Fatores associados ? posi??o do tubo orotraqueal em crian?as

Made available in DSpace on 2015-04-14T13:33:14Z (GMT). No. of bitstreams: 1 383165.pdf: 1143955 bytes, checksum: 2d4559743b1f33d0f5ca44b17bd043b0 (MD5) Previous issue date: 2006-08-03Objetivos: Medir a preval?ncia da posi??o inadequada do tubo orotraqueal, estabelecer a freq??ncia do uso de f?rmulas ou recomenda??es para estimar a posi??o do tubo traqueal e comparar a precis?o dos principais m?todos utilizados para estimar esta dist?ncia em crian?as. M?todos: Inclu?das todas as intuba??es via orotraqueal ocorridas em duas UTIP de hospitais universit?rios de Porto Alegre, entre agosto de 2004 e julho de 2005. Foi feita revis?o do prontu?rio e entrevista padronizada at? 72 horas ap?s o procedimento. Foram avaliados o g?nero, idade, peso, estatura, superf?cie corporal, motivo da intuba??o, comprimento do esterno e dist?ncia oro-trago-furcular. Obtivemos informa??es sobre os m?todos de escolha do di?metro do tubo e para estimar a posi??o do tubo traqueal. Atrav?s da radiografia de t?rax, era definida a dist?ncia orotraqueal como sendo adequada, baixa ou alta. Os dados foram comparados pelos testes t de Student, Mann-Whitney, Qui-quadrado e correla??o linear. Resultados: Foram inclu?das no estudo 208 intuba??es realizadas pela via orotraqueal. Em 65% (135/208) constatamos que a posi??o do tubo orotraqueal (TOT) era inadequada. Em 183 das 208 intuba??es orotraqueais (88%) foi poss?vel realizar a entrevista em tempo h?bil (<72 horas) com o m?dico respons?vel pelo procedimento. Em 45% (83/183) destes procedimentos foi empregado algum m?todo para estimar a profundidade de inser??o do TOT. O uso de f?rmulas ou m?todos n?o se associou a uma maior taxa de acerto da posi??o do TOT. Peso, altura, superf?cie corporal e comprimento esternal apresentaram forte correla??o com a dist?ncia orotraqueal. Em simula??o realizada para comparar o desempenho das f?rmulas que utilizam estas medidas, a maior taxa de sucesso obtida foi de 43,5%.Conclus?es: A freq??ncia de acerto da profundidade de inser??o do TOT ? baixa. O uso de m?todos para a sua estimativa n?o parece estar associado a um maior ?ndice de sucesso

Depth placement of endotracheal tube in children submitted to mechanical ventilation

BACKGROUNDd ANDd OBJEeCTIVEeS: To verify the prevalence of correct position of the tracheal tube after children intubation in two reference intensive care unit in south of Brazil. Evaluate the accuracy of the different methods and suggested formulas to estimate the depth insertion of the endotracheal tube. MEeTHODdS: A cross-sectional, observational study was designed. It was included all children intubated at pediatric ICU in Hospital São Lucas da PUCRS and Hospital de Clínicas de Porto Alegre between August and September of 2004. Patient with vertebral deviations, after surgeries or with airway malformations was excluded. In the first 24 hours after intubation the patients’ charts were reviewed, a questionnaire was filled, the physician who was responsible for the procedure was interviewed and the chest radiogram was analyzed. The position was considered correct if the tube extremity was between the first thoracic vertebra (T1) and the third thoracic vertebra (T3) with a tolerance of 0.5 cm. The different formulas to estimate the depth insertions of the endotracheal tube were applied in all patients and this distance was measured with the aim of evaluate the accuracy of each method. REeSULTS: The endotracheal tube position was correct in 60% (21 / 35) of the intubated children. A half of the physicians used some formula to estimate the depth of tracheal tube insertion. There was no difference between the group that used any formula and the group that didn’t use in predict the correct tube position (75% versus 47% p = 0,2). The most accurate method to estimate the endotracheal tube location was age group (68%; p = 0.02) when compared with height, tube diameter and age. CONCLUSIONS: The methods that are used to estimate the length of endotracheal tube to be introduced in children have low accuracy. It is imperative to develop a sharper and practical way to determine this distance

Depth placement of endotracheal tube in children submitted to mechanical ventilation

BACKGROUNDd ANDd OBJEeCTIVEeS: To verify the prevalence of correct position of the tracheal tube after children intubation in two reference intensive care unit in south of Brazil. Evaluate the accuracy of the different methods and suggested formulas to estimate the depth insertion of the endotracheal tube. MEeTHODdS: A cross-sectional, observational study was designed. It was included all children intubated at pediatric ICU in Hospital São Lucas da PUCRS and Hospital de Clínicas de Porto Alegre between August and September of 2004. Patient with vertebral deviations, after surgeries or with airway malformations was excluded. In the first 24 hours after intubation the patients’ charts were reviewed, a questionnaire was filled, the physician who was responsible for the procedure was interviewed and the chest radiogram was analyzed. The position was considered correct if the tube extremity was between the first thoracic vertebra (T1) and the third thoracic vertebra (T3) with a tolerance of 0.5 cm. The different formulas to estimate the depth insertions of the endotracheal tube were applied in all patients and this distance was measured with the aim of evaluate the accuracy of each method. REeSULTS: The endotracheal tube position was correct in 60% (21 / 35) of the intubated children. A half of the physicians used some formula to estimate the depth of tracheal tube insertion. There was no difference between the group that used any formula and the group that didn’t use in predict the correct tube position (75% versus 47% p = 0,2). The most accurate method to estimate the endotracheal tube location was age group (68%; p = 0.02) when compared with height, tube diameter and age. CONCLUSIONS: The methods that are used to estimate the length of endotracheal tube to be introduced in children have low accuracy. It is imperative to develop a sharper and practical way to determine this distance

Assessment of intubation procedures at reference pediatric and neonatal intensive care units

Objetivo: Descrever a taxa de sucesso e os fenômenos associados ao procedimento de intubação traqueal em duas unidades de terapia intensiva neonatais e duas pediátricas de Porto Alegre. Métodos: Estudo transversal, com etapas retrospectiva e prospectiva, em que foram avaliadas todas as intubações ocorridas durante 6 meses em quatro unidades selecionadas. Realizou-se revisão padronizada de prontuários e entrevista com os médicos responsáveis, para caracterizar o procedimento de intubação. Utilizou-se o teste t para variáveis contínuas com distribuição normal, Mann-Whitney para distribui ção assimétrica e o qui-quadrado para variáveis categóricas, com p < 0,05 para comparações entre as unidades. Resultados: Dos 134 procedimentos pediátricos, foram utilizados, respectivamente, sedativos e relaxantes musculares em 89,5 e 3% dos casos contra 24 e 0,9% dos 116 procedimentos neonatais (p < 0,001). Apenas 53,7% das crianças e 31,9% dos recém-nascidos apresentavam relaxamento muscular adequado no momento da intubação. As crian- ças inadequadamente relaxadas necessitaram mais tentativas de intuba ção (2,4±1,3 contra 1,7±1,2; p = 0,001), apresentaram mais hipoxemia (20,9% contra 5,5%; p = 0,015) e mais dificuldade para intubação (54,8% versus 25%; p < 0,001). Entre os recém-nascidos inadequadamente relaxados, havia mais casos de urgência e foram necessárias mais tentativas de intubação (2±1,2 versus 1,5±0,9; p = 0,036). Observaram-se dificuldades e complicações em, respectivamente, 38,8 e 28,3% das intubações pediátricas contra 29 e 12% das neonatais. Conclusões: Observa-se uma grande variabilidade no procedimento de intubação traqueal nas unidades estudadas, sendo marcante o uso infreqüente de relaxantes musculares. O inadequado relaxamento muscular neste procedimento se associa a maior dificuldade, maior número de tentativas de intubação e maior incidência de hipoxemia.Objective: To describe intubation procedures in two pediatric and two neonatal intensive care units in the city of Porto Alegre. Methods: Cross-sectional study divided into a retrospective and a prospective phase. All intubations performed in these units during a 6- month period were considered. Data were collected by interviewing the physician responsible for the procedure and reviewing the patients. charts, including drugs administered, sedation status, number of attempts, difficulties and complications during the procedure. Data were analyzed using the t test and the Mann-Whitney test for continuous variables and the chi-square test for categorical variables, considering a p < 0.05. Results: Sedatives were administered in 89.5% of the 134 pediatric procedures and 24% of the 116 neonatal procedures (p < 0.001). Muscle relaxants were prescribed for 3% of the children and 0.9% of the neonates. Only 53.7% of the children and 31.9% of the neonates were considered as adequately relaxed. The children who were inadequately relaxed had more intubations attempts (2.4±1.3 vs 1.7±1.2 p = 0.001), became more hypoxemic (20.9 vs 5.5% p = 0.015) and were more difficult to intubate (54.8 vs 25% p < 0.001). There were more urgent cases and more intubations attempts (2±1.2 vs 1.5±0.9 p = 0.036) among the inadequately relaxed neonates. Difficulties and complications occurred in 38.8 and 28.3% of the pediatric cases and 29 and 12% of the neonatal cases, respectively. Conclusions: There was no established routine for intubation procedures in the units studied, and the use of muscle relaxants was not usual. The absence of adequate muscle relaxation is associated with more intubation attempts, difficulties and hypoxemia during the intubation procedure

Assessment of intubation procedures at reference pediatric and neonatal intensive care units

Objetivo: Descrever a taxa de sucesso e os fenômenos associados ao procedimento de intubação traqueal em duas unidades de terapia intensiva neonatais e duas pediátricas de Porto Alegre. Métodos: Estudo transversal, com etapas retrospectiva e prospectiva, em que foram avaliadas todas as intubações ocorridas durante 6 meses em quatro unidades selecionadas. Realizou-se revisão padronizada de prontuários e entrevista com os médicos responsáveis, para caracterizar o procedimento de intubação. Utilizou-se o teste t para variáveis contínuas com distribuição normal, Mann-Whitney para distribui ção assimétrica e o qui-quadrado para variáveis categóricas, com p < 0,05 para comparações entre as unidades. Resultados: Dos 134 procedimentos pediátricos, foram utilizados, respectivamente, sedativos e relaxantes musculares em 89,5 e 3% dos casos contra 24 e 0,9% dos 116 procedimentos neonatais (p < 0,001). Apenas 53,7% das crianças e 31,9% dos recém-nascidos apresentavam relaxamento muscular adequado no momento da intubação. As crian- ças inadequadamente relaxadas necessitaram mais tentativas de intuba ção (2,4±1,3 contra 1,7±1,2; p = 0,001), apresentaram mais hipoxemia (20,9% contra 5,5%; p = 0,015) e mais dificuldade para intubação (54,8% versus 25%; p < 0,001). Entre os recém-nascidos inadequadamente relaxados, havia mais casos de urgência e foram necessárias mais tentativas de intubação (2±1,2 versus 1,5±0,9; p = 0,036). Observaram-se dificuldades e complicações em, respectivamente, 38,8 e 28,3% das intubações pediátricas contra 29 e 12% das neonatais. Conclusões: Observa-se uma grande variabilidade no procedimento de intubação traqueal nas unidades estudadas, sendo marcante o uso infreqüente de relaxantes musculares. O inadequado relaxamento muscular neste procedimento se associa a maior dificuldade, maior número de tentativas de intubação e maior incidência de hipoxemia.Objective: To describe intubation procedures in two pediatric and two neonatal intensive care units in the city of Porto Alegre. Methods: Cross-sectional study divided into a retrospective and a prospective phase. All intubations performed in these units during a 6- month period were considered. Data were collected by interviewing the physician responsible for the procedure and reviewing the patients. charts, including drugs administered, sedation status, number of attempts, difficulties and complications during the procedure. Data were analyzed using the t test and the Mann-Whitney test for continuous variables and the chi-square test for categorical variables, considering a p < 0.05. Results: Sedatives were administered in 89.5% of the 134 pediatric procedures and 24% of the 116 neonatal procedures (p < 0.001). Muscle relaxants were prescribed for 3% of the children and 0.9% of the neonates. Only 53.7% of the children and 31.9% of the neonates were considered as adequately relaxed. The children who were inadequately relaxed had more intubations attempts (2.4±1.3 vs 1.7±1.2 p = 0.001), became more hypoxemic (20.9 vs 5.5% p = 0.015) and were more difficult to intubate (54.8 vs 25% p < 0.001). There were more urgent cases and more intubations attempts (2±1.2 vs 1.5±0.9 p = 0.036) among the inadequately relaxed neonates. Difficulties and complications occurred in 38.8 and 28.3% of the pediatric cases and 29 and 12% of the neonatal cases, respectively. Conclusions: There was no established routine for intubation procedures in the units studied, and the use of muscle relaxants was not usual. The absence of adequate muscle relaxation is associated with more intubation attempts, difficulties and hypoxemia during the intubation procedure