Your browser doesn't support javascript.
Mostrar: 20 | 50 | 100
Resultados 1 - 20 de 3.393
Filtrar
1.
Zhongguo Dang Dai Er Ke Za Zhi ; 21(8): 812-819, 2019 Aug.
Artigo em Chinês | MEDLINE | ID: mdl-31416508

RESUMO

OBJECTIVE: To systematically evaluate the clinical effect of azithromycin (AZM) adjuvant therapy in children with bronchiolitis. METHODS: Related databases were searched for randomized controlled trials (RCTs) on AZM adjuvant therapy in children with bronchiolitis published up to February 17, 2019. RevMan 5.3 was used to perform the Meta analysis. RESULTS: A total of 14 RCTs were included, with 667 children in the intervention group and 651 in the control group. The pooled effect size showed that in the children with bronchiolitis, AZM adjuvant therapy did not shorten the length of hospital stay (MD=-0.29, 95%CI: -0.62 to 0.04, P=0.08) or oxygen supply time (MD=-0.33, 95%CI: -0.73 to 0.07, P=0.10), while it significantly shortened the time to the relief of wheezing (MD=-1.00, 95%CI: -1.72 to -0.28, P=0.007) and cough (MD=-0.48, 95%CI: -0.67 to -0.29, P<0.00001). The analysis of bacterial colonization revealed that AZM therapy significantly reduced the detection rates of Streptococcus pneumoniae (OR=0.24, 95%CI: 0.11-0.54, P=0.0006), Haemophilus (OR=0.28, 95%CI: 0.14-0.55, P=0.0002), and Moraxella catarrhalis (OR=0.21, 95%CI: 0.11-0.40, P<0.00001) in the nasopharyngeal region. CONCLUSIONS: AZM adjuvant therapy can reduce the time to the relief of wheezing and cough in children with bronchiolitis, but it has no marked effect on the length of hospital stay and oxygen supply time.


Assuntos
Azitromicina/uso terapêutico , Bronquiolite , Bronquiolite/tratamento farmacológico , Criança , Terapia Combinada , Humanos , Tempo de Internação , Sons Respiratórios
2.
Pan Afr Med J ; 32: 139, 2019.
Artigo em Francês | MEDLINE | ID: mdl-31303912

RESUMO

Spontaneous gastric perforation is rare in infants and the mechanisms leading to its onset are poorly understood. This study reports the first case of spontaneous gastric perforation occurred in Congo. This case report describes a 5-month years old female infant who, on the fourth day of hospitalization for severe acute bronchiolitis associated with diarrhea complicated by moderate acute dehydration, had violent onset of severe and painful abdominal distension associated with signs of shock. Abdominal x-ray without treatment showed a large volume pneumoperitoneum. Laparotomy showed round perforation on the posterior wall of the stomach which was sutured. The postoperative course was marked by the occurrence of septic shock and by infant death.


Assuntos
Bronquiolite/diagnóstico , Diarreia/etiologia , Pneumoperitônio/diagnóstico por imagem , Ruptura Gástrica/diagnóstico , Doença Aguda , Bronquiolite/fisiopatologia , Congo , Feminino , Hospitalização , Humanos , Lactente , Laparotomia/métodos , Ruptura Gástrica/fisiopatologia , Ruptura Gástrica/cirurgia
3.
Lima; Perú. Ministerio de Salud; 20190600. 24 p. graf, ilus.
Monografia em Espanhol | LILACS, LIPECS | ID: biblio-1005172

RESUMO

Contribuir a la protección del estado de salud y el desarrollo integral de los niños, mediante medidas de prevención, atención y control de la Bronquiolitis, mejorando así su calidad de vida.


Assuntos
Bronquiolite , Guia de Prática Clínica , Assistência Integral à Saúde , Prevenção Primária
4.
Recurso na Internet em Português | LIS - Localizador de Informação em Saúde | ID: lis-LISBR1.1-46529

RESUMO

A bronquiolite, inflamação dos bronquíolos (parte final dos brônquios), atinge principalmente os bebês menores de dois anos e é mais comum no inverno.


Assuntos
Bronquiolite , Bronquiolite Viral , Saúde da Criança , Doenças Respiratórias
6.
Emerg Med J ; 36(4): 248-249, 2019 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-30940682

RESUMO

A shortcut review was carried out to establish whether high-flow nasal oxygen was better than standard oxygen therapy in infants with signs and symptoms of bronchiolitis at reducing the need for escalation of therapy. Three papers presented the best evidence to answer the clinical question. The author, date and country of publication, patient group studied, study type, relevant outcomes, results and study weaknesses of these papers are tabulated. It is concluded that high-flow nasal oxygen has a role in the management of bronchiolitis and may reduce the need for escalation of therapy with patients with bronchiolitis under the age of 1 year.


Assuntos
Bronquiolite/terapia , Serviço Hospitalar de Emergência , Oxigenoterapia/métodos , Medicina de Emergência Baseada em Evidências , Humanos , Lactente , Recém-Nascido
7.
Evid. actual. práct. ambul ; 22(1): e001077, abr. 2019. tab.
Artigo em Espanhol | LILACS | ID: biblio-1015125

RESUMO

La bronquiolitis es una infección respiratoria aguda baja de causa viral, de aparición invernal, que es común en bebés de 0a 12 meses de edad. Conduce a que las vías respiratorias pequeñas se inflamen y se llenen de desechos, obstruyéndose.El bebé tiene una tos fuerte, secreción nasal, generalmente fiebre y puede presentar sibilancias dificultad respiratoria ydesaturación de oxígeno. Tras la presentación de un caso en la guardia se generó una controversia científica sobre lautilidad de los broncodilatadores en pacientes con bronquiolitis. Luego de realizar una búsqueda bibliográfica y seleccionarla evidencia más reciente y de mejor calidad, se concluye que la evidencia no apoya el uso de broncodilatadores enpacientes con bronquiolitis.(AU)


Bronchiolitis is a low acute respiratory lower respiratory tract infection of viral origin, winter appearance, which is commonin babies from 0 to 12 months of age. It causes the small airways in the lungs to become inflamed and fill with debris. Theinfant has a harsh cough, runny nose, usually fever and may have wheezing, respiratory distress and oxygen desaturation.After the presentation of a case in the emergency department, a scientific controversy was generated about the usefulnessof bronchodilators in patients with bronchiolitis. After conducting a literature search and selecting the most recent and bestquality evidence, it is concluded that evidence does not support the use of bronchodilators in patients with bronchioliTIS.(AU)


Assuntos
Humanos , Masculino , Feminino , Recém-Nascido , Lactente , Broncodilatadores/administração & dosagem , Bronquiolite/tratamento farmacológico , Epinefrina/administração & dosagem , Albuterol/administração & dosagem , Infecções Respiratórias/tratamento farmacológico , Broncodilatadores/efeitos adversos , Broncodilatadores/uso terapêutico , Bronquiolite/diagnóstico , Epinefrina/efeitos adversos , Sons Respiratórios/diagnóstico , Tosse/prevenção & controle , Albuterol/efeitos adversos , Albuterol/uso terapêutico , Febre/prevenção & controle
8.
Rev Soc Bras Med Trop ; 52: e20180329, 2019 Mar 28.
Artigo em Português | MEDLINE | ID: mdl-30942259

RESUMO

INTRODUCTION: Because the antibody neutralizing respiratory syncytial virus (anti-RSV) has a short period of immunization and high cost, the identification of regions and months of highest occurrence of bronchiolitis is very important. METHODS: An Autoregressive Conditional Poisson model was constructed for count data and compared to the standard time-series Poisson regression model. RESULTS: The metropolitan area of Paraná presented the highest average occurrence from May to July. CONCLUSIONS: The constructed model presented a better fit and allowed prediction of when and where the bronchiolitis hospitalizations are distributed.


Assuntos
Bronquiolite/epidemiologia , Hospitalização/estatística & dados numéricos , Infecções por Vírus Respiratório Sincicial/epidemiologia , Brasil/epidemiologia , Bronquiolite/terapia , Bronquiolite/virologia , Feminino , Mapeamento Geográfico , Humanos , Lactente , Distribuição de Poisson , Infecções por Vírus Respiratório Sincicial/terapia , Estações do Ano
9.
Rev Med Liege ; 74(4): 175-178, 2019 Apr.
Artigo em Francês | MEDLINE | ID: mdl-30997965

RESUMO

Bronchiolitis is one of the main reasons for hospitalization, or outpatient visits, in the paediatric population, especially among infants in the winter season. Despite the high incidence of the disease, ideal medical work up and treatment are still a matter of debate in the literature and among physicians. However, the most recent guidelines and review of literature do agree on some points. These agreements can be retained and used to improve the treatment of bronchiolitis in our setting.


Assuntos
Bronquiolite , Bronquiolite/terapia , Criança , Hospitalização , Humanos , Incidência , Lactente , Estações do Ano
10.
Arch Pediatr ; 26(3): 174-175, 2019 Apr.
Artigo em Francês | MEDLINE | ID: mdl-30827776

RESUMO

Over the past 10 years, continuous positive airway pressure (CPAP) has revolutionized the prognosis and management of bronchiolitis patients hospitalized in pediatric intensive care units (PICUs). High-flow nasal cannula (HFNC) is emerging as an alternative to CPAP. Despite encouraging results of several clinical and physiological studies, HFNC use remains controversial and its indications heterogeneous. To better define the place of HFNC in severe bronchiolitis respiratory support, we investigated the different ventilation assistance techniques used for severe bronchiolitis over 3 days at the peak of a bronchiolitis epidemic in December 2015. We conducted an observational cross-sectional study in 27 French university hospital PICUs. Fifty-nine patients were included. The results show that HFNC already accounts for nearly half of the respiratory support techniques used for severe bronchiolitis in French PICUs with no significant difference between the CPAP group and the HFNC group of patients.


Assuntos
Bronquiolite/terapia , Oxigenoterapia/métodos , Bronquiolite/epidemiologia , Pressão Positiva Contínua nas Vias Aéreas/estatística & dados numéricos , Estudos Transversais , França/epidemiologia , Humanos , Lactente , Unidades de Terapia Intensiva Pediátrica , Oxigenoterapia/estatística & dados numéricos
11.
Arerugi ; 68(2): 101-106, 2019.
Artigo em Japonês | MEDLINE | ID: mdl-30867360

RESUMO

A 68 year-old woman with dyspnea and cough had been treated with inhaled corticosteroids for X-15 years, but her symptoms worsened in X year. High-resolution chest CT revealed small centrilobular nodules in the right upper lobe in March X year. The patient was diagnosed with asthma and diffuse panbronchiolitis and treated with inhaled corticosteroids, a long-acting beta agonist, and clarithromycin, but her condition did not improve and her peripheral blood eosinophil count increased. In August X year, we performed a transbronchial biopsy of the right upper lung. Histopathological examination revealed eosinophilia in the bronchial secretions and mild nonspecific inflammatory changes. The diagnosis was bronchial asthma associated with bronchiolitis. The patient was treated successfully with mepolizumab.


Assuntos
Anticorpos Monoclonais Humanizados/uso terapêutico , Asma/terapia , Bronquiolite/terapia , Eosinofilia/terapia , Idoso , Feminino , Humanos
12.
J Biol Regul Homeost Agents ; 33(2): 409-413, 2019 Mar-Apr,.
Artigo em Inglês | MEDLINE | ID: mdl-30915829

RESUMO

Bronchiolitis is a widespread lower respiratory tract infection in infants and young children, and is closely related to the incidence of asthma, and T regulatory cells (Tregs) play a role in its pathogenesis.


Assuntos
Secretases da Proteína Precursora do Amiloide/antagonistas & inibidores , Bronquiolite/tratamento farmacológico , Infecções por Vírus Respiratório Sincicial/tratamento farmacológico , Linfócitos T Reguladores/efeitos dos fármacos , Bronquiolite/virologia , Criança , Pré-Escolar , Humanos , Lactente , Leucócitos Mononucleares , Vírus Sinciciais Respiratórios
14.
An. pediatr. (2003. Ed. impr.) ; 90(2): 79-85, feb. 2019. tab
Artigo em Espanhol | IBECS | ID: ibc-177218

RESUMO

Introducción: La prevalencia y la variabilidad de la práctica clínica en la bronquiolitis aguda la convierten en una candidata perfecta para evaluar la adecuación en el uso de recursos asistenciales. El objetivo de este estudio es comparar la utilización de recursos no recomendados para la atención de pacientes con bronquiolitis en el Servicio de Urgencias, antes y después de la instauración de un nuevo protocolo basado en las recomendaciones actuales. Métodos: Estudio retrospectivo de una muestra de pacientes diagnosticados de bronquiolitis aguda en el Servicio de Urgencias de un hospital terciario y seleccionados mediante aleatorización simple antes (diciembre de 2014) y después (diciembre de 2016) de la instauración de un nuevo protocolo. Se comparó el uso de pruebas diagnósticas y el tratamiento en ambos grupos. Resultados: Se han comparado 113 pacientes con bronquiolitis aguda atendidos en diciembre de 2014 y 128 en diciembre de 2016. Las características clínicas en ambos grupos eran similares. En el período posprotocolo se observó una disminución significativa en la utilización de salbutamol, tanto en el servicio de urgencias (33,6% vs 19,5%, p < 0,01) como al alta (46,7% vs 15,2%, p < 0,001); de adrenalina (12,4% vs 2,4%, p = 0,002) y de suero salino hipertónico nebulizado (5,3% vs 0,8%, p = 0,04). También disminuyó la solicitud de la prueba de detección rápida de VRS (40,7% vs 26,6%, p = 0,01). No se produjo un aumento en el número de ingresos o readmisiones en urgencias en las siguientes 72 horas. Conclusiones: la instauración de un nuevo protocolo de bronquiolitis aguda disminuyó la utilización de recursos no recomendados, principalmente el uso de broncodilatadores y de la prueba de detección rápida del VRS


Introduction: The prevalence and the variability of clinical practice in acute bronchiolitis make it a perfect candidate to monitor the proper use of resources. The aim of this study is to analyse the differences in the use of non-recommended resources in the management of bronchiolitis in the Emergency Department, before and after the establishment of a new protocol. Methods: A retrospective study was conducted on a sample of patients diagnosed with acute bronchiolitis in the Emergency Department of a tertiary hospital, before (December 2014) and after (December 2016) the implementation of a new protocol. A comparison was made on the use of diagnostic tests and treatments in both groups. Results: The analysis included a total of 113 patients with acute bronchiolitis examined in December 2014, and 128 patients in December 2016. The clinical characteristics in both groups were similar. In the post-protocol period, there was a significant decrease in the use of salbutamol, both in the Emergency Department (33.6% vs 19.5%, P < .01) and at discharge (46.7% vs 15.2%, P < .001); adrenaline (12.4% vs 2.4%, P = .002), and nebulised hypertonic saline solution (5.3% vs 0.8%, P = .04). Rapid respiratory syncytial virus (RSV) testing was also decreased (40.7% vs 26.6%, P = .01). This decrease was not associated with an increase in the number of admissions or re-assessments in the Emergency Department. Conclusions: The establishment of a new protocol for acute bronchiolitis decreased the use of non-recommended resources, mainly the use of bronchodilators and rapid RSV testing


Assuntos
Humanos , Pré-Escolar , Bronquiolite/diagnóstico , Protocolos/métodos , Bronquiolite/terapia , Broncodilatadores/uso terapêutico , Fatores de Risco , Oxigenoterapia/métodos , Estudos Retrospectivos
15.
An. pediatr. (2003. Ed. impr.) ; 90(2): 109-117, feb. 2019. tab, graf
Artigo em Espanhol | IBECS | ID: ibc-177222

RESUMO

Introducción: La bronquiolitis vírica aguda (BA) es una de las enfermedades respiratorias más frecuentes en los lactantes. Sin embargo, los criterios utilizados para su diagnóstico son heterogéneos e insuficientemente conocidos. Objetivo: Identificar los criterios de diagnóstico de BA empleados en España, tanto por expertos como por pediatras clínicos. Métodos: Estudio de metodología Delphi con expertos españoles en BA, buscando los puntos de consenso sobre el diagnóstico de BA. Posteriormente se realizó un estudio transversal mediante encuesta on-line dirigida a todos los pediatras españoles, contactados a través de mensajes de correo electrónico enviados por nueve sociedades científicas pediátricas. Se hizo análisis descriptivo y análisis factorial de los resultados de la encuesta, buscando si los criterios diagnósticos empleados se relacionaban con variables demográficas, geográficas o con la subespecialidad pediátrica. Resultados: Los 40 expertos participantes alcanzaron un consenso en muchos aspectos (primer episodio de dificultad respiratoria y aumento de la frecuencia respiratoria, diagnóstico en cualquier estación del año, y utilidad de la identificación de virus para el diagnóstico), pero manteniendo opiniones enfrentadas en cuestiones importantes como la edad máxima aceptable para el diagnóstico. A la encuesta on-line respondieron 1297 pediatras. Los criterios diagnósticos que aplican son heterogéneos y están fuertemente asociados con la subespecialidad pediátrica. Su acuerdo con el consenso de expertos y con estándares internacionales es muy bajo. Conclusiones: Los criterios usados en España para el diagnóstico de BA son heterogéneos. Esas diferencias pueden causar variabilidad en la práctica clínica en pacientes con BA


Introduction: Acute viral bronchiolitis (AB) is one of the most common respiratory diseases in infants. However, diagnostic criteria for AB are heterogeneous and not very well known. Objective: To identify the diagnostic criteria for AB used by experts and clinical paediatricians in Spain. Methods: Delphi study with Spanish AB experts, looking for the points of agreement about AB diagnosis. A subsequent cross-sectional study was conducted by means of an on-line questionnaire addressed to all Spanish paediatricians, reached through electronic mail messages sent by nine paediatric scientific societies. Descriptive and factorial analyses were carried out, looking for any association of diagnostic criteria with demographic or geographic variables, or with paediatric subspecialty. Results: Agreement was reached by 40 experts in many issues (first episode of respiratory distress and high respiratory frequency, diagnosis in any season of the year, and usefulness of virus identification in making diagnosis), but opposite views were maintained on key characteristics such as the maximum age for diagnosis. The on-line questionnaire was completed by 1297 paediatricians. Their diagnostic criteria were heterogeneous and strongly associated with their paediatric sub-specialty. Their agreement with the Spanish expert consensus and with international standards was very poor. Conclusions: Diagnostic criteria for AB in Spain are heterogeneous. These differences could cause variability in clinical practice with AB patients


Assuntos
Humanos , Bronquiolite/diagnóstico , Bronquiolite/epidemiologia , Pediatria , Consenso , Tomada de Decisão Clínica , Espanha/epidemiologia , Técnica Delfos , Estudos Transversais , Análise Fatorial , Inquéritos e Questionários
17.
Respir Investig ; 57(2): 172-182, 2019 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-30718103

RESUMO

BACKGROUND: There have been no reports on the relationship between lung radiological patterns and rheumatoid arthritis (RA) disease activity or RA treatment response in patients with RA-associated lung disease (RA-LD). METHODS: Patients with RA-LD who underwent treatment for RA from April 2005 to March 2015 were retrospectively evaluated. RA-LD patients were divided into three groups based on high-resolution computed tomography (HRCT) patterns [usual interstitial pneumonia (UIP), nonspecific interstitial pneumonia (NSIP), and bronchiolitis]. The disease activity score of 28 joints-erythrocyte sedimentation rate (DAS28-ESR) and the response of RA to treatment, as measured by the European League Against Rheumatism (EULAR) response criteria, were investigated. RESULTS: A total of 77 patients (21 with UIP, 23 with NSIP, and 33 with bronchiolitis) were enrolled. Median scores (interquartile range) on the DAS28-ESR at baseline were 5.27 (4.76-5.74), 5.48 (4.24-6.34), and 5.04 (3.90-5.66) for UIP, NSIP, and bronchiolitis, respectively; there were no statistical differences between the three groups (p = 0.412). One year after baseline, 19 (90%), 14 (61%), and 19 (58%) of patients in the UIP, NSIP, and bronchiolitis groups, respectively, were considered good or moderate responders, as evaluated using the EULAR response criteria; there was a significant difference between these three groups (p = 0.014). Multiple logistic regression analysis revealed that the UIP pattern was significantly associated with good or moderate response to RA treatment 1 year after baseline (p = 0.012). CONCLUSIONS: These results suggest that NSIP and bronchiolitis HRCT patterns may be risk factors for resistance to RA therapy.


Assuntos
Artrite Reumatoide/complicações , Artrite Reumatoide/terapia , Bronquiolite/diagnóstico por imagem , Bronquiolite/etiologia , Doenças Pulmonares Intersticiais/diagnóstico por imagem , Doenças Pulmonares Intersticiais/etiologia , Pulmão/diagnóstico por imagem , Intensificação de Imagem Radiográfica , Radiografia Torácica , Tomografia Computadorizada por Raios X , Adulto , Idoso , Artrite Reumatoide/diagnóstico , Sedimentação Sanguínea , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Valor Preditivo dos Testes , Prognóstico , Estudos Retrospectivos , Fatores de Risco , Resultado do Tratamento
18.
Isr Med Assoc J ; 21(2): 110-115, 2019 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-30772962

RESUMO

BACKGROUND: Respiratory syncytial virus (RSV)-related bronchiolitis is a common cause of morbidity in young infants. The recommendations for its passive prevention by palivizumab are currently under intensive debate. OBJECTIVES: To elucidate the optimal prevention strategy by studying the morbidity of RSV disease under the current recommendations for palivizumab prophylaxis in Israel. METHODS: We collected demographic and clinical data of all children hospitalized with microbiologically confirmed RSV bronchiolitis during 2015-2016 at Schneider Children's Medical Center. The seasonality of RSV disease was also studied for the period 2010-2017 in sentinel clinics scattered throughout Israel. RESULTS: Of the 426 hospitalized children, 106 (25%) had underlying diseases but were not eligible for palivizumab prophylaxis according to the current criteria in Israel. Their course was severe, with a mean hospital stay of 6.7 days and a 12% admission rate to the pediatric intensive care unit (PICU). Palivizumab-eligible children who did not receive the prophylaxis before hospitalization had the most severe course, with 22% admitted to the PICU. More children were diagnosed with RSV disease in October than in March among both hospitalized and ambulatory children; 44% of the palivizumab-eligible hospitalized children were admitted in the last 2 weeks of October, before 1 November which is the recommended date for starting palivizumab administration in Israel. CONCLUSIONS: According to the results of the present study we suggest advancing RSV prophylaxis in Israel from 1 November to mid-October. The precise palivizumab-eligible categories should be reconsidered.


Assuntos
Antivirais/administração & dosagem , Bronquiolite/epidemiologia , Hospitalização/estatística & dados numéricos , Palivizumab/administração & dosagem , Medicina Preventiva/métodos , Infecções por Vírus Respiratório Sincicial/epidemiologia , Bronquiolite/prevenção & controle , Esquema de Medicação , Feminino , Acesso aos Serviços de Saúde/estatística & dados numéricos , Humanos , Lactente , Israel , Tempo de Internação/estatística & dados numéricos , Masculino , Infecções por Vírus Respiratório Sincicial/prevenção & controle , Estações do Ano , Índice de Gravidade de Doença
19.
Eur J Pediatr ; 178(5): 623-632, 2019 May.
Artigo em Inglês | MEDLINE | ID: mdl-30747262

RESUMO

Bronchiolitis is the most common cause of hospitalization of children in the first year of life. The lung ultrasound is a new diagnostic tool which is inexpensive, non-invasive, rapid, and easily repeatable. Our prospective study was conducted in the emergency department and all patients underwent a routine clinical evaluation and lung ultrasound by the pediatricians who defined the clinical and the ultrasound score. We enrolled 76 infants (median age 90 days [IQR 62-183], 53.9% males). In nasopharyngeal aspirates, the respiratory syncytial virus was isolated in 33 patients. Considering the clinical score, children with higher score had a higher probability of requiring respiratory support (p 0.001). At the ultrasound evaluation, there was a significant difference on ultrasound score between those who will need respiratory support or not (p 0.003). Infants who needed ventilation with helmet continuous positive airway pressure had a more severe ultrasound score (p 0.028) and clinical score (p 0.004), if compared with those who did not need it.Conclusion: Our study shows that lung ultrasound in the bronchiolitis may be a useful method to be integrated with the clinical evaluation to better define the prognosis of the individual patient. Multicenter studies on larger populations are necessary to confirm our data. What is Known: • Bronchiolitis is the main cause of lower respiratory tract infection in children younger than 24 months. • Ultrasound can evaluate the lung parenchyma without ionizing radiations. What is New: • Lung ultrasound may be a useful diagnostic tool to define the prognosis of the infants affected by bronchiolitis if performed at the first assessment in the emergency department. • The score obtained at the ultrasound evaluation is higher in those who will need oxygen therapy during admission for more time and in those who will need respiratory support with helmet continuous positive airway pressure.


Assuntos
Bronquiolite/diagnóstico por imagem , Serviço Hospitalar de Emergência , Pulmão/diagnóstico por imagem , Sistemas Automatizados de Assistência Junto ao Leito , Bronquiolite/terapia , Feminino , Humanos , Lactente , Masculino , Prognóstico , Estudos Prospectivos , Respiração Artificial , Ultrassonografia
20.
Cochrane Database Syst Rev ; 1: CD010473, 2019 01 31.
Artigo em Inglês | MEDLINE | ID: mdl-30701528

RESUMO

BACKGROUND: Acute bronchiolitis is one of the most frequent causes of emergency department visits and hospitalisation in children. There is no specific treatment for bronchiolitis except for supportive treatment, which includes ensuring adequate hydration and oxygen supplementation. Continuous positive airway pressure (CPAP) aims to widen the lungs' peripheral airways, enabling deflation of overdistended lungs in bronchiolitis. Increased airway pressure also prevents the collapse of poorly supported peripheral small airways during expiration. Observational studies report that CPAP is beneficial for children with acute bronchiolitis. This is an update of a review first published in 2015. OBJECTIVES: To assess the efficacy and safety of CPAP compared to no CPAP or sham CPAP in infants and children up to three years of age with acute bronchiolitis. SEARCH METHODS: We conducted searches of CENTRAL (2017, Issue 12), which includes the Cochrane Acute Respiratory Infections Group's Specialised Register, MEDLINE (1946 to December, 2017), Embase (1974 to December 2017), CINAHL (1981 to December 2017), and LILACS (1982 to December 2017) in January 2018. SELECTION CRITERIA: We considered randomised controlled trials (RCTs), quasi-RCTs, cross-over RCTs, and cluster-RCTs evaluating the effect of CPAP in children with acute bronchiolitis. DATA COLLECTION AND ANALYSIS: Two review authors independently assessed study eligibility, extracted data using a structured pro forma, analysed data, and performed meta-analyses. MAIN RESULTS: We included three studies with a total of 122 children (62/60 in intervention/control arms) aged up to 12 months that investigated nasal CPAP compared with supportive (or "standard") therapy. We included one new trial (72 children) that contributed data to the assessment of respiratory rate and need for mechanical ventilation for this update. The included studies were single-centre trials conducted in France, the UK, and India. Two studies were parallel-group RCTs and one was a cross-over RCT. The evidence provided by the included studies was low quality; we assessed high risk of bias for blinding, incomplete outcome data, and selective reporting, and confidence intervals were wide.The effect of CPAP on the need for mechanical ventilation in children with acute bronchiolitis was uncertain due to imprecision around the effect estimate (3 RCTs, 122 children; risk ratio (RR) 0.69, 95% confidence interval (CI) 0.14 to 3.36; low-quality evidence). None of the trials measured time to recovery. Limited, low-quality evidence indicated that CPAP decreased respiratory rate (2 RCTs, 91 children; mean difference (MD) -3.81, 95% CI -5.78 to -1.84). Only one trial measured change in arterial oxygen saturation, and the results were imprecise (19 children; MD -1.70%, 95% CI -3.76 to 0.36). The effect of CPAP on change in arterial partial carbon dioxide pressure (pCO2) was imprecise (2 RCTs, 50 children; MD -2.62 mmHg, 95% CI -5.29 to 0.05; low-quality evidence). Duration of hospital stay was similar in both CPAP and supportive care groups (2 RCTs, 50 children; MD 0.07 days, 95% CI -0.36 to 0.50; low-quality evidence). Two studies did not report about pneumothorax, but pneumothorax did not occur in one study. No studies reported occurrences of deaths. Several outcomes (change in partial oxygen pressure, hospital admission rate (from emergency department to hospital), duration of emergency department stay, and need for intensive care unit admission) were not reported in the included studies. AUTHORS' CONCLUSIONS: Limited, low-quality evidence suggests that breathing improved (a decreased respiratory rate) in children with bronchiolitis who received CPAP; this finding is unchanged from the 2015 review. Further evidence for this outcome was provided by the inclusion of a low-quality study for the 2018 update. Due to the limited available evidence, the effect of CPAP in children with acute bronchiolitis is uncertain for other outcomes. Larger, adequately powered trials are needed to evaluate the effect of CPAP for children with acute bronchiolitis.


Assuntos
Bronquiolite/terapia , Pressão Positiva Contínua nas Vias Aéreas/métodos , Doença Aguda , Bronquiolite/sangue , Dióxido de Carbono , Pressão Positiva Contínua nas Vias Aéreas/estatística & dados numéricos , Humanos , Lactente , Recém-Nascido , Tempo de Internação , Oxigênio/sangue , Pressão Parcial , Ensaios Clínicos Controlados Aleatórios como Assunto , Respiração Artificial/estatística & dados numéricos , Taxa Respiratória , Viés de Seleção
SELEÇÃO DE REFERÊNCIAS
DETALHE DA PESQUISA