A randomized trial of nebulized 3% hypertonic saline with salbutamol in the treatment of acute bronchiolitis in hospitalized infants

OBJECTIVE: Acute bronchiolitis is a common disorder of infants that often results in hospitalization. Apart from supportive care, no therapy has been shown to influence the course of the disease, except for a possible effect of nebulized hypertonic saline (HS). To determine whether this does have beneficial effects on length of stay in hospital or on severity scores, we undertook a double-blind, randomized, controlled trial in a pediatric department of a Portuguese hospital. METHODS: Previously healthy infants, younger than 12 months, hospitalized with mild-to-moderate acute viral bronchiolitis were randomized to receive either nebulized 3% (hypertonic, HS) or 0.9% (normal, NS) saline during their entire hospital stay. Primary endpoints were: length of hospital stay and severity scores on each day of hospitalization. Need for supplemental oxygen, further add-on medications and adverse effects were also analyzed. RESULTS: Sixty-eight patients completed the study (HS: 33; NS: 35). The median length of hospital stay did not differ between groups: HS: 5.6 ± 2.3 days; NS: 5.4 ± 2.1 days (P = 0.747). We found no difference between groups in severity scores from day 1 to day 4. There were no differences in need for supplemental oxygen or add-on medications. Patients in HS group had significantly more cough (46% vs. 20%, P = 0.025) and rhinorrhoe (58% vs. 31%, P = 0.30). CONCLUSION: This study does not support the use of nebulized HS over NS in therapy of hospitalized children with mild-to-moderate acute viral bronchiolitis

Determinação de elementos traço em amostras ambientais por ICP OES

Neste trabalho é avaliada a aplicação da técnica de ICP OES (Espectrometria de Emissão com Plasma Indutivamente Acoplado) para a determinação de elementos traço em amostras ambientais. Foram investigados os comportamentos de As, Ba, Cd, Co, Cu, Cr, Mn, Ni, Pb, V e Zn, utilizando-se espectrômetro com vista de observação axial/radial do plasma e sistema de detecção baseado em dispositivos de carga acoplada (CCD). No presente estudo, foi avaliado o desempenho dos nebulizadores pneumáticos do tipo concêntrico (Meinhard), “cross flow” e GemCone® acoplados às câmaras de nebulização de duplo passo (Scott) e ciclônica, bem como do nebulizador ultra-sônico para a introdução de amostras no plasma. Investigou-se a robustez do plasma, potência de radiofreqüência (RF), vazão dos gases de nebulização e auxiliar, bem como a altura de observação, para ambas as vistas de observação do plasma. Sob condições otimizadas os limites de detecção (LD), em ng mL-1, para os elementos As, Ba, Cd, Co, Cr, Cu, Mn, Ni, Pb, V e Zn, em solução aquosa de HNO3 5% (v/v), utilizando-se a configuração axial do plasma, foram: 1,1 - 16; 0,002 - 0,32; 0,03 - 1,2; 0,02 - 0,72; 0,03 - 0,82; 0,04 - 3,0; 0,003 - 0,76; 0,08 - 3,8; 0,22 - 8,9; 0,04 - 2,6; e 0,02 - 1,2 respectivamente. Utilizando-se a configuração radial, os LDs (ng mL-1) dos mesmos elementos foram: 10 - 87; 0,01 - 0,91; 0,07 - 3,8; 0,16 - 4,3; 0,13 - 8,1; 0,16 - 4,3; 0,01 - 0,81; 0,43 - 7,6; 1,4 - 37; 0,28 - 6,0 e 0,77 - 9,5 respectivamente. Com relação à nebulização pneumática, os LDs são relativamente mais baixos quando é utilizado o nebulizador concêntrico acoplado à câmara de nebulização ciclônica. LDs ainda melhores são obtidos mediante o uso de nebulização ultra-sônica mas, neste caso, foi observado que o plasma é menos robusto. As metodologias foram desenvolvidas mediante o uso de materiais de referência certificados sendo analisados os seguintes materiais: sedimento marinho (PACS-2/NRCC), folhas de maçã (apple leaves – 1515/NIST) e água (natural water – 1640/NIST), obtendo-se concentrações concordantes com as certificadas, com exceção do Ni em folha de maçã, que não foi detectado utilizando-se a nebulização pneumática e também não pôde ser determinado com exatidão mediante o uso de nebulizador ultra-sônico. Interferências não espectrais observadas na análise de sedimento marinho foram contornadas através da diluição da amostra, ou através da lavagem da câmara de nebulização com solução de HNO3 5% (v/v), por 60 s entre cada ciclo de leitura. Estas interferências não puderam ser contornadas com o uso de padrão interno (PI). A interferência espectral do As sobre o Cd não foi observada fazendo-se a medição do sinal em área de pico, demarcado com somente 3 pontos/pico. Após serem estabelecidas as metodologias de análise, foram analisadas as seguintes amostras não certificadas: água de rio, água subterrânea (poço artesiano), água tratada e de chuva, folhas de eucalipto e bambu, acículas de pinus e infusão de chá preto, sendo possível quantificar baixas concentrações dos elementos investigados, utilizando-se a calibração externa.

Efeitos do desfluorano, sevofluorano e isofluorano sobre variáveis respiratórias e hemogasométricas em cães

Com este estudo objetivou-se avaliar, comparativamente, os efeitos de três anestésicos inalatórios sobre variáveis respiratórias e hemogasométricas em cães. Para tal, utilizaram-se 30 cães sadios, adultos, machos e fêmeas evitando-se aquelas em estro ou em gestação. Os animais foram separados e protocolados em três grupos de 10 cães cada (G1, G2 e G3). Induziu-se a anestesia geral com administração intravenosa de propofol, na dose de 10±1,3 mg/kg. em seguida procedeu-se à intubação orotraqueal e anestesia geral inalatória pelo desfluorano (G1), sevofluorano (G2) e isofluorano (G3), diluídos em oxigênio a 100,00%, por meio de circuito anestésico tipo semi-fechado, dotado de vaporizadores calibrados para cada agente anestésico. As variáveis estudadas foram Freqüência Respiratória, CO2 ao Final da Expiração, Saturação de Oxihemoglobina, Volume Corrente, Volume Minuto, Pressão Parcial Arterial de O2, Pressão Parcial Arterial de CO2, Excesso de Bases e pH. A avaliação estatística destas variáveis foi realizada pela Análise de Perfil, sendo considerado o nível de significância de 5,00%. Os resultados obtidos permitiram concluir que o desfluorano deprime o sistema respiratório aumentando a pressão parcial arterial de CO2 e o CO2 ao final da expiração; e diminuindo a pressão parcial arterial de O2 e o volume minuto, quando comparado com os outros anestésicos em teste.

Uma intervenção educativa para profissionais de saúde na prevenção de pneumonia associada à ventilação mecânica

Quasi-experimental study, prospective with quantitative approach, performed at the Hospital do Coração in Natal, aimed at verified the existence of difference between the care given by health professionals to the patients under mechanical ventilation (MV) in the Intensive Care Unit, before and after an educative intervention. The population was of 31 professionals, with data collected between november 05 of 2007 to march 27 of 2008. The results show a yong population, female gender, middle level of education, nursing technique, working between 05 and 09 years on nursing profession, and 01 to 04 years on Intensive Care Unit; almost all, never had an kind of training over prevent pneumonia associated to mechanical ventilation; from those that had training, occur on the work place with duration from 12 to 24 hours. About endotracheal intubation, the cuff was tested with a sterilized syringe had a positive change after a educative intervention, increased from 75,0% to 100,0%; the sterile guide was used on 75,0% before and 100,0% after an educative intervention. Regarding endotracheal suction procedure, was not informed to the patient on 72,7% before, however was informed on 56,7% after; the hands was not previously washed 68,5% before, however was 63,3% after the procedure; mask was used on 74,2 % opportunities before and 76,7% after; the aspiration catheter had adequated size on 98,9% observation before and 100,0% after; the gaze was sterilized on 95,7% before and 100,0% after; the ventilator was connected to the patient during the aspiration intervals on 94,4% observation before and 100,0% after; the ambu bag was clean and protected on 76,1% before and 85,7% after; the aspiration catheter was discarded after be used on 98,9% before and 100,0% after; FIO2 was turned to the begging value on 32,9% observation before and 12,0% after; before the procedure 71,9% professions washed their hands and 73,3% after; before, notes of aspiration results were performed on 70,8% observation and 86,7% after. Regarding devices used on respiratory tract, aspirator flasks were not swapped on 84,6% observations before and 71,0% after; daily látex extention change was not performed on 93,6% observation before and 87,1% after; the ambu bag change was not performed on 50,0% observation before even if was duty or unprotected and on 75,8% opportunities was changed, after; nebulization was not prepared with sterile fluids or manipulated aseptically on 65,2% observation before, perhaps was on 71,7% after; before nebulizers were not changed on 65,2% observations, perhaps were on 60,9% after. Concerning ventilator breathing circuits, condense fluids cumulated on circuits were removed on 55,0% opportunities before, and 64,0% after; moisturizer was not filled with sterile water when already had small amount of liquid inside on 78,4% observations before, and 90,2% after; MV circuits were changed on 97,0% observations on presence of visible duty or when presents some kind of failure, before and 98,4% after. About body position, on 51,3% observations the decubitus position change were done before and 78,2% after; fowler position was maitened on 95,5% observations before and 98,2% after; Regarding respiratory physiotherapy, enteral diet was not interrupted before respiratory physiotherapy on 94,9% before and 90,0% after; respiratory physiotherapy devices were not disinfected or sterile on 69,6% observations before but they re on 60,0% after; before the cateter was not tested before introduction enteral diet or medications on 100,0% but after was done on 15,2%. About enteral feeding, intestine motility and measure of stomach contents were not done on 100,0% observations before, but was 15,2% after. We conclude that 05 of 07 valuated procedures in relation to MV, had a significant improvement on quality of care given after educative intervention, when compared before intervention

Gestión del boil off gas en la planta de regasificación de Cartagena

Este proyecto trata sobre la gestión del boil-off gas, o BOG (vapor de gas natural que se produce en las instalaciones de gas natural licuado de las plantas de regasificación), generado en la planta de regasificación de Gas Natural Licuado de Cartagena, tanto en las situaciones en las que se opera por debajo del mínimo técnico, como en las cargas y descargas de buques, en las cuales se ha de gestionar una cantidad del boil-off adicional. Para recuperar el boil-off, las plantas cuentan con un relicuador (intercambiador de calor) en el que el BOG es relicuado por el GNL que se envía a los vaporizadores para ser regasificado y emitido a la red. De forma complementaria cuentan también con una antorcha/venteo donde se quema el exceso de boil-off que no puede ser tratado por el relicuador. Se procede a un análisis de la situación actual, y de cómo la baja demanda de regasificación dificulta la gestión del boil-off. Se simula el proceso de relicuación actual en distintas situaciones de operación. Ante la situación de baja demanda, ha aumentado considerablemente el número de días en los que las plantas españolas en general, y la planta de Cartagena en particular, operan por debajo del mínimo técnico, que es el nivel de producción mínimo para recuperar todo el boil-off generado en cualquier situación de operación al tiempo que mantiene en frío todas las instalaciones, y garantiza el 100% de disponibilidad inmediata del resto de los equipos en condiciones de seguridad de funcionamiento estable. Esta situación supone inconvenientes tanto operativos como medioambientales y acarrea mayores costes económicos, a los cuales da solución el presente proyecto, decidiendo qué alternativa técnica es la más adecuada y definiéndola. Abstract This project is about the management of the boil-off gas (BOG), natural vapour gas that is produced in liquefied natural gas (LNG) regasification plants. Specifically, the study is focused on the LNG regasification plant located in Cartagena, when it operates both below the technical minimum level of regasification and in the loading/unloading of LNG carriers, situations when it is needed to handle additional BOG. In order to make the most of BOG, the plants have a re-condenser (heat exchanger). Here, the BOG is re-liquefied by the LNG that is submitted to the vaporizers and delivered to the grid. The plants also have a flare/vent where the excess of BOG that cannot be treated by the re-condenser is burned. An analysis of the current situation of the demand is performed, evaluating how low markets demand for regasification difficult the BOG management. Besides, it is simulated the current re-liquefaction operating in different environments. Due to the reduction of the demand for natural gas, the periods when Spanish LNG regasification plants (and particularly the factory of Cartagena) are operating below the technical minimum level of regasification are more usual. This level is the minimum production to recover all the BOG generated in any operating situation while maintaining cold all facilities, fully guaranteeing the immediate availability from other equipment in a safely and stable operation. This situation carries both operational and environmental drawbacks, and leads to higher economic costs. This project aims to solve this problem, presenting several technical solutions and deciding which is the most appropriate.