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        "resumen" => "<span class="elsevierStyleSectionTitle">Fundamento</span><p id="spar0005" class="elsevierStyleSimplePara elsevierViewall">La laringitis postextubaci&#243;n &#40;LPE&#41; es una complicaci&#243;n frecuente en las unidades de cuidados intensivos pedi&#225;tricos &#40;10&#8211;15&#37;&#41;&#46; Varios estudios han observado altas tasas de fracaso con el tratamiento habitual</p> <span class="elsevierStyleSectionTitle">Hip&#243;tesis</span><p id="spar0010" class="elsevierStyleSimplePara elsevierViewall">&#8220;La aplicaci&#243;n de CPAP no invasiva en ni&#241;os con LPE reducir&#225; los fracasos de tratamiento en comparaci&#243;n con el manejo convencional&#8221;</p> <span class="elsevierStyleSectionTitle">Pacientes Y M&#233;todo</span><p id="spar0015" class="elsevierStyleSimplePara elsevierViewall">Se requer&#237;a un total de 25 pacientes por grupo para detectar la diferencia estipulada entre los tratamientos&#46; &#201;stos fueron asignados al azar &#40;bloques de 10&#41; para recibir terapia convencional &#40;nebulizaciones de epine-frina y O<span class="elsevierStyleInf">2</span> humidificado&#41; o experimental &#40;CPAP no invasiva durante 18 h&#41;&#46; Completados 9 meses del estudio&#44; al observar en un an&#225;lisis interino una diferencia significativa en los resultados entre los dos grupos estudiados&#44; se suspendi&#243; la investigaci&#243;n</p> <span class="elsevierStyleSectionTitle">Resultados</span><p id="spar0020" class="elsevierStyleSimplePara elsevierViewall">De 270 ni&#241;os extubados durante el estudio&#44; 28 &#40;10&#44;3&#37;&#41; manifestaron LPE y 25 cumplieron los requisitos de admisi&#243;n&#44; conformando 13 el grupo convencional y 12 el grupo CPAP&#46; Ambos fueron comparables en sus caracter&#237;sticas generales&#44; tiempo de intubaci&#243;n&#44; FiO<span class="elsevierStyleInf">2</span> al ingreso&#44; uso de corticoides preextubaci&#243;n y puntuaci&#243;n de ingreso de dificultad respiratoria &#40;p &#62; 0&#44;05&#41;&#46; Con terapia convencional mejoraron 5 &#40;38&#44;5&#37;&#41; y los restantes 8 no mejoraron o empeo-raron&#46; De los que recibieron CPAP no invasiva mejoraron 11 &#40;91&#44;7&#37;&#41; &#40;p<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>0&#44;01&#41;&#46; Los que fracasaron con la tratamiento convencional &#40;8&#41; fueron sometidos a la CPAP con la que mejoraron todos&#46; El &#250;nico fracaso en este &#250;ltimo debi&#243; ser rein-tubado</p> <span class="elsevierStyleSectionTitle">Conclusione</span><p id="spar0025" class="elsevierStyleSimplePara elsevierViewall">Se verifica la hip&#243;tesis planteada&#46; El tratamiento propuesto disminuy&#243; los fracasos en un 53&#44;2&#37;&#44; en relaci&#243;n con el tradicional</p>"
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        "resumen" => "<p id="spar0030" class="elsevierStyleSimplePara elsevierViewall">Post-extubation laryngeal edema &#40;PLE&#41; is a common complication &#40;10-15&#37;&#41; in pediatric intensive care units&#44; 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 &#40;CPAP&#41; 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&#46; The patients were assigned to receive the conventional treat-ment &#40;nebulized epinephrin and humidified oxygen&#41; or the experimental treatment &#40;non-invasive CPAP treatment for 18 hours&#41;&#44; using a randomized block design &#40;10-patient blocks&#41;&#46; After 9 months&#44; 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&#44; 28 &#40;10&#46;3&#37;&#41; developed PLE and 25 met the enrollment requirements&#46; Thirteen were assigned to conventional therapy and 12 to CPAP&#46; General characteristics&#44; time of intubation&#44; FiO2 upon admission&#44; use of corticoids before extubation and scores for respiratory difficulty upon admission were similar in the two groups &#40;p &#62; 0&#46;05&#41;&#46; With conventional therapy&#44; 5 &#40;38&#46;5&#37;&#41; children improved and 8 patients worsened or remained the same&#46; Eleven &#40;91&#46;7&#37;&#41; of the patients receiving CPAP improved &#40;p<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>0&#46;01&#41;&#46; Those who failed on conventional treatment were prescribed CPAP and all then improved&#44; although one had to be re-intubated</p> <span class="elsevierStyleSectionTitle">Conclusions</span><p id="spar0050" class="elsevierStyleSimplePara elsevierViewall">The hypothesis was confirmed&#46; CPAP treatment reduced the failure rate by 53&#46;2&#37; in comparison withconventional therapy</p>"
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Journal Information
Vol. 38. Issue 10.
Pages 463-467 (October 2002)
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Vol. 38. Issue 10.
Pages 463-467 (October 2002)
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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
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10975
J.A. Rodrígueza,
Corresponding author
horrio@saval.cl

Correspondencia: UCI Hospital Roberto del Río.Casilla: 70002 Correo Central. Santiago-Chile
, B. Von Dessauerb, G. Duffauc
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
This item has received
Article information
Fundamento

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

Hipótesis

“La aplicación de CPAP no invasiva en niños con LPE reducirá los fracasos de tratamiento en comparación con el manejo convencional”

Pacientes Y Método

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 O2 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

Resultados

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, FiO2 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=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

Conclusione

Se verifica la hipótesis planteada. El tratamiento propuesto disminuyó los fracasos en un 53,2%, en relación con el tradicional

Palabras clave:
Laringitis postextubación
CPAP no invasiva
Epinefrina
Niños

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

Hypothesis

Non-invasive continuous positive airways pressure (CPAP) in children with PLE may have a lower failure rate than conventional management

Patients And Method

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

Results

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=0.01). Those who failed on conventional treatment were prescribed CPAP and all then improved, although one had to be re-intubated

Conclusions

The hypothesis was confirmed. CPAP treatment reduced the failure rate by 53.2% in comparison withconventional therapy

Keywords:
Postextubation laryngeal edema
Non-invasive continuous airways pressure
Epinephrin
Children
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Copyright © 2002. Sociedad Española de Neumología y Cirugía Torácica
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