Efeitos da aplicação de protocolo de desmame de ventilação mecânica em Unidade Coronária: estudo randomizado

Piotto, Raquel Ferrari; Maia, Lília Nigro; Machado, Maurício de Nassau; Orrico, Suzana Perez

doi:10.1590/s0102-76382011000200011

Cited by 37 publications

(10 citation statements)

References 35 publications

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“…Chaiwat 2010 [79], Kollef 1997 [80], Ely 1996 [81], Krishnan 2004 [82], Marelich 2000 [83], Namen 2001 [84], Navalesi 2008 [85], Piotto 2011 [86], Roh 2012 [87], Rose 2008 [88], Simeone 2002 [89], Stahl 2009 [90]…”

Section: Resultsmentioning

confidence: 99%

The clinical practice guideline for the management of ARDS in Japan

et al. 2017

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BackgroundThe Japanese Society of Respiratory Care Medicine and the Japanese Society of Intensive Care Medicine provide here a clinical practice guideline for the management of adult patients with ARDS in the ICU.MethodThe guideline was developed applying the GRADE system for performing robust systematic reviews with plausible recommendations. The guideline consists of 13 clinical questions mainly regarding ventilator settings and drug therapies (the last question includes 11 medications that are not approved for clinical use in Japan).ResultsThe recommendations for adult patients with ARDS include: we suggest against early tracheostomy (GRADE 2C), we suggest using NPPV for early respiratory management (GRADE 2C), we recommend the use of low tidal volumes at 6-8 mL/kg (GRADE 1B), we suggest setting the plateau pressure at 30cmH20 or less (GRADE2B), we suggest using PEEP within the range of plateau pressures less than or equal to 30cmH2O, without compromising hemodynamics (Grade 2B), and using higher PEEP levels in patients with moderate to severe ARDS (Grade 2B), we suggest using protocolized methods for liberation from mechanical ventilation (Grade 2D), we suggest prone positioning especially in patients with moderate to severe respiratory dysfunction (GRADE 2C), we suggest against the use of high frequency oscillation (GRADE 2C), we suggest the use of neuromuscular blocking agents in patients requiring mechanical ventilation under certain circumstances (GRADE 2B), we suggest fluid restriction in the management of ARDS (GRADE 2A), we do not suggest the use of neutrophil elastase inhibitors (GRADE 2D), we suggest the administration of steroids, equivalent to methylprednisolone 1-2mg/kg/ day (GRADE 2A), and we do not recommend other medications for the treatment of adult patients with ARDS (GRADE1B; inhaled/intravenous β2 stimulants, prostaglandin E1, activated protein C, ketoconazole, and lisofylline, GRADE 1C; inhaled nitric oxide, GRADE 1D; surfactant, GRADE 2B; granulocyte macrophage colony-stimulating factor, N-acetylcysteine, GRADE 2C; Statin.)ConclusionsThis article was translated from the Japanese version originally published as the ARDS clinical practice guidelines 2016 by the committee of ARDS clinical practice guideline (Tokyo, 2016, 293p, available from http://www.jsicm.org/ARDSGL/ARDSGL2016.pdf). The original article, written for Japanese healthcare providers, provides points of view that are different from those in other countries.Electronic supplementary materialThe online version of this article (doi:10.1186/s40560-017-0222-3) contains supplementary material, which is available to authorized users.

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Section: Resultsmentioning

confidence: 99%

The clinical practice guideline for the management of ARDS in Japan

et al. 2017

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“…Recent studies show that 33% to 46% of the patients admitted to these units use MV sometime during the hospitalization 6,7 . Currently, most patients submitted to mechanical ventilatory support can be quickly removed from the ventilator, as soon as the condition responsible for their hospitalization has been treated and/or stabilized 8 .…”

Section: Introductionmentioning

confidence: 99%

Influência da atuação fisioterapêutica no processo de ventilação mecânica de pacientes admitidos em UTI no período noturno após cirurgia cardíaca não complicada

et al. 2016

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“…When IMV is no longer required, the most appropriate method for its discontinuation must be determined [ 7 ] . The spontaneous breathing trial (SBT) is a simple method using pressure support ventilation (PSV) to determine whether a patient would tolerate IMV interruption.…”

Section: Introductionmentioning

confidence: 99%

Relationship between pre-extubation positive end-expiratory pressure and oxygenation after coronary artery bypass grafting

Lima¹,

Borges²,

Costa³

et al. 2015

Revista Brasileira De Cirurgia Cardiovascular

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IntroductionAfter removal of endotracheal tube and artificial ventilation, ventilatory support should be continued, offering oxygen supply to ensure an arterial oxygen saturation close to physiological.ObjectiveThe aim of this study was to investigate the effects of positive-end expiratory pressure before extubation on the oxygenation indices of patients undergoing coronary artery bypass grafting.MethodsA randomized clinical trial with seventy-eight patients undergoing coronary artery bypass grafting divided into three groups and ventilated with different positive-end expiratory pressure levels prior to extubation: Group A, 5 cmH2O (n=32); Group B, 8 cmH2O (n=26); and Group C, 10 cmH2O (n=20). Oxygenation index data were obtained from arterial blood gas samples collected at 1, 3, and 6 h after extubation. Patients with chronic pulmonary disease and those who underwent off-pump, emergency, or combined surgeries were excluded. For statistical analysis, we used Shapiro-Wilk, G, Kruskal-Wallis, and analysis of variance tests and set the level of significance at P<0.05.ResultsGroups were homogenous with regard to demographic, clinical, and surgical variables. There were no statistically significant differences between groups in the first 6 h after extubation with regard to oxygenation indices and oxygen therapy utilization.ConclusionIn this sample of patients undergoing coronary artery bypass grafting, the use of different positive-end expiratory pressure levels before extubation did not affect gas exchange or oxygen therapy utilization in the first 6 h after endotracheal tube removal.

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Efeitos da aplicação de protocolo de desmame de ventilação mecânica em Unidade Coronária: estudo randomizado

Cited by 37 publications

References 35 publications

The clinical practice guideline for the management of ARDS in Japan

The clinical practice guideline for the management of ARDS in Japan

Influência da atuação fisioterapêutica no processo de ventilação mecânica de pacientes admitidos em UTI no período noturno após cirurgia cardíaca não complicada

Relationship between pre-extubation positive end-expiratory pressure and oxygenation after coronary artery bypass grafting

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