Avaliação da força muscular respiratória em pacientes submetidos à ventilação mecânica prolongada pré e pós extubação em um hospital de FortalezaCE

OR)G)NAL ART)CLE

Avaliação da Força Muscular Respiratória em Pacientes Submetidos à

Ventilação Mecânica Prolongada Pré e Pós Extubação em um (ospital de

Fortaleza/CE

Assessment of Respiratory Muscle Strength in Patients Undergoing Prolonged

Mechanical Ventilation Pre and Post extubation in a hospital in Fortaleza / CE

Priscila Mesquita Moreira ,Renata dos Santos Vasconcelos , Raquel Pinto Sales , Camila Barbosa Araújo , Audair Tavares Xavier Moreira , Cristiano Teles de SousaǡÀŽ‹ƒƒ”‹ƒƒ–‘•‘…Šƒ, Vasco Pinheiro Diógenes Bastos .

ͳǤ ƒ…—Ž†ƒ†‡–‡‰”ƒ†ƒ†‘‡ƒ”žȂ ǤʹǤ‡•–”‡‡‹²…‹ƒ•±†‹…ƒ•Ǥ͵Ǥ‡•–”ƒ†ƒ‡‹²…‹ƒ•±†‹…ƒ•’‡Žƒ ǤͶǤ‡•‹†²…‹ƒ—Ž–‹’”‘ϐ‹••‹‘ƒŽ ‘•’‹–ƒŽ‹˜‡”•‹–ž”‹‘ƒŽ–‡”ƒ–À†‹‘ȋǦ ȌǤͷǤ‘•’‹–ƒŽ‹˜‡”•‹–ž”‹‘ƒŽ–‡”ƒ–À†‹‘ȋǦ ȌǤ͸Ǥ‡–”‘‹˜‡”•‹–ž”‹‘•–ž…‹‘†‘ Ceará - Estácio F)C. . Centro Universitário Estácio do Ceará- Estácio F)C. . Universitário Estácio do Ceará- Estácio F)C.

Abstract

Introduction: The evaluation of the strength of respiratory muscles is the key to weaning from mechanical ventilation. Objective: To assess

respiratory muscle strength in patients undergoing prolonged mechanical ventilation pre and post extubation. Methods: Field research,

descriptive, observational and longitudinal with a quantitative approach, conducted carried out from August to November , in the )ntensive Care Unit Respiratory Messejana (ospital - Fortaleza - CE. The study included patients regardless of sex, aged , with conditions to extubation. The variables analyzed were age, sex, personal history, diagnosis, duration of mechanical ventilation, Acute Physiology and Chronic (ealth Evaluation APAC(E )) score and values of maximal inspiratory and expiratory pressure. The values of maximum inspiratory and expiratory pressures were measured at two time points: before extubation, after the patient had a favorable response to spontaneous breathing test and hours after extubation. Results: The sample consisted of patients on prolonged mechanical ventilation and extubation phase. When analyzing the values of

the maximum pressure before extubation, we found an average of - . ± . cm( O for maximal inspiratory pressure and + . ± . cm( O for maximal expiratory pressure. The indexes hours after extubation were - ± . cm( O for maximal inspiratory pressure and + ± . cm( O for maximal expiratory pressure. All patients had successful extubation. Conclusion:……‘”†‹‰–‘–Š‡ϐ‹†‹‰•‘ˆ–Š‡’”‡•‡–•–—†›ǡ

we observed an improvement in respiratory muscle strength after hours of extubation, suggesting that mechanical ventilation for prolonged periods can cause respiratory muscle weakness and atrophy.

Keywords:—•…Ž‡–”‡‰–ŠǤ‹”™ƒ›‡š–—„ƒ–‹‘Ǥ‡•’‹”ƒ–‹‘”–‹ϐ‹…‹ƒŽ

Resumo

Introdução: A avaliação da força dos músculos respiratórios é fundamental para a retirada da ventilação mecânica. Objetivo: Avaliar a força

muscular respiratória de pacientes submetidos à ventilação mecânica prolongada pré e pós extubação. Métodos: Pesquisa de campo, descritiva, ‘„•‡”˜ƒ…‹‘ƒŽ‡Ž‘‰‹–—†‹ƒŽ…‘ƒ„‘”†ƒ‰‡“—ƒ–‹–ƒ–‹˜ƒǡ”‡ƒŽ‹œƒ†ƒ‘’‡”À‘†‘†‡ƒ‰‘•–‘ƒ‘˜‡„”‘†‡ʹͲͲͻǡƒ‹†ƒ†‡†‡‡”ƒ’‹ƒ–‡•‹˜ƒ ‡•’‹”ƒ–×”‹ƒ †‘ ‘•’‹–ƒŽ †‡ ‡••‡Œƒƒ Ǧ ‘”–ƒŽ‡œƒ Ȃ Ǥ ‘”ƒ ‹…Ž—À†‘• ‘ ‡•–—†‘ ’ƒ…‹‡–‡•ǡ ‹†‡’‡†‡–‡ †‘ •‡š‘ǡ ƒ‹‘”‡• †‡ ͳͺ ƒ‘•ǡ apresentando condições de extubação. As variáveis analisadas foram: idade, sexo, antecedentes pessoais, diagnóstico, tempo de ventilação mecânica, escore Acute Physiology and Chronic Health Evaluation APAC(E )) e valores de pressão inspiratória e expiratória máximas. Os valores de pressão inspiratória e expiratória máximas foram mensurados em dois momentos: antes da extubação, após o paciente ter resposta favorável ao teste de respiração espontânea, e horas após a extubação. Resultados: A amostra foi composta por pacientes que estavam em ventilação

mecânica prolongada e em fase de extubação. Quando analisados os valores das pressões máximas antes da extubação, encontrou-se uma média de - , ± , cm( O para pressão inspiratória máxima e + , ± , cm( O para pressão expiratória máxima. Já os valores após horas da extubação foram de - ± , cm( O para pressão inspiratória máxima e + ± , cm( O para pressão expiratória máxima. Todos os pacientes tiveram sucesso na extubação. Conclusão: De acordo com os achados do presente estudo, observou-se uma melhora da força muscular respiratória ƒ’וʹͶŠ‘”ƒ•†‡‡š–—„ƒ­ ‘ǡ•—‰‡”‹†‘“—‡ƒ˜‡–‹Žƒ­ ‘‡…Ÿ‹…ƒ’‘”–‡’‘’”‘Ž‘‰ƒ†‘’‘†‡…ƒ—•ƒ”ˆ”ƒ“—‡œƒ‡Š‹’‘–”‘ϐ‹ƒ—•…—Žƒ””‡•’‹”ƒ–×”‹ƒǤ

Palavras chave•ǣ ‘”­ƒ—•…—Žƒ”Ǥš–—„ƒ­ ‘Ǥ‡•’‹”ƒ­ ‘”–‹ϐ‹…‹ƒŽ

Correspondência: Vasco Pinheiro Diógenes Bastos. e-mail: vascodiogenes@yahoo.com.br

INTRODUÇÃO

ǀĞŶƟůĂĕĆŽ ŵĞĐąŶŝĐĂ ;sDͿ ĐŽŶƐƟƚƵŝ Ƶŵ ĚŽƐ ƉŝůĂƌĞƐ ƚĞƌĂƉġƵƟĐŽƐ ĚĂƐ hŶŝĚĂĚĞƐ ĚĞ ƚĞƌĂƉŝĂ /ŶƚĞŶƐŝǀĂ ;hd/ƐͿ ŶŽ ƚƌĂƚĂŵĞŶƚŽ ĚŽƐ ƉĂĐŝĞŶƚĞƐ ĐŽŵ ŝŶƐƵĮĐŝġŶĐŝĂ ƌĞƐƉŝƌĂƚſƌŝĂ aguda.;ϭͿ ůŽŶŐĂ ƉĞƌŵĂŶġŶĐŝĂ Ğŵ ǀĞŶƟůĂĕĆŽ ŵĞĐąŶŝĐĂ͕ ĂƐƐŽĐŝĂĚĂ Ă ƌĞƉĞƟĚŽƐ ŝŶƐƵĐĞƐƐŽƐ ŶĂ ƌĞƟƌĂĚĂ ĚŽ ƐƵƉŽƌƚĞ ǀĞŶƟůĂƚſƌŝŽ͕ĐŽŶƐƟƚƵŝƵŵĂƉƌŽďůĞŵĄƟĐĂĚĞŶƚƌŽĚĂƐhd/Ɛ͘;ϭͿ

ŶƚƌĞ ŽƐ ĨĂƚŽƌĞƐ ƋƵĞ ĐĂƵƐĂŵ ĂƵŵĞŶƚŽ ĚŽ ƚĞŵƉŽ ĚĞ ƉĞƌŵĂŶġŶĐŝĂ Ğŵ sD͕ ĚĞƐƚĂĐĂŵͲƐĞ ĂƐ ĂůƚĞƌĂĕƁĞƐ ĚŽ ƉĂĚƌĆŽ ƌĞƐƉŝƌĂƚſƌŝŽ Ğ Ž ĐŽŵƉƌŽŵĞƟŵĞŶƚŽ ĚŽƐ ŵƷƐĐƵůŽƐ ƌĞƐƉŝƌĂƚſƌŝŽƐ;Ϯ͕ϯͿ_{͘ ůĠŵ ĚĞ ŽƵƚƌŽƐ ĨĂƚŽƌĞƐ ĐŽŵŽ͗}

ƵƐŽ ƉƌŽůŽŶŐĂĚŽ ĚĞ ďůŽƋƵĞĂĚŽƌĞƐ ŶĞƵƌŽŵƵƐĐƵůĂƌĞƐ Ğ ĐŽƌƟĐŽƐƚĞƌŽŝĚĞƐ͕ Ă ĚĞƐŶƵƚƌŝĕĆŽ͕ ĂƐ ĚŝƐĨƵŶĕƁĞƐ ĐĂƌĚŝŽǀĂƐĐƵůĂƌĞƐ Ğ ƉƌŝŶĐŝƉĂůŵĞŶƚĞ Ă ŝŶĂƟǀŝĚĂĚĞ ĚĂ ŵƵƐĐƵůĂƚƵƌĂƌĞƐƉŝƌĂƚſƌŝĂŐĞƌĂŵŶŽƉĂĐŝĞŶƚĞƵŵĂĨƌĂƋƵĞnjĂ ŵƵƐĐƵůĂƌŝŵƉŽƌƚĂŶƚĞ;ϰͿ_.

sDƉƌŽůŽŶŐĂĚĂĐŽŶƐŝƐƚĞŶĂĚĞƉĞŶĚġŶĐŝĂĚĂĂƐƐŝƐƚġŶĐŝĂ ǀĞŶƟůĂƚſƌŝĂŵĞĐąŶŝĐĂ͕ŝŶǀĂƐŝǀĂŽƵŶĆŽŝŶǀĂƐŝǀĂ͕ƉŽƌŵĂŝƐĚĞ ϲŚŽƌĂƐƉŽƌĚŝĂƉŽƌƚĞŵƉŽƐƵƉĞƌŝŽƌĂƚƌġƐƐĞŵĂŶĂƐ;ϱ͕ϲͿ_{. No}

ƉĂĐŝĞŶƚĞĚĞƉĞŶĚĞŶƚĞĚĂsD͕ĞƐƟŵĂͲƐĞƋƵĞϰϭйĚŽƚĞŵƉŽ ƚŽƚĂů Ġ ĚĞƐƟŶĂĚŽ Ă ƐĞƵ ƉƌŽĐĞƐƐŽ ĚĞ ĚĞƐĐŽŶƟŶƵĂĕĆŽ͕ ŽƵ ƐĞũĂ͕ĂŽĚĞƐŵĂŵĞĚĂsD;ϳͿ_.

K ŝŶşĐŝŽ ĚŽ ƉƌŽĐĞƐƐŽ ĚĞ ƌĞƟƌĂĚĂ ĚŽ ƐƵƉŽƌƚĞ ǀĞŶƟůĂƚſƌŝŽ ĚĞƉĞŶĚĞ ĚĞ ǀĄƌŝŽƐ ĨĂƚŽƌĞƐ͕ ĐŽŵŽ͗ ƌĞƐŽůƵĕĆŽ ĚĂ ĐĂƵƐĂ ƋƵĞ ĚĞƚĞƌŵŝŶŽƵ Ă ŶĞĐĞƐƐŝĚĂĚĞ ĚŽ ƐƵƉŽƌƚĞ ǀĞŶƟůĂƚſƌŝŽ͕ ƐƵƐƉĞŶƐĆŽ ĚĂ ƐĞĚĂĕĆŽ Ğ ĚŽ ďůŽƋƵĞĂĚŽƌ ŶĞƵƌŽŵƵƐĐƵůĂƌ͕ ŶşǀĞů ĚĞ ĐŽŶƐĐŝġŶĐŝĂ͕ ƉƌĞƐĞŶĕĂ ĚĞ ĚŝƐƚƷƌďŝŽƐ ĞůĞƚƌŽůşƟĐŽƐ Ğ ŵĞƚĂďſůŝĐŽƐ͕ ƚƌŽĐĂ ŐĂƐŽƐĂ͕ ƉĂƚŽůŽŐŝĂƐ ƉƵůŵŽŶĂƌĞƐ Ğͬ ŽƵ ĞdžƚƌĂƉƵůŵŽŶĂƌĞƐ ĂƐƐŽĐŝĂĚĂƐ͕ ĨŽƌĕĂ Ğ ƌĞƐŝƐƚġŶĐŝĂ ĚĂ ŵƵƐĐƵůĂƚƵƌĂƌĞƐƉŝƌĂƚſƌŝĂ;ϰ͕ϴ͕ϵͿ_.

ŵĞĚŝĚĂ ĚĂƐ ƉƌĞƐƐƁĞƐ ƌĞƐƉŝƌĂƚſƌŝĂƐ ŵĄdžŝŵĂƐ ƌĞƉƌĞƐĞŶƚĂ Ƶŵ ĐƌŝƚĠƌŝŽ ŝŵƉŽƌƚĂŶƚĞ ŶĂ ĂǀĂůŝĂĕĆŽ ĚŽƐ ƉĂĐŝĞŶƚĞƐ Ğŵ ǀĞŶƟůĂĕĆŽ ŵĞĐąŶŝĐĂ͕ ĂůĠŵ ĚĞ ƐĞƌ Ƶŵ ŵĠƚŽĚŽ ƐŝŵƉůĞƐ Ğ ŶĆŽ ŝŶǀĂƐŝǀŽ ƋƵĞ ƉŽĚĞ ĚĞƚĞƌŵŝŶĂƌ ĐŽŵ ďŽĂ ƉƌĞĐŝƐĆŽ ĂƐ ĂůƚĞƌĂĕƁĞƐƋƵĂŶƟƚĂƟǀĂƐĚĂĨŽƌĕĂŵƵƐĐƵůĂƌƌĞƐƉŝƌĂƚſƌŝĂ͘Ɛ ĂůƚĞƌĂĕƁĞƐĚĂĨŽƌĕĂŵƵƐĐƵůĂƌƉŽĚĞŵƐĞƌĐůĂƐƐŝĮĐĂĚĂƐĐŽŵŽ͗ ĨƌĂƋƵĞnjĂ͕ĨĂĚŝŐĂ͕ŽƵĨĂůġŶĐŝĂŵƵƐĐƵůĂƌƌĞƐƉŝƌĂƚſƌŝĂ;ϯ͕ϭϬ͕ϭϭͿ_.

ŵĞĚŝĚĂ ĚĂ ƉƌĞƐƐĆŽ ŝŶƐƉŝƌĂƚſƌŝĂ ŵĄdžŝŵĂ ;W/ŵĄdžͿ Ġ ŵĞŶƐƵƌĂĚĂ Ă ƉĂƌƟƌ ĚĞ ƵŵĂ ĞdžƉŝƌĂĕĆŽ ŵĄdžŝŵĂ͕ ǀŽůƵŵĞ ƌĞƐŝĚƵĂů ĂƚĠ Ă ĐĂƉĂĐŝĚĂĚĞ ƉƵůŵŽŶĂƌ ƚŽƚĂů͘ :Ą Ă ƉƌĞƐƐĆŽ ĞdžƉŝƌĂƚſƌŝĂŵĄdžŝŵĂ;WŵĄdžͿĠŵĞĚŝĚĂĂƉĂƌƟƌĚĂŝŶƐƉŝƌĂĕĆŽ ŵĄdžŝŵĂ͕ĐĂƉĂĐŝĚĂĚĞƉƵůŵŽŶĂƌƚŽƚĂůĂƚĠŽǀŽůƵŵĞƌĞƐŝĚƵĂů͘

;ϭϮͿ

ĂǀĂůŝĂĕĆŽ ĚĂ ĨŽƌĕĂ ĚŽƐ ŵƷƐĐƵůŽƐ ƌĞƐƉŝƌĂƚſƌŝŽƐ Ġ ĨƵŶĚĂŵĞŶƚĂů ƉĂƌĂ Ă ƌĞƟƌĂĚĂ ĚĂ ǀĞŶƟůĂĕĆŽ ŵĞĐąŶŝĐĂ͕ ũĄ ƋƵĞ Ă ŚŝƉŽƚƌŽĮĂ Ğ Ă ĨĂĚŝŐĂ ŵƵƐĐƵůĂƌ ƐĆŽ ĐŽŶƐŝĚĞƌĂĚĂƐ ƵŵĂ ĚĂƐ ĐĂƵƐĂƐ ƉƌŝŵĄƌŝĂƐ ƋƵĞ ŝŵƉŽƐƐŝďŝůŝƚĂŵ Ž ƉƌŽĐĞƐƐŽ ĚĞ ĞdžƚƵďĂĕĆŽ;ϮͿ_{͘ ůĠŵ ĚŝƐƐŽ͕ Ă ĚĞĐŝƐĆŽ ĚĂ ĞdžƚƵďĂĕĆŽ ĚŽ}

ƉĂĐŝĞŶƚĞ ĚĞǀĞ ƐĞƌ ĨĞŝƚĂ ƋƵĂŶĚŽ ŽƐ ĐƌŝƚĠƌŝŽƐ͕ ĐŽŶĚŝĕƁĞƐ Ğ şŶĚŝĐĞƐĚĞĚĞƐŵĂŵĞĞƐƟǀĞƌĞŵĨĂǀŽƌĄǀĞŝƐƉŽƌŵĞŝŽĚĞƵŵĂ ĂĚĞƋƵĂĚĂĂǀĂůŝĂĕĆŽĚĂĨƵŶĕĆŽǀĞŶƟůĂƚſƌŝĂĞĚĂƐǀŝĂƐĂĠƌĞĂƐ superiores;ϳͿ.

ŝĂŶƚĞ ĚŝƐƐŽ͕ Ž ƉƌĞƐĞŶƚĞ ĞƐƚƵĚŽ ŽďũĞƟǀŽƵ ĂǀĂůŝĂƌ Ă ĨŽƌĕĂ

ŵƵƐĐƵůĂƌƌĞƐƉŝƌĂƚſƌŝĂĚĞƉĂĐŝĞŶƚĞƐƐƵďŵĞƟĚŽƐăǀĞŶƟůĂĕĆŽ ŵĞĐąŶŝĐĂƉƌŽůŽŶŐĂĚĂŶĂƉƌĠĞƉſƐĞdžƚƵďĂĕĆŽ͘

METODOLOGIA

dƌĂƚĂͲƐĞ ĚĞ ƵŵĂ ƉĞƐƋƵŝƐĂ ĚĞ ĐĂŵƉŽ ĚŽ ƟƉŽ ĚĞƐĐƌŝƟǀĂ͕ ŽďƐĞƌǀĂĐŝŽŶĂůĞůŽŶŐŝƚƵĚŝŶĂůĐŽŵĂďŽƌĚĂŐĞŵƋƵĂŶƟƚĂƟǀĂ͘ KƐ ƉĂĐŝĞŶƚĞƐ ĨŽƌĂŵ ƌĞĐƌƵƚĂĚŽƐ ŶĂ hŶŝĚĂĚĞ ĚĞ dĞƌĂƉŝĂ /ŶƚĞŶƐŝǀĂZĞƐƉŝƌĂƚſƌŝĂĚŽ,ŽƐƉŝƚĂůĚĞDĞƐƐĞũĂŶĂͲƌ͘ĂƌůŽƐ ůďĞƌƚŽ^ƚƵĚĂƌƚ'ŽŵĞƐ͕&ŽƌƚĂůĞnjĂʹ͘ĐŽůĞƚĂĚĞĚĂĚŽƐ ĨŽŝƌĞĂůŝnjĂĚĂŶŽƉĞƌşŽĚŽĚĞĂŐŽƐƚŽĂŶŽǀĞŵďƌŽĚĞϮϬϬϵ͘ ƉĞƐƋƵŝƐĂƐĞŐƵŝƵŽƐĂƐƉĞĐƚŽƐĠƟĐŽƐƋƵĞĞŶǀŽůǀĞŵĞƐƚƵĚŽƐ ĐŽŵ ƐĞƌĞƐ ŚƵŵĂŶŽƐ͕ ƐĞŐƵŝŶĚŽ ĂƐ ŶŽƌŵĂƐ ĚĂ ZĞƐŽůƵĕĆŽ ϭϵϲͬϵϲ ĚŽ ŽŶƐĞůŚŽ EĂĐŝŽŶĂů ĚĞ ^ĂƷĚĞ ʹ ƉĞƐƋƵŝƐĂ envolvendo seres humanos;ϭϯͿ͘ KƐ ƌĞƐƉŽŶƐĄǀĞŝƐ ƉĞůŽƐ ƉĂĐŝĞŶƚĞƐĨŽƌĂŵŝŶĨŽƌŵĂĚŽƐƋƵĂŶƚŽăĮŶĂůŝĚĂĚĞĚŽĞƐƚƵĚŽ Ğ ĂƐƐŝŶĂƌĂŵ Ž ƚĞƌŵŽ ĚĞ ĐŽŶƐĞŶƟŵĞŶƚŽ ůŝǀƌĞ ĞƐĐůĂƌĞĐŝĚŽ ĂƉƌŽǀĂĚŽƉĞůŽĐŽŵŝƚġĚĞĠƟĐĂĞŵƉĞƐƋƵŝƐĂĚŽ,ŽƐƉŝƚĂůĚĞ DĞƐƐĞũĂŶĂĐŽŵŶƷŵĞƌŽĚĞƉƌŽƚŽĐŽůŽϲϯϬͬϬϵ͘

&ŽƌĂŵ ŝŶĐůƵşĚŽƐ ŶŽ ĞƐƚƵĚŽ ƉĂĐŝĞŶƚĞƐ ĚŽ ƐĞdžŽ ĨĞŵŝŶŝŶŽ Ğ ŵĂƐĐƵůŝŶŽ͕ŵĂŝŽƌĞƐĚĞϭϴĂŶŽƐ͕ƋƵĞƟŶŚĂŵĐŽŶĚŝĕƁĞƐĚĞ ƐĞƌĞdžƚƵďĂĚŽƐ͕ƐĞŶĚŽĞƐƐĂƐĐŽŶĚŝĕƁĞƐĚĞƚĞƌŵŝŶĂĚĂƐƉĞůĂ ĞƋƵŝƉĞĚŽŚŽƐƉŝƚĂů͘KƐĐƌŝƚĠƌŝŽƐĚĞĞdžĐůƵƐĆŽĨŽƌĂŵ͗ƉĂĐŝĞŶƚĞƐ ƚƌĂƋƵĞŽƐƚŽŵŝnjĂĚŽƐ ĂŶƚĞƐ ĚĂ ƉƌŝŵĞŝƌĂ ĞdžƚƵďĂĕĆŽ͕ ŽƐ ƋƵĞ ĂƉƌĞƐĞŶƚĂƌĂŵĞdžƚƵďĂĕĆŽĂĐŝĚĞŶƚĂůĞŽƐƋƵĞĂƉƌĞƐĞŶƚĂƐƐĞŵ ĂůŐƵŵĂĂůƚĞƌĂĕĆŽƋƵĞŝŵƉĞĚŝƐƐĞĂƌĞĂůŝnjĂĕĆŽĚŽƚĞƐƚĞ͘ /ŶŝĐŝĂůŵĞŶƚĞ͕ ƌĞĂůŝnjŽƵͲƐĞ ƵŵĂ ǀŝƐŝƚĂ ĐŽŵ Ž ĐŚĞĨĞ ĚĂ ƵŶŝĚĂĚĞ͕ ƋƵĂŶĚŽ ĨŽƌĂŵ ĚĂĚŽƐ ĞƐĐůĂƌĞĐŝŵĞŶƚŽƐ ƐŽďƌĞ Ă ƉĞƐƋƵŝƐĂĂĮŵĚĞƋƵĞĞůĂĨŽƐƐĞĂƵƚŽƌŝnjĂĚĂ͘ŵƐĞŐƵŝĚĂ͕Ž ĮƐŝŽƚĞƌĂƉĞƵƚĂĚĂƵŶŝĚĂĚĞĨŽŝƐŽůŝĐŝƚĂĚŽƉĂƌĂƐĞůĞĐŝŽŶĂƌŽƐ ƉĂĐŝĞŶƚĞƐ ƋƵĞ ƐĞ ĂĚĞƋƵĂǀĂŵ ĂŽƐ ĐƌŝƚĠƌŝŽƐ ĚĞ ĞdžƚƵďĂĕĆŽ͘ WĂƌĂ ĐĂĚĂ ƉĂĐŝĞŶƚĞ͕ ĐŽůĞƚĂƌĂŵͲƐĞ ŽƐ ƐĞŐƵŝŶƚĞƐ ĚĂĚŽƐ͗ ŝĚĂĚĞ͕ ƐĞdžŽ͕ ĂŶƚĞĐĞĚĞŶƚĞƐ ƉĞƐƐŽĂŝƐ͕ ĚŝĂŐŶſƐƟĐŽ͕ ƚĞŵƉŽ ĚĞǀĞŶƟůĂĕĆŽŵĞĐąŶŝĐĂ͕ŐƌĂǀŝĚĂĚĞĚĂĚŽĞŶĕĂƉŽƌŵĞŝŽĚŽ

ĞƐĐŽƌĞĚŽĐƵƚĞWŚLJƐŝŽůŽŐLJĂŶĚŚƌŽŶŝĐ,ĞĂůƚŚǀĂůƵĂƟŽŶ

;W,//Ϳ͕ǀĂůŽƌĞƐĚĞW/ŵĄdžĞWŵĄdž͘

KƐǀĂůŽƌĞƐĚĂW/ŵĄdžĞĚĂWŵĄdžĨŽƌĂŵŵĞŶƐƵƌĂĚŽƐƉĞůŽ ĮƐŝŽƚĞƌĂƉĞƵƚĂ ĚĂ ƵŶŝĚĂĚĞ͕ Ğŵ ĚŽŝƐ ŵŽŵĞŶƚŽƐ͗ ĂŶƚĞƐ ĚĂ ĞdžƚƵďĂĕĆŽ͕ĂƉſƐŽƉĂĐŝĞŶƚĞƚĞƌƌĞƐƉŽƐƚĂĨĂǀŽƌĄǀĞůĂŽƚĞƐƚĞ ĚĞƌĞƐƉŝƌĂĕĆŽĞƐƉŽŶƚąŶĞĂĞϮϰŚŽƌĂƐĂƉſƐĂĞdžƚƵďĂĕĆŽ͘EĂ ƉƌŝŵĞŝƌĂĂǀĂůŝĂĕĆŽ͕ŽƉĂĐŝĞŶƚĞĞƐƚĂǀĂĞŵĚĞĐƷďŝƚŽĚŽƌƐĂů ĐŽŵ Ă ĐĂďĞĐĞŝƌĂ ĞůĞǀĂĚĂ Ă ϰϱΣ ĐŽŵ Ž ŵĂŶŽǀĂĐƵƀŵĞƚƌŽ ;ŵĂƌĐĂ'ĞƌĂƌ®ͿĐŽŶĞĐƚĂĚŽĚŝƌĞƚĂŵĞŶƚĞĂŽƚƵƌŽƚƌĂƋƵĞů

Ğ ƐŽůŝĐŝƚĂĚŽ ƋƵĞ Ž ƉĂĐŝĞŶƚĞ ƌĞĂůŝnjĂƐƐĞ ƵŵĂ ŝŶƐƉŝƌĂĕĆŽ ŵĄdžŝŵĂ Ă ƉĂƌƟƌ ĚŽ ǀŽůƵŵĞ ƌĞƐŝĚƵĂů ƉĂƌĂ W/ŵĄdž Ğ ƵŵĂ ĞdžƉŝƌĂĕĆŽ ŵĄdžŝŵĂ Ă ƉĂƌƟƌ ĚĂ ĐĂƉĂĐŝĚĂĚĞ ƉƵůŵŽŶĂƌ ƚŽƚĂů ƉĂƌĂWŵĄdž;ϭϰͿ_.

WĂƌĂ Ž ƐĞŐƵŶĚŽ ŵŽŵĞŶƚŽ͕ Ž ƉĂĐŝĞŶƚĞ ĞƐƚĂǀĂ ƐĞŶƚĂĚŽ ĐŽŵ Ž ŵĂŶŽǀĂĐƵƀŵĞƚƌŽ ;ŵĂƌĐĂ 'ĞƌĂƌ®Ϳ ĐŽŶĞĐƚĂĚŽ Ă

KƐ ĚĂĚŽƐ ĨŽƌĂŵ ŽƌŐĂŶŝnjĂĚŽƐ Ğ ƉƌŽĐĞƐƐĂĚŽƐ Ğŵ ƵŵĂ ĨƌĞƋƵġŶĐŝĂ ƐŝŵƉůĞƐ Ğ ƉĞƌĐĞŶƚƵĂů Ğ ƉĂƌĂ ĂŶĄůŝƐĞ ƵƟůŝnjŽƵͲ ƐĞ ƵŵĂ ƉůĂŶŝůŚĂ ĞůĞƚƌƀŶŝĐĂ ĚŽ ƉƌŽŐƌĂŵĂ DŝĐƌŽƐŽŌ džĐĞů®

ǀĞƌƐĆŽϮϬϬϳ͘

RESULTADOS

&ŽƌĂŵƐĞůĞĐŝŽŶĂĚŽƐ͕ĂŽĮŶĂůĚŽĞƐƚƵĚŽ͕ĚŽnjĞƉĂĐŝĞŶƚĞƐƋƵĞ ĞƐƚĂǀĂŵĞŵǀĞŶƟůĂĕĆŽŵĞĐąŶŝĐĂƉƌŽůŽŶŐĂĚĂĞĞŵĨĂƐĞĚĞ ĞdžƚƵďĂĕĆŽ͕ƐĞŶĚŽϰϭ͕ϲй;ŶсϱͿĚŽƐĞdžŽŵĂƐĐƵůŝŶŽĞϱϴ͕ϰй ;ŶсϳͿĚŽƐĞdžŽĨĞŵŝŶŝŶŽ͕ĐŽŵŵĠĚŝĂĚĞŝĚĂĚĞĚĞϱϵ͕ϳϭц Ϯ͕ϴϲ ĂŶŽƐ͘ YƵĂŶƚŽ ĂŽ ĚŝĂŐŶſƐƟĐŽ͕ ĨŽŝ ĞǀŝĚĞŶĐŝĂĚŽ ƋƵĞ ϱϴй;ŶсϳͿĚŽƐƉĂĐŝĞŶƚĞƐĂƉƌĞƐĞŶƚĂƌĂŵWK͕ƐĞŐƵŝĚŽĚĞ WŶĞƵŵŽŶŝĂĐŽŵϯϰй;ŶсϰͿĞƐŵĂĐŽŵϴй;ŶсϭͿ;dĂďĞůĂϭͿ͘

Tabela 1 - ŝƐƚƌŝďƵŝĕĆŽĚŽƐĚĂĚŽƐĚĞĂĐŽƌĚŽĐŽŵŽƉĞƌĮů ĞƉŝĚĞŵŝŽůſŐŝĐŽ͕&ŽƌƚĂůĞnjĂ͕ͬϮϬϬϵ͘

WĂƌąŵĞƚƌŽƐ EǑ й

'ġŶĞƌŽ

DĂƐĐƵůŝŶŽ ϱ ϰϮ͕Ϭ

Feminino ϳ ϱϴ͕Ϭ

Idade

ϰϬਅϱϬĂŶŽƐ 1 ϴ͕Ϭ

ϱϬਅϲϬĂŶŽƐ 4 ϯϯ͕Ϭ

ϲϬਅϳϬĂŶŽƐ ϱ ϰϮ͕Ϭ

ϳϬਅϴϬĂŶŽƐ 2 ϭϳ͕Ϭ

ƐƚĂĚŽĐŝǀŝů

Solteiro ϱ ϰϮ͕Ϭ

Casado ϳ ϱϴ͕Ϭ

ŝĂŐŶſƐƟĐŽĐůşŶŝĐŽ

WK ϳ _ϱϴ͕Ϭ

WŶĞƵŵŽŶŝĂ 4 _ϯϰ͕Ϭ

ƐŵĂ 1 _ϴ͕Ϭ

ŶƚĞĐĞĚĞŶƚĞƐ

,ŝƉĞƌƚĞŶƐĆŽ 4 ϯϰ͕Ϭ

ŝĂďĞƚĞƐDĞůŝƚŽ 1 ϴ͕Ϭ

Tabagismo ϳ ϱϴ͕Ϭ

YƵĂŶĚŽĂŶĂůŝƐĂĚŽŽƐǀĂůŽƌĞƐĚĂƐƉƌĞƐƐƁĞƐŵĄdžŝŵĂƐĂŶƚĞƐ ĚĂ ĞdžƚƵďĂĕĆŽ͕ ĞŶĐŽŶƚƌŽƵͲƐĞ ƵŵĂ ŵĠĚŝĂ ĚĞ Ͳ ϯϴ͕ϯ ц ϯ͕Ϭϭ

Đŵ,2KƉĂƌĂĂW/ŵĄdžĞнϰϳ͕ϱцϯ͕ϯϲĐŵ,2KƉĂƌĂĂWŵĄdž͘

:ĄŽƐǀĂůŽƌĞƐĂƉſƐϮϰŚŽƌĂƐĚĂĞdžƚƵďĂĕĆŽĨŽƌĂŵĚĞͲϰϳц ϯ͕ϯϲĐŵ,2KƉĂƌĂW/ŵĄdžĞнϱϬцϲ͕ϮϱĐŵ,2KƉĂƌĂWŵĄdž͘

YƵĂŶĚŽ ĂŶĂůŝƐĂĚŽ ŽƐ ǀĂůŽƌĞƐ ĚĂ W/ŵĄdž ĂƉſƐ Ϯϰ ŚŽƌĂƐ ĚĂ ĞdžƚƵďĂĕĆŽ͕ ĞŶĐŽŶƚƌŽƵͲƐĞ ƋƵĞ ϱϴй ;ŶсϳͿ ĚŽƐ ƉĂĐŝĞŶƚĞƐ ĂƉƌĞƐĞŶƚĂƌĂŵĂƵŵĞŶƚŽĚŽǀĂůŽƌĚĂW/ŵĄdž͘:Ą͕ĞŵƌĞůĂĕĆŽ ĂWŵĄdž͕ĂŵĞůŚŽƌĂŽĐŽƌƌĞƵĞŵϰϮй;ŶсϱͿĚŽƐƉĂĐŝĞŶƚĞƐ͘ K ƚĞŵƉŽ ĚĞ ǀĞŶƟůĂĕĆŽ ŵĞĐąŶŝĐĂ ĚĂ ĂŵŽƐƚƌĂ ĨŽŝ ĚĞ ϵ͕ϱϳ ц ϭ͕ϯϴ ĚŝĂƐ͕ ƐĞŶĚŽ Ž ƉĂĐŝĞŶƚĞ ĐŽŵ ĚŝĂŐŶſƐƟĐŽ ĚĞ ĂƐŵĂ Ž ƋƵĞ ƉĞƌŵĂŶĞĐĞƵ ŵĂŝƐ ƚĞŵƉŽ ŶŽ ƐƵƉŽƌƚĞ ǀĞŶƟůĂƚſƌŝŽ͕

Ğŵ ƚŽƌŶŽ ĚĞ ϭϳ ĚŝĂƐ͕ ĞŶƋƵĂŶƚŽ ŽƐ ƉĂĐŝĞŶƚĞƐ ĐŽŵ WK ƉĞƌŵĂŶĞĐĞƌĂŵϴ͕ϱĚŝĂƐ;ŐƌĄĮĐŽϭͿ͘

'ƌĄĮĐŽ ϭŝƐƚƌŝďƵŝĕĆŽ ĚĂ ĂŵŽƐƚƌĂ ƐĞŐƵŶĚŽ Ž ƚĞŵƉŽ ĚĞ

ǀĞŶƟůĂĕĆŽŵĞĐąŶŝĐĂĞŽĚŝĂŐŶſƐƟĐŽĐůşŶŝĐŽ͘&ŽƌƚĂůĞnjĂ͕ͬ ϮϬϬϵ͘

Tempo de Ventilação Mecânica

ŽĂŶĂůŝƐĂƌŽǀĂůŽƌĚŽW,//͕ŽďƐĞƌǀŽƵͲƐĞƵŵĂŵĠĚŝĂĚĞ ϭϭ͕ϭϰцϭ͕ϰϳĞƐĐŽƌĞƐĂŶƚĞƐĚĂĞdžƚƵďĂĕĆŽĞĚĞϭϬ͕ϰϮцϭ͕ϯϮ ĞƐĐŽƌĞƐϮϰŚŽƌĂƐĂƉſƐĂĞdžƚƵďĂĕĆŽ͕ŶĆŽĞdžŝƐƟŶĚŽŐƌĂŶĚĞƐ ĂůƚĞƌĂĕƁĞƐ ĐŽŵ ƌĞůĂĕĆŽ ĂŽ ĞƐƚĂĚŽ ĚŽ ƉĂĐŝĞŶƚĞ ŶŽƐ ĚŽŝƐ ŵŽŵĞŶƚŽƐ ĚĂ ƉĞƐƋƵŝƐĂ͕ ĂƉƌĞƐĞŶƚĂŶĚŽ şŶĚŝĐĞ ƉƌŽŐŶſƐƟĐŽ ĚĞŵŽƌƚĂůŝĚĂĚĞĚĞϭϱй͘

DISCUSSÃO

KĞƐƚƵĚŽĚĞZŽƐĞ͕&ƌĂƐĞƌ;ϭϲͿ_{ĚĞƐƚĂĐĂƋƵĞϮϬйĚŽƐƉĂĐŝĞŶƚĞƐ}

ƐƵďŵĞƟĚŽƐ ă ǀĞŶƟůĂĕĆŽ ŵĞĐąŶŝĐĂ͕ ĞƐƚĆŽ ĐůĂƐƐŝĮĐĂĚŽƐ ĚĞŶƚƌŽ ĚŽ ĐŽŶĐĞŝƚŽ ĚĞ ǀĞŶƟůĂĕĆŽ ŵĞĐąŶŝĐĂ ƉƌŽůŽŶŐĂĚĂ͕ ƐĞŶĚŽϲϬйĚĞƐƐĞƐƉĂĐŝĞŶƚĞƐƉŽƌƚĂĚŽƌĞƐĚĞWK͘&ĂƌĂŚ͕ DĂŬŚŽƵů;ϭϳͿ _{ĐŝƚĂ ƋƵĞ ĂƐ ĞdžĂĐĞƌďĂĕƁĞƐ ĚŽƐ ƉĂĐŝĞŶƚĞƐ}

ĐŽŵ WK ŐĞƌĂůŵĞŶƚĞ ĞǀŽůƵĞŵ ĐŽŵ Ă ŶĞĐĞƐƐŝĚĂĚĞ ĚĞ ŝŶƚĞƌǀĞŶĕĆŽ ŵĠĚŝĐĂ Ğ ĞƐƐĞƐ ĞǀĞŶƚŽƐ ƐĆŽ ĐůŝŶŝĐĂŵĞŶƚĞ ŝŵƉŽƌƚĂŶƚĞƐ͘EŽƉƌĞƐĞŶƚĞĞƐƚƵĚŽ͕ŽƚĞŵƉŽĚĞǀĞŶƟůĂĕĆŽ ŵĞĐąŶŝĐĂĨŽŝĞŵŵĠĚŝĂĚĞϵ͕ϱϳцϭ͕ϯϴĚŝĂƐ͕ƐĞŶĚŽƋƵĞŽƐ ƉĂĐŝĞŶƚĞƐ ĐŽŵ ĚŝĂŐŶſƐƟĐŽ ĚĞ ĂƐŵĂ ƉĞƌŵĂŶĞĐĞƌĂŵ ŵĂŝƐ ƚĞŵƉŽ ŶŽ ƐƵƉŽƌƚĞ ǀĞŶƟůĂƚſƌŝŽ͕ ĐŽŵ ŵĠĚŝĂ ĚĞ ϭϳ ц ϭ͕ϮϬ ĚŝĂƐ͕ĞŶƋƵĂŶƚŽƋƵĞŽƐƉĂĐŝĞŶƚĞƐĐŽŵWKƉĞƌŵĂŶĞĐĞƌĂŵ ĞŵŵĠĚŝĂϴ͕ϱцϮ͕ϯϰĚŝĂƐ͘

Segundo Chen ĞƚĂů;ϭϴͿĂĐĂƵƐĂŵĂŝƐĐŽŵƵŵĚĞĚĞƉĞŶĚġŶĐŝĂ ĚĂ ǀĞŶƟůĂĕĆŽ ŵĞĐąŶŝĐĂ Ġ Ă ĨƌĂƋƵĞnjĂ ĚŽƐ ŵƷƐĐƵůŽƐ ŝŶƐƉŝƌĂƚſƌŝŽƐ͕ƉƌŝŶĐŝƉĂůŵĞŶƚĞƋƵĂŶĚŽĂƐƐŽĐŝĂĚŽĂŽƵƐŽĚĞ ƌĞůĂdžĂŶƚĞƐ ŵƵƐĐƵůĂƌĞƐ ŽƵ ĂůƚĂƐ ĚŽƐĞƐ ĚĞ ĞƐƚĞƌſŝĚĞƐ͕ ƋƵĞ ƉŽĚĞŵ ĨĂǀŽƌĞĐĞƌ Ž ĂƉĂƌĞĐŝŵĞŶƚŽ ĚĞ ŵŝŽƉĂƟĂƐ͘ WĞƌƌĞŶ

Ğƚ Ăů;ϮͿ _{ƋƵĞ ƌĞĂůŝnjĂƌĂŵ Ƶŵ ĞŶƐĂŝŽ ĐůşŶŝĐŽ Ğ ŽďƐĞƌǀĂƌĂŵ}

ƵŵĂ ƌĞĚƵĕĆŽ ŶĂ ĨŽƌĕĂ ĚŽ ĚŝĂĨƌĂŐŵĂ ĂƉſƐ͕ ϭϮ ŚŽƌĂƐ ĚĞ ǀĞŶƟůĂĕĆŽŵĞĐąŶŝĐĂĐŽŶƚƌŽůĂĚĂ͘DŽƐƚƌĂŶĚŽƋƵĞƉĂĐŝĞŶƚĞƐ ƐƵďŵĞƟĚŽƐ ă ĂƐƐŝƐƚġŶĐŝĂ ǀĞŶƟůĂƚſƌŝĂ ƉƌŽůŽŶŐĂĚĂ ƉŽĚĞŵ ĂƉƌĞƐĞŶƚĂƌĂůƚĞƌĂĕƁĞƐŝŵƉŽƌƚĂŶƚĞƐŶĂĨŽƌĕĂĚŽƐŵƷƐĐƵůŽƐ ƌĞƐƉŝƌĂƚſƌŝŽƐ͘

ŽďƐĞƌǀĂƌĂŵ ƋƵĞ ƉĂĐŝĞŶƚĞƐ ĐĂƉĂnjĞƐ ĚĞ ŐĞƌĂƌ W/ŵĄdž ƐƵƉĞƌŝŽƌĂͲϯϬĐŵ,2KƐĆŽĞdžƚƵďĂĚŽƐĐŽŵƐƵĐĞƐƐŽĞŽƐƋƵĞ

ŽďƟǀĞƌĂŵ W/ŵĄdž ŝŶĨĞƌŝŽƌ Ă Ͳ ϮϬ Đŵ,2K ƐĆŽ ŝŶĐĂƉĂnjĞƐ ĚĞ

ŵĂŶƚĞƌĂƌĞƐƉŝƌĂĕĆŽĞƐƉŽŶƚąŶĞĂ͘KƐƌĞƐƵůƚĂĚŽƐĚŽƉƌĞƐĞŶƚĞ ĞƐƚƵĚŽĐŽƌƌŽďŽƌĂŵĞƐƐĞƐĚĂĚŽƐ͕ƵŵĂǀĞnjƋƵĞŽƐƉĂĐŝĞŶƚĞƐ

ĂƉƌĞƐĞŶƚĂƌĂŵƵŵĂŵĠĚŝĂĚĞW/ŵĄdžĚĞϯϴ͕ϯцϯ͕ϬϭĐŵ,2KĞ

ƚŽĚŽƐƟǀĞƌĂŵƵŵĞdžƚƵďĂĕĆŽďĞŵƐƵĐĞĚŝĚĂ͘

ŵƌĞůĂĕĆŽăWŵĄdž͕ŽƐĞƐƚƵĚŽƐĚĞ^ĂůĂŵĞƚĂů;ϭϵͿ _atestam

ƋƵĞĞƐƚĞƉĂƌąŵĞƚƌŽŶĆŽĠƵŵĨĂƚŽƌƉƌĞĚŝƟǀŽĚĞƐƵĐĞƐƐŽ ĚĂ ĞdžƚƵďĂĕĆŽ ŵĂƐ ĚĞǀĞ ƐĞƌ ĂǀĂůŝĂĚŽ͕ ƉŽŝƐ ĞdžƉƌĞƐƐĂ Ă ĨŽƌĕĂĚŽƐŵƷƐĐƵůŽƐĞdžƉŝƌĂƚſƌŝŽƐ͕ŽƵƐĞũĂ͕ĂĐĂƉĂĐŝĚĂĚĞĚĞ ƚŽƐƐĞ͘ ƐƐŝŵ͕ Ă ĚŝŵŝŶƵŝĕĆŽ ĚĂ WŵĄdž ƐŝŐŶŝĮĐĂ ƵŵĂ ƚŽƐƐĞ ŝŶĞĮĐĂnjŽƵĂďŽůŝĚĂ͕ŽƋƵĞƉŽĚĞĐĂƵƐĂƌĨĂůŚĂĚĂĞdžƚƵďĂĕĆŽ ƉƌŝŶĐŝƉĂůŵĞŶƚĞĞŵƉĂĐŝĞŶƚĞƐŚŝƉĞƌƐĞĐƌĞƟǀŽƐ͘

^ĞŐƵŶĚŽ^ŽƵnjĂ;ϭϮͿ_{ĂƐŵĞŶƐƵƌĂĕƁĞƐĚĂƐƉƌĞƐƐƁĞƐƌĞƐƉŝƌĂƚſƌŝĂƐ}

ŵĄdžŝŵĂƐ ĚĞƉĞŶĚĞŵ ĚĂ ĐŽŵƉƌĞĞŶƐĆŽ ĚĂƐ ŵĂŶŽďƌĂƐ Ă ƐĞƌĞŵĞdžĞĐƵƚĂĚĂƐ͕ĚĂƉŽƐŝĕĆŽĞĚĂĐŽŽƉĞƌĂĕĆŽĚŽƉĂĐŝĞŶƚĞ ĚĞ ƌĞĂůŝnjĂƌ ĞƐĨŽƌĕŽƐ ƌĞƐƉŝƌĂƚſƌŝŽƐ ŵĄdžŝŵŽƐ͘ ůĠŵ ĚŝƐƐŽ͕ ŽƐ ǀĂůŽƌĞƐ ĚĞƉĞŶĚĞŵ ƚĂŵďĠŵ ĚŽ ǀŽůƵŵĞ ƉƵůŵŽŶĂƌ Ğŵ ƋƵĞ ĨŽƌĂŵ ĨĞŝƚĂƐ ĂƐ ŵĞŶƐƵƌĂĕƁĞƐ͘ ŽŵŽ Ă ŵĞĚŝĚĂ ĚĂƐ ƉƌĞƐƐƁĞƐ ŵĄdžŝŵĂƐ ĨŽŝ ƌĞĂůŝnjĂĚĂ Ğŵ ĚŽŝƐ ŵŽŵĞŶƚŽƐ͕ Ž ƉŽƐŝĐŝŽŶĂŵĞŶƚŽ ĚŽ ƉĂĐŝĞŶƚĞ Ğ Ă ƌĞƐŝƐƚġŶĐŝĂ ĚĂ ǀŝĂ ĂĠƌĞĂ

ƉŽĚĞŵƚĞƌŝŶƚĞƌĨĞƌŝĚŽŶŽƌĞƐƵůƚĂĚŽĚŽƐǀĂůŽƌĞƐƉƌĠĞƉſƐ ĞdžƚƵďĂĕĆŽ͕ƉŽŝƐŽƚƵƌŽƚƌĂƋƵĞĂůĂƵŵĞŶƚĂĂƌĞƐŝƐƚġŶĐŝĂĞ ĐŽŶƐĞƋƵĞŶƚĞŵĞŶƚĞĚŝŵŝŶƵŝŽǀŽůƵŵĞƉƵůŵŽŶĂƌ͕ƉŽĚĞŶĚŽ ƌĞƐƵůƚĂƌĞŵƵŵŵĞŶŽƌǀĂůŽƌĚĂW/ŵĄdžĞWŵĄdž͘

^ĞŐƵŶĚŽ ůǀĞƐĞƚ Ăů;ϮϬͿ_{Ž W, // Ġ Ƶŵ ƐŝƐƚĞŵĂ ĚĞ}

ĐůĂƐƐŝĮĐĂĕĆŽ ĚĞ ƐĞǀĞƌŝĚĂĚĞ ĚĞ ĚŽĞŶĕĂ ƋƵĞ ŽďũĞƟǀĂ ă ĚĞƐĐƌŝĕĆŽ ƋƵĂŶƟƚĂƟǀĂ ĚŽ ŐƌĂƵ ĚĞ ĚŝƐĨƵŶĕĆŽ ŽƌŐąŶŝĐĂ ĚŽ ƉĂĐŝĞŶƚĞ ŐƌĂǀĞ Ğ Ă ĞdžƉƌĞƐƐĆŽ ĚŽ şŶĚŝĐĞ ƉƌŽŐŶſƐƟĐŽ͘ ĂƉůŝĐĂĕĆŽĚĞƐƐĞƐŝƐƚĞŵĂƉĞƌŵŝƟƵĂĐŽŵƉĂŶŚĂƌĂĞǀŽůƵĕĆŽĞ ĂƌĞƐƉŽƐƚĂĚŽƉĂĐŝĞŶƚĞĂŶƚĞƐĞĂƉſƐĂĞdžƚƵďĂĕĆŽ͘

K ƉƌĞƐĞŶƚĞ ĞƐƚƵĚŽ ƌĞŐŝƐƚƌĂ ĐŽŵŽ ƉƌŝŶĐŝƉĂů ůŝŵŝƚĂĕĆŽ Ž ƚĂŵĂŶŚŽ ĚĂ ĂŵŽƐƚƌĂ͕ ƐĞŶĚŽ ŶĞĐĞƐƐĄƌŝĂ Ă ƌĞĂůŝnjĂĕĆŽ ĚĞ ŶŽǀŽƐ ƚƌĂďĂůŚŽƐ ĐŽŵ ĂŵŽƐƚƌĂƐ ŵĂŝŽƌĞƐ ƉĂƌĂ ǀĞƌŝĮĐĂƌ Ă ƌĞƉƌŽĚƵƟďŝůŝĚĂĚĞĞĂĐŽŶƐŝƐƚġŶĐŝĂĚĞƐƐĞƐĂĐŚĂĚŽƐ͘

CONCLUSÃO

KďƐĞƌǀŽƵͲƐĞƵŵĂŵĞůŚŽƌĂĚĂĨŽƌĕĂŵƵƐĐƵůĂƌƌĞƐƉŝƌĂƚſƌŝĂ ĂƉſƐϮϰŚŽƌĂƐĚĞĞdžƚƵďĂĕĆŽ͕ƐƵŐĞƌŝŶĚŽƋƵĞĂsDƉŽƌƚĞŵƉŽ ƉƌŽůŽŶŐĂĚŽ ƉŽĚĞ ĐĂƵƐĂƌ ĨƌĂƋƵĞnjĂ Ğ ŚŝƉŽƚƌŽĮĂ ŵƵƐĐƵůĂƌ ƌĞƐƉŝƌĂƚſƌŝĂĞĐŽŶƐĞƋƵĞŶƚĞŵĞŶƚĞĚŝĮĐƵůƚĂƌŽƉƌŽĐĞƐƐŽĚĞ ĚĞƐŵĂŵĞĚĂsDĞĞdžƚƵďĂĕĆŽ͘

REFERÊNCIAS

ϭ͘>Ƶ,D͕ŚĞŶ>͕tĂŶŐ:͕,ƵŶŐD͕>ŝŶD^͕zĂŶz,ĞƚĂů͘KƵƚĐŽŵĞƐ ŽĨĂƉƌŽůŽŶŐĞĚŵĞĐŚĂŶŝĐǀĞŶƟůĂƟŽŶ͗ĂĚŝƐĐƌŝŵŝŶĂƟŽŶŵŽĚĞůďĂƐĞĚŽŶ ůŽŶŐŝƚƵĚŝŶĂůŚĞĂůƚŚŝŶƐƵƌĂŶĐĞĂŶĚĚĞĂƚŚĐĞƌƟĮĐĂƚĞĚĂƚĂ͘,ĞĂůƚŚ^Ğƌǀ ZĞƐ͘ϮϬϭϮ͖ϭϮ͗ϭϬϬ͘K/͗ϭϬ͘ϭϭϴϲͬϭϰϳϮͲϲϵϲϯͲϭϮͲϭϬϬ

Ϯ͘ WĞƌƌĞŶ ͕ ŽŵĞŶŝŐŚĞƫ '͕ DĂƵƌŝ ^͕ 'ĞŶŝŶŝ &͕ sŝnjnjĂƌĚŝ E͘ WƌŽƚŽĐŽůͲ ĚŝƌĞĐƚĞĚ ǁĞĂŶŝŶŐ ĨƌŽŵ ŵĞĐŚĂŶŝĂů ǀĞŶƟůĂƟŽŶ͗ ĐůŝŶŝĐĂů ŽƵƚĐŽŵĞƐ ŝŶ ƉĂƟĞŶƚƐƌĂŶĚŽŵŝnjĞĚĨŽƌϯϬŵŝŶŽƵϭϮϬŵŝŶƚƌŝĂůǁŝƚŚƉƌĞƐƐƵƌĞƐƵƉƉŽƌƚ ǀĞŶƟůĂƟŽŶ͘/ŶƚĞŶƐŝǀĞĂƌĞDĞĚ͘ϮϬϬϮ͖Ϯϴ;ϯͿ͗ϭϬϱϴͲϲϯ͘WƵďDĞĚ͖WD/ ϭϮϭϴϱϰϮϱ͘

ϯ͘&ƌƵƚŽƐͲsŝǀĂƌ&͕ƐƚĞďĂŶ͘tĞĂŶŝŶŐĨƌŽŵŵĞĐŚĂŶŝĐĂůǀĞŶƟůĂƟŽŶ͗ǁŚLJ ĂƌĞ ǁĞ ƐƟůů ůŽŽŬŝŶŐ ĨŽƌ ĂůƚĞƌŶĂƟǀĞ ŵĞƚŚŽĚƐ͍͘ DĞĚ /ŶƚĞŶƐŝǀĂ͘ ϮϬϭϯ͖ ϯϳ;ϵͿ͗ϲϬϱͲϭϳ͘WƵďDĞĚ͖WD/ϮϯϬϴϰϭϮϬ͘

ϰ͘sĞƌĐĞůĞƐ͕>ĞĐŚŶĞƌ:͕,ĂůƉŝŶ͕^ĐŚĂƌĨ^D͘dŚĞĂƐƐŽĐŝĂƟŽŶďĞƚǁĞĞŶ ĐŽŵŽƌďŝĚ ŝůůŶĞƐƐ͕ ĐŽůŽŶŝnjĂƟŽŶ ƐƚĂƚƵƐ͕ ĂŶĚ ĂĐƵƚĞ ŚŽƐƉŝƚĂůŝnjĂƟŽŶ ŝŶ ƉĂƟĞŶƚƐƌĞĐĞŝǀŝŶŐƉƌŽůŽŶŐĞĚŵĞĐŚĂŶŝĐĂůǀĞŶƟůĂƟŽŶ͘ZĞƐƉŝƌĂƌĞ͘ϮϬϭϯ͖ ϱϴ;ϮͿ͗ϮϱϬͲϲ͘WƵďDĞĚ͖WD/ϮϮϳϬϵϱϲϱ͘

ϱ͘^ŽƵƐĂ͘sĞŶƟůĂĕĆŽŵĞĐąŶŝĐĂƉƌŽůŽŶŐĂĚĂ͗ĐĂƌĂĐƚĞƌŝnjĂĕĆŽĚĞŵŽŐƌĄĮĐĂĞ ĨĂƚŽƌĞƐƉƌĞĚŝƐƉŽŶĞŶƚĞƐ͘ZĞǀWŽƌƚDĞĚ/ŶƚĞŶ͘ϮϬϬϳ͖ϭϬ;ϮͿ͗ϮϯϯͲϯϲ͘

ϲ͘dŚŝůůĞt͘^ŝŵƉůĞ͕ĚŝĸĐƵůƚ͕ŽƌƉƌŽůŽŶŐĞĚǁĞĂŶŝŶŐ͗ƚŚĞŵŽƐƚŝŵƉŽƌƚĂŶƚ ĨĂĐƚŽƌŝƐƚŚĞƐƵĐĐĞƐƐŽƌĨĂŝůƵƌĞŽĨƚŚĞĮƌƐƚǁĞĂŶŝŶŐƚƌŝĂů͘ZĞƐƉŝƌĂƌĞ ΀/ŶƚĞƌŶĞƚ΁͘ϮϬϭϭDĂLJ΁΀ĂĐĞƐƐŽϮϬϭϰũĂŶϭϳ΁͖ϱϲ;ϱͿ͗ϳϭϲͲϳ͘ŝƐƉŽŶşǀĞůĞŵ͗ ŚƩƉ͗ͬͬŵLJĚŝŐŝŵĂŐ͘ƌƌĚ͘ĐŽŵͬĂƌƟĐůĞͬ^ŝŵƉůĞ͕ͺŝĸĐƵůƚ͕ͺKƌͺWƌŽůŽŶŐĞĚͺ tĞĂŶŝŶŐйϯͺdŚĞͺDŽƐƚͺ/ŵƉŽƌƚĂŶƚͺ&ĂĐƚŽƌͺ/ƐͺdŚĞͺ^ƵĐĐĞƐƐͺKƌͺ &ĂŝůƵƌĞͺKĨͺdŚĞͺ&ŝƌƐƚͺtĞĂŶŝŶŐͺdƌŝĂůͬϳϮϰϳϬϭͬϲϵϰϬϮͬĂƌƟĐůĞ͘Śƚŵů͘

ϳ͘ ŵďƌŽƐŝŶŽ E͕ sĞŶƚƵƌĞůůŝ ͕ sĂŐŚĞŐŐŝŶŝ '͕ ůŝŶŝ ͘ ZĞŚĂďŝͲ ůŝƚĂƟŽŶ͕ǁĞĂŶŝŶŐĂŶĚƉŚLJƐŝĐĂůƚŚĞƌĂƉLJƐƚƌĂƚĞŐŝĞƐŝŶĐŚƌŽŶŝĐĐƌŝƟĐĂůůLJŝůů ƉĂƟĞŶƚƐ͘ƵƌZĞƐƉŝƌ:͘ϮϬϭϮ͖ϯϵ;ϮͿ͗ϰϴϳͲϵϮ͘WƵďDĞĚ͖WD/ϮϮϭϯϱϮϳϴ͘

ϴ͘ tĂŶnjƵŝƚĂ Z͕ WŽůŝͲĚĞͲ&ŝŐƵĞŝƌĞĚŽ >&͕ WĨƵĞƚnjĞŶƌĞŝƚĞƌ &͕ ĂǀĂůĐĂŶƟ ͕ tĞƐƚƉŚĂů'͘ZĞƉůĂĐĞŵĞŶƚŽĨĨĞŶƚĂŶLJůŝŶĨƵƐŝŽŶďLJĞŶƚĞƌĂůŵĞƚŚĂĚŽŶĞ ĚĞĐƌĞĂƐĞƐƚŚĞǁĞĂŶŝŶŐƟŵĞĨƌŽŵŵĞĐŚĂŶŝĐĂůǀĞŶƟůĂƟŽŶ͗ĂƌĂŶĚŽŵŝnjĞĚ ĐŽŶƚƌŽůůĞĚƚƌŝĂů͘ƌŝƚĂƌĞ͘ϮϬϭϮ͖ϭϲ;ϮͿ͗ϰϵ͘K/͗ϭϬ͘ϭϭϴϲͬĐĐϭϭϮϱϬ͘

ϵ͘ 'ŽůĚǁĂƐƐĞƌ Z͕ &ĂƌŝĂƐ ͕ &ƌĞŝƚĂƐ ͕ ^ĂĚĚLJ &͕ ŵĂĚŽ s͕ KŬĂŵŽƚŽ sE͘ ĞƐŵĂŵĞ Ğ ŝŶƚĞƌƌƵƉĕĆŽ ĚĂ ǀĞŶƟůĂĕĆŽ ŵĞĐąŶŝĐĂ͘ ZĞǀ͘ ďƌĂƐ͘ ƚĞƌ͘ ŝŶƚĞŶƐŝǀĂ ΀/ŶƚĞƌŶĞƚ΁͘ ϮϬϬϳ ΀ĂĐĞƐƐŽ ϮϬϭϰ &Ğǀ ϮϬϭϮ΁͖ ϭϵ;ϯͿ͗ ϯϴϰͲϵϮ͘ ŝƐƉŽŶşǀĞůĞŵ͗ŚƩƉ͗ͬͬǁǁǁ͘ƐĐŝĞůŽ͘ďƌͬƉĚĨͬƌďƟͬǀϭϵŶϯͬǀϭϵŶϯĂϮϭ͘ƉĚĨ͘

ϭϬ͘^ŝůǀĂ^͕dŝŵĞŶĞƚƐŬLJ<d͕dĂŶŝŐƵĐŚŝ͕ĂůĞŐĂƌŽ^͕njĞǀĞĚŽ^͕^ƚƵƐZ͕ ĚĞDĂƚŽƐ'&:͕ĞƚĂů͘>ŽǁŵĞĐŚĂŶŝĐĂůǀĞŶƟůĂƟŽŶƟŵĞƐĂŶĚƌĞŝŶƚƵďĂƟŽŶ ƌĂƚĞƐĂƐƐŽĐŝĂƚĞĚǁŝƚŚĂƐƉĞĐŝĮĐǁĞĂŶŝŶŐƉƌŽƚŽĐŽůŝŶĂŶŝŶƚĞŶƐŝǀĞĐĂƌĞ ƵŶŝƚƐĞƫŶŐ͗ĂƌĞƚƌŽƐƉĞĐƟǀĞƐƚƵĚLJ͘ůŝŶŝĐƐ΀/ŶƚĞƌŶĞƚ΁͘^ĞƉƚϮϬϭϮ΀ĂĐĞƐƐŽ ϮϬϭϰ &Ğǀ ϭϰ͖ ϲϳ;ϵͿ͗ ϵϵϱͲϭϬϬϬ͘ ŝƐƉŝŶşǀĞů Ğŵ͗ ŚƩƉ͗ͬͬǁǁǁ͘ƐĐŝĞůŽ͘ďƌͬ ƐĐŝĞůŽ͘ƉŚƉ͍ƐĐƌŝƉƚсƐĐŝͺĂƌƩĞdžƚΘƉŝĚс^ϭϴϬϳͲϱϵϯϮϮϬϭϮϬϬϬϵϬϬϬϬϮ͘

ϭϭ͘ şĂnj D͕ KƐƉŝŶĂͲdĂƐĐſŶ '͕ ^ĂůĂnjĂƌ ͘ ZĞƐƉŝƌĂƚŽƌLJ ŵƵƐĐůĞ ĚLJƐĨƵŶĐƟŽŶ͗ Ă ŵƵůƟĐĂƵƐĂů ĞŶƟƚLJ ŝŶ ƚŚĞ ĐƌŝƟĐĂůůLJ ŝůů ƉĂƟĞŶƚ ƵŶĚĞƌŐŽŝŶŐŵĞĐŚĂŶŝĐĂůǀĞŶƟůĂƟŽŶ͘ƌĐŚƌŽŶĐŽŶĞƵŵŽů͘ϮϬϭϰ͖ϱϬ;ϮͿ͗ ϳϯͲϳ͘K/͗ϭϬ͘ϭϬϭϲͬũ͘ĂƌďƌĞƐ͘ϮϬϭϯ͘Ϭϯ͘ϬϬϱ͘

ϭϮ͘ ĂƐƚƌŽ ͕ ŽƌƚŽƉĂƐƐŝ &͕ ^ĂďďĂŐ Z͕ dŽƌƌĞͲŽƵƐĐŽƵůĞƚ >͕ <ƺŵƉĞů ͕ &ĞƌƌĞŝƌĂ WŽƌƚŽ ͘ ZĞƐƉŝƌĂƚŽƌLJ ŵƵƐĐůĞ ĂƐƐĞƐƐŵĞŶƚ ŝŶ ƉƌĞĚŝĐƟŶŐ ĞdžƚƵďĂƟŽŶŽƵƚĐŽŵĞŝŶƉĂƟĞŶƚƐǁŝƚŚƐƚƌŽŬĞ͘ƌĐŚƌŽŶĐŽŶĞƵŵŽů͘ϮϬϭϮ͖ ϰϴ;ϴͿ͗ϮϳϰͲϵ͘K/͗ϭϬ͘ϭϬϭϲͬũ͘ĂƌďƌĞƐ͘ϮϬϭϮ͘Ϭϰ͘ϬϭϬ͘

ϭϯ͘ƌĂƐŝů͘ZĞƐŽůƵĕĆŽE^ŶŽϭϵϲ͕ĚĞϭϬĚĞŶŽǀĞŵďƌŽĚĞϭϵϵϲ͘ƉƌŽǀĂƌ ĚŝƌĞƚƌŝnjĞƐĞŶŽƌŵĂƐƌĞŐƵůĂŵĞŶƚĂĚŽƌĂƐĚĞƉĞƐƋƵŝƐĂĞŶǀŽůǀĞŶĚŽƐĞƌĞƐ ŚƵŵĂŶŽƐ͘ŝĄƌŝŽKĮĐŝĂů΀ĚĂ΁ZĞƉƷďůŝĐĂ&ĞĚĞƌĂƟǀĂĚŽƌĂƐŝů͘ϭϵϵϲͬϭϬ͘ KhϭϲͬϭϬͬϭϵϵϲ͗ϮϭϬϴϭͲϮϭϬϴϱ͘

ϭϱ͘WƌĞƐƚŽ͕WƌĞƐƚŽ>E͘&ŝƐŝŽƚĞƌĂƉŝĂƌĞƐƉŝƌĂƚſƌŝĂ͗ƵŵĂŶŽǀĂǀŝƐĆŽ͘Ϯ͘ĞĚ͘ ZŝŽĚĞ:ĂŶĞŝƌŽ͗W͖ϮϬϬϱ͘

ϭϲ͘ZŽƐĞ>͕&ƌĂƐĞƌ/D͘WĂƟĞŶƚĐŚĂƌĂĐƚĞƌŝƐƟĐƐĂŶĚŽƵƚĐŽŵĞƐŽĨĂƉƌŽǀŝŶĐŝĂů ƉƌŽůŽŶŐĞĚͲǀĞŶƟůĂƟŽŶ ǁĞĂŶŝŶŐ ĐĞŶƚƌĞ͗ Ă ƌĞƚƌŽƐƉĞĐƟǀĞ ĐŽŚŽƌƚ ƐƚƵĚLJ͘ ĂŶZĞƐƉŝƌ:͘ϮϬϭϮ͖ϭϵ;ϯͿ͗ϮϭϲͲϮϬ͘WƵďDĞĚ͖WD/ϮϮϲϳϵϲϭϱ͘

ϭϳ͘&ĂƌĂŚZ͕DĂŬŚŽƵůE͘KƉƟŵĂůƟŵĞŶĞĞĚĞĚĨŽƌǁŝƚŚĚƌĂǁĂůŽĨŵĞĐŚĂŶŝĐĂů ǀĞŶƟůĂƟŽŶŝŶƉĂƟĞŶƚƐǁŝƚŚĐŚƌŽŶŝĐŽďƐƚƌƵĐƟǀĞƉƵůŵŽŶĂƌLJĚŝƐĞĂƐĞ͘/Ɛƌ DĞĚƐƐŽĐ:͘ϮϬϭϭ͖ϭϯ;ϭϬͿ͗ϲϬϵͲϭϮ͘WƵďDĞĚ͖WD/ϮϮϬϵϳϮϯϬ͘

ϭϴ͘ŚĞŶz,͕>ŝŶ,>͕,ƐŝĂŽ,&͕ŚŽƵ>d͕<ĂŽ<͕,ƵĂŶŐĞƚĂů͘īĞĐƚƐ ŽĨĞdžĞƌĐŝƐĞƚƌĂŝŶŝŶŐŽŶƉƵůŵŽŶĂƌLJŵĞĐŚĂŶŝĐƐĂŶĚĨƵŶĐƟŽŶĂůƐƚĂƚƵƐŝŶ ƉĂƟĞŶƚƐ ǁŝƚŚ ƉƌŽůŽŶŐĞĚ ŵĞĐŚĂŶŝĐĂů ǀĞŶƟůĂƟŽŶ͘ ZĞƐƉŝƌ ĂƌĞ͘ ϮϬϭϮ͖ ϱϳ;ϱͿ͗ϳϮϳͲϯϰ͘WƵďDĞĚ͖WD/ϮϮϭϱϮϵϳϴ͘

ŽŵŽĐŝƚĂƌĞƐƚĞĂƌƟŐŽͬ,ŽǁƚŽĐŝƚĞƚŚŝƐĂƌƟĐůĞ͗

DŽƌĞŝƌĂWD͕sĂƐĐŽŶĐĞůŽƐZ^͕^ĂůĞƐZW͕ƌĂƷũŽ͕DŽƌĞŝƌĂdy͕^ŽƵƐĂd͕ZŽĐŚĂDD͕ĂƐƚŽƐsW͘ǀĂůŝĂĕĆŽĚĂ&ŽƌĕĂDƵƐĐƵůĂƌZĞƐƉŝƌĂƚſƌŝĂĞŵWĂĐŝĞŶƚĞƐ ^ƵďŵĞƟĚŽƐăsĞŶƟůĂĕĆŽDĞĐąŶŝĐĂWƌŽůŽŶŐĂĚĂWƌĠĞWſƐdžƚƵďĂĕĆŽĞŵƵŵ,ŽƐƉŝƚĂůĚĞ&ŽƌƚĂůĞnjĂͬ͘:,ĞĂůƚŚŝŽů^Đŝ͘ϮϬϭϰďƌͲ:ƵŶ͖Ϯ;ϮͿ͗ϱϳͲϲϭ͘

ϭϵ͘ ^ĂůĂŵ ͕ dŝůůƵĐŬĚŚĂƌƌLJ >͕ ŵŽĂƚĞŶŐͲĚũĞƉŽŶŐ z͕ DĂŶƚŚŽƵƐ ͘ EĞƵƌŽůŽŐŝĐ ƐƚĂƚƵƐ͕ ĐŽƵŐŚ͕ ƐĞĐƌĞƟŽŶƐ ĂŶĚ ĞdžƚƵďĂƟŽŶƐ ŽƵƚĐŽŵĞƐ͘ /ŶƚĞŶƐŝǀĞĂƌĞDĞĚ͘ϮϬϬϰ͖ϯϬ;ϮͿ͗ϭϯϯϰͲϯϵ͘WƵďDĞĚ͖WD/ϭϰϵϵϵϰϰϰ͘