Aspectos morfofuncionais diafragmáticos agudos e seu uso como preditores de sucesso de extubação em pacientes com lesão neurológica aguda

Abstract

Introduction. There is a high rate of ventilatory weaning failure in patients with acute neurological injury, due to the difficulty in choosing patients who are suitable for the weaning evolution. Objectives Evaluate acute diaphragmatic morphofunctional aspects and predictors of successful extubation in patients with acute neurological injury. Method: Prospective longitudinal observational study, carried out at Santa Casa de Campo Grande/MS. Diaphragmatic ultrasonographic evaluation in patients with acute neurological injury under invasive mechanical ventilation in the first 24 hours, between 48 and 72 hours of hospitalization in the Intensive Care Unit (ICU) and pre-extubation. In pre-extubation, weaning predictor indices and VISAGE score were also evaluated. For the analysis, the participants were allocated into groups according to whether or not they progressed to tracheostomy, and those who evolved to extubation were divided into extubation success and failure. Statistical tests: ANOVA for the repeated measures model, Student's t test and multiple logistic regression. Results: Mobility and APACHE II were independent predictors of evolution to tracheostomy; rapid shallow breathing index (RSRI) and VISAGE score were independent predictors of extubation failure or success; SSRI/shallow diaphragmatic breathing index (DIRRS), VISAGE score and maximal expiratory pressure (MEP) when associated, were predictors of extubation success/failure. Conclusion: The VISAGE score and the IRRS when isolated and when combined with the DIRRS and Pemax are good predictors of success or failure in extubation. Diaphragmatic mobility, APACHE II, age, total invasive mechanical ventilation time and total ICU time influence the evolution to tracheostomy.