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1.
Respir Res ; 19(1): 191, 2018 Oct 01.
Artigo em Inglês | MEDLINE | ID: mdl-30285741

RESUMO

BACKGROUND: Cough pressure, an expression of expiratory muscle strength, is usually measured with esophageal or gastric balloons, but these invasive catheters can be uncomfortable for the patient or their placement impractical. Because pressure in the thorax and abdomen are expected to be similar during a cough, we hypothesized that measurement at other thoracic or abdominal locations might also be similar as well as useful in clinical scenarios. This study aimed to compare cough pressures measured at thoracic and abdominal sites that could serve as alternatives to esophageal pressures (Pes). METHODS: Nine patients scheduled for laparotomy were asked to cough as forcefully as possible from total lung capacity in supine position. Three cough maneuvers were performed while Pes (the gold standard) as well as gastric, central venous, bladder and rectal pressures (Pga, Pcv, Pbl, and Prec, respectively) were measured simultaneously. The intraclass correlation coefficient (ICC) was used to evaluate the repeatability of the measurements in each patient at each site and evaluate agreement between alternative sites (Pga, Pcv, Pbl, and Prec) and Pes. Bland-Altman plots were used to compare Pes and the measurements at the other sites. RESULTS: Median (first quartile, third quartile) maximum pressures were as follows: Pes 112 (89,148), Pga 105 (92,156), Pcv 102 (91,149), Pbl 118 (93,157), and Prec 103 (88,150) cmH2O. The ICCs showed excellent within-site repeatability of the measurements (p < 0.001) and excellent agreement between alternative sites and Pes (p < 0.004). The Bland-Altman plots showed minimal differences between Pes, Pga, Pcv, and Prec. However, Pbl was higher than the other pressures in most patients, and the difference between Pes and Pbl was slightly larger. CONCLUSIONS: Cough pressure can be measured in the esophagus, stomach, superior vena cava or rectum, since their values are similar. It can also be measured in the bladder, although the value will be slightly higher. These results potentially facilitate the assessment of dynamic expiratory muscle strength with fewer invasive catheter placements in most hospitalized patients, thus providing an option that will be particularly useful in those undergoing thoracic or abdominal surgery. TRIAL REGISTRATION: NCT02957045 registered at November 7, 2016. Retrospectively registered.


Assuntos
Pressão Venosa Central/fisiologia , Tosse/fisiopatologia , Esôfago/fisiologia , Reto/fisiologia , Estômago/fisiologia , Bexiga Urinária/fisiologia , Idoso , Tosse/diagnóstico , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Força Muscular/fisiologia , Estudos Prospectivos
2.
Artigo em Inglês | MEDLINE | ID: mdl-30310272

RESUMO

Background: Hypercapnic encephalopathy is relatively frequent in severe exacerbations of COPD (ECOPDs), with its intensity usually being evaluated through clinical scales. Bispectral index (BIS) is a relatively new technique, based on the analysis of the electroencephalographic signal, which provides a good approximation to the level of consciousness, having already been validated in anesthesia. Objective: The objective of the study was to evaluate the utility of BIS in the assessment of the intensity of hypercapnic encephalopathy in ECOPD patients. Patients and methods: A total of ten ECOPD patients were included, and the level of brain activity was assessed using BIS and different scales: Glasgow Coma Scale, Ramsay Sedation Scale (RSS), and Richmond Agitation-Sedation Scale. The evaluation was performed both in the acute phase and 3 months after discharge. Results: BIS was recorded for a total of about 600 minutes. During ECOPD, BIS values ranged from 58.8 (95% CI: 48.6-69) for RSS score of 4 to 92.2 (95% CI: 90.1-94.3) for RSS score of 2. A significant correlation was observed between values obtained with BIS and those from the three scales, although the best fit was for RSS, followed by Glasgow and Richmond (r=-0.757, r=0.701, and r=0.615, respectively; P<0.001 for all). In the stable phase after discharge, BIS showed values considered as normal for a wake state (94.6; 95% CI: 91.7-97.9). Conclusion: BIS may be useful for the objective early detection and automatic monitoring of the intensity of hypercapnic encephalopathy in ECOPD, facilitating the early detection and follow-up of this condition, which may avoid management problems in these patients.


Assuntos
Encefalopatias/etiologia , Sedação Consciente/métodos , Eletroencefalografia/métodos , Hipercapnia , Monitorização Fisiológica/instrumentação , Doença Pulmonar Obstrutiva Crônica/complicações , Idoso , Encefalopatias/diagnóstico por imagem , Encefalopatias/terapia , Estudos de Casos e Controles , Monitores de Consciência , Progressão da Doença , Diagnóstico Precoce , Serviço Hospitalar de Emergência , Feminino , Escala de Coma de Glasgow , Humanos , Masculino , Pessoa de Meia-Idade , Monitorização Fisiológica/métodos , Projetos Piloto , Prognóstico , Estudos Prospectivos , Doença Pulmonar Obstrutiva Crônica/diagnóstico , Medição de Risco , Índice de Gravidade de Doença , Resultado do Tratamento
4.
Best Pract Res Clin Anaesthesiol ; 29(3): 315-30, 2015 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-26643097

RESUMO

Post-operative pulmonary complications (PPCs) can have severe consequences and their incidence is high. In recent years, PPCs have been the subject of numerous studies and articles, which have provided a great deal of information that is beneficial but that can cause confusion on a practical level. This review focusses on three main points: (1) the definitions of PPCs, which are heterogeneous and often vary from one report to another, despite emerging consensus; (2) the risk as reflected in the pool of PPC predictors, with each study identifying some but leaving us with a myriad of combinations; and (3) the many PPC prediction scores proposed, each with its strengths and limitations. We attempt to clarify the practical and research implications of the current situation.


Assuntos
Pneumopatias/epidemiologia , Complicações Pós-Operatórias/epidemiologia , Medição de Risco/métodos , Humanos , Incidência , Pneumopatias/etiologia , Complicações Pós-Operatórias/fisiopatologia , Valor Preditivo dos Testes , Fatores de Risco
5.
Eur J Anaesthesiol ; 32(7): 458-70, 2015 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-26020123

RESUMO

BACKGROUND: Postoperative respiratory failure (PRF) is the most frequent respiratory complication following surgery. OBJECTIVE: The objective of this study was to build a clinically useful predictive model for the development of PRF. DESIGN: A prospective observational study of a multicentre cohort. SETTING: Sixty-three hospitals across Europe. PATIENTS: Patients undergoing any surgical procedure under general or regional anaesthesia during 7-day recruitment periods. MAIN OUTCOME MEASURES: Development of PRF within 5 days of surgery. PRF was defined by a partial pressure of oxygen in arterial blood (PaO2) less than 8 kPa or new onset oxyhaemoglobin saturation measured by pulse oximetry (SpO2) less than 90% whilst breathing room air that required conventional oxygen therapy, noninvasive or invasive mechanical ventilation. RESULTS: PRF developed in 224 patients (4.2% of the 5384 patients studied). In-hospital mortality [95% confidence interval (95% CI)] was higher in patients who developed PRF [10.3% (6.3 to 14.3) vs. 0.4% (0.2 to 0.6)]. Regression modelling identified a predictive PRF score that includes seven independent risk factors: low preoperative SpO2; at least one preoperative respiratory symptom; preoperative chronic liver disease; history of congestive heart failure; open intrathoracic or upper abdominal surgery; surgical procedure lasting at least 2 h; and emergency surgery. The area under the receiver operating characteristic curve (c-statistic) was 0.82 (95% CI 0.79 to 0.85) and the Hosmer-Lemeshow goodness-of-fit statistic was 7.08 (P = 0.253). CONCLUSION: A risk score based on seven objective, easily assessed factors was able to predict which patients would develop PRF. The score could potentially facilitate preoperative risk assessment and management and provide a basis for testing interventions to improve outcomes.The study was registered at ClinicalTrials.gov (identifier NCT01346709).


Assuntos
Complicações Pós-Operatórias/diagnóstico , Complicações Pós-Operatórias/prevenção & controle , Insuficiência Respiratória/diagnóstico , Insuficiência Respiratória/prevenção & controle , Adulto , Idoso , Anestesia por Condução , Anestesia Geral , Estudos de Coortes , Cuidados Críticos/estatística & dados numéricos , Europa (Continente) , Feminino , Mortalidade Hospitalar , Humanos , Masculino , Pessoa de Meia-Idade , Oximetria , Oxigênio/sangue , Oxiemoglobinas/análise , Oxiemoglobinas/metabolismo , Complicações Pós-Operatórias/mortalidade , Estudos Prospectivos , Insuficiência Respiratória/mortalidade , Fatores de Risco , Resultado do Tratamento
7.
Anesthesiology ; 121(2): 219-31, 2014 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-24901240

RESUMO

BACKGROUND: No externally validated risk score for postoperative pulmonary complications (PPCs) is currently available. The authors tested the generalizability of the Assess Respiratory Risk in Surgical Patients in Catalonia risk score for PPCs in a large European cohort (Prospective Evaluation of a RIsk Score for postoperative pulmonary COmPlications in Europe). METHODS: Sixty-three centers recruited 5,859 surgical patients receiving general, neuraxial, or plexus block anesthesia. The Assess Respiratory Risk in Surgical Patients in Catalonia factors (age, preoperative arterial oxygen saturation in air, acute respiratory infection during the previous month, preoperative anemia, upper abdominal or intrathoracic surgery, surgical duration, and emergency surgery) were recorded, along with PPC occurrence (respiratory infection or failure, bronchospasm, atelectasis, pleural effusion, pneumothorax, or aspiration pneumonitis). Discrimination, calibration, and diagnostic accuracy measures of the Assess Respiratory Risk in Surgical Patients in Catalonia score's performance were calculated for the Prospective Evaluation of a RIsk Score for postoperative pulmonary COmPlications in Europe cohort and three subsamples: Spain, Western Europe, and Eastern Europe. RESULTS: The full Prospective Evaluation of a RIsk Score for postoperative pulmonary COmPlications in Europe data set included 5,099 patients; 725 PPCs were recorded for 404 patients (7.9%). The score's discrimination was good: c-statistic (95% CI), 0.80 (0.78 to 0.82). Predicted versus observed PPC rates for low, intermediate, and high risk were 0.87 and 3.39% (score <26), 7.82 and 12.98% (≥ 26 and <45), and 38.13 and 38.01% (≥ 45), respectively; the positive likelihood ratio for a score of 45 or greater was 7.12 (5.93 to 8.56). The score performed best in the Western Europe subsample-c-statistic, 0.87 (0.83 to 0.90) and positive likelihood ratio, 11.56 (8.63 to 15.47)-and worst in the Eastern Europe subsample. The predicted (5.5%) and observed (5.7%) PPC rates were most similar in the Spain subsample. CONCLUSIONS: The Assess Respiratory Risk in Surgical Patients in Catalonia score predicts three levels of PPC risk in hospitals outside the development setting. Performance differs between geographic areas.


Assuntos
Pneumopatias/diagnóstico , Complicações Pós-Operatórias/diagnóstico , Adulto , Idoso , Idoso de 80 Anos ou mais , Anemia/complicações , Calibragem , Estudos de Coortes , Coleta de Dados , Emergências , Feminino , Humanos , Tempo de Internação , Pneumopatias/etiologia , Masculino , Pessoa de Meia-Idade , Valor Preditivo dos Testes , Estudos Prospectivos , Controle de Qualidade , Infecções Respiratórias/complicações , Medição de Risco , Fatores de Risco , Tamanho da Amostra
8.
Curr Opin Crit Care ; 20(1): 56-62, 2014 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-24240985

RESUMO

PURPOSE OF REVIEW: This review discusses our present understanding of postoperative respiratory failure (PRF) pathogenesis, risk factors, and perioperative-risk reduction strategies. RECENT FINDINGS: PRF, the most frequent postoperative pulmonary complication, is defined by impaired blood gas exchange appearing after surgery. PRF leads to longer hospital stays and higher mortality. The time frame for recognizing when respiratory failure is related to the surgical-anesthetic insult remains imprecise, however, and researchers have used different clinical events instead of blood gas measures to define the outcome. Still, studies in specific surgical populations or large patient samples have identified a range of predictors of PRF risk: type of surgery and comorbidity, mechanical ventilation, and multiple hits to the lung have been found to be relevant in most of these studies. Recently, risk-scoring systems for PRF have been developed and are being applied in new controlled trials of PRF-risk reduction measures. Current evidence favors carefully managing intraoperative ventilator use and fluids, reducing surgical aggression, and preventing wound infection and pain. SUMMARY: PRF is a life-threatening event that is challenging for the surgical team. Risk prediction scales based on large population studies are being developed and validated. We need high-quality trials of preventive measures, particularly those related to ventilator use in both high risk and general populations.


Assuntos
Anestesia/efeitos adversos , Complicações Pós-Operatórias/prevenção & controle , Respiração Artificial/efeitos adversos , Insuficiência Respiratória/prevenção & controle , Comorbidade , Feminino , Humanos , Masculino , Complicações Pós-Operatórias/etiologia , Complicações Pós-Operatórias/fisiopatologia , Período Pós-Operatório , Insuficiência Respiratória/etiologia , Insuficiência Respiratória/fisiopatologia , Fatores de Risco , Índice de Gravidade de Doença , Fatores de Tempo
9.
J Cardiothorac Vasc Anesth ; 28(4): 919-24, 2014 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-24016684

RESUMO

OBJECTIVE: Almitrine enhances hypoxic pulmonary vasoconstriction (HPV) and can improve hypoxemia related to one-lung ventilation (OLV). Studies using almitrine have been conducted without inhaled anesthetics because they could inhibit HPV, counteracting the effect of almitrine. This hypothesis, however, has not been confirmed. This study's aim was to evaluate whether almitrine could improve oxygenation when administered during OLV with sevoflurane anesthesia. DESIGN: A prospective, randomized, double-blind, placebo-controlled trial. SETTING: A tertiary care, university teaching hospital. PARTICIPANTS: Thirty adult patients undergoing open-chest thoracic surgery. INTERVENTIONS: Patients were assigned randomly to receive almitrine or placebo during OLV. Respiratory and hemodynamic variables were recorded continuously. Anesthesia was maintained with sevoflurane and remifentanil. Intraoperative techniques and medical teams were the same all over the study. MEASUREMENTS AND MAIN RESULTS: Respiratory and hemodynamic variables were measured during two-lung ventilation and during open-chest OLV. Two-way repeated-measures analysis of variance was used to compare the effects of almitrine and placebo. During OLV, PaO2 and shunt fraction worsened in all patients without significant differences between groups. At 30-minutes of OLV, PaO2 was 184±67 mmHg in the almitrine group and 145±56 mmHg in the placebo group, while shunt fraction were 31%±6% and 36%±13%, respectively. Mean pulmonary artery pressure was higher in the almitrine group (31±5 v 24±5 mmHg, p<0.001). CONCLUSIONS: During anesthesia with sevoflurane for open-chest OLV, almitrine failed to improve oxygenation and increased pulmonary artery pressure. The combination of sevoflurane and almitrine should, therefore, be avoided.


Assuntos
Almitrina/administração & dosagem , Anestesia Geral/métodos , Hemodinâmica/efeitos dos fármacos , Hipóxia/tratamento farmacológico , Éteres Metílicos/administração & dosagem , Ventilação Monopulmonar/métodos , Consumo de Oxigênio/efeitos dos fármacos , Adolescente , Adulto , Idoso , Anestésicos Inalatórios/administração & dosagem , Gasometria , Método Duplo-Cego , Feminino , Humanos , Hipóxia/metabolismo , Hipóxia/fisiopatologia , Pulmão/metabolismo , Pulmão/fisiopatologia , Masculino , Pessoa de Meia-Idade , Monitorização Intraoperatória , Estudos Prospectivos , Fármacos do Sistema Respiratório/administração & dosagem , Sevoflurano , Procedimentos Cirúrgicos Torácicos , Adulto Jovem
10.
Rev. colomb. anestesiol ; 41(2): 120-126, abr.-jun. 2013. tab
Artigo em Espanhol | LILACS, COLNAL | ID: lil-677431

RESUMO

Introducción: Para la óptima realización de la ultrasonografía endobronquial (USEB) lineal es imprescindible que el paciente esté sedado para que se mantenga tranquilo, no tosa ni se mueva y el endoscopista trabaje cómodamente con un buen rendimiento de la exploración. Actualmente la técnica anestésica no está estandarizada y varía desde una anestesia general a una sedación. El objetivo del presente trabajo es conocer la dosificación, la seguridad y la satisfacción de la sedación endovenosa con propofol y remifentanilo e identificar los posibles factores predictivos de tos durante el procedimiento. Pacientes y métodos: Se estudió prospectivamente a los pacientes a quienes se realizó la USEB bajo sedación en un hospital de tercer nivel. Resultados: Se realizó la USEB a 90pacientes bajo sedación con remifentanilo y propofol, a una velocidad de infusión de 0,13 (0,09-0,17) ixgkg-¹ min^¹ y 2,34 (1,5-3,6) mgkg-¹ h_1, respectivamente. El 81% de los pacientes tosieron en algún momento de la exploración. En el 8% de los pacientes se interrumpió el procedimiento puntualmente por tos y desaturación. No se registraron complicaciones graves directamente relacionadas con la sedación. El nivel de satisfacción del neumólogo y del paciente con el procedimiento fue excelente o bueno en la mayoría de casos. No se observó relación estadísticamente significativa entre el número de episodios de tos durante la ecobroncoscopia y las variables test de la tos, ser tosedor habitual, hábito tabáquico o grado de severidad de la EPOC. Conclusiones: La sedación con remifentanilo y propofol realizada por un anestesiólogo permite realizar la USEB lineal en ventilación espontánea aunque con una elevada incidencia de tos y desaturación, siendo esta última la complicación más frecuente. No se encontraron factores predictivos de la tos durante el procedimiento.


Introduction: Optimal linear endobronchial ultrasound (EBUS) outcomes require sedation to ensure that the patient remains calm, immobile, and does not cough, and so that the bronchoscopist can work comfortably. The choice of anesthesia techniques, on a spectrum ranging from general anesthesia to sedation, is not standardized. The aims of this study were to determine doses, safety and satisfaction for intravenous sedation with propofol and remifentanil, and identify potential predictors of coughing during the procedure, and determine patient and bronchoscopist satisfaction with the procedure. Patients and methods: The prospective study included patients undergoing EBUS under sedation in a tertiary hospital. Results: A total of 90 patients underwent EBUS under sedation with remifentanil and propofol, at infusion rates of 0,13 (0,09-0,17) g kg-¹ min^¹ and 2.34 (1.5-3.6) mg kg-¹ Lr¹, respectively. Just over four fifths of the patients (81%) coughed at some point during the ultrasound procedure. In 8% of patients the procedure was promptly discontinued due to coughing and desaturation. There were no major complications directly related to sedation. Bronchoscopists and patients rated their satisfaction with the procedure as excellent or good in most cases. There was no statistically significant relationship between the number of coughing episodes during the procedure and any of the following variables: positive cough test, a habitual cough, tobacco dependence, or severity of chronic obstructive pulmonary disease. Conclusions: Remifentanil and propofol administered by an anesthesiologist enabled spontaneously breathing patients to undergo linear EBUS, although with a high incidence of coughing and particularly desaturation. No predictors for coughing during EBUS were identified.


Assuntos
Humanos
12.
Curr Opin Anaesthesiol ; 26(2): 107-15, 2013 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-23407154

RESUMO

PURPOSE OF REVIEW: Postoperative pulmonary complications (PPCs) are common and lead to longer hospital stays and higher mortality. A wide range of patient, anaesthetic and surgical factors have been associated with risk for PPCs. This review discusses our present understanding of PPC risk factors that can be used to plan preoperative risk reduction strategies. The methodological and statistical basis for building risk scores is also described. RECENT FINDINGS: Studies in specific surgical populations or large patient samples have identified a range of predictors of PPC risk. Factors such as age, types of comorbidity and surgical characteristics have been found to be relevant in most of these studies. Recently, researchers have begun to develop risk scoring systems for a PPC composite outcome or for specific PPCs, especially pneumonia and respiratory failure. Preoperative arterial oxyhaemoglobin saturation is an objective measure that is easy to record and discriminates level of risk for impaired cardiorespiratory function. Preoperative anaemia and recent respiratory infection are factors that have lately been found to confer risk for PPCs. SUMMARY: PPC risk prediction scales based on large population studies are being developed. New studies to confirm the validity of these scales in different geographic areas will be needed before we can be sure of their generalizability.


Assuntos
Pneumopatias/etiologia , Complicações Pós-Operatórias/etiologia , Consumo de Bebidas Alcoólicas , Anemia/complicações , Complicações do Diabetes/etiologia , Humanos , Pneumopatias/prevenção & controle , Oxigênio/sangue , Complicações Pós-Operatórias/prevenção & controle , Infecções Respiratórias/complicações , Fatores de Risco , Apneia Obstrutiva do Sono/complicações
13.
PLoS One ; 7(11): e47725, 2012.
Artigo em Inglês | MEDLINE | ID: mdl-23133602

RESUMO

BACKGROUND AND AIMS: This was a safety and efficacy pharmacogenetic study of a previously performed randomized trial which compared the effectiveness of treatment of hepatitis C virus infection with pegylated interferon alpha (pegIFNα) 2a vs. 2b, both with ribavirin, for 48 weeks, in HCV-HIV coinfected patients. METHODS: The study groups were made of 99 patients (efficacy pharmacogenetic substudy) and of 114 patients (safety pharmacogenetic substudy). Polymorphisms in the following candidate genes IL28B, IL6, IL10, TNFα, IFNγ, CCL5, MxA, OAS1, SOCS3, CTLA4 and ITPA were assessed. Genotyping was carried out using Sequenom iPLEX-Gold, a single-base extension polymerase chain reaction. Efficacy end-points assessed were: rapid, early and sustained virological response (RVR, EVR and SVR, respectively). Safety end-points assessed were: anemia, neutropenia, thrombocytopenia, flu-like syndrome, gastrointestinal disturbances and depression. Chi square test, Student's T test, Mann-Whitney U test and logistic regression were used for statistic analyses. RESULTS: As efficacy is concerned, IL28B and CTLA4 gene polymorphisms were associated with RVR (p<0.05 for both comparisons). Nevertheless, only polymorphism in the IL28B gene was associated with SVR (p = 0.004). In the multivariate analysis, the only gene independently associated with SVR was IL28B (OR 2.61, 95%CI 1.2-5.6, p = 0.01). With respect to safety, there were no significant associations between flu-like syndrome or depression and the genetic variants studied. Gastrointestinal disturbances were associated with ITPA gene polymorphism (p = 0.04). Anemia was associated with OAS1 and CTLA4 gene polymorphisms (p = 0.049 and p = 0.045, respectively), neutropenia and thromobocytopenia were associated with SOCS3 gene polymorphism (p = 0.02 and p = 0.002, respectively). In the multivariate analysis, the associations of the SOCS3 gene polymorphism with neutropenia (OR 0.26, 95%CI 0.09-0.75, p = 0.01) and thrombocytopenia (OR 0.07, 95%CI 0.008-0.57, p = 0.01) remained significant. CONCLUSIONS: In HCV-HIV coinfected patients treated with PegIFNα and ribavirin, SVR is associated with IL28B rs8099917 polymorphism. HCV treatment-induced neutropenia and thrombocytopenia are associated with SOCS3 rs4969170 polymorphism.


Assuntos
Regulação Viral da Expressão Gênica , Variação Genética , Infecções por HIV/tratamento farmacológico , Infecções por HIV/genética , Hepatite C/tratamento farmacológico , Hepatite C/genética , Interleucinas/biossíntese , Farmacogenética/métodos , Proteínas Supressoras da Sinalização de Citocina/biossíntese , Adulto , Feminino , Genótipo , Infecções por HIV/complicações , Hepatite C/complicações , Humanos , Interferon-alfa/metabolismo , Interferons , Masculino , Modelos Genéticos , Modelos Estatísticos , Fenótipo , Polimorfismo Genético , Ribavirina/farmacologia , Proteína 3 Supressora da Sinalização de Citocinas
19.
Anesthesiology ; 113(6): 1338-50, 2010 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-21045639

RESUMO

BACKGROUND: Current knowledge of the risk for postoperative pulmonary complications (PPCs) rests on studies that narrowly selected patients and procedures. Hypothesizing that PPC occurrence could be predicted from a reduced set of perioperative variables, we aimed to develop a predictive index for a broad surgical population. METHODS: Patients undergoing surgical procedures given general, neuraxial, or regional anesthesia in 59 hospitals were randomly selected for this prospective, multicenter study. The main outcome was the development of at least one of the following: respiratory infection, respiratory failure, bronchospasm, atelectasis, pleural effusion, pneumothorax, or aspiration pneumonitis. The cohort was randomly divided into a development subsample to construct a logistic regression model and a validation subsample. A PPC predictive index was constructed. RESULTS: Of 2,464 patients studied, 252 events were observed in 123 (5%). Thirty-day mortality was higher in patients with a PPC (19.5%; 95% [CI], 12.5-26.5%) than in those without a PPC (0.5%; 95% CI, 0.2-0.8%). Regression modeling identified seven independent risk factors: low preoperative arterial oxygen saturation, acute respiratory infection during the previous month, age, preoperative anemia, upper abdominal or intrathoracic surgery, surgical duration of at least 2 h, and emergency surgery. The area under the receiver operating characteristic curve was 90% (95% CI, 85-94%) for the development subsample and 88% (95% CI, 84-93%) for the validation subsample. CONCLUSION: The risk index based on seven objective, easily assessed factors has excellent discriminative ability. The index can be used to assess individual risk of PPC and focus further research on measures to improve patient care.


Assuntos
Pneumopatias/diagnóstico , Complicações Pós-Operatórias/diagnóstico , Adulto , Idoso , Idoso de 80 Anos ou mais , Anestesia , Estudos de Coortes , Coleta de Dados/normas , Feminino , Humanos , Tempo de Internação , Modelos Logísticos , Pneumopatias/epidemiologia , Pneumopatias/mortalidade , Masculino , Pessoa de Meia-Idade , População , Complicações Pós-Operatórias/epidemiologia , Complicações Pós-Operatórias/mortalidade , Valor Preditivo dos Testes , Estudos Prospectivos , Respiração Artificial , Fatores de Risco , Tamanho da Amostra , Estações do Ano , Espanha/epidemiologia , Resultado do Tratamento
20.
Eur J Endocrinol ; 163(6): 887-93, 2010 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-20870707

RESUMO

CONTEXT: Lipocalin-2 and adipocyte fatty-acid-binding protein (A-FABP or FABP4) are adipokines potentially involved in the pathophysiology of obesity and metabolic syndrome in adults. In children, they have been scarcely studied. OBJECTIVE: To analyze lipocalin-2 and A-FABP circulating levels before and after 2 years of a dieting and lifestyle intervention in a prepubertal obese cohort. DESIGN AND SETTING: Case-control study with a prospective follow-up of cases for 2 years in our referral pediatric endocrine outpatient center. PATIENTS AND METHODS: Seventy-three prepubertal obese children, 8.03 ± 1.08-years old, and 47 age- and gender-matched lean controls were studied. Anthropometric parameters, blood pressure, fasting oral glucose tolerance test, homeostatic model insulin resistance index (HOMA-IR), lipid profile, lipocalin-2, and A-FABP were evaluated. Weight loss was considered if z-score body mass index (BMI) decreased at least 0.5 s.d. RESULTS: At baseline, lipocalin-2 and A-FABP were higher in prepubertal obese children than those in lean controls (P<0.001). A-FABP showed a gradual increase, according to the obesity degree (r(2)=0.632; P<0.001). After 2 years, obese patients who lost weight showed a decrease in A-FABP (a mean 2% reduction in BMI was associated with a mean 29% decrease in A-FABP (P<0.001)) without changes in lipocalin-2 levels. Regression model analysis adjusted by age, sex, BMI, and HOMA showed that A-FABP was lower in males (ß=-5.77 (CI 95%: -9.7; -1.84)) and was modified by BMI (ß=2.7 (CI 95%: 1.77-3.62), r(2)=0.659). Lipocalin-2 was not modified by any of these variables. CONCLUSIONS: Prepubertal obese children show high plasma lipocalin-2 and A-FABP levels, but only A-FABP is influenced by weight loss.


Assuntos
Proteínas de Ligação a Ácido Graxo/sangue , Lipocalinas/sangue , Perda de Peso/fisiologia , Adipócitos/metabolismo , Estudos de Casos e Controles , Criança , Feminino , Humanos , Estudos Longitudinais , Masculino , Obesidade/metabolismo
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