Factores Predictores de Fracaso de Ventilación Mecánica No Invasiva Fuera de la UTI

Tradicionalmente el empleo de la ventilación mecánica no invasiva (VMNI) ha estado en la unidad de cuidados intensivos (UCI). La escasez de recursos y la disponibilidad de camas en la UCI, junto con la posibilidad del empleo de la VMNI temprana hacen necesaria la determinación de los factores predictivos de éxito o fracaso de la misma fuera de la UCI, que permitan optimizar la técnica. El objetivo de nuestro estudio fue determinar cuáles son los factores predictivos de fracaso de la VMNI fuera de la UCI. En estos 7 años de estudio un total de 249 episodios de la VMNI y 204 pacientes fueron considerados. La edad promedio fue de 70,6 ± 15,5 (IC 68,4-72,8); Un total de 55 (22,10%); fueron trasladados a la UTI; mientras que 194 (77,9%) continuó con la VMNI fuera de la UCI. La VMNI se puede utilizar fuera de la UCI; con escasez de monitoreo; niveles de IPAP, número de cuadrantes afectados en la Rx tórax; PAS, FC y PO2 se pueden utilizar como predictores en el uso de esta tecnología fuera de la UCI

Volume-assured pressure support mode plus pirfenidone as resuscitation therapy in patients with exacerbation of idiopathic pulmonary fibrosis

Introduction: Treatment among advanced stage idiopathic pulmonary fibrosis is quite challenging, especially considering that no major evidence has been released about it. This case report demonstrates and discusses the benefit of non-invasive mechanical ventilation in volume-assured pressure support (AVAPS) mode plus pirfenidone based on the relief of a patient’s symptoms in combination with high-resolution computed tomography (HRCT) evidence.Material and methods: An 83-year-old female patient with multiple hospital admissions within a  six-month period initially presented with cardiac symptoms which were later attributed to a possible exacerbation of her primary diagnosis, idiopathic pulmonary fibrosis.Conclusion: The addition of non-invasive mechanical ventilation in AVAPS mode plus pirfenidone can improve the survival rates even in patients with current exacerbations of acute respiratory failure due to idiopathic pulmonary fibrosis

Use of noninvasive mechanical ventilation with pressure support guaranteed with average volume in de novo hypoxaemic respiratory failure. A pilot study

Background: This study was designed to determine the results associated with the use of noninvasive mechanical ventilation (NIV) using the BiPAP S/T-AVAPS ventilation strategy in subjects with mild to moderate de novo hypoxaemic respiratory failure. Methods: This is a prospective study that includes subjects with de novo hypoxaemic respiratory failure (not produced by acute exacerbations of COPD, chronic lung disease, or congestive heart failure) with mild to moderate PaO2/FiO2, who were admitted to the Intensive Care Unit (ICU) of Santa Maria Clinic in Guayaquil, Ecuador. Subjects were divided into two groups and compared according to their PaO2/FiO2: higher than 100 and up to 200 mm Hg (moderate ARDS) or between 200 and 300 mm Hg (mild ARDS) (both groups were ventilated with the BiPAP S/T-AVAPS strategy). A value of P < 0.05 was considered significant. Results: A total of 38 subjects were analysed in this study. The total rate of intubation was 34.2% while the mortality rate was 28.9%. Significant differences were observed when comparing success versus failure in exhaled tidal volumes (P = 0.04), peak inspired pressure (P < 0.001), PaO2 (P < 0.001), SaO2 (P < 0.002), PaO2/FiO2 (P < 0.002), RR (P < 0.001), HR (P < 0.001), and inspiratory time (P = 0.029) measured at baseline and at 12-hour, 24-hour and 48-hour intervals. Conclusion: The BiPAP S/T-AVAPS ventilatory mode can be used in subjects with de novo hypoxaemic respiratory failure with special vigilance concerning exhaled tidal volumes and inspired pressure.Background: This study was designed to determine the results associated with the use of noninvasive mechanicalventilation (NIV) using the BiPAP S/T-AVAPS ventilation strategy in subjects with mild to moderate de novo hypoxaemicrespiratory failure. Methods: This is a prospective study that includes subjects with de novo hypoxaemic respiratory failure (not producedby acute exacerbations of COPD, chronic lung disease, or congestive heart failure) with mild to moderate PaO2/FiO2,who were admitted to the Intensive Care Unit (ICU) of Santa Maria Clinic in Guayaquil, Ecuador.Subjects were divided into two groups and compared according to their PaO2/FiO2: higher than 100 and up to 200mm Hg (moderate ARDS) or between 200 and 300 mm Hg (mild ARDS) (both groups were ventilated with the BiPAPS/T-AVAPS strategy). Results: A total of 38 subjects were analysed in this study. The total rate of intubation was 34.2% while the mortalityrate was 28.9%. Significant differences were observed when comparing success versus failure in exhaled tidalvolumes heart rate (P = 0.04), peak inspired pressure (P &lt; 0.001), PaO2 (P &lt; 0.001), SaO2 (P &lt; 0.002), PaO2/FiO2 (P &lt;0.002), arterial blood pressure (P &lt; 0.001), HR (P &lt; 0.001), and inspiratory time (P = 0.029) measured at baseline andat 12-hour, 24-hour and 48-hour intervals. Conclusion: The BiPAP S/T-AVAPS ventilatory mode can be used in subjects with de novo hypoxaemic respiratoryfailure with special vigilance concerning exhaled tidal volumes and inspired pressure