OriginalEvolución de 10 años de aplicación de la ventilación mecánica en la insuficiencia respiratoria aguda del paciente hematológico ingresado en la unidad de cuidados intensivosTen-year evolution of mechanical ventilation in acute respiratory failure in the hematogical patient admitted to the intensive care unit
Section snippets
Introducción
El pronóstico de la enfermedad hematológica ha experimentado una mejoría en las últimas décadas1, 2. A pesar de ello, los pacientes que requieren ingreso en la unidad de cuidados intensivos (UCI) presentan una mortalidad elevada1, 2, 3, 4, 5. La causa principal de ingreso en UCI es el desarrollo de una insuficiencia respiratoria aguda (IRA), que precisa soporte ventilatorio en ocasiones1, 2, 3, 4, 5, 6, 7, debido a la aparición de infiltrados pulmonares tanto infecciosos como no infecciosos8.
Material y métodos
Se realizó un estudio observacional retrospectivo, cuyo protocolo de estudio fue aprobado por el Comité Ético de Investigación Clínica Hospitalaria. Fueron incluidos todos los pacientes hematológicos con IRA que ingresaron en la UCI entre enero de 2001 y hasta diciembre 2011 y que precisaron soporte ventilatorio. Las patologías hematológicas incluidas fueron: leucemia aguda (linfoblástica o mielocítica), linfoma no hodgkiniano, mieloma múltiple, leucemia crónica, y enfermedad de Hodgkin,
Resultados
Durante el periodo de estudio se ingresaron 132 pacientes con patología hematológica de un total de 11.501 pacientes ingresados, siendo en 41 (31%) casos preciso el soporte ventilatorio, 35 (85%) fueron ventilados con VMNI y 6 (15%) con VMI. La muestra de pacientes (tabla 1) estaba constituida principalmente por 26 (63%) hombres, con una edad media de 56 ± 6 años, un SOFA de 7 ± 3 y un SAPS 2 de 63 ± 18. Al comparar ambos grupos, se pudo constatar que, al ingreso, el grupo VMI presentaba una
Discusión
Este estudio retrospectivo puso de manifiesto que el paciente hematológico ingresado en UCI y sometido a ventilación mecánica por IRA presentó una menor mortalidad que en otras series3, 5, 7, y que el empleo de la VMNI ha sido una pieza clave en las medidas de soporte, puesto que influyó en la reducción de la mortalidad de dichos pacientes.
Es de destacar que en nuestra serie se empleó como medida de soporte ventilatorio la VMNI, ya que es práctica habitual en nuestra unidad realizar un intento
Conflicto de intereses
Los autores declaran no tener ningún conflicto de intereses.
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