Noninvasive ventilation in a pediatric ICU: factors associated with failure. / Ventilação não invasiva em pacientes em uma Unidade de Terapia Intensiva Pediátrica: fatores associados à falha.

Objective Evaluate the efficacy of Noninvasive Mechanical Ventilation (NIV) in preventing Endotracheal Intubation (ETI) in a heterogeneous pediatric population and identify predictive factors associated with NIV failure in Pediatric Intensive Care Unit (PICU). Methods Prospective non-randomized clinical trial conducted with patients aged 0-10 years, hospitalized in a PICU with NIV indication, who presented acute or chronic respiratory failure. Demographic data and clinical and cardiorespiratory parameters were evaluated, and patients who did not progress to ETI in 48 h after withdrawal of NIV were classified as "success group", whereas those who progressed to ETI were included in the "failure group". Multivariate logistic regression was performed to identify the predictive factors of failure to prevent ETI. Results Fifty-two patients, 27 (51.9%) males, with median age of 6 (1-120) months were included in the study. When evaluating the effectiveness of NIV, 36 (69.2%) patients were successful, with no need for ETI. After analyzing the predictive factors associated with failure, patients with tachypnea after 2 h of NIV were 4.8 times more likely to require ETI in 48 h. Regardless of outcome, heart (p<0.001) and respiratory (p<0.001) rates decreased and oxygen saturation (p<0.001) increased after 2 h of NIV. Conclusion We concluded that use of NIV was effective in the studied population, with significant improvement in cardiorespiratory parameters after 2 h of NIV, and that tachypnea was a predictive factor of failure to prevent ETI.

Ventilação não invasiva em pacientes em uma Unidade de Terapia Intensiva Pediátrica: fatores associados à falha / Noninvasive ventilation in a pediatric ICU: factors associated with failure

RESUMO Objetivo Avaliar a eficácia da ventilação mecânica não invasiva (VNI) em prevenir a intubação orotraqueal em uma população heterogênea de pacientes pediátricos e identificar os fatores preditivos associados à sua falha em Unidade de Terapia Intensiva Pediátrica (UTIP). Métodos Estudo clínico, prospectivo não randomizado, com pacientes de 0 a 10 anos de idade internados em UTIP com indicação de VNI, que apresentaram insuficiência respiratória aguda ou crônica agudizada. Foram avaliados parâmetros demográficos, clínicos e cardiorrespiratórios, e os pacientes que não evoluíram para tubo orotraqueal (TOT) por 48 horas após retirada da VNI foram classificados como "grupo sucesso". O "grupo falha" necessitou de TOT. Para identificar os fatores preditores para falha na prevenção de TOT, foi realizada a regressão logística multivariada. Resultados Foram incluídos 52 pacientes, sendo 27 (51,9%) meninos, com idade mediana de 6 (1-120) meses. Ao avaliar a eficácia da VNI, 36 (69,2%) pacientes apresentaram sucesso, sem necessidade de TOT. Após análise dos fatores preditivos para pertencer ao "grupo falha", os pacientes com taquipneia após 2 horas da colocação da VNI apresentaram 4,8 vezes mais chances de necessitar de TOT em 48 horas. Independentemente do desfecho, foram observados diminuição da frequência cardíaca (p < 0,001) e da frequência respiratória (p < 0,001) e aumento da saturação periférica de oxigênio (p < 0,001) 2 horas após a colocação da VNI. Conclusão A utilização da VNI foi eficaz na população estudada, com melhora significativa nos parâmetros cardiorrespiratórios 2 horas após a colocação da VNI, sendo a presença de taquipneia um fator preditivo para falha na prevenção de TOT.

ABSTRACT Objective Evaluate the efficacy of Noninvasive Mechanical Ventilation (NIV) in preventing Endotracheal Intubation (ETI) in a heterogeneous pediatric population and identify predictive factors associated with NIV failure in Pediatric Intensive Care Unit (PICU). Methods Prospective non-randomized clinical trial conducted with patients aged 0-10 years, hospitalized in a PICU with NIV indication, who presented acute or chronic respiratory failure. Demographic data and clinical and cardiorespiratory parameters were evaluated, and patients who did not progress to ETI in 48 h after withdrawal of NIV were classified as "success group", whereas those who progressed to ETI were included in the "failure group". Multivariate logistic regression was performed to identify the predictive factors of failure to prevent ETI. Results Fifty-two patients, 27 (51.9%) males, with median age of 6 (1-120) months were included in the study. When evaluating the effectiveness of NIV, 36 (69.2%) patients were successful, with no need for ETI. After analyzing the predictive factors associated with failure, patients with tachypnea after 2 h of NIV were 4.8 times more likely to require ETI in 48 h. Regardless of outcome, heart (p<0.001) and respiratory (p<0.001) rates decreased and oxygen saturation (p<0.001) increased after 2 h of NIV. Conclusion We concluded that use of NIV was effective in the studied population, with significant improvement in cardiorespiratory parameters after 2 h of NIV, and that tachypnea was a predictive factor of failure to prevent ETI.

Hypertonic Saline as a Useful Tool for Sputum Induction and Pathogen Detection in Cystic Fibrosis.

PURPOSE: The aim of this study was to compare the qualitative and semi-quantitative detection of pathogens in the airway secretions of patients with cystic fibrosis (CF) and the sputum induction capacity before and after inhalation of 7% hypertonic saline solution (HSS). METHODS: The study enrolled 64 patients with CF. Airway secretions were collected from all enrolled patients with CF before and after inhalation of 7% HSS, and the samples were screened for pathogens. RESULTS: Inhalation of 7% HSS increased the probability of producing sputum from 36 to 52% (p = 0.002) in children with CF. The effect was most in children under 11 years. Inhalation of 7% HSS improved qualitative pathogen identification (p = 0.008). Inhalation of 7% HSS increased the mucoid Pseudomonas aeruginosa (p = 0.002) and non-mucoid P. aeruginosa in the semi-quantitative analysis (p = 0.035). Four new pathogens (Aspergillus fumigatus, Achromobacter xylosoxidans, Ochrobactrum anthropi, and Elizabethkingia meningoseptica) were identified in the sputum samples collected from the airways of patients with CF following 7% HSS. CONCLUSIONS: Inhalation of 7% HSS increased sputum production and pathogen identification in children with CF. The inhalation of 7% HSS was feasible and should be implemented for routine pathogen detection in the airways of patients with CF, particularly in those patients who do not produce sputum.

Quality of life assessment in patients with cystic fibrosis by means of the Cystic Fibrosis Questionnaire.

OBJECTIVE: To assess the quality of life (QoL) of patients with cystic fibrosis (CF) followed at a university referral center for CF. METHODS: A cross-sectional study involving application of the Cystic Fibrosis Questionnaire (CFQ) and Shwachman score in CF patients between April of 2008 and June of 2009. RESULTS: The sample consisted of 75 patients. The mean age was 12.5 ± 5.1 years (range, 6.1-26.4 years). The patients were divided into three groups by age in years: group I (< 12), II (12-14), and III (> 14). The highest and lowest CFQ scores were for the nutrition domain in group III (89.3 ± 16.2) and the social domain in group II (59.5 ± 22.3), respectively. Groups I and III differed significantly regarding the treatment domain (p = 0.001). Regarding Shwachman scores, there were significant differences between patients scoring < 70 and those scoring > 70 in the social (group I; p = 0.045), respiratory (group II; p = 0.053), and digestive (p = 0.042) domains. In group III, severity did not correlate with QoL. In groups I and II, patients with an FEV1 < 80% of predicted did not differ from other patients for any CFQ domain. However, in group III, values for the following domains were significantly lower in patients with an FEV1 < 80%: physical (p = 0.012); body image (p = 0.031); respiratory (p = 0.023), emotional (p = 0.041); and social role (p = 0.024). CONCLUSIONS: It is important to assess QoL in CF patients, because it can improve treatment compliance.

Avaliação da qualidade de vida de pacientes com fibrose cística por meio do Cystic Fibrosis Questionnaire / Quality of life assessment in patients with cystic fibrosis by means of the Cystic Fibrosis Questionnaire

OBJETIVO: Avaliar a qualidade de vida (QV) de pacientes com fibrose cística (FC) acompanhados em um centro universitário de referência em atendimento a FC. MÉTODOS: Estudo transversal com a aplicação do Cystic Fibrosis Questionnaire (CFQ) e escore de Shwachman em pacientes com FC entre abril de 2008 e junho de 2009. RESULTADOS: Participaram 75 pacientes, com média de idade de 12,5 ± 5,1 anos (variação: 6,1-26,4 anos). Os pacientes foram divididos em três grupos de acordo com a idade: grupo I (< 12 anos), II (12-14 anos) e III (> 14 anos). As pontuações mais altas e mais baixas no CFQ foram para o domínio alimentação do grupo III (89,3 ± 16,2) e para o domínio social no grupo II (59,5 ± 22,3), respectivamente. Houve uma diferença significativa no domínio tratamento entre os grupos III e I (p = 0,001). Pacientes com escore de Shwachman < 70 apresentaram diferenças significativas em relação aos domínios social (grupo I; p = 0,045), respiratório (grupo II; p = 0,053) e digestivo (p = 0,042) quando comparados aqueles com escores > 70. No grupo III, não se observou associação entre gravidade e QV. Nos grupos I e II, não se observou diferenças entre os pacientes com VEF1 < 80 por cento do previsto e os demais pacientes em todos os domínios do CFQ. Entretanto, no grupo III, as médias dos pacientes com VEF1 < 80 por cento do previsto foram significativamente menores nos domínios físico (p = 0,012), imagem corporal (p = 0,031), respiratório (p = 0,023), emocional (p = 0,041) e papel social (p = 0,024). CONCLUSÕES: A avaliação da QV em pacientes com FC é importante, pois contribui para uma melhor aderência ao tratamento.

OBJECTIVE: To assess the quality of life (QoL) of patients with cystic fibrosis (CF) followed at a university referral center for CF. METHODS: A cross-sectional study involving application of the Cystic Fibrosis Questionnaire (CFQ) and Shwachman score in CF patients between April of 2008 and June of 2009. RESULTS: The sample consisted of 75 patients. The mean age was 12.5 ± 5.1 years (range, 6.1-26.4 years). The patients were divided into three groups by age in years: group I (< 12), II (12-14), and III (> 14). The highest and lowest CFQ scores were for the nutrition domain in group III (89.3 ± 16.2) and the social domain in group II (59.5 ± 22.3), respectively. Groups I and III differed significantly regarding the treatment domain (p = 0.001). Regarding Shwachman scores, there were significant differences between patients scoring < 70 and those scoring > 70 in the social (group I; p = 0.045), respiratory (group II; p = 0.053), and digestive (p = 0.042) domains. In group III, severity did not correlate with QoL. In groups I and II, patients with an FEV1 < 80 percent of predicted did not differ from other patients for any CFQ domain. However, in group III, values for the following domains were significantly lower in patients with an FEV1 < 80 percent: physical (p = 0.012); body image (p = 0.031); respiratory (p = 0.023), emotional (p = 0.041); and social role (p = 0.024). CONCLUSIONS: It is important to assess QoL in CF patients, because it can improve treatment compliance.