Indicação e uso da ventilação não-invasiva e da cânula nasal de alto fluxo, e orientações sobre manejo da ventilação mecânica invasiva no tratamento da insuficiência respiratória aguda na COVID-19*
Indication and use of noninvasive ventilation and high-flow nasal cannula, and guidance on the management of invasive mechanical ventilation for the treatment of acute respiratory failure in COVID-19*
Bruno Prata Martinez, Flávio Maciel Dias de Andrade, Ângelo Roncalli, Jocimar Avelar Martins, Daniel da Cunha Ribeiro, Ezequiel Mânica Pianezzola, Luiz Alberto Forgiarini Júnior, Wildberg Alencar Lima, Leny Vieira Cavalheiro, Darlan Laurício Matte, Marlus Karsten
Resumo
O presente documento apresenta orientações para o atendimento de Fisioterapia a pacientes com suspeita ou diagnostico de COVID-19, com foco na indicação e uso da ventilação não-invasiva(VNI) e da cânula nasal de alto fluxo (CNAF), bem como sobre manejo da ventilação mecânica invasiva. Algumas intervenções vêm sendo descritas com intuito de melhorar desfechos relacionados à insuficiência respiratória da COVID-19, como a VNI e a CNAF. Com base em estudos científicos atuais, informações advindas da experiência no tratamento da COVID-19, maior risco de disseminação do vírus, aliados à indisponibilidade de alguns recursos na maioria das unidades de terapia intensiva brasileiras, recomenda-se que a VNI e a CNAF não sejam estratégias ventilatórias de primeira linha. Entretanto, em situações específicas, definidas pela equipe multiprofissional, pode ser feito um teste de resposta à VNI ou CNAF, desde que respeitadas condições de biossegurança e resposta do paciente, visando não postergar a intubação orotraqueal.
Palavras-chave
Abstract
This document focus on the use of noninvasive ventilation (NIV) and high-flow nasal cannula (HFNC), as well as on the management of invasive mechanical ventilation in patients with COVID-19. NIV and HFNC have been described to improve outcomes related to the respiratory failure in patients with COVID-19. Based on the available evidence along with a high risk of aerosol dispersion and inadequate environments in most Brazilian intensive care units, NIV and HFNC are not recommended as the first option for ventilatory support in patients with COVID-19. However, a NIV/HFNC trial can be considered once safety measures are guaranteed and according to the patient’s response; endotracheal intubation should not be postponed.
Keywords
Referências
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