Artigo Original/Original Article
Estratégias de suporte ventilatório no recém-nascido pré-termo – Inquérito nacional (2008)
Respiratory support strategies for the preterm newborn – National survey 2008
Gustavo Rocha
, Joana Saldanha*,2, Israel Macedo*,3, Augusta Areias*,4
,1,**
Corresponding author
gusrocha@oninet.pt
Correspondência/Correspondence to: Gustavo Rocha Serviço de Neonatologia, Departamento de Pediatria Hospital de São João, Piso 2 Alameda Professor Hernâni Monteiro 4202-451 Porto, Telefone: 225512100, extensão/extension 1949 Fax: 225512273.
Correspondência/Correspondence to: Gustavo Rocha Serviço de Neonatologia, Departamento de Pediatria Hospital de São João, Piso 2 Alameda Professor Hernâni Monteiro 4202-451 Porto, Telefone: 225512100, extensão/extension 1949 Fax: 225512273.
1 Serviço de Neonatologia, Hospital de São João, Porto/Neonatal Unit, Hospital de São João, Porto
2 Unidade de Neonatologia, Hospital de Santa Maria, Lisboa/Neonatal Unit, Hospital de Santa Maria, Lisboa
3 Unidade de Neonatologia, Maternidade Dr. Alfredo da Costa, Lisboa/Neonatal Unit, Maternidade Dr. Alfredo da Costa, Lisboa
4 Unidade de Neonatologia, Maternidade Júlio Dinis, Centro Hospitalar do Porto, Porto/Neonatal Unit, Maternidade Júlio Dinis, Centro Hospitalar do Porto, Porto
* Comissão de Investigação Científica da Secção de Neonatologia da Sociedade Portuguesa de Pediatria/Portuguese Society of Paediatrics Neonatology Section Scientific Research Committee
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"autores" => array:1 [ 0 => array:4 [ "autoresLista" => "Gustavo Rocha, Joana Saldanha, Israel Macedo, Augusta Areias" "autores" => array:4 [ 0 => array:4 [ "nombre" => "Gustavo" "apellidos" => "Rocha" "email" => array:1 [ 0 => "gusrocha@oninet.pt" ] "referencia" => array:3 [ 0 => array:2 [ "etiqueta" => "*" "identificador" => "af0025" ] 1 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">1</span>" "identificador" => "af0005" ] 2 => array:2 [ "etiqueta" => "**" "identificador" => "cr0005" ] ] ] 1 => array:3 [ "nombre" => "Joana" "apellidos" => "Saldanha" "referencia" => array:2 [ 0 => array:2 [ "etiqueta" => "*" "identificador" => "af0025" ] 1 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">2</span>" "identificador" => "af0010" ] ] ] 2 => array:3 [ "nombre" => "Israel" "apellidos" => "Macedo" "referencia" => array:2 [ 0 => array:2 [ "etiqueta" => "*" "identificador" => "af0025" ] 1 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">3</span>" "identificador" 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Júlio Dinis, Centro Hospitalar do Porto, Porto" "etiqueta" => "4" "identificador" => "af0020" ] 4 => array:3 [ "entidad" => "Comissão de Investigação Científica da Secção de Neonatologia da Sociedade Portuguesa de Pediatria/Portuguese Society of Paediatrics Neonatology Section Scientific Research Committee" "etiqueta" => "*" "identificador" => "af0025" ] ] "correspondencia" => array:1 [ 0 => array:3 [ "identificador" => "cr0005" "etiqueta" => "**" "correspondencia" => "<span class="elsevierStyleBold">Correspondência/<span class="elsevierStyleItalic">Correspondence to:</span></span> Gustavo Rocha Serviço de Neonatologia, Departamento de Pediatria Hospital de São João, Piso 2 Alameda Professor Hernâni Monteiro 4202-451 Porto, Telefone: 225512100, extensão/extension 1949 Fax: 225512273." ] ] ] ] "titulosAlternativos" => array:1 [ "en" => array:1 [ "titulo" => "Respiratory support strategies for the preterm newborn – National survey 2008" ] ] "pdfFichero" => "main.pdf" "tienePdf" => true "fechaRecibido" => "2008-10-28" "fechaAceptado" => "2009-05-18" "PalabrasClave" => array:2 [ "pt" => array:1 [ 0 => array:4 [ "clase" => "keyword" "titulo" => "Palavras-chave" "identificador" => "xpalclavsec570334" "palabras" => array:5 [ 0 => "Recém-nascido" 1 => "ventilação" 2 => "doença pulmonar crónica da prematuridade" 3 => "doença das membranas hialinas" 4 => "saturação de oxigénio" ] ] ] "en" => array:1 [ 0 => array:4 [ "clase" => "keyword" "titulo" => "Key-words" "identificador" => "xpalclavsec570333" "palabras" => array:5 [ 0 => "Newborn" 1 => "ventilation" 2 => "chronic lung disease of prematurity" 3 => "respiratory distress syndrome" 4 => "oxygen saturation" ] ] ] ] "tieneResumen" => true "resumen" => array:2 [ "pt" => array:2 [ "titulo" => "Resumo" "resumen" => "<span id="as0005" class="elsevierStyleSection elsevierViewall"><p id="sp0005" class="elsevierStyleSimplePara elsevierViewall"><span class="elsevierStyleBold">Introdução:</span> As estratégias de suporte ventilatório utilizadas no recém-nascido têm sido motivo de grande investigação.</p><p id="sp0010" class="elsevierStyleSimplePara elsevierViewall"><span class="elsevierStyleBold">Objectivos:</span> Avaliar as práticas de suporte ventilatório nas unidades de neonatologia nacionais utilizadas na assistência ao recém-nascido de extremo baixo peso e avaliar se estão em conformidade com a prática baseada na evidência.</p><p id="sp0015" class="elsevierStyleSimplePara elsevierViewall"><span class="elsevierStyleBold">Métodos:</span> Foi enviado, por via electrónica, a 31 unidades de neonatologia nacionais, um inquérito sobre tipos de ventiladores, modos de ventilação, monitorização da função pulmonar, valores de saturação de oxigénio permitidos e prevalência de doença pulmonar crónica da prematuridade.</p><p id="sp0020" class="elsevierStyleSimplePara elsevierViewall"><span class="elsevierStyleBold">Resultados:</span> A percentagem de resposta foi de 94%. O modelo de ventilador Draeger Babylog é o mais utilizado. Doze (41%) unidades preconizam o NCPAP precoce. A ventilação sincronizada é de eleição em 24 (83%) unidades (SIMV, SIPPV, PSV) e 4 (14%) têm possibilidade de ventilação por alta frequência oscilatória. O modo ventilatório SIMV é o mais utilizado (n<span class="elsevierStyleHsp" style=""></span>=<span class="elsevierStyleHsp" style=""></span>13, 45%) no “desmame” ventilatório. O surfactante exógeno é usado preferencialmente de modo profiláctico em 12 (41%) unidades. Todas as unidades usam valores de função respiratória no ajuste dos parâmetros ventilatórios e cinco (17%) utilizam monitorização contínua da PaCO<span class="elsevierStyleInf">2</span>: medição transcutânea<span class="elsevierStyleHsp" style=""></span>=<span class="elsevierStyleHsp" style=""></span>3; capnometria<span class="elsevierStyleHsp" style=""></span>=<span class="elsevierStyleHsp" style=""></span>2. Dezassete (59%) unidades utilizam valores de saturação de oxigénio de 90%-95% na doença das membranas hialinas e 15 (52%) utilizam valores de 85%-90% na doença pulmonar crónica da prematuridade. A prevalência de doença pulmonar crónica da prematuridade variou entre os 0% e os 75% (mediana: 10).</p><p id="sp0025" class="elsevierStyleSimplePara elsevierViewall"><span class="elsevierStyleBold">Conclusão:</span> As estratégias de suporte ventilatório usadas nas unidades portuguesas reflectem, em parte, a evidência de estudos multicêntricos aleatorizados. É necessário mais investimento no uso de NCPAP precoce, preferencialmente com <span class="elsevierStyleItalic">prongs</span> binasal, uso do modo SIPPV no “desmame” ventilatório, uso de estratégias ventilatórias com volumes correntes optimizados e utilização criteriosa de surfactante exógeno, de modo a assegurar a prática baseada na evidência.</p><p id="sp0030" class="elsevierStyleSimplePara elsevierViewall"><span class="elsevierStyleBold">Rev Port Pneumol 2009; XV (6): 1043-1071</span></p></span>" ] "en" => array:2 [ "titulo" => "Abstract" "resumen" => "<span id="as0010" class="elsevierStyleSection elsevierViewall"><p id="sp0035" class="elsevierStyleSimplePara elsevierViewall"><span class="elsevierStyleBold">Background:</span> Respiratory support strategies for the preterm newborn have been the subject of intense research.</p><p id="sp0040" class="elsevierStyleSimplePara elsevierViewall"><span class="elsevierStyleBold">Aim:</span> To survey neonatal respiratory support practices in Portugal and to determine whether they reflect evidence from randomised trials.</p><p id="sp0045" class="elsevierStyleSimplePara elsevierViewall"><span class="elsevierStyleBold">Methods:</span> Questionnaires were given out to 31 Portuguese neonatal units to determine the types of ventilators, modes of ventilation, lung function monitoring, use of exogenous surfactant, oxygen saturation levels used and the prevalence of chronic lung disease in the preterm newborn.</p><p id="sp0050" class="elsevierStyleSimplePara elsevierViewall"><span class="elsevierStyleBold">Results:</span> There was a 94% response rate. Draeger babylog was the most frequently used ventilator in neonates. Twelve (41%) units prefer to use early nasal continuous positive airway pressure (NCPAP) whenever possible. Triggered ventilation is the choice of invasive ventilation in 24 (83%) units (SIMV, SIPPV, PSV); four (14%) units have high frequency oscillation ventilation. SIMV is the most frequent (n<span class="elsevierStyleHsp" style=""></span>=<span class="elsevierStyleHsp" style=""></span>13, 45%) weaning mode. Exogenous surfactant is used as prophylactic in 12 (41%) units. All units use lung function measurements to aid choice of ventilator settings and five (17%) units monitor PaCO<span class="elsevierStyleInf">2</span> (transcutaneous<span class="elsevierStyleHsp" style=""></span>=<span class="elsevierStyleHsp" style=""></span>3; capnometry<span class="elsevierStyleHsp" style=""></span>=<span class="elsevierStyleHsp" style=""></span>2). Seventeen (59%) units allow oxygen saturation levels from 90% to 95% in infants with respiratory distress syndrome and 15 (52%) levels from 85% to 90% in infants with chronic lung disease. Prevalence of chronic lung disease of prematurity ranged from 0% to 75% (median: 10).</p><p id="sp0055" class="elsevierStyleSimplePara elsevierViewall"><span class="elsevierStyleBold">Conclusions:</span> Many respiratory strategies for extremely low birth weight infants reflect the result of large randomised trials. More effective methods may be required to encourage the use of early NCPAP preferably with binasal prongs, the use of SIPPV as the main weaning mode, the use of volume targeted ventilation and a more judicious use of exogenous surfactant in order to ensure evidence–based practice.</p><p id="sp0060" class="elsevierStyleSimplePara elsevierViewall"><span class="elsevierStyleBold">Rev Port Pneumol 2009; XV (6): 1043-1071</span></p></span>" ] ] "lecturaRecomendada" => array:1 [ 0 => array:3 [ "vista" => "all" "titulo" => "<span class="elsevierStyleSectionTitle" id="st0025">Bibliografia/Bibliography</span>" "seccion" => array:1 [ 0 => array:2 [ "vista" => "all" "bibliografiaReferencia" => array:40 [ 0 => array:3 [ "identificador" => "bb0005" "etiqueta" => "1." 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"autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:6 [ 0 => "A. Castillo" 1 => "A. Sola" 2 => "H. Baquero" 3 => "F. Neira" 4 => "R. Alvis" 5 => "R. Deulofeut" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1542/peds.2007-0117" "Revista" => array:6 [ "tituloSerie" => "Pediatrics" "fecha" => "2008" "volumen" => "121" "paginaInicial" => "882" "paginaFinal" => "889" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/18450890" "web" => "Medline" ] ] ] ] ] ] ] ] 39 => array:3 [ "identificador" => "bb0200" "etiqueta" => "40." "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Oxygen-saturation targets and outcomes in extremely preterm infants" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:4 [ 0 => "L.M. Askie" 1 => "D.J. Henderson-Smart" 2 => "L. Irwing" 3 => "J.M. 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Article information
ISSN: 08732159Original language: Portuguese
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| 2023 March | 25 | 21 | 46 |
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| 2021 April | 56 | 27 | 83 |
| 2021 March | 48 | 17 | 65 |
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| 2020 December | 23 | 5 | 28 |
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| 2018 February | 20 | 11 | 31 |
| 2018 January | 30 | 15 | 45 |
| 2017 December | 20 | 18 | 38 |
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| 2017 April | 12 | 15 | 27 |
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| 2016 April | 3 | 3 | 6 |
| 2016 March | 2 | 11 | 13 |
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| 2015 December | 8 | 5 | 13 |
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