Avaliação do tempo médio entre a intubação orotraqueal e a indicação de traqueostomia
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Tipo
TCC
Data de publicação
2023-11-27
Periódico
Citações (Scopus)
Autores
Hatashita, João Gabriel
Schemberg, João Pedro Subtil
Schemberg, João Pedro Subtil
Orientador
Junior, Carlos Hespanha Marinho
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INTRODUÇÃO: A manutenção de via aérea é primordial no atendimento pré-hospitalar, garantindo, oxigenação e prevenção contra aspiração. Diversas abordagens, como o uso de máscara de ventilação e dispositivos supraglóticos, podem ser empregadas para manter a via aérea permeável. No entanto, a traqueostomia é recomendada quando é necessária uma via aérea definitiva com suporte ventilatório. Devido a amostras pequenas nos estudos, há um debate em relação ao momento ideal para realizar a traqueostomia. Com isso, não há um padrão para o momento da transição da intubação orotraqueal para a traqueostomia. Portanto, justifica-se a realização deste estudo devido à carência de orientações claras sobre o tempo dessa conversão. OBJETIVOS: Pesquisar o tempo médio de troca da intubação orotraqueal para a traqueostomia. METODOLOGIA: Essa pesquisa foi um estudo prospectivo analítico transversal. Realizado com médicos de diferentes especialidades. Os dados foram coletados entre maio e setembro de 2023 por meio de formulário digital na plataforma Google Forms, e por meio de procura direta de profissionais que se encaixavam nos critérios de inclusão. O formulário contou com dois casos clínicos de pacientes submetidos a intubação orotraqueal com diferentes prognósticos, sendo um de melhor e outro de pior prognóstico junto a outras informações clínicas presentes no caso clínico. No formulário foram feitas duas perguntas diretas, uma para cada caso clínico, de qual o tempo em dias que o médico julga ideal realizar a troca da intubação orotraqueal para a traqueostomia. RESULTADOS: Os resultados demonstraram uma diferença significativa quando comparado às respostas totais do caso um em comparação com o caso dois, sendo que no segundo caso a média em dias foi inferior à média do caso um. Entretanto, essa diferença não se mostrou significativa entre os grupos médicos quando comparado às respostas do caso dois. CONCLUSÃO: Conclui-se que os médicos que trabalham em UTIs e emergência tendem a optar por realizar traqueostomias precocemente em pacientes que apresentam um pior prognóstico. Enquanto, médicos que não trabalham na área de emergência divergem dos emergencistas em casos mais leves, mas vão ao encontro deles ao lidar com pacientes em estado crítico.
INTRODUCTION: Airway maintenance is paramount in pre-hospital care, ensuring oxygenation and prevention against aspiration. Various approaches, such as the use of ventilation masks and supraglottic devices, can be employed to keep the airway patent. However, tracheostomy is recommended when a definitive airway with ventilatory support is required. Due to limited study samples, there is a debate regarding the optimal timing for performing tracheostomy. Consequently, there is no defined standard for the transition from orotracheal intubation to tracheostomy. Therefore, the conduction of this study is justified due to the absence of clear guidelines concerning the timing of this conversion. OBJECTIVES: To investigate the average time for transitioning from orotracheal intubation to tracheostomy. METHODOLOGY: This research was a cross-sectional analytical prospective study conducted with a sample comprising physicians from various specialties. Data was collected between May and September 2023 through a digital form on the Google Forms platform and via direct contact with professionals meeting the inclusion criteria. The form included two clinical cases of patients subjected to orotracheal intubation with different prognoses, one having a better prognosis and the other a worse prognosis, along with other clinical information provided in the case scenarios. Two direct questions were asked in the form, one for each clinical case, inquiring about the number of days the physician deemed ideal for transitioning from orotracheal intubation to tracheostomy. RESULTS: The results showed a significant difference when comparing the total responses for case one versus case two, with the average time in days for the second case being lower than that for the first case. However, this difference did not prove statistically significant between the two physicians’ groups when comparing responses within case two. CONCLUSION: It can be concluded that physicians working in ICUs and emergency departments tend to opt for performing tracheostomies early in patients with a worse prognosis. On the other hand, physicians who do not work in the emergency setting differ from emergency physicians in milder cases but align with them when dealing with critically ill patients.
INTRODUCTION: Airway maintenance is paramount in pre-hospital care, ensuring oxygenation and prevention against aspiration. Various approaches, such as the use of ventilation masks and supraglottic devices, can be employed to keep the airway patent. However, tracheostomy is recommended when a definitive airway with ventilatory support is required. Due to limited study samples, there is a debate regarding the optimal timing for performing tracheostomy. Consequently, there is no defined standard for the transition from orotracheal intubation to tracheostomy. Therefore, the conduction of this study is justified due to the absence of clear guidelines concerning the timing of this conversion. OBJECTIVES: To investigate the average time for transitioning from orotracheal intubation to tracheostomy. METHODOLOGY: This research was a cross-sectional analytical prospective study conducted with a sample comprising physicians from various specialties. Data was collected between May and September 2023 through a digital form on the Google Forms platform and via direct contact with professionals meeting the inclusion criteria. The form included two clinical cases of patients subjected to orotracheal intubation with different prognoses, one having a better prognosis and the other a worse prognosis, along with other clinical information provided in the case scenarios. Two direct questions were asked in the form, one for each clinical case, inquiring about the number of days the physician deemed ideal for transitioning from orotracheal intubation to tracheostomy. RESULTS: The results showed a significant difference when comparing the total responses for case one versus case two, with the average time in days for the second case being lower than that for the first case. However, this difference did not prove statistically significant between the two physicians’ groups when comparing responses within case two. CONCLUSION: It can be concluded that physicians working in ICUs and emergency departments tend to opt for performing tracheostomies early in patients with a worse prognosis. On the other hand, physicians who do not work in the emergency setting differ from emergency physicians in milder cases but align with them when dealing with critically ill patients.
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Palavras-chave
intubação intratraqueal , traqueostomia , troca de tratamento , time-to-treatment , intubation , intratracheal , tracheostomy