Variações na mensuração dos parâmetros de desmame da ventilação mecânica em hospitais da cidade de Fortaleza

Abstract

SUMMARY BACKGROUND AND OBJECTIVES:The number of patients requiring prolonged time on mechanical ventilation is increasing considerably in the intensive care unit (ICU). The objective of this study was to characterize the variability of methods and criteria used by physiotherapists to obtain weaning parameters in hospitals of Fortaleza. METHODS: After approval by the UNIFOR Ethics Committee, survey questionnaires were distributed among physiotherapists working in the ICU of three public and three private hospitals. Forty-four physiotherapists answered thirty-two multiple choice questions anonymously. RESULTS:The main results concerned parameters commonly evaluated by physiotherapists. A significant difference between hospitals was found regarding the rapid shallow breathing index and maximum inspiratory pressure, which are more often used in private hospitals, with a percentage of 100% and 89.5%, respectively. Concerning the ventilatory

Low pressure support changes the rapid shallow breathing index (RSBI) in critically ill patients on mechanical ventilation

“…To calculate the RSBI, the method with the patient breathing without the aid of ventilatory support was the most common in Fortaleza 17 . Moreover, the use of the ventilatory support to obtain RSBI was common in hospitals in Distrito Federal 18 and São Paulo 19 .…”

“…In Brazil, three studies that evaluated methods of obtaining weaning parameters in different capitals (Fortaleza, Distrito Federal, and São Paulo) found differences. In Fortaleza, the RSBI measurements are performed with the patient breathing spontaneously through the T-tube 17 . In Distrito Federal, 95% of hospitals obtain the parameters from the display of the ventilators, and only 5% through a spirometer 18 .…”

Ventilatory weaning practices in intensive care units in the city of Cali

“…With respect to postgraduate degrees in Brazil, (10-12) over 80% of physiotherapists had postgraduate degrees. An unlikely situation is presented in Cali, where only 8% of physiotherapists and 3% of respiratory therapists have postgraduate specialization.…”

Comparação do índice de respiração rápida e superficial (IRRS) calculado de forma direta e indireta no pós-operatório de cirurgia cardíaca

“…Mont' Alverne et al 20 demonstrated that 100% of physical therapists from private hospitals of the city of Fortaleza use RSBI as predictive index of weaning and, at public hospitals at the same city, 76% use RSBI as a predictive index. In the same study, the authors reported that over 70% of physical therapists, both at private and public hospitals, get the data of RR through direct observation of chest expansion, and for the MV, they use the direct respirometry.…”

“…The minimum pressure of support that may compensate the resistance of the circuit should be adjusted up to 8 cmH 2 O 3 . The difficulty of obtaining RSBI can occur in situations in which the ventilometer is not available at the ICU, either for logistic reasons or due to its high cost, and the weaning needs to be evaluated and progressed 20 . Thus, the objective of the present study was to compare and to evaluate the agreement between the RSBI calculated with the values provided by the software of the mechanical ventilator Raphael ® and that calculated through values obtained by the digital ventilometer.…”