Palabras clave
ventilación mecánica
volumen corriente
frecuencia respiratoria
fracción inspirada de oxígeno
presión positiva de fin de espiración
monitoreo respiratorio
sincronía paciente-ventilador
´desconexión del ventilador
Categorías
Cómo citar
Resumen
La ventilación mecánica protectora ha demostrado reducir la mortalidad en los pacientes con síndrome de distrés respiratorio agudo. Sin embargo, muchos pacientes no reciben el tratamiento ni el monitoreo ventilatorio adecuado.
La implementación de la ventilación mecánica se puede mejorar aplicando conceptos y herramientas descriptas en los protocolos publicados. La preparación del ventilador, del circuito respiratorio y de las interfaces permite corregir el volumen compresible, acondicionar el gas inspirado, y minimizar el espacio muerto instrumental.
La elección del modo ventilatorio, del volumen corriente y de la frecuencia respiratoria iniciales permiten asegurar una correcta ventilación minuto. La presión positiva de fin de espiración y la fracción inspirada de oxígeno son las variables más relevantes para mantener una adecuada oxigenación. El monitoreo de la mecánica respiratoria, del intercambio gaseoso y de la sincronía paciente-ventilador permite evaluar la respuesta a intervenciones terapéuticas, detectar complicaciones, y efectuar correcciones.
La detección del momento oportuno para iniciar la transición desde la ventilación controlada hacia la fase de soporte ventilatorio parcial y el inicio de la desconexión es un desafío importante para disminuir los riesgos asociados con la duración prolongada de la ventilación mecánica.
Citas
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Derechos de autor 2023 María Eugenia Dotta, Magdalena Botto, Juan Manuel Carballo, María Lucía Gimenez, Norberto Tiribelli