Ventilación mecánica no invasiva en la enfermedad pulmonar obstructiva crónica y en el edema agudo de pulmón cardiogénico

Cervera, G. Rialp; Blanco, A. del Castillo; Aizcorreta, O. Pérez; Morais, Luísa

doi:10.1016/j.medin.2012.09.007

Cited by 27 publications

(10 citation statements)

References 60 publications

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“…The clinical outcomes obtained with the use of HFNC for decompensated chronic respiratory failure are consistent with the moderate severity of the patients who received this therapy, with lower intubation and mortality rates than that reported for patients with NIV. (18) Thus, our rate of intubation was 10% for HFNC (18 - 28% reported for NIV), and the hospital mortality rate was 6.6% ( versus 10 - 13% for NIV).…”

Section: Discussionmentioning

confidence: 64%

Efficacy and safety of high-flow nasal cannula oxygen therapy in moderate acute hypercapnic respiratory failure

Yuste¹,

Moreno²,

Narbona³

et al. 2019

Revista Brasileira De Terapia Intensiva

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Objective To assess the efficacy and safety of high-flow nasal cannula oxygen therapy in treating moderate hypercapnic respiratory failure in patients who cannot tolerate or have contraindications to noninvasive mechanical ventilation. Methods A prospective observational 13-month study involving subjects admitted to an intensive care unit with or developing moderate hypercapnic respiratory failure. Clinical and gas exchange parameters were recorded at regular intervals during the first 24 hours. The endpoints were a oxygen saturation between 88 and 92% along with a reduction in breathing effort (respiratory rate) and pH normalization (≥ 7.35). Subjects were considered nonresponders if they required ventilatory support. Results Thirty subjects were treated with high-flow nasal cannula oxygen therapy. They consisted of a mixed population with chronic obstructive pulmonary disease exacerbation, acute cardiogenic pulmonary edema, and postoperative and postextubation respiratory failure. A nonsignificant improvement was observed in respiratory rate (28.0 ± 0.9 versus 24.3 ± 1.5, p = 0.22), which was apparent in the first four hours of treatment. The pH improved, although normal levels were only reached after 24 hours on high-flow nasal cannula therapy (7.28 ± 0.02 versus 7.37 ± 0.01, p = 0.02). The rate of nonresponders was 13.3% (4 subjects), of whom one needed and accepted noninvasive mechanical ventilation and three required intubation. Intensive care unit mortality was 3.3% (1 subject), and a patient died after discharge to the ward (hospital mortality of 6.6%). Conclusion High-flow nasal cannula oxygen therapy is effective for moderate hypercapnic respiratory failure as it helps normalize clinical and gas exchange levels with an acceptable rate of nonresponders who require ventilatory support.

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Section: Discussionmentioning

confidence: 64%

Efficacy and safety of high-flow nasal cannula oxygen therapy in moderate acute hypercapnic respiratory failure

Yuste¹,

Moreno²,

Narbona³

et al. 2019

Revista Brasileira De Terapia Intensiva

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“…Noninvasive ventilation, when added to conventional therapy, improves the outcome of patients with acute respiratory failure that is due to hypercapnic exacerbation of COPD or heart failure in situations of acute pulmonary edema [54]. Biphasic positive airway pressure can improve the right ventricular function and decrease plasma levels of natriuretic peptides [55].…”

Section: Therapy For Cardiovascular Diseases In Copd Patientsmentioning

confidence: 99%

Lung Disease and Hypertension

Imaizumi

Eguchi

Kario³

2014

Pulse

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Chronic obstructive pulmonary disease (COPD) patients are at a high risk of developing cardiovascular diseases. Airflow limitation is a predictor of future risks of hypertension and cardiovascular events. COPD is now understood as a systemic inflammatory disease, with the focus on inflammation of the lungs. An association between inflammation and sympathetic overactivity has also been reported. In this article, we review the association between chronic lung disease and the risks of hypertension, cardiovascular morbidity, the underlying mechanisms, and the therapeutic approach to hypertension and cardiovascular diseases in patients with lung diseases.

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“…La presencia de dos o más de los siguientes criterios gasométricos: PaCo2 > 45mmhg, PaFiO2 <300, PH: >7.25 y/o <7.35, se han definido para indicar el uso de la VMNI (1-3) (20-23). El gradiente alveolo-arterial de oxígeno (Grad[A-a] O2) es una forma sencilla de medir la alteración entre el alveolo y el capilar, su uso está dado en el estudio de diferentes patologías como en EPOC y TEP (27)(28)(29); en cirrosis no se reconoce su uso en la indicación de la VMNI. Se suele indicar que el valor del Grad(A-a)O2 no debe exceder los 20 mmHg en situaciones de estabilidad hemodinámica y FiO2 de 0,21 (30).…”

Section: Discussionunclassified

Corto circuito pulmonar, índice arterio-alveolar y gradiente alveolo-arterial de oxígeno previa ventilación mecánica no invasiva

Izquierdo

Muñoz

Diaz³

2015

rev. investig. andin.

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Objetivo. Describir el comportamiento de gradiente alveolo-arterial oxígeno (Grad[A-a]O2), índice arterio-alveolar de oxígeno (Ind[a-A]O2) y corto circuito pulmonar (Qs/Qt) en un grupo de pacientes previa instauración de ventilación mecánica no invasiva –VMNI- en una unidad de cuidado intensivo UCI.Metodología. Estudio transversal retrospectivo. Calculamos el Grad[A-a]O2) mediante la ecuación: PAO2 = [[(pAtm-pH2O)xFiO2]-(pCO2/RespQ)]-PaO2], para: RespQ = (0,8); (pAtm = 560mmHg para Bogotá, 2640 metros sobre nivel del mar); pH2O = (47mmHg); el (Ind[a-A]O2) y (Qs/Qt) con la fórmula: (Cco2- Cao2)/ (Cco2- Cvo2). Ámbito: Hospital terciario. Pacientes: 16 sujetos de UCI mediante muestra no probabilística consecutiva, que recibieron VMNI en un periodo de medición de 3 meses. Variables de interés principal: diagnóstico, edad, gasometría sanguínea, se calcularon las variables: (Grad [A-a]O2), (Ind[a-A]O2) y (Qs/Qt).Resultados. El promedio de edad de la población objeto de estudio fue de 59,6; de los cuales el 56% (n=9) fueron mujeres. La VMNI se utilizó en el 14% (n=16) de los pacientes con una población total de 116 en un periodo de tres meses. Los valores gasométricos encontrados (media ± desviación estándar) fueron: (Ind [a-A]O2)= (0,38mmHg ± 0,2mmHg), (Qs/Qt) = (25% ± 8.1%) y (Grad [A-a]O2) = (159mmHg ± 64.1mmHg), FiO2 suministrada de acuerdo a los requerimientos de cada paciente, PaCO2 (42mmhg ± 15mmHg), PaO2/FiO2 = (149 ± 44.2), SvO2 (n=8) = (66,2% ± 9.3%), PH = (7,38 ± 0.1), SaO2 = (92% ± 2.8%), y PaO2 = (70mmHg ± 15.4mmHg).Conclusiones. Los valores gasométricos (Qs/Qt = >25 ± 8.1%), (Ind[a-A]O2 = < 0,38 ± 0.2mmHg) y (Grad[A-a]O2 = >159 ± 64.1mmHg), identificados en este grupo de pacientes, pueden ser tenidos en cuenta previa instauración de VMNI en sujetos con características similares a una altura de 2.640 metros sobre el nivel del mar.

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Ventilación mecánica no invasiva en la enfermedad pulmonar obstructiva crónica y en el edema agudo de pulmón cardiogénico

Cited by 27 publications

References 60 publications

Efficacy and safety of high-flow nasal cannula oxygen therapy in moderate acute hypercapnic respiratory failure

Efficacy and safety of high-flow nasal cannula oxygen therapy in moderate acute hypercapnic respiratory failure

Lung Disease and Hypertension

Corto circuito pulmonar, índice arterio-alveolar y gradiente alveolo-arterial de oxígeno previa ventilación mecánica no invasiva

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