RESUMO
OBJECTIVE: To compare two methods for defining and classifying the severity of pediatric acute respiratory distress syndrome: the Berlin classification, which uses the relationship between the partial pressure of oxygen and the fraction of inspired oxygen, and the classification of the Pediatric Acute Lung Injury Consensus Conference, which uses the oxygenation index. METHODS: This was a prospective study of patients aged 0 - 18 years with a diagnosis of acute respiratory distress syndrome who were invasively mechanically ventilated and provided one to three arterial blood gas samples, totaling 140 valid measurements. These measures were evaluated for correlation using the Spearman test and agreement using the kappa coefficient between the two classifications, initially using the general population of the study and then subdividing it into patients with and without bronchospasm and those with and without the use of neuromuscular blockers. The effect of these two factors (bronchospasm and neuromuscular blocking agent) separately and together on both classifications was also assessed using two-way analysis of variance. RESULTS: In the general population, who were 54 patients aged 0 - 18 years a strong negative correlation was found by Spearman's test (ρ -0.91; p < 0.001), and strong agreement was found by the kappa coefficient (0.62; p < 0.001) in the comparison between Berlin and Pediatric Acute Lung Injury Consensus Conference. In the populations with and without bronchospasm and who did and did not use neuromuscular blockers, the correlation coefficients were similar to those of the general population, though among patients not using neuromuscular blockers, there was greater agreement between the classifications than for patients using neuromuscular blockers (kappa 0.67 versus 0.56, p < 0.001 for both). Neuromuscular blockers had a significant effect on the relationship between the partial pressure of oxygen and the fraction of inspired oxygen (analysis of variance; F: 12.9; p < 0.001) and the oxygenation index (analysis of variance; F: 8.3; p = 0.004). CONCLUSION: There was a strong correlation and agreement between the two classifications in the general population and in the subgroups studied. Use of neuromuscular blockers had a significant effect on the severity of acute respiratory distress syndrome.
Assuntos
Síndrome do Desconforto Respiratório , Índice de Gravidade de Doença , Humanos , Criança , Lactente , Adolescente , Pré-Escolar , Estudos Prospectivos , Feminino , Masculino , Síndrome do Desconforto Respiratório/classificação , Síndrome do Desconforto Respiratório/diagnóstico , Recém-Nascido , Lesão Pulmonar Aguda/classificação , Lesão Pulmonar Aguda/diagnóstico , Respiração Artificial , Bloqueadores Neuromusculares/uso terapêutico , Gasometria/métodos , Espasmo Brônquico , ConsensoRESUMO
OBJECTIVE: To compare the thermographic pattern of regions of interest (ROI) of respiratory muscles in young asthmatics with and without bronchospasm induced by eucapnic voluntary hyperpnea (EVH). MATERIALS AND METHODS: Cross-sectional study carried out with 55 young (55% male and 45% females) aged 12.5 ± 3.3 years, divided in nine nonasthmatics, 22 asthmatics without exercise-induced bronchospasm compatible response (EIB-cr) and 24 asthmatics with EIB-cr. The diagnosis of EIB was given to subjects with a fall in forced expiratory volume in the first second (FEV1) ≥ 10% compared to baseline. Thermographic recordings of respiratory muscles were delimited in ROI of the sternocleidomastoid (SCM), pectoral, and rectus abdominis intention area. Thermal captures and FEV1 were taken before and 5, 10, 15 and 30 min after EVH. RESULTS: Twenty-four (52.1%) of asthmatics had EIB-cr. There was a decrease in temperature at 10 min after EVH test in the SCM, pectoral and rectus abdominis ROIs in all groups (both with p < 0.05). There was a decrease in temperature (% basal) in asthmatic with EIB-cr compared to nonasthmatics in the rectus abdominis area (p < 0.05). CONCLUSION: There was a decrease in temperature in the ROIs of different muscle groups, especially in asthmatics. The greater drop in FEV1 observed in individuals with EIB-cr was initially associated with a decrease in skin temperature, with a difference between the nonasthmatics in the abdominal muscle area. It is likely that this decrease in temperature occurred due to a temporary displacement of blood flow to the most used muscle groups, with a decrease in the region of the skin evaluated in the thermography.
Assuntos
Valor Preditivo dos Testes , Músculos Respiratórios , Termografia , Humanos , Masculino , Feminino , Estudos Transversais , Criança , Adolescente , Músculos Respiratórios/fisiopatologia , Volume Expiratório Forçado , Termografia/métodos , Estudos de Casos e Controles , Fatores de Tempo , Asma Induzida por Exercício/fisiopatologia , Asma Induzida por Exercício/diagnóstico , Pulmão/fisiopatologia , Fatores Etários , Asma/fisiopatologia , Asma/complicações , Asma/diagnóstico , Hiperventilação/fisiopatologia , Espasmo Brônquico/fisiopatologia , Espasmo Brônquico/etiologiaRESUMO
El asma es una enfermedad inflamatoria crónica de las vías aéreas asociada con un aumento en la reactividad de las mismas, que al exponerse a diversos estímulos produce un descenso del flujo aéreo ocasionado broncoespasmo. Se estima que el 4,3% de la población mundial está afectada de asma. Los asmáticos tienen un riesgo elevado de morbilidad y mortalidad perioperatorias debido al broncoespasmo que podría presentarse como complicación, por lo que su reconocimiento y manejo en el periodo intraoperatorio es un desafío para el anestesiólogo. Se presenta el caso de un paciente masculino de 37 años con antecedente de asma que ingresa a cirugía de urgencia por un cuadro de abdomen agudo quirúrgico (apendicitis aguda), el cual al momento de la intubación endotraqueal intercurrio con broncoespasmo de difícil resolución y durante el intraoperatorio persistió con datos característicos de obstrucción de vía aérea. A propósito de ello, se realiza una revisión sobre las consideraciones más relevantes que se deben tener en cuenta durante la valoración y manejo anestésicos del paciente asmático.
Assuntos
Espasmo BrônquicoRESUMO
Background: Ketamine is used in intravenous anesthesia for the maintenance in the general anesthesia. It has characteristics to prevent the difficult of breathing due to bronchospasm, as well as the delivery of histamine associated with asthmatic attack. These effects come from the direct action in the bronchial muscle, as well as from the potentiation of its catecholamines, which is why its use is very controversial, given that there are not enough trials to back it up. Moreover, the effect of ketamine on bronchospasm due to anaphylactic reaction has not been studied. The election treatment is epinephrine and there are factors associated with its use. The objective was to present the case of a patient with a history of allergic reaction to midazolam, who presented bronchospasm due to the administration of this drug, and who received unconventional treatment with positive outcomes. Clinical case: We present the case of a young female with a history of allergies to medicines, specifically to benzodiazepines, who presented bronchospasm and oxygen saturation drop after receiving a dose of midazolam into her eye while she was working. The use of ketamine was proposed after adrenaline, a beta-agonist, inhaled anticholinergics, a steroid and antihistamine drugs were used. Conclusion: Trials are needed in order to demonstrate the efficacy of ketamine in this particular context; however, the outcome in this case was positive.
Introducción: la ketamina es utilizada en anestesia intravenosa en el mantenimiento en la anestesia general. Su efecto cuenta con propiedades para prevenir la dificultad respiratoria asociada a broncoconstricción y la secreción de histamina asociada a crisis asmática. Estos efectos derivan de la acción directa en el músculo bronquial, así como de la potencialización de las catecolaminas, por lo que su uso muy controversial, ya que hasta el día de hoy no hay suficientes estudios que lo sustenten. Además, el efecto de la ketamina en el broncoespasmo debido a anafilaxia no está estudiado. El tratamiento de elección es la epinefrina y hay factores que están asociados en el éxito de esta. El objetivo fue presentar el caso de una paciente con antecedente de alergia a midazolam, que presentó broncoespasmo al estar en contacto con este y a la que se le administró tratamiento no convencional con resultados favorables. Caso clínico: presentamos el caso de una mujer joven con antecedentes de alergias a medicamentos, específicamente a benzodiacepinas, la cual presentó broncoespasmo y caída de la saturación posteriores al contacto con midazolam intraocular mientras laboraba. Se propuso la utilización de ketamina posterior a adrenalina, betaagonista y anticolinérgicos inhalados, esteroide y antihistamínico. Conclusión: es necesario hacer estudios que demuestren la eficacia de la ketamina en este contexto en particular; en este caso, los resultados fueron positivos.
Assuntos
Anafilaxia , Asma , Espasmo Brônquico , Ketamina , Anafilaxia/induzido quimicamente , Anafilaxia/tratamento farmacológico , Espasmo Brônquico/induzido quimicamente , Espasmo Brônquico/tratamento farmacológico , Feminino , Humanos , Ketamina/efeitos adversos , Midazolam/uso terapêuticoRESUMO
Exacerbação aguda de asma é uma condição frequente na criança e no adolescente e uma das causas mais comuns de procura aos pronto atendimentos e de internações. Pode ocorrer em pacientes que ainda não foram diagnosticados como asmáticos, e mesmo naqueles cujo controle da doença não se encontre adequado. Reconhecer a exacerbação e iniciar seu tratamento desde o domicílio até o adequado manejo inicial em ambiente hospitalar é fundamental para evitar sua evolução para complicações que coloquem o paciente em risco de vida. O tratamento compreende o reconhecimento e tratamento da hipoxemia, da obstrução e do processo inflamatório, além de fornecer orientações na alta hospitalar e encaminhamentos para continuidade do tratamento.
Acute exacerbation of asthma is a frequent condition in children and adolescents and one of the most common causes of seeking emergency care and hospitalization. It can occur in patients who have not yet been diagnosed with asthma, and even in those whose disease control is not adequate. Recognizing the exacerbation and starting its treatment from home until proper initial management in a hospital environment is essential to avoid its evolution to complications that put the patient at risk of life. Treatment comprises the recognition and treatment of hypoxemia, obstruction, and the inflammatory process, in addition to providing guidance at hospital discharge and referrals for continued treatment.
Assuntos
Humanos , Recém-Nascido , Lactente , Pré-Escolar , Criança , Adolescente , Asma , Sociedades Médicas , Terapêutica , Alergia e Imunologia , Pacientes , Pediatria , Encaminhamento e Consulta , Teofilina , Espasmo Brônquico , Epinefrina , Corticosteroides , Ipratrópio , Anestésicos Inalatórios , Serviços Médicos de Emergência , Agonistas de Receptores Adrenérgicos beta 2 , Ventilação não Invasiva , Aminofilina , Hospitalização , Ketamina , Sulfato de Magnésio , Hipóxia , AntibacterianosRESUMO
OBJECTIVE: To examine the impact of climate variability on the occurrence of exercise-induced bronchospasm in the rainy and dry seasons of a Brazilian semi-arid region. METHODS: This sample comprised 82 adolescents aged 15 to 18 years, who were submitted to exercise-induced bronchospasm assessment on a treadmill and outdoors, during the rainy and the dry season. Anthropometric variables, sexual maturity and forced expiratory volume in the first second were analyzed. Air temperature and humidity, decline in forced expiratory volume in the first second (%) and frequency of bronchospasm were compared between seasons using the independent Student's t test, the Wilcoxon and McNemar tests, respectively. The level of significance was set at p<0.05. RESULTS: The mean age was 15.65±0.82 years. Air temperature, air humidity and decline in forced expiratory volume in the first second (%) differed between seasons, with higher air temperature and humidity in the rainy season (29.6ºC±0.1 and 70.8%±0.6 versus 28.5ºC±0.2 and 48.5%±0.6; p<0.05). The decline in forced expiratory volume in the first second (%) was greater in the dry season (9.43%±9.97 versus 12.94%±15.65; p<0.05). The frequency of bronchospasm did not differ between seasons. CONCLUSION: The dry season had a negative impact on forced expiratory volume in the first second in adolescents, with greater decrease detected during this period. Findings of this study suggested bronchospasm tends to be more severe under low humidity conditions.
Assuntos
Asma Induzida por Exercício , Espasmo Brônquico , Adolescente , Asma Induzida por Exercício/epidemiologia , Espasmo Brônquico/epidemiologia , Espasmo Brônquico/etiologia , Teste de Esforço , Volume Expiratório Forçado , Humanos , Estações do AnoRESUMO
Abstract Introduction: Post-anesthetic complications, particularly respiratory complications, continue to be a source of concern due to their high frequency, particularly in pediatrics. Objective: To describe the incidence of respiratory complications in the post-anesthesia care unit of an intermediate complexity center during a six-month period, and to explore the variables associated with major respiratory complications. Materials and Methods: Retrospective cohort study based on clinical record reviews. The records of the post-anesthesia care unit of an intermediate complexity pediatric institution located in Medellin, Colombia, were reviewed. This center uses a nursing-based care model that includes patient extubation in the post-anesthesia care unit. Results: The records of 1181 patients were analyzed. The cumulative incidences of major complications were bronchospasm 1.44%, laryngospasm 0.68% and respiratory depression 0.59%. There were no cases of cardiac arrest or acute pulmonary edema. A history of respiratory infection less than 15 days before the procedure, rhinitis and female sex were associated with major respiratory complications. Conclusions: A low frequency of respiratory complications was found during care provided by nursing staff trained in anesthesia recovery and pediatric airway in the post-anesthesia care unit.
Resumen Introducción: Las complicaciones postanestésicas, especialmente las respiratorias, siguen siendo causa de preocupación por su alta frecuencia, en particular, en la población pediátrica. Objetivo: Describir la incidencia de complicaciones respiratorias en la unidad de cuidados postanestésicos de una institución de mediana complejidad, en un período de seis meses y explorar las variables relacionadas con las complicaciones respiratorias mayores. Materiales y métodos: Estudio de cohorte retrospectivo, basado en la valoración de historias clínicas. Se revisaron los registros de la unidad de cuidados postanestésicos de una institución pediátrica de mediana complejidad ubicada en Medellín. Esta institución utiliza un modelo de atención -basado en enfermería- que incluye la extubación del paciente en la unidad de cuidados postanestésicos. Resultados: Se analizaron los registros de 1181 pacientes. La incidencia acumulada de complicaciones mayores fue: broncoespasmo 1,44 %, laringoespasmo 0,68 % y depresión respiratoria 0,59 %. No se presentaron casos de paro cardiaco ni de edema agudo de pulmón. El antecedente de infección respiratoria menor a 15 días, rinitis y sexo femenino se asociaron con complicaciones respiratorias mayores. Conclusiones: Durante la atención en la unidad de cuidados postanestésicos por parte del personal de enfermería entrenado en la recuperación de la anestesia y de la vía aérea de los pacientes pediátricos, se encontró una baja frecuencia de complicaciones respiratorias.
Assuntos
Humanos , Masculino , Feminino , Edema Pulmonar , Insuficiência Respiratória , Anestesia , Anestésicos , Espasmo Brônquico , Rinite , Laringismo , Estudos de Coortes , Colômbia , Edema , Parada Cardíaca , Infecções , Recursos Humanos de EnfermagemRESUMO
BACKGROUND: Intra-arterial chemotherapy is a new retinoblastoma treatment associated with high rates of globe salvage that has been widely adopted for primary treatment of retinoblastoma but is less frequently used as secondary treatment for refractory retinoblastoma. This systematic review aims to summarize the reported outcomes of intra-arterial chemotherapy for refractory retinoblastoma. METHODS: We conducted a systematic review of studies published on PubMed, Medline, and Embase from 2011 to 2021 reporting globe salvage rates following intra-arterial chemotherapy for secondary treatment of refractory retinoblastoma. RESULTS: Our search yielded 316 studies, and 24 met inclusion criteria. The 24 included studies were comprised of 1366 patients and 1757 eyes. Among these, 1184 (67%) eyes received secondary indication treatment, and globe salvage was achieved for 776 of these 1184 eyes (64%). Sixteen studies reported cannulation success rates from 71.8 to 100%. Pooled analysis of subjects revealed 21 patients (2.6%) with metastatic disease and 26 deaths (3%) during study follow-up periods (7-74 months). The most common ocular complications were vitreous hemorrhage (13.2%), loss of eyelashes (12.7%), and periocular edema (10.5%). The most common systemic complications were nausea/vomiting (20.5%), neutropenia (14.1%), fever (8.2%), and bronchospasm (6.2%). CONCLUSIONS: Intra-arterial chemotherapy is associated with high rates of globe salvage and low rates of serious complications in patients with refractory retinoblastoma. Unfortunately, current literature is predominantly comprised of retrospective case studies, and further high-quality evidence is necessary to inform clinical practice.
Assuntos
Resistencia a Medicamentos Antineoplásicos , Neoplasias da Retina/tratamento farmacológico , Retinoblastoma/tratamento farmacológico , Terapia de Salvação/métodos , Antineoplásicos/administração & dosagem , Espasmo Brônquico/induzido quimicamente , Carboplatina/administração & dosagem , Edema/induzido quimicamente , Pestanas/efeitos dos fármacos , Neutropenia Febril/induzido quimicamente , Humanos , Infusões Intra-Arteriais/efeitos adversos , Infusões Intra-Arteriais/métodos , Melfalan/administração & dosagem , Metotrexato/administração & dosagem , Náusea/induzido quimicamente , Neoplasias da Retina/mortalidade , Neoplasias da Retina/radioterapia , Retinoblastoma/mortalidade , Retinoblastoma/radioterapia , Terapia de Salvação/efeitos adversos , Terapia de Salvação/estatística & dados numéricos , Topotecan/administração & dosagem , Hemorragia Vítrea/induzido quimicamente , Vômito/induzido quimicamenteRESUMO
RESUMEN El asma es una enfermedad obstructiva en la que, las resistencias respiratorias se encuentran aumentadas. Los hechos responsables de este aumento de resistencias son el propio broncoespasmo, la inflamación y el remodelado de la vía aérea con reducción de su diámetro. Todavía falta mucho por conocer y estudiar, pero sabemos que la ventilación mecánica no invasiva, como nueva forma de soporte ventilatorio que ha venido tomando auge en las últimas décadas, tiene numerosos beneficios en la práctica médica. A pesar de que algunas investigaciones plantean la controversialidad del empleo de la ventilación no invasiva en el asma grave, queremos realizar con el presente trabajo un acercamiento a varios de los estudios que se han llevado a cabo donde justifican totalmente el empleo de la misma como una medida de éxito en el manejo del asma, con resultados positivos y exitosos. Donde ha probado mejorar la situación funcional y reducir las necesidades de ingreso hospitalario, aliviando el agotamiento muscular y de esta manera mejorando el trabajo respiratorio. Aún queda bastante camino por recorrer con esta variante de ventilación que ha surgido y tomado auge por todos los logros y expectativas que ha venido a cumplir (AU).
SUMMARY Asthma is an obstructive disease in which, respiratory resistances are increased. The factors responsible for this increase in resistance are bronchospasm, inflammation and remodeling of the airway with reduction of its diameter. Much remains to be known and studied, but we know that noninvasive ventilation (NIV), as a new form of ventilatory support that has been growing in recent decades, has numerous benefits in medical practice. Although some research raises the controversy about the use of NIV in severe asthma, we want to do with the present work an approach to several of the studies that have been carried out where they totally justify the use of it as a measure of success in managing asthma, with positive and successful results. Where he has tried to improve the functional situation and reduce the need for hospital admission, alleviating muscle exhaustion and thus improving breathing work. There is still enough way to go with this variant of ventilation that has emerged and taken shape for all the achievements and expectations it has come to fulfill (AU).
Assuntos
Humanos , Respiração Artificial/métodos , Asma/complicações , Fatores de Risco , Asma/tratamento farmacológico , Espasmo Brônquico , Doença CatastróficaRESUMO
ABSTRACT Objective: To examine the impact of climate variability on the occurrence of exercise-induced bronchospasm in the rainy and dry seasons of a Brazilian semi-arid region. Methods: This sample comprised 82 adolescents aged 15 to 18 years, who were submitted to exercise-induced bronchospasm assessment on a treadmill and outdoors, during the rainy and the dry season. Anthropometric variables, sexual maturity and forced expiratory volume in the first second were analyzed. Air temperature and humidity, decline in forced expiratory volume in the first second (%) and frequency of bronchospasm were compared between seasons using the independent Student's t test, the Wilcoxon and McNemar tests, respectively. The level of significance was set at p<0.05. Results: The mean age was 15.65±0.82 years. Air temperature, air humidity and decline in forced expiratory volume in the first second (%) differed between seasons, with higher air temperature and humidity in the rainy season (29.6ºC±0.1 and 70.8%±0.6 versus 28.5ºC±0.2 and 48.5%±0.6; p<0.05). The decline in forced expiratory volume in the first second (%) was greater in the dry season (9.43%±9.97 versus 12.94%±15.65; p<0.05). The frequency of bronchospasm did not differ between seasons. Conclusion: The dry season had a negative impact on forced expiratory volume in the first second in adolescents, with greater decrease detected during this period. Findings of this study suggested bronchospasm tends to be more severe under low humidity conditions.
RESUMO Objetivo: Verificar a influência das alterações climáticas sobre o broncoespasmo induzido por exercício, nos períodos chuvoso e seco de uma região do semiárido brasileiro. Métodos: Foram submetidos à avaliação do broncoespasmo em esteira ergométrica, em ambiente externo, nos períodos chuvoso e seco, 82 adolescentes, com idades de 15 a 18 anos. Foram avaliadas as variáveis antropométricas, a maturação sexual e o volume expiratório forçado no primeiro segundo. Para comparação da temperatura e umidade, queda do volume expiratório forçado no primeiro segundo (%) e frequência do broncoespasmo entre os períodos, foram utilizados o teste t de Student independente, o teste de Wilcoxon e o teste de McNemar, respectivamente. O nível de significância adotado foi p<0,05. Resultados: A média de idade foi 15,65±0,82 anos. A temperatura, a umidade e a queda do volume expiratório forçado no primeiro segundo (%) diferiram entre os períodos, com valores de temperatura e umidade maiores no período chuvoso (29,6ºC±0,1 e 70,8%±0,6 versus 28,5ºC±0,2 e 48,4%±0,6; p<0,05). A queda do volume expiratório forçado no primeiro segundo (%) foi maior no período seco (9,43%±9,97 versus 12,94%±15,65; p<0,05), e não foi encontrada diferença da frequência do broncoespasmo entre os períodos. Conclusão: O período seco influenciou negativamente no volume expiratório forçado no primeiro segundo de adolescentes, observando maior percentual de queda dessa variável nesse período. De acordo com os achados, propõe-se uma maior gravidade do broncoespasmo induzido por exercício em condições de baixa umidade.