{"id":1429,"date":"2018-04-05T21:29:45","date_gmt":"2018-04-05T21:29:45","guid":{"rendered":"http:\/\/localhost:8080\/mywordpress\/mechanical-ventilation\/"},"modified":"2020-09-18T14:59:30","modified_gmt":"2020-09-18T21:59:30","slug":"vent_weaning","status":"publish","type":"page","link":"http:\/\/142.11.238.239\/es\/vent_weaning\/","title":{"rendered":"Ventilaci\u00f3n mec\u00e1nica"},"content":{"rendered":"<div class=\"l3-header-con no-banner\">\n<div class=\"l3-header-icon\">\n\t\t<img decoding=\"async\"  src=\"\/wp-content\/uploads\/2018\/12\/Vent-Icon.png\" alt=\"keys\" \/>\n\t<\/div>\n<div class=\"l3-header-text no-banner\">\n\t\t\t\tVentilaci\u00f3n mec\u00e1nica\n                         <\/div>\n<\/p><\/div>\n<div style=\"clear:both\"><\/div>\n\r\n<ul class=\"breadcrumb\">\r\n\t<li class=\"active\">Claves Del \u00c9xito<\/li>\r\n\t<li class=\"dropdown\">\r\n\t\t<a href=\"#\" class=\"dropdown-toggle\" data-toggle=\"dropdown\">See All Articles <b class=\"caret\"><\/b><\/a>\r\n\t\t<ul class=\"dropdown-menu\">\r\n\r\n\t\t\t<li class=\"\"><a href=\"http:\/\/142.11.238.239\/es\/cuff_aspiration\/\">Desinflado del manguito<\/a><\/li>\r\n\r\n\t\t\t<li class=\"\"><a href=\"http:\/\/142.11.238.239\/es\/secretions\/\">Manejo de la Secreciones<\/a><\/li>\r\n\r\n\t\t\t<li class=\"\"><a href=\"http:\/\/142.11.238.239\/es\/size\/\">Tama\u00f1o del tubo de traqueostom\u00eda<\/a><\/li>\r\n\r\n\t\t\t<li class=\"\"><a href=\"http:\/\/142.11.238.239\/es\/vent_weaning\/\">Ventilaci\u00f3n mec\u00e1nica<\/a><\/li>\r\n\r\n\t\t\t<li class=\"\"><a href=\"http:\/\/142.11.238.239\/es\/vent_adjust\/\">Alarmas de Ventilaci\u00f3n mec\u00e1nica<\/a><\/li>\r\n\r\n\t\t<\/ul>\r\n\t<\/li>\r\n<\/ul>\r\n\n<h2 class=\"seminars_header\">Concepto err\u00f3neo: \"Tenemos que esperar hasta que el\npaciente est\u00e9 desconectado del ventilador\"<\/h2>\n<p class=\"page_paragraph translation-block\">Muchos cl\u00ednicos creen que es necesario esperar hasta\nque el paciente sea desconectado de la ventilaci\u00f3n\nmec\u00e1nica para colocar la V\u00e1lvula <span class=\"pm_ws\">Passy Muir<\/span><sup>\u00ae<\/sup>. Sin\nembargo, la evidencia indica que:<\/p>\n<ul>\n<li>\n<p class=\"page_paragraph\">Un retraso en el tratamiento puede hacer m\u00e1s da\u00f1o que\nbien. Hasta el 50% de pacientes de unidades de cuidados\nintensivos que requieren ventilaci\u00f3n mec\u00e1nica presentan\nS\u00edndrome de respuesta inflamatoria sist\u00e9mica (SIRS). 50-\n70% de los pacientes con SIRS desarrollan debilidad\nmuscular patol\u00f3gica difusa (miopat\u00eda) y trastornos de los\nnervios perif\u00e9ricos.<sup>1<\/sup><\/p>\n<\/li>\n<li>\n<p class=\"page_paragraph\">La debilidad muscular es un factor predictivo\nindependiente de disfunci\u00f3n far\u00edngea y aspiraci\u00f3n\nsintom\u00e1tica. La neumon\u00eda causada por la aspiraci\u00f3n\ncausa una lesi\u00f3n pulmonar aguda, que se traduce en\nfracaso de la desconexi\u00f3n, retraso del alta hospitalaria y\nmortalidad.<sup>2<\/sup><\/p>\n<\/li>\n<li>\n<p class=\"page_paragraph\">La incapacidad para comunicarse causa la mayor\nansiedad para los pacientes con ventilaci\u00f3n mec\u00e1nica. La\nansiedad inducida por el miedo compromete\nnotablemente la funci\u00f3n respiratoria y contribuye a los\nfracasos posteriores a la desconexi\u00f3n.<sup>3<\/sup><\/p>\n<\/li>\n<\/ul>\n<h3 class=\"seminars_header translation-block\">La investigaci\u00f3n cl\u00ednica demuestra que el uso temprano\nde la V\u00e1lvula <span class=\"pm_ws\">Passy Muir<\/span><sup>\u00ae<\/sup>, incluida la aplicaci\u00f3n del\nventilador, puede acelerar la desconexi\u00f3n del ventilador.<\/h3>\n<ul>\n<li>\n<p class=\"page_paragraph translation-block\">El uso de la V\u00e1lvula <span class=\"pm_ws\">Passy Muir<\/span> en pacientes con\nventilaci\u00f3n mec\u00e1nica facilita la vocalizaci\u00f3n\nindependiente, lo que les permite convertirse en\nparticipantes activos en su atenci\u00f3n m\u00e9dica. Mejorar la\ncomunicaci\u00f3n entre el paciente y el equipo de atenci\u00f3n\nm\u00e9dica reduce la ansiedad de los pacientes y mejora su\nsentido de bienestar, dignidad y motivaci\u00f3n para\ndesconectarse.<sup>4-6<\/sup><\/p>\n<\/li>\n<li>\n<p class=\"page_paragraph translation-block\">La V\u00e1lvula <span class=\"pm_ws\">Passy Muir<\/span> restablece un sistema respiratorio\ncerrado que restaura la PEEP fisiol\u00f3gica, lo que mejora\nlas saturaciones de ox\u00edgeno y reduce el soporte del\nventilador. Hay una mayor tolerancia a los intentos de\ndesconexi\u00f3n que conducen a la ventilaci\u00f3n\nindependiente. Los pacientes informaron que la\nventilaci\u00f3n es m\u00e1s f\u00e1cil y que han podido tolerar los\nensayos de CPAP durante m\u00e1s tiempo con la V\u00e1lvula en\nsu lugar.<\/li>\n<\/p>\n<li>\n<p class=\"page_paragraph\">Los equipos multidisciplinarios que incorporan la V\u00e1lvula\ncomo una estrategia de rutina en la desconexi\u00f3n del\nventilador han mejorado los resultados. En un estudio de\ncuidados cr\u00edticos, el University College London Hospital\nencontr\u00f3 una reducci\u00f3n en la UCI y la mortalidad\nhospitalaria, as\u00ed como la duraci\u00f3n de la ventilaci\u00f3n\nmec\u00e1nica (reducci\u00f3n promedio de 11 d\u00edas) despu\u00e9s de un\nenfoque en equipo con el uso de V\u00e1lvulas de habla.<sup>8<\/sup><\/li>\n<\/p>\n<li>\n<p class=\"page_paragraph\">Southport y Ormskirk Hospital han desconectado de la\nventilaci\u00f3n mec\u00e1nica exitosamente a pacientes con lesi\u00f3n\nde la m\u00e9dula espinal cervical que hab\u00edan fallado en todos\nlos otros intentos de desconexi\u00f3n utilizando un m\u00e9todo de\nrespiraci\u00f3n progresiva sin ventilador en conjunto con la\nV\u00e1lvula de habla.<sup>9<\/sup><\/p>\n<\/li>\n<li>\n<p class=\"page_paragraph translation-block\">Tras la incorporaci\u00f3n de la V\u00e1lvula <span class=\"pm_ws\">Passy Muir<\/span> en su\nprotocolo de desconexi\u00f3n, el Madonna Rehabilitation\nHospital pudo liberar el 62% de sus pacientes con\nventilador en un promedio de 12.5 d\u00edas. Esto est\u00e1 muy\npor encima del \u00edndice de referencia de 50% en un\npromedio de 20 d\u00edas establecidos por la  National Association of Long Term Hospitals.<sup>10,11<\/sup><\/p>\n<\/li>\n<li>\n<p class=\"page_paragraph translation-block\">La intervenci\u00f3n temprana de un equipo multidisciplinario\nen Kindred Hospital en Wyoming Valley, PA, incorpor\u00f3 la\nterapia de ambulaci\u00f3n junto con la V\u00e1lvula <span class=\"pm_ws\">Passy Muir<\/span> en\nsus protocolos de desconexi\u00f3n. Esto dio lugar a un\naumento en las tasas de desconexi\u00f3n del ventilador en un\n13% durante un per\u00edodo de 1.5 a\u00f1os.<sup>12<\/sup><\/p>\n<\/li>\n<\/ul>\n<hr>\n<h2>Videos Relacionados<\/h2>\n<div class=\"row\">\n<div class=\"col-sm-3\">\n<div style=\"max-width:600px; margin-left:auto; margin-right:auto;\">\n<style>.codegena{position:relative;width:100%;height:0;padding-bottom:56.27198%;}.codegena iframe{position:absolute;top:0;left:0;width:100%;height:100%;}\/*Youtube Embed Code : Created with Codegena.com *\/<\/style>\n<div class=\"codegena\"><iframe loading=\"lazy\" width=\"320\" height=\"215\" src=\"https:\/\/www.youtube.com\/embed\/ih596Bch1w8?rel=0\" frameborder=\"0\" allow=\"autoplay; encrypted-media\" allowfullscreen><\/iframe><\/div>\n<\/div>\n<p>      <center><strong><font size=\"4\"><\/font><\/strong><\/center>\n  <\/div>\n<div class=\"col-sm-3\">\n<div style=\"max-width:600px; margin-left:auto; margin-right:auto;\">\n<style>.codegena{position:relative;width:100%;height:0;padding-bottom:56.27198%;}.codegena iframe{position:absolute;top:0;left:0;width:100%;height:100%;}\/*Youtube Embed Code : Created with Codegena.com *\/<\/style>\n<div class=\"codegena\"><iframe loading=\"lazy\" width=\"320\" height=\"215\" src=\"https:\/\/www.youtube.com\/embed\/3tfKov4SWEs?rel=0\" frameborder=\"0\" allow=\"autoplay; encrypted-media\" allowfullscreen><\/iframe><\/div>\n<\/div>\n<p>      <center><strong><font size=\"4\"><\/font><\/strong><\/center>\n  <\/div>\n<div class=\"col-sm-3\">\n<div style=\"max-width:600px; margin-left:auto; margin-right:auto;\">\n<style>.codegena{position:relative;width:100%;height:0;padding-bottom:56.27198%;}.codegena iframe{position:absolute;top:0;left:0;width:100%;height:100%;}\/*Youtube Embed Code : Created with Codegena.com *\/<\/style>\n<div class=\"codegena\"><iframe loading=\"lazy\" width=\"320\" height=\"215\" src=\"https:\/\/www.youtube.com\/embed\/lz21bjtamwU?rel=0\" frameborder=\"0\" allow=\"autoplay; encrypted-media\" allowfullscreen><\/iframe><\/div>\n<\/div>\n<p>     <center><strong><font size=\"4\"><\/font><\/strong><\/center>\n  <\/div>\n<div class=\"col-sm-3\">\n<div style=\"max-width:600px; margin-left:auto; margin-right:auto;\">\n<style>.codegena{position:relative;width:100%;height:0;padding-bottom:56.27198%;}.codegena iframe{position:absolute;top:0;left:0;width:100%;height:100%;}\/*Youtube Embed Code : Created with Codegena.com *\/<\/style>\n<div class=\"codegena\"><iframe loading=\"lazy\" width=\"320\" height=\"215\" src=\"https:\/\/www.youtube.com\/embed\/P-wXoY_zgMA?rel=0\" frameborder=\"0\" allow=\"autoplay; encrypted-media\" allowfullscreen><\/iframe><\/div>\n<\/div>\n<p>     <center><strong><font size=\"4\"><\/font><\/strong><\/center>\n  <\/div>\n<\/div>\n<p><\/p>\n<hr>\n<h3 class=\"benefits\">Fuentes: <\/h3>\n<ol>\n<li>Burkhead, L. (2011). Swallowing evaluation and ventilator dependency\u2014Considerations and contemporary approaches. Perspectives. 22(2):18-22.<\/li>\n<li>Mirzakhani, H., Williams, J.N., Mello, J., Joseph, S., Meyer, M., Waak, K., Schmidt, U., Kelly, E., Eikermann, M. (2012). Muscle Weakness Predicts Pharyngeal Dysfunction in Symptomatic Aspiration in Long-term Ventilated Patients. Anesthesiology. Aug;119(2):389-397.<\/li>\n<li>Chen, Y.J. et al (2011). Psychophysiological determinants of repeated ventilator weaning failure: an explanatory model. American Association of Critical Care Nurses. Jul;20(4):292-302.<\/li>\n<li>Desai, A. et al. (2009) Helping the chronically critically ill to communicate: speaking valve pilot trial. American Journal Respiuratory Care Medicine. 179:A3083.<\/li>\n<li>Bell, S.(1996). Use of the <span class=\"pm_ws\"><span class=\"pm_ws\">Passy Muir<\/span><\/span><sup>\u00ae<\/sup> Tracheostomy Speaking Valve in mechanically ventilated neurological patients. Neurology. 16(1):63-68.<\/li>\n<li>Manzano, J. et al. (1993). Verbal communication of ventilator-dependent patients. Critical Care Medicine. 21(4):512-517.<\/li>\n<li>Frey, J. &#038; Wood, S. Weaning from Mechanical Ventilation Augmented by the <span class=\"pm_ws\"><span class=\"pm_ws\">Passy Muir<\/span><\/span><sup>\u00ae<\/sup> Speaking Valve (1991). Abstract at the International Conference of American Lung Association and American Thoracic Society<\/li>\n<li>Black, C. et al. (2012). A Multidisciplinary team approach to weaning from prolonged mechanical ventilation. British Journal of Hospital Medicine. Aug;, 73(8): 462-466.<\/li>\n<li>Atito-Narh, E. et al (2008). Slow ventilator weaning after cervical spinal cord injury. British Journal of Intensive Care. 95-102.<\/li>\n<li>Kobak, J. &#038; Dean, L. (2011). Use of the <span class=\"pm_ws\"><span class=\"pm_ws\">Passy Muir<\/span><\/span><sup>\u00ae<\/sup> Valve for weaning in long term acute care hospital. Respiratory Therapy. 6 (4):44, 57.<\/li>\n<li>Windhorst, C., et al (2009). Patients requiring tracheostomy and mechanical ventilation: a model for interdisciplinary decision making. The ASHA Leader, 14 (1), 10-13.<\/li>\n<li>Gurnari, D. &#038; Martin, C. (October, 2011). Early collaboration of respiratory and rehabilitation department improves ventilator weaning rates. Poster presented at the Conference of the National Association of Long Term Hospitals, New Orleans, LA.<\/li>\n<\/ol>","protected":false},"excerpt":{"rendered":"Mechanical Ventilation Misconception: &#8220;We need to wait until the patient is off the ventilator&#8221; Many clinicians believe it is necessary to wait until the patient is weaned from mechanical ventilation to place the <span class=\"pm_ws\"><span class=\"pm_ws\">Passy Muir<\/span><\/span><sup>\u00ae<\/sup> Valve. However, evidence indicates that: A delay in treatment may do more harm than good. Up to 50% of intensive [&hellip;]","protected":false},"author":6,"featured_media":218,"parent":0,"menu_order":0,"comment_status":"closed","ping_status":"closed","template":"","meta":[],"yst_prominent_words":[2672,2280,2277,2670,2278,724,444,75,65,2279,72,74,73,62,202,356,2281,1991,2671,310],"_links":{"self":[{"href":"http:\/\/142.11.238.239\/es\/wp-json\/wp\/v2\/pages\/1429"}],"collection":[{"href":"http:\/\/142.11.238.239\/es\/wp-json\/wp\/v2\/pages"}],"about":[{"href":"http:\/\/142.11.238.239\/es\/wp-json\/wp\/v2\/types\/page"}],"author":[{"embeddable":true,"href":"http:\/\/142.11.238.239\/es\/wp-json\/wp\/v2\/users\/6"}],"replies":[{"embeddable":true,"href":"http:\/\/142.11.238.239\/es\/wp-json\/wp\/v2\/comments?post=1429"}],"version-history":[{"count":3,"href":"http:\/\/142.11.238.239\/es\/wp-json\/wp\/v2\/pages\/1429\/revisions"}],"predecessor-version":[{"id":15334,"href":"http:\/\/142.11.238.239\/es\/wp-json\/wp\/v2\/pages\/1429\/revisions\/15334"}],"wp:featuredmedia":[{"embeddable":true,"href":"http:\/\/142.11.238.239\/es\/wp-json\/wp\/v2\/media\/218"}],"wp:attachment":[{"href":"http:\/\/142.11.238.239\/es\/wp-json\/wp\/v2\/media?parent=1429"}],"wp:term":[{"taxonomy":"yst_prominent_words","embeddable":true,"href":"http:\/\/142.11.238.239\/es\/wp-json\/wp\/v2\/yst_prominent_words?post=1429"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}