Your browser doesn't support javascript.
loading
Show: 20 | 50 | 100
Results 1 - 20 de 351
Filter
1.
Rev. cuba. anestesiol. reanim ; 20(2): e688, 2021. tab, graf
Article in Spanish | LILACS, CUMED | ID: biblio-1289349

ABSTRACT

Introducción: El accidente cerebrovascular es una de las causas más comunes de mortalidad a nivel mundial. Objetivo: Determinar la asociación existente entre el desarrollo de afecciones neurológicas y la necesidad de ventilación mecánica con el aumento de la incidencia de mortalidad en la unidad de cuidados intensivos. Métodos: Estudio observacional, prospectivo de corte transversal, realizado en la unidad de cuidados intensivos de un hospital de atención secundaria. La población de estudio estuvo constituida por 52 pacientes con accidente cerebrovascular los cuales recibieron soporte respiratorio artificial entre los años 2018 y 2020. La variable de interés final fue la mortalidad. Los factores neurológicos estudiados fueron el tipo de accidente cerebrovascular, puntuación de la escala de coma de Glasgow, ausencia de reflejos de tallo encefálico, anisocoria y complicaciones neurológicas. El nivel de significación se halló según p valor ≤ 0,05 a través de Chi cuadrado de independencia. Resultados: La mortalidad proporcional predominó en el accidente cerebrovascular hemorrágico tipo hemorragia intracraneal no traumática (p= 0,118), ausencia de reflejos del tallo encefálico (p=0,000), anisocoria (p=0,000), escala de coma de Glasgow <8 puntos (p=0,000) y complicaciones neurológicas como la hipertensión endocraneana (p=0,010). Conclusiones: Los factores neurológicos asociados a la mortalidad fueron la ausencia de reflejos del tallo encefálico, anisocoria, escala de coma de Glasgow <8 puntos y complicaciones neurológicas como la hipertensión endocraneana(AU)


Introduction: Cerebrovascular accident is one of the commonest causes of mortality in the world. Objective: To determine the association between development of neurological disorders and the need for mechanical ventilation with an increased incidence of mortality in the intensive care unit. Methods: An observational, prospective and cross-sectional study was carried out in the intensive care unit of a secondary care hospital. The study population consisted of 52 patients with cerebrovascular accident who received artificial respiratory support between 2018 and 2020. The final variable of interest was mortality. The neurological factors studied were type of cerebrovascular accident, score according to the Glasgow coma scale, absence of brainstem reflexes, anisocoria, and neurological complications. The level of significance was determined according to P ≤ 0.05, through chi-square of independence. Results: Proportional mortality prevailed in hemorrhagic cerebrovascular accident of nontraumatic intracranial hemorrhage type (P=0.118), absence of brainstem reflexes (P=0.000), anisocoria (P=0.000), score of less than eight points according to the Glasgow coma scale (P=0.000), and neurological complications such as endocranial hypertension (P=0.010). Conclusions: The neurological factors associated with mortality were absence of brainstem reflexes, anisocoria, score of less than eight points according to the Glasgow coma scale, and neurological complications such as endocranial hypertension(AU)


Subject(s)
Humans , Stroke/mortality , Respiration, Artificial/adverse effects , Secondary Care , Cross-Sectional Studies , Prospective Studies , Intensive Care Units , Nervous System Diseases/complications
2.
Rev. Bras. Saúde Mater. Infant. (Online) ; 21(3): 905-914, July-Sept. 2021. tab, graf
Article in English | LILACS | ID: biblio-1346995

ABSTRACT

Abstract Objectives: to determine the prevalence and factors associated with recurrent wheezing in the first year of life among premature newborns from Neonatal Intensive Care Units, in the city of Montes Claros, northern Minas Gerais. Methods: cross-sectional study, with data collection from medical records of a follow-up clinic, interviews with mothers and, eventually, search in hospital records. Bivariate analyzes were carried out between sociodemographic and clinical characteristics and recurrent wheezing. Variables associated up to the level of 20% were analyzed by binary logistic regression, and associations defined by the Odds Ratio and respective 95% confidence intervals. Only variables associated with a 5% significance level were maintained in the final model of logistic regression. Results: among 277 infants studied, about one fifth (21.3%) were extremely low birth weight preterm and more than half (60.7%) had birth weight below 1500 grams. The prevalence of recurrent wheezing was 14.4% (CI95% = 10.3-18.4). Mechanical ventilation (OR = 2.12; CI95% = 1.09-4.76; p = 0.030) and oxygen therapy time ≥ 15 days (OR = 2.49; CI95%= 1.12-5.00; p = 0.010) were the risk factors for the event. Conclusions: there is a high prevalence of recurrent wheezing in the evaluated group and the associated variables reiterate the risk of prolonged oxygen therapy and mechanical ventilation for premature newborns.


Resumo Objetivos: determinar a prevalência e fatores associados à sibilância recorrente no primeiro ano de vida entre recém-nascidos prematuros egressos de Unidades de Terapia Intensiva Neonatais, na cidade de Montes Claros, norte de Minas Gerais. Métodos: estudo transversal, com coleta de dados em prontuários de ambulatório de seguimento, entrevistas com mães e, eventualmente, consultas aos prontuários hospitalares. Foram realizadas análises bivariadas entre as características sociodemográficas e clínicas e a sibilância recorrente. As variáveis associadas ao desfecho até um nível de significância de p ≤20% foram analisadas por regressão logística binária e as associações definidas pelas Odds Ratios e respectivos intervalos de confiança de 95%. Somente variáveis associadas a um nível de significância de 5% foram mantidas no modelo final de regressão logística. Resultados: entre 277 crianças estudadas, cerca de um quinto (21,3%) eram prematuros de extremo baixo peso e mais da metade (60,7%) tinha peso de nascimento abaixo de 1500 gramas. A prevalência de sibilância recorrente foi de 14,4% (IC95%=10,3-18,4). Ventilação mecânica (OR=2,12; IC95%= 1,09-4,76; p=0,030) e tempo de oxigenioterapia ≥15 dias (OR=2,49; IC95%=1,12-5,00; p=0,010) foram os fatores de risco para o evento. Conclusão: existe uma elevada prevalência de sibilância recorrente no grupo avaliado e as variáveis associadas reiteram o risco do uso prolongado de oxigenioterapia e da ventilação mecânica para recém-nascidos prematuros.


Subject(s)
Humans , Infant, Newborn , Infant , Oxygen Inhalation Therapy/adverse effects , Respiration, Artificial/adverse effects , Infant, Premature , Intensive Care Units, Neonatal , Odds Ratio , Survival Analysis , Respiratory Sounds/diagnosis , Prevalence , Risk Factors , Socioeconomic Factors , Brazil , Bronchopulmonary Dysplasia/complications , Medical Records , Cross-Sectional Studies , Infant, Extremely Low Birth Weight
3.
Medisan ; 25(2)mar.-abr. 2021. tab
Article in Spanish | LILACS, CUMED | ID: biblio-1250341

ABSTRACT

Introducción: La neumonía asociada a la ventilación mecánica es una infección, que se relaciona con los cuidados sanitarios. Objetivo: Caracterizar clínica y epidemiológicamente a niños y adolescentes con neumonía asociada a la ventilación mecánica, según variables seleccionadas. Método: Se realizó un estudio descriptivo y transversal de 36 pacientes con neumonía asociada a la ventilación mecánica, ingresados en la Unidad de Cuidados Intensivos del Hospital Infantil Norte Dr. Juan de la Cruz Martínez Maceira de Santiago de Cuba, desde enero del 2017 hasta diciembre del 2018. Resultados: Se halló un predominio de los pacientes menores de 5 años de edad (80,6 %), del sexo masculino (66,7 %), la ventilación mecánica prolongada (69,4 %) y las neumonías asociadas a la ventilación de aparición tardía relacionadas con la mortalidad. Los microorganismos más frecuentes resultaron ser los gramnegativos. La combinación de cefalosporinas y vancomicina fue la más utilizada. Conclusiones: La evolución de los pacientes dependió del tiempo de inicio, el microorganismo predominante y el tratamiento antimicrobiano empleado.


Introduction: The pneumonia associated with the mechanical ventilation is an infection that is related to the sanitary cares. Objective: To characterize clinical and epidemiologically children and adolescents with pneumonia associated with the mechanical ventilation, according to selected variables. Method: A descriptive and cross-sectional study of 36 patients with pneumonia associated with mechanical ventilation admitted in the Intensive Cares Unit of Dr. Juan de la Cruz Martínez Maceira Northern Children Hospital; was carried out in Santiago de Cuba, from January, 2017 to December, 2018. Results: There was a prevalence of the patients under 5 years (80.6 %), the male sex (66.7 %), the long lasting mechanical ventilation (69.4 %) and pneumonias associated with the ventilation of late appearance related to mortality. The most frequent microorganisms were the Gram negative. The combination of cephalosporins and vancomycin were the most used. Conclusions: The clinical course of the patients depended on the time of beginning, the predominant microorganism and the antimicrobial treatment used.


Subject(s)
Pneumonia, Ventilator-Associated/therapy , Pneumonia, Ventilator-Associated/epidemiology , Respiration, Artificial/adverse effects , Child, Preschool , Adolescent
4.
J. bras. pneumol ; 47(1): e20190286, 2021. tab, graf
Article in English | LILACS | ID: biblio-1154691

ABSTRACT

ABSTRACT Objective: In ICU patients on mechanical ventilation (MV), ventilator-associated pneumonia (VAP) is a common infection. However, such infection can be prevented through oral care protocols. The objective of this study was to compare the efficiency of the use of chlorhexidine and oral hygiene protocols (brushing and clinical procedures) with that of the use of chlorhexidine alone (intervention group and control group, respectively) in decreasing the prevalence of VAP in patients ≥ 18 years of age admitted to the ICU and requiring MV. Methods: In this systematic review and meta-analysis, studies were identified through searches of various national and international databases, as well as of the gray literature, and were selected in accordance with eligibility criteria. Results: We evaluated six studies, involving a collective total of 1,276 patients. We classified the risk of bias as low in three studies, high in two, and uncertain in one; among the six risk domains evaluated, a low risk of bias was predominant in five. The results for random risks were similar in terms of direction and statistical magnitude-chi-square = 6.34; risk difference: −0.06 (95% CI: −0.11 to −0.02); I2 = 21%; p = 0.007. There was a decrease in the prevalence of VAP in the intervention group (n = 1,276) included in the meta-analysis. Conclusions: Protocols that include the mechanical removal of oral biofilm in combination with the use of chlorhexidine can reduce the incidence of VAP among ICU patients requiring MV.


RESUMO Objetivo: A pneumonia associada à ventilação mecânica (PAVM) é uma infecção frequente em UTI. No entanto, essa infecção pode ser evitada através de protocolos de cuidados orais. O objetivo deste estudo foi comparar a eficiência de protocolos de higiene bucal (escovação e procedimentos clínicos) aliados ao uso de clorexidina (grupo intervenção) com a de protocolos que fazem uso somente de clorexidina (grupo controle) na diminuição da prevalência da PAVM em pacientes adultos (≥ 18 anos) internados em UTI sob VM. Métodos: Nesta revisão sistemática e meta-análise, várias bases de dados nacionais e internacionais foram utilizadas para a identificação e seleção de estudos e literatura cinza seguindo critérios de elegibilidade. Resultados: Foram incluídos seis estudos, envolvendo 1.276 pacientes. Após a classificação dos estudos, três apresentaram baixo risco de viés, dois apresentaram risco de viés alto, e o risco foi incerto em um; entre os seis domínios avaliados houve predomínio de baixo risco de viés em cinco deles. Os resultados para riscos aleatórios foram semelhantes em direção e magnitude estatística - qui-quadrado = 6,34; diferença de risco: −0,06 (IC95%: −0,11 a −0,02); I2 = 21%; p = 0,007. Houve diminuição na prevalência de PAVM no grupo intervenção (n = 1.276) incluídos na meta-análise. Conclusões: Protocolos que incluem a remoção mecânica do biofilme associada ao uso de clorexidina podem reduzir a incidência de PAVM em pacientes internados em UTI sob VM.


Subject(s)
Humans , Oral Hygiene , Chlorhexidine/therapeutic use , Pneumonia, Ventilator-Associated/prevention & control , Respiration, Artificial/adverse effects , Toothbrushing
5.
J. bras. pneumol ; 47(1): e20200360, 2021. tab, graf
Article in English | LILACS | ID: biblio-1154677

ABSTRACT

ABSTRACT Objective: To evaluate the association that protective mechanical ventilation (MV), based on VT and maximum distending pressure (MDP), has with mortality in patients at risk for ARDS. Methods: This was a prospective cohort study conducted in an ICU and including 116 patients on MV who had at least one risk factor for the development of ARDS. Ventilatory parameters were collected twice a day for seven days, and patients were divided into two groups (protective MV and nonprotective MV) based on the MDP (difference between maximum airway pressure and PEEP) or VT. The outcome measures were 28-day mortality, ICU mortality, and in-hospital mortality. The risk factors associated with the adoption of nonprotective MV were also assessed. Results: Nonprotective MV based on VT and MDP was applied in 49 (42.2%) and 38 (32.8%) of the patients, respectively. Multivariate Cox regression showed that protective MV based on MDP was associated with lower in-hospital mortality (hazard ratio = 0.37; 95% CI: 0.19-0.73) and lower ICU mortality (hazard ratio = 0.40; 95% CI: 0.19-0.85), after adjustment for age, Simplified Acute Physiology Score 3, and vasopressor use, as well as the baseline values for PaO2/FiO2 ratio, PEEP, pH, and PaCO2. These associations were not observed when nonprotective MV was based on the VT. Conclusions: The MDP seems to be a useful tool, better than VT, for adjusting MV in patients at risk for ARDS.


RESUMO Objetivo: Avaliar a associação da ventilação mecânica (VM) protetora, com base no VT e na pressão de distensão máxima (PDM), com a mortalidade em pacientes com fator de risco para SDRA. Métodos: Este estudo de coorte prospectivo foi conduzido em uma UTI e incluiu 116 pacientes em VM que apresentavam pelo menos um fator de risco para o desenvolvimento de SDRA. Os parâmetros ventilatórios foram coletados duas vezes ao dia durante sete dias, e os pacientes foram divididos em dois grupos (VM protetora e VM não protetora) com base na PDM (diferença entre pressão máxima de vias aéreas e PEEP) ou no VT. Os desfechos foram mortalidade em 28 dias, mortalidade na UTI e mortalidade hospitalar. Os fatores de risco associados com a adoção da VM não protetora também foram avaliados. Resultados: A VM não protetora com base no VT e na PDM ocorreu em 49 (42,2%) e em 38 (32,8%) dos pacientes, respectivamente. A regressão multivariada de Cox mostrou que a VM protetora com base na PDM associou-se a menor mortalidade hospitalar (hazard ratio = 0,37; IC95%: 0,19-0,73) e em UTI (hazard ratio = 0,40; IC95%, 0,19-0,85), após ajuste para idade, Simplified Acute Physiology Score 3, uso de vasopressor e valores basais de PaO2/FiO2, PEEP, pH e PaCO2. Essas associações não foram observadas quando a VM não protetora foi baseada no VT. Conclusões: A PDM parece ser uma ferramenta útil, melhor do que o VT, para o ajuste da VM em pacientes sob risco para SDRA.


Subject(s)
Humans , Respiration, Artificial/adverse effects , Respiratory Distress Syndrome, Newborn , Respiratory Distress Syndrome, Newborn/etiology , Prospective Studies , Risk Factors , Positive-Pressure Respiration
7.
J. bras. pneumol ; 47(3): e20200569, 2021. tab, graf
Article in English | LILACS | ID: biblio-1279285

ABSTRACT

ABSTRACT Objective: Ventilator-associated pneumonia (VAP) is a serious complication of mechanical ventilation (MV). However, data on VAP in patients on prolonged MV (PMV) are scarce. We aimed to describe the characteristics of VAP patients on PMV and to identify factors associated with mortality. Methods: This was a retrospective cohort study including VAP patients on PMV. We recorded baseline characteristics, as well as 30-day and 90-day mortality rates. Variables associated with mortality were determined by Kaplan-Meier survival analysis and Cox regression model. Results: We identified 80 episodes of VAP in 62 subjects on PMV. The medians for age, Charlson Comorbidity Index, SOFA score, and days on MV were, respectively, 69.5 years, 5, 4, and 56 days. Episodes of VAP occurred between days 21 and 50 of MV in 28 patients (45.2%) and, by day 90 of MV, in 48 patients (77.4%). The 30-day and 90-day mortality rates were 30.0% and 63.7%, respectively. There were associations of 30-day mortality with the SOFA score (hazard ratio [HR] = 1.30; 95% CI: 1.12-1.52; p < 0.001) and use of vasoactive agents (HR = 4.0; 95% CI: 1.2-12.9; p = 0.02), whereas 90-day mortality was associated with age (HR = 1.03; 95% CI: 1.00-1.05; p = 0.003), SOFA score (HR = 1.20; 95% CI: 1.07-1.34; p = 0.001), use of vasoactive agents (HR = 4.07; 95% CI: 1.93-8.55; p < 0.001), and COPD (HR = 3.35; 95% CI: 1.71-6.60; p < 0.001). Conclusions: Mortality rates in VAP patients on PMV are considerably high. The onset of VAP can occur various days after MV initiation. The SOFA score is useful for predicting fatal outcomes. The factors associated with mortality could help guide therapeutic decisions and determine prognosis.


RESUMO Objetivo: A pneumonia associada à ventilação mecânica (PAVM) é uma séria complicação da ventilação mecânica (VM). Entretanto, dados sobre PAVM em pacientes em VM prolongada (VMP) são escassos. Nosso objetivo foi descrever as características de pacientes com PAVM em VMP e identificar fatores associados à mortalidade. Métodos: Estudo de coorte retrospectivo incluindo pacientes com PAVM em VMP. Foram registradas características basais, bem como as taxas de mortalidade em 30 e 90 dias. As variáveis associadas à mortalidade foram determinadas por meio da análise de sobrevida de Kaplan-Meier e do modelo de regressão de Cox. Resultados: Foram identificados 80 episódios de PAVM em 62 indivíduos em VMP. As medianas de idade, índice de comorbidade de Charlson, pontuação no SOFA, e dias em VM foram, respectivamente, de 69,5 anos, 5, 4 e 56 dias. Os episódios de PAVM ocorreram entre o 21º e o 50º dia de VM em 28 pacientes (45,2%) e até o 90º dia de VM em 48 pacientes (77,4%). As taxas de mortalidade em 30 e 90 dias foram de 30,0% e 63,7%, respectivamente. A mortalidade em 30 dias associou-se a pontuação no SOFA (razão de risco [RR] = 1,30; IC95%: 1,12-1,52; p < 0,001) e uso de drogas vasoativas (RR = 4,0; IC95%: 1,2-12,9; p = 0,02), enquanto a mortalidade em 90 dias associou-se a idade (RR = 1,03; IC95%: 1,00-1,05; p = 0,003), pontuação no SOFA (RR = 1,20; IC95%: 1,07-1,34; p = 0,001), uso de drogas vasoativas (RR = 4,07; IC95%: 1,93-8,55; p < 0,001) e DPOC (RR = 3,35; IC95%: 1,71-6,60; p < 0,001). Conclusões: As taxas de mortalidade em pacientes com PAVM em VMP são consideravelmente altas. O início da PAVM pode ocorrer vários dias após a instituição da VM. O escore SOFA é útil para predição de desfechos fatais. Os fatores associados à mortalidade podem ajudar a orientar as decisões terapêuticas e a determinar o prognóstico.


Subject(s)
Humans , Aged , Pneumonia, Ventilator-Associated/etiology , Respiration, Artificial/adverse effects , Retrospective Studies , Risk Factors , Organ Dysfunction Scores , Intensive Care Units
8.
Acta otorrinolaringol. cir. cabeza cuello ; 49(2): 112-120, 2021. TAB, ILUS, GRAF
Article in Spanish | LILACS | ID: biblio-1253865

ABSTRACT

Resumen Introducción: actualmente los profesionales de la salud se enfrentan al manejo de las vías aéreas artificiales en grupos pediátricos, esto requiere de cuidados delicados y mucha atención para detectar, establecer y manejar situaciones apremiantes; por esta razón, existe un mayor riesgo de aparición de infecciones bacterianas traqueopulmonares. El objetivo del estudio fue analizar la caracterización de las infecciones en pacientes pediátricos portadores de cánula de traqueotomía en las diferentes publicaciones científicas. Materiales y métodos: se realizó una revisión sistemática mediante la búsqueda de la literatura existente entre los años 2015-2020 en las bases de datos Elsevier, PubMed, Google Académico y SciELO, teniendo en cuenta los criterios de inclusión artículos en idioma inglés, español y población de edad entre los 0-15 años con infección de cánula de traqueotomía en los años 2015-2020. Resultados: de 258 artículos distribuidos en las bases de datos, se seleccionaron 21 artículos que cumplían con los criterios de inclusión. Conclusiones: a pesar de que en la actualidad existan criterios clínicos, factores de riesgo y pruebas de laboratorio asociados a infecciones de la cánula postraqueotomía en pacientes pediátricos, se requiere mayor investigación para definir las guías clínicas de manejo en la toma de decisiones médicas. Asimismo, se consideró como limitación importante la cantidad de literatura existente con respecto al tema.


Abstract Introduction: Currently, health professionals face the management of artificial airways in pediatric groups, this requires delicate care and a lot of attention to detect, establish and manage pressing situations, which is why there is a greater risk of tracheo-pulmonary bacterial infections. The objective was to analyze the characterization of infections in pediatric patients with tracheostomy tubes in the different scientific publications. Method: A systematic review of the literature was carried out between the years 2015-2020 in Elsevier, PubMed, Google Academic and SciELO databases, taking into account the inclusion criteria of the population aged 0-15 years in the years 2015-2020. The amount of existing literature on the subject was considered an important limitation. Results: From 258 articles distributed in the databases, 21 articles were selected that met the inclusion criteria. Conclusions: Although there are currently clinical criteria, risk factors and laboratory tests associated with infections of the post-tracheotomy tube in pediatric patients, further research is required to define clinical guidelines for management in medical decision-making.


Subject(s)
Humans , Male , Female , Infant, Newborn , Infant , Child, Preschool , Child , Adolescent , Bacterial Infections/etiology , Tracheitis/microbiology , Tracheotomy/adverse effects , Bronchitis/microbiology , Cannula/adverse effects , Respiration, Artificial/adverse effects , Bacterial Infections/diagnosis , Bacterial Infections/drug therapy , Tracheitis/diagnosis , Tracheitis/drug therapy , Bronchitis/diagnosis , Bronchitis/drug therapy
9.
Int. j. odontostomatol. (Print) ; 14(4): 701-704, dic. 2020. graf
Article in Spanish | LILACS | ID: biblio-1134560

ABSTRACT

RESUMEN: El objetivo de este artículo es presentar algunas consideraciones odontológicas y un protocolo de mantención para el manejo y cuidado de cavidad oral en pacientes en ventilación mecánica invasiva (VMI) en unidades de cuidados intensivos hospitalarios. Además, presentar recomendaciones para la implementación de estas. Desde el desarrollo del COVID-19 en el mundo, los casos de VMI prolongada han aumentado y junto con ellos, se ha visibilizado las complicaciones propias de este tipo de terapia, dentro de las cuales encontramos aquellas que afectan la cavidad oral. Los centros hospitalarios normalmente cuentan con servicios dentales conformados por distintas especialidades, las cuales en un trabajo mancomunado pueden entregar herramientas y educar al personal encargado para el cuidado de la cavidad oral en estos pacientes si es que son requeridos, siendo el odontólogo el encargado de evaluar las distintas situaciones clínicas y entregar directrices para la prevención y tratamiento de patología de la cavidad oral. En este trabajo se describen los pasos a seguir para realizar una correcta higiene oral de estos pacientes y el manejo de las distintas complicaciones posibles de observar, junto con la experiencia local de cómo solucionarlos de la mejor manera. Consideramos importante que las unidades de cuidados intensivos (UCI) conozcan el rol del odontólogo y las acciones que este equipo puede aportar en el cuidado de los pacientes hospitalizados para disminuir los riesgos asociados a ventilación prolongada, basados principalmente en el manejo de la higiene oral y lesiones asociadas.


ABSTRACT: The aim of this sutudy dental considerations and an oral cavity maintenance and care protocol in patients on invasive mechanical ventilation (IMV) in hospital intensive care units. Since the development of COVID-19 in the world, cases of prolonged IMV have increased and together with them, the complications of this type of therapy have been made visible, among which we find those that affect the oral cavity. Hospital centers normally have dental services made up of different specialties, which in a joint effort can provide tools and educate the personnel in charge of the care of the oral cavity in these patients if they are required, being the dentist the one in charge of evaluating and deliver guidelines for the prevention and treatment of pathology of the oral cavity. This work describes the steps to be followed to carry out correct oral hygiene in these patients and the management of the different complications that may be observed, along with local experience on how to best solve them. We consider important that the intensive care units (ICU) get to know the role of the dentist in the hospital environment and that they become part of the care of hospitalized patients to reduce the risks associated with prolonged ventilation, based mainly on oral hygiene management and associated injuries.


Subject(s)
Humans , Patient Care Team , Respiration, Artificial/adverse effects , Dental Care/instrumentation , COVID-19 , Intubation, Intratracheal/adverse effects , Clinical Protocols , Intensive Care Units
10.
Rev. medica electron ; 42(5): 2233-2247, sept.-oct. 2020. tab, graf
Article in Spanish | LILACS, CUMED | ID: biblio-1144730

ABSTRACT

RESUMEN Introducción: la presencia de la ventilación mecánica, crea interrogantes vinculadas con la importancia de conocer la influencia del estado nutricional y su asociación con factores de riesgo. Objetivo: relacionar el estado nutricional según indicadores antropométricos agrupados con variables sociodemográficas, clínicas y de laboratorio. Las que fueron estudiadas en pacientes ventilados artificialmente al ingreso en Unidad de Cuidados Intensivos del Hospital Universitario "Celia Sánchez Manduley", durante los años 2017 al 2018. Materiales y método: se realizó un estudio observacional, analítico de cohorte prospectiva, con pacientes que cumplieron con los criterios de inclusión. Se utilizaron técnicas de estadística descriptiva, medidas de tendencia central y dispersión. El nivel de significación de se halló según p valor ≤ 0,05 a través de Chi cuadrado de Pearson (X2) y la prueba T de student. Resultados: el sexo masculino y la edad mayor de 60 años estuvieron significativamente asociados a los ventilados desnutridos. La medición de los indicadores bioquímicos aislados no fue significativamente útil para la evaluación del estado nutricional en estos pacientes. Conclusiones: la comorbilidad, las infecciones nosocomiales, la ventilación de mediana duración y las entidades clínicas neurológicas, predominaron con alta mortalidad al egreso, pero sin asociación significativa al estado nutricional (AU).


ABSTRACT Introduction: the presence of mechanical ventilation brings about questions related to the importance of knowing the influence of the nutritional status and its relation with risks factors. Objective: to establish a relationship of the nutritional status according to grouped anthropometric indicators with laboratory, clinical and socio-demographic variables that were studied in artificially ventilated patients when admitting them in the Intensive Care Unit of the University Hospital "Celia Sánchez Manduley", during 2017 and 2018. Materials and method: a cohort, prospective, analytical, observational study was carried out with patients who fulfilled the inclusion criteria. Different techniques of descriptive statistics were used, together of with measures of central tendency and dispersion. The level of significance was determined according to value p ≤ 0,05 by means of Pearson's Chi Squared (X2) and the student T test. Results: male sex and ages over 60 years were significantly associated to malnutritioned ventilated patients. Measuring isolated biochemical indicators was not significantly useful to assess nutritional status in these patients. Conclusions: comorbidity, nosocomial infections, average lasting ventilation, and neurological clinical entities predominated, with high mortality at discharging, but without significant association to the nutritional status (AU).


Subject(s)
Humans , Male , Female , Patients , Respiration, Artificial/adverse effects , Nutritional Status/physiology , Clinical Diagnosis , Risk Factors , Clinical Laboratory Techniques/methods , Malnutrition/complications , Intensive Care Units
11.
Rev. cuba. anestesiol. reanim ; 19(2): e598, mayo.-ago. 2020. tab
Article in Spanish | LILACS, CUMED | ID: biblio-1126356

ABSTRACT

Introducción: La desnutrición en pacientes ingresados en una sala de terapia intensiva es elevada, pero en el anciano crítico es aún mayor, con repercusión sobre el aparato respiratorio, prolongación de la ventilación y otras complicaciones. Objetivo: Caracterizar el estado nutricional en pacientes geriátricos con ventilación mecánica en una unidad de cuidados intensivos. Métodos: Se realizó un estudio descriptivo, prospectivo y de corte transversal durante el periodo de enero de 2017 a marzo de 2019 en la unidad de cuidados intensivos del Hospital General Docente "Orlando Pantoja Tamayo". Se estudiaron 83 pacientes con edades mayor o igual a 60 años, los cuales requirieron del uso de ventilación mecánica más de 24 h. El estado nutricional fue evaluado con el empleo del índice de control nutricional. Resultados: Predominó el sexo masculino, el grupo de edades de 60 a 74 años, y las enfermedades tipo quirúrgicas. Solo 9,1 % de los que recibieron ventilación mecánica invasiva no estaban desnutrido. Los que fallecieron tenían desnutrición moderada o severa. Conclusiones: En los pacientes geriátricos ventilados, ingresados en la unidad de cuidados intensivos, se encontró un alto grado de malnutrición. La desnutrición moderada o severa predominó en la mayoría de los que recibieron ventilación mecánica invasiva y en el grupo de fallecidos(AU)


Introduction: Malnutrition in patients hospitalized in an intensive care room is high, but it is even higher in the critically-ill elderly patient, with repercussions on the respiratory system, prolonged ventilation, and other complications. Objective: To characterize the nutritional status of geriatric patients under mechanical ventilation in an intensive care unit. Methods: A descriptive, prospective and cross-sectional study was carried out during the period from January 2017 to March 2019, in the intensive care unit of Orlando Pantoja Tamayo General Teaching Hospital. 83 patients aged 60 or older were studied; they required mechanical ventilation for more than 24 hours. The nutritional status was evaluated with the use of the nutritional control score. Results: There was a predominance of the male sex, the age group 60-74 years, and of surgical diseases. Only 9.1% of those who received invasive mechanical ventilation were not undernourished. Those who died had moderate or severe undernutrition. Conclusions: In ventilated geriatric patients hospitalized in the intensive care unit, a high degree of malnutrition was found. Moderate or severe malnutrition predominated in the majority of those who received invasive mechanical ventilation and in the group of the deceased(AU)


Subject(s)
Humans , Aged , Aged, 80 and over , Respiration, Artificial/adverse effects , Malnutrition/complications , Malnutrition/epidemiology , Nutrition Surveys/standards , Epidemiology, Descriptive , Cross-Sectional Studies , Prospective Studies , Critical Care Outcomes , Intensive Care Units/statistics & numerical data
12.
Fisioter. Pesqui. (Online) ; 27(1): 34-40, jan.-mar. 2020. tab, graf
Article in Portuguese | LILACS | ID: biblio-1090406

ABSTRACT

RESUMO Na unidade de terapia intensiva (UTI) pediátrica, a falha de extubação pode aumentar o risco de mortalidade. Este estudo objetivou: (1) verificar a taxa de falha de extubação na UTI pediátrica de um hospital público do município de Bauru (São Paulo, Brasil); (2) identificar a principal causa atribuída à falha de extubação; (3) avaliar se características como a idade e o tempo de ventilação mecânica invasiva (VMI) estão associadas à falha de extubação; (4) avaliar se o tempo de permanência na UTI e hospital é maior entre os pacientes que apresentaram falha de extubação. Foi realizado estudo de coorte retrospectivo com 89 pacientes internados de maio de 2017 até julho de 2018. Os resultados mostraram taxa de falha de extubação correspondente a 16%. A principal causa atribuída à falha de extubação foi o estridor laríngeo, totalizando 57% dos casos. A comparação intergrupos (sucesso vs. falha de extubação) não mostrou diferenças em relação à idade (p=0,294) e ao tempo de VMI (p=0,228). No entanto, observamos que o grupo falha de extubação apresentou maior tempo de UTI (p=0,000) e hospital (p=0,010). Desta forma, concluímos que a taxa de extubação está de acordo com a observada em outros estudos. O estridor laríngeo foi responsável por mais da metade dos casos de falha de extubação. Embora a idade e o tempo de VMI não tenham sido características associadas à falha de extubação, esta contribuiu para o maior período de permanência na UTI e no hospital.


RESUMEN En la unidad de cuidados intensivos (UCI) pediátrica, el fracaso de la extubación puede aumentar el riesgo de mortalidad. Este estudio tuvo el objetivo de: (1) verificar el índice de fracaso de la extubación en la UCI pediátrica de un hospital público en el municipio de Bauru (São Paulo, Brasil); (2) identificar la causa principal atribuida al fracaso de la extubación; (3) evaluar si las características edad y tiempo de ventilación mecánica invasiva (VMI) están asociadas al fracaso de la extubación; (4) evaluar si la duración en la UCI y el hospital es mayor entre los pacientes que experimentaron este fracaso. Se realizó un estudio de cohorte retrospectivo con 89 pacientes hospitalizados desde mayo de 2017 hasta julio de 2018. Los índices del fracaso de la extubación fueron del 16%. El estridor laríngeo fue la causa principal atribuida al fracaso de la extubación, lo que totaliza el 57% de los casos. La comparación intergrupal (éxito versus fracaso de la extubación) no presentó diferencias en relación con la edad (p=0,294) y el tiempo VMI (p=0,228). Se observó que el grupo fracaso de la extubación estuvo más tiempo en la UCI (p=0,000) y el hospital (p=0,010). Se concluye que el índice de extubación está en consonancia con lo observado en otros estudios. El estridor laríngeo fue el responsable de más de la mitad de los casos de fracaso de la extubación. Las características edad y el tiempo de VMI no estuvieron asociadas al fracaso de la extubación, pero esta contribuyó a un período más prolongado en la UCI y en el hospital.


ABSTRACT In the pediatric intensive care unit (ICU), extubation failure may increase mortality risk. This study aimed: (1) to verify the rate of extubation failure in the pediatric ICU of a public hospital located in the city of Bauru (São Paulo, Brazil); (2) to identify the main cause attributed to extubation failure; (3) to evaluate whether age and time of invasive mechanical ventilation (IMV) are characteristics associated to extubation failure; (4) to evaluate whether the length of stay in the ICU/hospital is longer among patients who presented extubation failure. A retrospective study was performed with 89 hospitalized patients from May 2017 to July 2018. Results showed an extubation failure rate corresponding to 16%. The main cause attributed to extubation failure was laryngeal stridor, totaling 57% of the cases. Intergroup comparison (success vs. failure of extubation) showed no differences in relation to age (p=0.294) and IMV time (p=0.228). However, we observed that the extubation failure group had longer ICU (p=0.000) and hospital time (p=0.010). In this way, we conclude that the rate of extubation failure is in agreement with other studies. Laryngeal stridor was responsible for more than half of cases of extubation failure. Although IMV time and age were not associated with the extubation failure, they contributed to a longer stay in the ICU and in the hospital.


Subject(s)
Humans , Male , Female , Infant, Newborn , Infant , Child, Preschool , Child , Adolescent , Respiration, Artificial/adverse effects , Intensive Care Units, Pediatric/statistics & numerical data , Airway Extubation/adverse effects , Respiration, Artificial/statistics & numerical data , Time Factors , Respiratory Sounds/etiology , Retrospective Studies , Risk Factors , Cohort Studies , Age Factors , Treatment Failure , Electronic Health Records , Airway Extubation/statistics & numerical data , Length of Stay
16.
Rev Assoc Med Bras (1992) ; 66(Suppl 2): 96-101, 2020. tab, graf
Article in English | SES-SP, LILACS, SES-SP | ID: biblio-1136393

ABSTRACT

SUMMARY COVID-19, caused by SARS-CoV-2, can present respiratory complications that often lead patients to depend on mechanical ventilation (MV) for several days. It is known that Pneumonia Associated with Mechanical Ventilation (PAMV) is frequent in patients who use this equipment for a long time. As a consequence of COVID-19, its prolonged use can lead to a worse prognosis for the patients. For this reason, in addition to the insufficiency of devices for mechanical ventilation to meet the current demand, it is necessary to adopt measures aimed at preventing complications that may aggravate the patient's clinical condition and, consequently, increase the average hospital stay and the respective hospital care costs. Therefore, the objective of this study was to discuss, in a concise and practical way, and based on the available literature, the importance of adopting adequate oral hygiene protocols for patients on mechanical ventilation. Based on the data obtained, it was identified that the adoption of effective oral hygiene measures, especially under the supervision of dental professionals, can contribute to the reduction of morbidity and mortality associated with MV, resulting in greater availability of mechanical ventilation equipment. Since such equipment is in great demand during the COVID-19 pandemic, the knowledge and implementation of effective oral hygiene measures will undoubtedly have an impact on improving the quality of care offered to patients, therefore benefiting all those in critical health conditions and assisted in ICUs.


RESUMO A COVID-19, causada pelo Sars-CoV-2, pode apresentar complicações respiratórias que, muitas vezes, levam o paciente a depender da ventilação mecânica por vários dias. Sabe-se que a Pneumonia Associada à Ventilação Mecânica (PAVM) é frequente nos pacientes que utilizam esse equipamento por um longo período de tempo e que sua ocorrência, consequente à COVID-19, pode cursar com um pior prognóstico para o paciente. Por esse motivo, e somado à insuficiência de aparelhos para atendimento da demanda atual, faz-se necessária a adoção de medidas que visem à prevenção de complicações que possam agravar o quadro clínico do paciente e, consequentemente, aumentar o tempo médio de internação e os respectivos custos da assistência. Sendo assim, o objetivo deste estudo foi discorrer de forma concisa e prática, com base na literatura disponível, sobre a importância da adoção de protocolos adequados de higiene oral nos pacientes em ventilação mecânica. Com base nos dados obtidos, identificou-se que a adoção de medidas efetivas de higiene oral, principalmente sob a supervisão do profissional dentista, pode contribuir para a redução da morbimortalidade associada à PAVM, resultando em maior disponibilidade de equipamentos de ventilação mecânica. Desde que tais equipamentos estão sendo muito demandados durante a pandemia da COVID-19, o conhecimento e a implantação de medidas efetivas de higiene oral, indubitavelmente, repercutirão na melhoria da qualidade da assistência oferecida aos pacientes, portanto, beneficiando todos aqueles em situação crítica de saúde e assistidos em UTIs.


Subject(s)
Humans , Oral Hygiene , Pneumonia, Viral/therapy , Respiration, Artificial/adverse effects , Coronavirus Infections/therapy , Pandemics , Pneumonia, Viral/epidemiology , Quality of Health Care , Toothbrushing/methods , Coronavirus Infections , Coronavirus Infections/epidemiology , Betacoronavirus , Intensive Care Units , Mouthwashes/therapeutic use
17.
Article in Chinese | WPRIM | ID: wpr-880769

ABSTRACT

OBJECTIVE@#To elucidate the pathogenic role of leukotriene B4 (LTB4) in pulmonary hyper-permeability and inflammation induced by lung-protective mechanical ventilation (LPMV) in rabbits.@*METHODS@#Thirty-two healthy Japanese white rabbits were randomized into 4 groups for treatment with vehicle or bestatin (a leukotriene A4 hydrolase inhibitor that inhibits LTB4 production) administered intragastrically at the daily dose of 8 mg/kg for 5 days, followed by sham operation (group S and group BS, respectively, in which the rabbits were anesthetized only) or LPMV (group PM and group BPM, respectively, in which the rabbits received ventilation with 50% oxygen at a tidal volume of 8 mL/kg for 5 h). The concentrations of LTB4 and cyclic adenosine monophosphate (cAMP) in the lung tissues were analyzed by ELISA. cAMP content, protein kinase A (PKA) protein expression and the Rap1-GTP protein to total Rap1 protein ratio were determined to assess the activities of cAMP/PKA and Rap1 signaling pathways. The lung injury was evaluated by assessing lung permeability index, lung wet/dry weight ratio, polymorphonuclear leukocyte (PMN) count in bronchoalveolar lavage fluid (BALF), pulmonary myeloperoxidase (MPO) activity and lung histological scores.@*RESULTS@#None of the examined parameters differed significantly between group S and group BS. All the parameters with the exception of lung histological score increased significantly in group PM and group BPM as compared to those in group S (@*CONCLUSIONS@#LPMV can induce LTB4 overproduction to down-regulate cAMP/PKA and Rap1 signaling pathways in the lungs of rabbits, which results in lung hyper-permeability and inflammation. Bestatin can inhibit LTB4 production in the lungs to protect against LPMV-induced lung hyper-permeability and inflammation.


Subject(s)
Animals , Bronchoalveolar Lavage Fluid , Leukotriene B4 , Lung , Lung Injury/prevention & control , Neutrophils , Rabbits , Respiration, Artificial/adverse effects
18.
Rev. bras. ter. intensiva ; 31(4): 541-547, out.-dez. 2019. tab
Article in Portuguese | LILACS | ID: biblio-1058050

ABSTRACT

RESUMO As infecções do trato respiratório inferior associadas à ventilação mecânica são uma das complicações mais frequentes em pacientes em ventilação mecânica. Há muitos anos, a traqueobronquite associada à ventilação mecânica tem sido considerada uma doença que não demanda antibioticoterapia. Na última década, diversos estudos demonstraram que a traqueobronquite associada à ventilação mecânica deve ser considerada um processo intermediário que leva à pneumonia associada à ventilação mecânica, uma vez que apesar de ter impacto limitado sobre a mortalidade dos pacientes gravemente enfermos internados nas unidades de terapia intensiva, em contrapartida, demonstra associação significativa com o aumento dos custos hospitalares desses pacientes, assim como do tempo de internação na unidade de terapia intensiva e hospitalar, do uso de antibióticos, e da duração da ventilação mecânica. Embora ainda necessitemos de evidências científicas mais robustas, especialmente no que tange às modalidades terapêuticas, os dados atuais a respeito da traqueobronquite associada à ventilação mecânica salientam que há desfechos suficientemente importantes que exigem vigilância epidemiológica e controle clínico adequados.


ABSTRACT Ventilator-associated lower respiratory tract infection is one of the most frequent complications in mechanically ventilated patients. Ventilator-associated tracheobronchitis has been considered a disease that does not warrant antibiotic treatment by the medical community for many years. In the last decade, several studies have shown that tracheobronchitis could be considered an intermediate process that leads to ventilator-associated pneumonia. Furthermore, ventilator-associated tracheobronchitis has a limited impact on overall mortality but shows a significant association with increased patient costs, length of stay, antibiotic use, and duration of mechanical ventilation. Although we still need clear evidence, especially concerning treatment modalities, the present study on ventilator-associated tracheobronchitis highlights that there are important impacts of including this condition in clinical management and epidemiological and infection surveillance.


Subject(s)
Humans , Respiration, Artificial/adverse effects , Tracheitis/etiology , Bronchitis/etiology , Respiration, Artificial/methods , Respiratory Tract Infections/etiology , Respiratory Tract Infections/epidemiology , Tracheitis/epidemiology , Bronchitis/epidemiology , Pneumonia, Ventilator-Associated/epidemiology , Anti-Bacterial Agents/administration & dosage
19.
Rev. Assoc. Med. Bras. (1992) ; 65(7): 952-958, July 2019. tab, graf
Article in English | LILACS | ID: biblio-1013011

ABSTRACT

SUMMARY PURPOSE In this prospective observational study, we aimed to investigate the role of the maximum compressed (MC) and uncompressed (UC) thickness of the quadriceps femoris muscle (QFMT) measured by ultrasonography (USG) in the detection of nutritional risk in intensive care patients (ICPs) with different volume status. METHODS 55 patients were included. Right, left, and total ucQFMT and mcQFMT measurements were obtained by a standard USG device within the first 48 hours after ICU admission. Clinical examination and the USG device were used to determine the volume status of the patients. SOFA, APACHE II, modified NUTRIC scores, and demographic data were collected. RESULTS There was a significant difference between the nutritional risk of patients in terms of left, right, and total mcQFMT measurements (p=0.025, p=0.039; p=0.028, respectively), mechanical ventilation requirement (p=0.014), presence of infection (p=0.019), and sepsis (p=0.006). There was no significant difference between different volume statuses in terms of mcQFMT measurements. In the multi-variance analysis, mcQFMT measurements were found to be independently associated with high nutritional risk (p=0.019, Exp(B)=0.256, 95%CI=0.082-0.800 for modified NUTRIC score ≥ 5), and higher nutritional risk (p=0.009, Exp(B)=0.144, 95%CI=0.033-0.620 for modified NUTRIC score ≥ 6). a Total mcQFMT value below 1.36 cm was a predictor for higher nutritional risk with 79% sensitivity and 70% specificity (AUC=0.749, p=0.002, likelihood ratio=2.04). CONCLUSION Ultrasonographic measurement of total mcQFMT can be used as a novel nutritional risk assessment parameter in medical ICPs with different volume statuses. Thus, patients who could benefit from aggressive nutritional therapy can be easily identified in these patient groups.


RESUMO OBJETIVO Neste estudo observacional prospectivo, objetivamos investigar o papel da espessura do músculo quadríceps femoral (QFMT) comprimido (mc) e não comprimido (uc) medida pela ultrassonografia (USG) na detecção do risco nutricional em pacientes de terapia intensiva (ICPs) com status de volume diferente. MÉTODOS Cinquenta e cinco pacientes foram incluídos. As medidas direita, esquerda e total de ucQFMT e mcQFMT foram obtidas por um dispositivo USG padrão nas primeiras 48 horas após a admissão na UTI. O exame clínico e o dispositivo USG foram usados para determinar o status volumétrico dos pacientes. Sofa, Apache II, escores Nutric modificados e dados demográficos foram coletados. RESULTADOS Houve diferença significativa entre o risco nutricional dos pacientes em termos de medidas da QTFMT esquerda, direita e total (p=0,025, p=0,039; p=0,028, respectivamente), necessidade de ventilação mecânica (p=0,014), presença de infecção (p=0,019) e sepse (p=0,006). Não houve diferença significativa entre os diferentes status de volume em termos de medidas de mcQFMT. Na análise de variância múltipla, verificou-se que as medidas da FCFMT estavam independentemente associadas a alto risco nutricional (p=0,019, Exp (B)=0,256, 95%CI=0,082-0,800 para escore Nutric modificado ≥ 5) e maior risco nutricional (p=0,009, Exp (B)=0,144, 95%CI=0,033-0,620 para o escore Nutric modificado ≥ 6). O valor total de mcQFMT abaixo de 1,36 cm foi um preditor de maior risco nutricional com sensibilidade de 79% e especificidade de 70% (ASC=0,749, p=0,002, razão de verossimilhança = 2,04). CONCLUSÃO A medida ultrassonográfica do mcQFMT total pode ser usada como um novo parâmetro de avaliação de risco nutricional em ICPs médicas com diferentes status de volume. Assim, pacientes que podem se beneficiar de uma terapia nutricional agressiva podem ser facilmente identificados nesses grupos de pacientes.


Subject(s)
Humans , Male , Female , Aged , Aged, 80 and over , Nutritional Status/physiology , Ultrasonography/methods , Quadriceps Muscle/pathology , Quadriceps Muscle/diagnostic imaging , Reference Values , Respiration, Artificial/adverse effects , Logistic Models , Nutrition Assessment , Prospective Studies , Sensitivity and Specificity , Critical Illness , Risk Assessment , APACHE , Malnutrition/physiopathology , Malnutrition/pathology , Malnutrition/diagnostic imaging , Nutrition Therapy/methods , Quadriceps Muscle/physiopathology , Intensive Care Units , Length of Stay , Middle Aged
20.
Rev. Assoc. Med. Bras. (1992) ; 65(6): 839-844, June 2019. tab
Article in English | LILACS | ID: biblio-1012996

ABSTRACT

SUMMARY OBJECTIVE: To verify the association between prone position, increased diuresis, and decreased cumulative fluid balance in critically ill pediatric patients who underwent mechanical ventilation (MV) for pulmonary causes and describe adverse events related to the use of the position. METHODS: This is a retrospective observational study. Patients aged between 1 month and 12 years who underwent MV for pulmonary causes, between January 2013 and December 2015, were selected and divided between those who were put on prone position (PG) and those who were not (CG) during the hospitalization at the Pediatric Intensive Care Unit (PICU). Data were analyzed longitudinally from D1 to D4. RESULTS: A total of 77 patients (PG = 37 and CG = 40) were analyzed. The general characteristics of both groups were similar. In the comparison between the groups, there was no increase in diuresis or decrease in cumulative fluid balance in the prone group. In the longitudinal analysis of D1 to D4, we saw that the PG presented higher diuresis (p = 0.034) and a lower cumulative fluid balance (p = 0.001) in D2. Regarding the use of diuretics, there was greater use of furosemide (P <0.001) and spironolactone (P = 0.04) in the PG. There was no increase in adverse events during the use of the prone position. CONCLUSION: The prone position was not associated with increased diuresis or decreased cumulative fluid balance in critically ill pediatric patients who underwent to MV for pulmonary causes.


RESUMO OBJETIVO: Verificar a associação entre posição prona, aumento da diurese e diminuição do balanço hídrico em pacientes pediátricos criticamente enfermos e submetidos à ventilação mecânica (VM) por causa pulmonar, além de descrever eventuais intercorrências relacionadas à aplicação dessa posição. MÉTODOS: Estudo observacional retrospectivo. Pacientes submetidos à VM por causa pulmonar, com idade entre 1 mês e 12 anos no período entre janeiro de 2013 e dezembro de 2015, foram selecionados e divididos entre os que receberam posição prona (GP) e os que não receberam (GC) durante a internação na Unidade de Terapia Intensiva Pediátrica (Utip). Os dados foram analisados longitudinalmente de D1 a D4. RESULTADOS: Foram analisados77 pacientes (GP=37 e GC=40). Em termos de características gerais, os grupos foram semelhantes entre si. Na comparação entre os grupos, não houve aumento da diurese ou diminuição do balanço hídrico cumulativo no grupo prona. Na análise longitudinal de D1 a D4, evidenciou-se que o GP apresentou maior diurese (p=0,034) e menor balanço hídrico cumulativo (p = 0,001) no D2. Com relação ao uso de diuréticos, houve maior uso de furosemida (P<0,001) e de espironolactona (P=0,04) no GP. Não houve aumento de eventos adversos durante a utilização da posição prona. CONCLUSÃO: A posição prona não demonstrou associação com aumento da diurese ou diminuição de balanço hídrico cumulativo em pacientes críticos pediátricos submetidos à VM por causa pulmonar.


Subject(s)
Humans , Male , Female , Infant, Newborn , Infant , Child, Preschool , Child , Respiration, Artificial/adverse effects , Water-Electrolyte Balance/physiology , Prone Position/physiology , Diuresis/physiology , Respiration, Artificial/mortality , Time Factors , Retrospective Studies , Treatment Outcome , Critical Illness , Length of Stay/statistics & numerical data
SELECTION OF CITATIONS
SEARCH DETAIL