Encuesta sobre el procedimiento de extubación en las unidades de cuidados intensivos de Buenos Aires, Argentina / Survey on the extubation procedure in intensive care units in Buenos Aires, Argentina

RESUMEN Objetivo: Conocer la práctica habitual del manejo de la vía aérea durante el procedimiento de extubación mediante una encuesta online a profesionales de las unidades de cuidados intensivos de la Ciudad Autónoma de Buenos Aires y Provincia de Buenos, Argentina. Métodos: Estudio descriptivo transversal de tipo encuesta online del 11 de febrero al 11 de marzo de 2013. Se envió por correo electrónico una invitación voluntaria y anónima para acceder a la encuesta a 500 participantes a partir de una base de datos confeccionada por los investigadores de este estudio. Resultados: De un total de 500 participantes, 217 (44%) respondieron la encuesta. El 59,4% son kinesiólogos. Ciento noventa y cinco (89,9%) profesionales se desempeñan en atención de adultos. Con respecto al procedimiento de desinflado del balón y extubación, 203 (93,5%) realizan aspiración endotraqueal y 27 (12,5%) emplean presión positiva. El 53,5% de los participantes informó haber tenido en los últimos 3 meses complicaciones inmediatas a este procedimiento. Se informaron un total de 163 complicaciones, siendo el estridor el más prevalente (52,7%). Conclusión: La mayoría de los profesionales de unidades de cuidados intensivos de la Ciudad Autónoma de Buenos Aires y Provincia de Buenos Aires, Argentina, emplea aspiración endotraqueal sin aplicar presión positiva durante el procedimiento de extubación.

ABSTRACT Objective: To examine the usual practice of airway management during the extubation procedure through an online survey to professionals working in intensive care units in the Autonomous City of Buenos Aires and in the Province of Buenos Aires, Argentina. Methods: A cross-sectional descriptive study online survey was conducted from February 11 to March 11, 2013. A database was generated, and a voluntary and anonymous invitation to access the survey was sent by email to 500 participants. Results: Out of a total of 500 participants, 217 (44%) responded to the survey, of whom 59.4% were physical therapists. One hundred ninety-five (89.9%) professionals were working in adult care. Regarding the cuff deflation procedure and extubation, 203 (93.5%) performe endotracheal suctioning, and 27 (12.5%) use positive pressure. Approximately 53.5% of participants reported having experienced immediate complications with this procedure in the last three months. In all, 163 complications were reported, and stridor was the most prevalent (52.7%). Conclusion: Most professionals working in intensive care units in the Autonomous City of Buenos Aires and in the Province of Buenos Aires, Argentina, use endotracheal suctioning without applying positive pressure during extubation.

Survey on the extubation procedure in intensive care units in Buenos Aires, Argentina. / Encuesta sobre el procedimiento de extubación en las unidades de cuidados intensivos de Buenos Aires, Argentina.

OBJECTIVE: To examine the usual practice of airway management during the extubation procedure through an online survey to professionals working in intensive care units in the Autonomous City of Buenos Aires and in the Province of Buenos Aires, Argentina. METHODS: A cross-sectional descriptive study online survey was conducted from February 11 to March 11, 2013. A database was generated, and a voluntary and anonymous invitation to access the survey was sent by email to 500 participants. RESULTS: Out of a total of 500 participants, 217 (44%) responded to the survey, of whom 59.4% were physical therapists. One hundred ninety-five (89.9%) professionals were working in adult care. Regarding the cuff deflation procedure and extubation, 203 (93.5%) performe endotracheal suctioning, and 27 (12.5%) use positive pressure. Approximately 53.5% of participants reported having experienced immediate complications with this procedure in the last three months. In all, 163 complications were reported, and stridor was the most prevalent (52.7%). CONCLUSION: Most professionals working in intensive care units in the Autonomous City of Buenos Aires and in the Province of Buenos Aires, Argentina, use endotracheal suctioning without applying positive pressure during extubation.

OBJETIVO: Conocer la práctica habitual del manejo de la vía aérea durante el procedimiento de extubación mediante una encuesta online a profesionales de las unidades de cuidados intensivos de la Ciudad Autónoma de Buenos Aires y Provincia de Buenos, Argentina. MÉTODOS: Estudio descriptivo transversal de tipo encuesta online del 11 de febrero al 11 de marzo de 2013. Se envió por correo electrónico una invitación voluntaria y anónima para acceder a la encuesta a 500 participantes a partir de una base de datos confeccionada por los investigadores de este estudio. RESULTADOS: De un total de 500 participantes, 217 (44%) respondieron la encuesta. El 59,4% son kinesiólogos. Ciento noventa y cinco (89,9%) profesionales se desempeñan en atención de adultos. Con respecto al procedimiento de desinflado del balón y extubación, 203 (93,5%) realizan aspiración endotraqueal y 27 (12,5%) emplean presión positiva. El 53,5% de los participantes informó haber tenido en los últimos 3 meses complicaciones inmediatas a este procedimiento. Se informaron un total de 163 complicaciones, siendo el estridor el más prevalente (52,7%). CONCLUSIÓN: La mayoría de los profesionales de unidades de cuidados intensivos de la Ciudad Autónoma de Buenos Aires y Provincia de Buenos Aires, Argentina, emplea aspiración endotraqueal sin aplicar presión positiva durante el procedimiento de extubación.

Características de los pacientes desvinculados de la ventilación mecánica invasiva: Un estudio multicéntrico / Characteristics of Patients Weaning From Invasive Mechnical Ventilation. A multicenter Study

El proceso de weaning incluye la liberación del paciente del soporte ventilatorio y del tubo orotraqueal y se clasifica en simple, dificultoso y prolongado, basado en la dificultad y la duración del mismo. El objetivo fue describir las características epidemiológicas de pacientes desvinculados exitosamente de la ventilación mecánica invasiva y establecer asociaciones entre los tipos de weaning y las variables que influyeron en la evolución de las mismas asociadas a la mortalidad. Realizamos un estudio de cohorte prospectivo, analítico, longitudinal y multicéntrico en tres unidades de terapia intensiva de la Ciudad Autónoma de Buenos Aires, Argentina. Fueron incluidos sujetos que requirieron ventilación mecánica invasiva mayor a 12hs. y desvinculados exitosamente. Las variables estudiadas fueron tipo de weaning, tiempo en ventilación mecánica invasiva, falla de extubación, estadía y mortalidad en terapia intensiva. La prevalencia del weaning simple, dificultoso y prolongado correspondió a un 52.2% (95/182), 25.8% (47/182) y 22% (40/182), respectivamente. Aumentó el promedio de días de ventilación mecánica invasiva a 3,5 cada vez que cambió la categoría (Coefciente B: 3.5; SE 0.6). Aquellos pacientes que fallaron la extubación presentaron mayor riesgo de realizar weaning prolongado ( OR = 23; IC95%: 3.55-149.45). No se halló asociación entre la mortalidad y el tipo de weaning (OR = 0.68; IC95%: 0.31-1.51). En conclusión, no se asoció el tipo de weaning con mortalidad en la terapia intensiva. La falla de extubación, la traqueostomia y la presencia de delirio se asociaron con mayores días de ventilación mecánica invasiva.

The weaning process includes the release from the ventilatory support and endotracheal tube. It is classified into simple, difficult and prolonged, according to its difficulty and duration. The purpose was to describe the epidemiological characteristics of patients successfully weaned from invasive mechanical ventilation and establish associations between the different types of weaning and the variables influencing the evolution of these characteristics associated with mortality. We conducted a multicenter, prospective, longitudinal, analytical cohort study in three intensive care units of the Autonomous City of Buenos Aires, Argentina. We included patients who required invasive mechanical ventilation for more than 12 hours and were successfully weaned from it. The variables to be analyzed were: type of weaning, amount of days the patients received invasive mechanical ventilation, extubation failure and length of stay and mortality in the intensive care unit. The prevalence of simple, difficult or prolonged weaning was 52.2% (95/182), 25.8% (47/182) and 22% (40/182), respectively. The average of days the patients received invasive mechanical ventilation increased to 3.5 every time the category changed (B Coefficient: 3.5; SE [standard error] = 0.6). Patients with extubation failure presented a higher risk of prolonged weaning (OR [odds ratio] = 23; CI [confidence interval] = 95%: 3.55-149.45). No association was found between mortality and type of weaning (OR = 0.68; 95% CI: 0.31-1.51). In conclusion, the type of weaning was not associated with mortality in the intensive care unit. The extubation failure, tracheostomy and presence of delirium were associated with a larger amount of days receiving invasive mechanical ventilation.

Effect of applying positive pressure with or without endotracheal suctioning during extubation: a laboratory study.

BACKGROUND: During invasive mechanical ventilation, secretions accumulate in the subglottic space; consequently, there is a risk of aspiration of these secretions into the airway during cuff deflation and extubation. To minimize this risk, 2 extubation methods are used. The first consists of introducing a suction catheter into the endotracheal tube (ETT) and the trachea. After initiating suctioning, the cuff is deflated and the ETT is removed together with the suction catheter. The second technique involves applying positive pressure to the ETT using a resuscitation bag. Once the manual breath is delivered, the ETT cuff is deflated and the ETT is removed without suction. The aim of this laboratory study is to determine the existence and magnitude of differences in leak volume during cuff deflation and extubation using various combinations of positive pressure with or without endotracheal suctioning. METHODS: An ETT connected to a ventilator was placed in a model trachea. Colored water was instilled in the space above the cuff. To measure the leak volume, a collection chamber was attached to the distal end of the model. Nine procedures were defined, based on the delivery of different positive pressure levels with or without endotracheal suctioning during extubation. The volume of leakage, in milliliters, was the unit of analysis. Procedures yielding values lower than 1 mL were assessed by the Friedman test, and a P value of less than .05 was considered significant. Post hoc comparisons were performed with a Wilcoxon test, followed by a Bonferroni correction. RESULTS: The application of CPAP 15, pressure support ventilation (PSV)15/10, and PSV 20/5 produced 0.4, 0.2, and 0.1 mL of leak volume, respectively. Statistically significant differences were found between CPAP 15 and PSV 15/10 (P = .003) and between CPAP 15 and PSV 20/5 (P = .01), but not between PSV 15/10 and PSV 20/5 (P = .30). The addition of suctioning increased leak volume, with statistically significant differences between CPAP 15 and CPAP 15 + endotracheal suctioning (P = .001) and between PSV 15/10 and PSV 15/10 + endotracheal suctioning (P = .001). CONCLUSIONS: Endotracheal suctioning during cuff deflation and extubation produced greater leakage. Application of CPAP 15, PSV 15/10, and PSV 20/5 resulted in the lowest leak values, with the best results being obtained with the use of PSV 15/10 and PSV 20/5.