RESUMO
Non-invasive ventilation (NIV) is nowadays increasingly used. The significant decrease in tracheal intubation related complications makes it particularly attractive in patients with moderately acute respiratory failure (ARF) who still have some degree of respiratory autonomy. It has also been used to support patients with chronic respiratory failure. However, final outcomes are variable according to the conditions which determined its application. This Consensus was performed in order to review the evidence supporting the use of positive pressure NIV. The patho-physiological background of NIV and the equipment required technology are described. Available evidence clearly suggests benefits of NIV in acute exacerbation of chronic obstructive pulmonary disease (COPD) and in cardiogenic pulmonary edema (Recommendation A). When considering ARF in the setting of acute respiratory distress syndrome results are uncertain, unless dealing with immunosupressed patients (Recommendation B). Positive results are also shown in weaning of mechanical ventilation (MV), particularly regarding acute exacerbation of COPD patients (Recommendation A). An improved quality of life in chronic respiratory failure and a longer survival in restrictive disorders has also been shown (Recommendation B) while its benefit in stable COPD patients is still controversial (Recommendation C). NIV should be performed according to pre-established standards. A revision of NIV related complications is performed and the cost-benefit comparison with invasive MV is also considered.
La ventilación no invasiva (VNI) ha alcanzado notable difusión en los últimos años. El ahorro delas complicaciones causadas por la intubación traqueal la hace especialmente atractiva en pacientesque presentan insuficiencia respiratoria aguda (IRA) no muy grave y que conservan cierta autonomía respiratoria.También se han descripto efectos terapéuticos en pacientes con insuficiencia respiratoria crónica de etiologías diversas. No obstante, los resultados obtenidos son variables según las circunstancias que motivan su aplicación. A fin de revisar la evidencia a favor de su uso se elaboró este Consenso referido particularmente a la VNI a presión positiva. Se describen su fundamento fisiopatológico, esencial para su correcta aplicación, y elequipamiento necesario para implementarla. La evidencia existente en la literatura establece definida utilidad de la VNI en la exacerbación de la EPOC y en el edema agudo de pulmón cardiogénico (Recomendación A).Su beneficio es aún incierto en pacientes con IRA secundaria a síndrome de dificultad respiratoria aguda, salvoen el subgrupo de pacientes inmunosuprimidos (Recomendación B). Los resultados son también favorablesen la desvinculación de la asistencia respiratoria mecánica (ARM), especialmente en pacientes ventilados por exacerbación de EPOC (Recomendación A). En la insuficiencia respiratoria crónica se ha hallado mejoría en la calidad de vida y mayor sobrevida en pacientes con enfermedades restrictivas (Recomendación B), mientrasque existe aún controversia sobre su utilidad en pacientes con EPOC estable (Recomendación C). La VNI debeser aplicada con estándares de cuidados que son establecidos. Se revisan las eventuales complicaciones derivadasde su uso y el beneficio costo-efectividad ahorrando recursos de mayor complejidad y disminuyendolos riesgos que implica la ARM invasiva.
Assuntos
Humanos , Insuficiência Respiratória/terapia , Respiração Artificial/métodos , Ventiladores Mecânicos , Doença Aguda , Argentina , Doença Crônica , Análise Custo-Benefício , Desmame do Respirador/normas , Doença Pulmonar Obstrutiva Crônica/terapia , Insuficiência Respiratória/fisiopatologia , Respiração Artificial/efeitos adversos , Respiração Artificial/normas , Ventiladores Mecânicos/normasRESUMO
Non-invasive ventilation (NIV) is nowadays increasingly used. The significant decrease in tracheal intubation related complications makes it particularly attractive in patients with moderately acute respiratory failure (ARF) who still have some degree of respiratory autonomy. It has also been used to support patients with chronic respiratory failure. However, final outcomes are variable according to the conditions which determined its application. This Consensus was performed in order to review the evidence supporting the use of positive pressure NIV. The patho-physiological background of NIV and the equipment required technology are described. Available evidence clearly suggests benefits of NIV in acute exacerbation of chronic obstructive pulmonary disease (COPD) and in cardiogenic pulmonary edema (Recommendation A). When considering ARF in the setting of acute respiratory distress syndrome results are uncertain, unless dealing with immunosupressed patients (Recommendation B). Positive results are also shown in weaning of mechanical ventilation (MV), particularly regarding acute exacerbation of COPD patients (Recommendation A). An improved quality of life in chronic respiratory failure and a longer survival in restrictive disorders has also been shown (Recommendation B) while its benefit in stable COPD patients is still controversial (Recommendation C). NIV should be performed according to pre-established standards. A revision of NIV related complications is performed and the cost-benefit comparison with invasive MV is also considered.(AU)
La ventilación no invasiva (VNI) ha alcanzado notable difusión en los últimos años. El ahorro delas complicaciones causadas por la intubación traqueal la hace especialmente atractiva en pacientesque presentan insuficiencia respiratoria aguda (IRA) no muy grave y que conservan cierta autonomía respiratoria.También se han descripto efectos terapéuticos en pacientes con insuficiencia respiratoria crónica de etiologías diversas. No obstante, los resultados obtenidos son variables según las circunstancias que motivan su aplicación. A fin de revisar la evidencia a favor de su uso se elaboró este Consenso referido particularmente a la VNI a presión positiva. Se describen su fundamento fisiopatológico, esencial para su correcta aplicación, y elequipamiento necesario para implementarla. La evidencia existente en la literatura establece definida utilidad de la VNI en la exacerbación de la EPOC y en el edema agudo de pulmón cardiogénico (Recomendación A).Su beneficio es aún incierto en pacientes con IRA secundaria a síndrome de dificultad respiratoria aguda, salvoen el subgrupo de pacientes inmunosuprimidos (Recomendación B). Los resultados son también favorablesen la desvinculación de la asistencia respiratoria mecánica (ARM), especialmente en pacientes ventilados por exacerbación de EPOC (Recomendación A). En la insuficiencia respiratoria crónica se ha hallado mejoría en la calidad de vida y mayor sobrevida en pacientes con enfermedades restrictivas (Recomendación B), mientrasque existe aún controversia sobre su utilidad en pacientes con EPOC estable (Recomendación C). La VNI debeser aplicada con estándares de cuidados que son establecidos. Se revisan las eventuales complicaciones derivadasde su uso y el beneficio costo-efectividad ahorrando recursos de mayor complejidad y disminuyendolos riesgos que implica la ARM invasiva.(AU)
Assuntos
Humanos , Respiração Artificial/métodos , Insuficiência Respiratória/terapia , Ventiladores Mecânicos , Doença Aguda , Argentina , Doença Crônica , Análise Custo-Benefício , Doença Pulmonar Obstrutiva Crônica/terapia , Respiração Artificial/efeitos adversos , Respiração Artificial/normas , Insuficiência Respiratória/fisiopatologia , Desmame do Respirador/normas , Ventiladores Mecânicos/normasRESUMO
Severe involvement of the respiratory muscles is seen in 25% of patients with a diagnosis of Guillain Barré syndrome. In order to evaluate the clinical characteristics and evolution of this disorder we reviewed the clinical records of patients admitted with this diagnosis to our Hospital between January 1987 and December 1996. We identified 44 patients with respiratory failure. The age was 34.0 +/- 14.1 years, 31 patients were male and 13 female; 70.5% required mechanical ventilation (MV). The time elapsed between the beginning of symptoms and MV was 9.4 +/- 8.0 days. Total duration of MV was 1,224 +/- 1,208 hours. Patients who required ventilatory support during the first 48 hours of evolution had a significantly longer duration of MV compared to the rest of the group (2,100 +/- 2,076 vs 934 +/- 735 hours, p < 0.05). Two of the survivors needed ventilatory support for more than 6 months. All patients showed quadriparesia, 55% had cranial nerve involvement and 43% had autonomic dysregulation. Twenty-four percent had a positive serologic titer for cytomegalovirus infection. The vital capacity measured before the beginning of MV was 1,050 +/- 378 ml and at discharge 2,837 +/- 1,080 ml. Mortality was 18%, with a higher mean age among those who died (44.9 +/- 17.5 years vs 31.9 +/- 12.5, p < 0.02). Mortality was also related to sepsis, barotrauma and severe autonomic dysfunction. In our group, we identified male preponderance, a high percentage of MV with an extended duration, and a longer MV time in the group of patients with a faster evolution.
Assuntos
Síndrome de Guillain-Barré/complicações , Insuficiência Respiratória/etiologia , Adolescente , Adulto , Idoso , Feminino , Seguimentos , Humanos , Masculino , Pessoa de Meia-Idade , Respiração ArtificialRESUMO
Severe involvement of the respiratory muscles is seen in 25
of patients with a diagnosis of Guillain Barré syndrome. In order to evaluate the clinical characteristics and evolution of this disorder we reviewed the clinical records of patients admitted with this diagnosis to our Hospital between January 1987 and December 1996. We identified 44 patients with respiratory failure. The age was 34.0 +/- 14.1 years, 31 patients were male and 13 female; 70.5
required mechanical ventilation (MV). The time elapsed between the beginning of symptoms and MV was 9.4 +/- 8.0 days. Total duration of MV was 1,224 +/- 1,208 hours. Patients who required ventilatory support during the first 48 hours of evolution had a significantly longer duration of MV compared to the rest of the group (2,100 +/- 2,076 vs 934 +/- 735 hours, p < 0.05). Two of the survivors needed ventilatory support for more than 6 months. All patients showed quadriparesia, 55
had cranial nerve involvement and 43
had autonomic dysregulation. Twenty-four percent had a positive serologic titer for cytomegalovirus infection. The vital capacity measured before the beginning of MV was 1,050 +/- 378 ml and at discharge 2,837 +/- 1,080 ml. Mortality was 18
, with a higher mean age among those who died (44.9 +/- 17.5 years vs 31.9 +/- 12.5, p < 0.02). Mortality was also related to sepsis, barotrauma and severe autonomic dysfunction. In our group, we identified male preponderance, a high percentage of MV with an extended duration, and a longer MV time in the group of patients with a faster evolution.