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BACKGROUND: Patient-ventilator asynchronies are usually detected by visual inspection of ventilator waveforms but with low sensitivity, even when performed by experts in the field. Recently, estimation of the inspiratory muscle pressure (Pmus) waveforms through artificial intelligence algorithm has been proposed (Magnamed®, São Paulo, Brazil). We hypothesized that the display of these waveforms could help healthcare providers identify patient-ventilator asynchronies. METHODS: A prospective single-center randomized study with parallel assignment was conducted to assess whether the display of the estimated Pmus waveform would improve the correct identification of asynchronies in simulated clinical scenarios. The primary outcome was the mean asynchrony detection rate (sensitivity). Physicians and respiratory therapists who work in intensive care units were randomized to control or intervention group. In both groups, participants analyzed pressure and flow waveforms of 49 different scenarios elaborated using the ASL-5000 lung simulator. In the intervention group the estimated Pmus waveform was displayed in addition to pressure and flow waveforms. RESULTS: A total of 98 participants were included, 49 per group. The sensitivity per participant in identifying asynchronies was significantly higher in the Pmus group (65.8 ± 16.2 vs. 52.94 ± 8.42, p < 0.001). This effect remained when stratifying asynchronies by type. CONCLUSIONS: We showed that the display of the Pmus waveform improved the ability of healthcare professionals to recognize patient-ventilator asynchronies by visual inspection of ventilator tracings. These findings require clinical validation. TRIAL REGISTRATION: ClinicalTrials.gov: NTC05144607. Retrospectively registered 3 December 2021.
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Inteligencia Artificial , Respiración Artificial , Humanos , Brasil , Atención a la Salud , Personal de Salud , Músculos , Estudios Prospectivos , Ventiladores MecánicosRESUMEN
ABSTRACT BACKGROUND AND OBJECTIVES Continuous infusion sedoanalgesia may favor negative hospital outcomes, thus, the objective was to analyze the relationship between continuous infusion sedoanalgesia and factors such as duration of mechanical pulmonary ventilation (MPV), extubation failure, hospital infections, length of hospitalization, and death in a mixed pediatric intensive care unit (PICU). The aim of this study was to identify the association of the use of sedatives and analgesics in continuous infusion with hospital outcomes through the control of confounding variables. METHODS Retrospective cohort with hospitalizations of children aged zero to 14 years, from 2012 to 2017. Use of continuous sedoanalgesia was considered a factor for the outcomes: duration of MPV, extubation failure, hospital infections (healthcare-associated infections - HCAI, fungal infection and catheter-related bloodstream infection), length of stay in the PICU and hospital, and death. Poisson regression was performed with adjustment by progressive models, with a significance level of 5%, calculation of relative risk (RR) and confidence interval (95% CI). RESULTS A total of 894 hospitalizations were analyzed, with a predominance of males (54.3%), non-malnourished children (70.7%) and without a diagnosis of chronic disease (55.1%). Infants accounted for half of the population. The outcomes that were associated with continuous sedoanalgesia in the final model were: MPV time > 4 days (RR=2.74; 95%CI=1.90-3.93), HCAI (RR=1.91; 95%CI=.32-2.80), fungal infection (RR=2.00; 95%CI=1.12-3.58), length of stay in the PICU > 3 days (RR=1.81; 95%CI=1.51-2.17) and hospital stay > 10 days (RR=1.52; 95%CI=1.27-1.84), and death (RR=0.64; 95%CI=0.43-0.95). CONCLUSION MPV time longer than four days, diagnosis of HCAI, diagnosis of fungal infection, length of stay in the PICU longer than three days, and hospitalization time longer than 10 days were factors more present in children who received continuous infusion of sedoanalgesia. Death, on the other hand, was more related to severity variables than to the use of psychoactive drugs.
RESUMO JUSTIFICATIVA E OBJETIVOS A sedoanalgesia em infusão contínua pode favorecer desfechos hospitalares negativos, assim, o objetivo foi analisar a relação entre sedoanalgesia em infusão contínua e fatores como tempo de ventilação pulmonar mecânica (VPM), falha de extubação, infecções hospitalares, tempo de internação e óbito numa unidade de terapia intensiva pediátrica (UTIP) mista. MÉTODOS Coorte retrospectivo com internações de crianças de zero a 14 anos, de 2012 a 2017. Uso de sedoanalgesia contínua foi considerado fator para os desfechos tempo de VPM, falha de extubação, infecções hospitalares (infecções relacionadas à assistência à saúde - IRAS, infecção fúngica e infecção de corrente sanguínea relacionada a cateter), tempo de internação em UTIP e no hospital e óbito. Foi realizada a regressão de Poisson com ajuste por modelos progressivos com nível de significância de 5%, cálculo do risco relativo (RR) e intervalo de confiança (IC 95%). Este estudo buscou identificar a associação do uso de sedativos e analgésicos em infusão contínua com desfechos hospitalares por meio do controle de variáveis de confusão. RESULTADOS Foram analisadas 894 internações, predominando o sexo masculino (54,3%), crianças não desnutridas (70,7%) e sem diagnóstico de doença crônica (55,1%). Lactentes representaram metade da população. Os desfechos que se associaram à sedoanalgesia contínua no modelo final foram: tempo de VPM > 4 dias (RR=2,74; IC95%=1,90-3,93), IRAS (RR=1,91; IC95%=1,32-2,80), infecção fúngica (RR=2,00; IC95%=1,12-3,58), tempo de internação na UTIP > 3 dias (RR=1,81; IC95%=1,51-2,17) e hospitalar > 10 dias (RR=1,52; IC95%=1,27-1,84) e óbito (RR=0,64; IC95%=0,43-0,95). CONCLUSÃO: Tempo de VPM maior que quatro dias, diagnóstico de IRAS, diagnóstico de infecção fúngica, tempo de internação na UTIP maior que três dias e tempo de internação hospitalar maior que 10 dias foram mais incidentes nas crianças que receberam sedoanalgesia em infusão contínua. Já o óbito apresentou maior relação com as variáveis de gravidade do que com o uso de fármacos psicoativos.
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RESUMO Objetivo Avaliar a eficácia da ventilação mecânica não invasiva (VNI) em prevenir a intubação orotraqueal em uma população heterogênea de pacientes pediátricos e identificar os fatores preditivos associados à sua falha em Unidade de Terapia Intensiva Pediátrica (UTIP). Métodos Estudo clínico, prospectivo não randomizado, com pacientes de 0 a 10 anos de idade internados em UTIP com indicação de VNI, que apresentaram insuficiência respiratória aguda ou crônica agudizada. Foram avaliados parâmetros demográficos, clínicos e cardiorrespiratórios, e os pacientes que não evoluíram para tubo orotraqueal (TOT) por 48 horas após retirada da VNI foram classificados como "grupo sucesso". O "grupo falha" necessitou de TOT. Para identificar os fatores preditores para falha na prevenção de TOT, foi realizada a regressão logística multivariada. Resultados Foram incluídos 52 pacientes, sendo 27 (51,9%) meninos, com idade mediana de 6 (1-120) meses. Ao avaliar a eficácia da VNI, 36 (69,2%) pacientes apresentaram sucesso, sem necessidade de TOT. Após análise dos fatores preditivos para pertencer ao "grupo falha", os pacientes com taquipneia após 2 horas da colocação da VNI apresentaram 4,8 vezes mais chances de necessitar de TOT em 48 horas. Independentemente do desfecho, foram observados diminuição da frequência cardíaca (p < 0,001) e da frequência respiratória (p < 0,001) e aumento da saturação periférica de oxigênio (p < 0,001) 2 horas após a colocação da VNI. Conclusão A utilização da VNI foi eficaz na população estudada, com melhora significativa nos parâmetros cardiorrespiratórios 2 horas após a colocação da VNI, sendo a presença de taquipneia um fator preditivo para falha na prevenção de TOT.
ABSTRACT Objective Evaluate the efficacy of Noninvasive Mechanical Ventilation (NIV) in preventing Endotracheal Intubation (ETI) in a heterogeneous pediatric population and identify predictive factors associated with NIV failure in Pediatric Intensive Care Unit (PICU). Methods Prospective non-randomized clinical trial conducted with patients aged 0-10 years, hospitalized in a PICU with NIV indication, who presented acute or chronic respiratory failure. Demographic data and clinical and cardiorespiratory parameters were evaluated, and patients who did not progress to ETI in 48 h after withdrawal of NIV were classified as "success group", whereas those who progressed to ETI were included in the "failure group". Multivariate logistic regression was performed to identify the predictive factors of failure to prevent ETI. Results Fifty-two patients, 27 (51.9%) males, with median age of 6 (1-120) months were included in the study. When evaluating the effectiveness of NIV, 36 (69.2%) patients were successful, with no need for ETI. After analyzing the predictive factors associated with failure, patients with tachypnea after 2 h of NIV were 4.8 times more likely to require ETI in 48 h. Regardless of outcome, heart (p<0.001) and respiratory (p<0.001) rates decreased and oxygen saturation (p<0.001) increased after 2 h of NIV. Conclusion We concluded that use of NIV was effective in the studied population, with significant improvement in cardiorespiratory parameters after 2 h of NIV, and that tachypnea was a predictive factor of failure to prevent ETI.
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Humanos , Masculino , Recién Nacido , Lactante , Preescolar , Niño , Respiración Artificial/métodos , Insuficiencia Respiratoria/terapia , Ventilación no Invasiva/métodos , Respiración Artificial/estadística & datos numéricos , Insuficiencia Respiratoria/diagnóstico , Unidades de Cuidado Intensivo Pediátrico/estadística & datos numéricos , Estudios Prospectivos , Resultado del TratamientoRESUMEN
The objective of this study is to determine the incidence of post-extubation acute laryngeal lesions in a pediatric intensive care unit (PICU) and potential risk factors. Children, aged 28 days to 5 years, admitted to the PICU who required endotracheal intubation for at least 24 h were enrolled. Exclusion criteria were a previous intubation, history of laryngeal disease, current or past tracheostomy, the presence of craniofacial malformations and patients considered on palliative care. All patients underwent flexible fiber-optic laryngoscopy (FFL) not later than 8 h after extubation. A blinded researcher identified and classified laryngeal lesions based on recorded media. 231 children were enrolled between November 2005 and December 2015. At FFL examination, 102 children (44.15%) presented moderate to severe laryngeal lesions. On a multivariable analysis, we found that for each additional day with repositioning of the endotracheal tube, there was an increase of 7.3% (RR 95% CI 1.012-1.137; P = 0.018) on the baseline risk of developing moderate to severe acute laryngeal lesions. Furthermore, for each additional dose of sedation per day of intubation, there was also an increase of 3.5% on the same baseline risk (RR 95% CI 1.001-1.070; P = 0.041). The amount of tube repositioning episodes and the need for extra doses of sedation (as a proxy for possible agitation) were found to be associated with acute laryngeal lesions. Adequate sedation and minimized tube repositioning should be pursued to possibly prevent the development of post-extubation airway compromise.
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Hipnóticos y Sedantes/uso terapéutico , Intubación Intratraqueal , Enfermedades de la Laringe , Laringe , Ajuste de Prótesis/efectos adversos , Brasil/epidemiología , Preescolar , Femenino , Humanos , Enfermedad Iatrogénica/epidemiología , Enfermedad Iatrogénica/prevención & control , Lactante , Unidades de Cuidado Intensivo Pediátrico/estadística & datos numéricos , Intubación Intratraqueal/efectos adversos , Intubación Intratraqueal/instrumentación , Intubación Intratraqueal/métodos , Enfermedades de la Laringe/diagnóstico , Enfermedades de la Laringe/epidemiología , Enfermedades de la Laringe/etiología , Laringoscopía/métodos , Laringe/diagnóstico por imagen , Laringe/lesiones , Masculino , Respiración Artificial/métodos , Factores de RiesgoRESUMEN
JUSTIFICATIVA E OBJETIVOS: Muitos pacientes permanecem na sala de emergência em ventilação mecânica (VM). No Brasil há falta de leitos disponíveis suficientes em terapia intensiva. Nesse cenário, o conhecimento do médico emergencista dos princípios básicos da VM é de fundamental importância. O objetivo deste estudo foi apresentar os princípios básicos de inicio e manutenção do paciente em VM na emergência e orientar as condutas diante das principais complicações. CONTEÚDO: Os princípios da sedação e a analgesia devem ser de conhecimento do emergencista para acessar a via aérea com segurança e manter o paciente em VM. A configuração inicial do ventilador conforme situação clínica deve ser então iniciada. Geralmente nas modalidades convencionais: volume assisto-controlado (VCV), pressão assisto-controlado (PCV) ou pressão de suporte (PS). Após o inicio da VM invasiva algumas complicações associadas (barotraumas, instabilidade hemodinâmica, hiperinsuflação dinâmica, obstruções da viaaérea) à ela devem ser diagnosticadas e manipuladas pelo médicoe mergencista. CONCLUSÃO: O conhecimento das recomendações na abordagem inicial, manutenção e conduta nas complicações da VM invasiva são essenciais para o médico emergencista.
BACKGROUND AND OBJECTIVES: Many patients remain in the emergency room on mechanical ventilation (MV). In Brazil, there are not sufficient beds available in intensive care units. In this scenario, the emergency physician's knowledge of the basic principles of MV is crucial. The objective of this study was to present the basic principles for starting and maintaining the patient on MV in an emergency setting, and to guide procedures in face of major medical complications. CONTENTS: The emergency doctor should know the principles of sedation and analgesia to access the airway safely and maintain the patient on MV. The initial settings of the ventilator according to the clinical situation should then be initiated. Generally conventional modalities: volume-controlled ventilation (VCV), pressure-controlled ventilation (PCV) or pressure support ventilation (PS). After start of invasive MV, some associated complications (barotrauma, hemodynamic instability, dynamic hyperinflation,airway obstruction) must be diagnosed and handled by the emergency physician. CONCLUSION: Knowledge of the recommendations for the initial approach, maintenance and management of complications in invasive MV is essential for the emergency physician.
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Humanos , Medicina de Emergencia/educación , Respiración Artificial/instrumentación , Servicios Médicos de Urgencia/métodosRESUMEN
OBJECTIVES: To describe noninvasive positive-pressure ventilation use in intensive care unit clinical practice, factors associated with NPPV failure and the associated prognosis. METHODS: A prospective cohort study. RESULTS: Medical disorders (59%) and elective surgery (21%) were the main causes for admission to the intensive care unit. The main indications for the initiation of noninvasive positive-pressure ventilation were the following: post-extubation, acute respiratory failure and use as an adjunctive technique to chest physiotherapy. The noninvasive positive-pressure ventilation failure group was older and had a higher Simplified Acute Physiology Score II score. The noninvasive positive-pressure ventilation failure rate was 35%. The main reasons for intubation were acute respiratory failure (55%) and a decreased level of consciousness (20%). The noninvasive positive-pressure ventilation failure group presented a shorter period of noninvasive positive-pressure ventilation use than the successful group [three (2-5) versus four (3-7) days]; they had lower levels of pH, HCO3 and base excess, and the FiO2 level was higher. These patients also presented lower PaO2:FiO2 ratios; on the last day of support, the inspiratory positive airway pressure and expiratory positive airway pressure were higher. The failure group also had a longer average duration of stay in the intensive care unit [17 (10-26) days vs. 8 (5-14) days], as well as a higher mortality rate (9 vs. 51%). There was an association between failure and mortality, which had an odds ratio (95% CI) of 10.6 (5.93 -19.07). The multiple logistic regression analysis using noninvasive positive pressure ventilation failure as a dependent variable found that treatment tended to fail in patients with a Simplified Acute Physiology Score II$34, an inspiratory positive airway pressure level > 15 cmH2O and pH<7.40. CONCLUSION: The indications for noninvasive positive-pressure ventilation were quite varied. The failure group had a longer intensive care unit stay and higher mortality. Simplified Acute Physiology Score II > 34, pH<7.40 and higher inspiratory positive airway pressure levels were associated with failure.
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Femenino , Humanos , Masculino , Persona de Mediana Edad , Respiración con Presión Positiva/estadística & datos numéricos , Insuficiencia Respiratoria/terapia , Estudios de Cohortes , Hospitales Universitarios , Unidades de Cuidados Intensivos , Pronóstico , Estudios Prospectivos , Respiración con Presión Positiva/métodos , Insuficiencia Respiratoria/etiología , Resultado del TratamientoRESUMEN
OBJETIVO: Investigar uma possível associação entre a carga de trabalho de profissionais da saúde e eventos adversos intermediários, tais como extubação acidental, obstrução do tubo endotraqueal e desconexão acidental do circuito do ventilador, durante ventilação mecânica neonatal em unidades neonatais de alto risco. MÉTODO: Este estudo de coorte prospectiva analisou os dados referentes a 543 recém-nascidos de unidades de terapia intensiva neonatal (UTINs) de São Luís (MA) por 6 meses, durante os quais 136 recém-nascidos foram submetidos a ventilação mecânica em 1.108 turnos e foram observados 4.554 vezes. RESULTADOS: Ocorreram eventos adversos 117 vezes durante esse período. As associações entre carga de trabalho e eventos adversos foram analisadas por meio de equações de estimação generalizada. As variáveis de ajuste foram: peso de nascimento, gênero, maternidade estudada, pontuação no índice de risco clínico para bebês (clinical risk index for babies) e demanda de cuidados, determinada pela escala desenvolvida pela Northern Neonatal Network. Quanto maior o número de recém-nascidos classificados de acordo com a demanda de cuidados (RCDCs) por enfermeiro e técnico em enfermagem, maior a probabilidade da ocorrência de eventos adversos intermediários relacionados à ventilação mecânica. Um número de RCDCs > 22 por enfermeiro [risco relativo (RR) = 2,86] e > 4,8 por enfermeiro auxiliar (RR = 3,41) esteve associado a uma maior prevalência de eventos adversos intermediários. CONCLUSÕES: A carga de trabalho dos profissionais de UTINs parece interferir nos resultados intermediários do cuidado neonatal e, portanto, deve ser levada em conta na avaliação dos desfechos na UTIN.
OBJECTIVE: To investigate a possible association between the intensity of staff workload and intermediate adverse events, such as accidental extubation, obstruction of the endotracheal tube, and accidental disconnection of the ventilator circuit, during neonatal mechanical ventilation in high-risk neonatal units. METHOD: This prospective cohort study analyzed data of 543 newborns from public neonatal intensive care units (NICUs) in the city of São Luís, state of Maranhão, Northeastern Brazil, for 6 months, during which 136 newborns were submitted to mechanical ventilation in 1,108 shifts and were observed a total of 4,554 times. RESULTS: Adverse events occurred 117 times during this period. The associations between workload and adverse events were analyzed by means of generalized estimating equations. The adjustment variables were: birth weight, gender, maternity unit, Clinical Risk Index for Babies score, and care demand, the latter measured by the Northern Neonatal Network Scale. The larger the number of newborns classified by care demand (NCCD) per nurse and nursing technician, the more likely the occurrence of intermediate adverse events linked to mechanical ventilation. A number of NCCD > 22 per nurse (relative risk [RR] = 2.86) and > 4.8 per auxiliary nurse (RR = 3.41) was associated with a higher prevalence of intermediate adverse events. CONCLUSIONS: The workload of NICU professionals seems to interfere with the intermediate results of neonatal care and thus should be taken into consideration when evaluating NICU outcomes.
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Humanos , Recién Nacido , Unidades de Cuidado Intensivo Neonatal/estadística & datos numéricos , Errores Médicos/estadística & datos numéricos , Respiración Artificial/efectos adversos , Carga de Trabajo/estadística & datos numéricos , Interpretación Estadística de Datos , Errores Médicos/clasificación , Cuerpo Médico de Hospitales/estadística & datos numéricos , Asistentes de Enfermería/estadística & datos numéricos , Personal de Enfermería en Hospital/estadística & datos numéricos , Estudios Prospectivos , Estadísticas no ParamétricasRESUMEN
INTRODUCTION: Echocardiographic, electrocardiographic and other cardiorespiratory variables can change during weaning from mechanical ventilation. OBJECTIVES: To analyze changes in cardiac function, using Doppler echocardiogram, in critical patients during weaning from mechanical ventilation, using two different weaning methods: pressure support ventilation and T-tube; and comparing patient subgroups: success vs. failure in weaning. METHODS: Randomized crossover clinical trial including patients under mechanical ventilation for more than 48 h and considered ready for weaning. Cardiorespiratory variables, oxygenation, electrocardiogram and Doppler echocardiogram findings were analyzed at baseline and after 30 min in pressure support ventilation and T-tube. Pressure support ventilation vs. T-tube and weaning success vs. failure were compared using ANOVA and Student's t-test. The level of significance was p<0.05. RESULTS: Twenty-four adult patients were evaluated. Seven patients failed at the first weaning attempt. No echocardiographic or electrocardiographic differences were observed between pressure support ventilation and T-tube. Weaning failure patients presented increases in left atrium, intraventricular septum thickness, posterior wall thickness and diameter of left ventricle and shorter isovolumetric relaxation time. Successfully weaned patients had higher levels of oxygenation. CONCLUSION: No differences were observed between Doppler echocardiographic variables and electrocardiographic and other cardiorespiratory variables during pressure support ventilation and T-tube. However cardiac structures were smaller, isovolumetric relaxation time was larger, and oxygenation level was greater in successfully weaned patients.
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Adulto , Anciano , Anciano de 80 o más Años , Femenino , Humanos , Masculino , Persona de Mediana Edad , Adulto Joven , Ecocardiografía Doppler , Corazón/fisiología , Respiración Artificial , Desconexión del Ventilador/métodos , Análisis de Varianza , APACHE , Unidades de Cuidados Intensivos , Presión , Factores de TiempoRESUMEN
El manejo de la vía aérea (MVA) debe ser prioridad en el cuidado de pacientes críticos, las intervenciones en vía aérea tienen como finalidad asegurarla o controlar la ventilación ademas de evitar complicaciones.1,2,3 La evaluación de vía aérea (EVA) previa es un prerrequisito, con el fin de determinar la dificultad de la maniobra, los posibles riesgos y complicaciones a las que se ve enfrentado el médico y el paciente.4,5,6,7 Surgen interrogantes con respecto a la EVA como parte del MVA en las unidades de cuidado intensivo, como los siguientes: ¿Con qué frecuencia realizamos esta evaluación?, ¿es nuestra evaluación completa y adecuada?, si es así, ¿con qué certeza podemos afirmar que la evaluación nos puede dar información cierta? y ¿qué tan confiados podemos sentirnos a la hora de intubar nuestro paciente? El siguiente texto tiene como finalidad discutir la importancia de las actitudes adecuadas y los procesos a seguir previos al MVA en el paciente crítico.
Airway management (MVA) must be priority in the care of critical patients. Airway intervention is needed to assure or control the ventilation.1,2 The Airway evaluation (EVA) is a requirement, with the purpose of determining the difficulty of the orotraqueal intubation maneuver, the possible risks and complications for the physician and the patient.4,5,6,7 There is some questions with respect to EVA like part of the MVA in the intensive care units; ¿how frequently we made this evaluation?, ¿Is it a complete and suitable evaluation?, if it is thus, ¿how certain could we affirm that the evaluation can give true information to us? and ¿how trusted can we feel at the time of patient intubation? The following text has the purpose of discuss the importance of suitable attitudes and the processes to follow previously to the MVA in the critical patient.
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HumanosRESUMEN
JUSTIFICATIVA E OBJETIVOS: O teste de permeabilidade avalia obstrução de via aérea superior e é classicamente realizado em modo assistido-controlado de ventilação mecânica. O objetivo deste estudo foi analisar este teste em ventilação espontânea, através de três diferentes métodos e compará-los. MÉTODO: Vinte pacientes intubados foram submetidos a três diferentes formas do teste de permeabilidade, todos em ventilação espontânea: com o ventilômetro e o paciente conectado ao ventilador (teste 1); através do display do ventilador mecânico (teste 2); e com o ventilômetro e o paciente desconectado do ventilador (teste 3). O vazamento ao redor do tubo traqueal (TT) foi definido como a porcentagem decorrente da diferença entre o volume-corrente inspirado (balonete insuflado) e expirado (balonete desinsuflado). Foram avaliadas as diferenças entre os três testes, bem como correlacionado a porcentagem de vazamento entre os testes com três variáveis: pressão do balonete, diâmetro do TT e tempo de intubação. RESULTADOS: Houve diferença significativa (p < 0,05) de vazamento entre os testes 1 e 2 em relação ao teste 3 no geral e relacionado à intubação, com período inferior a 48h e pressão de balonete abaixo de 20 cmH2O. Em relação ao diâmetro do tubo, houve diferença apenas entre os testes 2 e 3 para tubos de 8,5 mm. CONCLUSÕES: O teste de permeabilidade em ventilação espontânea parece ser mais fidedigno quando realizado com o paciente conectado ao ventilador mecânico, mas novos estudos devem ser realizados para a determinação da real contribuição do teste em ventilação espontânea para a predição de edema de laringe.
BACKGROUND AND OBJECTIVES: The cuff leak test aims to evaluate the presence of airway obstruction and normally is carried through in the controlled mode of mechanical ventilation. The objective of this study was to evaluate the cuff leak in patients breathing spontaneously, across three different methods, and to compare them. METHODS: Twenty intubated patients had been submitted to three different forms of cuff leak test, all of them in spontaneous respiration: measuring air leak buy using a ventilometer and with the patient connected to the mechanical ventilator (test 1); through the display of the mechanical ventilator (test 2); and with ventilometer and the patient detached from the mechanical ventilator (test 3). The air leak around the tracheal tube (TT) was defined as the percentage difference between the inspired tidal volume (insufflated cuff) and exhaled (deflated cuff). The air leak differences between the three tests were evaluated, as well as their correlations to three variables: cuff pressure, TT diameter and intubation time. RESULTS: Statistically significant (p < 0.05) air leak difference was observed between the tests 1 and 2 in relation to the test 3 in the general and regarding time intubation below 48h and cuff pressure below 20 cmH2O. Regarding the tube diameter, it had been difference only between tests 2 and 3 for 8.5 mm tubes. CONCLUSIONS: The cuff leak test in spontaneous ventilation seems to be more accurate when the patient is connected to the mechanical ventilator, and that additional studies are needed to determine the real contribution of the test in this ventilation mode to predict laryngeal edema.
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Humanos , Masculino , Femenino , Adulto , Persona de Mediana Edad , Respiración Artificial/métodosRESUMEN
Con el objetivo de evaluar los factores de riesgo de las infecciones nosocomiales en la Unidad de Terapia Intensiva Neonatal del Hospital General Universitario "Abel Santamaría Cuadrado" de Pinar del Río, se realizó una investigación observacional, analítica, de tipo caso-control, para ello se estudiaron 170 niños ingresados en esta unidad en el período comprendido de abril de 2001 a diciembre de 2003. Se recogió en una planilla tipo y momento de adquisición de la infección, abordaje vascular, ventilación mecánica y gérmenes aislados, entre otros. Se elaboró una base de datos en Microsoft Excel-97, se aplicaron los Test de Chi cuadrado y test de Student, ambos con un intervalo de confianza de p < 0.05. Se observó que el peso al nacer, el sexo, la edad gestacional, estadía en UCIN, ventilación mecánica y abordaje vascular profundo resultaron estar relacionados de forma significativa con la adquisición de las infecciones nosocomiales, al ser comparado con un grupo control de similares características. Los gérmenes más frecuentes asilados fueron la E. Coli y el estafilococo coagulasa negativo.
With the purpose of evaluating risk factors of nosocomial infections in the Intensive Care Unit of the "Abel Santamaría Cuadrado" General Hospital in Pinar del Río, an observational, analytical and a case-control research was performed in 170 children admitted at this Unit from April 1st., 2001, to December 31st., 2003. The nosocomial infection and time of being infected were recorded in a form, as well as the vascular approach, artificial ventilation and isolated germs, among others. A data base using the Microsoft Excel 97 software was designed, and chi-square test was used, both of them with a confidence interval of p<0,05. It was observed that birth weight, sex, gestational age, stay at ICU, artificial ventilation and deep vascular approach were related significantly with the onset of the nosocomial infection versus a control group showing similar characteristics. E. Coli and negative coagulase were the most frequent isolated germs.