Destete en una UCI polivalente

Incidencia y factores de riesgo de fracaso. Valoración de índices predictivos

  • Ana Graciela França Círculo Católico de Obreros del Uruguay, CTI. Jefe, médico intensivista
  • Alejandro Ebeid Círculo Católico de Obreros del Uruguay. Médico intensivista
  • Carlos Formento Círculo Católico de Obreros del Uruguay. Médico intensivista
  • Daniel Loza Círculo Católico de Obreros del Uruguay. Médico intensivista
Palabras clave: DESCONEXIÓN DEL VENTILADOR, FACTORES DE RIESGO, INCIDENCIA

Resumen

Introducción: la desvinculación de la ventilación mecánica (VM) es controversial. Su fracaso genera morbimortalidad. 
Objetivos: determinar incidencia de destete, factores de riesgo de fracaso: necesidad de reintubación antes de 48 horas posextubación, valoración de índices predictivos. 
Material y método: estudio prospectivo. Cohorte abierta, adultos destetados de VM por 24 horas o más, período mayo de 2010 a junio de 2011. Excluidos: traqueostomizados. Evaluados diariamente con parámetros clínico-gasométricos para prueba de ventilación espontánea, medición previa: presión inspiratoria máxima (Pimax), presión-oclusión en primeros 100 milisegundos de inicio de inspiración (P0.1), cociente P0.1/ Pimax. Previo a extubar: medida del índice de Yang-Tobin (frecuencia respiratoria/volumen corriente en litros). 
Resultados: 78 pacientes, 58,7 años ± 21,4 (edad media ± 1 desvío estándar), 59% hombres; 61,5%, destete simple en tubo T. Fracaso de destete: 12,8%. Fracción de eyección del ventrículo izquierdo (FEVI) < 45% determinó riesgo relativo de destete dificultoso o prolongado = 3,08, intervalo de confianza (IC) 95%, 1,72-5,51 (p = 0,0001) y fue el único factor de riesgo independiente de fracaso (regresión logística), Odds Ratio = 6,01, IC 95%, 1,40-25,72, (p=0,01). Fueron estadísticamente significativas las diferencias en grupos éxito y fracaso de: balance hídrico en últimas 24 horas, p = 0,002; Pimax, p = 0,006; P0.1, p = 0,04; P0.1/Pimax, p = 0,0001; índice Yang-Tobin, p = 0,03. Mortalidad 30% en fracaso y 4,4% en éxito, p = 0,03. Áreas bajo la curva ROC ("receiver operating characteristic") de significación estadística para Pimax: 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. 
Conclusiones: incidencia de destete simple menor a los reportes. Fracaso connota mayor mortalidad. FEVI < 45%: factor de riesgo independiente de fracaso. Índices predictivos P0.1, Pimax, P0.1/Pimax significativos.

Citas

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Publicado
2013-06-30
Cómo citar
1.
França AG, Ebeid A, Formento C, Loza D. Destete en una UCI polivalente. Rev. Méd. Urug. [Internet]. 30 de junio de 2013 [citado 23 de noviembre de 2020];29(2):85-6. Disponible en: http://revista.rmu.org.uy/ojsrmu311/index.php/rmu/article/view/285
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