Uso del dispositivo de asistencia respiratoria Novalung® como puente a trasplante pulmonar: Caso clínico / Bridge to lung transplantation with a novel pumpless lung assist device: Report of one case

Devices such as Novalung® can be used as a bridge to lung transplantation while waiting for a suitable donor. We report a 50 year-old male with a terminal pulmonary fibrosis and candidate for lung transplantation. He was admitted to the hospital due to a severe deterioration of his respiratory condition, with the presence of severe respiratory acidosis despite conventional invasive respiratory support. Respiratory support with Novalung® was started, resulting in a progressive reduction ofpCOz that became normal ten hours after the installation of the device. Five days later a successful lung transplantation wasperformed.

Bronchopulmonary dysplasia in very low birth weight infants.

Objective. To determine the risk factors for development of bronchopulmonary dysplasia (BPD) by evaluating mild and moderate/severe BPD in extramural neonates with a birth weight <1501 g. Methods. A case-control study was conducted between January 1, 2004- December 31, 2006. Patients with BPD and without BPD were compared. Bronchopulmonary dysplasia was diagnosed and classified according to the Bancalari criteria. One-hundred and six (106) extramural premature infants with a birth weight <1501 g and admitted to the Neonatal Unit in the first three days of life and survived for more than 28 postnatal days were included. Patients with multiple congenital anomalies and complex cardiac pathologies were excluded. The maternal and neonatal risk factors, clinical features, mechanical ventilation treatment were compared. The principal risk factors for BPD development were analyzed and followed by logistic regression test. Results. The diagnosis was mild BPD in 27 of the 106 patients and moderate/severe BPD in 29. The incidence of BPD was 52.8%. Fifty of 106 patients had no BPD. Analysis of risk factors revealed that gestational age ≤28 weeks (p=0.019), birth weight ≤1000 g (p=0.007), hypothermia (p=0.003), acidosis (p=0.003) and hypotension (p=0.005) at admission, respiratory distress syndrome (RDS) ( p<0.001), mechanical ventilation therapy (p<0.001), surfactant therapy (p=0.005), higher amount of mean fluid therapy on 7th days (p=0.008), nosocomial infection (p<0.001), higher amount of mean packed red cell transfusions (p<0.001) and more than two packed red cell transfusions (p=0.033) were risk factors associated with the development of BPD. Multivariant logistic regression analysis showed acidosis at admission (OR 5.12, 95%CI 1.17–22.27, p=0.029), surfactant treatment (OR 7.53, 95%CI 2.14–26.45, p=0.002), nosocomial infections (OR 4.66, 95%CI 1.27–17.12, p=0.02) and PDA (OR 9.60, 95%CI 2.23–41.22, p=0.002) were risk factors increasing the severity of BPD. Conclusion. The most important risk factors for BPD development in our study were RDS and nosocomial infections while the presence of acidosis at admission, surfactant administration, nosocomial infections and the presence of PDA were the most important risk factors regarding BPD severity. Presence of acidosis at admission as a risk factor emphasized the importance of suitable transport conditions for premature infants.

Distúrbios do equilíbrio ácido-básico / Acid-base balance disorders

Objetivo: Revisar as bases teóricas da manutenção do equilíbrio ácido-básico, a fisiopatologia dos principais distúrbios e sua terapêutica na criança. Métodos: Foram obtidas referências em artigos recentes de revisão e arquivos pessoais através de busca computadorizada na Biblioteca Nacional de Medicina(Medline). Resultados: Distúrbios ácido-básico são freqüentemente encontrados em pacientes criticamente doentes. Sua fisiopatologia e principais causas são umcomplexo e multifatorial. O tratamento deve ser ajustado para cada distúrbio e sua causa de base. Freqüentemente requer correção agressiva e monitorização contínua. Conclusões: O entendimento da fisiologia do equilíbrio ácido-básico bem como a compreesão da fisiopatologia dos principais distúrbios associados às situações clínicas representam um desafio para o pediatra. Seu manejo requer intervenção adequada e cuidadosa

Diagnostico e terapia da hipoxia fetal durante o parto / Diagnosis and treatment of the intrapartum fetal hypoxia

Os autores discutem brevemente os mecanismos patofisiologicos das causas mais frequentes da hipoxia e acidose fetal intraparto, ou seja, a reducao da perfusao utero-placentaria e feto placentaria decorrentes principalmente da hiperatividade uterina e/ou compressao funicular. Tres metodos diagnosticos da hipoxia fetal intraparto sao abordados: a amnioscopia, cardiotocografia e a pHmetria do sangue no couro cabeludo fetal. Concluem que a pHmetria apresenta os melhores resultados em sensibilidade, especifidade e valores preditivos. O seu emprego na obstetricia atual e limitado pela falta de condicoes do seu uso de maneira continua, tornando-a um metodo complementar da cardiotocografia continua intraparto. E apresentado pelos autores um esquema de aplicacao pratica combinada dos tres metodos acima citados na vigilancia do bem estar fetal no trabalho de parto. A principal terapeutica da hipoxia fetal intraparto e a rapida interrupcao do parto, por intervencao obstetrica adequada ao periodo do trabalho de parto. Novos metodos como tocolise e amnioinfusao podem melhorar os resultados perinatais e ajudar a diminuir a incidencia de casareas.

Manejo intensivo del status asmaticus / Intensive management of the status asthmaticus

Las crisis de asma bronquial usualmente pueden ser moderadas o severas y ocasionalmente pueden amenazar la vida y ser fatales. Aunque los principios fisiopatológicos y terapéuticos son aplicables a las diferentes formas de presentación, debera realizarse una distinción importante en el manejo de las crisis severas y de las status asmaticus. En el presente trabajo se presenta la experiencia de los autoresw en el manejo del status asmaticus en la Unidad de Cuidados Intensivos del Hospital Universitario de Caracas y aportan elementos de discusión y estrategias que contribuyen al establecimiento de criterios uniformes en la definición y manejo del status asmaticus