RESUMO
INTRODUCTION: Endotracheal tube (ETT) insertion depth estimation is important for optimal placement of ETT tip and balanced ventilation of the lungs. Various methods are available to determine the ETT insertion depth. The Neonatal Resuscitation Programme recommends the gestational age and nasal-tragus length (NTL) methods for estimating ETT insertion depth during cardiopulmonary resuscitation. However, the prospective data comparing these two methods is lacking. METHODS AND ANALYSIS: This is an open-label multi-centre randomised controlled trial, where gestational age and NTL methods will be used to determine the initial ETT insertion depth in term and preterm infants that are less than 28 days old, requiring oral intubation in the delivery room or neonatal intensive care unit (NICU). SITES AND SAMPLE SIZE: The trial is aimed to recruit 454 infants over 3 years across tertiary level NICUs. OUTCOMES: The primary outcome includes an optimally positioned ETT, defined as an ETT tip between the upper border of the first thoracic vertebra and the lower border of the second thoracic vertebra. The outcome is assessed by a paediatric radiologist, who will be masked to the group assignment. Secondary outcomes are malpositioned ETT tips, pneumothorax, ETT repositioning, chronic lung disease, invasive ventilation days, and death. ANALYSIS: Data will be analysed using the intention-to-treat principle. The primary and categorical secondary outcomes will be compared using the χ2 test. Adjusted risk ratios of outcomes will be calculated along with 95% CIs through multivariable logistic regression analysis, including covariates deemed biologically to influence the outcomes. ETHICS AND DISSEMINATION: The study has been approved by the PNU Research Ethics Board (20-0148) and the respective ethical review boards of the participating centres. The results will be disseminated through conference meetings, social media platforms, and publications in scientific journals. TRIAL REGISTRATION NUMBER: NCT04393337.
Assuntos
Recém-Nascido Prematuro , Ressuscitação , Criança , Idade Gestacional , Humanos , Lactente , Recém-Nascido , Intubação Intratraqueal/métodos , Estudos Multicêntricos como Assunto , Estudos Prospectivos , Ensaios Clínicos Controlados Aleatórios como Assunto , Ressuscitação/métodosRESUMO
El uso recreacional de drogas psicoactivas es una práctica generalizada en población de adultos jóvenes en el mundo. Existe evidencia de que los opioides y la cocaína producen toxicidad renal. La necrosis tubular aguda, rabdomiolisis y la glomerulonefritis focal segmentaria son las presentaciones más comunes. Reportamos un caso de daño renal agudo en un joven después del uso recreacional de alcohol, cocaína y opioides, cuyos hallazgos patológicos son descritos brevemente en la literatura.
Recreational drug use is a widespread activity in the young adult population. Cocaine and opioids have well described mechanism for renal toxicity, they include local and systemic toxicity, acute tubular necrosis, rhabdomylolysis and focal segmental glomerulosclerosis are among the most common presentations. We report a case of acute kidney injury in a young man after the recreational use of alcohol, cocaine and opioids, the pathological findings are described and a brief review of the literature is presented.
