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. 2014 Jul-Sep;26(3):215-39.
doi: 10.5935/0103-507x.20140034.

Brazilian recommendations of mechanical ventilation 2013. Part 2

[Article in English, Portuguese]
Carmen Sílvia Valente Barbas, Alexandre Marini Ísola, Augusto Manoel de Carvalho Farias, Alexandre Biasi Cavalcanti, Ana Maria Casati Gama, Antonio Carlos Magalhães Duarte, Arthur Vianna, Ary Serpa Neto, Bruno de Arruda Bravim, Bruno do Valle Pinheiro, Bruno Franco Mazza, Carlos Roberto Ribeiro de Carvalho, Carlos Toufen Júnior, Cid Marcos Nascimento David, Corine Taniguchi, Débora Dutra da Silveira Mazza, Desanka Dragosavac, Diogo Oliveira Toledo, Eduardo Leite Costa, Eliana Bernadete Caser, Eliezer Silva, Fabio Ferreira Amorim, Felipe Saddy, Filomena Regina Barbosa Gomes Galas, Gisele Sampaio Silva, Gustavo Faissol Janot de Matos, João Claudio Emmerich, Jorge Luis dos Santos Valiatti, José Mario Meira Teles, Josué Almeida Victorino, Juliana Carvalho Ferreira, Luciana Passuello do Vale Prodomo, Ludhmila Abrahão Hajjar, Luiz Claudio Martins, Luis Marcelo Sá Malbouisson, Mara Ambrosina de Oliveira Vargas, Marco Antonio Soares Reis, Marcelo Brito Passos Amato, Marcelo Alcântara Holanda, Marcelo Park, Marcia Jacomelli, Marcos Tavares, Marta Cristina Paulette Damasceno, Murillo Santucci César Assunção, Moyzes Pinto Coelho Duarte Damasceno, Nazah Cherif Mohamed Youssef, Paulo José Zimmermann Teixeira, Pedro Caruso, Péricles Almeida Delfino Duarte, Octavio Messeder, Raquel Caserta Eid, Ricardo Goulart Rodrigues, Rodrigo Francisco de Jesus, Ronaldo Adib Kairalla, Sandra Justino, Sergio Nogueira Nemer, Simone Barbosa Romero, Verônica Moreira Amado

Brazilian recommendations of mechanical ventilation 2013. Part 2

[Article in English, Portuguese]
Carmen Sílvia Valente Barbas et al. Rev Bras Ter Intensiva. 2014 Jul-Sep.

Abstract
in English, Portuguese

Perspectives on invasive and noninvasive ventilatory support for critically ill patients are evolving, as much evidence indicates that ventilation may have positive effects on patient survival and the quality of the care provided in intensive care units in Brazil. For those reasons, the Brazilian Association of Intensive Care Medicine (Associação de Medicina Intensiva Brasileira - AMIB) and the Brazilian Thoracic Society (Sociedade Brasileira de Pneumologia e Tisiologia - SBPT), represented by the Mechanical Ventilation Committee and the Commission of Intensive Therapy, respectively, decided to review the literature and draft recommendations for mechanical ventilation with the goal of creating a document for bedside guidance as to the best practices on mechanical ventilation available to their members. The document was based on the available evidence regarding 29 subtopics selected as the most relevant for the subject of interest. The project was developed in several stages, during which the selected topics were distributed among experts recommended by both societies with recent publications on the subject of interest and/or significant teaching and research activity in the field of mechanical ventilation in Brazil. The experts were divided into pairs that were charged with performing a thorough review of the international literature on each topic. All the experts met at the Forum on Mechanical Ventilation, which was held at the headquarters of AMIB in São Paulo on August 3 and 4, 2013, to collaboratively draft the final text corresponding to each sub-topic, which was presented to, appraised, discussed and approved in a plenary session that included all 58 participants and aimed to create the final document.

O suporte ventilatório artificial invasivo e não invasivo ao paciente grave tem evoluído e inúmeras evidências têm surgido, podendo ter impacto na melhora da sobrevida e da qualidade do atendimento oferecido nas unidades de terapia intensiva no Brasil. Isto posto, a Associação de Medicina Intensiva Brasileira (AMIB) e a Sociedade Brasileira de Pneumologia e Tisiologia (SBPT) - representadas por seu Comitê de Ventilação Mecânica e sua Comissão de Terapia Intensiva, respectivamente, decidiram revisar a literatura e preparar recomendações sobre ventilação mecânica, objetivando oferecer aos associados um documento orientador das melhores práticas da ventilação mecânica na beira do leito, com base nas evidências existentes, sobre os 29 subtemas selecionados como mais relevantes no assunto. O projeto envolveu etapas que visaram distribuir os subtemas relevantes ao assunto entre experts indicados por ambas as sociedades, que tivessem publicações recentes no assunto e/ou atividades relevantes em ensino e pesquisa no Brasil, na área de ventilação mecânica. Esses profissionais, divididos por subtemas em duplas, responsabilizaram-se por fazer uma extensa revisão da literatura mundial. Reuniram-se todos no Fórum de Ventilação Mecânica, na sede da AMIB, na cidade de São Paulo (SP), em 3 e 4 de agosto de 2013, para finalização conjunta do texto de cada subtema e apresentação, apreciação, discussão e aprovação em plenária pelos 58 participantes, permitindo a elaboração de um documento final.

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Conflict of interest statement

Individual conflicts of interest:

Carmen Silvia Valente Barbas - received honorary for lectures from Covidien and Mindray. Alexandre Marini Ísola - received honorary for lectures from Covidien and Mindray. Augusto Manoel de Carvalho Farias - received funds for CAPTIVATE study from Novartis and support to attend the AMIB congress from Sanofi-Aventis and Expressa. Ana Maria Casati Gama - received grant support from Boehringer company for lectures and for attending ATS congress in 2014. Arthur Oswaldo de Abreu Vianna - received funding support to attend critical care congress from E. Tamussino. Carlos Roberto Ribeiro Carvalho - is a stake holder of TIMPEL. Corine Taniguchi - received honoraria for a lecture on ventilator-associated pneumonia from Covidien and for two classes on automatic weaning from mechanical ventilation from Draeger. Diogo Oliveira Toledo - received honoraria from Danone and Nestlé for lectures. Gustavo Faissol Janot de Matos - received financial support from Edwards Lifescience for training lecture given to company employees. Jorge Luis Valiatti - received honoraria from Intermed Brazil for consulting and training during the years 2005-2012. José Mario Meira Teles - received honoraria for lectures from Hospira. Juliana Carvalho Ferreira - received grants to her Institution. Marcelo Brito Passos Amato - declares that his laboratory (LIM-09 USP) has received funding for research in the last 5 years from the following companies: a) Covidien 2012-2014 (for experimental studies and simulations on patient-ventilator synchrony), b) Dixtal Biomedical/Philips 2009-2013 (for experimental studies on Electrical Impedance Tomography), c) the SA Timpel 2013-2014 (for experimental studies on Electrical Impedance Tomography). Marcelo Alcântara Holanda - declares he is the founder and owner of the platform and the virtual simulator for teaching XLung Mechanical Ventilation. Marcelo Park - received funding for lectures on ECMO from Maquet and Nipro. Murillo Santucci César Assunção - received honoraria for lectures from the following industries: Edwards Lifescience, Eli Lilly, Pfizer, Astrazeneca, Roche, Thermo-Fisher, Astellas, Novartis, and Baxter and research grants and monitors from Edwards Lifescience, Dixtal-Philips, Masimo and Eli Lilly. Alexandre Biasi Cavalcanti, Antonio Duarte, Ary Serpa Neto, Bruno Bravin, Bruno do Vale Pinheiro, Bruno Franco Mazza, Carlos Toufen, Cid Marcos David, Débora Dutra da Silveira Mazza, Desanka Dragosavac, Eduardo Leite, Eliana Caser, Eliezer Silva, Fabio Amorim, Felipe Saddy, Filomena Galas, Gisele Sampaio, João Claudio Emmerich, Josué Victorino, Luciana Prodomo, Ludhmila Abrahão Hajjar, Luis Claudio Martins, Luis Marcelo Malbouisson, Mara Ambrosina Vargas, Marco Antonio Soares Reis, Marcia Jacomelli, Marcos Soares Tavares, Marta Cristina Paulette Damasceno, Moyzes Pinto Coelho Duarte Damasceno, Nazah Youssef, Paulo José Zimmermann, Pedro Caruso, Péricles Almeida Delfino Duarte, Octavio Messeder, Raquel Caserta Eid, Ricardo Goulart Rodrigues, Rodrigo Francisco de Jesus, Ronaldo Adib Kairalla, Sandra Justino, Sergio Nemer, Simone Barbosa Romero and Verônica Amado - have no conflict of interest.

Conflicts of interest: With the help of the Brazilian Thoracic Society, the AMIB Division of Scientific Issues procured financial support from industrial companies and laboratories, distributed as sponsorship quotas, to cover part of the event costs (participants' air tickets, food and lodging). None of those companies participated in the drafting of the present document, nor had access to its content until it was disclosed (after its final format was approved) as brochures distributed at the Brazilian Congress of Intensive Care Medicine in Rio de Janeiro in 2013. The companies that collaborated with the present project are: Air Liquide, Covidien, GE, Intermed, Magnamed, Mindray and Philips.

Figures

Figure 1
Figure 1
Use of noninvasive ventilation for discontinuation of mechanical ventilation. SBT - spontaneous breathing trial; NIV - noninvasive ventilation; COPD - chronic obstructive pulmonary disease; RF - acute or exacerbated respiratory failure.
Figure 2
Figure 2
Hemodynamic management algorithm suggested in mechanically ventilated patients. LV - left ventricular; RV - right ventricular; MV - mechanical ventilation; PEEP - positive end-expiratory pressure.
See this image and copyright information in PMC

References

    1. Guyatt GH, Oxman AD, Vist GE, Kunz R, Falck-Ytter Y, Alonso-Coello P, Schünemann HJ, GRADE Working Group GRADE: an emerging consensus on rating quality of evidence and strength of recommendations. BMJ. 2008;336(7650):924–926. - PMC - PubMed
    1. Guyatt GH, Oxman AD, Kunz R, Vist GE, Falck-Ytter Y, Schünemann HJ, GRADE Working Group What is "quality of evidence" and why is it important to clinicians? BMJ. 2008;336(7651):995–998. - PMC - PubMed
    1. Guyatt GH, Oxman AD, Kunz R, Falck-Ytter Y, Vist GE, Liberati A, Schünemann HJ, GRADE Working Group Going from evidence to recommendations. BMJ. 2008;336(7652):1049–1051. Erratum in BMJ. 2008;336(7658):doi:10.1136/bmj.a402. - PMC - PubMed
    1. Brozek J, Oxman AD, Schünemann HJ. GRADEpro (Computer Program) Version 3.2 for Windows. Available at http://www.cc-ims.net/revman/gradepro 2012.
    1. Hernandez G, Fernandez R, Lopez-Reina P, Cuena R, Pedrosa A, Ortiz R, et al. Noninvasive ventilation reduces intubation in chest trauma-related hypoxemia: a randomized clinical trial. Chest. 2010;137(1):74–80. - PubMed