Brazilian Journal of Pulmonology

ISSN (on-line): 1806-3756 | ISSN (printed): 1806-3713

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Acute asthma in adults in the emergency room: clinical management in the first hour

Asma aguda em adultos na sala de emergência: o manejo clínico na primeira hora

Paulo de Tarso Roth Dalcin, Alan Castoldi Medeiros, Marcelo Kurz Siqueira, Felipe Mallmann, Mariane Lacerda, Marcelo Basso Gazzana, Sérgio Saldanha Menna Barreto

J Bras Pneumol.2000;26(6):297-306

Abstract PDF PT

Asthma is a disease with high prevalence in our country and around the world. Although new therapeutic approaches have been recently developed, there appears to be a worldwide increase in morbidity and mortality from asthma. In many institutions, asthma exacerbation is still a common medical emergency. Clinical evidence demonstrates that the first hour of management of acute asthma in the emergency room entails crucial decisions that could be determinant in the clinical outcome. In this non-systematic review, the authors focus on the first hour assessment and treatment of patients with acute asthma and outline an appropriate strategy for their management. Diagnosis, severity assessment, pharmacological treatment, complications, and the decision regarding the place where additional treatment will take place will be considered. It is reasonable to expect that these recommendations will help physicians make appropriate decisions about the first hour care of acute asthma in the emergency room.

 


Keywords: Asthma. Emergency medicine. Emergency treatment. Clinical procedures. Emergency medical services.

 


Clinical characteristics and evolution of non-HIV-infected immunocompromised patients with an in-hospital diagnosis of tuberculosis

Características clínicas e evolução de pacientes imunocomprometidos não HIV com diagnóstico intra-hospitalar de tuberculose

Denise Rossato Silva, Diego Millán Menegotto, Luis Fernando Schulz, Marcelo Basso Gazzana, Paulo de Tarso Roth Dalcin

J Bras Pneumol.2010;36(4):-

Abstract PDF PT PDF EN Portuguese Text

Objective: To investigate the characteristics of and risk factors for mortality among non-HIV-infected immunocompromised patients with an in-hospital diagnosis of tuberculosis. Methods: This was a two-year, retrospective cohort study of patients with an in-hospital diagnosis of tuberculosis. The predictive factors for mortality were evaluated. Results: During the study period, 337 hospitalized patients were diagnosed with tuberculosis, and 61 of those patients presented with immunosuppression that was unrelated to HIV infection. Extrapulmonary tuberculosis was found in 47.5% of cases. In the latter group, the in-hospital mortality rate was 21.3%, and the mortality rate after discharge was 18.8%. One-year survival was significantly higher among the immunocompetent patients than among the HIV patients (p = 0.008) and the non-HIV-infected immunocompromised patients (p = 0.015), although there was no such difference between the two latter groups (p = 0.848). Among the non-HIV-infected immunocompromised patients, the only factor statistically associated with mortality was the need for mechanical ventilation. Among the patients over 60 years of age, fibrosis/atelectasis on chest X-rays and dyspnea were more common, whereas fever and consolidations were less common. Fever was also less common among the patients with neoplasms. The time from admission to the initiation of treatment was significant longer in patients over 60 years of age, as well as in those with diabetes and those with end-stage renal disease. Weight loss was least common in patients with diabetes and in those using corticosteroids. Conclusions: The lower prevalence of classic symptoms, the occurrence of extrapulmonary tuberculosis, the delayed initiation of treatment, and the high mortality rate reflect the diagnostic and therapeutic challenges of tuberculosis in non-HIV-infected immunocompromised patients.

 


Keywords: Hospitalization; Immunosuppression; Risk factors; Tuberculosis/mortality; Immunocompromised host.

 


The electronic cigarette: the new cigarette of the 21st century?

Cigarro eletrônico: o novo cigarro do século 21?

Marli Maria Knorst, Igor Gorski Benedetto, Mariana Costa Hoffmeister, Marcelo Basso Gazzana

J Bras Pneumol.2014;40(5):564-573

Abstract PDF PT PDF EN Portuguese Text

The electronic nicotine delivery system, also known as the electronic cigarette, is generating considerable controversy, not only in the general population but also among health professionals. Smokers the world over have been increasingly using electronic cigarettes as an aid to smoking cessation and as a substitute for conventional cigarettes. There are few available data regarding the safety of electronic cigarettes. There is as yet no evidence that electronic cigarettes are effective in treating nicotine addiction. Some smokers have reported using electronic cigarettes for over a year, often combined with conventional cigarettes, thus prolonging nicotine addiction. In addition, the increasing use of electronic cigarettes by adolescents is a cause for concern. The objective of this study was to describe electronic cigarettes and their components, as well as to review the literature regarding their safety; their impact on smoking initiation and smoking cessation; and regulatory issues related to their use.

 


Keywords: Smoking; Tobacco Products; Nicotine.

 


Should we use prognostic scores for acute pulmonary thromboembolism in clinical practice?

Devemos utilizar escores prognósticos para tromboembolia pulmonar aguda na prática clínica?

Marcelo Basso Gazzana1,2,3,a, Igor Gorski Benedetto1,2,3,b

J Bras Pneumol.2019;45(1):e20190036-e20190036

PDF PT PDF EN Portuguese Text



Alternative diagnoses based on CT angiography of the chest in patients with suspected pulmonary thromboembolism

Diagnósticos alternativos corroborados por angiotomografia computadorizada de tórax em pacientes com suspeita de tromboembolia pulmonar

Eleci Vaz Ferreira1,2, Marcelo Basso Gazzana2,3, Muriel Bossle Sarmento4, Pedro Arends Guazzelli4, Mariana Costa Hoffmeister4, Vinicius André Guerra2, Renato Seligman4,5, Marli Maria Knorst2,3,4

J Bras Pneumol.2016;42(1):35-41

Abstract PDF PT PDF EN Portuguese Text

Objective: To determine the prevalence of alternative diagnoses based on chest CT angiography (CTA) in patients with suspected pulmonary thromboembolism (PTE) who tested negative for PTE, as well as whether those alternative diagnoses had been considered prior to the CTA. Methods: This was a cross-sectional, retrospective study involving 191 adult patients undergoing CTA for suspected PTE between September of 2009 and May of 2012. Chest X-rays and CTAs were reviewed to determine whether the findings suggested an alternative diagnosis in the cases not diagnosed as PTE. Data on symptoms, risk factors, comorbidities, length of hospital stay, and mortality were collected. Results: On the basis of the CTA findings, PTE was diagnosed in 47 cases (24.6%). Among the 144 patients not diagnosed with PTE via CTA, the findings were abnormal in 120 (83.3%). Such findings were consistent with an alternative diagnosis that explained the symptoms in 75 patients (39.3%). Among those 75 cases, there were only 39 (20.4%) in which the same alterations had not been previously detected on chest X-rays. The most common alternative diagnosis, made solely on the basis of the CTA findings, was pneumonia (identified in 20 cases). Symptoms, risk factors, comorbidities, and the in-hospital mortality rate did not differ significantly between the patients with and without PTE. However, the median hospital stay was significantly longer in the patients with PTE than in those without (18.0 and 9.5 days, respectively; p = 0.001). Conclusions: Our results indicate that chest CTA is useful in cases of suspected PTE, because it can confirm the diagnosis and reveal findings consistent with an alternative diagnosis in a significant number of patients.

 


Keywords: Pulmonary embolism/diagnosis; Pulmonary embolism/epidemiology; Angiography.

 


Six-minute walk distance is not related to quality of life in patients with non-cystic fibrosis bronchiectasis

Distância percorrida no teste de caminhada de seis minutos não se relaciona com qualidade de vida em pacientes com bronquiectasias não fibrocísticas

Patrícia Santos Jacques, Marcelo Basso Gazzana, Dora Veronisi Palombini, Sérgio Saldanha Menna Barreto, Paulo de Tarso Roth Dalcin

J Bras Pneumol.2012;38(3):346-355

Abstract PDF PT PDF EN Portuguese Text

Objective: To evaluate physical performance on the six-minute walk test (6MWT) in patients with non-cystic fibrosis bronchiectasis and to investigate its relationship with quality of life (QoL). To identify predictors of exercise performance, we also investigated whether six-minute walk distance (6MWD) is associated with clinical and spirometric findings. Methods: This was a cross-sectional study involving patients with non-cystic fibrosis bronchiectasis (age,  18 years), with at least one respiratory symptom for  2 years and an FEV1  70% of predicted. Patients underwent clinical evaluation, pulmonary function tests, the 6MWT, and QoL assessment with the Medical Outcomes Study 36-item Short-Form Health Survey (SF-36). Results: We included 70 patients (48 females). Mean age was 54.5 ± 17.7 years, and mean FEV1 was 44.9 ± 14.5% of predicted. The patients were divided into two groups: 6MWD-low (6MWD below the predicted lower limit; n = 23); and 6MWD-norm (normal 6MWD; n = 47). The following variables were significantly lower in the 6MWD-low group than in the 6MWD-norm group: age; age at diagnosis of bronchiectasis; proportion of former smokers; body mass index (BMI); FEV1% of predicted; and MEP% of predicted. There were no significant differences in the SF-36 scores between the groups. In the logistic regression model, lower age and lower BMI were significantly associated with lower 6MWD. Conclusions: In this sample, there was a high proportion of patients who had a lower than expected 6MWD. Although 6MWD was not related to QoL, it was associated with age and BMI.

 


Keywords: Bronchiectasis; Quality of life; Respiratory function tests; Exercise tolerance.

 


Septic pulmonary embolism secondary to jugular thrombophlebitis: a case of Lemierre's syndrome

Embolia pulmonar séptica secundária à tromboflebite jugular: um caso de síndrome de Lemierre

Denise Rossato Silva, Marcelo Basso Gazzana, Ricardo Albaneze, Paulo de Tarso Roth Dalcin, Josi Vidart, Nei Gulcó

J Bras Pneumol.2008;34(12):1079-1083

Abstract PDF PT PDF EN Portuguese Text

Abstract Lemierre's syndrome is characterized by acute oropharyngeal infection, complicated by internal jugular venous thrombosis secondary to septic thrombophlebitis, and by metastatic infections in various distant organs-most commonly in the lungs. We report a case of Lemierre's syndrome in a 56-year-old female who presented with right-sided neck mass and fever. Right internal jugular venous thrombosis was demonstrated on an ultrasound. A computed tomography scan of the chest revealed multiple opacities throughout both lungs. An open surgical biopsy was performed due to suspicion of pulmonary metastases. Anatomopathological examination revealed septic emboli in lung parenchyma. Retrospectively, the patient reported a history of pharyngitis two weeks prior to hospitalization. After the diagnosis had been made, the patient was treated with broad-spectrum antibiotics (cefuroxime for 7 days and azithromycin for 5 days; subsequently, because fever persisted, cefepime for 7 days). One month later, a computed tomography scan of the chest revealed resolution of the opacities.

 


Keywords: Pulmonary embolism; Lung abscess; Thrombophlebitis; Jugular veins; Pharyngitis.

 


Classification of risk and prophylaxis for venous thromboembolism in university hospital patients

Estratificação de risco e profilaxia para tromboembolia venosa em pacientes internados em hospital geral universitário

Sérgio Saldanha Menna Barreto, Carlo Sasso Faccin, Paula Mallman da Silva, Larissa Pretto Centeno, Marcelo Basso Gazzana

J Bras Pneumol.1998;24(5):299-302

Abstract PDF PT

Objectives: To identify the frequency of risk factors, classification of degree of risk and the practice of prophylaxis to venous thromboembolism (VTE) in a general hospital. Methods: Randomly selected cases were included. Patients were excluded if they were on anticoagulant treatment. Determination of risk factors and classification of degree of risk were done according to international consensus. Results: Most patients (96%) had at least one recognized risk factor, 81% of them fulfilled the criteria to be classified as moderate/high risk. Prophylactic measures were prescribed to 221 (63%) patients. There was a significant association between the higher risk level for VTE and increased use of heparin (p < 0.001). Contraindications to the use of heparin were noticed in 7% of the cases. Conclusion: Risk factors for VTE are usually seen and prophylaxis is unsatisfactory. Contraindications to the use of heparin are uncommon; prophylaxis should be considered for a higher number of patients.

 


Keywords: Pulmonary embolism. Deep venous thrombosis. Prevention.

 


Predictors of physical and mental health-related quality of life in patients with interstitial lung disease: a multifactorial analysis

Fatores preditores da qualidade de vida relacionada à saúde física e mental em pacientes com doença pulmonar intersticial: uma análise multifatorial

Ana Cláudia Coelho, Marli Maria Knorst, Marcelo Basso Gazzana, Sérgio Saldanha Menna Barreto

J Bras Pneumol.2010;36(5):562-570

Abstract PDF PT PDF EN Portuguese Text

Objective: To determine predictors of health-related quality of life (HRQoL) in patients with interstitial lung disease (ILD). Methods: A cross-sectional study comprising 63 patients, all of whom underwent lung function testing and the six-minute walk test. The following instruments were used: the Medical Outcomes Study 36-item Short-form Survey (SF-36), the Saint George's Respiratory Questionnaire (SGRQ), the Beck Anxiety Inventory, the Beck Depression Inventory, and the Modified Medical Research Council Dyspnea Scale. Principal component analysis was used in order to reduce the dimensionality of the data, thereby identifying the predictor variables, and multiple linear regression analysis was used in order to identify the explanatory variables. Results: Of the 63 patients, 34 were female. The mean age was 60.1 ± 13.3 years, the mean FVC was 64.17 ± 15.54% of predicted, and the mean DLCO was 44.21 ± 14.47% of predicted. All of the patients evaluated had impaired HRQoL, scoring worst for the SF-36 physical functioning and SGRQ activity domains. Of the patients evaluated, 60.3% and 57.1% showed symptoms of anxiety and depression, respectively. The principal component analysis identified one predictor of physical HRQoL and one predictor of mental HRQoL. Depression had a strong influence on the predictor of mental HRQoL, and the degree of dyspnea had a strong influence on both predictors of HRQoL in the patients evaluated. Variables related to lung function, exercise capacity, and anxiety had no impact on these predictors. Conclusions: In our sample of patients with ILD, the degree of dyspnea had a major impact on the physical and mental HRQoL, and depression had an impact on mental HRQoL.

 


Keywords: Anxiety; Depression; Dyspnea; Lung diseases, interstitial; Quality of life; Respiratory function tests.

 


Idiopathic pulmonary fibrosis and emphysema in smokers

Fibrose pulmonar idiopática simultânea a enfisema em pacientes tabagistas

Denise Rossato Silva, Marcelo Basso Gazzana, Sérgio Saldanha Menna Barreto, Marli Maria Knorst

J Bras Pneumol.2008;34(10):779-786

Abstract PDF PT PDF EN Portuguese Text

Objective: To describe the clinical and functional findings recently reported in the medical literature for patients diagnosed with emphysema involving the upper lobes and idiopathic pulmonary fibrosis (IPF) involving the lower lobes. Methods: Eleven patients with emphysema and IPF were identified retrospectively. All of the patients underwent high-resolution computed tomography of the lung and pulmonary function tests. Results: Of the 11 patients, 8 were male and 3 were female. The mean age was 70.7 ± 7.2 years (range, 61-86 years). All of the patients were smokers (mean smoking history, 61.5 ± 43.5 pack-years). The mean values of forced vital capacity (FVC), forced expiratory volume in one second (FEV1) and FEV1/FVC were 72.1 ± 12.7%, 68.2 ± 11.9% and 74.4 ± 10.8, respectively. Lung volumes were normal in 7 patients. A restrictive pattern was observed in 3 patients, and hyperinflation was present in one. The diffusing capacity was moderatelyto- severely reduced in all of the patients (mean, 27.7% ± 12.9% of predicted). Ten of the 11 patients performed the six-minute walk test. The mean distance covered was 358.4 ± 143.1 m, and 9 of the 10 patients presented desaturation ≥ 4%. Echocardiographic findings suggestive of pulmonary hypertension were present in 4 patients (mean systolic pulmonary artery pressure, 61.8 mmHg; range, 36-84 mmHg). Conclusions: The concomitant presence of emphysema and IPF causes characteristic changes on pulmonary function tests. The most significant finding is a discrepancy between diffusing capacity and spirometry results.

 


Keywords: Pulmonary emphysema; Pulmonary fibrosis; Lung Diseases, interstitial; Anoxia; Hypertension, pulmonary.

 


Pulmonary arterial hypertension and thyroid disease

Hipertensão arterial pulmonar e doenças da tireoide

Denise Rossato Silva, Marcelo Basso Gazzana, Ângela Beatriz John, Débora Rodrigues Siqueira, Ana Luiza Silva Maia, Sérgio Saldanha Menna Barreto

J Bras Pneumol.2009;35(2):179-185

Abstract PDF PT PDF EN Portuguese Text

Recent studies have suggested an association between pulmonary arterial hypertension (PAH) and thyroid diseases (hypothyroidism and hyperthyroidism). This combination has a good prognosis, because the increase in the pulmonary artery pressure is usually slight and reverses after the treatment of the thyroid disease. Although the exact mechanism involved in the pathogenesis of this combination has not yet been established, it has been hypothesized that thyroid hormones and autoimmunity have a direct influence. Due to the high prevalence of thyroid disease in patients with PAH, thyroid function tests should be considered in the investigation of every patient with PAH. In this review, we describe the prevalence of PAH in patients with thyroid diseases and the prevalence of thyroid disease in patients with PAH, as well as addressing the principal effects that thyroid diseases have on the respiratory system. In addition, we report the treatment effects in patients with these diseases.

 


Keywords: Hypertension, pulmonary; Graves disease; Hyperthyroidism; Hypothyroidism; Thyroid hormones; Echocardiography.

 


Pulmonary hypertension: a report of six cases and updating review

Hipertensão pulmonar: relato de seis casos e atualização do tema

Sérgio Saldanha Menna Barreto, Marcelo Basso Gazzana

J Bras Pneumol.2000;26(6):321-336

Abstract PDF PT

Pulmonary hypertension occurs when the pressure of the pulmonary artery is disproportionally high for a certain level of pulmonary blood flow. Values of mean pulmonary artery pressure of more than 25 mm Hg at rest or 30 mm Hg during exercise allow the diagnosis of pulmonary hypertension. Sustained or chronic pulmonary hypertension may be secondary to known diseases, mainly to those of cardiac or pulmonary nature, or may be a primary abnormality of the pulmonary circulation, with or without identification of associated conditions. Advances in the knowledge of the mechanisms of vasoconstriction and vascular remodeling have brought better prospects for the treatment of the disease. The correct use of vasodilators and anticoagulants, the new vasodilators, as epoprostenol and its analogs, and surgical techniques have increased the survival of many patients. Pneumologists can view cases of pulmonary hypertension as complications of pulmonary diseases or as a result of dyspnea investigation. Despite its etiology, pulmonary hypertension represents a clear abnormality that affects the right ventricle and can be potentially fatal to patients. Image methods have made the diagnosis of pulmonary hypertension more accessible and non-invasive. Six cases of patients with pulmonary hypertension of different causes are presented and discussed. In conclusion, according to new concepts, idiopathic pulmonary hypertension is no longer an irreversible condition, and the identification of associated conditions with potential treatments can be favorable in the management of the patients with pulmonary hypertension.

 


Keywords: pulmonary hypertension, vascular resistance, lung diseases, vasodilator agents

 


Hepatopulmonary syndrome in a patient with AIDS and virus C cirrhosis (viral cirrhosis type C)

Síndrome hepatopulmonar em paciente com cirrose por vírus C e SIDA

Maria Angélica Pires Ferreira, Marcelo Basso Gazzana, Sérgio Saldanha Menna Barreto, Marli Maria Knorst

J Bras Pneumol.2001;27(1):52-55

Abstract PDF PT

Hepatopulmonary syndrome is characterized by a triad consisting of liver disorder, pulmonary vascular dilatation, and hypoxemia. No case of hepatopulmonary syndrome associated with AIDS has been reported so far. In this study, the authors report the case of a 43-year woman with AIDS and virus C cirrhosis taking prophylactic cotrimoxazole for pneumocystosis and retroviral therapy. Upon admission, the patient presented dyspnea, cyanosis, digital clubbing, vascular spiders, and normal chest examination. Chest X-ray revealed bilateral interstitial infiltration and evidenced increased alveolar-arterial gradient and liver function impairment. Intrapulmonary shunt was evidenced by contrast-enhanced echocardiography and radionuclide perfusion scanning, thus confirming hepatopulmonary syndrome.

 


Keywords: Hepatopulmonary syndrome. Acquired human immunodeficiency syndrome. Human viral hepatitis. Anoxemia. Liver cirrhosis.

 


Inhalation therapy in mechanical ventilation

Terapia inalatória em ventilação mecânica

Juçara Gasparetto Maccari, Cassiano Teixeira, Marcelo Basso Gazzana, Augusto Savi, Felippe Leopoldo Dexheimer-Neto, Marli Maria Knorst

J Bras Pneumol.2015;41(5):467-472

Abstract PDF PT PDF EN Portuguese Text

Patients with obstructive lung disease often require ventilatory support via invasive or noninvasive mechanical ventilation, depending on the severity of the exacerbation. The use of inhaled bronchodilators can significantly reduce airway resistance, contributing to the improvement of respiratory mechanics and patient-ventilator synchrony. Although various studies have been published on this topic, little is known about the effectiveness of the bronchodilators routinely prescribed for patients on mechanical ventilation or about the deposition of those drugs throughout the lungs. The inhaled bronchodilators most commonly used in ICUs are beta adrenergic agonists and anticholinergics. Various factors might influence the effect of bronchodilators, including ventilation mode, position of the spacer in the circuit, tube size, formulation, drug dose, severity of the disease, and patient-ventilator synchrony. Knowledge of the pharmacological properties of bronchodilators and the appropriate techniques for their administration is fundamental to optimizing the treatment of these patients.

 


Keywords: Bronchial hyperreactivity; Drug delivery systems; Respiration, artificial.

 


Pulmonary thromboembolism in necropsies at the Clinics Hospital of Porto Alegre 1985-1995

Tromboembolia pulmonar em necropsias no Hospital de Clínicas de Porto Alegre, 1985-1995

Sérgio Menna-Barreto, Marcelle Reesink Cerski, Marcelo Basso Gazzana, Stephen Doral Stefani, Roberta Rossi

J Bras Pneumol.1997;23(3):131-136

Abstract PDF PT

Objectives: The purpose of this study is to establish the prevalence of pulmonary thromboembolism (PTE) in autopsies and its rate of antemortem suspicion at Hospital de Clínicas de Porto Alegre (HCPA). Design: Cohort study with historical data. Setting: School hospital with 728 beds. Patients and methods: The adult autopsy reports were studied from 1985 to 1995 as well as the records of patients whose autopsies diagnosed PTE. Antemortem suspicion of PTE was considered from explicit notes on patients records, from requests of lung scan, or from full anticoagulation. Results: In the period mentioned, 9,607 deaths occurred, and 767 (7.98%) autopsies were performed. Significant PTE (> 1 pulmonary subsegment) in 30 (3.9%) patients. In 3 (10%) patients, PTE was considered the effective cause of death. Clinic suspicion was present in 5 (16.6%) patients; in 25 (83.4%) patients, there were only postmortem findings. Conclusion: PTE rates in autopsies were similar to those found in international literature. The rates of clinical suspicion were half of the ones mentioned in school hospitals in the United States and Europe. PTE was subsuspected in life in patients hospitalized at HCPA.

 


Keywords: Venous thromboembolism. Deep venous thrombosis. Pulmonary artery. Pulmonary infarction.

 


Severe tuberculosis requiring ICU admission

Tuberculose grave com necessidade de internação em UTI

Denise Rossato Silva, Marcelo Basso Gazzana, Paulo de Tarso Roth Dalcin

J Bras Pneumol.2012;38(3):386-394

Abstract PDF PT PDF EN Portuguese Text

Tuberculosis is a curable disease that can evolve to severe forms, requiring the treatment of the patients in an ICU, especially if there is a delay in the diagnosis or if it affects elderly patients, those on dialysis, or those with HIV infection or other states of immunosuppression, as well as in cases of multidrug resistant disease. Knowledge of the radiological presentation of the cases can help diagnose these severe forms, as can the introduction of new tests, such as the early detection of the etiological agent by PCR and chest CT, which favors the early initiation of treatment. In addition, the use of regimens without isoniazid and rifampin, as well as uncertain enteral absorption and low serum concentrations of antituberculosis drugs, can reduce the efficacy of treatment. For such patients, the prognosis is generally poor and mortality rates are high.

 


Keywords: Tuberculosis; Respiratory insufficiency; Respiration, artificial; Hospitalization.

 


Usefulness of radiological signs of pulmonary congestion in predicting failed spontaneous breathing trials

Utilidade de sinais radiológicos de congestão pulmonar para predizer o fracasso do teste de respiração espontânea

Ana Carolina Peçanha Antonio, Cassiano Teixeira, Priscylla Souza Castro, Ana Paula Zanardo, Marcelo Basso Gazzana, Marli Knorst

J Bras Pneumol.2017;43(4):253-258

Abstract PDF PT PDF EN Portuguese Text

Objective: Inspiratory fall in intrathoracic pressure during a spontaneous breathing trial (SBT) may precipitate cardiac dysfunction and acute pulmonary edema. We aimed to determine the relationship between radiological signs of pulmonary congestion prior to an SBT and weaning outcomes. Methods: This was a post hoc analysis of a prospective cohort study involving patients in an adult medical-surgical ICU. All enrolled individuals met the eligibility criteria for liberation from mechanical ventilation. Tracheostomized subjects were excluded. The primary endpoint was SBT failure, defined as the inability to tolerate a T-piece trial for 30-120 min. An attending radiologist applied a radiological score on interpretation of digital chest X-rays performed before the SBT. Results: A total of 170 T-piece trials were carried out; SBT failure occurred in 28 trials (16.4%), and 133 subjects (78.3%) were extubated at first attempt. Radiological scores were similar between SBT-failure and SBT-success groups (median [interquartile range] = 3 [2-4] points vs. 3 [2-4] points; p = 0.15), which, according to the score criteria, represented interstitial lung congestion. The analysis of ROC curves demonstrated poor accuracy (area under the curve = 0.58) of chest x-rays findings of congestion prior to the SBT for discriminating between SBT failure and SBT success. No correlation was found between fluid balance in the 48 h preceding the SBT and radiological score results (ρ = −0.13). Conclusions: Radiological findings of pulmonary congestion should not delay SBT indication, given that they did not predict weaning failure in the medical-surgical critically ill population. (ClinicalTrials.gov identifier: NCT02022839 [http://www.clinicaltrials.gov/])

 


Keywords: Radiography; Pulmonary edema; Ventilator weaning.

 


 

 


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