Your browser doesn't support javascript.
Mostrar: 20 | 50 | 100
Resultados 1 - 20 de 43
Filtrar
Mais filtros










Intervalo de ano de publicação
1.
Rev. Hosp. Ital. B. Aires (2004) ; 39(3): 77-80, sept. 2019. tab.
Artigo em Espanhol | LILACS | ID: biblio-1048219

RESUMO

Antecedentes y objetivo: el ayuno preoperatorio disminuye el riesgo de aspiración del contenido gástrico y sus complicaciones. Sin embargo, si es excesivo, favorece la regurgitación y el riesgo de broncoaspiración tras la inducción anestésica, así como alteraciones metabólicas e hidroelectrolíticas. Analizamos su duración, en pacientes con cirugías programadas en un hospital público de agudos. Material y métodos: se encuestó a todos los pacientes mayores de 18 años con cirugías programadas. Se recolectaron datos sobre la prescripción médica de ayuno, la hora de inducción anestésica y personales. El ayuno prescripto se comparó con las recomendaciones de las guías de la AAARBA (Asociación de Anestesia, Analgesia y Reanimación de Buenos Aires). Resultados: se reclutaron 139 pacientes, con una mediana de edad de 48 años (30; 64), 53% femeninos. La mediana del ayuno prescripto fue de 12,5 horas tanto para sólidos como para líquidos. El ayuno para sólidos que realizaron los pacientes tuvo una mediana de 14 horas, la cual resultó significativamente mayor que la prescripción (p < 0,001). En cambio, el ayuno para líquidos tuvo una mediana de 12 horas, no hallándose una diferencia significativa (p = 0,452) con lo prescripto. En comparación con la guía de la AAARBA, el ayuno prescripto excedió la recomendación para sólidos (4,5 h) y para líquidos (10,5 h). El ayuno realizado por el paciente excedió lo prescripto para sólidos (1,5 h), mientras que para líquidos fue inferior (0,5 h). Conclusión: el ayuno preoperatorio prescripto no se adecuó a las recomendaciones actuales. Las horas de ayuno realizadas por el paciente resultaron excesivas. (AU)


Background and objective: preoperative fasting reduces the risk of aspiration of gastric contents and its complications. However, if fasting is excessive, it favours regurgitation and the risk of pulmonary aspiration in patients undergoing general anaesthetic, such as metabolic and electrolyte disorders. We analysed its duration in patients with elective surgeries in public acute care hospital. Material and methodologies: patients over 18 years old with elective surgeries were surveyed. Data about medical fasting indication, time of induction of anaesthesia and personal information was collected. The prescribed fast was compared with the recommendations of the AAARBA (Association of Anaesthesia, Analgesia and Reanimation of Buenos Aires) guidelines. Results: 139 patients were gathered with a median of 48 years old (30; 64), 53% of them were female. Fasting indication median was of 12.5 h for solids and liquids. The fasting made by the patient for solids had a median of 14 h which resulted to be significantly higher to the indication (p < 0.001). By contrast, the fasting for liquids had a median of 12 h which it did not show a significant difference (p = 0.452) with the indication. In comparison with the AAARBA guideline, the fasting indication exceeded the recommendation for solids (4.5 h) and for liquids (10.5 h). The fasting made by the patient exceeded to what was indicated for solids (1.5 h) while for liquids, it was inferior (0.5 h). Conclusion: the indicated preoperative fasting was not adequate to the current recommendations. The hours of fasting made by patient were excessive. (AU)


Assuntos
Humanos , Masculino , Feminino , Adulto , Pessoa de Meia-Idade , Adulto Jovem , Cuidados Pré-Operatórios/métodos , Jejum/metabolismo , Procedimentos Cirúrgicos Eletivos/efeitos adversos , Ansiedade , Pneumonia/prevenção & controle , Cirurgia Geral/tendências , Sede , Jejum/fisiologia , Fome , Procedimentos Cirúrgicos Eletivos/métodos , Desidratação , Refluxo Laringofaríngeo/mortalidade , Refluxo Laringofaríngeo/prevenção & controle , Aspiração Respiratória de Conteúdos Gástricos/complicações , Hipoglicemia , Anestesia Geral/tendências
2.
Pediatr Crit Care Med ; 19(6): 528-537, 2018 06.
Artigo em Inglês | MEDLINE | ID: mdl-29863636

RESUMO

OBJECTIVES: Cricoid pressure is often used to prevent regurgitation during induction and mask ventilation prior to high-risk tracheal intubation in critically ill children. Clinical data in children showing benefit are limited. Our objective was to evaluate the association between cricoid pressure use and the occurrence of regurgitation during tracheal intubation for critically ill children in PICU. DESIGN: A retrospective cohort study of a multicenter pediatric airway quality improvement registry. SETTINGS: Thirty-five PICUs within general and children's hospitals (29 in the United States, three in Canada, one in Japan, one in Singapore, and one in New Zealand). PATIENTS: Children (< 18 yr) with initial tracheal intubation using direct laryngoscopy in PICUs between July 2010 and December 2015. INTERVENTIONS: None. MEASUREMENTS AND MAIN RESULTS: Multivariable logistic regression analysis was used to evaluate the association between cricoid pressure use and the occurrence of regurgitation while adjusting for underlying differences in patient and clinical care factors. Of 7,825 events, cricoid pressure was used in 1,819 (23%). Regurgitation was reported in 106 of 7,825 (1.4%) and clinical aspiration in 51 of 7,825 (0.7%). Regurgitation was reported in 35 of 1,819 (1.9%) with cricoid pressure, and 71 of 6,006 (1.2%) without cricoid pressure (unadjusted odds ratio, 1.64; 95% CI, 1.09-2.47; p = 0.018). On multivariable analysis, cricoid pressure was not associated with the occurrence of regurgitation after adjusting for patient, practice, and known regurgitation risk factors (adjusted odds ratio, 1.57; 95% CI, 0.99-2.47; p = 0.054). A sensitivity analysis in propensity score-matched cohorts showed cricoid pressure was associated with a higher regurgitation rate (adjusted odds ratio, 1.01; 95% CI, 1.00-1.02; p = 0.036). CONCLUSIONS: Cricoid pressure during induction and mask ventilation before tracheal intubation in the current ICU practice was not associated with a lower regurgitation rate after adjusting for previously reported confounders. Further studies are needed to determine whether cricoid pressure for specific indication with proper maneuver would be effective in reducing regurgitation events.


Assuntos
Cartilagem Cricoide/fisiopatologia , Estado Terminal/terapia , Intubação Intratraqueal/efeitos adversos , Refluxo Laringofaríngeo/epidemiologia , Canadá , Criança , Pré-Escolar , Estudos de Coortes , Feminino , Humanos , Lactente , Unidades de Terapia Intensiva Pediátrica , Intubação Intratraqueal/métodos , Japão , Refluxo Laringofaríngeo/etiologia , Refluxo Laringofaríngeo/prevenção & controle , Laringoscopia/efeitos adversos , Masculino , Nova Zelândia , Pressão , Pontuação de Propensão , Melhoria de Qualidade , Sistema de Registros , Estudos Retrospectivos , Singapura , Estados Unidos
3.
Acta otorrinolaringol. esp ; 69(2): 80-85, mar.-abr. 2018. tab, ilus, graf
Artigo em Espanhol | IBECS | ID: ibc-172137

RESUMO

Introducción y objetivos: El reflujo faringo-laríngeo (RFL) es una enfermedad caracterizada por la presencia de síntomas, signos y alteraciones tisulares, consecuencia del movimiento retrógrado del contenido gastrointestinal hacia el tracto aerodigestivo superior. Representa hasta el 10% de las consultas en otorrinolaringología. El objetivo de nuestro trabajo es describir los hallazgos obtenidos al aplicar el test de determinación de pepsina en saliva (PEP-test) en una muestra de pacientes con signos clínicos sugestivos de RFL. Material y métodos: En nuestro estudio clínico descriptivo se han incluido 142 sujetos con síntomas sugestivos de RFL que obtuvieron puntuaciones por encima de 13 en la escala RSI. A todos ellos se les realizó una endoscopia laríngea para descartar otras enfermedades que pudieran justificar los síntomas y el PEP-test. Ésta se realizó en ayunas a todos los sujetos, y en aquellos con resultados negativos se realizó una segunda determinación una hora después de comer. Resultados: Los resultados obtenidos en las pruebas realizadas en los 142 sujetos incluidos fueron los siguientes: 105 pacientes (73,94%) presentaron resultados positivos en alguna de las determinaciones de pepsina en saliva y en 37 sujetos (26,06%) los resultados de ambas determinaciones fueron negativos. Conclusión: El PEP-test es un método sencillo, económico, no invasivo y fácilmente repetible que podría minimizar el uso de tratamientos empíricos y pruebas invasivas para el diagnóstico del RFL, si bien son necesarias más investigaciones para la validación del mismo (AU)


Introduction and objectives: Laryngopharyngeal Reflux (LPR) is a disease characterized by the presence of symptoms, signs and tissue damage caused by retrograde flow of gastric contents to the upper aerodigestive tract. It represents up to 10% of otolaryngology consultations. The aim of the study is to describe the findings obtained by applying the salivary pepsin test (PEP-test) in a sample of patients with the clinical suspicion of LPR. Material and methods: Our descriptive clinical study included 142 subjects with symptoms suggestive of LPR and a score above 13 on the RSI scale. The subjects underwent laryngeal endoscopy to rule out other pathologies that could justify the symptoms and the salivary pepsin test (PEP-test). The latter was carried out on fasting subjects and a second test one hour after eating, only on those with negative results. Results: The results obtained in the tests performed on the 142 patients included in the study were: 105 (73.94%) presented positive results in some of the salivary pepsin tests and the results of both tests were negative in 37 subjects (26.06%). Conclusion: The salivary pepsin test is a simple, low-cost, non-invasive and easily repeatable tool which could minimize empirical treatments and invasive tests for LPR diagnosis, although further research is needed for its validation (AU)


Assuntos
Humanos , Masculino , Feminino , Adulto Jovem , Adulto , Pessoa de Meia-Idade , Reprodutibilidade dos Testes/instrumentação , Pepsina A/análise , Refluxo Laringofaríngeo/diagnóstico , Saliva , Pepsina A , Refluxo Laringofaríngeo/etiologia , Refluxo Laringofaríngeo/prevenção & controle , Refluxo Laringofaríngeo/terapia , Diagnóstico Precoce
4.
J Biol Regul Homeost Agents ; 32(1 Suppl. 2): 9-19, 2018.
Artigo em Inglês | MEDLINE | ID: mdl-29436210

RESUMO

Laryngopharyngeal Reflux (LPR) should be considered as part of extraesophageal reflux (EER). This reflux involves respiratory structures other than, or in addition to, the oesophagus. A new medical device for the treatment of gastric reflux, including LPR, has been launched in Italy: Marial®. Therefore, the aim of the present survey was to analyse the prescriptive behaviour both considering the past or current treatments and clinical features during a specialist routine visit. The current survey was conducted in 86 Otorhinolaryngological centers, distributed in all of Italy. Globally, 4.418 subjects [47% males and 53% females, 50.1 (14.5) years-of-age] were visited. The visits included laryngoscopy, Reflux Finding Score (RFS) and Reflux Symptom Index (RSI) questionnaires. The total RSI median score was 15 (12-19) and the total median RFS value was 10 (8-12). Interestingly, a significant change in the new drug prescription was observed (p<0.0001): over two-third of patients (67%) received Marial® as monotherapy, whereas PPI plus add-on were prescribed to almost one-third of the patients. PPI alone was prescribed in less than 1%. In conclusion, LPR is a common disorder characterized by typical signs and symptoms; LPR patients may be correctly identified and scored by evidence-based criteria. In addition, the present survey reported that LPR treatment has been considerably changed by the introduction of a new medical device.


Assuntos
Atitude do Pessoal de Saúde , Equipamentos e Provisões , Refluxo Laringofaríngeo/terapia , Laringoscopia , Otolaringologia , Médicos/psicologia , Inquéritos e Questionários , Feminino , Humanos , Itália , Refluxo Laringofaríngeo/prevenção & controle , Masculino , Pessoa de Meia-Idade
5.
Nutrients ; 9(11)2017 Oct 28.
Artigo em Inglês | MEDLINE | ID: mdl-29143799

RESUMO

Functional regurgitation (FR) is common in early infancy and represents a major drain on healthcare resources. This double-blind, randomized controlled trial investigated the effects of a formula containing partially hydrolysed, 100% whey protein, starch and Lactobacillus reuteri (DSM 17938) on gastric emptying rate (GErate) and regurgitation frequency in infants with FR. Enrolled infants were randomly allocated to receive either the test formula or a standard starter formula for four weeks. Ultrasound GErate assessment was performed at baseline (week 0) and at week 4; the number of regurgitations, feed volumes and potential adverse events were recorded in a daily diary. Eighty infants aged four weeks to five months were enrolled; 72 (test group = 37; control group = 35) completed the study. Compared to controls, the test group showed greater percentage changes in GErate (12.3% vs. 9.1%, p < 0.01). Mean daily regurgitations decreased from 7.4 (0.8) at week 0 to 2.6 (1.0) at week 4 in the test group and from 7.5 (1.0) to 5.3 (1.0) in controls (between-group difference, p < 0.0001). Compared to a standard formula, a starch-thickened partially hydrolysed whey protein formula supplemented with Lactobacillus reuteri is more effective in decreasing the frequency of regurgitation and improving GErate, and can be of benefit to infants with FR.


Assuntos
Esvaziamento Gástrico , Fórmulas Infantis , Lactobacillus reuteri/fisiologia , Refluxo Laringofaríngeo/prevenção & controle , Probióticos/administração & dosagem , Hidrolisados de Proteína/administração & dosagem , Amido/administração & dosagem , Proteínas do Soro do Leite/administração & dosagem , Método Duplo-Cego , Humanos , Lactente , Fórmulas Infantis/efeitos adversos , Itália , Refluxo Laringofaríngeo/diagnóstico por imagem , Refluxo Laringofaríngeo/fisiopatologia , Probióticos/efeitos adversos , Hidrolisados de Proteína/efeitos adversos , Amido/efeitos adversos , Fatores de Tempo , Resultado do Tratamento , Proteínas do Soro do Leite/efeitos adversos
6.
Am J Otolaryngol ; 38(5): 603-607, 2017.
Artigo em Inglês | MEDLINE | ID: mdl-28688630

RESUMO

OBJECTIVE: Laryngopharyngeal reflux (LPR) symptoms are often resistant to management and cause significant quality of life impairment to patients with this disease. This study assesses the utility of a sleep-positioning device (SPD) in treating LPR. DESIGN: Single center prospective cohort study. SETTING: Tertiary medical center PARTICIPANTS: 27 adult patients with diagnosed laryngopharyngeal reflux. INTERVENTION: An SPD consisting of a two-component wedge-shaped base pillow and a lateral positioning body pillow (Medcline, Amenity Health Inc.) was given to patients with a diagnosis of LPR. Subjects slept using the device for at least 6h per night for 28 consecutive nights. MAIN OUTCOMES: Primary outcomes were Nocturnal Gastroesophageal Reflux Symptom Severity and Impact Questionnaire (N-GSSIQ) and the Reflux Symptoms Index (RSI) survey instrument. Each was collected at baseline, after 14, and after 28days of SPD use. RESULTS: 27 patients (19 female and 8 male; age 57.1±12.8, BMI 29.0±8.1) were recruited. At baseline mean N-GSSIQ was 50.1±22.4 and mean RSI of 29.6±7.7. Repeated measure analysis showed that subjects' total N-GSSIQ scores decreased by an average of 19.1 (p=0.0004) points by two weeks and 26.5 points by 4weeks (p<0.0001). RSI decreased an average of 5.3 points by 2weeks (p=0.0425) and an average of 14.0 points by 4weeks (p<0.0001). CONCLUSIONS: In patients with LPR, SPD treatment significantly improves self-reported symptoms of nocturnal reflux as well as symptoms specific to LPR. These results support the therapeutic efficacy of a SPD for patients with LPR.


Assuntos
Refluxo Laringofaríngeo/prevenção & controle , Posicionamento do Paciente/instrumentação , Postura , Sono , Adulto , Idoso , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Estudos Prospectivos , Qualidade de Vida , Inquéritos e Questionários , Resultado do Tratamento
7.
Laryngoscope ; 127(11): 2466-2474, 2017 11.
Artigo em Inglês | MEDLINE | ID: mdl-28543926

RESUMO

OBJECTIVES/HYPOTHESIS: External cricoid pressure is increasingly used to augment the upper esophageal sphincter (UES). Our objective was to determine the effect of 1) pressures applied to cricoid, supracricoid, and subcricoid regions on the length and amplitude of the UES high-pressure zone (UESHPZ), and 2) the external cricoid pressure on lower esophageal sphincter (LES) tone. STUDY DESIGN: Case-control study. METHODS: We studied 11 patients with supraesophageal reflux (mean age 58 ± 12 years) and 10 healthy volunteers (mean age 47 ± 19 years). We tested 20, 30, and 40 mm Hg pressures to cricoid, 1 cm proximal and 1 cm distal to the cricoid. In an additional 15 healthy volunteers (mean age 46 ± 23 years), we studied the effect of external cricoid pressure on LES tone. UES and LES pressures were determined using high-resolution manometry. RESULTS: There was significant increase of UESHPZ length with application of pressure at all sites. The increase of UESHPZ length was relatively symmetric, more orad, and more caudad when the pressure was applied at the cricoid, supracricoid, and subcricoid levels, respectively. The magnitude of pressure increase was greatest at the middle and orad part of the UESHPZ when the pressure was applied at the cricoid and supracricoid levels, respectively. The corresponding magnitude of increase in the caudad part of the UESHPZ was not observed with pressure at the subcricoid level. There was no change of the LES pressure with application of cricoid pressure. CONCLUSIONS: The effect of external pressure on the UESHPZ is site dependent. Subcricoid pressure has the least effect on UESHPZ. External cricoid pressure at 20 to 40 mm Hg has no effect on the LES pressure. LEVEL OF EVIDENCE: 3b. Laryngoscope, 127:2466-2474, 2017.


Assuntos
Cartilagem Cricoide/fisiopatologia , Esfíncter Esofágico Superior/fisiopatologia , Refluxo Laringofaríngeo/prevenção & controle , Refluxo Laringofaríngeo/fisiopatologia , Estudos de Casos e Controles , Feminino , Humanos , Masculino , Manometria/instrumentação , Pessoa de Meia-Idade , Pressão , Resultado do Tratamento
8.
Anesth Analg ; 124(4): 1168-1173, 2017 04.
Artigo em Inglês | MEDLINE | ID: mdl-28079588

RESUMO

BACKGROUND: We tested the hypothesis whether gender differences exist in the applied cricoid force necessary to prevent regurgitation. Real-time visual and dynamic means were used to assess the effectiveness of different applied cricoid forces in occluding the esophageal entrance in men (group 1) and in women (group 2). METHODS: In anesthetized and paralyzed patients, the glottis and esophageal entrance were visualized with a Glidescope video laryngoscope. Trained operators performed cricoid pressure (CP) and gastric tube insertion trials. Successful gastric tube insertion in the presence of CP was considered ineffective CP, whereas unsuccessful insertion was considered effective CP. The applied cricoid forces were measured with a novel instrument, the cricometer. The first patient in each group received 20 N. The applied cricoid force in successive patients was determined by the response of the previous patient within the same group, using the up-and-down sequential allocation technique. RESULTS: In the 30 men and 30 women who qualified for the study, the median cricoid force (cricoid force = 50) that occluded the esophageal entrance was 30.8 N (95% confidence interval = 28.15-33.5) in men, and 18.7 N in women (95% confidence interval = 17.1-20.3; P < .0001). Patency of the esophageal entrance was observed when CP was not applied and when inadequate forces that allowed successful esophageal cannulation were used. CONCLUSIONS: The current study provides evidence that the median force necessary to occlude the esophageal entrance to prevent regurgitation is less in women compared with men. Applying the appropriate cricoid force in women should also decrease airway-related problems that tend to occur with the use of excessive forces. The findings of the current study may only be applicable to patients with normal body habitus.


Assuntos
Cartilagem Cricoide/anatomia & histologia , Esôfago/anatomia & histologia , Refluxo Laringofaríngeo/prevenção & controle , Laringoscópios , Pressão , Caracteres Sexuais , Adulto , Cartilagem Cricoide/fisiologia , Esôfago/fisiologia , Feminino , Glote/anatomia & histologia , Glote/fisiologia , Humanos , Intubação Intratraqueal , Refluxo Laringofaríngeo/fisiopatologia , Masculino , Pessoa de Meia-Idade , Adulto Jovem
9.
Rev. esp. anestesiol. reanim ; 63(10): 599-603, dic. 2016. ilus, graf
Artigo em Espanhol | IBECS | ID: ibc-157980

RESUMO

La intubación traqueal ha sido considerada históricamente la técnica ideal en el manejo de la vía aérea en procedimientos quirúrgicos laparoscópicos. La introducción de este tipo intervenciones en los circuitos de cirugía mayor ambulatoria exige el empleo de técnicas anestésicas que ofrezcan una recuperación postoperatoria óptima y un alta precoz bajo unas condiciones de seguridad estrictas. La mascarilla laríngea se plantea como opción adecuada a la intubación traqueal, incluso en pacientes de mayor riesgo gracias a los nuevos modelos con modificaciones orientadas a mejorar sus características, lo que las convierten en dispositivos de gran proyección dentro del manejo total de la vía aérea. Presentamos el primer caso de funduplicatura de Nissen laparoscópica realizado con mascarilla laríngea Baska Mask® en un paciente con riesgo alto de regurgitación por reflujo gastroesofágico (AU)


Tracheal intubation has historically been considered the ideal technique to handle the airway in laparoscopic surgical procedures. The introduction of such procedures in ambulatory surgery requires the use of anesthetic techniques that offer optimal and early postoperative recovery under strict security conditions. Laryngeal mask is proposed as a suitable alternative to tracheal intubation, even in high risk patients due to new devices which have been modified to improve their characteristics, becoming great alternatives in the overall management of the airway. We report the first case of laparoscopic Nissen fundoplication performed with a laryngeal Baska Mask in patient with high risk of regurgitation due to its gastroesophageal reflux (AU)


Assuntos
Humanos , Masculino , Pessoa de Meia-Idade , Máscaras Laríngeas/tendências , Máscaras Laríngeas , Fundoplicatura/instrumentação , Fundoplicatura/métodos , Fundoplicatura , Laparoscopia/métodos , Laparoscopia , Asma/complicações , Propofol/uso terapêutico , Intubação Intratraqueal/instrumentação , Intubação Intratraqueal/métodos , Refluxo Laringofaríngeo/tratamento farmacológico , Refluxo Laringofaríngeo/prevenção & controle , Fentanila/uso terapêutico
10.
Resuscitation ; 102: 70-4, 2016 May.
Artigo em Inglês | MEDLINE | ID: mdl-26921473

RESUMO

BACKGROUND: Chest compressions and ventilation are lifesaving tasks during cardio-pulmonary resuscitation (CPR). Besides oxygenation, endotracheal intubation (ETI) during CPR is performed to avoid aspiration of gastric contents. If intubation is difficult or impossible, supraglottic airway devices are utilized. We tested six different airway devices regarding their potential to protect against regurgitation and aspiration during CPR in a randomized experimental human cadaver study. METHODS: Five-hundred ml of 0.01% methylene-blue-solution were instilled into the stomach of 30 adult human cadavers via an oro-gastric tube. The cadavers were then randomly assigned to one of six groups, resulting in 5 cadavers in each group. Airway management was performed with either bag-valve ventilation, Laryngeal Tube, EasyTube, Laryngeal Mask (Classic), I-Gel, or ETI. Thereafter 5min of CPR were performed according to the 2010 Guidelines of the European Resuscitation Council. Pulmonary aspiration was defined as the presence of methylene-blue-solution below the vocal cords or the ETI cuff as assessed by fiber-optic bronchoscopy. RESULTS: Thirty cadavers were included (14 females, 16 males). Aspiration was detected in three out of five cadavers receiving bag-valve ventilation and in two out of five intubated with LMA or I-Gel. In cadavers intubated with the LT, aspiration occurred in one out of five cases. No aspiration could be detected in cadavers intubated with ETI and EasyTube. CONCLUSION: This study provides experimental evidence that, during CPR, ETI offers superior protection against regurgitation and pulmonary aspiration of gastric contents than supraglottic airway devices or bag-valve ventilation.


Assuntos
Manuseio das Vias Aéreas/instrumentação , Reanimação Cardiopulmonar/métodos , Intubação Intratraqueal/instrumentação , Máscaras Laríngeas , Refluxo Laringofaríngeo/prevenção & controle , Pneumonia Aspirativa/prevenção & controle , Respiração Artificial/instrumentação , Adulto , Idoso , Idoso de 80 Anos ou mais , Cadáver , Desenho de Equipamento , Feminino , Parada Cardíaca/terapia , Humanos , Masculino , Manequins , Pessoa de Meia-Idade , Projetos Piloto
11.
Nutrition ; 32(2): 206-12, 2016 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-26704966

RESUMO

OBJECTIVES: Cow's milk allergy (CMA) is treated in formula-fed infants with an extensive protein hydrolysate. This study aimed to evaluate the nutritional safety of a non-thickened and thickened extensively casein hydrolyzed protein formula (NT- and T-eCHF) in infants with CMA. METHODS: Infants younger than 6 mo old with a positive cow milk challenge test, positive IgE, or skin prick test for cow milk were selected. Weight and length were followed during the 6 mo intervention with the NT-eCHF and T-eCHF. RESULTS: A challenge was performed in 50/71 infants with suspected CMA and was positive in 34/50. All children with confirmed CMA tolerated the eCHF. The T-eCHF leads to a significant improvement of the stool consistency in the whole population and in the subpopulation of infants with proven CMA. Height and weight evolution was satisfactory throughout the 6 mo study. CONCLUSIONS: The eCHF fulfills the criteria of a hypoallergenic formula and the NT- and T-eCHF reduced CMA symptoms. Growth was within normal range.


Assuntos
Caseínas/administração & dosagem , Fórmulas Infantis/administração & dosagem , Animais , Estatura , Peso Corporal , Desenvolvimento Infantil , Carboidratos da Dieta/análise , Gorduras na Dieta/análise , Fibras na Dieta/análise , Proteínas na Dieta/análise , Método Duplo-Cego , Ingestão de Energia , Feminino , Humanos , Imunoglobulina E/sangue , Lactente , Refluxo Laringofaríngeo/prevenção & controle , Masculino , Leite , Hipersensibilidade a Leite/prevenção & controle , Estudos Prospectivos , Hidrolisados de Proteína/administração & dosagem , Viscosidade
13.
Fed Regist ; 80(149): 46192-4, 2015 Aug 04.
Artigo em Inglês | MEDLINE | ID: mdl-26242000

RESUMO

The Food and Drug Administration (FDA) is classifying the external upper esophageal sphincter (UES) compression device into class II (special controls). The special controls that will apply to the device are identified in this order and will be part of the codified language for the external UES compression device's classification. The Agency is classifying the device into class II (special controls) in order to provide a reasonable assurance of safety and effectiveness of the device.


Assuntos
Aprovação de Equipamentos/legislação & jurisprudência , Otolaringologia/classificação , Otolaringologia/instrumentação , Segurança de Equipamentos/classificação , Esfíncter Esofágico Superior , Humanos , Refluxo Laringofaríngeo/prevenção & controle , Estados Unidos
15.
Arch Dis Child Fetal Neonatal Ed ; 100(5): F394-9, 2015 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-26040920

RESUMO

OBJECTIVE: To evaluate the efficacy and safety of gastric lavage (GL) in neonates born through meconium-stained liquor (MSL). DESIGN: A systematic review of randomised controlled trials by searching databases MEDLINE (from 1966), EMBASE (from1980), CINAHL, Cochrane Central Register of Controlled Trials, Google Scholar and proceedings of Pediatric Academic Society meetings (2002-2014). SETTING: Delivery room/Neonatal ward. PATIENTS: Neonates with gestation >34 weeks and birth weight ≥1800 g born through MSL. INTERVENTIONS: Prophylactic GL versus no intervention before first feed. MAIN OUTCOME MEASURE: Feeding intolerance, defined as inability to initiate/upgrade feeds due to problems such as retching, vomiting, regurgitation and gastric residuals. RESULTS: A total of six studies (GL: 918, no GL: 966) were included in the review. Meta-analysis using fixed-effects model showed decreased incidence of feed intolerance following GL ((81/918 (8.8%) vs 114/966 (11.8%); risk ratio (RR): 0.71 (95% CI 0.55 to 0.93)). However, the results were not significant when random-effects model was used (RR: 0.78 (95% CI 0.55 to 1.09)). No significant adverse effects of GL were reported. CONCLUSIONS: Routine GL immediately after birth may improve feed tolerance in neonates born through MSL. However, the evidence is limited, with probable small-study bias and high risk of bias in a number of the included studies. Well-designed studies with adequate sample size are essential to confirm these findings.


Assuntos
Líquido Amniótico , Lavagem Gástrica , Refluxo Laringofaríngeo/prevenção & controle , Mecônio , Vômito/prevenção & controle , Comportamento Alimentar , Lavagem Gástrica/efeitos adversos , Humanos , Recém-Nascido
16.
World J Gastroenterol ; 21(5): 1680-3, 2015 Feb 07.
Artigo em Inglês | MEDLINE | ID: mdl-25663791

RESUMO

Belching is a common symptom of gastroesophageal reflux disease. If the symptoms are not relieved after anti-reflux treatment, another etiology should be considered. Here, we report a case of a 43-year-old man who presented with belching, regurgitation, chest tightness and dyspnea for 18 mo, which became gradually more severe. Gastroscopic examination suggested superficial gastritis. Twenty-four-hour esophageal pH monitoring showed that the Demeester score was 11.4, in the normal range. High-resolution manometry showed that integrated relaxation pressure and intrabolus pressure were higher than normal (20 mmHg and 22.4 mmHg, respectively), indicating gastroesophageal junction outflow tract obstruction. Pulmonary function test showed severe obstructive ventilation dysfunction [forced expiratory volume in 1 second (FEV1)/forced vital capacity 32%, FEV1 was 1.21 L, occupying 35% predicted value after salbuterol inhalation], and positive bronchial dilation test (∆FEV1 260 mL, ∆FEV1% 27%). Skin prick test showed Dermatophagoides farinae (++), house dust mite (++++), and shrimp protein (++). Fractional exhaled nitric oxide measurement was 76 ppb. All the symptoms were alleviated completely and pulmonary function increased after combination therapy with corticosteroids and long-acting ß2-agonist. Bronchial asthma was eventually diagnosed by laboratory tests and the effect of anti-asthmatic treatment, therefore, physicians, especially the Gastrointestinal physicians, should pay attention to the belching symptoms of asthma.


Assuntos
Asma/diagnóstico , Dispneia/etiologia , Eructação/etiologia , Refluxo Gastroesofágico/diagnóstico , Refluxo Laringofaríngeo/etiologia , Pulmão/fisiopatologia , Corticosteroides/administração & dosagem , Agonistas de Receptores Adrenérgicos beta 2/administração & dosagem , Adulto , Asma/complicações , Asma/tratamento farmacológico , Asma/fisiopatologia , Broncodilatadores/administração & dosagem , Diagnóstico Diferencial , Dispneia/fisiopatologia , Dispneia/prevenção & controle , Eructação/fisiopatologia , Eructação/prevenção & controle , Monitoramento do pH Esofágico , Volume Expiratório Forçado , Refluxo Gastroesofágico/complicações , Refluxo Gastroesofágico/fisiopatologia , Gastroscopia , Humanos , Refluxo Laringofaríngeo/fisiopatologia , Refluxo Laringofaríngeo/prevenção & controle , Pulmão/efeitos dos fármacos , Masculino , Manometria , Valor Preditivo dos Testes , Fatores de Risco , Resultado do Tratamento , Capacidade Vital
17.
Child Care Health Dev ; 41(1): 52-6, 2015 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-24910161

RESUMO

BACKGROUND: Efficacy of burping in lowering colic and regurgitation episodes in healthy term babies lacks evidence in literature. METHODS: We conducted a randomized controlled trial to compare efficacy of burping versus no-burping in 71 mother-baby dyads in community setting. Primary outcome was reduction in event rates of colic and regurgitation episodes over 3 months. RESULTS: Baseline characteristics were similar in two groups. Difference in incidence rates of colic between the control and burping group was 1.57 episodes/infant/100 weeks [95% confidence interval (CI): -0.63 to 3.76]. There was statistically no significant reduction in colic episodes between burping and non-burping study subjects during 3 months of follow-up (adjusted relative risk 0.64; 95% CI: 0.22-1.86, P-value 0.41). Incidence rate difference of regurgitation episodes/infant/week between burping and control group was 4.36 (95% CI: 4.04 to 4.69) and there was statistically significant increase in burping group (adjusted relative risk 2.05; 95% CI: 1.92-2.18, P-value < 0.0001). CONCLUSIONS: Although burping is a rite of passage, our study showed that burping did not significantly lower colic events and there was significant increase in regurgitation episodes in healthy term infants up to 3 months of follow-up.


Assuntos
Cólica/prevenção & controle , Cuidado do Lactente/métodos , Refluxo Laringofaríngeo/prevenção & controle , Adulto , Cólica/epidemiologia , Métodos de Alimentação/estatística & dados numéricos , Feminino , Humanos , Incidência , Índia , Lactente , Recém-Nascido , Refluxo Laringofaríngeo/epidemiologia , Masculino , Idade Materna , Prevalência , Estudos Prospectivos , Adulto Jovem
18.
J Am Coll Nutr ; 33(2): 136-46, 2014.
Artigo em Inglês | MEDLINE | ID: mdl-24724771

RESUMO

OBJECTIVE: Spit-up (regurgitation) reduction with prethickened milk protein-based infant formulas containing rice starch has been clinically demonstrated in infants with heavy spit-ups but not in otherwise healthy normal infants with common spit-ups. The objective of this study was to evaluate growth, gastrointestinal tolerance, and efficacy to reduce common spit-up in normal, healthy term infants fed an investigational rice starch prethickened lactose-free milk protein-based infant formula. METHODS: This double-blind, randomized, parallel study evaluated the investigational rice starch prethickened lactose-free (low lactose < 100 mg/L) milk protein-based infant formula compared to a standard, commercially available, iso-nutrient, lactose-containing (100% of carbohydrate) milk-based infant formula (control) for growth and gastrointestinal tolerance in healthy term infants (n = 132/group) fed from 14 ± 3 days to 112 days of age. Data were classified and analyzed as evaluable (EV; subjects completing study per protocol) or intent-to-treat data (ITT; all subjects with available data). RESULTS: Growth as indicated by weight gain (primary variable) and formula intake were not significantly different (p > 0.05) between feeding groups (EV or ITT). Though both formulas were well tolerated, spit-up frequency was significantly lower (p < 0.05) in the rice versus control group by 53% at 28 days of age, 54% at 56 days, 48% at 84 days, and 32% at 112 days (EV). Importantly, infants in the rice group were 1.6 to 1.8 times more likely to report zero spit-up than infants in the control group. The rice group also had higher percentages of soft and yellow stools. CONCLUSIONS: The rice starch prethickened lactose-free milk protein-based formula (rice) supported normal growth and safe use as the sole source of feeding for normal infants over the first 4 months of life. The rice formula was efficacious in providing a clinically relevant reduction of spit-up frequency in otherwise healthy term infants.


Assuntos
Fórmulas Infantis/química , Lactose/análise , Refluxo Laringofaríngeo/prevenção & controle , Proteínas do Leite/análise , Oryza , Método Duplo-Cego , Feminino , Humanos , Lactente , Recém-Nascido , Masculino , Estudos Prospectivos , Amido , Resultado do Tratamento
19.
Acta Paediatr ; 103(6): e243-50, 2014 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-24575806

RESUMO

AIM: Cow's milk protein allergy (CMPA) is treated using an elimination diet with an extensive protein hydrolysate. We explored whether a thickened or nonthickened version was best for infants with suspected CMPA, which commonly causes regurgitation/vomiting. METHODS: Diagnosis of CMPA was based on a positive challenge test. We compared the efficacy of two casein extensive hydrolysates (eCH), a nonthickened version (NT-eCH) and a thickened version (T-eCH), using a symptom-based score covering regurgitation, crying, stool consistency, eczema, urticarial and respiratory symptoms. RESULTS: A challenge was performed in 52/72 infants with suspected CMPA and was positive in 65.4%. All confirmed CMPA cases tolerated eCH. The symptom-based score decreased significantly in all infants within a month, and the highest reduction was in those with confirmed CMPA. Regurgitation was reduced in all infants (6.4 ± 3.2-2.8 ± 2.9, p < 0.001), but fell more with the T-eCH (-4.2 ± 3.2 regurgitations/day vs. -3.0 ± 4.5, ns), especially in infants with a negative challenge (-3.9 ± 4.0 vs. -1.9 ± 3.4, ns). CONCLUSION: eCH fulfilled the criteria for a hypoallergenic formula, and the NT-eCH and T-eCH formulas both reduced CMPA symptoms. The symptom-based score is useful for evaluating how effective dietary treatments are for CMPA.


Assuntos
Fórmulas Infantis , Refluxo Laringofaríngeo/dietoterapia , Hipersensibilidade a Leite/dietoterapia , Proteínas do Leite/efeitos adversos , Hidrolisados de Proteína/uso terapêutico , Vômito/dietoterapia , Animais , Bovinos , Feminino , Humanos , Lactente , Refluxo Laringofaríngeo/etiologia , Refluxo Laringofaríngeo/prevenção & controle , Masculino , Hipersensibilidade a Leite/complicações , Hipersensibilidade a Leite/diagnóstico , Proteínas do Leite/imunologia , Estudos Prospectivos , Vômito/etiologia , Vômito/prevenção & controle
20.
Int J Food Sci Nutr ; 65(5): 646-8, 2014 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-24635827

RESUMO

Forty breastfed full-term infants were randomly, double blind assigned to receive orally Lactobacillus reuteri (L. reuteri) DSM 17938, 5 drops/daily (10(8) colony-forming units), for 4 weeks (n = 20) or an identical placebo (n = 20), starting before third day of life. They underwent basal and final visit to monitor growth parameters and gastrointestinal (GI) disease. Parents registered daily: crying minutes, stool frequency and consistency, numbers of regurgitations, adverse events. Secretory IgA (sIgA) has been measured in saliva on 28th day. Treated infants demonstrated a reduction in daily regurgitations at the end of treatment (p = 0.02), three neonates in the placebo group only needed simethicone for GI pain, sIgA level was similar in both groups. Random casualty produced an unbalanced gender distribution in the groups, but this bias did not affect the results. Therefore, early administration of L. reuteri DSM 17938 resulted beneficial in preventing regurgitation episodes during the first month of life.


Assuntos
Aleitamento Materno , Lactobacillus reuteri , Refluxo Laringofaríngeo/prevenção & controle , Probióticos/administração & dosagem , Administração Oral , Contagem de Colônia Microbiana , Método Duplo-Cego , Feminino , Humanos , Imunoglobulina A/metabolismo , Recém-Nascido , Modelos Lineares , Masculino
SELEÇÃO DE REFERÊNCIAS
DETALHE DA PESQUISA