Ventilação não invasiva na insuficiência respiratória aguda na bronquiolite por vírus sincicial respiratório

Abstract

ObjectivesThe present study focused on respiratory syncytial virus bronchiolitis with respiratory failure. The aim of the study was to determine whether noninvasive ventilation reduces the need for endotracheal intubation or slows the clinical progression of acute respiratory syncytial virus bronchiolitis by reducing the incidence of infectious complications. MethodsThe present study was a retrospective cohort study. Cohort A was comprised of children who were admitted to the pediatric intensive and special care unit from 2003-2005 before starting noninvasive ventilation; cohort B was comprised of children who were admitted to the pediatric intensive and special care unit from 2006-2008 after starting noninvasive ventilation. With the exception of noninvasive ventilation, the therapeutic support was the same for the two groups. All children who were diagnosed with respiratory syncytial virus bronchiolitis and respiratory failure between November 2003 and March 2008 were included in the cohort. Demographic, clinical and blood gas variables were analyzed. ResultsA total of 162 children were included; 75% of the subjects were less than 3 months old. Group A included 64 children, and group B included 98 children. In group B, 34 of the children required noninvasive ventilation. The distributions of the variables age, preterm birth, congenital heart disease, cerebral palsy and chronic lung disease were similar between the two groups. On admission, the data for blood gas analysis and the number of apneas were not significantly different between the groups. In group B, fewer children required invasive ventilation (group A: 12/64 versus group B: 7/98; p=0.02), and there was a reduction in the number of cases of bacterial pneumonia (group A: 19/64 versus group B: 12/98; p=0.008). There was no record of mortality in either of the groups. ConclusionBy comparing children with the same disease both before and after noninvasive ventilation was used for ventilation support, we verified a reduction in infectious complications and cases requiring intubation.

Use of noninvasive ventilation for acute respiratory failure in intensive care unit.

“…Identification of predictive success or failure of NIV can both avoid unnecessary EI as to avoid a late EI and its complications. (20,21) In this sense, the implementation of therapy must follow strict criteria for the indication, patient selection and usage mode in order to increase the success rate of therapy without compromising the patient's evolution in case of failure. (22,23) It is considered that the ability of the team and their level of experience in the use of NIV are critical to the success of the technique.…”

Ventilação mecânica não invasiva na bronquiolite viral aguda: estudo de coorte retrospectivo

“…Em sua forma mais grave, acompanhada de insuficiência respiratória aguda, com necessidade de ventilação mecânica invasiva (VMI), a BVA pode representar uma importante causa de morbimortalidade. Cerca de 2-6% dos casos necessitam ser admitidos em Unidade de Terapia Intensiva (UTI) acarretando um maior tempo de internação hospitalar e um aumento substancial dos custos com a internação 8,9,10,11 . A ventilação mecânica não invasiva (VMNI) é o fornecimento de suporte ventilatório sem a necessidade de uma via aérea invasiva.…”