Associação entre ajustes ventilatórios não protetores e a evolução de pacientes com aids e fatores de risco para síndrome do desconforto respiratório agudo

Abstract

OBJECTIVES: To evaluate the association between ventilatory settings and mortality in acquired immunodeficiency syndrome (AIDS) patients and with risk for acute respiratory distress syndrome (ARDS) submitted to mechanical ventilation (MV). METHODS: This prospective cohort study was carried out in one Intensive Care Unit (ICU) of the University Hospital of Universidade Federal de Juiz de Fora, and included 30 patients with AIDS under MV. Ventilatory parameters were collected twice daily for seven days, and patients were divided into two groups (protective or non-protective MV), based on the maximal distending pressure (MDP) or the tidal volume (TV). The outcomes were hospital mortality, ICU mortality, and 28-day mortality. We also evaluated risk factors associated with the adoption of a non-protective ventilatory strategy. RESULTS: Non-protective MV occurred in 40% of the patients based on the MDP, and in 47% based on the TV. The cox proportional regression, adjusted for covariates, didn’t show association between non-protective MV and hospital, ICU, and 28-day mortality. Female gender and respiratory rate were independent factors associated with non-protective MV, based on the MDP; while predicted body weight and respiratory rate were those associated with non-protective MV based on the TV. CONCLUSIONS: In this cohort, a non-protective MV didn’t associate with mortality in AIDS patients and with risk for ARDS. Potentially injurious ventilatory settings were female gender, predicted body weight and respiratory rate.