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Introdução: A Ventilação Mecânica Não Invasiva é um avanço importante no tratamento da Insuficiência Respiratória Aguda. O não reconhecimento atempado das indicações e a tardia aplicação da técnica, assim como a não ponderação dos seus limites, pode contribuir para deteriorar os resultados clínicos. Por vezes, a indicação para Ventilação Mecânica Não Invasiva é colocada como medida paliativa em doentes com contraindicação para ventilação invasiva. A Unidade de Cuidados Agudos Diferenciados do Centro Hospitalar Cova da Beira foi criada como unidade de internamento com capacidade de prestar cuidados correspondentes ao nível 2 de cuidados intensivos, estando dotada com seis camas, cada uma com monitorização contínua de sinais vitais e com ventilador mecânico de cuidados intensivos com programação de ventilação não invasiva (VersaMed iVent201 GE Healthcare), tornando-se o local preferencial de início de Ventilação Mecânica Não Invasiva na instituição.
Objetivo: Determinar as variáveis relacionadas com o resultado da Ventilação Mecânica Não Invasiva nos doentes com Insuficiência Respiratória.
Metodologia: Estudo retrospetivo de todos os doentes submetidos a tratamento com Ventilação Mecânica Não Invasiva durante o primeiro ano de funcionamento da Unidade de Cuidados Agudos Diferenciados (setembro de 2013 a agosto de 2014). Definiu-se falência como: necessidade de entubação traqueal e ventilação invasiva ou óbito durante o internamento ou nos 7 dias seguintes. Estudaram-se dados demográficos, comorbilidades, parâmetros clínicos e laboratoriais.
Resultados: Dos setenta e cinco doentes que realizaram Ventilação Mecânica Não Invasiva na Unidade de Cuidados Agudos Diferenciados do Centro Hospitalar Cova da Beira, 53,3% pertencem ao sexo masculino e outros 46,7% ao sexo feminino. Destes a grande maioria pertence a grupos etários mais altos, sendo que a média de idades é de 76,67 ± 11,748 anos. A média do Índice de Massa Corporal foi de 28,86 ± 6,14 Kg/m2. A média do Score de Charlson foi de 6,69 ± 2,5. O tempo médio de internamento na Unidade de Cuidados Agudos Diferenciados foi de 3,92 ± 2,61 dias. Quanto à proveniência, 73% dos doentes vinham do Serviço de Urgência, 13% do Serviço de Medicina Interna, 11% da Unidade de Cuidados Intensivos e 3% de outros serviços. Analisando os motivos de aplicação da Ventilação Mecânica Não Invasiva, 41,3% deviam-se a Insuficiência Respiratória Aguda Hipoxémica, 25,3% a Exacerbações Agudas da Doença Pulmonar Obstrutiva Crónica, 12% a Insuficiência Cardíaca Congestiva, 10,7% a Continuidade de tratamento, 6,7% a Doenças Restritivas do Tórax e 4% a Paliação. Quanto à relação com o resultado da Ventilação Mecânica Não Invasiva, de todos os fatores analisados apenas dois mostraram ter influência no prognóstico da aplicação desta terapêutica: a ocorrência de episódios de hipertensão durante a ventilação e a proveniência dos doentes.
Conclusão: Apenas dois fatores demostraram estar associados ao resultado da ventilação. A ocorrência de episódios de hipertensão durante a ventilação relaciona-se com uma maior taxa de insucesso, podendo por isso ser considerado um fator de mau prognóstico. Concomitantemente, a proveniência encontra-se relacionada com o resultado da ventilação, tal que, doentes provenientes da Unidade de Cuidados Intensivos e do Serviço de Urgência estão associados a uma resposta favorável à ventilação mecânica não invasiva. Contrariamente, os doentes com origem no Serviço de Medicina Interna e em outros serviços apresentavam uma maior taxa de insucesso.
Introduction: Noninvasive Mechanical Ventilation is an important advance in the treatment of acute respiratory failure. Failure to timely recognition of indications and the late implementation of technical as well as non-consideration of their limits, can contribute to deteriorating clinical outcomes. Sometimes the indication for Noninvasive Mechanical Ventilation is placed as a palliative measure in patients with contraindications for Invasive Ventilation. The Differentiated Acute Care Unit of Hospital Center of Cova da Beira was created as an internment unit with the capacity of providing medical care corresponding to level 2 of intensive care and is equipped with six beds, each with continuous monitoring of vital signs and mechanical ventilator for intensive care with noninvasive ventilation programming (VersaMed iVent201 GE Healthcare), making it the preferred site for early noninvasive ventilation at the institution. Aim: Determine the variables related to the outcome of Noninvasive Ventilation in these patients with respiratory failure Methods: Retrospective study of all patients treated with noninvasive mechanical ventilation during the first year of operation of the Differentiated Acute Care Unit (September 2013 to August 2014). It was defined as failure: the need for endotracheal intubation and invasive ventilation or death during hospitalization or the next 7 days. It was studied demographic data, comorbidities, clinical and laboratory parameters. Results: Of seventy-five patients who underwent noninvasive mechanical ventilation in Differentiated Acute Care Unit of Hospital Center of Cova da Beira, 53.3% were males and 46.7% were females. Of these, the vast majority belong to higher age groups, with the average age being 76.67 ± 11.748 years. The average body mass index was 28.86 ± 6.14 kg/m2. The mean Charlson score was 6.69 ± 2.5. The average stay in the Differentiated Acute Care Unit was 3.92 ± 2.61 days. As to the origin, 73% of patients came from the emergency department, 13% from the Internal Medicine Service, 11% from the Intensive Care Unit and 3% from other services. Analyzing the reasons for application of noninvasive mechanical ventilation, 41.3% were due to hypoxic acute respiratory failure, 25.3% to acute exacerbations of chronic obstructive pulmonary disease, 12% to congestive heart failure, 10.7% to chronic treatment, 6.7% to restrictive thoracic disease and 4% to palliation. As for the relationship with the result of Noninvasive Mechanical Ventilation, of all factors analyzed only two have been shown to influence the outcome of this therapy: the occurrence of episodes of hypertension during ventilation and the provenance of patients. Conclusion: Only two factors have shown to be associated with the result of ventilation. The occurrence of episodes of hypertension during ventilation correlates with a higher failure rate and can therefore be considered a poor prognostic factor. Concomitantly, the origin is related to the result of ventilation, such that patients from the Intensive Care Unit and Emergency Department are associated with a favorable response to Noninvasive Mechanical Ventilation. In contrast, patients originating from the Internal Medicine Service and other services had a higher failure rate.
Introduction: Noninvasive Mechanical Ventilation is an important advance in the treatment of acute respiratory failure. Failure to timely recognition of indications and the late implementation of technical as well as non-consideration of their limits, can contribute to deteriorating clinical outcomes. Sometimes the indication for Noninvasive Mechanical Ventilation is placed as a palliative measure in patients with contraindications for Invasive Ventilation. The Differentiated Acute Care Unit of Hospital Center of Cova da Beira was created as an internment unit with the capacity of providing medical care corresponding to level 2 of intensive care and is equipped with six beds, each with continuous monitoring of vital signs and mechanical ventilator for intensive care with noninvasive ventilation programming (VersaMed iVent201 GE Healthcare), making it the preferred site for early noninvasive ventilation at the institution. Aim: Determine the variables related to the outcome of Noninvasive Ventilation in these patients with respiratory failure Methods: Retrospective study of all patients treated with noninvasive mechanical ventilation during the first year of operation of the Differentiated Acute Care Unit (September 2013 to August 2014). It was defined as failure: the need for endotracheal intubation and invasive ventilation or death during hospitalization or the next 7 days. It was studied demographic data, comorbidities, clinical and laboratory parameters. Results: Of seventy-five patients who underwent noninvasive mechanical ventilation in Differentiated Acute Care Unit of Hospital Center of Cova da Beira, 53.3% were males and 46.7% were females. Of these, the vast majority belong to higher age groups, with the average age being 76.67 ± 11.748 years. The average body mass index was 28.86 ± 6.14 kg/m2. The mean Charlson score was 6.69 ± 2.5. The average stay in the Differentiated Acute Care Unit was 3.92 ± 2.61 days. As to the origin, 73% of patients came from the emergency department, 13% from the Internal Medicine Service, 11% from the Intensive Care Unit and 3% from other services. Analyzing the reasons for application of noninvasive mechanical ventilation, 41.3% were due to hypoxic acute respiratory failure, 25.3% to acute exacerbations of chronic obstructive pulmonary disease, 12% to congestive heart failure, 10.7% to chronic treatment, 6.7% to restrictive thoracic disease and 4% to palliation. As for the relationship with the result of Noninvasive Mechanical Ventilation, of all factors analyzed only two have been shown to influence the outcome of this therapy: the occurrence of episodes of hypertension during ventilation and the provenance of patients. Conclusion: Only two factors have shown to be associated with the result of ventilation. The occurrence of episodes of hypertension during ventilation correlates with a higher failure rate and can therefore be considered a poor prognostic factor. Concomitantly, the origin is related to the result of ventilation, such that patients from the Intensive Care Unit and Emergency Department are associated with a favorable response to Noninvasive Mechanical Ventilation. In contrast, patients originating from the Internal Medicine Service and other services had a higher failure rate.
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Keywords
Cuidados Intensivos Insuficiência Respiratória Ventilação Não Invasiva