IAH was frequent in patients undergoing abdominal surgeries during ICU stay, and it predicted the occurrence of AKI. Serial assessments of IAP did not provided better discriminatory power than initial evaluation.
Objective: To evaluate the diagnostic performance of the rapid shallow breathing index (RSBI) in predicting extubation failure among adult patients in the intensive care unit and to determine the appropriateness of the classical RSBI cut-off value. Methods: This was a prospective study conducted in the adult intensive care unit of the Botucatu School of Medicine Hospital das Clínicas. The RSBI was evaluated in 73 consecutive patients considered clinically ready for extubation. Results: The classical RSBI cut-off value (105 breaths/min/L) presented a sensitivity of 20% and a specificity of 95% (sum = 115%). Analysis of the receiver operator characteristic (ROC) curve revealed a better cut-off value (76.5 breaths/min/L), which presented a sensitivity of 66% and a specificity of 74% (sum = 140%). The area under the ROC curve for the RSBI was 0.78. Conclusions: The classical RSBI cut-off value proved inappropriate, predicting only 20% of the cases of extubation failure in our sample. The new cut-off value provided substantial improvement in sensitivity, with an acceptable loss of specificity. The area under the ROC curve indicated that the discriminative power of the RSBI is satisfactory, which justifies the validation of this index for use.Keywords: Adult; Intensive care; ROC curve; Ventilator weaning; Diagnosis; Respiration, artificial. ResumoObjetivo: Avaliar o desempenho diagnóstico do índice de respiração rápida e superficial (IRRS) na predição do insucesso da extubação de pacientes adultos em terapia intensiva e verificar a adequação do valor de corte clássico para esse índice. Métodos: Estudo prospectivo realizado na unidade de terapia intensiva de adultos do Hospital das Clínicas da Faculdade de Medicina de Botucatu, através da avaliação do IRRS em 73 pacientes consecutivos considerados clinicamente prontos para extubação. Resultados: O IRRS com valor de corte clássico (105 ciclos/min/L) apresentou sensibilidade de 20% e especificidade de 95% (soma = 115%). A análise da curva receiver operator characteristic (ROC) demonstrou melhor valor de corte (76,5 ciclos/min/L), o qual forneceu sensibilidade de 66% e especificidade de 74% (soma = 140%), e a área sob a curva ROC para o IRRS foi de 0,78. Conclusões: O valor de corte clássico do IRRS se mostrou inadequado nesta casuística, prevendo apenas 20% dos pacientes com falha na extubação. A obtenção do novo valor de corte permitiu um acréscimo substancial de sensibilidade, com aceitável redução da especificidade. O valor da área sob a curva ROC indicou satisfatório poder discriminativo do índice, justificando a validação de sua aplicação.
BackgroundChronic kidney disease (CKD) is one of the most serious public health problems. The increasing prevalence of CKD in developed and developing countries has led to a global epidemic. The hypothesis proposed is that patients undergoing dialysis would experience a marked negative influence on physiological variables of sleep and autonomic nervous system activity, compromising quality of life.Methods/DesignA prospective, consecutive, double blind, randomized controlled clinical trial is proposed to address the effect of dialysis on sleep, pulmonary function, respiratory mechanics, upper airway collapsibility, autonomic nervous activity, depression, anxiety, stress and quality of life in patients with CKD. The measurement protocol will include body weight (kg); height (cm); body mass index calculated as weight/height2; circumferences (cm) of the neck, waist, and hip; heart and respiratory rates; blood pressures; Mallampati index; tonsil index; heart rate variability; maximum ventilatory pressures; negative expiratory pressure test, and polysomnography (sleep study), as well as the administration of specific questionnaires addressing sleep apnea, excessive daytime sleepiness, depression, anxiety, stress, and quality of life.DiscussionCKD is a major public health problem worldwide, and its incidence has increased in part by the increased life expectancy and increasing number of cases of diabetes mellitus and hypertension. Sleep disorders are common in patients with renal insufficiency. Our hypothesis is that the weather weight gain due to volume overload observed during interdialytic period will influence the degree of collapsibility of the upper airway due to narrowing and predispose to upper airway occlusion during sleep, and to investigate the negative influences of haemodialysis in the physiological variables of sleep, and autonomic nervous system, and respiratory mechanics and thereby compromise the quality of life of patients.Trial registrationThe protocol for this study is registered with the Brazilian Registry of Clinical Trials (ReBEC RBR-7yhr4w and World Health Organization under Universal Trial Number UTN: U1111-1127-9390 [http://www.ensaiosclinicos.gov.br/rg/RBR-7yhr4w/]).
Durante a gestação, diversas alterações fisiológicas e psicológicas podem ocorrer no organismo da gestante, incluindo o desenvolvimento ou agravamento de patologias psiquiátricas, como a depressão, que são influenciadas pelas diversas alterações hormonais, sociais e comportamentais da mulher durante esse período. Objetivo: Esse trabalho tem por objetivo avaliar as consequências da depressão gestacional no desenvolvimento fetal. Metodologia: Essa revisão integrativa da literatura foi realizada por meio de pesquisa nas bases de dados SciELO, PubMed e BVS utilizando os seguintes descritores e operadores booleanos: antepartum depression OR gestational depression AND fetal development NOT postpartum. Resultados: A grande maioria apresentou resultados positivos da influência da depressão materna no desenvolvimento fetal, com apenas três artigos não encontrando relações evidentes. Há associações entre a depressão gestacional com o desenvolvimento cerebral do feto, alterações de expressões genéticas e desfechos desfavoráveis, dentre eles o parto prematuro, menor comprimento e peso ao nascer e diminuição do perímetro cefálico. Dos treze artigos incluídos, todos são observacionais analíticos, sendo doze destes do tipo coorte e um caso-controle. Conclusão: Apesar dos resultados positivos, é fundamental ter um padrão metodológico das pesquisas sobre o tema, a fim de cessar dúvidas geradas por artigos contraditórios em pontos específicos. Além disso, levar em consideração outros fatores, como sociais e econômicos, para que haja resultados confiáveis para reforçar a importância do cuidado envolvendo a saúde mental de gestantes.
Introduction: The Chronic Kidney Disease (CKD) is characterized as a clinical condition wherein the progressive loss of renal function for a period longer than months to years will lead to the onset of end-stage renal disease (ESRD). In the advanced stages of CKD, patients can only be treated with replacement therapy, dialysis or transplantation. In this context, hemodialysis (HD) presents as the main treatment option for these patients due to the lack of donors. Patients with ESRD in HD often present signs and symptoms related to pre-existing or acquired comorbidities with worsening of the disease. The most frequent are electrolytic disturbances, anemia, malnutrition, bone disease, Melittus diabetes, systemic arterial hypertension, gastrointestinal disorders, respiratory disorders, cardiovascular diseases, neurological changes and sleep disorders. Obstructive sleep apnea (OSA) presents a tenfold prevalence in patients with ESRD when compared to the general population, worsening the clinical symptoms and cardiovascular complications of this disease. The increase in the number of ESRD patients submitted to HD has assumed epidemic proportions worldwide. The causal association between sleep-disordered breathing, in particular OSA and ESRD, is still not well understood, which expands the possibility of new findings for the prevention, diagnosis and treatment of OSA, improving quality of life and reducing morbimortality. Objective: The present study involving ESRD patients undergone HD was designed with three main objectives: 1) to verify the prevalence and severity of sleep-disordered breathing; 2) to analyze the behavior of sleep apnea / hypopnea index (AHI) during the interdialitic period; 3) to verify weight gain and anthropometric measurements during the interdialitic period. A consecutive single-center cross-sectional clinical study will be performed, double-blind, non-randomized to investigate the behavior of AHI in patients with ESRD undergoing HD in the nephrology unit (UNEFRO) at the Hospital of Santa Casa de Misericordia de Avaré, (SP), Brazil. The design and conduct of this study followed the guidelines of the Strengthening the Reporting of Observational Studies in Epidemiology (STROBE) statement. Trial Registration: This protocol follows the STROBE (STrengthening the Reporting of OBservational studies in Epidemiology) and the study has been registered on ClinicalTrials.gov (NCT02390193).
A mudança da rotina do tratamento de fisioterapia provocada pela pandemia do coronavírus (COVID-19) tem contribuído para a regressão de ganhos funcionais e aparecimento de deformidades ósseas e articulares. O objetivo deste estudo foi identificar o impacto da pandemia de COVID-19 na rotina do tratamento de fisioterapia e no desempenho funcional de crianças e adolescentes com Paralisia Cerebral (PC) sob a ótica dos pais. Trata-se de um estudo transversal qualitativo descritivo que coletou informações sobre a rotina dos atendimentos de fisioterapia antes e durante a pandemia COVID-19 e do desempenho funcional de crianças e adolescentes com Paralisia Cerebral de 6 até 18 anos provenientes da região sudeste do Brasil sob a perceptiva dos pais Os danos provocados pela interrupção do tratamento de fisioterapia foram maiores entre os indivíduos mais graves (GMFCS 4 e 5) evidenciando a necessidade de validação do atendimento remoto e a elaboração de políticas públicas abrangentes com o objetivo de garantir a segurança do paciente em serviços essenciais como a fisioterapia durante situações emergencias futuras.
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