Miller Anestesia

2661 / 2894

un ensayo clínico de pequeño tamaño advirtió del riesgo de sufrir
complicaciones isquémicas miocárdicas cuando los pacientes con
EPCA son tratados con presión positiva de dos niveles en la vía
respiratoria (BiPAP, un tipo de PSV), en comparación con la CPA .
Recientemente, dos metaanálisis han demostrado que tanto la CPAP
como la NIPPV reducen de manera significativa la necesidad de
intubación, pero la CPAP disminuye significativamente la mortali-
dad, mientras que la NIPPV se asocia con una tendencia clara, pero
no significativa, hacia una mejoría de la supervivenci El
mismo metaanálisis no encontró diferencias significativas en cuanto
a complicaciones isquémicas miocárdicas entre la CPAP y la NIPPV.
En general, algunos autores postulan que la CPAP debería ser con-
siderada como el tratamiento de primera elección en los pacientes
con EPCA, porque es menos cara, más sencilla de suministrar e
igual de eficaz que la NIPP .
Varios aspectos sobre la ventilación no invasiva de los
pacientes con EPCA siguen sin respuesta: ¿el mecanismo causante
del EPCA (insuficiencia cardíaca diastólica frente a sistólica
influye sobre la respuesta a la ventilación no invasiva?, ¿hasta qué
punto es aconsejable el uso de CPAP o NIPPV en los pacientes con
infarto agudo de miocardio?, ¿existen diferentes indicaciones para
la CPAP o NIPPV en los subgrupos de estos pacientes? No obs-
tante, en los pacientes hipercápnicos con EPCA podría ser mejor
utilizar la NIPP Por último, se necesitan más estudios que
investiguen los parámetros óptimos para la administración de
CPAP y NPPV en los pacientes con EPCA.
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Seccíón VII
Cuidados críticos
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