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2015, Number 2

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Rev Cub Med Int Emerg 2015; 14 (2)

Results of the application of a weaning protocol from the mechanics ventilation

Iglesias ANR, Pérez PJ, Guirola PJJ, Pérez GE, Guerra CG, Varela VA

Language: Spanish
References: 27
Page: 96-110
PDF size: 229.55 Kb.


ABSTRACT

Introduction: The weaning process is carried out with the objective of restoring the patient to spontaneous ventilation in the minor possible time; when it is prolonged the number of complications associate and permanency at intensive care can increase.
Objective: To establish a protocol of precocious and sure weaning in order to diminish the ventilation time and the complications associated with mechanics ventilation, at Provincial General Educational Dr. Antonio Luaces Iraola Hospital, in Ciego de Avila.
Method: Investigation in three stages: exploratory retrospective descriptive study of patients with lingering ventilation that were entered in the adults intensive care unit during the period from January, 1997 to December, 2004.
Results: Elaboration of a protocol, keeping in mind the best scientific evidences applicable to the context and determination of predictors starting from approaches of experts (thorax X rays valuation, FOUR scale, PEEP levels, PaO2/ FiO2 relation, presence of cough reflection, Fr/ Vt, inotropic drugs doses, static lung compliance and pulse oximeter. The protocol was validated, it consists in four phases: before weaning, weaning in course, extubation and postextubation and it includes a methodology for its implementation, evaluation and adherence.
Conclusions: The protocol application permitted to minimize the failure intents in the weaning, which diminished the ventilation time and the associated complications to mechanics ventilation.


REFERENCES

  1. Castañeda L, Caballero A. Destete de la ventilación mecánica. En: Caballero López A, editor. Terapia Intensiva. 2a ed. La Habana: Ciencias Médicas; 2007. p. 542-552.

  2. Esteban A, Frutos F, Tobin MJ. A comparison of four methods of weaning patients from mechanical ventilation. Spanish Lung Failure Collaborative Group. N Engl J Med [Internet]. 1995 [citado 3 Feb 2005];332: [aprox. 5 p.]. Disponible en: http://content.nejm.org/cgi/content/abstract/332/6/345

  3. Brochard L, Rauss A, Benito S. Comparison of three methods of gradual withdrawal from ventilatory support during weaning from mechanical ventilation. Am J Resp Crit Care Med [Internet] 1994 [citado 5 Feb 2005];150: [aprox. 8 p.]. Disponible en: http://ajrccm.atsjournals.org/cgi/content/abstract/150/4/896

  4. Collective Task-Force facilitated by the American College of Chest Physicians; American Association for Respiratory Care; American College of Critical Care Medicine. Evidence-based guidelines for weaning and discontinuing ventilatory support. Chest. 2001;120:375S-95S.

  5. Goldwasser R, Farias A, Freitas E, Sadd F, Amado V, Okamoto V. III Consenso Brasileño de ventilación mecánica. J Bras Pneumol [Internet] 2007 [citado 20 Ene 2009]; 33(supl. 2): [aprox. 7 p.]. Disponible en: http://www.scielo.br/scielo.php?script=sci_arttext&pid=S1806- 37132007000800001&lng=en&nrm=iso&tlng=pt

  6. Boles JM, Bion J, Connors A, Herridge M, Marsh B, Melot C, et al. Weaning from mechanical ventilation. Eur Respir J. 2007;29:1033-1056.

  7. Conti G, Montini L, Pennisi MA, Cavaliere F, Arcangeli A, Bocci MG, et al. A prospective, blinded evaluation of indexes proposed to predict weaning from mechanical ventilation. Intensive Care Med. 2004;30:830–6.

  8. Murray JF, Matthay MA, Luce JM, Flick MR. An expanded definition of the adult respiratory distress syndrome. Am Rev Resp Dis. 1988;138:720-3.

  9. Guirola J. Pérez L, Ibarra R, Alvarado K. Maniobra de reclutamiento alveolar en la injuria pulmonar Aguda y el síndrome de distress respiratorio del adulto. Rev Cub Med Int Emerg. [Internet] 2008 [citado 5 Abril 2009];7(4). Disponible en: http://www.bvs.sld.cu/revistas/mie/vol7_4_08/mie05408.htm

  10. Vincent JL, Opal SM, Marshall JC. Ten reasons why we should NOT use severity scores as entry criteria for clinical trials or in our treatment decisions. Crit Care Med 2010; [citado 5 Abril 2011];38(1):283-287. Disponible en: http://www.ncbi.nlm.nih.gov/pubmed/19730252

  11. Zambon M, Vincent JL. Mortality Rates for Patients With Acute Lung Injury/ARDS Have Decreased Over Time. Chest [Internet]. 2008 [citado 5 Abr 2009];133:1120-7. Disponible en: http://www.ncbi.nlm.nih.gov/pubmed/18263687? ordinalpos=1&itool=EntrezSystem2.PEntrez.Pubmed.Pubmed_ResultsPanel.Pub med_RVDocSum.

  12. Phua J, Badia J, Adhikari N Friedrich J O, Fowler R A, Singh J. et al. Has mortality from acute respiratory distress syndrome decreased over time? A systematic review. Am J Respir Crit Care Med [revista en Internet]. 2009 [citado 5 Abr 2010]; 179: 220-227. Disponible en: http://www.ajrccm.org/cgi/content/full/179/3/220.

  13. Puga M, Pérez E, Pérez F, Gómez A. Factores que influyen en la mortalidad del paciente Ventilado en una unidad de cuidados intensivos. Rev Cub Med Int Emerg. [internet] 2009;8(2):1490-1498. Disponible en: http://bvs.sld.cu/revistas/mie/vol8_4_09/mie02409.htm.

  14. Funk GC, Anders S, Breyer M, Burghuber S, Edelman G, Heind W. Incidence and outcome of weaning from mechanical ventilation according to new categories. ERJ. [Internet] 2010 [citado 11 Abr 2011];35(1):88-94. Disponible en: http://erj.ersjournals.com/content/35/1/88.full

  15. Sellares J, Acerbi I, Loureiro H, Dellaca R L, Ferrer M, Torres A, et al. Respiratory impedance during weaning from mechanical ventilation in a mixed population of critically ill patients. Brit J Anaest [Internet] 2009. [citado 11 Abr 2011];103(6):828-832. Disponible en: http://bja.oxfordjournals.org/misc/terms.shtml .

  16. Aboussouan L, Loutfi S, Chris D. Determinants of Time-To-Weaning in a Specialized Respiratory Care Unit. Chest [Internet] 2005. [citado 12 Nov 2011]; 128(5):317- 326.Disponibleen:http://chestjournal.chestpubs.org/content/128/5/3117.full.

  17. Hernández G, Fernández R, Luzón E, Cuena R, Montejo JC. The early phase of the minute ventilation recovery curve predicts extubation failure better than the minute ventilation recovery time. Chest 2007;131:1315-22.

  18. Seymour CW, Christie JD, Gaughan CA, Fuchs BD. Evaluation of a new method for measurement of minute ventilation recovery time. Respir Care. 2006;51:133-9.

  19. Kulkarni AP, Agarwal V. Extubation failure in intensive care unit. Predictors and management. Indian J Crit Care Med [Internet]. 2008 [citado 11 May 2009];12(1): [aprox. 4 p.]. Disponible en: http://www.ijccm.org/article.asp? issn=0972- 5229;year=2008;volume=12;issue=1;spage=1;epage=9;aulast=Kulkarni

  20. Arangola J, Sarasino A, Ferrari N. Estudio prospectivo de factores e índices pronósticos en el destete de la ventilación mecánica. Rev. Ecuatoriana Med Crit [Internet]. 2000 [citado 20 Ene 2009]; 2(2): [aprox. 8 p.]. Disponible en: http://www.medicosecuador.com/medicina_critica/rev_vol2_num2/indices_pron os_destetea.html

  21. Lim Alonso N, Pardo Núñez A, Ortiz Montoso M, Martínez A, Coll WA. Deshabituación de la Ventilación artificial. ¿Cómo lo asumimos en nuestra unidad? Rev Cubana Med Intens Emerg [Internet]. 2002 [citado 20 Ene 2009]; 1(2): [aprox. 8 p.]. Disponible en: http://bvs.sld.cu/revistas/mie/vol1_1_02/mie02102.htm

  22. Puga SC, Bravo R, Peña R, Padrón A, Marine HM, Ayala JL. Aplicación de un Protocolo para la retirada rápida de la Ventilación Mecánica. Rev. Cubana Med. Milit. [Internet]. 2001 [citado 20 Ene 2009]; 30(Supl. 1): [aprox. 8 p.]. Disponible en: http://bvs.sld.cu/revistas/mil/vol30_s_01/MIL06401.htm

  23. Guardiola JJ, Sarmiento X, Rello J. Neumonía asociada a ventilación mecánica: riesgos, problemas y nuevos conceptos. Medicina Intensiva.2001. [Consultado 12-05-11];25(3):113-23. Disponible en: http://www.google.com.cu/url? q=http://www.elsevier.es/sites/default/files/elsevier/pdf/64/64v25n03a130135 67pdf001.pdf&sa=U&ei=KzYDT9nxEofx0gH46NHEAg&ved=0CBIQFjAA&usg=AFQ jCNG01yfYMGbWWal49hGL048BKwS9Cg

  24. Agrafiotis M, Siempos, II, Falagas ME. Frequency, prevention, outcome and treatment of ventilator-associated tracheobronchitis: systematic review and meta-analysis. Respir Med [Internet] 2010. [citado 12 Jul 2011];104(3):325- 336. Disponible en: http://www.ncbi.nlm.nih.gov/pubmed/20205347.

  25. Carlucci A, Ceriana P, Prinianakis G, Fanfulla F, Colombo R, Nava S. Determinants of weaning success in patients with prolonged mechanical ventilation. Crit Care. 2009 [citado 15 Ene 2010];13(3):R97. Disponible en: http://www.w3.org/1999/xhtml">

  26. Frutos F, Alia I, Lorenzo Ml, García Pardo L, Nolla M, Ibáñez J. Utilización de la ventilación mecánica en 72 unidades de Cuidados Intensivos en España. Medicina Intensiva. 2003;7(01):1-12.

  27. Heunks LM, Hoeven van der J G. Clinical review: T he ABC of weaning failure - a structured approach. Critical Care [Internet] 2010 [citado 15 Oct 2010]; 14 : 245. Disponible en: h ttp://ccforum.com/content/14/6/245/?mkt=254330




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