109 resultados para respiratory insufficiens


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Conselho Nacional de Desenvolvimento Científico e Tecnológico (CNPq)

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Objectives: The effectiveness of noninvasive positive-pressure ventilation in preventing reintubation due to respiratory failure in children remains uncertain. A pilot study was designed to evaluate the frequency of extubation failure, develop a randomization approach, and analyze the feasibility of a powered randomized trial to compare noninvasive positive-pressure ventilation and standard oxygen therapy post extubation for preventing reintubation within 48 hours in children with respiratory failure.Design: Prospective pilot study.Setting: PICU at a university-affiliated hospital.Patients: Children aged between 28 days and 3 years undergoing invasive mechanical ventilation for greater than or equal to 48 hours with respiratory failure after programmed extubation.Interventions: Patients were prospectively enrolled and randomly assigned into noninvasive positive-pressure ventilation group and inhaled oxygen group after programmed extubation from May 2012 to May 2013.Measurements and Main Results: Length of stay in PICU and hospital, oxygenation index, blood gas before and after tracheal extubation, failure and reason for tracheal extubation, complications, mechanical ventilation variables before tracheal extubation, arterial blood gas, and respiratory and heart rates before and 1 hour after tracheal extubation were analyzed. One hundred eight patients were included (noninvasive positive-pressure ventilation group, n = 55 and inhaled oxygen group, n = 53), with 66 exclusions. Groups did not significantly differ for gender, age, disease severity, Pediatric Risk of Mortality at admission, tracheal intubation, and mechanical ventilation indications. There was no statistically significant difference in reintubation rate (noninvasive positive-pressure ventilation group, 9.1%; inhaled oxygen group, 11.3%; p > 0.05) and length of stay (days) in PICU (noninvasive positive-pressure ventilation group, 3 [116]; inhaled oxygen group, 2 [1-25]; p > 0.05) or hospital (noninvasive positive-pressure ventilation group, 19 [7-141]; inhaled oxygen group, 17 [8-80]).Conclusions: The study indicates that a larger randomized trial comparing noninvasive positive-pressure ventilation and standard oxygen therapy in children with respiratory failure is feasible, providing a basis for a future trial in this setting. No differences were seen between groups. The number of excluded patients was high.

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Purpose. The present study aimed to compare actors/actresses's voices and vocally trained subjects through aerodynamic and electroglottographic (EGG) analyses. We hypothesized that glottal and breathing functions would reflect technical and physiological differences between vocally trained and untrained subjects.Methods. Forty participants with normal voices participated in this study (20 professional theater actors and 20 untrained participants). In each group, 10 male and 10 female subjects were assessed. All participants underwent aerodynamic and EGG assessment of voice. From the Phonatory Aerodynamic System, three protocols were used: comfortable sustained phonation with EGG, voice efficiency with EGG, and running speech. Contact quotient was calculated from EGG. All phonatory tasks were produced at three different loudness levels. Mean sound pressure level and fundamental frequency were also assessed. Univariate, multivariate, and correlation statistical analyses were performed.Results. Main differences between vocally trained and untrained participants were found in the following variables: mean sound pressure level, phonatory airflow, subglottic pressure, inspiratory airflow duration, inspiratory airflow, and inspiratory volume. These variables were greater for trained participants. Mean pitch was found to be lower for trained voices.Conclusions. The glottal source seemed to have a weak contribution when differentiating the training status in speaking voice. More prominent changes between vocally trained and untrained participants are demonstrated in respiratory-related variables. These findings may be related to better management of breathing function (better breath support).

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BACKGROUND: Previous studies have evaluated the effectiveness of postural drainage (PD), percussion (PERC), the coughing technique (CT), and other types of coughing in subjects with bronchiectasis. However, the application times of these techniques and the quality of the expectorated mucus require further study. The aim of our study was to evaluate the effectiveness of PD, percussion, CT, and huffing in subjects with bronchiectasis and assess the quantity and quality of bronchial mucus produced (measurement of wet and dry weight and determination of viscoelastic properties). METHODS: Twenty-two subjects with stable bronchiectasis (6 men; mean age: 51.5 y) underwent 4 d of experimental study (CT, PD+CT, PD+PERC+CT, and PD+huffing). The techniques were performed in 3 20-min periods separated by 10 min of rest. Before performing any technique (baseline) and after each period (30, 60, and 90 min), expectorated mucus was collected for analysis of viscoelasticity. RESULTS: A significant increase in the dry weight/wet weight ratio was found after 60 min of PD+PERC+CT (P = .01) and 90 min of PD+huffing (P = .03) and PD+PERC+CT (P = .007) in comparison with CT. PD+PERC+CT and PD+huffing led to the greatest removal of viscoelastic mucus at 60 min (P = .02 and P = .002, respectively) and continued to do so at 90 min (P = .02 and P = .01, respectively) in comparison with CT. An interaction effect was found, as all techniques led to a greater removal of elastic mucus in comparison with CT at 60 min (PD+CT, P = .001; PD+PERC+CT, P < .001; PD+huffing, P < .001), but only PD+PERC+CT and PD+huffing led to a greater removal of elastic mucus than CT at 90 min (P < .001 and P = .005, respectively). CONCLUSIONS: PD+PERC+CT and PD+huffing performed similarly regarding the removal of viscoelastic mucus in 2 and 3 20-min periods separated by 10 min of rest. PD+PERC+CT led to the greatest removal of mucus in the shortest period (2 20-min periods separated by 10 min of rest). (C) 2015 Daedalus Enterprises

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Conselho Nacional de Desenvolvimento Científico e Tecnológico (CNPq)

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Fundação de Amparo à Pesquisa do Estado de São Paulo (FAPESP)

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Fundação de Amparo à Pesquisa do Estado de São Paulo (FAPESP)

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1. 1. The respiration of the different castes of two species of leaf-cutting ants, Atta laevigata and Atta sexdens rubropilosa was measured in both workers and sexed forms. 2. 2. The respiratory rates (μl O2/mg(live)/hr) were, in A. laevigata, 0.644 (gardeners), 0.594 (cutters), 0.354 (soldiers), 0.233 (males) and 0.085 (females); in A. s. rubropilosa, 0.803 (gardeners), 0.748 (cutters), 0.510 (soldiers), 0.375 (males) and 0.274 (females), significantly higher than A. laevigata. 3. 3. All castes considered, the b-values of the equation relating oxygen consumption and weight in A. laevigata (0.53) were significantly different from that in A. s. rubropilosa (0.73). © 1981.

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We compared the effects of two anesthesia protocols in both immediate recovery time (IRT) and postoperative respiratory complications (PRCs) after laparotomy for bariatric surgery, and we determined the association between the longer IRT and the increase of PRC incidence. We conducted the study in two stages: (i) in a randomized controlled trial (RCT), patients received either intervention (sevoflurane-remifentanil-rocuronium-ropivacaine) or control protocol (isoflurane-sufentanil-atracurium-levobupivacaine). All patients received general anesthesia plus continuous epidural anesthesia and analgesia. Treatment was masked for all, except the provider anesthesiologist. We defined IRT as time since anesthetics discontinuation until tracheal extubation. Primary outcomes were IRT and PRCs incidence within 15 days after surgery. We also analyzed post-anesthesia care unit (PACU) and hospital length of stays; (ii) after the end of the RCT, we used the available data in an extension cohort study to investigate IRT > 20 min as exposure factor for PRCs. Control protocol (n = 152) resulted in longer IRT (30.4 ± 7.9 vs 18.2 ± 9.6 min; p < 0.0001), higher incidence of PRCs (6.58 vs 2.5 %; p = 0.048), and longer PACU and hospital stays than intervention protocol (n = 200); PRC relative risk (RR) = 2.6. Patients with IRT > 20 min (n = 190) presented higher incidence of PRCs (7.37 vs 0.62 %; p < 0.0001); RR = 12.06. Intervention protocol, with short-acting anesthetics, was more beneficial and safe compared to control protocol, with long-acting drugs, regarding the reduction of IRT, PRCs, and PACU and hospital stays for laparotomy in bariatric patients. We identified a 4.5-fold increase in the relative risk of PRCs when morbid obese patients are exposed to an IRT > 20 min.

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1. Respiratory rates of workers of the leaf cutting ant Atta sexdens rubropilosa were measured at different oxygen pressures, at 25°C. 2. In experiments where different ants were used at each of the oxygen pressures, respiration was regulated down to 70.8 mmHg. 3. When the same ants were submitted in sequence to declining pO2, the 'oxygen dependence indexes' (Tang P.S. (1933) Quart. Rev. Biol. 8, 260-274) also suggested a good regulatory capacity. 4. The results are discussed in terms of the variation of the partial pressures of O2 and CO2 that the ants probably encounter when wandering to and from the nest to forage, and when performing their heavy tasks (leaf transport, offspring and fungus care). 5. CO2 rise and O2 fall, from ants' respiration inside the ant hill, may act as the factors that, in a reflex way, keep the spiracles open and increase ventilation and the frequency of CO2 emission to keep the oxygen supply adequate to face the energetic demand of the routine level of activity of the workers, when passing from normoxia (air) to hypoxia (in nest galleries).