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El uso de la ventilación mecánica invasiva crónica se ha incrementado progresivamente en pediatría. Su uso tiene importantes beneficios, pero también riesgos asociados. La terapia ventilatoria debe ser supervisada en forma constante y dentro de los métodos de evaluación clínica de la ventilación se encuentra el análisis de los datos de monitorización almacenados en la memoria interna del ventilador. Estos datos contienen información almacenada durante el uso del ventilador que puede ayudarnos a tomar decisiones. Es importante considerar que la precisión de la información depende de la tecnología del ventilador y los componentes utilizados. El objetivo de esta revisión es dar a conocer la utilidad y limitaciones de la información de monitorización del ventilador mecánico en pacientes usuarios de ventilación mecánica crónica por traqueostomía, junto con describir su interpretación estructurada en forma sencilla y con ejemplos clínicos.
Long-term mechanical ventilation has increased in pediatric patients. Its use has important benefits, but also associated risks. Ventilatory therapy must be constantly monitored, and ventilator data analysis it's one of the evaluation methods. The device data contains information stored during the ventilator use and can help us with therapy decisions. The information accuracy depends on ventilator technology and the components that are used for ventilation. The objective of this review is to present the usefulness and limitations of the information on mechanical ventilator monitoring devices in patients using chronic mechanical ventilation by tracheostomy describing and structured interpretation in a simple way with the use of clinical examples.
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Humanos , Lactente , Pré-Escolar , Respiração Artificial/instrumentação , Tomada de Decisões , Análise de Dados , Monitorização Fisiológica/métodos , TraqueostomiaRESUMO
PURPOSE: To describe the implementation of a postfracture care program in a private hospital in Colombia, the results achieved after the program's first year, and the challenges encountered. METHODS: A cross-sectional descriptive study of the first year's outcomes. The program was implemented following best practices described in the "Capture the Fracture" framework. We assessed the management of fractures before the launch of the program. A multidisciplinary group was established to collaborate on the diagnosis and treatment of patients with osteoporotic fractures. A full-time program coordinator was appointed. We analyzed the program's clinical outcomes and limitations. RESULTS: One-hundred and ninety patients were included in the study, with an average age of 76.7. Hip fracture was the most frequent one (33.6%). After the first year of implementing the program, 39.4% of patients received osteoporosis treatment, with an adherence rate of 73%. The incidence of subsequent falls was 5.8% and 1% for new fractures. CONCLUSIONS: The implementation of a program for patients' care with fragility fractures is challenging for healthcare institutions. The role of a full-time coordinator is critical for the proper operation of such programs.
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INTRODUCCIÓN: Las enfermedades respiratorias crónicas (ERC) en niños han aumentado en los últimos años siendo la Rehabilitación Respiratoria uno de los tratamientos utilizados en esta población. OBJETIVO: Evaluar el impacto de un programa de entrenamiento aeróbico sobre cinta rodante en pacientes pediátricos con ERC del Hospital Josefina Martínez. METODOLOGÍA: Serie retrospectiva de casos con registro prospectivo de 9 pacientes con una edad promedio de 7,1 ± 3,9 años con ERC y entrenamiento aeróbico. Los pacientes realizaron 24 sesiones. Se analizaron los registros pre-post de los test de marcha de 6 min (TM6) y la velocidad máxima obtenida en el Test Cardiopulmonar Incremental (VTCI). RESULTADOS: Las medias de la distancia recorrida en TM6 pre y post entrenamiento fueron de 383 ± 142,4 m y 451,7 ± 142,4 m respectivamente (p < 0,0001). Las medias de las VTCI pre y post entrenamiento fueron: 4,1 ± 1,1 km/h y 5,4 ± 1,27 km/h (p = 0,001). CONCLUSIONES: La distancia recorrida en el TM6 y la capacidad máxima de trabajo mejoraron significativamente con el entrenamiento aeróbico en estos pacientes con ERC.
INTRODUCTION: Chronic respiratory diseases (CRD) in children have increased in recent years. Respiratory Rehabilitation is one of the treatments used in this population. OBJECTIVE: To evaluate the impact of a treadmill training program over pediatric patients with CRD in the Josefina Martínez Children's Hospital at Santiago de Chile. METHODS: Retrospective cases series with prospective record of 9 patients 7.1 ± 3.9 years-old with CRD and treadmill training. The patients performed 24 sessions. The Pre-post records of the 6-minute walk test (6MW) and the maximum speed obtained in the Incremental Load Test (ILT) were analyzed. RESULTS: Averages of the distance traveled pre and post-training were 383 ± 142.4 meters and 451.7 ± 142.4 meters respectively (p < 0.0001). The average maximum speed obtained in the ILT was 4.1 ± 1.1 km/h and 5.4 ± 1.27 km/h (p = 0.001). CONCLUSION: The distance walked in the 6-minute walk test and the maximum work capacity improve significantly with treadmill training in these patients with CRD.
Assuntos
Humanos , Masculino , Feminino , Pré-Escolar , Criança , Adolescente , Doenças Respiratórias/reabilitação , Treino Aeróbico/métodos , Marcha/fisiologia , Fatores de Tempo , Exercício Físico , Doença Crônica , Estudos Retrospectivos , Teste de Caminhada , Aptidão Cardiorrespiratória/fisiologiaRESUMO
INTRODUCCIÓN: El uso prolongado de traqueostomía (TQT) conlleva a complicaciones que pueden minimizarse con una decanulación segura y temprana. La presión inspiratoria mantenida (PiMant) evalúa el comportamiento dinámico de la vía aérea en inspiración, la que puede relacionarse con la tolerancia a la oclusión de la TQT en pacientes en vía de decanulación. El OBJETIVO es el de describir la medición de PiMant y relacionar su valor con la tolerancia al uso de cánula tapada. METODOLOGÍA: Se evaluó la PiMant a 16 pacientes traqueostomizados, con vacuómetro anaeroide, registrando la moda de las presiones obtenidas, saturación de oxígeno, frecuencias respiratoria y cardíaca, uso de musculatura accesoria y estridor, a los minutos 1, 5, 10 y 15 de la oclusión de la TQT. RESULTADOS: mediana edad 60 meses, rango de presiones −2 a −40 cmH2O. Valores de PiMant > −7 cmH2O se asocian a mejor tolerancia al uso de cánula tapada. El estridor severo, asociado a aumento en frecuencia respiratoria, frecuencia cardiaca y uso de musculatura accesoria fueron los principales indicadores de fin de la prueba. CONCLUSIONES: PiMant es una prueba segura. PiMant> −7cmH2O, presentan mejor tolerancia a uso de cánula tapada.
INTRODUCTION: The prolonged use of tracheostomy leads to several complications, being necessary a prompt and safe decannulation. Maintained Inspiratory Airway Pressure (PiMant) is a functional evaluation of the dynamic changes of upper airway in inspiration which could indicate the tolerance to capped tracheostomy and adapting to this new airflow resistance, prior to decannulate. METHODS: Sixteen tracheostomized patients were evaluated with PiMant using a vacuum gauge, recording pressure value, oxygen saturation, respiratory rate, heart rate, accesory muscles use and presence of stridor during 15 minutes. RESULTS: Median age 60 months-old, pressure range −2 to −40 cmH2O. PiMant values > −7 cmH2O were associated with better tolerance to capped tracheostomy. Stridor was associated to increase of respiratory effort being the best criteria to bring to a halt the test. CONCLUSIONS: PiMant is a safe assessment, and indicates tolerance to capped tracheostomy when values > −7 cmH2O are found.
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Humanos , Masculino , Feminino , Lactente , Pré-Escolar , Criança , Traqueostomia , Resistência das Vias Respiratórias , Inalação/fisiologia , Obstrução do Cateter , Oxigênio , Remoção de Dispositivo , Taxa Respiratória/fisiologia , Frequência Cardíaca/fisiologiaRESUMO
In chronic children with long-term mechanical ventilation, early discharge improves quality of life and decreases associated health costs. In order to achieve this goal, implementation of hospital and home care programs integrating a multidisciplinary team is necessary. In North America, the Respiratory Therapist (RT) performs an important part of the respiratory care and education to caregivers before patients' discharge. In Chile, the kinesiologist (physical therapist with respiratory care knowledge) assumes part of these functions, including permeability of the airway, education about oxygen therapy systems, mechanical ventilation support adaptation, thermo-humidification, aerosol therapy and monitoring.Additionally, unlike the traditional role of RTs, kinesiologists are involved in respiratory rehabilitation activities designed to optimize cardiorespiratory function prior to discharge, integrating general and specific training strategies, use of phonation devices and implementation of individualized respiratory assessments
En niños crónicos dependientes de ventilación mecánica prolongada (VMP), el alta precoz mejora la calidad de vida y disminuye los costos sanitarios asociados. Para lograrla es necesaria la implementación de programas hospitalarios y domiciliarios que integren a distintos profesionales. En Norteamérica es el Terapista Respiratorio (TR) quien ejecuta parte importante de los cuidados respiratorios y educación a los padres previo al alta. En Chile es el Kinesiólogo quien asume parte de estas funciones, incluyendo permeabilización de la vía aérea, adecuación de sistemas de soporte ventilatorio, oxigenoterapia, termohumedificación, aerosolterapía y monitorización.Adicionalmente, a diferencia del rol clásico del TR, el kinesiólogo desarrolla actividades de rehabilitación respiratoria tendientes a optimizar el estado funcional cardiorespiratorio previo al alta, integrando actividades de acondicionamiento general y especifico, uso de dispositivos fonatorios y ejecución de evaluaciones individualizadas de la función respiratoria
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Humanos , Criança , Alta do Paciente , Respiração Artificial/métodos , Insuficiência Respiratória/terapia , Terapia Respiratória , Modalidades de Fisioterapia , Equipe de Assistência ao Paciente , Insuficiência Respiratória/reabilitação , Assistência de Longa Duração , Especialidade de Fisioterapia/métodos , Serviços de Assistência DomiciliarRESUMO
Introduction: Speaking valve (SV) is an unidirectional flow device installed over the tracheostomy tube allowing phonation. Tolerance to this device depends on the permeability of the upper airway (UA), which may be indirectly assessed by measuring UA maintained expiratory pressure (PEMant). Objective: To evaluate the usefulness of the maintained expiratory pressure as a clinical indicator of tolerance to the SV. Method: Twenty three tracheostomized patients (median age 22 months-old) were evaluated with an aneroid manometer during 15 minutes, recording PEMant, arterial oxygen saturation (SaO2), heart rate, respiratory rate, accessory muscle use and wheezing as signs of respiratory distress Results: PEMant values less than 10 cmH2O are associated with tolerance of the SV and values over 20 cmH2O are associated with intolerance. Conclusion: Values under 10 cmH2O of PEMant can be used as an indicator of tolerance to VF.
Introducción: La válvula de fonación (VF), es un dispositivo de flujo unidireccional instalado sobre la cánula de traqueostomía posibilitando la fonación. La tolerancia a este dispositivo depende de la permeabilidad de la vía aérea superior (VAS), pudiendo ser valorada indirectamente a través de la medición de la presión espiratoria mantenida (PEMant) en vía aérea. Objetivo: Estudiar esta técnica como indicador clínico de tolerancia a la VF. Método: Se evaluaron 23 pacientes traqueostomizados (mediana de edad 22 meses) con un manómetro aneroide durante 15 minutos, registrando PEMant, saturación arterial de oxígeno (SaO2), frecuencia cardiaca, frecuencia respiratoria, uso de musculatura accesoria y sibilancias para valorar la dificultad respiratoria. Resultados: Valores de PEMant menores a 10 cmH2O se asocian con tolerancia a la VFy valores sobre 20 cmH2O a intolerancia a ésta. Conclusión: Valores bajo 10cmH2O de PEMant pueden ser indicadores de tolerancia al uso de VF.
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Humanos , Masculino , Feminino , Lactente , Pré-Escolar , Criança , Logoterapia/instrumentação , Traqueostomia/efeitos adversos , Distúrbios da Fala/fisiopatologia , Distúrbios da Fala/reabilitação , Broncoscopia , Expiração/fisiologia , Frequência Cardíaca/fisiologia , Estudos Longitudinais , Manometria , Monitorização Fisiológica , Oxigênio/sangue , Cuidados Pós-Operatórios , Pressão , Distúrbios da Fala/etiologiaRESUMO
BACKGROUND AND STUDY AIMS: Spontaneous intracerebral hemorrhage (ICH) represents the most fatal kind of stroke, and there is still no treatment available that improves the outcome. Statins are cholesterol reducers, and during the last few years many additional effects have been demonstrated that might be neuroprotective. We designed a pilot clinical study in order to evaluate whether the administration of statins is associated with a better outcome. PATIENTS AND METHODS: From August to December 2006 we carried out a prospective/retrospective non-randomized clinical study. The prospective group was treated with rosuvastatin (20 mg) and the retrospective control group was taken from our clinical records with a relation of 1:3. We included patients of both sexes, aged > or =15 years with proven ICH in CT-scan. Exclusion criteria were a history of neoplasm, head injury four weeks before admission, non-hypertensive reasons, brainstem hemorrhage, steroid administration, cranial surgery, initial hydrocephalus, and NIHSS > or =30. RESULTS: We analyzed 18 patients treated with rosuvastatin and 57 controls with similar basic characteristics. The mortality rate during hospitalization was 1 (5.6%) patient in the statin group and 9 (15.8%) in the control group; the hazard ratio adjusted by the initial Glasgow Coma Scale (GCS), intubation, admission in intensive care unit, disruption into the subarachnoid space was 0.20 (95% CI 0.02-1.67). The odds ratio for NIHSS > or =15 at release was 0.04 (95% CI 0.003-0.93). CONCLUSIONS: The use of statins during the acute phase of ICH could be associated with a better outcome. Further clinical trials are necessary to confirm a possible therapeutic effect and evaluate the toxicity of statins.
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Hemorragia Cerebral/tratamento farmacológico , Fluorbenzenos/uso terapêutico , Inibidores de Hidroximetilglutaril-CoA Redutases/uso terapêutico , Pirimidinas/uso terapêutico , Sulfonamidas/uso terapêutico , Adulto , Idoso , Anti-Hipertensivos/uso terapêutico , Hemorragia Cerebral/mortalidade , Feminino , Escala de Coma de Glasgow , Mortalidade Hospitalar , Humanos , Masculino , Pessoa de Meia-Idade , Razão de Chances , Projetos Piloto , Modelos de Riscos Proporcionais , Estudos Prospectivos , Estudos Retrospectivos , Rosuvastatina Cálcica , Tamanho da Amostra , Acidente Vascular Cerebral/tratamento farmacológico , Acidente Vascular Cerebral/mortalidade , Tomografia Computadorizada por Raios X , Resultado do TratamentoRESUMO
INTRODUCTION: Intracerebral hemorrhage (ICH) is the most lethal type of stroke. There are some clinical and radiological factors related to mortality. The time for obtaining medical care could be related with poor prognosis, but there are not available studies in Hispanics that evaluated this one. AIM: To determinate the association between epidemiological factors, time to obtain medical care, origin, and clinical characteristics with hospital mortality due to ICH. SUBJECTS AND METHODS: Study of cases and controls in a regional third level center, between January 2000 and December 2006 with patients of both sexes, older than 15 years with tomographic diagnosis of ICH. We excluded patients with NIHSS undetermined or traumatic head injury 4 weeks before. We studied demographic variables, time between beginning of symptoms and medical care, origin in kilometers until hospital, clinical characteristics at admission, including Glasgow and NIHSS. RESULTS: We analyzed 74 men and 101 women with mean age of 65 years. The etiology was hypertension in 77.4% and localization lobar in 39.4%. Eighty-five percent receipt medical care after 3 hours and 75.4% came from a radius < 100 km. Mortality in hospital was 16.6% with an explicative model of regression that included blood pressure < 130/80 mmHg, intubation, Glasgow < 9 at admission or NIHSS > 15, and hospitalization days. CONCLUSIONS: Demographic characteristics, causes, and localization are similar to previously informed series. The time for obtaining medical care is far from ideal, this could delay treatment; allow progression of disease, and then worse prognosis.
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Hemorragia Cerebral/mortalidade , Hemorragia Cerebral/terapia , Adulto , Idoso , Idoso de 80 Anos ou mais , Estudos de Casos e Controles , Hemorragia Cerebral/diagnóstico , Hemorragia Cerebral/epidemiologia , Feminino , Mortalidade Hospitalar , Hospitais , Humanos , Masculino , México , Pessoa de Meia-Idade , Estudos Retrospectivos , Fatores de Risco , Fatores de TempoRESUMO
1. Information regarding the use of continuous i.v. administration of nitroglycerine as an antihypertensive agent in the management of pre-eclampsia is scarce. In the present study, i.v. nitroglycerine or sublingual nifedipine were administered to 32 women with severe pre-eclampsia who were being managed with controlled plasma volume expansion and MgSO(4) loading and maintenance doses. Maternal blood pressure and heart rate responses, fetal heart rate responses and perinatal fetal-maternal adverse effects were evaluated using classical parametric and non-parametric data analysis and data modelling by mixed models. 2. An important hypotensive response was observed in both groups, although this reponse was greater, faster and exhibited less variability (more precision) in the nitroglycerine-treated group. Heart rate also increased in both the nitroglycerine- and nifedipine-treated groups (4.6 +/- 4.4 vs 8.6 +/- 5.3 b.p.m., respectively), although the increase in the nifedipine-treated group was almost twofold that in the nitroglycerine-treated group. There were no significant changes in fetal heart rate in response to vasodilator therapy. The frequency of perinatal fetal-maternal adverse effects was similar in both groups at 40% and the adverse effects observed included flushing, headache, palpitations and nausea. 3. In conclusion, i.v. infusion of nitroglycerine is an effective, safe and alternative therapy for severe pre-eclampsia.
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Nifedipino/administração & dosagem , Nifedipino/uso terapêutico , Nitroglicerina/administração & dosagem , Nitroglicerina/uso terapêutico , Pré-Eclâmpsia/tratamento farmacológico , Administração Sublingual , Adulto , Feminino , Humanos , Injeções Intravenosas , Sulfato de Magnésio/uso terapêutico , Nifedipino/efeitos adversos , Nitroglicerina/efeitos adversos , Gravidez , Fatores de Tempo , Vasodilatadores/administração & dosagem , Vasodilatadores/efeitos adversos , Vasodilatadores/uso terapêuticoRESUMO
Paciente de sexo femenino, de 26 años de edad, con antecedentes de rinitis y cuadros de obstrucción bronquial estacionales que presentó cuadro de úlceras en extremidades inferiores, asociadas a compromiso pulmonar en base a hemoptisis e imágenes radiológicas anormales transitorias, eosinofilia al frotis de sangre periférico y c-ANCA positivo y que responde favorablemente a la terapia con corticoides e inmunosupresores
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Humanos , Feminino , Adulto , Vasculite , Anticorpos Anticitoplasma de Neutrófilos/isolamento & purificação , Vasculite , Prednisona , Úlcera Cutânea/etiologiaRESUMO
Patients in chronic hemodialysis have a high mortality due to cardiovascular diseases. To study cardiovascular risk factors and nutritional status in a group of patients in maintenance hemodialysis, body mass index, blood pressure, serum levels of total cholesterol, HDL cholesterol, triglycerides and albumin were measured in 15 patients (8 males). Data were compared with available figures for the normal chilean population. Age ranged from 33 to 60 years oldin female patients and from 22 to 63 years old in males. Thirteen subjects (87 percent) has a high blood pressure, all had HDL cholesterol levels below 35 mg/dl, 4 (27 percent) had a total cholesterol over 200 mg/dl, 3 had triglyceride levels over 200 mg/dl, 2 (13 percent) smoked and none were diabetic. Mean body mass index was normal, albumin levels were 4.16 and 4.02 g/dl and serum creatinine was 11.64 and 9.68 mg/dl in males and females respectively. The estimated prevalence of high blood pressure, hypercholesterolemia and smoking in the general chilean population range from 9 to 22 percent, from 50 to 52 percent and from 45 to 51 percent respectively. In conclusion, this group of patients has a high frequency of high blood pressure and low HDL cholesterol levels
Assuntos
Humanos , Masculino , Feminino , Adulto , Pessoa de Meia-Idade , Doenças Cardiovasculares/etiologia , Nefropatias/complicações , Diálise Renal/efeitos adversos , Fatores de Risco , Creatinina/sangue , Albumina Sérica , Avaliação Nutricional , Lipoproteínas/sangueRESUMO
La vitamina D tiene un papel fundamental en la absorción de calcio y fósforo en el intestino. En el hígado se hidroxila a 25-hidroxivitamina D (25-OHD), su principal metabolito circulante. Se determinó por radioinmunoensayo, el nivel sérico de 25-OHD y por colorimetría, los niveles de calcio y fósforo en 41 niños de 5.34 ñ 3,53 años; 21 aparentemente sanos y 20 pacientes con enfermedades hepáticas: 14 con hepatitis viral aguda (HVA) y 6 con enfermedades hepáticas crónicas (EHC). El valor promedio de 25-OHD encontrado en el grupo con HVA, fue de 18.75 ñ 14.6 ng/mL (6=2.910, p<.025), en el grupo con EHC se obtuvo un valor promedio de 8.50ñ6.20 ng/mL (n.s.), En el grupo control el valor promedio fue de 8.99 ñ 4.05 ng/mL. El nivel promedio de calcio fue de 0.58 ñ 0.397 mg/dL para el grupo control, 10.18 ñ 1.267 mg/dL (t=2.052, p<.025) para el grupo con HVA y 10.65 ñ 1.96 mg/dL (t=2.370, p<.025) para el grupo con EHC. Los valores promedios de fósforo fueron: 4.29 ñ 0.811 mg/dL para el grupo control; 3.53 ñ 0.513 para los pacientes con HVA (t=0.804, n.s.) y 3.38 ñ 0.62 mg/dL con EHC (t0.909, n.s.). Se concluye que 25-OHD permanece en niveles normales en pacientes con enfermedades hepáticas agudas y que deben evaluarse aquellos con hepatopatías crónicas
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Humanos , Masculino , Feminino , Cálcio/sangue , Fósforo/sangue , Hidroxicolecalciferóis/sangue , Hepatopatias/sangue , Biomarcadores/análiseRESUMO
From October 1984 to March 1992, 21 patients of Hospital Nacional Guillermo Almenara Irigoyen-IPSS, Lima, Perú, with esophageal achalasia were treated with pneumatic dilatation using a 3.5 cm diameter Rider-Moeller balloon. The mean age was 40.5 years (range: 24-54). Six were men and 15 women. The mean time with dysphagia previous to treatment was 5.3 years. A total of 29 sessions were performed, 1.38 sessions per patient. The follow-up of the first 10 patients was carried for a mean time of 48.3 months (range:6-91). A satisfactory response to treatment was obtained in 8 patients (80%). Two patients (20%) relapsed after 2 and 3 treatment sessions needing surgery. One patient suffered a esophageal perforation recovering after surgical treatment. We conclude that pneumatic dilatation with Rider-Moeller balloon is a safe and not difficult medical procedure for esophagus achalasia.
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Cateterismo , Acalasia Esofágica/terapia , Adulto , Cateterismo/efeitos adversos , Cateterismo/instrumentação , Cateterismo/métodos , Esofagoscópios , Estudos de Avaliação como Assunto , Feminino , Tecnologia de Fibra Óptica/instrumentação , Seguimentos , Humanos , Masculino , Pessoa de Meia-Idade , Estudos Prospectivos , Indução de RemissãoRESUMO
El ejercicio fisico como modalidad terapeutica para los pacientes que han sufrido infarto del miocardio es una alternativa que la enfermera debe involucrar en el cuidado para reducir las complicaciones de la inmovilidad, estimular la adaptacion sicologica y lograr optimo restablecimiento funcional. Para implementar un programa de ejercicios en el manejo de un paciente debe partirse de la evaluacion clinica y la clasificacion pronostica de la lesion y sus implicaciones sistemicas. Se propone la clasificacion de Breustet. El programa debe ademas incluir medidas de soporte sicologico, familiar, social, educacional y con factores de riesgo coronario se inicia con la movilizacion pasiva-activa y deambulacion temprana procurando bajos consumos de oxigeno, cuando la respuesta del paciente es apropiada, se involucran nuevas actividades sin exceder de 4.5 minutos. Se presenta un plan de atencion al paciente que incluye el dia de evolucion post infarto, la actividad de enfermeria, su justificacion y el metodo de control de su impacto en el paciente. Comprende ejercicio fisico, aspectos de soporte emocional, actividades educacionales y de vigilancia y control