Intensive Care Unit, Hospital Sírio-Libanês, São Paulo, SP, Brazil.
Clinics (Sao Paulo). 2011;66(5):759-66. doi: 10.1590/s1807-59322011000500009.
Prolonged invasive mechanical ventilation and reintubation are associated with adverse outcomes and increased mortality. Daily screening to identify patients able to breathe without support is recommended to reduce the length of mechanical ventilation. Noninvasive positive-pressure ventilation has been proposed as a technique to shorten the time that patients remain on invasive ventilation.
We conducted a before-and-after study to evaluate the efficacy of an intervention that combined daily screening with the use of noninvasive ventilation immediately after extubation in selected patients. The population consisted of patients who had been intubated for at least 2 days.
The baseline characteristics were similar between the groups. The intervention group had a lower length of invasive ventilation (6 [4;9] vs. 7 [4;11.5] days, p = 0.04) and total (invasive plus noninvasive) ventilator support (7 [4;11] vs. 9 [6;8], p = 0.01). Similar reintubation rates within 72 hours were observed for both groups. In addition, a lower ICU mortality was found in the intervention group (10.8% vs. 24.3%, p = 0.03), with a higher cumulative survival probability at 60 days (p = 0.05). Multivariate analysis showed that the intervention was an independent factor associated with survival (RR: 2.77; CI 1.14-6.65; p = 0.03), whereas the opposite was found for reintubation at 72 hours (RR: 0.27; CI 0.11-0.65; p = 0.01).
The intervention reduced the length of invasive ventilation and total ventilatory support without increasing the risk of reintubation and was identified as an independent factor associated with survival.
延长有创机械通气和再次插管与不良结局和死亡率增加有关。推荐每天进行筛查，以识别能够无需支持自主呼吸的患者，从而减少机械通气时间。无创正压通气已被提议作为缩短患者接受有创通气时间的技术。
我们进行了一项前后对照研究，以评估联合使用每日筛查和有创通气拔管后立即使用无创通气对选定患者的效果。研究人群为至少接受 2 天插管的患者。
两组的基线特征相似。干预组的有创通气时间（6[4；9] vs. 7[4；11.5]天，p=0.04）和总通气支持（有创加无创）时间（7[4；11] vs. 9[6；8]，p=0.01）更短。两组在 72 小时内的再插管率相似。此外，干预组 ICU 死亡率较低（10.8% vs. 24.3%，p=0.03），60 天累积生存率更高（p=0.05）。多变量分析显示，干预是与生存相关的独立因素（RR：2.77；95%CI：1.14-6.65；p=0.03），而 72 小时内再插管则相反（RR：0.27；95%CI：0.11-0.65；p=0.01）。
该干预措施缩短了有创通气和总通气支持的时间，而不增加再插管的风险，并被确定为与生存相关的独立因素。
