RESUMEN
OBJECTIVES: Identifying and understanding the main risk factors associated with extubation failure of very low birthweight (VLBW) infants in different populations can subsequently help in establishing better criteria while taking decision of extubation. The aim of the study was to identify factors associated with extubation failure in VLBW infants. METHODS: A cohort study of VLBW infants who underwent their first extubation between April 2018 and December 2019 in a Neonatal Intensive Care Unit, Alagoas, Brazil, were included in this study. Extubation failure was defined as reintubation within seven days of extubation. Relative risks of predictive variables different between the extubation success group (ES) and extubation failure group (EF) were estimated with a robust Poisson regression model. RESULTS: Out of the 112 infants included, 26 (23%) cases exhibited extubation failure. Extremely low birth weight (RR 2.55, 95% CI 1.07, 6.06), mechanical ventilation duration for first extubation greater than seven days (RR 2.66, 95% CI 1.10, 6.45), vaginal delivery (RR 2.07, 95% CI 1.03, 4.18) and maternal chorioamnionitis (RR 4.89, 95% CI 1.26-18.98) remained independently associated with extubation failure. EF had a significant greater need for respiratory support, longer oxygen therapy duration, more bronchopulmonary dysplasia (BPD) and longer length of hospital stay, even when adjusted for confounding variables. CONCLUSIONS: Extremely low birth weight infants needing mechanical ventilation, wherein the duration for first extubation was longer than seven days, with vaginal delivery and maternal chorioamnionitis failed more frequently at the first attempt of extubation. And this failure increased the risk of BPD and the length of hospital stay.
Asunto(s)
Extubación Traqueal , Displasia Broncopulmonar , Respiración Artificial , Síndrome de Dificultad Respiratoria del Recién Nacido/terapia , Retratamiento , Extubación Traqueal/efectos adversos , Extubación Traqueal/métodos , Extubación Traqueal/estadística & datos numéricos , Brasil/epidemiología , Displasia Broncopulmonar/epidemiología , Displasia Broncopulmonar/etiología , Displasia Broncopulmonar/prevención & control , Resultados de Cuidados Críticos , Duración de la Terapia , Femenino , Humanos , Recien Nacido con Peso al Nacer Extremadamente Bajo , Recién Nacido , Unidades de Cuidado Intensivo Neonatal/estadística & datos numéricos , Tiempo de Internación/estadística & datos numéricos , Masculino , Respiración Artificial/efectos adversos , Respiración Artificial/métodos , Síndrome de Dificultad Respiratoria del Recién Nacido/epidemiología , Retratamiento/métodos , Retratamiento/estadística & datos numéricos , Factores de Riesgo , Insuficiencia del TratamientoRESUMEN
BACKGROUND: Few data are available on the use of spontaneous breathing trials (SBTs) in the neonatal population, despite advocacy of the practice in many neonatal ICUs. In this meta-analysis, we systematically reviewed the literature regarding the accuracy of SBTs as a predictor for extubation failure in premature infants. METHODS: Following the PRISMA recommendations, scientific articles were collected in December 2019 and January 2020 using PubMed, LILACS, Web of Science, Scopus, Google Scholar, OATD, and BDTD databases. The risk of bias in the studies included herein was assessed using the Quality Assessment of Diagnostic Accuracy Studies-2 tool. The pooled sensitivity and specificity of the studies were estimated using a mixed logistic regression model of 2 levels and a normal bivariate model. RESULTS: Six studies were included for qualitative and quantitative evaluation in this study. All SBTs were performed with endotracheal CPAP, with a total observation time of 3-5 min. The parameters for passing/failing the test were similar in 5 of the 6 studies and included bradycardia or desaturation during the test. The SBT showed a high pooled sensitivity (0.97, 95% CI 0.85-0.99), indicating proper identification of neonates "ready" for successful extubation. However, a low pooled specificity (0.40, 95% CI 0.24-0.58), with many false-positive cases, indicated inaccurate prediction of extubation failure. Heterogeneity of included studies was considerable for sensitivity and substantial for specificity. CONCLUSIONS: The SBT in premature infants can accurately predict extubation success but not extubation failure. Therefore, even though it is an attractive, practical, and easy-to-perform bedside assessment tool, there is a lack of evidence to support its use as an independent predictor of extubation failure in premature infants. Its routine use should be evaluated and monitored carefully.
Asunto(s)
Recien Nacido Prematuro , Desconexión del Ventilador , Extubación Traqueal , Humanos , Lactante , Recién Nacido , Sensibilidad y EspecificidadRESUMEN
A asma é a doença crônica mais comum da infância,caracterizada pela hiper-responsividade das vias aéreas inferiorese pela limitação variável ao fluxo aéreo. Objetivo: Determinar osfatores associados à qualidade de vida de crianças asmáticas em umambulatório público especializado. Métodos: Foram coletados dadossocioeconômicos familiares e biológicos de 77 crianças asmáticasentre 7 e 12 anos, no período de agosto e setembro de 2010, emum ambulatório público especializado em Maceió/AL. A avaliaçãoda qualidade de vida foi realizada através do Paedriatric AsthmaQuality of Life Questionnaire adaptado (PAQLQ-A). Para análiseestatística utilizaram-se os testes do qui-quadrado e exato de Fisher(p ≤ 5%). Resultados: A idade média das crianças em anos foi de 9,31(± 1,7). A maioria (60,8%) tinha uma renda familiar total de 1 a 2salários mínimos, 67,5% possuíam asma do tipo leve. A qualidadede vida foi considerada ruim em 24,7%. A idade das crianças entre7 e 9 anos e o sexo feminino apresentaram uma associação significativacom uma melhor qualidade de vida. A baixa renda familiarfoi associada a uma pior qualidade de vida. Conclusão: Criançasasmáticas de níveis socioeconômicos mais baixos apresentam maisfrequentemente uma pior qualidade de vida...
Asthma is the most common childhood chronic diseasecharacterized by lower airway hyperresponsiveness and variableairflow limitation. Objective: To determine factors associated withasthmatic childrens quality of life in a specialized public outpatientservice. Methods: Socioeconomic and biological data of 77 asthmaticchildren, from 7 to 12 years, between August and September 2010,in a specialized public outpatient service in Maceió, Alagoas werecollected. The quality of life evaluation was performed using the PaedriatricAsthma Quality of Life Questionnaire - adapted (PAQLQ--A). To statistical analysis the chi-square and Fisher exact tests (p ≤5%) were used. Results: The average age of childrens was 9.31 years(± 1.7). The majority (60.8%) had a total household income of 1 to2 minimum wages, and 67.5% had mild asthma. The quality of lifewas considered poor in 24.7%. The childrens age from 7 to 9 yearsand female showed a meaningful association with a better qualityof life. Low family income was associated with a poorer quality oflife. Conclusion: Asthmatic children of lower socioeconomic statushave more often a poorer quality of life...
Asunto(s)
Humanos , Asma , Niño , Calidad de VidaRESUMEN
Introdução: Os pontos gatilhos são manifestações comumenteencontradas na Síndrome Dolorosa Miofascial, associados à presençade músculos em estado de encurtamento ou contratura, comaumento do tônus e rigidez. A técnica de compressão isquêmica éum dos vários tratamentos propostos para inibir os pontos gatilhos.Objetivo: Avaliar o efeito imediato da técnica de compressão isquêmicana inibição de pontos gatilhos do músculo trapézio superior,através da percepção dolorosa subjetiva e da análise eletromiográficado referido músculo. Método: Participaram do presente estudo 24indivíduos com presença de ponto gatilho latente ou ativo. Foramanalisados os dados coletados na escala visual analógica adaptadae os valores médios das aquisições RMS (Root Mean Square) daeletromiografia de superfície, antes e após a aplicação da técnica,pelo teste de Wilcoxon, considerando-se um nível de significânciap ≤ 0,05. Resultados: Houve diferença estatisticamente significantena avaliação da escala visual analógica (p = 0,0002), porém a análisedo sinal eletromiográfico do músculo trapézio superior não reveloudiferenças com significância estatística (p = 0,4772). Conclusão:A técnica de compressão isquêmica foi eficaz apenas em reduzirimediatamente o quadro álgico provocado pelo ponto gatilho,sem alterações significantes no sinal eletromiográfico do músculotrápezio superior.
Introduction: Trigger points are manifestations commonlyfound in Myofascial Pain Syndrome, associated to the presenceof muscles in a state of shortening or contraction, with increasedtone and stiffness. The ischemic compression technique is one ofseveral treatments proposed to inhibit trigger points. Objective: Toevaluate the immediate effect of ischemic compression technique inthe inhibition of upper trapezius muscle trigger points, through thesubjective pain perception and muscle electromyographic analysis.Method: The study included 24 subjects with presence of latent oractive trigger point. Data collected were analyzed using the adaptedvisual analogue scale and the RMS (Root Mean Square) averageacquisition of surface electromyography before and after using thetechnique, through Wilcoxon test, considering a significance levelof p ≤ 0.05. Results: There was a statistically significant difference invisual analogue scale evaluation (p = 0.0002), but the electromyographicsignal analysis of the upper trapezius muscle revealed nodifferences with statistical significance (p = 0.4772). Conclusion:The ischemic compression technique was effective only in reducingimmediately the trigger point pain, with no significant changes inthe electromyographic signal of the upper trapezius muscle.