medigraphic.com
Colegio de Medicina Interna de México.

2017, Number 5

<< Back Next >>

Med Int Mex 2017; 33 (5)

Predictors in the retirement of mechanical ventilation: are they enough to neurocritical patient?

Pin-Gutiérrez E, Sánchez-Díaz JS, Flores-Hernández R, Martínez-Rodríguez EA, Peniche KG, Díaz-Gutiérrez SP, Cortés-Román JS, Huanca-Pacaje JM, Castañeda-Valladares E, Calyeca-Sánchez V

Language: Spanish
References: 19
Page: 675-681
PDF size: 513.12 Kb.


ABSTRACT

Long mechanical ventilation (MV) increases the risk of complications; moreover, early retirement of it exposes the patient to the risks presented before starting. The balance in speaking of prolonged mechanical ventilation and early retirement remains controversial, besides being an unresolved issue, even more so when speaking of neurological patients. Protection of the airway and prevention of further compromised brain compliance are the purposes of initiating invasive mechanical ventilation in patients with neurological impairment in addition to engaging the patient with particular fan under the presence of abnormal breathing patterns. Of patients requiring mechanical ventilation in the Intensive Care Unit (ICU), about 20% are due to neurological diseases. The appropriate time for extubation may be based on a clinical decision, which may be considered subjective, for this reason objective parameters have been proposed to make such a decision, they will identify candidates to perform test of spontaneous ventilation with great chance of success. The search for a parameter to evaluate the success or failure of extubation in neurological patient is a problem not solved so far, so it should be the subject of further studies, until today the Glasgow Coma Scale (SCG) is the variable associated with good or bad results.


REFERENCES

  1. Guerrero López F, Fernández Mondéjar E. Extubación de pacientes neurocríticos con bajo nivel de conciencia. Un problema por resolver. Med Intensiva 2000 ;24:304-6.

  2. Grotta J, Pasteur W, Khwaja G, Hamel T, et al. Elective intubation for neurologic deterioration after stroke. Neurology 1995;45,640-44.

  3. MacIntyre NR, Cook DJ, Ely EW Jr, Epstein SK, et al. American College of Chest Physicians; American Association for Respiratory Care; American College of Critical Care Medicine Evidence-Based Guidelines for Weaning and Discontinuing Ventilatory 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;120:375-396.

  4. Smith J, Ellenberger H, Ballanyi K, Richter DW, Feldman JL. Pre-Botzinger complex. A brainstem region that may generate respiratory rhythm in mammals. Science 1991;254:726-9.

  5. Muñoz-Ortiz J, Muñoz-Ortiz E, López-Meraz ML, Beltran- Parrazal L, Morgado-Valle C. El complejo pre-Bötzinger: generación y modulación del ritmo respiratorio. Neurología 2016;05:11.

  6. Vinko Tomicic F, Max Andresen H. Ventilación mecánica en el paciente con lesión cerebral aguda. Rev Med Chile 2011;139:382-390.

  7. Lovesio C. Evaluación clínica del paciente en coma. En: Lovesio C. Medicina Intensiva. Rosario-Argentina: Corpus, 2008;1116-1130.

  8. Bové-Ribé A. Los síndromes de apnea central de sueño. La respiración de Cheyne-Stokes. Vigilia-Sueño 2005;17:91- 120.

  9. Kryger MH. Abnormal control of breathing. In: Krynger MH, ed. Pathophysiology of respiration. New York: Wiley, 1981;1:103-122.

  10. English P, Williams G. Hyperglycaemic crises and lactic acidosis in diabetes mellitus. Postgrad Med J 2004;80:253- 261.

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

  12. Pelosi P, Ferguson ND, Frutos-Vivar F, Anzueto A, et al. Management and outcome of mechanically ventilated neurologic patients. Crit Care Med 2011;39:1482-1492.

  13. Souter MJ, Manno EM. Ventilatory management and extubation criteria of the neurological/neurosurgical patient. The Neurohospitalist 2013.3:39-45.

  14. Coplin WM, Pierson DJ, Cooley KD, Newell DW, Rubenfeld GD. Implications of extubation delay in brain injured patients meeting standard weaning criteria. Am J Respir Crit Care Med 2000;161:1530-36.

  15. Namen AM, Ely EW, Tatter SB, Case LD, et al. Predictors of successful extubation in neurosurgical patients. Am J Respir Crit Care Med 2001;163:658-664.

  16. Wendell LC, Raser J, Kasner S, Park S. Predictors of extubation success in patients with middle cerebral artery acute ischemic stroke. Stroke Res Treat 2011;2011:248789.

  17. Wang S, Zhang L, Huang K, Lin Z, et al. Predictors of extubation failure in neurocritical patients identified by a systematic review and meta-analysis. PLoS One 2014;9:e112198.

  18. Magaña Macías C, Salinas Martínez C, Santiago Toledo J, Olvera Guzmán y col. Evaluación del espacio muerto ajustado al volumen corriente en pacientes con ventilación mecánica. Rev Asoc Mex Med Crit y Ter Int 2011;25:131-141.

  19. Rishi M, Kashyap R, Wilson G, Schenck L, Hocker S. Association of extubation failure and functional outcomes in patients with acute neurologic illness. Neurocrit Care 2016;24:217-25.




2020     |     www.medigraphic.com