Hipoxemia refractaria: enfoque y tratamiento

Luis Fernando Guerrero Gonzalez

Resumen


La hipoxemia refractaria se ha convertido en una entidad compleja, con repercusiones clínicas y elevada mortalidad, a pesar de su infrecuente presentación. La presente revisión y actualización refleja una mirada a los diferentes enfoques de tratamiento y pronóstico de esta entidad, que causa dificultades a los equipos de cuidado intensivo en el mundo.

Palabras clave


Hipoxemia refractaria, bloqueo neuromuscular, maniobras de reclutamiento,membrana de oxigenación extracorpórea.

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Referencias


Esan A, Hess DR, Raoof S, George L, Sessler CN. Severe hypoxemic respiratory failure: Part 1 - Ventilatory strategies. Chest. 2010;137(5):1203–16.

Villar J, Kacmarek RM. Rescue strategies for refractory hypoxemia: a critical appraisal. 2009;1(November):2–5.

Raoof S, Goulet K, Esan A, Hess DR SC. Severe hypoxemic respiratory failure: Part 1 - Ventilatory strategies. Chest. 2010;137(5):1203–16.

Meade MO, Cook DJ, Guyatt GH, Slutsky AS, Arabi YM, Cooper DJ, et al. Ventilation strategy using low tidal volumes, recruitment maneuvers, and high positive end-expiratory pressure for acute lung injury and acute respiratory distress syndrome: a randomized controlled trial. Jama 2008;299(6):637–45.

Montgomery AB, Stager MA, Carrico CJ HL. Causes of mortality in patients with the adult respiratory distress syndrome. Am Rev Respir Dis. 1985;132(3):485–9.

Estenssoro E, Dubin A, Laffaire E, Canales H, Sáenz G, Moseinco M, et al. Incidence, clinical course, and outcome in 217 patients with acute respiratory distress syndrome. Crit Care Med 2002;30(11):2450–6.

Rubenfeld GD HM. Epidemiology and outcomes of acute lung injury. Chest. 131(2):554–62.

Hager DN. Recent Advances in the Management of the Acute Respiratory Distress Syndrome. Clin Chest Med 2015;36(3):481–96.

L I, M. Incidencia y factores de riesgo asociados con mortalidad y morbilidad por síndrome de dificultad respiratoria aguda (SDRA) en una unidad de cuidados intensivos pediátricos en Bogotá, Colombia. Acta Colomb Cuid Intensivo. 2012;12 (3):143–53.

Calderon J, Carvajal C, Giraldo N, Pacheco C. Mortalidad y factores asociados en pacientes con síndrome de dificultad respiratoria agudo ( SDRA ) en un hospital universitario. Acta Med Colomb. 2015;40:305–9.

Seeley E, McAuley DF, Eisner M, Miletin M, Matthay M a, Kallet RH. Predictors of mortality in acute lung injury during the era of lung protective ventilation. Thorax. 2008;63:994–8.

Monchi, Bellenfant, Cariou et al. Early Predictive Factors of Survival in the Acute Respiratory Distress Syndrome A Multivariate Analysis. Am J Respir Crit Care Med. 1998;158:1076–81.

Tokics L, Hedenstierna G, Svensson L et al. V/Q distribution and correlation to atelectasis in anesthetized paralyzed humans. J Appl Physiol. 1996;81(4):1822–33.

Alhazzani W, Alshahrani M, Jaeschke R, Forel JM, Papazian L, Sevransky J, et al. Neuromuscular blocking agents in acute respiratory distress syndrome: a systematic review and meta-analysis of randomized controlled trials. Crit Care 2013;17(2):R43.

Raoof S, Goulet K, Esan A, Hess DR SC. Severe Hypoxemic Respiratory Failure Part 2—Nonventilatory Strategies. Chest 2010;137(6)(3):1437–48.

Papazian L, Forel JM, Gacouin A, Penot-Ragon C, Perrin G, Loundou A et al. Neuromuscular Blockers in Early Acute Respiratory Distress Syndrome. N Engl J Med. 2010;363:1107–16.

Hough C. Should we ever give steroids to ARDS patients? Clin Chest Med. 2014;35(4):781–95.

Gagnon S, Boota AM, Fischl MA, Baier AH, Kirksey OW LVL. Corticosteroids as adjunctive therapy for severe Pneumocystis carinii pneumonia in the acquired immunodeficiency syndrome: A double-blind, placebo-controlled trial. N Engl J Med. 1990;323(21):1444–50.

Patroniti N, Foti G, Cortinovis B, Maggioni E, Bigatello LM, Cereda M, et al. Sigh improves gas exchange and lung volume in patients with acute respiratory distress syndrome undergoing pressure support ventilation. Anesthesiology. 2002;96(4):788–94.

C.M. Lim, Y. Koh, W. Park, J.Y. Chin, T.S. Shim SDL. Mechanistic scheme and effect of “extended sigh” as a recruitment maneuver in patients with acute respiratory distress syndrome: a preliminary study. Crit Care Med. 2001;29:1255–60.

I. Morán, L. Blanch, R. Fernández, E. Fernández-Mondéjar, E. Zavala JM. Acute physiologic effects of a stepwise recruitment maneuver in acute respiratory distress syndrome. Minerva Anestesiol. 2011;77:1167–75.

Iannuzzi M, De Sio A, De Robertis E, Piazza O, Servillo G TR. Different patterns of lung recruitment maneuvers in primary acute respiratory distress syndrome. Minerva Anestesiol. 2010;76:692–8.

Hess DR. Recruitment Maneuvers and PEEP Titration. Respir Care 2015; 60(11):1688–704.

Suzumura EA, Figueiró M, Normilio Silva K, Laranjeira L, Oliveira C, Buehler AM, Bugano D, Passos Amato MB, Ribeiro Carvalho CR, Berwanger O CA. Effects of alveolar recruitment maneuvers on clinical outcomes in patients with acute respiratory distress syndrome: A systematic review and meta-analysis. Intensive Care Med. 2014;40(9):1227–40.

Douglas WW, Rehder K, Beynen FM, Sessler a D, Marsh HM. Improved oxygenation in patients with acute respiratory failure: the prone position. Am Rev Respir Dis. 1977;115(4):559–66.

Gattinoni L, Tognoni G, Pesenti A, Taccone P, Mascheroni D, Labarta V, Malacrida R, Di Giulio P, Fumagalli R, Pelosi P, Brazzi L LR. Effect of Prone Positioning on the Survival of Patients With Acute Respiratory Failure. N Engl J Med. 2001;568(23):568–73.

Guerin C, Gaillard S, Lemasson S et al. Effects of systematic prone positioning in hypoxemic acute respiratory failure: a randomized controlled trial. JAMA. 2004;292(19):2379–87.

Mancebo J, Fernández R, Blanch L et al. A multicenter trial of prolonged prone ventilation in severe acute respiratory distress syndrome. Am J Respir Crit Care Med. 2006;173(11):1233–9.

Sud S, Friedrich JO, Taccone P et al. Prone ventilation reduces mortality in patients with acute respiratory failure and severe hypoxemia: systematic review and meta-analysis. Intensive Care Med. 2010;36(4):585–99.

Gattinoni L, Carlesso E, Taccone P, Polli F, Gurin C, Mancebo J. Prone positioning improves survival in severe ARDS: A pathophysiologic review and individual patient meta-analysis. Minerva Anestesiol. 2010;76(6):448–54.

Guérin C, Reignier J, Richard J-C, Beuret P, Gacouin A, Boulain T, et al. Prone Positioning in Severe Acute Respiratory Distress Syndrome. N Engl J Med 2013;368(368):2159–68.

Beitler JR, Shaefi S, Montesi SB et al. Prone positioning reduces mortality from acute respiratory distress syndrome in the low tidal volume era: a meta-analysis. Intensive Care Med. 2014;40(3):332–41.

Lee JM, Bae W, Lee YJ, Cho Y-J. The Efficacy and Safety of Prone Positional Ventilation in Acute Respiratory Distress Syndrome:updated study-level meta-analysis of 11 randomized controlled trials. Crit Care Med 2014;42(5):1252–62.

Taccone P, Pesenti A, Latini R, Polli F, Vagginelli F, Mietto C, et al. Prone Positioning in Patients With Moderate and Severe Acute Respiratory Distress Syndrome. Jama. 2009;302(18):1977–84.

Michaels AJ, Wanek SM, Dreifuss B a, Gish DM, Otero D, Payne R, et al. A protocolized approach to pulmonary failure and the role of intermittent prone positioning. J Trauma 2002;52(6):1037–47;

Johannigman JA, Davis K, Miller SL, Campbell RS, Luchette FA, Frame SB, et al. Prone positioning for acute respiratory distress syndrome in the surgical intensive care unit: Who, when, and how long? Surgery. 2000;128(4):708–16.

Ferguson ND, Cook DJ, Guyatt GH, Mehta S, Hand L, Austin P, et al. High-Frequency Oscillation in Early Acute Respiratory Distress Syndrome. N Engl J Med 2013;368(9):795–805.

Young D, Lamb S, Shah S, Mackenzie I, Tunnicliffe W, Lall R, et al. High-Frequency Oscillation for Acute Respiratory Distress Syndrome. N Engl J Med 2013;368:806–13.

Huang C-T, Lin H-H, Ruan S-Y, Lee M-S, Tsai Y-J, Yu C-J. Efficacy and adverse events of high-frequency oscillatory ventilation in adult patients with acute respiratory distress syndrome: a meta-analysis. Crit Care 2014;18(3):R102.

Delgado Martín M FFR. Strategies against refractory hypoxemia in acute respiratory distress syndrome. Med Intensiva. 2013;37(6):423–30.

Putensen C, Zech S, Wrigge H, Zinserling J, Stuber F, Von Spiegel T MN. Long-Term Effects of Spontaneous Breathing During Ventilatory Support in Patients with Acute Lung Injury. Am J Respir Crit Care Med. 2001;164(1):43–9.

Putensen C, Mutz NJ, Putensen-Himmer G ZJ. Spontaneous Breathing During Ventilatory Support Improves Ventilation – Perfusion Distributions in Patients with Acute Respiratory Distress Syndrome. Am J Respir Crit Care Med. 1999;159(4):1241–8.

Neumann P, Golisch W, Strohmeyer A, Buscher H, Burchardi H, Sydow M. Influence of different release times on spontaneous breathing pattern during airway pressure release ventilation. Intensive Care Med. 2002;28(12):1742–9.

Räsänen J, Cane RD, Downs JB, Hurst JM, Jousela IT, Kirby RR, Rogove HJ SM. Airway pressure release ventilation during acute lung injury: a prospective multicenter trial. Crit Care Med. 1991;19(10):1234–41.

Villar J. The use of positive end-expiratory pressure in the management of the acute respiratory distress syndrome. Minerva Anestesiol 2005;71(6):265–72.

Santa Cruz R, Rojas JI, Nervi R, Heredia R, Ciapponi A. High versus low positive end-expiratory pressure (PEEP) levels for mechanically ventilated adult patients with acute lung injury and acute respiratory distress syndrome. Cochrane database Syst Rev 2013;6(6):CD009098.

Gilbert-Kawai ET, Mitchell K, Martin D, Carlisle J, Grocott MPW. Permissive hypoxaemia versus normoxaemia for mechanically ventilated critically ill patients. Cochrane database Syst Rev. 2014;5(5):CD009931.

Hickling KG HS and JR. Low mortality associated with low volume pressure limited ventilation with permissive hypercapnia in severe adult respiratory distress syndrome. Intensive Care Med. 1990;16:372–7.

Curley GF, Laffey JG, Kavanagh BP. CrossTalk proposal: There is added benefit to providing permissive hypercapnia in the treatment of ARDS. J Physiol 2013;591(Pt 11):2763–5.

Kregenow D a, Rubenfeld GD, Hudson LD, Swenson ER. Hypercapnic acidosis and mortality in acute lung injury. Crit Care Med. 2006;34(1):1–7.

Ruan S-Y. Inhaled nitric oxide therapy and risk of renal dysfunction: a systematic review and meta-analysis of randomized trials. Crit Care 2015;19(1):1–10.

L. A, P. S. Low-dose inhaled nitric oxide in patients with acute lung injury. Clin Pulm Med 2004;11(4):261–2.

Rossaint R, Falke KJ, Lopez F et al. Inhaled nitric oxide for the adult respiratory distress syndrome. N Engl J Med. 1993;328(6):399–405.

Lundin S, Mang H, Smithies M, Stenqvist O FC. Inhalation of nitric oxide in acute lung injury: results of a European multicentre study. The European Study Group of Inhaled Nitric Oxide. Intensive Care Med. 1999;25(9):911–9.

Torbic, H., Szumita, P., Anger, K., Nuccio, P., LaGambina, S. and Weinhouse G. Inhaled epoprostenol versus inhaled nitric oxide for refractory hypoxemia in critically ill patients. J Crit Care. 2013;28:844–8.

Zwissler, B., Kemming, G., Habler, O. K, M., Merkel, M., Haller M et al. Inhaled prostacyclin versus inhaled nitric oxide in adult respiratory distress syndrome. Am J Respir Crit Care Med 1996;154:1671–7.

Haraldsson A, Kieler-Jensen N, Nathorst-Westfelt U, Bergh CH, Ricksten SE. Comparison of inhaled nitric oxide and inhaled aerosolized prostacyclin in the evaluation of heart transplant candidates with elevated pulmonary vascular resistance. Chest. 1998;114(3):780–6.

Sawheny E, Ellis AL, Kinasewitz GT. Iloprost improves gas exchange in patients with pulmonary hypertension and ARDS. Chest. 2013;144(1):55–62.

Gattinoni L, Pesenti A, Mascheroni D, Marcolin R, Fumagalli R, Rossi F, et al. Low-frequency positive-pressure ventilation with extracorporeal CO2 removal in severe acute respiratory failure. Jama 1986;256(7):881–6.

Gomez-Caro A, Badia JR, Ausin P. Asistencia respiratoria extracorpórea en la insuficiencia respiratoria grave y el SDRA. Situación actual y aplicaciones clínicas. Arch Bronconeumol. 2010;46(10):531–7.

Peek GJ, Mugford M, Tiruvoipati R, Wilson A, Allen E, Thalanany MM, et al. Efficacy and economic assessment of conventional ventilatory support versus extracorporeal membrane oxygenation for severe adult respiratory failure (CESAR): a multicentre randomised controlled trial. Lancet. 2009;374(9698):1351–63.

Davies AR, Jones D, Bailey M, Beca J, Bellomo R, Blackwell N, et al. Extracorporeal membrane oxygenation for 2009 influenza A(H1N1) acute respiratory distress syndrome. JAMA. 2009;302(17):1888–95.

Noah M a, Peek GJ, Finney SJ, Griffiths MJ, Harrison D a, Grieve R, et al. Referral to an extracorporeal membrane oxygenation center and mortality among patients with severe 2009 influenza A(H1N1). JAMA 2011;306(15):1659–68.

Richard C, Argaud L, Blet A, Boulain T, Contentin L, Dechartres A, et al. Extracorporeal life support for patients with acute respiratory distress syndrome (adult and paediatric). Consensus conference organized by the French Intensive Care Society. Ann Intensive Care. 2014;31(8):779–95




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