Interacción corazón-pulmón: aspecto clave para orientar el manejo de la ventilación mecánica en el embarazo
DOI:
https://doi.org/10.18597/rcog.4364Palabras clave:
corazón, pulmón, gestación, hemodinámica, ventilación mecánica, pulso arterialResumen
Objetivo: ofrecer al lector un marco conceptual que permita comprender los principios fundamentales que modulan la interacción corazón-pulmón tanto en condiciones fisiológicas como con el uso de la ventilación mecánica, y cómo esta última impacta las variables hemodinámicas en la mujer gestante, así como la perfusión uteroplacentaria.
Material y métodos: a partir de un caso hipotético que ilustra de manera práctica el tema, se plantearon las siguientes preguntas: ¿cómo es la interacción corazón-pulmón en las gestantes?, ¿cómo se afecta esta interacción con la ventilación mecánica? y ¿qué variables se deben tener en cuenta para hacer un uso adecuado de esta intervención y mejorar los desenlaces materno-perinatales? Para contestar estas preguntas se desarrolló una revisión narrativa estructurada que inicia con la descripción de los cambios que se presentan en la fisiología cardiopulmonar en el embarazo, luego se repasan los determinantes del gasto cardiaco y los cambios que desencadena la ventilación mecánica en esta interacción, y, por último, se abordan las variables de la función cardiopulmonar que se deben medir en el manejo de la ventilación mecánica.
Resultados: la gestación, por las modificaciones anatómicas y fisiológicas, supone un desafío mayor para los sistemas respiratorio y cardiovascular, así como para su interrelación. El uso de la ventilación mecánica cambia de manera importante la dinámica sobre los patrones fisiológicos de la interacción corazón-pulmón y, por ello, en gestantes se hace necesario minimizar este impacto mediante el uso de volúmenes corrientes bajos, niveles controlados de presión positiva al final de la expiración, y la optimización del volumen circulatorio con una presión arterial media normal.
Conclusiones: la comprensión de los principios fisiológicos que orquestan la interacción corazón-pulmón es un reto que requiere conocer la fisiología cardiovascular y pulmonar dentro y fuera de la gestación. La aproximación a estos principios fisiológicos permitirá al obstetra y al especialista en medicina crítica conocer el impacto que tiene el soporte ventilatorio sobre las variables hemodinámicas maternas.
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