Síndrome do Desconforto Respiratório Agudo Pediátrico (SDRAp): frequência, mortalidade, trocas gasosas e terapêuticas empregadas na UTI Pediátrica do Hospital das Clínicas da Faculdade de Medicina de Botucatu- análise retrospectiva de 3 anos
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Data
2019-06-26
Autores
Antoniazzi, Carolina de Lima
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Universidade Estadual Paulista (Unesp)
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INTRODUÇÃO: Em 1994, a Conferência de Consenso Americano-Européia estabeleceu pela primeira vez critérios diagnósticos para definir a Síndrome do Desconforto Respiratório Agudo (SDRA), critérios estes utilizados desde então em adultos e crianças. Em 2012, uma nova definição – a chamada definição de Berlim – foi proposta para adultos, porém sem referências quanto à sua aplicabilidade na faixa etária pediátrica. Em 2015 foi publicado o Pediatric Acute Lung Injury Consensus Conference (PALICC) que teve como objetivo definir SDRA em pediatria (SDRAp), especificando fatores predisponentes, etiologia e fisiopatologia. OBJETIVOS: Estratificar a gravidade da SDRAp, bem como descrever sua frequência e mortalidade na UTI Pediátrica do Hospital das Clinicas da Faculdade de Medicina de Botucatu utilizando os novos critérios definidos pelo PALICC; comparar a estratégia ventilatória utilizada com o que é atualmente recomendado pela Conferência de Consenso em SDRAp e descrever a frequência de utilização de terapias adjuvantes. MÉTODOS: Os dados foram obtidos do prontuário eletrônico de todos os pacientes internados na unidade no período compreendido entre 30 de julho de 2012 a 30 de julho de 2015. Foram aplicados os critérios para diagnóstico e classificação da SDRAp para todos os pacientes com diagnóstico de insuficiência respiratória aguda (IRA) e realizada estatística descritiva dos dados. RESULTADOS: Foram analisados 396 prontuários durante o período estabelecido, sendo que 148 (37,4%) foram incluídos no estudo, todos com o diagnóstico de IRA. Dentre estes, 35 (23,6%) preencheram critérios diagnósticos para SDRAp, sendo 14 classificados como SDRAp leve (40%), 8 como SDRAp moderada (23%) e 13 como SDRAp grave (37%). A mortalidade por SDRAp foi de 20%, sendo 14,3% nos casos leves e 23% nos graves. As médias da pressão inspiratória (Pip), da pressão expiratória final positiva (PEEP) e do gradiente de pressão (Pip – PEEP) máximas utilizadas nos casos graves foram respectivamente 27 cmH2O, 11 cmH2O e 13 cmH2O e a média da FiO2 máxima foi de 60%. A média da PaCO2 variou de 43 mmHg (SDRAp leve) a 58 mmHg (SDRAp grave). A posição prona foi utilizada em todos os casos graves e na maioria dos casos moderados e a ventilação oscilatória de alta frequência (VOAF) associada ao óxido nítrico inalatório (NOi) foram utilizados em todos os casos de SDRAp grave. CONCLUSĀO: A SDRAp representou quase ¼ das internações por insuficiência respiratória aguda na UTIP do HC da Faculdade de Medicina de Botucatu e 8,8% do total de internações no período estudado. A maioria dos casos de SDRAp foram leves, seguidos dos casos graves e moderados respectivamente. Apesar da mortalidade alta, a mesma, permaneceu abaixo do que é descrito na literatura. A ventilação mecânica utilizada pode ser considerada protetora. A posição prona e o NOi foram as terapias adjuvantes mais utilizadas.
INTRODUCTION: In 1994, the American-European Consensus Conference first established diagnostic criteria to define Acute Respiratory Distress Syndrome (ARDS), criteria that have since been used in adults and children. In 2012, a new definition - the so-called Berlin definition - was proposed for adults, but without references as to its applicability in the pediatric age group. In 2015, the Pediatric Acute Lung Injury Consensus Conference (PALICC) was published to define ARDS in pediatrics (ARDS), specifying predisposing factors, etiology and pathophysiology. OBJECTIVES: To clarify the severity of ARDS, as well as to describe its incidence and mortality in the Pediatric ICU of Hospital das Clinicas da Faculdade de Medicina de Botucatu using the new criteria defined by the PALICC; compare the ventilatory strategy used with what is currently recommended by the Consensus Conference in ARDS and describe the frequency of use of adjuvant therapies. METHODS: The data were obtained from the electronic records of all patients hospitalized in the unit from July 30, 2012 to July 30, 2015. The criteria for diagnosis and classification of ARDS were applied to all patients with a diagnosis of insufficiency (ARI) and performed descriptive statistics of the data. RESULTS: A total of 396 records were analyzed during the study period, of which 148 (37.4%) were included in the study, all with ARI diagnosis. Of these, 35 (23.6%) fulfilled diagnostic criteria for ARDS, with 14 classified as mild ARDS (40%), 8 as moderate ARDS (23%) and 13 as severe ARDS (37%). Mortality due to ARDS was 20%, with 14.3% in mild cases and 23% in severe cases. The mean inspiratory pressure (PEP), maximal positive end - expiratory pressure (PEEP) and pressure gradient (Pip - PEEP) used in severe cases were 27 cmH2O, 11 cmH2O and 13 cmH2O, respectively, and the mean maximum FiO2 was 60%. The mean PaCO2 ranged from 43 mmHg (mild ARDS) to 58 mmHg (severe ARDS). The prone position was used in all severe and in most cases moderate cases and high frequency oscillatory ventilation (HFOV) associated with inhaled nitric oxide (NOi) were used in all cases of severe ARDS. CONCLUSION: SDRAp accounted for almost ¼ of hospitalizations for acute respiratory failure in the PICU of the HC of Botucatu and 8.8% of the total hospitalizations in the period studied. Most cases of ARDS were mild, followed by severe and moderate cases, respectively. Despite the high mortality rate, it remained below what is described in the literature. The mechanical ventilation used may be considered protective. The prone position and NOi were the most commonly used adjuvant therapies.
INTRODUCTION: In 1994, the American-European Consensus Conference first established diagnostic criteria to define Acute Respiratory Distress Syndrome (ARDS), criteria that have since been used in adults and children. In 2012, a new definition - the so-called Berlin definition - was proposed for adults, but without references as to its applicability in the pediatric age group. In 2015, the Pediatric Acute Lung Injury Consensus Conference (PALICC) was published to define ARDS in pediatrics (ARDS), specifying predisposing factors, etiology and pathophysiology. OBJECTIVES: To clarify the severity of ARDS, as well as to describe its incidence and mortality in the Pediatric ICU of Hospital das Clinicas da Faculdade de Medicina de Botucatu using the new criteria defined by the PALICC; compare the ventilatory strategy used with what is currently recommended by the Consensus Conference in ARDS and describe the frequency of use of adjuvant therapies. METHODS: The data were obtained from the electronic records of all patients hospitalized in the unit from July 30, 2012 to July 30, 2015. The criteria for diagnosis and classification of ARDS were applied to all patients with a diagnosis of insufficiency (ARI) and performed descriptive statistics of the data. RESULTS: A total of 396 records were analyzed during the study period, of which 148 (37.4%) were included in the study, all with ARI diagnosis. Of these, 35 (23.6%) fulfilled diagnostic criteria for ARDS, with 14 classified as mild ARDS (40%), 8 as moderate ARDS (23%) and 13 as severe ARDS (37%). Mortality due to ARDS was 20%, with 14.3% in mild cases and 23% in severe cases. The mean inspiratory pressure (PEP), maximal positive end - expiratory pressure (PEEP) and pressure gradient (Pip - PEEP) used in severe cases were 27 cmH2O, 11 cmH2O and 13 cmH2O, respectively, and the mean maximum FiO2 was 60%. The mean PaCO2 ranged from 43 mmHg (mild ARDS) to 58 mmHg (severe ARDS). The prone position was used in all severe and in most cases moderate cases and high frequency oscillatory ventilation (HFOV) associated with inhaled nitric oxide (NOi) were used in all cases of severe ARDS. CONCLUSION: SDRAp accounted for almost ¼ of hospitalizations for acute respiratory failure in the PICU of the HC of Botucatu and 8.8% of the total hospitalizations in the period studied. Most cases of ARDS were mild, followed by severe and moderate cases, respectively. Despite the high mortality rate, it remained below what is described in the literature. The mechanical ventilation used may be considered protective. The prone position and NOi were the most commonly used adjuvant therapies.
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síndrome do desconforto respiratório agudo, mortalidade, ventilação mecânica, crianças, acute respiratory distress syndrome, mortality, mechanical ventilation, children