7/25/2019 Desmame Da VPMec No RN

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ALGORITMO PARA DESMAME DE VM NO PERODO NEONATAL

1. Cook DJ, Walter SD, Cook RJ, et al.Incidence of and risk factors for ventilator-associated pneumonia in critically ill patients. Ann Intern Med 1998; 129: 433-439. 2. Ely EW, Baker

AM, Evans GW, et al. The cost of respiratory care in mechanically ventilated patients with chronic obstructive pulmonary disease. Crit Care Med 2000; 28: 408-413. 3. Epstein SK,Ciubotaru RL, Wong JB. Effect of failed extubation on the outcome of mechanical ventilation. Chest 1997; 112: 186-192. 4. Epstein, SK, Ciubotaru RL. Independent effects of etiology of

failure and time to reintubation on outcome for patients failing extubation. Am J Respir Crit Care Med 1998; 158:489-493. 5. Restrepo RD, Fortenberry JD, Spainhour, C, et al. Protocol-

driven ventilator management in children: Comparison to nonprotocol care. J Intensive Care Med 2004; 19: 274-284. 6. Reyes ZC, Claure N, Tauscher MK, et al. Randomized

controlled trial comparing synchronized intermittent mandatory ventilation and synchronized intermittent mandatory ventilation plus pressure support in pretern infants. Pediatrics 2006;

118: 1409-1417. 7. Fontela PS, Piva JP, Garcia PC, et al. Risk factors for extubation failure in mechanically ventilated pediatric patients. Pediatr Crit Care Med 2005; 6: 166-170.

VM >24H

RESOLUO DE CAUSA PRIMRIAPEEP 5 ; FiO2 40%; PaO2 50 70

Ph 7,3 PaO2 / FiO2 150

SuspenderSedao eanalgesia

RN ACORDADOBOA REATIVIDADESIMV COM CICLOS ESPONTNEOS REGULARESESTABILIDADE HEMODINMICADROGAS VASOATIVAS EM DOSES BAIXAS

Bloquear dietatemporariamente

Fisioterapia easpirao

PRESSO DE SUPORTE 160 ou elevao de 20%; Alterao PAM (mais ou menos); Aumento do esforo respiratrio

(TIC, retrao diafragmtica,gemncia, FR>60 ou BSA);

Sonolncia, agitao, desconforto; Sat O2 < 89 - 90 %;

Inalao c/adrenalina 1 amp +SF 0,9% 5 ml

Sinais deintolerncia 2 ou+ tens

CPAP nasal FiO2 10% maior PEEP = ou pouco

acima da anterior

Fluxo 6 - 8 l/min

Boa estabilidade Respirao efetiva Sat > 90% Hemodinamicamente

estvelNEBULIZAO

COM OXIMETRIA

Fisioterapia maisintensiva

principalmentese hipersecreo

Retornar paraSIMV //PSV

APSESTABILIZAO

RETORNAR DIETA

Retornaranalgesia