RESUMO
Despite advances in weaning protocols, extubation failure (EF) is associated with poor outcomes. Many predictors of EF have been proposed, including hypercapnia at the end of the spontaneous breathing test (SBT). However, performing arterial blood gases at the end of SBT is not routinely recommended, whereas end-tidal carbon dioxide (EtCO2) can be routinely monitored during SBT. We aimed to evaluate the clinical utility of EtCO2 to predict EF. Patients undergoing planned extubation were eligible. Non-inclusion criteria were tracheostomy and patients extubated after successful T-tube SBT. We recorded clinical data and EtCO2 in 189 patients during a successful one-hour low pressure support SBT. EtCO2 measured before successful SBT was lower in patients with EF compared to those with successful extubation (27 [24-29] vs 30 [27-47] mmHg, p = 0.02), while EtCO2 measured at five minutes and at the end of the SBT was not different between the two groups (26 [22-28] vs. 29 [28-49] mmHg, p = 0.06 and 26 [26-29] vs. 29 [27-49] mmHg, p = 0.09, respectively). Variables identified by multivariable analysis as independently associated with EF were acute respiratory failure as the cause of intubation and ineffective cough. Our study suggests that recording EtCO2 during successful SBT appears to have limited predictive value for EF.
Assuntos
Influenza Humana/complicações , Enfisema Mediastínico/diagnóstico , Adulto , Tosse/etiologia , Estado Terminal/terapia , Febre/etiologia , Humanos , Vírus da Influenza A Subtipo H1N1/efeitos dos fármacos , Vírus da Influenza A Subtipo H1N1/patogenicidade , Masculino , Enfisema Mediastínico/etiologia , Radiografia/métodos , Ruptura Espontânea/diagnóstico , Ruptura Espontânea/etiologia , Tomografia Computadorizada por Raios X/métodosRESUMO
In a multicenter cohort study including 22 oseltamivir-treated patients with influenza A(H1N1)pdm09 acute respiratory distress syndrome, prevalence of the H275Y substitution in the neuraminidase, responsible for highly reduced sensitivity to oseltamivir, was 23%. Patients infected with the H275Y mutant virus had higher day 28 mortality than others (80% vs 12%; P = .011).
Assuntos
Vírus da Influenza A Subtipo H1N1 , Influenza Humana , Pneumonia , Síndrome do Desconforto Respiratório , Antivirais/farmacologia , Antivirais/uso terapêutico , Estudos de Coortes , Farmacorresistência Viral , Humanos , Vírus da Influenza A Subtipo H1N1/genética , Influenza Humana/tratamento farmacológico , Neuraminidase/genética , Oseltamivir/uso terapêutico , Pneumonia/tratamento farmacológico , Síndrome do Desconforto Respiratório/tratamento farmacológicoAssuntos
Ponte de Artéria Coronária/efeitos adversos , Ponte de Artéria Coronária/métodos , Mamilos/patologia , Complicações Pós-Operatórias/etiologia , Idoso , Humanos , Masculino , Artéria Torácica Interna , Necrose/etiologia , Mamilos/irrigação sanguínea , Coleta de Tecidos e Órgãos/efeitos adversos , Coleta de Tecidos e Órgãos/métodosAssuntos
Acetaminofen/análise , Absorção Gástrica , Influenza Humana/sangue , Acetaminofen/sangue , Acetaminofen/uso terapêutico , Antivirais/uso terapêutico , Humanos , Influenza Humana/complicações , Influenza Humana/fisiopatologia , Unidades de Terapia Intensiva/organização & administração , Unidades de Terapia Intensiva/estatística & dados numéricos , Projetos PilotoAssuntos
Embolia Gordurosa/complicações , Infusões Intraósseas/efeitos adversos , Dor Abdominal/etiologia , Idoso , Transtornos da Consciência/diagnóstico , Transtornos da Consciência/etiologia , Embolia Gordurosa/diagnóstico por imagem , Febre/etiologia , Febre/fisiopatologia , Humanos , Infusões Intraósseas/métodos , Imageamento por Ressonância Magnética/métodos , MasculinoRESUMO
BACKGROUND: Pleural effusion is common during invasive mechanical ventilation, but its role during weaning is unclear. We aimed at assessing the prevalence and risk factors for pleural effusion at initiation of weaning. We also assessed its impact on weaning outcomes and its evolution in patients with difficult weaning. METHODS: We performed a prospective multicenter study in five intensive care units in France. Two hundred and forty-nine patients were explored using ultrasonography. Presence of moderate-to-large pleural effusion (defined as a maximal interpleural distance ≥ 15 mm) was assessed at weaning start and during difficult weaning. RESULTS: Seventy-three (29%) patients failed weaning, including 46 (18%) who failed the first spontaneous breathing trial (SBT) and 39 (16%) who failed extubation. Moderate-to-large pleural effusion was detected in 81 (33%) patients at weaning start. Moderate-to-large pleural effusion was associated with more failures of the first SBT [27 (33%) vs. 19 (11%), p < 0.001], more weaning failures [37 (47%) vs. 36 (22%), p < 0.001], less ventilator-free days at day 28 [21 (5-24) vs. 23 (16-26), p = 0.01], and a higher mortality at day 28 [14 (17%) vs. 14 (8%), p = 0.04]. The association of pleural effusion with weaning failure persisted in multivariable analysis and sensitivity analyses. Short-term (48 h) fluid balance change was not associated with the evolution of interpleural distance in patients with difficult weaning. CONCLUSIONS: In this multicenter observational study, pleural effusion was frequent during the weaning process and was associated with worse weaning outcomes.