Surfactante pulmonar : avaliação e terapia na bronquiolite viral aguda grave

Detalhes bibliográficos
Autor(a) principal: Hartmann, Francine
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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spelling 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). 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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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