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Vol. 56. Núm. 2.
Páginas 121-126 (Febrero 2002)
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Vol. 56. Núm. 2.
Páginas 121-126 (Febrero 2002)
Acceso a texto completo
Nuevas tendencias en ventilación mecánica
New trends in mechanical ventilation
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A. Greenough
Autor para correspondencia
anne.greenough@kcl.ac.uk

Correspondencia: Children Nationwide Regional Neonatal Intensive Care. 4th Floor, Ruskin Wing. King’s College Hospital. Londres SE5 9RS Reino Unido.
Children Nationwide Professor of Neonatology and Clinical Respiratory Physiology. Head of the Academic Department of Paediatrics. Guy’s, King’s and St. Thomas’ Medical School. King’s College Hospital. Londres
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En la Unidad de Cuidados Intensivos Neonatales se aplican diversas técnicas ventilatorias, aunque se dispone de evidencias limitadas que respalden su uso, particularmente de las modalidades de introducción más reciente. En estudios aleatorizados se ha demostrado que la ventilación con presión positiva intermitente y frecuencias elevadas reduce los escapes aéreos y que la ventilación asistida sincronizada con el paciente se ha asociado a una reducción de la duración de la ventilación. La ventilación de alta frecuencia oscilatoria “de rescate™ parece reducir la incidencia de escapes aéreos y la ventilación de alta frecuencia oscilatoria profiláctica reduce la enfermedad pulmonar crónica, aunque posiblemente a expensas de un aumento de la patología intracerebral. Los resultados de estudios de casuística indican que la ventilación con presión positiva continua nasal, la ventilación con volumen garantizado y la ventilación con presión de soporte, presentan ventajas, si bien estas técnicas no se han sometido a un análisis riguroso en estudios aleatorizados extensos. Los neonatólogos no deben dejarse seducir por unos resultados preliminares prometedores. Las estrategias ventilatorias deben introducirse en la práctica clínica únicamente si se ha demostrado su eficacia y su falta de afectos adversos a largo plazo en estudios de dimensión y diseño adecuados.

Palabras clave:
Presión positiva continua de las vías respiratorias
Ventilación asistida y sincronizada
Alta frecuencia oscilatoria
Recién nacidos

Many ventilatory techniques are employed on the Neonatal Intensive Care Unit, but there is limited evidence supporting the use, in particular of the more recently introduced modes. Randomized trials have demonstrated that high frequency positive pressure ventilation reduced airleaks and patient triggered ventilation was associated with a shorter duration of ventilation. “Rescue™ high frequency oscillation was suggested to reduce airleaks and prophylactic high frequency oscillation decrease chronic lung disease, but possibly at the expense of increased intracerebral pathology. Results from anecdotal series suggest that nasal continuous positive airways pressure, volume guarantee and pressure support ventilation have advantages, but the techniques have not been subjected to rigorous testing in large randomized trials. Neonatologists must not be seduced by promising preliminary results. Ventilatory strategies should only be introduced into routine clinical practice if proven efficacious and without long term adverse effects in appropriately sized studies.

Key words:
Continuous positive airway pressure
Patient triggered ventilation
High frequency oscillation
New borns
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