Predição no sucesso do desmame da ventilação mecânica em pacientes neurocríticos: uma revisão

Abstract

INTRODUCTION: The weaning of the mechanical ventilation (MV) is a procedure that demands a critical evaluation of indicators, which determine the best time to encourage spontaneous breathing. The MV discontinuation shall never be delayed, mainly because of possible medical complications and costs involved in keeping a patient in an Intensive Care Unit (ICU). OBJECTIVE: The purpose of this study was to identify the cautions, steps and prediction parameters which most closely relate to the success of MV weaning of neurocritical patients. METHODOLOGY: Review of reliable, MV weaning-related articles of neurocritical patients in the MEDLINE, LILACS and Cochrane Library databases. Mechanical ventilation, weaning predictors, neurocritical patients and neurosurgical were the most used key words. RESULTS: Ten out of seventeen articles were selected for discussion and conclusion. These ten were chosen specially because of their coherence and methodological reliability. DISCUSSION AND CONCLUSION: Both the Rapid Shallow Breathing Index (RSBI) and the Glasgow Coma Scale (GCS) correlates well with the progression of weaning from mechanical ventilation devices. It was observed that the daily awakening - that is - the gradual sedation withdrawal and the early tracheostomy have positive influence on the weaning process success.