Factores asociados al éxito de la ventilación mecánica no invasiva en la paciente gestante
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Fecha
2020
Autores
Arroyo Ripoll, Manuel Fernando
Barrera Medina, Daniel Sebastián
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Ediciones Universidad Simón Bolívar
Facultad de Ciencias de la Salud
Facultad de Ciencias de la Salud
Resumen
Introducción: La insuficiencia respiratoria aguda (IRA) afecta al 0.2% de todos los embarazos, sin embargo, la morbimortalidad tanto para la madre como para el feto es alta. Las causas de insuficiencia respiratoria pueden ser específicas del embarazo como la preeclampsia, embolia de líquido amniótico y la miocardiopatía periparto.
La ventilación mecánica no invasiva (VMNI) es una intervención que pretende: mejorar el intercambio de gases, aliviar el trabajo respiratorio y disminuir la tasa de mortalidad en escenarios seleccionados; la presente publicación pretende identificar los factores relacionados con el éxito de la ventilación no invasiva en las pacientes obstétricas.
Objetivo Establecer los factores asociados al éxito de la ventilación mecánica no invasiva en una población obstétrica pertenecientes a 5 Unidades de cuidados intensivos del país entre el año 2006 al año 2017. Métodos Se realizó un estudio analítico observacional de cohorte retrospectivo, multicentrico, entre el 1 de enero de 2006 al 31 de diciembre de 2017, las variables fueron extraídas de las historias clínicas durante el periodo de 2 semanas. Se revisaron las historias de las pacientes que recibieron ventilación mecánica invasiva y no invasiva durante el periodo de estudio seleccionando aquellas que cumplieron con los criterios de selección.
Resultados Desde 1 de enero de 2006 al 31 de diciembre de 2017 se evaluaron 67 pacientes, divididos en dos grupos de ventilación mecánica, uno invasivo (VMI) compuesto por 32 pacientes (47.8%) y otro no invasiva (VMNI) conformado por 35 mujeres (52.2%). Todas pacientes obstétricas. La patología más prevalente fue la Preeclampsia (Preeclampsia severa y Síndrome de HELLP), seguido de septicemias de origen pulmonar. La presión arterial media tuvo valores mas altos en el grupo de VMNI (83,9±17,2) respecto al grupo de VMI (68,9±18,8), mostrando diferencias significativas entre los dos grupos (p-valor 0,0012). A nivel paraclínico la LHD con valores mas altos para el grupo de VMI (1145,2±1324,1) respecto al grupo VMNI (572,8±408,8; p=0,0176). la creatinina fue significativamente mas alta en el grupo de VMI respecto VMNI con valores (1,4±1,3 - 0,8±0,3; p-valor 0,0140) respectivamente. En los gases arteriales, el pH (7,36±0,08 - 7,42±0,06, p= 0,0039), siendo más alta para la VMNI. PAFI mostró diferencia; para PAFI de 300 a 201 (11 (34,4%) - 24 (68,6%). P=0,0048) siendo mayor en VMNI. Para PAFI de 149 a 101 (10 (31,3%) - 3 (8,6%); P=0,0226) con mayor proporción para la VMI.
Respecto a los scores SOFA y omSOFA (5,2 IQ: 4,7-5,74 - 3,0 IQ: 2,6-3,5, p=0,0000838), (6,3 IQ: 5,7-6,8 - 3,8 IQ: 3,3-4,3, p=0,0001757) respectivamente. Se encontró una correlación fuerte entre estos dos scores, Coeficiente de Correlación del 80.2% y un R² de 64,3%. El promedio de estancia en la UCI (10,84±6,08 - 6,06±4,61, p=0,0005) mayor para paciente con VMI, así mismo los días de ventilación (4,81±4,28 - 2,49±2,54, p=0,0080).
Conclusiones: La VMNI puede administrarse de manera segura en mujeres embarazadas con insuficiencia respiratoria hipoxémica debido a preeclampsia, cardiomiopatia periparto, neumonía adquirida en la comunidad. La estabilidad de órgano sobre todo cardiovascular y renal, un menor puntaje de la evaluación secuencial de falla orgánica y puntaje de la evaluación secuencial de falla orgánica obstétrico modificado y valores de ph y pCo2 normales para la paciente obstétrica fueron encontrados como factores asociados al éxito en la VMNI.
Introduction: Acute respiratory failure (ARF) affects 0.2% of all pregnancies, however morbidity and mortality for both the mother and the fetus are high. The causes of respiratory failure may be specific to pregnancy such as pre-eclampsia, amniotic fluid embolism, and peripartum cardiomyopathy. Non-invasive mechanical ventilation (NIMV) is an intervention that aims to: improve gas exchange, relieve respiratory work and decrease the mortality rate in selected scenarios; This publication aims to identify factors related to the success of non-invasive ventilation in obstetric patients. Objectives: To establish the factors associated with the success of non-invasive mechanical ventilation in an obstetric population belonging to 5 intensive care units in the country between 2006 and 2017. Methodology: A multicenter, retrospective, observational, analytical cohort study was conducted between January 1, 2006 and December 31, 2017, variables were extracted from the medical records during the 2-week period. The histories of patients who received invasive and non-invasive mechanical ventilation during the study period were reviewed, selecting those who met the selection criteria. Results: From January 1, 2006 to December 31, 2017, 67 patients were evaluated, divided into two mechanical ventilation groups, one invasive (IMV) composed of 32 patients (47.8%) and the other non-invasive (VMNI) made up of 35 women. (52.2%). All obstetric patients. The most prevalent pathology was Preeclampsia (severe Preeclampsia and HELLP Syndrome), followed by sepsis of pulmonary origin. The mean arterial pressure had higher values in the NIMV group (83.9 ± 17.2) compared to the IMV group (68.9 ± 18.8), showing significant differences between the two groups (p-value 0, 0012). At the paraclinical level, the LHD with higher values for the IMV group (1145.2 ± 1324.1) compared to the NIMV group (572.8 ± 408.8; p = 0.0176). creatinine was significantly higher in the IMV group compared to NIMV with values (1.4 ± 1.3 - 0.8 ± 0.3; p-value 0.0140) respectively. In arterial gases, the pH (7.36 ± 0.08 - 7.42 ± 0.06, p = 0.0039), being higher for NIMV. PAFI showed a difference; for PAFI from 300 to 201 (11 (34.4%) - 24 (68.6%). P = 0.0048) being higher in NIMV. For PAFI from 149 to 101 (10 (31.3%) - 3 (8.6%); P = 0.0226) with a higher proportion for IMV. Regarding the SOFA and omSOFA scores (5.2 IQ: 4.7-5.74 - 3.0 IQ: 2.6-3.5, p = 0.0000838), (6.3 IQ: 5.7 -6.8 - 3.8 IQ: 3.3-4.3, p = 0.0001757) respectively. A strong correlation was found between these two scores, Correlation Coefficient of 80.2% and an R² of 64.3%. The average stay in the ICU (10.84 ± 6.08 - 6.06 ± 4.61, p = 0.0005) higher for a patient with IMV, as well as the days of ventilation (4.81 ± 4.28 - 2.49 ± 2.54, p = 0.0080). Conclusions: NIMV can be administered safely in pregnant women with hypoxemic respiratory failure due to pre-eclampsia, peripartum cardiomyopathy, community- acquired pneumonia. Organ stability, especially cardiovascular and renal, a lower score for the sequential evaluation of organic failure and a score for the sequential evaluation of modified obstetric organic failure and normal pH and pCo2 values for the obstetric patient were found as factors associated with success in the VMNI.
Introduction: Acute respiratory failure (ARF) affects 0.2% of all pregnancies, however morbidity and mortality for both the mother and the fetus are high. The causes of respiratory failure may be specific to pregnancy such as pre-eclampsia, amniotic fluid embolism, and peripartum cardiomyopathy. Non-invasive mechanical ventilation (NIMV) is an intervention that aims to: improve gas exchange, relieve respiratory work and decrease the mortality rate in selected scenarios; This publication aims to identify factors related to the success of non-invasive ventilation in obstetric patients. Objectives: To establish the factors associated with the success of non-invasive mechanical ventilation in an obstetric population belonging to 5 intensive care units in the country between 2006 and 2017. Methodology: A multicenter, retrospective, observational, analytical cohort study was conducted between January 1, 2006 and December 31, 2017, variables were extracted from the medical records during the 2-week period. The histories of patients who received invasive and non-invasive mechanical ventilation during the study period were reviewed, selecting those who met the selection criteria. Results: From January 1, 2006 to December 31, 2017, 67 patients were evaluated, divided into two mechanical ventilation groups, one invasive (IMV) composed of 32 patients (47.8%) and the other non-invasive (VMNI) made up of 35 women. (52.2%). All obstetric patients. The most prevalent pathology was Preeclampsia (severe Preeclampsia and HELLP Syndrome), followed by sepsis of pulmonary origin. The mean arterial pressure had higher values in the NIMV group (83.9 ± 17.2) compared to the IMV group (68.9 ± 18.8), showing significant differences between the two groups (p-value 0, 0012). At the paraclinical level, the LHD with higher values for the IMV group (1145.2 ± 1324.1) compared to the NIMV group (572.8 ± 408.8; p = 0.0176). creatinine was significantly higher in the IMV group compared to NIMV with values (1.4 ± 1.3 - 0.8 ± 0.3; p-value 0.0140) respectively. In arterial gases, the pH (7.36 ± 0.08 - 7.42 ± 0.06, p = 0.0039), being higher for NIMV. PAFI showed a difference; for PAFI from 300 to 201 (11 (34.4%) - 24 (68.6%). P = 0.0048) being higher in NIMV. For PAFI from 149 to 101 (10 (31.3%) - 3 (8.6%); P = 0.0226) with a higher proportion for IMV. Regarding the SOFA and omSOFA scores (5.2 IQ: 4.7-5.74 - 3.0 IQ: 2.6-3.5, p = 0.0000838), (6.3 IQ: 5.7 -6.8 - 3.8 IQ: 3.3-4.3, p = 0.0001757) respectively. A strong correlation was found between these two scores, Correlation Coefficient of 80.2% and an R² of 64.3%. The average stay in the ICU (10.84 ± 6.08 - 6.06 ± 4.61, p = 0.0005) higher for a patient with IMV, as well as the days of ventilation (4.81 ± 4.28 - 2.49 ± 2.54, p = 0.0080). Conclusions: NIMV can be administered safely in pregnant women with hypoxemic respiratory failure due to pre-eclampsia, peripartum cardiomyopathy, community- acquired pneumonia. Organ stability, especially cardiovascular and renal, a lower score for the sequential evaluation of organic failure and a score for the sequential evaluation of modified obstetric organic failure and normal pH and pCo2 values for the obstetric patient were found as factors associated with success in the VMNI.
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Palabras clave
Gestante, Ventilación mecánica no invasiva, Cuidados intensivos, Pregnant, Non-invasive mechanical ventilation, Intensive care