ObjectiveTo investigate the association between the rapid shallow breathing index and successful extubation in patients with traumatic brain injury. MethodsThis study was a prospective study conducted in patients with traumatic brain injury of both genders who underwent mechanical ventilation for at least two days and who passed a spontaneous breathing trial. The minute volume and respiratory rate were measured using a ventilometer, and the data were used to calculate the rapid shallow breathing index (respiratory rate/tidal volume). The dependent variable was the extubation outcome: reintubation after up to 48 hours (extubation failure) or not (extubation success). The independent variable was the rapid shallow breathing index measured after a successful spontaneous breathing trial. ResultsThe sample comprised 119 individuals, including 111 (93.3%) males. The average age of the sample was 35.0±12.9 years old. The average duration of mechanical ventilation was 8.1±3.6 days. A total of 104 (87.4%) participants achieved successful extubation. No association was found between the rapid shallow breathing index and extubation success. ConclusionThe rapid shallow breathing index was not associated with successful extubation in patients with traumatic brain injury.
OBJECTIVE: To evaluate the association between extubation failure and outcomes (clinical and functional) in patients with traumatic brain injury (TBI). METHODS: A prospective cohort study involving 311 consecutive patients with TBI. The patients were divided into two groups according to extubation outcome: extubation success; and extubation failure (defined as reintubation within 48 h after extubation). A multivariate model was developed in order to determine whether extubation failure was an independent predictor of in-hospital mortality. RESULTS: The mean age was 35.7 ± 13.8 years. Males accounted for 92.3%. The incidence of extubation failure was 13.8%. In-hospital mortality was 4.5% and 20.9% in successfully extubated patients and in those with extubation failure, respectively (p = 0.001). Tracheostomy was more common in the extubation failure group (55.8% vs. 1.9%; p < 0.001). The median length of hospital stay was significantly greater in the extubation failure group than in the extubation success group (44 days vs. 27 days; p = 0.002). Functional status at discharge was worse among the patients in the extubation failure group. The multivariate analysis showed that extubation failure was an independent predictor of in-hospital mortality (OR = 4.96; 95% CI, 1.86-13.22). CONCLUSIONS: In patients with TBI, extubation failure appears to lengthen hospital stays; to increase the frequency of tracheostomy and of pulmonary complications; to worsen functional outcomes; and to increase mortality.
Introdução: O suporte ventilatório invasivo constitui um dispositivo terapêutico imprescindível em pacientes com Traumatismo Crânio Encefálico grave. Nas UTIs a Pneumonia Associada à Ventilação Mecânica (PAV) é a complicação pulmonar que mais comumente acomete os pacientes internados em uso de Ventilação Mecânica (VM). Objetivo: Verificar a incidência de PAV em pacientes com TCE submetidos à craniotomia, assim como a associação da PAV com o tempo de VM, tempo de permanência e mortalidade na UTI. Métodos: Estudo de coorte prospectivo, realizado em hospital de referência no atendimento e tratamento de pacientes politraumatizados. A população compreende pacientes internados na UTI com diagnóstico de TCE, submetidos à craniotomia, que fizeram uso de suporte ventilatório invasivo durante a internação. As variáveis de interesse do estudo foram: ocorrência de PAV; idade; sexo; tipo de acidente; causa da VM; tempo de VM; tempo deinternação na UTI; mortalidade na UTI. Resultados: O estudo contou com 77 pacientes, e destes, 90,9% pertenciam ao sexo masculino. Os indivíduos jovens predominaram no estudo, com média de idade de 36,6 ± 13,7 anos. Dos 77 pacientes, 20 (26,0%) foram acometidos por PAV. Foi encontrada associação entre a PAV e o tempo prolongado de VM e tempo de permanência na UTI. Não foi encontrada associação da PAV com o óbito. Conclusão: A PAV foi infecção frequente em pacientes com TCE submetidos à craniotomia e esteve associada à maior duração da VM e maior tempo de permanência na UTI.
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