Ventilación mecánica invasiva en EPOC y asma / Invasive mechanical ventilation in COPD and asthma

Los pacientes con EPOC y asmáticos utilizan una proporción sustancial de ventilación mecánica en la UCI, y su mortalidad global en tratamiento con ventilación mecánica puede ser significativa. Desde el punto de vista fisiopatológico, muestran un incremento de la resistencia de la vía aérea, hiperinsuflación pulmonar y elevado espacio muerto anatómico, lo que conduce a un mayor trabajo respiratorio. Si la demanda ventilatoria sobrepasa la capacidad de la musculatura respiratoria, se producirá el fracaso respiratorio agudo.El principal objetivo de la ventilación mecánica en este tipo de pacientes es proporcionar una mejora en el intercambio gaseoso, así como el suficiente descanso para la musculatura respiratoria tras un periodo de agotamiento. La evidencia actual apoya el uso de la ventilación mecánica no invasiva en estos pacientes (especialmente en la EPOC), pero con frecuencia se precisa de la ventilación mecánica invasiva para los pacientes con enfermedad más severa. El clínico debe ser muy cauto para evitar complicaciones relacionadas con la ventilación mecánica durante el soporte ventilatorio. Una causa mayor de morbilidad y mortalidad en estos pacientes es la excesiva hiperinsuflación dinámica pulmonar con presión positiva al final de la espiración (PEEP intrínseca o auto-PEEP). El objetivo de este artículo es proporcionar una concisa actualización de los aspectos más relevantes para el óptimo manejo ventilatorio en estos pacientes (AU)

COPD and asthmatic patients use a substantial proportion of mechanical ventilationin the ICU, and their overall mortality with ventilatory support can be significant. From the pathophysiologicalstandpoint, they have increased airway resistance, pulmonary hyperinflation,and high pulmonary dead space, leading to increased work of breathing. If ventilatory demandexceeds work output of the respiratory muscles, acute respiratory failure follows. The main goal of mechanical ventilation in this kind of patients is to improve pulmonary gasexchange and to allow for sufficient rest of compromised respiratory muscles to recover fromthe fatigued state. The current evidence supports the use of noninvasive positive-pressureventilation for these patients (especially in COPD), but invasive ventilation also is requiredfrequently in patients who have more severe disease. The physician must be cautious to avoidcomplications related to mechanical ventilation during ventilatory support. One major cause ofthe morbidity and mortality arising during mechanical ventilation in these patients is excessivedynamic pulmonary hyperinflation (DH) with intrinsic positive end-expiratory pressure (intrinsicPEEP or auto-PEEP). The purpose of this article is to provide a concise update of the mostrelevant aspects for the optimal ventilatory management in these patients (AU)

[Invasive mechanical ventilation in COPD and asthma]. / Ventilación mecánica invasiva en EPOC y asma.

COPD and asthmatic patients use a substantial proportion of mechanical ventilation in the ICU, and their overall mortality with ventilatory support can be significant. From the pathophysiological standpoint, they have increased airway resistance, pulmonary hyperinflation, and high pulmonary dead space, leading to increased work of breathing. If ventilatory demand exceeds work output of the respiratory muscles, acute respiratory failure follows. The main goal of mechanical ventilation in this kind of patients is to improve pulmonary gas exchange and to allow for sufficient rest of compromised respiratory muscles to recover from the fatigued state. The current evidence supports the use of noninvasive positive-pressure ventilation for these patients (especially in COPD), but invasive ventilation also is required frequently in patients who have more severe disease. The physician must be cautious to avoid complications related to mechanical ventilation during ventilatory support. One major cause of the morbidity and mortality arising during mechanical ventilation in these patients is excessive dynamic pulmonary hyperinflation (DH) with intrinsic positive end-expiratory pressure (intrinsic PEEP or auto-PEEP). The purpose of this article is to provide a concise update of the most relevant aspects for the optimal ventilatory management in these patients.