questions that the author considered necessary to respond in order to face a ventilated patient. Results: They were made 5 algorithms or practical guides, result of new publications, the guides based on the evidence, the recommendations of the group of experts and the result of our own investigations and they included: Beginning of the mechanical ventilation, ventilation with the "MARK" in the intensive municipal area, ventilation with the "SAVINA" in the centers of integral diagnosis, practical guide for the patient that "fights against" the adaptation with the breather and an algorithm for the withdrawal of the ventilation. Conclusions: The proposed algorithms constitute a tool of high value in order to facilitate the handling of the ventilated patients in such units.

REFERENCES

1. Portal Web del Ministerio del Poder Popular para Salud de Venezuela. [Citado 3 Feb 2007]. Disponible en: http://www.msds.gov.ve/msd/modules.php? name=Content&pa=showpage&pid=269

2. Esteban A, Anzueto A, Frutos F, Alía I. Characteristics and Outcomes in Adult Patients Receiving Mechanical Ventilation A 28-Day International Study. JAMA. 2002;287:345-55.

3. Pinsky M: Cardiovascular Issues in Respiratory Care. Chest. 2005;128(Suppl 2):592S-7S.

4. Slutsky A, Tremblay L. Multiple system organ failure: is mechanical ventilation a contributing factor? Am J Respir Crit Care Med. 1998;157:1721-5.

5. Gordo Vidal F, Delgado Arnaiz C, Calvo Herranz E: Lesion pulmonar inducida por la ventilación mecánica. Med Intensiva. 2007;31(1):18-26.

6. Esteban A, Anzueto A, Alia I, Gordo F, Tobin M, for the Mechanical Ventilation International Study Group: How is mechanical ventilation employed in the Intensive Care Unit? An International Utilization Review. Am Respir Crit Care Med. 2000;161:1450-8.

7. MacIntyre N, Cook D, Ely E. Evidence based guidelines for weaning and discontinuing ventilatory support. A collective Task Force facilitated by the ACCP, AARC, and the ACCCM. Chest. 2001;120:(Suppl 6):375S-83S.

8. International Consensus Conferences in Intensive Care Medicine: Ventilator associated lung injury in SDRA. October 29-30, Toronto; 1998.

9. Kollef M., Shapiro S., Silver P. A randomized, controlled trial of protocol-directed versus physician-directed weaning from mechanical ventilation. Crit Care Med. 1997;25:567.

10. The Acute Respiratory Distress Syndrome Network: Ventilation with lower tidal volumes as compared with traditional tidal volumes for acute lung injury and the acute respiratory distress syndrome. N Engl J Med. 2000;342:1301-8.

11. Tomicic V, Espinoza M, Andersen M: Grupo Chileno para el Estudio de la Ventilación Mecánica: Características de los pacientes que reciben ventilación mecánica, estudio multicéntrico chileno. Rev Med Chile. 2008;136:959-67.

12. Gajic O, Dara SI, Mendes JL, Adesanya AO, Festic E:Ventilator-associated lung injury inpatients without acute lung injury at the onset of mechanical ventilation. Crit Care Med. 2004;32:1817-24.

13. Determann R, Royakkers A, Wolthuis E: Ventilation with lower tidal volumes as compared with conventional tidal volumes for patients without acute lung injury: a preventive randomized controlled trial. Critical Care. 2010;14:1-14.

14. Adams A, Simonson D, Dries D. Ventilator-induced lung injury. Respir Care Clin. 2003;9:343-9.

15. Lluviano García JA, Torres Cortés M: ¿Cómo se utiliza la ventilación mecánica en las Unidades de Terapia Intensiva de México?. Med Critica. 2006;20(3):120-5.

16. Grasso S, Stripoli T, Michele M: ARDSnet Ventilatory Protocol and Alveolar Hyperinflation. Role of Positive End-Expiratory Pressure. Am J Respir Crit Care Med. 2007;176:761-7.

17. Goodman RB, Strieter RM, Martin DP, Steinberg KP, Milberg JA, Maunder RJ. Inflammatory cytokines in patients with persistence of the acute respiratory distress syndrome. Am J Respir Crit Care Med. 1996;154:602-11.

18. Colmenero R, Fernández R, Fernández MA, Rivera R, Vázquez G. PEEP and low tidal volume ventilation reduce lung water in porcine pulmonary edema. Am J Respir Crit Care Med.1997;155:964-70.

19. Sassoon C. Patient ventilator asynchrony. Curr Opin Crit Care. 2001;7:28-33.

20. Garcia V: El paciente en "lucha" con el ventilador. Medicrit. 2007;4(3):76-81.

21. Alia I, Esteban A. Weaning from mechanical ventilation. Crit Care. 2000;4:72-8.

22. Puga M, Gómez A, Palacio H: Prueba de ventilación espontánea y retirada definitiva de la VM en una UCI. Rev Cub Med Int Emerg. 2006;5(1):265-73.

23. Ely E, Baker A, Dunagan D. Effect on the duration of mechanical ventilation of identifying patients capable of breathing spontaneously. N Engl J Med. 2006;335:1864-96.

24. Laghi F, D'Alfonso N, Tobin MJ. Pattern of recovering from diaphragmatic failure over 24 hours. J Appl Phisiol. 1995;79:339-45.

25. Marelich G, Murin S, Battistella F, Viera T: Protocol weaning of Mechanical. Chest. 2000;118(2):459-67.

26. Puga M, Pérez E, Pérez F. Factores que influyen en la mortalidad del paciente ventilado. Rev Cub Med Int Emerg. 2009;8(2):1490-8.