Abstract
Rev Bras Ter Intensiva. 2007;19(3):331-336
DOI 10.1590/S0103-507X2007000300011
BACKGROUND AND OBJECTIVES: To compare the attainment of the rapid shallow breathing index (IRRS) in modalities PSV 10 cmH2O and PEEP 5 cmH2O (PSV10), CPAP 5 cmH2O (CPAP5) and spontaneous breathing (SB), correlating them with success on failure in the withdrawal of mechanical ventilation (MV). METHODS: Prospective study including 54 patients in MV > 48 hours, submitted to the IRRS in three ventilatory modalities: PSV10, CPAP5 and SB at the moments before and after T-tube spontaneous breathing. The patients were removed from MV when IRRS was < 105. RESULTS: There wasn't statistically significant difference between IRRS values at the moments before and after T-tube SB. There was statistically significant difference IRRS value between the modalities CPAP5 and PSV10 (p = 0.008), and between the modalities SB and PSV10 (p = 0.01) at the moment before T-Tube SB and of IRRS value, gotten between CPAP5 and PSV10 (p = 0.01) at the moment after T-tube SB. CONCLUSIONS: From this sample, it can be observed that IRRS values are overestimated when gotten in modality PSV10. It was also evidenced that there is no need of a 30 min T-tube SB before extubation, when the weaning is performed with the technique of gradual reduction of PSV. This study suggested that IRRS is able to predict weaning success; however it is not able to determine failure when it was < 105. It is recommended that IRRS must be analyzed in association with other predictive weaning parameters.
Abstract
Rev Bras Ter Intensiva. 2007;19(1):31-37
DOI 10.1590/S0103-507X2007000100004
BACKGROUND AND OBJECTIVES: Mechanical ventilation incurs significant morbidity and mortality, weaning intensive care unit patients is highly desirable, although it is usuallyconducted in an empirical manner. Thus, this article assessed a weaning protocol implementation and compared two different methods. METHODS: It was carried out a study involving 120 patients who had received mechanical ventilation for more than 48 hours. These patients were randomlyassigned to undergo one of two weaning techniques: pressure-supportventilation + PEEP (PSP) technique, which was applied to the patients in equal days, forming the PSP group (PSPG) and the T-tube method (TT), applied in odd days and forming the TT group (TTG). Standardized protocols were followedfor each technique RESULTS: The patients response to extubation revealed similar progress in both PSP and TT groups, but after the Chi-square statistical test, the benefits of using a weaning protocol was clear. One hundred nine (90.83%) of all patients, had a successful weaning and any noninvasive ventilation type was needed in a span time of 24 hours after extubation, and only eleven (9.17%), had an unsuccessful weaning. CONCLUSIONS: Although this study didn't show any difference between the two methods applied, we could conclude that, the implementation of standardized weaning protocols can substantially decrease the patient's reintubation rate, promoting a downward trend in mortality and morbidity for these patients and shortening their hospital and intensive care units length of stay.