Benefícios da utilização da escala Comfort-Behavior em pacientes pediátricos ventilados mecanicamente: ensaio clínico randomizado cego

Abstract

Introduction: Pediatric patients admitted to a pediatric intensive care unit (PICU) progress to acute pulmonary respiratory failure and require ventilatory support. Due to the invasive procedures to which the child is submitted during the period of hospitalization, it is necessary to use sedation to control pain and synchronize the patient with the ventilator. The COMFORT-BEHAVIOR scale is widely used within the pediatric environment to adjust sedation and synchrony with invasive mechanical ventilation (IMV). Objectives: To analyze the benefits of applying the COMFORT-BEHAVIOR scale in patients hospitalized with IMV in a PICU, in addition to comparing with a control group the variables: time of IMV, days of hospitalization, days of sedatives and days of vasoactive drugs. Methods: A blind randomized clinical trial was carried out in individuals admitted to the PICU of a hospital in the south of Minas Gerais, from February 2021 to May 2022. Allocated into two groups: study (EG, n=35) and control (CG, n=34). Patients received physical therapy three times a day. In the EG, the sedation adjustment was performed through the scores of the COMFORT-BEHAVIOR scale by the physical therapists in three periods (morning, afternoon and night) and in the pre and post extubation moment, analyzing behavioral and physiological parameters with seven variables, including level of alertness, calmness, agitation and respiratory response (only if the patient is using IMV), crying (only in spontaneous breathing), physical movement, muscle tone and facial tension. Each variable has a score of 1 to 5 points resulting in a final score for the patient's sedation status. In the CG, the sedation adjustment maintained the one used as a routine in the PICU, through the evaluation of the medical team. For statistical analysis, the Student's t test was used for two independent samples and the Chi-square test, considered p < 0.05, and for the analysis of method agreement, Bland-Altman and Pearson's analysis of the scores of the scale. Partial Results: Regarding the scale score, 60% of the EG participants obtained a score for moderate

sedation adjustment and 40% of the patients had a score of low sedation at the time of pre- extubation. In the intergroup comparison, a statistical difference was observed in the

variables days of hospitalization (p 0.003), days of IMV (p 0.006), number of patients who required the use of adrenaline (p 0.004) and days of adrenaline (p 0.001). In secondary outcomes, there was a statistical difference in the intragroup comparison in the variables death (p 0.037), tracheostomy (p 0.018), extubation failure (p 0.037) and need for reintubation (p 0.009). 0.73, and a moderate (r = 0.585) and positive (p < 0.001) correlation with pre- and post-extubation scale scores. Final Considerations: It is demonstrated that the COMFORT-BEHAVIOR scale presents an excellent index of application reliability, with regard to the scores of the pre and post extubation moment. The EG had shorter IMV days, hospitalization days, days of adrenaline use and better outcomes when compared to the CG.