Tratamento homeopático em um caso de pneumonia com evolução para sindrome de desconforto respiratorio agudo (SDRA) / Homeopathic treatment of a case of pneumonia progressing into acute respiratory distress syndrome (ARDS)

O presente artigo relata um caso de pneumonia com derrame pleural que recebeu tratamento homeopático individualizado coadjuvante. Paciente de sexo masculino, de 4 anos de idade, com história de febre há 3 dias e cansaço. Foi internado no pronto socorro em 02/05/2011 e encaminhado para a UTI-Pediátrica, em 04/06/2011, devido à piora da insuficiência respiratória e necessidade de intubação orotraqueal. Ao chegar à UTI-Pediátrica, apresentava doença pulmonar de acometimento agudo, infiltrados pulmonares bilaterais na radiografia de tórax, e a razão entre a pressão parcial arterial de oxigênio (PaO2) e a fração inspirada de oxigênio (FiO2) era igual a 132, sendo menor que 200, firmando-se, assim, o diagnostico de síndrome do desconforto respiratório agudo (SDRA). Após 48 horas de internação hospitalar, foi realizada consulta homeopática seguida de repertorização, foi administrado Phosphorus 30cH, 2 gotas diluídas em 2 ml de agua destilada via sonda nasogastrica, em dose única. Foi observada melhora radiológica, o que permitiu a extubação após 48 horas e a alta para a enfermaria 4 dias depois do inicio do tratamento homeopático.(AU)

This article reports a case of pneumonia with pleural effusion treated with homeopathy as adjuvant. Four-year-old patient, with history of fever for 3 days and fatigue, was admitted in the emergency room in 06/05/2011 but he had to be transferred to the Pediatric ICU due to the worsening of respiratory failure and the need of tracheal intubation. Upon arriving at the Pediatric-ICU he exhibited symptoms of acute pulmonary disease, bilateral pulmonary infiltrates on chest Xray, and ratio between arterial partial pressure of oxygen (PaO2) and the fraction of inspired oxygen (FiO2) = 132, i.e. lower than 200, thus confirming the diagnosis of acute respiratory distress syndrome (ARDS). Forty-eight hours later, he was subjected to homeopathic consultation; analysis of data pointed to the prescription of Phosphorus, which was prescribed in dilution 30cH, in a single dose of 2 drops diluted in 2 ml of distilled water by nasogastric tube. There was radiological improvement after 48 hours; the patient was extubated and discharged to the infirmary 4 days after the onset of the homeopathic treatment..(AU)

Tratamento homeopático em um caso de pneumonia com evolução para sindrome de desconforto respiratorio agudo (SDRA) / Homeopathic treatment of a case of pneumonia progressing into acute respiratory distress syndrome (ARDS)

O presente artigo relata um caso de pneumonia com derrame pleural que recebeu tratamento homeopático individualizado coadjuvante. Paciente de sexo masculino, de 4 anos de idade, com história de febre há 3 dias e cansaço. Foi internado no pronto socorro em 02/05/2011 e encaminhado para a UTI-Pediátrica, em 04/06/2011, devido à piora da insuficiência respiratória e necessidade de intubação orotraqueal. Ao chegar à UTI-Pediátrica, apresentava doença pulmonar de acometimento agudo, infiltrados pulmonares bilaterais na radiografia de tórax, e a razão entre a pressão parcial arterial de oxigênio (PaO2) e a fração inspirada de oxigênio (FiO2) era igual a 132, sendo menor que 200, firmando-se, assim, o diagnostico de síndrome do desconforto respiratório agudo (SDRA). Após 48 horas de internação hospitalar, foi realizada consulta homeopática seguida de repertorização, foi administrado Phosphorus 30cH, 2 gotas diluídas em 2 ml de agua destilada via sonda nasogastrica, em dose única. Foi observada melhora radiológica, o que permitiu a extubação após 48 horas e a alta para a enfermaria 4 dias depois do inicio do tratamento homeopático.

This article reports a case of pneumonia with pleural effusion treated with homeopathy as adjuvant. Four-year-old patient, with history of fever for 3 days and fatigue, was admitted in the emergency room in 06/05/2011 but he had to be transferred to the Pediatric ICU due to the worsening of respiratory failure and the need of tracheal intubation. Upon arriving at the Pediatric-ICU he exhibited symptoms of acute pulmonary disease, bilateral pulmonary infiltrates on chest Xray, and ratio between arterial partial pressure of oxygen (PaO2) and the fraction of inspired oxygen (FiO2) = 132, i.e. lower than 200, thus confirming the diagnosis of acute respiratory distress syndrome (ARDS). Forty-eight hours later, he was subjected to homeopathic consultation; analysis of data pointed to the prescription of Phosphorus, which was prescribed in dilution 30cH, in a single dose of 2 drops diluted in 2 ml of distilled water by nasogastric tube. There was radiological improvement after 48 hours; the patient was extubated and discharged to the infirmary 4 days after the onset of the homeopathic treatment.

Homeopatia no tratamento de pneumonia com derrame pleural na UTI pediátrica: relato de caso / Homeopathy in the treatment of pneumonia with pleural effusion in the pediatric ICU: a case report

O presente artigo relata um caso de tratamento de pneumonia associada com derrame pleural, em um pré-escolar de 4 anos de idade, com antecedentes de alergia alimentar, refluxo gastresofágico, rinite, asma, hipogamaglobulinemia, eosinofilia, gastrite, encefalite e internações prévias por pneumonia. Além do comprometimento pulmonar, apresentava alteração do sistema nervoso central, com alternância de sonolência e agitação psicomotora. Foi tratado com Bryonia alba 30 cH 1 gota dose única, tendo boa evolução clínica e após 4 dias do inicio do tratamento homeopático, teve alta do UTI Pediátrica.(AU)

This article reports the homeopathic treatment of pneumonia with pleural effusion in a 4-year-old boy with a background of food allergy, gastroesophageal reflux, rhinitis, asthma, hypogammaglobulinemia, eosinophilia, gastritis, encephalitis and previous hospitalizations due to pneumonia. Besides the affection of the lungs he exhibited disturbs of the central nervous system, with sleepiness alternating with psychomotor agitation. He was treated with Bryonia alba 30cH 1 drop single dose, exhibiting good clinical response and 4 days after the onset of homeopathic treatment could be discharged from the pediatric ICU.(AU)

Homeopatia no tratamento de pneumonia com derrame pleural na UTI pediátrica: relato de caso / Homeopathy in the treatment of pneumonia with pleural effusion in the pediatric ICU: a case report

O presente artigo relata um caso de tratamento de pneumonia associada com derrame pleural, em um pré-escolar de 4 anos de idade, com antecedentes de alergia alimentar, refluxo gastresofágico, rinite, asma, hipogamaglobulinemia, eosinofilia, gastrite, encefalite e internações prévias por pneumonia. Além do comprometimento pulmonar, apresentava alteração do sistema nervoso central, com alternância de sonolência e agitação psicomotora. Foi tratado com Bryonia alba 30 cH 1 gota dose única, tendo boa evolução clínica e após 4 dias do inicio do tratamento homeopático, teve alta do UTI Pediátrica.

This article reports the homeopathic treatment of pneumonia with pleural effusion in a 4-year-old boy with a background of food allergy, gastroesophageal reflux, rhinitis, asthma, hypogammaglobulinemia, eosinophilia, gastritis, encephalitis and previous hospitalizations due to pneumonia. Besides the affection of the lungs he exhibited disturbs of the central nervous system, with sleepiness alternating with psychomotor agitation. He was treated with Bryonia alba 30cH 1 drop single dose, exhibiting good clinical response and 4 days after the onset of homeopathic treatment could be discharged from the pediatric ICU.

Age-related differences in the use of morphine, diazepam, and pancuronium for mechanically ventilated children.

Mechanically ventilated children usually require a combination of sedation (morphine = M, diazepam = D) and paralysis (pancuronium = P) to minimize anxiety, discomfort, and the risks of self-extubation, tracheal injury, and pulmonary barotrauma. We sought to determine whether our use of MDP varied with patient age. Cases where the dosage of MDP would be influenced by neurological, hemodynamic, or painful diagnoses were excluded. The 36 cases selected were divided according to age into three groups (less than 4 months = A, 4-18 months = B, greater than 18 months = C). The daily sum of MDP dosages was calculated for each of the 326 study days, a mean of 9 study days for each case. The median daily drug usage in group B (2.3 mg/kg/day) was twice that in either group A (younger) or group C (older) (both p less than 0.001). This finding may be explained by developmental changes in physiology, pharmacology, and behavior, and may have been influenced by a paradoxical drug effect or multiple drug antagonism.

Effect of neuromuscular blockade on oxygen consumption and energy expenditure in sedated, mechanically ventilated children.

OBJECTIVE: To quantify the effects of neuromuscular blockade (NMB) on energy expenditure for intubated, mechanically ventilated, critically ill children. DESIGN: A prospective, unblinded clinical study. Each subject was studied twice, before and after establishment of NMB. SETTING: A tertiary care pediatric intensive care unit. PATIENTS: Critically ill children undergoing mechanical ventilation and receiving ongoing sedation were eligible, if they had a cuffed endotracheal tube and were physiologically stable. INTERVENTIONS: A total of 20 children (age, 1 to 15 yrs) were studied in an unblinded, crossover fashion. All were mechanically ventilated via a cuffed endotracheal tube, with ventilator rate and tidal volume adequate to provide complete ventilation, and F(IO2) <0.6. Absence of gas leak around the endotracheal tube was assured, and all patients were sedated using continuous infusions of midazolam and/or fentanyl; no changes in ventilator settings, nutritional input, or inotropic drug dose were permitted during the study period. Each patient underwent indirect calorimetry immediately before establishment of NMB. NMB was then induced, and indirect calorimetry was repeated. Complete blockade was verified using a peripheral nerve stimulator. In each case, the two sets of measurements were completed within a 1-hr period. MEASUREMENTS AND MAIN RESULTS: Data analyzed included identifying and diagnostic information, oxygen consumption, and carbon dioxide production. Energy expenditure was calculated using standard formulas. Oxygen consumption and energy expenditure values obtained before and after the establishment of NMB were compared by using paired Student's t-test. NMB reduced oxygen consumption from 6.54+/-0.49 mL/kg/min to 5.90+/-0.40 ml/kg/min, and energy expenditure was reduced from 46.5+/-3.7 kcal/kg/24 hrs to 41.0+/-2.8 kcal/kg/24 hrs (p < .001 in each case). The reduction in oxygen consumption was 8.7+/-1.7%, and that in energy expenditure 10.3+/-1.8%, of pre-NMB values, respectively. CONCLUSION: NMB significantly reduces oxygen consumption and energy expenditure in critically ill children who are sedated and mechanically ventilated; the degree of reduction is small.

Estudo de crianças com síndrome do desconforto respiratório agudo: correlaçäo anatomoclínica radiológica / A study of children with acute respiratory distress syndrome: histopathological, clincal and radiological correlation

Estudo retrospectivo com revisäo dos casos clínicos de Sídrome do Desconforto Respiratório Agudo, realizado no período de out/88 a dez/90 na Unidade de Pacientes Graves do Instituto Fernandes Figueira. Os autores estudaram as características clínicas, radiológicas e histopatológicas de acordo com o estágio evolutivo da doença. Dentre 459 casos estudados, foram selecionados 49 (11 por cento). Onze casos tiveram exame anatomopatológico [biopsia (4), necropsia (8) e foram classificados de acordo com o estágio evolutivo em: fase exsudativa inicial, fase proliferativa celular e fase proliferativa fibrótica. Houve correlaçäo clínica radiológica e anatomopatológica nos casos confirmados com exame histológico. Os autores consideram importante estudos futuros em que a interaçäo entre a pesquisa clínica e experimental permita o melhor conhecimento desta Síndrome na populaçäo pediátrica