ALGORITMO PARA DESMAME DE VM NO PERODO NEONATAL

VM >24H

RESOLUO DE CAUSA PRIMRIA

PEEP 5 ; FiO2 40%; PaO2 50 70
Ph 7,3 PaO2 / FiO2 150
Suspender
Sedao e
analgesia
RN ACORDADO
BOA REATIVIDADE
SIMV COM CICLOS ESPONTNEOS REGULARES
ESTABILIDADE HEMODINMICA
DROGAS VASOATIVAS EM DOSES BAIXAS
Bloquear dieta
temporariamente

Fisioterapia e
aspirao

SINAIS DE INTOLERNCIA

FC > 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 %;

PRESSO DE SUPORTE <10 E

VOLUME CORRENTE=4 - 6
ml/Kg POR 30 min

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

CPAP nasal

FiO2 10% maior

PEEP = ou pouco
acima da anterior

Fluxo 6 - 8 l/min
Fisioterapia mais
intensiva
principalmente
se hipersecreo

Sinais de
intolerncia 2 ou
+ tens

Retornar para
SIMV //PSV

Retornar
analgesia

APS
ESTABILIZAO
RETORNAR DIETA
Boa estabilidade

Respirao efetiva

Sat > 90%

Hemodinamicamente
estvel

NEBULIZAO
COM OXIMETRIA

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. Protocoldriven 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.