Navegando por Palavras-chave "Pediatric intensive care unit"
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- ItemAcesso aberto (Open Access)Colonização orofaríngea de crianças à admissão em uma unidade de cuidados intensivos(Escola Paulista de Enfermagem, Universidade Federal de São Paulo (UNIFESP), 2007-12-01) Kusahara, Denise Miyuki [UNIFESP]; Peterlini, Maria Angélica Sorgini [UNIFESP]; Pedreira, Mavilde da Luz Gonçalves [UNIFESP]; Universidade Federal de São Paulo (UNIFESP)Objectives: This study aimed to identify the microbiological oropharyngeal colonization pattern in children admitted at a Pediatric Intensive Care Unit (PICU) and to verify the influence of children's and implemented therapies' characteristics before admission at the UCIP on this pattern. Prospective study realized at a PICU of a university hospital. METHODS: Samples of oropharyngeal secretion were obtained in the first 24 hours of the children's admission. Variables related to the children's and the therapies' characteristics were investigated. RESULTS: The majority of the children had normal nutritional state, admitted in the hospital in emergencies situations, with chronic diseases and without alterations in the clinical conditions of the oral cavity. CONCLUSION: The children who were colonized by pathogenic microorganisms presented a longer hospital stay (p=0,020) than those with cultures with normal flora species. The investigated characteristics of the children did not exert any significant influence the microbiological oropharyngeal colonization pattern.
- ItemAcesso aberto (Open Access)Delirium em pediatria: conhecimentos e práticas de enfermeiros intensivistas pediatras(Universidade Federal de São Paulo, 2024-01-17) Costa, Ricardo Augusto Silva [UNIFESP]; Kusahara, Denise Miyuki [UNIFESP]; Anacleto, Aline Santa Cruz Belela [UNIFESP]; http://lattes.cnpq.br/8189405676536389; http://lattes.cnpq.br/2666393667209812; http://lattes.cnpq.br/3675124786713387Introdução: O delirium é uma síndrome de disfunção cerebral aguda, que ocorre com frequência, em pacientes gravemente enfermos. A prevenção, o diagnóstico e o tratamento do delirium podem ser influenciadas pelos conhecimentos e práticas de enfermeiros em relação ao agravo. Contudo, em pediatria, estudos sobre essas questões ainda são incipientes. Objetivos: Identificar conhecimentos e práticas de enfermeiros intensivistas pediatras sobre delirium em crianças. Método: Estudo quantitativo, analítico, do tipo Survey, realizado de forma online, com amostra não probabilística, composta por enfermeiros pediatras, atuantes em unidades de terapia intensiva pediátrica, em todo território nacional. Para a coleta dos dados foi utilizado questionário elaborado pelos pesquisadores, cujo conteúdo foi avaliado por sete juízes com a versão final aprovada com 93% de concordância entre eles. O questionário foi composto por variáveis referentes à caracterização dos enfermeiros, conhecimento acerca do delirium em crianças, habilidades e práticas diárias relacionadas ao delirium e barreiras para identificação, prevenção e tratamento do agravo, mensuradas por meio de escala do tipo Likert e alternativas que denotavam a frequência de realização de determinadas ações. Os dados foram analisados segundo estatística descritiva e inferencial, adotando se como nível de significância 5% e Intervalo de Confiança de 95%. Resultados: Participaram da pesquisa 107 enfermeiros, predominantemente das regiões Nordeste (43,0%) e Sudeste (40,0%) do país. Dentre os participantes, 35,5% haviam recebido informações prévias sobre delirium em crianças, no curso de especialização (63,2%) ou em cursos livres (55,3%). No tocante ao conhecimento sobre o delirium, maior percentual de acertos foi identificado para as questões que abordavam sinais de delirium (94,4%), características do delirium hiperativo (92,5%) e hipoativo (92,5%) e medidas não farmacológicas de prevenção e controle do agravo (95,3%). Com relação às práticas voltadas ao delirium, 43,4% dos participantes informaram terem instrumentos implementados em seus serviços. Pediatric Confusion Assessment Method for the Intensive Care Unit (pCAM ICU), e Cornell Assessment of Pediatric Delirium foram os instrumentos de rastreio mais utilizados pelos participantes. No tratamento,41,2% dos participantes informaram utilizar antagonistas de benzodiazepínicos nos casos de delirium hipoativo e/ou misto, com pouca investidura nas medidas não farmacológicas. Ademais, 75,7% disseram não ter formação continuada em serviço sobre temas voltados para o quadro clínico em questão e 80,4% concordaram que existem barreiras no serviço que impedem a correta identificação e tratamento do delirium, com destaque à falha de comunicação entre as equipes (88,7%), ausência de escalas implementadas (95,3%), e dimensionamento de enfermagem falho (88,7%). A natureza do serviço esteve significativamente associada à frequência de inclusão de intervenções relacionadas ao delirium na prescrição de enfermagem (p=0,018), e ações de educação para prevenção do delirium (p=0,027). O conhecimento prévio sobre delirium em pediatria foi estatisticamente associado às assertivas que evidenciavam barreiras para implementação de ações de rastreio, prevenção e manejo do delirium em crianças. Conclusão: O conhecimento sobre delirium pediátrico entre enfermeiros intensivistas pediatras é ainda incipiente e mais evidenciado dentre aqueles com pós-graduação lato sensu. Práticas relacionadas ao rastreio, prevenção e tratamento do delirium em crianças são variadas e sofrem influência de barreiras estruturais, de comunicação e de educação dos profissionais nos serviços de saúde.
- ItemAcesso aberto (Open Access)Hypophosphatemia in critically ill children(Faculdade de Medicina / Universidade de São Paulo - FM/USP, 2004-01-01) Menezes, Fernanda Souza de [UNIFESP]; Leite, Heitor Pons [UNIFESP]; Fernandez, Juliana [UNIFESP]; Benzecry, Silvana Gomes [UNIFESP]; Carvalho, Werther Brunow de [UNIFESP]; Universidade Federal de São Paulo (UNIFESP)The purpose of this paper is to review clinical studies on hypophosphatemia in pediatric intensive care unit patients with a view to verifying prevalence and risk factors associated with this disorder. We searched the computerized bibliographic databases Medline, Embase, Cochrane Library, and LILACS to identify eligible studies. Search terms included critically ill, pediatric intensive care, trauma, sepsis, infectious diseases, malnutrition, inflammatory response, surgery, starvation, respiratory failure, diuretic, steroid, antiacid therapy, mechanical ventilation. The search period covered those clinical trials published from January 1990 to January 2004. Studies concerning endocrinological disorders, genetic syndromes, rickets, renal diseases, anorexia nervosa, alcohol abuse, and prematurity were not included in this review. Out of 27 studies retrieved, only 8 involved pediatric patients, and most of these were case reports. One clinical trial and one retrospective study were identified. The prevalence of hypophosphatemia exceeded 50%. The commonly associated factors in most patients with hypophosphatemia were refeeding syndrome, malnutrition, sepsis, trauma, and diuretic and steroid therapy. Given the high prevalence, clinical manifestations, and multiple risk factors, the early identification of this disorder in critically ill children is crucial for adequate replacement therapy and also to avoid complications.
- ItemSomente MetadadadosIatrogenic pneumothorax in mechanically ventilated children: Incidence, risk factors and other outcomes(Elsevier B.V., 2015-05-01) Lucas da Silva, Paulo Sergio; Aguiar, Vania Euzebio de; Machado Fonseca, Marcelo Cunio [UNIFESP]; Hosp Servidor Publ Municipal; Universidade Federal de São Paulo (UNIFESP)Objectives: Determine prevalence, risk factors and outcomes of iatrogenic pneumothoraces (IPs) in a pediatric intensive care unit (PICU).Methods: Patients with IP (cases) and patients without IP (controls) were retrieved from a 5-year prospective cohort of 645 PICU patients who received mechanical ventilation (MV).Results: Twenty cases and eighty controls were assessed. the overall prevalence of IP was 3%. Eleven IPs were procedure-related IP and 9 MV related. Performance of thoracic invasive procedures (odds ratio 11) was the significant IP predictor in the logistic regression analysis. IP incidence was higher within 12 hours. There were no differences between the groups concerning duration of MV, length of PICU and hospital stays. IP patients had a significantly higher mortality rate (p = 0.005).Conclusions: Performance of thoracic invasive procedures was strongly associated with IPs events in mechanically ventilated children. Many of these events may potentially be preventable with the implementation of quality improvement programs. (C) 2015 Elsevier Inc. All rights reserved.
- ItemSomente MetadadadosRevisiting unplanned extubation in the pediatric intensive care unit: What's new?(Mosby-Elsevier, 2017) Lucas da Silva, Paulo Sergio; Farah, Daniela [UNIFESP]; Machado Fonseca, Marcelo Cunio [UNIFESP]In 2010, recommendations for preventing unplanned extubations (UEs) in pediatric patients were published based on a literature review. Since then, there have been an increasing number of publications related to UE focusing on children. If the introduction of care bundles and larger body of evidence on UE had impact on UE occurrence, this would have important implications on clinical practice. We searched for relevant publications published between Jan 1, 2010 and Jun 30, 2016 in the MEDLINE, EMBASE, and Cochrane systems. Eight articles were eligible for data abstraction. Three studies were of high methodological quality. The mean contemporaneous incidence of UEs was 1.19 UEs/100 intubation days. The primary risk factors were as follows: caregiver bedside procedures/manipulation, agitation, and endotracheal tube care. The ideal incidence of UEs remains unknown. Key areas identified in the current review may be amenable to changes in unit processes by implementing a care bundle strategy. (C) 2017 Elsevier Inc. All rights reserved.
- ItemSomente MetadadadosValue of Repeat Cranial Computed Tomography in Pediatric Patients Sustaining Moderate to Severe Traumatic Brain Injury(Lippincott Williams & Wilkins, 2008-12-01) Lucas da Silva, Paulo Sergio; Reis, Maria Eunice; Aguiar, Vania Euzebio; Universidade Federal de São Paulo (UNIFESP)Background: Repeat head computed tomography (CT) is standard practice for traumatic brain injury (TBI) at many centers. the few studies available in children remain unclear over the value of repeat CT within 24 hours to 48 hours of lesion in such patients. the purpose of the present study was to assess the value of repeat cranial CT in children presenting moderate or severe TBI.Methods: A retrospective study performed within a pediatric intensive care unit between January 2000 and December 2006. All patients with moderate and severe TBI who survived the first 24 hours after admission were included. Clinical data collected included age, lesion mechanism, time between first and second CTs, disease severity score at admission, and Glasgow Coma Scale (GCS) both at admission and (lay of repeat CT.Results: A total of 63 children were assessed whose mean age was 72 months (48-112). the time between the first and the second CT scans averaged 25.78 hours +/- 13.75 hours (range, 6-48 hours). the reasons for ordering repeat CT scans were divided as follows: follow-up (78%), neurologic deterioration (20.4%.), and increased intracranial pressure (1.6%). the change on the follow-tip CT scan was compared with the GCS score. the GCS score was improved in 66.6% of patients, remained the same in 15.9%, and worsened in 17.5%. the appearance on the CT scans was better, the same or worse in 41.3%, 34.9%, and 23.8% of patients, respectively. There was a significant association between GCS and changes in findings on repeat CT (OR = 34.5, confidence interval [5.98-199.04], p = 0.000009). the positive and negative predictive values were 82% and 89%, respectively. One patient with a worsened GCS required surgical intervention based on the repeat CT scan.Conclusion: An unchanged or improving neurologic examination in children sustaining moderate or severe TBI who are appropriately monitored may be adequate to exclude the possibility of neurosurgical intervention and, hence, repeat head CT scan.