Factores predictivos de fracaso en el destete de la ventilación mecánica no invasiva en urgencias / Predictors of noninvasive mechanical ventilation weaning failure in the emergency department

RESUMEN

OBJETIVOS: Analizar los factores predictivos del fracaso del destete en los pacientes sometidos a ventilación mecánica no invasiva (VMNI) en un servicio de urgencias hospitalario (SUH). MÉTODO: Estudio observacional de cohortes prospectivo con muestreo consecutivo de los pacientes que precisaron VMNI durante la atención en el SUH. Se estableció como variable dependiente el fracaso del destete de la VMNI, definido comola necesidad de reiniciar o instaurar la VMNI durante el mismo ingreso hospitalario tras el primer intento de destete. RESULTADOS: Del total de 675 pacientes elegibles, se incluyeron 360 pacientes (53,4%). Se excluyeron 100 (31,7%),58 (18,4%) y 157 (49,9%) por VMNI domiciliaria, fracaso previo al intento de destete y por realización del intento de destete fuera del SUH, respectivamente. Sesenta y dos casos (17,3%) presentaron con fracaso del destete de la VMNI. Los factores independientes asociados al fracaso del destete fueron la concentración de bicarbonato antes del destete (ORa: 1,06; IC 95%: 1,01-1,12; p = 0,014), la duración VMNI en horas (ORa: 1,10; IC 95%: 1,04-1,16; p < 0,001) yun pH < 7,35 antes del destete (ORa: 2,48; IC: 1,16-5,31; p = 0,019). CONCLUSIÓN: El fracaso del destete de la VMNI en el SUH ocurrió en un 17% de los casos. La duración de la técnica, elvalor del HCO3- y el pH < 7,35 antes del destete fueron factores independientes asociados al fracaso

ABSTRACT

OBJETIVES: To analyze factors related to the failure of noninvasive mechanical ventilation (NIV) weaning in a hospital emergency department (ED). METHODS: Prospective, observational cohort study with enrolled a sample of consecutive patients who required NIV during ED care. The dependent variable was NIV weaning failure, defined by the need to restart NIV in the ED after a first attempt to withdraw the respirator. RESULTS: Of a total of 675 candidates, we included 360 patients (53.4%). Exclusions were 100 patients (31.7%) who were on NIV at home; 58 (18.4%) in whom NIV initially failed; and 157 (49.9%) in whom weaning was attempted outside the ED. Seventy-two (17.3%) cases of weaning failure in the ED were observed. Factors independently associated with failure were the bicarbonate (HCO3) concentrations before attempted weaning (adjusted odds ratio [aOR], 1.06; 95% CI, 1.01-1.12;P = .014), time on NIV in hours (aOR, 1.10; 95% CI, 1.04-1.16;P < .001), and a pH less than 7.35 before weaning (aOR, 2.48; 95% CI, 1.16-5.31;P = .019). CONCLUSIONS: Weaning failure occurs in 17% of ED patients on NIV. Time on NIV, HCO3 concentration, and a pH less than 7.35 before weaning are independently associated with failure to wean from the respirator