Incidência e fatores de risco associados à falha na ventilação não invasiva em pacientes pediátricos / Incidence and risk factors associated with noninvasive ventilation failure in pediatric patients

Introdução: O suporte ventilatório é usado para o tratamento de pacientes com insuficiência respiratória aguda (IRpA) ou crônica agudizada. A ventilação não-invasiva (VNI) na IRpA pediátrica é amplamente usada em bebês prematuros e crianças, porém até a data atual os estudos têm sido escassos. Portanto, o objetivo do presente estudo foi determinar os fatores de risco associados à falha na VNI em uma unidade de terapia intensiva pediátrica.Métodos: Coorte retrospectiva a partir de prontuários de pacientes admitidos na unidade de terapia intensiva (UTI) Pediátrica de um Hospital de Caxias do Sul, entre maio de 2017 e outubro de 2019, que utilizaram VNI.Resultados: A incidência de falha na VNI foi de 33%. Asma (RR = 1,36; IC95% = 1,08-1,72), uso de VNI em pacientes pós-extubação (RR = 1,97; IC95% = 1,17-3,29), uso contínuo da VNI (RR = 2,44; IC95% = 1,18-5,05), encerramento à noite (RR = 2,52; IC95% = 1,53-4,14), modalidade final ventilação mandatória intermitente sincronizada (SIMV) (RR = 4,20; IC95% = 2,20-7,90), pressão expiratória positiva final (PEEP) no início da ventilação (6,8 ± 1,1; p < 0,01) e fração inspiratória de O2 (FIO2) final (53,10 ± 18,50; p < 0,01) foram associados à falha. Adicionalmente, a pressão arterial sistólica (PAS) inicial (118,68 ± 18,68 mmHg; p = 0,02), a frequência respiratória inicial (FR) (47,69 ± 14,76; p = 0,28) e final (47,54 ± 14,76; p < 0,01) foram associados a falha.Conclusão: A modalidade ventilatória final SIMV, demostra ser o melhor preditor de risco de falha, seguido do turno em que a VNI é finalizada, onde à noite existe maior risco de falha. Além disso, foram preditores de falha, porém com menor robustez, a pressão positiva inspiratória (PIP) final e a FR final.

Introduction: Ventilatory support is used for the treatment of patients with acutely chronic or acute respiratory failure (ARF). Noninvasive ventilation (NIV) in pediatric ARF is widely used in preterm infants and children, but studies to date have been limited. Therefore, the aim of the present study was to determine the risk factors associated with NIV failure in a pediatric intensive care unit.Methods: This retrospective cohort study was based on medical records of patients admitted to the pediatric intensive care unit of a hospital in Caxias do Sul, southern Brazil, between May 2017 and October 2019, who used NIV.Results: The incidence of NIV failure was 33%. Asthma (relative risk [RR] = 1.36; 95% confidence interval [CI] = 1.08-1.72), post-extubation use of NIV (RR = 1.97; 95% CI = 1.17-3.29), continuous use of NIV (RR = 2.44; 95% CI = 1.18-5.05), completion at night (RR = 2.52; 95% CI = 1.53-4.14), final mode synchronized intermittent mandatory ventilation (SIMV) (RR = 4.20; 95% CI = 2.20-7.90), positive end-expiratory pressure at the beginning of ventilation (6.8 ± 1.1; p < 0.01), and final fraction of inspired oxygen (53.10 ± 18.50; p < 0.01) were associated with failure. Additionally, initial systolic blood pressure (118.68 ± 18.68 mmHg; p = 0.02), initial respiratory rate (IRR) (47.69 ± 14.76; p = 0.28), and final respiratory rate (47.54 ± 14.76; p < 0.01) were associated with failure.Conclusion: The final ventilatory mode SIMV proves to be the best failure risk predictor, followed by the shift in which NIV is completed, as there is a greater risk of failure at night. In addition, final positive inspiratory pressure and final respiratory rate were less robust predictors of failure.

Desfecho da aplicação da ventilação mecânica não invasiva na bronquiolite / Outcome of the application of noninvasive mechanical ventilation in bronchiolitis

A bronquiolite é uma infecção viral que pode levar a insuficiência ventilatória, nestes casos a aplicação de ventilação não invasiva é uma opção ao tratamento convencional. O objetivo deste estudo é identificar o desfecho da aplicação de ventilação não invasiva em crianças com bronquiolite. Trata-se de uma revisão da literatura, com busca de artigos nas bases de dados Biblioteca Virtual em Saúde, Cochrane Library, PEDro, Pubmed, Scielo e Science Direct, sem restrição de período, a partir das palavras chave Noninvasive ventilation AND Bronchiolitis. De um total de 1.192 artigos encontrados, 11 foram inclusos no presente estudo, quatro abordaram o desfecho relacionado à aspectos clínicos gerais (aumento no uso de VNI; menor tempo de internação; redução da frequência respiratória e fração inspirada de oxigênio) e sete relataram o índice de sucesso ou falha, e apesar da diferença entre as médias (sucesso 88,5 versus falha 15,1) não houve diferença significativa. Conclui-se que o desfecho de falha tem alta prevalência (11,5%), apesar disso, os estudos encontraram diferentes benefícios advindos do incremento na aplicação de VNI (redução da necessidade de ventilação mecânica invasiva, menor tempo de permanência em UTI, redução da mortalidade, melhora da frequência respiratória e da fração inspirada de oxigênio). (AU)

Bronchiolitis is a viral infection that can lead to ventilatory failure. In such cases, the application of noninvasive ventilation (NIV) is an alternative to conventional treatment. The aim of this study is to identify the outcome of the application of NIV in children with bronchiolitis. This is a literature review whose search for articles included the Virtual Health Library, Cochrane Library, PEDro, PubMed, SciELO, and Science Direct databases, with no date restriction, based on the keywords Noninvasive ventilation AND Bronchiolitis. Of a total of 1192 articles found, 11 were included in the present study. Four addressed the outcome related to general clinical aspects (increased use of NIV, shorter hospital stay, and reduced respiratory rate and inspired oxygen fraction) and seven reported the success or failure rate. Despite the difference between the means (success 88.5 versus failure 15.1) there was no significant difference. In conclusion, the failure outcome has a high prevalence (11.5%); however, studies have found different benefits arising from the increased application of NIV (reduced need for invasive mechanical ventilation, shorter intensive care unit stay, reduced mortality, and improved respiratory rate and inspired oxygen fraction). (AU)

Tracing back hepatitis B virus genotype D introduction and dissemination in South Brazil.

Hepatitis B virus (HBV) infection is widespread and it is considered a major health problem in the world. HBV is classified into genotypes and subgenotypes. HBV genotype D (HBV-D) has been detected worldwide with high prevalence in some specific regions from Europe and South America. In Brazil, this genotype is very frequent in the South region and its introduction and dissemination have been associated with European immigration (mainly Italian). The present study aimed to trace back the introduction and dissemination of HBV-D in South Brazil. Fifty-two chronic hepatitis B patients from two cities with an early history of Italian immigration in South Brazil were selected for the present study. HBV-DNA was detected, quantified and a partial genomic region (S/P overlapped genes) was amplified by PCR and sequenced for the determination of HBV genotypes/subgenotypes. HBV complete genome sequences of some selected samples were further obtained. Bayesian coalescent analyses were performed to estimate the HBV-D evolutionary dynamics. Phylogenetic analysis demonstrated the occurrence of three genotypes according the tree topology: HBV-D (n = 49; 94.2%), HBV-A (n = 2; 3.9%) and HBV-G (n = 1; 1.9%). In addition, HBV-D presented three subgenotypes: HBV-D3 (n = 39; 79.6%), HBV-D2 (n = 8; 16.3%), and HBV-D1 (n = 2; 4.1%). The Bayesian coalescent analysis demonstrated that the HBV-D was introduced in the 20th century. HBV-D3 was the first to be introduced in South Brazil, probably between 1904 and 1942. HBV-D2 and HBV-D1 were introduced later; HBV-D2 between 1946 and 1953 and HBV-D1 between 1954 and 1969. HBV-D3 spread at a high rate from the 1920s to the 1980s, while HBV-D2 showed a slower growth from the 1960s to the 1990s and HBV-D1 infections demonstrated low and constant population size across time. After the 2000s, a stationary growth was detected for all these three-D subgenotypes. HBV-D showed a high prevalence in South Brazil and this is possibly associated with the first introduction and dissemination of HBV-D3 at the beginning of the 20th century.

The HLA-G 14-bp insertion/deletion polymorphism is associated with chronic hepatitis B in Southern Brazil: A case-control study.

There is growing evidence that the non-classical HLA-G has a role in the process of the immune response against pathogens, including HBV and HIV. Previous studies demonstrated that a 14-bp insertion/deletion (indel) polymorphism at 3'-untranslated region of HLA-G gene interferes in the mRNA stability and expression. The present study aimed to evaluate the association of the 14-bp indel polymorphism (rs371194629) with HBV infection in chronic hepatitis B (CHB) mono-infected and HBV/HIV co-infected patients from Southern Brazil. A total of 817 individuals were analyzed, including 357 CHB patients, 134 HBV/HIV co-infected patients and 326 healthy controls. The 14-bp indel polymorphism was analyzed by DNA amplification using PCR. Logistic regression models were performed to compute adjusted odds ratios (aORs) and 95% confidence intervals (95% CIs). To control for multiple comparisons, the Bonferroni correction was applied to the p-values. The 14-bp Ins allele was observed in 47.6% of the CHB mono-infected patients and in 41.6% of the controls (aOR = 1.33; 95% CI: 1.05-1.60; p = 0.02; pcorrected = 0.08). The results also showed that the 14-bp Ins/Ins genotype was present in 21.8% of the CHB mono-infected patients and in 12.9% of the controls (aOR = 1.91; 95% CI: 1.21-3.01; p < 0.01; pcorrected = 0.02). There was significant association between the 14-bp indel and CHB monoinfection, but not in HBV/HIV co-infection. In conclusion, the 14-bp indel polymorphism was associated with CHB in this specific population.

Discriminant analyzes for the use of tobacco, alcohol and other drugs among adolescents in an urban center in southern Brazil

Introduction: The consumption of tobacco, alcohol, and illicit drugs is a problem in adolescence, especially in the school context. This study aimed to identify the demographic and social variables that distinguished the students who had used tobacco, alcohol and/or other drugs at some point of their lives from those who had never used these substances. Methods: A school-based cross-sectional study was conducted to evaluate students attending the ninth year of elementary education in the city of Caxias do Sul (n = 1,285). Results: Alcohol was the most consumed drug (74.9%). In all the three discriminant profiles, adolescents who used tobacco throughout their lives presented more family conflict and hierarchy, higher age, greater difficulty in talking to their mother, father, and siblings, and higher school failure rates. The group that reported lifetime use of alcohol showed similar characteristics, and also reported greater loneliness. The group that has used illicit drugs was characterized, as well as other factors, by meeting with friends outside school more often, not having a good friend, being lonely, and having difficulties in talking to their father. Conclusions: Several aspects of the social and family environment can act as factors that propitiate or distance adolescents from drugs. Public policies have a role of fundamental importance in this regard.

Risk factors for hepatitis B transmission in South Brazil.

BACKGROUND: Hepatitis B virus (HBV) infection is a major public health problem in Brazil. Several risk factors are involved in HBV infection and their identification by a rational and essential approach is required to prevent the transmission of this infection in Brazil. OBJECTIVES: To evaluate risk factors associated with HBV infection in South Brazil. METHODS: A total of 260 patients with HBV and 260 controls from Caxias do Sul (state of Rio Grande do Sul, Brazil) participated in this study. All participants were given a standard questionnaire to yield the sociodemographic information and to identify HBV risk factors. HBV infection was detected by HBsAg test in all participants. FINDINGS: HBV infection in these cases was strongly associated with history of a family member HBV-infected, mainly mother [odds ratio (OR) = 4.86; 95% confidence intervals (CI): 1.69-13.91], father (OR = 5.28; 95% CI: 1.58-17.71), and/or siblings (OR = 22.16; 95% CI: 9.39-52.25); sharing personal objects (OR = 1.40; 95% CI: 1.37-2.38); and having history of blood transfusion (OR = 2.05; 95% CI: 1.10-2.84). CONCLUSIONS: HBV infection was strongly associated with having a family member infected with hepatitis B, sharing personal objects, and having history of blood transfusion.

Risk factors for hepatitis B transmission in South Brazil

BACKGROUND Hepatitis B virus (HBV) infection is a major public health problem in Brazil. Several risk factors are involved in HBV infection and their identification by a rational and essential approach is required to prevent the transmission of this infection in Brazil. OBJECTIVES To evaluate risk factors associated with HBV infection in South Brazil. METHODS A total of 260 patients with HBV and 260 controls from Caxias do Sul (state of Rio Grande do Sul, Brazil) participated in this study. All participants were given a standard questionnaire to yield the sociodemographic information and to identify HBV risk factors. HBV infection was detected by HBsAg test in all participants. FINDINGS HBV infection in these cases was strongly associated with history of a family member HBV-infected, mainly mother [odds ratio (OR) = 4.86; 95% confidence intervals (CI): 1.69-13.91], father (OR = 5.28; 95% CI: 1.58-17.71), and/or siblings (OR = 22.16; 95% CI: 9.39-52.25); sharing personal objects (OR = 1.40; 95% CI: 1.37-2.38); and having history of blood transfusion (OR = 2.05; 95% CI: 1.10-2.84). CONCLUSIONS HBV infection was strongly associated with having a family member infected with hepatitis B, sharing personal objects, and having history of blood transfusion.