Ventilação não invasiva na unidade de terapia intensiva de um hospital universitário: características relacionadas ao sucesso e insucesso
DOI:
https://doi.org/10.1590/1809-2950/17000626012019Palavras-chave:
Cuidados Críticos, Respiração Artificial, Ventilação PulmonarResumo
O objetivo deste estudo foi descrever características de sucesso e insucesso do uso da ventilação não invasiva (VNI) na unidade de terapia intensiva (UTI) de um hospital universitário. Trata-se de um estudo observacional prospectivo no qual foram incluídos 75 pacientes, com idade média de 58,3±18,8 anos. Desses, doze necessitaram do uso da VNI por mais de uma vez, totalizando 92 utilizações. Evidenciou-se que, delas, a taxa de sucesso foi de 60,9% (56). O grupo insucesso apresentou mais indivíduos do sexo masculino (p=0,006) e número maior de pacientes com diagnóstico de infecção extrapulmonar (p=0,012). Não foram encontradas diferenças entre os grupos de sucesso e insucesso nos quesitos de modo, modelo, máscara, tempo total de permanência e razões para a instalação da VNI. No grupo insucesso, a pressão positiva inspiratória nas vias aéreas (Ipap) e o volume corrente (VC) foram superiores (p=0,029 e p=0,011, respectivamente). A saturação periférica de oxigênio (p=0,047), o pH (p=0,004), base excess (p=0,006) e o bicarbonato (p=0,013) apresentaram valores inferiores. Concluiu-se que os indivíduos do sexo masculino com diagnóstico de infecção extrapulmonar e que evoluíram com acidose metabólica evoluíram com mais insucesso na utilização da VNI. Esses, necessitaram de parâmetros elevados de Ipap e VC.
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Referências
Ozyilmaz E, Ugurlu A, Nava S. Timing of noninvasive ventilation
failure: causes, risk factors, and potential remedies. BMC Pulm
Med. 2014;14(1):19. doi:10.1186/1471-2466-14-19
Balami JS, Packham SM, Gosney MA. Non-invasive ventilation
for respiratory failure due to acute exacerbations of chronic
obstructive pulmonary disease in older patients. Age Ageing.
;35(1):75–9. doi:10.1093/ageing/afi211
Keenan SP, Sinuff T, Cook DJ, Hill NS. Which patients with acute
exacerbation of chronic obstructive pulmonary disease benefit
from noninvasive positive-pressure ventilation? A systematic
review of the literature. Ann Intern Med. 2003;138(11):861-70.
Antón A, Güell R, Gómez J, Serrano J, Castellano A, Carrasco JL
et al. Predicting the result of noninvasive ventilation in severe
acute exacerbations of patients with chronic airflow limitation.
Chest. 2000;117(3):828-33.
Díaz GG, Alcaraz AC, Talavera JCP, Pérez PJ, Rodriguez AE,
Cordoba FG et al. Noninvasive positive-pressure ventilation
to treat hypercapnic coma secondary to respiratory failure.
Chest. 2005;127(3):952–60. doi:10.1378/chest.127.3.952
Winck JC, Azevedo LF, Costa-Pereira A, Antonelli M, Wyatt JC.
Efficacy and safety of non-invasive ventilation in the treatment
of acute cardiogenic pulmonary edema – a systematic review
and meta-analysis. Crit Care. 2006;10(2):R69. doi:10.1186/cc4905
Gray A, Goodacre S, Newby DE, Masson M, Sampson F, Nicholl
J, et al. Noninvasive ventilation in acute cardiogenic pulmonary
edema. N Engl J Med. 2008;359(2):142-51. doi:10.1056/
NEJMoa0707992
Masip J, Betbesé AJ, Páez J, Vecilla F, Cañizares R, Padró J, et al.
Non-invasive pressure support ventilation versus conventional
oxygen therapy in acute cardiogenic pulmonary oedema: a
randomised trial. Lancet. 2000;356(9248):2126-32.
Nava S, Carbone G, DiBattista N, Bellone A, Baiardi P, Cosentini R
et al. Noninvasive ventilation in cardiogenic pulmonary edema:
a multicenter randomized trial. Am J Respir Crit Care Med.
;168(12):1432-7. doi:10.1164/rccm.200211-1270OC
Hess DR. The role of noninvasive ventilation in the ventilator
discontinuation process. Respir Care. 2012;57(10):1619–25.
doi:10.4187/respcare.01943
Nava S, Gregoretti C, Fanfulla F, Squadrone E, Grassi M,
Carlucci A et al. Noninvasive ventilation to prevent respiratory
failure after extubation in high-risk patients. Crit Care Med.
;33(11):2465-70.
Ferrer M, Valencia M, Nicolas JM, Bernadich O, Badia JR, Torres
A. Early noninvasive ventilation averts extubation failure in
patients at risk: a randomized trial. Am J Respir Crit Care Med.
;173(2):164-70. doi:10.1164/rccm.200505-718OC
Esteban A, Frutos-Vivar F, Ferguson ND, Arabi Y, Apezteguía
C, González M, et al. Noninvasive positive-pressure ventilation
for respiratory failure after extubation. N Engl J Med.
;350(24):2452–60. doi:10.1056/NEJMoa032736
Ornico SR, Lobo SM, Sanches HS, Deberaldini M, Tófoli LT,
Vidal AM, et al. Noninvasive ventilation immediately after
extubation improves weaning outcome after acute respiratory
failure: a randomized controlled trial. Crit Care. 2013;17(2):R39.
doi:10.1186/cc12549
Antonelli M, Conti G, Moro ML, Esquinas A, Gonzalez-Diaz
G, Confalonieri M, et al. Predictors of failure of noninvasive
positive pressure ventilation in patients with acute hypoxemic
respiratory failure: a multi-center study. Intensive Care Med.
;27(11):1718-28. doi:10.1007/s00134-001-1114-4
Rana S, Jenad H, Gay PC, Buck CF, Hubmayr RD, Gajic O.
Failure of non-invasive ventilation in patients with acute lung
injury: observational cohort study. Crit Care. 2006;10(3):R79.
doi:10.1186/cc4923
Schettino G, Altobelli N, Kacmarek RM. Noninvasive positivepressure ventilation in acute respiratory failure outside
clinical trials: experience at the Massachusetts General
Hospital. Crit Care Med. 2008;36(2):441-7. doi:10.1097/01.
CCM.0000300084.67277.90
Passarini JN de S, Zambon L, Morcillo AM, Kosour C, Saad IAB.
Use of non-invasive ventilation in acute pulmonary edema
and chronic obstructive pulmonary disease exacerbation in
emergency medicine: predictors of failure. Rev Bras Ter Intensiva.
;24(3):278-83. doi:10.1590/S0103-507X2012000300012
Delgado M, Marcos A, Tizón A, Carrillo A, Santos A, Balerdi B
et al. Impact of noninvasive ventilation failure upon patient
prognosis. Subanalysis of a multicenter study. Med Intensiva.
;36(9):604-10. doi:10.1016/j.medine.2012.12.001
Yamauchi LY, Travaglia TCF, Bernardes SRN, Figueiroa MC,
Tanaka C, Fu C. Noninvasive positive-pressure ventilation in
clinical practice at a large university-affiliated Brazilian hospital.
Clinics. 2012;67(7):767-72. doi:10.5935/0103-507X.20150046
Azevedo LCP, Park M, Salluh JIF, Rea-Neto A, Souza-Dantas
VC, Varaschin P, et al. Clinical outcomes of patients requiring
ventilatory support in Brazilian intensive care units: a
multicenter, prospective, cohort study. Crit Care. 2013;17(2):R63.
doi:10.1186/cc12594
Carlucci A, Richard J-C, 22. Carlucci A, Richard J-C, Wysocki M, Lepage E, Brochard L.
Noninvasive versus conventional mechanical ventilation.
Am J Respir Crit Care Med. 2001;163(4):874-80. doi:10.1164/
ajrccm.163.4.2006027
Meduri GU, Turner RE, Abou-Shala N, Wunderink R, Tolley
E. Noninvasive positive pressure ventilation via face mask.
First-line intervention in patients with acute hypercapnic and
hypoxemic respiratory failure. Chest. 1996;109(1):179-93.
Alsous F, Amoateng-Adjepong Y, Manthous CA. Noninvasive
ventilation: experience at a community teaching hospital.
Intensive Care Med. 1999;25(5):458-63.
Girault C, Briel A, Hellot M-F, Tamion F, Woinet D, Leroy J, et al.
Noninvasive mechanical ventilation in clinical practice: a 2-year
experience in a medical intensive care unit. Crit Care Med.
;31(2):552-9. doi: 10.1097/01.CCM.0000050288.49328.F0
Sinuff T, Cook D, Randall J, Allen C. Noninvasive positivepressure ventilation: a utilization review of use in a teaching
hospital. Can Med Assoc J. 2000;163(8):969-73.
Barbas CSV, Ísola AM, Farias AM de C, Cavalcanti AB, Gama
AMC, Duarte ACM, et al. Brazilian recommendations of
mechanical ventilation 2013. Part I. Rev Bras Ter Intensiva.
;26(2):89-121. doi:10.5935/0103-507X.20140017
Keenan SP, Sinuff T, Burns KEA, Muscedere J, Kutsogiannis
J, Mehta S, et al. Clinical practice guidelines for the use of
noninvasive positive-pressure ventilation and noninvasive
continuous positive airway pressure in the acute care setting.
Can Med Assoc J. 2011;183(3):E195-214. doi:10.1503/cmaj.100071
Thille AW, Contou D, Fragnoli C, Córdoba-Izquierdo A, Boissier
F, Brun-Buisson C. Non-invasive ventilation for acute hypoxemic
respiratory failure: intubation rate and risk factors. Crit Care.
;17(6):R269. doi:10.1186/cc13103
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