ASSOBRAFIR Ciência
https://assobrafirciencia.org/article/5de0265a0e8825d16c4ce1d5
ASSOBRAFIR Ciência
Artigo Original

Comportamento dos valores da pressão inspiratória máxima e do índice de respiração rápida superficial durante o teste de respiração espontânea

Behavior of the values of maximal inspiratory pressure and rapid shallow breathing index during spontaneous breathing trial

Eduardo Eriko Tenório de França, Priscilla Gonçalves Melo, Maria Cecília Cedrim Costa, Francimar Ferrari Ramos, Marco Aurélio Valois Correa Júnior, Célia Maria Barbosa de Andrade Castro, Maria Amparo Andrade, Flávio Maciel Dias de Andrade, Luana Carneiro Ribeiro, Eduarda Lubambo Costa, Carolina Sales de Souza, Mateus Parrois Torres de Melo

Downloads: 0
Views: 103

Resumo

Introdução: O processo de retirada prematura da Ventilação Mecânica (VM) impõe intenso estresse aos sistemas respiratório e cardiovascular, podendo retardar o tempo de recuperação do paciente. No entanto, a VM prolongada, também, pode acarretar sérias complicações neuromusculares e dificuldade no desmame. Neste sentido, para garantir maior segurança quanto à capacidade do paciente em reassumir adequadamente a respiração espontânea, alguns índices fisiológicos são utilizados na terapia intensiva, de forma a predizer o sucesso no desmame da VM. Encontram-se, entre os mais utilizados, a Pressão Inspiratória Máxima (Pimáx) e o Índice de Respiração Rápida e Superficial (IRRS). Objetivo: Avaliar o comportamento da Pimáx e do IRRS mensurados no primeiro minuto e após o término do Teste de Respiração Espontânea (TRE) realizado em “tubo-T” ou Ventilação com Pressão de Suporte (PSV). Métodos: Foram incluídos pacientes internados na Unidade de Terapia Intensiva, no período entre novembro de 2011 a março de 2012, em VM, por mais de 48h, submetidos ao TRE em “tubo T” ou PSV, realizado durante 30min. Antes e após o TRE, os pacientes foram submetidos à avaliação da Pimáx e do IRRS. Resultados: Foram estudados 30 pacientes, sendo “tubo-T” (n = 14) e PSV (n = 16). A Pimáx aumentou de forma significativa apenas no grupo “tubo-T”, enquanto o IRRS apresentou redução significativa, em ambos os grupos, imediatamente após o TRE. Conclusões: O TRE realizado em “tubo T” e em PSV, durante 30 minutos, promoveu significativas alterações nos valores de Pimáx e do IRRS avaliados antes e após o TRE.

Palavras-chave

Índice de Respiração Rápida e Superficial; Pressão Inspiratória Máxima; Teste de Respiração Espontânea.

Abstract

Introduction: The process of premature withdrawal of mechanical ventilation (MV) imposes intense stress to respiratory and cardiovascular systems, and can delay the recovery time of the patient. However, the MV can also cause serious neuromuscular complications and difficulty in weaning. In this regard, to ensure greater certainty as to the patient’s ability to resume spontaneous breathing properly, some physiological indices are used in intensive care in order to predict successful weaning from MV. Among them, the most commonly used are the maximal inspiratory pressure (MIP) and the index of rapid shallow breathing (IRRS). Objective: To evaluate the MIP and the IRRS measured in the first minute and after the spontaneous breathing trial (SBT) performed in “T-tube” or pressure support ventilation (PSV). Methods: Patients admitted to the intensive care unit during the period between November 2011 and March 2012 in MV for more than 48 hours were submitted to SBT in “T-tube” or PSV during 30 min. Before and after SBT, patients were evaluated for MIP and IRRS. Results: We studied 30 patients, “T-tube” (n = 14) and PSV (n = 16). The MIP increased significantly only in the group “T-tube”, while the IRRS was significantly reduced in both groups immediately after the SBT. Conclusions: The SBT held in “T-tube” and PSV for 30 minutes promoted significant changes in the values of MIP and IRRS evaluated before and after the test.

Keywords

Maximum inspiratory pressure; Rapid shallow breathing index; Spontaneous breathing trial.

Referências

1. Shanely R, Coombes JS, Zergeroglu AM, Webb AI, Powers SK. Short-duration mechanical ventilation enhances diaphragmatic fatigue resistance but impairs force production. Chest. 2003 Jan;123(1):195-201.

2. MacIntyre NR. Evidence-based ventilator weaning and discontinuation. Respir Care. 2004 Jul;49(7):830-6.

3. Tobin MJ. Advances in mechanical ventilation. N Engl J Med. 2001 Jun 28;344(26):1986-96.

4. Vassilakopoulos T, Petrof BJ. Ventilator-induced diaphragmatic dysfunction. Am J Respir Crit Care Med. 2004 Feb 1;169(3):336-41.

5. Chang AT, Boots RJ, Brown MG, Paratz J, Hodges PW. Reduced inspiratory muscle endurance following successful weaning from prolonged mechanical ventilation. Chest. 2005 Aug;128(2):553-9.

6. Alia I, Esteban A. Weaning from mechanical ventilation. Crit Care. 2000;4:72-80.

7. Kupfer Y, Tessler S. Weaning the difficult patient: the evolution from art to science. Chest. 2001 Jan;119(1):7-9.

8. MacIntyre N. Discontinuing mechanical ventilatory support: removing positive pressure ventilation vs removing the artificial airway. Chest. 2006 Dec;130(6):1635-6.

9. Esteban A, Alia I, Gordo F, Fernández R, Solsona JF, Vallverdú I, et al. Extubation outcome after spontaneous breathing trials with T-tube or pressure support ventilation. Am J Respir Crit Care Med. 1997 Aug;156(2 Pt 1):459-65.

10. Vallverdu I, Calaf N, Subirana M, Net A, Benito S, Mancebo J. Clinical characteristics, respiratory functional parameters, and outcome of a two-hour T-piece trial in patients weaning from mechanical ventilation. Am J Respir Crit Care Med. 1998 Dec;158(6):1855-62.

11. Meade M, Guyatt G, Cook D, Griffith L, Sinuff T, Kergl C et al. Predicting success in weaning from mechanical ventilation. Chest. 2001 Dec;120:(6 Suppl):400S-24S.

12. Yang KL, Tobin MJ. A prospective study of indexes predicting the outcome of trials of weaning from mechanical ventilation. N Engl J Med. 1991 May 23;324(21):1445-50.

13. Kuo PH, Wu HD, Lu BY, Chen MT, Kuo SH, Yang PC. Predictive value of rapid shallow breathing index measured at initiation and termination of a 2-hour spontaneous breathing trial for weaning outcome in ICU Patients. J Formos Med Assoc. 2006 May;105(5):390-8.

14. Brandão D. Comparação entre as diferentes formas de mensuração da pressão Inspiratória Máxima (Pimáx) em pacientes com via aérea artificial. In: XII Congresso Brasileiro de Medicina Intensiva. Recife; 2006. Rev Bras Terap Intensiva. 2006:(Suppl): S265.

15. Matic I, Majeric-Kogler V. Comparison of pressure support and T-tube weaning from mechanical ventilation: randomized prospective study. Croat Med J. 2004 Apr;45(2):162-6.

16. Banner MJ, Kirby RR, MacIntyre NR. Patient and ventilator work of breathing and ventilatory muscle loads at different levels of pressure support ventilation. Chest. 1991 Aug;100(2):531-3.

17. Vassilakopoulos T, Routsi C, Sotiropoulou C,Bitsakou C, Stanopoulos I, Roussos C, Zakynthinos S. The combination of the load/force balance and the frequency/tidal volume can predict weaning outcome. Intensive Care Med. 2006 May;32(05):684-91.

18. Krieger BP, Isber J, Breitenbucher A, Throop G, Ershowsky P. Serial measurements of the rapidshallow-breathing index as predictor of weaning outcome in elderly medical patients. Chest. 1997 Oct;112(4):1029-34.

19. Chatila W, Jacob B, Guaglionone D, Manthous CA. The unassisted respiratory rate-tidal volume ratio accurately predicts weaning outcome. Am J Med. 1996 Jul;101(1):61-7.

20. Jacob B, Chatila W, Manthous CA. The unassisted respiratory rate/tidal volume ratio accurately predicts weaning outcome in postoperative patients. Crit Care Med. 1997 Feb;25(2):253-7.

21. Segal LN, Oei E, Oppenheimer BW, Goldring RM, Bustami RT, Ruggiero S, et al. Evolution of pattern of breathing during a spontaneous breathing trial predicts successful extubation. Intensive Care Med. 2010 Mar;36(3):487-95.

22. Costa AD, Rieder M de M, Vieira SR. Weaning from mechanical ventilation by using pressure support or T-tube ventilation. Comparison between patients with and without heart disease. Arq Bras Cardiol. 2005 Jul;85(1):32-8.

23. Amaral JL. Desmame da Ventilação Artificial. In: David C, editor. Ventilação Mecânica: da Fisiologia ao Consenso Brasileiro. 1ª ed. Rio de Janeiro: Revinter; 1996.

24. Branson RD, Campbell RS. Modes of Ventilator operation. In: MacIntyre NR, Branson RD, editors. Mechanical Ventilation. 2nd ed. Philadelphia: Saunders; 2001.

5de0265a0e8825d16c4ce1d5 assobrafir Articles
Links & Downloads

ASSOBRAFIR Ciência

Share this page
Page Sections