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Vol. 12. Issue 2.
Pages 131-146 (March - April 2006)
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Vol. 12. Issue 2.
Pages 131-146 (March - April 2006)
Artigo Original\Original Article
Open Access
Determinantes cardíacas do tempo de ventilação mecânica e mortalidade de doentes com insuficiência respiratória crónica exacerbada. A importância dos parâmetros ecocardiográficos
Cardiac influence on mechanical ventilation time and mortality in exacerbated chronic respiratory failure patients. The role of echocardiographic parameters
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Paulo Marcelino1,
Corresponding author
pmarcelino@fm.ul.pt
paulo-alex-ma@hotmail.com

Correspondência/Correspondence to: Paulo Marcelino. Hospital de Curry Cabral, Unidade de Cuidados Intensivos, Rua da Beneficência, 8, 1066-169, Lisboa
, Nuno Germano2, Ana Paiva Nunes2, Lígia Flora3, Ana Moleiro2, Susan Marum1, Ana Paula Fernandes1
1 Assistente Hospitalar de Medicina Interna/Internal Medicine Hospital Assistant, Hospital de Curry Cabral, Unidade de Cuidados Intensivos (Director: Dr. Luís Mourão). Centro de Cardiologia da Universidade de Lisboa (CCUL)/Intensive Care Unit (Director: Dr. Luís Mourão) Curry Cabral Hospital, Lisbon University Cardiology Centre (CCUL).
2 Interno do Internato Complementar de Medicina Interna/Complementary Internal Medicine Intern, Hospital de Curry Cabral, Unidade de Cuidados Intensivos (Director: Dr. Luís Mourão). Centro de Cardiologia da Universidade de Lisboa (CCUL)/Intensive Care Unit (Director: Dr. Luís Mourão) Curry Cabral Hospital, Lisbon University Cardiology Centre (CCUL).
3 Interna do Internato Complementar de Pneumologia/Complementary Pulmonology Intern, Hospital de Curry Cabral, Unidade de Cuidados Intensivos (Director: Dr. Luís Mourão). Centro de Cardiologia da Universidade de Lisboa (CCUL)/Intensive Care Unit (Director: Dr. Luís Mourão) Curry Cabral Hospital, Lisbon University Cardiology Centre (CCUL).
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Objectivo: estudar determinantes cardiovasculares condicionantes do tempo de ventilação, mortalidade e gravidade de doença em doentes admitidos numa unidade de cuidados intensivos para ventilação mecânica por exacerbação de insuficiência respiratória crónica.

Desenho e local: Estudo prospectivo, com duração de 30 meses numa unidade de cuidados intensivos médico-cirúrgica com 14 camas.

Material e métodos: Estudados 59 doentes com idade média de 74,7 +/- 9,7 anos, tempo médio de ventilação de 10,8 +/- 12,6 dias, APACHE II médio de 23 +/- 8,3. Avaliaram-se parâmetros ecocardiográficos (dimensões das cavidades, débito cardíaco, estudo Doppler do fluxo transvalvular mitral, estudo da veia cava inferior) e electrocardiográficos (presença de ritmo sinusal ou fibrilhação auricular) nas primeiras 24 horas de internamento na Unidade e parâmetros gasimétricos à saída.

Resultados: Um tempo de ventilação mais prolongado associou-se à presença de fibrilhação auricular (p=0,027), à presença conjunta de fibrilhação auricular e uma veia cava inferior dilatada (> 20mm p=0,004) e com níveis séricos de bicarbonato> 35mEq/l na gasimetria obtida à saída (p=0,04). Verificaram-se 12 óbitos. A mortalidade associou-se à presença de dilatação do ventrículo direito (p=0,03) e a uma relação entre o ventrículo direito e o esquerdo> 0,6 (p=0,04). Conclusão: Nos doentes submetidos a ventilação mecânica por exacerbação de insuficiência respiratória crónica, a presença de fibrilhação auricular indica a possibilidade de um período de ventilação mais prolongado, em especial se houver concomitantemente uma veia cava inferior com diâmetro> 20mm. Nestes doentes, a presença de dilatação das cavidades direitas pode indicar uma probabilidade mais elevada de mortalidade.

Rev Port Pneumol 2006; XII (2): 131-146

Palavras-chave:
Insuficiência respiratória crónica
ventilação mecânica
ecocardiografia
Abstract

Objective: To study the influence of cardiac status on the length of mechanical ventilation, outcome and disease severity in patients admitted to an Intensive Care Unit (ICU) with exacerbation of chronic respiratory failure.

Design and setting: A 30-month prospective study in a 14 bed ICU

Patients and methods: Fifty nine patients were enrolled, with a mean age 74.7 +/−9.7 years, mean length of ventilator support 10.8 +/−12.6 days, and mean APACHE II score 23 +/- 8.3. Within the first 24 hours of admittance, cardiac chamber dimensions, inferior vena cava (IVC), and mitral transvalvular Doppler were evaluated using transthoracic echocardiography; the cardiac rhythm was recorded (presence of sinus rhythm or atrial fibrillation). Blood gases were evaluated at discharge.

Results: Greater length of ventilation was observed in patients presenting atrial fibrillation (p=0.027), particularly when a dilated IVC was also present (>20mm, p=0.004). A high level of serum bicarbonate (>35mEq/l), was also related with longer ventilation (p=0. 04). Twelve patients died. Mortality was related to the presence of a dilated right ventricle (p=0. 03) and a ratio between right and left ventricle> 0. 6 (p=0.04). Conclusion: Patients submitted to mechanical ventilation due to exacerbation of chronic respiratory failure which present atrial fibrillation require a longer ventilation period, particularly if a dilated IVC is also present. Patients with dilated right cardiac chambers are at an increased risk of a fatal outcome.

Rev Port Pneumol 2006; XII (2): 131-146

Key-words:
Mechanical ventilation
chronic respiratory failure
echocardiography
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Copyright © 2006. Sociedade Portuguesa de Pneumologia/SPP
Pulmonology
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