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  1 / 1925 MEDLINE  
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[PMID]:28448390
[Au] Autor:Patino M; Kalin M; Griffin A; Minhajuddin A; Ding L; Williams T; Ishman S; Mahmoud M; Kurth CD; Szmuk P
[Ad] Endereço:From the *Department of Anesthesiology, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio; Departments of †Anesthesiology and ‡Clinical Sciences, UT Southwestern and Children's Medical Center, Dallas, Texas; §Division of Biostatistics and Epidemiology, Cincinnati, Ohio; ‖University of Texas Southwestern and Children's Medical Center, Dallas, Texas; ¶Division of Pediatric Otolaryngology, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio; #Department of Anesthesia and Pediatrics, University of Cincinnati College of Medicine, Cincinnati, Ohio; **Department of Anesthesiology, University of Texas Southwestern and Children's Medical Center, Dallas, Texas; and ††Dallas and Outcome Research Consortium, Cleveland, Ohio.
[Ti] Título:Comparison of Postoperative Respiratory Monitoring by Acoustic and Transthoracic Impedance Technologies in Pediatric Patients at Risk of Respiratory Depression.
[So] Source:Anesth Analg;124(6):1937-1942, 2017 06.
[Is] ISSN:1526-7598
[Cp] País de publicação:United States
[La] Idioma:eng
[Ab] Resumo:BACKGROUND: In children, postoperative respiratory rate (RR) monitoring by transthoracic impedance (TI), capnography, and manual counting has limitations. The rainbow acoustic monitor (RAM) measures continuous RR noninvasively by a different methodology. Our primary aim was to compare the degree of agreement and accuracy of RR measurements as determined by RAM and TI to that of manual counting. Secondary aims include tolerance and analysis of alarm events. METHODS: Sixty-two children (2-16 years old) were admitted after tonsillectomy or receiving postoperative patient/parental-controlled analgesia. RR was measured at regular intervals by RAM, TI, and manual count. Each TI or RAM alarm resulted in a clinical evaluation to categorize as a true or false alarm. To assess accuracy and degree of agreement of RR measured by RAM or TI compared with manual counting, a Bland-Altman analysis was utilized showing the average difference and the limits of agreement. Sensitivity and specificity of RR alarms by TI and RAM are presented. RESULTS: Fifty-eight posttonsillectomy children and 4 patient/parental-controlled analgesia users aged 6.5 ± 3.4 years and weighting 35.3 ± 22.7 kg (body mass index percentile 76.6 ± 30.8) were included. The average monitoring time per patient was 15.9 ± 4.8 hours. RAM was tolerated 87% of the total monitoring time. The manual RR count was significantly different from TI (P = .007) with an average difference ± SD of 1.39 ± 10.6 but were not significantly different from RAM (P = .81) with an average difference ± SD of 0.17 ± 6.8. The proportion of time when RR measurements differed by ≥4 breaths was 22% by TI and was 11% by RAM. Overall, 276 alarms were detected (mean alarms/patient = 4.5). The mean number of alarms per patient were 1.58 ± 2.49 and 2.87 ± 4.32 for RAM and TI, respectively. The mean number of false alarms was 0.18 ± 0.71 for RAM and 1.00 ± 2.78 for TI. The RAM was found to have 46.6% sensitivity (95% confidence interval [CI], 0.29-0.64), 95.9% specificity (95% CI, 0.90-1.00), 88.9% positive predictive value (95% CI, 0.73-1.00), and 72.1% negative predictive value (95% CI, 0.61-0.84), whereas the TI monitor had 68.5% sensitivity (95% CI, 0.53-0.84), 72.0% specificity (95% CI, 0.60-0.84), 59.0% positive (95% CI, 0.44-0.74), and 79.5% negative predictive value (95% CI, 0.69-0.90). CONCLUSIONS: In children at risk of postoperative respiratory depression, RR assessment by RAM was not different to manual counting. RAM was well tolerated, had a lower incidence of false alarms, and had better specificity and positive predictive value than TI. Rigorous evaluation of the negative predictive value is essential to determine the role of postoperative respiratory monitoring with RAM.
[Mh] Termos MeSH primário: Acústica
Pulmão/fisiopatologia
Monitorização Fisiológica/métodos
Insuficiência Respiratória/diagnóstico
Taxa Respiratória
Tonsilectomia/efeitos adversos
[Mh] Termos MeSH secundário: Acústica/instrumentação
Adolescente
Criança
Pré-Escolar
Alarmes Clínicos
Impedância Elétrica
Reações Falso-Negativas
Reações Falso-Positivas
Feminino
Seres Humanos
Masculino
Monitorização Fisiológica/instrumentação
Ohio
Projetos Piloto
Pletismografia de Impedância
Valor Preditivo dos Testes
Estudos Prospectivos
Reprodutibilidade dos Testes
Insuficiência Respiratória/etiologia
Insuficiência Respiratória/fisiopatologia
Texas
Fatores de Tempo
Transdutores
Resultado do Tratamento
[Pt] Tipo de publicação:COMPARATIVE STUDY; JOURNAL ARTICLE; MULTICENTER STUDY; OBSERVATIONAL STUDY; RESEARCH SUPPORT, NON-U.S. GOV'T
[Em] Mês de entrada:1708
[Cu] Atualização por classe:180105
[Lr] Data última revisão:
180105
[Sb] Subgrupo de revista:AIM; IM
[Da] Data de entrada para processamento:170428
[St] Status:MEDLINE
[do] DOI:10.1213/ANE.0000000000002062


  2 / 1925 MEDLINE  
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[PMID]:29245221
[Au] Autor:Duckheim M; Klee K; Götz N; Helle P; Groga-Bada P; Mizera L; Gawaz M; Zuern CS; Eick C
[Ad] Endereço:aDepartment of Cardiology, Innere Medizin III, Eberhard-Karls-Universität Tübingen, TübingenbDepartment of Internal Medicine, Filderklinik Stuttgart, Stuttgart, Germany.
[Ti] Título:Deceleration capacity as a risk predictor in patients presenting to the emergency department with syncope: A prospective exploratory pilot study.
[So] Source:Medicine (Baltimore);96(49):e8605, 2017 Dec.
[Is] ISSN:1536-5964
[Cp] País de publicação:United States
[La] Idioma:eng
[Ab] Resumo:Syncope is a common cause for admission to the emergency department (ED). Due to limited clinical resources there is great interest in developing risk stratification tools that allow identifying patients with syncope who are at low risk and can be safely discharged. Deceleration capacity (DC) is a strong risk predictor in postinfarction and heart failure patients. The aim of this study was to evaluate whether DC provides prognostic information in patients presenting to ED with syncope.We prospectively enrolled 395 patients presenting to the ED due to syncope. Patient's electrocardiogram (ECG) for the calculation of DC was recorded by monitoring devices which were started after admission. Both the modified early warning score (MEWS) and the San Francisco syncope score (SFSS) were determined in every patient. Primary endpoint was mortality after 180 days.Eight patients (2%) died after 180 days. DC was significantly lower in the group of nonsurvivors as compared with survivors (3.1 ±â€Š2.5 ms vs 6.7 ±â€Š2.4 ms; P < .001), whereas the MEWS was comparable in both was comparable in both groups. (2.1 ±â€Š0.8 vs 2.1 ±â€Š1.0; P = .84). The SFSS failed at identifying 4 of 8 nonsurvivors (50%) as high risk patients. No patient with a favorable DC (≥7 ms) died (0.0% vs 3.7%; P = .01, OR 0.55 (95% CI 0.40-0.76), P < .001). In the receiver operating characteristic (ROC) analysis DC yielded an area under the curve of 0.85 (95% CI 0.71-0.98).Our study demonstrates that DC is a predictor of 180-days-mortality in patients admitted to the ED due to syncope. Syncope patients at low risk can be identified by DC and may be discharged safely.
[Mh] Termos MeSH primário: Eletrocardiografia/métodos
Frequência Cardíaca/fisiologia
Medição de Risco/métodos
Síncope/fisiopatologia
[Mh] Termos MeSH secundário: Adulto
Idoso
Área Sob a Curva
Sistema Nervoso Autônomo/fisiologia
Causas de Morte
Serviço Hospitalar de Emergência
Feminino
Hospitalização
Seres Humanos
Masculino
Meia-Idade
Alta do Paciente
Projetos Piloto
Valor Preditivo dos Testes
Prognóstico
Estudos Prospectivos
Curva ROC
Taxa Respiratória/fisiologia
Síncope/mortalidade
[Pt] Tipo de publicação:EVALUATION STUDIES; JOURNAL ARTICLE
[Em] Mês de entrada:1712
[Cu] Atualização por classe:171222
[Lr] Data última revisão:
171222
[Sb] Subgrupo de revista:AIM; IM
[Da] Data de entrada para processamento:171217
[St] Status:MEDLINE
[do] DOI:10.1097/MD.0000000000008605


  3 / 1925 MEDLINE  
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[PMID]:29173298
[Au] Autor:Chowdhury D; Williams KB; Chidekel A; Pizarro C; Preedy C; Young M; Hendrickson C; Robinson DL; Kreiger PA; Puffenberger EG; Strauss KA
[Ad] Endereço:Cardiology Care for Children, Lancaster, PA.
[Ti] Título:Management of Congenital Heart Disease Associated with Ellis-van Creveld Short-rib Thoracic Dysplasia.
[So] Source:J Pediatr;191:145-151, 2017 Dec.
[Is] ISSN:1097-6833
[Cp] País de publicação:United States
[La] Idioma:eng
[Ab] Resumo:OBJECTIVE: To evaluate clinical outcome of patients with Ellis-van Creveld syndrome (EVC) in whom congenital heart disease (CHD) repair was delayed intentionally to reduce the risk of postoperative respiratory morbidity and mortality. STUDY DESIGN: This retrospective review of 51 EVC c.1886+5G>T homozygotes born between 2005 and 2014 focused on 18 subjects who underwent surgery for CHD, subdivided into early (mean, 1.3 months) vs delayed (mean, 50.1 months) repair. RESULTS: Growth trajectories differed between control subjects and patients with EVC, and CHD was associated with slower weight gain. Relative to controls, infants with EVC had a 40%-75% higher respiratory rates (independent of CHD) accompanied by signs of compensated respiratory acidosis. Blood gases and respiratory rates approached normal values by age 4 years. Hemodynamically significant CHD was present in 23 children, 18 (78%) of whom underwent surgical repair. Surgery was performed at 1.3 ± 1.3 months for children born between 2005 and 2009 (n = 9) and 50.1 ± 40.2 months (P = .009) for children born between 2010 and 2014 (n = 9). The latter had shorter postoperative mechanical ventilation (1.1 ± 2.4 days vs 49.6 ± 57.1 days; P = .075), shorter intensive care duration of stay (16 ± 24 days vs 48.6 ± 44.2 days; P = .155), and no postoperative tracheostomies (vs 60%; P = .028) or deaths (vs 44%; P = .082). CONCLUSION: Among children with EVC and possibly other short-rib thoracic dysplasias, delayed surgical repair of CHD reduces postoperative morbidity and improves survival. Respiratory rate serves as a simple indicator for optimal timing of surgical repair.
[Mh] Termos MeSH primário: Síndrome de Ellis-Van Creveld
Cardiopatias Congênitas/cirurgia
[Mh] Termos MeSH secundário: Pré-Escolar
Síndrome de Ellis-Van Creveld/mortalidade
Síndrome de Ellis-Van Creveld/fisiopatologia
Feminino
Seguimentos
Cardiopatias Congênitas/mortalidade
Cardiopatias Congênitas/fisiopatologia
Seres Humanos
Lactente
Recém-Nascido
Masculino
Complicações Pós-Operatórias/epidemiologia
Complicações Pós-Operatórias/prevenção & controle
Taxa Respiratória
Estudos Retrospectivos
Toracotomia
Fatores de Tempo
Resultado do Tratamento
Ganho de Peso
[Pt] Tipo de publicação:JOURNAL ARTICLE
[Em] Mês de entrada:1712
[Cu] Atualização por classe:171211
[Lr] Data última revisão:
171211
[Sb] Subgrupo de revista:AIM; IM
[Da] Data de entrada para processamento:171128
[St] Status:MEDLINE


  4 / 1925 MEDLINE  
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[PMID]:29029556
[Au] Autor:Bloemen MAT; de Groot JF; Backx FJG; Benner J; Kruitwagen CLJJ; Takken T
[Ad] Endereço:Research Group Lifestyle and Health, HU University of Applied Sciences Utrecht, Bolognalaan 101, PO Box 85182 3508 AD, Utrecht, the Netherlands.
[Ti] Título:Wheelchair Shuttle Test for Assessing Aerobic Fitness in Youth With Spina Bifida: Validity and Reliability.
[So] Source:Phys Ther;97(10):1020-1029, 2017 10 01.
[Is] ISSN:1538-6724
[Cp] País de publicação:United States
[La] Idioma:eng
[Ab] Resumo:Background: Testing aerobic fitness in youth is important because of expected relationships with health. Objective: The purpose of the study was to estimate the validity and reliability of the Shuttle Ride Test in youth who have spina bifida and use a wheelchair for mobility and sport. Design: Ths study is a validity and reliability study. Methods: The Shuttle Ride Test, Graded Wheelchair Propulsion Test, and skill-related fitness tests were administered to 33 participants for the validity study (age = 14.5 ± 3.1 y) and to 28 participants for the reliability study (age = 14.7 ± 3.3 y). Results: No significant differences were found between the Graded Wheelchair Propulsion Test and the Shuttle Ride Test for most cardiorespiratory responses. Correlations between the Graded Wheelchair Propulsion Test and the Shuttle Ride Test were moderate to high (r = .55-.97). The variance in peak oxygen uptake (VO2peak) could be predicted for 77% of the participants by height, number of shuttles completed, and weight, with large prediction intervals. High correlations were found between number of shuttles completed and skill-related fitness tests (CI = .73 to -.92). Intraclass correlation coefficients were high (.77-.98), with a smallest detectable change of 1.5 for number of shuttles completed and with coefficients of variation of 6.2% and 6.4% for absolute VO2peak and relative VO2peak, respectively. Conclusions: When measuring VO2peak directly by using a mobile gas analysis system, the Shuttle Ride Test is highly valid for testing VO2peak in youth who have spina bifida and use a wheelchair for mobility and sport. The outcome measure of number of shuttles represents aerobic fitness and is also highly correlated with both anaerobic performance and agility. It is not possible to predict VO2peak accurately by using the number of shuttles completed. Moreover, the Shuttle Ride Test is highly reliable in youth with spina bifida, with a good smallest detectable change for the number of shuttles completed.
[Mh] Termos MeSH primário: Teste de Esforço/métodos
Consumo de Oxigênio/fisiologia
Aptidão Física/fisiologia
Disrafismo Espinal/fisiopatologia
Cadeiras de Rodas
[Mh] Termos MeSH secundário: Adolescente
Limiar Anaeróbio/fisiologia
Criança
Teste de Esforço/estatística & dados numéricos
Feminino
Seres Humanos
Masculino
Países Baixos
Reprodutibilidade dos Testes
Respiração
Taxa Respiratória/fisiologia
Esportes
Transportes
[Pt] Tipo de publicação:JOURNAL ARTICLE
[Em] Mês de entrada:1710
[Cu] Atualização por classe:171017
[Lr] Data última revisão:
171017
[Sb] Subgrupo de revista:AIM; IM
[Da] Data de entrada para processamento:171015
[St] Status:MEDLINE
[do] DOI:10.1093/ptj/pzx075


  5 / 1925 MEDLINE  
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[PMID]:28972124
[Au] Autor:Wu R; Liu Y; Wang L; Li B; Xu F
[Ad] Endereço:State Key Laboratory of Magnetic Resonance and Atomic and Molecular Physics, Key Laboratory of Magnetic Resonance in Biological System, Wuhan Institute of Physics and Mathematics, Center of Excellence for Brain Science and Intelligent Technology, the Chinese Academy of Sciences, Wuhan 430071, China,
[Ti] Título:Activity Patterns Elicited by Airflow in the Olfactory Bulb and Their Possible Functions.
[So] Source:J Neurosci;37(44):10700-10711, 2017 Nov 01.
[Is] ISSN:1529-2401
[Cp] País de publicação:United States
[La] Idioma:eng
[Ab] Resumo:Olfactory sensory neurons (OSNs) can sense both odorants and airflows. In the olfactory bulb (OB), the coding of odor information has been well studied, but the coding of mechanical stimulation is rarely investigated. Unlike odor-sensing functions of OSNs, the airflow-sensing functions of OSNs are also largely unknown. Here, the activity patterns elicited by mechanical airflow in male rat OBs were mapped using fMRI and correlated with local field potential recordings. In an attempt to reveal possible functions of airflow sensing, the relationship between airflow patterns and physiological parameters was also examined. We found the following: (1) the activity pattern in the OB evoked by airflow in the nasal cavity was more broadly distributed than patterns evoked by odors; (2) the pattern intensity increases with total airflow, while the pattern topography with total airflow remains almost unchanged; and (3) the heart rate, spontaneous respiratory rate, and electroencephalograph power in the ß band decreased with regular mechanical airflow in the nasal cavity. The mapping results provide evidence that the signals elicited by mechanical airflow in OSNs are transmitted to the OB, and that the OB has the potential to code and process mechanical information. Our functional data indicate that airflow rhythm in the olfactory system can regulate the physiological and brain states, providing an explanation for the effects of breath control in meditation, yoga, and Taoism practices. Presentation of odor information in the olfactory bulb has been well studied, but studies about breathing features are rare. Here, using blood oxygen level-dependent functional MRI for the first time in such an investigation, we explored the global activity patterns in the rat olfactory bulb elicited by airflow in the nasal cavity. We found that the activity pattern elicited by airflow is broadly distributed, with increasing pattern intensity and similar topography under increasing total airflow. Further, heart rate, spontaneous respiratory rate in the lung, and electroencephalograph power in the ß band decreased with regular airflow in the nasal cavity. Our study provides further understanding of the airflow map in the olfactory bulb o, and evidence for the possible mechanosensitivity functions of olfactory sensory neurons.
[Mh] Termos MeSH primário: Bulbo Olfatório/fisiologia
Neurônios Receptores Olfatórios/fisiologia
Ventilação Pulmonar/fisiologia
Taxa Respiratória/fisiologia
[Mh] Termos MeSH secundário: Animais
Eletroencefalografia/métodos
Masculino
Cavidade Nasal/fisiologia
Odorantes
Ratos
Ratos Sprague-Dawley
Volume de Ventilação Pulmonar/fisiologia
[Pt] Tipo de publicação:JOURNAL ARTICLE
[Em] Mês de entrada:1711
[Cu] Atualização por classe:171113
[Lr] Data última revisão:
171113
[Sb] Subgrupo de revista:IM
[Da] Data de entrada para processamento:171004
[St] Status:MEDLINE
[do] DOI:10.1523/JNEUROSCI.2210-17.2017


  6 / 1925 MEDLINE  
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[PMID]:28720186
[Au] Autor:Steinman Y; van den Oord MHAH; Frings-Dresen MHW; Sluiter JK
[Ti] Título:Flight Performance During Exposure to Acute Hypobaric Hypoxia.
[So] Source:Aerosp Med Hum Perform;88(8):760-767, 2017 Aug 01.
[Is] ISSN:2375-6314
[Cp] País de publicação:United States
[La] Idioma:eng
[Ab] Resumo:INTRODUCTION: The purpose of the present study was to examine the influence of hypobaric hypoxia (HH) on a pilot's flight performance during exposure to simulated altitudes of 91, 3048, and 4572 m (300, 10,000, and 15,000 ft) and to monitor the pilot's physiological reactions. METHOD: In a single-blinded counter-balanced design, 12 male pilots were exposed to HH while flying in a flight simulator that had been placed in a hypobaric chamber. Flight performance of the pilots, pilot's alertness level, Spo2, heart rate (HR), minute ventilation (VE), and breathing frequency (BF) were measured. RESULTS: A significant difference was found in Flight Profile Accuracy (FPA) between the three altitudes. Post hoc analysis showed no significant difference in performance between 91 m and 3048 m. A trend was observed at 4572 m, suggesting a decrease in flight performance at that altitude. Significantly lower alertness levels were observed at the start of the flight at 4572 m compared to 91 m, and at the end of the flight at 4572 m compared to the start at that altitude. Spo2 and BF decreased, and HR increased significantly with altitude. DISCUSSION: The present study did not provide decisive evidence for a decrease in flight performance during exposure to simulated altitudes of 3048 and 4572 m. However, large interindividual variation in pilots' flight performance combined with a gradual decrease in alertness levels observed in the present study puts into question the ability of pilots to safely fly an aircraft while exposed to these altitudes without supplemental oxygen.Steinman Y, van den Oord MHAH, Frings-Dresen MHW, Sluiter JK. Flight performance during exposure to acute hypobaric hypoxia. Aerosp Med Hum Perform. 2017; 88(8):760-767.
[Mh] Termos MeSH primário: Altitude
Pressão Atmosférica
Frequência Cardíaca
Hipóxia/fisiopatologia
Pilotos
Ventilação Pulmonar
Taxa Respiratória
Análise e Desempenho de Tarefas
Vigília
[Mh] Termos MeSH secundário: Adulto
Medicina Aeroespacial
Aeronaves
Seres Humanos
Hipóxia/psicologia
Masculino
Treinamento por Simulação
Adulto Jovem
[Pt] Tipo de publicação:JOURNAL ARTICLE
[Em] Mês de entrada:1709
[Cu] Atualização por classe:170926
[Lr] Data última revisão:
170926
[Sb] Subgrupo de revista:IM; S
[Da] Data de entrada para processamento:170720
[St] Status:MEDLINE
[do] DOI:10.3357/AMHP.4789.2017


  7 / 1925 MEDLINE  
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[PMID]:28687637
[Au] Autor:Kipps AK; Poole SF; Slaney C; Feehan S; Longhurst CA; Sharek PJ; Goel VV
[Ad] Endereço:Department of Pediatrics, Stanford Children's Health, Palo Alto, California; akipps@stanford.edu.
[Ti] Título:Inpatient-Derived Vital Sign Parameters Implementation: An Initiative to Decrease Alarm Burden.
[So] Source:Pediatrics;140(2), 2017 Aug.
[Is] ISSN:1098-4275
[Cp] País de publicação:United States
[La] Idioma:eng
[Ab] Resumo:OBJECTIVES: To implement data-driven vital sign parameters to reduce bedside monitor alarm burden. METHODS: Single-center, quality-improvement initiative with historical controls assessing the impact of age-based, inpatient-derived heart rate (HR) and respiratory rate (RR) parameters on a 20-bed acute care ward that serves primarily pediatric cardiology patients. The primary outcome was the number of alarms per monitored bed day (MBD) with the aim to decrease the alarms per MBD. Balancing measures included the frequency of missed rapid response team activations, acute respiratory code events, and cardiorespiratory arrest events in the unit with the new vital sign parameters. RESULTS: The median number of all cardiorespiratory monitor alarms per MBD decreased by 21% from 52 (baseline period) to 41 (postintervention period) ( < .001). This included a 17% decrease in the median HR alarms (9-7.5 per MBD) and a 53% drop in RR alarms (16.8-8.0 per MBD). There were 57 rapid response team activations, 8 acute respiratory code events, and no cardiorespiratory arrest events after the implementation of the new parameters. An evaluation of HRs and RRs recorded at the time of the event revealed that all patients with HRs and/or RRs out of range per former default parameters would also be out of range with the new parameters. CONCLUSIONS: Implementation of data-driven HR and iteratively derived RR parameters safely decreased the total alarm frequency by 21% in a pediatric acute care unit.
[Mh] Termos MeSH primário: Alarmes Clínicos
Parada Cardíaca/enfermagem
Cardiopatias/enfermagem
Admissão do Paciente
Melhoria de Qualidade/organização & administração
Processamento de Sinais Assistido por Computador
Sinais Vitais
[Mh] Termos MeSH secundário: Adolescente
Esgotamento Profissional/enfermagem
Esgotamento Profissional/prevenção & controle
Serviço Hospitalar de Cardiologia/organização & administração
Criança
Pré-Escolar
Feminino
Implementação de Plano de Saúde
Frequência Cardíaca
Seres Humanos
Lactente
Masculino
Segurança do Paciente
Taxa Respiratória
[Pt] Tipo de publicação:JOURNAL ARTICLE
[Em] Mês de entrada:1708
[Cu] Atualização por classe:170828
[Lr] Data última revisão:
170828
[Sb] Subgrupo de revista:AIM; IM
[Da] Data de entrada para processamento:170709
[St] Status:MEDLINE


  8 / 1925 MEDLINE  
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[PMID]:28681708
[Au] Autor:Rizzi M; Radovanovic D; Santus P; Airoldi A; Frassanito F; Vanni S; Cristiano A; Masala IF; Sarzi-Puttini P
[Ad] Endereço:Respiratory Unit, Centre for Sleep and Respiratory Disorders, University Hospital Luigi Sacco, Milan, Italy. rizzi.maurizio@asst-fbf-sacco.it.
[Ti] Título:Influence of autonomic nervous system dysfunction in the genesis of sleep disorders in fibromyalgia patients.
[So] Source:Clin Exp Rheumatol;35 Suppl 105(3):74-80, 2017 May-Jun.
[Is] ISSN:0392-856X
[Cp] País de publicação:Italy
[La] Idioma:eng
[Ab] Resumo:OBJECTIVES: Fibromyalgia (FM) is characterised by chronic musculoskeletal pain, autonomic nervous system (ANS) dysfunction, and disturbed sleep. The aim of this study was to evaluate the influence of ANS dysfunction on the genesis of sleep disorders. METHODS: Fifty female FM patients and 45 healthy subjects matched for age, gender and body mass index underwent a clinical, polysomnographic and autonomic profile evaluation at rest and during a tilt test in order to determine muscle sympathetic nerve activity (MSNA), plasma catecholamine levels, and the spectral indices of cardiac sympathetic (LFRR) and vagal (HFRR) modulation computed by means of the spectrum analysis of RR during sleep. RESULTS: The FM patients had a higher heart rate (HR), more MSNA and a higher LF/HF ratio, and lower HFRR values at rest (p<0.05), and showed no increase in MSNA, a smaller decrease in HFRR, and an excessive rate of syncope (46%) during the tilt test. Their sleep was less efficient (p<0.01), and they had a higher proportion of stage 1 non-REM sleep (p<0.001), experienced many arousals and periodic limb movements (PLMs) per hour of sleep (p<0.001) and a high proportion of periodic breathing (PB%) (p<0.0001). Their cyclic alternating pattern (CAP) rate was significantly increased (p<0.001). During sleep, they had a higher HR and LF/HF ratio, and a lower HFRR (p<0.001). The number of tender points, CAP rate, PB% and PLMI correlated positively with HR and the LF/HF ratio, and negatively with HFRR during sleep. CONCLUSIONS: Our findings seem to show that sleep causes the same effects as a stressful test in FM patients. A vicious circle is created during sleep: pain increases sympathetic cardiovascular activation and reduces sleep efficiency, thus causing lighter sleep, a higher CAP rate, more arousals, a higher PLMI, and increasing the occurrence of PB, which gives rise to abnormal cardiovascular neural control and exaggerated pain sensitivity.
[Mh] Termos MeSH primário: Fibromialgia/fisiopatologia
Transtornos do Sono-Vigília/fisiopatologia
Sistema Nervoso Simpático/fisiopatologia
Nervo Vago/fisiopatologia
[Mh] Termos MeSH secundário: Adulto
Sistema Nervoso Autônomo/fisiopatologia
Pressão Sanguínea
Estudos de Casos e Controles
Catecolaminas/sangue
Eletrocardiografia
Feminino
Fibromialgia/sangue
Fibromialgia/complicações
Seres Humanos
Meia-Idade
Condução Nervosa
Nervo Fibular/fisiopatologia
Polissonografia
Taxa Respiratória
Transtornos do Sono-Vigília/sangue
Transtornos do Sono-Vigília/complicações
Análise Espectral
[Pt] Tipo de publicação:JOURNAL ARTICLE
[Nm] Nome de substância:
0 (Catecholamines)
[Em] Mês de entrada:1708
[Cu] Atualização por classe:170831
[Lr] Data última revisão:
170831
[Sb] Subgrupo de revista:IM
[Da] Data de entrada para processamento:170707
[St] Status:MEDLINE


  9 / 1925 MEDLINE  
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[PMID]:28662195
[Au] Autor:Mehta JH; Williams GW; Harvey BC; Grewal NK; George EE
[Ad] Endereço:Department of Anesthesiology, The University of Texas Health Science Center at Houston, Houston, Texas, United States of America.
[Ti] Título:The relationship between minute ventilation and end tidal CO2 in intubated and spontaneously breathing patients undergoing procedural sedation.
[So] Source:PLoS One;12(6):e0180187, 2017.
[Is] ISSN:1932-6203
[Cp] País de publicação:United States
[La] Idioma:eng
[Ab] Resumo:BACKGROUND: Monitoring respiratory status using end tidal CO2 (EtCO2), which reliably reflects arterial PaCO2 in intubated patients under general anesthesia, has often proven both inaccurate and inadequate when monitoring non-intubated and spontaneously breathing patients. This is particularly important in patients undergoing procedural sedation (e.g., endoscopy, colonoscopy). This can be undertaken in the operating theater, but is also often delivered outside the operating room by non-anesthesia providers. In this study we evaluated the ability for conventional EtCO2 monitoring to reflect changes in ventilation in non-intubated surgical patients undergoing monitored anesthesia care and compared and contrasted these findings to both intubated patients under general anesthesia and spontaneously breathing volunteers. METHODS: Minute Ventilation (MV), tidal volume (TV), and respiratory rate (RR) were continuously collected from an impedance-based Respiratory Volume Monitor (RVM) simultaneously with capnography data in 160 patients from three patient groups: non-intubated surgical patients managed using spinal anesthesia and Procedural Sedation (n = 58); intubated surgical patients under General Anesthesia (n = 54); and spontaneously breathing Awake Volunteers (n = 48). EtCO2 instrument sensitivity was calculated for each patient as the slope of a Deming regression between corresponding measurements of EtCO2 and MV and expressed as angle from the x-axis (θ). All data are presented as mean ± SD unless otherwise indicated. RESULTS: While, as expected, EtCO2 and MV measurements were negatively correlated in most patients, we found gross systematic differences across the three cohorts. In the General Anesthesia patients, small changes in MV resulted in large changes in EtCO2 (high sensitivity, θ = -83.6 ± 9.9°). In contrast, in the Awake Volunteers patients, large changes in MV resulted in insignificant changes in EtCO2 (low sensitivity, θ = -24.7 ± 19.7°, p < 0.0001 vs General Anesthesia). In the Procedural Sedation patients, EtCO2 sensitivity showed a bimodal distribution, with an approximately even split between patients showing high EtCO2 instrument sensitivity, similar to those under General Anesthesia, and patients with low EtCO2 instrument sensitivity, similar to the Awake Volunteers. CONCLUSIONS: When monitoring non-intubated patients undergoing procedural sedation, EtCO2 often provides inadequate instrument sensitivity when detecting changes in ventilation. This suggests that augmenting standard patient care with EtCO2 monitoring is a less than optimal solution for detecting changes in respiratory status in non-intubated patients. Instead, adding direct monitoring of MV with an RVM may be preferable for continuous assessment of adequacy of ventilation in non-intubated patients.
[Mh] Termos MeSH primário: Dióxido de Carbono/análise
Hipnóticos e Sedativos/administração & dosagem
Intubação Intratraqueal
Volume de Ventilação Pulmonar
[Mh] Termos MeSH secundário: Idoso
Anestesia Geral
Capnografia
Estudos de Coortes
Feminino
Seres Humanos
Masculino
Meia-Idade
Taxa Respiratória
[Pt] Tipo de publicação:JOURNAL ARTICLE
[Nm] Nome de substância:
0 (Hypnotics and Sedatives); 142M471B3J (Carbon Dioxide)
[Em] Mês de entrada:1710
[Cu] Atualização por classe:171002
[Lr] Data última revisão:
171002
[Sb] Subgrupo de revista:IM
[Da] Data de entrada para processamento:170630
[St] Status:MEDLINE
[do] DOI:10.1371/journal.pone.0180187


  10 / 1925 MEDLINE  
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[PMID]:28591048
[Au] Autor:Lu W; Fu Q; Luo X; Fu S; Hu K
[Ad] Endereço:The Department of SICU, The Second Affiliated Hospital of Zhejiang University School of Medicine, Hangzhou, Zhejiang Province, China.
[Ti] Título:Effects of dexmedetomidine on sleep quality of patients after surgery without mechanical ventilation in ICU.
[So] Source:Medicine (Baltimore);96(23):e7081, 2017 Jun.
[Is] ISSN:1536-5964
[Cp] País de publicação:United States
[La] Idioma:eng
[Ab] Resumo:Sleep quality of patients in intensive care unit (ICU) has been recently recognized as an important aspect of the intensive care. Dexmedetomidine is one of the most recently introduced for sedation in the ICU. This study was designed to evaluate the effect of dexmedetomidine on sleep quality of patients without mechanical ventilation in ICU.The patients who were included in this study were divided into two groups. In the sedation group, dexmedetomidine was given by a continuous infusion targeting a sedation level -1 to -2 on the score of RASS (Richmond Agitation-Sedation Scale). In the no sedation group, the patients slept by themselves. No other sedatives were given. Bispectral Index (BIS) was performed on these hemodynamically stable critically ill patients for 12 consecutive hours. Sleep time and sleep depth were recorded.Twenty patients were studied. Compared to no sedation group, sleep efficiency and sleep time of patients in the sedation group was significantly higher during the night. Moreover, there was no significantly difference between the changes of blood pressure, heart rate, and respiratory rate.Dexmedetomidine is a clinically effective and safe sedative for the highly selected critically ill patients without endotracheal tube and mechanical ventilation in the ICU to increases total sleep time and improve sleep efficiency.
[Mh] Termos MeSH primário: Cuidados Críticos
Dexmedetomidina/uso terapêutico
Hipnóticos e Sedativos/uso terapêutico
Cuidados Pós-Operatórios
Sono/efeitos dos fármacos
[Mh] Termos MeSH secundário: Adulto
Idoso
Idoso de 80 Anos ou mais
Pressão Sanguínea/efeitos dos fármacos
Estado Terminal
Feminino
Frequência Cardíaca/efeitos dos fármacos
Seres Humanos
Unidades de Terapia Intensiva
Masculino
Meia-Idade
Taxa Respiratória/efeitos dos fármacos
[Pt] Tipo de publicação:JOURNAL ARTICLE; OBSERVATIONAL STUDY
[Nm] Nome de substância:
0 (Hypnotics and Sedatives); 67VB76HONO (Dexmedetomidine)
[Em] Mês de entrada:1707
[Cu] Atualização por classe:170706
[Lr] Data última revisão:
170706
[Sb] Subgrupo de revista:AIM; IM
[Da] Data de entrada para processamento:170608
[St] Status:MEDLINE
[do] DOI:10.1097/MD.0000000000007081



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