Navegando por Palavras-chave "Decúbito dorsal"
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- ItemSomente MetadadadosApneia obstrutiva do sono em crianças(Universidade Federal de São Paulo (UNIFESP), 2003) Prado, Lucila Bizari Fernandes do [UNIFESP]; Prado, Gilmar Fernandes do [UNIFESP]Contexto e Objetivos. Em adultos, a apneia obstrutiva do sono e pior quando o paciente esta em posicao supina. Entretanto, a relacao entre posicao e apneia do sono na crianca e desconhecida. O objetivo deste estudo foi avaliar a relacao entre apneia obstrutiva e posicao corporal durante o sono na crianca. Desenho. Analise retrospectiva da relacao entre posicao corporal e apneia obstrutiva em criancas obesas e nao obesas. Local. Centro Pediatrico de Cuidados Terciarios de Sono. The Eudowood Division of Pediatnc Respiratory Sciences, Johns Hopkins University, The Johns Hopkins Hospital, Baltimore, MD, USA Material e Metodo. Pacientes: criancas saudaveis sob outros aspectos, idade entre 1 e 10 anos, submetidas a polissonografia por suspeita de sindrome da apneia obstrutiva do sono. Intervencao. Revisao retrospectiva da relacao entre posicao corporal durante o sono e apneia obstrutiva durante a polissonografia. Medidas. Foram avaliadas 80 polissonografias de 56 criancas nao obesas e 24 obesas. A posicao corporal foi determinada por um sensor durante a polissonografia e confirmada por revisao dos videotapes. Criancas obesas e nao obesas foram avaliadas separadamente. Resultados: As criancas apresentaram um indice de apneia-hipopneia obstrutivas menor quando em posicao supina versus prona e apneias de menor duracao quando em supina que quando em decubito lateral. Nao houve diferenca na duracao da apneia entre as posicoes supina e prona. Criancas obesas e nao obesas apresentaram alteracoes posicionais similares. Conclusao: Criancas com apneia obstrutiva do sono, em contraste com adultos, respiram melhor quando em posicao supina
- ItemSomente MetadadadosApnéia obstrutiva do sono: Estudo por meio de telerradiografias horizontais e verticais(Universidade Federal de São Paulo (UNIFESP), 2009-03-25) Nauff, Fabio [UNIFESP]; Lederman, Henrique Manoel [UNIFESP]; Universidade Federal de São Paulo (UNIFESP)Objective: Assess the variation of areas and diameters of regions of the superior airways And soft palate of individuals with obstructive sleep apnea, through teleradiography taken with the individual in upright or lying down position. Methods: The cephalograms obtained from 22 male individuals suffering from obstructive sleep apnea diagnosed by polyssomnography (IHA>10 events/hour) and overweight (BMI between 25 – 34,9 kg/m2) were assessed. The teleradiographies in lateral position were taken in upright (standing) and horizontal (lying in supine position). In the cephalometric tracing, the upper airways in the craniofacial area were defined and divided in three sectors: Nasopharynx, oropharynx and hypopharynx. The areas in the three sectors were measured e compared for the two positions of the individual, as well as the smaller diameter of the oropharynx and the hypopharynx. The area of the soft palate and its larger diameter were also compared. Results: The lying position showed, in average, a smaller area of the nasopharynx, (p=0,001), a smaller area of the oropharynx (p<0,001) , a smaller area of the hypopharynx (p<0,001), a smaller diameter of the oropharynx (p<0,001) and a smaller diameter of the hypopharynx (p<0,001), than the upright position. The lying position showed, also, a larger area of the soft palate (p<0,001) and larger diameter of the soft palate (p=0,007), in average, than the upright position. Conclusions: Individuals with obstructive sleep apnea when changing from vertical to horizontal position suffer an area reduction in the upper airways and smaller diameter of the oropharynx and the hypopharynx, suggesting obstruction. The soft palate with the individual in the lying position showed a larger radiographic area and width when compared with the individual in the upright position.
- ItemSomente MetadadadosDecúbito dorsal nos retalhos microcirúrgicos do músculo grande dorsal(Universidade Federal de São Paulo (UNIFESP), 1998) Andrade, Fernando Antonio Gomes de [UNIFESP]; Ferreira, Lydia Masako [UNIFESP]; Universidade Federal de São Paulo (UNIFESP)Foram realizados 100 retalhos microcirurgicos no Hospital da Universidade de Paris VII- Hospital Saint-Louis e estudados na Universidade Federal de São Paulo - Escola Pauiista de Medicina. A sistematizacao do decubito dorsal como posicao no pre-operatorio propiciou uma opcao que facilitou a disseccao do retalho e a realizacao da cirurgia numa so posicao; a equipe de anestesia pode, entao, trabalhar com uma posicao definitiva, o que favoreceu a fixacao do tubo endotraqueal e a monitoracao dos parametros clinicos. Devido a esses fatores, a cirurgia foi realizada com seguranca e conforto. A media de nove pacientes operados por ano confirmou a tendencia de nao se supervalorizar os retalhos microcirurgicos. Nao houve limites de idade que contra-indicassem a microcirurgia, que foi realizada em pacientes de seis e 78 anos, com media de 37,8 anos. As regioes dos membros inferiores e a da cabeca foram as que tiveram maior indicacao do retalho microcirurgico do grande dorsal; a porcentagem de reintervencao cirurgica foi de 11 por cento devida a trombose; e a perda total do retalho foi de 4 por cento , todos em membros inferiores
- ItemAcesso aberto (Open Access)Effects of prone position on the oxygenation of patients with acute respiratory distress syndrome(Associação Paulista de Medicina - APM, 2006-02-01) Rossetti, Heloisa Baccaro [UNIFESP]; Machado, Flávia Ribeiro [UNIFESP]; Valiatti, Jorge Luis dos Santos [UNIFESP]; Amaral, José Luiz Gomes do [UNIFESP]; Universidade Federal de São Paulo (UNIFESP)CONTEXT AND OBJECTIVE: Acute respiratory distress syndrome (ARDS) is characterized by arterial hypoxemia, and prone position (PP) is one possible management strategy. The objective here was to evaluate the effects of PP on oxygenation. DESIGN AND SETTING: Non-randomized, open, prospective, controlled clinical trial, in a surgical intensive care unit at a tertiary university hospital. METHODS: Forty-one ARDS patients underwent PP for three-hour periods. Arterial partial oxygen pressure (PaO2) was measured immediately before changing to PP, after 30, 60, 120 and 180 minutes in PP and 60 minutes after returning to dorsal recumbent position (DP). The paired-t and Dunnett tests were used. RESULTS: A notable clinical improvement in oxygenation (> 15%) was detected in 78.0% of patients. This persisted for 60 minutes after returning to DP in 56% and lasted for 12 and 48 hours in 53.6% and 46.3%, respectively. Maximum improvement was seen after 30 minutes in 12.5% of responding patients and after 180 minutes in 40.6%. No statistically significant associations between PP response and age, gender, weight, PEEP level, tidal volume, respiratory rate, PaO2/FiO2 or duration of mechanical ventilation were detected. One accidental extubation and four cases of deterioration through oxygenation were detected. The 48-hour mortality rate was 17%. CONCLUSIONS: For a significant number of ARDS patients, PP may rapidly enhance arterial oxygenation and its inclusion for management of severe ARDS is justified. However, it is not a cost-free maneuver and caution is needed in deciding on using PP.
- ItemAcesso aberto (Open Access)Posição prona(Sociedade Brasileira de Pneumologia e Tisiologia, 2005-08-01) Paiva, Kelly Cristina De Albuquerque [UNIFESP]; Beppu, Osvaldo Shigueomi [UNIFESP]; Universidade Federal de São Paulo (UNIFESP)The prone position is a maneuver used to combat hypoxemia in patients with acute respiratory distress syndrome. Despite the fact that this is currently considered an efficient way to improve oxygenation, the physiological mechanisms that bring about improvements in respiratory function are not yet fully understood. The aim of this review is to discuss the physiological and clinical aspects of the prone position in patients with acute respiratory distress syndrome.