Impactos clínicos da falha de extubação em pacientes críticos internados na Unidade de Terapia Intensiva
Clinical impacts of extubation failure in critically ill patients admitted to an Intensive Care Unit
Ana Clara Budal, Aline Braz Pereira, Daniela Delvan, Graziela de Vila de Luca Tonon, Larissa Bedendo Pires da Luz Alexandre, Michelli Marcela Dadam
Resumo
Introdução: A falha de extubação e necessidade de reintubação ocorre em até 30% dos pacientes e está associada a aumento da mortalidade. Objetivo: Avaliar a frequência de falha de extubação em 48 horas e 7 dias em pacientes com mais de 24 horas de ventilação mecânica invasiva e submetidos à extubação planejada na unidade de terapia intensiva; e identificar os fatores de risco e desfechos clínicos associados à falha de extubação em 7 dias. Métodos: Estudo observacional, longitudinal e comparativo, com análise de caráter retrospectiva e prospectiva, de pacientes internados nas unidade de terapia intensiva de um hospital público do norte de Santa Catarina, no período de Outubro de 2021 à Setembro de 2024. Foram incluídos no estudo pacientes internados na unidade de terapia intensiva, de ambos os sexos, com idade igual ou superior a 18 anos, em ventilação mecânica invasiva por tempo superior a 24 horas e submetidos ao protocolo de desmame e extubação da instituição. Resultados: Foram incluídos 683 pacientes (527 retrospectivos e 156 prospectivos) submetidos à uma extubação planejada no período do estudo. A frequência de falha de extubação em 48 horas e 7 dias foi de 20% e 27%, respectivamente. Os pacientes com falha de extubação apresentaram maior tempo de permanência e maior mortalidade na unidade de terapia intensiva e hospitalar. Foram identificados como fatores de risco associados à falha de extubação em 7 dias: doenças hepáticas como causa de admissão na unidade de terapia intensiva, a presença de comorbidades como doenças neurológicas, da idade acima de 65 anos, tosse ineficaz, problemas de vias aéreas superiores, o uso da ventilação mecânica invasiva por mais de 72 horas e uso de ventilação não invasiva após extubação. Conclusão: Esses achados evidenciam a importância de uma avaliação cuidadosa e individualizada dos pacientes em risco, visando a otimização das estratégias de desmame e extubação, com o intuito de melhorar os desfechos clínicos e reduzir a mortalidade associada. Contudo, os achados das associações deste estudo devem ser interpretados como geradores de hipóteses e a relação de causalidade necessita de confirmação em estudos prospectivos.
Material Suplementar
Este artigo acompanha material suplementar.
Tabela S1. Checklist diário de avaliação de aptidão para o desmame da VM e TER
Tabela S2. Instrumento de coleta de dados
Palavras-chave
Abstract
Introduction: Extubation failure and the need for reintubation occur in up to 30% of patients and are associated with increased mortality. Objective: To evaluate the frequency of extubation failure at 48 hours and 7 days in patients who underwent more than 24 hours of invasive mechanical ventilation and planned extubation in the intensive care unit; and to identify risk factors and clinical outcomes associated with extubation failure within 7 days. Methods: This was an observational, longitudinal, and comparative study, with both retrospective and prospective analysis, including patients admitted to the intensive care units of a public hospital in northern Santa Catarina, between October 2021 and September 2024. Patients admitted to the intensive care unit of either sex, aged 18 years or older, who required invasive mechanical ventilation for more than 24 hours and underwent the institutional weaning and extubation protocol, were included. Results: A total of 683 patients (527 retrospective and 156 prospective) who underwent planned extubation during the study period were included. The frequency of extubation failure at 48 hours and 7 days was 20% and 27%, respectively. Patients with extubation failure had longer intensive care unit and hospital stays, as well as higher intensive care unit and hospital mortality. Risk factors associated with extubation failure within 7 days included liver disease as the cause of intensive care unit admission, the presence of comorbidities such as neurological disease, age greater than 65 years, ineffective cough, upper airway problems, use of invasive mechanical ventilation for more than 72 hours, and the need for non-invasive ventilation after extubation. Conclusion: These findings highlight the importance of careful and individualized assessment of patients at risk, aiming to optimize weaning and extubation strategies to improve clinical outcomes and reduce associated mortality. However, the associations observed in this study should be interpreted as hypothesis-generating, and causal relationships need to be confirmed in prospective studies.
Supplementary Material
This article includes supplementary material.
Table S1. Daily checklist for assessing readiness for weaning from VM and TRE
Table S2. Data collection instrument
Keywords
Referências
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Submetido em:
20/08/2025
Aceito em:
29/10/2025
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