ABSTRACT
The objective of this study is to verify the risk factors for invasive mechanical ventilation (IMV) for ≥48h, aiming at the best indication of orotracheal tubes (OTTs) with supra-cuff suction devices. This retrospective and observational study was carried out at the Adult Intensive Care Unit of the University Hospital during a 2-year period. Patients undergoing orotracheal intubation were enrolled. Demographic and clinical data were collected from medical records. A total of 1185 medical records were analyzed, of which 820 were included in the study. The markers associated with intubation for ≥48h were as follows: positive history of diseases (RR=1.42; 95%CI=1.17 to 1.74), especially alcohol addiction (RR=1.60; 95%CI=1.22 to 2.09) or former alcohol addiction (RR=1.50; 95%CI=1.06 to 2.13); clinical hospitalization (RR=1.06; 95%CI=0.98 to 1.16); emergency intubation (RR=3.24; 95%CI=3.01 to 3.95); intubation performed in the emergency department (RR=3.44; 95%CI=3.01 to 3.95) and other hospital facilities (RR=2.92; 95%CI=2.49 to 3.42); and intubation due to lowered level of consciousness (RR=3.40; 95%CI=2.95 to 3.93), acute respiratory failure (RR=3.43; 95%CI=2.98 to 3.54), and airway protection (RR=2.87; 95%CI=2.32 to 3.54). Patients on IMV for ≥48h had an RR of 2.07 (95%CI=1.79 to 2.40) for death. Patients with history of diseases, especially past or current history of alcoholism with clinical hospitalization, who underwent emergency intubation in the emergency department or in other hospital facilities due to lowered level of consciousness, acute respiratory failure, or protect airways, are most likely to require IMV for ≥48h. Also, patients on IMV for ≥48h had an high RR for death.
ABSTRACT
The use of synchronized intermittent mandatory ventilation with pressure support ventilation (SIMV + PSV) mode has been discontinued. This study analyzed the association between medical outcomes related to the use of assist-control (A/C) and SIMV + PSV in an intensive care unit. In this observational and retrospective study, modes of ventilation and medical data were collected from electronic medical records for three consecutive years and were related to medical outcomes (mortality), duration of mechanical ventilation, length of hospital stay and the need for tracheostomy. Participants were divided into groups according to the modes of ventilation: A/C and SIMV + PSV. Statistical analyses were performed in the R environment. Alpha = 0.05. The using chi-square, Fisher's exact, Mann-Whitney and Kruskal-Wallis tests were used. 345 adult participants were included; 211/345 (61.16%) were males. Of the participants, 151/345 (43.77%) were on SIMV + PSV and 194/345 (56.23%) were on A/C. The comparative analysis between the modes of ventilation showed no significant differences in length of hospital stay (p = 0.675), duration of mechanical ventilation (p = 0.952), mortality (p = 0.241), failed extubation (p = 0.411) and the need for tracheostomy (p = 0.301). SIMV + PSV as a mode of ventilation showed similar statistical results to the A/C mode, when compared to analyzed medical outcomes.
