La ventilación mecánica simultánea a varios pacientes con un solo ventilador podría disminuir el déficit de esos dispositivos para atender a los enfermos con insuficiencia respiratoria aguda por Covid-19. objetivo: Comunicar los resultados de un ejercicio de ventilación mecánica con un ventilador en un simulador de pulmón, y simultáneamente en dos y cuatro simuladores. resultados: No se observaron diferencias estadísticamente significativas entre la presión positiva al final de la espiración, presión media de la vía aérea y presión pico programadas, registradas y medidas, excepto al ventilar simultáneamente cuatro simuladores de pulmón. Conclusiones: La ventilación mecánica simultánea debe ser instaurada por personal médico con experiencia en el procedimiento, restringirse a dos pacientes y ser realizada en la unidad de cuidados intensivos.Palabras clave: Ventilación mecánica controlada. Insuficiencia respiratoria aguda. COVID-19. Simuladores de pulmón.
simultaneous mechanical ventilation of several patients with a single ventilator abstract introduction:Simultaneous mechanical ventilation of several patients with a single ventilator might reduce the deficit of these devices for the care of patients with acute respiratory failure due to Covid-19. objective: To communicate the results of a mechanical ventilation exercise with a ventilator in a lung simulator, and simultaneously in two and four. results: No statistically significant differences were observed between positive end-expiratory pressure, mean airway pressure, and programmed, recorded and measured peak pressure, except when simultaneously ventilating four lung simulators. Conclusions: Simultaneous mechanical ventilation should be implemented by medical personnel with experience in the procedure, be restricted to two patients and carried out in the intensive care unit.
data de hace más de 50 años y con mayor impulso en la década de los 70, se le atribuye una mejoría en la presión parcial de oxígeno arterial (PaO 2 ) al incrementar la presión media de la vía aérea (Pma), mayor aclaramiento de la presión parcial de dióxido de carbono arterial (PaCO 2 ) y permite la monitorización de la presión meseta (Pmeseta) en la mecánica ventilatoria; sin embargo, los estudios clínicos sobre su uso son escasos y controversiales. En este artículo se abordan los mecanismos fisiológicos, fisiopatológicos y la evidencia sobre el uso de la PFI en ventilación mecánica (VM). Palabras clave: pausa inspiratoria, pausa al final de la inspiración, presión meseta, presión media de la vía aérea, síndrome de distrés respiratorio agudo, ventilación mecánica.
Introduction. Hemodynamic monitoring of a critically ill patient is an indispensable tool both inside and outside intensive care; we currently have invasive, minimally invasive and non-invasive devices; however, no device has been shown to have a positive impact on the patient's evolution; arterial and venous blood gases provide information on the patient's actual microcirculatory and metabolic status and may be a hemodynamic monitoring tool.
Objective. To carry out a non-systematic review of the literature of hemodynamic monitoring carried out through the variables obtained in arterial and venous blood gases.
Material and methods. A non-systematic review of the literature was performed in the PubMed, OvidSP and ScienceDirect databases with selection of articles from 2000 to 2019.
Results. It was found that there are variables obtained in arterial and venous blood gases such as central venous oxygen saturation (SvcO2), venous-to-arterial carbon dioxide pressure (∆pv-aCO2), venous-to-arterial carbon dioxide pressure/arteriovenous oxygen content difference (∆pv-aCO2/∆Ca-vO2) that are related to cellular oxygenation, cardiac output (CO), microcirculatory veno-arterial flow and anaerobic metabolism and allow to assess tissue perfusion status.
Conclusion. The variables obtained by arterial and venous blood gases allow for non-invasive, accessible and affordable hemodynamic monitoring that can guide medical decision-making in critically ill patients.
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