Factores de riesgo de destete ventilatorio fallido en pacientes sépticos en una unidad de cuidado intensivo: estudio de casos y controles

Publicado

2022-10-01

Risk factors associated with failed weaning from mechanical ventilation in septic patients admitted to an intensive care unit: a case-control study

Factores de riesgo de destete ventilatorio fallido en pacientes sépticos en una unidad de cuidado intensivo: estudio de casos y controles

Palabras clave:

Sepsis, Respiration, Artificial, Ventilator Weaning (en)
Sepsis, Respiración artificial, Desconexión del ventilador (es)

Descargas

Autores/as

Lorena Enriquez Riascos Universidad Libre - Facultad de Ciencias de la Salud - Maestría en Epidemiología - Cali - Colombia https://orcid.org/0000-0001-9769-929X
Herney Andrés García Perdomo Universidad del Valle - Escuela de Medicina - Departmento de Cirugía - Sección de Urología - Grupo de investigación UROGIV - Cali - Colombia. https://orcid.org/0000-0001-6945-8261

Resumen (en)
Resumen (es)

Introduction: Several risk factors associated with weaning failure may be observed in septic patients requiring invasive mechanical ventilation.

Objective: To determine the risk factors associated with weaning failure in septic patients admitted to an intensive care unit (ICU) in Cali, Colombia, between January 2014 and June 2018.

Materials and methods: Case-control study conducted in 315 patients who required mechanical ventilation for more than 48 hours and were distributed as follows: 105 cases (weaning failure) and 210 controls (successful weaning). Information about sociodemographic and clinical variables was obtained from their medical records. A bivariate analysis was performed to determine the association between each independent variable and weaning failure. A multivariate analysis was also carried out using a logistic regression model in which the variables with a p<0.20 in the bivariate analysis were entered. A significance level of p≤0.05 was considered.

Results: Requiring mechanical ventilation for more than 7 days (OR: 15.13; 95%CI: 8.25-27.74), having a high APACHE II score (mortality risk >50%) on ICU admission (OR: 3.16; 95%CI: 1.73-5.77), and having diuresis ≤0.5 mL/kg/h (OR: 1.87; 95%CI: 1.0-3.50) were significantly associated with weaning failure.

Conclusions: Requiring mechanical ventilation for more than 7 days, having diuresis ≤0.5ml/kg/h, as well as a high APACHE ll score on ICU admission were risk factors associated with failed weaning from mechanical ventilation in this study; however, age, blood urea nitrogen, creatinine, and positive fluid balance were not significantly associated with it, despite being described as risk factors in the literature.

Introducción. En pacientes sépticos con requerimiento de ventilación mecánica invasiva pueden presentarse diferentes factores de riesgo de destete ventilatorio fallido.

Objetivo. Determinar los factores de riesgo de destete ventilatorio fallido en pacientes sépticos admitidos a una unidad de cuidados intensivos (UCI) de Cali, Colombia, entre enero de 2014 y junio 2018

Materiales y métodos. Estudio de casos y controles realizado en 315 pacientes que requirieron ventilación mecánica por más de 48 horas distribuidos así: 105 casos (destete fallido) y 210 controles (destete exitoso). La información sobre variables sociodemográficas y clínicas se obtuvo a partir de la revisión de historias clínicas. Se realizó un análisis bivariado para determinar las asociaciones de cada variable independiente con el destete fallido y un análisis multivariado mediante un modelo de regresión logística en el que se ingresaron las variables que en el análisis bivariado tuvieron un valor p<0.20. Se consideró un nivel de significancia de p≤0.05.

Resultados. Haber requerido ventilación mecánica por más de 7 días (OR: 15.13; IC95% 8.25-27.74), tener un puntaje APACHE II alto (riesgo de mortalidad >50%) al ingreso a UCI (OR: 3.16; 95%IC: 1.73-5.77) y tener diuresis ≤0.5 mL/kg/h (OR: 1.87; IC95% 1.0-3.50) se asociaron significativamente con el destete ventilatorio fallido.

Conclusiones. En el presente estudio, el requerimiento de ventilación mecánica mayor a 7 días, la diuresis ≤0.5 mL/kg/h y un puntaje APACHE II alto al ingreso a UCI fueron factores de riesgo para destete ventilatorio fallido, pero no se observó asociación con la edad, el nitrógeno ureico en sangre, la creatinina y el balance de líquidos positivos, a pesar de que estos han sido descritos como factores de riesgo en la literatura.

Descargas

Los datos de descargas todavía no están disponibles.

Citas

Fernando S, McIsaac D, Rochwerg B, Bagshaw SM, Muscedere J, Munshi L, et al. Frailty and invasive mechanical ventilation: association with outcomes, extubation failure, and tracheostomy. Intensive Care Med. 2019;45(12):1742-52. https://doi.org/gq23wn.

Gómez-Gómez B, Sánchez-Luna JP, Pérez-Beltrán CF, Díaz-Greene EJ, Rodríguez-Weber, FL. Choque séptico. Lo que sabíamos y lo que debemos saber... Med. interna Méx. 2017;33(3):381-91.

Jouffroy R, Saade A, Muret A, Pascal P, Michaloux M, Carli P, et al. Fluid resuscitation in pre-hospital management of septic shock. Am J Emerg Med. 2018;36(10):1754-8. https://doi.org/gd96f5.

Rangel-Vera JA, Laguado-Nieto MA, Amaris-Vergara AA, Vargas-Ordoñez JE, Garcia-Leon SJ, Centeno-Hurtado KT. Actualización en sepsis y choque séptico en adultos. MedUNAB. 2019;20(2):213-27. https://doi.org/js3w.

Demoule A, Jung B, Prodanovic H, Molinari N, Chanques G, Coirault C, et al. Diaphragm dysfunction on admission to the intensive care unit prevalence, risk factors, and prognostic impact—a prospective study. Respir Crit Care Med. 2013;188(2):213-9. https://doi.org/gg52w8.

Dres M, Goligher E, Heunks LMA, Brochard LJ. Critical illness-associated diaphragm weakness. Intensive Care Med. 2017;43(10):1441-52. https://doi.org/gf9rfx.

Jaffee W, Hodgins S, McGee WT. Tissue Edema, Fluid Balance, and Patient Outcomes in Severe Sepsis: An Organ Systems Review. J Intensive Care Med. 2018;33(9):502-9. https://doi.org/gcmf8d.

Caltabeloti F, Monsel A, Arbelot C, Brisson H, Lu Q, Gu WJ, et al. Early fluid loading in acute respiratory distress syndrome with septic shock deteriorates lung aeration without impairing arterial oxygenation: a lung ultrasound observational study. Crit Care. 2014;18(3):R91. https://doi.org/f6gc9b.

Funk G, Anders S, Breyer MK, Burghuber OC, Edelmann G, Heindl W, et al. Incidence and outcome of weaning from mechanical ventilation according to new categories. Eur Respir J. 2010;35(1):88-94. https://doi.org/fjr7dz.

Boles JM, Bion J. Connors A, Herridge M, Marsh B, Melot C, et al. Weaning from mechanical ventilation. Eur Respir J. 2007;29(5):1033-56. https://doi.org/dbx5c5.

Ouellette DR, Patel S, Girard TD, Morris PE, Schmidt GA, Truwit, JD, et al. Liberation From Mechanical Ventilation in Critically Ill Adults : An Of fi cial American College of Chest Physicians/American Thoracic Society Clinical Practice Guideline Trials, Protocols Minimizing Sedation, and Noninvasive Ventilation Immediately After Extubation. Chest. 2017;151(1):166-80. https://doi.org/f9vwgg.

Vieira J, Castro I, Curvello A, Demarzo S, Caruso P, Pastore L, et al. Effect of acute kidney injury on weaning from mechanical ventilation in critically ill patients. Crit Care Med. 2007;35(1):184-91. https://doi.org/cqjn7z.

Pin-Gutiérrez E, Sánchez-Díaz JS, Flores-Hernández R, Martínez-Rodríguez EA, Peniche KG, Díaz-Gutiérrez SP, et al. Los predictores en el retiro de la ventilación mecánica ¿resultan suficientes para el paciente neurocrítico? Med Int Mex. 2017;33(5):675-81. https://doi.org/jq6p.

Thille AW. Simple, difficult, or prolonged weaning: the most important factor is the success or failure of the first weaning trial. Respir Care. 2011;56(5):716-7. https://doi.org/c2h6nf.

Colombia. Ministerio de Salud. Resolución 8430 de 1993 (octubre 4): Por la cual se establecen las normas científicas, técnicas y administrativas para la investigación en salud. Bogotá D.C.; octubre 4 de 1993 [cited 2020 Oct 30]. Available from: https://bit.ly/31gu7do.

World Medical Association (WMA). WMA Declaration of Helsinki – Ethical principles for medical research involving human subjects. Fortaleza: 64th WMA General Assembly; 2013.

Doorduin J, van der Hoeven JG, Heunks LM. The differential diagnosis for failure to wean from mechanical ventilation. Curr Opin Anaesthesiol. 2016;29(2):150-7. https://doi.org/f8c4xj.

Loss SH, Pinheiro de Oliviera R, Gasparetto-Maccaro J, Savi A, Manozzo-Boniatti M, Pereira-Hetzel M, et al.

The reality of patients requiring prolonged mechanical ventilation: a multicenter study. Rev Bras Ter Intensiva. 2015;27(1):26-35. https://doi.org/jq6q.

Hsiung-Lee EL, Jiann-Lim DL, Taculod JM, Sahagun JT, Otero JP, Teo K, et al. Factors Associated with Reintubation in an Intensive Care Unit: A Prospective Observational Study. Indian J Crit Care Med. 2017 2017;21(3):131-7. https://doi.org/jq6r.

Houzé MH, Deye N, Mateo J, Mégarbane B, Bizouard F, Baud FJ, de la Garanderie DP, et al. Predictors of Extubation Failure Related to Aspiration and/or Excessive Upper Airway Secretions. Respir Care. 2020;65(4):475-81. https://doi.org/jq6s.

Matsuda W, Uemura T, Yamamoto M, Uemura Y, Kimura A. Impact of frailty on protocol-based weaning from mechanical ventilation in patients with sepsis: a retrospective cohort study. Acute Med Surg. 2020;7(1):e608. https://doi.org/jq6t.

Fernando SM, McIsaac DI, Perry JJ, Rochwerg B, Bagshaw SM, Thavorn K, et al. Frailty and Associated Outcomes and Resource Utilization Among Older ICU Patients With Suspected Infection. Critical Care Medicine. 2019;47(8):e669-e6. https://doi.org/jq6v.

Vanhorebeek I, Latronico N, Van den Berghe G. ICU-acquired weakness. Intensive Care Med. 2020;46(4):637-53. https://doi.org/gg7gtw.

Ghiani A, Paderewska J, Sainis A, Crispin A, Walcher S, Neurohr C. Variables predicting weaning outcome in prolonged mechanically ventilated tracheotomized patients: a retrospective study. J Intensive Care. 2020;8:19. https://doi.org/js3x.

Upadya A, Tilluckdharry L, Muralidharan V, Amoateng-Adjepong Y, Manthous CA. Fluid balance and weaning outcomes. Intensive Care Med. 2005;31(12):1643-7. https://doi.org/fp5pp5.

Petrof BJ. Diaphragm Weakness in the Critically Ill: Basic Mechanisms Reveal Therapeutic Opportunities. Chest. 2018;154(6):1395-403. https://doi.org/gfsd6g.

Roberts KJ. 2018 Year in Review: Adult Invasive Mechanical Ventilation. Respir Care. 2019;64(5):604-9. https://doi.org/gmxjcc.

Chia-Cheng T, Kuo-Tung H, Yung-Che C, Chin-Chou W, Shih-Feng L, Mei-Lien T, et al. Factors Predicting Ventilator Dependence in Patients with Ventilator-Associated Pneumonia. ScientificWorldJournal. 2012;2012:547241. https://doi.org/gb8d2b.

Godinjak A, Iglica A, Rama A, Tančica I, Jusufović S, Ajanović A, Kukuljac A. Predictive value of SAPS II and APACHE II scoring systems for patient outcome in a medical intensive care unit. Acta Med Acad. 2016;45(2):97-103. https://doi.org/ghx39w.

Aminiahidashti H, Mohammad S, Hosseini N, Khatir IG, Fatemeh J, Baboli M. Assessment of Acute Physiology and Chronic Health Evaluation (APACH II) Scoring System in Predicting Mortality among Patients Admitted in an Emergency Department. J Mazandaran Univ Med Sci. 2016;25(133):67-75.

van Mourik N, Metske HA, Hofstra JJ, Binnekade JM, Geerts BF, Schultz MJ, et al. Cumulative fluid balance predicts mortality and increases time on mechanical ventilation in ARDS patients: An observational cohort study. PLoS ONE. 2019;14(10):e0224563. https://doi.org/jq6x.

Reynolds PM, Wells L, MacLaren R, Scoular SK. Establishing the Therapeutic Index of Fluid Resuscitation in the Septic Patient: A Narrative Review and Meta-Analysis. Pharmacotherapy. 2020;40(3):256-69. https://doi.org/jq6z.

Bissell BD, Laine ME, Thompson-Bastin ML, Flannery AH, Kelly A, Riser J, et al. Impact of protocolized diuresis for de-resuscitation in the intensive care unit. Crit Care. 2020;24(1):70. https://doi.org/gg52mx.

Dres M, Estellat C, Baudel JL, Belonde F, Cousty J, Galbois A, et al. Comparison of a preventive or curative strategy of fluid removal on the weaning of mechanical ventilation: a study protocol for a multicentre randomised open-label parallel-group trial. BMJ Open. 2021;11(8):e048286. https://doi.org/jq63.

Licencia

Derechos de autor 2021 Revista de la Facultad de Medicina

Esta obra está bajo una licencia Creative Commons Reconocimiento 3.0 Unported.