RESUMO
Urban air pollution is a major factor that affects the respiratory health of children and adolescents. Less studied is exposure during the first two years of life. This study analyzed the influence of acute and subchronic exposure to urban air pollutants on the severity of acute respiratory failure (ARF) in the first two years of life. This population-based study included 7364 infants hospitalized with ARF. Acute exposure was considered to have occurred 1, 3 and 7 days before hospitalization and subchronic exposure was considered the mean of the last 30 and 60 days. We found that for acute exposure, significant increases in days of hospitalization (LOS) occurred at lag 1 day for NO2 (0.24), SO2 (6.64), and CO (1.86); lag 3 days for PM10 (0.30), PM2.5 (0.37), SO2 (10.8), and CO (0.71); and lag 7 days for NO2 (0.16), SO2 (5.07) and CO (0.87). Increases in the risk of death occurred at lag 1 day for NO2 (1.06), SO2 (3.64), and CO (1.28); and lag 3 days for NO2 (1.04), SO2 (2.04), and CO (1.19). Subchronic exposures at 30 and 60 days occurred for SO2 (9.18, 3.77) and CO (6.53, 2.97), respectively. The associations were more pronounced with higher temperatures and lower relative humidity levels. We concluded that acute and subchronic exposure to higher atmospheric concentrations of all the pollutants studied were associated with greater severity of ARF. The greatest increases in LOS and risk of death occurred with hot and dry weather.
Assuntos
Poluentes Atmosféricos , Poluição do Ar , Poluentes Ambientais , Insuficiência Respiratória , Criança , Adolescente , Humanos , Lactente , Dióxido de Nitrogênio/toxicidade , Dióxido de Nitrogênio/análise , Poluentes Atmosféricos/toxicidade , Poluentes Atmosféricos/análise , Poluição do Ar/efeitos adversos , Poluição do Ar/análise , Insuficiência Respiratória/induzido quimicamente , Insuficiência Respiratória/epidemiologia , Material Particulado/efeitos adversos , Material Particulado/análise , Exposição Ambiental/efeitos adversos , Exposição Ambiental/análise , ChinaRESUMO
El talco, un silicato de magnesio hidratado, formó parte durante décadas del cuidado tradicional de lactantes y niños pequeños. Si bien en los niños su inhalación aguda, que suele ser accidental durante el cambio de pañales, no es frecuente, es una condición potencialmente peligrosa, que puede provocar dificultad respiratoria grave e incluso cuadros mortales. Se describe el grave compromiso respiratorio por neumonitis química asociado con la inhalación accidental de talco en un lactante de 14 meses. El niño presentó un cuadro de dificultad respiratoria con requerimiento de asistencia respiratoria mecánica (ARM) durante una semana. En cuanto al tratamiento, no existe un estándar, se utilizaron antibióticos y corticoides sistémicos y aerosolterapia. No presentó complicaciones en otros órganos o sistemas. Su evolución fue favorable, se pudo externar al décimo día de internación y presentó posteriormente episodios aislados de hiperreactividad bronquial.
Talc is a hydrated magnesium silicate. It was part of traditional infant and young child care for decades. In children, its acute inhalation, generally accidental during diaper changes, although not frequent, is a potentially dangerous condition, and can cause severe respiratory distress and even death. We describe the case of a 14-month child who had an accidental inhalation of talc, chemical pneumonitis and severe respiratory compromise. The patient had acute respiratory distress syndrome requiring mechanical ventilation for one week. There is no standard treatment, we used systemic antibiotics and corticosteroids and aerosol therapy. He did not have complications in other organs or systems. He was hospitalized for ten days. In the follow up, he had isolated episodes of bronchial hyperresponsiveness.
Assuntos
Humanos , Masculino , Lactente , Pneumonia/induzido quimicamente , Insuficiência Respiratória/induzido quimicamente , Talco/efeitos adversos , Pneumonia/terapia , Respiração Artificial , Insuficiência Respiratória/terapia , Acidentes Domésticos , Inalação , Intubação IntratraquealRESUMO
Respiratory depression from isoflurane seems to be greater in birds than in mammals. Isoflurane respiratory anesthetic index (AI) has only been evaluated in ducks (Anas platyrhynchos), which indeed showed a lower AI compared to mammals, but the isoflurane AI for other avian species is not known. The aim of this study was to evaluate the isoflurane AI in chickens (Gallus gallus domesticus). Six adult hens were anesthetized with isoflurane for determination of the minimum anesthetic concentration (MAC) using the bracketing method. During a second anesthetic event, the isoflurane AI was determined by progressively increasing the expired fraction of isoflurane by 0.5 times MAC until apnea was achieved (ETiso-apnea). The isoflurane AI was considered the ratio between the ETiso-apnea and the MAC. Heart rate, systolic arterial pressure, respiratory rate, and end-tidal carbon dioxide were continuously monitored throughout both anesthetic events. Data were analyzed using a mixed-effect model with Greenhouse-Geisser correction, followed by Tukey's test. The MAC for isoflurane was 1.18% ± 0.09% (mean ± SD). The ETiso-apnea was 3.31% ± 0.34% and the isoflurane AI was 2.80 ± 0.26. In chickens, isoflurane AI is similar to that measured in mammals, which is in contrast with published data in other avian species.
Assuntos
Anestesia por Inalação/veterinária , Anestésicos Inalatórios/efeitos adversos , Galinhas/fisiologia , Isoflurano/efeitos adversos , Insuficiência Respiratória/veterinária , Anestesia por Inalação/efeitos adversos , Anestésicos Inalatórios/administração & dosagem , Animais , Feminino , Isoflurano/administração & dosagem , Insuficiência Respiratória/induzido quimicamenteRESUMO
PURPOSE: To analyze the incidence of respiratory depression (RD) in patients undergoing anesthesia using opioids in a postanesthesia care unit. DESIGN: Retrospective cohort study. METHODS: Quantitative approach, performed by documentary analysis of medical records in the postanesthesia care unit. FINDINGS: A total of 330 patients were included in the study, with a prevalence of female (186; 56.36%) and nonobese patients (295; 89.39%). Five cases of RD in the immediate postoperative period were found, corresponding to an incidence of 1.52%. Each case in this study showed different risk factors related to opioid-induced RD. CONCLUSIONS: Nursing surveillance is essential in the decision-making process regarding the knowledge of physiological, pharmacologic, and risk factors to detect clinical signs of RD.
Assuntos
Analgésicos Opioides , Anestesia , Insuficiência Respiratória , Analgésicos Opioides/efeitos adversos , Anestesia/métodos , Feminino , Humanos , Incidência , Masculino , Enfermagem em Pós-Anestésico , Insuficiência Respiratória/induzido quimicamente , Insuficiência Respiratória/epidemiologia , Insuficiência Respiratória/enfermagem , Estudos RetrospectivosRESUMO
La leucemia promielocítica aguda (APL) es el subtipo de leucemia mieloide aguda de mejor pronóstico en niños. Su incidencia es menor a 10%. Desde el punto de vista citogenético se observa una translocación t (15;17). En la terapéutica la incorporación del ácido transretinoico ha logrado altas tasas de remisión completa debido a la rápida desaparición de la coagulopatía y, en consecuencia, disminución de la tasa de recaídas, en comparación con el tratamiento de monoterapia. En general es un fármaco bien tolerado pero puede tener reacciones adversas; el más grave es el síndrome de ácido transretinoico (ATRA), potencialmente mortal. Las manifestaciones clínicas son: fiebre, ganancia de peso, infiltrados pulmonares, síndrome de dificultad respiratoria, derrame pleural o pericárdico, hipotensión, insuficiencia hepática y renal. El tratamiento es con suspensión del ácido transretinoico, medidas de apoyo y altas dosis de esteroides. Se presenta un caso clínico del hospital del Niño DIF con APL y Síndrome de ATRA.
The leukemia promyelocytic acute (APL) is the subtype of leukemia myeloid acute of better prognosis in children. Its incidence is less than 10%. From the point of view cytogenetic is observed a translocation t (15; 17). The addition of the acid transretinoico has achieved high rates of complete remission because of the rapid disappearance of the coagulopathy and, consequently, decrease in the rate of relapses, compared with monotherapy treatment. In general it is a well-tolerated drug but can have adverse reactions; the most serious is transretinoico acid (ATRA), potentially fatal syndrome. The manifestations are: fever, weight gain, pulmonary infiltrates, syndrome of shortness of breath, hypotension, pleural effusion or pericardial, hepatic and renal insufficiency. The treatment is with suspension of the acid transretinoico, measures of support and high doses of steroids. It presents a case clinical of the Hospital del Niño DIF with APL and syndrome of ATRA.
Assuntos
Humanos , Feminino , Pré-Escolar , Tretinoína/efeitos adversos , Leucemia Promielocítica Aguda/tratamento farmacológico , Antineoplásicos/efeitos adversos , Derrame Pleural/induzido quimicamente , Insuficiência Respiratória/induzido quimicamente , Síndrome , Evolução Fatal , Febre/induzido quimicamente , Hepatomegalia/induzido quimicamente , Hipóxia/induzido quimicamenteRESUMO
A 66-year-old male patient was referred to our clinic with severe pneumonia. Bronchoscopy was performed due to clinical worsening despite antibiotics and diuretic therapy, respiratory failure and radiographic progression. Because bacterial cultures of the bronchoalveolar lavage fluid were negative and after using amiodarone for almost one month, we eliminated amiodarone from his medication regimen due to suspicion of amiodarone toxicity. Accordingly, we also initiated systemic steroid therapy. Chest X-ray done after 72 hours showed a significant resolution of lung consolidations and the patient exhibited significant clinical improvement, with decline of his oxygen requirements.
Assuntos
Amiodarona/efeitos adversos , Doenças Pulmonares Intersticiais/induzido quimicamente , Insuficiência Respiratória/induzido quimicamente , Vasodilatadores/efeitos adversos , Idoso , Humanos , Pulmão/efeitos dos fármacos , Doenças Pulmonares Intersticiais/diagnóstico por imagem , Masculino , Pneumonia/induzido quimicamente , Pneumonia/diagnóstico por imagem , Radiografia Torácica , Insuficiência Respiratória/diagnóstico por imagemRESUMO
Summary A 66-year-old male patient was referred to our clinic with severe pneumonia. Bronchoscopy was performed due to clinical worsening despite antibiotics and diuretic therapy, respiratory failure and radiographic progression. Because bacterial cultures of the bronchoalveolar lavage fluid were negative and after using amiodarone for almost one month, we eliminated amiodarone from his medication regimen due to suspicion of amiodarone toxicity. Accordingly, we also initiated systemic steroid therapy. Chest X-ray done after 72 hours showed a significant resolution of lung consolidations and the patient exhibited significant clinical improvement, with decline of his oxygen requirements.
Assuntos
Humanos , Masculino , Idoso , Insuficiência Respiratória/induzido quimicamente , Vasodilatadores/efeitos adversos , Doenças Pulmonares Intersticiais/induzido quimicamente , Amiodarona/efeitos adversos , Pneumonia/induzido quimicamente , Pneumonia/diagnóstico por imagem , Insuficiência Respiratória/diagnóstico por imagem , Radiografia Torácica , Doenças Pulmonares Intersticiais/diagnóstico por imagem , Pulmão/efeitos dos fármacosRESUMO
Household air pollution (HAP) contributes to the global burden of disease. Our primary purpose was to determine whether HAP exposure was associated with reduced lung function and respiratory and non-respiratory symptoms in Belizean adults and children. Our secondary purpose was to investigate whether lifestyle (physical activity (PA) and fruit and vegetable consumption (FV)) is associated with reported symptoms. Belizean adults (n = 67, 19 Male) and children (n = 23, 6 Male) from San Ignacio Belize and surrounding areas participated in this cross-sectional study. Data collection took place at free walk-in clinics. Investigators performed initial screenings and administered questionnaires on (1) sources of HAP exposure; (2) reported respiratory and non-respiratory symptoms and (3) validated lifestyle questionnaires. Participants then performed pulmonary function tests (PFTs) and exhaled breath carbon monoxide (CO). There were no significant associations between HAP exposure and pulmonary function in adults. Increased exhaled CO was associated with a significantly lower forced expiratory volume in 1-s divided by forced vital capacity (FEV1/FVC) in children. Exposed adults experienced headaches, burning eyes, wheezing and phlegm production more frequently than unexposed adults. Adults who met PA guidelines were less likely to experience tightness and pressure in the chest compared to those not meeting guidelines. In conclusion, adults exposed to HAP experienced greater respiratory and non-respiratory symptoms, which may be attenuated by lifestyle modifications.
Assuntos
Poluentes Atmosféricos/efeitos adversos , Poluição do Ar em Ambientes Fechados/efeitos adversos , Dieta , Exercício Físico , Doenças Respiratórias/epidemiologia , Adolescente , Adulto , Belize/epidemiologia , Criança , Estudos Transversais , Feminino , Humanos , Estilo de Vida , Masculino , Pessoa de Meia-Idade , Testes de Função Respiratória , Insuficiência Respiratória/induzido quimicamente , Insuficiência Respiratória/epidemiologia , Doenças Respiratórias/induzido quimicamenteRESUMO
We investigated the effect of fish oil (FO) supplementation, at 4 g/day, on the respiratory performance and blood lipid profile of 32 patients with breast cancer at the beginning of chemotherapy. They were randomized into two groups: control (C) and FO supplemented (S). Both groups underwent three respiratory evaluations and blood harvest (before chemotherapy-Day 0, and 30 and 60 days after supplementation). The S group showed a significant increase in the maximal inspiratory and expiratory pressure (P ≤ 0.05 vs. Day 0) and in the maximum voluntary ventilation (P ≤ 0.05). In the treadmill 6-min-walk test, the S group had a significant increase in the walked distance (P ≤ 0.05). Blood lactate concentration was significantly lower in the S group after 60 days, at rest, when compared to C (P ≤ 0.05). Plasma high-density lipoprotein (HDL) cholesterol concentration remained the same after 60 days of supplementation, while in the C group, it decreased significantly (P ≤ 0.05 Day 0 vs. Day 60). Triacylglycerol (TAG) plasma concentration in the S group was lower when compared to the C group (P ≤ 0.05 Day 60S vs. Day 60). Supplementation with FO caused improvement in the respiratory muscle strength and endurance, ameliorated functional performance, and kept TAG, HDL cholesterol, and lactate plasma concentration at normal levels.
Assuntos
Antineoplásicos/efeitos adversos , Neoplasias da Mama/tratamento farmacológico , Suplementos Nutricionais , Óleos de Peixe/uso terapêutico , Pulmão/efeitos dos fármacos , Resistência Física/efeitos dos fármacos , Insuficiência Respiratória/prevenção & controle , Adulto , Antineoplásicos/uso terapêutico , Brasil , Neoplasias da Mama/sangue , Neoplasias da Mama/dietoterapia , Neoplasias da Mama/cirurgia , Quimioterapia Adjuvante/efeitos adversos , HDL-Colesterol/sangue , Suplementos Nutricionais/efeitos adversos , Teste de Esforço , Feminino , Óleos de Peixe/efeitos adversos , Humanos , Ácido Láctico/sangue , Pulmão/fisiopatologia , Pessoa de Meia-Idade , Força Muscular/efeitos dos fármacos , Cuidados Pós-Operatórios , Complicações Pós-Operatórias/induzido quimicamente , Complicações Pós-Operatórias/fisiopatologia , Complicações Pós-Operatórias/prevenção & controle , Reprodutibilidade dos Testes , Insuficiência Respiratória/induzido quimicamente , Insuficiência Respiratória/etiologia , Insuficiência Respiratória/fisiopatologia , Músculos Respiratórios/efeitos dos fármacos , Músculos Respiratórios/fisiopatologia , Triglicerídeos/sangueRESUMO
Tea tree oil is an essential oil containing a mixture of aromatic hydrocarbons. We describe an 18-month-old male patient who ingested tea tree oil, developed central nervous system depression, respiratory distress, and received early emergency department treatment with surfactant. Early treatment of hydrocarbon pneumonitis with surfactant has not been previously described. Early administration of surfactant should be further evaluated for treatment of hydrocarbon aspiration.