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1.
Crit Care ; 28(1): 171, 2024 05 21.
Artigo em Inglês | MEDLINE | ID: mdl-38773629

RESUMO

BACKGROUND: Tidal expiratory flow limitation (EFLT) complicates the delivery of mechanical ventilation but is only diagnosed by performing specific manoeuvres. Instantaneous analysis of expiratory resistance (Rex) can be an alternative way to detect EFLT without changing ventilatory settings. This study aimed to determine the agreement of EFLT detection by Rex analysis and the PEEP reduction manoeuvre using contingency table and agreement coefficient. The patterns of Rex were explored. METHODS: Medical patients ≥ 15-year-old receiving mechanical ventilation underwent a PEEP reduction manoeuvre from 5 cmH2O to zero for EFLT detection. Waveforms were recorded and analyzed off-line. The instantaneous Rex was calculated and was plotted against the volume axis, overlapped by the flow-volume loop for inspection. Lung mechanics, characteristics of the patients, and clinical outcomes were collected. The result of the Rex method was validated using a separate independent dataset. RESULTS: 339 patients initially enrolled and underwent a PEEP reduction. The prevalence of EFLT was 16.5%. EFLT patients had higher adjusted hospital mortality than non-EFLT cases. The Rex method showed 20% prevalence of EFLT and the result was 90.3% in agreement with PEEP reduction manoeuvre. In the validation dataset, the Rex method had resulted in 91.4% agreement. Three patterns of Rex were identified: no EFLT, early EFLT, associated with airway disease, and late EFLT, associated with non-airway diseases, including obesity. In early EFLT, external PEEP was less likely to eliminate EFLT. CONCLUSIONS: The Rex method shows an excellent agreement with the PEEP reduction manoeuvre and allows real-time detection of EFLT. Two subtypes of EFLT are identified by Rex analysis. TRIAL REGISTRATION: Clinical trial registered with www.thaiclinicaltrials.org (TCTR20190318003). The registration date was on 18 March 2019, and the first subject enrollment was performed on 26 March 2019.


Assuntos
Respiração Artificial , Humanos , Masculino , Feminino , Respiração Artificial/métodos , Respiração Artificial/estatística & dados numéricos , Pessoa de Meia-Idade , Idoso , Volume de Ventilação Pulmonar/fisiologia , Respiração com Pressão Positiva/métodos , Respiração com Pressão Positiva/estatística & dados numéricos , Respiração com Pressão Positiva/normas , Expiração/fisiologia , Adulto
2.
Crit Care Explor ; 6(5): e1088, 2024 May 01.
Artigo em Inglês | MEDLINE | ID: mdl-38747691

RESUMO

IMPORTANCE: A recent study showed an association between high hospital-level noninvasive positive pressure ventilation (NIPPV) use and in-hospital cardiac arrest (IHCA) in children with bronchiolitis. OBJECTIVES: We aimed to determine if patient-level exposure to NIPPV in children with bronchiolitis was associated with IHCA. DESIGN, SETTING AND PARTICIPANTS: Retrospective cohort study at a single-center quaternary PICU in North America including children with International Classification of Diseases primary or secondary diagnoses of bronchiolitis in the Virtual Pediatric Systems database. MAIN OUTCOMES AND MEASURES: The primary exposure was NIPPV and the primary outcome was IHCA. MEASUREMENTS AND MAIN RESULTS: Of 4698 eligible ICU admissions with bronchiolitis diagnoses, IHCA occurred in 1.2% (57/4698). At IHCA onset, invasive mechanical ventilation (IMV) was the most frequent level of respiratory support (65%, 37/57), with 12% (7/57) receiving NIPPV. Patients with IHCA had higher Pediatric Risk of Mortality-III scores (3 [0-8] vs. 0 [0-2]; p < 0.001), more frequently had a complex chronic condition (94.7% vs. 46.2%; p < 0.001), and had higher mortality (21.1% vs. 1.0%; p < 0.001) compared with patients without IHCA. Return of spontaneous circulation (ROSC) was achieved in 93% (53/57) of IHCAs; 79% (45/57) survived to hospital discharge. All seven children without chronic medical conditions and with active bronchiolitis symptoms at the time of IHCA achieved ROSC, and 86% (6/7) survived to discharge. In multivariable analysis restricted to patients receiving NIPPV or IMV, NIPPV exposure was associated with lower odds of IHCA (adjusted odds ratio [aOR], 0.07; 95% CI, 0.03-0.18) compared with IMV. In secondary analysis evaluating categorical respiratory support in all patients, compared with IMV, NIPPV was associated with lower odds of IHCA (aOR, 0.35; 95% CI, 0.14-0.87), whereas no difference was found for minimal respiratory support (none/nasal cannula/humidified high-flow nasal cannula [aOR, 0.56; 95% CI, 0.23-1.36]). CONCLUSIONS AND RELEVANCE: Cardiac arrest in children with bronchiolitis is uncommon, occurring in 1.2% of bronchiolitis ICU admissions. NIPPV use in children with bronchiolitis was associated with lower odds of IHCA.


Assuntos
Bronquiolite , Parada Cardíaca , Humanos , Bronquiolite/terapia , Bronquiolite/epidemiologia , Bronquiolite/complicações , Estudos Retrospectivos , Lactente , Feminino , Masculino , Parada Cardíaca/terapia , Parada Cardíaca/mortalidade , Parada Cardíaca/epidemiologia , Parada Cardíaca/etiologia , Unidades de Terapia Intensiva Pediátrica/estatística & dados numéricos , Ventilação não Invasiva , Pré-Escolar , Respiração com Pressão Positiva/métodos , Respiração com Pressão Positiva/estatística & dados numéricos , Estudos de Coortes
3.
Sleep Med ; 107: 26-30, 2023 07.
Artigo em Inglês | MEDLINE | ID: mdl-37099917

RESUMO

OBJECTIVE/BACKGROUND: Sleep-disordered breathing (SDB) is very common after ischemic stroke, and its treatment may have a positive impact on recovery from stroke and on secondary stroke prevention. This study sought to determine the prevalence of positive airway pressure (PAP) use after stroke. PATIENTS/METHODS: Participants in the Brain Attack Surveillance in Corpus Christi (BASIC) project underwent a home sleep apnea test shortly after ischemic stroke. Demographics and co-morbidities were ascertained from the medical record. Self-reported PAP use (present vs absent) was assessed at 3, 6, and 12 months after stroke. Fisher exact tests and t-tests were used to compare PAP users versus non-users. RESULTS: Of 328 participants who were found to have SDB after stroke, only 20 (6.1%) indicated using PAP at any point during the 12-month follow up period. High pre-stroke sleep apnea risk based on Berlin Questionnaire score, neck circumference, and co-morbid atrial fibrillation were associated with any self-reported PAP use; race/ethnicity, insurance status and other demographic variables were not associated with PAP use. CONCLUSIONS: Only a small proportion of individuals with ischemic stroke and SDB received treatment with PAP during the initial year after stroke among participants in this population-based cohort study in Nueces County, Texas. Closing the substantial treatment gap for SDB after stroke might improve sleepiness and neurologic recovery.


Assuntos
Respiração com Pressão Positiva , Síndromes da Apneia do Sono , Reabilitação do Acidente Vascular Cerebral , Acidente Vascular Cerebral , Acidente Vascular Cerebral/complicações , Respiração com Pressão Positiva/estatística & dados numéricos , Síndromes da Apneia do Sono/etiologia , Síndromes da Apneia do Sono/terapia , Humanos , Masculino , Feminino , Pessoa de Meia-Idade , Idoso , Autorrelato
4.
Respir Physiol Neurobiol ; 298: 103842, 2022 04.
Artigo em Inglês | MEDLINE | ID: mdl-35026479

RESUMO

BACKGROUND: Noninvasive ventilation (NIV) and High-flow nasal cannula (HFNC) are the main forms of treatment for acute respiratory failure. This study aimed to evaluate the effect, safety, and applicability of the NIV and HFNC in patients with acute hypoxemic respiratory failure (AHRF) caused by COVID-19. METHODS: In this retrospective study, we monitored the effect of NIV and HFNC on the SpO2 and respiratory rate before, during, and after treatment, length of stay, rates of endotracheal intubation, and mortality in patients with AHRF caused by COVID-19. Additionally, data regarding RT-PCR from physiotherapists who were directly involved in assisting COVID-19 patients and non-COVID-19. RESULTS: 62.2 % of patients were treated with HFNC. ROX index increased during and after NIV and HFNC treatment (P < 0.05). SpO2 increased during NIV treatment (P < 0.05), but was not maintained after treatment (P = 0.17). In addition, there was no difference in the respiratory rate during or after the NIV (P = 0.95) or HFNC (P = 0.60) treatment. The mortality rate was 35.7 % for NIV vs 21.4 % for HFNC (P = 0.45), while the total endotracheal intubation rate was 57.1 % for NIV vs 69.6 % for HFNC (P = 0.49). Two adverse events occurred during treatment with NIV and eight occurred during treatment with HFNC. There was no difference in the physiotherapists who tested positive for SARS-COV-2 directly involved in assisting COVID-19 patients and non-COVID-19 ones (P = 0.81). CONCLUSION: The application of NIV and HFNC in the critical care unit is feasible and associated with favorable outcomes. In addition, there was no increase in the infection of physiotherapists with SARS-CoV-2.


Assuntos
COVID-19/terapia , Cânula , Intubação Intratraqueal , Ventilação não Invasiva , Avaliação de Processos e Resultados em Cuidados de Saúde , Oxigênio/administração & dosagem , Respiração com Pressão Positiva , Insuficiência Respiratória/terapia , Taxa Respiratória/efeitos dos fármacos , Doença Aguda , Administração por Inalação , Adulto , Idoso , Idoso de 80 Anos ou mais , Brasil , COVID-19/complicações , COVID-19/mortalidade , Cânula/efeitos adversos , Cânula/normas , Cânula/estatística & dados numéricos , Estudos de Viabilidade , Feminino , Humanos , Unidades de Terapia Intensiva , Intubação Intratraqueal/estatística & dados numéricos , Tempo de Internação/estatística & dados numéricos , Masculino , Pessoa de Meia-Idade , Ventilação não Invasiva/efeitos adversos , Ventilação não Invasiva/métodos , Ventilação não Invasiva/normas , Ventilação não Invasiva/estatística & dados numéricos , Avaliação de Processos e Resultados em Cuidados de Saúde/estatística & dados numéricos , Fisioterapeutas , Respiração com Pressão Positiva/efeitos adversos , Respiração com Pressão Positiva/normas , Respiração com Pressão Positiva/estatística & dados numéricos , Insuficiência Respiratória/etiologia , Insuficiência Respiratória/mortalidade , Estudos Retrospectivos
5.
Crit Care ; 25(1): 230, 2021 06 30.
Artigo em Inglês | MEDLINE | ID: mdl-34193224

RESUMO

BACKGROUND: Individualized positive end-expiratory pressure (PEEP) by electrical impedance tomography (EIT) has potential interest in the optimization of ventilation distribution in acute respiratory distress syndrome (ARDS). The aim of the study was to determine whether early individualized titration of PEEP with EIT improved outcomes in patients with ARDS. METHODS: A total of 117 ARDS patients receiving mechanical ventilation were randomly assigned to EIT group (n = 61, PEEP adjusted based on ventilation distribution) or control group (n = 56, low PEEP/FiO2 table). The primary outcome was 28-day mortality. Secondary and exploratory outcomes were ventilator-free days, length of ICU stay, incidence of pneumothorax and barotrauma, and difference in Sequential Organ Failure Assessment (SOFA) score at day 1 (ΔD1-SOFA) and day 2 (ΔD2-SOFA) compared with baseline. MEASUREMENTS AND MAIN RESULTS: There was no statistical difference in the value of PEEP between the EIT group and control group, but the combination of PEEP and FiO2 was different between groups. In the control group, a significantly positive correlation was found between the PEEP value and the corresponding FiO2 (r = 0.47, p < 0.00001) since a given matched table was used for PEEP settings. Diverse combinations of PEEP and FiO2 were found in the EIT group (r = 0.05, p = 0.68). There was no significant difference in mortality rate (21% vs. 27%, EIT vs. control, p = 0.63), ICU length of stay (13.0 (7.0, 25.0) vs 10.0 (7.0, 14.8), median (25th-75th percentile); p = 0.17), and ventilator-free days at day 28 (14.0 (2.0, 23.0) vs 19.0 (0.0, 24.0), p = 0.55) between the two groups. The incidence of new barotrauma was zero. Compared with control group, significantly lower ΔD1-SOFA and ΔD2-SOFA were found in the EIT group (p < 0.001) in a post hoc comparison. Moreover, the EIT group exhibited a significant decrease of SOFA at day 2 compared with baseline (paired t-test, difference by - 1 (- 3.5, 0), p = 0.001). However, the control group did show a similar decrease (difference by 1 (- 2, 2), p = 0.131). CONCLUSION: Our study showed a 6% absolute decrease in mortality in the EIT group: a statistically non-significant, but clinically non-negligible result. This result along with the showed improvement in organ function might justify further reserach to validate the beneficial effect of individualized EIT-guided PEEP setting on clinical outcomes of patients with ARDS. TRIAL REGISTRATION: ClinicalTrials, NCT02361398. Registered 11 February 2015-prospectively registered, https://clinicaltrials.gov/show/NCT02361398 .


Assuntos
Impedância Elétrica/uso terapêutico , Respiração com Pressão Positiva/métodos , Síndrome do Desconforto Respiratório/fisiopatologia , Tomografia/estatística & dados numéricos , Adulto , Idoso , Análise de Variância , China/epidemiologia , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Escores de Disfunção Orgânica , Respiração com Pressão Positiva/instrumentação , Respiração com Pressão Positiva/estatística & dados numéricos , Estudos Prospectivos , Síndrome do Desconforto Respiratório/epidemiologia , Tomografia/métodos
6.
Ann R Coll Surg Engl ; 103(7): 504-507, 2021 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-34192497

RESUMO

INTRODUCTION: Tracheomalacia after thyroidectomy is not well understood. Reports on tracheomalacia are conflicting, with some suggesting a high rate and other large cohorts in which no tracheomalacia is reported. The aim of our study was to assess the incidence and factors associated with tracheomalacia after thyroidectomy in patients with retrosternal goitres requiring sternotomy at a high-volume tertiary care referral centre. METHODS: A longitudinal cohort study was conducted from January 2011 to December 2019. All adult patients who underwent thyroidectomy with sternotomy were included. Tracheomalacia was considered when tracheal rings were soft compared with other parts (proximal or distal) of the trachea and required either tracheostomy or resection with anastomosis. The decision to perform a tracheostomy or to administer continuous or bilevel positive airway pressure postoperatively was made depending on the degree of tracheomalacia. Logistic regression analysis was used to assess factors associated with tracheomalacia. RESULTS: We evaluated 40 patients who underwent thyroidectomy with sternotomy. The mean age of our cohort was 48.7 ± 11.3 years and the population was predominantly female (67.5%). One patient required tracheal resection with anastomosis, and two patients required tracheostomy. Multivariable logistic regression analysis did not reveal any patient- or thyroid-related factor significantly associated with the development of tracheomalacia in our cohort. CONCLUSIONS: The incidence of tracheomalacia after thyroidectomy with sternotomy appears to be very low. However, the occurrence of tracheomalacia after thyroidectomy in cases of large goitre is possible and hence worrisome.


Assuntos
Bócio/cirurgia , Complicações Pós-Operatórias/epidemiologia , Esternotomia/efeitos adversos , Tireoidectomia/efeitos adversos , Traqueomalácia/epidemiologia , Adulto , Estudos Transversais , Feminino , Bócio/patologia , Humanos , Incidência , Estudos Longitudinais , Masculino , Pessoa de Meia-Idade , Tamanho do Órgão , Respiração com Pressão Positiva/estatística & dados numéricos , Complicações Pós-Operatórias/diagnóstico , Complicações Pós-Operatórias/etiologia , Complicações Pós-Operatórias/terapia , Estudos Retrospectivos , Esternotomia/métodos , Glândula Tireoide/patologia , Glândula Tireoide/cirurgia , Tireoidectomia/métodos , Traqueia/patologia , Traqueia/cirurgia , Traqueomalácia/diagnóstico , Traqueomalácia/etiologia , Traqueomalácia/terapia , Traqueostomia/estatística & dados numéricos
7.
Medicine (Baltimore) ; 100(16): e25547, 2021 Apr 23.
Artigo em Inglês | MEDLINE | ID: mdl-33879703

RESUMO

ABSTRACT: This study aimed to estimate the value of serum procalcitonin (PCT) for non-invasive positive pressure ventilation (NIPPV) prediction in the patients with acute exacerbation of chronic obstructive pulmonary disease (AECOPD).A total of 220 AECOPD patients were divided into NIPPV group (n = 121) and control group (routine treatment, n = 99) based on the routine standards and physicians' experience. Logistic regression analysis was performed to identify the independent factors for NIPPV treatment. Additionally, the predictive values of the factors were measured through receiver operation characteristic (ROC) curve.NIPPV group and control group showed significant differences in respiratory rate (RR), PaO2, PaCO2, pH, oxygenation index, erythrocyte sedimentation rate (ESR), neutrophil, CRP (C-reaction protein), and PCT (P < .05 for all). PCT, CRP, PaCO2, RR, and neutrophil were independently correlated with NIPPV treatment in AECOPD. ROC curve showed that PCT had superior predictive value, with AUC of 0.899, the sensitivity of 86%, and the specificity of 91.9%. The cut-off value of serum PCT for NIPPV prediction was 88.50 ng/l.AECOPD patients who require NIPPV treatment frequently have high levels of PCT, CRP, PaCO2, RR and neutrophil. Serum PCT may be employed as an indicator for NIPPV treatment in AECOPD patients.


Assuntos
Regras de Decisão Clínica , Ventilação não Invasiva/estatística & dados numéricos , Respiração com Pressão Positiva/estatística & dados numéricos , Pró-Calcitonina/sangue , Doença Pulmonar Obstrutiva Crônica/sangue , Doença Aguda , Idoso , Gasometria , Sedimentação Sanguínea , Proteína C-Reativa/análise , Feminino , Humanos , Contagem de Leucócitos , Modelos Logísticos , Masculino , Pessoa de Meia-Idade , Neutrófilos/metabolismo , Valor Preditivo dos Testes , Doença Pulmonar Obstrutiva Crônica/terapia , Curva ROC , Valores de Referência , Taxa Respiratória , Exacerbação dos Sintomas
8.
BMC Pregnancy Childbirth ; 21(Suppl 1): 235, 2021 Mar 26.
Artigo em Inglês | MEDLINE | ID: mdl-33765958

RESUMO

BACKGROUND: Annually, 14 million newborns require stimulation to initiate breathing at birth and 6 million require bag-mask-ventilation (BMV). Many countries have invested in facility-based neonatal resuscitation equipment and training. However, there is no consistent tracking for neonatal resuscitation coverage. METHODS: The EN-BIRTH study, in five hospitals in Bangladesh, Nepal, and Tanzania (2017-2018), collected time-stamped data for care around birth, including neonatal resuscitation. Researchers surveyed women and extracted data from routine labour ward registers. To assess accuracy, we compared gold standard observed coverage to survey-reported and register-recorded coverage, using absolute difference, validity ratios, and individual-level validation metrics (sensitivity, specificity, percent agreement). We analysed two resuscitation numerators (stimulation, BMV) and three denominators (live births and fresh stillbirths, non-crying, non-breathing). We also examined timeliness of BMV. Qualitative data were collected from health workers and data collectors regarding barriers and enablers to routine recording of resuscitation. RESULTS: Among 22,752 observed births, 5330 (23.4%) babies did not cry and 3860 (17.0%) did not breathe in the first minute after birth. 16.2% (n = 3688) of babies were stimulated and 4.4% (n = 998) received BMV. Survey-report underestimated coverage of stimulation and BMV. Four of five labour ward registers captured resuscitation numerators. Stimulation had variable accuracy (sensitivity 7.5-40.8%, specificity 66.8-99.5%), BMV accuracy was higher (sensitivity 12.4-48.4%, specificity > 93%), with small absolute differences between observed and recorded BMV. Accuracy did not vary by denominator option. < 1% of BMV was initiated within 1 min of birth. Enablers to register recording included training and data use while barriers included register design, documentation burden, and time pressure. CONCLUSIONS: Population-based surveys are unlikely to be useful for measuring resuscitation coverage given low validity of exit-survey report. Routine labour ward registers have potential to accurately capture BMV as the numerator. Measuring the true denominator for clinical need is complex; newborns may require BMV if breathing ineffectively or experiencing apnoea after initial drying/stimulation or subsequently at any time. Further denominator research is required to evaluate non-crying as a potential alternative in the context of respectful care. Measuring quality gaps, notably timely provision of resuscitation, is crucial for programme improvement and impact, but unlikely to be feasible in routine systems, requiring audits and special studies.


Assuntos
Confiabilidade dos Dados , Morte Perinatal/prevenção & controle , Respiração com Pressão Positiva/estatística & dados numéricos , Ressuscitação/estatística & dados numéricos , Adolescente , Adulto , Bangladesh/epidemiologia , Feminino , Humanos , Recém-Nascido , Nascido Vivo , Masculino , Máscaras/estatística & dados numéricos , Nepal/epidemiologia , Respiração com Pressão Positiva/instrumentação , Respiração com Pressão Positiva/métodos , Gravidez , Sistema de Registros/estatística & dados numéricos , Ressuscitação/instrumentação , Ressuscitação/métodos , Natimorto , Inquéritos e Questionários/estatística & dados numéricos , Tanzânia/epidemiologia , Adulto Jovem
9.
Crit Care ; 25(1): 60, 2021 02 15.
Artigo em Inglês | MEDLINE | ID: mdl-33588912

RESUMO

BACKGROUND: Reverse triggering (RT) is a dyssynchrony defined by a respiratory muscle contraction following a passive mechanical insufflation. It is potentially harmful for the lung and the diaphragm, but its detection is challenging. Magnitude of effort generated by RT is currently unknown. Our objective was to validate supervised methods for automatic detection of RT using only airway pressure (Paw) and flow. A secondary objective was to describe the magnitude of the efforts generated during RT. METHODS: We developed algorithms for detection of RT using Paw and flow waveforms. Experts having Paw, flow and esophageal pressure (Pes) assessed automatic detection accuracy by comparison against visual assessment. Muscular pressure (Pmus) was measured from Pes during RT, triggered breaths and ineffective efforts. RESULTS: Tracings from 20 hypoxemic patients were used (mean age 65 ± 12 years, 65% male, ICU survival 75%). RT was present in 24% of the breaths ranging from 0 (patients paralyzed or in pressure support ventilation) to 93.3%. Automatic detection accuracy was 95.5%: sensitivity 83.1%, specificity 99.4%, positive predictive value 97.6%, negative predictive value 95.0% and kappa index of 0.87. Pmus of RT ranged from 1.3 to 36.8 cmH20, with a median of 8.7 cmH20. RT with breath stacking had the highest levels of Pmus, and RTs with no breath stacking were of similar magnitude than pressure support breaths. CONCLUSION: An automated detection tool using airway pressure and flow can diagnose reverse triggering with excellent accuracy. RT generates a median Pmus of 9 cmH2O with important variability between and within patients. TRIAL REGISTRATION: BEARDS, NCT03447288.


Assuntos
Respiração Artificial/métodos , Trabalho Respiratório/fisiologia , Idoso , Área Sob a Curva , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Respiração com Pressão Positiva/métodos , Respiração com Pressão Positiva/estatística & dados numéricos , Pressão , Curva ROC , Respiração Artificial/estatística & dados numéricos , Mecânica Respiratória/fisiologia , Pesos e Medidas/instrumentação
10.
J Pediatr ; 229: 141-146, 2021 02.
Artigo em Inglês | MEDLINE | ID: mdl-33068569

RESUMO

OBJECTIVE: To assess the procedural and clinical outcomes associated with the introduction of minimally invasive surfactant therapy (MIST) into standard care at 2 tertiary Australian neonatal intensive care units. STUDY DESIGN: A prospective audit was designed before the introduction of MIST in 2018, with data collected over a period of 18 months. Procedural data were completed by the clinical team performing MIST, including clinical observations, medication use, and adverse events. The audit team collected demographic data and subsequent clinical outcomes from medical records. RESULTS: There were 135 MIST procedures recorded in 122 infants. For the included infants, the median gestation was 302/7 weeks (IQR, 276/7 to 322/7 weeks) and birth weight was 1439 g (IQR, 982-1958 g). During the MIST procedure, desaturation to a peripheral oxygen saturation of <80% was common, occurring in 75.2% of procedures. Other adverse events included need for positive pressure ventilation (10.6%) and bradycardia <100 beats per minute (13.3%). The use of atropine premedication was associated with a significantly lower incidence of bradycardia: 8.6% vs 52.9% (P < .01). Senior clinicians demonstrated higher rates of procedural success. The majority of infants (63.9%) treated with MIST did not require subsequent intubation and mechanical ventilation. CONCLUSIONS: MIST can be successfully introduced in neonatal units with limited experience of this technique. The use of atropine premedication decreases the incidence of bradycardia during the procedure. Success rates can be optimized by limiting MIST to clinicians with greater competence in endotracheal intubation.


Assuntos
Intubação Intratraqueal , Surfactantes Pulmonares/administração & dosagem , Síndrome do Desconforto Respiratório do Recém-Nascido/terapia , Antiarrítmicos/uso terapêutico , Atropina/uso terapêutico , Austrália/epidemiologia , Bradicardia/etiologia , Bradicardia/prevenção & controle , Auditoria Clínica , Competência Clínica , Feminino , Humanos , Recém-Nascido , Unidades de Terapia Intensiva Neonatal , Masculino , Oxigênio/sangue , Respiração com Pressão Positiva/estatística & dados numéricos , Pré-Medicação , Estudos Prospectivos
11.
Laryngoscope ; 131(4): E1375-E1379, 2021 04.
Artigo em Inglês | MEDLINE | ID: mdl-32865831

RESUMO

OBJECTIVES/HYPOTHESIS: Selective upper airway stimulation (sUAS) is a well-established treatment option for obstructive sleep apnea (OSA). This study aimed to determine if there are benefits in performing a home sleep test (HST) to evaluate postoperative sUAS effectiveness after patient acclimatization compared to the generally used polysomnography (PSG) titration, as measured by long-term follow-up outcomes. STUDY DESIGN: Retrospective comparative cohort analysis. METHODS: We conducted an analysis of consecutive patients at our center who had completed a 6-month follow-up (month 6 [M6]) and recorded data from M6, month 12 (M12), and month 24 (M24). After device activation, we performed an HST with the patient's stimulation settings, and measured the apnea-hypopnea index (AHI), Epworth Sleepiness Scale (ESS), and device usage. These values were compared to patients who had undergone PSG-based device titration. RESULTS: Baseline values of the initial 131 patients show high ESS and moderate OSA. At the 2-month time point of the HST, nearly half of the patients (46.2%) reached an AHI ≤15/hr, and approximately a fifth (19.2%) reached <5/hr. The PSG and HST groups differed in median ESS at M24, but no other differences were observed for ESS at M6 and M12. Both groups showed similar AHI, oxygen desaturation, and usage hours per week. CONCLUSIONS: Adjusting therapy by using the HST technique after device activation and acclimatization has clinical and economic advantages. These advantages are contingent on several conditions being met when deviating from the standard device protocol, including precise communication with the referring sleep medicine physicians, especially their role in helping with long-term follow-up. LEVEL OF EVIDENCE: 4 Laryngoscope, 131:E1375-E1379, 2021.


Assuntos
Terapia por Estimulação Elétrica/instrumentação , Nervo Hipoglosso/cirurgia , Neuroestimuladores Implantáveis/estatística & dados numéricos , Apneia Obstrutiva do Sono/terapia , Feminino , Seguimentos , Humanos , Nervo Hipoglosso/fisiopatologia , Neuroestimuladores Implantáveis/efeitos adversos , Laringe/fisiopatologia , Masculino , Pessoa de Meia-Idade , Cooperação do Paciente/estatística & dados numéricos , Polissonografia/métodos , Polissonografia/estatística & dados numéricos , Respiração com Pressão Positiva/métodos , Respiração com Pressão Positiva/estatística & dados numéricos , Período Pós-Operatório , Estudos Retrospectivos , Sono/fisiologia , Apneia Obstrutiva do Sono/fisiopatologia , Traqueia/fisiopatologia , Resultado do Tratamento
12.
Intern Emerg Med ; 16(5): 1183-1190, 2021 08.
Artigo em Inglês | MEDLINE | ID: mdl-33222116

RESUMO

The role of noninvasive positive pressure ventilation (NIPPV) in COVID-19 patients with acute hypoxemic respiratory failure (AHRF) is uncertain, as no direct evidence exists to support NIPPV use in such patients. We retrospectively assessed the effectiveness and safety of NIPPV in a cohort of COVID-19 patients consecutively admitted to the COVID-19 general wards of a medium-size Italian hospital, from March 6 to May 7, 2020. Healthcare workers (HCWs) caring for COVID-19 patients were monitored, undergoing nasopharyngeal swab for SARS-CoV-2 in case of onset of COVID-19 symptoms, and periodic SARS-CoV-2 screening serology. Overall, 50 patients (mean age 74.6 years) received NIPPV, of which 22 (44%) were successfully weaned, avoiding endotracheal intubation (ETI) and AHRF-related death. Due to limited life expectancy, 25 (50%) of 50 NIPPV-treated patients received a "do not intubate" (DNI) order. Among these, only 6 (24%) were weaned from NIPPV. Of the remaining 25 NIPPV-treated patients without treatment limitations, 16 (64%) were successfully weaned, 9 (36%) underwent delayed ETI and, of these, 3 (33.3%) died. NIPPV success was predicted by the use of corticosteroids (OR 15.4, CI 1.79-132.57, p 0.013) and the increase in the PaO2/FiO2 ratio measured 24-48 h after NIPPV initiation (OR 1.02, CI 1-1.03, p 0.015), while it was inversely correlated with the presence of a DNI order (OR 0.03, CI 0.001-0.57, p 0.020). During the study period, 2 of 124 (1.6%) HCWs caring for COVID-19 patients were diagnosed with SARS-CoV-2 infection. Apart from patients with limited life expectancy, NIPPV was effective in a substantially high percentage of patients with COVID-19-associated AHRF. The risk of SARS-CoV-2 infection among HCWs was low.


Assuntos
COVID-19/complicações , Ventilação não Invasiva/normas , Respiração com Pressão Positiva/normas , Insuficiência Respiratória/etiologia , Idoso , Idoso de 80 Anos ou mais , COVID-19/terapia , Distribuição de Qui-Quadrado , Feminino , Humanos , Controle de Infecções/instrumentação , Controle de Infecções/métodos , Controle de Infecções/estatística & dados numéricos , Masculino , Pessoa de Meia-Idade , Análise Multivariada , Ventilação não Invasiva/métodos , Ventilação não Invasiva/estatística & dados numéricos , Escores de Disfunção Orgânica , Respiração com Pressão Positiva/métodos , Respiração com Pressão Positiva/estatística & dados numéricos , Insuficiência Respiratória/terapia , Mecânica Respiratória/efeitos dos fármacos , Mecânica Respiratória/fisiologia , Estudos Retrospectivos
13.
Sensors (Basel) ; 20(23)2020 Nov 27.
Artigo em Inglês | MEDLINE | ID: mdl-33260852

RESUMO

Although the cure for the SARS-CoV-2 virus (COVID-19) will come in the form of pharmaceutical solutions and/or a vaccine, one of the only ways to face it at present is to guarantee the best quality of health for patients, so that they can overcome the disease on their own. Therefore, and considering that COVID-19 generally causes damage to the respiratory system (in the form of lung infection), it is essential to ensure the best pulmonary ventilation for the patient. However, depending on the severity of the disease and the health condition of the patient, the situation can become critical when the patient has respiratory distress or becomes unable to breathe on his/her own. In that case, the ventilator becomes the lifeline of the patient. This device must keep patients stable until, on their own or with the help of medications, they manage to overcome the lung infection. However, with thousands or hundreds of thousands of infected patients, no country has enough ventilators. If this situation has become critical in the Global North, it has turned disastrous in developing countries, where ventilators are even more scarce. This article shows the race against time of a multidisciplinary research team at the University of Huelva, UHU, southwest of Spain, to develop an inexpensive, multifunctional, and easy-to-manufacture ventilator, which has been named ResUHUrge. The device meets all medical requirements and is developed with open-source hardware and software.


Assuntos
COVID-19/terapia , Pandemias , SARS-CoV-2 , Ventiladores Mecânicos , Engenharia Biomédica , Custos e Análise de Custo , Desenho de Equipamento , Humanos , Ventilação com Pressão Positiva Intermitente/economia , Ventilação com Pressão Positiva Intermitente/instrumentação , Ventilação com Pressão Positiva Intermitente/estatística & dados numéricos , Respiração com Pressão Positiva/economia , Respiração com Pressão Positiva/instrumentação , Respiração com Pressão Positiva/estatística & dados numéricos , Espanha , Interface Usuário-Computador , Ventiladores Mecânicos/economia
14.
Crit Care ; 24(1): 662, 2020 11 25.
Artigo em Inglês | MEDLINE | ID: mdl-33239039

RESUMO

BACKGROUND: Flow-controlled ventilation is a novel ventilation method which allows to individualize ventilation according to dynamic lung mechanic limits based on direct tracheal pressure measurement at a stable constant gas flow during inspiration and expiration. The aim of this porcine study was to compare individualized flow-controlled ventilation (FCV) and current guideline-conform pressure-controlled ventilation (PCV) in long-term ventilation. METHODS: Anesthetized pigs were ventilated with either FCV or PCV over a period of 10 h with a fixed FiO2 of 0.3. FCV settings were individualized by compliance-guided positive end-expiratory pressure (PEEP) and peak pressure (Ppeak) titration. Flow was adjusted to maintain normocapnia and the inspiration to expiration ratio (I:E ratio) was set at 1:1. PCV was performed with a PEEP of 5 cm H2O and Ppeak was set to achieve a tidal volume (VT) of 7 ml/kg. The respiratory rate was adjusted to maintain normocapnia and the I:E ratio was set at 1:1.5. Repeated measurements during observation period were assessed by linear mixed-effects model. RESULTS: In FCV (n = 6), respiratory minute volume was significantly reduced (6.0 vs 12.7, MD - 6.8 (- 8.2 to - 5.4) l/min; p < 0.001) as compared to PCV (n = 6). Oxygenation was improved in the FCV group (paO2 119.8 vs 96.6, MD 23.2 (9.0 to 37.5) Torr; 15.97 vs 12.87, MD 3.10 (1.19 to 5.00) kPa; p = 0.010) and CO2 removal was more efficient (paCO2 40.1 vs 44.9, MD - 4.7 (- 7.4 to - 2.0) Torr; 5.35 vs 5.98, MD - 0.63 (- 0.99 to - 0.27) kPa; p = 0.006). Ppeak and driving pressure were comparable in both groups, whereas PEEP was significantly lower in FCV (p = 0.002). Computed tomography revealed a significant reduction in non-aerated lung tissue in individualized FCV (p = 0.026) and no significant difference in overdistended lung tissue, although a significantly higher VT was applied (8.2 vs 7.6, MD 0.7 (0.2 to 1.2) ml/kg; p = 0.025). CONCLUSION: Our long-term ventilation study demonstrates the applicability of a compliance-guided individualization of FCV settings, which resulted in significantly improved gas exchange and lung tissue aeration without signs of overinflation as compared to best clinical practice PCV.


Assuntos
Respiração com Pressão Positiva/normas , Respiração Artificial/normas , Animais , Dióxido de Carbono/análise , Dióxido de Carbono/sangue , Modelos Animais de Doenças , Oxigênio/análise , Oxigênio/sangue , Respiração com Pressão Positiva/estatística & dados numéricos , Estudos Prospectivos , Troca Gasosa Pulmonar/fisiologia , Respiração Artificial/métodos , Respiração Artificial/estatística & dados numéricos , Suínos/fisiologia , Tomografia Computadorizada por Raios X/métodos
15.
Am J Emerg Med ; 38(12): 2653-2657, 2020 12.
Artigo em Inglês | MEDLINE | ID: mdl-33041124

RESUMO

STUDY OBJECTIVE: To describe changes in cardiac function throughout the course of resuscitation of patients with suspected septic shock. METHODS: Prospective observational cohort study of Point-of-Care Transthoracic Echocardiograms (TTE) obtained in Emergency Department (ED) patients with a presumed infectious cause of hypotension within one hour of initiating IV fluid resuscitation. Findings of this pre-resuscitation TTE were compared to mid-resuscitation TTE (obtained upon disposition from the ED), and post-resuscitation TTE (obtained after admission to hospital). RESULTS: 22 enrolled patients had a second TTE available for comparison to the initial, pre-resuscitation TTE. 12 patients had a mid-resuscitation TTE and 16 patients had a post-resuscitation TTE. We observed a high incidence of changes on TTE during the clinical course of resuscitation (14/22 [64%]). Patients who developed LV or RV dysfunction during resuscitation were more likely to require vasopressor infusion and ICU admission (Spearman's coefficients [95% CI] of 0.68 [0.36-0.86] and 0.47 [0.04;0.75] respectively). Development of RV dysfunction alone was associated with increased use of positive pressure ventilation and vasopressor infusion (Spearman's coefficients [95% CI] of 0.43 [0;0.72] and 0.47 [0.05,0.75] respectively). CONCLUSIONS: Cardiac function changes assessed by TTE are common during the resuscitation of patients with septic shock. These changes likely reflect the underlying physiology of patients with septic shock and correlate with need for interventions and higher level of care. Further work is required to characterize these changes and to elucidate how to use these physiologic data to guide management.


Assuntos
Hidratação , Ressuscitação , Choque Séptico/fisiopatologia , Disfunção Ventricular Esquerda/fisiopatologia , Disfunção Ventricular Direita/fisiopatologia , Idoso , Estudos de Coortes , Ecocardiografia , Serviço Hospitalar de Emergência , Feminino , Hospitalização , Humanos , Unidades de Terapia Intensiva/estatística & dados numéricos , Masculino , Pessoa de Meia-Idade , Sistemas Automatizados de Assistência Junto ao Leito , Respiração com Pressão Positiva/estatística & dados numéricos , Estudos Prospectivos , Choque Séptico/diagnóstico por imagem , Choque Séptico/terapia , Vasoconstritores/uso terapêutico , Disfunção Ventricular Esquerda/diagnóstico por imagem , Disfunção Ventricular Direita/diagnóstico por imagem
16.
Pediatrics ; 146(4)2020 10.
Artigo em Inglês | MEDLINE | ID: mdl-32917847

RESUMO

BACKGROUND: International guidelines for resuscitation recommend using positive end-expiratory pressure (PEEP) during ventilation of preterm newborns. Reliable PEEP-valves for self-inflating bags have been lacking, and effects of PEEP during resuscitation of term newborns are insufficiently studied. The objective was to determine if adding a new PEEP valve to the bag-mask during resuscitation of term and near-term newborns could improve heart rate response. METHODS: This randomized controlled trial was performed at Haydom Lutheran Hospital in Tanzania (September 2016 to June 2018). Helping Babies Breathe-trained midwives performed newborn resuscitation using self-inflating bags with or without a new, integrated PEEP valve. All live-born newborns who received bag-mask ventilation at birth were eligible. Heart rate response measured by ECG was the primary outcome, and clinical outcome and ventilation data were recorded. RESULTS: Among 417 included newborns (median birth weight 3200 g), 206 were ventilated without and 211 with PEEP. We found no difference in heart rate response. Median (interquartile range) measured PEEP in the PEEP group was 4.7 (2.0-5.6) millibar. The PEEP group received lower tidal volumes (4.9 [1.9-8.2] vs 6.3 [3.9-10.5] mL/kg; P = .02) and had borderline lower expired CO2 (2.9 [1.5-4.3] vs 3.3 [1.9-5.0] %; P = .05). Twenty four-hour mortality was 9% in both groups. CONCLUSIONS: We found no evidence for improved heart rate response during bag-mask ventilation with PEEP compared with no PEEP. The PEEP valve delivered a median PEEP within the intended range. The findings do not support routine use of PEEP during resuscitation of newborns around term.


Assuntos
Frequência Cardíaca/fisiologia , Respiração com Pressão Positiva/instrumentação , Respiração Artificial/métodos , Ressuscitação/instrumentação , Eletrocardiografia , Humanos , Recém-Nascido , Recém-Nascido Prematuro , Tocologia , Respiração com Pressão Positiva/estatística & dados numéricos , Ressuscitação/métodos , Ressuscitação/estatística & dados numéricos , Tamanho da Amostra , Nascimento a Termo
17.
Crit Care ; 24(1): 556, 2020 09 14.
Artigo em Inglês | MEDLINE | ID: mdl-32928269

RESUMO

BACKGROUND: Pressure support ventilation (PSV) is the prevalent weaning method. Proportional assist ventilation (PAV) is an assisted ventilation mode, which is recently being applied to wean the patients from mechanical ventilation. Whether PAV or PSV is superior for weaning remains unclear. METHODS: Eligible randomized controlled trials published before April 2020 were retrieved from databases. We calculated the risk ratio (RR) and mean difference (MD) with 95% confidence intervals (CIs). RESULTS: Seven articles, involving 634 patients, met the selection criteria. Compared to PSV, PAV was associated with a significantly higher rate of weaning success (fixed-effect RR 1.16; 95% CI 1.07-1.26; I2 = 0.0%; trial sequential analysis-adjusted CI 1.03-1.30), and the trial sequential monitoring boundary for benefit was crossed. Compared to PSV, PAV was associated with a lower proportion of patients requiring reintubation (RR 0.49; 95% CI 0.28-0.87; I2 = 0%), a shorter ICU length of stay (MD - 1.58 (days), 95% CI - 2.68 to - 0.47; I2 = 0%), and a shorter mechanical ventilation duration (MD - 40.26 (hours); 95% CI - 66.67 to - 13.84; I2 = 0%). There was no significant difference between PAV and PSV with regard to mortality (RR 0.66; 95% CI 0.42-1.06; I2 = 0%) or weaning duration (MD - 0.01 (hours); 95% CI - 1.30-1.28; I2 = 0%). CONCLUSION: The results of the meta-analysis suggest that PAV is superior to PSV in terms of weaning success, and the statistical power is confirmed using trial sequential analysis.


Assuntos
Suporte Ventilatório Interativo/normas , Respiração com Pressão Positiva/normas , Desmame , Humanos , Suporte Ventilatório Interativo/métodos , Suporte Ventilatório Interativo/estatística & dados numéricos , Respiração com Pressão Positiva/métodos , Respiração com Pressão Positiva/estatística & dados numéricos , Respiração Artificial/métodos , Respiração Artificial/normas , Respiração Artificial/estatística & dados numéricos , Fatores de Tempo
18.
Crit Care ; 24(1): 467, 2020 07 28.
Artigo em Inglês | MEDLINE | ID: mdl-32723356

RESUMO

BACKGROUND: The driving pressure of the respiratory system is a valuable indicator of global lung stress during passive mechanical ventilation. Monitoring lung stress in assisted ventilation is indispensable, but achieving passive conditions in spontaneously breathing patients to measure driving pressure is challenging. The accuracy of the morphology of airway pressure (Paw) during end-inspiratory occlusion to assure passive conditions during pressure support ventilation has not been examined. METHODS: Retrospective analysis of end-inspiratory occlusions obtained from critically ill patients during pressure support ventilation. Flow, airway, esophageal, gastric, and transdiaphragmatic pressures were analyzed. The rise of gastric pressure during occlusion with a constant/decreasing transdiaphragmatic pressure was used to identify and quantify the expiratory muscle activity. The Paw during occlusion was classified in three patterns, based on the differences at three pre-defined points after occlusion (0.3, 1, and 2 s): a "passive-like" decrease followed by plateau, a pattern with "clear plateau," and an "irregular rise" pattern, which included all cases of late or continuous increase, with or without plateau. RESULTS: Data from 40 patients and 227 occlusions were analyzed. Expiratory muscle activity during occlusion was identified in 79% of occlusions, and at all levels of assist. After classifying occlusions according to Paw pattern, expiratory muscle activity was identified in 52%, 67%, and 100% of cases of Paw of passive-like, clear plateau, or irregular rise pattern, respectively. The driving pressure was evaluated in the 133 occlusions having a passive-like or clear plateau pattern in Paw. An increase in gastric pressure was present in 46%, 62%, and 64% of cases at 0.3, 1, and 2 s, respectively, and it was greater than 2 cmH2O, in 10%, 20%, and 15% of cases at 0.3, 1, and 2 s, respectively. CONCLUSIONS: The pattern of Paw during an end-inspiratory occlusion in pressure support cannot assure the absence of expiratory muscle activity and accurate measurement of driving pressure. Yet, because driving pressure can only be overestimated due to expiratory muscle contraction, in everyday practice, a low driving pressure indicates an absence of global lung over-stretch. A measurement of high driving pressure should prompt further diagnostic workup, such as a measurement of esophageal pressure.


Assuntos
Respiração com Pressão Positiva/normas , Respiração Artificial/normas , Músculos Respiratórios/fisiopatologia , Idoso , Idoso de 80 Anos ou mais , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Respiração com Pressão Positiva/métodos , Respiração com Pressão Positiva/estatística & dados numéricos , Respiração Artificial/instrumentação , Respiração Artificial/métodos , Fenômenos Fisiológicos Respiratórios/imunologia , Estudos Retrospectivos
19.
PLoS One ; 15(7): e0235363, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32628732

RESUMO

OBJECTIVE: There are differences in the adoption rates of less invasive surfactant administration (LISA) worldwide. We aimed to describe and analyze the process of LISA introduction at the country level. METHODS: A standardized training program (33 courses covering >500 neonatologists) was followed by a cohort study. Data regarding consecutive LISA procedures were acquired over 12 months in 31 tertiary neonatal centers, using a dedicated on-line platform. RESULTS: Of 500 LISA procedures, 75% were performed by specialists and 25% by residents. The mean percentage share of LISA in all surfactant therapies was 24%, which represents a 6-fold increase compared to previous years. After 12 months, 76% of the procedures were rated "easy/very easy" vs 59% at baseline (p<0.05). Surfactant re-treatment rate was 15%. Twenty-three percent of infants required mechanical ventilation within 72 hours of life. Oxygen desaturation and surfactant reflux were the most frequent complications. Unlike previous reports describing exclusive use of nasal continuous positive airway pressure (nCPAP) during LISA, majority of procedures (63%) were carried out using nasal intermittent positive pressure ventilation (NIPPV) or Bilevel Positive Airway Pressure (BiPAP). Efficacy of LISA with NIPPV or BiPAP was not significantly different from that with nCPAP (22.4% vs 24.5% of cases requiring intubation). Ventilation was provided with nasal cannulas or nasal masks (90%) and rarely with "RAM" cannulas or nasopharyngeal tubes. Rigid catheters were preferred (88.4%); tracheal insertion was successful at first attempt in 87% of cases. Majority of infants (79%) received no premedication prior to the procedure and almost all were given caffeine citrate. Median time of instillation was 1.5 minutes. CONCLUSIONS: The LISA procedure does not appear to be technically difficult to master. Training combining theory with practical exercises is an efficient implementation strategy. Variations in adoption rates indicate the need for additional, more personalized teachings in some centers.


Assuntos
Implementação de Plano de Saúde/estatística & dados numéricos , Respiração com Pressão Positiva/estatística & dados numéricos , Padrões de Prática Médica/estatística & dados numéricos , Surfactantes Pulmonares/administração & dosagem , Síndrome do Desconforto Respiratório do Recém-Nascido/terapia , Feminino , Humanos , Recém-Nascido , Recém-Nascido Prematuro , Internato e Residência/organização & administração , Internato e Residência/estatística & dados numéricos , Masculino , Neonatologistas/educação , Neonatologistas/estatística & dados numéricos , Polônia , Respiração com Pressão Positiva/efeitos adversos , Respiração com Pressão Positiva/métodos , Padrões de Prática Médica/organização & administração , Estudos Prospectivos
20.
Pediatr Cardiol ; 41(5): 962-971, 2020 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-32556487

RESUMO

BACKGROUND: Care of pediatric heart transplant recipients relies upon serial invasive hemodynamic evaluation, generally performed under the artificial conditions created by anesthesia and supportive ventilation. OBJECTIVES: This study aimed to evaluate the hemodynamic impacts of different anesthetic and ventilatory strategies. METHODS: We compared retrospectively the cardiac index, right- and left-sided filling pressures, and pulmonary and systemic vascular resistances of all clinically well and rejection-free heart transplant recipients catheterized from 2005 through 2017. Effects of spontaneous versus positive pressure ventilation and of sedation versus general anesthesia were tested with generalized linear mixed models for repeated measures using robust sandwich estimators of the covariance matrices. Least squared means showed adjusted mean outcome values, controlled for appropriate confounders. RESULTS: 720 catheterizations from 101 recipients met inclusion criteria. Adjusted cardiac index was 3.14 L/min/m2 (95% CI 3.01-3.67) among spontaneously breathing and 2.71 L/min/m2 (95% CI 2.56-2.86) among ventilated recipients (p < 0.0001). With spontaneous breathing, left filling pressures were lower (9.9 vs 11.0 mmHg, p = 0.030) and systemic vascular resistances were higher (24.0 vs 20.5 Woods units, p < 0.0001). After isolating sedated from anesthetized spontaneously breathing patients, the observed differences in filling pressures and resistances emerged as a function of sedation versus general anesthesia rather than of spontaneous versus positive pressure ventilation. CONCLUSION: In pediatric heart transplant recipients, positive pressure ventilation reduces cardiac output but does not alter filling pressures or vascular resistances. Moderate sedation yields lower left filling pressures and higher systemic vascular resistances than does general anesthesia. Differences are quantitatively small.


Assuntos
Anestesia/efeitos adversos , Cateterismo Cardíaco/métodos , Sedação Profunda/efeitos adversos , Respiração com Pressão Positiva/efeitos adversos , Resistência Vascular , Adolescente , Anestesia/estatística & dados numéricos , Criança , Sedação Profunda/estatística & dados numéricos , Feminino , Transplante de Coração/efeitos adversos , Humanos , Masculino , Respiração com Pressão Positiva/estatística & dados numéricos , Estudos Retrospectivos , Transplantados/estatística & dados numéricos
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