Modelo asistencial ambulatorio de alta resolución COVID-A2R: una solución efectiva en el servicio de urgencias para pacientes con COVID-19 y riesgo de evolución desfavorable / Effective fast-track ambulatory care pathway for patients with COVID-19 at risk for poor outcome: the COVID-A2R model in a hospital emergency department

Objetivo. Evaluar la efectividad de un modelo asistencial basado en la derivación desde el servicio de urgencias hospitalarios (SUH) a una consulta presencial precoz de alta resolución (COVID-A2R), para pacientes con infección por SARS-CoV-2 sin insuficiencia respiratoria, pero con factor de riesgo de complicación/deterioro clínico. Método. Cohorte retrospectiva de pacientes remitidos por COVID-19 (RT-PCR) desde el SUH de un hospital terciario a COVID-A2R (7 de enero - 17 de febrero de 2021). Los criterios de inclusión son presencia de alta comorbilidad y elevación de biomarcadores inflamatorios en pacientes sin neumonía, o la presencia de neumonía con elevación de biomarcadores inflamatorios sin insuficiencia respiratoria. La variable de resultado principal fue el no requerimiento de revisita en el SUH con ingreso hospitalario y su distribución temporal. Los objetivos secundarios son la frecuentación en COVID-A2R y el impacto económico potencial. Resultados. Se incluyeron 278 pacientes, edad mediana de 57 años, 57,9% hombres e índice de Charlson de 1. Consultaron en el SUH tras 7 (4-11) días de clínica y un 71,8% de los casos presentaban neumonía. El 64,7% de los pacientes requirió una visita única en COVID-A2R. No se produjo una revisita a urgencias con ingreso en el 87,8% (83,4-91,1) de los pacientes. De los 34 pacientes que ingresaron, el 88,2% lo hizo en menos de 5 días. El ahorro potencial del modelo fue de 1.708 días de ingreso hospitalario. Conclusiones. Un modelo asistencial ambulatorio con una consulta de alta resolución tras el alta de urgencias es efectivo para pacientes con COVID-19 sin insuficiencia respiratoria con marcadores clínicos o analíticos de evolución desfavorable.

Objective. To evaluate the effectiveness of a care pathway (Spanish acronym, COVID-A2R) through which patients with SARS-CoV-2 infection were referred by a hospital emergency department (ED) for fast-track in-person outpatient clinic care if they did not have respiratory insufficiency but were at high risk for complications and poor outcome. Methods. Retrospective cohort of patients referred to the COVID-A2R pathway after being diagnosed with COVID-19 by reverse transcription polymerase chain reaction assay in a tertiary care hospital ED between January 7 and February 17, 2021. The inclusion criteria were 1) absence of pneumonia but presence of serious comorbidity and/or elevated biomarkers of inflammation, and 2) pneumonia with or without elevated inflammatory markers but without respiratory insufficiency. The main outcome was need for an emergency department revisit with hospital admission and time from ED evaluation to hospitalization. Secondary outcomes were the number of COVID-A2R visits and the potential economic impact. Results. We included 278 patients with a median age of 57 years (57.9% men) and a median Charlson Comorbidity Index of 1. The median time since onset of symptoms was 7 days (interquartile range, 4–11 days). Pneumonia was diagnosed in 71.8%, and 64.7% required only 1 in-person visit in the COVID-A2R pathway. No revisits to the ED were needed by 87.8% (83.4%–91.1%) of the patients. Of the 34 patients who were hospitalized, 88.2% were admitted within 5 days. The COVID-A2R model potentially saved 1708 days of hospitalization. Conclusion. The fast-track ambulatory care model was effective after emergency department discharge of patients with COVID-19 without respiratory insufficiency but with clinical or laboratory indicators of risk for poor outcome.

Effective fast-track ambulatory care pathway for patients with COVID-19 at risk for poor outcome: the COVID-A2R model in a hospital emergency department. / Modelo asistencial ambulatorio de alta resolución COVID-A2R: una solución efectiva en el servicio de urgencias para pacientes con COVID-19 y riesgo de evolución desfavorable.

OBJECTIVES: To evaluate the effectiveness of a care pathway (Spanish acronym, COVID-A2R) through which patients with SARS-CoV-2 infection were referred by a hospital emergency department (ED) for fast-track in-person outpatient clinic care if they did not have respiratory insufficiency but were at high risk for complications and poor outcome. MATERIAL AND METHODS: Retrospective cohort of patients referred to the COVID-A2R pathway after being diagnosed with COVID-19 by reverse transcription polymerase chain reaction assay in a tertiary care hospital ED between January 7 and February 17, 2021. The inclusion criteria were 1) absence of pneumonia but presence of serious comorbidity and/or elevated biomarkers of inflammation, and 2) pneumonia with or without elevated inflammatory markers but without respiratory insufficiency. The main outcome was need for an emergency department revisit with hospital admission and time from ED evaluation to hospitalization. Secondary outcomes were the number of COVID-A2R visits and the potential economic impact. RESULTS: We included 278 patients with a median age of 57 years (57.9% men) and a median Charlson Comorbidity Index of 1. The median time since onset of symptoms was 7 days (interquartile range, 4-11 days). Pneumonia was diagnosed in 71.8%, and 64.7% required only 1 in-person visit in the COVID-A2R pathway. No revisits to the ED were needed by 87.8% (83.4%-91.1%) of the patients. Of the 34 patients who were hospitalized, 88.2% were admitted within 5 days. The COVID-A2R model potentially saved 1708 days of hospitalization. CONCLUSION: The fast-track ambulatory care model was effective after emergency department discharge of patients with COVID-19 without respiratory insufficiency but with clinical or laboratory indicators of risk for poor outcome.

OBJETIVO: Evaluar la efectividad de un modelo asistencial basado en la derivación desde el servicio de urgencias hospitalarios (SUH) a una consulta presencial precoz de alta resolución (COVID-A2R), para pacientes con infección por SARS-CoV-2 sin insuficiencia respiratoria, pero con factor de riesgo de complicación/deterioro clínico. METODO: Cohorte retrospectiva de pacientes remitidos por COVID-19 (RT-PCR) desde el SUH de un hospital terciario a COVID-A2R (7 de enero - 17 de febrero de 2021). Los criterios de inclusión son presencia de alta comorbilidad y elevación de biomarcadores inflamatorios en pacientes sin neumonía, o la presencia de neumonía con elevación de biomarcadores inflamatorios sin insuficiencia respiratoria. La variable de resultado principal fue el no requerimiento de revisita en el SUH con ingreso hospitalario y su distribución temporal. Los objetivos secundarios son la frecuentación en COVID-A2R y el impacto económico potencial. RESULTADOS: Se incluyeron 278 pacientes, edad mediana de 57 años, 57,9% hombres e índice de Charlson de 1. Consultaron en el SUH tras 7 (4-11) días de clínica y un 71,8% de los casos presentaban neumonía. El 64,7% de los pacientes requirió una visita única en COVID-A2R. No se produjo una revisita a urgencias con ingreso en el 87,8% (83,4-91,1) de los pacientes. De los 34 pacientes que ingresaron, el 88,2% lo hizo en menos de 5 días. El ahorro potencial del modelo fue de 1.708 días de ingreso hospitalario. CONCLUSIONES: Un modelo asistencial ambulatorio con una consulta de alta resolución tras el alta de urgencias es efectivo para pacientes con COVID-19 sin insuficiencia respiratoria con marcadores clínicos o analíticos de evolución desfavorable.

Oxigenoterapia y cuidados paliativos en pacientes con insuficiencia cardiaca / Oxygen therapy and palliative care in patients with heart failure

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Nuevas perspectivas en la titulación de la oxigenoterapia: ¿es la titulación automática el futuro? / New Perspectives in Oxygen Therapy Titration: Is Automatic Titration the Future?

La oxigenoterapia, como todos los tratamientos que dependen de la tecnología, no para de evolucionar. No hay dudas respecto a su eficacia en el tratamiento de la insuficiencia respiratoria aguda y crónica en diferentes escenarios clínicos. Sin embargo, su dosificación terapéutica no es tan estricta como la de otros tratamientos. El uso de flujos más altos de lo necesario y por periodos demasiado prolongados, derivados de la percepción de «terapia salvavidas con pocos efectos secundarios» por parte del clínico, ha conllevado un uso bastante liberal de este medicamento, pese a la evidencia de que tanto su uso en exceso como su ajuste subóptimo tienen efectos nocivos. La titulación de la oxigenoterapia ha demostrado efectos beneficiosos en los pacientes. Tradicionalmente, se ha realizado de forma manual. Recientemente, se han desarrollado nuevos dispositivos para ajustar automáticamente las tasas de flujo de oxígeno a las necesidades de cada paciente, con el objetivo de mantener las saturaciones de oxígeno estables. Estos sistemas de suministro de oxígeno de circuito cerrado tienen el potencial de reducir el error médico, mejorar la morbimortalidad y reducir los costes del cuidado. Dar a conocer estos nuevos avances tecnológicos ayudará a concienciar a la comunidad médica de los riesgos del uso inadecuado del tratamiento con oxígeno. Este trabajo pretende ser una puesta al día de las recientes novedades en relación con la titulación de la oxigenoterapia

Oxygen therapy, like all technology-based treatments, is continuously evolving. There are no doubts as to its effectiveness in the treatment of acute and respiratory failure in different clinical scenarios. However, the dosing guidelines for oxygen therapy are not as strict as for other treatments. The use of higher than necessary flows over excessively long periods, derived from the clinician's perception of it as a ‘life-saving treatment with few side effects’, has led to a rather liberal use of this intervention, despite evidence that overuse and suboptimal adjustment can be harmful. The titration of oxygen therapy, which is traditionally performed manually, has been shown to be beneficial. Recently, new devices have been developed that automatically adjust oxygen flow rates to the needs of each patient, in order to maintain stable oxygen saturation levels. These closed-loop oxygen supply systems can potentially reduce medical error, improve morbidity and mortality, and reduce care costs. Familiarizing the medical community with these technological advances will improve awareness of the risks of the inappropriate use of oxygen therapy. The aim of this paper is to provide an update of recent developments in oxygen therapy titration

Nuevas perspectivas en la titulación de la oxigenoterapia: ¿es la titulación automática el futuro? / New Perspectives in Oxygen Therapy Titration: Is Automatic Titration the Future?

La oxigenoterapia, como todos los tratamientos que dependen de la tecnología, no para de evolucionar. No hay dudas respecto a su eficacia en el tratamiento de la insuficiencia respiratoria aguda y crónica en diferentes escenarios clínicos. Sin embargo, su dosificación terapéutica no es tan estricta como la de otros tratamientos. El uso de flujos más altos de lo necesario y por periodos demasiado prolongados, derivados de la percepción de «terapia salvavidas con pocos efectos secundarios» por parte del clínico, ha conllevado un uso bastante liberal de este medicamento, pese a la evidencia de que tanto su uso en exceso como su ajuste subóptimo tienen efectos nocivos. La titulación de la oxigenoterapia ha demostrado efectos beneficiosos en los pacientes. Tradicionalmente, se ha realizado de forma manual. Recientemente, se han desarrollado nuevos dispositivos para ajustar automáticamente las tasas de flujo de oxígeno a las necesidades de cada paciente, con el objetivo de mantener las saturaciones de oxígeno estables. Estos sistemas de suministro de oxígeno de circuito cerrado tienen el potencial de reducir el error médico, mejorar la morbimortalidad y reducir los costes del cuidado. Dar a conocer estos nuevos avances tecnológicos ayudará a concienciar a la comunidad médica de los riesgos del uso inadecuado del tratamiento con oxígeno. Este trabajo pretende ser una puesta al día de las recientes novedades en relación con la titulación de la oxigenoterapia

Oxygen therapy, like all technology-based treatments, is continuously evolving. There are no doubts as to its effectiveness in the treatment of acute and respiratory failure in different clinical scenarios. However, the dosing guidelines for oxygen therapy are not as strict as for other treatments. The use of higher than necessary flows over excessively long periods, derived from the clinician's perception of it as a ‘life-saving treatment with few side effects’, has led to a rather liberal use of this intervention, despite evidence that overuse and suboptimal adjustment can be harmful. The titration of oxygen therapy, which is traditionally performed manually, has been shown to be beneficial. Recently, new devices have been developed that automatically adjust oxygen flow rates to the needs of each patient, in order to maintain stable oxygen saturation levels. These closed-loop oxygen supply systems can potentially reduce medical error, improve morbidity and mortality, and reduce care costs. Familiarizing the medical community with these technological advances will improve awareness of the risks of the inappropriate use of oxygen therapy. The aim of this paper is to provide an update of recent developments in oxygen therapy titration

Effect of risk of malnutrition on 30-day mortality among older patients with acute heart failure in Emergency Departments.

BACKGROUND: Little is known about the prevalence and impact of risk of malnutrition on short-term mortality among seniors presenting with acute heart failure (AHF) in emergency setting. The objective was to determine the impact of risk of malnutrition on 30-day mortality risk among older patients who attended in Emergency Departments (EDs) for AHF. MATERIAL AND METHODS: We performed a secondary analysis of the OAK-3 Registry including all consecutive patients ≥65 years attending in 16 Spanish EDs for AHF. Risk of malnutrition was defined by the Mini Nutritional Assessment Short Form (MNA-SF) < 12 points. Unadjusted and adjusted logistic regression models were used to assess the association between risk of malnutrition and 30-day mortality. RESULTS: We included 749 patients (mean age: 85 (SD 6); 55.8% females). Risk of malnutrition was observed in 594 (79.3%) patients. The rate of 30-day mortality was 8.8%. After adjusting for MEESSI-AHF risk score clinical categories (model 1) and after adding all variables showing a significantly different distribution among groups (model 2), the risk of malnutrition was an independent factor associated with 30-day mortality (adjusted OR by model 1 = 3.4; 95%CI 1.2-9.7; p = .020 and adjusted OR by model 2 = 3.1; 95%CI 1.1-9.0; p = .033) compared to normal nutritional status. CONCLUSIONS: The risk of malnutrition assessed by the MNA-SF is associated with 30-day mortality in older patients with AHF who were attended in EDs. Routine screening of risk of malnutrition may help emergency physicians in decision-making and establishing a care plan.

New Perspectives in Oxygen Therapy Titration: Is Automatic Titration the Future? / Nuevas perspectivas en la titulación de la oxigenoterapia: ¿es la titulación automática el futuro?

Oxygen therapy, like all technology-based treatments, is continuously evolving. There are no doubts as to its effectiveness in the treatment of acute and respiratory failure in different clinical scenarios. However, the dosing guidelines for oxygen therapy are not as strict as for other treatments. The use of higher than necessary flows over excessively long periods, derived from the clinician's perception of it as a 'life-saving treatment with few side effects', has led to a rather liberal use of this intervention, despite evidence that overuse and suboptimal adjustment can be harmful. The titration of oxygen therapy, which is traditionally performed manually, has been shown to be beneficial. Recently, new devices have been developed that automatically adjust oxygen flow rates to the needs of each patient, in order to maintain stable oxygen saturation levels. These closed-loop oxygen supply systems can potentially reduce medical error, improve morbidity and mortality, and reduce care costs. Familiarizing the medical community with these technological advances will improve awareness of the risks of the inappropriate use of oxygen therapy. The aim of this paper is to provide an update of recent developments in oxygen therapy titration.

Efectividad y seguridad de la terapia de alto flujo con cánulas nasales en pacientes con insuficiencia cardiaca aguda / Efficacy and safety of high-flow nasal cannula oxygen therapy in patients with acute heart failure

Objetivos. Valorar la eficacia y seguridad de la terapia de alto flujo con cánulas nasales (TAFCN) en pacientes con insuficiencia respiratoria aguda (IRA) secundaria a insuficiencia cardiaca aguda (ICA) y refractaria al tratamiento con oxigenoterapia convencional o ventilación no invasiva. Métodos. Estudio observacional prospectivo de pacientes con ICA e IRA atendidos en un servicio de urgencias, con ingreso posterior en una unidad de corta estancia, que, tras 24 horas presentaron empeoramiento y a los que se administró TAFCN. Para evaluar la eficacia se utilizó la escala de disnea modificada de Borg y la oxigenación al alta de urgencias, a las 24 h de tratamiento con oxigenación convencional y a los 60, 120 minutos y 24 h de iniciada la TAFCN. Para evaluar la seguridad se midió grado de confort y eventos adversos producidos. Resultados. Se recogieron 44 pacientes con edad media de 84 (7) años, 75 % mujeres. El uso de la TAFCN supuso una mejoría significativa en los parámetros clínicos y gasométricos (basal, 60 min, 120 min y 24 h), en la escala de disnea y confort, oximetría y cociente de oxigenación y una disminución de la frecuencia respiratoria (p < 0,05). No hubo cambios significativos en la presión arterial de dióxido de carbono. El efecto secundario más frecuente fue el calor (20,4%). Conclusiones. La TAFCN es una alternativa para el tratamiento de los pacientes con IRA secundaria a ICA

Objectives. To evaluate the efficacy and safety of high-flow nasal cannula (HFNC) oxygen therapy in patients in acute respiratory failure due to acute heart failure (AHF) refractory to conventional oxygen therapy or noninvasive ventilation. Methods. Prospective observational study of patients with AHF and respiratory failure attended in an emergency department whose condition worsened after they were admitted to a short-stay unit, leading to use of HFNCs. Efficacy was assessed using a modified Borg dyspnea scale and oxygenation variables on discharge from the emergency department. Data were recorded after 24 hours on conventional oxygen therapy and after 60 and 120 minutes and 24 hours of HFNC therapy. Safety outcomes were the degree of patient comfort and the frequency of adverse events. Results. Forty-four patients with a mean (SD) age of 84 (7) years (75% women) were enrolled. Significant improvements were observed after HFNC oxygen therapy (baseline vs 60 and 120 minutes and baseline vs 24 hours) on clinical outcomes and oxygenation as well as decrease in respiratory frequency (P<.05). No significant changes in the partial pressure of carbon dioxide in arterial blood were detected. The most common side effect was feeling too warm (20.4%). Conclusion. HFNC oxygen therapy offers a treatment alternative for patients with acute respiratory failure due to AHF

Acerca de la ventilación mecánica no invasiva frente a la presión positiva en la vía aérea en el edema pulmonar cardiogénico / Non-Invasive Mechanical Ventilation Compared to Positive Airway Pressure in Cardiogenic Pulmonary Edema

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Terapia de alto flujo con cánulas nasales en pacientes con insuficiencia cardíaca aguda / Terapia de alto fluxo com cânulas nasais em pacientes com insuficiência cardíaca aguda / High flow nasal cannula oxygen therapy in patients with acute heart failure

Los pacientes con insuficiencia cardíaca aguda (ICA) llevan asociado con frecuencia situaciones de insuficiencia respiratoria aguda (IRA) que precisan de suplementos de oxigenación y ventilación. Tradicionalmente, se utilizan tres sistemas para tratar la IRA: oxigenoterapia de alto o bajo flujo, presurización de la vía aérea con ventilación no invasiva (VNI) o CPAP y ventilación mecánica invasiva. Existe un grupo no desdeñable de pacientes con ICA en los que, tras ser tratados y estabilizados, se mantienen con disnea e hipoxemia refractarias a los sistemas de oxigenoterapia convencional. En las últimas dos décadas se ha desarrollado una nueva estrategia para el tratamiento no invasivo de la IRA, la terapia de alto flujo con cánulas nasales (TAFCN). Ésta ofrece al paciente un gas calentado y humidificado de forma activa a flujo elevado de hasta 60 lpm, asegurando una fracción de oxígeno (O2) inspirado (FIO2) hasta del 100%, con una tolerancia y confort significativos. Su eficacia y seguridad ha sido evaluada en diferentes escenarios de IRA en adultos. Se revisan las características técnicas y su funcionamiento, indicaciones tanto en ICA y en otros escenarios, protocolo de inicio, así como las complicaciones y contraindicaciones de esta terapia.

Acute heart failure (AHF) is associated with frequent events of acute respiratory distress (ARD) requiring oxygen and ventilation supplements. Three systems are traditionally used to treat ARD: high or low flow oxygen therapy, continuous positive airway pressure (CPAP) with non-invasive ventilation (NIV) or with invasive mechanical ventilation. There is a non negligible group of patients with AHF who maintain dyspnea and hypoxemia refractory to conventional oxygen therapy systems after receiving treatment and becoming stabilized. In the last two decades a new strategy has been developed for non-invasive treatment of ARD, that is, high flow nasal cannula oxygen therapy (HFNCOT). This treatment provides an active elevated flow of up to 60 bpm of heated humidified gas, ensuring a fraction of inspired oxygen (FiO2) of 100% with significant patient tolerance and comfort. The efficacy and safety of HFNCOT has been evaluated in different scenarios of ARD in adults. We review the technical characteristics, function and indications of HFNCOT in both AHF and other settings, as well as the protocol of initiation and the complications and contraindications of this therapy.

Os pacientes com insuficiência cardíaca aguda (ICA) frequentemente padecem de forma concomitante, quadros de insuficiência respiratória aguda (IRA) sendo necessário nesses casos, fazer uso de oxigenação e ventilação suplementaria. Tradicionalmente se utilizam três sistemas para tratar a IRA: oxigenoterapia de alto ou baixo fluxo, pressurização das vias aéreas com ventilação não invasiva (VNI) ou CPAP e ventilação mecânica invasiva. Existe um significante número de pacientes com ICA, os quais, após serem tratados e estabilizados, continuam apresentando dispnéia e hipóxia refratária aos sistemas de oxigenoterapia convencionais. Nas últimas décadas foi desenvolvida uma nova estratégia para o tratamento não invasivo da IRA: a terapia de alto fluxo com cânulas nasais (TAFCN). Com essa técnica o paciente recebe o gás aquecido e umidificado de forma ativa com fluxo elevado a até 60 lpm, o que estabelece a fração de oxigênio (O2) inspirado (FL02) em praticamente 100%, com notável tolerância e conforto para o paciente. Sua eficácia e segurança foi avaliada em diferentes episódios de IRA em adultos. Este estudo tem como objetivo revisar as características técnicas, funcionamento, indicações, tanto em ICA como em outros quadros clínicos, protocolo de início, assim como as complicações e contraindicações da referida terapia.

Efficacy and safety of high-flow nasal cannula oxygen therapy in patients with acute heart failure. / Efectividad y seguridad de la terapia de alto flujo con cánulas nasales en pacientes con insuficiencia cardiaca aguda.

OBJECTIVES: To evaluate the efficacy and safety of high-flow nasal cannula (HFNC) oxygen therapy in patients in acute respiratory failure due to acute heart failure (AHF) refractory to conventional oxygen therapy or noninvasive ventilation. METHODS: Prospective observational study of patients with AHF and respiratory failure attended in an emergency department whose condition worsened after they were admitted to a short-stay unit, leading to use of HFNCs. Efficacy was assessed using a modified Borg dyspnea scale and oxygenation variables on discharge from the emergency department. Data were recorded after 24 hours on conventional oxygen therapy and after 60 and 120 minutes and 24 hours of HFNC therapy. Safety outcomes were the degree of patient comfort and the frequency of adverse events. RESULTS: Prospective observational study of patients with AHF and respiratory failure attended in an emergency department whose condition worsened after they were admitted to a short-stay unit, leading to use of HFNCs. Efficacy was assessed using a modified Borg dyspnea scale and oxygenation variables on discharge from the emergency department. Data were recorded after 24 hours on conventional oxygen therapy and after 60 and 120 minutes and 24 hours of HFNC therapy. Safety outcomes were the degree of patient comfort and the frequency of adverse events. CONCLUSION: HFNC oxygen therapy offers a treatment alternative for patients with acute respiratory failure due to AHF.

OBJETIVOS: Valorar la eficacia y seguridad de la terapia de alto flujo con cánulas nasales (TAFCN) en pacientes con insuficiencia respiratoria aguda (IRA) secundaria a insuficiencia cardiaca aguda (ICA) y refractaria al tratamiento con oxigenoterapia convencional o ventilación no invasiva. METODOS: Estudio observacional prospectivo de pacientes con ICA e IRA atendidos en un servicio de urgencias, con ingreso posterior en una unidad de corta estancia, que, tras 24 horas presentaron empeoramiento y a los que se administró TAFCN. Para evaluar la eficacia se utilizó la escala de disnea modificada de Borg y la oxigenación al alta de urgencias, a las 24 h de tratamiento con oxigenación convencional y a los 60, 120 minutos y 24 h de iniciada la TAFCN. Para evaluar la seguridad se midió grado de confort y eventos adversos producidos. RESULTADOS: Se recogieron 44 pacientes con edad media de 84 (7) años, 75 % mujeres. El uso de la TAFCN supuso una mejoría significativa en los parámetros clínicos y gasométricos (basal, 60 min, 120 min y 24 h), en la escala de disnea y confort, oximetría y cociente de oxigenación y una disminución de la frecuencia respiratoria (p < 0,05). No hubo cambios significativos en la presión arterial de dióxido de carbono. El efecto secundario más frecuente fue el calor (20,4%). CONCLUSIONES: La TAFCN es una alternativa para el tratamiento de los pacientes con IRA secundaria a ICA.