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1.
Artigo em Inglês | LILACS-Express | LILACS | ID: biblio-1288037

RESUMO

ABSTRACT Objective: To describe, for the first time in the pediatric population, the use of an effective technique to mobilize secretion in a patient whose disease imposes many care limitations. Case description: 2-year-old infant with Epidermolysis Bullosa, dependent on mechanical ventilation after cardiorespiratory arrest. Infant evolved with atelectasis in the right upper lobe with restriction to all manual secretion mobilization techniques due to the risk of worsening skin lesions. We opted for tracheal aspiration in a closed system combined with expiratory pause, a technique only described in adult patients so far. Comments: This case report is the first to use this technique in a pediatric patient. The use of expiratory pause combined with tracheal aspiration not only optimized the mobilization of secretion, but it was also a safe tool for reversing atelectasis. Our case report brings an important result because it increases the possibilities of managing pediatric patients admitted to intensive care units, especially in situations of absolute contraindication for chest maneuvers.


RESUMO Objetivo: Descrever pela primeira vez na população pediátrica a utilização de técnica eficaz para mobilização de secreção em paciente cuja patologia impõe muitas limitações no seu cuidado. Descrição do caso: Lactente de 2 anos e 4 meses com diagnóstico de epidermólise bolhosa dependente de ventilação mecânica pós-parada cardiorrespiratória evoluiu com atelectasia em lobo superior direito, com restrição a todas as técnicas manuais de mobilização de secreção em virtude do risco de agravamento das lesões de pele. Optou-se pela realização de aspiração traqueal em sistema fechado combinada à pausa expiratória, técnica até então só descrita em pacientes adultos. Comentários: O relato trata, portanto, do primeiro caso a utilizar essa técnica em paciente pediátrico. O uso da pausa expiratória combinada à aspiração traqueal não só otimizou a mobilização de secreção como também foi uma ferramenta segura para a reversão da atelectasia. O resultado revela-se importante, pois amplia as possibilidades do manejo de pacientes pediátricos internados nas unidades de terapia intensiva, principalmente em situações de contraindicação absoluta de manipulação torácica.

2.
Einstein (Sao Paulo) ; 19: eAO5846, 2021.
Artigo em Inglês, Português | MEDLINE | ID: mdl-34133643

RESUMO

OBJECTIVE: To evaluate the evolution of clinical outcomes in children with bronchiolitis who used a high-flow nasal cannula, and to determine after long of non-clinical improvement the therapy should be discontinued, and treatment should be escalated to other forms of ventilatory support. METHODS: An observational retrospective study of infants with bronchiolitis who used a high-flow nasal cannula. Patients were divided into two study groups according to success or failure of high-flow nasal cannula therapy, namely the Success Group and the Failure Group. The main demographics and clinical variables were assessed 30 minutes and 6 hours after initiating therapy until removal of the high-flow nasal cannula. RESULTS: A total of 83 children were studied and 18 children (21.7%) failed therapy. Among subjects with successful therapy, a significant decrease in respiratory rate (p<0.001), and a significant increase in peripheral oxygen saturation (p<0.001) were observed within 30 minutes. The Success Group was significantly different from the Failure Group after 6 hours, for both respiratory rate (p<0.01) and peripheral oxygen saturation (p<0.01). CONCLUSION: The absence of clinical sign improvement within 30 minutes and for up to a maximum of 6 hours can be considered as failure of the high-flow nasal cannula therapy. If this time elapses with no improvements, escalating to another type of ventilatory support should be considered.


Assuntos
Bronquiolite , Cânula , Bronquiolite/terapia , Criança , Humanos , Lactente , Oxigenoterapia , Estudos Retrospectivos
3.
Einstein (Säo Paulo) ; 19: eAO5846, 2021. tab
Artigo em Inglês | LILACS | ID: biblio-1286286

RESUMO

ABSTRACT Objective: To evaluate the evolution of clinical outcomes in children with bronchiolitis who used a high-flow nasal cannula, and to determine after long of non-clinical improvement the therapy should be discontinued, and treatment should be escalated to other forms of ventilatory support. Methods: An observational retrospective study of infants with bronchiolitis who used a high-flow nasal cannula. Patients were divided into two study groups according to success or failure of high-flow nasal cannula therapy, namely the Success Group and the Failure Group. The main demographics and clinical variables were assessed 30 minutes and 6 hours after initiating therapy until removal of the high-flow nasal cannula. Results: A total of 83 children were studied and 18 children (21.7%) failed therapy. Among subjects with successful therapy, a significant decrease in respiratory rate (p<0.001), and a significant increase in peripheral oxygen saturation (p<0.001) were observed within 30 minutes. The Success Group was significantly different from the Failure Group after 6 hours, for both respiratory rate (p<0.01) and peripheral oxygen saturation (p<0.01). Conclusion: The absence of clinical sign improvement within 30 minutes and for up to a maximum of 6 hours can be considered as failure of the high-flow nasal cannula therapy. If this time elapses with no improvements, escalating to another type of ventilatory support should be considered.


RESUMO Objetivo: Avaliar a evolução de desfechos clínicos em crianças com bronquiolite que utilizaram cânula nasal de alto fluxo, e determinar com quanto tempo de não melhora clínica a terapia deve ser interrompida para escalonamento do tratamento para outras formas de suporte ventilatório. Métodos: Estudo observacional retrospectivo, de lactentes com bronquiolite que utilizaram cânula nasal de alto fluxo. Os pacientes foram divididos em dois grupos de estudo, de acordo com o sucesso ou não da terapêutica com cânula nasal de alto fluxo, nomeados Grupo Sucesso e Grupo Falha. Foram analisadas as principais características demográficas e variáveis clínicas, tendo sido avaliadas 30 minutos e 6 horas após o início do tratamento até a retirada da cânula nasal de alto fluxo. Resultados: Foram estudados 83 crianças; destas, 18 crianças (21,7%) falharam. Entre os pacientes que tiveram sucesso na terapia, observou-se diminuição significativa da frequência respiratória (p<0,001), e também aumento significativo da saturação de oxigênio (p<0,001) já nos primeiros 30 minutos. O Grupo Sucesso foi significativamente diferente do Grupo Falha a partir de 6 horas, tanto para frequência respiratória (p<0,01), quanto para saturação de oxigênio (p<0,01). Conclusão: Na ausência de melhora dos sinais clínicos, a falha da terapia com cânula nasal de alto fluxo já pode ser considerada a partir de 30 minutos e, no máximo, em até 6 horas após o início da terapia. Após esse período sem melhora, o escalonamento para outro tipo de suporte ventilatório deve ser avaliado.


Assuntos
Humanos , Lactente , Criança , Bronquiolite/terapia , Estudos Retrospectivos , Cânula , Oxigenoterapia
4.
PLoS One ; 15(12): e0243694, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-33306735

RESUMO

INTRODUCTION: Respiratory tract diseases are the major cause of morbidity and mortality in children under the age of 5 years, constituting the highest rate of hospitalization in this age group. OBJECTIVES: To determine the prevalence of hospitalizations for respiratory diseases in childhood in the last 5 years and to assess the impact of social isolation due to COVID-19 on the seasonal behavior of these diseases. METHODS: A cross-sectional clinical study was carried out, with a survey of all patients aged 0 to 17 years who were admitted with a diagnosis of respiratory diseases between January 2015 and July 2020. The database was delivered to the researchers anonymized. The variables used for analysis were date of admission, date of discharge, length of stay, age, sex and diagnosis. In order to make the analysis possible, the diagnoses were grouped into upper respiratory infection (URI), asthma / bronchitis, bronchiolitis and pneumonia. RESULTS: 2236 admissions were included in the study. Children under 5 years old account for 81% of hospitalizations for respiratory disease in our population. In the adjusted model, an average reduction of 38 hospitalizations was observed in the period of social isolation (coefficient: -37.66; 95% CI (- 68.17; -7.15); p = 0.016). CONCLUSION: The social isolation measures adopted during the COVID-19 pandemic dramatically interfered with the seasonality of childhood respiratory diseases. This was reflected in the unexpected reduction in the number of hospitalizations in the pediatric population during this period.


Assuntos
Asma/terapia , Bronquite/terapia , COVID-19 , Hospitalização , Infecções Respiratórias/terapia , SARS-CoV-2 , Estações do Ano , Adolescente , Asma/epidemiologia , Bronquite/epidemiologia , COVID-19/epidemiologia , COVID-19/prevenção & controle , Criança , Pré-Escolar , Estudos Transversais , Feminino , Hospitais Pediátricos , Humanos , Lactente , Recém-Nascido , Masculino , Infecções Respiratórias/epidemiologia , Isolamento Social
5.
Sci Rep ; 10(1): 15914, 2020 09 28.
Artigo em Inglês | MEDLINE | ID: mdl-32985553

RESUMO

High-flow nasal cannula (HFNC) therapy is routinely used in the treatment of infants with bronchiolitis. This study sought to identify markers associated with failure of HFNC therapy that serve as warnings for early staging of other ventilatory support products. A retrospective study of infants with a diagnosis of bronchiolitis, receiving HFNC and admitted to the pediatric intensive care unit from January 2016 to June 2017, was conducted. The subjects were divided into two study groups according to the success or failure of HFNC therapy. Risk factors were assessed using the following variables: age, time between hospital admission and start of HFNC, equipment model, and the need for a nasogastric tube. Eighty-one infants were studied, and 18 (21.7%) of them exhibited therapy failure. The results of the logistic models showed that the chances of failure for patients requiring a nasogastric tube during HFNC use were more likely than those for patients with oral nutrition (OR = 8.17; 95% CI 2.30-28.99; p = 0.001). The HFNC failure was not associated with the device used (OR = 1.56; 95% CI 0.54-4.52; p = 0.41), time between hospital admission and HFNC installation (OR = 1.01; 95% CI 0.98-1.03; p = 0.73), or age (OR = 0.98; 95% CI 0.82-1.17; p = 0.82). Among late outcomes evaluated, the patients with therapy failure had longer total durations of O2 use (p < 0.001) and longer hospital stays (p < 0.001). The need to use a nasogastric tube during HFNC use was associated with HFNC therapy failure and can be considered as a marker of severity in children with bronchiolitis.


Assuntos
Bronquiolite/terapia , Cânula , Intubação Gastrointestinal , Oxigenoterapia/instrumentação , Feminino , Hospitalização , Humanos , Lactente , Unidades de Terapia Intensiva Pediátrica , Tempo de Internação , Masculino , Prognóstico , Fatores de Risco , Falha de Tratamento
6.
Einstein (Sao Paulo) ; 16(4): eAO4199, 2018 Nov 08.
Artigo em Inglês, Português | MEDLINE | ID: mdl-30427479

RESUMO

OBJECTIVE: To evaluate if distress respiratory decreases after using helium-oxygen mixture in pediatric patients diagnosed with bronchospasm. METHODS: This is a retrospective, non-randomized study that included patients diagnosed with bronchospasm, who received a helium-oxygen mixture at three time points (30, 60, and 120 minutes) according to the organization protocol singular, and were admitted to the intensive care unit, from January 2012 to December 2013. This protocol includes patients with bronchospasm who sustained a modified Wood score of moderate to severe, even after one hour of conventional treatment. RESULTS: Twenty children were included in the study. The mean score of severity of the disease at the initial moment was 5.6 (SD:2.0), and at moment 120 minutes, it was 3.4 (SD: 2.0). The severity score showed a significant improvement as of 30 minutes (p<0.001). CONCLUSION: The use of helium-oxygen mixture proved to be effective in diminishing the respiratory distress score for children with airway obstructions; it should be considered a supplementary therapeutic option, together with drug therapy, in specific clinical situations.


Assuntos
Espasmo Brônquico/terapia , Hélio/administração & dosagem , Oxigenoterapia/métodos , Criança , Pré-Escolar , Feminino , Humanos , Unidades de Terapia Intensiva Pediátrica , Masculino , Ensaios Clínicos Controlados não Aleatórios como Assunto , Estudos Retrospectivos , Índice de Gravidade de Doença , Fatores de Tempo , Resultado do Tratamento
7.
Einstein (Säo Paulo) ; 16(4): eAO4199, 2018. tab, graf
Artigo em Inglês | LILACS | ID: biblio-975102

RESUMO

ABSTRACT Objective To evaluate if distress respiratory decreases after using helium-oxygen mixture in pediatric patients diagnosed with bronchospasm. Methods This is a retrospective, non-randomized study that included patients diagnosed with bronchospasm, who received a helium-oxygen mixture at three time points (30, 60, and 120 minutes) according to the organization protocol singular, and were admitted to the intensive care unit, from January 2012 to December 2013. This protocol includes patients with bronchospasm who sustained a modified Wood score of moderate to severe, even after one hour of conventional treatment. Results Twenty children were included in the study. The mean score of severity of the disease at the initial moment was 5.6 (SD:2.0), and at moment 120 minutes, it was 3.4 (SD: 2.0). The severity score showed a significant improvement as of 30 minutes (p<0.001). Conclusion The use of helium-oxygen mixture proved to be effective in diminishing the respiratory distress score for children with airway obstructions; it should be considered a supplementary therapeutic option, together with drug therapy, in specific clinical situations.


RESUMO Objetivo Avaliar se o desconforto diminui após o uso da mistura hélio-oxigênio em pacientes pediátricos com diagnóstico de broncoespasmo. Métodos Estudo retrospectivo, não randomizado, no qual foram incluídos pacientes com diagnóstico de broncoespasmo que utilizaram a mistura hélio-oxigênio em três momentos (30, 60 e 120 minutos), seguindo o protocolo institucional, internados em unidade de terapia intensiva pediátrica de janeiro de 2012 a dezembro 2013. Este protocolo incluía pacientes com diagnóstico de broncoespasmo que mantivessem escore de Wood modificado de moderado a grave, mesmo após 1 hora de tratamento convencional. Resultados Foram incluídas 20 crianças neste estudo. A média do escore de gravidade da doença no momento zero foi de 5,6 (DP:2,0) e, no momento 120 minutos, 3,4 (DP: 2,0). O escore de gravidade apresentou melhora significante a partir dos 30 minutos (p<0,001). Conclusão A utilização da mistura hélio-oxigênio mostrou-se eficaz na redução do escore de desconforto respiratório de crianças com doenças obstrutivas e deve ser considerada recurso terapêutico complementar à terapia medicamentosa em situações clínicas específicas.


Assuntos
Humanos , Masculino , Feminino , Pré-Escolar , Criança , Oxigenoterapia/métodos , Espasmo Brônquico/terapia , Hélio/administração & dosagem , Fatores de Tempo , Índice de Gravidade de Doença , Unidades de Terapia Intensiva Pediátrica , Estudos Retrospectivos , Resultado do Tratamento , Ensaios Clínicos Controlados não Aleatórios como Assunto
8.
Einstein (Sao Paulo) ; 15(2): 162-166, 2017.
Artigo em Inglês, Português | MEDLINE | ID: mdl-28767913

RESUMO

Objective: To assess whether the spontaneous breathing test can predict the extubation failure in pediatric population. Methods: A prospective and observational study that evaluated data of inpatients at the Pediatric Intensive Care Unit between May 2011 and August 2013, receiving mechanical ventilation for at least 24 hours followed by extubation. The patients were classified in two groups: Test Group, with patients extubated after spontaneous breathing test, and Control Group, with patients extubated without spontaneous breathing test. Results: A total of 95 children were enrolled in the study, 71 in the Test Group and 24 in the Control Group. A direct comparison was made between the two groups regarding sex, age, mechanical ventilation time, indication to start mechanical ventilation and respiratory parameters before extubation in the Control Group, and before the spontaneous breathing test in the Test Group. There was no difference between the parameters evaluated. According to the analysis of probability of extubation failure between the two groups, the likelihood of extubation failure in the Control Group was 1,412 higher than in the Test Group, nevertheless, this range did not reach significance (p=0.706). This model was considered well-adjusted according to the Hosmer-Lemeshow test (p=0.758). Conclusion: The spontaneous breathing test was not able to predict the extubation failure in pediatric population. Objetivo: Avaliar se o teste de respiração espontânea pode ser utilizado para predizer falha da extubação na população pediátrica. Métodos: Estudo prospectivo, observacional, no qual foram avaliados todos os pacientes internados no Centro de Terapia Intensiva Pediátrica, no período de maio de 2011 a agosto de 2013, que utilizaram ventilação mecânica por mais de 24 horas e que foram extubados. Os pacientes foram classificados em dois grupos: Grupo Teste, que incluiu os pacientes extubados depois do teste de respiração espontânea; e Grupo Controle, pacientes foram sem teste de respiração espontânea. Resultados: Dos 95 pacientes incluídos no estudo, 71 crianças eram do Grupo Teste e 24 eram do Grupo Controle. Os grupos foram comparados em relação a: sexo, idade, tempo de ventilação mecânica, indicação para início da ventilação mecânica e parâmetros ventilatórios pré-extubação, no Grupo Controle, e pré-realização do teste, no Grupo Teste. Não foram observadas diferenças entre os parâmetros analisados. Em relação à análise da probabilidade de falha da extubação entre os dois grupos de estudo, a chance de falha do Grupo Controle foi 1.412 maior do que a das crianças do Grupo Teste, porém este acréscimo não foi significativo (p=0,706). O modelo foi considerado bem ajustado de acordo com o teste de Hosmer-Lemeshow (p=0,758). Conclusão: O teste de respiração espontânea para a população pediátrica não foi capaz de prever a falha da extubação.


Assuntos
Unidades de Terapia Intensiva Pediátrica/estatística & dados numéricos , Respiração Artificial/métodos , Testes de Função Respiratória/métodos , Desmame do Respirador/métodos , Criança , Pré-Escolar , Feminino , Humanos , Lactente , Masculino , Valor Preditivo dos Testes , Estudos Prospectivos
9.
Einstein (Säo Paulo) ; 15(2): 162-166, Apr.-June 2017. tab
Artigo em Inglês | LILACS | ID: biblio-891374

RESUMO

ABSTRACT Objective To assess whether the spontaneous breathing test can predict the extubation failure in pediatric population. Methods A prospective and observational study that evaluated data of inpatients at the Pediatric Intensive Care Unit between May 2011 and August 2013, receiving mechanical ventilation for at least 24 hours followed by extubation. The patients were classified in two groups: Test Group, with patients extubated after spontaneous breathing test, and Control Group, with patients extubated without spontaneous breathing test. Results A total of 95 children were enrolled in the study, 71 in the Test Group and 24 in the Control Group. A direct comparison was made between the two groups regarding sex, age, mechanical ventilation time, indication to start mechanical ventilation and respiratory parameters before extubation in the Control Group, and before the spontaneous breathing test in the Test Group. There was no difference between the parameters evaluated. According to the analysis of probability of extubation failure between the two groups, the likelihood of extubation failure in the Control Group was 1,412 higher than in the Test Group, nevertheless, this range did not reach significance (p=0.706). This model was considered well-adjusted according to the Hosmer-Lemeshow test (p=0.758). Conclusion The spontaneous breathing test was not able to predict the extubation failure in pediatric population.


RESUMO Objetivo Avaliar se o teste de respiração espontânea pode ser utilizado para predizer falha da extubação na população pediátrica. Métodos Estudo prospectivo, observacional, no qual foram avaliados todos os pacientes internados no Centro de Terapia Intensiva Pediátrica, no período de maio de 2011 a agosto de 2013, que utilizaram ventilação mecânica por mais de 24 horas e que foram extubados. Os pacientes foram classificados em dois grupos: Grupo Teste, que incluiu os pacientes extubados depois do teste de respiração espontânea; e Grupo Controle, pacientes foram sem teste de respiração espontânea. Resultados Dos 95 pacientes incluídos no estudo, 71 crianças eram do Grupo Teste e 24 eram do Grupo Controle. Os grupos foram comparados em relação a: sexo, idade, tempo de ventilação mecânica, indicação para início da ventilação mecânica e parâmetros ventilatórios pré-extubação, no Grupo Controle, e pré-realização do teste, no Grupo Teste. Não foram observadas diferenças entre os parâmetros analisados. Em relação à análise da probabilidade de falha da extubação entre os dois grupos de estudo, a chance de falha do Grupo Controle foi 1.412 maior do que a das crianças do Grupo Teste, porém este acréscimo não foi significativo (p=0,706). O modelo foi considerado bem ajustado de acordo com o teste de Hosmer-Lemeshow (p=0,758). Conclusão O teste de respiração espontânea para a população pediátrica não foi capaz de prever a falha da extubação.


Assuntos
Humanos , Masculino , Feminino , Lactente , Pré-Escolar , Criança , Respiração Artificial/métodos , Testes de Função Respiratória/métodos , Unidades de Terapia Intensiva Pediátrica/estatística & dados numéricos , Desmame do Respirador/métodos , Valor Preditivo dos Testes , Estudos Prospectivos
10.
Einstein (Sao Paulo) ; 13(2): 226-31, 2015.
Artigo em Inglês, Português | MEDLINE | ID: mdl-26061076

RESUMO

Objective To determine the risk factors associated with stridor, with special attention to the role of the cuffed orotracheal cannula. Methods Prospective analysis of all the intubated patients submitted to mechanical ventilator support from January 2008 to April 2011. The relevant factors for stridor collected were age, weight, size and type of airway tube, diagnosis, and duration of mechanical ventilation. The effects of variables on stridor were evaluated using uni- and multivariate logistic regression models. Results A total of 136 patients were included. Mean age was 1.4 year (3 days to 17 years). The mean duration of mechanical ventilation was 73.5 hours. Fifty-six patients (41.2%) presented with stridor after extubation. The total reintubation rate was 19.6% and 12.5 in patients with and without stridor, respectively. The duration of mechanical ventilation (>72 hours) was associated with a greater risk for stridor (odds ratio of 8.60; 95% confidence interval of 2.98-24.82; p<0.001). The presence of the cuffed orotracheal cannula was not associated with stridor (odds ratio of 98; 95% confidence interval of 0.46-2.06; p=0.953). Conclusion The main risk factor for stridor after extubation in our population was duration of mechanical ventilation. The presence of the cuffed orotracheal cannula was not associated with increased risk for stridor, reinforcing the use of the cuffed orotracheal cannula in children with respiratory distress.


Assuntos
Intubação Intratraqueal/efeitos adversos , Respiração Artificial/efeitos adversos , Sons Respiratórios/etiologia , Adolescente , Fatores Etários , Criança , Pré-Escolar , Feminino , Humanos , Lactente , Recém-Nascido , Unidades de Terapia Intensiva Pediátrica , Intubação Intratraqueal/instrumentação , Masculino , Estudos Prospectivos , Respiração Artificial/instrumentação , Sons Respiratórios/fisiopatologia , Fatores de Risco , Desmame do Respirador
11.
Einstein (Säo Paulo) ; 13(2): 226-231, Apr-Jun/2015. tab, graf
Artigo em Inglês | LILACS | ID: lil-751423

RESUMO

Objective To determine the risk factors associated with stridor, with special attention to the role of the cuffed orotracheal cannula. Methods Prospective analysis of all the intubated patients submitted to mechanical ventilator support from January 2008 to April 2011. The relevant factors for stridor collected were age, weight, size and type of airway tube, diagnosis, and duration of mechanical ventilation. The effects of variables on stridor were evaluated using uni- and multivariate logistic regression models. Results A total of 136 patients were included. Mean age was 1.4 year (3 days to 17 years). The mean duration of mechanical ventilation was 73.5 hours. Fifty-six patients (41.2%) presented with stridor after extubation. The total reintubation rate was 19.6% and 12.5 in patients with and without stridor, respectively. The duration of mechanical ventilation (>72 hours) was associated with a greater risk for stridor (odds ratio of 8.60; 95% confidence interval of 2.98-24.82; p<0.001). The presence of the cuffed orotracheal cannula was not associated with stridor (odds ratio of 98; 95% confidence interval of 0.46-2.06; p=0.953). Conclusion The main risk factor for stridor after extubation in our population was duration of mechanical ventilation. The presence of the cuffed orotracheal cannula was not associated with increased risk for stridor, reinforcing the use of the cuffed orotracheal cannula in children with respiratory distress. .


Objetivo Determinar os fatores de risco associados ao estridor, com especial atenção para o papel da cânula orotraqueal. Métodos Análise prospectiva de todos os pacientes entubados submetidos à ventilação mecânica no período de janeiro de 2008 a abril de 2011. Os fatores relevantes para estridor coletados foram idade, peso, tamanho e tipo da cânula orotraqueal, diagnóstico, e duração da ventilação mecânica. Os efeitos das variáveis sobre estridor foram avaliados utilizando modelos de regressão logística uni e multivariada. Resultados Foram incluídos 136 pacientes. A média de idade foi 1,4 ano (3 dias a 17 anos). O tempo médio de ventilação mecânica foi 73,5 horas. Apresentaram estridor após extubação 56 pacientes (41,2%). A taxa de reintubação foi de 19,6% e 12,5% em pacientes com ou sem estridor, respectivamente. A duração da ventilação mecânica (>72 horas) foi associada a um maior risco de estridor (odds ratio de 8,60; intervalo de confiança de 95% de 2,98-24,82; p<0,001). A presença da cânula orotraqueal não foi associada ao estridor (odds ratio de 0,98; intervalo de confiança de 95% de 0,46- 2,06; p=0,953). Conclusão O principal fator de risco para estridor após extubação em nossa população foi o tempo de ventilação mecânica. A presença da cânula orotraqueal não foi associada a maior risco de estridor, reforçando o uso de cânulas com balonete em crianças com dificuldade respiratória. .


Assuntos
Adolescente , Criança , Pré-Escolar , Feminino , Humanos , Lactente , Recém-Nascido , Masculino , Intubação Intratraqueal/efeitos adversos , Respiração Artificial/efeitos adversos , Sons Respiratórios/etiologia , Fatores Etários , Unidades de Terapia Intensiva Pediátrica , Intubação Intratraqueal/instrumentação , Estudos Prospectivos , Fatores de Risco , Respiração Artificial/instrumentação , Sons Respiratórios/fisiopatologia , Desmame do Respirador
12.
Clinics (Sao Paulo) ; 65(11): 1133-7, 2010.
Artigo em Inglês | MEDLINE | ID: mdl-21243286

RESUMO

OBJECTIVES: To determine the viruses and risk factors associated with hospital and intensive care unit (ICU) admissions in infants with acute bronchiolitis. INTRODUCTION: Bronchiolitis is a major cause of morbidity in infants. Widespread use of molecular-based methods has yielded new insights about its etiology, but the impact of viral etiologies on early outcomes is still unclear. METHODS: Seventy-seven infants with bronchiolitis who were under two years of age and visited an emergency unit were included. Using molecular-based methods, samples were tested for 12 different respiratory viruses. Logistic regression models were used to identify clinical and virological variables associated with the main endpoints: hospital admission and ICU admission. RESULTS: We identified at least one virus in 93.5% of patients, and coinfections were found in nearly 40% of patients. RSV was the most common pathogen (63.6%), followed by rhinovirus (39%). Identification of RSV was only associated with an increased risk of hospital admission in the univariate model. Younger age and enterovirus infection were associated with an increased risk of hospital admission, while atopy of a first-degree relative showed a protective effect. Prematurity was associated with an increased risk of admission to the ICU. Coinfections were not associated with worse outcomes. CONCLUSIONS: Molecular-based methods resulted in high rates of viral identification but did not change the significant role of RSV in acute bronchiolitis. Younger age and enterovirus infection were risk factors for hospital admission, while prematurity appeared to be a significant risk factor for admission to the ICU in acute viral bronchiolitis.


Assuntos
Bronquiolite Viral/virologia , Doença Aguda , Brasil , Bronquiolite Viral/complicações , Estudos de Coortes , Enterovirus/isolamento & purificação , Feminino , Hospitalização , Humanos , Lactente , Unidades de Terapia Intensiva Pediátrica , Modelos Logísticos , Masculino , Infecções por Picornaviridae/complicações , Infecções por Picornaviridae/virologia , Reação em Cadeia da Polimerase , Estudos Prospectivos , Vírus Sinciciais Respiratórios/isolamento & purificação , Rhinovirus/isolamento & purificação , Fatores de Risco
13.
Clinics ; 65(11): 1133-1137, 2010. graf, tab
Artigo em Inglês | LILACS | ID: lil-571430

RESUMO

OBJECTIVES: To determine the viruses and risk factors associated with hospital and intensive care unit (ICU) admissions in infants with acute bronchiolitis. INTRODUCTION: Bronchiolitis is a major cause of morbidity in infants. Widespread use of molecular-based methods has yielded new insights about its etiology, but the impact of viral etiologies on early outcomes is still unclear. METHODS: Seventy-seven infants with bronchiolitis who were under two years of age and visited an emergency unit were included. Using molecular-based methods, samples were tested for 12 different respiratory viruses. Logistic regression models were used to identify clinical and virological variables associated with the main endpoints: hospital admission and ICU admission. RESULTS: We identified at least one virus in 93.5 percent of patients, and coinfections were found in nearly 40 percent of patients. RSV was the most common pathogen (63.6 percent), followed by rhinovirus (39 percent). Identification of RSV was only associated with an increased risk of hospital admission in the univariate model. Younger age and enterovirus infection were associated with an increased risk of hospital admission, while atopy of a first-degree relative showed a protective effect. Prematurity was associated with an increased risk of admission to the ICU. Coinfections were not associated with worse outcomes. CONCLUSIONS: Molecular-based methods resulted in high rates of viral identification but did not change the significant role of RSV in acute bronchiolitis. Younger age and enterovirus infection were risk factors for hospital admission, while prematurity appeared to be a significant risk factor for admission to the ICU in acute viral bronchiolitis.


Assuntos
Feminino , Humanos , Lactente , Masculino , Bronquiolite Viral/virologia , Doença Aguda , Brasil , Bronquiolite Viral/complicações , Estudos de Coortes , Enterovirus/isolamento & purificação , Hospitalização , Unidades de Terapia Intensiva Pediátrica , Modelos Logísticos , Reação em Cadeia da Polimerase , Estudos Prospectivos , Infecções por Picornaviridae/complicações , Infecções por Picornaviridae/virologia , Fatores de Risco , Vírus Sinciciais Respiratórios/isolamento & purificação , Rhinovirus/isolamento & purificação
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