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[PMID]:27532916
[Au] Autor:Isayama T; Iwami H; McDonald S; Beyene J
[Ad] Endereço:Clinical Epidemiology & Biostatistics, McMaster University, Hamilton, Ontario, Canada2Department of Newborn and Developmental Paediatrics, Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada.
[Ti] Título:Association of Noninvasive Ventilation Strategies With Mortality and Bronchopulmonary Dysplasia Among Preterm Infants: A Systematic Review and Meta-analysis.
[So] Source:JAMA;316(6):611-24, 2016 Aug 09.
[Is] ISSN:1538-3598
[Cp] País de publicação:United States
[La] Idioma:eng
[Ab] Resumo:IMPORTANCE: Various noninvasive ventilation strategies are used to prevent bronchopulmonary dysplasia (BPD) of preterm infants; however, the best mode is uncertain. OBJECTIVE: To compare 7 ventilation strategies for preterm infants including nasal continuous positive airway pressure (CPAP) alone, intubation and surfactant administration followed by immediate extubation (INSURE), less invasive surfactant administration (LISA), noninvasive intermittent positive pressure ventilation, nebulized surfactant administration, surfactant administration via laryngeal mask airway, and mechanical ventilation. DATA SOURCES: MEDLINE, EMBASE, CINAHL, and Cochrane CENTRAL from their inceptions to June 2016. STUDY SELECTION: Randomized clinical trials comparing ventilation strategies for infants younger than 33 weeks' gestational age within 24 hours of birth who had not been intubated. DATA EXTRACTION AND SYNTHESIS: Data were independently extracted by 2 reviewers and synthesized with Bayesian random-effects network meta-analyses. MAIN OUTCOMES AND MEASURES: A composite of death or BPD at 36 weeks' postmenstrual age was the primary outcome. Death, BPD, severe intraventricular hemorrhage, and air leak by discharge were the main secondary outcomes. RESULTS: Among 5598 infants involved in 30 trials, the incidence of the primary outcome was 33% (1665 of 4987; including 505 deaths and 1160 cases of BPD). The secondary outcomes ranged from 6% (314 of 5587) for air leak to 26% (1160 of 4455) for BPD . Compared with mechanical ventilation, LISA had a lower odds of the primary outcome (odds ratio [OR], 0.49; 95% credible interval [CrI], 0.30-0.79; absolute risk difference [RD], 164 fewer per 1000 infants; 57-253 fewer per 1000 infants; moderate quality of evidence), BPD(OR, 0.53; 95% CrI, 0.27-0.96; absolute RD, 133 fewer per 1000 infants; 95% CrI, 9-234 fewer per 1000 infants; moderate-quality), and severe intraventricular hemorrhage (OR, 0.44; 95% CrI, 0.19-0.99; absolute RD, 58 fewer per 1000 births; 95% CrI, 1-86 fewer per 1000 births; moderate-quality). Compared with nasal CPAP alone, LISA had a lower odds of the primary outcome (OR, 0.58; 95% CrI, 0.35-0.93; absolute RD, 112 fewer per 1000 births; 95% CrI, 16-190 fewer per 1000 births; moderate quality), and air leak (OR, 0.24; 95% CrI, 0.05-0.96; absolute RD, 47 fewer per 1000 births; 95% CrI, 2-59 fewer per 1000 births; very low quality). Ranking probabilities indicated that LISA was the best strategy with a surface under the cumulative ranking curve of 0.85 to 0.94, but this finding was not robust for death when limited to higher-quality evidence. CONCLUSIONS AND RELEVANCE: Among preterm infants, the use of LISA was associated with the lowest likelihood of the composite outcome of death or BPD at 36 weeks' postmenstrual age. These findings were limited by the overall low quality of evidence and lack of robustness in higher-quality trials.
[Mh] Termos MeSH primário: Displasia Broncopulmonar/epidemiologia
Pressão Positiva Contínua nas Vias Aéreas
Mortalidade Infantil
Respiração com Pressão Positiva Intermitente
Ventilação não Invasiva/métodos
Surfactantes Pulmonares/administração & dosagem
[Mh] Termos MeSH secundário: Teorema de Bayes
Displasia Broncopulmonar/prevenção & controle
Hemorragia Cerebral/epidemiologia
Idade Gestacional
Seres Humanos
Lactente
Recém-Nascido
Recém-Nascido Prematuro
Intubação Intratraqueal
Máscaras Laríngeas
Razão de Chances
Viés de Publicação
Ensaios Clínicos Controlados Aleatórios como Assunto
[Pt] Tipo de publicação:COMPARATIVE STUDY; JOURNAL ARTICLE; META-ANALYSIS; REVIEW
[Nm] Nome de substância:
0 (Pulmonary Surfactants)
[Em] Mês de entrada:1609
[Cu] Atualização por classe:161017
[Lr] Data última revisão:
161017
[Sb] Subgrupo de revista:AIM; IM
[Da] Data de entrada para processamento:160818
[St] Status:MEDLINE
[do] DOI:10.1001/jama.2016.10708


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[PMID]:27445550
[Au] Autor:Chen YH; Yeh MC; Hu HC; Lee CS; Li LF; Chen NH; Huang CC; Kao KC
[Ad] Endereço:Department of Respiratory Care, Chang Gung University College of Medicine, 259 Wenhua 1st Road, Guishan District, Taoyuan City 33302, Taiwan.
[Ti] Título:Effects of Lung Expansion Therapy on Lung Function in Patients with Prolonged Mechanical Ventilation.
[So] Source:Can Respir J;2016:5624315, 2016.
[Is] ISSN:1916-7245
[Cp] País de publicação:Egypt
[La] Idioma:eng
[Ab] Resumo:Common complications in PMV include changes in the airway clearance mechanism, pulmonary function, and respiratory muscle strength, as well as chest radiological changes such as atelectasis. Lung expansion therapy which includes IPPB and PEEP prevents and treats pulmonary atelectasis and improves lung compliance. Our study presented that patients with PMV have improvements in lung volume and oxygenation after receiving IPPB therapy. The combination of IPPB and PEEP therapy also results in increase in respiratory muscle strength. The application of IPPB facilitates the homogeneous gas distribution in the lung and results in recruitment of collapsed alveoli. PEEP therapy may reduce risk of respiratory muscle fatigue by preventing premature airway collapse during expiration. The physiologic effects of IPPB and PEEP may result in enhancement of pulmonary function and thus increase the possibility of successful weaning from mechanical ventilator during weaning process. For patients with PMV who were under the risk of atelectasis, the application of IPPB may be considered as a supplement therapy for the enhancement of weaning outcome during their stay in the hospital.
[Mh] Termos MeSH primário: Respiração com Pressão Positiva Intermitente
[Mh] Termos MeSH secundário: Idoso
Idoso de 80 Anos ou mais
Feminino
Seres Humanos
Tempo de Internação
Masculino
Meia-Idade
Estudos Prospectivos
Testes de Função Respiratória
[Pt] Tipo de publicação:COMPARATIVE STUDY; JOURNAL ARTICLE; RANDOMIZED CONTROLLED TRIAL
[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:160723
[St] Status:MEDLINE
[do] DOI:10.1155/2016/5624315


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[PMID]:26807682
[Au] Autor:Bosma KJ; Read BA; Bahrgard Nikoo MJ; Jones PM; Priestap FA; Lewis JF
[Ad] Endereço:1London Health Sciences Centre, London, ON, Canada. 2Department of Medicine, The University of Western Ontario, London, ON, Canada.
[Ti] Título:A Pilot Randomized Trial Comparing Weaning From Mechanical Ventilation on Pressure Support Versus Proportional Assist Ventilation.
[So] Source:Crit Care Med;44(6):1098-108, 2016 Jun.
[Is] ISSN:1530-0293
[Cp] País de publicação:United States
[La] Idioma:eng
[Ab] Resumo:OBJECTIVES: Despite protocols incorporating spontaneous breathing trials, 31% of ICU patients experience difficult or prolonged weaning from mechanical ventilation. Nonfatiguing modes such as pressure support ventilation are recommended. Proportional assist ventilation provides assistance in proportion to patient effort, which may optimize weaning. However, it is not known how proportional assist ventilation performs relative to pressure support ventilation over a prolonged period in the complex ICU setting. The purpose of this study was to compare the physiologic and clinical performance (failure rate), safety, and feasibility of protocols using daily spontaneous breathing trial plus pressure support ventilation versus proportional assist ventilation until ventilation discontinuation. DESIGN: Single-center, unblinded pilot randomized controlled trial. SETTING: Medical-surgical ICU of a tertiary-care hospital. PATIENTS: Adult patients intubated greater than 36 hours were randomized if they met eligibility criteria for partial ventilatory support, tolerated pressure support ventilation greater than or equal to 30 minutes, and either failed or did not meet criteria for a spontaneous breathing trial. INTERVENTIONS: Patients were randomized to the pressure support ventilation or proportional assist ventilation protocol (PAV+, Puritan Bennett 840; Covidien, Boulder, CO). Both protocols used progressive decreases in level of assistance as tolerated, coupled with daily assessment for spontaneous breathing trials. MEASUREMENTS AND MAIN RESULTS: Of 54 patients randomized, outcome data are available for 50 patients; 27 were randomized to receive proportional assist ventilation and 23 to receive pressure support ventilation. There were no adverse events linked to the study interventions, and protocol violations were infrequent. Recruitment was slower than projected (1.3 patients per month). The median (interquartile range) time from randomization to successful extubation was 3.9 days (2.8-8.4 d) on proportional assist ventilation versus 4.9 days (2.9-26.3 d) on pressure support ventilation (p = 0.39). Time to live ICU discharge was 7.3 days (5.2-11.4 d) on proportional assist ventilation versus 12.4 days (7.5-30.8 d) on pressure support ventilation (p = 0.03). CONCLUSION: This pilot study demonstrates the utility, safety, and feasibility of the weaning protocols and provides important information to guide the design of a future randomized controlled trial comparing weaning from mechanical ventilation on pressure support ventilation versus proportional assist ventilation.
[Mh] Termos MeSH primário: Suporte Ventilatório Interativo
Respiração com Pressão Positiva Intermitente
Desmame do Respirador/métodos
[Mh] Termos MeSH secundário: Idoso
Extubação
Antipsicóticos/administração & dosagem
Feminino
Seres Humanos
Hipnóticos e Sedativos/administração & dosagem
Unidades de Terapia Intensiva
Suporte Ventilatório Interativo/efeitos adversos
Respiração com Pressão Positiva Intermitente/efeitos adversos
Tempo de Internação
Masculino
Pressões Respiratórias Máximas
Meia-Idade
Entorpecentes/administração & dosagem
Projetos Piloto
Estudos Prospectivos
Volume de Ventilação Pulmonar
Fatores de Tempo
[Pt] Tipo de publicação:COMPARATIVE STUDY; JOURNAL ARTICLE; RANDOMIZED CONTROLLED TRIAL
[Nm] Nome de substância:
0 (Antipsychotic Agents); 0 (Hypnotics and Sedatives); 0 (Narcotics)
[Em] Mês de entrada:1705
[Cu] Atualização por classe:171005
[Lr] Data última revisão:
171005
[Sb] Subgrupo de revista:AIM; IM
[Da] Data de entrada para processamento:160126
[St] Status:MEDLINE
[do] DOI:10.1097/CCM.0000000000001600


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[PMID]:26474274
[Au] Autor:Bradley TD; Floras JS; ADVENT-HF Investigators
[Ti] Título:The SERVE-HF Trial.
[So] Source:Can Respir J;22(6):313, 2015 Nov-Dec.
[Is] ISSN:1916-7245
[Cp] País de publicação:Egypt
[La] Idioma:eng
[Mh] Termos MeSH primário: Ensaios Clínicos como Assunto/métodos
Insuficiência Cardíaca/complicações
Respiração com Pressão Positiva Intermitente/métodos
Apneia Central do Sono/terapia
[Mh] Termos MeSH secundário: Insuficiência Cardíaca/mortalidade
Seres Humanos
Respiração com Pressão Positiva Intermitente/efeitos adversos
Projetos de Pesquisa
Apneia Central do Sono/complicações
Taxa de Sobrevida
[Pt] Tipo de publicação:JOURNAL ARTICLE
[Em] Mês de entrada:1609
[Cu] Atualização por classe:161215
[Lr] Data última revisão:
161215
[Sb] Subgrupo de revista:IM
[Da] Data de entrada para processamento:151017
[St] Status:MEDLINE


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[PMID]:26277878
[Au] Autor:Feghali M; Jean KM; Emery SP
[Ad] Endereço:Department of Obstetrics, Gynecology, and Reproductive Sciences, University of Pittsburgh School of Medicine, Pittsburgh, PA, USA.
[Ti] Título:Ultrasound assessment of congenital fetal lung masses and neonatal respiratory outcomes.
[So] Source:Prenat Diagn;35(12):1208-12, 2015 Dec.
[Is] ISSN:1097-0223
[Cp] País de publicação:England
[La] Idioma:eng
[Ab] Resumo:OBJECTIVE: Fetal congenital lung masses generate concern for compromised postnatal respiratory function. Congenital pulmonary adenomatoid malformation volume ratio (CVR) has been used to predict the risk of hydrops fetalis and need for antenatal intervention. This study investigates whether CVR could be used to predict neonatal respiratory outcomes. METHODS: The ultrasounds of fetuses diagnosed with a lung mass between 2005 and 2013 were reviewed. CVR was calculated at each ultrasound using the formula for a prolate ellipse divided by head circumference. The pregnancy outcome and information about NICU admission for respiratory insufficiency were collected. RESULTS: Forty-two fetuses were diagnosed with a lung mass during the study period. CVR prior to 24 weeks and between 24 and 32 weeks were associated with NICU admission (p < 0.0001 and <0.008, respectively). CVR increased up to 32 weeks and decreased thereafter for most subjects. The decrease in CVR beyond 32 weeks was larger for cases that required NICU admission (p = 0.002). For a CVR cut-off of <0.5, the sensitivity was 100%, the specificity 85.7%, and negative predictive value was 100% for regular nursery care. CONCLUSION: In pregnancies diagnosed with fetal lung masses, CVR predicted normal respiratory outcomes and need for NICU admission. This information may be helpful for delivery planning. © 2015 John Wiley & Sons, Ltd.
[Mh] Termos MeSH primário: Doenças Fetais/diagnóstico por imagem
Pneumopatias/congênito
[Mh] Termos MeSH secundário: Feminino
Seres Humanos
Terapia Intensiva Neonatal/estatística & dados numéricos
Respiração com Pressão Positiva Intermitente/estatística & dados numéricos
Pneumopatias/diagnóstico por imagem
Gravidez
Respiração
Estudos Retrospectivos
Ultrassonografia Pré-Natal
[Pt] Tipo de publicação:JOURNAL ARTICLE
[Em] Mês de entrada:1610
[Cu] Atualização por classe:170103
[Lr] Data última revisão:
170103
[Sb] Subgrupo de revista:IM
[Da] Data de entrada para processamento:150818
[St] Status:MEDLINE
[do] DOI:10.1002/pd.4678


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[PMID]:25384211
[Au] Autor:Mellies U; Goebel C
[Ad] Endereço:1 Department of Pediatric Pulmonology, University of Essen, Childrens' Hospital, Essen, Germany; and.
[Ti] Título:Optimum insufflation capacity and peak cough flow in neuromuscular disorders.
[So] Source:Ann Am Thorac Soc;11(10):1560-8, 2014 Dec.
[Is] ISSN:2325-6621
[Cp] País de publicação:United States
[La] Idioma:eng
[Ab] Resumo:RATIONALE: For patients with neuromuscular disorders, lung insufflation with positive pressure is an accepted technique to increase inspiratory volume over VC to improve peak cough flow (PCF). OBJECTIVES: The aim of the study was to determine the pressure or volume required to achieve the highest individual PCF. METHODS: In 40 patients dependent on noninvasive ventilation (VC, 16 ± 11% predicted; age, 20 ± 4 yr) and in 20 healthy control subjects, insufflation capacity (IC) was measured during titration from 10 to maximum 40 mbar using intermittent positive pressure breathing (IPPB) or the lung insufflation assist maneuver (LIAM) of the VENTIlogic LS ventilator. MEASUREMENTS AND MAIN RESULTS: IPPB or LIAM titration resulted in a pressure-volume curve with an estimated total compliance of 0.23 ± 0.11 L/kPa in the patients and 1.0 ± 0.3 L/kPa in the controls and a plateau for IC at pressures between 30 and 40 mbar. IPPB or LIAM improved VC from 451 ± 229 ml to a maximum IC (ICmax) of 1,027 ± 329 ml, and PCF improved from 109 ± 45 to 202 ± 62 L/min (P < 0.01 for all). The highest individual PCF was achieved with 27 ± 6 mbar and an IC of 924 ± 379 ml, which was significantly below ICmax (P < 0.01). CONCLUSIONS: A submaximal insufflation is ideal for generating the best individual PCF even in patients with severely reduced compliance of the respiratory system. Optimum insufflation capacity can be achieved using IPPB or LIAM with moderate pressures. Both techniques are equally effective and considered safe.
[Mh] Termos MeSH primário: Tosse/fisiopatologia
Insuflação/métodos
Respiração com Pressão Positiva Intermitente/métodos
Doenças Neuromusculares/complicações
Músculos Respiratórios/fisiopatologia
Terapia Respiratória/métodos
Capacidade Vital/fisiologia
[Mh] Termos MeSH secundário: Adolescente
Adulto
Criança
Tosse/etiologia
Tosse/terapia
Feminino
Seguimentos
Seres Humanos
Masculino
Doenças Neuromusculares/fisiopatologia
Estudos Retrospectivos
Adulto Jovem
[Pt] Tipo de publicação:JOURNAL ARTICLE; RANDOMIZED CONTROLLED TRIAL
[Em] Mês de entrada:1509
[Cu] Atualização por classe:141231
[Lr] Data última revisão:
141231
[Sb] Subgrupo de revista:IM
[Da] Data de entrada para processamento:141111
[St] Status:MEDLINE
[do] DOI:10.1513/AnnalsATS.201406-264OC


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[PMID]:25171575
[Au] Autor:Lacombe M; Del Amo Castrillo L; Boré A; Chapeau D; Horvat E; Vaugier I; Lejaille M; Orlikowski D; Prigent H; Lofaso F
[Ad] Endereço:Réanimation Médicale, Physiologie - Explorations Fonctionnelles, Centre d'Innovations Technologiques UMR 805, Hôpital Raymond Poincaré, AP-HP, Garches, and EA 4497, Université de Versailles Saint-Quentin-en-Yvelines, Versailles, France.
[Ti] Título:Comparison of three cough-augmentation techniques in neuromuscular patients: mechanical insufflation combined with manually assisted cough, insufflation-exsufflation alone and insufflation-exsufflation combined with manually assisted cough.
[So] Source:Respiration;88(3):215-22, 2014.
[Is] ISSN:1423-0356
[Cp] País de publicação:Switzerland
[La] Idioma:eng
[Ab] Resumo:BACKGROUND: Mechanical insufflation-exsufflation (MI-E), more commonly known as 'cough assist therapy', is a method which produces inspiratory and expiratory assistance to improve cough performances. However, other alternatives or combinations are possible. OBJECTIVE: The objective was to compare the effects of mechanical insufflation combined with manually assisted coughing (MAC), insufflation-exsufflation alone and insufflation-exsufflation combined with MAC in neuromuscular patients requiring cough assistance. METHODS: Eighteen neuromuscular patients with severe respiratory muscle dysfunction and peak cough flow (PCF) lower than 3 liters/s or maximal expiratory pressure (MEP) lower than +45 cm H2O were studied. Patients were studied under three cough-assisted conditions, which were used in random order: insufflation by intermittent positive-pressure breathing (IPPB) combined with MAC, MI-E and MI-E + MAC. RESULTS: Overall, PCF was higher with IPPB + MAC than with MI-E + MAC or MI-E alone. Among the 12 patients who had higher PCF values with IPPB + MAC than with the two other techniques, 9 exhibited mask pressure swings during MI-E exsufflation, with a transient positive-pressure value due to the expiratory flow produced by the combined patient cough effort and MAC. Each of these 9 patients had higher PCF values (>5 liters/s) than did the other 9 patients when using IPPB + MAC. CONCLUSION: Our results indicate that adding the MI-E device to MAC is unhelpful in patients whose PCF with an insufflation technique and MAC exceeds 5 liters/s. This is because the expiratory flow produced by the patient's effort and MAC transitorily exceeds the vacuum capacity of the MI-E device, which therefore becomes a transient load against the PCF.
[Mh] Termos MeSH primário: Tosse
Insuflação/métodos
Respiração com Pressão Positiva Intermitente/métodos
Insuficiência Respiratória/terapia
Paralisia Respiratória/terapia
Terapia Respiratória/métodos
[Mh] Termos MeSH secundário: Adulto
Idoso
Estudos Cross-Over
Feminino
Seres Humanos
Masculino
Erros Inatos do Metabolismo/complicações
Meia-Idade
Atrofia Muscular Espinal/complicações
Distrofias Musculares/complicações
Doenças Neuromusculares/complicações
Insuficiência Respiratória/etiologia
Paralisia Respiratória/etiologia
Resultado do Tratamento
Adulto Jovem
[Pt] Tipo de publicação:COMPARATIVE STUDY; JOURNAL ARTICLE; RANDOMIZED CONTROLLED TRIAL
[Em] Mês de entrada:1505
[Cu] Atualização por classe:140917
[Lr] Data última revisão:
140917
[Sb] Subgrupo de revista:IM
[Da] Data de entrada para processamento:140830
[St] Status:MEDLINE
[do] DOI:10.1159/000364911


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[PMID]:24743461
[Au] Autor:Yuan G; Bach JR; Saporito L; Berman A
[Ad] Endereço:From the Firestone Institute for Respiratory Health, Department of Medicine, McMaster University, Hamilton, Ontario, Canada (GY); and Department of Physical Medicine and Rehabilitation (JRB, LS); Department of Neurosciences (JRB, LS); and Department of Internal Medicine, Division of Pulmonary and Critical Care Medicine (AB), Rutgers-New Jersey Medical School, University Hospital, Newark, NJ.
[Ti] Título:Fiber-optic bronchoscopy and volume-cycled mouthpiece ventilation for a patient with multiple sclerosis and ventilatory failure.
[So] Source:Am J Phys Med Rehabil;93(7):612-4, 2014 Jul.
[Is] ISSN:1537-7385
[Cp] País de publicação:United States
[La] Idioma:eng
[Ab] Resumo:Fiber-optic bronchoscopy supported by continuous or bilevel positive airway pressure has helped patients with hypoxemic or hypercapnic respiratory failure avoid respiratory complications. The authors describe a case of a 57-yr-old man with multiple sclerosis with a vital capacity of 250 ml (5% of predicted normal) who was using continuous noninvasive intermittent positive pressure ventilatory support when he underwent bronchoscopy while receiving continuous noninvasive intermittent positive pressure ventilatory support via a 15-mm angled mouthpiece interface. He was switched from a nasal to a 15-mm angled mouthpiece interface for continuous noninvasive intermittent positive pressure ventilatory support for the procedure. Simple mouthpieces may be useful alternatives to other facial interfaces for ventilatory support during bronchoscopy because of patient comfort and operator convenience.
[Mh] Termos MeSH primário: Broncoscopia/métodos
Pressão Positiva Contínua nas Vias Aéreas/instrumentação
Respiração com Pressão Positiva Intermitente/instrumentação
Esclerose Múltipla/complicações
Insuficiência Respiratória/terapia
[Mh] Termos MeSH secundário: Tecnologia de Fibra Óptica
Seres Humanos
Masculino
Meia-Idade
Ventilação não Invasiva/instrumentação
Insuficiência Respiratória/etiologia
[Pt] Tipo de publicação:CASE REPORTS; JOURNAL ARTICLE
[Em] Mês de entrada:1408
[Cu] Atualização por classe:161018
[Lr] Data última revisão:
161018
[Sb] Subgrupo de revista:AIM; IM
[Da] Data de entrada para processamento:140419
[St] Status:MEDLINE
[do] DOI:10.1097/PHM.0000000000000096


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[PMID]:24170912
[Au] Autor:Marjanovic N; Le Floch S; Jaffrelot M; L'Her E
[Ad] Endereço:Emergency Department, Pôle Arsibou, Centre Hospitalier Universitaire de la Cavale Blanche, 29609 Brest, France.
[Ti] Título:Evaluation of manual and automatic manually triggered ventilation performance and ergonomics using a simulation model.
[So] Source:Respir Care;59(5):735-42, 2014 May.
[Is] ISSN:1943-3654
[Cp] País de publicação:United States
[La] Idioma:eng
[Ab] Resumo:BACKGROUND: In the absence of endotracheal intubation, the manual bag-valve-mask (BVM) is the most frequently used ventilation technique during resuscitation. The efficiency of other devices has been poorly studied. The bench-test study described here was designed to evaluate the effectiveness of an automatic, manually triggered system, and to compare it with manual BVM ventilation. METHODS: A respiratory system bench model was assembled using a lung simulator connected to a manikin to simulate a patient with unprotected airways. Fifty health-care providers from different professional groups (emergency physicians, residents, advanced paramedics, nurses, and paramedics; n = 10 per group) evaluated manual BVM ventilation, and compared it with an automatic manually triggered device (EasyCPR). Three pathological situations were simulated (restrictive, obstructive, normal). Standard ventilation parameters were recorded; the ergonomics of the system were assessed by the health-care professionals using a standard numerical scale once the recordings were completed. RESULTS: The tidal volume fell within the standard range (400-600 mL) for 25.6% of breaths (0.6-45 breaths) using manual BVM ventilation, and for 28.6% of breaths (0.3-80 breaths) using the automatic manually triggered device (EasyCPR) (P < .0002). Peak inspiratory airway pressure was lower using the automatic manually triggered device (EasyCPR) (10.6 ± 5 vs 15.9 ± 10 cm H2O, P < .001). The ventilation rate fell consistently within the guidelines, in the case of the automatic manually triggered device (EasyCPR) only (10.3 ± 2 vs 17.6 ± 6, P < .001). Significant pulmonary overdistention was observed when using the manual BVM device during the normal and obstructive sequences. The nurses and paramedics considered the ergonomics of the automatic manually triggered device (EasyCPR) to be better than those of the manual device. CONCLUSIONS: The use of an automatic manually triggered device may improve ventilation efficiency and decrease the risk of pulmonary overdistention, while decreasing the ventilation rate.
[Mh] Termos MeSH primário: Atitude do Pessoal de Saúde
Reanimação Cardiopulmonar/instrumentação
Respiração com Pressão Positiva Intermitente/instrumentação
[Mh] Termos MeSH secundário: Reanimação Cardiopulmonar/efeitos adversos
Reanimação Cardiopulmonar/métodos
Desenho de Equipamento
Ergonomia
Seres Humanos
Respiração com Pressão Positiva Intermitente/efeitos adversos
Respiração com Pressão Positiva Intermitente/métodos
Manequins
Volume Residual
Taxa Respiratória
Volume de Ventilação Pulmonar
[Pt] Tipo de publicação:EVALUATION STUDIES; JOURNAL ARTICLE
[Em] Mês de entrada:1501
[Cu] Atualização por classe:171116
[Lr] Data última revisão:
171116
[Sb] Subgrupo de revista:IM
[Da] Data de entrada para processamento:131031
[St] Status:MEDLINE
[do] DOI:10.4187/respcare.02557


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[PMID]:23672834
[Au] Autor:Khirani S; Colella M; Caldarelli V; Aubertin G; Boulé M; Forin V; Ramirez A; Fauroux B
[Ad] Endereço:S2A Santé, Ivry-sur-Seine, France; Pediatric Pulmonary Department, AP-HP, Hôpital Armand Trousseau, Paris, France.
[Ti] Título:Longitudinal course of lung function and respiratory muscle strength in spinal muscular atrophy type 2 and 3.
[So] Source:Eur J Paediatr Neurol;17(6):552-60, 2013 Nov.
[Is] ISSN:1532-2130
[Cp] País de publicação:England
[La] Idioma:eng
[Ab] Resumo:BACKGROUND: Spinal muscular atrophy (SMA) is a common genetic disorder that causes severe hypotonia and weakness, and often fatal restrictive lung disease. The aim of the study was to describe the natural history of the respiratory involvement in patients with SMA type 2 and 3 in order to assess the relevance of the clinical classification and identify the parameters associated with the earliest and most rapid decline over time. METHODS: Thirty-one patients aged 3-21 years were followed over a 10-year period. Lung function, blood gases, respiratory mechanics and muscle strength with recording of oesogastric pressures were measured during routine follow-up. RESULTS: At least two measurements were available in 16 patients (seven type 2 and nine type 3). Among all the volitional and non-volitional, invasive and non-invasive tests, forced vital capacity (FVC) and sniff nasal inspiratory pressure (SNIP) were shown to be the most informative parameters, showing lower values in SMA type 2, with however a similar rate of decline in patients with SMA type 2 and 3. CONCLUSION: Our results confirm an earlier decline in lung and respiratory muscle function in patients classified as SMA type 2 as compared with patients classified as type 3. This decline can be assessed by two simple non-invasive tests, FVC and SNIP, with the last maneuver being feasible and reliable in the youngest children, underlying its interest for the monitoring of children with SMA.
[Mh] Termos MeSH primário: Pneumopatias/etiologia
Pneumopatias/patologia
Força Muscular/fisiologia
Músculos Respiratórios/fisiopatologia
Atrofias Musculares Espinais da Infância/complicações
[Mh] Termos MeSH secundário: Adolescente
Criança
Pré-Escolar
Feminino
Seres Humanos
Respiração com Pressão Positiva Intermitente
Estudos Longitudinais
Masculino
Força Muscular/genética
Atrofias Musculares Espinais da Infância/patologia
Capacidade Vital
Adulto Jovem
[Pt] Tipo de publicação:JOURNAL ARTICLE; RESEARCH SUPPORT, NON-U.S. GOV'T
[Em] Mês de entrada:1407
[Cu] Atualização por classe:131115
[Lr] Data última revisão:
131115
[Sb] Subgrupo de revista:IM
[Da] Data de entrada para processamento:130516
[St] Status:MEDLINE



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