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Vol. 29. Núm. 5.
Páginas 220-225 (Junio - Julio 1993)
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Vol. 29. Núm. 5.
Páginas 220-225 (Junio - Julio 1993)
DOI: 10.1016/S0300-2896(15)31215-1
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Efectos a corto plazo del uso domiciliario de ventilación mecánica nocturna con presión positiva continua por vía nasal en pacientes con enfermedad pulmonar obstructiva crónica
The short term effects of nocturnal domiciliary mechanical ventilation with nasal continuous positive pressure in patients with chronic obstructive pulmonary disease
Visitas
...
M.A. Morales Gordillo, R. Otero Candelera, J.F. Medina Gallardo, F. Hernández Utrera, F. Capote Gil, J. Castillo Gómez
Servicio de Neumología. Hospital Universitario Virgen del Rocío. Sevilla
Información del artículo

Hemos estudiado el efecto de la aplicación nocturna de CPAPn, durante un período de tres meses, sobre la mecánica pulmonar, el intercambio gaseoso y su repercusión clínica en pacientes con EPOC e insuficiencia respiratoria global crónica. El estudio se realizó en 12 pacientes con EPOC (FEV1 + SD=29±8%) e hipercapnia crónica (PaCO2±SD=55±6) clínicamente estables, utilizando un grupo control de siete pacientes con similar grado de obstrucción e hipercapnia (FEV1±SD=35±9%; PaCO2±SD=50±4). Se aplicó CPAP durante las horas de sueño (tiempo medio de 6 horas; rango: 5-10 horas) a una presión media de 7,5cm H2O (rango: 5-10cm H2O). Se obtuvo mejoría en el volumen residual (RV) (p<0,05), presión inspiratoria máxima (PIM) (p<0,02) y en la sensación de disnea valorada mediante la escala de Borg (p<0,05). No observamos cambios estadísticamente significativos en los valores correspondientes a flujos, resistencia de la vía aérea, patrón ventilatorio ni en los valores gasométricos. En el grupo control no encontramos cambios significativos en ninguno de los parámetros evaluados. De nuestros resultados se puede deducir que la aplicación de CPAPn intermitente nocturna, a corto plazo, mejora la hiperinsuflación, la fuerza muscular y la sensación de disnea de pacientes con EPOC de grado moderado-severo. Por tanto, esta forma de ventilación mecánica podría ser considerada como una posibilidad terapéutica eficaz de la que se podrían beneficiar estos pacientes.

The effect of the nocturnal application of CPAPn on pulmonary mechanics over a period of three months, gaseous exchange and clinical repercussion in patients with chronic obstructive pulmonary disease (COPD) and chronic respiratory failure were studied. Twelve patients with COPD (FEV1±SD=29±8%) and clinically stable chronic hypercapnia (PaCO2±SD=55±6) were studied using a control group of seven patients with a similar grade of obstruction and hypercapnia (FEV1±SD=35±9%; PaCO2±SD=50±4). CPAPn was applied during the hours of sleep (mean time 6 hours, range 5-10 hours) at a mean pressure of 7.5cm of H2O=(range: 5-10cmH2O). Improvement was observed in residual volume (RV) (p<0.05), maximum inspiratory pressure (MIP) (p<0.02) and in the sensation of dyspnea evaluated by the Borg scale (p<0.05). No significant statistical differences were seen in the values corresponding to flows, airway resistance, ventilation pattern or in the gasometric values. No significant changes were found in any of the parameters evaluated. From these results it may be deduced that the short term application of intermittent nocturnal CPAPn improves hyperinsuflation, muscular strength and the sensation of dyspnea in patients with moderate-servere grades of COPD. Therefore this type of mechanical ventilation could be considered as an effective therapeutic possibility for these patients.

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