RESUMO
INTRODUCTION: Many experimental models using lung lavage have been developed for the study of acute respiratory distress syndrome (ARDS). The original technique has been modified by many authors, resulting in difficulties with reproducibility. There is insufficient detail on the lung injury models used, including hemodynamic stability during animal preparation and drawbacks encountered such as mortality. The authors studied the effects of the pulmonary recruitment and the use of fixed tidal volume (Vt) or fixed inspiratory pressure in the experimental ARDS model installation. METHODS: Adult rabbits were submitted to repeated lung lavages with 30 ml/kg warm saline until the ARDS definition (PaO2/FiO2 ≤ 100) was reached. The animals were divided into three groups, according to the technique used for mechanical ventilation: 1) fixed Vt of 10 ml/kg; 2) fixed inspiratory pressure (IP) with a tidal volume of 10 ml/kg prior to the first lung lavage; and 3) fixed Vt of 10 ml/kg with pulmonary recruitment before the first lavage. RESULTS: The use of alveolar recruitment maneuvers, and the use of a fixed Vt or IP between the lung lavages did not change the number of lung lavages necessary to obtain the experimental model of ARDS or the hemodynamic stability of the animals during the procedure. A trend was observed toward an increased mortality rate with the recruitment maneuver and with the use of a fixed IP. DISCUSSION: There were no differences between the three study groups, with no disadvantage in method of lung recruitment, either fixed tidal volume or fixed inspiratory pressure, regarding the number of lung lavages necessary to obtain the ARDS animal model. Furthermore, the three different procedures resulted in good hemodynamic stability of the animals, and low mortality rate.
Assuntos
Modelos Animais de Doenças , Síndrome do Desconforto Respiratório/fisiopatologia , Animais , Lavagem Broncoalveolar/métodos , Hemodinâmica/fisiologia , Respiração com Pressão Positiva/métodos , Coelhos , Volume de Ventilação Pulmonar/fisiologiaRESUMO
OBJECTIVES: This study aims to describe the association between different postoperative complications and the length of hospital stay among children undergoing neurosurgical procedures. METHODS: A retrospective cohort study was carried out between May 2004 and May 2009 in a tertiary community hospital. All postoperative complications following neurosurgical procedures and their association with the main outcomes [length of intensive care unit (ICU) and hospital stay] were investigated in a univariate and multivariate analysis. RESULTS: The medical records of 198 patients treated during the study period were reviewed. The most frequently performed surgeries were ventriculoperitoneal shunting (16.7%), correction of craniosynostosis (30%) and brain tumor resections (28.3%). Of the 198 patients eligible for this analysis, 79 (39.9%) suffered from at least one complication. The most frequent complications were fever (30.3%), hypothermia (16%), postextubation laryngitis (15.1%) and postoperative bleeding (7%). Factors independently associated with a longer pediatric ICU stay were fever (odds ratio 1.39, 95% confidence interval 1.1-3.2; p = 0.001), laryngitis (odds ratio 2.24, 95% confidence interval 1.8-5.2; p = 0.001), postoperative bleeding requiring reoperation (odds ratio 1.8, 95% confidence interval 1.4-3.9; p < 0.001) and infection (odds ratio 3.71, 95% confidence interval 1.8-12.4; p = 0.033). Fever (odds ratio 2.54, 95% confidence interval 2-7.4; p = 0.001) and infection (odds ratio 11.23, 95% confidence interval 4-22.4; p = 0.003) were related to the total length of the patient's hospital stay. CONCLUSIONS: In this study population, most elective neurosurgical procedures were not associated with significant complications, and morbidity and mortality were low. Some complications significantly influenced patients' outcomes and should be monitored for early diagnosis. This study may improve our understanding and identification of postoperative outcomes in pediatric neurosurgery.
Assuntos
Unidades de Terapia Intensiva/estatística & dados numéricos , Tempo de Internação/estatística & dados numéricos , Procedimentos Neurocirúrgicos/estatística & dados numéricos , Complicações Pós-Operatórias/mortalidade , Adolescente , Neoplasias Encefálicas/mortalidade , Neoplasias Encefálicas/cirurgia , Criança , Pré-Escolar , Craniossinostoses/mortalidade , Craniossinostoses/cirurgia , Epilepsia/mortalidade , Epilepsia/cirurgia , Feminino , Mortalidade Hospitalar , Hospitais Comunitários/estatística & dados numéricos , Humanos , Lactente , Masculino , Morbidade , Estudos Retrospectivos , Fatores de Risco , Centros de Atenção Terciária/estatística & dados numéricos , Derivação Ventriculoperitoneal/estatística & dados numéricosRESUMO
O surfactante pulmonar é uma substância fundamental na mecânica pulmonar, com atividade biofísica e de proteção alveolar por reduzir a tensão superficial e impedir o seu colabamento.Na síndrome do desconforto respiratório tipo agudo(SDRA) ocorre uma diminuição quantitativa e disfunção qualitativa do surfactante com agravamento do quadro clínico.Estudamos, em um modelo experimental de SDRA em coelho adulto, os efeitos da adição de polietilenoglicol ao surfactante pulmonar exógeno quanto à melhora da complacência pulmonar, pressão ventilatória, índice de oxigenação, diferença alvéolo-arterial de oxigênio, gradiente alvéolo-arterial de oxigênio pressão arterial parcial de CO2, pelo índice de eficiência ventilatória, diâmetro alveolar médio e índice de distorção. A utilização do surfactante melhorou a oxigenação, e a mecânica pulmonar, sem no entanto, haver diferença entre os grupos surfactante e surfactante mais polietilenoglicol / Lung surfactant is a fundamental substance in lung mechanics, with biophysical activity to reduce alveolar surface tension and to avoid pulmonary collapse. In the acute respiratory distress syndrome (ARDS) occurs a quantitative and qualitative surfactant dysfunction with worsening of clinical status. We study, in an experimental model of ARDS in adult rabbit, the effects of polyethyeneglycol addition to the exogenous surfactant to improve the pulmonary compliance, ventilatory pressure, oxygenation index, arterial-alveolar oxygen ratio , alveolar-arterial oxygen gradient, carbon dioxide partial arterial pressure, ventilatory efficiency index , alveolar medium diameter and ditorsion index. Surfactant treatment improved arterial oxygenation and the lung mechanics, with no differences between the study groups...
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Coelhos , Animais , Mecânica Respiratória , Surfactantes Pulmonares , Síndrome do Desconforto Respiratório , Polietilenos , Coelhos , Tensoativos/uso terapêuticoAssuntos
Humanos , Criança , Creches , Controle de Infecções , Enfermagem Pediátrica , Infecção HospitalarRESUMO
É relatado um caso de recém-nascido com fístula esofagotraqueal em H. O quadro clínico, o diagnóstico com RX constratado de esôfago, a traqueobroncospia e a esofagoscopia confirmaram o diagnóstico. A fístula esofagotraqueal em H (FTEH) foi dividida através de acesso cirúrgico cervical no lado esquerdo do pescoço devido à posiçäo da fístula, com bom resultado