Extubación en el paciente neurocrítico con lesiones encefálicas agudas: revisión narrativa de la literatura
DOI:
https://doi.org/10.17533/udea.iatreia.180Palabras clave:
Cuidados Críticos, Destete, Extubación Traqueal, Lesiones Encefálicas, Lesiones Traumáticas del Encéfalo, Manifestaciones NeurológicasResumen
Introducción: el destete ventilatorio (weaning) y la extubación en el paciente con lesiones encefálicas agudas es un desafío para el personal de salud ya que no hay un consenso claro sobre los criterios de extubación.
Objetivo: resumir la evidencia disponible sobre la extubación del paciente con lesiones encefálicas agudas y analizar posibles alternativas a los criterios clásicos de extubación.
Métodos: se realizó una búsqueda de la literatura médica, en los idiomas español e inglés, de los últimos 20 años en diferentes bases de datos. Se incluyeron revisiones sistemáticas con o sin metaanálisis, guías y recomendaciones de sociedades científicas, ensayos clínicos y estudios observacionales que cumplieran los criterios de inclusión.
Resultados: se recolectaron 262 artículos de interés, de los cuales, mediante un análisis y comparación de la evidencia, se seleccionaron 48 artículos que tuvieron más relevancia para cumplir el objetivo planteado.
Conclusiones: la evidencia disponible es débil a la hora de brindar una recomendación sobre los criterios de extubación en el paciente neurocrítico. Podría realizarse una extubación precoz con un nivel mínimo de conciencia, pero manteniendo los reflejos protectores de las vías respiratorias, sin tener aumento en la tasa de reintubación o mortalidad.
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