Uso do colírio de atropina para redução do índice de pneumonia no processo de intubação orotraqueal e ventilação mecânica

Abstract

Introduction: Pneumonia associated to mechanical ventilation may occur during or after orotracheal intubation and is responsible for 8% to 28% of secondary complications to invasive ventilatory support. Saliva aspiration occurs during the period of orotracheal intubation due to the impairment of the defense mechanisms of the respiratory tract caussed the pipe inserted into the larynx, thus exposing to high risk of developing pneumonia. Objective: This study assessed the efficacy and safety of sublingual atropine sulfate drops in reducing aspiration and pneumonia index in the process of mechanical ventilation, by decreasing the production of saliva. Method: This study is a randomized, double-blind, clinical trial carried out at the São Vicente de Paulo Hospital, located in the city of Passo Fundo, in the state of Rio Grande do Sul. The sample was composed by adult patients who were admitted to the hospital intensive care unit, comprising forty patients randomly assigned to active drug (two drops of sublingual 1% atropine eye drops, every six hours) and to placebo. These patients underwent a routine medical assessment conducted by the intensive care unit team, who was not involved in this study, both at the diagnosis of pneumonia (clinically and by chest radiograph) as well as at the potential adverse effects. The primary efficacy endpoint was the incidence of pneumonia, while the secondary endpoint was death. Assessment instruments for adverse reactions and perceived effects related to salivation were used. Results: There was no difference in the outcomes of effectiveness and safety between the two groups. The only significant difference between the groups was in the time until the beginning of the treatment: the atropine group took twice as long to start its use when compared with the placebo group, which may have prevented a potential advantage of atropine over placebo. The deaths were apparently related to underlying disease and severity of the clinical picture. There were no reported adverse effects of atropine or placebo. In this pioneer phase II clinical trial, atropine did not prove to be helpful in reducing the incidence of pneumonia associated with mechanical ventilation and death. However, a conservative confusion bias may have occurred