Del soporte ventilatorio a la autonomía respiratoria
Una revisión narrativa de los predictores del destete en cuidados críticos
Keywords:
Desconexión del Ventilador, Ventilación Mecánica, Factores de Riesgo, Unidad de Cuidados Intensivos, UCIAbstract
La ventilación mecánica constituye un soporte vital que reemplaza la función respiratoria en pacientes críticamente enfermos, permitiendo un intercambio gaseoso adecuado mientras se trata la patología subyacente. Esta revisión narrativa explora los factores clínicos, fisiológicos y contextuales que influyen en el proceso de destete de la ventilación mecánica invasiva (VMI). Para ello, se realizó una búsqueda las bases de datos especializadas PubMed, Epistemonikos, Cochrane Library y TripDatabase, seleccionando estudios relacionados con insuficiencia respiratoria aguda (IRA), síndrome de distrés respiratorio agudo (SDRA), debilidad muscular adquirida en unidades de cuidados intensivos (UCI) y estrategias de destete, de hace 5 años al momento de la revisión. Los hallazgos más relevantes señalan que variables como el puntaje APACHE II (Acute Physiology And Chronic Health Evaluation II), enfermedad pulmonar obstructiva crónica (EPOC), diabetes, duración de la ventilación, estado nutricional, edad y parámetros respiratorios (PaO₂/FiO₂), presión de meseta y compliance pulmonar), así como la magnitud de la respuesta inflamatoria sistémica, influyen en el éxito del destete. También se identificaron factores determinantes en subgrupos específicos, como pacientes con quemaduras extensas o IRA. Esta revisión destaca la heterogeneidad de los pacientes críticos y la necesidad de estrategias de destete individualizadas, subrayando la importancia de intervenciones como la movilización precoz y el soporte nutricional. Se concluye que la identificación oportuna de factores de riesgo y la implementación de protocolos adaptados pueden optimizar el proceso de destete, reducir complicaciones y mejorar la eficiencia clínica con recursos limitados.
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