Ventilación no invasiva en pacientes con encefalopatía hipercápnica grave en una sala de hospitalización convencional
Non-invasive ventilation in patients with severe hypercapnic encephalopathy in a conventional hospital ward
Y. Dueñas-Pareja, S. López-Martín, J. García-García, R. Melchor, M.J. Rodríguez-Nieto, N. González-Mangado, G. Peces-Barba
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gpecesba@fjd.es
Correspondencia: Fundación Jiménez Díaz. Servicio de Neumología Avda. Reyes Católicos, 2. 28040 Madrid
Correspondencia: Fundación Jiménez Díaz. Servicio de Neumología Avda. Reyes Católicos, 2. 28040 Madrid
Servicio de Neumología. Fundación Jiménez Díaz. Madrid
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González-Mangado, G. Peces-Barba" "autores" => array:7 [ 0 => array:2 [ "nombre" => "Y." "apellidos" => "Dueñas-Pareja" ] 1 => array:2 [ "nombre" => "S." "apellidos" => "López-Martín" ] 2 => array:2 [ "nombre" => "J." "apellidos" => "García-García" ] 3 => array:2 [ "nombre" => "R." "apellidos" => "Melchor" ] 4 => array:2 [ "nombre" => "M.J." "apellidos" => "Rodríguez-Nieto" ] 5 => array:2 [ "nombre" => "N." "apellidos" => "González-Mangado" ] 6 => array:4 [ "nombre" => "G." "apellidos" => "Peces-Barba" "email" => array:1 [ 0 => "gpecesba@fjd.es" ] "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">¿</span>" "identificador" => "cor0005" ] ] ] ] "afiliaciones" => array:1 [ 0 => array:1 [ "entidad" => "Servicio de Neumología. Fundación Jiménez Díaz. Madrid" ] ] "correspondencia" => array:1 [ 0 => array:3 [ "identificador" => "cor0005" "etiqueta" => "⁎" "correspondencia" => "Correspondencia: Fundación Jiménez Díaz. Servicio de Neumología Avda. Reyes Católicos, 2. 28040 Madrid" ] ] ] ] "titulosAlternativos" => array:1 [ "en" => array:1 [ "titulo" => "Non-invasive ventilation in patients with severe hypercapnic encephalopathy in a conventional hospital ward" ] ] "pdfFichero" => "main.pdf" "tienePdf" => true "fechaRecibido" => "2001-02-18" "fechaAceptado" => "2002-05-21" "PalabrasClave" => array:2 [ "es" => array:1 [ 0 => array:4 [ "clase" => "keyword" "titulo" => "Palabras clave" "identificador" => "xpalclavsec190545" "palabras" => array:6 [ 0 => "Ventilación no invasiva (VNI)" 1 => "Enfermedad pulmonar obstructiva crónica (EPOC)" 2 => "Estupor" 3 => "Coma" 4 => "Insuficiencia respiratoria aguda" 5 => "Hipercapnia" ] ] ] "en" => array:1 [ 0 => array:4 [ "clase" => "keyword" "titulo" => "Keywords" "identificador" => "xpalclavsec190546" "palabras" => array:6 [ 0 => "Non-invasive ventilation (NIV)" 1 => "Chronic obstructive pulmonary disease (COPD)" 2 => "Impaired consciousness" 3 => "Coma" 4 => "Acute respiratory insufficiency" 5 => "Hypercapnia" ] ] ] ] "tieneResumen" => true "resumen" => array:2 [ "es" => array:1 [ "resumen" => "<span class="elsevierStyleSectionTitle">Objetivo</span><p id="spar0005" class="elsevierStyleSimplePara elsevierViewall">Mostrar nuestra experiencia con la ventilación no invasiva (VNI) con doble nivel de presión (BIPAP) en una sala general de neumología en pacientes en estupor o coma hipercápnicos sin criterios de ingreso en unidad de cuidados intensivos (UCI)</p> <span class="elsevierStyleSectionTitle">Material y métodos</span><p id="spar0010" class="elsevierStyleSimplePara elsevierViewall">Estudio prospectivo de 13 pacientes, edad media 81 años (límites, 65-96), 10 pacientes presentaban exacerbación de enfermedad pulmonar obstructiva crónica (EPOC) con volumen espiratorio forzado en el primer segundo (FEV<span class="elsevierStyleInf">1</span>) medio en situación estable de 35,2 ± 14,6%, índice de Glasgow ingreso<span class="elsevierStyleHsp" style=""></span>=<span class="elsevierStyleHsp" style=""></span>7, tratados con VNI mediante mascarilla facial. Se realizaron controles gasométricos hasta la suspensión de la VNI</p> <span class="elsevierStyleSectionTitle">Resultados</span><p id="spar0015" class="elsevierStyleSimplePara elsevierViewall">Tras una media de ventilación de 19 ± 5 h/día en las primeras 48 h y posteriormente 6 ± 1 h/día hasta un promedio total de 74 ± 9 h, sobrevivieron 9 pacientes (69%). En este grupo los valores iniciales medios de pH y pCO<span class="elsevierStyleInf">2</span>fueron de 7,17 ± 0,028 y 101 ± 9<span class="elsevierStyleHsp" style=""></span>mmHg, respectivamente; de ellos en 7 casos (78%) se revirtió el coma en las primeras 48 h y se observó una mejoría significativa en el valor de pH en el control de las 12-24 h. Los valores medios al alta de pH y pCO<span class="elsevierStyleInf">2</span>fueron 7,44 ± 0,013 y 54 ± 2,8<span class="elsevierStyleHsp" style=""></span>mmHg, respectivamente. Fallecieron 4 pacientes, cuyos valores gasométricos iniciales o evolutivos hasta las primeras 12-24 h no presentaron diferencia significativa con el grupo de supervivientes</p> <span class="elsevierStyleSectionTitle">Conclusion</span><p id="spar0020" class="elsevierStyleSimplePara elsevierViewall">La aplicación de la VNI en una sala general de neumología puede constituir una alternativa a la intubación orotraqueal (IOT) en pacientes en situación de estupor o coma hipercápnicos que no cumplen criterios de ingreso en UCI</p>" ] "en" => array:1 [ "resumen" => "<span class="elsevierStyleSectionTitle">Objective</span><p id="spar0025" class="elsevierStyleSimplePara elsevierViewall">To report our experience with non-invasive ventilation (NIV) at two levels of pressure (Bi-PAP) on a general respiratory medicine ward with patients in hypercapnic impaired consciousness and/or coma who had not previously been in an intensive care unit (ICU)</p> <span class="elsevierStyleSectionTitle">Methods</span><p id="spar0030" class="elsevierStyleSimplePara elsevierViewall">This was a prospective study of 13 patients, mean age 81 years (65-96), treated with NIV through a face mask. Ten had chronic obstructive pulmonary disease, with a mean FEV1 in stable condition of 35.2 ± 14.6%. Glasgow scores upon admission were<span class="elsevierStyleHsp" style=""></span>=<span class="elsevierStyleHsp" style=""></span>7. Arterial gases were monitored until suspension of NIV</p> <span class="elsevierStyleSectionTitle">Results</span><p id="spar0035" class="elsevierStyleSimplePara elsevierViewall">After NIV for a mean 19 ± 5 h/day in the first 48 hours and later of 6 ± 1 h/day until a total of 74 ± 9 h, 9 patients (69%) survived. The mean initial pH for these patients was 7.17 ± 0.028 and the mean initial pCO2 was 101 ± 9<span class="elsevierStyleHsp" style=""></span>mm Hg. In 7 cases (78%), coma was reversed in the first 48 h and a significant improvement in pH was observed in the 12-24 h analysis. Mean pH upon discharge was 7.44 ± 0.013 and mean pCO2 was 54 ± 2.8<span class="elsevierStyleHsp" style=""></span>mmHg. Four patients died, even though their initial or subsequent arterial gases at 12-24 h were not significantly different from those of the survivors</p> <span class="elsevierStyleSectionTitle">Conclusion</span><p id="spar0040" class="elsevierStyleSimplePara elsevierViewall">NIV on a general respiratory medicine ward can offer an alternative to orotracheal intubation for patients with hypercapnic impaired consciousness and/or coma who do not meet the criteria for admission to the ICU</p>" ] ] "bibliografia" => array:2 [ "titulo" => "Bibliografía" "seccion" => array:1 [ 0 => array:2 [ "identificador" => "bibs0005" "bibliografiaReferencia" => array:19 [ 0 => array:3 [ "identificador" => "bib0005" "etiqueta" => "1." 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| Year/Month | Html | Total | |
|---|---|---|---|
| 2024 November | 8 | 37 | 45 |
| 2024 October | 43 | 136 | 179 |
| 2024 September | 35 | 125 | 160 |
| 2024 August | 52 | 116 | 168 |
| 2024 July | 31 | 90 | 121 |
| 2024 June | 61 | 149 | 210 |
| 2024 May | 48 | 119 | 167 |
| 2024 April | 31 | 122 | 153 |
| 2024 March | 46 | 106 | 152 |
| 2024 February | 24 | 98 | 122 |
| 2024 January | 0 | 39 | 39 |
| 2023 December | 0 | 31 | 31 |
| 2023 November | 0 | 31 | 31 |
| 2023 October | 0 | 40 | 40 |
| 2023 September | 0 | 30 | 30 |
| 2023 August | 0 | 17 | 17 |
| 2023 July | 0 | 34 | 34 |
| 2023 June | 0 | 17 | 17 |
| 2023 May | 0 | 3 | 3 |
| 2023 April | 1 | 6 | 7 |
| 2023 March | 4 | 21 | 25 |
| 2023 February | 33 | 87 | 120 |
| 2023 January | 26 | 99 | 125 |
| 2022 December | 33 | 97 | 130 |
| 2022 November | 46 | 68 | 114 |
| 2022 October | 26 | 124 | 150 |
| 2022 September | 22 | 156 | 178 |
| 2022 August | 38 | 142 | 180 |
| 2022 July | 21 | 129 | 150 |
| 2022 June | 24 | 126 | 150 |
| 2022 May | 33 | 90 | 123 |
| 2022 April | 26 | 119 | 145 |
| 2022 March | 33 | 102 | 135 |
| 2022 February | 28 | 143 | 171 |
| 2022 January | 28 | 130 | 158 |
| 2021 December | 14 | 83 | 97 |
| 2021 November | 24 | 72 | 96 |
| 2021 October | 29 | 71 | 100 |
| 2021 September | 28 | 66 | 94 |
| 2021 August | 35 | 62 | 97 |
| 2021 July | 25 | 57 | 82 |
| 2021 June | 34 | 56 | 90 |
| 2021 May | 21 | 54 | 75 |
| 2021 April | 22 | 66 | 88 |
| 2021 March | 63 | 48 | 111 |
| 2021 February | 56 | 41 | 97 |
| 2021 January | 85 | 45 | 130 |
| 2020 December | 35 | 44 | 79 |
| 2020 November | 21 | 56 | 77 |
| 2020 October | 14 | 18 | 32 |
| 2020 September | 18 | 20 | 38 |
| 2020 August | 35 | 26 | 61 |
| 2020 July | 16 | 29 | 45 |
| 2020 June | 14 | 24 | 38 |
| 2020 May | 23 | 22 | 45 |
| 2020 April | 36 | 20 | 56 |
| 2020 March | 18 | 26 | 44 |
| 2020 February | 27 | 31 | 58 |
| 2020 January | 38 | 45 | 83 |
| 2019 December | 25 | 44 | 69 |
| 2019 November | 5 | 14 | 19 |
| 2019 October | 21 | 32 | 53 |
| 2019 September | 15 | 39 | 54 |
| 2019 August | 16 | 22 | 38 |
| 2019 July | 22 | 58 | 80 |
| 2019 June | 21 | 45 | 66 |
| 2019 May | 33 | 68 | 101 |
| 2019 April | 13 | 80 | 93 |
| 2019 March | 14 | 81 | 95 |
| 2019 February | 15 | 44 | 59 |
| 2019 January | 15 | 66 | 81 |
| 2018 December | 15 | 88 | 103 |
| 2018 November | 33 | 100 | 133 |
| 2018 October | 27 | 57 | 84 |
| 2018 September | 10 | 129 | 139 |
| 2018 July | 1 | 0 | 1 |
| 2018 May | 9 | 3 | 12 |
| 2018 April | 15 | 3 | 18 |
| 2018 March | 10 | 9 | 19 |
| 2018 February | 10 | 11 | 21 |
| 2018 January | 26 | 29 | 55 |
| 2017 December | 8 | 32 | 40 |
| 2017 November | 12 | 80 | 92 |
| 2017 October | 14 | 76 | 90 |
| 2017 September | 10 | 49 | 59 |
| 2017 August | 11 | 60 | 71 |
| 2017 July | 11 | 68 | 79 |
| 2017 June | 16 | 107 | 123 |
| 2017 May | 11 | 63 | 74 |
| 2017 April | 17 | 72 | 89 |
| 2017 March | 8 | 93 | 101 |
| 2017 February | 7 | 85 | 92 |
| 2017 January | 12 | 55 | 67 |
| 2016 December | 15 | 60 | 75 |
| 2016 November | 30 | 37 | 67 |
| 2016 October | 36 | 46 | 82 |
| 2016 September | 32 | 25 | 57 |
| 2016 August | 21 | 12 | 33 |
| 2016 July | 31 | 12 | 43 |
| 2016 June | 24 | 17 | 41 |
| 2016 May | 26 | 9 | 35 |
| 2016 April | 12 | 1 | 13 |
| 2016 March | 11 | 3 | 14 |
| 2016 February | 11 | 3 | 14 |
| 2016 January | 27 | 15 | 42 |
| 2015 December | 36 | 21 | 57 |
| 2015 November | 36 | 7 | 43 |
| 2015 October | 204 | 1 | 205 |
| 2015 September | 178 | 0 | 178 |
| 2015 August | 201 | 0 | 201 |
| 2015 July | 170 | 0 | 170 |
| 2015 June | 162 | 0 | 162 |
| 2015 May | 190 | 0 | 190 |
| 2015 April | 152 | 0 | 152 |
| 2015 March | 180 | 0 | 180 |
| 2015 February | 159 | 0 | 159 |
| 2015 January | 178 | 0 | 178 |
| 2014 December | 142 | 0 | 142 |
| 2014 November | 165 | 0 | 165 |
| 2014 October | 153 | 0 | 153 |
| 2014 September | 140 | 0 | 140 |
| 2014 August | 111 | 0 | 111 |
| 2014 July | 131 | 0 | 131 |
| 2014 June | 119 | 0 | 119 |
| 2014 May | 157 | 0 | 157 |
| 2014 April | 117 | 0 | 117 |
| 2014 March | 133 | 0 | 133 |
| 2014 February | 106 | 0 | 106 |
| 2014 January | 147 | 0 | 147 |
| 2013 December | 154 | 0 | 154 |
| 2013 November | 115 | 0 | 115 |
| 2013 October | 138 | 0 | 138 |
| 2013 September | 95 | 0 | 95 |
| 2013 August | 109 | 0 | 109 |
| 2013 July | 125 | 0 | 125 |
| 2013 June | 65 | 0 | 65 |
| 2013 May | 82 | 0 | 82 |
| 2013 April | 46 | 0 | 46 |
| 2013 March | 19 | 0 | 19 |
| 2000 January | 4083 | 0 | 4083 |
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