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Vol. 46. Issue S6.
II Foro Nacional de Neumólogos en Formación
Pages 14-21 (October 2010)
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Vol. 46. Issue S6.
II Foro Nacional de Neumólogos en Formación
Pages 14-21 (October 2010)
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Ventilación no invasiva
Non-invasive ventilation
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115637
Jose Manuel Gallardo Romeroa, Teresa Gómez Garcíab, José Norberto Sancho Chustc, Mónica González Martínezd,
Corresponding author
Mogonzalez@Humv.Es

Autor para correspondencia.
a Complejo Asistencial de Burgos, Burgos, España
b Hospital Gregorio Marañón, Madrid, España
c Hospital Sant Joan de Alicant, Alicante, España
d Hospital Universitario Marqués de Valdecilla, Santander, España
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La llegada de la ventilación mecánica no invasiva (VMNI) ha condicionado un cambio radical en el manejo de la insuficiencia respiratoria aguda y crónica. A lo largo de los últimos años, hemos asistido al incremento progresivo en el número de aplicaciones posibles de la VMNI, tanto en el ámbito hospitalario como extrahospitalario. Su uso se ha universalizado en todos los hospitales y en la actualidad los residentes del siglo XXI reciben una formación específica que no existía hasa hace sólo unos años.

Es deber de todos nosotros encabezar el avance asistencial y científico que ha supuesto el desarrollo de la VMNI, liderando los acontecimientos que acompañen al mejor conocimiento de las bases fisiopatológicas de la ventilación, de sus continuas aplicaciones en la práctica clínica diaria y del perfeccionamiento de los elementos necesarios para una correcta aplicación de la técnica.

En la presente revisión se pretende efectuar un recorrido global en el procedimiento de la VMNI, desde los conocimientos más teóricos –fisiopatología de la VMNI–, hasta las habilidades más prácticas –reconocimiento de las asincronías paciente-ventilador–. En este progreso de lo complejo a lo básico o de lo básico a lo complejo, según se mire, intentaremos profundizar en las nociones necesarias para comprender el propio funcionamiento técnico del ventilador, adentrándonos en los diferentes modos y parámetros, y exponiendo las capacidades que debemos desarrollar para la correcta indicación, uso y monitorización de la técnica, con una última reflexión acerca de otras ayudas respiratorias que podemos ofrecer a pacientes con fracaso ventilatorio.

Palabras clave:
Ventilación no invasiva
Insuficiencia respiratoria
Mecanismos de acción
Tipos de ventiladores
Modos y parámetros ventilatorios
Monitorización
Asincronía
Abstract

The advent of non-invasive mechanical ventilation (NIMV) has radically changed the management of acute and chronic respiratory failure. Over the last few years, the number of possible applications of NIMV has progressively increased, both in the hospital and extrahospital setting. NIMV is now used in all hospitals and resident physicians currently receive specific training –nonexistent until a few years ago– in this modality.

It falls to all of us to push forward the clinical and scientific advances represented by the development of NIMV, by promoting the events that accompany better knowledge of the physiopathological bases of ventilation and of its continuous applications in daily clinical practice and by perfecting the elements required for the correct application of this technique.

The present review aims to provide a broad overview of NIMV, from the most theoretical knowledge (the physiopathology of NIMV) to the most practical skills (recognition of patient-ventilator asynchrony). Through this progression from the complex to the most basic, or from the basics to the most complex, depending on the perspective taken, we aim to provide deeper knowledge of the concepts required to understand the technical functioning of the ventilator, describing its distinct modes and parameters and the abilities that must be developed for the correct indication, use and monitoring of the technique. We provide a final reflection on other forms of respiratory support that can be offered to patients with ventilatory failure.

Keywords:
Non-invasive mechanical ventilation
Respiratory failure
Mechanisms of action
Ventilator types
Ventilator modes and parameters
Monitoring asynchrony
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