Ventilação mecânica no Brasil: aspectos epidemiológicos / Mechanical ventilation in Brazil: epidemiological aspects

JUSTIFICATIVA E OBJETIVOS: Existem poucos estudos epidemiológicos em ventilação mecânica. O objetivo deste estudo foi demonstrar como a ventilação mecânica vem sendo realizada nas UTI brasileiras. MÉTODO: O estudo foi realizado com prevalência de um dia em 40 UTI, com 390 pacientes internados, sendo 217 em ventilação mecânica. Os resultados medidos foram a caracterização dos pacientes ventilados, sua distribuição pelo Brasil, as causas da ventilação mecânica, os principais modos ventilatórios usados, os parâmetros ventilatórios mais importantes e a fase de desmame da ventilação mecânica. RESULTADOS: As medianas da idade dos pacientes ventilados, do escore APACHE II, e do tempo de ventilação mecânica foram, respectivamente, de 66 anos, 20 pontos e 11 dias. A ventilação mecânica foi determinada pela insuficiência respiratória aguda (IRA) em 71 por cento dos pacientes, o coma em 21,2 por cento, a doença pulmonar obstrutiva crônica em 5,5 por cento e a doença neuromuscular em 2,3 por cento. A ventilação controlada a volume (VCV) (30 por cento), a ventilação com pressão de suporte (PSV) (29,5 por cento) e a ventilação controlada à pressão (PCV) (18 por cento) foram as mais utilizadas, sendo que no desmame predominou a PSV (63,5 por cento). A mediana do volume corrente foi maior nos pacientes em VCV (8 mL/kg). As medianas de pressão inspiratória máxima (30 cmH2O) e de pressão positiva no fim da expiração (PEEP) (8 cmH2O) foram maiores nos pacientes em PCV. CONCLUSÕES: O predomínio de pacientes ventilados nas UTI foi indicado pela sua maior gravidade clínica e pelo maior tempo de internação. A IRA foi a principal indicação de ventilação mecânica. VCV e PSV ventilaram mais pacientes, sendo a PSV na fase de desmame ventilatório.

BACKGROUND AND OBJECTIVES: There are few epidemiological studies in mechanical ventilation, and the aim of the study is to show how this procedure is being used in Brazil. METHODS: A 1-day point prevalence study was performed in 40 ICUs, with 390 patients; 217 of these patients were in mechanical ventilation. The results evaluated were the characteristics of ventilated patients, their distribution in Brazil, the mechanical ventilation's causes, the main ventilatory modes, the more important ventilators settings, and the weaning stage of mechanical ventilation. RESULTS: The median age of the ventilated patients was 66 years old. The median APACHE II was 20, while the median time of mechanical ventilation was 11 days. Acute respiratory failure occurred in 71 percent of the patients, coma in 21.2 percent, acute exacerbation of chronic respiratory failure in 5.5 percent, and the neuromuscular disease in 2.3 percent. The volume-controlled ventilation (VCV) (30 percent), the pressure support ventilation (PSV) (29.5 percent), and the pressure-controlled ventilation (PCV) (18 percent) were the ventilatory modes most used; the PSV had been the main mode in weaning (63.5 percent). The median of tidal volume (8 mL/kg) was higher in VCV. The median of maximal inspiratory pression (30 cmH2O) and the median of positive end-expiration pressure (PEEP) (8 cmH2O) were higher in PCV. CONCLUSIONS: The predominance of ventilated patients in ICUs was marked by clinical severity of them, and a longer hospital stay time; acute respiratory failure was the principal mechanical ventilation cause; VCV and PSV ventilated more patients, with PSV being more used in weaning patients.

[Mechanical ventilation in Brazil: epidemiological aspects]. / Ventilação mecânica no Brasil: aspectos epidemiológicos.

BACKGROUND AND OBJECTIVES: There are few epidemiological studies in mechanical ventilation, and the aim of the study is to show how this procedure is being used in Brazil. METHODS: A 1-day point prevalence study was performed in 40 ICUs, with 390 patients; 217 of these patients were in mechanical ventilation. The results evaluated were the characteristics of ventilated patients, their distribution in Brazil, the mechanical ventilation's causes, the main ventilatory modes, the more important ventilators settings, and the weaning stage of mechanical ventilation. RESULTS: The median age of the ventilated patients was 66 years old. The median APACHE II was 20, while the median time of mechanical ventilation was 11 days. Acute respiratory failure occurred in 71% of the patients, coma in 21.2%, acute exacerbation of chronic respiratory failure in 5.5%, and the neuromuscular disease in 2.3%. The volume-controlled ventilation (VCV) (30%), the pressure support ventilation (PSV) (29.5%), and the pressure-controlled ventilation (PCV) (18%) were the ventilatory modes most used; the PSV had been the main mode in weaning (63.5%). The median of tidal volume (8 mL/kg) was higher in VCV. The median of maximal inspiratory pression (30 cmH2O) and the median of positive end-expiration pressure (PEEP) (8 cmH2O) were higher in PCV. CONCLUSIONS: The predominance of ventilated patients in ICUs was marked by clinical severity of them, and a longer hospital stay time; acute respiratory failure was the principal mechanical ventilation cause; VCV and PSV ventilated more patients, with PSV being more used in weaning patients.