ABSTRACT
PURPOSE: To compare the acute oxygenation effects of high-frequency oscillatory ventilation (HFOV) plus inhaled nitric oxide (iNO) with pressure-controlled assist/control ventilation (PCACV) plus iNO in acute hypoxemic respiratory failure (AHRF) children. METHODS: Children with AHRF, aged between 1 month and 14 years under PCACV with PEEP ≥ 10 cmH(2) O were randomly assigned to PCACV (PCVG, n = 14) or HFOV (HFVG, n = 14) in a crossover design. Oxygenation indexes and hemodynamic variables were recorded at enrollment (Tind), 1 hr after PCACV start (T0) and then every 4 hr (T4h, etc.). RESULTS: PO(2)/FiO(2) significantly increased after 4 hr compared to enrollment in both groups [(PCVG-Tind: 111.95 ± 37 < T4h: 143.88 ± 47.5 mmHg, P < 0.05; HFVG-Tind: 123.76 ± 33 < T4h: 194.61 ± 62.42 mmHg, P < 0.05)] without any statistical differences between groups. At T8h, PO(2)/FiO(2) was greater for HFVG compared with PCVG (HFVG: 227.9 ± 80.7 > PCVG: 171.21 ± 52.9 mmHg, P < 0.05). FiO(2) could be significantly reduced after 4 hr for HFVG (HFVG-T4h: 0.53 ± 0.09 < Tind: 0.64 ± 0.2; P < 0.05) but only after 8 hr for PCVG. Comparing groups at T8h, it was observed that FiO(2) decrease was greater for HFVG (HFVG: 0.47 ± 0.06 < PCVG: 0.58 ± 0.1; P < 0.05). CONCLUSION: Both ventilatory techniques with iNO improve oxygenation. HFOV causes earlier FiO(2) reduction and increased PO(2)/FiO(2) ratio compared to PCACV at 8 hr. However, at the end of the protocol, there was no significant difference and no clinical improvement derived from the application of both ventilatory strategies with iNO. It is not possible to say what would have happened if a different conventional ventilatory mode and a fully protective ventilatory strategy had been used, given the fact that our study is non-blind, and that a limited number of patients were included in each group.
Subject(s)
High-Frequency Ventilation , Nitric Oxide/administration & dosage , Adolescent , Child , Child, Preschool , Cross-Over Studies , Female , Humans , Infant , Male , Oxygen/blood , Respiratory Insufficiency/therapyABSTRACT
JUSTIFICATIVA E OBJETIVOS: As indicações de transfusão de eritrócitos não estão bem estabelecidas em crianças gravemente enfermas. O objetivo deste estudo foi descrever a prática da transfusão de eritrócitos na UTI Pediátrica do Hospital de Clínicas da Universidade Estadual Paulista (HC-UNESP). MÉTODO: Estudo retrospectivo observacional realizado durante o ano de 2003. RESULTADOS: Setenta e cinco pacientes receberam transfusão, havendo registro de 105 indicações. Mais da metade dos pacientes (53,3 por cento) tinha menos que um ano de idade. Taquipnéia (75,2 por cento), palidez (65,7 por cento) e hipotensão (51,4 por cento) foram os registros mais freqüentemente observados antes da transfusão. Além disso, a gasometria evidenciou acidose metabólica (68,08 por cento) e hipoxemia (63,8 por cento). Dos 93 registros de valores de hemoglobina (Hb), 54 (58,1 por cento) estavam entre 7 e 10 g/dL e dos 90 registros de hematócrito (Ht) observou-se que 66 (73,3 por cento) apresentavam valores entre 21 por cento e 30 por cento. As principais indicações de transfusão foram anemia em 75 crianças (71,4 por cento) e sangramento ativo em 26 (24,7 por cento). O valor médio de Hb antes da transfusão foi de 7,82 ± 2,82 g/dL. Sete transfusões foram indicadas para pacientes com valores de Hb > 10 g/dL, crianças estas em pós-operatório imediato de intervenção cirúrgica cardíaca e casos de choque séptico. CONCLUSÕES: A transfusão de eritrócitos vem sendo utilizada criteriosamente, com indicações restritivas (Hb entre 7 e 10 g/dL). Nem sempre há anotação dos valores de Hb imediatamente antes da transfusão. A partir deste estudo, foi elaborado um protocolo de indicação de transfusão na unidade.
BACKGROUND AND OBJECTIVES: Indications of red blood cell transfusion in critically ill children are not very well determined. This study aims to describe red blood cells transfusion practice at the PICU of UNESP-Botucatu Medical School. METHODS: Retrospective observational study of all patients who received transfusion during 2003. RESULTS: Seventy five patients received transfusion and 105 indications were recorded. 53.3 percent of the patients were less than one year of age. Increased respiratory rate (75.2 percent), paleness (65.7 percent), and hypotension (51.4 percent) were the alterations more frequently recorded, before transfusion. Also, metabolic acidosis (68.08 percent) e and hipoxemia (63.8 percent) were very frequently observed. From 93 hemoglobin (Hb) values recorded, 54 (58.1 percent) varied from 7 to 10 g/dL and from 90 records of hematocrit (Ht) 66 (73.3 percent) varied from 21 percent to 30 percent. The main indications of the transfusion were anemia, in 75 children (71.4 percent), and active bleeding in 26 (24.7 percent). The mean value of Hb before transfusion was 7.82 ± 2.82 g/dL. Seven transfusions were indicated for patients with Hb levels higher than 10 g/dL (postoperative heart surgery and septic patients). CONCLUSIONS: red blood cells transfusion is carefully prescribed at the PICU by using restrictive indications (Hb between 7 and 10 g/dL). Not always is possible to find out records of the Hb levels immediately before transfusion. Hence, a protocol to better prescribe red blood cell transfusion at the PICU was adopted.
Subject(s)
Humans , Male , Female , Infant, Newborn , Infant , Child, Preschool , Child , Adolescent , Intensive Care Units, Pediatric , Erythrocyte Transfusion/standards , Erythrocyte TransfusionABSTRACT
JUSTIFICATIVA E OBJETIVOS: O objetivo desse estudo foi rever a literatura sobre a utilização de óxido nítrico inalatório em crianças com síndrome do desconforto respiratório agudo. CONTEÚDO: Revisão bibliográfica e seleção de publicações mais relevantes sobre óxido nítrico inalatório, utilizando a base de dados MedLine e Cochrane de Revisões Sistemáticas. A revisão incluiu descrição de aspectos da definição, fisiopatologia e tratamento ventilatório da síndrome do desconforto respiratório agudo, assim como o metabolismo, efeitos biológicos e aplicação clínica do óxido nítrico inalatório, comentando dose, administração e retirada do gás, precações, efeitos adversos e contra-indicações. CONCLUSÕES: O óxido nítrico, vasodilatador pulmonar seletivo, tem efeitos benéficos sobre as trocas gasosas e ventilação em crianças com hipóxia grave. É seguro quando administrado em ambiente de tratamento intensivo sob rigorosa monitorização. Estudos aleatórios e controlados devem enfocar a administração precoce do gás na síndrome do desconforto respiratório agudo, quando essa é potencialmente reversível.
BACKGROUND AND OBJECTIVE: The objective of this study was to review the literature on inhaled nitric oxide to children with acute respiratory distress syndrome. CONTENTS: A review of literature and selection of the most important publications on inhaled nitric oxide, using the MedLine and Cochrane Systematic Review Databases. This review was organized as follows: introduction; metabolism and biological effects; clinical applications; dosage, gas administration and weaning process; warnings and side-effects. Inhaled nitric oxide use was described in acute respiratory distress syndrome. CONCLUSIONS: Inhaled nitric oxide as the first vasodilator to produce selective pulmonary vasodilation has beneficial effects on gas exchange and ventilation, improving outcome in children with severe hypoxia. It is safe when administered in intensive care units under strict surveillance and monitoring. Further studies should be concentrated on early treatment, when acute respiratory distress syndrome is potentially reversible.
Subject(s)
Nitric Oxide/administration & dosage , Nitric Oxide/adverse effects , Nitric Oxide/therapeutic use , Respiratory Distress Syndrome, Newborn/therapyABSTRACT
BACKGROUND AND OBJECTIVES: Indications of red blood cell transfusion in critically ill children are not very well determined. This study aims to describe red blood cells transfusion practice at the PICU of UNESP-Botucatu Medical School. METHODS: Retrospective observational study of all patients who received transfusion during 2003. RESULTS: Seventy five patients received transfusion and 105 indications were recorded. 53.3% of the patients were less than one year of age. Increased respiratory rate (75.2%), paleness (65.7%), and hypotension (51.4%) were the alterations more frequently recorded, before transfusion. Also, metabolic acidosis (68.08%) e and hipoxemia (63.8%) were very frequently observed. From 93 hemoglobin (Hb) values recorded, 54 (58.1%) varied from 7 to 10 g/dL and from 90 records of hematocrit (Ht) 66 (73.3%) varied from 21% to 30%. The main indications of the transfusion were anemia, in 75 children (71.4%), and active bleeding in 26 (24.7%). The mean value of Hb before transfusion was 7.82 ± 2.82 g/dL. Seven transfusions were indicated for patients with Hb levels higher than 10 g/dL (postoperative heart surgery and septic patients). CONCLUSIONS: red blood cells transfusion is carefully prescribed at the PICU by using restrictive indications (Hb between 7 and 10 g/dL). Not always is possible to find out records of the Hb levels immediately before transfusion. Hence, a protocol to better prescribe red blood cell transfusion at the PICU was adopted.
ABSTRACT
BACKGROUND AND OBJECTIVE: The objective of this study was to review the literature on inhaled nitric oxide to children with acute respiratory distress syndrome. CONTENTS: A review of literature and selection of the most important publications on inhaled nitric oxide, using the MedLine and Cochrane Systematic Review Databases. This review was organized as follows: introduction; metabolism and biological effects; clinical applications; dosage, gas administration and weaning process; warnings and side-effects. Inhaled nitric oxide use was described in acute respiratory distress syndrome. CONCLUSIONS: Inhaled nitric oxide as the first vasodilator to produce selective pulmonary vasodilation has beneficial effects on gas exchange and ventilation, improving outcome in children with severe hypoxia. It is safe when administered in intensive care units under strict surveillance and monitoring. Further studies should be concentrated on early treatment, when acute respiratory distress syndrome is potentially reversible.
ABSTRACT
O Vírus Respiratório Sincicial Humano (VRSH) é descrito como o mais importante patógeno viral causador de doenças respiratórias agudas das vias respiratórias inferiores em crianças. Neste estudo 84 amostras de crianças com idade abaixo dos dois anos apresentando sintomas de doença respiratória aguda, foram obtidas no período de setembro de 2000 a novembro de 2001. Analise por imunofluorescência indireta e transcrição reversa seguida de PCR, revelou que 18 per center (15/84) das amostras foram positivas, sendo que em 80 per center (12/15) dos casos a detecção de VRSH foi observada em crianças abaixo dos seis meses, e também que os subgrupos A e B co-circularam. Estes são os primeiros dados obtidos para a cidade de Botucatu, sendo que a sazonalidade mostrou-se evidente pela maior circulação desse vírus entre os meses de maio e julho.
