Success or failure predictive indexes of extubation in renal transplants patients under mechanical ventilation – pilot study
Silva, Luciana Domingues Angelo da; Almeida, Marcella M. Musumeci F.; Quaresma, Matheus Oliveira; Castro, Talita; Santos, Mariana Ares; Chiavegato, Luciana Dias
Abstract
Introduction: Currently, chronic kidney disease (CKD) is a major health problem and in the most severe conditions, kidney transplantation is an alternative treatment. However immunosuppression induced these patients to respiratory complications and endotracheal intubation. In order to assist the decision of the best time for weaning and extubation of these patients, there are predictive indexes that should be considered in preliminary assesment. Objective: To check the capacity of predictive indexes for weaning of mechanical ventilation, rapid shallow breathing index (RSBI), oxygenation rate (PaO2 /FiO2 ) and maximum inspiratory pressure (MIP) in predicting the success or extubation failure in kidney transplant patients. Methods: This study is a prospective cohort carried out with patients aged over 18, under mechanical ventilation for more than 24 hours. The patients were submitted to the Spontaneous Breathing Test, also the assessment of the Rapid Shallow Breathing Index, oxygenation index (PaO2 /FiO2 ), and maximum inspiratory pressure (MIP) and they were observed during 48 hours after to evaluate the success and extubation failure. Results: A total of 106 patients were eligible, and 20 of these were included with mean age of 46.9 ± 3.06 years and 14 of the subjects were male. Three patients showed extubation failure, and needed to have reintubation within the period of 48 hours as considered. Conclusion: The indices to predict weaning of mechanical ventilation, when within the expected normal values, seem to be able to predict extubation, with the exception of MIP that, even in cases of success, showed itself to be at levels lower than the predicted percentage.
Keywords
References
1. JER. J. Doença Renal Crônica: Definição, Epidemiologia e Classificação. . J Bras Nefrol. 2004;26(3):1-3.
2. Cury JL, Brunetto AF, Aydos RD. Efeitos negativos da insuficiência renal crônica sobre a função pulmonar e a capacidade funcional. Brazilian Journal of Physical Therapy. 2010;14:91-8.
3. Drury DR, Henry JP, Goodman J. The Effects of Continuous Pressure Breathing on Kidney Function. The Journal of clinical investigation. 1947;26(5):945-51.
4. Pierson DJ. Respiratory considerations in the patient with renal failure. Respiratory care. 2006;51(4):413-22.
5. Miller WT, Jr. Pulmonary infections in patients who have received solid organ transplants. Seminars in Roentgenology.35(2):152-70.
6. Canet E, Osman D, Lambert J, Guitton C, Heng AE, Argaud L, et al. Acute respiratory failure in kidney transplant recipients: a multicenter study. Critical care. 2011;15(2):R91.
7. Koyner JL, Murray PT. Mechanical ventilation and the kidney. Blood purification. 2010;29(1):52-68.
8. Goldwasser R, Farias A, Freitas EE, Saddy F, Amado V, Okamoto VN. Desmame e interrupção da ventilação mecânica. Revista Brasileira de Terapia Intensiva. 2007;19:384-92.
9. MacIntyre NR, Cook DJ, Ely EW, Jr., Epstein SK, Fink JB, Heffner JE, et al. Evidence-based guidelines for weaning and discontinuing ventilatory support: a collective task force facilitated by the American College of Chest Physicians; the American Association for Respiratory Care; and the American College of Critical Care Medicine. Chest. 2001;120(6 Suppl):375S-95S.
10. Navalesi P, Frigerio P, Patzlaff A, Haussermann S, Henseke P, Kubitschek M. Prolonged weaning: from the intensive care unit to home. Revista portuguesa de pneumologia. 2014;20(5):264-72.
11. Karacan O, Tutal E, Colak T, Sezer S, Eyuboglu FO, Haberal M. Pulmonary function in renal transplant recipients and end-stage renal disease patients undergoing maintenance dialysis. Transplantation proceedings. 2006;38(2):396-400.
12. Condessa RL, Brauner JS, Saul AL, Baptista M, Silva AC, Vieira SR. Inspiratory muscle training did not accelerate weaning from mechanical ventilation but did improve tidal volume and maximal respiratory pressures: a randomised trial. Journal of physiotherapy.2013;59(2):101-7.
13. Ladeira MT, Vital FM, Andriolo RB, Andriolo BN, Atallah AN, Peccin MS. Pressure support versus T-tube for weaning from mechanical ventilation in adults. The Cochrane database of systematic reviews. 2014;5:CD006056.
14. Metnitz PG, Moreno RP, Almeida E, Jordan B, Bauer P, Campos RA, et al. SAPS 3--From evaluation of the patient to evaluation of the intensive care unit. Part 1: Objectives, methods and cohort description. Intensive care medicine. 2005;31(10):1336-44.
15. Vincent JL et al. The SOFA (Sepsis-related Organ Failure Assessment) score to describe organ dysfunction / failure. Intensive Care Med. 1996;22:707-710
16. Neder JA, Andreoni S, Lerario MC, Nery LE. Reference values for lung function tests: II. Maximal respiratory pressures and voluntary ventilation. Brazilian Journal of Medical and Biological Research. 1999;32:719-27.
17. Blackwood B, Alderdice F, Burns K, Cardwell C, Lavery G, O’Halloran P. Use of weaning protocols for reducing duration of mechanical ventilation in critically ill adult patients: Cochrane systematic review and meta-analysis. Bmj. 2011;342:c7237.
18. Carvalho, CRR et al, III Consenso Brasileiro de Ventilação Mecanica, J Bras Pneumol. 2007;33(Supl 2):S 54-S 70
19. Nemer SN, Barbas CSV. Parâmetros preditivos para o desmame da ventilação mecânica. Jornal Brasileiro de Pneumologia. 2011;37:669-79.
20. Figueroa-Casas JB, Dwivedi AK, Connery SM, Quansah R, Ellerbrook L, Galvis J. Predictive models of prolonged mechanical ventilation yield moderate accuracy. Journal of critical care. 2015;30(3):502-5.
21. Bush A, Gabriel R. Pulmonary function in chronic renal failure: effects of dialysis and transplantation. Thorax. 1991;46(6):424-8.
22. González-Castro A, Suárez-Lopez V, Gómez-Marcos V, González-Fernandez C, Iglesias-Posadilla D, Burón-Mediavilla J, et al. Valor de la fracción de espacio muerto (Vd/Vt) como predictor de éxito en la extubación. Medicina Intensiva. 2011;35:529-38.
23. Kovelis D, Pitta F, Probst VS, Peres CPA, Delfino VDA, Mocelin AJ, et al. Função pulmonar e força muscular respiratória em pacientes com doença renal crônica submetidos à hemodiálise. Jornal Brasileiro de Pneumologia. 2008;34:907-12.
24. Totonchi Z, Baazm F, Chitsazan M, Seifi S, Chitsazan M. Predictors of prolonged mechanical ventilation after open heart surgery. Journal of cardiovascular and thoracic research. 2014;6(4):211-6.
25. Vieira WP, Gomes KWP, Frota NB, Andrade JECB, Vieira RMRdA, Moura FEA, et al. Manifestações musculoesqueléticas em pacientes submetidos à hemodiálise. Revista Brasileira de Reumatologia. 2005;45:357-64
26. Guleria S, Agarwal RK, Guleria R, Bhowmik D, Agarwal SK, Tiwari SC. The effect of renal transplantation on pulmonary function and respiratory muscle strength in patients with end-stage renal disease. Transplantation proceedings. 2005;37(2):664-5.
27. Bark H, Heimer D, Chaimovitz C, Mostoslovski M. Effect of chronic renal failure on respiratory muscle strength. Respiration; international review of thoracic diseases. 1988;54(3):153-61.
28. Sidhu J, Ahuja G, Aulakh B, Narang A, Whig J, Sidhu U. Changes in pulmonary function in patients with chronic renal failure after successful renal transplantation. Scandinavian journal of urology and nephrology. 2007;41(2):155-60.
29. Santos LdeO,Borges MR, FigueiredoLC, Guedes CA.Comparision among three methods to measure the rapid shallow breathing index in patients submitted to weaning in mechanical ventilation, Rev Bras Ter Intensiva.2007 Sep,19(3):331-6
30. Burns KE, Lellouche F, Lessard MR, Friedrich JO. Automated weaning and spontaneous breathing trial systems versus non-automated weaning strategies for discontinuation time in invasively ventilated postoperative adults. The Cochrane database of systematic reviews. 2014;2
31. Peñuelas Ó1, Thille AW, Esteban A. Discontinuation of ventilatory support: new solutions to old dilemmasCurr Opin Crit Care. 2015 Feb;21(1):74-81.
32. Shunsuke Takaki, MD, Modified Rapid Shallow Breathing Index Adjusted With Anthropom Parameters Increases Predictive Power for Extubation Failure Com With the Unmodified Index in Postcardiac Surgery Patients. J Cardiothoracic and Vascular Anesthesia, Vol 29, No 1, 2015:64–68
33. Thille AW1, Cortés-Puch I, Esteban A. Weaning from the ventilator and extubation in ICU. Curr Opin Crit Care. 2013 Feb;19(1):57-64.
Facebook
Google+
Twitter
LinkedIn
Mendeley
StumbleUpon
CiteULike
Reddit
Email