Avaliação da relação entre espaço morto e volume corrente como índice preditivo de falha de extubação

Abstract

Objective: The objective of this study was to evaluate the ratio of dead space to tidal volume (VD/VT) as a predictor of extubation failure of children from mechanical ventilation.Methods: From September 2001 to January 2003 we studied a cohort consisting of all children (1 day-15 years) submitted to mechanical ventilation at a pediatric intensive care unit who were extubated and for whom preextubation ventilometry data were available, including the VD/VT ratio. Extubation success was defined as no need for any type of ventilatory support, invasive or otherwise, within 48 hours. Patients who tolerated extubation, with or without noninvasive support, were defined as success-R and compared with those who were reintubated. Statistic analysis was based on a VD/VT cutoff point of 0.65.Results: During the study period 250 children received mechanical ventilation at the pediatric intensive care unit. Eighty-six of these children comprised the study sample. Twenty-one children (24.4%) met the criteria for extubation failure, with 11 (12.8%) of these requiring non-invasive support and 10 (11.6%) reintubation. Their mean age was 16.8 (±30.1) months (median = 5.5 months). The mean VD/VT ratio for all cases was 0.62 (±0.18). Mean VD/VT ratios for patients with successful and failed extubations were 0.62 (±0.17) and 0.65 (±0.21) (p = 0.472), respectively. Logistic regression failed to reveal any statistically significant correlation between VD/ VT ratio and success or failure of extubation (p = 0.8458), even for patients who were reintubated (p = 0.5576). Conclusions:In a pediatric population receiving mechanical ventilation due to a variety of etiologies, the VD/ VT ratio was unable to predict the populations at risk of extubation failure or of reintubation.J Pediatr (Rio J). 2006;82(5):347-53: Respiratory failure, lung disease, respiratory dead space, pulmonary volume measurement, artificial respiration, child.

Avaliação do conhecimento de fisioterapeutas sobre os protocolos de desmame e extubação em pediatria

“…É importante salientar que somente a avaliação da relação VD/VT não é preditora de sucesso da extubação na pediatria, e de acordo com os resultados, 80,5% dos profissionais concordam que essa avaliação é limitada para identificar falhas na extubação. Destaca-se que a relação VD/VT é utilizado como parâmetro de avaliação do grau de lesão pulmonar na pediatria, e não como preditor da extubação 21 .…”

Análise Das Caracteristicas Clínicas Dos Pacientes Com Síndrome Do Desconforto Respiratório Agudo Submetidos À Posição Prona: Estudo Retrospectivo

“…A presença de regiões pulmonares colapsadas tem sido associada ao aumento do risco de infecções respiratórias, bem como à hipoxemia por aumento do shunt. A sua expansão faz-se necessária para melhorar a oxigenação e diminuir o risco de pneumonia, propiciando o desmame da ventilação mecânica e a extubação (BOUSSO, 2006;MATSUMOTO;CARVALHO, 2007). Tal expansão pode ser auxiliada com as manobras de recrutamento alveolar.…”

Avaliação do teste de respiração espontânea na extubação de neonatos pré-termo

“…Thus, the determination or prediction of the appropriate extubation time, and its success, is of paramount importance. (10,11) MV patients weaning is one of the critical ventilatory support phases, and is related to complications and mortality. (12)(13)(14) If the extubation failure could be accurately predicted, the extubation could be better scheduled, and the reintubation trauma prevented.…”

“…(15)(16)(17)(18) The SBT is a simple technique performed immediately before the extubation and may provide useful information on the patient's spontaneous breathing ability. (10,19) This test is already common and well founded in adult and pediatric intensive care units (ICUs), however, few studies were developed to validate its neonatal use. (20,21) This study mainly aimed to check if SBT is a good success predictor in preterm newborns extubation, analyzing the respiratory rate (RR), heart rate (HR), pulse oxygen saturation (SpO 2 ) and the Silverman-Andersen score (SAS).…”