Professional Documents
Culture Documents
Enfoque de la falla
respiratoria aguda
Volumen 14 Suplemento 5 / Junio de 2014
Resumen
La falla respiratoria es frecuente en la unidad de cuidado intensivo y puede ser
considerada como un trastorno en la fisiología pulmonar, con capacidad de dar
lugar a morbilidad y mortalidad significativas cuando no se tiene una interven-
ción pronta y apropiada. Se desconoce en cierto modo la frecuencia global con
la que se presenta. De otro lado, la falla respiratoria aguda puede agruparse de
acuerdo con la anormalidad primaria y los componentes individuales del sistema
respiratorio. Puede surgir de una anomalía en cualquiera de los componentes
del sistema respiratorio, incluyendo vías respiratorias, alvéolos, sistema nervioso
central, sistema nervioso periférico, músculos respiratorios y pared torácica. En
última instancia, todos los mecanismos de falla respiratoria aguda deterioran
la capacidad del alvéolo para permitir la ventilación/perfusión y menoscaban
el intercambio de gases, ya sea por la absorción de oxígeno y la excreción de
dióxido de carbono o ambos.
Desde el punto de vista de la patogénesis se puede clasificar como de origen
neuromuscular, secundario a enfermedades de las vías respiratorias obstructi-
vas, o a procesos alveolares como el edema pulmonar y neumonía, y a enferme-
dades vasculares.
Asegurar la vía aérea es vital en un paciente con dificultad respiratoria aguda,
por tanto, la indicación más común en la intubación endotraqueal es la falla
respiratoria. Esperar demasiado para intubar puede contribuir a la morbilidad y
mortalidad del paciente.
Palabras clave: falla respiratoria aguda.
Abstract
(1)
Internista Neumólogo, Hos-
pital Santa Clara, Bogotá - Co- Respiratory failure is common in intensive care, can be regarded as a disorder in
lombia.
(2)
Internista Felow Neumólogo,
lung physiology with the potential to result in significant morbidity and morta-
Hospital Santa Clara, Bogotá - lity when no prompt and appropriate intervention.
Colombia.
Correspondencia:
The overall frequency of respiratory failure is not well known. Acute respira-
ducger25@hotmail.com tory failure can be grouped according to primary abnormality and the indivi-
Recibido: 16/04/2014.
dual components of the respiratory system. It may arise from an abnormality in
Aceptado: 02/05/2014. any component of the respiratory system, including the airways, alveoli, central
93
nervous system, peripheral nervous system, respiratory muscles and chest wall. All acute respiratory
failure mechanisms ultimately impair the ability of the alveolus to allow for ventilation/perfusion
and impaired gas exchange either in the absorption of oxygen, carbon dioxide excretion or both.
From the perspective of the pathogenesis of acute respiratory failure can be classified as secondary
neuromuscular origin, obstructive disease of airways, alveolar process as pulmonary edema, pneu-
monia, and vascular disease.
Ensure the airway is vital in a patient with acute respiratory distress. Therefore the most common
indication for endotracheal intubation is respiratory failure. Waiting too long to intubate may con-
tribute to morbidity and mortality of patients.
Keywords: acute respiratory failure.
Figura 1. Causas de falla respiratoria de acuerdo con las anormalidades primarias que se presentan en el paciente.
Difusa
Hipoventilación PA-aO2 elevada
Figura 3. Flujograma del abordaje según los gases arteriales y la radiología del paciente con falla respiratoria.
Tiene falla respiratoria Dudas si tiene falla respiratoria No tiene falla respiratoria
Intubación Si No
¿Alteración en
la oxigenación o
ventilación?
No Candidato a
No ventilación mecánica Si No
no invasiva
Éxito Si
Si ¿Requiere anticipar el rumbo clínico?
Observación
Si No
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