RESUMO
El conocimiento científico y clínico sobre los trastornos respiratorios del sueño se ha desarrollado de manera acelerada en las últimas décadas. El objetivo de este estudio es presentar la experiencia adquirida en nuestro país, en el diagnóstico y tratamiento del síndrome de apneas del sueño de tipo obstructivo, durante el desarrollo de una nueva disciplina en el ámbito de la neumología. Se revisaron los registros de 3109 pacientes; 447 con historias clínicas electrónicas y cuestionarios para cuantificación de síntomas y 1779 polisomnografías de pacientes con apneas de tipo obstructivo. Se presenta la evolución de la referencia de pacientes, las características demográficas (en especial el aumento de la prevalencia en jóvenes) y los hallazgos clínicos más frecuentes. Se destacan los factores de riesgo relevantes: obesidad y su relación con la severidad, enfermedades endocrinas y desplazamiento cefálico de fluidos. Se destaca el modo de acceso y la adherencia al tratamiento. La implementación de unidades clínicas de sueño permitió la referencia de pacientes para el diagnóstico y el tratamiento, dando lugar a una nueva disciplina de la neumología. La prevalencia de las apneas obstructivas del sueño es muy elevada, con progresivo y sostenido incremento. El tratamiento con aplicación de presión nasal no invasiva es factible. Aunque con distintos grados de accesibilidad y adherencia, ha permitido la corrección del trastorno respiratorio del sueño más relevante.
Scientific and clinical knowledge on sleep-disordered breathing has developed at an accelerated pace in the last decades. The objective of this study is to present the experience gained in our country in the diagnosis and treatment of obstructive sleep apnea syndrome during the development of a new discipline in the field of pneumology. Clinical records of 3109 patients were reviewed; 447 with electronic medical records and questionnaires for quantification of symptoms and 1779 polysomnographies of patients with obstructive apneas. The time evolution of the patient referral, the demographic characteristics (especially the increase in the prevalence in young people) and the most frequent clinical findings are presented. We highlight the relevant risk factors: obesity and its relationship with severity, endocrine diseases and cephalic fluid displacement. Access mode and adherence to treatment are highlighted. The implementation of sleep clinics allowed the referral of patients for diagnosis and treatment, giving rise to a new discipline of pneumology. The prevalence of obstructive sleep apnea is high, with progressive and sustained increase. Treatment with non-invasive nasal pressure application is feasible. Although with different degrees of accessibility and adherence, it has allowed the correction of the most relevant respiratory sleep disorder
O conhecimento científico e clínico sobre os transtornos respiratórios do sono desenvolveu-se rapidamente nas últimas décadas. O objetivo deste estudo é apresentar a experiência adquirida em nosso país no diagnóstico e tratamento da síndrome da apneia obstrutiva do sono durante o desenvolvimento de uma nova disciplina no campo da pneumologia. Os registros de 3109 pacientes foram revisados; 447 com registros médicos eletrônicos e questionários para quantificação de sintomas e 1779 polissonografias de pacientes com apnéia obstrutiva. Apresentamos a evolução da referência do paciente, as características demográficas (especialmente o aumento da prevalência em jovens) e os achados clínicos mais freqüentes. Destacamos os fatores de risco relevantes: obesidade e sua relação com severidade, doenças endócrinas e deslocamento do cefálico de fluídos. O modo de acesso e a adesão ao tratamento são destacados. A implementação de unidades de sono clínicas permitiu a referência de pacientes para diagnóstico e tratamento, dando origem a uma nova disciplina de pneumologia. A prevalência da apneia obstrutiva do sono é muito alta, com aumento progressivo e sustentado. O tratamento com pressão nasal não invasiva é viável. Embora com diferentes graus de acessibilidade e adesão, permitiu a correção do transtorno do sono respiratório mais relevante.
Assuntos
Humanos , Masculino , Feminino , Adulto , Pessoa de Meia-Idade , Idoso , Respiração com Pressão Positiva/estatística & dados numéricos , Apneia Obstrutiva do Sono/diagnóstico , Apneia Obstrutiva do Sono/terapia , Apneia Obstrutiva do Sono/epidemiologia , Uruguai , Acromegalia/complicações , Comorbidade , Epidemiologia Descritiva , Prevalência , Fatores de Risco , Deslocamentos de Líquidos Corporais/fisiologia , Distribuição por Idade e Sexo , Cooperação e Adesão ao Tratamento/estatística & dados numéricos , Hipotireoidismo/complicações , Obesidade/complicaçõesRESUMO
PURPOSE: To investigate the impacts of albumin synergized with hydroxyethyl starch (HES) on early microvascular albumin leakage after major abdominal surgery in rabbits. METHODS: Forty male Japanese rabbits were randomly divided into four groups: the control group, the saline group, the albumin group, and the Syn group (hydroxyethyl starch+albumin). The latter three groups were performed gastrectomy plus resection of pancreatic body and tail and splenectomy. The serum albumin concentration was detected before and 48h after surgery, and the conditions of mesenteric microvascular leakage in these 4 groups were observed under microscope 48 h after surgery to calculate the leakage rate. RESULTS: Compared with the saline group, the albumin group and the Syn group exhibited significantly increased serum albumin concentrations 48h after surgery (P<0.05). The albumin leakage rate was the most obvious in the albumin group, followed by the saline group, while that in the Syn group was the minimal, and there existed significant differences among these groups (P<0.05) . CONCLUSION: Simple administration of albumin in the early stage after major abdominal surgery could increase the albumin leakage, while the synergization of albumin and hydroxyethyl starch could reduce the albumin leakage.
Assuntos
Permeabilidade Capilar/fisiologia , Derivados de Hidroxietil Amido/administração & dosagem , Albumina Sérica/administração & dosagem , Albumina Sérica/análise , Abdome/cirurgia , Animais , Sinergismo Farmacológico , Deslocamentos de Líquidos Corporais/fisiologia , Masculino , Modelos Animais , Coelhos , Distribuição Aleatória , Albumina Sérica/metabolismo , Cloreto de SódioRESUMO
Abstract Purpose: To investigate the impacts of albumin synergized with hydroxyethyl starch (HES) on early microvascular albumin leakage after major abdominal surgery in rabbits. Methods: Forty male Japanese rabbits were randomly divided into four groups: the control group, the saline group, the albumin group, and the Syn group (hydroxyethyl starch+albumin). The latter three groups were performed gastrectomy plus resection of pancreatic body and tail and splenectomy. The serum albumin concentration was detected before and 48h after surgery, and the conditions of mesenteric microvascular leakage in these 4 groups were observed under microscope 48 h after surgery to calculate the leakage rate. Results: Compared with the saline group, the albumin group and the Syn group exhibited significantly increased serum albumin concentrations 48h after surgery (P<0.05). The albumin leakage rate was the most obvious in the albumin group, followed by the saline group, while that in the Syn group was the minimal, and there existed significant differences among these groups (P<0.05) . Conclusion: Simple administration of albumin in the early stage after major abdominal surgery could increase the albumin leakage, while the synergization of albumin and hydroxyethyl starch could reduce the albumin leakage.
Assuntos
Animais , Masculino , Coelhos , Albumina Sérica/administração & dosagem , Albumina Sérica/análise , Permeabilidade Capilar/fisiologia , Derivados de Hidroxietil Amido/administração & dosagem , Albumina Sérica/metabolismo , Cloreto de Sódio , Distribuição Aleatória , Deslocamentos de Líquidos Corporais/fisiologia , Modelos Animais , Sinergismo Farmacológico , Abdome/cirurgiaRESUMO
OBJECTIVE: The purpose of this study was to examine the isovolumetric distribution kinetics of crystalloid fluid during cardiopulmonary bypass. METHODS: Ten patients undergoing coronary artery bypass grafting participated in this prospective observational study. The blood hemoglobin and the serum albumin and sodium concentrations were measured repeatedly during the distribution of priming solution (Ringer's acetate 1470 ml and mannitol 15% 200 ml) and initial cardioplegia. The rate of crystalloid fluid distribution was calculated based on 3-min Hb changes. The preoperative blood volume was extrapolated from the marked hemodilution occurring during the onset of cardiopulmonary bypass. Clinicaltrials.gov: NCT01115166. RESULTS: The distribution half-time of Ringer's acetate averaged 8 minutes, corresponding to a transcapillary escape rate of 0.38 ml/kg/min. The intravascular albumin mass increased by 5.4% according to mass balance calculations. The preoperative blood volume, as extrapolated from the drop in hemoglobin concentration by 32% (mean) at the beginning of cardiopulmonary bypass, was 0.6-1.2 L less than that estimated by anthropometric methods (p<0.02). The mass balance of sodium indicated a translocation from the intracellular to the extracellular fluid space in 8 of the 10 patients, with a median volume of 236 ml. CONCLUSIONS: The distribution half-time of Ringer's solution during isovolumetric cardiopulmonary bypass was 8 minutes, which is the same as for crystalloid fluid infusions in healthy subjects. The intravascular albumin mass increased. Most patients were hypovolemic prior to the start of anesthesia. Intracellular edema did not occur.
Assuntos
Volume Sanguíneo/fisiologia , Ponte Cardiopulmonar , Soluções Isotônicas/farmacocinética , Idoso , Idoso de 80 Anos ou mais , Volume Sanguíneo/efeitos dos fármacos , Edema Encefálico/etiologia , Ponte de Artéria Coronária , Soluções Cristaloides , Espaço Extracelular/metabolismo , Feminino , Deslocamentos de Líquidos Corporais/efeitos dos fármacos , Deslocamentos de Líquidos Corporais/fisiologia , Hemoglobinas/análise , Humanos , Masculino , Manitol/farmacologia , Pessoa de Meia-Idade , Estudos Prospectivos , Albumina Sérica/análise , Sódio/sangue , Sódio/urina , Equilíbrio Hidroeletrolítico/fisiologiaRESUMO
OBJECTIVE: The purpose of this study was to examine the isovolumetric distribution kinetics of crystalloid fluid during cardiopulmonary bypass. METHODS: Ten patients undergoing coronary artery bypass grafting participated in this prospective observational study. The blood hemoglobin and the serum albumin and sodium concentrations were measured repeatedly during the distribution of priming solution (Ringer's acetate 1470 ml and mannitol 15% 200 ml) and initial cardioplegia. The rate of crystalloid fluid distribution was calculated based on 3-min Hb changes. The preoperative blood volume was extrapolated from the marked hemodilution occurring during the onset of cardiopulmonary bypass. Clinicaltrials.gov: NCT01115166. RESULTS: The distribution half-time of Ringer's acetate averaged 8 minutes, corresponding to a transcapillary escape rate of 0.38 ml/kg/min. The intravascular albumin mass increased by 5.4% according to mass balance calculations. The preoperative blood volume, as extrapolated from the drop in hemoglobin concentration by 32% (mean) at the beginning of cardiopulmonary bypass, was 0.6-1.2 L less than that estimated by anthropometric methods (p<0.02). The mass balance of sodium indicated a translocation from the intracellular to the extracellular fluid space in 8 of the 10 patients, with a median volume of 236 ml. CONCLUSIONS: The distribution half-time of Ringer's solution during isovolumetric cardiopulmonary bypass was 8 minutes, which is the same as for crystalloid fluid infusions in healthy subjects. The intravascular albumin mass increased. Most patients were hypovolemic prior to the start of anesthesia. Intracellular edema did not occur. .
Assuntos
Idoso , Idoso de 80 Anos ou mais , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Volume Sanguíneo/fisiologia , Ponte Cardiopulmonar , Soluções Isotônicas/farmacocinética , Volume Sanguíneo/efeitos dos fármacos , Edema Encefálico/etiologia , Ponte de Artéria Coronária , Espaço Extracelular/metabolismo , Deslocamentos de Líquidos Corporais/efeitos dos fármacos , Deslocamentos de Líquidos Corporais/fisiologia , Hemoglobinas/análise , Manitol/farmacologia , Estudos Prospectivos , Albumina Sérica/análise , Sódio/sangue , Sódio/urina , Equilíbrio Hidroeletrolítico/fisiologiaRESUMO
BACKGROUND: Surfactant deficiency is the pivotal abnormality in Neonatal and Acute Respiratory Distress Syndrome. Surfactant deactivation can produce hypoxemia, loss of lung compliance, and pulmonary edema, but its circulatory consequences are less understood. OBJECTIVE: To describe the sequential hemodynamic changes and pulmonary edema formation after surfactant deactivation in piglets. METHODS: Surfactant deactivation was induced by tracheal instillation of polysorbate 20 in 15 anesthetized and mechanically ventilated Large White piglets. The hemodynamic consequences of surfactant deactivation were assessed at 30, 120, and 240 min by transpulmonary thermodilution and traditional methods. RESULTS: Surfactant deactivation caused hypoxemia, reduced lung compliance, and progressively increased lung water content (P < 0.01). Early hypovolemia was observed, with reductions of the global end-diastolic volume and stroke volume (P < 0.05). Reduced cardiac output was observed at the end of the study (P < 0.05). Standard monitoring was unable to detect these early preload alterations. Surprisingly, the bronchoalveolar protein content was greatly increased at the end of the study compared with baseline levels (P < 0.01). This finding was inconsistent with the notion that the pulmonary edema induced by surfactant deactivation was exclusively caused by high surface tension. CONCLUSIONS: Hypovolemia develops early after surfactant deactivation, in part due to the resulting fluid shift from the intravascular compartment to the lungs.
Assuntos
Água Extravascular Pulmonar/fisiologia , Deslocamentos de Líquidos Corporais/fisiologia , Hipovolemia/fisiopatologia , Surfactantes Pulmonares , Anestesia , Animais , Gasometria , Líquido da Lavagem Broncoalveolar , Excipientes , Hemodinâmica/fisiologia , Hipovolemia/induzido quimicamente , Complacência Pulmonar/fisiologia , Polissorbatos , Respiração com Pressão Positiva , Edema Pulmonar/patologia , Respiração Artificial , Suínos , TermodiluiçãoRESUMO
Hypocapnia/alkalosis is a consequence of several lung and metabolic pathologies. The aim of this study was to determine whether the increase of fluid filtration rate (FFR) that occurs during Hypocapnia/alkalosis circumstances is determined by hypocapnia, alkalosis or both. 7 groups were formed (N=36) using isolated rabbit lungs. Group 1: Control (PCO2 6%, pH: 7.35-7.45); Group 2 (n=6): Hypocapnia/Alkalosis (CO2 1%, pH: 7.9); Group 3 (n=6): Hypocapnia/Normo-pH (CO2 1% pH 7.35-7.45), Group 4 (n=6) Normocapnia/Alcalosis (CO2 6%, pH: 7.9). Fenoterol, papaverine and hydrocortisone were added to Groups 5, 6 and 7 (n=4) respectively, all under Normocapnia/Alkalosis. FFR and Pulmonary Arterial Pressure (Pap) were considerably higher in group 2 than in control (FFR: 1.92g/min +/- 0.6 vs 0.0 g/min +/- 0.006). A strong influence exerted by pH was observed when Group 3 and group 4 were compared (FFR: 0.02 g/min +/- 0.009 vs 2.3 g/min +/- 0.9) and (Pap: 13.5 cmH2O +/- 1.4 vs 90 cmH2O +/- 15). A reduced effect was observed in groups 5 and 6 (papaverine and hydrocorisone) and a totally abolished effect was observed in group 7 (fenoterol) (FFR: 0.001 +/- 0.0003 mL/min and Pap: 14 +/- 0.8 cmH2O). Pulmonary edema induced by Hypocapnia/alkalosis is a consequence of alkalosis and not of hypocapnia. This effect could be due to inflammatory damage in the lung parenchyma and alkalosis-mediated vasoconstriction.