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Revista Médica del Uruguay

versión On-line ISSN 1688-0390

Resumen

FRANCA, Ana Graciela; EBEID, Alejandro; FORMENTO, Carlos  y  LOZA, Daniel. Destete en una UCI polivalente. Incidencia y factores de riesgo de fracaso. Valoración de índices predictivos. Rev. Méd. Urug. [online]. 2013, vol.29, n.2, pp.85-96. ISSN 1688-0390.

Summary Introduction: weaning from mechanical ventilation (MV) is a controversial issue. Weaning failure results in morbimortality. Objectives: to determine the incidence of weaning, the risk factors for failure: need for reintubation within 48 hours of extubation, and to assess predictive factors. Method: prospective study. Open cohort, adults who were weaned from mechanical during 24 hours or more, from May 2010 through June 2011. Tracheostomized patients were excluded. Patients were assessed daily in terms of clinical-gasometric parameters to test spontaneous ventilation, initial measurements: maximum inspiratory pressure (Mip), occlusion pressure in the first 100 milliseconds after inspiration onset (P0.1), quotient P0.1/maximum inspiratory pressure (Mip). Prior to extubation: measurement of the Yang Tobin index (respiratory frequency/tidal volume in liters). Results: 78 patient s, 58.7 years old ± 21.4 (average age ± 1 standard deviation), 59% men; 61.5%, T-tube simple weaning. Weaning failure: 12.8%. Ejection fraction of the left ventricle (LVEF) <45% determined a relative risk of difficult or long weaning = 3.08, confidence interval (CI) 95%, 1.72-5.51 (p = 0,0001) and it was the only independent risk factor for failure (logistic regression), Odds Ratio = 6.01, CI 95%, 1.40-25.72, (p=0.01). The differences between the success and failure groups were statistically significant in terms of: water balance in the last 24 hours, p = 0.002; Mip, p = 0.006; P 0.1, p = 0.04; P0.1/Mip, p = 0.0001; Yang-Tobin index, p = 0.03. Mortality was 30% in the case of failure and 4.4% when weaning was successful, p = 0.03. Areas under the ROC ("receiver operating characteristic") curve that were statistically significant for Mip: 0.77, IC 95%, 0.62-0.92; P0.1: 0.70, IC 95%, 0.51-0.90; P0.1/Pimax: 0.85, IC 95%, 0.73-0. 97. Conclusions: incidence of simple weaning is lower than reported. Failure implies a higher mortality. LVEF

Palabras clave : VENTILADOR WEANING; RISK FACTORS; INCIDENCE.

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