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[PMID]:28858086
[Au] Autor:Lin SC; Lin HW; Chiang BL
[Ad] Endereço:aDepartment of Pediatrics, Shuang Ho Hospital bDepartment of Pediatrics, School of Medicine, College of Medicine, Taipei Medical University cGraduate Institute of Clinical Medicine, College of Medicine, National Taiwan University dDepartment of Mathematics, Soochow University eEvidence Based Medicine Center, Wan Fang Hospital, Taipei Medical University, Taipei, Taiwan.
[Ti] Título:Association of croup with asthma in children: A cohort study.
[So] Source:Medicine (Baltimore);96(35):e7667, 2017 Sep.
[Is] ISSN:1536-5964
[Cp] País de publicação:United States
[La] Idioma:eng
[Ab] Resumo:Asthma and croup are common inflammatory airway diseases involving the bronchus in children. However, no study has reported the effects of urbanization, sex, age, and bronchiolitis on the association of croup and its duration with asthma development. We used the Taiwan Longitudinal Health Insurance Database (LHID) to perform this population-based cohort study; here, the cluster effect caused by hospitalization was considered to evaluate the association between croup and asthma development and the risk factors for asthma in children of different age groups. We evaluated children with croup aged <12 years (n = 1204) and age-matched control patients (n = 140,887) by using Cox proportional hazards regression analysis within a hospitalization cluster. Of all 142,091 patients, 5799 (including 155 with croup [419 per 1000 person-y] and 5644 controls [106 per 1000 person-y]) had asthma during the 5-year follow-up period. During the 5-year follow-up period, the hazard ratios (HRs [95% CIs]) for asthma were 2.10 (1.81-2.44) in all children with croup, 2.13 (1.85-2.46) in those aged 0 to 5 years, and 2.22 (1.87-2.65) in those aged 6 to 12 years. Children with croup aged 7 to 9 years had a higher HR for asthma than did those in other age groups. Boys with croup had a higher HR for asthma. The adjusted HR for asthma was 1.78 times higher in children with croup living in urban areas than in those living in rural areas. In conclusion, our analyses indicated that sex, age, bronchiolitis, and urbanization level are significantly associated with croup and asthma development. According to our cumulative hazard rate curves, younger children with croup should be closely monitored for asthma development for at least 3 years.
[Mh] Termos MeSH primário: Asma/epidemiologia
Crupe/complicações
[Mh] Termos MeSH secundário: Fatores Etários
Asma/complicações
Criança
Serviços de Saúde da Criança
Pré-Escolar
Estudos de Coortes
Bases de Dados Factuais
Feminino
Seres Humanos
Lactente
Recém-Nascido
Masculino
Fatores de Risco
Taiwan/epidemiologia
[Pt] Tipo de publicação:JOURNAL ARTICLE
[Em] Mês de entrada:1709
[Cu] Atualização por classe:170912
[Lr] Data última revisão:
170912
[Sb] Subgrupo de revista:AIM; IM
[Da] Data de entrada para processamento:170901
[St] Status:MEDLINE
[do] DOI:10.1097/MD.0000000000007667


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[PMID]:28436091
[Au] Autor:Lee MN; Kang KA; Park SJ; Kim SJ
[Ad] Endereço:Department of Nursing, College of Health Science, Kangwon National University, Samcheok, South Korea.
[Ti] Título:Effects of pre-education combined with a simulation for caring for children with croup on senior nursing students.
[So] Source:Nurs Health Sci;19(2):264-272, 2017 Jun.
[Is] ISSN:1442-2018
[Cp] País de publicação:Australia
[La] Idioma:eng
[Ab] Resumo:Educational outcomes, such as knowledge, confidence in performance, ability in nursing practice, and satisfaction with learning methods in caring for children with croup, were compared between groups of students that received education through simulation combined with pre-education, simulation only, and pre-education only. In this quasi-experimental design, the educational intervention for the experimental group was the pre-education modality. Data from a convenience sample of 127 senior nursing students were drawn from three nursing schools in South Korea. There were significant differences in the mean scores of knowledge, confidence in performance, satisfaction with the learning method, and ability in nursing practice between the three groups. Pre-education with simulation significantly enhanced students' knowledge, confidence in performance, ability in nursing practice, and satisfaction with learning methods compared with pre-education or simulation alone. Simulation strategies should focus more on enhancing nursing students' learning outcomes.
[Mh] Termos MeSH primário: Competência Clínica/normas
Crupe/terapia
Simulação de Paciente
Enfermagem Pediátrica/educação
Estudantes de Enfermagem/psicologia
[Mh] Termos MeSH secundário: Adulto
Bacharelado em Enfermagem/métodos
Avaliação Educacional/métodos
Feminino
Seres Humanos
Aprendizagem
Masculino
República da Coreia
[Pt] Tipo de publicação:JOURNAL ARTICLE
[Em] Mês de entrada:1707
[Cu] Atualização por classe:170713
[Lr] Data última revisão:
170713
[Sb] Subgrupo de revista:IM; N
[Da] Data de entrada para processamento:170425
[St] Status:MEDLINE
[do] DOI:10.1111/nhs.12340


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[PMID]:28292873
[Au] Autor:Tyler A; McLeod L; Beaty B; Juarez-Colunga E; Birkholz M; Hyman D; Kempe A; Todd J; Dempsey AF
[Ad] Endereço:Children's Hospital Colorado, Aurora, Colorado; amy.tyler@childrenscolorado.org.
[Ti] Título:Variation in Inpatient Croup Management and Outcomes.
[So] Source:Pediatrics;139(4), 2017 Apr.
[Is] ISSN:1098-4275
[Cp] País de publicação:United States
[La] Idioma:eng
[Ab] Resumo:BACKGROUND AND OBJECTIVES: Croup is a clinical diagnosis, and the available evidence suggests that, except in rare cases, ancillary testing, such as radiologic imaging, is not helpful. Given the paucity of inpatient-specific evidence for croup care, we hypothesized that there would be marked variability in the use of not routinely indicated resources (NRIRs). Our primary study objective was to describe the variation and predictors of variation in the use of NRIRs. METHODS: This was a retrospective cohort study that used the Pediatric Health Information System database of generally healthy inpatients with croup aged 6 months to 15 years who were admitted between January 1, 2012 and September 30, 2014. We measured variability in the use of NRIRs: chest and lateral neck radiographs, viral testing, parenteral steroids, and antibiotics. Risk-adjusted analysis was used to compare resource utilization adjusted for hospital-specific effects and average case mix. RESULTS: The cohort included 26 hospitals and 6236 patients with a median age of 18 months. Nine percent of patients required intensive care services, and 3% had a 30-day readmission for croup. We found marked variability in adjusted and unadjusted utilization across hospitals for all resources. In the risk-adjusted analysis, hospital-specific effects rather than patient characteristics were the main predictor of variability in the use of NRIRs. CONCLUSIONS: We observed an up to fivefold difference in NRIR utilization attributable to hospital-level practice variability in inpatient croup care. This study highlights a need for inpatient-specific evidence and quality-improvement interventions to reduce unnecessary utilization and to improve patient outcomes.
[Mh] Termos MeSH primário: Crupe/terapia
Recursos em Saúde/estatística & dados numéricos
Hospitalização/estatística & dados numéricos
Pacientes Internados/estatística & dados numéricos
[Mh] Termos MeSH secundário: Adolescente
Criança
Pré-Escolar
Estudos de Coortes
Bases de Dados Factuais
Gerenciamento Clínico
Feminino
Seres Humanos
Lactente
Masculino
Estudos Retrospectivos
[Pt] Tipo de publicação:JOURNAL ARTICLE
[Em] Mês de entrada:1708
[Cu] Atualização por classe:170803
[Lr] Data última revisão:
170803
[Sb] Subgrupo de revista:AIM; IM
[Da] Data de entrada para processamento:170316
[St] Status:MEDLINE


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[PMID]:27729160
[Au] Autor:Hiebert JC; Zhao YD; Willis EB
[Ad] Endereço:Department of Otorhinolaryngology, The University of Oklahoma Health Sciences Center, 920 Stanton L. Young Blvd WP 1290, Oklahoma City, OK, 73104, USA. Electronic address: Jared-hiebert@ouhsc.edu.
[Ti] Título:Bronchoscopy findings in recurrent croup: A systematic review and meta-analysis.
[So] Source:Int J Pediatr Otorhinolaryngol;90:86-90, 2016 Nov.
[Is] ISSN:1872-8464
[Cp] País de publicação:Ireland
[La] Idioma:eng
[Ab] Resumo:IMPORTANCE: The etiology of recurrent croup is often anatomic. Currently there is no set criteria for determining who should undergo diagnostic bronchoscopy and which patients are at most risk for having a clinically significant finding. Few studies have addressed these questions. OBJECTIVE: To identify risk factors for clinically significant findings on bronchoscopy in children with recurrent croup and the frequency of bronchoscopy findings in general. DATA SOURCES: PUBMED, Ovid MEDLINE, EMBASE. STUDY SELECTION: Articles addressing bronchoscopy in children with recurrent croup, up to July 2016, were reviewed. Related keywords and medical subject headings were used during the search. The abstracts were reviewed to determine suitability for inclusion based on a set of criteria. Manual crosscheck of references was performed. DATA EXTRACTION: We analyzed the bronchoscopy findings of individual patients in each study and their associated risk factors when available. RESULTS: We reviewed 11 articles, published between 1992 and 2016, including 885 patients (654 males, 237 females). Only 5 studies, including 455 patients, had sufficient data for meta-analysis. Our study revealed that the three most common bronchoscopy findings were subglottic stenosis, reflux changes, and broncho/tracheomalacia. Only 8.7% of patients were noted to have clinically significant findings on bronchoscopy. Meta analysis showed an association between significant bronchoscopy findings and History of Intubation [OR = 5.17, 95% CI 2.65-10.09], Inpatient Consultation [OR = 4.01, 95% CI 1.44-11.20], Age < 3 [OR = 3.22, 95% 1.66-6.27], Age < 1 [OR = 2.86, 95% CI 1.28-6.40], and Prematurity [OR = 2.90, 95% CI 1.39-6.06]. Our study found a high incidence of a History of GERD (20%) and Asthma/Allergies (35%) among patients with recurrent croup, but these variables did not reach statistical significance in patients with significant bronchoscopy findings ([OR = 1.62, 95% CI 0.79-3.30], [OR = 0.57, 95% CI 0.30-1.08] respectively). CONCLUSION: The risk factors most associated with clinically significant bronchoscopy findings in recurrent croup are Intubation, Inpatient Consultation, Age < 3, Age <1, and Prematurity. A History of GERD and Asthma/Allergy, though highly prevalent in recurrent croup patients, were not statistically associated with significant bronchoscopy findings. RELEVANCE: The results should guide physicians in selecting which recurrent croup patients are most at risk for significant findings and thus may warrant bronchoscopy.
[Mh] Termos MeSH primário: Broncomalácia/diagnóstico por imagem
Broncoscopia
Crupe/etiologia
Refluxo Gastroesofágico/diagnóstico por imagem
Laringoestenose/diagnóstico por imagem
Traqueomalácia/diagnóstico por imagem
[Mh] Termos MeSH secundário: Fatores Etários
Broncomalácia/complicações
Pré-Escolar
Crupe/epidemiologia
Refluxo Gastroesofágico/complicações
Seres Humanos
Lactente
Intubação Intratraqueal
Laringoestenose/complicações
Nascimento Prematuro/epidemiologia
Recidiva
Encaminhamento e Consulta
Fatores de Risco
Traqueomalácia/complicações
[Pt] Tipo de publicação:JOURNAL ARTICLE; META-ANALYSIS; REVIEW
[Em] Mês de entrada:1703
[Cu] Atualização por classe:170817
[Lr] Data última revisão:
170817
[Sb] Subgrupo de revista:IM
[Da] Data de entrada para processamento:161013
[St] Status:MEDLINE


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[PMID]:27637124
[Au] Autor:Johnson DW
[Ad] Endereço:University of Calgary, Calgary, Canada.
[Ti] Título:Croup.
[So] Source:Am Fam Physician;94(6):476-8, 2016 Sep 15.
[Is] ISSN:1532-0650
[Cp] País de publicação:United States
[La] Idioma:eng
[Mh] Termos MeSH primário: Crupe/diagnóstico
Crupe/terapia
[Mh] Termos MeSH secundário: Administração por Inalação
Administração Oral
Anti-Inflamatórios/administração & dosagem
Dexametasona/administração & dosagem
Hélio
Seres Humanos
Injeções Intramusculares
Oxigênio
[Pt] Tipo de publicação:JOURNAL ARTICLE
[Nm] Nome de substância:
0 (Anti-Inflammatory Agents); 206GF3GB41 (Helium); 58933-55-4 (heliox); 7S5I7G3JQL (Dexamethasone); S88TT14065 (Oxygen)
[Em] Mês de entrada:1703
[Cu] Atualização por classe:170817
[Lr] Data última revisão:
170817
[Sb] Subgrupo de revista:AIM; IM
[Da] Data de entrada para processamento:160917
[St] Status:MEDLINE


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[PMID]:27514690
[Au] Autor:Fathima S; Simmonds K; Invik J; Scott AN; Drews S
[Ad] Endereço:Provincial Laboratory for Public Health (ProvLab), Calgary, AB, Canada.
[Ti] Título:Use of laboratory and administrative data to understand the potential impact of human parainfluenza virus 4 on cases of bronchiolitis, croup, and pneumonia in Alberta, Canada.
[So] Source:BMC Infect Dis;16(1):402, 2016 Aug 11.
[Is] ISSN:1471-2334
[Cp] País de publicação:England
[La] Idioma:eng
[Ab] Resumo:BACKGROUND: Human Parainfluenza Virus (hPIV) causes severe respiratory illness in infants and adults. Our study describes the association of hPIV1-4 with bronchiolitis, croup, and pneumonia using retrospective laboratory, administrative and public health data. Due to issues including the historic lack of hPIV4 in some commercial respiratory virus panels, the description of the impact of hPIV4 on croup, bronchiolitis, and pneumonia at population levels has often been limited. This study will use routine clinical laboratory data, and administrative data to provide a preliminary description of the impact of hPIV4 on these diseases in our population. METHODS: A three year cohort of patients positive for hPIV was linked with data from physician visits and hospital admissions to define cases and hospitalization status. International Classification of Disease (ICD-9) codes were used to determine if cases had croup, bronchiolitis, and pneumonia. We also looked at differences in hospitalization status, age and gender among hPIV1-4. All statistical analysis was done using SPSS (Version 19.0.0, IBM Corp© 2010) and Graphpad Prism V6 (GraphPad Software, Inc., 2012). RESULTS: Only hPIV1 and hPIV4 specimens had positivity rates greater than 5 % of all specimens sent for respiratory virus panel testing. hPIV1 exhibited a biennial pattern while the pattern for hPIV3 was less interpretable due to lower positivity rates. Circulation patterns for hPIV2 and hPIV4 were not assessed due to the low positivity rates of theses specimens. From 2010 to 2013, there were 2300 hPIV cases with hPIV3 (46 %) being the most common, followed by hPIV1 (27 %), hPIV4 (16 %) and hPIV2 (11 %). The median age was 2 years for all hPIV types. Males were slightly greater than females for hPIV1 and hPIV2, with an equal distribution for hPIV3 and slightly more females than males for hPIV4. hPIV1 and hPIV2 had the highest or proportion of croup while hPIV3 and hPIV4 had the highest proportion of pneumonia. Within hPIV4 cases, distributions of diseases were; pneumonia (21 %, 95 % CI 17.1-25.7), bronchiolitis (18 %, 95 % CI 14.3-22.5), croup (2 %, 95 % CI 0.8-3.9), mixed illness of any of pneumonia, bronchiolitis or croup (4 %, 95 % CI 2.5-7.0) or other respiratory diseases (54 %, 95 % CI 49.1-59.6). CONCLUSIONS: We used laboratory and administrative data to undertake a descriptive analysis of the association of hPIV1-4 with croup, bronchiolitis and pneumonia. hPIV4 appears to be more associated more with bronchiolitis and pneumonia and less with croup in our population.
[Mh] Termos MeSH primário: Bronquiolite/virologia
Crupe/virologia
Vírus da Parainfluenza 4 Humana/isolamento & purificação
Pneumonia/virologia
[Mh] Termos MeSH secundário: Adolescente
Adulto
Fatores Etários
Idoso
Alberta
Bronquiolite/diagnóstico
Canadá
Criança
Pré-Escolar
Crupe/diagnóstico
Bases de Dados Factuais
Feminino
Hospitalização
Seres Humanos
Lactente
Recém-Nascido
Masculino
Meia-Idade
Vírus da Parainfluenza 1 Humana/isolamento & purificação
Vírus da Parainfluenza 2 Humana/isolamento & purificação
Vírus da Parainfluenza 3 Humana/isolamento & purificação
Pneumonia/diagnóstico
Estudos Retrospectivos
Fatores Sexuais
Adulto Jovem
[Pt] Tipo de publicação:JOURNAL ARTICLE
[Em] Mês de entrada:1706
[Cu] Atualização por classe:170606
[Lr] Data última revisão:
170606
[Sb] Subgrupo de revista:IM
[Da] Data de entrada para processamento:160813
[St] Status:MEDLINE
[do] DOI:10.1186/s12879-016-1748-z


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[PMID]:27139290
[Au] Autor:Bjornson CL; Williamson J; Johnson DW
[Ad] Endereço:From the *Department of Pediatrics, †Alberta Children's Hospital Research Institute, ‡Department of Pharmacology and Therapeutics, University of Calgary, Calgary, Alberta, Canada.
[Ti] Título:Telephone Out Patient Score: The Derivation and Validation of a Telephone Follow-up Assessment Tool for Use in Clinical Research in Children With Croup.
[So] Source:Pediatr Emerg Care;32(5):290-7, 2016 May.
[Is] ISSN:1535-1815
[Cp] País de publicação:United States
[La] Idioma:eng
[Ab] Resumo:OBJECTIVE: The objective was to derive a simple clinical scoring instrument for assessing children with croup by telephone for use in clinical research studies. METHODS: We reviewed published literature on croup scores, surveyed experienced pediatric emergency nurses and physicians, and conducted a prospective cohort study. Score items were derived from published literature and surveys of experienced clinicians. We enrolled children with croup attending an urban pediatric emergency department. Families of children enrolled were contacted daily by telephone and asked standardized questions about their child's clinical symptoms and family functioning. Data from this survey were used to derive the clinical score. RESULTS: We identified 11 unique croup scores from the literature and interviewed 6 experienced clinicians. We enrolled 330 children and achieved complete follow-up for 301. Of the various groupings of items and duration of assessment, the 2-item score (barky cough and stridor) was the simplest and most reliable. Three days of follow-up yielded optimal correlations. CONCLUSIONS: We derived a 2-item Telephone Out Patient score assessed daily for 3 days after an emergency department visit. Validation of this score in a future, independent prospective cohort is needed.
[Mh] Termos MeSH primário: Crupe/terapia
Avaliação de Resultados (Cuidados de Saúde)/métodos
Pacientes Ambulatoriais
Medicina de Emergência Pediátrica/métodos
Telefone
[Mh] Termos MeSH secundário: Pré-Escolar
Serviço Hospitalar de Emergência
Feminino
Hospitais Urbanos
Seres Humanos
Lactente
Masculino
Estudos Prospectivos
[Pt] Tipo de publicação:JOURNAL ARTICLE; VALIDATION STUDIES
[Em] Mês de entrada:1703
[Cu] Atualização por classe:170327
[Lr] Data última revisão:
170327
[Sb] Subgrupo de revista:IM
[Da] Data de entrada para processamento:160504
[St] Status:MEDLINE
[do] DOI:10.1097/PEC.0000000000000796


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[PMID]:27063760
[Au] Autor:Munson PD
[Ad] Endereço:Division of Pediatric Otolaryngology, Sanford Children's Hospital, University of South Dakota School of Medicine, 1300W 22nd St, Sioux Falls, SD 57105, United States. Electronic address: Patrick.munson@sanfordhealth.org.
[Ti] Título:Recurrent croup and persistent laryngomalacia: Clinical resolution after supraglottoplasty.
[So] Source:Int J Pediatr Otorhinolaryngol;84:94-6, 2016 May.
[Is] ISSN:1872-8464
[Cp] País de publicação:Ireland
[La] Idioma:eng
[Ab] Resumo:OBJECTIVES: To determine if children with recurrent croup (RC) and persistent laryngomalacia (LM) clinically improve after supraglottoplasty (SGP). MATERIAL AND METHODS: Retrospective chart review cohort at tertiary care children's hospital consisting of patients diagnosed with LM and RC that underwent SGP from July 2011 to August 2014. Clinical history, demographics, clinical outcomes, and operative complications were reviewed. Specifically, the episodes of croup requiring systemic steroids were compared pre- and post-SGP with statistical analysis. RESULTS: Out of 107 patients undergoing SGP for LM, 6 patients (5.6%) were diagnosed with RC. Mean age at first croup episode was 11.5 months. Mean age at SGP was 4.3 years. Mean number of emergency department visits was 3.2 (range 2-6 visits) prior to SGP. Mean number of episodes of croup requiring systemic steroids before and after SGP was 9.8 vs. 0.2 (p=0.003). Mean length of followup after SGP was 30.5 months (range 18-46 months). There were no surgical postoperative complications. CONCLUSIONS: This is the first series to describe the clinical resolution of croup episodes in children with LM corrected by SGP. Recurrent croup should be added among other conditions associated with late-onset or persistent laryngomalacia.
[Mh] Termos MeSH primário: Crupe/cirurgia
Glote/cirurgia
Laringomalácia/cirurgia
[Mh] Termos MeSH secundário: Criança
Pré-Escolar
Crupe/complicações
Feminino
Seguimentos
Seres Humanos
Lactente
Laringomalácia/complicações
Masculino
Recidiva
Estudos Retrospectivos
Resultado do Tratamento
[Pt] Tipo de publicação:JOURNAL ARTICLE
[Em] Mês de entrada:1612
[Cu] Atualização por classe:161230
[Lr] Data última revisão:
161230
[Sb] Subgrupo de revista:IM
[Da] Data de entrada para processamento:160412
[St] Status:MEDLINE


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[PMID]:27029657
[Au] Autor:Gelbart B; Parsons S; Sarpal A; Ninova P; Butt W
[Ad] Endereço:Paediatric Intensive Care, Royal Children's Hospital, Melbourne, Victoria, Murdoch Children's Research Institute Melbourne Victoria.
[Ti] Título:Intensive care management of children intubated for croup: a retrospective analysis.
[So] Source:Anaesth Intensive Care;44(2):245-50, 2016 Mar.
[Is] ISSN:0310-057X
[Cp] País de publicação:Australia
[La] Idioma:eng
[Ab] Resumo:Croup remains the commonest reason for acute upper airway obstruction in children, yet there are scarce contemporary data of airway management in those requiring intubation. We performed a retrospective analysis of the intensive care management of children intubated for croup in two quaternary Paediatric Intensive Care Units: Royal Children's Hospital Melbourne, Australia and Alberta Children's Hospital Calgary, Canada. Patients intubated for less than three days were compared with those intubated for greater than three days. Patients less than 10 kg body weight were compared to those greater than 10 kg. Demographic, clinical and microbiological data were recorded. Seventy-seven cases of croup requiring intubation were identified. The median duration of intubation was 60 hours. Parainfluenza was the most common viral aetiology, detected in 30% of cases. Antibiotics were prescribed in 51% of patients. Corticosteroids were prescribed pre intubation in two-thirds of patients and all post intubation, with the median dose being prednisolone 3 mg/kg/day. Primary extubation failure occurred in 6.5% of patients. Neither the duration of intubation nor patient size were associated with extubation failure. An air leak test was performed in 69% of patients and poorly predicted extubation success. One non-urgent tracheostomy was performed and there was one death from hypoxic ischaemic encephalopathy. Endotracheal tube leak is poorly recorded and may not predict successful extubation.
[Mh] Termos MeSH primário: Cuidados Críticos
Crupe/terapia
Intubação Intratraqueal
[Mh] Termos MeSH secundário: Pré-Escolar
Seres Humanos
Lactente
Prednisolona/uso terapêutico
Estudos Retrospectivos
[Pt] Tipo de publicação:JOURNAL ARTICLE
[Nm] Nome de substância:
9PHQ9Y1OLM (Prednisolone)
[Em] Mês de entrada:1606
[Cu] Atualização por classe:160331
[Lr] Data última revisão:
160331
[Sb] Subgrupo de revista:IM
[Da] Data de entrada para processamento:160401
[St] Status:MEDLINE


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[PMID]:26910479
[Au] Autor:Leung K; Newth CJ; Hotz JC; O'Brien KC; Fink JB; Coates AL
[Ad] Endereço:1Physiology and Experimental Medicine Program of the Research Institute of The Hospital for Sick Children, University of Toronto, Toronto, Ontario, Canada. 2Departments of Anesthesiology and Critical Care Medicine and Respiratory Therapy, Children's Hospital Los Angeles, Keck School of Medicine, University of Southern California, Los Angeles, CA. 3Department of Respiratory Therapy, Rush University, Chicago, IL.
[Ti] Título:Delivery of Epinephrine in the Vapor Phase for the Treatment of Croup.
[So] Source:Pediatr Crit Care Med;17(4):e177-81, 2016 Apr.
[Is] ISSN:1529-7535
[Cp] País de publicação:United States
[La] Idioma:eng
[Ab] Resumo:OBJECTIVES: The Vapotherm system delivers high humidity to the airway of patients by using semipermeable tubules where heated liquid water is in contact with air. The humidified air is conducted to the patient via a heated tube. Preliminary clinical observations in infants with croup suggested that epinephrine added to the water supplying the humidity was delivered successfully in the vapor phase. The purpose of this study was to evaluate the efficiency of the delivery of epinephrine in the vapor phase and to develop the feasibility criteria for a clinical pilot study. DESIGN: Thirty milligrams of epinephrine in a 1-L bag of sterile water was used as the humidification source for a Vapotherm 2000i. The output of the heated circuit was condensed and collected into a small Erlenmeyer flask via a metal coil while the whole collection system was submerged in an ice slurry to maintain the outflow temperature from the flask between 0°C and 2°C. The in vitro system was tested at 40°C with flows of 5, 10, and 15 L/min and L-epinephrine concentrations of 15, 30, and 60 mg/L. Each test was duplicated at each of the six conditions. SETTING: Academic children's hospital research laboratory. PATIENTS: None. INTERVENTIONS: None. MEASUREMENTS AND MAIN RESULTS: The system recovered more than 90% of the water vapor from the fully saturated air at 40°C. The epinephrine concentration recovery quantified by ultraviolet-visible spectrophotometry was 23.9% (27.5-20.4%) (mean and range) of the initial concentration. At flows of 5, 10, and 15 L/min, the delivery of epinephrine would be 1.8, 3.6, and 4.2 µg/min, respectively, which is in the therapeutic range used for parenteral infusion in young children. CONCLUSIONS: The Vapotherm system can be used to deliver epinephrine in pharmacological doses to the respiratory system as a vapor and thus as an alternative to droplets by conventional nebulization.
[Mh] Termos MeSH primário: Agonistas alfa-Adrenérgicos/administração & dosagem
Agonistas Adrenérgicos beta/administração & dosagem
Crupe/tratamento farmacológico
Epinefrina/administração & dosagem
Nebulizadores e Vaporizadores
[Mh] Termos MeSH secundário: Administração Intranasal
Desenho de Equipamento
Estudos de Viabilidade
Seres Humanos
Umidade
Volatilização
[Pt] Tipo de publicação:EVALUATION STUDIES; JOURNAL ARTICLE; RESEARCH SUPPORT, NON-U.S. GOV'T
[Nm] Nome de substância:
0 (Adrenergic alpha-Agonists); 0 (Adrenergic beta-Agonists); YKH834O4BH (Epinephrine)
[Em] Mês de entrada:1701
[Cu] Atualização por classe:170113
[Lr] Data última revisão:
170113
[Sb] Subgrupo de revista:IM
[Da] Data de entrada para processamento:160225
[St] Status:MEDLINE
[do] DOI:10.1097/PCC.0000000000000666



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