Navegando por Palavras-chave "ventilator weaning"

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    Analysis of Risk Factors for Extubation Failure in Subjects Submitted to Non-Emergency Elective Intracranial Surgery
    (Daedalus Enterprises Inc, 2012-12-01) Vidotto, Milena Carlos [UNIFESP]; Sogame, Luciana Carrupt Machado [UNIFESP]; Gazzotti, Mariana Rodrigues [UNIFESP]; Prandini, Mirto Nelson [UNIFESP]; Jardim, Jose Roberto [UNIFESP]; Universidade Federal de São Paulo (UNIFESP); Escola Super Ciencias Santa Casa Misericordia Vit
    BACKGROUND: Extubation failure is defined as the re-institution of respiratory support ranging from 24 to 72 hours following scheduled extubation and occurs in 2% to 25% of extubated patients. the aim of this study was to determine clinical and surgical risk factors that may predict extubation failure in patients submitted to non-emergency intracranial surgery. METHODS: This was a prospective observational cohort study. the study was carried out on 317 subjects submitted to non-emergency intracranial surgery for tumors, aneurysms, and arteriovenous malformation. Preoperative assessment was performed and subjects were followed up for the determination of extubation failure until either discharge from hospital or death. RESULTS: Twenty-six (8.2%) of the 317 subjects experienced extubation failure following surgery. the following variables were considered for the multivariate analysis: level of consciousness at the time of extubation, duration of mechanical ventilation prior to extubation, sex and the use of intraoperative mannitol. the multivariate analysis determined that the most important variable for extubation failure was the level of consciousness at the time of extubation (P = .001), followed by female sex, which also showed to be significant (P = .006). CONCLUSIONS: Lower level of consciousness (GCS 8T-10T) and female sex were considered risk factors for extubation failure in subjects submitted to elective intracranial surgery.
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    The impact of daily evaluation and spontaneous breathing test on the duration of pediatric mechanical ventilation: A randomized controlled trial
    (Lippincott Williams & Wilkins, 2011-11-01) Foronda, Flávia Andrea Krepel; Troster, Eduardo Juan; Farias, Julio A.; Barbas, Carmen Sílvia Valente; Ferraro, Alexandre Archanjo [UNIFESP]; Faria, Lucília Sandra Pinto de; Bousso, Albert; Panico, Flávia Feijó; Delgado, Artur Figueiredo; Hosp Sirio Libanes; Universidade Federal de São Paulo (UNIFESP); Universidade de São Paulo (USP); Hosp Albert Einstein; Univ Buenos Aires
    Objectives: To assess whether the combination of daily evaluation and use of a spontaneous breathing test could shorten the duration of mechanical ventilation as compared with weaning based on our standard of care. Secondary outcome measures included extubation failure rate and the need for noninvasive ventilation.Design: A prospective, randomized controlled trial.Setting: Two pediatric intensive care units at university hospitals in Brazil.Patients: the trial involved children between 28 days and 15 yrs of age who were receiving mechanical ventilation for at least 24 hrs.Interventions: Patients were randomly assigned to one of two weaning protocols. in the test group, the children underwent a daily evaluation to check readiness for weaning with a spontaneous breathing test with 10 cm H(2)O pressure support and a positive end-expiratory pressure of 5 cm H(2)O for 2 hrs. the spontaneous breathing test was repeated the next day for children who failed it. in the control group, weaning was performed according to standard care procedures.Measurements and Main Results: A total of 294 eligible children were randomized, with 155 to the test group and 139 to the control group. the time to extubation was shorter in the test group, where the median mechanical ventilation duration was 3.5 days (95% confidence interval, 3.0 to 4.0) as compared to 4.7 days (95% confidence interval, 4.1 to 5.3) in the control group (p = .0127). This significant reduction in the mechanical ventilation duration for the intervention group was not associated with increased rates of extubation failure or noninvasive ventilation. It represents a 30% reduction in the risk of remaining on mechanical ventilation (hazard ratio: 0.70).Conclusions: A daily evaluation to check readiness for weaning combined with a spontaneous breathing test reduced the mechanical ventilation duration for children on mechanical ventilation for > 24 hrs, without increasing the extubation failure rate or the need for noninvasive ventilation. (Crit Care Med 2011; 39: 2526-2533)
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    Medida da freqüência respiratória e do volume corrente para prever a falha na extubação de recém-nascidos de muito baixo peso em ventilação mecânica
    (Sociedade de Pediatria de São Paulo, 2008-03-01) Davidson, Josy [UNIFESP]; Miyoshi, Milton Harumi [UNIFESP]; Dos Santos, Amelia Miyashiro [UNIFESP]; Carvalho, Werther Brunow de [UNIFESP]; Universidade Federal de São Paulo (UNIFESP)
    OBJECTIVE: To verify if respiratory rate (RR), tidal volume (TV) and respiratory rate and tidal volume ratio (RR/TV) could predict extubation failure in very low birth weight infants submitted to mechanical ventilation. METHODS: This prospective observational study enrolled newborn infants with gestational age <37 weeks and birth weight <1,500g, mechanically ventilated from birth during 48 hours to 30 days and thought to be ready for extubation. As soon as the physicians decided for extubation, the neonates received endotracheal continuous positive airway pressure (CPAP) for 10 minutes while spontaneous RR, TV and RR/TV were measured using a fixed-orifice pneumotachograph positioned between the endotracheal tube and the ventilator circuit. Thereafter, the neonates were extubated to nasal CPAP. Extubation failure was defined as the need for reintubation within 48 hours. RESULTS: Of the 35 studied infants, 20 (57%) were successfully extubated and 15 (43%) required reintubation. RR and RR/TV before extubation had a trend to be higher in unsuccessfully extubated infants. TV was similar in both groups. Sensitivity and specificity of these parameters as predictors of extubation failure were 50 and 67% respectively for RR, 40 and 67% for TV and 40 and 73% for RR/TV. CONCLUSIONS: RR, TV and RR/TV showed low sensitivity and specificity to predict extubation failure in mechanically ventilated very low birth weight infants.