Pruebas de función respiratoria en la hipoventilación alveolar y soporte ventilatorio
Barra lateral del artículo
Contenido principal del artículo
Resumen
La bomba ventilatoria es responsable de la ventilación alveolar (centros respiratorios, vías de conducción nerviosa, placa neuromuscular, músculos respiratorios y caja torácica). Una disminución de la ventilación minuto alveolar está inversamente relacionada con el valor de CO2 arterial, por lo que la hipoventilación es la causa de la hipercapnia.
El fallo de la bomba ventilatoria determina hipoventilación y la necesidad de asistencia respiratoria mecánica (invasiva o no invasiva). El uso de pruebas funcionales respiratorias facilita la correcta interpretación de la hipoventilación alveolar y la toma de decisiones terapéuticas. La función respiratoria permite predecir la necesidad de soporte ventilatorio antes de que aparezca hipercapnia evidente. Asimismo, la información correctamente interpretada puede ofrecer al clínico claves para realizar diagnósticos diferenciales y permitir una estimación pronóstica.
Esta revisión contribuye a comprender los trastornos funcionales respiratorios asociados a la hipoventilación, centrándose en la interrelación entre los indicadores de las pruebas funcionales y las modalidades de tratamiento con soporte ventilatorio.
Downloads
Detalles del artículo
Número
Sección
Esta obra está bajo una licencia internacional Creative Commons Atribución 4.0.
Cómo citar
Referencias
Laier-Groeneveld G, Criée CP. Pathophysiology, diagnostics and treatment of the respiratory pump. Pneumologe 2021;18(1):3-12. https://doi.org/10.1007/s10405-020-00357-y
Hoffman RJ, Garner HW, Rojas CA, Grage RA, Sonavane SK, Johnson EM et al. Atypical Causes of Dyspnea: A Review of Neuromuscular and Chest Wall Disorders that Compromise Ventilation. J Thorac Imaging 2022;37(4):W45-W55. https://doi.org/10.1097/RTI.0000000000000641
Pegoraro P, Borsini E, Young P. Revista Fronteras en Medicina 2016;(2): 0056-0059. https://doi.org/10.31954/RFEM/20162/0056-0059
Yamasawa F, Kawashiro T, Yokoyama T, Ohtsuka N. Standard values and normal limits for arterial blood gases in healthy elderly Japanese subjects. Nihon Kyobu Shikkan Gakkai Zasshi 1992; 30:430-4.
Palm A, Ekström M, Emilsson Ö, Ersson K, Ljunggren M, Sundh J et al. Control of hypercapnia and mortality in home mechanical ventilation: the population-based DISCOVERY study. ERJ Open Res 2024;10(6):00461-2024. https://doi.org/10.1183/23120541.00461-2024
Wilson MW, Labaki WW, Choi PJ. Mortality and Healthcare Use of Patients with Compensated Hypercapnia. Ann Am Thorac Soc 2021;18(12):2027-2032. https://doi.org/10.1513/AnnalsATS.202009-1197OC
Dave C, Wharton S, Mukherjee R, Faqihi BM, Stockley RA, Turner AM. Development and Relevance of Hypercapnia in COPD. Can Respir J 2021;2021:6623093. https://doi.org/10.1155/2021/6623093
Böing S, Randerath WJ. Chronic hypoventilation syndromes and sleep-related hypoventilation. J Thorac Dis 2015;7(8):1273-85. https://doi.org/10.3978/j.issn.2072-1439.2015.06.10
Hopper K. A Quick Reference on Respiratory Acidosis. Vet Clin North Am Small Anim Pract 2025:S0195-5616(25)00133-0. https://doi.org/10.1016/j.cvsm.2025.09.003
Deenen JC, Horlings CG, Verschuuren JJ, Verbeek AL, van Engelen BG. The Epidemiology of Neuromuscular Disorders: A Comprehensive Overview of the Literature. J Neuromuscul Dis 2015;2(1):73-85.
Lefter S, Hardiman O, Ryan AM. A population-based epidemiologic study of adult neuromuscular disease in the Republic of Ireland. Neurology 2017;88(3):304-313. https://doi.org/10.1212/WNL.0000000000003504
Maquilón C, Antolini M, Valdés N, Andrade M, Canales K, Rabec C et al. Results of the home mechanical ventilation national program among adults in Chile between 2008 and 2017. BMC Pulm Med 2021;21(1):394. https://doi.org/10.1186/s12890-021-01764-4
Mier-Jedrzejowicz A, Brophy C, Moxham J, Green M. Assessment of diaphragm weakness. Am Rev Respir Dis 1988;137(4):877-83. https://doi.org/10.1164/ajrccm/137.4.877
Morgan RK, McNally S, Alexander M, Conroy R, Hardiman O, Costello RW. Use of Sniff nasal-inspiratory force to predict survival in amyotrophic lateral sclerosis. Am J Respir Crit Care Med 2005;171(3):269-74. https://doi.org/10.1164/rccm.200403-314oc
Hukins CA, Hillman DR. Daytime predictors of sleep hypoventilation in Duchenne muscular dystrophy. Am J Respir Crit Care Med 2000;161(1):166-70. https://doi.org/10.1164/ajrccm.161.1.9901057
Toledo A, Montiel G, Franceschini C. Guías Ventilación Mecánica Domiciliaria. Rev Am Med Resp 2021; 1:1-10.
Khan A, Frazer-Green L, Amin R, Wolfe L, Faulkner G, Casey K et al. Respiratory Management of Patients with Neuromuscular Weakness: An American College of Chest Physicians Clinical Practice Guideline and Expert Panel Report. Chest 2023;164(2):394-413. https://doi.org/10.1016/j.chest.2023.03.011
Restrepo RD, Hirst KR, Wittnebel L, Wettstein R. AARC clinical practice guideline: transcutaneous monitoring of carbon dioxide and oxygen: 2012. Respir Care 2012;57(11):1955-62. https://doi.org/10.4187/respcare.02011
Tzani P, Chiesa S, Aiello M, Scarascia A, Catellani C, Elia D et al. The value of cough peak flow in the assessment of cough efficacy in neuromuscular patients. A cross sectional study. Eur J Phys Rehabil Med 2014;50(4):427-32.
Bach JR, Saporito LR. Criteria for extubation and tracheostomy tube removal for patients with ventilatory failure. A different approach to weaning. Chest 1996;110(6):1566-71. https://doi.org/10.1378/chest.110.6.1566
Suárez AA, Pessolano FA, Monteiro SG, Ferreyra G, Capria ME, Mesa L et al. Peak flow and peak cough flow in the evaluation of expiratory muscle weakness and bulbar impairment in patients with neuromuscular disease. Am J Phys Med Rehabil 2002;81(7):506-11. https://doi.org/10.1097/00002060-200207000-00007
Tilanus TBM, Groothuis JT, TenBroek-Pastoor JMC, Feuth TB, Heijdra YF, Slenders JPL et al. The predictive value of respiratory function tests for non-invasive ventilation in amyotrophic lateral sclerosis. Respir Res 2017;18(1):144. https://doi.org/10.1186/s12931-017-0624-8
Pascua J, Blanco M, Ernst G, Salvado A, Borsini E. Trayectoria vital de pacientes con soporte ventilatorio crónico domiciliario. Medicina (B Aires) 2022;82(6):898-903. https://doi.org/10.1016/j.neuarg.2022.04.004
Borsini E, Blanco M, Ernst G, Pascua J, Salvado A, Reisin R. Utilización de ventilación no invasiva en pacientes con esclerosis lateral amiotrófica. Neurología Argentina 2022;4:221-228. https://doi.org/10.1016/j.neuarg.2022.04.004
Egea-Santaolalla CJ, Chiner-Vives E, Díaz-Lobato S, Mangado NG, Lujan-Tomé M, Mediano-San Andrés O. Ventilación mecánica a domicilio. Open Respir Arch 2020;2:67-88. https://doi.org/10.1016/j.opresp.2020.02.007
Lightowler JV, Wedzicha JA, Elliott MW, Ram FS. Non-invasive positive pressure ventilation to treat respiratory failure resulting from exacerbations of chronic obstructive pulmonary disease: Cochrane systematic review and meta-analysis. BMJ 2003; 25:326(7382):185. https://doi.org/10.1136/bmj.326.7382.185
Elliott MW, Mulvey DA, Moxham J, Green M, Branthwaite MA. Domiciliary nocturnal nasal intermittent positive pressure ventilation in COPD: mechanisms underlying changes in arterial blood gas tensions. Eur Respir J 1991;4(9):1044-52.
Brochard L. Mechanical ventilation: invasive versus noninvasive. Eur Respir J Suppl 2003;47:31s-37s. https://doi.org/10.1183/09031936.03.00050403
Graziani A, Carenzi B, Morgagni F Praticò B, Casalini P Stefanini GF. Functional respiratory effects of noninvasive ventilation in acute hypercapnic patients with chronic obstructive pulmonary disease. Crit Care 2009;13(1):9. https://doi.org/10.1186/cc7173
Ergan B, Oczkowski S, Rochwerg B, Carlucci A, Chatwin M, Clini E et al. European Respiratory Society guidelines on long-term home non-invasive ventilation for management of COPD. Eur Respir J 2019;28;54(3):1901003. https://doi.org/10.1183/13993003.01003-2019
Kakavas S, Kotsiou OS, Perlikos F, Mermiri M, Mavrovounis G, Gourgoulianis K et al. Pulmonary function testing in COPD: looking beyond the curtain of FEV1. NPJ Prim Care Respir Med 2021;7;31(1):23. https://doi.org/10.1038/s41533-021-00236-w
Salzman SH. Which pulmonary function tests best differentiate between COPD phenotypes? Respir Care 2012;57(1):50-57. https://doi.org/10.4187/respcare.01585
Pinto LM, Alghamdi M, Benedetti A, Zaihra T, Landry T, Bourbeau J. Derivation and validation of clinical phenotypes for COPD: a systematic review. Respir Res 2015;18;16(1):50. https://doi.org/10.1186/s12931-015-0208-4
Wedzicha JA, Brill SE, Allinson JP, Donaldson GC. Mechanisms and impact of the frequent exacerbator phenotype in chronic obstructive pulmonary disease. BMC Med 2013;14;11:181. https://doi.org/10.1186/1741-7015-11-181
Corlateanu A, Mendez Y, Wang Y, Garnica RJA, Botnaru V, Siafakas N. Chronic obstructive pulmonary disease and phenotypes: a state-of-the-art. Pulmonology 2020;26(2):95-100. https://doi.org/10.1016/j.pulmoe.2019.10.006
O'Donnell DE, Laveneziana P, Webb K, Neder JA. Chronic obstructive pulmonary disease: clinical integrative physiology. Clin Chest Med 2014;35(1):51-69. https://doi.org/10.1016/j.ccm.2013.09.008
D'Ascanio M, Viccaro F, Calabrò N, Guerrieri G, Pizzirusso D, Mancini R et al. Assessing Static Lung Hyperinflation by Whole-Body Plethysmography, Helium Dilution, and Impulse Oscillometry System (IOS) in Patients with COPD. Int J Chron Obstruct Pulmon Dis 2020;15:2583-2589. https://doi.org/10.2147/copd.s264261
Celli BR. Predictors of mortality in COPD. Respir Med 2010;104(6):773-9. https://doi.org/10.1016/j.rmed.2009.12.017
Haynes JM, Kaminsky DA, Ruppel GL. The Role of Pulmonary Function Testing in the Diagnosis and Management of COPD. Respir Care 2023;68(7):889-913. https://doi.org/10.4187/respcare.10757
Nishimura M, Makita H, Nagai K, Konno S, Nasuhara Y, Hasegawa M et al. Hokkaido COPD Cohort Study Investigators. Annual change in pulmonary function and clinical phenotype in chronic obstructive pulmonary disease. Am J Respir Crit Care Med 2012;185(1):44-52. https://doi.org/10.1164/rccm.201106-0992OC
Caruso P, Albuquerque AL, Santana PV, Zumpano-Cardenas L, Ferreira JG, Prina E et al. Métodos diagnósticos para evaluar la fuerza muscular inspiratoria y espiratoria. J Bras Pneumol 2015;41:110–123. https://doi.org/10.1590/s1806-37132015000004474
Tudorache V, Oancea C, Mlădinescu OF. Clinical relevance of maximal inspiratory pressure: determination in COPD exacerbation. Int J Chron Obstruct Pulmon Dis 2010;5:119-23. https://doi.org/10.2147/copd.s9194
Moran F, Bradley JM, Piper AJ. Non-invasive ventilation for cystic fibrosis. Cochrane Database Syst Rev 2017;20;2(2):CD002769. https://doi.org/10.1002/14651858.cd002769.pub5
Archangelidi O, Carr SB, Simmonds NJ, Bilton D, Banya W, Cullinan P; CF-EpiNet. Non-invasive ventilation and clinical outcomes in cystic fibrosis: Findings from the UK CF registry. J Cyst Fibros 2019;18(5):665-670. https://doi.org/10.1016/j.jcf.2018.11.006
Gernhold L, Neurohr C, Tsitouras K, Lutz N, Briese S, Ghiani A. Hypercapnia and lung function parameters in chronic obstructive pulmonary disease. BMC Pulm Med 2024;24(1):345. https://doi.org/10.1186/s12890-024-03151-1
Murphy PB, Rehal S, Arbane G, Bourke S, Calverley PMA, Crook AM et al. Effect of Home Noninvasive Ventilation With Oxygen Therapy vs Oxygen Therapy Alone on Hospital Readmission or Death After an Acute COPD Exacerbation: A Randomized Clinical Trial. JAMA 2017;317(21):2177-2186. https://doi.org/10.1001/jama.2017.4451
Köhnlein T, Windisch W, Köhler D, Drabik A, Geiseler J, Hartl S et al. Non-invasive positive pressure ventilation for the treatment of severe stable chronic obstructive pulmonary disease: a prospective, multicentre, randomised, controlled clinical trial. Lancet Respir Med 2014;2(9):698-705. https://doi.org/10.1016/s2213-2600(14)70153-5
Struik FM, Lacasse Y, Goldstein RS, Kerstjens HA, Wijkstra PJ. Nocturnal noninvasive positive pressure ventilation in stable COPD: a systematic review and individual patient data meta-analysis. Respir Med 2014;108(2):329-37. http://dx.doi.org/10.1016/j.rmed.2013.10.007
Dreher M, Storre JH, Schmoor C, Windisch W. High-intensity versus low-intensity non-invasive ventilation in patients with stable hypercapnic COPD: a randomised crossover trial. Thorax 2010;65(4):303-8. https://doi.org/10.1136/thx.2009.124263
Márquez-Martín E, Ruiz FO, Ramos PC, López-Campos JL, Azcona BV, Cortés EB. Randomized trial of non-invasive ventilation combined with exercise training in patients with chronic hypercapnic failure due to chronic obstructive pulmonary disease. Respir Med 2014;108(12):1741-51. https://doi.org/10.1016/j.rmed.2014.10.005
Salturk C, Karakurt Z, Takir HB, Balci M, Kargin F, Mocin O et al. Comparison of exercise capacity in COPD and other etiologies of chronic respiratory failure requiring non-invasive mechanical ventilation at home: retrospective analysis of 1-year follow-up. Int J Chron Obstruct Pulmon Dis 2015;10:2559-69. https://doi.org/10.2147/copd.s91950
Duiverman ML, Wempe JB, Bladder G, Vonk JM, Zijlstra JG, Kerstjens HA et al. Two-year home-based nocturnal noninvasive ventilation added to rehabilitation in chronic obstructive pulmonary disease patients: a randomized controlled trial. Respir Res 2011;12(1):112. https://doi.org/10.1186/1465-9921-12-112
Ekkernkamp E, Storre JH, Windisch W, Dreher M. Impact of intelligent volume-assured pressure support on sleep quality in stable hypercapnic chronic obstructive pulmonary disease patients: a randomized, crossover study. Respiration 2014;88(4):270-6. https://doi.org/10.1159/000364946
Pérez de Llano LA, Golpe R, Piquer MO, Racamonde AV, Caruncho MV, López MJ et al. Clinical heterogeneity among patients with obesity hypoventilation syndrome: therapeutic implications. Respiration 2008;75(1):34-9. https://doi.org/10.1159/000105460
De Lucas-Ramos P, de Miguel-Díez J, Santacruz-Siminiani A, González-Moro JM, Buendía-García MJ, Izquierdo-Alonso JL. Benefits at 1 year of nocturnal intermittent positive pressure ventilation in patients with obesity-hypoventilation syndrome. Respir Med 2004;98(10):961-7. https://doi.org/10.1016/j.rmed.2004.03.014
Redolfi S, Corda L, La Piana G, Spandrio S, Prometti P, Tantucci C. Long-term non-invasive ventilation increases chemosensitivity and leptin in obesity-hypoventilation syndrome. Respir Med 2007;101(6):1191-5. https://doi.org/10.1016/j.rmed.2006.11.005
Rabec C, de Lucas Ramos P, Veale D. Respiratory complications of obesity. Arch Bronconeumol 2011;47(5):252-61. https://doi.org/10.1016/j.arbres.2011.01.012
Masa JF, Pépin JL, Borel JC, Mokhlesi B, Murphy PB, Sánchez-Quiroga MÁ. Obesity hypoventilation syndrome. Eur Respir Rev 2019;28(151):180097. https://doi.org/10.1183/16000617.0097-2018
de Lucas Ramos P, Rodríguez González-Moro JM, Rubio-Socorro Y. Obesidad y función pulmonar [Obesity and lung function]. Arch Bronconeumol 2004;40 Suppl 5:27-31. https://doi.org/10.1157/13077885
Rochester DF, Enson Y. Current concepts in the pathogenesis of the obesity-hypoventilation syndrome. Mechanical and circulatory factors. Am J Med 1974;57(3):402-20. https://doi.org/10.1016/0002-9343(74)90135-1
Drummond M, Santos A, Pinto T, Goncalves M, Marinho A, Sucena M et al. Triple 0 - A new respiratory syndrome? Eur Respir J 2012;40(56):2071.
Ford ES. The epidemiology of obesity and asthma. J Allergy Clin Immunol 2005;115(5):897-909. https://doi.org/10.1016/j.jaci.2004.11.050
Pite H, Aguiar L, Morello J, Monteiro EC, Alves AC, Bourbon M et al. Metabolic Dysfunction and Asthma: Current Perspectives. J Asthma Allergy 2020;13:237-247. https://doi.org/10.2147/jaa.s208823
Peters U, Dixon AE, Forno E. Obesity and asthma. J Allergy Clin Immunol 2018;141(4):1169-1179. https://doi.org/10.1016/j.jaci.2018.02.004
Böhmer AB, Wappler F. Preoperative evaluation and preparation of the morbidly obese patient. Curr Opin Anaesthesiol 2017;30(1):126-132. https://doi.org/10.1097/aco.0000000000000411
Bluth T, Pelosi P, de Abreu MG. The obese patient undergoing nonbariatric surgery. Curr Opin Anaesthesiol 2016;29(3):421-9. https://doi.org/10.1097/aco.0000000000000337
Bazurro S, Ball L, Pelosi P. Perioperative management of obese patient. Curr Opin Crit Care 2018;24(6):560-567. https://doi.org/10.1097/mcc.0000000000000555
Clavellina-Gaytán D, Velázquez-Fernández D, Del-Villar E, Domínguez-Cherit G, Sánchez H, Mosti M et al. Evaluation of spirometric testing as a routine preoperative assessment in patients undergoing bariatric surgery. Obes Surg 2015;25(3):530-6. https://doi.org/10.1007/s11695-014-1420-x
Murphy PB, Patout M, Arbane G, Mandal S, Kaltsakas G, Polkey M et al. Cost-effectiveness of outpatient versus inpatient non-invasive ventilation setup in obesity hypoventilation syndrome: the OPIP trial. Thorax 2023;78(1):24-31. https://doi.org/10.1136/thorax-2021-218497
Howard ME, Ridgers A. Implementing non-invasive ventilation at home: the frontier for chronic respiratory failure? Thorax 2023;78(1):7-8. https://doi.org/10.1136/thorax-2022-219480
Fagerudd S, Lammintausta A, Laitinen T, Anttalainen U, Saaresranta T. Home non-invasive ventilation: An observational study of aetiology, chronic respiratory failure of multiple aetiologies, survival and treatment adherence. Heliyon 2024;10(12):e32508. https://doi.org/10.1016/j.heliyon.2024.e32508