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Master's Dissertation
DOI
https://doi.org/10.11606/D.5.2024.tde-15052024-165300
Document
Author
Full name
Larissa Padrão Isensee
E-mail
Institute/School/College
Knowledge Area
Date of Defense
Published
São Paulo, 2024
Supervisor
Committee
Fu, Carolina (President)
Hirota, Adriana Sayuri
Lunardi, Adriana Claudia
Park, Marcelo
Title in Portuguese
Avaliação da taxa de falha de extubação em pacientes sob ventilação mecânica no Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo
Keywords in Portuguese
Cuidados críticos
Desmame do respirador
Extubação
Fisioterapia
Manuseio das vias aéreas
Respiração artificial
Abstract in Portuguese
A necessidade de suporte ventilatório invasivo em pacientes críticos é comum no ambiente de terapia intensiva, no entanto, devemos evitar seu prolongamento e planejar o desmame o mais rápido possível, uma vez que a permanência desse suporte traz riscos e complicações, além do aumento da morbimortalidade. Todavia, o processo de desmame requer atenção, pois quando realizado precocemente, há o risco de reintubação e com isso piores desfechos. O objetivo do presente estudo foi verificar a taxa de falha de extubação e identificar os seus fatores de risco. Tratou-se de um estudo de coorte prospectivo realizado nas UTIs do Hospital das Clínicas da Faculdade de Medicina da USP entre 2019 e 2020, durante o período de internação até a alta hospitalar. Foram incluídos pacientes adultos no primeiro evento de VM invasiva superior a 24 horas submetidos a extubação, e foram excluídos os que tiveram extubação acidental, paliativa ou por ausência de informações. Formulários padronizados na plataforma REDCap foram utilizados para armazenar todos os dados relativos ao paciente, retirados do prontuário eletrônico e diretamente com as equipes multiprofissionais das unidades. Foram coletados tanto os dados clínicos e demográficos, quanto os referentes ao suporte ventilatório invasivo, extubação e desfecho de cada paciente. Comparado ao grupo que teve sucesso de extubação, o grupo que falhou teve maior pontuação no SAPS III e o predomínio de pacientes cirúrgicos. Além disso, esse grupo apresentou também maior mortalidade, permaneceu mais tempo em VM, prolongando seu período de internação na UTI e no hospital. A taxa de falha de extubação observada foi de 16,21% e os fatores de risco identificados foram idade e causa de intubação neurológica
Title in English
Evaluation of the extubation failure rate in mechanically ventilated patients at the Hospital das Clínicas, Faculdade de Medicina da Universidade de São Paulo
Keywords in English
Airway extubation
Airway management
Artificial respiration
Critical care
Physical therapy
Ventilator Weaning
Abstract in English
The need for invasive ventilatory support in critically ill patients is common in the intensive care setting, however, we should avoid its prolongation and plan weaning as soon as possible, since the permanence of this support brings risks and complications, in addition to increased morbidity and mortality. However, the weaning process requires attention, because when performed early, there is a risk of reintubation and, with it, worse outcomes. The aim of the present study was to verify the extubation failure rate and identify the risk factors for this. This was a prospective cohort study carried out in the ICUs of the Hospital das Clínicas da Faculdade de Medicina da USP between 2019 and 2020, during the period of hospitalization until hospital discharge. Adult patients in the first invasive MV event for more than 24 hours who underwent extubation were included, and those who had accidental, palliative or lack of information were excluded. Standardized forms on the REDCap platform were used to store all data related to the patient, taken from the electronic medical record and directly with the multidisciplinary teams of the units. Both clinical and demographic data were collected, as were those related to invasive ventilatory support, extubation and outcome for each patient. Compared to the group that had successful extubation, the group that failed had a higher score on the SAPS III and a predominance of surgical patients. In addition, this group also had higher mortality, spent more time on MV, prolonging their length of stay in the ICU and hospital. The observed extubation failure rate was 16,21% and the identified risk factors were age and cause of intubation neurological
 
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Publishing Date
2024-05-28
 
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