Uso de Bilevel en prematuros de 33 a 36 semanas de gestación
DOI:
https://doi.org/10.22529/me.2022.7(3)02Resumen
INTRODUCCIÓN: El uso de Ventilación no invasiva (VNI) en neonatología se ha incrementado. Sin embargo, aún con el desarrollo de distintos modos de VNI, un porcentaje importante fracasa y requiere ARM. La VNI con Bilevel provee dos niveles alternantes de CPAP con el fin de incrementar la capacidad residual funcional (CRF). El beneficio teórico sería que el cambio en la CRF puede reclutar alvéolos inestables y prevenir su colapso, y tiene la ventaja de no necesitar sincronización. El uso temprano de VNI con BiLevel en niños de 33 a 36.6 semanas con síndrome de Dificultad Respiratoria(SDR) podría mejorar los parámetros gasométricos y necesidades de O2 durante la fase aguda, y podría tener efecto en el tiempo de soporte respiratorio y estadía hospitalaria, comparado con el CPAP nasal. OBJETIVO: Evaluar el curso clínico, evolución de los parámetros gasométricos y resultados respiratorios en prematuros tardíos con SDR asignados a CPAP o BiLevel. MATERIAL Y MÉTODO: Estudio piloto, prospectivo y aleatorizado. Un total de 16 niños con edad gestacional de 33 a 36.6 semanas con SDR que cumplieron los criterios de inclusión fueron aleatorizados al grupo CPAP (n=8, PEEP de 5-6 cmH2O y una FiO2 para mantener una SO2 entre 92-96%) o BiLevel (n=8, PEEP inferior de 5-6 cmH2O y un nivel superior de PEEP de 9-10 cmH2O, un tiempo en nivel superior de 1,5 segundos 15 veces por minuto y la FiO2 para mantener la SO2 entre 92-96%) provisto por Ventilador Neumovent GraphNeo. Se evaluaron parámetros gasométricos y FiO2 durante las primeras 12 hs de estudio, necesidad de ARM, incidencia de neumotórax, días de O2 y estadía hospitalaria en ambos grupos. RESULTADOS: Los requerimientos de FiO2 y valores de PaCO2 y pH durante las primeras 12 hs del estudio en ambos grupos fueron similares (p=>0.05). No hubo diferencias significativas entre CPAP vs BiLevel en necesidad de ARM (37.5% vs 25%, p=0.58), horas de VNI (34.3 vs 35.1, p= 0.94) , horas de ARM (11.9 vs 10.1, p=0.85), días de O2 (4.25 vs 3.9, p=0.76), dosis de surfactante (0.38 vs 0.25, p=0.58), neumotórax (0% vs 12.5%, p=0.3), tiempo en lograr alimentación enteral total (4.75 vs 4.75, p=0.99), y días de internación (16.6 vs 10.2, p=0.16). CONCLUSIONES: Los datos presentados no muestran diferencias significativas entre ambos grupos. Si bien hubo una tendencia a menor necesidad de O2, ARM, uso de surfactante y días de internación y mayor incidencia de neumotórax en el grupo BiLevel, se necesita evaluar un número mayor de niños para confirmar los datos. Tanto el CPAP como el BiLevel son estrategias eficaces y seguras para el manejo del SDR en prematuros tardíos.Descargas
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