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Introducción: El síndrome de dificultad respiratoria aguda producido por la COVID-19 provoca alteraciones en el intercambio de oxígeno y la excreción de dióxido de carbono con consecuencias neurológicas. Objetivo: Describir las implicaciones del oxígeno y el dióxido de carbono sobre la dinámica cerebral durante el tratamiento ventilatorio del síndrome de dificultad respiratoria aguda en el accidente cerebrovascular. Métodos: Se realizó una búsqueda en bases referenciales como: PubMed/Medline, SciELO, Google Académico y BVS Cuba. Los términos incluidos fueron brain-lung crosstalk, ARDS, mechanical ventilation, COVID-19 related stroke, ARDS related stroke y su traducción al español. Fueron referenciados libros de neurointensivismo y ventilación mecánica artificial. El período de búsqueda incluyó los últimos 20 años. Se seleccionaron 46 bibliografías que cumplieron con los criterios de selección. Resultados: Se ha descrito que los niveles de oxígeno y dióxido de carbono participan en la neurorregulación vascular en pacientes con daño cerebral. Algunas alteraciones alusivas son la vasodilatación cerebral refleja o efectos vasoconstrictores con reducción de la presión de perfusión cerebral. Como consecuencia aumenta la presión intracraneal y aparecen afectaciones neurocognitivas, isquemia cerebral tardía o herniación del tronco encefálico. Conclusiones: El control de la oxigenación y la excreción de dióxido de carbono resultaron cruciales para mantener la homeostasis neuronal, evita la disminución de la presión de perfusión cerebral y el aumento de la presión intracraneal. Se sugiere evitar la hipoxemia e hiperoxemia, limitar o eludir la hipercapnia y usar hiperventilación hipocápnica solo en condiciones de herniación del tallo encefálico(AU)
Introduction: The acute respiratory distress syndrome produced by COVID-19 causes alterations in the exchange of oxygen and the excretion of carbon dioxide with neurological consequences. Objective: To describe the implications of oxygen and carbon dioxide on brain dynamics during ventilatory treatment of acute respiratory distress syndrome in stroke. Methods: A search was carried out in referential bases such as PubMed/Medline, SciELO, Google Scholar and VHL Cuba. The terms included were brain-lung crosstalk, ARDS, mechanical ventilation, COVID-19 related stroke, ARDS related stroke and their translation into Spanish. Books on neurointensive care and artificial mechanical ventilation were referenced. The search period included the last 20 years. Forty six bibliographies that met the selection criteria were selected. Results: Oxygen and carbon dioxide levels have been described to participate in vascular neuroregulation in patients with brain damage. Some allusive alterations are reflex cerebral vasodilatation or vasoconstrictor effects with reduced cerebral perfusion pressure. As a consequence, intracranial pressure increases and neurocognitive impairments, delayed cerebral ischemia or brainstem herniation appear. Conclusions: The control of oxygenation and the excretion of carbon dioxide were crucial to maintain neuronal homeostasis, avoiding the decrease in cerebral perfusion pressure and the increase in intracranial pressure. It is suggested to avoid hypoxemia and hyperoxemia, limit or avoid hypercapnia, and use hypocapnic hyperventilation only in conditions of brainstem herniation(AU)
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Humanos , Masculino , Feminino , Respiração Artificial/métodos , Síndrome do Desconforto Respiratório do Recém-Nascido/complicações , Hipertensão Intracraniana/diagnóstico , Acidente Vascular Cerebral/epidemiologia , COVID-19/epidemiologia , HipóxiaRESUMO
Introduction: The systemic viral disease caused by the SARS-CoV-2 called coronavirus disease 2019 (COVID-19) continues to be a public health problem worldwide. Objective: This study is aimed to evaluate the association and predictive value of indices of systemic inflammation with severity and non-survival of COVID-19 in Mexican patients. Materials and Methods: A retrospective study was carried out on 807 subjects with a confirmed diagnosis of COVID-19. Clinical characteristics, acute respiratory distress syndrome (ARDS), severity according to PaO2/FiO2 ratio, invasive mechanical ventilation (IMV), and non-survival outcome were considered to assess the predictive value and the association of 11 systemic inflammatory indices derived from hematological parameters analyzed at the hospital admission of patients. The receiver operating characteristics curve was applied to determine the thresholds for 11 biomarkers, and their prognostic values were assessed via the Kaplan-Meier method. Results: 26% of the studied subjects showed COVID-19 severe (PaO2/FiO2 ratio ≤ 100), 82.4% required IMV, and 39.2% were non-survival. The indices NHL, NLR, RDW, dNLR, and SIRI displayed predictive values for severe COVID-19 and non-survival. NHL, SIRI, and NLR showed predictive value for IMV. The cut-off values for RDW (OR = 1.85, p < 0.001), NHL (OR = 1.67, p = 0.004) and NLR (OR = 1.56, p = 0.012) were mainly associated with severe COVID-19. NHL (OR = 3.07, p < 0.001), AISI (OR = 2.64, p < 0.001) and SIRI (OR = 2.51, p < 0.001) were associated with IMV support, while for non-survival the main indices associated were NHL (OR = 2.65, p < 0.001), NLR (OR = 2.26, p < 0.001), dNLR (OR = 1.92, p < 0.001), SIRI (OR = 1.67, p = 0.002) and SII (OR = 1.50, p = 0.010). The patients with an RDW, PLR, NLR, dNLR, MLR, SII, and NHL above the cut-off had a survival probability of COVID-19 50% lower, with an estimated mean survival time of 40 days. Conclusion: The emergent systemic inflammation indices NHL, NLR, RDW, SII, and SIRI have a predictive power of severe COVID-19, IMV support, and low survival probability during hospitalization by COVID-19 in Mexican patients.
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The gasometric analysis offers a formal evaluation in the process of weaning for the mechanical ventilation (MV). Gasometry and clinical symptoms allow the identificaron of patients who are candidates for a spontaneous breathing test (SBT). The decrease in SvcO2 > 5.4% and the increase in APv-aCO2 > 40%, after 30 minutes of SBT, predict with very good precision failure to remove MV. The oxygenation indices (IsOx) show changes and also change at the end of the SBT and could predict extubation failure, but cut-off points need to be established in pulmonary and non-pulmonary problems.
El análisis gasométrico ofrece una evaluación formal en el proceso de weaning y para retiro de la ventilación mecánica (VM). La gasometría y la clínica permiten identificar a los pacientes candidatos a una prueba de respiración espontánea (PRE). La disminución de la SvcO2 > 5,4% y el incremento del APv-aCO2 > 40%, posterior a 30 minutos de PRE predicen con muy buena precisión fracaso en el retiro de la VM. Los índices de oxigenación (IsOx) presentan cambios también se modifican al final de la PRE y podría predecir fracaso en la extubación, pero se necesita establecer puntos de corte en problemas pulmonares y no pulmonares.
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Humanos , Oxigênio/análise , Testes de Função Respiratória , Desmame do Respirador/métodos , GasometriaRESUMO
BACKGROUND: According to the World Health Organization, Mexico presents one of the highest mortality rates due to coronavirus disease 2019 (COVID-19). The "cytokine storm" phenomenon has been proposed as a pathological hallmark of severe COVID-19. OBJECTIVE: To determine the association of serum cytokine levels with COVID-19 severity. METHODS: We studied the cytokines IL-2, IL-4, IL-6, IL-10, TNF-α, and the IFN-γ serum levels through flow cytometry in 56 COVID-19 patients (24 critical and 32 non-critical) from Northwest Mexico. RESULTS: We observed a significant increase in the IL-6 and the IL-10 levels in the sera of critical patients. These cytokines were also associated with mechanical ventilation necessity and death, IL-6 showing AUC values above 0.7 for both variables; and correlated with Na+, creatinine, and platelet levels. On the other hand, no association was found between IL-2, IL-4, TNF-α, and IFN-γ with tested variables. CONCLUSION: Our results corroborate previous observations regarding IL-6 and IL-10 involvement in the severity of COVID-19.
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COVID-19/sangue , COVID-19/fisiopatologia , Interleucina-10/metabolismo , Interleucina-6/metabolismo , COVID-19/patologia , Síndrome da Liberação de Citocina/sangue , Síndrome da Liberação de Citocina/patologia , Feminino , Humanos , Interleucina-10/sangue , Interleucina-6/sangue , Masculino , México , Gravidade do PacienteRESUMO
INTRODUCTION: The lack of mechanical ventilators for patients with COVID-19 has necessitated the use of other noninvasive ventilation (NIV) systems. One of these NIV systems is the use of an adapted snorkel mask with inspiration valves and pressure valve (PEEP). CASE AND OUTCOMES: A 48-year-old man with no previous history of lung disease was admitted to the emergency room with a diagnosis of acute respiratory failure due to SARS-COV2. The patient did not improve saturation with the use of the reservoir mask. Oxygenation was started using an adapted snorkel mask with a PEEP valve with an alveolar recruitment function and double oxygen flow. The patient presented clinical and radiological improvement after 2 days of use and was discharged 16 days later. DISCUSSION: The use of a snorkel mask is an important, viable, and simpler NIV modality for the management of patients with COVID-19 with respiratory failure who fail to use a reservoir mask, and it can be an alternative before the use of a mechanical ventilator. CONCLUSION: The use of the adapted snorkel mask with Charlotte valve and PEEP is a feasible alternative for the treatment of patients with COVID-19.
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INTRODUCTION: Until now, the ventilatory strategy with BiPAP S/T plus average volume-assured pressure support (AVAPS) has not been evaluated for its use in the different types of acute respiratory failure (ARF). Consequently we report the results of the use of this ventilatory strategy in these clinical scenarios. MATERIAL AND METHODS: This is a single-centre prospective study. The subjects were categorised according to the type of ARF: (1) hypercapnic ARF: chronic obstructive pulmonary disease and bronchial asthma; and (2) hypoxaemic ARF: pneumonia, acute respiratory distress syndrome, congestive heart failure, and interstitial lung disease. Multiple logistic regression was used to determine predictors of non-invasive mechanical ventilation (NIV) failure (intubation). Further, in a subgroup of patients with de novo hypoxaemic ARF, analysis of variances with repeated measures was used to determine factors associated with NIV outcome. RESULTS: Sixty-eight subjects were included in this study. The NIV success rate was 69.1% and the mortality rate was 20.6%. A multivariate analysis showed that the number of affected lung quadrants on chest X-ray (OR: 4.23, 95% CI: 4.17-4.31; P < 0.001) and ARF precipitating disease (OR: 4.46, 95% CI: 4.43-4.51; P < 0.001) were determinants of NIV failure. In the hypoxaemic ARF subgroup (n = 58), significant differences in several parameters were found between patients with positive and negative outcomes. CONCLUSIONS: The use of BiPAP S/T - AVAPS in subjects with hypercapnic ARF is associated with a better outcome than in those with de novo hypoxaemic ARF.
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Ventilação não Invasiva , Síndrome do Desconforto Respiratório , Insuficiência Respiratória , Pressão Positiva Contínua nas Vias Aéreas , Humanos , Ventilação não Invasiva/métodos , Estudos Prospectivos , Respiração Artificial/métodos , Síndrome do Desconforto Respiratório/etiologia , Síndrome do Desconforto Respiratório/terapia , Insuficiência Respiratória/etiologia , Insuficiência Respiratória/terapiaRESUMO
RESUMEN: Los pulmones son el sitio predominante en la infección por COVID-19. Esta puede conducir al síndrome distrés respiratorio agudo (SDRA). Frente a su sintomatología severa, la ventilación mecánica (VM), y sus valores de mecánica ventilatoria aparecen como una herramienta fundamental. Un complemento, para analizar el estado de avance de esta patología es la radiografía de tórax (RT), aunque en ocasiones esta depende de la experiencia del equipo de salud. Así el objetivo de esta investigación fue explorar la relación de las medidas de mecánica ventilatoria y radiográficas con el tiempo de conexión a VM en pacientes COVID-19. Estudio retrospectivo, que incluyó a 23 pacientes en VM. Se recolectó información de variables de mecánica ventilatoria; PEEP, presión plateau, presión de distensión y compliance estática. Desde la RT se midió, altura y ancho pulmonar, ángulo costodiafragmático y espacio intercostal. Los resultados indicaron que las variables de mecánica ventilatoria tales como el PEEP y el plateau se relacionaron significativamente con el tiempo de conexión a VM (r=0,449; p=0,035 y r=0,472; p=0,026), mientras que las variables radiográficas construidas en base al ángulo costodiafragmático y el espacio intercostal presentaron similares comportamientos (r= 0,462; p=0,046 y r=-0,543; p=0,009). En conclusión, la presión resultante de la programación del ventilador mecánico junto a cambios estructurales observados en la RT, se relacionan con el tiempo de conexión a VM.
SUMMARY: The lungs are the predominant site of COVID-19 infection. This can lead to severe acute respiratory síndrome (ARDS). In view of its severe symptoms, mechanical ventilation (MV) and its ventilatory mechanics values appear as a fundamental tool. Chest radiography (CR) is a complement to analyze the state of progress of this pathology, although this sometimes depends on the experience of the health team. Thus, the aim of this research was to explore the relationship of ventilatory mechanics and radiographic measures with connection time to MV in COVID-19 patients. Retrospective study, which included 23 patients on MV. Information on ventilatory mechanics variables was collected; PEEP, plateau pressure, distension pressure and static compliance. And from CR, lung height and width, costodiaphragmatic angle and intercostal space were measured. The results indicated that ventilatory mechanics variables such as PEEP and plateau were significantly related to connection time to MV (r = 0.449; p = 0.035 and r = 0.472; p = 0.026), while the radiographic variables Constructed on the basis of the costodiaphragmatic angle and the intercostal space, they showed similar behaviors (r = 0.462; p = 0.046 and r = -0.543; p = 0.009). In conclusion, the pressure resulting from mechanical ventilator programming, together with the structural changes observed in CR, are related to the connection time to MV.
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Humanos , Masculino , Feminino , Pessoa de Meia-Idade , Pneumonia Viral/patologia , Pneumonia Viral/diagnóstico por imagem , Respiração Artificial , Radiografia Torácica , Infecções por Coronavirus/patologia , Infecções por Coronavirus/diagnóstico por imagem , Pressão , Fatores de Tempo , Estudos Retrospectivos , Respiração com Pressão PositivaRESUMO
Introducción: La desnutrición en pacientes ingresados en una sala de terapia intensiva es elevada, pero en el anciano crítico es aún mayor, con repercusión sobre el aparato respiratorio, prolongación de la ventilación y otras complicaciones. Objetivo: Caracterizar el estado nutricional en pacientes geriátricos con ventilación mecánica en una unidad de cuidados intensivos. Métodos: Se realizó un estudio descriptivo, prospectivo y de corte transversal durante el periodo de enero de 2017 a marzo de 2019 en la unidad de cuidados intensivos del Hospital General Docente "Orlando Pantoja Tamayo". Se estudiaron 83 pacientes con edades mayor o igual a 60 años, los cuales requirieron del uso de ventilación mecánica más de 24 h. El estado nutricional fue evaluado con el empleo del índice de control nutricional. Resultados: Predominó el sexo masculino, el grupo de edades de 60 a 74 años, y las enfermedades tipo quirúrgicas. Solo 9,1 % de los que recibieron ventilación mecánica invasiva no estaban desnutrido. Los que fallecieron tenían desnutrición moderada o severa. Conclusiones: En los pacientes geriátricos ventilados, ingresados en la unidad de cuidados intensivos, se encontró un alto grado de malnutrición. La desnutrición moderada o severa predominó en la mayoría de los que recibieron ventilación mecánica invasiva y en el grupo de fallecidos(AU)
Introduction: Malnutrition in patients hospitalized in an intensive care room is high, but it is even higher in the critically-ill elderly patient, with repercussions on the respiratory system, prolonged ventilation, and other complications. Objective: To characterize the nutritional status of geriatric patients under mechanical ventilation in an intensive care unit. Methods: A descriptive, prospective and cross-sectional study was carried out during the period from January 2017 to March 2019, in the intensive care unit of Orlando Pantoja Tamayo General Teaching Hospital. 83 patients aged 60 or older were studied; they required mechanical ventilation for more than 24 hours. The nutritional status was evaluated with the use of the nutritional control score. Results: There was a predominance of the male sex, the age group 60-74 years, and of surgical diseases. Only 9.1% of those who received invasive mechanical ventilation were not undernourished. Those who died had moderate or severe undernutrition. Conclusions: In ventilated geriatric patients hospitalized in the intensive care unit, a high degree of malnutrition was found. Moderate or severe malnutrition predominated in the majority of those who received invasive mechanical ventilation and in the group of the deceased(AU)
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Humanos , Idoso , Idoso de 80 Anos ou mais , Respiração Artificial/efeitos adversos , Desnutrição/complicações , Desnutrição/epidemiologia , Inquéritos Nutricionais/normas , Epidemiologia Descritiva , Estudos Transversais , Estudos Prospectivos , Resultados de Cuidados Críticos , Unidades de Terapia Intensiva/estatística & dados numéricosRESUMO
Se realizó una investigación descriptiva, de serie de casos, de 31 pacientes ingresados en la Unidad de Cuidados Intensivos del Hospital Provincial Docente Clinicoquirúrgico Saturnino Lora Torres de Santiago de Cuba, de enero de 2014 a igual mes de 2017, quienes presentaron el síndrome de insuficiencia respiratoria aguda, con vistas a describir los factores pronóstico de mortalidad por esta causa. En la serie predominaron el sexo masculino, la edad promedio de 57 años y la hipertensión arterial como enfermedad crónica asociada. La mayoría de los pacientes recibía ventilación mecánica previa al diagnóstico, en la modalidad controlada por volumen, y en un menor número se aplicaron maniobras de incorporación alveolar. La insuficiencia respiratoria moderada de causa extrapulmonar figuró en pacientes con ventilación prolongada, en tanto la complicación más frecuente fue la disfunción multiorgánica, que además resultó la principal causa de muerte. Finalmente, no se encontró relación directa entre la presencia de estos factores pronóstico de mortalidad y la probabilidad de fallecer.
A descriptive investigation, of cases series, in 31 patients admitted in the Intensive Care Unit of Saturnino Lora Torres Teaching Clinical-Surgical Provincial Hospital in Santiago de Cuba, was carried out from January, 2014 to same month in 2017, who presented acute respiratory failure, with the aim of describing the mortality prognosis factors for this cause. In the series the male sex, the average age 57 year-old and hypertension prevailed as associated chronic diseases. Most of the patients received mechanic ventilation previous to the diagnosis, in the modality controlled through volume, and in a lower number maneuvers of alveolar incorporation were applied. The moderate respiratory failure of extrapulmonar cause was present in patients with prolonged ventilation, as long as the most frequent complication was the multiple organs dysfunction which was also the main cause of death. Finally, there was no direct relationship between the presence of these mortality factors prognosis and the probability of dying.
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Humanos , Masculino , Feminino , Adulto , Pessoa de Meia-Idade , Idoso , Idoso de 80 Anos ou mais , Adulto Jovem , Prognóstico , Respiração Artificial , Insuficiência Respiratória/etiologia , Cuidados Críticos/métodos , Insuficiência Respiratória/complicações , Insuficiência Respiratória/mortalidadeRESUMO
Introducción: Los traumatismos torácicos son causa importante de morbi-mortalidad. El volet costal con contusión pulmonar ensombrece el pronóstico. Objetivo: Presentar una estrategia ventilatoria para estabilizar la pared torácica, corregir la hipoxemia y proteger el parénquima pulmonar. Caso clínico: Paciente con volet costal, neumotórax bilateral y contusión pulmonar que produjo un distress respiratorio, requirió ventilación mecánica. Ante la necesidad de estabilizar la pared tóracica y reclutar el parénquima pulmonar se ventiló con liberación de presiones en la vía aérea. Requirió toracotomía para solucionar definitivamente la lesión pulmonar y se realizó toracoplastia. El paciente egresó sin secuelas luego de 21 días de hospitalización. Conclusiones: La ventilación con liberación de presiones en la vía aérea se propone como una estrategia que facilita la estabilidad de la pared torácica, el reclutamiento alveolar, teóricamente ofrece ventajas en protección pulmonar y en la respuesta inflamatoria sistémica. En este caso particular se lograron los objetivos esperados con el empleo de esta modalidad como puente para la cirugía correctiva(AU)
Introduction: Thoracic trauma is an important cause of morbidity and mortality. The costal volet with pulmonary contusion overshadows the prognosis Objective: To present a ventilatory strategy to stabilize the chest wall, correct hypoxemia and protect the lung parenchyma. Clinical case: A patient with costal volet, bilateral pneumothorax and pulmonary contusion that produced a respiratory distress; required mechanical ventilation. Given the need to stabilize the thoracic wall and recruit the lung parenchyma, it was ventilated with release of airway pressures. A thoracotomy was required to definitively resolve the lung lesion and thoracoplasty was performed. The patient withdrew without sequelae after 21 days of hospitalization. Conclusions: The APRV is proposed as a strategy that facilitates the stability of the thoracic wall, the alveolar recruitment, theoretically offers advantages in pulmonary protection and in the systemic inflammatory response. In this particular case the expected objectives were achieved with the use of this modality as a bridge for corrective surgery(AU)
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Humanos , Masculino , Pessoa de Meia-Idade , Ferimentos e Lesões , Pressão Positiva Contínua nas Vias Aéreas/métodos , Traumatismos Torácicos/terapiaRESUMO
Introducción: el síndrome de dificultad respiratorio agudo (SDRA) es la manifestación más grave de compromiso pulmonar agudo. Actualmente no hay datos disponibles para documentar los factores asociados con la mortalidad en nuestro medio. Diseño del estudio: estudio de cohorte retrospectiva. Objetivo: describir los factores asociados a la mortalidad en pacientes adultos hospitalizados en la unidad de cuidado crítico con SDRA entre enero 2007 y diciembre de 2011. Métodos: se recolectaron datos con respecto a causas de SDRA, estancia hospitalaria y en la UCI, gravedad de la enfermedad crítica y el estado vital al egreso. Se realizó un análisis de regresión logística para determinar los factores asociados de manera independiente con la mortalidad hospitalaria. Resultados: se analizaron 141 pacientes con SDRA, la mediana de edad fue 44 años y 62.9% fueron hombres. La primera causa de SDRA fue el choque séptico de origen pulmonar en 49.6% y el APACHE II tuvo una mediana de 18. La mediana de la PaO2/FIO2 al inicio del SDRA fue 91.5 y a las 72 horas fue 125. La mediana de PEEP requerido al inicio de la ventilación mecánica fue de 10 cmH2O y a las 72 horas fue de 12. La estancia en la UCI fue de 13 días y la mortalidad hospitalaria fue del 54%. Los factores asociados con mortalidad fueron el choque de origen pulmonar (OR = 2.45; IC 95% = 1.04-5.77) y el puntaje APACHE II (OR = 1.05 por cada punto; IC 95% = 1.003-1.1). El nivel de PEEP igual o menor en las primeras 72 horas se comportó como un factor protector (OR = 0.36; IC 95% = 0.16-0.82). Conclusiones: el SDRA tiene una alta mortalidad en nuestro medio y los factores más fuertemente asociados con dicha mortalidad son dependientes de la enfermedad de base y de la intensidad de la respuesta biológica a la misma. (Acta Med Colomb 2015; 40 305-309).
Introduction: acute respiratory distress syndrome (ARDS) is the most serious manifestation of acute pulmonary compromise. Currently no data are available to document the factors associated with mortality in our environment. Study Design: retrospective cohort study. Objective: To describe the factors associated with mortality in adult patients hospitalized in critical care unit with ARDS from January 2007 to December 2011. Methods: Data were collected with regard to causes of ARDS, hospital and ICU stay, critical illness severity and vital status at discharge. Logistic regression analysis was performed to determine factors independently associated with hospital mortality. Results: 141 patients with ARDS were analyzed; the median age was 44 years and 62.9% were men. The first cause of ARDS was septic shock of pulmonary origin in 49.6% and APACHE II had a median of 18. The median PaO2/FIO2 at the beginning of ARDS was 91.5 and at 72 hours was 125. The median PEEP required at the initiation of mechanical ventilation was 10 cmH2O and at 72 hours 12. The ICU stay was 13 days and hospital mortality was 54%. Factors associated with mortality were the shock of pulmonary origin (OR = 2.45; 95% CI = 1.04-5.77) and APACHE II (OR = 1.05 per point, 95% CI = 1.003-1.1). PEEP level equal to or less within 72 hours acted as a protective factor (OR = 0.36; 95% CI = 0.16-0.82). Conclusions: ARDS has a high mortality in our environment and the factors most strongly associated with this mortality are dependent on the underlying disease and the intensity of biological response to it. (Acta Med Colomb 2015; 40 305-309).
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Humanos , Masculino , Feminino , Adulto , Síndrome do Desconforto Respiratório do Recém-Nascido , Respiração Artificial , Mecânica Respiratória , Mortalidade , Lesão Pulmonar Aguda , HipóxiaRESUMO
La ventilación mecánica es un método de soporte de la vida de personas en estado crítico. Tradicionalmente se ha empleado en pacientes bajo el efecto de sedación continua lo que significa para ellos una total abstracción de su situación actual. Tal práctica depara un traumático despertar, ampliamente informado en la literatura, tanto por los efectos adversos de los medicamentos sedantes, como por las implicaciones sicológicas de haber sido objeto y no sujeto de cuidado. Este trabajo, por el contrario, está enfocado en pacientes con ventilación mecánica, sin sedación. Objetivo: describir las diferentes formas de comunicación empleadas por pacientes cuya experiencia en una Unidad de Cuidado Intensivo ha sido la ventilación mecánica sin efectos de sedación continúa. Metodología: se realizó una investigación con enfoque fenomenológico, durante el 2006, que contó con la participación de siete hombres y dos mujeres con edades entre 24 y 75 años de edad. La técnica de recolección de la información fue la entrevista en profundidad. Resultados: la descripción de cada experiencia permitió entender cómo el ser humano, estando críticamente enfermo, con una vía aérea artificial como medio de vida, activa un importante número de formas para hacerse entender. Conclusión: se demostró la importancia que tiene para el paciente ser tratado como sujeto activo en su experiencia de comunicación con el personal de salud y sus familiares, dado que fue significativa la multiplicidad de herramientas no verbales empleadas que contribuyeron a una percepción positiva de la experiencia.
The mechanical ventilation mechanism is a support method used to safeguard the life of people in a cri¬tical state. Traditionally, it has been used in patients under the effects of continuous sedation, which implies a total abstraction of their current situation for the patients; such scenarios afford the patients a traumatic one to wake up, broadly informed in the literature, for the adverse effects of the sedative me¬dications, like the psychological implications that it can cause independent of quality of care. Objective: to describe the different communication forms used for patients whose experience in an intensive critical care unit has involved the mechanical ventilation without continues sedation effects. Methodology: the investigation was carried out with phenomenological focus during 2006 and had the participation of seven men and two women with ages between 24 and 75 years of age. The technique of information gathering was the in-depth interview. Results: The description of each experience allowed understanding of the human being critically sick with an artificial air way as living medium, requesting active ways to be made unders¬tood. Conclusion: it demonstrated the importance for the patient to be treated as an active subject by means of the communication with the health personnel and relatives. Many non verbal tools were employed and their contribution brought upon a positive perception of the experience.