2V4vSHf0l

DIRETRIZES BRASILEIRAS DE Ventilação Mecânica – 2013
Técnicas de desmame gradual
• Recomendação: Evitar o uso de SIMV, pois pode prolongar o período de retirada da VMI. 29
Como conduzir o paciente com Falência de Extubação
• Recomendação: Reintubar o paciente o quanto antes, identificar e tratar as causas
da falência e assim que possível reiniciar o processo de retirada (exceção: pode-se
tentar VNI curativa no paciente cirúrgico).
REFERÊNCIAS BIBLIOGRÁFICAS – TEMA 23
1. Brochard L, Rauss A, Benito S, Conti G, Mancebo J, Rekik N, et al. Comparison of three methods
of gradual withdrawal from ventilatory support during weaning from mechanical ventilation. Am
J Respir Crit Care Med. 1994;150(4):896-903.
2. Esteban A, Frutos F, Tobin MJ, Alía I, Solsona JF, Valverdú I, et al. A comparison of four methods of
weaning patients from mechanical ventilation. Spanish Lung Failure Collaborative Group. N Engl J Med.
1995;332(6):345-50.
3. Epstein, S.K. Intensive Care Med (2002) 28:535–546
4. MacIntyre NR, Cook DJ, Ely EW Jr, Epstein SK, Fink JB, HeffnerJE, 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):375S-395S. Also in: Respir Care 2002;47(2): 69-90.
5. Esteban, A. Int Care Med, 24: 999-1008, 1998
6. Ely EW, Baker AM, Dunagan DP, Burke HL, Smith AC, Kelly PT, et al. Effect on the duration of mechanical ventilation
of identifying patients capable of breathing spontaneously. N Engl J Med 1996; 335(25):1864-1869.
7. Kollef MH, Shapiro SD, Silver P, St. John RE, Prentice D, Sauer S, et al. A randomized, controlled trial of protocol-
-directed versus physician-directed weaning from mechanical ventilation. Crit Care Med 1997;25(4):567-574.
8. Marelich GP, Murin S, Battistella F, Inciardi J, Vierra T, Roby M. Protocol weaning of mechanical ventilation
in medical and surgical patients by respiratory care practitioners and nurses: effect on weaning
time and incidence of ventilator-associated pneumonia. Chest 2000;118(2):459-467.
9. Navalesi P, Frigerio P, Moretti MP, Sommariva M, Vesconi S, Baiardi P, et al. Rate of reintubation in
mechanically ventilated neurosurgical and neurologic patients: evaluation of a systemic approach to
weaning and extubation. Crit Care Med 2008;36(11):2986-2992.
10. Blackwood B, Alderdice F, Burns K, Cardwell C. 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.
11. Kress JP, Pohlman AS, O’Connor MF, Hall JB. Daily interruption of sedative infusions in critically
ill patients undergoing mechanical ventilation. N Engl J Med. 2000;342(20):1471-7.
12. Goldwasser R, Farias A, Freitas EE,et al. Desmame e interrupção da ventilação mecânica. In: Carvalho CR,
coordinator. III Consenso Brasileiro de Ventilação Mecânica. J Bras Pneumol. 2007;33(Suppl 2S):S128-S136
111