Elaboration of neonatal and pediatric mechanical lungs

Pediatric patients or newborns admitted to Neonatal Intensive Care Units (NICU) receive life support care due to various conditions and pathologies. The physiotherapist controls and applies medicinal gases, institutes and monitors invasive and non-invasive mechanical ventilation, as well as performs weaning, among others. Learning ventilatory management must be appropriate for the age and, therefore, consider different lungs for the proper simulations of compliance and resistance. Although the insertion of physical therapists is relatively recent, there are several postgraduate courses and training in this area. The creation of a mechanical lungthat covers, separately, neonatal and pediatric patients will be a fundamental tool for the learning and training of future professionals who will work in the area. To develop two neonatal and pediatric mechanical lungs, as well as to simulate different elastic and resistive behaviors inherent in clinical practice. Experimental study, bench, divided into two stages: creation of mechanical lungs and evaluation of mechanical characteristics. The lungs will be made on a two-story metallic base: on the upper floor, the pediatric lung and the lower floor, the neonatal. In the second stage, the mechanical lung will be connected to a mechanical ventilator, using its own ventilatory parameters used in both types of patients. For the neonatal, respiratory rate of 35rpm, inspiratory time of 0.45 and endotracheal tube of 3.0 mm. The pediatric lung will be ventilated with a volume between 100-120mL, 20-25 compliance and a 4.5mm orotracheal tube. The construction of the neonatal and pediatric mechanical lung will strongly add the teaching of the Neonatal and Pediatric Intensive Physical Therapy specialty in the Undergraduate and Graduate settings, adding value to the teaching and training of professionals.

Can preterm birth affect the palate morphology? A systematic review

The purpose of this review was to evaluate whether preterm birth affects palate morphology. Opened electronic search in PubMed (MEDLINE), Lilacs, Scopus and Web of Science was conducted and a partial search of the gray literature using Google Scholar, Open Gray and ProQuest. We included studies with infants born prematurely (born up to the 37th week of gestation and weighing less than 2.500 g) and not preterm infants; intubated and not intubated. Two independent reviewers performed study selection, data extraction, and bias risk assessment. Selection criteria included observational, retrospective and prospective, randomized or nonrandomized cohort studies and control studies. There was no restriction on publication time and article language. A total of 2344 articles were found after the duplicates were removed, of which 7 met the inclusion criteria and were submitted to a Bias Risk analysis using MASTARI. Scientific evidence was found for altered palate morphology among premature infants, and oral intubation was a contributing factor for such alterations. Based on this review, it is concluded that premature birth changes palate morphology, when prematurity is associated with the use of the orotracheal tube.

Medical device-related pressure injuries in critical patients: prevalence and associated factors

ABSTRACT Objective: To determine the prevalence of medical device-related pressure injuries in critical patients and analyze the associated factors. Method: Epidemiological, cross-sectional study. Sociodemographic, clinical and medical device data were collected. Inspection of the skin/mucous membranes was performed to identify and classify the injuries. Analysis using descriptive statistics, Poisson regression and the Spearman correlation coefficient. Results: Ninety-three patients were evaluated and 58 developed injuries, with a prevalence of 62.4%. Injuries by the orotracheal tube (50%), nasogastric tube (44.1%) and urinary catheter (28.6%) were the most prevalent, and the most affected regions were, respectively, the auricular (79.5%), nasal ala (86.7%) and urethral meatus (76.9%). Factors associated with injuries were severe edema (p = 0.005), low Braden (p<0.001) and Glasgow (p = 0.008) scores, length of stay in intensive care (p<0.001) and hospitalization diagnosis classified as other causes (p<0.001). The use of more than one device (p<0.001) and a longer time of use (p<0.001) were correlated. Conclusion: The high prevalence of injuries and the associated factors indicate the need for preventive measures and risk monitoring.

One Lung Ventilation Using an Orotracheal Tube and an Endobronchial Blocker in a Patient with Difficult Airway

One-Lung Ventilation (OLV) is achieved in thoracic surgeries to facilitate collapse of one lung for better surgical visualisation. Double-lumen tubes and bronchial blockers are two commonly used devices for OLV. Patients with ‘difficult airway’ pose significant challenges for insertion of Double Lumen Endotracheal Tube (DLT). Dual malignancy such as carcinoma of lung and head and neck is extremely rare to present with. Patients presenting with restricted mouth opening due to previous surgeries and requiring lung isolation techniques may pose significant challenges to anaesthesiologist. The difficult airway scenario may arise in such patients owing to their previous surgery to the tongue, larynx, neck, mandible or previous radiation. The present case was of 47-year-old of lung isolation achieved in a patient with restricted mouth opening with an orotracheal tube, bougie, endobronchial blocker and a flexible Fibre Optic Bronchoscope (FOB). Left upper lobectomy was successfully performed after passing endobronchial blocker through a conventional orotracheal tube under the guidance of FOB.

Orotracheal tube versus supraglottic devices in biological, chemical and radiological disasters: meta-analysis in manikin-based studies

ABSTRACT Objective: To compare the mean time of orotracheal intubation and insertion of supraglottic airway devices, considering healthcare providers wearing waterproof overall, gloves, boots, eye protection and mask at the Chemical, Biological, Radiological and Nuclear context in simulation setting. Methods: Six databases were searched. The selected studies were put in a pool of results using a random-effects meta-analysis, with standardized mean differences and calculation of 95% confidence intervals. Results: Nine observational studies were included. Regarding reducing time to provide ventilatory support, subgroup analyses were made. The emergency setting subgroup: -12.97 [-16.11; -9.83]; I2 = 64%. The surgery setting subgroup: -14.96 [-18.65; -11.27]; I2 = 75%. Another analysis was made by reproductive methodology subgroups. Ophir’s subgroup: -15.70 [-17.04; -14.37]; I2 = 0%. All meta-analyses had orotracheal tube as comparator. Conclusion: Moderate level of evidence was in favor of insertion of supraglottic devices because of fast application.

Systematic review and meta-analysis comparing ventilatory support in chemical, biological and radiological emergencies

Objective: to compare the mean development time of the techniques of direct laryngoscopy and insertion of supraglottic devices; and to evaluate the success rate in the first attempt of these techniques, considering health professionals wearing specific personal protective equipment (waterproof overalls; gloves; boots; eye protection; mask). Method: meta-analysis with studies from LILACS, MEDLINE, CINAHL, Cochrane, Scopus and Web of Science. The keywords were the following: personal protective equipment; airway management; intubation; laryngeal masks. Results: in the “reduction of the time of the procedures” outcome, the general analysis of the supraglottic devices in comparison with the orotracheal tube initially presented high heterogeneity of the data (I2= 97%). Subgroup analysis had an impact on reducing heterogeneity among the data. The “laryngeal mask as a guide for orotracheal intubation” subgroup showed moderate heterogeneity (I2= 74%). The “2ndgeneration supraglottic devices” subgroup showed homogeneity (I2= 0%). All the meta-analyses favored supraglottic devices. In the “success in the first attempt” outcome, moderate homogeneity was found (I2= 52%), showing a higher proportion of correct answers for supraglottic devices. Conclusion: in the context of chemical, biological or radiological disaster, the insertion of the supraglottic device proved to be faster and more likely to be successful by health professionals. PROSPERO record (CRD42019136139).

The VIP patient syndrome in Latin America is known as “The recommended patient syndrome” a tale of unfortunate decisions and complications.

When a VIP patient or a patient who has an economic, social or family relationship with the doctors who treat them, arrive to the ER there is a subtle risk of making unorthodox decisions, Also, wasting resources, breaking standards of care and in the lowest scenario causing unintended complications to the patient. Case Report: We report a 55-year-old patient related to a physician. She was admitted to the emergency room due to abdominal pain, on admission was suspected appendicitis versus abdominal mass, an abdominal CT scan with contrast was performed and she developed an allergic reaction due to the contrast, she required intubation that was complicated with selective intubation and a massive atelectasis. After removal the orotracheal tube she presented fentanyl toxicity and finally after discharge developed post-traumatic stress. Conclusion: in LA (Latin America) this syndrome is an entity that exists, has been little described and in our knowledge has never been quantified. Patients are victims of multiple non-malicious complications, which originate in the desire of their health team trying to provide a closer, faster and more personalized attention outside of the guidelines of treatment. Ethical principles and prevention should be strengthened through an adequate clinical history and a detailed physical examination to avoid this event.

Medical Device-Related Pressure Injuries: an integrative literature review

ABSTRACT Objetives: To identify and analyze the scientific evidence regarding the occurrence of Medical Device-Related Pressure Injuries, considering the development sites; and to describe the devices of risk and the measures of prevention and treatment. Method: Integrative, search-based review: CINAHL, PubMed, Wiley InterScience, Scopus, and Web Of Science. The terms “pressure ulcer” and “medical devices” were used, including original articles and case studies published between 2010 and 2015. Nine studies were selected. Results: Posterior cervical region and nose had the highest injury frequencies, respectively, 66.0% and 40.0%. Eleven risk devices were identified, with emphasis on Non-Invasive Ventilation masks and orotracheal tube. For prevention and treatment emerged recommendations specific to the device employed and general measures. Conclusion: Medical Device-Related Pressure Injuries are frequent problems, however, they can be prevented and treated based on the recommendations of the articles raised in this review.