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        "titulo" => "Abstract"
        "resumen" => "<span class="elsevierStyleSectionTitle">Objective</span><p id="spar0030" class="elsevierStyleSimplePara elsevierViewall">To study the influence of cardiac status on the length of mechanical ventilation&#44; outcome and disease severity in patients admitted to an Intensive Care Unit &#40;ICU&#41; with exacerbation of chronic respiratory failure&#46;</p> <span class="elsevierStyleSectionTitle">Design and setting</span><p id="spar0035" class="elsevierStyleSimplePara elsevierViewall">A 30-month prospective study in a 14 bed ICU</p> <span class="elsevierStyleSectionTitle">Patients and methods</span><p id="spar0040" class="elsevierStyleSimplePara elsevierViewall">Fifty nine patients were enrolled&#44; with a mean age 74&#46;7 &#43;&#47;- 9&#46;7 years&#44; mean length of ventilator support 10&#46;8 &#43;&#47;- 12&#46;6 days&#44; and mean APACHE II score 23 &#43;&#47;- 8&#46;3&#46; Within the first 24 hours of admittance&#44; cardiac chamber dimensions&#44; inferior vena cava &#40;IVC&#41;&#44; and mitral transvalvular Doppler were evaluated using transthoracic echocardiography&#59; the cardiac rhythm was recorded &#40;presence of sinus rhythm or atrial fibrillation&#41;&#46; Blood gases were evaluated at discharge&#46;</p> <span class="elsevierStyleSectionTitle">Results</span><p id="spar0045" class="elsevierStyleSimplePara elsevierViewall">Greater length of ventilation was observed in patients presenting atrial fibrillation &#40;p<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>0&#46;027&#41;&#44; particularly when a dilated IVC was also present &#40;&#62;20<span class="elsevierStyleHsp" style=""></span>mm&#44; p<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>0&#46;004&#41;&#46; A high level of serum bicarbonate &#40;&#62;35<span class="elsevierStyleHsp" style=""></span>mEq&#47;l&#41;&#44; was also related with longer ventilation &#40;p<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>0&#46; 04&#41;&#46; Twelve patients died&#46; Mortality was related to the presence of a dilated right ventricle &#40;p<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>0&#46;03&#41; and a ratio between right and left ventricle &#62; 0&#46; 6 &#40;p<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>0&#46;04&#41;&#46;</p> <span class="elsevierStyleSectionTitle">Conclusion</span><p id="spar0050" class="elsevierStyleSimplePara elsevierViewall">Patients submitted to mechanical ventilation due to exacerbation of chronic respiratory failure which present atrial fibrillation require a longer ventilation period&#44; particularly if a dilated IVC is also present&#46; Patients with dilated right cardiac chambers are at an increased risk of a fatal outcome&#46;</p>"
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        "resumen" => "<span class="elsevierStyleSectionTitle">Objectivo</span><p id="spar0005" class="elsevierStyleSimplePara elsevierViewall">estudar determinantes cardiovasculares condicionantes do tempo de ventila&#231;&#227;o&#44; mortalidade e gravidade de doen&#231;a em doentes admitidos numa unidade de cuidados intensivos para ventila&#231;&#227;o mec&#226;nica por exacerba&#231;&#227;o de insufici&#234;ncia respirat&#243;ria cr&#243;nica&#46;</p> <span class="elsevierStyleSectionTitle">Desenho e local</span><p id="spar0010" class="elsevierStyleSimplePara elsevierViewall">Estudo prospectivo&#44; com dura&#231;&#227;o de 30 meses numa unidade de cuidados intensivos m&#233;dico-cir&#250;rgica com 14 camas&#46;</p> <span class="elsevierStyleSectionTitle">Material e m&#233;todos</span><p id="spar0015" class="elsevierStyleSimplePara elsevierViewall">Estudados 59 doentes com idade m&#233;dia de 74&#44;7 &#43;&#47;- 9&#44;7 anos&#44; tempo m&#233;dio de ventila&#231;&#227;o de 10&#44;8 &#43;&#47;- 12&#44;6 dias&#44; APACHE II m&#233;dio de 23 &#43;&#47;- 8&#44;3&#46; Avaliaram-se par&#226;metros ecocardiogr&#225;ficos &#40;dimens&#245;es das cavidades&#44; d&#233;bito card&#237;aco&#44; estudo Doppler do fluxo transvalvular mitral&#44; estudo da veia cava inferior&#41; e electrocardiogr&#225;ficos &#40;presen&#231;a de ritmo sinusal ou fibrilha&#231;&#227;o auricular&#41; nas primeiras 24 horas de internamento na Unidade e par&#226;metros gasim&#233;tricos &#224; sa&#237;da&#46;</p> <span class="elsevierStyleSectionTitle">Resultados</span><p id="spar0020" class="elsevierStyleSimplePara elsevierViewall">Um tempo de ventila&#231;&#227;o mais prolongado associou-se &#224; presen&#231;a de fibrilha&#231;&#227;o auricular &#40;p<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>0&#44;027&#41;&#44; &#224; presen&#231;a conjunta de fibrilha&#231;&#227;o auricular e uma veia cava inferior dilatada &#40;&#62; 20<span class="elsevierStyleHsp" style=""></span>mm p<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>0&#44;004&#41; e com n&#237;veis s&#233;ricos de bicarbonato &#62; 35mEq&#47;l na gasimetria obtida &#224; sa&#237;da &#40;p<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>0&#44;04&#41;&#46; Verificaram-se 12 &#243;bitos&#46; A mortalidade associou-se &#224; presen&#231;a de dilata&#231;&#227;o do ventr&#237;culo direito &#40;p<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>0&#44;03&#41; e a uma rela&#231;&#227;o entre o ventr&#237;culo direito e o esquerdo &#62; 0&#44;6 &#40;p<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>0&#44;04&#41;&#46;</p> <span class="elsevierStyleSectionTitle">Conclus&#227;o</span><p id="spar0025" class="elsevierStyleSimplePara elsevierViewall">Nos doentes submetidos a ventila&#231;&#227;o mec&#226;nica por exacerba&#231;&#227;o de insufici&#234;ncia respirat&#243;ria cr&#243;nica&#44; a presen&#231;a de fibrilha&#231;&#227;o auricular indica a possibilidade de um per&#237;odo de ventila&#231;&#227;o mais prolongado&#44; em especial se houver concomitantemente uma veia cava inferior com di&#226;metro &#62; 20mm&#46; Nestes doentes&#44; a presen&#231;a de dilata&#231;&#227;o das cavidades direitas pode indicar uma probabilidade mais elevada de mortalidade&#46;</p>"
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Vol. 12. Issue 2.
Pages 131-146 (March - April 2006)
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Vol. 12. Issue 2.
Pages 131-146 (March - April 2006)
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Cardiac influence on mechanical ventilation time and mortality in exacerbated chronic respiratory failure patients. The role of echocardiographic parameters
Determinantes cardíacas do tempo de ventilação mecânica e mortalidade de doentes com insuficiência respiratória crónica exacerbada. A importância dos parâmetros ecocardiográficos
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Paulo Marcelino1,
Corresponding author
paulo-alex-ma@hotmail.com
alternativo.pmarcelino@fm.ul.pt

Correspondence to/Correspondência: Hospital de Curry Cabral, Unidade de Cuidados Intensivos, Rua da Beneficência, 8, 1066-169, Lisboa.
, Nuno Germano2, Ana Paiva Nunes2, Lígia Flora3, Ana Moleiro2, Susan Marum1, Ana Paula Fernandes1, Luís Mourão4,5
1 Assistente Hospitalar de Medicina Interna/Internal Medicine Hospital Assistant
2 Interno do Internato Complementar de Medicina Interna/Complementary Internal Medicine Intern
3 Interna do Internato Complementar de Pneumologia/Complementary Pulmonology Intern
4 Hospital de Curry Cabral, Unidade de Cuidados Intensivos, Curry Cabral Hospital, Lisbon University Cardiology Centre (CCUL)
5 Centro de Cardiologia da Universidade de Lisboa (CCUL)/Intensive Care Unit, Curry Cabral Hospital, Lisbon University Cardiology Centre (CCUL)
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Article information
Abstract
Objective

To study the influence of cardiac status on the length of mechanical ventilation, outcome and disease severity in patients admitted to an Intensive Care Unit (ICU) with exacerbation of chronic respiratory failure.

Design and setting

A 30-month prospective study in a 14 bed ICU

Patients and methods

Fifty nine patients were enrolled, with a mean age 74.7 +/- 9.7 years, mean length of ventilator support 10.8 +/- 12.6 days, and mean APACHE II score 23 +/- 8.3. Within the first 24 hours of admittance, cardiac chamber dimensions, inferior vena cava (IVC), and mitral transvalvular Doppler were evaluated using transthoracic echocardiography; the cardiac rhythm was recorded (presence of sinus rhythm or atrial fibrillation). Blood gases were evaluated at discharge.

Results

Greater length of ventilation was observed in patients presenting atrial fibrillation (p=0.027), particularly when a dilated IVC was also present (>20mm, p=0.004). A high level of serum bicarbonate (>35mEq/l), was also related with longer ventilation (p=0. 04). Twelve patients died. Mortality was related to the presence of a dilated right ventricle (p=0.03) and a ratio between right and left ventricle > 0. 6 (p=0.04).

Conclusion

Patients submitted to mechanical ventilation due to exacerbation of chronic respiratory failure which present atrial fibrillation require a longer ventilation period, particularly if a dilated IVC is also present. Patients with dilated right cardiac chambers are at an increased risk of a fatal outcome.

Key-words:
Mechanical ventilation
chronic respiratory failure
echocardiography
Resumo
Objectivo

estudar determinantes cardiovasculares condicionantes do tempo de ventilação, mortalidade e gravidade de doença em doentes admitidos numa unidade de cuidados intensivos para ventilação mecânica por exacerbação de insuficiência respiratória crónica.

Desenho e local

Estudo prospectivo, com duração de 30 meses numa unidade de cuidados intensivos médico-cirúrgica com 14 camas.

Material e métodos

Estudados 59 doentes com idade média de 74,7 +/- 9,7 anos, tempo médio de ventilação de 10,8 +/- 12,6 dias, APACHE II médio de 23 +/- 8,3. Avaliaram-se parâmetros ecocardiográficos (dimensões das cavidades, débito cardíaco, estudo Doppler do fluxo transvalvular mitral, estudo da veia cava inferior) e electrocardiográficos (presença de ritmo sinusal ou fibrilhação auricular) nas primeiras 24 horas de internamento na Unidade e parâmetros gasimétricos à saída.

Resultados

Um tempo de ventilação mais prolongado associou-se à presença de fibrilhação auricular (p=0,027), à presença conjunta de fibrilhação auricular e uma veia cava inferior dilatada (> 20mm p=0,004) e com níveis séricos de bicarbonato > 35mEq/l na gasimetria obtida à saída (p=0,04). Verificaram-se 12 óbitos. A mortalidade associou-se à presença de dilatação do ventrículo direito (p=0,03) e a uma relação entre o ventrículo direito e o esquerdo > 0,6 (p=0,04).

Conclusão

Nos doentes submetidos a ventilação mecânica por exacerbação de insuficiência respiratória crónica, a presença de fibrilhação auricular indica a possibilidade de um período de ventilação mais prolongado, em especial se houver concomitantemente uma veia cava inferior com diâmetro > 20mm. Nestes doentes, a presença de dilatação das cavidades direitas pode indicar uma probabilidade mais elevada de mortalidade.

Palavras-chave:
Insuficiência respiratória crónica
ventilação mecânica
ecocardiografia
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Copyright © 2006. Sociedade Portuguesa de Pneumologia
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