MORTALIDAD DE LA HIPOXEMIA REFRACTARIA EN EL SÍNDROME DE DIFICULTAD RESPIRATORIA AGUDA SEVERO CON EL CUMPLIMIENTO DE LAS MEDIDAS DE PROTECCIÓN PULMONAR EN EL ÁREA DE TERAPIA INTENSIVA DEL HOSPITAL TEODORO MALDONADO CARBO DURANTE EL PERIODO MAYO 2005-JUNIO 2016

Abstract

Severe acute respiratory distress syndrome is a common disease in intensive care units that is often associated with refractory hypoxemia. Both entities are characterized by having a high morbidity and mortality rate in the patients who develop this pathology. Mechanical ventilation is one of the most important indicators of management support in these patients, so most studies were performed with the aim of improving pulmonary injury caused by these pathophysiological process Objective: Determine the mortality of refractory hypoxemia in severe acute respiratory distress syndrome using the pulmonary protection measures in the Intensive Care area of Teodoro Maldonado Carbo Hospital during the period May 2005-June 2016. Materials and methods: A descriptive, cross-sectional study of 7159 of patients' medical records admitted in the Intensive Care Unit of the Teodoro Maldonado Carbo Hospital, were divided in two groups of patients with severe ARDS with refractory hypoxemia. The first group consisting of those patients who received conventional treatment during the period May 2005 to May 2010 and the second, who received pulmonary protection therapy during the period June 2010-June 2016. Results: The mortality of refractory hypoxemia in patients with severe ARDS who received pulmonary protection therapy was 74%, and 91% in the conventional therapy group, indicating that the use of pulmonary protection strategies significantly influences in the mortality of those patients (p=<0,01). Pneumonia was the main cause of severe ARDS with refractory hypoxemia, with 37% and 42% in the conventional and protection therapy groups, while septic shock was the principal cause of death in these patients with 49% and 44%. Within the parameters of the mechanical ventilator, considering that the pulmonary protection strategies are based on the use of low current volumes, maintaining a Pplato <29 cm H2O, with PEEP between 4-10 cm H2O, inspiratory flow 40-50 l / min, among the most important elements in this study for the management of refractory hypoxemia in patients with severe XII ARDS. Conclusions: Refractory hypoxemia in patients with severe acute respiratory distress syndrome is a pathology with a high mortality rate. It was concluded in this study that, in patients with severe ARDS who developed refractory hypoxemia, the use of pulmonary protection therapy significantly reduced their mortality rate, using low tidal volumes, elevated PEEP, among other parameters which differed from the conventional therapy. In the meantime, with the existence of different types of management in the distress syndrome and several worldwide studies, there are no other studies in Ecuador about this therapy. For this reason, it is recommended to carry out a multicenter study focused on different hospitals, to promote pulmonary protection strategies for all medical personnel, resulting in benefits not only for the patients but also for the hospital unit in which they are located.