Máscara laríngea como opção para ventilação com pressão positiva de recém-nascidos em sala de parto.
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Data
2018-01-05
Autores
Tannuri, Abdo Eduardo Garbim
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Universidade Estadual Paulista (Unesp)
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Tannuri AEG. Máscara laríngea como opção para ventilação com pressão positiva de recém-nascidos em sala de parto (dissertação). Botucatu: Faculdade de Medicina de Botucatu-UNESP; 2018. Introdução: A ventilação com pressão positiva (VPP) é o procedimento mais importante e efetivo na reanimação neonatal em sala de parto. Quando ocorre falha da ventilação com balão e máscara é necessária a intubação orotraqueal (IOT), que é um procedimento complexo, que exige maior nível de treinamento e experiência do profissional que presta assistência. A máscara laríngea é uma opção de interface que permite o estabelecimento da VPP de forma rápida e efetiva, podendo ser manuseada por profissionais menos experientes. O objetivo deste estudo foi avaliar o tempo para o estabelecimento da VPP eficaz, realizada por profissionais com diferentes níveis de experiência, utilizando três tipos de interface (máscara facial-MF, máscara laríngea-ML e cânula orotraqueal-COT), comparando as interfaces e os profissionais entre si. Métodos: Estudo experimental, com manequim de simulação, com participação de médicos com diferentes níveis de formação em reanimação neonatal, divididos em dois grupos: G1-médicos pediatras em formação (residentes de Pediatria Geral); G2-Neonatologistas e residentes de Neonatologia. Após treinamento, foi proposta situação simulada de reanimação neonatal e os participantes realizaram a ventilação utilizando os 3 dispositivos. As variáveis estudadas foram: falha para estabelecer ventilação, tempo despendido para ventilação efetiva e valores pressóricos obtidos. Resultados: Participaram 40 médicos no G1 e 24 no G2. Os tempos médios para ventilação efetiva nos grupos G1e G2 foram, respectivamente: MF=12±8s vs 11±6s; ML=15±6s vs 14±4s; IOT=31±16s vs 24±6s. Falha na IOT ocorreu em 25% no G1 vs 8% no G2 (P=0,18). Nos dois grupos o tempo médio para IOT foi superior aos demais dispositivos. Os valores pressóricos médios foram adequados com as três interfaces. Conclusão: A ML teve desempenho semelhante à MF e foi eficaz no estabelecimento da VPP em tempo mais curto que a intubação, independentemente da experiência do profissional.
Tannuri AEG. Laryngeal mask as an option for positive pressure ventilation of newborns in the delivery room. (dissertação). Botucatu: Faculdade de Medicina de Botucatu-UNESP; 2018. Background: Positive-pressure ventilation (PPV) is the most important and effective procedure in neonatal resuscitation in the delivery room. In case of balloon and mask ventilation faillure orotracheal intubation (IOT) is required. This procedure is complex and requires higher level of training and experience of the caregiver. Laryngeal mask is na interface option that allows the establishment of VPP in a fast and effective way, and can be handled by less experienced professionals. The objective of this study was to evaluate the time to establish effective PPV, performed by professionals with different levels of experience, using three types of interface (FM-face mask, laryngeal mask-LM and orotracheal cannula-OTC). Comparisons where done among interfaces and between professionals. Methods: Experimental study, using simulation manikin, with participation of physicians with diferente levels of training in neonatal resuscitation, divided into two groups: G1-pediatricians in training (residents of General Pediatrics); G2-Neonatologists and residents of Neonatology. After training, a simulated neonatal resuscitation situation was proposed and the participants performed ventilation using the 3 devices. The studied variables were: failure to establish ventilation, time spent for effective ventilation and pressure values obtained. Results: 40 physicians participated in G1 and 24 in G2. The mean times for effective ventilation in the G1 and G2 groups were, respectively: FM = 12 ± 8s vs 11 ± 6s; LM = 15 ± 6s vs 14 ± 4s; OTC = 31 ± 16s vs 24 ± 6s. Failure of intubation occurred in 25% in G1 vs 8% in G2 (P = 0.18). In both groups the mean time to intubation was higher than the other devices. Mean pressure values were adequate with all three interfaces. Conclusion: Laryngeal mask performed similarly to face mask and was effective in establishing PPV in a shorter time than intubation, regardless of the professional experience.
Tannuri AEG. Laryngeal mask as an option for positive pressure ventilation of newborns in the delivery room. (dissertação). Botucatu: Faculdade de Medicina de Botucatu-UNESP; 2018. Background: Positive-pressure ventilation (PPV) is the most important and effective procedure in neonatal resuscitation in the delivery room. In case of balloon and mask ventilation faillure orotracheal intubation (IOT) is required. This procedure is complex and requires higher level of training and experience of the caregiver. Laryngeal mask is na interface option that allows the establishment of VPP in a fast and effective way, and can be handled by less experienced professionals. The objective of this study was to evaluate the time to establish effective PPV, performed by professionals with different levels of experience, using three types of interface (FM-face mask, laryngeal mask-LM and orotracheal cannula-OTC). Comparisons where done among interfaces and between professionals. Methods: Experimental study, using simulation manikin, with participation of physicians with diferente levels of training in neonatal resuscitation, divided into two groups: G1-pediatricians in training (residents of General Pediatrics); G2-Neonatologists and residents of Neonatology. After training, a simulated neonatal resuscitation situation was proposed and the participants performed ventilation using the 3 devices. The studied variables were: failure to establish ventilation, time spent for effective ventilation and pressure values obtained. Results: 40 physicians participated in G1 and 24 in G2. The mean times for effective ventilation in the G1 and G2 groups were, respectively: FM = 12 ± 8s vs 11 ± 6s; LM = 15 ± 6s vs 14 ± 4s; OTC = 31 ± 16s vs 24 ± 6s. Failure of intubation occurred in 25% in G1 vs 8% in G2 (P = 0.18). In both groups the mean time to intubation was higher than the other devices. Mean pressure values were adequate with all three interfaces. Conclusion: Laryngeal mask performed similarly to face mask and was effective in establishing PPV in a shorter time than intubation, regardless of the professional experience.
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Palavras-chave
ressuscitação, recém-nascido, ventilação pulmonar, máscara laríngea