RESUMO
OBJECTIVE: To describe main indications, doses, length of infusion and side effects related to dexmedetomidine infusion. METHODS: Observational and retrospective study evaluating dexmedetomidine use in pediatric intensive care unit. RESULTS: 77 children received dexmedetomidine infusion longer than 6 hours for mechanical ventilation weaning (32.5%), post- neurosurgery and post-upper airway surgery (24.7%), non-invasive ventilation (13%), refractory tachycardia (6.5%) and other causes (23.3%). After 6 hours of infusion, significant decrease in mean arterial pressure and heart rate was observed in all groups. Six children (8%) required withdrawal of drug because of possible side effects: hypotension, bradycardia and somnolence. CONCLUSION: Dexmedetomidine may be used as sedative in critically ill children without much side effects.
Assuntos
Dexmedetomidina , Hipnóticos e Sedativos , Adolescente , Pressão Sanguínea/efeitos dos fármacos , Brasil , Criança , Pré-Escolar , Estado Terminal , Dexmedetomidina/administração & dosagem , Dexmedetomidina/efeitos adversos , Dexmedetomidina/uso terapêutico , Frequência Cardíaca/efeitos dos fármacos , Humanos , Hipnóticos e Sedativos/administração & dosagem , Hipnóticos e Sedativos/efeitos adversos , Hipnóticos e Sedativos/uso terapêutico , Lactente , Infusões Intravenosas , Unidades de Terapia Intensiva Pediátrica , Estudos Retrospectivos , Desmame do Respirador/métodosRESUMO
OBJECTIVE: To analyze the characteristics of children with acute viral bronchiolitis subjected to mechanical ventilation for three consecutive years and to correlate their progression with mechanical ventilation parameters and fluid balance. METHODS: Longitudinal study of a series of infants (< one year old) subjected to mechanical ventilation for acute viral bronchitis from January 2012 to September 2014 in the pediatric intensive care unit. The children's clinical records were reviewed, and their anthropometric data, mechanical ventilation parameters, fluid balance, clinical progression, and major complications were recorded. RESULTS: Sixty-six infants (3.0 ± 2.0 months old and with an average weight of 4.7 ± 1.4kg) were included, of whom 62% were boys; a virus was identified in 86%. The average duration of mechanical ventilation was 6.5 ± 2.9 days, and the average length of stay in the pediatric intensive care unit was 9.1 ± 3.5 days; the mortality rate was 1.5% (1/66). The peak inspiratory pressure remained at 30cmH2O during the first four days of mechanical ventilation and then decreased before extubation (25 cmH2O; p < 0.05). Pneumothorax occurred in 10% of the sample and extubation failure in 9%, which was due to upper airway obstruction in half of the cases. The cumulative fluid balance on mechanical ventilation day four was 402 ± 254mL, which corresponds to an increase of 9.0 ± 5.9% in body weight. Thirty-seven patients (56%) exhibited a weight gain of 10% or more, which was not significantly associated with the ventilation parameters on mechanical ventilation day four, extubation failure, duration of mechanical ventilation or length of stay in the pediatric intensive care unit. CONCLUSION: The rate of mechanical ventilation for acute viral bronchiolitis remains constant, being associated with low mortality, few adverse effects, and positive cumulative fluid balance during the first days. Better fluid control might reduce the duration of mechanical ventilation.
Assuntos
Extubação , Bronquiolite Viral/terapia , Unidades de Terapia Intensiva Pediátrica , Respiração Artificial , Feminino , Hidratação , Humanos , Lactente , Tempo de Internação , Estudos Longitudinais , Masculino , Aumento de Peso/fisiologiaRESUMO
RESUMO Objetivo: Analisar as características de crianças com bronquiolite viral aguda submetidas à ventilação mecânica em 3 anos consecutivos, relacionando a evolução com os parâmetros de ventilação mecânica e o balanço hídrico. Métodos: Estudo longitudinal de uma série de casos de lactentes (< 1 ano) submetidos à ventilação mecânica por bronquiolite viral aguda entre janeiro de 2012 e setembro de 2014 na unidade de terapia intensiva pediátrica. Os prontuários foram revisados e foram coletados dados antropométricos e dados referentes à ventilação mecânica, ao balanço hídrico, à evolução e a complicações maiores. Resultados: Incluídos 66 lactentes (3,0 ± 2,0 meses e peso médio de 4,7 ± 1,4kg), sendo 62% do sexo masculino, com etiologia viral identificada em 86%. O tempo médio de ventilação mecânica foi 6,5 ± 2,9 dias, tempo de unidade de terapia intensiva pediátrica de 9,1 ± 3,5 dias, com mortalidade de 1,5% (1/66). O pico de pressão inspiratória médio manteve-se em 30cmH2O nos 4 primeiros dias de ventilação mecânica, reduzindo-se na pré-extubação (25cmH2O; p < 0,05). Pneumotórax ocorreu em 10% e falha de extubação em 9%, sendo a metade por obstrução alta. O balanço hídrico cumulativo no quarto dia de ventilação mecânica foi 402 ± 254mL, correspondendo a um aumento de 9,0 ± 5,9% no peso. Tiveram aumento de 10% ou mais no peso 37 pacientes (56%), sem associação significativa aos parâmetros ventilatórios no 4º dia de ventilação mecânica, falha de extubação ou tempos de ventilação mecânica e unidade de terapia intensiva pediátrica. Conclusão: A taxa de ventilação mecânica na bronquiolite viral aguda tem se mantido constante, apresentando baixa mortalidade, poucos efeitos adversos e associada a balanço hídrico cumulativo positivo nos primeiros dias. Melhor controle hídrico poderia reduzir o tempo de ventilação mecânica.
ABSTRACT Objective: To analyze the characteristics of children with acute viral bronchiolitis subjected to mechanical ventilation for three consecutive years and to correlate their progression with mechanical ventilation parameters and fluid balance. Methods: Longitudinal study of a series of infants (< one year old) subjected to mechanical ventilation for acute viral bronchitis from January 2012 to September 2014 in the pediatric intensive care unit. The children's clinical records were reviewed, and their anthropometric data, mechanical ventilation parameters, fluid balance, clinical progression, and major complications were recorded. Results: Sixty-six infants (3.0 ± 2.0 months old and with an average weight of 4.7 ± 1.4kg) were included, of whom 62% were boys; a virus was identified in 86%. The average duration of mechanical ventilation was 6.5 ± 2.9 days, and the average length of stay in the pediatric intensive care unit was 9.1 ± 3.5 days; the mortality rate was 1.5% (1/66). The peak inspiratory pressure remained at 30cmH2O during the first four days of mechanical ventilation and then decreased before extubation (25 cmH2O; p < 0.05). Pneumothorax occurred in 10% of the sample and extubation failure in 9%, which was due to upper airway obstruction in half of the cases. The cumulative fluid balance on mechanical ventilation day four was 402 ± 254mL, which corresponds to an increase of 9.0 ± 5.9% in body weight. Thirty-seven patients (56%) exhibited a weight gain of 10% or more, which was not significantly associated with the ventilation parameters on mechanical ventilation day four, extubation failure, duration of mechanical ventilation or length of stay in the pediatric intensive care unit. Conclusion: The rate of mechanical ventilation for acute viral bronchiolitis remains constant, being associated with low mortality, few adverse effects, and positive cumulative fluid balance during the first days. Better fluid control might reduce the duration of mechanical ventilation.
Assuntos
Humanos , Masculino , Feminino , Lactente , Respiração Artificial , Bronquiolite Viral/terapia , Unidades de Terapia Intensiva Pediátrica , Extubação , Aumento de Peso/fisiologia , Estudos Longitudinais , Hidratação , Tempo de InternaçãoRESUMO
OBJECTIVE: To test the hypothesis that azithromycin reduces the length of hospitalization and oxygen requirement in infants with acute viral bronchiolitis (AB). STUDY DESIGN: We performed a randomized, double-blinded, placebo-controlled trial in southern Brazil, from 2009 to 2011. Infants (<12 months of age) hospitalized with AB were recruited in 2 hospitals. Patients were randomized to receive either azithromycin or placebo, administered orally, for 7 days. At enrollment, clinical data were recorded and nasopharyngeal samples were collected for viral identification through immunofluorescence. Main outcomes were duration of oxygen requirement and length of hospitalization. RESULTS: One hundred eighty-four patients were included in the study (azithromycin 88 subjects, placebo 96 subjects). Baseline clinical characteristics and viral identification were not different between the groups studied. A virus was detected in 112 (63%) patients, and of those, 92% were positive for respiratory syncytial virus. The use of azithromycin did not reduce the median number of days of either hospitalization (P = .28) or oxygen requirement (P = .47). CONCLUSIONS: Azithromycin did not improve major clinical outcomes in a large sample of hospitalized infants with AB, even when restricting the findings to those with positive respiratory syncytial virus samples. Azithromycin therapy should not be given for AB because it provides no benefit and overuse increases overall antibiotic resistance.