Pacientes internados na UTI B em VM por mais de 24 horas são, em usa maioria, homens, com menos de 60 anos, provenientes principalmente, do Pronto Socorro do hospital, que esperam cerca de 4 dias por uma vaga na UTI; permanecem cerca de 16 dias em VM, apresentam taxa de ocorrência de eventos adversos de 55,4%, taxa de sucesso da extubação de 67,7% e mortalidade geral de 26,9%. Nosso estudo mostrou taxa de reintubação elevada principalmente nos pacientes mais velhos, acima dos valores reportados em estudos nacionais e internacionais, com identificação de duas variáveis independentemente associadas ao fracasso da extubação, idade e tempo de VM, compatíveis com os resultados de outros estudos. Não houve a confirmação do papel preditivo do BNP em relação ao resultado do TRE, talvez por número insuficiente de pacientes submetidos á dosagem. Observamos que nossos pacientes submetidos ao TRE são, mais graves e esperam mais tempo por um leito em UTI, quando comparado com outros serviços, variáveis que, certamente, interferem no resultado do DVM e na evolução dos pacientes.
Nossos dados estão de acordo com os relatos da literatura que sugerem que idade, escore de gravidade, tempo de internação hospitalar antes da transferência para a UTI, tempo de VM e gravidade do comprometimento pulmonar são variáveis associadas tanto à dificuldade do DVM quanto ao risco de morrer.
Tais dados sugerem que devemos implementar melhorias nos cuidados aos doentes gravemente enfermos em nosso hospital e, em nossa UTI, diminuindo o tempo de espera por um leito em UTI além da revisão dos procedimentos relativos a identificação e manejo dos pacientes prontos ao TRE e à extubação, como a implantação de protocolo que associe outros índices preditores do resultado do desmame ventilatório ao Teste de Respiração Espontânea, uma vez que o sucesso da extubação é uma variável diretamente relacionada à sobrevida dos pacientes.
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ANEXO A
Parecer Consubstanciado do CEP
ANEXO B
Termo de outorga e aceitação de auxílios