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Advisor(s)
Abstract(s)
Introdução: A ventilação não invasiva (VNI) é uma forma de
suporte ventilatório não invasivo, com benefícios comprovados
em diversas patologias. O objetivo foi avaliar as indicações
da VNI em doentes com insuficiência respiratória e
identificar fatores preditivos da resposta à VNI.
Material e Métodos: Análise retrospetiva dos processos clínicos
de doentes submetidos a VNI, internados no Serviço de
Medicina, entre Janeiro e Dezembro de 2014.
Resultados: Incluídos 54 doentes, com idade média de 82,2
anos (± 8,4). Quarenta e quatro doentes apresentavam patologias
que são consideradas indicações, com níveis de evidência
estabelecida, para utilização de VNI: 33 (75,0%) tinham
insuficiência cardíaca descompensada, cinco (11,4%)
exacerbação aguda da doença pulmonar obstrutiva crónica,
quatro (9,1%) síndrome de obesidade-hipoventilação e dois
(4,5%) pneumonia no imunocomprometido. A taxa de falência
foi 20,5%. Nos restantes doentes, a VNI foi utilizada na
pneumonia no imunocompetente, choque séptico e intoxicação
por benzodiazepinas. A taxa de falência foi 70,0%.
Verificou-se uma melhoria estatisticamente significativa nos
parâmetros gasométricos duas horas após a VNI nos doentes
com patologia com níveis de evidência estabelecida
para VNI e nos doentes em que não houve falência desta
modalidade ventilatória.
Conclusão: Na nossa amostra a taxa falência da VNI foi bastante
inferior nos doentes que cumpriam as indicações formais
para a VNI. Assim, apesar da crescente utilização da
VNI, a seleção criteriosa dos doentes constitui uma etapa
essencial para o seu sucesso. O melhor preditor do sucesso
da VNI foi a boa resposta após 1 a 2 horas de terapêutica.
Introduction: Non-invasive ventilation (NIV) is a non-intrusive form of ventilatory support, with proven benefits in several clinical conditions. The objective was to assess NIV indications in patients with respiratory insufficiency and to identify predictors of NIV response. Material and Methods: Retrospective analysis of the clinical processes of patients undergoing NIV, admitted to Internal Medicine, between January and December 2014. Results: Study included 54 patients, with a mean age of 82.2 years (± 8.4). Forty-four patients had pathologies that are considered indications, with established evidence of the need of NIV: 33 (75.0%) had heart failure, five (11.4%) acute exacerbation of chronic obstructive pulmonary disease, four (9.1%) obesity hypoventilation syndrome and two (4.5%) severe immunocompromised pneumonia. The failure rate was 20.5%. In the remaining 10 patients, NIV was used in severe immunocompetent pneumonia, septic shock and benzodiazepine intoxication, with a failure rate of 70.0%. There was a statistically significant improvement in gasometer parameters two hours after NIV in patients demonstrating clear evidence for the need of NIV and in patients in whom there was no failure of this ventilatory modality. Conclusion: In our sample the failure rate of NIV was significantly lower in patients who complied with the formal indications for the initiation of this type of ventilation. Thus, despite the increasing use of NIV, careful patient selection is an essential step in its success. The best predictor of NIV success was good response after 1 to 2 hours of therapy.
Introduction: Non-invasive ventilation (NIV) is a non-intrusive form of ventilatory support, with proven benefits in several clinical conditions. The objective was to assess NIV indications in patients with respiratory insufficiency and to identify predictors of NIV response. Material and Methods: Retrospective analysis of the clinical processes of patients undergoing NIV, admitted to Internal Medicine, between January and December 2014. Results: Study included 54 patients, with a mean age of 82.2 years (± 8.4). Forty-four patients had pathologies that are considered indications, with established evidence of the need of NIV: 33 (75.0%) had heart failure, five (11.4%) acute exacerbation of chronic obstructive pulmonary disease, four (9.1%) obesity hypoventilation syndrome and two (4.5%) severe immunocompromised pneumonia. The failure rate was 20.5%. In the remaining 10 patients, NIV was used in severe immunocompetent pneumonia, septic shock and benzodiazepine intoxication, with a failure rate of 70.0%. There was a statistically significant improvement in gasometer parameters two hours after NIV in patients demonstrating clear evidence for the need of NIV and in patients in whom there was no failure of this ventilatory modality. Conclusion: In our sample the failure rate of NIV was significantly lower in patients who complied with the formal indications for the initiation of this type of ventilation. Thus, despite the increasing use of NIV, careful patient selection is an essential step in its success. The best predictor of NIV success was good response after 1 to 2 hours of therapy.
Description
Keywords
Insuficiência Respiratória Ventilação Não Invasiva