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- ItemEmbargoAnálise da freqüência respiratória e do volume corrente como preditivo para a falha na extubação da recém-nascidos muito baixo peso(Universidade Federal de São Paulo (UNIFESP), 2006-05-31) Davidson, Josy [UNIFESP]; Carvalho, Werther Brunow de [UNIFESP]; http://lattes.cnpq.br/0981020175869536; http://lattes.cnpq.br/6101587222452300; Universidade Federal de São Paulo (UNIFESP)Objetive: to analyze the relation between respiratory rate (RR) and tidal volume (TV) ratio as a predictive index for extubation very low birth weight infants submitted to mechanical ventilation. Methods: Prospective observational collection of data with newborns less than 37 weeks gestation, less than or iqual to 1.500 grams who were mechanically ventilated for at least 48 hours and less than 30 days and had planned extubation. As soon as physicians decided to extubate infant, a fixed-area pneumotachograph was installed between endotracheal tube and ventilator circuit. Infant stayed in endotracheal continuous positive airway pressure (CPAP) mode during 10 minutes and spontaneous tidal volume (TV) and respiratory rate (RR) were collected. After measurements, neonate was extubated and used nasal CPAP. Extubation failure was considered if infant required reintubation within 48 hours, except if infant evaluated with airway obstruction. RR/TV was indexed to body weight in the day of the study and means of RR, TV and RR/TV during 10 minutes were calculeted. For continuous variables were used Student t-test and for categorical variables between groups were used Chi-square or the Fisher´s exact test. A cutoff was calculated for respiratory rate and tidal volume and sensibility and specificity were also calculated. Results: Thirty-five infants were enrolled and fifteen (43%) failure extubation. During 10- minute measurements, there were no differences between groups in RR, TV and RR/TV. Specificity and sensibility were for RR 40% ,67%, TV was 50%, 67% and RR/TV was 40%, 73%, respectively. Conclusion: Respiratory rate tidal volume ratio was not a good predictor for extubation success.
- ItemAcesso aberto (Open Access)Efeitos da tosse manualmente assistida sobre a mecânica do sistema respiratório de pacientes em suporte ventilatório total(Sociedade Brasileira de Pneumologia e Tisiologia, 2008-06-01) Avena, Katia de Miranda; Duarte, Antonio Carlos Magalhães; Cravo, Sergio Luiz [UNIFESP]; Sologuren, Maria José Junho; Gastaldi, Ada Clarice [UNIFESP]; Centro Universitário do Triângulo; Hospital Português Serviço de Fisioterapia; Universidade Federal de São Paulo (UNIFESP); Universidade Federal do Estado do Rio de JaneiroOBJECTIVE: Manually assisted coughing (MAC) consists of a vigorous thrust applied to the chest at the beginning of a spontaneous expiration or of the expiratory phase of mechanical ventilation. Due to routine use of MAC in intensive care units, the objective of this study was to assess the effects of MAC on respiratory system mechanics in patients requiring full ventilatory support. METHODS: We assessed 16 sedated patients on full ventilatory support (no active participation in ventilation). Respiratory system mechanics and oxyhemoglobin saturation were measured before and after MAC, as well as after endotracheal aspiration. Bilateral MAC was performed ten times on each patient, with three respiratory cycle intervals between each application. RESULTS: Data analysis demonstrated a decrease in resistive pressure and respiratory system resistance, together with an increase in oxyhemoglobin saturation, after MAC combined with endotracheal aspiration. No evidence of alterations in peak pressures, plateau pressures or respiratory system compliance change was observed after MAC. CONCLUSIONS: The use of MAC alters respiratory system mechanics, increasing resistive forces by removing secretions. The technique is considered safe and efficacious for postoperative patients. Using MAC in conjunction with endotracheal aspiration provided benefits, achieving the proposed objective: the displacement and removal of airway secretions.
- ItemAcesso aberto (Open Access)Fatores preditores independentes de ventilação mecânica prolongada em pacientes submetidos à cirurgia de revascularização miocárdica(Sociedade Brasileira de Cirurgia Cardiovascular, 2012-12-01) Piotto, Raquel Ferrari; Ferreira, Fabricio Beltrame [UNIFESP]; Colósimo, Flávia Cortez; Silva, Gilmara Silveira Da; Sousa, Alexandre Gonçalves De; Braile, Domingo Marcolino; Hospital Beneficência Portuguesa de São Paulo Centro de Ensino e Pesquisa; Universidade Federal de São Paulo (UNIFESP); Faculdade Regional de Medicina de São José do Rio PretoOBJECTIVE: To determine independent predictors of prolonged mechanical ventilation in patients undergoing coronary artery bypass graft surgery. METHODS: Data of patients undergoing coronary artery bypass graft surgery were included prospectively from July 2009 to July 2010. All data were input into an electronic database. The resulting cohort included a total of 2952 patients of which 77 remained more than 48 hours on mechanical ventilation. Patients were divided into two groups: 1) a prolonged ventilation group, needing mechanical ventilation for more than 48 hours and 2) not prolonged ventilation group, undergoing a successful extubation within 48 hours. RESULTS: After adjustment for confounding factors a multivariate analysis identified the following factors as independent predictors of prolonged mechanical ventilation: age (OR 1.06 95% CI 1.03 -1.09; P <0.001), chronic renal failure (OR 3.52 95% CI 1.84 - 6.74; P <0.001), chronic obstructive pulmonary disease (OR 2.65 95% CI 1.38 -5.09; P = 0.004), coronary artery bypass graft associated with other procedures (OR 3.33 95 % CI 1.89 - 5.58; P <0.001) and clamping time (OR 1.01 95% CI 1.00 -1.02; P = 0.018). CONCLUSION: The identification of these predictors allows the development of preventive strategies that could reduce invasive ventilation time, since patients on prolonged mechanical ventilation present greater morbidity and mortality rates.
- ItemAcesso aberto (Open Access)Incidence of tracheal aspiration in tracheotomized patients in use of mechanical ventilation(Instituto Brasileiro de Estudos e Pesquisas de Gastroenterologia - IBEPEGE Colégio Brasileiro de Cirurgia Digestiva - CBCD Sociedade Brasileira de Motilidade Digestiva - SBMD Federação Brasileira de Gastroenterologia - FBGSociedade Brasileira de Hepatologia - SBHSociedade Brasileira de Endoscopia Digestiva - SOBED, 2009-12-01) Simão, Mariana De Almeida; Alacid, Camila Albuquerque Nobre; Rodrigues, Katia Alonso; Albuquerque, Christiane [UNIFESP]; Furkim, Ana Maria; Universidade Federal de São Paulo (UNIFESP); Hospital Universitário Pedro ErnestoCONTEXT: Many patients in use of mechanical ventilation show clinical complications due to tracheal aspiration. Assessment and early methods are necessary, so that preventive and safety measures apply to this patients OBJECTIVE: To study the incidence of tracheal aspiration of saliva in tracheotomized patients treated in intensive care unit using two modes of mechanical ventilation and with different sedation levels. METHOD: Prospective study with 14 tracheotomized non-neurological patients using mechanical ventilation. The sample was divided into two groups based on ventilation mode: pressure support ventilation and pressure controlled ventilation. Those two groups were subdivided into two others according to sedation level. The speech pathology evaluation was completed via the blue dye test in order to analyze the incidence of tracheal aspiration of saliva. RESULTS: Sedation levels and mechanical ventilation time related to tracheal aspiration were not statistically significant in this study. On the other hand, ventilation mode and tracheal aspiration showed statistical significance, and there was a higher incidence of tracheal aspiration in the pressure controlled ventilation mode. CONCLUSION: It was possible to observe a significant relationship between tracheal aspiration incidence and pressure controlled ventilation mode, which means the inclusion of those patients in the risk group for oropharyngeal dysphagia and their insertion in prevention protocols. The relationship between tracheal aspiration and sedation level, as well as tracheal aspiration and mechanical ventilation, were not statistically significant in this sample, needing further research.
- ItemSomente MetadadadosPEEP periódico na síndrome do desconforto respiratório agudo experimental provocada por administração de ácido oléico.(Universidade Federal de São Paulo (UNIFESP), 2003) Lanza, Fernanda de Cordoba [UNIFESP]; Beppu, Osvaldo Shigueomi [UNIFESP]Introdução: Ventilacao mecanica com baixos volumes correntes, baixas pressoes inspiratorias e utilizacao de PEEP tem sido descrita como necessaria em pacientes com Sindrome do Desconforto Respiratorio Agudo para evitar o inicio ou o agravamento da lesao pulmonar induzida pela ventilacao mecanica e a hipoxemia. Entretanto a PEEP pode levar a alteracoes hemodinamicas, comprometendo ainda mais este quadro. Portanto a utilizacao de PEEP periodico (PEEP P), ou seja, elevados niveis de PEEP intercalados com baixos valores, em alguns ciclos respiratorios, poderia manter os beneficios da PEEP constante (PEEP C), evitando o comprometimento cardiovascular. Metodos: 12 caes com SDRA induzida por infusao de acido oleico foram estudados e randomizados em dois grupos. Grupo um: realizaram-se dois procedimentos: PEEP P5-10 consistiu na elevacao da PEEP de 5 para 10cmH20, e comparado posteriormente com PEEP C de 10cmH20; PEEP P518 elevacao da PEEP de 5 para 18cmH20, e comparada posteriormente PEEP C de 18cmH20; e grupo dois, onde foi realizada previamente manobra de recrutamento(MR) pulmonar (elevacao da pressao inspiratoria (PIP) ate 50cmH20), seguida da realizacao do mesmo procedimento do grupo PEEP P5-18. PEEP P foi definido como elevacao da PEEP para valores pre-determinados por apenas um ciclo respiratorio a cada vinte segundos. Conclusao: Concluiu-se que PEEP P pode manter a oxigenacao, porem a MR previa e necessaria para essa manutencao e para melhora da Pa02. Ha perda da oxigenacao ao realizar PEEP P com altos valores de PEEP isoladamente. Nao houve risco cardiovascular que comprometesse a utilizacao de PEEP P
- ItemAcesso aberto (Open Access)Safety in intrahospital transportation: evaluation of respiratory and hemodynamic parameters. A prospective cohort study(Associação Paulista de Medicina - APM, 2008-11-01) Mazza, Bruno Franco [UNIFESP]; Amaral, José Luiz Gomes do [UNIFESP]; Rosseti, Heloisa [UNIFESP]; Carvalho, Rosana Borges [UNIFESP]; Senna, Ana Paula Resque [UNIFESP]; Guimarães, Hélio Penna [UNIFESP]; Machado, Flávia Ribeiro [UNIFESP]; Universidade Federal de São Paulo (UNIFESP)CONTEXT AND OBJECTIVE: Intrahospital transportation of mechanically ventilated patients is a high-risk situation. We aimed to determine whether transfers could be safely performed by using a transportation routine. DESIGN AND SETTING: Prospective cohort study with before and after evaluation. METHODS: Mechanically ventilated patients who needed transportation were included. Hemodynamic and respiratory parameters were measured before and after transportation. Statistical analysis consisted of variance analysis and paired Student's t test. Results were considered significant if P < 0.05. RESULTS: We studied 37 transfers of 26 patients (12 female) of mean age 46.6 ± 15.7. Patients with pulmonary diseases, positive end expiratory pressure > 5, FiO2 > 0.4 and vasoactive drug use comprised 42.4%, 24.3%, 21.6% and 33.0% of cases, respectively. Mean duration of transportation was 43.4 ± 18.9 minutes. Complications occurred in 32.4%. There was a significant increase in CO2 (before transportation, 29.6 ± 7.3 and after transportation, 34.9 ± 7.0; P = 0.000); a trend towards improved PO2/FiO2 ratio (before transportation, 318.0 ± 137.0 and after transportation, 356.8 ± 119.9; P = 0.053); increased heart rate (before transportation, 80.9 ± 18.7 and after transportation, 85.5 ± 17.6; P = 0.08); and no significant change in mean arterial blood pressure (P = 0.93). CONCLUSION: These results suggest that intrahospital transportation can be safely performed. Our low incidence of complications was possibly related to both the presence of a multidisciplinary transportation team and proper equipment.
- ItemEmbargoTraqueostomia precoce versus traqueostomia tardia em pacientes críticos: Revisão Sistemática(Universidade Federal de São Paulo (UNIFESP), 2011-07-27) Silva, Brenda Nazaré Gomes da [UNIFESP]; Valente, Orsine [UNIFESP]; Universidade Federal de São Paulo (UNIFESP)Contexto: O uso da ventilação mecânica prolongada pelos pacientes críticos em unidades de terapia intensiva (UTI) é uma das situações clínicas mais frequentes nas quais a traqueostomia é indicada. E os termos traqueostomias, .“precoce.” e .“tardia.” referem-se ao tempo para a realização desse procedimento. As evidências disponíveis sobre as possíveis vantagens da traqueostomia precoce em relação a tardia são conflitantes, mas incluem redução do tempo de permanência hospitalar e mortalidade. Objetivos: Comparar a efetividade e a segurança das traqueostomias precoce e tardia em pacientes críticos com previsão de permanecerem em ventilação mecânica prolongada. Métodos: Revisão sistemática de estudos aleatórios. As seguintes bases de dados eletrônicas foram uilizadas: The Cochrane Library, MEDLINE, EMBASE, LILACS, Current Controlled Trials, PEDro e CINHAL, até a data de dezembro de 2010. Foram incluídos ensaios controlados e aleatórios ou quasi-aleatórios que compararam traqueostomia precoce (dois a 10 dias após o início da a intubação) e traqueostomia tardia (>10 dias após o início da intubação) em pacientes adultos críticos com previsão para ventilação mecânica prolongada. Não houve qualquer restrição quanto ao idioma ou ano da publicação. Foram feitas metanálises com modelo estatístico de efeito aleatório para mortalidade e pneumonia. Resultados: Foram incluídos quatro estudos de alto risco de viés, totalizando 673 pacientes alocados para traqueostomia precoce ou tardia. Não foi possível observar fortes evidências que favorecessem à traqueostomia precoce para mortalidade (três estudos, 49,6% [148/298] versus 64,1% [193/201], risco relativo [RR] de 0,67 [IC 95% 0,42, 1,04], P=0,08); e pneumonia (12,2%, 33/269 versus 21,8%, 59/270, RR 0,42 [dois estudos, IC 95% 0,13, 1,39, P=0,15]). Entretanto foi possível encontrar estimativa estatisticamente significativa para tempo de permanência em ventilação mecânica (um estudo, DM -9,8 dias, IC 95% - 11,48, -8,12; P<0,00001) e na UTI (um estudo, DM -11.40 [-12.42, -10.38, P<0.00001] que favoreceram ao grupo de traqueostomia precoce. Conclusões: De acordo com evidências de qualidade moderada, a traqueostomia precoce tem potencial para ser mais efetiva e segura do que a traqueostomia tardia para a redução de mortalidade, pneumonia e tempo de permanência na ventilação mecânica e na UTI. Entretanto esses resultados necessitam ser confirmados ou não por estudos adequados que ainda não foram finalizados e outros que possivelmente serão realizados no futuro.
- ItemSomente MetadadadosValidação clínica dos sinais e sintomas e comportamento dos diagnósticos de enfermagem respiratórios em pacientes sob ventilação mecânica invasiva(Universidade Federal de São Paulo (UNIFESP), 2005) Zeitoun, Sandra Salloum [UNIFESP]; Barros, Alba Lucia Bottura Leite de [UNIFESP]