Utilización de la CPAP de forma no invasiva en la laringitis postextubación del paciente pediátrico. Estudio controlado y aleatorizado
Non-invasive continuous positive airways pressure for laryngitis postextubation in pediatric patients
J.A. Rodrígueza,
, B. Von Dessauerb, G. Duffauc
Corresponding author
horrio@saval.cl
Correspondencia: UCI Hospital Roberto del Río.Casilla: 70002 Correo Central. Santiago-Chile
Correspondencia: UCI Hospital Roberto del Río.Casilla: 70002 Correo Central. Santiago-Chile
a Instructor de la Escuela de Kinesiología. Facultad de Medicina. Universidad de Chile. Coordinador Unidad Kinesiología
b Profesora Agregada de Pediatría. Jefa de la Unidad de Cuidados Intensivos.Hospital de Niños Roberto del Río
c Profesor Titular de Pediatría. Facultad de Medicina. Universidad de Chile
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"apellidos" => "Rodríguez" "email" => array:1 [ 0 => "horrio@saval.cl" ] "referencia" => array:2 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">a</span>" "identificador" => "aff0005" ] 1 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">¿</span>" "identificador" => "cor0005" ] ] ] 1 => array:3 [ "nombre" => "B." "apellidos" => "Von Dessauer" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">b</span>" "identificador" => "aff0010" ] ] ] 2 => array:3 [ "nombre" => "G." "apellidos" => "Duffau" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">c</span>" "identificador" => "aff0015" ] ] ] ] "afiliaciones" => array:3 [ 0 => array:3 [ "entidad" => "Instructor de la Escuela de Kinesiología. Facultad de Medicina. Universidad de Chile. Coordinador Unidad Kinesiología" "etiqueta" => "<span class="elsevierStyleSup">a</span>" "identificador" => "aff0005" ] 1 => array:3 [ "entidad" => "Profesora Agregada de Pediatría. Jefa de la Unidad de Cuidados Intensivos.Hospital de Niños Roberto del Río" "etiqueta" => "<span class="elsevierStyleSup">b</span>" "identificador" => "aff0010" ] 2 => array:3 [ "entidad" => "Profesor Titular de Pediatría. Facultad de Medicina. Universidad de Chile" "etiqueta" => "<span class="elsevierStyleSup">c</span>" "identificador" => "aff0015" ] ] "correspondencia" => array:1 [ 0 => array:3 [ "identificador" => "cor0005" "etiqueta" => "⁎" "correspondencia" => "Correspondencia: UCI Hospital Roberto del Río.Casilla: 70002 Correo Central. Santiago-Chile" ] ] ] ] "titulosAlternativos" => array:1 [ "en" => array:1 [ "titulo" => "Non-invasive continuous positive airways pressure for laryngitis postextubation in pediatric patients" ] ] "pdfFichero" => "main.pdf" "tienePdf" => true "fechaRecibido" => "2002-01-28" "fechaAceptado" => "2002-05-28" "PalabrasClave" => array:2 [ "es" => array:1 [ 0 => array:4 [ "clase" => "keyword" "titulo" => "Palabras clave" "identificador" => "xpalclavsec190665" "palabras" => array:4 [ 0 => "Laringitis postextubación" 1 => "CPAP no invasiva" 2 => "Epinefrina" 3 => "Niños" ] ] ] "en" => array:1 [ 0 => array:4 [ "clase" => "keyword" "titulo" => "Keywords" "identificador" => "xpalclavsec190666" "palabras" => array:4 [ 0 => "Postextubation laryngeal edema" 1 => "Non-invasive continuous airways pressure" 2 => "Epinephrin" 3 => "Children" ] ] ] ] "tieneResumen" => true "resumen" => array:2 [ "es" => array:1 [ "resumen" => "<span class="elsevierStyleSectionTitle">Fundamento</span><p id="spar0005" class="elsevierStyleSimplePara elsevierViewall">La laringitis postextubación (LPE) es una complicación frecuente en las unidades de cuidados intensivos pediátricos (10–15%). Varios estudios han observado altas tasas de fracaso con el tratamiento habitual</p> <span class="elsevierStyleSectionTitle">Hipótesis</span><p id="spar0010" class="elsevierStyleSimplePara elsevierViewall">“La aplicación de CPAP no invasiva en niños con LPE reducirá los fracasos de tratamiento en comparación con el manejo convencional”</p> <span class="elsevierStyleSectionTitle">Pacientes Y Método</span><p id="spar0015" class="elsevierStyleSimplePara elsevierViewall">Se requería un total de 25 pacientes por grupo para detectar la diferencia estipulada entre los tratamientos. Éstos fueron asignados al azar (bloques de 10) para recibir terapia convencional (nebulizaciones de epine-frina y O<span class="elsevierStyleInf">2</span> humidificado) o experimental (CPAP no invasiva durante 18 h). Completados 9 meses del estudio, al observar en un análisis interino una diferencia significativa en los resultados entre los dos grupos estudiados, se suspendió la investigación</p> <span class="elsevierStyleSectionTitle">Resultados</span><p id="spar0020" class="elsevierStyleSimplePara elsevierViewall">De 270 niños extubados durante el estudio, 28 (10,3%) manifestaron LPE y 25 cumplieron los requisitos de admisión, conformando 13 el grupo convencional y 12 el grupo CPAP. Ambos fueron comparables en sus características generales, tiempo de intubación, FiO<span class="elsevierStyleInf">2</span> al ingreso, uso de corticoides preextubación y puntuación de ingreso de dificultad respiratoria (p > 0,05). Con terapia convencional mejoraron 5 (38,5%) y los restantes 8 no mejoraron o empeo-raron. De los que recibieron CPAP no invasiva mejoraron 11 (91,7%) (p<span class="elsevierStyleHsp" style=""></span>=<span class="elsevierStyleHsp" style=""></span>0,01). Los que fracasaron con la tratamiento convencional (8) fueron sometidos a la CPAP con la que mejoraron todos. El único fracaso en este último debió ser rein-tubado</p> <span class="elsevierStyleSectionTitle">Conclusione</span><p id="spar0025" class="elsevierStyleSimplePara elsevierViewall">Se verifica la hipótesis planteada. El tratamiento propuesto disminuyó los fracasos en un 53,2%, en relación con el tradicional</p>" ] "en" => array:1 [ "resumen" => "<p id="spar0030" class="elsevierStyleSimplePara elsevierViewall">Post-extubation laryngeal edema (PLE) is a common complication (10-15%) in pediatric intensive care units, and some authors have reported high failure rates for conventional treatment</p> <span class="elsevierStyleSectionTitle">Hypothesis</span><p id="spar0035" class="elsevierStyleSimplePara elsevierViewall">Non-invasive continuous positive airways pressure (CPAP) in children with PLE may have a lower failure rate than conventional management</p> <span class="elsevierStyleSectionTitle">Patients And Method</span><p id="spar0040" class="elsevierStyleSimplePara elsevierViewall">Twenty-five patients were needed to detect a difference between the two treatment groups. The patients were assigned to receive the conventional treat-ment (nebulized epinephrin and humidified oxygen) or the experimental treatment (non-invasive CPAP treatment for 18 hours), using a randomized block design (10-patient blocks). After 9 months, the study was halted when a significant difference emerged between the two groups</p> <span class="elsevierStyleSectionTitle">Results</span><p id="spar0045" class="elsevierStyleSimplePara elsevierViewall">Of 270 children extubated during the study, 28 (10.3%) developed PLE and 25 met the enrollment requirements. Thirteen were assigned to conventional therapy and 12 to CPAP. General characteristics, time of intubation, FiO2 upon admission, use of corticoids before extubation and scores for respiratory difficulty upon admission were similar in the two groups (p > 0.05). With conventional therapy, 5 (38.5%) children improved and 8 patients worsened or remained the same. Eleven (91.7%) of the patients receiving CPAP improved (p<span class="elsevierStyleHsp" style=""></span>=<span class="elsevierStyleHsp" style=""></span>0.01). Those who failed on conventional treatment were prescribed CPAP and all then improved, although one had to be re-intubated</p> <span class="elsevierStyleSectionTitle">Conclusions</span><p id="spar0050" class="elsevierStyleSimplePara elsevierViewall">The hypothesis was confirmed. CPAP treatment reduced the failure rate by 53.2% in comparison withconventional therapy</p>" ] ] "bibliografia" => array:2 [ "titulo" => "Bibliografía" "seccion" => array:1 [ 0 => array:2 [ "identificador" => "bibs0005" "bibliografiaReferencia" => array:21 [ 0 => array:3 [ "identificador" => "bib0005" "etiqueta" => "1." 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| Year/Month | Html | Total | |
|---|---|---|---|
| 2024 November | 4 | 4 | 8 |
| 2024 October | 38 | 24 | 62 |
| 2024 September | 46 | 25 | 71 |
| 2024 August | 57 | 75 | 132 |
| 2024 July | 53 | 36 | 89 |
| 2024 June | 58 | 59 | 117 |
| 2024 May | 46 | 50 | 96 |
| 2024 April | 35 | 27 | 62 |
| 2024 March | 42 | 36 | 78 |
| 2024 February | 40 | 28 | 68 |
| 2024 January | 0 | 2 | 2 |
| 2023 December | 0 | 24 | 24 |
| 2023 November | 0 | 15 | 15 |
| 2023 October | 0 | 17 | 17 |
| 2023 September | 0 | 5 | 5 |
| 2023 July | 0 | 5 | 5 |
| 2023 June | 0 | 14 | 14 |
| 2023 March | 1 | 2 | 3 |
| 2023 February | 35 | 14 | 49 |
| 2023 January | 29 | 30 | 59 |
| 2022 December | 26 | 31 | 57 |
| 2022 November | 24 | 19 | 43 |
| 2022 October | 38 | 61 | 99 |
| 2022 September | 29 | 29 | 58 |
| 2022 August | 36 | 59 | 95 |
| 2022 July | 26 | 59 | 85 |
| 2022 June | 23 | 43 | 66 |
| 2022 May | 38 | 33 | 71 |
| 2022 April | 42 | 20 | 62 |
| 2022 March | 68 | 35 | 103 |
| 2022 February | 40 | 26 | 66 |
| 2022 January | 49 | 35 | 84 |
| 2021 December | 22 | 48 | 70 |
| 2021 November | 23 | 41 | 64 |
| 2021 October | 31 | 34 | 65 |
| 2021 September | 23 | 56 | 79 |
| 2021 August | 22 | 36 | 58 |
| 2021 July | 28 | 24 | 52 |
| 2021 June | 22 | 33 | 55 |
| 2021 May | 13 | 26 | 39 |
| 2021 April | 110 | 55 | 165 |
| 2021 March | 72 | 21 | 93 |
| 2021 February | 57 | 15 | 72 |
| 2021 January | 35 | 16 | 51 |
| 2020 December | 35 | 13 | 48 |
| 2020 November | 22 | 14 | 36 |
| 2020 October | 25 | 12 | 37 |
| 2020 September | 24 | 14 | 38 |
| 2020 August | 39 | 15 | 54 |
| 2020 July | 20 | 17 | 37 |
| 2020 June | 21 | 9 | 30 |
| 2020 May | 24 | 21 | 45 |
| 2020 April | 38 | 11 | 49 |
| 2020 March | 18 | 18 | 36 |
| 2020 February | 33 | 38 | 71 |
| 2020 January | 38 | 31 | 69 |
| 2019 December | 25 | 23 | 48 |
| 2019 November | 20 | 21 | 41 |
| 2019 October | 10 | 34 | 44 |
| 2019 September | 16 | 35 | 51 |
| 2019 August | 15 | 15 | 30 |
| 2019 July | 31 | 43 | 74 |
| 2019 June | 20 | 32 | 52 |
| 2019 May | 46 | 57 | 103 |
| 2019 April | 28 | 83 | 111 |
| 2019 March | 18 | 28 | 46 |
| 2019 February | 7 | 27 | 34 |
| 2019 January | 10 | 28 | 38 |
| 2018 December | 14 | 21 | 35 |
| 2018 November | 24 | 30 | 54 |
| 2018 October | 36 | 23 | 59 |
| 2018 September | 24 | 11 | 35 |
| 2018 May | 8 | 1 | 9 |
| 2018 April | 7 | 5 | 12 |
| 2018 March | 4 | 6 | 10 |
| 2018 February | 7 | 13 | 20 |
| 2018 January | 5 | 8 | 13 |
| 2017 December | 11 | 14 | 25 |
| 2017 November | 5 | 10 | 15 |
| 2017 October | 7 | 15 | 22 |
| 2017 September | 5 | 16 | 21 |
| 2017 August | 10 | 13 | 23 |
| 2017 July | 4 | 17 | 21 |
| 2017 June | 15 | 15 | 30 |
| 2017 May | 10 | 16 | 26 |
| 2017 April | 5 | 10 | 15 |
| 2017 March | 4 | 19 | 23 |
| 2017 February | 3 | 11 | 14 |
| 2017 January | 1 | 2 | 3 |
| 2016 December | 9 | 10 | 19 |
| 2016 November | 26 | 21 | 47 |
| 2016 October | 19 | 18 | 37 |
| 2016 September | 23 | 15 | 38 |
| 2016 August | 22 | 12 | 34 |
| 2016 July | 23 | 8 | 31 |
| 2016 June | 28 | 22 | 50 |
| 2016 May | 18 | 15 | 33 |
| 2016 April | 12 | 3 | 15 |
| 2016 March | 8 | 3 | 11 |
| 2016 February | 13 | 4 | 17 |
| 2016 January | 25 | 14 | 39 |
| 2015 December | 36 | 20 | 56 |
| 2015 November | 26 | 8 | 34 |
| 2015 October | 113 | 1 | 114 |
| 2015 September | 71 | 0 | 71 |
| 2015 August | 102 | 0 | 102 |
| 2015 July | 108 | 0 | 108 |
| 2015 June | 66 | 0 | 66 |
| 2015 May | 94 | 0 | 94 |
| 2015 April | 73 | 0 | 73 |
| 2015 March | 94 | 0 | 94 |
| 2015 February | 66 | 0 | 66 |
| 2015 January | 62 | 0 | 62 |
| 2014 December | 61 | 0 | 61 |
| 2014 November | 73 | 0 | 73 |
| 2014 October | 102 | 0 | 102 |
| 2014 September | 80 | 0 | 80 |
| 2014 August | 76 | 0 | 76 |
| 2014 July | 97 | 0 | 97 |
| 2014 June | 84 | 0 | 84 |
| 2014 May | 80 | 0 | 80 |
| 2014 April | 80 | 0 | 80 |
| 2014 March | 93 | 0 | 93 |
| 2014 February | 73 | 0 | 73 |
| 2014 January | 64 | 0 | 64 |
| 2013 December | 52 | 0 | 52 |
| 2013 November | 66 | 0 | 66 |
| 2013 October | 88 | 0 | 88 |
| 2013 September | 73 | 0 | 73 |
| 2013 August | 91 | 0 | 91 |
| 2013 July | 98 | 0 | 98 |
| 2013 June | 83 | 0 | 83 |
| 2013 May | 62 | 0 | 62 |
| 2013 April | 44 | 0 | 44 |
| 2013 March | 15 | 0 | 15 |
| 2000 January | 3594 | 0 | 3594 |
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