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Vol. 59. Núm. 4.
Páginas 366-372 (Octubre 2003)
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Vol. 59. Núm. 4.
Páginas 366-372 (Octubre 2003)
Acceso a texto completo
Ventilación mecánica en el síndrome de dificultad respiratoria aguda/lesión pulmonar aguda
Mechanical ventilation in acute respiratory distress syndrome/acute lung injury
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J.A. Medina Villanueva*, S. Menéndez Cuervo, C. Rey Galán, J.A. Concha Torre
Unidad de Cuidados Intensivos Pediátricos. Hospital Central de Asturias. Oviedo. España
Información del artículo

El síndrome de dificultad respiratoria aguda (SDRA), descrito inicialmente por Ashbaugh en 1967, consiste en un cuadro agudo de insuficiencia respiratoria hipoxémica (PaO2/FiO2 ≤ 200) con presencia de infiltrados bilaterales en la placa simple de tórax relacionados con un edema pulmonar difuso no cardiogénico

Aunque la etiología del SDRA es múltiple y variada, una agresión (primariamente pulmonar o extrapulmonar) puede desencadenar una respuesta inflamatoria sistémica que perpetúe el daño pulmonar una vez erradicada la causa inicial que puso en marcha el cuadro

La mayoría de pacientes con SDRA requieren VM durante su evolución, constituyendo la ventilación convencional optimizada según los criterios de protección pulmonar el estándar de calidad actual. Otras estrategias de ventilación mecánica como la VAFO, basadas asimismo en los conceptos de reclutamiento alveolar y mantenimiento de un volumen pulmonar adecuado, pueden constituir alternativas útiles

En esta revisión se analiza asimismo el nivel de evidencia con el que actualmente se utilizan recursos terapéuticos como la ventilación en prono, la inhalación de óxido nítrico (NO) y prostaciclina, el empleo de surfactante exógeno y las técnicas de soporte vital extracorpóreo en el manejo de pacientes con SDRA

Palabras clave:
Síndrome de dificultad respiratoria aguda
Medicina basada en la evidencia
Ventilación mecánica
Ventilación de alta frecuencia
Niños

Acute respiratory distress syndrome (ARDS), which was first described by Ashbaugh in 1967, consists of acute hypoxemic respiratory failure (PaO2/FiO2 ≤ 200) associated with bilateral infiltrates on the chest radiograph caused by noncardiac diffuse pulmonary edema

Although ARDS is of multiple etiology, pulmonary or extrapulmonary injury can produce a systemic inflammatory response that perpetuates lung disturbances once the initial cause has been eliminated

Most patients with ARDS require mechanical ventilation. Currently, the gold standard is conventional ventilation optimized to protect against ventilator-associated lung injury. Other mechanical ventilation strategies such as high-frequency oscillatory ventilation, which is also based on alveolar recruitment and adequate lung volume, can be useful alternatives

In this review, the level of evidence for other therapies, such as prone positioning, nitric oxide and prostacyclin inhalation, exogenous surfactant, and extracorporeal vital support techniques are also analyzed

Key words:
Acute respiratory distress syndrome
Evidence-based medicine
Mechanical ventilation
High-frequency ventilation
Children
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