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Avances en pronósticos y terapias para exacerbación aguda de EPOC en UCI: Una revisión narrativa
Resumen
La enfermedad pulmonar obstructiva crónica (EPOC) es una de las principales causas de mortalidad a nivel mundial. Esta revisión bibliográfica descriptiva-cualitativa tiene como objetivo actualizar los conocimientos sobre el pronóstico, tratamiento y complicaciones de la EPOC en pacientes ingresados en la unidad de cuidados intensivos (UCI). Se analizaron críticamente 30 artículos recientes, identificando nuevas herramientas pronósticas como el Red Cell Index, que podrían predecir mejor la morbimortalidad que los scores tradicionales. La infección por SARS-CoV-2 incrementa el riesgo de ingreso en UCI de pacientes con EPOC, pero no su mortalidad. Un conteo de eosinófilos >300 células/μL podría sugerir menor necesidad de ventilación mecánica invasiva durante exacerbaciones. Se desaconseja la terapia de mantenimiento con macrólidos por su escaso beneficio y mayor mortalidad en UCI. Se recomienda administrar azitromicina en urgencias previo al ingreso y el uso de estatinas para reducir delirium y mortalidad. La oxigenación nasal de alto flujo disminuye la necesidad de ventilación invasiva. Se requieren más estudios multicéntricos que evalúen terapias combinadas para mejorar el pronóstico de estos pacientes críticos.
Palabras clave
Referencias
Albert, R. K., Connett, J., Bailey, W. C., Casaburi, R., Cooper, J. A. D., Criner, G. J., Curtis, J. L., Dransfield, M. T., Han, M. K., Lazarus, S. C., Make, B., Marchetti, N., Martinez, F. J., Madinger, N. E., McEvoy, C., Niewoehner, D. E., Porsasz, J., Price, C. S., Reilly, J., … Anthonisen, N. R. (2011). Azithromycin for Prevention of Exacerbations of COPD. New England Journal of Medicine, 365(8), 689–698. https://doi.org/10.1056/NEJMoa1104623
An, J. Y., Park, J. Y., Cho, J., Kim, H. E., Park, J., & Oh, J. (2023). The Relationship between Delirium and Statin Use According to Disease Severity in Patients in the Intensive Care Unit. Clinical Psychopharmacology and Neuroscience, 21(1), 179–187. https://doi.org/10.9758/cpn.2023.21.1.179
Cai, M., Deng, Y., & Hu, T. (2024). Prognostic Value of Leukocyte-Based Risk Model for Acute Kidney Injury Prediction in Critically Ill Acute Exacerbation of Chronic Obstructive Pulmonary Disease Patients. International Journal of COPD, 19, 619–632. https://doi.org/10.2147/COPD.S444888
Casas Rodríguez, J., Zambrano Córdova, J. R., Vélez Muentes, J. R., & Vera Pinargote, R. G. (2021). Criterios de patologías que requieren ingreso a la unidad de cuidados intensivo. RECIMUNDO, 5(1), 172–178. https://doi.org/10.26820/recimundo/5.(esp.1).nov.2021.172-178
Chen, D., Cao, C., Jiang, L., Tan, Y., Yuan, H., Pan, B., Ma, M., Zhang, H., & Wan, X. (2020). Serum cystatin C: A potential predictor for hospital-acquired acute kidney injury in patients with acute exacerbation of COPD. Chronic Respiratory Disease, 17, 147997312094067. https://doi.org/10.1177/1479973120940677
Córdova, D., Orna, C., Toaquiza, D., Espinel, M., Corrales, V., Chungandro, A., & Mora, J. (2022, junio 5). Revisión de actualidad, diagnóstico y tratamiento de la enfermedad pulmonar obstructiva crónica. https://revistasanitariadeinvestigacion.com/revision-de-actualidad-diagnostico-y-tratamiento-de-la-enfermedad-pulmonar-obstructiva-cronica/.
Eva Mañas Baena Daniel López Padilla, D. (2024). ALGORITMOS EN SUEÑO Y TERAPIAS RESPIRATORIAS NO INVASIVAS. www.ergon.es
Fu, X., Wang, L., Wang, G., Liu, X., Wang, X., Ma, S., & Miao, F. (2022). Delirium in elderly patients with COPD combined with respiratory failure undergoing mechanical ventilation: a prospective cohort study. BMC Pulmonary Medicine, 22(1). https://doi.org/10.1186/s12890-022-02052-5
Galerneau, L. M., Bailly, S., Terzi, N., Ruckly, S., Garrouste-Orgeas, M., Oziel, J., Hong Tuan Ha, V., Gainnier, M., Siami, S., Dupuis, C., Forel, J. M., Dartevel, A., Dessajan, J., Adrie, C., Goldgran-Toledano, D., Laurent, V., Argaud, L., Reignier, J., Pepin, J. L., … Timsit, J. F. (2023). Non-ventilator-associated ICU-acquired pneumonia (NV-ICU-AP) in patients with acute exacerbation of COPD: From the French OUTCOMEREA cohort. Critical Care, 27(1). https://doi.org/10.1186/s13054-023-04631-2
Guo, X., Lin, H., Guo, D., & Luo, Q. (2022). Azithromycin use prior to ICU admission is associated with a lower short-term mortality for critically ill acute exacerbations of chronic obstructive pulmonary disease patients: A retrospective cohort study. Chronic Respiratory Disease, 19. https://doi.org/10.1177/14799731221140797
İlhan, B., Bozdereli Berikol, G., & Doğan, H. (2022a). The predictive value of modified risk scores in patients with acute exacerbation of COPD: a retrospective cohort study. Internal and Emergency Medicine, 17(7), 2119–2127. https://doi.org/10.1007/s11739-022-03048-z
İlhan, B., Bozdereli Berikol, G., & Doğan, H. (2022b). The predictive value of modified risk scores in patients with acute exacerbation of COPD: a retrospective cohort study. Internal and Emergency Medicine, 17(7), 2119–2127. https://doi.org/10.1007/s11739-022-03048-z
Jain, V., & Yuan, J. M. (2020). Predictive symptoms and comorbidities for severe COVID-19 and intensive care unit admission: a systematic review and meta-analysis. En International Journal of Public Health (Vol. 65, Número 5, pp. 533–546). Springer. https://doi.org/10.1007/s00038-020-01390-7
Kang, H. S., Kim, S. K., Kim, Y. H., Kim, J. W., Lee, S. H., Yoon, H. K., & Rhee, C. K. (2021). The association between eosinophilic exacerbation and eosinophilic levels in stable COPD. BMC Pulmonary Medicine, 21(1), 74. https://doi.org/10.1186/s12890-021-01443-4
Karla Villacres-García, E. I., Madeley Gadvay Bonilla III, N., Stefania Vivar-Morán, C. I., & Kayra Espinoza-Balseca, L. I. (2022). Prevención y manejo clínico de la neumonía asociada a ventilación mecánica en unidad de cuidados intensivos. Mayo Especial, 8(2), 500–519. https://doi.org/10.23857/dc.v8i2.2768
Lee, S. C., Son, K. J., Han, C. H., Park, S. C., & Jung, J. Y. (2021). Impact of COPD on COVID-19 prognosis: A nationwide population-based study in South Korea. Scientific Reports, 11(1). https://doi.org/10.1038/s41598-021-83226-9
López, J., Martínez, C., Rego, J., Piñera, J., & Saborit, A. (2022). Causas asociadas a mortalidad por epoc en el Hospital Clínico Quirúrgico Docente “Dr. Salvador Allende”. Revista Información Científica, 101 No.2, 1–12.
Miravitlles, M., Calle, M., Molina, J., Almagro, P., Gómez, J.-T., Trigueros, J. A., Cosío, B. G., Casanova, C., López-Campos, J. L., Riesco, J. A., Simonet, P., Rigau, D., Soriano, J. B., Ancochea, J., & Soler-Cataluña, J. J. (2022). Actualización 2021 de la Guía Española de la EPOC (GesEPOC). Tratamiento farmacológico de la EPOC estable. Archivos de Bronconeumología, 58(1), 69–81. https://doi.org/10.1016/j.arbres.2021.03.005
Oh, S., Kim, J. H., Cho, K. H., Kim, M. C., Sim, D. S., Hong, Y. J., Ahn, Y., & Jeong, M. H. (2022). Clinical impact of pulmonary hypertension on the outcomes of acute myocardial infarction patients with or without chronic obstructive pulmonary disease. Medicine (United States), 101(3), E28627. https://doi.org/10.1097/MD.0000000000028627
Pace, S., & Giugno, E. (2023). Exacerbación de EPOC.
Pizarro, C., Nieto, V., & Dueñas, C. (2022). Consenso de criterios de ingreso a Cuidados Intensivos.
Shi, Y., Shi, Y., Xu, Z., & Wang, Y. (2023). Association of Red Cell Index and Hospital Mortality in Chronic Obstructive Pulmonary Disease Patients Admitted to the Intensive Care Unit: A Retrospective Cohort Study. International Journal of COPD, 18, 2267–2276. https://doi.org/10.2147/COPD.S427433
Stempel, J. M., Gopalakrishnan, A., Krishnamoorthy, P., Lo, K. B., Mittal, V., Moghbeli, N., Varadi, G., & Rangaswami, J. (2021). Pulmonary Arterial Hypertension in Hospitalized Patients With Polycythemia Vera (from the National Inpatient Database). The American Journal of Cardiology, 143, 154–157. https://doi.org/10.1016/j.amjcard.2020.12.023
Trump, M. W., Ganapathiraju, I., Jackson, J. A., Branick, K., Taylor, M., Oetting, T. W., & Pelaez, C. A. (2022). Nasal high flow therapy use in wards in patients with chronic obstructive pulmonary disease may spare ICU resources. Clinical Respiratory Journal, 16(2), 116–122. https://doi.org/10.1111/crj.13458
Uzun, S., Djamin, R. S., Kluytmans, J. A. J. W., Mulder, P. G. H., van’t Veer, N. E., Ermens, A. A. M., Pelle, A. J., Hoogsteden, H. C., Aerts, J. G. J. V, & van der Eerden, M. M. (2014). Azithromycin maintenance treatment in patients with frequent exacerbations of chronic obstructive pulmonary disease (COLUMBUS): a randomised, double-blind, placebo-controlled trial. The Lancet Respiratory Medicine, 2(5), 361–368. https://doi.org/10.1016/S2213-2600(14)70019-0
Villacres Fernández, F. A., Gavilanes Torres, A. A., & Cruz Villegas, J. A. (2022). Enfermedad pulmonar obstructiva crónica (EPOC). RECIMUNDO, 6(3), 94–102. https://doi.org/10.26820/recimundo/6.(3).junio.2022.94-102
Wan, X., Chen, D., Tan, Y., Ma, M., Zhang, F., Liu, Z., Chen, Y., Shao, W., & Cao, C. (2020). Incidence, risk factors, and prognostic implications of acute kidney injury in patients with acute exacerbation of copd. International Journal of COPD, 15, 1085–1092. https://doi.org/10.2147/COPD.S238343
Wedzicha, J. A., Calverley, P. M. A., Albert, R. K., Anzueto, A., Criner, G. J., Hurst, J. R., Miravitlles, M., Papi, A., Rabe, K. F., Rigau, D., Sliwinski, P., Tonia, T., Vestbo, J., Wilson, K. C., & Krishnan, J. A. (2017). Prevention of COPD exacerbations: a European Respiratory Society/American Thoracic Society guideline. European Respiratory Journal, 50(3), 1602265. https://doi.org/10.1183/13993003.02265-2016
Xia, J., Hu, C., Wang, L., & Zhang, Y. (2023). Association between statin use on delirium and 30-day mortality in patients with chronic obstructive pulmonary disease in the intensive care unit. European Journal of Medical Research, 28(1). https://doi.org/10.1186/s40001-023-01551-3
Zhang, J., DeMeo, D. L., Silverman, E. K., Make, B. J., Wade, R. C., Wells, J. M., Cho, M. H., & Hobbs, B. D. (2021). Secondary polycythemia in chronic obstructive pulmonary disease: prevalence and risk factors. BMC Pulmonary Medicine, 21(1), 235. https://doi.org/10.1186/s12890-021-01585-5
Zinellu, A., Zinellu, E., Mangoni, A. A., Pau, M. C., Carru, C., Pirina, P., & Fois, A. G. (2022). Clinical significance of the neutrophil-to-lymphocyte ratio and platelet-to-lymphocyte ratio in acute exacerbations of COPD: present and future. European Respiratory Review, 31(166), 220095. https://doi.org/10.1183/16000617.0095-2022
Albert, R. K., Connett, J., Bailey, W. C., Casaburi, R., Cooper, J. A. D., Criner, G. J., Curtis, J. L., Dransfield, M. T., Han, M. K., Lazarus, S. C., Make, B., Marchetti, N., Martinez, F. J., Madinger, N. E., McEvoy, C., Niewoehner, D. E., Porsasz, J., Price, C. S., Reilly, J., … Anthonisen, N. R. (2011). Azithromycin for Prevention of Exacerbations of COPD. New England Journal of Medicine, 365(8), 689–698. https://doi.org/10.1056/NEJMoa1104623
An, J. Y., Park, J. Y., Cho, J., Kim, H. E., Park, J., & Oh, J. (2023). The Relationship between Delirium and Statin Use According to Disease Severity in Patients in the Intensive Care Unit. Clinical Psychopharmacology and Neuroscience, 21(1), 179–187. https://doi.org/10.9758/cpn.2023.21.1.179
Cai, M., Deng, Y., & Hu, T. (2024). Prognostic Value of Leukocyte-Based Risk Model for Acute Kidney Injury Prediction in Critically Ill Acute Exacerbation of Chronic Obstructive Pulmonary Disease Patients. International Journal of COPD, 19, 619–632. https://doi.org/10.2147/COPD.S444888
Casas Rodríguez, J., Zambrano Córdova, J. R., Vélez Muentes, J. R., & Vera Pinargote, R. G. (2021). Criterios de patologías que requieren ingreso a la unidad de cuidados intensivo. RECIMUNDO, 5(1), 172–178. https://doi.org/10.26820/recimundo/5.(esp.1).nov.2021.172-178
Chen, D., Cao, C., Jiang, L., Tan, Y., Yuan, H., Pan, B., Ma, M., Zhang, H., & Wan, X. (2020). Serum cystatin C: A potential predictor for hospital-acquired acute kidney injury in patients with acute exacerbation of COPD. Chronic Respiratory Disease, 17, 147997312094067. https://doi.org/10.1177/1479973120940677
Córdova, D., Orna, C., Toaquiza, D., Espinel, M., Corrales, V., Chungandro, A., & Mora, J. (2022, junio 5). Revisión de actualidad, diagnóstico y tratamiento de la enfermedad pulmonar obstructiva crónica. https://revistasanitariadeinvestigacion.com/revision-de-actualidad-diagnostico-y-tratamiento-de-la-enfermedad-pulmonar-obstructiva-cronica/.
Eva Mañas Baena Daniel López Padilla, D. (2024). ALGORITMOS EN SUEÑO Y TERAPIAS RESPIRATORIAS NO INVASIVAS. www.ergon.es
Fu, X., Wang, L., Wang, G., Liu, X., Wang, X., Ma, S., & Miao, F. (2022). Delirium in elderly patients with COPD combined with respiratory failure undergoing mechanical ventilation: a prospective cohort study. BMC Pulmonary Medicine, 22(1). https://doi.org/10.1186/s12890-022-02052-5
Galerneau, L. M., Bailly, S., Terzi, N., Ruckly, S., Garrouste-Orgeas, M., Oziel, J., Hong Tuan Ha, V., Gainnier, M., Siami, S., Dupuis, C., Forel, J. M., Dartevel, A., Dessajan, J., Adrie, C., Goldgran-Toledano, D., Laurent, V., Argaud, L., Reignier, J., Pepin, J. L., … Timsit, J. F. (2023). Non-ventilator-associated ICU-acquired pneumonia (NV-ICU-AP) in patients with acute exacerbation of COPD: From the French OUTCOMEREA cohort. Critical Care, 27(1). https://doi.org/10.1186/s13054-023-04631-2
Guo, X., Lin, H., Guo, D., & Luo, Q. (2022). Azithromycin use prior to ICU admission is associated with a lower short-term mortality for critically ill acute exacerbations of chronic obstructive pulmonary disease patients: A retrospective cohort study. Chronic Respiratory Disease, 19. https://doi.org/10.1177/14799731221140797
İlhan, B., Bozdereli Berikol, G., & Doğan, H. (2022a). The predictive value of modified risk scores in patients with acute exacerbation of COPD: a retrospective cohort study. Internal and Emergency Medicine, 17(7), 2119–2127. https://doi.org/10.1007/s11739-022-03048-z
İlhan, B., Bozdereli Berikol, G., & Doğan, H. (2022b). The predictive value of modified risk scores in patients with acute exacerbation of COPD: a retrospective cohort study. Internal and Emergency Medicine, 17(7), 2119–2127. https://doi.org/10.1007/s11739-022-03048-z
Jain, V., & Yuan, J. M. (2020). Predictive symptoms and comorbidities for severe COVID-19 and intensive care unit admission: a systematic review and meta-analysis. En International Journal of Public Health (Vol. 65, Número 5, pp. 533–546). Springer. https://doi.org/10.1007/s00038-020-01390-7
Kang, H. S., Kim, S. K., Kim, Y. H., Kim, J. W., Lee, S. H., Yoon, H. K., & Rhee, C. K. (2021). The association between eosinophilic exacerbation and eosinophilic levels in stable COPD. BMC Pulmonary Medicine, 21(1), 74. https://doi.org/10.1186/s12890-021-01443-4
Karla Villacres-García, E. I., Madeley Gadvay Bonilla III, N., Stefania Vivar-Morán, C. I., & Kayra Espinoza-Balseca, L. I. (2022). Prevención y manejo clínico de la neumonía asociada a ventilación mecánica en unidad de cuidados intensivos. Mayo Especial, 8(2), 500–519. https://doi.org/10.23857/dc.v8i2.2768
Lee, S. C., Son, K. J., Han, C. H., Park, S. C., & Jung, J. Y. (2021). Impact of COPD on COVID-19 prognosis: A nationwide population-based study in South Korea. Scientific Reports, 11(1). https://doi.org/10.1038/s41598-021-83226-9
López, J., Martínez, C., Rego, J., Piñera, J., & Saborit, A. (2022). Causas asociadas a mortalidad por epoc en el Hospital Clínico Quirúrgico Docente “Dr. Salvador Allende”. Revista Información Científica, 101 No.2, 1–12.
Miravitlles, M., Calle, M., Molina, J., Almagro, P., Gómez, J.-T., Trigueros, J. A., Cosío, B. G., Casanova, C., López-Campos, J. L., Riesco, J. A., Simonet, P., Rigau, D., Soriano, J. B., Ancochea, J., & Soler-Cataluña, J. J. (2022). Actualización 2021 de la Guía Española de la EPOC (GesEPOC). Tratamiento farmacológico de la EPOC estable. Archivos de Bronconeumología, 58(1), 69–81. https://doi.org/10.1016/j.arbres.2021.03.005
Oh, S., Kim, J. H., Cho, K. H., Kim, M. C., Sim, D. S., Hong, Y. J., Ahn, Y., & Jeong, M. H. (2022). Clinical impact of pulmonary hypertension on the outcomes of acute myocardial infarction patients with or without chronic obstructive pulmonary disease. Medicine (United States), 101(3), E28627. https://doi.org/10.1097/MD.0000000000028627
Pace, S., & Giugno, E. (2023). Exacerbación de EPOC.
Pizarro, C., Nieto, V., & Dueñas, C. (2022). Consenso de criterios de ingreso a Cuidados Intensivos.
Shi, Y., Shi, Y., Xu, Z., & Wang, Y. (2023). Association of Red Cell Index and Hospital Mortality in Chronic Obstructive Pulmonary Disease Patients Admitted to the Intensive Care Unit: A Retrospective Cohort Study. International Journal of COPD, 18, 2267–2276. https://doi.org/10.2147/COPD.S427433
Stempel, J. M., Gopalakrishnan, A., Krishnamoorthy, P., Lo, K. B., Mittal, V., Moghbeli, N., Varadi, G., & Rangaswami, J. (2021). Pulmonary Arterial Hypertension in Hospitalized Patients With Polycythemia Vera (from the National Inpatient Database). The American Journal of Cardiology, 143, 154–157. https://doi.org/10.1016/j.amjcard.2020.12.023
Trump, M. W., Ganapathiraju, I., Jackson, J. A., Branick, K., Taylor, M., Oetting, T. W., & Pelaez, C. A. (2022). Nasal high flow therapy use in wards in patients with chronic obstructive pulmonary disease may spare ICU resources. Clinical Respiratory Journal, 16(2), 116–122. https://doi.org/10.1111/crj.13458
Uzun, S., Djamin, R. S., Kluytmans, J. A. J. W., Mulder, P. G. H., van’t Veer, N. E., Ermens, A. A. M., Pelle, A. J., Hoogsteden, H. C., Aerts, J. G. J. V, & van der Eerden, M. M. (2014). Azithromycin maintenance treatment in patients with frequent exacerbations of chronic obstructive pulmonary disease (COLUMBUS): a randomised, double-blind, placebo-controlled trial. The Lancet Respiratory Medicine, 2(5), 361–368. https://doi.org/10.1016/S2213-2600(14)70019-0
Villacres Fernández, F. A., Gavilanes Torres, A. A., & Cruz Villegas, J. A. (2022). Enfermedad pulmonar obstructiva crónica (EPOC). RECIMUNDO, 6(3), 94–102. https://doi.org/10.26820/recimundo/6.(3).junio.2022.94-102
Wan, X., Chen, D., Tan, Y., Ma, M., Zhang, F., Liu, Z., Chen, Y., Shao, W., & Cao, C. (2020). Incidence, risk factors, and prognostic implications of acute kidney injury in patients with acute exacerbation of copd. International Journal of COPD, 15, 1085–1092. https://doi.org/10.2147/COPD.S238343
Wedzicha, J. A., Calverley, P. M. A., Albert, R. K., Anzueto, A., Criner, G. J., Hurst, J. R., Miravitlles, M., Papi, A., Rabe, K. F., Rigau, D., Sliwinski, P., Tonia, T., Vestbo, J., Wilson, K. C., & Krishnan, J. A. (2017). Prevention of COPD exacerbations: a European Respiratory Society/American Thoracic Society guideline. European Respiratory Journal, 50(3), 1602265. https://doi.org/10.1183/13993003.02265-2016
Xia, J., Hu, C., Wang, L., & Zhang, Y. (2023). Association between statin use on delirium and 30-day mortality in patients with chronic obstructive pulmonary disease in the intensive care unit. European Journal of Medical Research, 28(1). https://doi.org/10.1186/s40001-023-01551-3
Zhang, J., DeMeo, D. L., Silverman, E. K., Make, B. J., Wade, R. C., Wells, J. M., Cho, M. H., & Hobbs, B. D. (2021). Secondary polycythemia in chronic obstructive pulmonary disease: prevalence and risk factors. BMC Pulmonary Medicine, 21(1), 235. https://doi.org/10.1186/s12890-021-01585-5
Zinellu, A., Zinellu, E., Mangoni, A. A., Pau, M. C., Carru, C., Pirina, P., & Fois, A. G. (2022). Clinical significance of the neutrophil-to-lymphocyte ratio and platelet-to-lymphocyte ratio in acute exacerbations of COPD: present and future. European Respiratory Review, 31(166), 220095. https://doi.org/10.1183/16000617.0095-2022
DOI: https://doi.org/10.23857/pc.v9i8.7721
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