VENTILACION MECANICA NO INVASIVA EN EL WEANING DIFICIL Dr. Antonio M. Esquinas Rodríguez, FCCP, International Fellow AARC Unidad de Cuidados Intensivos Hospital Morales Meseguer. Murcia. España antmesquinas@gmail.com

BASES FISIOPATOLOGICAS DEL WEANING DIFICIL

Background-1 Normal Mechanical Ventilation Mechanical ventilation is an essential life- saving technology. Although this process often is termed "ventilator weaning”. 42% of the time. One third of patients, however, are not successful on initial attempts at liberation.

AIRWAY OPTIONS -MECHANICAL VENTILATION. Tracheostomy and intubation. Poor oxygenation Occurrence of nosocomial pneumonia after tracheostomy. Stenosis of the cricoid cartilage caused by long-term intubation. Longer ICU stay Higher ICU mortality .

ALTERACIONES EN EL INTERCAMBIO GASEOSO. PERSISTENCIA DE LA CAUSA DESENCADENANTE DEL FALLO RESPIRATORIO. OBSTRUCCIÓN DE LA VÍA AÉREA. TOS INADECUADA. SECRECIONES ABUNDANTES. ALTERACIONES DEL ESTADO NEUROLÓGICO. PERSISTENCIA DEL DOLOR. INADECUADO RENDIMIENTO NEUROMUSCULAR. MAL ESTADO NUTRICIONAL. INESTABILIDAD HEMODINÁMICA Y CARDIOVASCULAR (PERSISTENCIA DE HIPOTENSIÓN, FIEBRE O ANEMIA).

DIFICULT WEANING: ASPECTOS PRACTICOS: EXTUBACION Y VMNI.

VENTILACION MECANICA NO INVASIVA EN WEANING: TRAQUEOSTOMIZADOS-DECANULACION Y VMNI

7/18 ( 38%) CASOS VMNI- DOMICILIARIA

DECISIONES PRACTICAS EN PACIENTES CON WEANING DIFICIL

Weaning-Noninvasive Ventilation-Extubacion con VMNI Weaning-Noninvasive Ventilation-Extubacion con VMNI. Puntos claves extubacion

CAUSES OF NIV FAILURE

WEANING-OPCIONES DE CONTROL DE SECRECIONES BRONQUIALES EN UCI

INTERNATIONAL WEANING PRACTICE.

INTERNATIONAL WEANING SURVEY. Phase I. Dr. Rafael UÑA OREJÓN ANESTESIOLOGÍA Hospital LA PAZ. Madrid. Dra. Ana Paula Gonçalves Medicina Intensiva. Hospital Sousa Martins. Unidad Medica Quirúrgica Guarda. Portugal Dr. Nicholas Hill Pulmonary, Critical Care Tufts-New England Medical Center. Boston. USA Dr. Miguel Salguero Medicina Intensiva. Hospital Carlos Haya. Malaga Dr. Stefano NAVA Fondazione Salvatore Maugeri Pavia. Italia. Dra.Carmen Martín Delgado Medicina Intensiva. Hospital Mancha Centro. Ciudad Real. Dr. Manuel Perez Marquez Medicina Intensiva Fundación Jimenez Díaz. Madrid Dra.María Belén Estébanez Montiel Medicina Intensiva. Hospital: Hospital del Tajo. Madrid. Dr. A.Esquinas. Unidad de Cuidados Intensivos Hospital Morales Meseguer. Murcia. Dr. Enrique Alday muñoz Anestesiología y reanimación. Hospital la Princesa. Madrid. Dr. Michele Vitacca Fondazione Salvatore Maugeri Brescia.Italia

INTERNATIONAL WEANING SURVEY. Phase I. 12 HOSPITALES 4534—VENTILACION MECANICA 948- VMNI ( 20.90%) 352 VMNI - WEANING ( 37.13%) 321 31 VMNI POSTEXTUBACION DECANULADOS -VMNI (91.2%) (8.80%)

INTERNATIONAL WEANING SURVEY INTERNATIONAL WEANING SURVEY. Phase I- Scenario/Ventilators/Interface/Protocols.

INTERNATIONAL WEANING SURVEY. Phase I- Weaning Strategies.

SUMARIO DE ESTRATEGIAS EN EL WEANING DIFICIL.

Ventilatory strategies- 1 Early Extubation and NIMV-COPD Oxygen-therapy NIMV ETI Weaning Extubation Early Traqueostomy Early Extubation and NIMV-COPD

NIMV Treatment Extubation -Ventilatory strategies- 2 Extubation NIMV preventive Success (High Risk Population) Failure NIMV Treatment Failure NIMV Re-intubation

Weaning Failure. Ventilatory strategies- 3 Reintubation Persistent Weaning Failure Selective extubation and NIMV Failure-ETI Succes Traqueostomy Failure Weaning Succes Decanulation Selective decanulation-NIMV Failure Succes Ventilator Depend -ETI