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Cambios en la mecánica ventilatoria debidos a variaciones de la PEEP y la presión soporte: estudio en sujetos sanos bajo ventilación mecánica no invasiva
Changes in ventilatory mechanics caused by variations in PEEP and pressure support: study in healthy subjects under non-invasive mechanical ventilation
DOI:
https://doi.org/10.15446/revfacmed.v65n2.60938Palabras clave:
Ventilación no invasiva, Mecánica respiratoria, Trabajo respiratorio. (es)Noninvasive Ventilation, Respiratory Mechanics, Work of Breathing. (en)
Introducción. Por lo general, la mecánica ventilatoria se ha estimado en modo controlado con el uso de aproximaciones no adecuadas para ventilación espontánea.
Objetivo. Medir los cambios de la mecánica ventilatoria ante variaciones de la presión positiva al final de la expiración (PEEP, por su sigla en inglés) y la presión soporte (PS) en ventilación mecánica no invasiva.
Materiales y métodos. A través de una estrategia no invasiva, se estimó la mecánica ventilatoria bajo diferentes niveles de PEEP y PS. Para tal fin, se utilizó un simulador mecánico y se registró una base de datos de 14 sujetos sanos conectados de manera no invasiva a un ventilador mecánico.
Resultados. Se obtuvieron valores medianos de resistencia y compliancia de 91.2[77.8-135.9]mL/cmH2O y 8.3[6.1-10.4]cmH2O/L/s para los 14 sujetos sanos con PEEP y PS de 0 cmH2O, respectivamente. En los incrementos de PEEP, los sujetos presentaron aumento estadísticamente significativo en la compliancia. Por el contrario, en el incremento de presión soporte, no se observaron cambios de ningún parámetro.
Conclusiones. Se encontraron valores de compliancia y resistencia, acordes con los configurados en el simulador mecánico y coherentes con los reportados en la literatura en el caso de sujetos sanos. Esto resulta de gran utilidad al tomar decisiones en unidades de cuidados intensivos.
Introduction: Traditionally, ventilatory mechanics has been delivered in controlled modes through the use of inappropriate approaches for spontaneous ventilation.
Objective: To measure the changes of ventilatory mechanics caused by PEEP and pressure support (PS) variations in non-invasive mechanical ventilation.
Materials and methods: The ventilatory mechanics was evaluated through a non-invasive strategy, under different PEEP and pressure support levels. For this purpose, a mechanical simulator was used, and a database of 14 healthy subjects non-invasively connected to a mechanical ventilator was recorded.
Results: For the 14 healthy subjects under PEEP and pressure support conditions of 0 cmH2O, the median resistance and compliance values were 91.2 [77.8-135.9] mL/cmH2O and 8.3[6.1-10.4]cmH2O/L/s, respectively. PEEP compliance showed a statistically significant increase in all subjects. On the other hand, no changes in any of the parameters were observed regarding pressure support increase.
Conclusions: The proposed technique allowed to find compliance and resistance values consistent with those set in the mechanical simulator, which, in turn, coincide with those reported in the literature for healthy subjects. This information is useful for decision-making in intensive care units..
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