Interpretación de las curvas del respirador en pacientes con insuficiencia respiratoria aguda

Correger, Enrique; Murias, Tiberio Feliz; Chacon, Encarna; Estruga, Anna; Sales, Bernat; López-Aguilar, Josefina; Montanyà, Jaume; Lucangelo, Umberto; Garcia-Esquirol, Oscar; Villagrá, Ana; Villar, Jesús; Kacmarek, Robert M.; Burgueño, Ma Jose; Blanch, Lluís

doi:10.1016/j.medin.2011.08.005

Cited by 30 publications

(17 citation statements)

References 36 publications

(25 reference statements)

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“…Subjects on any assisted mode of ventilation requiring aspiration of secretions by clinical judgment or ventilator display curves [ 21 ] were connected to a mechanical aspiration device (Cough Assist E70™, Respironics, Philips) without previously performing conventional secretion suctioning. Insufflation plateau was set at 50 cmH 2 O, with a duration of 3 s, followed by an exsufflation phase at a negative pressure of − 45 cmH 2 O maintained for 4 s. These insufflation-exsufflation pressures are slightly above the ± 40 cmH 2 O recommended by the manufacturer, which are meant to be applied by face mask mainly, and were chosen to overcome resistance to air flow exerted by the artificial airways [ 22 ].…”

Section: Methodsmentioning

confidence: 99%

Preliminary experience on the safety and tolerability of mechanical “insufflation-exsufflation” in subjects with artificial airway

Sánchez-García

Santos

Rodríguez-Trigo

et al. 2018

ICMx

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BackgroundCatheter suctioning of respiratory secretions in intubated subjects is limited to the proximal airway and associated with traumatic lesions to the mucosa and poor tolerance. “Mechanical insufflation-exsufflation” exerts positive pressure, followed by an abrupt drop to negative pressure. Potential advantages of this technique are aspiration of distal airway secretions, avoiding trauma, and improving tolerance.MethodsWe applied insufflation of 50 cmH2O for 3 s and exsufflation of − 45 cmH2O for 4 s in patients with an endotracheal tube or tracheostomy cannula requiring secretion suctioning. Cycles of 10 to 12 insufflations-exsufflations were performed and repeated if secretions were aspirated and visible in the proximal artificial airway. Clinical and laboratory parameters were collected before and 5 and 60 min after the procedure. Subjects were followed during their ICU stay until discharge or death.ResultsMechanical insufflation-exsufflation was applied 26 times to 7 male and 6 female subjects requiring suctioning. Mean age was 62.6 ± 20 years and mean Apache II score 23.3 ± 7.4 points. At each session, a median of 2 (IQR 1; 2) cycles on median day of intubation 11.5 (IQR 6.25; 25.75) were performed. Mean insufflation tidal volume was 1043.6 ± 649.9 ml. No statistically significant differences were identified between baseline and post-procedure time points. Barotrauma, desaturation, atelectasis, hemoptysis, or other airway complication and hemodynamic complications were not detected. All, except one, of the mechanical insufflation-exsufflation sessions were productive, showing secretions in the proximal artificial airway, and were well tolerated.ConclusionsOur preliminary data suggest that mechanical insufflation-exsufflation may be safe and effective in patients with artificial airway. Safety and efficacy need to be confirmed in larger studies with different patient populations.Trial registrationEudraCT 2017-005201-13 (EU Clinical Trials Register).

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Section: Methodsmentioning

confidence: 99%

Preliminary experience on the safety and tolerability of mechanical “insufflation-exsufflation” in subjects with artificial airway

Sánchez-García

Santos

Rodríguez-Trigo

et al. 2018

ICMx

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“…Nowadays, IEE detection is based on the careful observation of patients' inspiratory efforts and waveforms on mechanical ventilators. 7,8 IEEs can be detected by identifying a sudden decrease in expiratory flow that is due to a reduction in expiratory driving pressure (alveolar pressure minus airway pressure) caused by the activity of inspiratory muscles (see Figure). Nevertheless, the clinical ability to recognize patient-ventilator dyssynchronies by visual inspection of flow and airway pressure tracings is generally quite low.…”

Section: Subjectsmentioning

confidence: 99%

Nurses' Detection of Ineffective Inspiratory Efforts During Mechanical Ventilation

Chacon¹,

Estruga²,

Murias³

et al. 2012

American Journal of Critical Care

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Background Patient-ventilator dyssynchrony is common and may influence patients' outcomes. Detection of such dyssynchronies relies on careful observation of patients and airway flow and pressure measurements. Given the shortage of specialists, critical care nurses could be trained to identify dyssynchronies. Objective To evaluate the accuracy of specifically trained critical care nurses in detecting ineffective inspiratory efforts during expiration. Methods We compared 2 nurses' evaluations of measurements from 1007 breaths in 8 patients with the evaluations of experienced critical care physicians. Sensitivity, specificity, positive predictive value, negative predictive value, and the Cohen κ for interobserver agreement were calculated. Results For the first nurse, sensitivity was 92.5%, specificity was 98.3%, positive predictive value was 95.4%, negative predictive value was 97.1%, and κ was 0.92 (95% CI, 0.89-0.94). For the second nurse, sensitivity was 98.5%, specificity was 84.7%, positive predictive value was 70.7%, negative predictive value was 99.3%, and κ was 0.74 (95% CI, 0.70-0.78). Conclusion Specifically trained nurses can reliably detect ineffective inspiratory efforts during expiration.

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“…A introdução de transdutores de fluxo nos ventiladores mecânicos entre as décadas de 70 a 90, permitiu aos profissionais realizarem em tempo real toda a monitorização, além de responder com eficiência à demanda exigida pelo paciente por meio das curvas de pressão, fluxo e volume gerados pelo paciente 10 .…”

Section: Introductionunclassified

Interpretação gráfica e monitorização ventilatória

Santos

Camerino

Braide

et al. 2019

Rev. Med. (São Paulo)

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Objetivos: avaliar o conhecimento do fisioterapeuta em relação à interpretação gráfica e à monitorização ventilatória. Métodos: estudo quantitativo realizado entre março e abril de 2018, em três hospitais de Fortaleza/CE, com 41 fisioterapeutas intensivistas sobre seu conhecimento no que diz respeito à interpretação gráfica e monitorização ventilatória, bem como sua abordagem terapêutica frente aos achados clínicos. Os dados foram colhidos por meio de um questionário com 10 questões objetivas e analisados por meio do software Statistical Package for Social Sciences (SPSS) 17.0. Resultados: a maioria dos fisioterapeutas tinham entre 6 e 10 anos de atuação na UTI (43,9%). Quando questionados sobre os conhecimentos básicos de pressão e parâmetros de normalidade do Índice de Oxigenação, 80,5% e 70,6% fisioterapeutas ofereceram respoatas corretasrespectivamente. Acerca do conhecimento de monitorização ventilatória, o conceito de drive pressure foi o que apresentou melhor índice de assertiva com 73,2% acertos. Já sobre a análise gráfica, a interpretação da apneia (87,8%) e a abordagem na auto-PEEP (58,5%) foram as questões com maior número de acertos. Conclusão: houve assertividades relevantes no tocante ao conhecimento dos conceitos básicos, da monitorização dos parâmetros ventilatórios e da interpretação gráfica por parte dos profissionais entrevistados, porém sugere-se que haja mais estudos sobre a temática por meio de uma estratégia de educação continuada a fim de gerar um maior suporte teórico-prático para os fisioterapeutas intensivistas.

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Interpretación de las curvas del respirador en pacientes con insuficiencia respiratoria aguda

Cited by 30 publications

References 36 publications

Preliminary experience on the safety and tolerability of mechanical “insufflation-exsufflation” in subjects with artificial airway

Preliminary experience on the safety and tolerability of mechanical “insufflation-exsufflation” in subjects with artificial airway

Nurses' Detection of Ineffective Inspiratory Efforts During Mechanical Ventilation

Interpretação gráfica e monitorização ventilatória

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