Avaliação do gradiente de pressão utilizado na ventilação mecânica invasiva em pacientes com insuficiência respiratória hipoxêmica aguda internados na UTI Pediátrica do Hospital das Clínicas da Faculdade de Medicina de Botucatu: análise retrospectiva de 5 anos
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2021-12-08
Autores
Ananias, Felipe Conceição
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Universidade Estadual Paulista (Unesp)
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Introdução: A insuficiência respiratória aguda (IRA) é a principal causa de internação em Unidades de Terapia Intensiva Pediátricas (UTIP). Caracteriza-se pela incapacidade do sistema respiratório em atender as demandas metabólicas do organismo. O tratamento convencional da IRA hipoxêmica envolve dentre outras medidas instituição de assistência respiratória, particularmente nos casos mais graves. A Ventilação Mecânica (VM) ocupa posição de destaque, desde que é capaz de modificar a evolução da doença e reduzir a mortalidade. A assistência respiratória, no entanto, pode ser causa de lesão pulmonar quando realizado de forma agressiva. O conceito de ventilação protetora surge com objetivo de reduzir os efeitos negativos da ventilação mecânica e, consequentemente, garantir melhor evolução dos pacientes. Em pediatria, embora não haja consenso sobre melhor modo ventilatório, grande parte dos pacientes são ventilados a modos controlados a pressão. Utiliza-se então o conceito de gradiente de pressão. Estudos na faixa etária pediátrica são escassos quanto a esse conceito. Objetivos: Descrever o gradiente médio de pressão utilizado nas primeiras 48 horas de VM em pacientes pediátricos com diagnóstico de IRA hipoxêmica internados na UTI-Pediátrica do Hospital das Clínicas da Faculdade de Medicina de Botucatu, correlacionando-o com a mortalidade. Descrever a mortalidade por IRA hipoxêmica na referida Unidade. Resultados: Foram incluídos 162 pacientes com insuficiência respiratória aguda hipoxêmica em ventilação mecânica em modo com pressão controlada. Dentre as variáveis analisadas, idade e sexo apresentaram associação significante com mortalidade. Idade mais avançada [(OR 1,02; IC 95% (1,002-1,037) p<0,05] e sexo masculino [OR 0,065; IC 95% (0,005-0,793); p<0,05] apresentaram correlação com a mortalidade. A idade média dos pacientes que evoluíram para óbito foi de 54,8 meses (aproximadamente 4 anos e 6 meses). Com relação ao sexo, 9 pacientes (81,82%) dos 11 que evoluíram para óbito eram do sexo masculino. As demais variáveis analisadas não apresentaram correlação significante com mortalidade. Conclusão: Não há correlação entre o gradiente de pressão e mortalidade. Existe maior mortalidade dos pacientes do sexo masculino e de maior idade com diagnóstico de IRA hipoxêmica aguda.
Introduction: Acute respiratory failure (ARI) is the main cause of admission to Pediatric Intensive Care Units (PICU). It is characterized by the inability of the respiratory system in meeting the body's metabolic demands. Conventional treatment of hypoxemic ARF involves, among other supports, the provision of respiratory assistance, particularly in the more severe cases. Mechanical Ventilation (MV) occupies a prominent position, since it is able to modify the evolution of the disease and reduce mortality. Conventional treatment of hypoxemic ARF involves control of the underlying disease control of the underlying disease, offering hemodynamic support when needed, correction of hydroelectrolytic and acid-base disturbances, and the provision of respiratory assistance, particularly in the more severe cases. Mechanical ventilation (MV) occupies a prominent position, since it is able to modify the evolution of the disease and reduce mortality. Respiratory assistance, however, may cause lung injury when performed aggressively. The concept of protective ventilation arises with the objective of reducing negative effects of mechanical ventilation and consequently ensuring better patient outcomes. In pediatrics, although there is no consensus on the best ventilatory, most patients are ventilated in pressure controlled modes. Therefore, the concept of pressure gradient is used. Studies in the pediatric age group are scarce regarding this concept. Objectives: To describe the mean pressure gradient used during the first 48 hours of hours of MV in pediatric patients with diagnosis of hypoxemic ARF admitted to the Pediatric ICU of the Hospital das Clínicas da Faculdade School of Medicine of Botucatu, correlating it with mortality. To describe the mortality rate due to hypoxemic ARF in this Unit. Results: We included 162 patients with hypoxemic acute respiratory failure hypoxemic acute respiratory failure on pressure controlled mechanical ventilation were included. Among the variables analyzed, age and gender were significantly associated with mortality significant association with mortality. Older age [(OR 1.02; IC 95% (1.002-1.037) p<0.05] and male sex [OR 0.065; IC 95% (0.005-0.793); p<0.05] correlated with mortality. The mean age of patients who died was 54.8 months (approximately 4 years and 6 months). Regarding gender, 9 patients (81.82%) of the 11 who died were male.The other variables analyzed showed no significant correlation with mortality. significant correlation with mortality. Conclusion: There is no correlation between pressure gradient and mortality. There is a higher mortality rate among male patients and older patients older patients diagnosed with acute hypoxemic ARF.
Introduction: Acute respiratory failure (ARI) is the main cause of admission to Pediatric Intensive Care Units (PICU). It is characterized by the inability of the respiratory system in meeting the body's metabolic demands. Conventional treatment of hypoxemic ARF involves, among other supports, the provision of respiratory assistance, particularly in the more severe cases. Mechanical Ventilation (MV) occupies a prominent position, since it is able to modify the evolution of the disease and reduce mortality. Conventional treatment of hypoxemic ARF involves control of the underlying disease control of the underlying disease, offering hemodynamic support when needed, correction of hydroelectrolytic and acid-base disturbances, and the provision of respiratory assistance, particularly in the more severe cases. Mechanical ventilation (MV) occupies a prominent position, since it is able to modify the evolution of the disease and reduce mortality. Respiratory assistance, however, may cause lung injury when performed aggressively. The concept of protective ventilation arises with the objective of reducing negative effects of mechanical ventilation and consequently ensuring better patient outcomes. In pediatrics, although there is no consensus on the best ventilatory, most patients are ventilated in pressure controlled modes. Therefore, the concept of pressure gradient is used. Studies in the pediatric age group are scarce regarding this concept. Objectives: To describe the mean pressure gradient used during the first 48 hours of hours of MV in pediatric patients with diagnosis of hypoxemic ARF admitted to the Pediatric ICU of the Hospital das Clínicas da Faculdade School of Medicine of Botucatu, correlating it with mortality. To describe the mortality rate due to hypoxemic ARF in this Unit. Results: We included 162 patients with hypoxemic acute respiratory failure hypoxemic acute respiratory failure on pressure controlled mechanical ventilation were included. Among the variables analyzed, age and gender were significantly associated with mortality significant association with mortality. Older age [(OR 1.02; IC 95% (1.002-1.037) p<0.05] and male sex [OR 0.065; IC 95% (0.005-0.793); p<0.05] correlated with mortality. The mean age of patients who died was 54.8 months (approximately 4 years and 6 months). Regarding gender, 9 patients (81.82%) of the 11 who died were male.The other variables analyzed showed no significant correlation with mortality. significant correlation with mortality. Conclusion: There is no correlation between pressure gradient and mortality. There is a higher mortality rate among male patients and older patients older patients diagnosed with acute hypoxemic ARF.
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Ventilação mecânica, Pediatria, Insuficiência respiratória, Mechanical ventilation, Respiratory failure, Pediatric