Respiratory support and the process of weaning from invasive mechanical ventilation in patients admitted to the Adult ICU of a University Hospital: Descriptive longitudinal study
DOI:
https://doi.org/10.33448/rsd-v13i8.46163Keywords:
Intensive Care Unit; Respiratory Therapy; Mechanical Ventilation; Ventilator Weaning; Intubation, Intratracheal.Abstract
Objectives: To describe the profile of respiratory support and the process of weaning from invasive mechanical ventilation in patients admitted to the adult intensive care unit (ICU) of a university hospital and to comparatively evaluate the clinical outcomes of these patients in relation to the type of respiratory support used. Methodology: This was a descriptive longitudinal observational study of patients admitted to the hospital's Adult ICU between 10/16/2023 and 12/15/2023 and aged 18 years or older. Results: A homogeneous patient profile was found, with a predominance of overweight in both groups and an estimated higher risk of mortality in the intubated group. There was a predominance of patients admitted without ventilatory support, with low-flow oxygen therapy (FiO2 <40%). The group of patients admitted intubated to the ICU were predominantly ventilated in controlled mode, with rapid extubation and lower mortality. On the other hand, the group of patients who underwent orotracheal intubation (OTI) in the ICU were mostly ventilated in spontaneous mode, with high mortality before extubation and higher mortality than the other group. Conclusion: There is a predominance of ICU admissions of patients without ventilatory support. Post-operative patients generally require invasive mechanical ventilation and when they undergo OTI they remain mechanically ventilated for less time than those who are intubated in the ICU in emergency situations. The highest mortality rate was observed in those who underwent OTI. The process of ventilator weaning up to extubation can vary when there is no internal hospital protocol.
References
Abbott, M., Pereira, S. M., Sanders, N., Girard, M., Sankar, A., & Sklar, M. C. (2024). Weaning from mechanical ventilation in the operating room: a systematic review. British journal of anaesthesia, S0007-0912(24)00263-0. https://doi.org/10.1016/j.bja.2024.03.043
Bacci, S. L. L. D. S., Pereira, J. M., Chagas, A. C. D. S., Carvalho, L. R., & Azevedo, V. M. G. O. (2019). Role of physical therapists in the weaning and extubation procedures of pediatric and neonatal intensive care units: a survey. Brazilian journal of physical therapy, 23(4), 317–323. https://doi.org/10.1016/j.bjpt.2018.08.012
Baptistella, A. R., Sarmento, F. J., da Silva, K. R., Baptistella, S. F., Taglietti, M., Zuquello, R. Á., & Nunes Filho, J. R. (2018). Predictive factors of weaning from mechanical ventilation and extubation outcome: A systematic review. Journal of critical care, 48, 56–62. https://doi.org/10.1016/j.jcrc.2018.08.023.
Bellani, G., Laffey, J. G., Pham, T., Fan, E., Brochard, L., Esteban, A., Gattinoni, L., van Haren, F., Larsson, A., McAuley, D. F., Ranieri, M., Rubenfeld, G., Thompson, B. T., Wrigge, H., Slutsky, A. S., Pesenti, A., LUNG SAFE Investigators, & ESICM Trials Group (2016). Epidemiology, Patterns of Care, and Mortality for Patients With Acute Respiratory Distress Syndrome in Intensive Care Units in 50 Countries. JAMA, 315(8), 788–800. https://doi.org/10.1001/jama.2016.0291
Bureau, C., Van Hollebeke, M., & Dres, M. (2023). Managing respiratory muscle weakness during weaning from invasive ventilation. European respiratory review : an official journal of the European Respiratory Society, 32(168), 220205. https://doi.org/10.1183/16000617.0205-2022
Christensen, M., & Liang, M. (2023). Critical care: A concept analysis. International journal of nursing sciences, 10(3), 403–413. https://doi.org/10.1016/j.ijnss.2023.06.020
Cummings, S. R., Newman, T. B. & Hulley, S. B. (2008). Delineando estudos de coorte. In: Hulley, S. B., Cummings, S. R., Browner, W. S., Grady, D. G., & Newman, T. B. Delineando a pesquisa clínica: uma abordagem epidemiológica (3rd ed., pp. 115–125). Artmed.
Damasceno, M. P., David, C. M., Souza, P. C., Chiavone, P. A., Cardoso, L. T., Amaral, J. L., Tasanato, E., Silva, N. B., Luiz, R. R., & Grupo de Ventilação Mecânica do Fundo AMIB (2006). Ventilação mecânica no Brasil: aspectos epidemiológicos [Mechanical ventilation in Brazil: epidemiological aspects]. Revista Brasileira de terapia intensiva, 18(3), 219–228.
Futier, E., Godet, T., Millot, A., Constantin, J. M., & Jaber, S. (2014). Mechanical ventilation in abdominal surgery. Annales francaises d'anesthesie et de reanimation, 33(7-8), 472–475. https://doi.org/10.1016/j.annfar.2014.07.007
Groenland, C. N. L., Termorshuizen, F., Rietdijk, W. J. R., van den Brule, J., Dongelmans, D. A., de Jonge, E., de Lange, D. W., de Smet, A. M. G. A., de Keizer, N. F., Weigel, J. D., Jewbali, L. S. D., Boersma, E., & den Uil, C. A. (2019). Emergency Department to ICU Time Is Associated With Hospital Mortality: A Registry Analysis of 14,788 Patients From Six University Hospitals in The Netherlands. Critical care medicine, 47(11), 1564–1571. https://doi.org/10.1097/CCM.0000000000003957
Jaber, S., & De Jong, A. (2023). Weaning from mechanical ventilation in intensive care units: a call for new international consensus guidelines. The Lancet. Respiratory medicine, 11(5), 398–400. https://doi.org/10.1016/S2213-2600(22)00502-1
Jackson, M., & Cairns, T. (2021). Care of the critically ill patient. Surgery (Oxford, Oxfordshire), 39(1), 29–36. https://doi.org/10.1016/j.mpsur.2020.11.002
Laor, A., Tal, S., Guller, V., Zbar, A. P., & Mavor, E. (2016). The Charlson Comorbidity Index (CCI) as a Mortality Predictor after Surgery in Elderly Patients. The American surgeon, 82(1), 22–27.
Lin, S., Ge, S., He, W., & Zeng, M. (2021). Association of delayed time in the emergency department with the clinical outcomes for critically ill patients. QJM: monthly journal of the Association of Physicians, 114(5), 311–317. https://doi.org/10.1093/qjmed/hcaa192
Navalesi, P., Bruni, A., Garofalo, E., Biamonte, E., Longhini, F., & Frigerio, P. (2019). Weaning off mechanical ventilation: much less an art, but not yet a science. Annals of translational medicine, 7(Suppl 8), S353. https://doi.org/10.21037/atm.2019.09.83
Pham, T., Heunks, L., Bellani, G., Madotto, F., Aragao, I., Beduneau, G., Goligher, E. C., Grasselli, G., Laake, J. H., Mancebo, J., Peñuelas, O., Piquilloud, L., Pesenti, A., Wunsch, H., van Haren, F., Brochard, L., Laffey, J. G., & WEAN SAFE Investigators (2023). Weaning from mechanical ventilation in intensive care units across 50 countries (WEAN SAFE): a multicentre, prospective, observational cohort study. The Lancet. Respiratory medicine, 11(5), 465–476. https://doi.org/10.1016/S2213-2600(22)00449-0
Polo Friz, M., Rezoagli, E., Safaee Fakhr, B., Florio, G., Carlesso, E., Giudici, R., Forlini, C., Tardini, F., Langer, T., Laratta, M., Casella, G., Forastieri Molinari, A., Protti, A., Cecconi, M., Cabrini, L., Biagioni, E., Berselli, A., Mirabella, L., Tonetti, T., De Robertis, E., … Bellani, G. (2024). Successful Versus Failed Transition From Controlled Ventilation to Pressure Support Ventilation in COVID-19 Patients: A Retrospective Cohort Study. Critical care explorations, 6(2), e1039. https://doi.org/10.1097/CCE.0000000000001039
Rengel, K. F.; Hayhurst, C. J.; Pandharipande, P. P. & Hughes, C. G. (2019). Long-term Cognitive and Functional Impairments After Critical Illness. Anesthesia & Analgesia, 128(4), 772-780, April 2019. | DOI: 10.1213/ANE.0000000000004066.
Rose, L., & Messer, B. (2024). Prolonged Mechanical Ventilation, Weaning, and the Role of Tracheostomy. Critical care clinics, 40(2), 409–427. https://doi.org/10.1016/j.ccc.2024.01.008
Trudzinski, F. C., Neetz, B., Bornitz, F., Müller, M., Weis, A., Kronsteiner, D., Herth, F. J. F., Sturm, N., Gassmann, V., Frerk, T., Neurohr, C., Ghiani, A., Joves, B., Schneider, A., Szecsenyi, J., von Schumann, S., & Meis, J. (2022). Risk Factors for Prolonged Mechanical Ventilation and Weaning Failure: A Systematic Review. Respiration; international review of thoracic diseases, 101(10), 959–969. https://doi.org/10.1159/000525604
Yehya, N., Harhay, M. O., Curley, M. A. Q., Schoenfeld, D. A., & Reeder, R. W. (2019). Reappraisal of Ventilator-Free Days in Critical Care Research. American journal of respiratory and critical care medicine, 200(7), 828–836. https://doi.org/10.1164/rccm.201810-2050CP
Downloads
Published
How to Cite
Issue
Section
License
Copyright (c) 2024 Cristiane da Fonseca Simões; Raquel Siqueira Nóbrega; Leda Tomiko Yamada da Silveira; Ronaldo Batista dos Santos
![Creative Commons License](http://i.creativecommons.org/l/by/4.0/88x31.png)
This work is licensed under a Creative Commons Attribution 4.0 International License.
Authors who publish with this journal agree to the following terms:
1) Authors retain copyright and grant the journal right of first publication with the work simultaneously licensed under a Creative Commons Attribution License that allows others to share the work with an acknowledgement of the work's authorship and initial publication in this journal.
2) Authors are able to enter into separate, additional contractual arrangements for the non-exclusive distribution of the journal's published version of the work (e.g., post it to an institutional repository or publish it in a book), with an acknowledgement of its initial publication in this journal.
3) Authors are permitted and encouraged to post their work online (e.g., in institutional repositories or on their website) prior to and during the submission process, as it can lead to productive exchanges, as well as earlier and greater citation of published work.