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Title: Respiratory Muscle Assessment in Predicting Extubation Outcome in Patients With Stroke
Authors: Castro, Antonio A. M. [UNIFESP]
Cortopassi, Felipe
Sabbag, Russell
Torre-Bouscoulet, Luis
Kuempel, Claudia [UNIFESP]
Porto, Elias Ferreira [UNIFESP]
Universidade Federal de São Paulo (UNIFESP)
Adventist Univ
Fed Univ Pampa Unipampa
Yale Univ
Tufts Univ
Inst Nacl Enfermedades Resp
Keywords: Mechanical ventilation
Respiratory muscles
Respiratory mechanics
Issue Date: 1-Aug-2012
Publisher: Ediciones Doyma S A
Citation: Archivos de Bronconeumologia. Barcelona: Ediciones Doyma S A, v. 48, n. 8, p. 274-279, 2012.
Abstract: Background: Patients with cerebral infarction often present impaired consciousness and unsatisfactory extubation. We aimed to assess the respiratory mechanics components that might be associated with the success of extubation in stroke patients.Methods: Twenty consecutive patients with stroke who needed mechanical ventilation support were enrolled. the maximal inspiratory pressure, gastric and the esophageal pressure (Pdi/Pdimax), minute volume, respiratory rate, static compliance, airway resistance, rapid and superficial respiration index (RSRI), inspiratory time/total respiratory cycle (Ti/Ttot), and PaO2/FiO(2) were measured.Results: the group who presented success to the extubation process presented 12.5 +/- 2.2 = days in mechan-ical ventilation and the group who failed presented 13.1 +/- 2 = days. the mean Ti/Ttot and Pdi/Pdimax for the failure group was 0.4 +/- 0.08 (0.36-0.44) and 0.5 +/- 0.7 (0.43-0.56), respectively. the Ti/Ttot ratio was 0.37 +/- 0.05 (0.34-0.41; p=0.0008) and the Pdi/Pdimax was 0.25 +/- 0.05 for the success group (0.21-0.28; p < 0.0001). A correlation was found between Pdi/Pdimax ratio and the RSRI (r = 0.55; p = 0.009) and PaO2/FiO(2) (r = -0.59; p = 0.005). Patients who presented a high RSRI (OR, 3.66; p = 0.004) and Pdi (OR, 7.3; p = 0.002), and low PaO2/FlO(2) (OR, 4.09; p = 0.007), Pdi/Pdimax (OR, 4.12; p = 0.002) and RAW (OR, 3.0; p = 0.02) developed mechanical ventilation extubation failure.Conclusion: Muscular fatigue index is an important predicting variable to the extubation process in prolonged mechanical ventilation of stroke patients. (C) 2012 SEPAR. Published by Elsevier Espana, S.L. All rights reserved.
ISSN: 0300-2896
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