Capacidade preditiva de variáveis demográficas, clínicas e testes ventilatórios para definir falha ou sucesso da extubação em uma população pediátrica submetida a ventilação pulmonar mecânica por diferentes etiologias

• Ano de defesa: 2007
• Autor(a) principal: Johnston, Cíntia
• Orientador(a): Piva, Jefferson Pedro
• Tipo de documento: Tese
• Tipo de acesso: Acesso aberto
• Idioma: por
• Instituição de defesa: Pontifícia Universidade Católica do Rio Grande do Sul; Porto Alegre
• Palavras-chave em Português: MEDICINA; PEDIATRIA; RESPIRAÇÃO ARTIFICIAL; UNIDADES DE TERAPIA INTENSIVA PEDIÁTRICA
• Link de acesso: http://hdl.handle.net/10923/4693

OBJECTIVES: To evaluate the demographic characteristics, ventilation parameters (VP), blood gases and ventilatory indexes as risk factors of extubation failure in children with different diagnosis submitted to mechanical ventilation (MV). METHODS: This is an observational study (March/2004 to March/2006), run in an university hospital, with 274 consecutive extubated children. Ventilatory indexes used: rapid shallow breathing index [RSBI= (RR/VT)/weight]; ventilatory muscle force (MIP and MEP); load/force balance [LFB= 15x(MAPx3)/MIP+0. 03xRSBI-5]. To make comparisons the sample was divided according to major clinical diagnosis [acute bronchiolitis (AB), neurological disease (ND) and cardiac surgery postoperative (CSPO)] and each of these diagnostic groups were divided in successful extubation and extubation failure groups. Statistical analysis: to analyze non parametric variables and parametrical variables, Pearson’s chi-squared and Student t test were respectively used; for ventilatory indexes Kruskal-Wallis for non pareated samples was used; a multiple variate analysis was performed to compare diagnosis groups, and to create a risk factor index. SPSS software version 11. 0 (SPSS Inc, Chicago, Illinois, USA) was used. The PUCRS Ethical Committee (CEP 271/04) approved the study and informed consent. RESULTS: Clinical diagnosis: 90 (33%) AB, 43 (16%) ND e 59 (22%) CSPO, 82 (29%) other diagnosis. After extubation median (IQ 25%-75%): age 12 (4-60) months, weight 8. 5 (5. 4-17) Kg. There were 8 (3%) deaths. Risk of extubation failure among the diagnosis [odds (CI 95%)]: for CSPO 1. 1 (0. 28-4. 17); P= 0. 92 and for ND 2. 0 (0. 50-8. 0);P= 0. 35. For AB it was not possible to run the analysis due to the sample size. Risk factors to extubation failure (whole sample): MV time a 7 days [3. 8 (1. 25-11. 8); P= 0. 020], OI a 3 [2. 6 (1. 0-6. 7); P= 0. 04], VE b 1. 5 ml/Kg/min [2. 6 (1. 0-7. 0); P= 0. 05], MIP a -50cmH2O [5. 4 (1. 85-16); P= 0. 002] and LFB a 4. 5 [2. 5 (0. 60-10); P= 0. 02]. Percentual risk with more than six factors: AB [35%]; CSPO [60%]; ND [100%]. CONCLUSIONS: There are differences between the variables [MV time a 7 days, OI a 3, VE b 1. 5 ml/Kg/min, MIP a -50cmH2O, RFC a 4. 5] and the cutoff points by clinical diagnosis. The children with six or more risk factors have from 35% to 100% probability of extubation failure.