Navegando por Palavras-chave "Ventilator weaning"
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- ItemAcesso aberto (Open Access)Implications of extubation failure and prolonged mechanical ventilation in the postoperative period following elective intracranial surgery(Associação Brasileira de Divulgação Científica, 2011-12-01) Vidotto, Milena Carlos [UNIFESP]; Sogame, Luciana Carrupt Machado [UNIFESP]; Gazzotti, Mariana Rodrigues [UNIFESP]; Prandini, Mirto Nelso [UNIFESP]; Jardim, José Roberto [UNIFESP]; Universidade Federal de São Paulo (UNIFESP); Santa Casa de Misericórdia de Vitória Escola Superior de Ciências Departamento de FisioterapiaPatients undergoing neurosurgery are predisposed to a variety of complications related to mechanical ventilation (MV). There is an increased incidence of extubation failure, pneumonia, and prolonged MV among such patients. The aim of the present study was to assess the influence of extubation failure and prolonged MV on the following variables: postoperative pulmonary complications (PPC), mortality, reoperation, tracheostomy, and duration of postoperative hospitalization following elective intra-cranial surgery. The study involved a prospective observational cohort of 317 patients submitted to elective intracranial surgery for tumors, aneurysms and arteriovenous malformation. Preoperative assessment was performed and patients were followed up for the determination of extubation failure and prolonged MV (>48 h) until discharge from the hospital or death. The occurrence of PPC, incidence of death, the need for reoperation and tracheostomy, and the length of hospitalization were assessed during the postoperative period. Twenty-six patients (8.2%) experienced extubation failure and 30 (9.5%) needed prolonged MV after surgery. Multivariate analysis showed that extubation failure was significant for the occurrence of death (OR = 8.05 [1.88; 34.36]), PPC (OR = 11.18 [2.27; 55.02]) and tracheostomy (OR = 7.8 [1.12; 55.07]). Prolonged MV was significant only for the occurrence of PPC (OR = 4.87 [1.3; 18.18]). Elective intracranial surgery patients who experienced extubation failure or required prolonged MV had a higher incidence of PPC, reoperation and tracheostomy and required a longer period of time in the ICU. Level of consciousness and extubation failure were associated with death and PPC. Patients who required prolonged MV had a higher incidence of extubation failure.
- ItemAcesso aberto (Open Access)Incidence, indication and complications of postoperative reintubation after elective intracranial surgery(Associação Paulista de Medicina - APM, 2013-01-01) Hayashi, Lucas Yutaka; Gazzotti, Mariana Rodrigues; Vidotto, Milena Carlos [UNIFESP]; Jardim, José Roberto [UNIFESP]; São Paulo Centro Universitario Sao Camilo Department of Physiotherapy; Centro Universitario Sao Camilo Department of Physiotherapy; Universidade Federal de São Paulo (UNIFESP)CONTEXT AND OBJECTIVE There are no reports on reintubation incidence and its causes and consequences during the postoperative period following elective intracranial surgery. The objective here was to evaluate the incidence of reintubation and its causes and complications in this situation. DESIGN AND SETTING Prospective cohort study, using data obtained at a tertiary university hospital between 2003 and 2006. METHODS 169 patients who underwent elective intracranial surgery were studied. Preoperative assessment was performed and the patients were followed up until hospital discharge or death. The rate of reintubation with its causes and complications was ascertained. RESULTS The incidence of reintubation was 12.4%, and the principal cause was lowered level of consciousness (71.5%). There was greater incidence of reintubation among females (P = 0.028), and greater occurrence of altered level of consciousness at the time of extubation (P < 0.0001). Reintubated patients presented longer duration of mechanical ventilation (P < 0.0001), longer stays in the intensive care unit (ICU) and in the hospital (P < 0.0001), greater incidence of pulmonary complications (P < 0.0001), greater need for reoperation and tracheostomy, and higher mortality (P < 0.0001). CONCLUSION The incidence of reintubation in these patients was 12.4%. The main cause was lowering of the level of consciousness. Female gender and altered level of consciousness at the time of extubation correlated with higher incidence of reintubation. Reintubation was associated with pulmonary complications, longer durations of mechanical ventilation, hospitalization and stay in the ICU, greater incidence of tracheostomy and mortality.
- ItemSomente MetadadadosThe prediction of extubation success of postoperative neurosurgical patients using frequency-tidal volume ratios(Humana Press Inc, 2008-08-01) Vidotto, Milena Carlos [UNIFESP]; Sogame, Luciana Carrupt Machado; Calciolari, Christiane Costa [UNIFESP]; Nascimento, Oliver Augusto [UNIFESP]; Jardim, José Roberto [UNIFESP]; Universidade Federal de São Paulo (UNIFESP); EMESCAMBackground the process of discontinuing neurological patients from mechanical ventilation is still controversial. the aim of this study was to report the outcome from extubating patients undergoing elective craniotomy and correlate the result with the measured f/V(t) ratio.Materials and Methods in a cohort prospective study, all consecutive patients who required mechanical ventilation for up to 6 h after elective craniotomy were eligible for inclusion in this study. Patients passing daily screening criteria automatically received a spontaneous breathing trial (SBT). Immediately previous to the extubation, the expired minute volume (VE), breathing frequency (f), and tidal volume (V(t)) were measured and the breathing frequency-to-tidal volume ratio (f/V(t)) was calculated; consciousness level based on Glasgow Coma Scale (GCS) was evaluated at the same time. the extubation was considered a failure when patients needed reintubation within 48 h.Results Ninety-two patients were extubated and failure occurred in 16%. Despite 15 patients failed extubation just one of them presented the f/V(t) score over 105. the best cutoff value for f/V(t) observed was 62, but with low specificity (0.53) and negative predictive values (0.29). Area under the ROC curve for the f/V(t) was 0.69 +/- 0.07 (P = 0.02). Patients who failed the extubation process presented higher incidence of pneumonia (80%), higher need for tracheostomy (33%) and mortality rate of 40%.Conclusion the f/V(t) ratio does not predict extubation failure in patients who have undergone elective craniotomy. Patients who fail extubation present higher incidence of pneumonia, tracheostomy and higher mortality rate.
- ItemEmbargoTraqueostomia precoce versus traqueostomia tardia em pacientes críticos: Revisão Sistemática(Universidade Federal de São Paulo (UNIFESP), 2011-07-27) Silva, Brenda Nazaré Gomes da [UNIFESP]; Valente, Orsine [UNIFESP]; Universidade Federal de São Paulo (UNIFESP)Contexto: O uso da ventilação mecânica prolongada pelos pacientes críticos em unidades de terapia intensiva (UTI) é uma das situações clínicas mais frequentes nas quais a traqueostomia é indicada. E os termos traqueostomias, .“precoce.” e .“tardia.” referem-se ao tempo para a realização desse procedimento. As evidências disponíveis sobre as possíveis vantagens da traqueostomia precoce em relação a tardia são conflitantes, mas incluem redução do tempo de permanência hospitalar e mortalidade. Objetivos: Comparar a efetividade e a segurança das traqueostomias precoce e tardia em pacientes críticos com previsão de permanecerem em ventilação mecânica prolongada. Métodos: Revisão sistemática de estudos aleatórios. As seguintes bases de dados eletrônicas foram uilizadas: The Cochrane Library, MEDLINE, EMBASE, LILACS, Current Controlled Trials, PEDro e CINHAL, até a data de dezembro de 2010. Foram incluídos ensaios controlados e aleatórios ou quasi-aleatórios que compararam traqueostomia precoce (dois a 10 dias após o início da a intubação) e traqueostomia tardia (>10 dias após o início da intubação) em pacientes adultos críticos com previsão para ventilação mecânica prolongada. Não houve qualquer restrição quanto ao idioma ou ano da publicação. Foram feitas metanálises com modelo estatístico de efeito aleatório para mortalidade e pneumonia. Resultados: Foram incluídos quatro estudos de alto risco de viés, totalizando 673 pacientes alocados para traqueostomia precoce ou tardia. Não foi possível observar fortes evidências que favorecessem à traqueostomia precoce para mortalidade (três estudos, 49,6% [148/298] versus 64,1% [193/201], risco relativo [RR] de 0,67 [IC 95% 0,42, 1,04], P=0,08); e pneumonia (12,2%, 33/269 versus 21,8%, 59/270, RR 0,42 [dois estudos, IC 95% 0,13, 1,39, P=0,15]). Entretanto foi possível encontrar estimativa estatisticamente significativa para tempo de permanência em ventilação mecânica (um estudo, DM -9,8 dias, IC 95% - 11,48, -8,12; P<0,00001) e na UTI (um estudo, DM -11.40 [-12.42, -10.38, P<0.00001] que favoreceram ao grupo de traqueostomia precoce. Conclusões: De acordo com evidências de qualidade moderada, a traqueostomia precoce tem potencial para ser mais efetiva e segura do que a traqueostomia tardia para a redução de mortalidade, pneumonia e tempo de permanência na ventilação mecânica e na UTI. Entretanto esses resultados necessitam ser confirmados ou não por estudos adequados que ainda não foram finalizados e outros que possivelmente serão realizados no futuro.