Pressão Inspiratória Máxima (PIMAX) é melhor preditor de sucesso na extubação que o Índice de Respiração Rápida e Superficial (IRRS)

Abstract

Objective: To investigate the predictive value of maximal inspiratory pressure and the rapid shallow breathing index used in a weaning and extubation protocol and its difference between clinical and surgical patients in an intensive care unit of high complexity hospital. Methodology: A prospective cross-sectional study, conducted at the Adult Intensive Care Unit of the Hospital of Mandaqui (ICU-CHM), in São Paulo / SP. The study included patients who were admitted to the ICU-CHM in oro-tracheal intubation, mechanical ventilation, of both sexes, aged over 15 years and meet the criteria of weaning and extubation protocol. ROC curves were calculated to evaluate the performance of each index, positive predictive value, negative predictive value, positive likelihood ratio, negative likelihood ratio, as well as the accuracy and subsequent logistic regression. Results: 195 patients were included, of which 150 (76.92%) were successful and 45 (23.07%) failure to discontinue mechanical ventilation. The ROC curve analysis showed that the MIP has higher sensitivity and specificity in the general group of the RSBI, (AUC = 0.95 x 0.89) and likelihood ratio (positive 20.85 and 0.07 negative for MIP and 9.45 positive and negative 0.17 for IRRS) as well as in clinical patients (AUC = 0.99 x 0.90) and likelihood ratio (24.66 positive and negative 0.01 for MIP, and positive and negative 0.15 7.22 for the RSBI) and surgical (AUC = 0.99 x 0.87) with likelihood ratio (9.33 positive and negative 0.07 for MIP and 5.86 positive and 0.14 negative for the RSBI). Logistic regression showed that the MIP is significantly important between success and failure in groups (p <0.001) and that the RSBI also has significant importance between the two groups (p <0.003). The accuracy of MIP was higher (general group = 0.93, = 0.98 clinical and surgical = 0.93) than the RSBI (general group = 0.85, = 0.87 clinical and surgical = 0, 87). Conclusion: MIP and RSBI are good predictors of success in the weaning process, the MIP being best predictor that RSBI in our study.