Publication: Evaluación de la oximetría nocturna en el control de la eficacia de la ventilación mecánica no invasiva domiciliaria asociada a la evaluación clínica y gasométrica de una población heterogénea de pacientes
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2017-08-22
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Universidad Complutense de Madrid
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Abstract
La ventilación mecánica no invasiva (VMNI) se ha constituido en los últimos años en una terapia respiratoria domiciliaria muy utilizada, con claras indicaciones en pacientes con insuficiencia respiratoria crónica. Existe un alto nivel de evidencia científica en pacientes con enfermedades neuromusculares, alteraciones ventilatorias restrictivas portadores de defectos toracógenos y secuelas de tuberculosis, y con un menor nivel de evidencia aunque con un claro consenso, en el síndrome de hipoventilación-obesidad y otros síndromes de hipoventilación alveolar. En los pacientes con EPOC e insuficiencia respiratoria crónica, sin embargo, no se han establecido aún unos criterios claros de indicación de VNI, pero se considera que puede ser beneficiosa en determinados subgrupos de pacientes. Las últimas normativas de la Sociedad Alemana de Neumología del 2010 establecen criterios para la indicación de VMNI en el EPOC estable. Los objetivos fisiológicos de la VMNI son incrementar y mejorar la ventilación alveolar, mediante la corrección de la hipoventilación, y la asistencia parcial a la musculatura respiratoria, logra corregir las alteraciones del intercambio gaseoso y de los centros respiratorios. Los objetivos clínicos dependerían en parte del tipo de paciente, pero en general, pueden considerase básicamente la mejoría en la supervivencia y la calidad de vida de los pacientes. Otros objetivos incluyen la reducción en las agudizaciones, hospitalizaciones y visitas a urgencias, y por ende la reducción del gasto sanitario, lo que le convierte en una terapia coste efectiva. En la evaluación de su eficacia, además de tener en cuenta la sintomatología, variables gasométricas diurnas, funcionales, y la progresión de la enfermedad de base, es necesaria una monitorización periódica de la situación de la ventilación durante la noche, dado que esta terapia se aplica fundamentalmente durante el sueño. No existen unas normativas aceptadas ampliamente sobre la forma de seguimiento de los pacientes con VMNI domiciliaria. En general, se aconseja al menos un método sencillo como es la oximetría nocturna para determinar el efecto del soporte ventilatorio durante la noche en el paciente. Como ventajas cuenta con su simplicidad, precisar poco tiempo de interpretación y ser económicamente más accesible...
Home non-invasive ventilation (NIV) has become in recent years a widely used, with clear indications in patients with chronic respiratory insufficiency. There is a high level of scientific evidence in patients with neuromuscular diseases, disorders restrictive ventilatory disorders as thoracic cage deformity and sequelae of tuberculosis, and a lower level of evidence but with a clear consensus on the obesity-hypoventilation syndrome and other hypoventilation alveolar syndromes. In patients with COPD and chronic respiratory failure, however, they have not yet established clear criteria for indication of NIV, but is considered to be beneficial in certain subgroups of patients. The latest regulations of the German Society of Pneumology 2010 establishing criteria for indication of NIV in stable COPD. Physiological objectives of NIV are to increase and improve alveolar ventilation, by correcting hypoventilation, partial assistance to the respiratory muscles, and correct alterations in gas exchange and respiratory centers. Clinical objectives would depend in part on the type of patient, but in general can basically based in the improved survival and quality of life of patients. Other objectives include reducing exacerbations, hospitalizations and emergency room visits, and thus reducing health spending, making it a cost effective therapy. In assessing its effectiveness, taking into account the symptoms, daytime blood gases, functional, and progression of the underlying disease, regular monitoring of the situation of ventilation is necessary overnight, since this therapy applies primarily during sleep. There are few widely accepted standards on how to monitor patients with home NIV. In general, we recommend at least a simple method such as nocturnal oximetry to determine the effect of overnight ventilatory support to the patient. As advantages has its simplicity, which carries little interpretation time and be economically more accessible...
Home non-invasive ventilation (NIV) has become in recent years a widely used, with clear indications in patients with chronic respiratory insufficiency. There is a high level of scientific evidence in patients with neuromuscular diseases, disorders restrictive ventilatory disorders as thoracic cage deformity and sequelae of tuberculosis, and a lower level of evidence but with a clear consensus on the obesity-hypoventilation syndrome and other hypoventilation alveolar syndromes. In patients with COPD and chronic respiratory failure, however, they have not yet established clear criteria for indication of NIV, but is considered to be beneficial in certain subgroups of patients. The latest regulations of the German Society of Pneumology 2010 establishing criteria for indication of NIV in stable COPD. Physiological objectives of NIV are to increase and improve alveolar ventilation, by correcting hypoventilation, partial assistance to the respiratory muscles, and correct alterations in gas exchange and respiratory centers. Clinical objectives would depend in part on the type of patient, but in general can basically based in the improved survival and quality of life of patients. Other objectives include reducing exacerbations, hospitalizations and emergency room visits, and thus reducing health spending, making it a cost effective therapy. In assessing its effectiveness, taking into account the symptoms, daytime blood gases, functional, and progression of the underlying disease, regular monitoring of the situation of ventilation is necessary overnight, since this therapy applies primarily during sleep. There are few widely accepted standards on how to monitor patients with home NIV. In general, we recommend at least a simple method such as nocturnal oximetry to determine the effect of overnight ventilatory support to the patient. As advantages has its simplicity, which carries little interpretation time and be economically more accessible...
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Tesis inédita de la Universidad Complutense de Madrid, Facultad de Medicina, Departamento de Medicina, leída el 18-01-2016