Comportamento dos valores da pressão inspiratória máxima e do índice de respiração rápida superficial durante o teste de respiração espontânea
Behavior of the values of maximal inspiratory pressure and rapid shallow breathing index during spontaneous breathing trial
Eduardo Eriko Tenório de França, Priscilla Gonçalves Melo, Maria Cecília Cedrim Costa, Francimar Ferrari Ramos, Marco Aurélio Valois Correa Júnior, Célia Maria Barbosa de Andrade Castro, Maria Amparo Andrade, Flávio Maciel Dias de Andrade, Luana Carneiro Ribeiro, Eduarda Lubambo Costa, Carolina Sales de Souza, Mateus Parrois Torres de Melo
Resumo
Introdução: O processo de retirada prematura da Ventilação Mecânica (VM) impõe intenso estresse aos sistemas respiratório e cardiovascular, podendo retardar o tempo de recuperação do paciente. No entanto, a VM prolongada, também, pode acarretar sérias complicações neuromusculares e dificuldade no desmame. Neste sentido, para garantir maior segurança quanto à capacidade do paciente em reassumir adequadamente a respiração espontânea, alguns índices fisiológicos são utilizados na terapia intensiva, de forma a predizer o sucesso no desmame da VM. Encontram-se, entre os mais utilizados, a Pressão Inspiratória Máxima (Pimáx) e o Índice de Respiração Rápida e Superficial (IRRS). Objetivo: Avaliar o comportamento da Pimáx e do IRRS mensurados no primeiro minuto e após o término do Teste de Respiração Espontânea (TRE) realizado em “tubo-T” ou Ventilação com Pressão de Suporte (PSV). Métodos: Foram incluídos pacientes internados na Unidade de Terapia Intensiva, no período entre novembro de 2011 a março de 2012, em VM, por mais de 48h, submetidos ao TRE em “tubo T” ou PSV, realizado durante 30min. Antes e após o TRE, os pacientes foram submetidos à avaliação da Pimáx e do IRRS. Resultados: Foram estudados 30 pacientes, sendo “tubo-T” (n = 14) e PSV (n = 16). A Pimáx aumentou de forma significativa apenas no grupo “tubo-T”, enquanto o IRRS apresentou redução significativa, em ambos os grupos, imediatamente após o TRE. Conclusões: O TRE realizado em “tubo T” e em PSV, durante 30 minutos, promoveu significativas alterações nos valores de Pimáx e do IRRS avaliados antes e após o TRE.
Palavras-chave
Abstract
Introduction: The process of premature withdrawal of mechanical ventilation (MV) imposes intense stress to respiratory and cardiovascular systems, and can delay the recovery time of the patient. However, the MV can also cause serious neuromuscular complications and difficulty in weaning. In this regard, to ensure greater certainty as to the patient’s ability to resume spontaneous breathing properly, some physiological indices are used in intensive care in order to predict successful weaning from MV. Among them, the most commonly used are the maximal inspiratory pressure (MIP) and the index of rapid shallow breathing (IRRS). Objective: To evaluate the MIP and the IRRS measured in the first minute and after the spontaneous breathing trial (SBT) performed in “T-tube” or pressure support ventilation (PSV). Methods: Patients admitted to the intensive care unit during the period between November 2011 and March 2012 in MV for more than 48 hours were submitted to SBT in “T-tube” or PSV during 30 min. Before and after SBT, patients were evaluated for MIP and IRRS. Results: We studied 30 patients, “T-tube” (n = 14) and PSV (n = 16). The MIP increased significantly only in the group “T-tube”, while the IRRS was significantly reduced in both groups immediately after the SBT. Conclusions: The SBT held in “T-tube” and PSV for 30 minutes promoted significant changes in the values of MIP and IRRS evaluated before and after the test.
Keywords
Referências
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