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Evolución comparativa con ventilación no invasiva de pacientes con EPOC, síndrome de hipoventilación-obesidad e insuficiencia cardíaca congestiva ingresados en una unidad de monitorización respiratoria
Evolution of Patients With Chronic Obstructive Pulmonary Disease, Obesity Hypoventilation Syndrome or Congestive Heart Failure in a Respiratory Monitoring Unit
Ángel Ortega González, Germán Peces-Barba Romero
, Itziar Fernández Ormaechea, René Chumbi Flores, Noelia Cubero de Frutos, Nicolás González Mangado
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gpecesba@fjd.es
Correspondencia: Dr. G. Peces-Barba Romero. Servicio de Neumología. Fundación Jiménez Díaz-UTE. Avda. Reyes Católicos, 2. 28040 Madrid. España.
Correspondencia: Dr. G. Peces-Barba Romero. Servicio de Neumología. Fundación Jiménez Díaz-UTE. Avda. Reyes Católicos, 2. 28040 Madrid. España.
Servicio de Neumología. Fundación Jiménez Díaz. Madrid. España
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"apellidos" => "Soriano" ] 1 => array:2 [ "nombre" => "José Luis" "apellidos" => "Izquierdo Alonso" ] ] ] ] ] "idiomaDefecto" => "es" "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S0300289606706822?idApp=UINPBA00003Z" "url" => "/03002896/0000004200000009/v1_201305141822/S0300289606706822/v1_201305141822/es/main.assets" ] "es" => array:15 [ "idiomaDefecto" => true "cabecera" => "<span class="elsevierStyleTextfn">Originales</span>" "titulo" => "Evolución comparativa con ventilación no invasiva de pacientes con EPOC, síndrome de hipoventilación-obesidad e insuficiencia cardíaca congestiva ingresados en una unidad de monitorización respiratoria" "tieneTextoCompleto" => 0 "paginas" => array:1 [ 0 => array:2 [ "paginaInicial" => "423" "paginaFinal" => "429" ] ] "autores" => array:1 [ 0 => array:4 [ "autoresLista" => "Ángel Ortega González, Germán Peces-Barba Romero, Itziar Fernández Ormaechea, René Chumbi Flores, Noelia Cubero de Frutos, Nicolás González Mangado" "autores" => array:6 [ 0 => array:2 [ "nombre" => "Ángel" "apellidos" => "Ortega González" ] 1 => array:4 [ "nombre" => "Germán" "apellidos" => "Peces-Barba Romero" "email" => array:1 [ 0 => "gpecesba@fjd.es" ] "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">¿</span>" "identificador" => "cor1" ] ] ] 2 => array:2 [ "nombre" => "Itziar" "apellidos" => "Fernández Ormaechea" ] 3 => array:2 [ "nombre" => "René" "apellidos" => "Chumbi Flores" ] 4 => array:2 [ "nombre" => "Noelia" "apellidos" => "Cubero de Frutos" ] 5 => array:2 [ "nombre" => "Nicolás" "apellidos" => "González Mangado" ] ] "afiliaciones" => array:1 [ 0 => array:1 [ "entidad" => "Servicio de Neumología. Fundación Jiménez Díaz. Madrid. España" ] ] "correspondencia" => array:1 [ 0 => array:3 [ "identificador" => "cor1" "etiqueta" => "⁎" "correspondencia" => "Correspondencia: Dr. G. Peces-Barba Romero. Servicio de Neumología. Fundación Jiménez Díaz-UTE. Avda. Reyes Católicos, 2. 28040 Madrid. España." ] ] ] ] "titulosAlternativos" => array:1 [ "en" => array:1 [ "titulo" => "Evolution of Patients With Chronic Obstructive Pulmonary Disease, Obesity Hypoventilation Syndrome or Congestive Heart Failure in a Respiratory Monitoring Unit" ] ] "pdfFichero" => "main.pdf" "tienePdf" => true "fechaRecibido" => "2005-08-29" "fechaAceptado" => "2006-02-07" "PalabrasClave" => array:2 [ "es" => array:1 [ 0 => array:4 [ "clase" => "keyword" "titulo" => "Palabras clave" "identificador" => "xpalclavsec153144" "palabras" => array:7 [ 0 => "Ventilación no invasiva (VNI)" 1 => "Insuficiencia respiratoria aguda" 2 => "Enfermedad pulmonar obstructiva crónica (EPOC)" 3 => "Síndrome de hipoventilación-obesidad (SHO)" 4 => "Insuficiencia cardíaca congestiva" 5 => "Acidosis hipoxémica-hipercápnica" 6 => "Unidad de monitorización respiratoria" ] ] ] "en" => array:1 [ 0 => array:4 [ "clase" => "keyword" "titulo" => "Key words" "identificador" => "xpalclavsec153145" "palabras" => array:7 [ 0 => "Noninvasive ventilation" 1 => "Respiratory insufficiency" 2 => "Chronic obstructive pulmonary disease" 3 => "Obesity hypoventilation syndrome" 4 => "Heart failure, congestive" 5 => "Acidosis : respiratory" 6 => "Respiratory Monitoring Unit" ] ] ] ] "tieneResumen" => true "resumen" => array:2 [ "es" => array:1 [ "resumen" => "<span class="elsevierStyleSectionTitle">Objetivo</span><p class="elsevierStyleSimplePara elsevierViewall">Hemos realizado un trabajo comparativo en pacientes con enfermedad pulmonar obstructiva crónica (EPOC), síndrome de hipoventilación-obesidad (SHO) e insuficiencia cardíaca congestiva (ICC) sometidos a ventilación no invasiva (VNI) en una unidad de monitorización de neumología por presentar acidosis hipoxémica-hipercápnica. El objetivo ha sido valorar la respuesta clínica y gasométrica en función del diagnóstico.</p> <span class="elsevierStyleSectionTitle">Pacientes y métods</span><p class="elsevierStyleSimplePara elsevierViewall">Se trata de un estudio prospectivo (12 meses de duración) en 53 pacientes con acidosis hipoxémicahipercápnica, de los que 27 presentaban EPOC; 17, SHO, y 9, ICC. Realizamos un análisis de la gravedad gasométrica inicial, de la evolución gasométrica (tras tratamiento convencional y tras VNI a las 1-3 h y 12-24 h) y de la mortalidad. Todos ellos recibieron VNI tipo BiPAP en modo asistido-controlado.</p> <span class="elsevierStyleSectionTitle">Resultados</span><p class="elsevierStyleSimplePara elsevierViewall">La presentación gasométrica inicial era similar en las 3 entidades (valores medios ± desviación estándar de pH, 7,28<span class="elsevierStyleHsp" style=""></span>±<span class="elsevierStyleHsp" style=""></span>0,1 en la EPOC; 7,29<span class="elsevierStyleHsp" style=""></span>±<span class="elsevierStyleHsp" style=""></span>0,09 en SHO, y 7,24<span class="elsevierStyleHsp" style=""></span>±<span class="elsevierStyleHsp" style=""></span>0,07 en ICC; no significativo). Tras tratamiento convencional inicial, en los pacientes con EPOC se observó un empeoramiento de la presión arterial de anhídrido carbónico (p<span class="elsevierStyleHsp" style=""></span>=<span class="elsevierStyleHsp" style=""></span>0,026), y en aquellos con ICC, una mejoría de la presión arterial de oxígeno (p<span class="elsevierStyleHsp" style=""></span>=<span class="elsevierStyleHsp" style=""></span>0,028). Tras el inicio de la VNI (1-3 h) se produjo una mejoría del pH (p<span class="elsevierStyleHsp" style=""></span>=<span class="elsevierStyleHsp" style=""></span>0,002) y de la presión arterial de oxígeno (p<span class="elsevierStyleHsp" style=""></span>=<span class="elsevierStyleHsp" style=""></span>0,041) en la EPOC, y del pH (p<span class="elsevierStyleHsp" style=""></span>=<span class="elsevierStyleHsp" style=""></span>0,03) y de la presión arterial de anhídrido carbónico (p<span class="elsevierStyleHsp" style=""></span>=<span class="elsevierStyleHsp" style=""></span>0,045) en el SHO; no hubo cambios significativos en la ICC. Tras 12-24 h con VNI, el pH fue de 7,36<span class="elsevierStyleHsp" style=""></span>±<span class="elsevierStyleHsp" style=""></span>0,04 en la EPOC, de 7,36<span class="elsevierStyleHsp" style=""></span>±<span class="elsevierStyleHsp" style=""></span>0,05 en el SHO y de 7,25<span class="elsevierStyleHsp" style=""></span>±<span class="elsevierStyleHsp" style=""></span>0,1 (no significativo) en la ICC. La mortalidad fue del 11,1% en la EPOC, del 0% en el SHO y del 33,3% en la ICC (no significativo; p = 0,076).</p> <span class="elsevierStyleSectionTitle">Conclusiones</span><p class="elsevierStyleSimplePara elsevierViewall">Partiendo de una gravedad gasométrica similar, en el SHO y la EPOC se observó una mejor respuesta a la VNI que en la ICC. El inicio de la VNI suele precederse de mala respuesta al tratamiento convencional en la EPOC, lo que haría replantearse la demora para iniciarla.</p>" ] "en" => array:1 [ "resumen" => "<span class="elsevierStyleSectionTitle">Objective</span><p class="elsevierStyleSimplePara elsevierViewall">We compared the use of noninvasive ventilation (NIV) for hypercapnic acidosis with hypoxemia in patients with chronic obstructive pulmonary disease (COPD), obesity hypoventilation syndrome (OHS), or congestive heart failure (CHF) in a respiratory medicine monitoring unit. The objective was to evaluate each diagnostic group’s response to therapy in terms of clinical course and evolution of blood gases.</p> <span class="elsevierStyleSectionTitle">Patients and methods</span><p class="elsevierStyleSimplePara elsevierViewall">Prospective, 12-month study of 53 patients with hypercapnic acidosis with hypoxemia. Twenty-seven patients had COPD, 17 OHS, and 9 CHF. Severity was assessed based on initial arterial blood gas analysis. Clinical course was studied by blood gas analysis after conventional treatment and after NIV (1-3 hours and 12-24 hours). Mortality was recorded. All patients received bilevel positive airway pressure support in assist-control mode.</p> <span class="elsevierStyleSectionTitle">Results</span><p class="elsevierStyleSimplePara elsevierViewall">No significant differences were observed between mean (SD) initial pH findings in the 3 diagnostic groups: COPD, 7.28 (0.1); OHS, 7.29 (0.09); and CHF, 7.24 (0.07). (nonsignificant differences). After initial conventional treatment, PaCO<span class="elsevierStyleInf">2</span> worsened for COPD patients (<span class="elsevierStyleItalic">P</span>=.026) and PaO<span class="elsevierStyleInf">2</span> improved for CHF patients (<span class="elsevierStyleItalic">P</span>=.028). After 1 to 3 hours of NIV, pH (<span class="elsevierStyleItalic">P</span>=.002) and PaO<span class="elsevierStyleInf">2</span> (<span class="elsevierStyleItalic">P</span>=.041) improved for COPD patients, and pH (<span class="elsevierStyleItalic">P</span>=.03) and PaCO<span class="elsevierStyleInf">2</span> (<span class="elsevierStyleItalic">P</span>=.045) improved in OHS patients; no significant changes were observed in CHF patients. After 12 to 24 hours of NIV, the mean pH was 7.36 (0.04) for COPD patients, 7.36 (0.05) for OHS patients, and 7.25 (0.1) for CHF patients (not significant). The mortality rate was 11.1% for COPD, 0% for OHS, and 33.3% for CHS (not significant, <span class="elsevierStyleItalic">P</span>=.076).</p> <span class="elsevierStyleSectionTitle">Conclusions</span><p class="elsevierStyleSimplePara elsevierViewall">In this group of patients with similar initial arterial blood gas values, response to NIV was seen to be better in OHS and COPD than in CHF. 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Article information
ISSN: 03002896Original language: Spanish
DOI:10.1157/13092411
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| 2016 December | 51 | 23 | 74 |
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| 2016 February | 47 | 6 | 53 |
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| 2015 December | 58 | 19 | 77 |
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| 2015 October | 100 | 1 | 101 |
| 2015 September | 75 | 0 | 75 |
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| 2015 April | 78 | 0 | 78 |
| 2015 March | 65 | 0 | 65 |
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| 2014 December | 57 | 0 | 57 |
| 2014 November | 74 | 0 | 74 |
| 2014 October | 77 | 0 | 77 |
| 2014 September | 69 | 0 | 69 |
| 2014 August | 72 | 0 | 72 |
| 2014 July | 79 | 0 | 79 |
| 2014 June | 90 | 0 | 90 |
| 2014 May | 82 | 0 | 82 |
| 2014 April | 92 | 0 | 92 |
| 2014 March | 97 | 0 | 97 |
| 2014 February | 83 | 0 | 83 |
| 2014 January | 67 | 0 | 67 |
| 2013 December | 57 | 0 | 57 |
| 2013 November | 58 | 0 | 58 |
| 2013 October | 72 | 0 | 72 |
| 2013 September | 70 | 0 | 70 |
| 2013 August | 73 | 0 | 73 |
| 2013 July | 104 | 0 | 104 |
| 2013 June | 70 | 0 | 70 |
| 2013 May | 74 | 0 | 74 |
| 2013 April | 35 | 0 | 35 |
| 2013 March | 14 | 0 | 14 |
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