ABSTRACT
JUSTIFICATIVA E OBJETIVOS: Ângulo de fase (AF) é a diferença entre a voltagem e a corrente e pode ser usado como indicador de massa celular corporal. Estudos clínicos mostram que baixos AF estão associados com morbidade e mortalidade em pacientes críticos. O objetivo deste estudo foi conhecer a relação entre AF e o escore pediátrico de risco de mortalidade (PRISM I) em pacientes pediátricos sépticos críticos, associando esse indicador c om a gravidade da sepse. MÉTODO: Estudo transversal realizado na Unidade de Terapia Intensiva (UTI) Pediátrica do Instituto Fernandes Figueira. Os pacientes foram caracterizados de acordo com faixa etária, sexo, gravidade da sepse, etiologia da insuficiência respiratória, escore de PRISM I, grau de disfunção de múltiplos órgãos e sistemas (DMOS). A análise de bioimpedância elétrica (BIA) foi realizada em todos os pacientes e, através da razão dos valores de reactância (Xc) e resistência (R), foi calculado o AF (AF = arco-tangente da reactância/resistência x 180º /Pi). RESULTADOS: Foram avaliados 75 pacientes, sendo 68 (90,7 por cento) com sepse. A incidência de choque séptico foi 39,7 por cento, sepse grave 42,6 por cento e sepse 17,6 por cento. Não houve diferença estatística significativa entre as médias de ângulo de fase e as categorias de PRISM I, porém observou-se uma relação inversa entre os valores de AF e as categorias de PRISM I, DMOS e tempo de internação. Os valores mais baixos de AF (1,5º-2,2º) foram observados no maior escore de PRISM I (> 30 por cento). CONCLUSÕES: Os pacientes pediátricos críticos apresentaram baixos valores de angulo de fase, portanto deve ter a sua importância prognóstica estudada.
BACKGROUND AND OBJECTIVES: Phase angle (PA) is the difference between voltage and current and can be used as an indicator of body cell mass. Clinical studies show that low phase angle is associated with morbidity and mortality of critical patients. The purpose of this study was to know the relation between phase angle and the Pediatric Risk of Mortality I (PRISM I) score, associating this score with the severity of sepsis. METHODS: A transversal study was performed at the Pediatric Intensive Care Unit (PICU) in Instituto Fernandes Figueira. The patients were classified according to age, gender, sepsis severity, cause of respiratory failure, PRISM I score, multiple organ dysfunction syndromes (MODS). Electrical bioimpedance analysis (BIA) was performed in all patients. Phase angle was calculated directly from reactance (Xc) and resistance (R). AF = arc-tangent reactance/resistance x 180º/Pi. RESULTS: 75 patients (68 septic) were evaluated. The incidence of septic shock was 39.7 percent, severe sepsis 42.6 percent and sepsis 17.6 percent. There was no significative statistical difference between the mean values of BIA and the categories of PRISM I, MODS, or the length of stay the PICU. The PA's lowest values (1.5º-2.2º) were associated to the greatest PRISM's scores (> 30 percent). CONCLUSIONS: Pediatric critical patients show low phase angle values, which might have prognostic implication.
Subject(s)
Humans , Male , Female , Infant , Child, Preschool , Child , Shock, Septic/mortality , Sepsis/mortalityABSTRACT
BACKGROUND AND OBJECTIVES: Phase angle (PA) is the difference between voltage and current and can be used as an indicator of body cell mass. Clinical studies show that low phase angle is associated with morbidity and mortality of critical patients. The purpose of this study was to know the relation between phase angle and the Pediatric Risk of Mortality I (PRISM I) score, associating this score with the severity of sepsis. METHODS: A transversal study was performed at the Pediatric Intensive Care Unit (PICU) in Instituto Fernandes Figueira. The patients were classified according to age, gender, sepsis severity, cause of respiratory failure, PRISM I score, multiple organ dysfunction syndromes (MODS). Electrical bioimpedance analysis (BIA) was performed in all patients. Phase angle was calculated directly from reactance (Xc) and resistance (R). AF = arc-tangent reactance/resistance x 180º/Pi. RESULTS: 75 patients (68 septic) were evaluated. The incidence of septic shock was 39.7%, severe sepsis 42.6% and sepsis 17.6%. There was no significative statistical difference between the mean values of BIA and the categories of PRISM I, MODS, or the length of stay the PICU. The PA's lowest values (1.5º-2.2º) were associated to the greatest PRISM's scores (> 30%). CONCLUSIONS: Pediatric critical patients show low phase angle values, which might have prognostic implication.
ABSTRACT
1. We evaluated whether immunization affects bone-marrow responses to indomethacin, because allergenic sensitization and challenge upregulate responses to haemopoietic cytokines (including IL-5-driven eosinopoiesis) in murine bone-marrow, while indomethacin upregulates haemopoiesis and protects bone-marrow from radiation damage. 2. Progenitor (semi-solid) and/or precursor (liquid) cultures were established from bone-marrow of: (a) normal mice; (b) ovalbumin-sensitized mice, with or without intranasal challenge. Cultures were established with GM-CSF (2 ng ml(-1)) or IL-5 (1 ng ml(-1)), respectively, alone or associated with indomethacin (10(-7) - 10(-11) M) or aspirin (10(-7) - 10(-8) M). Total myeloid colony numbers and numbers of eosinophil-peroxidase-positive cells were determined at day 7. 3. In naïve BALB/c mice, indomethacin (10(-7) - 10(-9) M) increased GM-CSF-stimulated myeloid colony formation (P=0.003 and P=0.009, respectively). In contrast, it had no effect on bone-marrow of ovalbumin-sensitized and challenged mice. Indomethacin (10(-7) - 10(-9) M) also increased eosinophil precursor responses to IL-5 in bone-marrow of naïve (P<0.001 and P=0.002 respectively), but not sensitized-challenged mice. Aspirin (10(-7) M) had similar effects, equally abolished by sensitization. Enhancement of haemopoiesis by indomethacin required adherent cells from naïve bone-marrow. Nonadherent cells responded to IL-5 but not to indomethacin. Indomethacin was effective on bone-marrow from sham-sensitized, ovalbumin-challenged, but not from sensitized, saline-challenged mice. Plasma transfer from immune mice abolished eosinophil precursor responses to indomethacin in bone-marrow of naïve recipients. This was not prevented by previous removal of antibody from immune plasma. 4. COX inhibitors enhance haemopoiesis in naïve but not allergic mice. Responsiveness to indomethacin can be abolished either by active sensitization or by immune plasma transfer. Specific antibody is not involved.
