Determinant factors for mortality of patients receiving mechanical ventilation and effects of a protocol muscle training in weaning.

Abstract

Introduction: Prognostic factors are used in the Intensive Care Unit (ICU) to predict morbidity and mortality, especially in patients on mechanical ventilation (MV). Training protocols are used in MV patients with the aim of promoting the success of the weaning process. Objective: To assess which variables determine the outcome of patients undergoing mechanical ventilation and compare the effects of two protocols for weaning. Method: Patients under MV for more than 48 hours had collected the following information: gender, age, ideal weight, height, Acute Physiology and Chronic Health Evaluation (APACHE II), risk of mortality, Glasgow Coma Scale (GCS) and index Quick and perfunctory (IRRS) breathing. Patients with unsuccessful weaning performed one of weaning protocols: Progressive T -tube or tube -T + Threshold ® IMT. Patients were compared for outcome (death or non-death in the ICU) and the protocols through the t test or Mann-Whitney test was considered significant when P <0.05. Results: Of 128 patients evaluated 56.25% were men, the mean age was 60.05 ± 17.85 years and 40.62% patients died, and they had higher APACHE II scores, mortality risk, time VM and IRRS GCS and the lower value (p<0.05). The age, initial and final maximal inspiratory pressure, time of weaning and duration of MV was similar between protocols. Conclusion: The study suggests that the GCS, APACHE II risk of mortality, length of MV and IRRS variables determined the evolution of MV patients in this sample. Not found differences in the variables studied when comparing the two methods of weaning. Keywords: Intensive Care Unit; Mortality; Ventilator weaning; Respiration, artificial; APACHE; Airway extubation. ResumoIntrodução: Fatores prognósticos são usados na Unidade de Terapia Intensiva (UTI) para predizer morbimortalidade, especialmente em pacientes em Ventilação Mecânica (VM). Protocolos de treinamento são utilizados em pacientes em VM com o intuito de promover o sucesso no processo de desmame ventilatório. Objetivo: Avaliar quais variáveis determinam a evolução de pacientes submetidos à ventilação mecânica e comparar os efeitos de dois protocolos de desmame ventilatório. Método: Pacientes em VM por mais de 48h tiveram as seguintes informações coletadas: sexo, idade, massa ideal, estatura, Acute Physiology and Chronic Health Evaluation (APACHE II), risco de mortalidade, Escala de Coma de Glasgow (ECGl) e Índice de Respiração Rápida e Superficial (IRRS). Pacientes com insucesso de desmame realizaram um dos protocolos de desmame: Tubo-T progressivo ou Tubo-T + Threshold ® IMT. Os pacientes foram comparados quanto ao desfecho (óbito ou não-óbito na UTI) e quanto aos protocolos por meio do Teste t ou Teste Mann-Whitney, foi considerado como significante p<0.05. Resultados: Dos 128 pacientes avaliados 56,25% eram homens, a idade média era 60,05±17,85 anos e 40,62% pacientes foram a óbito, sendo que estes apresentaram maiores valores de APACHE II, risco de mortalidade, tempo de VM e IRRS e menor valor de ECGl (p<0,05). A idade, pressão in...

Inspiratory muscle training facilitates weaning from mechanical ventilation among patients in the intensive care unit: a systematic review

“…Citation tracking of the remaining 14 eligible papers identified one additional eligible paper. These 15 papers represented 10 eligible studies, [28][29][30][31][32][33][34][35][36][37] because one study was reported across five papers 34,38-41 and another study was reported across two papers. 28,42 Figure 1 presents the flow of studies through the review.…”

“…In six of the studies, [28][29][30]34,36,37 this measurement involved the application of a unidirectional valve for around 30 seconds to ensure that the pressure was generated from residual volume, as recommended. 44 Multiple studies (detailed below) reported data for the remaining outcomes and the data were in (or could be converted to) the same units.…”

“…Six studies [28][29][30][31]35,37 reported the weaning duration of 212 participants. On average, the inspiratory muscle training group had a shorter time to wean by 1.7 days, but this was not statistically significant (95% CI -0.3 to 3.6).…”

“…Seven studies [28][29][30]32,34,35,37 reported the total duration of mechanical ventilation (including the pre-training period) for 305 participants. The mean difference was 2.3 days shorter in the inspiratory muscle training group, but this was not statistically significant (95% CI -0.5 to 5.1).…”

Inspiratory muscle training to enhance recovery from invasive mechanical ventilation

“…Since 2011, 9 randomised trials of inspiratory muscle training in intensive care patients have been published (Cader et al, 2010, Martin et al, 2011, Condessa et al, 2013, Dixit and Prakash, 2014, Elbouhy et al, 2014, Ibrahiem et al, 2014, Pascotini et al, 2014, Shimizu et al, 2014, and the results of these studies have been summarised in 2 systematic reviews with meta-analyses (Moodie et al, 2011, Elkins andDentice, 2015). While the metaanalyses confirmed that inspiratory muscle training in ventilator-dependent patients increases respiratory muscle strength and facilitates weaning (Moodie et al, 2011, Elkins andDentice, 2015), there is wide variability in both patient selection and training programs used across the studies.…”