Cruces RP, Donoso FA, Le�n BJ, Valenzuela VJ, Camacho �J

Idioma: Español
Referencias bibliográficas: 37
Paginas: 67-73
Archivo PDF: 77.50 Kb.

RESUMEN

Introducci�n: La ventilaci�n de alta frecuencia oscilatoria (VAFO) es una modalidad empleada en pacientes con SDRA refractario a ventilaci�n mec�nica convencional (VMC). El rol de esta terapia frente a hipoxemia catastr�fica, con �ndice de oxigenaci�n (IO ≥ 40), no est� definido en la actualidad, por corresponder a pacientes habitualmente subsidiarios de empleo de oxigenaci�n con membrana extracorp�rea.
Objetivo: Presentar el efecto de la VAFO en SDRA grave con hipoxemia extrema, refractaria a terapia convencional m�xima.
Dise�o y pacientes: Se emple� el ventilador Sensor Medics 3100A seg�n protocolo preestablecido. Describimos la totalidad de los pacientes con insuficiencia respiratoria global que ingresaron entre 1999 y 2005 en nuestra Unidad que tras terapia ventilatoria convencional permanecieron con �ndice de oxigenaci�n mayor que 40. Se registr� intercambio gaseoso antes, durante las primeras 48 h y previo al retorno a VMC. Describimos permanencia en VAFO, complicaciones y mortalidad en este grupo.
Mediciones y resultados: Se ventilaron 12 pacientes con una mediana de edad de 3.5 meses; score de lesi�n pulmonar de 3.5 (3.25-4). Previo al inicio de la VAFO, la PaO₂/FIO₂ y el IO fueron de 39 y 47 respectivamente. La duraci�n de la VMC previa fue de 65 h. Esta terapia logr� una r�pida y progresiva mejor�a de la oxigenaci�n, m�xima a las 24 h de iniciada (PaO₂/FIO₂ = 137 e IO = 18, p ‹ 0.01). La supervivencia a los 28 d�as fue de 75%.
Conclusi�n: Una elevada supervivencia asociada a la mejor�a en la oxigenaci�n puede ser obtenida en pacientes con hipoxemia extrema empleando la VAFO, por lo que se constituye en opci�n terap�utica a considerar en este subgrupo.

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