Impact of daily evaluation and spontaneous breathing test on the duration of pediatric mechanical ventilation: a randomized controlled trial

Objectives: To assess whether the combination of daily evaluation and use of a spontaneous breathing test could shorten the duration of mechanical ventilation as compared with weaning based on our standard of care. Secondary outcome measures included extubation failure rate and the need for noninvasive ventilation.Design: A prospective, randomized controlled trial.Setting: Two pediatric intensive care units at university hospitals in Brazil.Patients: the trial involved children between 28 days and 15 yrs of age who were receiving mechanical ventilation for at least 24 hrs.Interventions: Patients were randomly assigned to one of two weaning protocols. in the test group, the children underwent a daily evaluation to check readiness for weaning with a spontaneous breathing test with 10 cm H(2)O pressure support and a positive end-expiratory pressure of 5 cm H(2)O for 2 hrs. the spontaneous breathing test was repeated the next day for children who failed it. in the control group, weaning was performed according to standard care procedures.Measurements and Main Results: A total of 294 eligible children were randomized, with 155 to the test group and 139 to the control group. the time to extubation was shorter in the test group, where the median mechanical ventilation duration was 3.5 days (95% confidence interval, 3.0 to 4.0) as compared to 4.7 days (95% confidence interval, 4.1 to 5.3) in the control group (p = .0127). This significant reduction in the mechanical ventilation duration for the intervention group was not associated with increased rates of extubation failure or noninvasive ventilation. It represents a 30% reduction in the risk of remaining on mechanical ventilation (hazard ratio: 0.70).Conclusions: A daily evaluation to check readiness for weaning combined with a spontaneous breathing test reduced the mechanical ventilation duration for children on mechanical ventilation for > 24 hrs, without increasing the extubation failure rate or the need for noninvasive ventilation. (Crit Care Med 2011; 39: 2526-2533)Hosp Sirio Libanes, Intens Care Unit, São Paulo, BrazilUniv São Paulo, Sch Med, Dept Pediat, Hosp Clin, São Paulo, BrazilUniv São Paulo, Sch Med, Dept Pneumol, Hosp Clin, São Paulo, BrazilHosp Albert Einstein, Intens Care Unit, São Paulo, BrazilUniv Buenos Aires, Hosp Ninos R Gutierrez, Intens Care Unit, Buenos Aires, DF, ArgentinaUniv São Paulo, Sch Med, Intens Care Unit, Univ Hosp, São Paulo, BrazilWeb of Scienc

Perfil clínico e atuação fisioterapêutica em pacientes atendidos na emergência pediátrica de um hospital público de Goiás

Nos últimos anos, tem-se ampliado a atuação fisioterapêutica no setor de urgência e emergência, visando reduzir complicações e tempo de internação hospitalar. Os objetivos deste estudo foram traçar o perfil dos pacientes admitidos na sala de reanimação do Serviço de Referência em Urgência Pediátrica (SERUPE) do Hospital das Clínicas da Universidade Federal de Goiás (HC/UFG) e descrever a atuação fisioterapêutica nesse setor. Trata-se de um estudo observacional, prospectivo, realizado entre fevereiro e junho de 2012, para o qual foram acompanhados todos os pacientes admitidos na sala de reanimação do SERUPE. Foram avaliados 47 pacientes, 53,2% (n=25) do sexo masculino, idade média de 5,2±4,1 anos e 74,5% (n=35) apresentavam doenças prévias. A queixa principal mais frequente foi dispneia em 26,1% (n=29) dos casos e as hipóteses diagnósticas mais identificadas foram doenças respiratórias em 69,4% (n=43). Do total de pacientes, 76,6% (n=36) necessitaram de oxigenoterapia, 21,3% (n=10), de assistência ventilatória e 31,9% (n=15) tiveram acompanhamento fisioterapêutico, 86,7% (n=13) com abordagem respiratória e motora. O tempo médio de permanência na sala de reanimação foi de 1,9±1,5 dias; subsequentemente, 63,8% (n=30) dos pacientes foram internados em enfermaria. Portanto, verifica-se que, no setor de emergência, existe uma grande demanda de pacientes com desordens respiratórias que podem se beneficiar com a presença de um fisioterapeuta