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        "resumen" => "<span class="elsevierStyleSectionTitle">Background</span><p id="spar0030" class="elsevierStyleSimplePara elsevierViewall">Respiratory support strategies for the preterm newborn have been the subject of intense research&#46;</p> <span class="elsevierStyleSectionTitle">Aim</span><p id="spar0035" class="elsevierStyleSimplePara elsevierViewall">To survey neonatal respiratory support practices in Portugal and to determine whether they reflect evidence from randomised trials&#46;</p> <span class="elsevierStyleSectionTitle">Methods</span><p id="spar0040" class="elsevierStyleSimplePara elsevierViewall">Questionnaires were given out to 31 Portuguese neonatal units to determine the types of ventilators&#44; modes of ventilation&#44; lung function monitoring&#44; use of exogenous surfactant&#44; oxygen saturation levels used and the prevalence of chronic lung disease in the preterm newborn&#46;</p> <span class="elsevierStyleSectionTitle">Results</span><p id="spar0045" class="elsevierStyleSimplePara elsevierViewall">There was a 94&#37; response rate&#46; Draeger babylog was the most frequently used ventilator in neonates&#46; Twelve &#40;41&#37;&#41; units prefer to use early nasal continuous positive airway pressure &#40;NCPAP&#41; whenever possible&#46; Triggered ventilation is the choice of invasive ventilation in 24 &#40;83&#37;&#41; units &#40;SIMV&#44; SIPPV&#44; PSV&#41;&#59; four &#40;14&#37;&#41; units have high frequency oscillation ventilation&#46; SIMV is the most frequent &#40;n<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>13&#44; 45&#37;&#41; weaning mode&#46; Exogenous surfactant is used as prophylactic in 12 &#40;41&#37;&#41; units&#46; All units use lung function measurements to aid choice of ventilator settings and five &#40;17&#37;&#41; units monitor PaCO<span class="elsevierStyleInf">2</span> &#40;transcutaneous &#61; 3&#59; capnometry &#61; 2&#41;&#46; Seventeen &#40;59&#37;&#41; units allow oxygen saturation levels from 90&#37; to 95&#37; in infants with respiratory distress syndrome and 15 &#40;52&#37;&#41; levels from 85&#37; to 90&#37; in infants with chronic lung disease&#46; Prevalence of chronic lung disease of prematurity ranged from 0&#37; to 75&#37; &#40;median&#58; 10&#41;&#46;</p> <span class="elsevierStyleSectionTitle">Conclusions</span><p id="spar0050" class="elsevierStyleSimplePara elsevierViewall">Many respiratory strategies for extremely low birth weight infants reflect the result of large randomised trials&#46; More effective methods may be required to encourage the use of early NCPAP preferably with binasal prongs&#44; the use of SIPPV as the main weaning mode&#44; the use of volume targeted ventilation and a more judicious use of exogenous surfactant in order to ensure evidence&#8211;based practice&#46;</p>"
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        "resumen" => "<span class="elsevierStyleSectionTitle">Introdu&#231;&#227;o</span><p id="spar0005" class="elsevierStyleSimplePara elsevierViewall">As estrat&#233;gias de suporte ventilat&#243;rio utilizadas no rec&#233;m-nascido t&#234;m sido motivo de grande investiga&#231;&#227;o&#46;</p> <span class="elsevierStyleSectionTitle">Objectivos</span><p id="spar0010" class="elsevierStyleSimplePara elsevierViewall">Avaliar as pr&#225;ticas de suporte ventilat&#243;rio nas unidades de neonatologia nacionais utilizadas na assist&#234;ncia ao rec&#233;m-nascido de extremo baixo peso e avaliar se est&#227;o em conformidade com a pr&#225;tica baseada na evid&#234;ncia&#46;</p> <span class="elsevierStyleSectionTitle">M&#233;todos</span><p id="spar0015" class="elsevierStyleSimplePara elsevierViewall">Foi enviado&#44; por via electr&#243;nica&#44; a 31 unidades de neonatologia nacionais&#44; um inqu&#233;rito sobre tipos de ventiladores&#44; modos de ventila&#231;&#227;o&#44; monitoriza&#231;&#227;o da fun&#231;&#227;o pulmonar&#44; valores de satura&#231;&#227;o de oxig&#233;nio permitidos e preval&#234;ncia de doen&#231;a pulmonar cr&#243;nica da prematuridade&#46;</p> <span class="elsevierStyleSectionTitle">Resultados</span><p id="spar0020" class="elsevierStyleSimplePara elsevierViewall">A percentagem de resposta foi de 94&#37;&#46; O modelo de ventilador Draeger Babylog &#233; o mais utilizado&#46; Doze &#40;41&#37;&#41; unidades preconizam o NCPAP precoce&#46; A ventila&#231;&#227;o sincronizada &#233; de elei&#231;&#227;o em 24 &#40;83&#37;&#41; unidades &#40;SIMV&#44; SIPPV&#44; PSV&#41; e 4 &#40;14&#37;&#41; t&#234;m possibilidade de ventila&#231;&#227;o por alta frequ&#234;ncia oscilat&#243;ria&#46; O modo ventilat&#243;rio SIMV &#233; o mais utilizado &#40;n<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>13&#44; 45&#37;&#41; no &#8220;desmame&#8221; ventilat&#243;rio&#46; O surfactante ex&#243;geno &#233; usado preferencialmente de modo profil&#225;ctico em 12 &#40;41&#37;&#41; unidades&#46; Todas as unidades usam valores de fun&#231;&#227;o respirat&#243;ria no ajuste dos par&#226;metros ventilat&#243;rios e cinco &#40;17&#37;&#41; utilizam monitoriza&#231;&#227;o cont&#237;nua da PaCO<span class="elsevierStyleInf">2</span>&#58; medi&#231;&#227;o transcut&#226;nea &#61; 3&#59; capnometria &#61; 2&#46; Dezassete &#40;59&#37;&#41; unidades utilizam valores de satura&#231;&#227;o de oxig&#233;nio de 90&#37;&#8211;95&#37; na doen&#231;a das membranas hialinas e 15 &#40;52&#37;&#41; utilizam valores de 85&#37;&#8211;90&#37; na doen&#231;a pulmonar cr&#243;nica da prematuridade&#46; A preval&#234;ncia de doen&#231;a pulmonar cr&#243;nica da prematuridade variou entre os 0&#37; e os 75&#37; &#40;mediana&#58; 10&#41;&#46;</p> <span class="elsevierStyleSectionTitle">Conclus&#227;o</span><p id="spar0025" class="elsevierStyleSimplePara elsevierViewall">As estrat&#233;gias de suporte ventilat&#243;rio usadas nas unidades portuguesas reflectem&#44; em parte&#44; a evid&#234;ncia de estudos multic&#234;ntricos aleatorizados&#46; &#201; necess&#225;rio mais investimento no uso de NCPAP precoce&#44; preferencialmente com <span class="elsevierStyleItalic">prongs</span> binasal&#44; uso do modo SIPPV no &#8220;desmame&#8221; ventilat&#243;rio&#44; uso de estrat&#233;gias ventilat&#243;rias com volumes correntes optimizados e utiliza&#231;&#227;o criteriosa de surfactante ex&#243;geno&#44; de modo a assegurar a pr&#225;tica baseada na evid&#234;ncia&#46;</p>"
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Respiratory support strategies for the preterm newborn – National survey 2008
Estratégias de suporte ventilatório no recém-nascido pré-termo – Inquérito nacional (2008)
Gustavo Rocha
,1,
Corresponding author
gusrocha@oninet.pt

Correspondence to/Correspondência: 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.
, Joana Saldanha
,2
, Israel Macedo
,3
, Augusta Areias
,4
¿ Comissão de Investigação Científica da Secção de Neonatologia da Sociedade Portuguesa de Pediatria/Portuguese Society of Paediatrics Neonatology Section Scientific Research Committee
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
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        "titulo" => "Estrat&#233;gias de suporte ventilat&#243;rio no rec&#233;m-nascido pr&#233;-termo &#8211; Inqu&#233;rito nacional &#40;2008&#41;"
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        "titulo" => "Abstract"
        "resumen" => "<span class="elsevierStyleSectionTitle">Background</span><p id="spar0030" class="elsevierStyleSimplePara elsevierViewall">Respiratory support strategies for the preterm newborn have been the subject of intense research&#46;</p> <span class="elsevierStyleSectionTitle">Aim</span><p id="spar0035" class="elsevierStyleSimplePara elsevierViewall">To survey neonatal respiratory support practices in Portugal and to determine whether they reflect evidence from randomised trials&#46;</p> <span class="elsevierStyleSectionTitle">Methods</span><p id="spar0040" class="elsevierStyleSimplePara elsevierViewall">Questionnaires were given out to 31 Portuguese neonatal units to determine the types of ventilators&#44; modes of ventilation&#44; lung function monitoring&#44; use of exogenous surfactant&#44; oxygen saturation levels used and the prevalence of chronic lung disease in the preterm newborn&#46;</p> <span class="elsevierStyleSectionTitle">Results</span><p id="spar0045" class="elsevierStyleSimplePara elsevierViewall">There was a 94&#37; response rate&#46; Draeger babylog was the most frequently used ventilator in neonates&#46; Twelve &#40;41&#37;&#41; units prefer to use early nasal continuous positive airway pressure &#40;NCPAP&#41; whenever possible&#46; Triggered ventilation is the choice of invasive ventilation in 24 &#40;83&#37;&#41; units &#40;SIMV&#44; SIPPV&#44; PSV&#41;&#59; four &#40;14&#37;&#41; units have high frequency oscillation ventilation&#46; SIMV is the most frequent &#40;n<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>13&#44; 45&#37;&#41; weaning mode&#46; Exogenous surfactant is used as prophylactic in 12 &#40;41&#37;&#41; units&#46; All units use lung function measurements to aid choice of ventilator settings and five &#40;17&#37;&#41; units monitor PaCO<span class="elsevierStyleInf">2</span> &#40;transcutaneous &#61; 3&#59; capnometry &#61; 2&#41;&#46; Seventeen &#40;59&#37;&#41; units allow oxygen saturation levels from 90&#37; to 95&#37; in infants with respiratory distress syndrome and 15 &#40;52&#37;&#41; levels from 85&#37; to 90&#37; in infants with chronic lung disease&#46; Prevalence of chronic lung disease of prematurity ranged from 0&#37; to 75&#37; &#40;median&#58; 10&#41;&#46;</p> <span class="elsevierStyleSectionTitle">Conclusions</span><p id="spar0050" class="elsevierStyleSimplePara elsevierViewall">Many respiratory strategies for extremely low birth weight infants reflect the result of large randomised trials&#46; More effective methods may be required to encourage the use of early NCPAP preferably with binasal prongs&#44; the use of SIPPV as the main weaning mode&#44; the use of volume targeted ventilation and a more judicious use of exogenous surfactant in order to ensure evidence&#8211;based practice&#46;</p>"
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        "resumen" => "<span class="elsevierStyleSectionTitle">Introdu&#231;&#227;o</span><p id="spar0005" class="elsevierStyleSimplePara elsevierViewall">As estrat&#233;gias de suporte ventilat&#243;rio utilizadas no rec&#233;m-nascido t&#234;m sido motivo de grande investiga&#231;&#227;o&#46;</p> <span class="elsevierStyleSectionTitle">Objectivos</span><p id="spar0010" class="elsevierStyleSimplePara elsevierViewall">Avaliar as pr&#225;ticas de suporte ventilat&#243;rio nas unidades de neonatologia nacionais utilizadas na assist&#234;ncia ao rec&#233;m-nascido de extremo baixo peso e avaliar se est&#227;o em conformidade com a pr&#225;tica baseada na evid&#234;ncia&#46;</p> <span class="elsevierStyleSectionTitle">M&#233;todos</span><p id="spar0015" class="elsevierStyleSimplePara elsevierViewall">Foi enviado&#44; por via electr&#243;nica&#44; a 31 unidades de neonatologia nacionais&#44; um inqu&#233;rito sobre tipos de ventiladores&#44; modos de ventila&#231;&#227;o&#44; monitoriza&#231;&#227;o da fun&#231;&#227;o pulmonar&#44; valores de satura&#231;&#227;o de oxig&#233;nio permitidos e preval&#234;ncia de doen&#231;a pulmonar cr&#243;nica da prematuridade&#46;</p> <span class="elsevierStyleSectionTitle">Resultados</span><p id="spar0020" class="elsevierStyleSimplePara elsevierViewall">A percentagem de resposta foi de 94&#37;&#46; O modelo de ventilador Draeger Babylog &#233; o mais utilizado&#46; Doze &#40;41&#37;&#41; unidades preconizam o NCPAP precoce&#46; A ventila&#231;&#227;o sincronizada &#233; de elei&#231;&#227;o em 24 &#40;83&#37;&#41; unidades &#40;SIMV&#44; SIPPV&#44; PSV&#41; e 4 &#40;14&#37;&#41; t&#234;m possibilidade de ventila&#231;&#227;o por alta frequ&#234;ncia oscilat&#243;ria&#46; O modo ventilat&#243;rio SIMV &#233; o mais utilizado &#40;n<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>13&#44; 45&#37;&#41; no &#8220;desmame&#8221; ventilat&#243;rio&#46; O surfactante ex&#243;geno &#233; usado preferencialmente de modo profil&#225;ctico em 12 &#40;41&#37;&#41; unidades&#46; Todas as unidades usam valores de fun&#231;&#227;o respirat&#243;ria no ajuste dos par&#226;metros ventilat&#243;rios e cinco &#40;17&#37;&#41; utilizam monitoriza&#231;&#227;o cont&#237;nua da PaCO<span class="elsevierStyleInf">2</span>&#58; medi&#231;&#227;o transcut&#226;nea &#61; 3&#59; capnometria &#61; 2&#46; Dezassete &#40;59&#37;&#41; unidades utilizam valores de satura&#231;&#227;o de oxig&#233;nio de 90&#37;&#8211;95&#37; na doen&#231;a das membranas hialinas e 15 &#40;52&#37;&#41; utilizam valores de 85&#37;&#8211;90&#37; na doen&#231;a pulmonar cr&#243;nica da prematuridade&#46; A preval&#234;ncia de doen&#231;a pulmonar cr&#243;nica da prematuridade variou entre os 0&#37; e os 75&#37; &#40;mediana&#58; 10&#41;&#46;</p> <span class="elsevierStyleSectionTitle">Conclus&#227;o</span><p id="spar0025" class="elsevierStyleSimplePara elsevierViewall">As estrat&#233;gias de suporte ventilat&#243;rio usadas nas unidades portuguesas reflectem&#44; em parte&#44; a evid&#234;ncia de estudos multic&#234;ntricos aleatorizados&#46; &#201; necess&#225;rio mais investimento no uso de NCPAP precoce&#44; preferencialmente com <span class="elsevierStyleItalic">prongs</span> binasal&#44; uso do modo SIPPV no &#8220;desmame&#8221; ventilat&#243;rio&#44; uso de estrat&#233;gias ventilat&#243;rias com volumes correntes optimizados e utiliza&#231;&#227;o criteriosa de surfactante ex&#243;geno&#44; de modo a assegurar a pr&#225;tica baseada na evid&#234;ncia&#46;</p>"
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