Recomendações para oxigenoterapia domiciliar prolongada em crianças e adolescentes / Recommendations for long-term home oxygen therapy in children and adolescents

OBJETIVO: Orientar pediatras, neonatologistas, pneumologistas, pneumologistas pediátricos e outros profissionais envolvidos na área sobre as principais indicações e as particularidades da oxigenoterapia domiciliar prolongada em crianças e adolescentes. FONTES DOS DADOS: Pesquisa bibliográfica na base de dados MEDLINE/PubMed (1990 a 2011). Adicionalmente, referências de estudos selecionados foram incluídas. Como para muitos dos aspectos não existem evidências científicas consistentes, algumas recomendações citadas foram feitas com base em experiência clínica. SÍNTESE DOS DADOS: Oxigenoterapia domiciliar prolongada tem sido uma prática crescente nos pacientes pediátricos e se encontra indicada em casos de displasia broncopulmonar, fibrose cística, bronquiolite obliterante, pneumopatias intersticiais, hipertensão pulmonar, etc. Ressaltam-se como benefícios: redução de internações, otimização do crescimento físico e do desenvolvimento neurológico, melhora da tolerância ao exercício e da qualidade do sono e prevenção da hipertensão pulmonar/. Os níveis de saturação de oxigênio indicativos para a oxigenoterapia diferem dos estabelecidos para adultos com doença pulmonar obstrutiva crônica e variam de acordo com a doença e faixa etária. Para a avaliação da saturação de oxigênio, utiliza-se a oximetria de pulso, sendo a gasometria arterial dispensável. Há três fontes de oxigênio disponíveis: cilindros gasosos, oxigênio líquido e concentradores de oxigênio. Os fluxos utilizados costumam ser menores, assim como o número de horas/dia necessários, quando comparados ao uso em adultos. Em algumas doenças há melhora, e a suspensão do oxigênio é possível. CONCLUSÕES: Oxigenoterapia domiciliar prolongada é uma terapêutica cada vez mais comum em pediatria e suas indicações são numerosas. Há particularidades relevantes quando comparada aos adultos em relação às indicações, modo de uso e monitorização.

OBJECTIVE: To advise pediatricians, neonatologists, pulmonologists, pediatric pulmonologists, and other professionals in the area on the main indications and characteristics of long-term home oxygen therapy in children and adolescents. DATA SOURCE: A literature search was carried out in the MEDLINE/PubMed database (1990 to 2011). Additionally, references from selected studies were included. As consistent scientific evidence does not exist for many aspects, some of the recommendations were based on clinical experience. DATA SYNTHESIS: Long-term home oxygen therapy has been a growing practice in pediatric patients and is indicated in bronchopulmonary dysplasia, cystic fibrosis, bronchiolitis obliterans, interstitial lung diseases, and pulmonary hypertension, among others. The benefits are: decrease in hospitalizations, optimization of physical growth and neurological development, improvement of exercise tolerance and quality of sleep, and prevention of pulmonary hypertension/cor pulmonale. The levels of oxygen saturation indicative for oxygen therapy differ from those established for adults with chronic obstructive pulmonary disease, and vary according to age and disease. Pulse oximetry is used to evaluate oxygen saturation; arterial blood gas is unnecessary. There are three available sources of oxygen: gas cylinders, liquid oxygen, and oxygen concentrators. The flows used are usually smaller, as are the number of hours/day needed when compared to the use in adults. Some diseases show improvement and oxygen therapy discontinuation is possible. CONCLUSIONS: Long-term home oxygen therapy is increasingly common in pediatrics and has many indications. There are relevant particularities when compared to its use in adults, regarding indications, directions for use, and monitoring.

Programa de oxigenoterapia domiciliaria de la Obra Social de Empleados públicos (OSEP), Mendoza (Argentina, experiencia de 7 años / Oxygen program home of Social work Public employees (OSEP), Mendoza, (Argentina), 7 years experience

Introducción La oxigenoterapia domiciliaria (OD) representa más del 70% del costo total de los cuidados médicos del enfermo hipoxémico. A continuación presentaremos la experiencia desarrollada en el Programa de Oxigenoterapia y Ventilación No Invasiva de la Obra Social de Empleados Públicos de Mendoza. Objetivos: conocer prevalencia, características demográficas y epidemiológicas, causaprincipal de prescripción, equipos suministrados, tiempo de estadía y causa de baja del Programa de Oxigenoterapia Domiciliaria de la Obra Social de Empleados Públicos (OSEP), Mendoza (Argentina). Material y método: Se realizó una evaluación retrospectiva de las historias clínicas ybase de datos de los pacientes del programa, durante el periodo enero 2004 a diciembre 2010. Se los dividió en Oxigenoterapia Crónica Domiciliaria (OCD) y Oxigenoterapia Situaciones Especiales (OSE). Resultados: Ingresaron al programa de OD 839 pacientes. Se los dividió en: a) OCD: 498pacientes, edad media 67,95 años, 60,85% hombres, causa prevalente de prescripción EPOC 68% y tiempo medio de estadía 20,56 meses. b) OSE: 341 pacientes, edad media 62,43 años, 51% mujeres, causa prevalente de prescripción enfermedades neoplásicas52,2% (Cáncer de Pulmón 50%) y tiempo medio de estadía de 5.45 meses.Conclusiones: La OCD representa el 59% de las prescripciones, prevalencia 19,8 c/100.000 habitantes/año, muy por debajo de la Europea, causa prevalente de indicación es EPOC (68%) asociada al tabaquismo en el 99%. La forma de suministro de oxígenoes concentrador en el 79,5% y el tiempo medio de estadía 20,56 meses. La OSE representa el 41% de las prescripciones, prevalencia de 16,85 c /100.000 habitantes/ año, se destacan las enfermedades terminales neoplásicas en 52,2%, donde el Cáncer de Pulmón ocupa el 50%. Alta tasa de egresos 87,4 %, elevada mortalidad 78,2% y menor tiempo medio de estadía 5.45 meses.

Introduction: The Domiciliary Oxygen therapy (DO) represents more than 70% of the total cost of the medical care of hypoxemic patients. This paper presents the experience of the Program of Oxygen Therapy and Non Invasive Ventilation of the Health InsuranceService of Public Employees of Mendoza.The objectives were to know the prevalence, demographic and epidemiologic characteristics, main reasons for oxygen therapy prescription, oxygen supply equipment, duration of oxygen therapy and reasons for discharge from the DO therapy at the Health Insurance Service of Public Employees of Mendoza. Material and method: The investigation method was a retrospective evaluation of the clinical records and database of patients registered in the program from January 2004 to December 2010. They were divided into Domiciliary Chronic Oxygen Therapy (DCO) and Oxygen Therapy Special Situations (OSS). Results: 839 patients were registered in the DO program. They were divided into: a)DCO: 498 patients, mean age 67.95 years; 60.85% were males. The main cause for prescription was COPD (68%) and average duration of treatment 20,56 months. b) OSS: 341 patients, mean age 62.43 years; 51% were females. The main cause for prescriptionwas neoplasic illnesses (52.2%; Lung Cancer 50%) and average time of duration of treatment was 5.45 months.Conclusions: The DCO represented 59% of the prescriptions, the prevalence was 19.8 inhabitants per 100 000 per year, much less than the European rates. The main cause for prescription was COPD (68%) which was associated to the smoking habit in 99% of cases. Theoxygen was supplied through oxygen concentrators in 79.5% of patients and the average duration of treatment was 20.56 months. The OSS represented 41% of the prescriptions, the prevalence was 16.85 per 100,000inhabitants per year. The main causes for prescription were the neoplasic terminal illnesses (52.2% of cases) and the lung cancer represented 50% of cases...

Sanitización y desinfección de alto nivel del material y equipo de inhaloterapia / High-level sanitization and disinfection of inhalotherapy material, equipment and devices", "_i": "

Considerando la importancia que en la etiopatogenia de la infecciónrespiratoria nosocomial tiene la colonización de la víaaérea a través de aerosoles contaminados producidos por equiposde inhaloterapia sometidos a una inadecuada desinfecciónde alto nivel, el uso de equipo desechable o la esterilización pormedio del autoclave con vapor sería lo más conveniente, sin embargo,en muchas ocasiones esto no es posible, por lo que laelección y el uso apropiado de desinfectantes como el glutaraldehído,así como la estandarización, control y evaluación de losprocesos como parte de las estrategias para prevenir las infeccionesnosocomiales, sin duda alguna representan un impactodentro de un marco seguro de atención a la salud.

Considering the importance that in etiopathogeny of the hospital-acquiredrespiratory infection have the colonization of theaerial route through contaminated aerosols produced by equipmentof inhaloterapia submissive an inadequate disinfectionof high level, the use of disposable equipment or sterilizationby means of the sterilizer with steam he would be most advisable,nevertheless in many occasions this is not possible, reasonwhy the appropriate the disinfectant election and use like theglutaraldehyde one, as well as the standardization, control andevaluation of the processes like part of the strategies to preventthe hospital-acquired infections, doubtless represent an impactwithin a safe frame of attention the health.

Oxigenoterapia en vuelos nacionales e internacionales en la Argentina / Oxygen therapy during Argentine-based national and international flights

No existe estudio que evalúe el estado de la oxigenoterapia en vuelo (OV) en nuestro país. El objetivo de este estudio fue evaluar los requisitos, dificultades, sistemas y costos de la OV de las companías aéreas nacionales (N) e internacionales (I) que operan desde Buenos Aires. Se utilizó la misma encuesta telefónica y metodología que el estudio de Stoller y col.12. Los autores se comunicaron telefónicamente con 25 aerolíneas que operaban en los dos aeropuertos de Buenos Aires en julio de 2007, y se interrogó sobre los requisitos necesarios para viajar, sistemas y costos. Se usaron técnicas estadísticas convencionales siendo significativa p<0.05. De 25 aerolíneas, se descartaron seis (24%) por falta de información (60% de las N y 16% de las I). El 100% de las N permitían la OV vs. 80% de las I (p<0.05). El 100% de las N y 94% de las I exigían certificado médico (p=NS). El 71% de las N requerían de aviso previo vs. 100% de las I (p<0.05). El 50% de las N proveían interfases de administración de oxígeno vs. 87% de las I (p=NS). El 100% de las N disponían del oxígeno sin cargo, vs. 50% de las I (p=NS). El costo oscilaba entre 70 a 300 dólares por escala. En conclusión, se observó una marcada dificultad en la provisión de información de las compañías aéreas, y restricciones de su uso. El costo es muy variable y se da principalmente en las compañías aéreas I. Consideramos necesario implementar acciones que faciliten el acceso de los pacientes y médicos a la información pertinente de cada compañía aérea sobre OV.

There are no data about supplemental oxygen in flight in our country. The objective of our study was to evaluate arranging in-flight-oxygen required by a simulated traveler, system of administration and costs, and to compare the results between Argentine-based (A) and international (I) airlines. The questionnaire used was similar to that of Stoller et al12. Data collection consisted of telephone calls placed by one of the authors to all commercial air carriers listed in our two Buenos Aires City airports during July 2007. A structured interview with questions was addressed on issues that an oxygen-using air traveler would need to arrange in-flight oxygen. Of the 25 airlines, 6 were discarded because of lack of information (24%, three A -60%-and one I-16%-). All A allowed in-flightoxygen vs. 80% of I (p<0.05), 100% of A and 94% of I required a medical certificate (p=NS); 71% of A and 100% of I required previous notification (p<0.05); 50% of A and 87% of I provided patient interphases of oxygen administration (p=NS). Free of charge oxygen could be provided by 100% of A and 50% of I, with airline charge between 70 to 300 dollars. In conclusion, we observed different policies, rules, availability, and a pronounced lack of standardization of airline information. The cost of oxygen was very different between airlines and it was superior on I. It will be necessary to carry out actions to facilitate patient access to oxygentherapy and to standardize medical information among airlines in our country.