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You searched for:"Pedro Celiny Ramos Garcia"
We found (7) results for your search.Abstract
Revista Brasileira de Terapia Intensiva. 2018;30(1):71-79
03-01-2018
DOI 10.5935/0103-507X.20180013
To undertake the translation and cross-cultural adaption into Brazilian Portuguese of the Pediatric Confusion Assessment Method for the Intensive Care Unit for the detection of delirium in pediatric intensive care units, including the algorithm and instructions.
A universalist approach for the translation and cross-cultural adaptation of health measurement instruments was used. A group of pediatric critical care specialists assessed conceptual and item equivalences. Semantic equivalence was evaluated by means of a translation from English to Portuguese by two independent translators; reconciliation into a single version; back-translation by a native English speaker; and consensus among six experts with respect to language and content understanding by means of Likert scale responses and the Content Validity Index. Finally, operational equivalence was assessed by applying a pre-test to 30 patients.
The back-translation was approved by the original authors. The medians of the expert consensus responses varied between good and excellent, except for the feature "acute onset" of the instructions. Items with a low Content Validity Index for the features "acute onset" and "disorganized thinking" were adapted. In the pre-test, the expression "signal with your head" was modified into "nod your head" for better understanding. No further adjustments were necessary, resulting in the final version for Brazilian Portuguese.
The Brazilian version of the Pediatric Confusion Assessment Method for the Intensive Care Unit was generated in agreement with the international recommendations and can be used in Brazil for the diagnosis of delirium in critically ill children 5 years of age or above and with no developmental cognitive disabilities.
Abstract
Revista Brasileira de Terapia Intensiva. 2018;30(1):71-79
03-01-2018
DOI 10.5935/0103-507X.20180013
To undertake the translation and cross-cultural adaption into Brazilian Portuguese of the Pediatric Confusion Assessment Method for the Intensive Care Unit for the detection of delirium in pediatric intensive care units, including the algorithm and instructions.
A universalist approach for the translation and cross-cultural adaptation of health measurement instruments was used. A group of pediatric critical care specialists assessed conceptual and item equivalences. Semantic equivalence was evaluated by means of a translation from English to Portuguese by two independent translators; reconciliation into a single version; back-translation by a native English speaker; and consensus among six experts with respect to language and content understanding by means of Likert scale responses and the Content Validity Index. Finally, operational equivalence was assessed by applying a pre-test to 30 patients.
The back-translation was approved by the original authors. The medians of the expert consensus responses varied between good and excellent, except for the feature "acute onset" of the instructions. Items with a low Content Validity Index for the features "acute onset" and "disorganized thinking" were adapted. In the pre-test, the expression "signal with your head" was modified into "nod your head" for better understanding. No further adjustments were necessary, resulting in the final version for Brazilian Portuguese.
The Brazilian version of the Pediatric Confusion Assessment Method for the Intensive Care Unit was generated in agreement with the international recommendations and can be used in Brazil for the diagnosis of delirium in critically ill children 5 years of age or above and with no developmental cognitive disabilities.
Abstract
Revista Brasileira de Terapia Intensiva. 2018;30(2):160-165
01-01-2018
DOI 10.5935/0103-507X.20180034
To compare the prevalence of malnutrition during two time periods in a pediatric intensive care unit.
This was a retrospective cross-sectional study of patients admitted to the pediatric intensive care unit of a university hospital during two one-year periods with an interval of four years between them. Nutritional evaluation was conducted based on weight and height measured at admission. The body mass index-for-age was the parameter chosen to evaluate nutritional status, as classified according to the World Health Organization, according to age group.
The total sample size was 881 (406 in the contemporary sample and 475 in the historical sample). There was a significant reduction in malnutrition in the contemporary sample (p = 0.03). Malnourishment in patients in the historical sample was significantly associated with mortality and length of stay, while malnourishment in patients in the contemporary sample was not associated with worse outcomes.
There was a significant reduction in malnutrition among patients in the same pediatric intensive care unit when comparing the two time periods. Our findings of a change in nutritional profile in critically ill patients corroborate the nutritional status data of children and adolescents worldwide.
Abstract
Revista Brasileira de Terapia Intensiva. 2018;30(2):160-165
01-01-2018
DOI 10.5935/0103-507X.20180034
To compare the prevalence of malnutrition during two time periods in a pediatric intensive care unit.
This was a retrospective cross-sectional study of patients admitted to the pediatric intensive care unit of a university hospital during two one-year periods with an interval of four years between them. Nutritional evaluation was conducted based on weight and height measured at admission. The body mass index-for-age was the parameter chosen to evaluate nutritional status, as classified according to the World Health Organization, according to age group.
The total sample size was 881 (406 in the contemporary sample and 475 in the historical sample). There was a significant reduction in malnutrition in the contemporary sample (p = 0.03). Malnourishment in patients in the historical sample was significantly associated with mortality and length of stay, while malnourishment in patients in the contemporary sample was not associated with worse outcomes.
There was a significant reduction in malnutrition among patients in the same pediatric intensive care unit when comparing the two time periods. Our findings of a change in nutritional profile in critically ill patients corroborate the nutritional status data of children and adolescents worldwide.
Abstract
Revista Brasileira de Terapia Intensiva. 2015;27(3):266-273
08-28-2015
DOI 10.5935/0103-507X.20150035
Acute respiratory distress syndrome is a disease of acute onset characterized by hypoxemia and infiltrates on chest radiographs that affects both adults and children of all ages. It is an important cause of respiratory failure in pediatric intensive care units and is associated with significant morbidity and mortality. Nevertheless, until recently, the definitions and diagnostic criteria for acute respiratory distress syndrome have focused on the adult population. In this article, we review the evolution of the definition of acute respiratory distress syndrome over nearly five decades, with a special focus on the new pediatric definition. We also discuss recommendations for the implementation of mechanical ventilation strategies in the treatment of acute respiratory distress syndrome in children and the use of adjuvant therapies.
Abstract
Revista Brasileira de Terapia Intensiva. 2015;27(3):266-273
08-28-2015
DOI 10.5935/0103-507X.20150035
Acute respiratory distress syndrome is a disease of acute onset characterized by hypoxemia and infiltrates on chest radiographs that affects both adults and children of all ages. It is an important cause of respiratory failure in pediatric intensive care units and is associated with significant morbidity and mortality. Nevertheless, until recently, the definitions and diagnostic criteria for acute respiratory distress syndrome have focused on the adult population. In this article, we review the evolution of the definition of acute respiratory distress syndrome over nearly five decades, with a special focus on the new pediatric definition. We also discuss recommendations for the implementation of mechanical ventilation strategies in the treatment of acute respiratory distress syndrome in children and the use of adjuvant therapies.
Abstract
Revista Brasileira de Terapia Intensiva. 2014;26(1):36-43
01-01-2014
DOI 10.5935/0103-507X.20140006
To assess the performance of the Nursing Activities Score in a pediatric intensive care unit, compare its scores expressed as time spent on nursing activities to the corresponding ones calculated using the Simplified Therapeutic Intervention Scoring System, and correlate the results obtained by both instruments with severity, morbidity and mortality.
Prospective, observational, and analytical cohort study conducted at a type III general pediatric intensive care unit. The study participants were all the children aged 29 days to 12 years admitted to the investigated pediatric intensive care unit from August 2008 to February 2009.
A total of 545 patients were studied, which corresponded to 2,951 assessments. The average score of the Simplified Therapeutic Intervention Scoring System was 28.79±10.37 (915±330 minutes), and that of the Nursing Activities Score was 55.6±11.82 (802±161 minutes). The number of minutes that resulted from the conversion of the Simplified Therapeutic Intervention Scoring System score was higher compared to that resulting from the Nursing Activities Score for all the assessments (p<0.001). The correlation between the instruments was significant, direct, positive, and moderate (R=0.564).
The agreement between the investigated instruments was satisfactory, and both instruments also exhibited satisfactory discrimination of mortality; for that purpose, the best cutoff point was 16 nursing hours/patient day.
Abstract
Revista Brasileira de Terapia Intensiva. 2014;26(1):36-43
01-01-2014
DOI 10.5935/0103-507X.20140006
To assess the performance of the Nursing Activities Score in a pediatric intensive care unit, compare its scores expressed as time spent on nursing activities to the corresponding ones calculated using the Simplified Therapeutic Intervention Scoring System, and correlate the results obtained by both instruments with severity, morbidity and mortality.
Prospective, observational, and analytical cohort study conducted at a type III general pediatric intensive care unit. The study participants were all the children aged 29 days to 12 years admitted to the investigated pediatric intensive care unit from August 2008 to February 2009.
A total of 545 patients were studied, which corresponded to 2,951 assessments. The average score of the Simplified Therapeutic Intervention Scoring System was 28.79±10.37 (915±330 minutes), and that of the Nursing Activities Score was 55.6±11.82 (802±161 minutes). The number of minutes that resulted from the conversion of the Simplified Therapeutic Intervention Scoring System score was higher compared to that resulting from the Nursing Activities Score for all the assessments (p<0.001). The correlation between the instruments was significant, direct, positive, and moderate (R=0.564).
The agreement between the investigated instruments was satisfactory, and both instruments also exhibited satisfactory discrimination of mortality; for that purpose, the best cutoff point was 16 nursing hours/patient day.
Abstract
Revista Brasileira de Terapia Intensiva. 2011;23(2):199-206
08-01-2011
DOI 10.1590/S0103-507X2011000200013
OBJECTIVES: Between 10% and 20% of children submitted to mechanical ventilation in the pediatric intensive care unit present extubation failure. Several ventilatory indexes have been proposed to predict extubation failure. The aim of this study was to analyze the accuracy of these indices in predicting successful extubation in children and to evaluate these variables according to the age of the patient and the specific disease. METHODS: A prospective observational study including all children submitted to mechanical ventilation in a Brazilian referral pediatric intensive care unit was conducted between August 2007 and August 2008. The tidal volume, maximal negative inspiratory pressure, rapid shallow breathing index and other ventilatory indexes were measured before extubation. These variables were analyzed according to the extubation outcome (success or failure) as well as age and specific disease (post cardiac surgery and acute viral bronchiolitis). RESULTS: A total of 100 patients were included (median age of 2.1 years old). Extubation failure was observed in 13% and was associated with lower weight (10.3+8.1 Kg vs. 5.5+2.4 Kg; p=0.01). We also evaluated the relationship between extubation failure and the main cause indicating mechanical ventilation: children who had received cardiac surgery (n=17) presented an extubation failure rate of 29.4% with a relative risk of 4.6 (1.2-17.2) when compared to children with acute viral bronchiolitis (n=47, extubation failure rate of 6.4%). The maximal inspiratory pressure was the only physiologic variable independently associated with the outcome. However, this variable showed a wide dispersion and lack of accuracy for predicting extubation success (sensitivity of 82% and specificity of 55% for a cut point of -37.5 cmH2O predicting successful extubation). The same wide dispersion was observed with other ventilatory indexes. CONCLUSION: The indexes for predicting extubation success in children submitted to mechanical ventilation are not accurate; they vary widely depending on age, main disease and other clinical aspects. New formulas including clinical variables should be developed for better prediction of extubation success in children submitted to mechanical ventilation
Abstract
Revista Brasileira de Terapia Intensiva. 2011;23(2):199-206
08-01-2011
DOI 10.1590/S0103-507X2011000200013
OBJECTIVES: Between 10% and 20% of children submitted to mechanical ventilation in the pediatric intensive care unit present extubation failure. Several ventilatory indexes have been proposed to predict extubation failure. The aim of this study was to analyze the accuracy of these indices in predicting successful extubation in children and to evaluate these variables according to the age of the patient and the specific disease. METHODS: A prospective observational study including all children submitted to mechanical ventilation in a Brazilian referral pediatric intensive care unit was conducted between August 2007 and August 2008. The tidal volume, maximal negative inspiratory pressure, rapid shallow breathing index and other ventilatory indexes were measured before extubation. These variables were analyzed according to the extubation outcome (success or failure) as well as age and specific disease (post cardiac surgery and acute viral bronchiolitis). RESULTS: A total of 100 patients were included (median age of 2.1 years old). Extubation failure was observed in 13% and was associated with lower weight (10.3+8.1 Kg vs. 5.5+2.4 Kg; p=0.01). We also evaluated the relationship between extubation failure and the main cause indicating mechanical ventilation: children who had received cardiac surgery (n=17) presented an extubation failure rate of 29.4% with a relative risk of 4.6 (1.2-17.2) when compared to children with acute viral bronchiolitis (n=47, extubation failure rate of 6.4%). The maximal inspiratory pressure was the only physiologic variable independently associated with the outcome. However, this variable showed a wide dispersion and lack of accuracy for predicting extubation success (sensitivity of 82% and specificity of 55% for a cut point of -37.5 cmH2O predicting successful extubation). The same wide dispersion was observed with other ventilatory indexes. CONCLUSION: The indexes for predicting extubation success in children submitted to mechanical ventilation are not accurate; they vary widely depending on age, main disease and other clinical aspects. New formulas including clinical variables should be developed for better prediction of extubation success in children submitted to mechanical ventilation
Abstract
Revista Brasileira de Terapia Intensiva. 2011;23(1):78-86
05-05-2011
DOI 10.1590/S0103-507X2011000100013
This review discusses the main dilemmas and difficulties related to end-of-life decision's in children with terminal and irreversible diseases and propose a rational sequence for delivering palliative care to this patients' group. The Medline and Lilacs databases were searched using the terms 'end of life', 'palliative care', 'death' and 'terminal disease' for articles published in recent years. The most relevant articles and those enrolling pediatric patients were selected and compared to previous authors' studies in this field. The current Brazilian Medical Ethics Code (2010) was analyzed regarding end-oflife practices and palliative care for terminal patients. Lack of knowledge, insufficient specific training, and legal concerns are the main reasons why end-of-life decisions in terminal children are based on medical opinion with scarce family participation. The current Brazilian Medical Ethics Code (2010) fully supports end-of-life decisions made consensually with active family participation. Honest dialogue with the family regarding diagnostic, prognostic, therapeutic and palliative care measures should be established gradually to identify the best strategy to meet the child's end-of-life needs. Treatment focused on the child's welfare combined with the family's participation is the basis for successful palliative care of children with terminal diseases.
Abstract
Revista Brasileira de Terapia Intensiva. 2011;23(1):78-86
05-05-2011
DOI 10.1590/S0103-507X2011000100013
This review discusses the main dilemmas and difficulties related to end-of-life decision's in children with terminal and irreversible diseases and propose a rational sequence for delivering palliative care to this patients' group. The Medline and Lilacs databases were searched using the terms 'end of life', 'palliative care', 'death' and 'terminal disease' for articles published in recent years. The most relevant articles and those enrolling pediatric patients were selected and compared to previous authors' studies in this field. The current Brazilian Medical Ethics Code (2010) was analyzed regarding end-oflife practices and palliative care for terminal patients. Lack of knowledge, insufficient specific training, and legal concerns are the main reasons why end-of-life decisions in terminal children are based on medical opinion with scarce family participation. The current Brazilian Medical Ethics Code (2010) fully supports end-of-life decisions made consensually with active family participation. Honest dialogue with the family regarding diagnostic, prognostic, therapeutic and palliative care measures should be established gradually to identify the best strategy to meet the child's end-of-life needs. Treatment focused on the child's welfare combined with the family's participation is the basis for successful palliative care of children with terminal diseases.
Abstract
Revista Brasileira de Terapia Intensiva. 2009;21(2):174-182
07-24-2009
DOI 10.1590/S0103-507X2009000200010
OBJECTIVE: To describe the characteristics and the outcome of infants with acute viral bronchiolitis submitted to mechanical ventilation. METHODS: We performed a retrospective study enrolling all infants (less than 12 months old) admitted with the diagnosis of acute viral bronchiolitis and submitted to mechanical ventilation in an university affiliated Brazilian pediatric intensive care unit between March, 2004 and September, 2006 (3 consecutives winters). The mechanical ventilation parameters' employed on 1st, 2nd, 3rd, 7th day and before extubation were evaluated as well as the evolution (mortality rate, presence of acute respiratory distress syndrome and the prevalence of complications). The groups were compared using the Student t test, the Mann-Whitney U test and the Chi-square test. RESULTS: Fifty-nine infants were included (3.8 ± 2.7 months old, 59% male), with 9.0 ± 9.4 days on mechanical ventilation. Prior mechanical ventilation, non invasive ventilation was instituted in 71% of children. Anemia was observed in 78% of the sample. In 51 infants (86.5%) the lower airway obstructive pattern was maintained up to tracheal extubation with a nil mortality and low prevalence of pneumothorax (7.8%). Acute respiratory distress syndrome occurred in 8 infants (13.5%), with higher mortality and a higher prevalence of pneumothorax (62.5%). CONCLUSIONS: The declining mortality in acute viral bronchiolitis is observed even in non developed regions, involving children with high rates of anemia and premature labor. The low mortality is associated with the maintenance of the lower airway obstructive pattern during the period on mechanical ventilation. The development of acute respiratory distress syndrome is associated with increased mortality and higher prevalence of complications, representing the actual challenge in the management of children with severe acute viral bronchiolitis.
Abstract
Revista Brasileira de Terapia Intensiva. 2009;21(2):174-182
07-24-2009
DOI 10.1590/S0103-507X2009000200010
OBJECTIVE: To describe the characteristics and the outcome of infants with acute viral bronchiolitis submitted to mechanical ventilation. METHODS: We performed a retrospective study enrolling all infants (less than 12 months old) admitted with the diagnosis of acute viral bronchiolitis and submitted to mechanical ventilation in an university affiliated Brazilian pediatric intensive care unit between March, 2004 and September, 2006 (3 consecutives winters). The mechanical ventilation parameters' employed on 1st, 2nd, 3rd, 7th day and before extubation were evaluated as well as the evolution (mortality rate, presence of acute respiratory distress syndrome and the prevalence of complications). The groups were compared using the Student t test, the Mann-Whitney U test and the Chi-square test. RESULTS: Fifty-nine infants were included (3.8 ± 2.7 months old, 59% male), with 9.0 ± 9.4 days on mechanical ventilation. Prior mechanical ventilation, non invasive ventilation was instituted in 71% of children. Anemia was observed in 78% of the sample. In 51 infants (86.5%) the lower airway obstructive pattern was maintained up to tracheal extubation with a nil mortality and low prevalence of pneumothorax (7.8%). Acute respiratory distress syndrome occurred in 8 infants (13.5%), with higher mortality and a higher prevalence of pneumothorax (62.5%). CONCLUSIONS: The declining mortality in acute viral bronchiolitis is observed even in non developed regions, involving children with high rates of anemia and premature labor. The low mortality is associated with the maintenance of the lower airway obstructive pattern during the period on mechanical ventilation. The development of acute respiratory distress syndrome is associated with increased mortality and higher prevalence of complications, representing the actual challenge in the management of children with severe acute viral bronchiolitis.
