Força muscular periférica e funcionalidade como preditores de sucesso para extubação após revascularização do miocárdio
Artigo original - e235376 - Publicado 31 de março de 2024
DOI:
https://doi.org/10.33233/rbfex.v23i1.5376Palavras-chave:
extubação das vias aéreas, cirurgia torácica, força muscularResumo
Introduction: Maximum inspiratory pressure (MIP) and the rapid and shallow breathing index are predictors for successful extubation. Peripheral muscle strength and functionality appear as possible predictors of success for extubation in other patient profiles, however, there is little evidence in patients undergoing to Coronary Artery Bypass Grafting (CABG). Objective: To assess peripheral muscle strength and functionality as predictors of success for extubation in patients undergoing to CABG. Methods: Prospective cohort study. At the time of hospital admission, patients were assessed for MIP, maximum expiratory pressure (MEP), Medical Research Council (MRC), peak of expiratory flow (PEF) and Functional Independence Measure (FIM). Patients were divided into two groups: Success Group (SG), which remained on spontaneous ventilation for more than 48 hours, and failure group (FG) that required invasive support in less than 48 hours. We compared the influence of muscle strength, cough and functionality variables between these groups. Results: 74 patients, Success Group (n = 59) and Failure Group (n = 15), were evaluated. The CI 95% was -1 (-5.33 to 3.33) in MIP, 4 (2.14 to 5.86) in MEP, 13 (-35.31 to 61.31) in PEF, 7 (6.27 to 7.73) in the MRC and 9 (8.08 to 9.92) in the FIM. Conclusion: Peripheral, expiratory muscle strength and functionality demonstrated a statistically significant influence on the success of extubation in patients after CABG.
Referências
Santos TD, Pereira SN, Portela LOC, Cardoso DM, Lago PD, Guarda SN, et al. Moderate-to-high intensity inspiratory muscle training improves the effects of combined training on exercise capacity in patients after coronary artery bypass graft surgery: A randomized clinical trial. Int J Cardiol. 2019 Mar 15;279:40-46. doi: 10.1016/j.ijcard.2018.12.013
Paez RP, Hossne Junior NA, Santo JADE, Berwanger O, Santos RHN, Kalil RAK, et al. Coronary artery bypass surgery in Brazil: Analysis of the National Reality Through the BYPASS Registry. Braz J Cardiovasc Surg. 2019;34(2):142-148. doi: 10.21470/1678-9741-2018-0313
Torrati, FG, Dantas, RAS. Circulação extracorpórea e complicações no período pós-operatório imediato de cirurgias cardíacas. Acta Paul Enferm. 2012;25(3):340-5. doi: 10.1590/S0103-21002012000300004
Cordeiro ALL, Silva LGR, Pinto MO, Araújo JS, Guimarães AR, Petto J. Behavior of pulmonary function after hospital discharge in patients submitted to myocardial revascularization. Int J Cardiovasc Sci. 2019;32(2)104-09. doi: 10.5935/2359-4802.20180092
Westerdahl E, Jonsson M, Emtner M. Pulmonary function and health-related quality of life 1-year follow up after cardiac surgery. J Cardiothorac Surg. 2016;11(1):99. doi: 10.1186/s13019-016-0491-2
Cordeiro ALL, Queiroz GO, Souza MM, Guimarães AR, Araújo TM, Junior MAV, et al. Mechanical ventilation time and peripheral muscle strength in post-heart surgery. Int J Cardiovasc Sci. 2016;29(2):134-38. doi: 10.5935/2359-4802.20160021.
Borges JBC, Ferreira DLMP, Carvalho SMR, Martins AS, Andrade RR, Silva MAM. Pain intensity and postoperative functional assessment after heart surgery. Braz J Cardiovasc. 2006;21(4):393-402. doi: 10.1590/S0102-76382006000400009
Vento DA, Faria AM, Silva LG, Ferreira JCM, Guimarães VA. Utilização da Escala do Medical Research Council no Desmame em Pacientes Críticos: Revisão de Literatura. Rev Educ Saúde. 2018;6(2):125-32. doi.org/10.29237/2358-9868.2018v6i2.p125-132
Flynn BC, He J, Richey M, Wirtz K, Daon E. Early extubation without increased adverse events in high-risk cardiac surgical patients. Ann Thorac Surg. 2019;107(2):453-59. doi: 10.1016/j.athoracsur.2018.09.034
Wong WT, Lai VK, Chee YE, Lee A. Fast-track cardiac care for adult cardiac surgical patients. Cochrane Database Syst Rev. 2016;9(9):CD003587. doi: 10.1002/14651858.CD003587.pub3
Souza LC, Guimarães FS, Lugon J. Evaluation of a new index of mechanical ventilation weaning: the timed inspiratory effort. Journal of Intensive Care Medicine. 2015;30(1):37-43. doi: 10.1177/0885066613483265
Souza LC, Guimarães FS, Lugon J. The timed inspiratory effort: a promising index of mechanical ventilation weaning for patients with neurologic or neuromuscular diseases. Respir Care 2015;60(2):231–38. doi: 10.4187/respcare.03393
Caruso P, Albuquerque ALP, Santana PV, Cardenas LZ, Ferreira JG, et al. Métodos diagnósticos para avaliação da força muscular inspiratória e expiratória. J Bras Pneumol. 2015;41(2):110-123. doi: 10.1590/S1806-37132015000004474
Ruchkys CV, Dias, RM, Sakurai E, Camargos PAM. Acurácia de medidores do pico do fluxo expiratório (peak-flow) da marca MiniWright. J Pediatr. (Rio J.). 2000;76(6):447-52. doi: 10.2223/JPED.92
Khemani RG, Sekayan T, Hotz J, Flink RC, Rafferty GF, Iyer N, et al. Risk factors for pediatric extubation failure: the importance of respiratory muscle strength. Crit Care Med. 2017 Aug;45(8):e798-e805. doi: 10.1097/CCM.0000000000002433
Thille AW, Boisser F, Ghezala HB, Razazi K, Mekontso-Dessap A, Brun-Buisson C. Risk factors for and prediction by caregivers of extubation failure in ICU patients: a prospective study. Crit Care Med. 2015;43(3):613-20. doi: 10.1097/CCM.0000000000000748
Jiang C, Esquinas A, Mina B. Evaluation of cough peak expiratory flow as a predictor of successful mechanical ventilation discontinuation: a narrative review of the literature. J Intensive Care 2017;5:(33);1-5. doi: 10.1186/s40560-017-0229-9
Wang TH, Wu CP, Wang LY. Chest physiotherapy with early mobilization may improve extubation outcome in critically ill patients in the intensive care units. Clin Respir J. 2018;12(11):2613-2621. doi: 10.1111/crj.12965
Jang MH, Shin MJ, Shin YB. Pulmonary and physical rehabilitation in critically ill patients. Acute Crit Care. 2019;34(1):1-13. doi: 10.4266/acc.2019.00444
Corcoran JR, Herbsman JM, Bushnik T, Van Lew S, Stolfi A, Parkin K, et al. Early rehabilitation in the medical and surgical intensive care units for patients with and without mechanical ventilation: an interprofessional performance improvement project. PM R. 2017;9(2):113-119. doi: 10.1016/j.pmrj.2016.06.015
Kutchak FM, Debesaitys AM, Rieder MM, Meneguzzi C, Skueresky AM, Junior LAF, et al. Reflex cough PEF as a predictor of successful extubation in neurological patients. J Bras Pneumol. 2015;41(4):358-64. doi: 10.1590/S1806-37132015000004453
Downloads
Publicado
Edição
Seção
Licença
Copyright (c) 2024 André Luiz Lisboa Cordeiro, Hayssa de Cássia Mascarenhas, Lucas Oliveira Soares, Vitória de Oliveira Pimentel, Larissa Maria Menezes Pinto, Maria Taynan Santana Mota, Layla Souza e Souza, Arthur Marchesini, GabrielGabriel Velloso Dantas Batista Andrade Ferreira, André Raimundo Guimarães
Este trabalho está licenciado sob uma licença Creative Commons Attribution 4.0 International License.
Autores que publicam nesta revista concordam com os seguintes termos: Autores mantém os direitos autorais e concedem à revista o direito de primeira publicação, com o trabalho simultaneamente licenciado sob a Licença Creative Commons Attribution que permite o compartilhamento do trabalho com reconhecimento da autoria e publicação inicial nesta revista; Autores têm autorização para assumir contratos adicionais separadamente, para distribuição não-exclusiva da versão do trabalho publicada nesta revista (ex.: publicar em repositório institucional ou como capítulo de livro), com reconhecimento de autoria e publicação inicial nesta revista; Autores têm permissão e são estimulados a publicar e distribuir seu trabalho online (ex.: em repositórios institucionais ou na sua página pessoal) a qualquer ponto antes ou durante o processo editorial, já que isso pode gerar alterações produtivas, bem como aumentar o impacto e a citação do trabalho publicado (Veja O Efeito do Acesso Livre).
