RESUMO
BACKGROUND: Atelectasis is a decrease of lung volume caused by airway obstruction or pressure on the external part of the lung. It is common after surgery and extubation. The purpose of this investigation was to determine factors related with alectasis following extubation in preterm neonates with a weight under 1250 g who were referred to a neonatal intensive care unit. METHODS: The study was conducted in neonates admitted to a neonatal intensive care unit requiring mechanically assisted ventilation. Preterm neonates born at 28 to 36 weeks' gestation and with 0 to 28 days' extrauterine life, with mechanically assisted ventilation for at least 24 hours, and that when undergoing planned extubation had a weight under 1250 g were included. Two comparative groups were formed: group A, with alectasis after extubation; group B, without alectasis after extubation. RESULTS: As factors associated with alectasis after extubation, reintubation in two or more occasions and cycling higher than 20 per minute, which were statistically relevant, were identified. CONCLUSIONS: In addition to previous general measures to prevent alectasis, extubation with ventilation not higher tan 20 cycles per minute should be programmed and reintubation should be avoided as much as possible.
INTRODUCCIÓN: la atelectasia es la disminución del volumen pulmonar causada por obstrucción de las vías aéreas o presión en la parte externa del pulmón. Es común después de una cirugía y de la extubación. El objetivo de esta investigación fue determinar los factores relacionados con la atelectasia posterior a extubación en recién nacidos prematuros con peso menor de 1250 g que fueron referidos a una unidad de cuidados intensivos neonatales. MÉTODOS: el estudio se realizó en los neonatos que ingresaron a una unidad de cuidados intensivos neonatales y que ameritaron asistencia mecánica para la ventilación. Se incluyeron los recién nacidos pretérmino de 28 a 36 semanas de gestación y de 0 a 28 días de vida extrauterina, con asistencia mecánica para la ventilación por lo menos durante 24 horas y que al ser extubados en forma planeada tuvieron un peso menor a 1250 g. Se formaron dos grupos comparativos: grupo A, con atelectasias posterior a extubación; grupo B, sin atelectasia posterior a extubación. RESULTADOS: como factores relacionados con la atelectasia posterior a la extubación se identificó la reintubación en dos o más ocasiones y el ciclado mayor de 20 por minuto, que fueron estadísticamente relevantes. CONCLUSIONES: además de las medidas generales previas, para evitar la atelectasia debe programarse la extubación con parámetros de ventilación no mayores de 20 ciclos por minuto y evitar, en la medida de lo posible, las reintubaciones.
Assuntos
Extubação , Doenças do Prematuro/etiologia , Atelectasia Pulmonar/etiologia , Extubação/métodos , Estudos de Casos e Controles , Feminino , Humanos , Recém-Nascido , Recém-Nascido Prematuro , Doenças do Prematuro/diagnóstico , Doenças do Prematuro/terapia , Terapia Intensiva Neonatal , Intubação Intratraqueal , Masculino , Atelectasia Pulmonar/diagnóstico , Atelectasia Pulmonar/prevenção & controle , Respiração Artificial/métodos , Fatores de RiscoRESUMO
OBJECTIVE: To determine the variability of the vital signs (temperature, heart rate and respiratory frequency), skin coloration and peripheral oxygen saturation in critically ill preterm newborns (CI PTNB) before, during and after sponge bathing as well as to determine the possible presence of secondary complications of this procedure. MATERIAL AND METHODS: We performed a quasi-experimental study (experimental, prospective, comparative and clinical study with intervention) May to December 2008, in a Neonatal Intensive Care Unit. We included CI PTNB of 0 to 28 days of extrauterine life who have practiced in the routine sponge bathing. Area of significance was considered when p < 0.05. RESULTS: During or after the events in any of the patients presented any complications after 12 h of monitoring, but it was necessary to increase the inspired fraction of oxygen and temperature in the incubator or radiant heat cradle temporarily. CONCLUSIONS: We conclude that the sponge bath is not safe for a CI PTNB and this should be performed in the shortest time possible, and the medical must be very alert to the possibility that patients require more support than they had prior to sponge bathing, mainly in the temperature of the incubator or radiant heat cradle and inspired fraction of oxygen for the required time according to the evolution of these variables.
Assuntos
Banhos/efeitos adversos , Temperatura Corporal , Cuidados Críticos/métodos , Estado Terminal , Frequência Cardíaca , Cuidado do Lactente/métodos , Doenças do Prematuro/fisiopatologia , Recém-Nascido Prematuro/fisiologia , Oxigênio/sangue , Respiração , Banhos/métodos , Contraindicações , Feminino , Humanos , Hipotermia/etiologia , Hipotermia/prevenção & controle , Hipóxia/etiologia , Hipóxia/prevenção & controle , Incubadoras para Lactentes , Recém-Nascido , Recém-Nascido Prematuro/sangue , Doenças do Prematuro/sangue , Doenças do Prematuro/prevenção & controle , Unidades de Terapia Intensiva Neonatal , Masculino , Oxigênio/administração & dosagem , Oxigenoterapia , Estudos Prospectivos , Taquicardia/etiologia , Taquicardia/prevenção & controle , Taquipneia/etiologia , Taquipneia/prevenção & controleRESUMO
OBJECTIVE: To determine the prevalence of nosocomial infection (NI) in newborns (NB) as well as the etiology, frequency mortality related to these infections in a tertiary-care hospital. MATERIAL AND METHODS: A retrospective epidemiological study was carried out with NB admitted to a tertiary-care neonatology hospital service from January 2006 to December 2008 who complied with selection criteria. All NB between the gestational ages of 25 to 44 weeks, NI supported by positive culture and either local or systemic infection were included. Descriptive statistic was used. RESULTS: NI prevalence in the Neonatal Service was an average of 30.4%. The most common microorganisms isolated in first event cultures (n = 100) were Gram-positive bacteria such as coagulase-negative staphylococci found in 55 patients (55%), followed by Gram-negative bacteria present in 44 patients (44%) and fungi such as Candida albicans and Candida sp. from 8 patients (8%); as to the second event (n = 32), Gram-negative bacteria were isolated from 20 patients (62.5%), Gram-positive bacteria such as coagulase-negative staphylococci were present in 6 patients (18.7%) and fungi such as Candida albicans were found in 5 patients (15.6%). Finally, regarding the third event (n = 18), Gram-negative bacteria were present in 16 patients (88.9%), Gram-positive bacteria were found in 15 patients (83.3%) such as coagulase-negative staphylococci in 10 patients (55.5%), and fungi such as Candida sp. in two (11.1%). Twelve (12%) who died secondary to IN, two suffered three NI events. CONCLUSIONS: Awareness of the various characteristics of NI in the work area (etiology, prevalence, and final outcome) is of great importance to design new interventions.
Assuntos
Infecção Hospitalar , Bactérias/isolamento & purificação , Infecção Hospitalar/epidemiologia , Infecção Hospitalar/microbiologia , Feminino , Humanos , Recém-Nascido , Masculino , Prevalência , Estudos RetrospectivosRESUMO
INTRODUCTION: The mechanical ventilator support (MVS) it is a procedure which improves survival of critically ill newborns (NB), but is not risk free one of them is tracheal damage reintubations by extubation failure. Knowledge that there is the medical literature is about preterm infant and there is not information about term NB. OBJECTIVE: To establish that factors are associated to the unsuccessful extubation in the term NB from 37 to 42 weeks of gestational age. MATERIAL AND METHODS: Retrospective study, of case-control in cohort including all the files and/or patient term NB that were interned in the Neonatal Intensive Care Unit of a Neonatology Service during the period of January from the 2004 to December of 2008 that they fulfilled the selection criteria. They were formed two groups: group A of cases (extubation failure) and group B of controls (successful extubation). Extubation failure was considered when there was need for the patient reintubate during first 72 hrs. We take into account to patient of term NB of one to 28 days of extrauterine life that remained with MVS at least 24 hrs and that to extubate was achieved with or without success, previous step for tracheal continuous positive airway pressure (CPAP), and that they were not more than 28 days with MVS. The statistical analysis was carried out by means of the descriptive and the inferential statistic. It was considered area of significance with p < 0.05. RESULTS: Fourty one patients were included divided in two groups: group A (cases) of 17 patients, and group B (controls) with 24 patients. The population's characteristics studied among the two groups didn't show significant differences. Of the variables studied between the two groups showed significant differences of age at start of ventilation, calories and the hemoglobin for controls and the time spent with MVS, reintubations number, and the peak inspiratory pressure (PIP) prior to the passage of the CPAP for cases, all with p < 0.05. In the multivariate analysis they were significant association as factor of risk for the extubation failure when the PIP was > 18 cm H2O, cycles > 15x' and hemoglobin < 13 g/dL. CONCLUSIONS: Based on the above we conclude that in the term NB with MVS before placing in tracheal CPAP for the extubation should have a PIP < or = 18 cm H2O, cycles < or = 15x' and a hemoglobin not smaller than 13 g/dL to avoid this way as much as possible the extubation failure and with it to improve the prognosis.