RESUMO
Resumen: Introducción: en el contexto de la pandemia de SARS-CoV-2, diferentes autores propusieron adaptaciones a máscaras de buceo comerciales (máscaras modificadas, MM) para proporcionar oxigenoterapia a pacientes con o sin presión positiva. Hasta la fecha, ninguno ha evaluado su desempeño como interfaz para la ventilación no invasiva (VNI) en el modo de soporte de presión inspiratoria (PSI). Objetivos: desarrollar una interfaz de VNI utilizando MM y evaluar su rendimiento en comparación con una máscara oronasal (MC) convencional. Métodos: las MM se adaptaron como interfaces VNI utilizando dos piezas creadas mediante impresión 3D. Se comparó su desempeño contra una MC en 10 voluntarios sanos en modo PSI (3 cmH2O) con dos niveles de presión positiva al final de la espiración (PEEP 4 y 8 cmH2O). Se compararon: fugas del sistema, frecuencia respiratoria, volumen corriente, oximetría de pulso, CO2 transcutáneo y comodidad. Resultados: con 4 cmH2O de PEEP no hubo diferencias significativas entre las máscaras en ninguna de las variables estudiadas. Con 8 cmH2O de PEEP, el uso de MM se asoció con un menor nivel de CO2tc (41,0±5,7 vs 43,5±8,1 mmHg; p=0,03) y un mayor confort (8,3±1,1 vs 6,5±1,4; p<0,01) que las MC. Conclusiones: el uso de MM para realizar VNI presenta, en voluntarios sanos, un rendimiento similar a las mascarillas oronasales estándar, con la ventaja de mayor comodidad y menor costo. Si bien restan estudios para avalar su utilización, en la emergencia sanitaria provocada por la pandemia SARS-CoV-2, la adaptación de máscaras de buceo podría representar una opción válida frente a la escasez de interfaces comerciales.
Abstract: Introduction: within the context of the SARS-CoV-2 pandemic, different authors proposed adaptations to snorkeling masks available in the market (modified masks: MM) to provide oxygen therapy with positive pressure ventilation or not. Until today, none of them has assessed its performance as an interface for non-invasive ventilation (NIV) in the inspiratory pressure support mode. Objective: to develop an interface of NIV using MM and assess its performance with a conventional full mask. Method: the MM were adapted as NIV interfaces using two pieces created by 3D printing. Their performance was compared to a that of a conventional mask in 10 healthy volunteers in inspiratory pressure support (3 cmH2O) mode with two levels of positive pressure towards the end of expiration (PEEP 4 and 8 cmH2O). The following were compared: system leaks, respiratory rate, normal volume, pulse oximetry, transcutaneous car bon dioxide and comfort. Results: with 4 cmH2O of PEEP, no significant differences were found between masks in none of the variables studied. With 8 cmH2O de PEEP, the use of MM were associated to a lower level of CO2tc (41.0±5.7 vs 43.5±8.1 mmHg; p=0.03) and greater comfort (8.3±1.1 vs 6.5±1.4; p<0.01) than conventional masks (CM). Conclusions: in healthy volunteers, MM for NIV evidence a similar performance than that of standard oronasal masks, and have a further advantage, as they are more comfortable and cheaper. Even if further studies are needed to support its use, modified snorkeling masks could represent a valid option during the health emergency caused by the SARS-CoV-2 pandemic in consideration of the scarce interfaces available in the market.
Resumo: Introdução: no contexto da pandemia de SARS-CoV2, diferentes autores propuseram adaptações às máscaras de mergulho comerciais (máscaras modificadas, MM) para fornecer oxigenoterapia a pacientes com ou sem pressão positiva. Até o momento, nenhum avaliou seu desempenho como interface para ventilação não invasiva (VNI) no modo de suporte de pressão inspiratória (PSI). Objetivos: desenvolver uma interface de VNI usando MM e avaliar seu desempenho em comparação com uma máscara oronasal convencional (MC). Métodos: as MMs foram adaptadas como interfaces VNI usando duas peças criadas por impressão 3D. Seu desempenho contra uma MC foi comparado em 10 voluntários saudáveis no modo PSI (3 cmH2O) com dois níveis de pressão positiva no final da expiração (PEEP 4 e 8 cmH2O). Vazamentos do sistema, frequência respiratória, volume corrente, oximetria de pulso, CO2 transcutâneo e conforto foram comparados. Resultados: com 4 cmH2O de PEEP, não se observaram diferenças significativas entre as máscaras em nenhuma das variáveis estudadas. Com PEEP de 8 cmH2O, o uso de MM foi associado a um menor nível de CO2tc (41,0 ± 5,7 vs 43,5 ± 8,1 mmHg; p = 0,03) e maior conforto (8,3 ± 1,1 vs 6,5 ± 1,4; p <0,01) do que a MC. Conclusões: o uso do MM para a realização da VNI apresenta, em voluntários saudáveis, desempenho semelhante às máscaras oronasais padrão, com a vantagem de maior conforto e menor custo. Embora ainda sejam necessários mais estudos que embasem seu uso, na emergência sanitária ocasionada pela pandemia do SARS-CoV-2, a adaptação de máscaras de mergulho pode representar uma opção válida diante da escassez de interfaces comerciais.
Assuntos
Respiração Artificial , Ventilação não Invasiva/métodos , COVID-19RESUMO
Resumen El presente trabajo indaga sobre la influencia de la depresión posparto (DPP) materna en las características prosódicas del Habla Dirigida al Bebé (HDB) y las emisiones preverbales infantiles en diversos contextos de interacción madre-hijo/a. Participaron 40 madres y sus bebés entre 3 y 6 meses de edad. Las madres fueron evaluadas con la Escala de DPP de Edimburgo (Cox, Holden y Sagoysky, 1987) y las díadas madre-hijo fueron filmadas en sesiones de juego no estructurado; 27 madres no presentaron indicadores de DPP y 13, sí. Las madres con DPP emitieron menor cantidad de vocalizaciones que las del grupo control y presentaron menor intensidad media y máxima al hablarle a sus bebés de 5-6 meses y esto fue particularmente observable en bebés varones (p < .07). Además, estas madres usaron menos curvas descendentes al dirigirse a bebés más pequeños (3-4 meses) y curvas ascendentes y descendentes al dirigirse a sus hijos varones (p < .01). En los bebés -tanto en los de 5-6 meses como en varones- (con madres con DPP se observó menor producción de emisiones preverbales, aunque sin ser significativa. La DPP materna impactó en los bebés más pequeños observándose una disminución de la frecuencia fundamental (p < .01) y de las intensidades media y máxima, pero solo en bebés varones (p < .05). También se halló una ausencia de curvas con forma de U en los varones e hijos de madres con DPP (p < .05). Aparentemente, la DPP afecta el HDB materno, el que varía a nivel acústico y prosódico en función de la edad del bebé afectando las emisiones preverbales, siendo mayor el impacto en los varones.
Abstract The present work aims to study the influence of postpartum depression (PPD) on the acoustic and melodic characteristics present in the vocal interaction between the mother and her baby. We analyze acoustic qualities of the mother's voice when she is talking to her baby (Infant-Directed Speech) such as fundamental frequency (F0 maximum, medium and minimum values) and intensity (maximum, medium and minimum values). The changes of F0 during a vocalization (intonation contours such as rising, falling, bell-shape, U-shape and sinusoidal and flat contours) were also examined. The same prosodic parameters were investigated in regard to prelinguistic vocalizations. The mothers were healthy, primiparous and native speakers of argentinian spanish. The babies were 3 to 6 month old, and those with congenital diseases or diseases that could affect the assessment of the variables under consideration were excluded. We evaluated 40 dyads of mother and child who attend the University Hospital of Maternity and Neonatology of Córdoba, Argentina. The presence of indicators for PPD was examined through the Edinburgh postpartum depression Scale (Cox, Holden & Sagoysky, 1987). The mother-infant interactions were filmed in unstructured play sessions. The categorization of different contexts in which those interactions occur were taken into account for the acoustic and melodic analysis. The types of interactional contexts were distinguished according the classification made in Papousek, Papousek & Symmes (1991). The results showed that 27 mothers did not present indicators of PPD and 13 did. Acoustically, the infant-directed speech of mothers who exhibit the presence of postpartum depression indicators featured lower values of medium and maximum intensity (p < .07, in both measures) in babies between 5 and 6 months old, and in male babies in particular (F0 medium p < .04 and F0 maximum p < .03). According to the melodic characteristics of IDS, less use of falling contours (p < .01) was found in mothers with PPD when addressing smaller babies -3 and 4 month old- and the same happened with the rising (p < .02) and falling (p < .01) contours when their children were males. In preverbal vocalizations, children whose mothers had indicators of postpartum psychopathology showed a lower number of emissions at a later age (p < .1) and in males (p < .1). Also, lower values of F0 were found in smaller babies (F0 minimum p < .01 and F0 medium p < .002). Male infants of mothers with PPD also presented a decrease in intensity (medium p < .05 and maximum p < .03). Finally, at the melodic analysis, the rising contours were not used at all for the oldest babies (p < .01) nor the U-shaped contours in males (p < .02). In conclusion, the findings of the present study not only confirm -through physiological measures- the effect of the interaction of mothers with their babies as a function of the presence of signs of postpartum depression, already from the first months of childhood life, but also that these alterations are modulated by the age and the gender of the infant. It is essential, therefore, to continue investigating whether these difficulties related to the primary bond that each mom and her child share are perpetuated over time. It is also necessary to adopt a gender perspective of maternal and child relationships and the importance of therapeutic approach and intervention of the dyad as early as the first months after birth. At the same time, the exhaustive and immediate diagnosis of PPD cases is a matter of primary healthcare and the multidisciplinary intervention is urgent from the beginning in order to ensure maternal-infant metal health and harmonic social, cognitive and emotional development in children.