CÂNULA NASAL DE ALTO FLUXO VERSUS VENTILAÇÃO NÃO INVASIVA EM PACIENTES IMUNOCOMPROMETIDOS COM INSUFICIÊNCIA RESPIRATÓRIA HIPOXÊMICA AGUDA: UMA REVISÃO SISTEMÁTICA ENTRE PNEUMOLOGIA E TERAPIA INTENSIVA
DOI:
https://doi.org/10.56238/levv17n61-032Palavras-chave:
Insuficiência Respiratória, Hospedeiro Imunocomprometido, Cânula Nasal de Alto Fluxo, Ventilação não InvasivaResumo
Introdução: A insuficiência respiratória hipoxêmica aguda é uma complicação frequente e de alto risco em pacientes imunocomprometidos, particularmente entre indivíduos com neoplasia hematológica, transplante de órgão sólido, neutropenia, exposição à quimioterapia, terapia prolongada com corticosteroides ou outras formas de imunossupressão clinicamente relevante. A cânula nasal de alto fluxo e a ventilação não invasiva são comumente usadas para evitar a intubação endotraqueal, mas sua eficácia comparativa permanece incerta nessa população. Objetivo: Esta revisão sistemática teve como objetivo comparar a cânula nasal de alto fluxo com a ventilação não invasiva em pacientes imunocomprometidos com insuficiência respiratória hipoxêmica aguda. Os objetivos secundários incluíram a avaliação de intubação, mortalidade, falha do tratamento, eventos adversos, conforto, tolerância e fatores que influenciam a seleção clínica entre ambas as estratégias. Métodos: Foi conduzida uma busca estruturada no PubMed, Scopus, Web of Science, Cochrane Library, LILACS, ClinicalTrials.gov e na International Clinical Trials Registry Platform. Estudos elegíveis incluíram populações clínicas adultas ou mistas com imunocomprometimento e insuficiência respiratória hipoxêmica aguda tratadas com cânula nasal de alto fluxo, ventilação não invasiva ou ambas. Ensaios randomizados, análises post hoc, coortes prospectivas e estudos comparativos retrospectivos foram considerados. O risco de viés foi avaliado usando RoB 2 ou ROBINS-I de acordo com o desenho do estudo, e a certeza da evidência foi julgada usando GRADE. Resultados e Discussão: Sete estudos foram incluídos na síntese qualitativa final. Estudos post hoc e observacionais anteriores sugeriram sinais mais baixos de intubação ou mortalidade com a cânula nasal de alto fluxo em comparação com a ventilação não invasiva, enquanto evidências randomizadas posteriores não demonstraram benefício de mortalidade ao adicionar rotineiramente ventilação não invasiva ao oxigênio nasal de alto fluxo. O ensaio RENOVATE ampliou a base de evidências, mas não resolveu definitivamente o subgrupo hipoxêmico imunocomprometido. No geral, a cânula nasal de alto fluxo parece ser uma estratégia razoável de primeira linha para muitos pacientes imunocomprometidos com hipoxemia de novo, enquanto a ventilação não invasiva deve ser reservada para fenótipos selecionados com um benefício fisiológico plausível da pressão positiva. Conclusão: A cânula nasal de alto fluxo deve ser considerada uma estratégia inicial preferencial em muitos pacientes imunocomprometidos com insuficiência respiratória hipoxêmica aguda quando monitoramento próximo e escalonamento precoce estão disponíveis. A ventilação não invasiva permanece útil em pacientes selecionados, mas não deve ser aplicada rotineiramente sem indicação fisiológica clara e critérios de falha predefinidos.
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