Respiratory muscle strength and state of consciousness values measured prior to the decannulation in different levels of complexity. A longitudinal prospective case series study.

Autor: Diaz-Ballve LP; Gabiente de Producción de Información Hospitalaria (GAPIH), Coordinación de Docencia e Investigación, Hospital Nacional Prof. Alejandro Posadas, El Palomar, Buenos Aires, Argentina. Electronic address: pablodiazballve@yahoo.com.ar., Villalba DS; Coordinación de Docencia e Investigación, Clínica Basilea, Ciudad Autónoma de Buenos Aires, Argentina., Andreu MF; Servicio de Kinesiología, Hospital Donación Francisco Santojanni, Ciudad Autónoma de Buenos Aires, Argentina., Escobar MA; Servicio de Kinesiología Respiratoria, Centro del Parque, Ciudad Autónoma de Buenos Aires, Argentina., Morel-Vulliez G; Servicio de Kinesiología Respiratoria, Centro del Parque, Ciudad Autónoma de Buenos Aires, Argentina., Lebus JM; Servicio de Kinesiología Respiratoria, Centro del Parque, Ciudad Autónoma de Buenos Aires, Argentina; Servicio de Kinesiología, Clínica de La Sagrada Familia, Ciudad Autónoma de Buenos Aires, Argentina., Rositi ES; Servicio de Kinesiología Respiratoria, Centro del Parque, Ciudad Autónoma de Buenos Aires, Argentina; Unidad de Kinesiología, H.I.G.A: Petrona V. de Cordero, San Fernando, Buenos Aires, Argentina.
Jazyk: English; Spanish; Castilian
Zdroj: Medicina intensiva [Med Intensiva (Engl Ed)] 2019 Jun - Jul; Vol. 43 (5), pp. 270-280. Date of Electronic Publication: 2018 Apr 24.
DOI: 10.1016/j.medin.2018.02.017
Abstrakt: Objective: To describe the variables related to effective cough capacity and the state of consciousness measured prior to decannulation and compare their measured values between the different areas of care such as the Intensive Care Unit (ICU), General ward and Mechanical Ventilation Weaning and Rehabilitation Centers (MVWRC). Secondarily analyze the evolution of patients once decannulated.
Design: Case series, longitudinal and prospective.
Scope: Multicentric 31 ICUs (polyvalent) and 5 MVWRC.
Patients: Tracheostomized adults prior to decannulation.
Measurements: Maximum expiratory pressure, peak expiratory flow coughed (PEFC), Glasgow Coma Scale (GCS).
Results: Two hundred and seven decannulated patients, 124 (60%) in ICU, 59 (28%) General ward and 24 (12%) in MVWRC. The PEFC presented differences between the patients (ICU 110 - 190 l/min versus MVWRC 167.5 - 232.5 l/min, p <.01). The GCS was different between General ward (9 -15) versus ICU (10-15) and MVWRC (12-15); p <.01 and p <.01, respectively. There were differences in the days of hospitalization (p <.01), days with tracheostomy (<0.01) and the number of patients referred at home (p =.02) between the different scenarios.
Conclusion: There are differences in the values of PEFC and GCS observed when decannulating between different areas. A considerable number of patients are decannulated with values of PEFC and maximum expiratory pressure below the suggested cut-off points as predictors of failure in the literature. No patient in our series was decanulated with an GCS <8, this reflects the importance that the treating team gives to the state of consciousness prior to decannulation.
(Copyright © 2018 Elsevier España, S.L.U. y SEMICYUC. All rights reserved.)
Databáze: MEDLINE
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