SR - Sistema Respiratório (Doenças pulmonares e respiratórias)
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- Cuidados de Enfermagem ao Doente Ventilado com Óxido NítricoPublication . Ramos, C.; Nunes, D.A Nitroterapia como forma de tratamento foi identificada pela primeira vez em 1987. Nesta data foi identificado o Óxido Nítrico (ON) como um factor de relaxamento derivado do endotélio, com uma acção importante na regulação do tónus vascular, na função plaquetária, na acção bactericida e modeladora do sistema imunitário. São diversas as situações clínicas em que se justifica a ventilação com ON no entanto, é possível estabelecer um factor comum entre elas : um quadro de Hipertensão Pulmonar. Na UCINP do Hospital Maria pia, foi iniciada a ventilação com ON no ano de 2000 e desde esta data foram já ventilados seis doentes com este gás, tendo sido obtidos resultados francamente satisfatórios.Nitroterapy was identified in 1987 as a way of treatment. In this year Nitric Oxide (NO) was divulged as a relaxation factor of the endothelium, with an important action on regulation of vascular tonus, plaquetary function, bactericide action and modeller of immunity system. Nitric Oxide is used especially in Pulmonary Hypertension. Since 2000, in the Intensive Care Unity of Maria Pia Hospital, six patients were ventilated using NO with good results.
- Displasia Broncopulmonar - Análise de 5 anos na Maternidade de Júlio DinisPublication . Miguez, M.; Mesquita, S.; Almeida, A.; Proença, E.A displasia broncopulmonar continua a ser uma patologia actual, com morbilidade e mortalidade importantes, no entanto, o conceito original criado por Northway et al tem sofrido algumas alterações ao longo do tempo. O presente trabalho pretende fazer uma análise retrospectiva dos casos de displasia broncopulmonar na Unidade de Cuidados Intensivos Neonatais da Maternidade Júlio Dinis, referente aos anos de 1997 a 2001, tentando relacionar alguns factores com o desenvolvimento desta patologia.
- Pneumonite intersticial crónicaPublication . Almeida, R.; Reis, G.; Ferreira, C.; Oliveira, M.; Oliveira, D.; Fernandes, P.; Ferreira, P.; Frutuoso, S.; Carreira, L.; Alves, V.; Paiva, A.; Guedes, M.A patologia pulmonar intersticial compreende um grupo de doenças crónicas caracterizadas por alterações das paredes alveolares e perda das unidades funcionais alveolocapilares. São doenças raras nas crianças, na sua maioria de causa desconhecida e revestindo-se habitualmente de uma elevada morbimortalidade, dada a pouca eficácia da terapêutica actualmente disponível. Os autores descrevem o caso clínico de uma criança de 3 anos, previamente saudável, que no contexto de uma infecção respiratória desenvolve um quadro de sibilância e insuficiência respiratória grave, na investigação do qual é diagnosticada uma pneumonite intersticial crónica. Foram tentadas diversas terapêuticas (corticoterapia sistémica, hidroxicloroquina, N-acetilcisteína) sem melhoria evidente.Interstitial lung disease includes a group of chronic diseases characterized by alterations in alveolar walls and loss of functional alveolar-capillary units. These are rare diseases in children, mostly with an unknown cause and associated with a high morbidity and mortality due to insufficient therapeutic effectiveness. The authors report a case of a previously healthy 3 years old child who presented with wheezing and severe respiratory insufficiency following a respiratory infection. The investigation performed led to the diagnosis of chronic interstitial pneumonitis. Several treatments have been tried (corticosteroids,hydroxychloroquine, N-acetylcysteine) without any obvious improvement.
- Abordagem diagnóstica e terapêutica das bronquiolites - revisão bibliográficaPublication . Bandeira, A.; Vieira, C.; Gomes, L.; Reis, G.; Guedes, M.RESUMO As bronquiolites são um problema de saúde frequente e potencialmente grave nos lactentes. Representam uma das principais causas de internamento hospitalar nos meses de Outono e Inverno. Até à data não existem estudos controlados e randomizados a provar a eficácia da maioria das atitudes terapêuticas. Os broncodilatadores, a adrenalina e os corticóides têm sido usados no tratamento, sem evidência comprovada da sua eficácia. Os autores fazem uma revisão dos conceitos de bronquiolite e dos níveis de evidência das várias atitudes terapêuticas, apresentando uma proposta de abordagem diagnóstica e terapêutica de acordo com a gravidade da situação clínica.
- Efeito da exposição prolongada a ruído ocupacional na função respiratória de trabalhadores da indústria têxtilPublication . Cardoso, A.; Oliveira, M.; Silva, A.; Águas, A.; Sousa-Pereira, A.Vibroacoustic disease is a pathology caused by long occupational exposure to large pressure amplitude and low frequency noise. It is a systemic disease, with evolvement of respiratory structures. The exposure workers to this noise of textile industry may favour alterations in lung function. We studied 28 women working more than ten years in cotton-mill rooms to evaluate their lung function, including Spirometry, forced oscillation technique (I.O.S.) and Diffusion capacity. These results were compared with those of 30 women of similar ages not exposed to similar noise and not presenting respiratory disease. Statistical significance (P<0.05) was found with FEV25, R5 and Delta Rs5-Rs20. There was a resistance frequency dependence in 36% of the population exposed to noise, not statistically confirmed. Neither restriction nor changes in diffusing capacity where detected. CONCLUSION: The analysis of global alterations of lung function parameters suggests small airways aggression by noise. However we cannot definitively exclude the influence of cotton dust inhalation in itself which effects could be increased by the loss of ciliated cells and impairment of airways clearance caused by noise.
- Hidroxicloroquina na hemossiderose pulmonar idiopática - Caso clínicoPublication . Almeida, M.; Reis, G.; Guedes, M.Os autores apresentam o caso de uma criança com hemossiderose pulmonar idiopática grave, que, após ter iniciado tratamento com hidroxicloroquina, apresentou alteração do seu curso clínico, com melhoria significativa e duradoura. A eficácia desta terapêutica é salientada. Reportam ainda a ocorrência de exacerbação clínica, com hemoptise, após administração de vacina antigripal. The authors present the case of a child with severe idiopathic pulmonary hemosiderosis who after having begun treatment with hydroxychloroquine had a significant and lasting improvement. The efficacy of this therapeutic is pointed out. They also report the occurrence of clinical exacerbation, with hemoptysis, after receiving an influenza vaccine.
- A case-control study on risk factors for early-onset respiratory tract infection in patients admitted in ICUPublication . Cardoso, T.; Lopes, M.; Carneiro, A.BACKGROUND: Respiratory tract infections are common in intensive care units (ICU), with incidences reported from 10 to 65%, and case fatality rates over 20% in pneumonia. This study was designed to identify risk factors for the development of an early onset respiratory tract infection (ERI) and to review the microbiological profile and the effectiveness of first intention antibiotic therapy. METHODS: Case-control, retrospective clinical study of the patients admitted to the Intensive Care Unit (ICU) of our hospital, a teaching and tertiary care facility, from January to September 2000 who had a respiratory tract infection diagnosed in the first 5 days of hospital stay. RESULTS: Of the 385 patients admitted to our unit: 129 (33,5%) had a diagnosis of ERI and 86 patients were admitted to the control group. Documented aspiration (adjusted OR = 5,265; 95% CI = 1,155 - 24,007) and fractured ribs (adjusted OR = 12,150; 95% CI = 1,571 - 93,941) were found to be independent risk factors for the development of ERI (multiple logistic regression model performed with the diagnostic group as dependent variable and adjusted for age, sex, SAPS II, documented aspiration, non-elective oro-tracheal intubation (OTI), fractured ribs, pneumothorax and pleural effusion).A total of 78 organisms were isolated in 61 patients (47%). The normal flora of the upper airway (Streptococcus pneumoniae, Staphylococcus aureus, Haemophilus influenza and Moraxella catharralis) accounted for 72% of all isolations achieved, polimicrobian infections were responsible for 25% of all microbiological documented infections. First intention treatment was, in 62% of the patients, the association amoxacillin+clavulanate, being effective in 75% of the patients to whom it was administered. The patients with ERI needed more days of OTI (6 vs 2, p < 0,001) and mechanical ventilation (6 vs 2, p < 0,001) and had a longer ICU (7 vs 2, p < 0,001) and hospital length of stay (17 vs 11, p = 0,018), when compared with controls. CONCLUSION: In this study documented tracheobronchial aspiration and fractured ribs were identified as independent risk factors for ERI. Microbiological profile was dominated by sensitive micro-organisms. The choice amoxacilin+clavulanate revealed to be a good option with an effectiveness rate of 77% in the patients in whom it was used.
- A importância do estudo da difusão alvéolo-capilar,Publication . PAES CARDOSO, A.; REIS FERREIRA, J.M.; MOREIRA DA SILVA, A.Rev Port Pneumol. 2007 Nov-Dec;13(6):763-74. [The importance of diffusing capacity as a complementary study to plethysmography in smokers] [Article in Portuguese] Paes Cardoso A, Reis Ferreira JM, Moreira da Silva A. Human Physiology, Porto University, Instituto de Ciências Biomédicas de Abel Salazar, Santo António Hospital. Abstract This study comprised 194 male and female heavy smokers or ex-smokers (>or= 1 pack-year) aged between 20 and 82, whose symptoms varied. Cases were only selected from patients with normal whole-body plethysmography. Subjects with any significant pathology and occupational risk factors were excluded from the study. Varying degrees of symptoms were found and a range of results from normal plethysmography examination, with abnormal levels of alveolar-capillary transfer, determined by the single-breath method to analyse CO (TLCO and TLCO-VA) coefficients. Using the chi-square test for statistical analysis of the sample revealed a significant variation in sensitivity between both parameters (p=0.0001). Possible limitations of using the single-breath method, of were reduced in this study (ventilatory restriction with Vital Capacity <1.5 litres) by the routine plethysmography results seen. Likewise, the presence of alterations in ventilatory distribution was, in principle, minimised by the absence of TLCsb/TLCplet values below 0.85% CONCLUSIONS: Normal plethysmography results in heavy or ex-smokers are not enough to confirm normal respiratory function, as a large percentage of cases present abnormalities in the alveolar-capillary transfer factor for CO. Alveolar limitation was considered not only anatomically, but also from a functional perspective. PMID: 18183328 [PubMed - indexed for MEDLINE]
- Non-invasive ventilation in cardiogenic pulmonary edema in the emergency department.Publication . Carvalho, L.; Carneiro, R.; Freire, E.; Pinheiro, P.; Aragão, I.; Martins, A.Abstract Bilevel positive pressure (BiPAP) non-invasive ventilation (NIV) is frequently used in our emergency department (ED), as an adjuvant in the treatment of acute cardiogenic pulmonary edema (ACPE) to reduce the need for tracheal intubation (TI) in these patients. The purpose of our study was to evaluate the safety of NIV in patients with ACPE in our ED, used by a group of physicians outside the intensive care unit (ICU), by comparing our results with previously published results. We also wanted to identify possible additional advantages of NIV in the treatment of acpe. We recorded clinical and physiological data before and after NIV of all patients with diagnosis and treatment of ACPE in our ED and for whom NIV was ordered as adjuvant treatment, between July 2004 and February 28 2005. During this period, NIV was ordered in 17 patients with ACPE. The mean ventilation pressures used were p(INSP) 16.5 +/- 5 cm H2O and p(exp) 8.8 +/- 4 cm H2O. none of the patients refused NIV. In six patients NIV was not initiated immediately together with medical therapeutics. one patient required Ti and the other 16 (94%) improved after NIV. After the acpe episode had resolved, fourteen patients (82%) were eventually discharged from hospital whereas 3 (18%) died during hospitalization. We observed a statistically significant improvement after one hour of NIV in respiratory and pulse rate, arterial pH, PaCO2 and peripheral blood O2 saturation. Despite the small sample size, these results suggest that it is possible to use NIV in the treatment of ACPE outside the ICU, without increasing the risks of TI or decreasing efficacy. In these cases NIV probably accelerates clinical resolution and relieves symptoms.
- EFEITO DO ENVELHECIMENTO CRONOLÓGICO NA FUNÇÃO PULMONAR: COMPARAÇÃO DA FUNÇÃO RESPIRATÓRIA ENTRE ADULTOS E IDOSOS SAUDÁVEISPublication . Ruivo, S.; Viana, P.; Martins, C.; Baeta, C.