Implementación de la ventilación mecánica protectora en pacientes con síndrome de distrés respiratorio agudo Revisión narrativa
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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.
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