Desmame da ventilação mecânica em pacientes com COVID-19*
Weaning from mechanical ventilation in patients with COVID-19*
Larissa Araújo de Castro, Ângelo Roncalli Miranda Rocha, Carlos Augusto Camillo
Resumo
O fisioterapeuta é fundamental no tratamento de pacientes com COVID-19, em especial na condução da ventilação mecânica (VM), desde a estratégia inicial até o reestabelecimento da ventilação espontânea. O corpo de evidências a respeito do desmame da VM em pacientes com COVID-19 ainda é incipiente e, portanto, sua execução deve combinar recomendações internacionalmente aceitas sobre desmame com medidas adicionais de segurança. Recomenda-se a avaliação diária da possibilidade de desmame, observando critérios como a capacidade de oxigenação e proteção de vias aéreas. Índices preditivos podem auxiliar, porém, devemos evitar aqueles que envolvem desconexão do ventilador mecânico pelo risco de aerossolização. Pela mesma razão, recomenda-se que o teste de respiração espontânea seja realizado em ventilação com suporte pressórico. A VM não invasiva pós extubação permanece indicada quando houver estrutura adequada para sua realização. Aos pacientes traqueostomizados em respiração espontânea, recomenda-se o uso de filtro trocador de calor e umidade de alta eficiência.
Palavras-chave
Abstract
The physiotherapist is essential for the treatment of patients with COVID-19, especially in the management of mechanical ventilation (MV), from the initial MV settings to the reestablishment of spontaneous breathing. The body of evidence regarding weaning from MV in patients with COVID-19 is still incipient and, therefore, its implementation should combine internationally accepted weaning recommendations with additional safety measures. Daily screenings of potentially eligible patients for weaning are recommended, observing criteria such as oxygenation and patient’s capacity of protecting the airways. Predictive indexes can be helpful; however, those involving disconnection from the mechanical ventilator must be avoided due to risk of aerosolization. For the same reason, it is recommended that spontaneous breathing trials should be performed using MV with pressure support. Non-invasive mechanical ventilation after extubation remains indicated when an adequate environment is guaranteed. For tracheostomized patients in spontaneous breathing, the use of a highly efficient heat and moisture exchanger filter is recommended.
Keywords
Referências
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