RESUMO
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.
Assuntos
Hipnóticos e Sedativos/uso terapêutico , Intubação Intratraqueal , Doenças da Laringe , Laringe , Ajuste de Prótese/efeitos adversos , Brasil/epidemiologia , Pré-Escolar , Feminino , Humanos , Doença Iatrogênica/epidemiologia , Doença Iatrogênica/prevenção & controle , Lactente , Unidades de Terapia Intensiva Pediátrica/estatística & dados numéricos , Intubação Intratraqueal/efeitos adversos , Intubação Intratraqueal/instrumentação , Intubação Intratraqueal/métodos , Doenças da Laringe/diagnóstico , Doenças da Laringe/epidemiologia , Doenças da Laringe/etiologia , Laringoscopia/métodos , Laringe/diagnóstico por imagem , Laringe/lesões , Masculino , Respiração Artificial/métodos , Fatores de RiscoRESUMO
A perfeita adaptação passiva das próteses sobre implantes é um fator importante para a obtenção do sucesso na Implantodontia. Para tanto, a eliminação de variáveis que possam afetar o processo de confecção de uma estrutura protética é fundamental, essas vão desde o procedimento de moldagem até a execução da peça protética, sendo que essa fase representa a transição da situação clínica para a fase laboratorial; desta maneira, o modelo de trabalho deve ser o mais preciso possível para evitar qualquer tipo de diferença significativa na adaptação final do trabalho. A confecção, em boca, do Index de resina é para auxiliar a conferencia dessa precisão de adaptação no modelo de gesso, eliminando futuros problemas no assentamento das estruturas, na dissipação das cargas mastigatórias e comprometimento da qualidade final do trabalho. Isto se torna imprescindível quando utilizamos a tecnologia CAD/CAM, pois as estruturassão fresadas em monobloco, onde se obtém uma estrutura única em que o assentamento passivo depende diretamente das informações de posicionamento dos análogos, passadas ao software através do modelo de gesso que foi previamente escaneado.
The perfect passive adaptation of the implant prosthesis is an important factor to achievesuccess in implantology. Therefore, the elimination of variables that can affect the process ofprosthetic construction is critical. These variables range from dental impression technique until the final execution of the implant supported prosthesis. The Prosthetic phase is the transition ofthe clinical situation to the laboratory phase; this way, the working model must be as accurateas possible to avoid any significant difference in the final adaptation of the restoration. Theproduction, in mouth, of the resin Index is to assist the conference of the precision fit on thestone model, eliminating future problems in the settlement of structures, dissipation of masticatory loads and commitment of the final quality of work. This becomes more imperative whenwe use the CAD / CAM technology, because the structures are milled in a single block where youget a unique structure in which the liability settlement depends directly on the analog position information, passed to the software through the plaster model that was previously scanned.
Assuntos
Humanos , Masculino , Feminino , Ajuste de Prótese/efeitos adversos , Ajuste de Prótese/métodos , Ajuste de Prótese/tendências , Modelos Dentários/efeitos adversos , Modelos Dentários , Desenho Assistido por ComputadorRESUMO
PURPOSE: To evaluate the influence of different metallic flask systems for acrylic resin denture processing on tooth displacement and framework misfit of mandibular fixed implant-supported complete dentures. METHODS: Standard mandibular implant-supported complete dentures in five implants were waxed and randomly assigned to three groups: G1 - conventional flask, G2 - double flask, and G3 - occlusion flask. Framework misfit in all the implants and the linear distances between teeth (I-I - incisor-to-incisor; P-P - premolar-to-premolar; M-M - molar-to-molar; RI-RM - right-incisor-to-right-molar; and LI-LM - left-incisor-to-left-molar) were measured before and after denture processing using an optical microscope. Dentures were processed by hot water curing cycle (9h/74°C). Collected data were analyzed by paired Student's t-test and one-way ANOVA (α=0.05). RESULTS: All the measured distances presented changes in tooth displacement after denture processing. However, the M-M distance for G1 (p=0.003) and the P-P (p=0.042) and LI-LM (p=0.044) distances for G3 showed statistically significant differences. Differences between the flask systems were not statistically significant. Statistically significant differences in the framework misfit due to denture processing were found for all the implants and groups, with the exception of right median implant for G2 and right distal implant for G3. A comparison of the flask systems found statistically significant differences in which G1 presented an increase in the misfit values and G2 and G3 a decrease. CONCLUSIONS: Different flask systems did not cause significant changes in tooth displacement. Frameworks misfit values were influenced by the different flask systems. The conventional flask presented an increase in the framework misfit, while the experimental flasks showed a decrease.
Assuntos
Materiais Dentários , Planejamento de Prótese Dentária/efeitos adversos , Prótese Dentária Fixada por Implante , Planejamento de Dentadura/efeitos adversos , Mandíbula , Metais , Ajuste de Prótese/efeitos adversos , Ajuste de Prótese/métodos , Mobilidade Dentária/etiologia , Dente Artificial , Resinas Acrílicas , Bases de Dentadura , Prótese Total Inferior , Falha de Prótese/efeitos adversos , Mobilidade Dentária/prevenção & controleRESUMO
OBJECTIVE: We sought to ascertain predictors of Patient Prosthesis Mismatch, an independent predictor of mortality, in patients with aortic stenosis using bioprosthetic valves. METHOD: We analyzed 2,107 sequential surgeries. Patient Prosthesis Mismatch was calculated using the effective orifice area of the prosthesis divided by the patient's body surface area. We defined nonsignificant, moderate, and severe Patient Prosthesis Mismatch as effective orifice area indexes of .0.85 cm(2)/m, 0.85-0.66 cm(2)/m(2), and <0.65 cm(2)/m(2), respectively. RESULTS: A total of 311 bioprosthetic patients were identified. The incidence of nonsignificant, moderate, and severe Patient Prosthesis Mismatch was 41%, 42, and 16%, respectively. Severe Patient Prosthesis Mismatch was significantly more prevalent in females (82%). In severe Patient Prosthesis Mismatch, the perfusion and the crossclamp times were considerably lower when compared with nonsignificant Patient Prosthesis Mismatch and moderate Patient Prosthesis Mismatch. Patients with severe Patient Prosthesis Mismatch had a significantly higher likelihood of spending time in the intensive care unit and a significantly longer length of stay in the hospital. Body surface area was not different in severe Patient Prosthesis Mismatch when compared with nonsignificant Patient Prosthesis Mismatch. In-hospital mortality in patients with nonsignificant, moderate, and severe Patient Prosthesis Mismatch was 2.3%, 6.1%, and 8%, respectively. Minimally invasive surgery was significantly associated with moderate Patient Prosthesis Mismatch in 49% of the patients, but not with severe Patient Prosthesis Mismatch. CONCLUSION: Severe Patient Prosthesis Mismatch is more common in females, but not in those with minimal available body surface area. Though operative times were shorter in these patients, intensive care unit and hospital lengths of stay were longer. Surgeons and cardiologists should be cognizant of these clinical predictors and complications prior to valve surgery.
Assuntos
Estenose da Valva Aórtica/cirurgia , Valva Aórtica/patologia , Bioprótese , Implante de Prótese de Valva Cardíaca/métodos , Próteses Valvulares Cardíacas , Ajuste de Prótese/efeitos adversos , Idoso , Valva Aórtica/cirurgia , Índice de Massa Corporal , Métodos Epidemiológicos , Feminino , Próteses Valvulares Cardíacas/efeitos adversos , Humanos , Tempo de Internação/estatística & dados numéricos , Masculino , Ajuste de Prótese/mortalidade , Fatores de Risco , Resultado do TratamentoRESUMO
OBJECTIVE: We sought to ascertain predictors of Patient Prosthesis Mismatch, an independent predictor of mortality, in patients with aortic stenosis using bioprosthetic valves. METHOD: We analyzed 2,107 sequential surgeries. Patient Prosthesis Mismatch was calculated using the effective orifice area of the prosthesis divided by the patient's body surface area. We defined nonsignificant, moderate, and severe Patient Prosthesis Mismatch as effective orifice area indexes of .0.85 cm²/m, 0.85-0.66 cm²/m², and <0.65 cm²/m², respectively. RESULTS: A total of 311 bioprosthetic patients were identified. The incidence of nonsignificant, moderate, and severe Patient Prosthesis Mismatch was 41 percent, 42, and 16 percent, respectively. Severe Patient Prosthesis Mismatch was significantly more prevalent in females (82 percent). In severe Patient Prosthesis Mismatch, the perfusion and the crossclamp times were considerably lower when compared with nonsignificant Patient Prosthesis Mismatch and moderate Patient Prosthesis Mismatch. Patients with severe Patient Prosthesis Mismatch had a significantly higher likelihood of spending time in the intensive care unit and a significantly longer length of stay in the hospital. Body surface area was not different in severe Patient Prosthesis Mismatch when compared with nonsignificant Patient Prosthesis Mismatch. In-hospital mortality in patients with nonsignificant, moderate, and severe Patient Prosthesis Mismatch was 2.3 percent, 6.1 percent, and 8 percent, respectively. Minimally invasive surgery was significantly associated with moderate Patient Prosthesis Mismatch in 49 percent of the patients, but not with severe Patient Prosthesis Mismatch. CONCLUSION: Severe Patient Prosthesis Mismatch is more common in females, but not in those with minimal available body surface area. Though operative times were shorter in these patients, intensive care unit and hospital lengths of stay were longer. Surgeons and cardiologists should be cognizant of these clinical predictors and complications prior to valve surgery.
Assuntos
Idoso , Feminino , Humanos , Masculino , Estenose da Valva Aórtica/cirurgia , Valva Aórtica/patologia , Bioprótese , Próteses Valvulares Cardíacas , Implante de Prótese de Valva Cardíaca/métodos , Ajuste de Prótese/efeitos adversos , Valva Aórtica/cirurgia , Índice de Massa Corporal , Métodos Epidemiológicos , Próteses Valvulares Cardíacas/efeitos adversos , Tempo de Internação/estatística & dados numéricos , Ajuste de Prótese/mortalidade , Fatores de Risco , Resultado do TratamentoRESUMO
Se realizó un estudio de la literatura con el objetivo de describir el paso clínico de instalación y control de prótesis total, durante el período comprendido de enero a mayo del 2005 en la Clínica Estomatológica Provincial Docente de Santiago de Cuba. Se abordaron diversos aspectos, definición de conceptos, así como todo el proceder clínico, instrucciones al paciente y consejo s a los portadores de prótesis. Se enfatizó en el paciente geriátrico, destacándose que precisamente este paso es el indicado para eliminar los defectos evidentes y donde el paciente adquiere el hábito de utilizarlos y el organismo de aceptarlo(AU)
A literature study was conducted aimed at describing the clinical step of installation and control of total prosthesis at the Provincial Teaching Dental Clinic of Santiago de Cuba from January to May, 2005. Diverse aspects were dealt with, as well as the definition of concepts, the whole clinical procedure, instructions to the patients and advises to prosthesis wearers. Emphasis was made on the geriatric patient, and it was stressed that this step is the indicated to eliminate the evident defects, and where the patient acquires the habit to use them and the body to accept them(AU)