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2020, Número 1

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Neumol Cir Torax 2020; 79 (1)


Efecto de tres modos ventilatorios como único soporte en un modelo experimental de inflamación sistémica por lipopolisacárido sobre la hemodinamia, fisiología pulmonar e histología

Guzmán-Cedillo AE, Olmos-Zúñiga JR, Jasso-Victoria R, García-Torrentera R, Gaxiola-Gaxiola M, Silva-Martínez M, Vázquez-Justiniano LF, Baltazares-Lipp M, Hernández-Jiménez C, Zenteno-Galindo E, Vadillo-Ortega F, González-Camarena R

Idioma: Español
Referencias bibliográficas: 60
Paginas: 37-49
Archivo PDF: 1393.71 Kb.


RESUMEN

Introducción: La asistencia mecánica ventilatoria (AMV) en modo liberación por presión de la vía aérea (APRV) y ventilación de alta frecuencia oscilatoria (VAFO) favorecen la protección pulmonar, pero no se utilizan en pacientes con sepsis. Objetivo: Comparar el efecto de la AMV en modo de ventilación controlada por presión (VCP), APRV y VAFO como única terapia sobre la hemodinamia, gasometría, mecánica e histología pulmonar en un modelo porcino de inflamación sistémica inducida por lipopolisacárido de Escherichia coli (E. coli). Material y métodos: Dieciocho cerdos con inflamación sistémica lipopolisacárido (LPS) E. coli, se trataron únicamente con AMV: grupo I: VCP, grupo II: APRV y grupo III: VAFO. Durante seis horas se evaluó la hemodinamia, gasometría, mecánica e histología pulmonar. Resultados: Los tres modos ventilatorios alteran la hemodinamia pulmonar, pero mantienen la gasometría y mecánica pulmonar. El modo VAFO mantiene estables los valores hemodinámicos sistémicos, disminuye la hiperlactatemia (p ‹ 0.05, ANDEVA-MR) y produce menor daño histológico (p ‹ 0.05, Kruskal-Wallis). Conclusión: Los modos VCP, APRV y VAFO utilizados como único soporte en las fases iniciales de inflamación sistémica inducida con LPS en cerdos, mantienen los valores gasométricos y ventilatorios dentro de los parámetros normales; pero, el modo VAFO favorece la recuperación de los valores hemodinámicos sistémicos y produce menor daño histológico.


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