{"id":117924,"date":"2018-03-11T10:47:38","date_gmt":"2018-03-11T10:47:38","guid":{"rendered":"https:\/\/www.deberes.net\/tesis\/sin-categoria\/efectividad-de-la-ventilacion-no-invasiva-en-el-tratamiento-del-sindrome-de-distres-respiratorio-del-adulto\/"},"modified":"2018-03-11T10:47:38","modified_gmt":"2018-03-11T10:47:38","slug":"efectividad-de-la-ventilacion-no-invasiva-en-el-tratamiento-del-sindrome-de-distres-respiratorio-del-adulto","status":"publish","type":"post","link":"https:\/\/www.deberes.net\/tesis\/patologia-clinica\/efectividad-de-la-ventilacion-no-invasiva-en-el-tratamiento-del-sindrome-de-distres-respiratorio-del-adulto\/","title":{"rendered":"Efectividad de la ventilaci\u00f3n no invasiva en el tratamiento del sindrome de distres respiratorio del adulto"},"content":{"rendered":"<h2>Tesis doctoral de <strong> Noemi Llamas Fernandez <\/strong><\/h2>\n<p>Introducci\u00f3n. El uso de la ventilaci\u00f3n mec\u00e1nica no invasiva (vmni) en el tratamiento del paciente con enfermedad pulmonar obstructiva cr\u00f3nica agudizado y en el edema agudo de pulm\u00f3n cardiog\u00e9nico, est\u00e1 ampliamente aceptado, sin embargo, su utilidad en el tratamiento de la insuficiencia respiratoria aguda hipox\u00e9mica y, sobre todo, en las formas m\u00e1s graves, como es el s\u00edndrome de distr\u00e9s respiratorio agudo (sdra), es controvertida.    objetivos. Los objetivos principales de este estudio fueron conocer la efectividad de la vmni en el tratamiento de los pacientes con sdra, la seguridad mediante el an\u00e1lisis de las complicaciones, as\u00ed como establecer los factores de riesgos relacionados con el resultado  de la vmni y con mortalidad hospitalaria, en este grupo de pacientes. material y m\u00e9todos. Estudio observacional, prospectivo, realizado en la unidad de cuidados intensivos del hospital general universitario j.M. Morales meseguer de murcia, entre junio de 1997 y diciembre de 2012. Se incluyeron los pacientes que, de forma consecutiva, presentaron criterios de sdra, seg\u00fan la definici\u00f3n en vigor en cada periodo y, que precisaron vmni. Se realiz\u00f3 recogida de datos sociodemogr\u00e1ficos, cl\u00ednicos, anal\u00edticos y evolutivos. Se defini\u00f3 \u00e9xito de la vmni cuando se evitaba la intubaci\u00f3n endotraqueal y el paciente era dado de alta vivo de la uci, permaneciendo en planta y sin necesidad de vmni al menos 24 horas. Los datos se expresan como medias \u00c2\u00b1 desviaci\u00f3n est\u00e1ndar, frecuencias absolutas y relativas. Las comparaciones entre variables mediante prueba de chi2 de pearson y t de student. An\u00e1lisis multivariante mediante regresi\u00f3n log\u00edstica. Se ha utilizado el programa spss versi\u00f3n 22.0 para windows. resultados. Se han analizado 421 episodios de sdra tratados con vmni. La edad media era de 58,3 \u00c2\u00b1 20,2 a\u00f1os y 59,5% eran hombres. La causa m\u00e1s frecuente de sdra fue la patolog\u00eda infecciosa. La gravedad medida por el \u00edndice saps ii era de 48 \u00c2\u00b1 15,5. El ventilador m\u00e1s utilizado fue el bipap vision, utiliz\u00e1ndose en modo bipap en 388  pacientes. Los niveles de ipap y epap al inicio de la terapia fueron 15 \u00c2\u00b1 1,4 y de 7,5 \u00c2\u00b1 0,9, respectivamente. Al inicio de la terapia, el valor de la frecuencia respiratoria y de la pao2\/fio2 era de 35,8 \u00c2\u00b1 5,6 y de 130,1 \u00c2\u00b1 34,6  respectivamente; a la hora de  vmni era de 33,5 \u00c2\u00b1 4,9 y 149 \u00c2\u00b1 37, (p &lt; 0,001).  El valor del \u00edndice sofa durante el periodo de vmni fue de 11,1 \u00c2\u00b1 5. 187 pacientes (44,4%) presentaron complicaciones relacionados con la vmni, siendo la m\u00e1s frecuente la lesi\u00f3n cut\u00e1nea (150; 35,6 %).  El \u00e9xito de vni y la mortalidad hospitalaria fueron de 26,8% y 51,3%. Mediante an\u00e1lisis multivariante, los factores predictivos de \u00e9xito de vmni fueron edad (or 0,978, ic-95%  0,961-0,995), saps ii (or 0,969, ic-95%  0,94-0,995), sofa m\u00e1ximo durante vmni (or 0,821, ic-95%  0,736-0,917), nivel de bicarbonato basal (or 1,160, ic-95%  1,082-1,243), relaci\u00f3n pao2\/fio2 y frecuencia respiratoria,  a la hora de iniciada la terapia (or 1,042, ic-95% 1,028-1,056 y  or 0,795 (ic-95% 0,735-0,861). Los factores predictivos de mortalidad fueron la orden de no intubaci\u00f3n (or 6,57, ic-95% 2,293-18,826), puntuaci\u00f3n \u00edndice sofa m\u00e1ximo total (or 1,436, ic-95%  1,31-1,575), presencia de c\u00e1ncer (or 3,91, ic-95%  1,778-8,595), la edad (or 1,031, ic-95%  1,014-1,049), y el \u00e9xito de la vmni (or 0,122, ic-95%  0,041-0,359). conclusiones. La utilizaci\u00f3n de la vmni en el tratamiento de la ira debido a sdra presenta una tasa de fracaso muy elevada, aunque con pocas complicaciones graves.  Los factores relacionados con el fracaso de la t\u00e9cnica est\u00e1n, generalmente, relacionados con variables que miden gravedad del proceso respiratorio y sist\u00e9mico.   introduction. The use of non invasive mechanical ventilation (nimv) in the treatment of patients with chronic obstructive pulmonary disease sharpness and acute lung cardiogenic edema, is widely accepted. Its utility in the treatment of the acute hypoxemic respiratory failure and, above all, in more severe forms, as in acute respiratory distress syndrome (ards)  , is controversial. objectives. The main objectives of this study were to know the effectiveness of the adapted in the treatment of patients with ards, security through the analysis of complications, as well as establishing the factors and risks associated with the outcome of the adapted with splitting hospital, in this group of patients. material and methods. Observational study, prospective, study carried out in intensive care unit of the university general hospital jm morales meseguer of murcia, between june 1997 and december 2012. Included patients who consecutively presented criteria for ards, according to the definition in force in each period, and that required adapted. Held collection of sociodemographic, clinical data, analytical and evolutionary. Success of the adapted was defined when the endotracheal intubation was avoided and the patient was alive discharged from the icu, staying in plant and adapted without at least 24 hours. Data are expressed as mean \u00c2\u00b1 standard deviation, absolute and relative frequencies. Comparisons between variables using pearson chi2 and student&apos;s t test. Multivariate analyses using logistic regression. It has been used the spss program version 22.0 for windows. results. We have analyzed 421 episodes of ards treated with nimv. The mean age was 58.3 \u00c2\u00b1 20.2 years and 59.5% were men. The most frequent cause of ards was infectious pathology. Gravity as measured by the saps ii index was 48 \u00c2\u00b1 15.5. The most widely used fan was the bipap vision, using bipap mode in 388 patients. The ipap and epap levels at the beginning of therapy were 15 \u00c2\u00b1 1.4 and 7.5 \u00c2\u00b1 0.9, respectively. At the beginning of the therapy, the value of respiratory rate and the pao2\/fio2 was 35.8 \u00c2\u00b1 5.6 and 130.1 \u00c2\u00b1 34.6 respectively; after an hour of nimv was 33.5 \u00c2\u00b1 4.9 and 149 \u00c2\u00b1 37, (p 0.001). The value of the index during the period of adapted sofa was 11.1 \u00c2\u00b1 5. 187 patients (44.4) presented complications related to the adapted, being the most frequent skin lesion (150; 35.6%). The success of niv and in-hospital mortality were 26.8% and 51.3%. By multivariate analysis, predictive success of adapted factors were age (or 0.978, 95% ci 0.961-0.995), saps ii (or 0.969, 95% ci 0.94-0.995), sofa max during adapted (or 0.821, 95%ci 0.736-0.917), level of basal bicarbonate (or 1.160, ic-95%  1.082-1.243), relationship pao2\/fio2 and rate of breathing, after an hour of therapy initiated (or 1.042, 95%ci 1.028-1.056 and or 0.795, ic-95%, 0.735-0.861). Predictive factors of mortality were the order of not intubation (or 6.57, 95% ci 2.293-18.826), index score total maximum sofa (or 1.436, ci-95%  1.31-1.575), presence of cancer (or 3.91, ci-95%  1.778-8.595), the age (or 1.031, ci-95%  1.014-1.049), and the success of the nimv (or 0.122, ci-95%  0.041-0.359), conclusions. The use of the nimv in the treatment of arf due to ards has a very high failure rate, but with few serious complications. Factors related to the failure of the technique are usually related to variables that measure the severity of respiratory and systemic process.<\/p>\n<p>&nbsp;<\/p>\n<h3>Datos acad\u00e9micos de la tesis doctoral \u00ab<strong>Efectividad de la ventilaci\u00f3n no invasiva en el tratamiento del sindrome de distres respiratorio del adulto<\/strong>\u00ab<\/h3>\n<ul>\n<li><strong>T\u00edtulo de la tesis:<\/strong>\u00a0 Efectividad de la ventilaci\u00f3n no invasiva en el tratamiento del sindrome de distres respiratorio del adulto <\/li>\n<li><strong>Autor:<\/strong>\u00a0 Noemi Llamas Fernandez <\/li>\n<li><strong>Universidad:<\/strong>\u00a0 Murcia<\/li>\n<li><strong>Fecha de lectura de la tesis:<\/strong>\u00a0 20\/07\/2015<\/li>\n<\/ul>\n<p>&nbsp;<\/p>\n<h3>Direcci\u00f3n y tribunal<\/h3>\n<ul>\n<li><strong>Director de la tesis<\/strong>\n<ul>\n<li>Juan  Miguel Sanchez Nieto<\/li>\n<\/ul>\n<\/li>\n<li><strong>Tribunal<\/strong>\n<ul>\n<li>Presidente del tribunal: Juan  Carlos Pardo talavera <\/li>\n<li>bernardo Gil rueda (vocal)<\/li>\n<li>Miguel Fernandez vivas (vocal)<\/li>\n<li>ascension Sanchez fernandez (vocal)<\/li>\n<\/ul>\n<\/li>\n<\/ul>\n<p>&nbsp;<\/p>\n","protected":false},"excerpt":{"rendered":"<p>Tesis doctoral de Noemi Llamas Fernandez Introducci\u00f3n. El uso de la ventilaci\u00f3n mec\u00e1nica no invasiva (vmni) en el tratamiento del [&hellip;]<\/p>\n","protected":false},"author":1,"featured_media":0,"comment_status":"open","ping_status":"open","sticky":false,"template":"","format":"standard","meta":{"site-sidebar-layout":"default","site-content-layout":"","ast-site-content-layout":"","site-content-style":"default","site-sidebar-style":"default","ast-global-header-display":"","ast-banner-title-visibility":"","ast-main-header-display":"","ast-hfb-above-header-display":"","ast-hfb-below-header-display":"","ast-hfb-mobile-header-display":"","site-post-title":"","ast-breadcrumbs-content":"","ast-featured-img":"","footer-sml-layout":"","theme-transparent-header-meta":"","adv-header-id-meta":"","stick-header-meta":"","header-above-stick-meta":"","header-main-stick-meta":"","header-below-stick-meta":"","astra-migrate-meta-layouts":"default","ast-page-background-enabled":"default","ast-page-background-meta":{"desktop":{"background-color":"var(--ast-global-color-4)","background-image":"","background-repeat":"repeat","background-position":"center center","background-size":"auto","background-attachment":"scroll","background-type":"","background-media":"","overlay-type":"","overlay-color":"","overlay-gradient":""},"tablet":{"background-color":"","background-image":"","background-repeat":"repeat","background-position":"center center","background-size":"auto","background-attachment":"scroll","background-type":"","background-media":"","overlay-type":"","overlay-color":"","overlay-gradient":""},"mobile":{"background-color":"","background-image":"","background-repeat":"repeat","background-position":"center center","background-size":"auto","background-attachment":"scroll","background-type":"","background-media":"","overlay-type":"","overlay-color":"","overlay-gradient":""}},"ast-content-background-meta":{"desktop":{"background-color":"var(--ast-global-color-5)","background-image":"","background-repeat":"repeat","background-position":"center center","background-size":"auto","background-attachment":"scroll","background-type":"","background-media":"","overlay-type":"","overlay-color":"","overlay-gradient":""},"tablet":{"background-color":"var(--ast-global-color-5)","background-image":"","background-repeat":"repeat","background-position":"center center","background-size":"auto","background-attachment":"scroll","background-type":"","background-media":"","overlay-type":"","overlay-color":"","overlay-gradient":""},"mobile":{"background-color":"var(--ast-global-color-5)","background-image":"","background-repeat":"repeat","background-position":"center center","background-size":"auto","background-attachment":"scroll","background-type":"","background-media":"","overlay-type":"","overlay-color":"","overlay-gradient":""}},"footnotes":""},"categories":[8235,384],"tags":[159738,72229,232101,90279,157085,232100],"class_list":["post-117924","post","type-post","status-publish","format-standard","hentry","category-murcia","category-patologia-clinica","tag-ascension-sanchez-fernandez","tag-bernardo-gil-rueda","tag-juan-carlos-pardo-talavera","tag-juan-miguel-sanchez-nieto","tag-miguel-fernandez-vivas","tag-noemi-llamas-fernandez"],"_links":{"self":[{"href":"https:\/\/www.deberes.net\/tesis\/wp-json\/wp\/v2\/posts\/117924","targetHints":{"allow":["GET"]}}],"collection":[{"href":"https:\/\/www.deberes.net\/tesis\/wp-json\/wp\/v2\/posts"}],"about":[{"href":"https:\/\/www.deberes.net\/tesis\/wp-json\/wp\/v2\/types\/post"}],"author":[{"embeddable":true,"href":"https:\/\/www.deberes.net\/tesis\/wp-json\/wp\/v2\/users\/1"}],"replies":[{"embeddable":true,"href":"https:\/\/www.deberes.net\/tesis\/wp-json\/wp\/v2\/comments?post=117924"}],"version-history":[{"count":0,"href":"https:\/\/www.deberes.net\/tesis\/wp-json\/wp\/v2\/posts\/117924\/revisions"}],"wp:attachment":[{"href":"https:\/\/www.deberes.net\/tesis\/wp-json\/wp\/v2\/media?parent=117924"}],"wp:term":[{"taxonomy":"category","embeddable":true,"href":"https:\/\/www.deberes.net\/tesis\/wp-json\/wp\/v2\/categories?post=117924"},{"taxonomy":"post_tag","embeddable":true,"href":"https:\/\/www.deberes.net\/tesis\/wp-json\/wp\/v2\/tags?post=117924"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}