Incidence Of Tracheal Aspiration In Tracheotomized Patients In Use Of Mechanical Ventilation

ARTIGO ORIGINAL / ORIGINAL ARTICLE

ARQGA/1450

INCIDENCE OF TRACHEAL ASPIRATION IN TRACHEOTOMIZED PATIENTS IN USE OF MECHANICAL VENTILATION
Mariana de Almeida SIMÃO1, Camila Albuquerque Nobre ALACID1, Katia Alonso RODRIGUES2, Christiane ALBUQUERQUE3 and Ana Maria FURKIM4
ABSTRACT – Context – Many patients in use of mechanical ventilation show clinical complications due to trachealaspiration. Assessment and early methods are necessary, so that preventive and safety measures apply to this patients. Objective - To study the incidence of tracheal aspiration of saliva in tracheotomized patients treated in intensive care unit using two modes of mechanical ventilation and with different sedation levels. Method - Prospective study with 14 tracheotomized non-neurological patients usingmechanical ventilation. The sample was divided into two groups based on ventilation mode: pressure support ventilation and pressure controlled ventilation. Those two groups were subdivided into two others according to sedation level. The speech pathology evaluation was completed via the blue dye test in order to analyze the incidence of tracheal aspiration of saliva. Results - Sedation levels andmechanical ventilation time related to tracheal aspiration were not statistically significant in this study. On the other hand, ventilation mode and tracheal aspiration showed statistical significance, and there was a higher incidence of tracheal aspiration in the pressure controlled ventilation mode. Conclusion - It was possible to observe a significant relationship between tracheal aspirationincidence and pressure controlled ventilation mode, which means the inclusion of those patients in the risk group for oropharyngeal dysphagia and their insertion in prevention protocols. The relationship between tracheal aspiration and sedation level, as well as tracheal aspiration and mechanical ventilation, were not statistically significant in this sample, needing further research. HEADINGS –Tracheostomy. Respiration, artificial. Deglutition disorders. Respiratory aspiration.

INTRODUCTION

Mechanical ventilation is indispensable to the maintenance of life mainly in intubated or tracheotomized patients with serious acute respiratory insufficiency in intensive care units (ICU). It is a support method, but not a curative therapy. The use of artificial ventilation is associated withspecific complications and its handling must be precise(11). There exist some ventilating modes that can be used. Pressure controlled ventilation (PCV) consists of making patients receive a programmed pressure during a specific time. Pressure support ventilation (PSV) is a parameter used for patients who present an adequate respiratory function, and do not have a minimum predetermined respiratoryfrequency. This mode is a way toward patients breathing without mechanical ventilation(15, 16). Individuals that depend on mechanical ventilation using orotracheal tubes or tracheotomy may present significant damages in the swallowing function(22). This may result in non coordination between swallowing and breathing, besides morphofunctional alterations such as reduction of laryngeal elevation, pharynxand larynx desensitization, and the reduction of subglottic
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arterial pressure, which may compromise the swallowing function(7, 21). The limitations of the swallowing function may put patients is risk of tracheal aspiration, mainly in cases of prolonged orotracheal intubation(8, 21). Some authors have also described tracheotomized patients in mechanical ventilation as being at high risk oftracheal aspiration(7, 10). Tracheal aspiration is defined as the presence of saliva, secretions and/or food residues below the level of vocal folds(2, 10, 18). One of most serious problems in patients with oropharyngeal dysphagia is the aspiration of saliva and/or food residues(2, 12), resulting in pulmonary complications, which may explain the high rates of disease and mortality in this group(2,...