ABSTRACT
Introducción: El destete o liberación de la ventilación mecánica (VM) es un proceso complejo y cuando es fallido aumentará los riesgos de complicaciones y gastos. Objetivo: Identificar factores de riesgo modificables para destete fallido en adultos con VM. Materiales y Métodos: Estudio de casos y controles realizado en pacientes ≥ 18 años ingresados en la unidad de cuidados intensivos de un hospital de tercer nivel. Los casos se identificaron como destete fallido (DF) del VM y los controles como destete simple. Se excluyeron los pacientes procedentes de otro hospital con VM. Los factores estudiados fueron el alto riesgo nutricional por el Nutric score modificado, la nutrición enteral tardía, el balance hídrico (BH) positivo y la ausencia de fisioterapia previos al destete. Se calculo el OR con una significancia < 0,05 para el análisis bivariado, multivariado y ajustado. Resultados: Se incluyeron 105 pacientes, 35 casos y 70 controles. El análisis bivariado encontró que el alto riesgo nutricional (OR = 2.5; IC 95% = 1,1 5,9; p=0,027) fue factor de riesgo, pero el análisis multivariado no lo confirmó. La nutrición enteral tardía (OR = 1,2; IC 95% = 0,4 3,4), el BH positivo (OR = 0,7; IC 95% = 0,3 1,7) y la ausencia de fisioterapia respiratoria (OR = 0,2; IC 95% = 0,004 0,011) no fueron factores de riesgo para DF. Conclusiones: El alto riesgo nutricional, la nutrición enteral tardía, el BH positivo y la ausencia de fisioterapia respiratoria antes del destete no fueron factores de riesgo para DF.
Background: Weaning of the mechanical ventilation (MV) is a complex process and when it fails, it can increase the risks of complications and expenses in health systems. Objective: To identify risk factors for failed weaning in adults with MV. Materials and Methods: Case-control study carried out in patients older than 18 years admitted to the intensive care unit of a tertiary care hospital. Cases were identified as failed weaning (FW) of MV, and controls were simple weaning. Patients from another hospital with MV were excluded. Risk factors studied were high nutritional risk by the modified Nutric score, late enteral nutrition, positive water balance (WB) and the absence of physical therapy prior to weaning. OR was calculated with a significance < 0.05 for bivariate, multivariate, and adjusted analysis. Results: 105 patients were included, 35 cases and 70 controls. The bivariate analysis found that high nutritional risk (OR = 2.5; 95% CI = 1.1 5.9; p = 0.027) was a risk factor, but the multivariate analysis did not confirm it. Late enteral nutrition (OR = 1.2; 95% CI = 0.4 3.4), positive WB (OR = 0.7; 95% CI = 0.3 1.7) and the absence of respiratory physiotherapy (OR = 0.2; 95% CI = 0.004 0.011) were not risk factors for FW. Conclusions: High nutritional risk, late enteral nutrition, positive BH and the absence of respiratory physiotherapy before weaning were not risk factors for FW.
