RESUMEN

Enfrentar un paciente con síndrome de insuficiencia respiratoria aguda (SIRA) siempre es un reto. Existe en la literatura médica un acúmulo de estudios al respecto, aunque en mayor cantidad en la última década, pero que en el momento de enfrentar al paciente en el ámbito clínico nos lleva a controversias y dudas. Sobremanera en los jóvenes médicos que inician su experiencia. En el presente artículo se intenta sugerir la forma inicial del manejo de esta patología siguiendo las interrogantes que habitualmente nos formulamos al abordar al paciente con SIRA: desde saber si mi paciente cumple los criterios de SIRA para iniciar el manejo como tal, iniciar el manejo con el ventilador basándonos en los objetivos generales ya dictados para el tratamiento con ventilación mecánica convencional, ¿qué métodos de reclutamiento alveolar existen?, ¿cuál es el modo ventilatorio adecuado para iniciar?, ¿qué es la protección pulmonar?, una consecuencia de la protección pulmonar es la hipercapnia permisiva pero es ¿resultado esperado o mera consecuencia? Estas interrogantes se intentan contestar en base a los estudios que más han impactado el quehacer médico en los últimos años y así se fundamenta esta revisión.

PALABRAS CLAVE

Síndrome de insuficiencia respiratoria aguda, ventilación mecánica, tratamiento.

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