Surfactante pulmonar : avaliação e terapia na bronquiolite viral aguda grave
Autor(a) principal: | |
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Data de Publicação: | 2015 |
Tipo de documento: | Tese |
Idioma: | por |
Título da fonte: | Biblioteca Digital de Teses e Dissertações da PUC_RS |
Texto Completo: | http://tede2.pucrs.br/tede2/handle/tede/6127 |
Resumo: | Objectives: To evaluate the response to surfactant of patients with acute bronchiolitis (AB) according the surfactant function and production, measured through the stable microbubble test and the lamellar body count. Study Design: Twenty four patients younger than 1 year of age, with the diagnosis of AB, who were in mechanical ventilation and received 100 mg of surfactant, according with the stablished routine by the pediatric intensive care unit, were studied. Previously to the administration, tracheal secretion was collected for virus identification, stable microbubble test and lamellar body count. Arterial blood gases were obtained. One hour, 6 hours and 24 hours after of surfactant administration arterial blood gases were again collected. Results: There was a 20% increase in PaO2 24 hours after surfactant administration in 2 (14.29%) of 14 patients with lamellar bodies ≤ 60.000 and in 5 (50%) of 10 patients with>60.000 lamellar bodies (p=0.08). Six (46.15%) of 13 patients with ≤13 microbubbles and one (9.09%) of 11 patients with>13 microbubbles had an increase in PaO2>20% after 24 hours of administration (p=0.08). Only 2 patients of 7 who responded to surfactant, had respiratory syncytial virus (RSV) positive. The patients with lamellar bodies ≤ 60.000 had a statistically significant increase in oxygenation after 6 hours of surfactant administration, not associated to a reduction of mechanical ventilation time or hospitalization time. The patients without positive RSV had a substantial increase in PaO2 after one hour after the administration of surfactant, that was maintained for 24 hours. Conclusion: The surfactant administration transiently improved oxygenation in patients with AVB. Patients who had no positive respiratory syncytial virus had an important improvement in oxygenation after administration of exogenous surfactant. LBC and SMT are not sufficiently sensitive and specific to predict who the patients with severe bronchiolitis responding to treatment with exogenous surfactant. |
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Fiori, Humberto Holmer529.191.450-53http://buscatextual.cnpq.br/buscatextual/visualizacv.do?id=K4707095U2Garcia, Pedro Celiny Ramoshttp://buscatextual.cnpq.br/buscatextual/visualizacv.do?id=K4787221J8014.591.620-05http://buscatextual.cnpq.br/buscatextual/visualizacv.do?id=K4479220T7Hartmann, Francine2015-06-12T11:40:25Z2015-03-23http://tede2.pucrs.br/tede2/handle/tede/6127Objectives: To evaluate the response to surfactant of patients with acute bronchiolitis (AB) according the surfactant function and production, measured through the stable microbubble test and the lamellar body count. Study Design: Twenty four patients younger than 1 year of age, with the diagnosis of AB, who were in mechanical ventilation and received 100 mg of surfactant, according with the stablished routine by the pediatric intensive care unit, were studied. Previously to the administration, tracheal secretion was collected for virus identification, stable microbubble test and lamellar body count. Arterial blood gases were obtained. One hour, 6 hours and 24 hours after of surfactant administration arterial blood gases were again collected. Results: There was a 20% increase in PaO2 24 hours after surfactant administration in 2 (14.29%) of 14 patients with lamellar bodies ≤ 60.000 and in 5 (50%) of 10 patients with>60.000 lamellar bodies (p=0.08). Six (46.15%) of 13 patients with ≤13 microbubbles and one (9.09%) of 11 patients with>13 microbubbles had an increase in PaO2>20% after 24 hours of administration (p=0.08). Only 2 patients of 7 who responded to surfactant, had respiratory syncytial virus (RSV) positive. The patients with lamellar bodies ≤ 60.000 had a statistically significant increase in oxygenation after 6 hours of surfactant administration, not associated to a reduction of mechanical ventilation time or hospitalization time. The patients without positive RSV had a substantial increase in PaO2 after one hour after the administration of surfactant, that was maintained for 24 hours. Conclusion: The surfactant administration transiently improved oxygenation in patients with AVB. Patients who had no positive respiratory syncytial virus had an important improvement in oxygenation after administration of exogenous surfactant. LBC and SMT are not sufficiently sensitive and specific to predict who the patients with severe bronchiolitis responding to treatment with exogenous surfactant.Objetivos: Avaliar a resposta à administração de surfactante exógeno de pacientes com bronquiolite viral aguda (BVA) grave conforme a função e produção de surfactante, medida através do teste das microbolhas estáveis (TME) e da contagem de corpos lamelares (CCL). Métodos: Foram estudados 24 pacientes, menores de 1 ano de idade, com diagnóstico de BVA grave, que estavam em ventilação mecânica e receberam 100mg/kg de surfactante exógeno, de acordo com a rotina estabelecida pela da unidade de tratamento intensivo pediátrico (UTIP). Previamente à administração, foi coletado uma amostra de secreção traqueal para identificação de vírus, realização da contagem de corpos lamelares e do teste das microbolhas estáveis. Foi obtido sangue arterial para gasometria. Uma hora, 6horas e 24horas após a administração de surfactante foi coletado novamente sangue arterial para gasometria. Resultados: Houve aumento de 20% na PaO2após 24 horas da administração de surfactante em 2 (14,29%) de 14 pacientes com corpos lamelares ≤ 60.000 e em 5 (50%) de 10 pacientes com >60.000 corpos lamelares (p=0,08). Seis (46,15%) de 13 pacientes com ≤13 microbolhas e 01 (9,09%) de 11 pacientes com >13 microbolhas tiveram um aumento na PaO2>20% após 24 horas da administração (p=0,08). Apenas 2 pacientes dos 7 que responderam ao surfactante exógeno, tinham vírus sincicial respiratório (VSR) positivo. Os pacientes com >60.000 corpos lamelares tiveram um aumento estatisticamente significativo da oxigenação após 6 horas do uso de surfactante, não associado a redução do tempo de ventilação e internação. Os pacientes sem VSR positivo tiveram um aumento substancial da PaO2arterial após 1 hora de administração do surfactante, que se manteve por 24 horas Conclusão: A administração de surfactante melhora transitoriamente a oxigenação dos pacientes com BVA. Os pacientes que não tinham vírus sincicial respiratório positivo tiveram uma importante melhora imediata na oxigenação após o uso de surfactante exógeno. A CCL e o TME não se mostraram suficientemente sensíveis e específicos para predizer quem são os pacientes com bronquiolite grave que responderão à terapia com surfactante exógeno.Submitted by Setor de Tratamento da Informação - BC/PUCRS (tede2@pucrs.br) on 2015-06-12T11:40:24Z No. of bitstreams: 1 470402 - Texto Parcial.pdf: 567544 bytes, checksum: 1fd6fe27525edbe0dfac418fc8ba5fd2 (MD5)Made available in DSpace on 2015-06-12T11:40:25Z (GMT). No. of bitstreams: 1 470402 - Texto Parcial.pdf: 567544 bytes, checksum: 1fd6fe27525edbe0dfac418fc8ba5fd2 (MD5) Previous issue date: 2015-03-23Conselho Nacional de Pesquisa e Desenvolvimento Científico e Tecnológico - CNPqapplication/pdfhttp://tede2.pucrs.br:80/tede2/retrieve/162936/470402%20-%20Texto%20Parcial.pdf.jpgporPontifícia Universidade Católica do Rio Grande do SulPrograma de Pós-Graduação em Medicina/Pediatria e Saúde da CriançaPUCRSBrasilFaculdade de MedicinaMEDICINAPEDIATRIABRONQUIOLITEUNIDADES DE TERAPIA INTENSIVASURFACTANTES PULMONARESLACTENTEDOENÇAS AGUDASCLINICA MEDICA::PEDIATRIASurfactante pulmonar : avaliação e terapia na bronquiolite viral aguda graveinfo:eu-repo/semantics/publishedVersioninfo:eu-repo/semantics/doctoralThesis3098206005268432148600600600600-8624664729441623247-7027121703779065955-2555911436985713659info:eu-repo/semantics/openAccessreponame:Biblioteca Digital de Teses e Dissertações da PUC_RSinstname:Pontifícia Universidade Católica do Rio Grande do Sul (PUCRS)instacron:PUC_RSTHUMBNAIL470402 - Texto Parcial.pdf.jpg470402 - Texto Parcial.pdf.jpgimage/jpeg2713http://tede2.pucrs.br/tede2/bitstream/tede/6127/4/470402+-+Texto+Parcial.pdf.jpg872a29e9ba900c05e79ea8508acbaad0MD54TEXT470402 - Texto Parcial.pdf.txt470402 - Texto Parcial.pdf.txttext/plain28869http://tede2.pucrs.br/tede2/bitstream/tede/6127/3/470402+-+Texto+Parcial.pdf.txt2ed262c077fc22774e309dd057fe45e4MD53ORIGINAL470402 - Texto Parcial.pdf470402 - Texto Parcial.pdfapplication/pdf567544http://tede2.pucrs.br/tede2/bitstream/tede/6127/2/470402+-+Texto+Parcial.pdf1fd6fe27525edbe0dfac418fc8ba5fd2MD52LICENSElicense.txtlicense.txttext/plain; charset=utf-8610http://tede2.pucrs.br/tede2/bitstream/tede/6127/1/license.txt5a9d6006225b368ef605ba16b4f6d1beMD51tede/61272015-09-29 08:24:57.433oai:tede2.pucrs.br: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Biblioteca Digital de Teses e Dissertaçõeshttp://tede2.pucrs.br/tede2/PRIhttps://tede2.pucrs.br/oai/requestbiblioteca.central@pucrs.br||opendoar:2015-09-29T11:24:57Biblioteca Digital de Teses e Dissertações da PUC_RS - Pontifícia Universidade Católica do Rio Grande do Sul (PUCRS)false |
dc.title.por.fl_str_mv |
Surfactante pulmonar : avaliação e terapia na bronquiolite viral aguda grave |
title |
Surfactante pulmonar : avaliação e terapia na bronquiolite viral aguda grave |
spellingShingle |
Surfactante pulmonar : avaliação e terapia na bronquiolite viral aguda grave Hartmann, Francine MEDICINA PEDIATRIA BRONQUIOLITE UNIDADES DE TERAPIA INTENSIVA SURFACTANTES PULMONARES LACTENTE DOENÇAS AGUDAS CLINICA MEDICA::PEDIATRIA |
title_short |
Surfactante pulmonar : avaliação e terapia na bronquiolite viral aguda grave |
title_full |
Surfactante pulmonar : avaliação e terapia na bronquiolite viral aguda grave |
title_fullStr |
Surfactante pulmonar : avaliação e terapia na bronquiolite viral aguda grave |
title_full_unstemmed |
Surfactante pulmonar : avaliação e terapia na bronquiolite viral aguda grave |
title_sort |
Surfactante pulmonar : avaliação e terapia na bronquiolite viral aguda grave |
author |
Hartmann, Francine |
author_facet |
Hartmann, Francine |
author_role |
author |
dc.contributor.advisor1.fl_str_mv |
Fiori, Humberto Holmer |
dc.contributor.advisor1ID.fl_str_mv |
529.191.450-53 |
dc.contributor.advisor1Lattes.fl_str_mv |
http://buscatextual.cnpq.br/buscatextual/visualizacv.do?id=K4707095U2 |
dc.contributor.advisor-co1.fl_str_mv |
Garcia, Pedro Celiny Ramos |
dc.contributor.advisor-co1Lattes.fl_str_mv |
http://buscatextual.cnpq.br/buscatextual/visualizacv.do?id=K4787221J8 |
dc.contributor.authorID.fl_str_mv |
014.591.620-05 |
dc.contributor.authorLattes.fl_str_mv |
http://buscatextual.cnpq.br/buscatextual/visualizacv.do?id=K4479220T7 |
dc.contributor.author.fl_str_mv |
Hartmann, Francine |
contributor_str_mv |
Fiori, Humberto Holmer Garcia, Pedro Celiny Ramos |
dc.subject.por.fl_str_mv |
MEDICINA PEDIATRIA BRONQUIOLITE UNIDADES DE TERAPIA INTENSIVA SURFACTANTES PULMONARES LACTENTE DOENÇAS AGUDAS |
topic |
MEDICINA PEDIATRIA BRONQUIOLITE UNIDADES DE TERAPIA INTENSIVA SURFACTANTES PULMONARES LACTENTE DOENÇAS AGUDAS CLINICA MEDICA::PEDIATRIA |
dc.subject.cnpq.fl_str_mv |
CLINICA MEDICA::PEDIATRIA |
description |
Objectives: To evaluate the response to surfactant of patients with acute bronchiolitis (AB) according the surfactant function and production, measured through the stable microbubble test and the lamellar body count. Study Design: Twenty four patients younger than 1 year of age, with the diagnosis of AB, who were in mechanical ventilation and received 100 mg of surfactant, according with the stablished routine by the pediatric intensive care unit, were studied. Previously to the administration, tracheal secretion was collected for virus identification, stable microbubble test and lamellar body count. Arterial blood gases were obtained. One hour, 6 hours and 24 hours after of surfactant administration arterial blood gases were again collected. Results: There was a 20% increase in PaO2 24 hours after surfactant administration in 2 (14.29%) of 14 patients with lamellar bodies ≤ 60.000 and in 5 (50%) of 10 patients with>60.000 lamellar bodies (p=0.08). Six (46.15%) of 13 patients with ≤13 microbubbles and one (9.09%) of 11 patients with>13 microbubbles had an increase in PaO2>20% after 24 hours of administration (p=0.08). Only 2 patients of 7 who responded to surfactant, had respiratory syncytial virus (RSV) positive. The patients with lamellar bodies ≤ 60.000 had a statistically significant increase in oxygenation after 6 hours of surfactant administration, not associated to a reduction of mechanical ventilation time or hospitalization time. The patients without positive RSV had a substantial increase in PaO2 after one hour after the administration of surfactant, that was maintained for 24 hours. Conclusion: The surfactant administration transiently improved oxygenation in patients with AVB. Patients who had no positive respiratory syncytial virus had an important improvement in oxygenation after administration of exogenous surfactant. LBC and SMT are not sufficiently sensitive and specific to predict who the patients with severe bronchiolitis responding to treatment with exogenous surfactant. |
publishDate |
2015 |
dc.date.accessioned.fl_str_mv |
2015-06-12T11:40:25Z |
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2015-03-23 |
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por |
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por |
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3098206005268432148 |
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600 600 600 600 |
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Pontifícia Universidade Católica do Rio Grande do Sul |
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Programa de Pós-Graduação em Medicina/Pediatria e Saúde da Criança |
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Brasil |
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Faculdade de Medicina |
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Pontifícia Universidade Católica do Rio Grande do Sul |
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