Avaliação da pressão inspiratória máxima em pacientes críticos não-cooperativos: comparação entre dois métodos

Abstract

Background: Although mechanical ventilation is necessary for treating acute respiratory insufficiency, it may be associated with deconditioning and respiratory muscle dysfunction. Maximal inspiratory pressure (MIP) evaluation is used to estimate inspiratory muscle strength in artificially ventilated patients, but there is no definition as to the best way to make this measurement. Objective: To compare two methods for MIP evaluation, using four different protocols, among non-cooperative artificially ventilated patients. Method: Thirty non-cooperative patients undergoing the process of weaning off mechanical ventilation were evaluated. In accordance with block randomization, the simple occlusion method (OM) or the unidirectional valve method (UV) was applied to each patient for time periods of 20 and 40 seconds. Additionally, during the 40s measurements, the MIP value at 30s was recorded. Results: The MIP values were higher at 40s than at 20s, both from OM (48.2 ± 21.7 vs. 36 ± 18.7 cmH 2 O; p< 0.001) and from UV (56.6 ± 23.3 vs. 43.4 ± 24 cmH 2 O; p< 0.001). The MaxIP values were higher from UV at 40s (UV40) than from OM at 40s (OM40) (56.6 ± 23.3 vs. 48.2 ± 21.7 cmH 2 O; p< 0.001). There was a difference between UV at 30 and 40s (51.5 ± 20.8 vs. 56.6 ± 23.3 cmH 2 O; p< 0.001). Conclusion: Among non-cooperative patients, higher MIP values were obtained from the unidirectional valve method with 40s of occlusion than from the other protocols evaluated.