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https://assobrafirciencia.org/article/doi/10.47066/2177-9333.AC.2020.0020
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Artigo Científico Original

Fatores de risco associados com falha de extubação em uma unidade de terapia intensiva de trauma

Carolina Ocelli de Araujo Alves, Julia Alencar Renault, Priscilla Ribeiro Soares, Ronaldo Angelo Dias da Silva

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Resumo

Introdução: O desafio clínico atual é melhorar o desmame da ventilação mecânica invasiva (VMI) em pacientes criticamente doentes. Parâmetros comumente utilizados são descritos pela literatura e capazes de informar sobre a capacidade do doente em respirar espontaneamente. Objetivo: identificar os fatores de risco para predizer o desfecho da extubação em pacientes internados em uma unidade de terapia intensiva (UTI) de trauma. Método: Estudo de coorte prospectivo para analisar o desfecho reintubação em pacientes vítimas de trauma. Adultos intubados que necessitaram de VMI por pelo menos 24h foram examinados e acompanhados até alta ou óbito. Para análise de dados foram empregados os testes de Mann Whitney, Qui-quadrado, teste exato de Fisher, e regressão logística binária múltipla. Resultados: Dos 262 pacientes que passaram por uma extubação planejada, 56 pacientes falharam (21,4%). A reintubação esteve associada independentemente com idade avançada (50,23±2,24 anos), maior escore no APACHE II (14,75±5,39), frequência respiratória (FR) elevada, intubação orotraqueal (IOT) por causas respiratórias (OR=4,4, IC 95%=1,792–11,025, p=0,04) e presença de doenças respiratórias (OR=3,3, IC95%=1,136–9,926, p=0,05). Além disso, pacientes que falharam a extubação tiveram maior tempo de internação (19,27 ± 9,90, p<0,001), maior taxa de mortalidade (RR=4,1, IC95%=2,87–6,19, p<0,001), necessidade de ventilação não invasiva (VNI) pós-extubação e traqueostomia. Conclusão: maior escore no APACHE II, FR elevada, IOT por causas respiratórias e presença de comorbidades respiratórias foram os fatores de risco independentes para reintubação. Insucesso na extubação planejada foi seguida de deterioração clínica, sugerindo um efeito específico da falha de extubação e reintubação nos desfechos dos pacientes.

Palavras-chave

Terapêutica; Manuseio das Vias Aéreas; Extubação; Respiração Artificial.

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Submetido em:
12/04/2021

Aceito em:
07/06/2021

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