Shortening ventilatory support with a protocol based on daily extubation screening and noninvasive ventilation in selected patients
Clinics
;
66(5): 759-766, 2011. ilus, graf, tab
Article
in English
| LILACS
| ID: lil-593837
ABSTRACT
BACKGROUND: Prolonged invasive mechanical ventilation and reintubation are associated with adverse outcomes and increased mortality. Daily screening to identify patients able to breathe without support is recommended to reduce the length of mechanical ventilation. Noninvasive positive-pressure ventilation has been proposed as a technique to shorten the time that patients remain on invasive ventilation. METHODS: We conducted a before-and-after study to evaluate the efficacy of an intervention that combined daily screening with the use of noninvasive ventilation immediately after extubation in selected patients. The population consisted of patients who had been intubated for at least 2 days. RESULTS: The baseline characteristics were similar between the groups. The intervention group had a lower length of invasive ventilation (6 [4;9] vs. 7 [4;11.5] days, p = 0.04) and total (invasive plus noninvasive) ventilator support (7 [4;11] vs. 9 [6;8], p = 0.01). Similar reintubation rates within 72 hours were observed for both groups. In addition, a lower ICU mortality was found in the intervention group (10.8 percent vs. 24.3 percent, p = 0.03), with a higher cumulative survival probability at 60 days (p = 0.05). Multivariate analysis showed that the intervention was an independent factor associated with survival (RR: 2.77; CI 1.14-6.65; p = 0.03), whereas the opposite was found for reintubation at 72 hours (RR: 0.27; CI 0.11-0.65; p = 0.01). CONCLUSION: The intervention reduced the length of invasive ventilation and total ventilatory support without increasing the risk of reintubation and was identified as an independent factor associated with survival.
Full text:
Available
Index:
LILACS (Americas)
Main subject:
Ventilator Weaning
/
Positive-Pressure Respiration
Type of study:
Diagnostic study
/
Practice guideline
/
Observational study
/
Prognostic study
/
Risk factors
/
Screening study
Limits:
Aged
/
Aged80
/
Female
/
Humans
/
Male
Language:
English
Journal:
Clinics
Journal subject:
Medicine
Year:
2011
Type:
Article
Affiliation country:
Brazil
Institution/Affiliation country:
Hospital Sírio-Libanês/BR
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