Ventilación mecánica invasiva en pacientes con infección por coronavirus 2019
Invasive mechanical ventilation in patients with coronavirus infection 2019
Resumen
La enfermedad COVID-19, producida por el nuevo coronavirus (SARS-CoV2), ha causado una pandemia global, afectando en mayor proporción a las personas mayores de 60 años. En este grupo etario es más frecuente la presentación grave o severa que terminará por desarrollar el Síndrome de Distrés Respiratorio (ARDS) y será necesario el uso de ventilación mecánica invasiva (VMI). Antes de la pandemia, el soporte ventilatorio invasivo se basó en prevenir la lesión pulmonar inducida por el ventilador con el uso de volúmenes tidal bajos y evitar una presión meseta elevada, lo que se denomina estrategia ventilatoria protectora de pulmón (lung-protective ventilation strategy). A inicios de la pandemia, varios autores propusieron características particulares del ARDS por el nuevo coronavirus, y de la mano un nuevo abordaje o manejo ventilatorio. En esta revisión se planteó como objetivo resumir los aspectos actuales de las indicaciones, manejo ventilatorio y complicaciones durante la ventilación mecánica invasiva por COVID-19. Se utilizaron dos motores de búsqueda, PubMed y BVS y las bases de datos Medline y LILACS. Los criterios de inclusión aplicados fueron artículos primarios y secundarios que aborden las indicaciones, modos y parámetros ventilatorios, y complicaciones de la ventilación mecánica invasiva en pacientes adultos con COVID-19, de los últimos 5 años, texto completo y acceso gratuito, seleccionándose 23 artículos. La información recopilada, avaló el manejo clásico del ARDS, es decir, la estrategia ventilatoria protectora de pulmón, y en los casos refractarios de hipoxemia, está indicado el uso de posición prono durante al menos 16 horas por día.
ABSTRACT
The disease COVID-19, produced by the new coronavirus (SARS-CoV2), has caused a global pandemic, affecting a greater proportion of people over 60 years of age. In this age group, is more frequent severe presentation that will end up developing the Respiratory Distress Syndrome (ARDS) and the use of invasive mechanical ventilation (IMV) will be necessary. Before the pandemic, invasive ventilatory support was based on preventing ventilator-induced lung injury with the use of low tidal volumes and avoiding high plateau pressure, which is called lung-protective ventilation strategy. At the beginning of the pandemic, several authors proposed particular characteristics of ARDS due to the new coronavirus, and in hand a new approach or ventilatory management. In this review, we set out as an objective to highlight the current aspects of the indications, ventilatory management and complications during invasive mechanical ventilation for COVID-19. Two search engines, PubMed and BVS, and the Medline and LILACS databases were used. The inclusion criteria applied were primary and secondary articles that address the indications, modes and ventilatory parameters, and complications of invasive mechanical ventilation in adult patients with COVID-19, from the last 5 years, full text and free access, selecting 23 articles. The information collected supported the classic management of ARDS, that is, the lung-protective ventilatory strategy, and in refractory cases of hypoxemia, the use of the prone position is indicated for at least 16 hours per day.
DOI:
Palabras clave
Referencias
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