Obstruções uretrais em felinos geralmente são secundárias à doença do trato urinário inferior felino (DTUIF), afecção comum em gatos. A doença pode ser auto-limitante, mas a obstrução uretral leva à parada da função renal, gerando uma série de distúrbios no organismo, que necessitam tratamento imediato. A maioria dos estudos sobre as alterações decorrentes da obstrução foi feito em animais em estado crítico ou experimentalmente. O objetivo do presente estudo foi descrever as principais alterações observadas em gatos obstruídos atendidos na rotina clínica e correlacioná-las. Foram avaliados 32 gatos machos com obstrução uretral e sem tratamento prévio. A avaliação constou de exame clínico, hemograma, bioquímica sérica (uréia, creatinina, proteína total, ALT, AST, fosfatase alcalina, sódio, potássio, cálcio, fósforo, magnésio, glicemia e lactato), gasometria venosa, exame e cultura de urina e eletrocardiograma (ECG). Os animais foram agrupados conforme o tempo de obstrução (mais e menos de 36 horas). As alterações mais comuns no histórico foram disúria (100% dos animais), disorexia (84,4%), apatia (71,8%), vocalização (68,7%) e oligodipsia (68,7%); no exame físico, desidratação (71,8%), taquipnéia (53,1%) e hipotermia (53,1%). As alterações laboratoriais mais freqüentes foram hipermagnesemia (100%), acidose metabólica (89,6%), hiperglicemia (88,9%), hiperazotemia (84,4%) e hiperpotassemia (80,6%). Vinte por cento dos gatos tinham infecção urinária. Alterações no ECG foram evidenciadas em 39,3% dos casos, sendo a parada atrial com ritmo sinoventricular a mais freqüente. Não houve relação entre as alterações no ECG e os níveis de potássio sérico. A análise dos grupos sugere agravamento da hiperazotemia, hiperpotassemia, hipermagnesemia e do estado geral com a evolução do processo. Nas correlações, a temperatura e a freqüência cardíaca apresentaram relação direta com pH sanguíneo, excesso de base e bicarbonato, e relação inversa com uréia, creatinina, potássio e fósforo. A uréia e creatinina se correlacionaram inversamente com sódio, pH sanguíneo, excesso de base e bicarbonato, e diretamente com potássio e fósforo. O estado geral correlacionou-se com a temperatura, uréia, creatinina, potássio, pH sanguíneo, excesso de base e bicarbonato. / Urethral obstruction is a frequent complication in cats with feline lower urinary tract disease (FLUTD), considered a common disease in cats. Most cases are self-limiting, but the urethral obstruction causes renal failure and metabolic alterations which needs immediate treatment. Previous reports selected cats that were critically ill or had a experimental induction of the disease. The goal of this study was to describe the clinical signs, laboratory and electrocardiographyc abnormalities in cats with urethral obstruction and to correlate these results. Thirty-two male cats with natural urethral obstruction and without previous therapy were studied. Complete blood count, serum chemistry profile (urea, creatinine, plasma protein, alanine transferase, aspartate transferase, alkaline phosphatase, sodium, potassium, calcium, phosphorus, magnesium, glucose and lactate), venous blood gas, urinalysis, urine culture and electrocardiogram (ECG) were performed. Two groups of 16 cats were composed (animals under and over 36 hours of obstruction). The most frequent abnormalities described were dysuria (100%), anorexia (84,4%), lethargy (71,8%), vocalization (68,7%), hypodipsia (68,7%), and dehydration (71,8%), tachypnea (53,1%) and hypothermia (53,1%) in physical evaluation. The laboratorial abnormalities most frequently observed were hypermagnesemia (100%), metabolic acidosis (89,6%), hyperglicemia (88,9%), azotemia (84,4%) and hyperkalemia (80,6%). Twenty per cent of cats had urinary infections. Abnormalities in ECG, such as atrial standstill with sinoventricular rhythm, were seen in 39,3% of cases, and there were no correlation with hyperkalemia. The analyses of the groups suggest worsening of azotemia, hyperkalemia, hypermagnesemia and lethargy with evolution of obstruction. Temperature and heart rate were positively correlated with blood pH, base excess and bicarbonate, and inversely correlated with urea, creatinine, potassium and phosphorus. Lethargy was correlated with temperature, blood pH, base excess and bicarbonate.

Submitted by Fabiana Gonçalves Pinto (benf@ndc.uff.br) on 2015-12-02T13:07:12Z No. of bitstreams: 1 Alexandra de Oliveira Matias Ferreira.pdf: 2619686 bytes, checksum: fa1037183c3466a23892ffc182f84c8c (MD5) / Made available in DSpace on 2015-12-02T13:07:12Z (GMT). No. of bitstreams: 1 Alexandra de Oliveira Matias Ferreira.pdf: 2619686 bytes, checksum: fa1037183c3466a23892ffc182f84c8c (MD5) Previous issue date: 2013 / Mestrado Profissional em Enfermagem Assistencial / Este estudo tem como objeto o efeito do oxigênio pré-aspiração em pacientes entubados em choque séptico em UTI. A questão de pesquisa é se há diferenças nos valores oximétricos após a aspiração endotraqueal na ausência da replemento de oxigênio em pacientes em choque séptico entubados sem injúria pulmonar? A hipótese é que não há diferenças nos valores oximétricos após a aspiração endotraqueal comparados entre a vigência ou não do replemento de oxigênio em pacientes em choque séptico entubados sem injúria pulmonar. Objetivo geral: confrontar a efetividade da recomendação preconizada pelo guidelines AARC quando à replementação de oxigênio pré-aspiração endotraqual aos pacientes em choque séptico entubados. O objetivos especifícos: comparar as variáveis oximétricas e hemodinâmicas mensuradas após a vigência ou ausência da replementação pré-aspiração em pacientes em choque séptico entubados e criar um protocolo operacional padrão com as recomendações oriundas dos resultados desse ensaio. Método: ensaio clínico crossover randomizado, 2X2, um-braço, duplo-cego de equivalência com pacientes em choque sepse sob ventilação mecânica internados em Unidade de Terapia Intensiva (UTI) de um hospital universitário de grande porte no município do Rio de Janeiro. A amostra consecutiva constituída de 22 pacientes por randomização simples A sequência AB foi inicialmente replementada com O2 e o grupo BA iniciou sem a referida maximização. Foram realizados pré e pós-teste com a coleta de sangue para análise dos gases arteriais. Após washout ocorreu a inversão entre grupos AB para BA. A comparação das diferenças das médias foi realizada através do teste t-student para amostras independentes homocedásticos e o seu similiar não-paramétricos Mann- whitney quando a amostra não era normal, ambos bicaudais com nível de significância adotado de 5% e intervalo de confiança de 95%. Para as variáveis dicotômicas foi utilizado o teste exato de Fisher e análise da estatística clínica foram empregados o Risco Relativo (RR), Aumento do Risco Absoluto(ARA), Redução do Risco Absoluto (RRA) todos com IC95% Resultados: a amostra foi predominantemente idosa, feminina, de baixa escolaridade e renda salarial. A análise da estatística inferencial evidenciou que os paciente se apresentavam hiperoxigenados com FiO2 acima do que era considerado como ideal para idade repercutindo num efeito mais preponderante na PaO2 que apresentou significância estatística com p < 0,05. Contudo, o ARA para hipoxemia foi insignificante clínica e estatísticamente com p <0,05, contudo, foi evidenciado para hiperoxemia. Para as demais variáveis não houve significância estatística e nem clínicas. Conclusão: O emprego da aspiração endotraqueal sem replementação não confere prejuízo ao paciente em relação às variáveis oximétricas e hemodinâmicas e, é preterível em relação a replementação de oxigênio. Produto: A criação do procedimento operacional padrão foi a forma de documentar uma prática que já vem sendo utilizada a pelo menos 11 anos, a partir de 2002, sem intercorrência registradas para os pacientes críticos em UTI / Introduction: This paper studied the effect of oxygen before aspiration in intubated patients in septic shock in the ICU . The research question is whether there are differences in oximetry values after endotracheal suction in the absence of oxygen increase in septic shock patients intubated without lung injury? The hypothesis is that no difference in oximetry values after endotracheal suctioning compared between the presence or absence of oxygen increase in septic shock patients intubated without lung injury. Overall Objective: To compare the effectiveness of the recommendations laid out when the AARC guidelines increase oxygen endotraqual intubated patients in septic shock before aspiration. Specific aim to compare oximetric and hemodynamic variables measured after the expiration or absence of increase before aspiration in intubated patients in septic shock and create a standard operating protocol with the recommendations arising from the results of this test. Method: a randomized crossover trial, 2X2, one - arm , double-blind equivalence in patients with septic shock, mechanical ventilation admitted to the Intensive Unit (ICU) of a university Therapy large hospital in the city of Rio de Janeiro. A consecutive sample of 22 patients. Inclusion criteria were: suspected and/or confirmed septic shock , mechanical ventilation > 12 hours , fraction of inspired oxygen (FiO2) ideal < 95 %, positive end expiratory pressure (PEEP) < 16 mm / Hg. Exclusion criteria: weaning process , surgical with chronic obstructive pulmonary disease ( COPD ) Gold IV , pregnant or postpartum women, under 18 years, and thrombocytopenic (less than 50.000.000/mm3 ) devoid of arterial catheter. A simple randomization was performed by a sequence of numbers generated in a spreadsheet. The AB sequence was initially increase with O2 and BA group started without such maximization. Post- test with blood sampling for analysis of arterial blood gases were performed before and . After washout reversal between AB to BA groups occurred. The determination of carryover was performed by adding the values in both sequences being missing for all variables of primary and secondary outcomes . Comparison of means was performed using the Student t test for independent samples homoscedastic because the variances were equal and its equal non- parametric Mann - Whitney when the sample was not normal, both with two-tailed significance level of 5 % and range 95% confidence. For dichotomous variables, the Fisher exact test and analysis of clinical statistics were used were used the relative risk (RR), Absolute Risk Increase (ARA), Absolute Risk Reduction (ARR) all with 95% CI. Results: The sample was predominantly elderly , female , low education and wage income . The inferential statistical analysis showed that the patient had hyperoxygenation with FiO2 above what was considered to be ideal for age reflecting a more prominent effect on PaO2 that was statistically significant with p < 0,05 for ARA does not cause hypoxemia , however was shown to hyperoxemia. The momentary increase in FiO2 causes a false negative rate of improvement that LPA may be a confounding factor for prognosis patient. For the other variables there was statistics nor clinical significance. Conclusion: The use of endotracheal suctioning without increase confers no injury to the patient regarding oximetric and hemodynamic variables and is beneficial regarding increase oxygen . Product: A creation of standard operating protocol is a way of documenting a practice that is already being used in at least 11 years , since 2002 , registered uneventful for critical patients in ICU

Einleitung: Alpakas gehören zu einer Tiergruppe, die in den vergangenen Jahren im Patientengut der Tierärzte immer häufiger anzutreffen ist. Daher ist es von großer Bedeutung, sich mit der Physiologie und Pathologie dieser Tierart zu beschäftigen. Die Versorgung der Neonaten spielt dabei eine große Rolle. Da Alpakacrias, wenn überhaupt, dann erst sehr spät, klinische Anzeichen einer Erkrankung zeigen, ist es für den Untersucher von großem Nutzen, einen Einblick in den Blutgas- und Säure-Basen-Haushalt, sowie Kenntnis von den hämatologischen und blutchemischen Parametern des Neonaten zu erhalten. Des Weiteren bietet die Blutuntersuchung ein wichtiges Hilfsmittel zur Überprüfung der Versorgung mit kolostralen Antikörpern. Ziele der Untersuchungen: Ein Ziel der Untersuchungen war die Erstellung von bisher nicht vorhandenen Referenzwerten für die venöse Blutgasanalyse, die Hämatologie und für einige blutchemische Parameter bei gesunden, lebensfrischen Alpakacrias innerhalb der ersten drei Lebenstage. Des Weiteren sollte in diesem Zusammenhang die Eignung eines mobil einsetzbaren Blutgasanalysegerätes (epoc®, Fa. Alere GmbH, Köln) für die Tierart Alpaka eruiert werden. Hierfür wurden Doppelbestimmungen der Proben mit einem etablierten stationären Blutgasanalysegerät (ABL90 FLEX®, Fa. Radiometer, Kopenhagen) durchgeführt. Tiere, Material und Methoden: In die Studie wurden 20 gesunde neugeborene Alpakacrias integriert. Die Fohlen stammten vornehmlich aus Stuten, die zur Geburtsüberwachung in die Klinik eingestallt wurden, bei anderen handelte es sich um solche, die innerhalb der ersten Lebensstunden wegen vermeintlich verzögerter Tränkeaufnahme vorgestellt worden waren, was sich aber nicht bestätigte. Alle Alpakafohlen wurden nach dem Gießener Vorsorgeschema II für neonatale Equiden klinisch untersucht. Anschließend erfolgte 3-8 Stunden p. n., 24 Stunden p. n. und 72 Stunden p. n. je eine Blutprobenentnahme. Der erste Analysezeitpunkt wurde bewusst nicht unmittelbar post natum gewählt, da die Etablierung einer stabilen Prägungsphase zwischen Muttertier und Cria nach der ersten Tränkeaufnahme abgewartet werden sollte. Die Blutentnahme erfolgte nach Reinigung und Desinfektion aus der ungestauten V. jugularis externa im Bereich des sechsten Halswirbels. Die Blutgasanalyse wurde innerhalb von 15 Minuten mit den zuvor genannten Blutgasautomaten durchgeführt. Die hämatologischen Parameter wurden mit dem pocH-100 iV (Fa. Sysmex Deutschland GmbH, Norderstedt) bestimmt, die blutchemischen Untersuchungen erfolgten mit dem FUJI DRI CHEM 3500 (Fa. Sysmex Deutschland GmbH, Norderstedt). Insgesamt wurden 55 Blutproben entnommen und analysiert. Pro Analysegerät (epoc®, ABL90 FLEX®, pocH-100 iV, FUJI DRI-CHEM 3500) wurden je 55 Messungen durchgeführt. Die statistische Auswertung erfolgte mit dem Programm IBM SPSS Statistics 22.0. Die Normalverteilung wurde mittels Shapiro-Wilk-Test überprüft. Für den Gerätevergleich (epoc®/ABL90 FLEX®) fand der Wilcoxon-Test Anwendung. Der Vergleich der Zeitpunkte erfolgte über den Friedman-Test für verbundene Stichproben. Des Weiteren wurden für die einzelnen Parameter der Median und die Perzentile, bzw. der Mittelwert und die Standardabweichung bestimmt. Die grafische Darstellung erfolgte mit Boxplots und Bland-Altman-Plots. Ergebnisse: Im Gerätevergleich konnte insgesamt auf eine gute Übereinstimmung der Messwerte geschlossen werden. Signifikante und gleichzeitig klinisch relevante Unterschiede gab es lediglich bei der Bestimmung der Sauerstoffsättigung und des Hämatokrits, was auf unterschiedliche Mess- und Berechnungsmethoden bei den Geräten zurückzuführen ist. So liegen die Hämatokritwerte beim epoc® deutlich unter denen vom ABL90 FLEX®. In diesem Zusammenhang wichtig für die Interpretation der Ergebnisse ist, dass für jedes Messgerät die individuellen Referenzbereiche berücksichtigt werden müssen. Die venöse Blutgasanalyse ergab für gesunde Crias zu Beginn des ersten Lebenstages einen pH-Wert von 7,34 – 7,40, einen Sauerstoffpartialdruck (pO2) von 21,6 – 29,2 mmHg, einen Kohlendioxidpartialdruck (pCO2) von 37,3 – 46,0 mmHg, eine Sauerstoffsättigung (sO2) von 30,5 – 48,0 %, ein aktuelles Bikarbonat (HCO3-) von 21,3 – 25,1 mmol/l, eine Standardbasenabweichung (SBE) von -3,3 – 0,2 mmol/l und einen Laktatgehalt von 1,6 – 3,4 mmol/l. Der pH Wert ähnelte im Verlauf dabei dem von Kälbern und Lämmern gleichen Alters, der pO2 war insgesamt etwas niedrig, aber konstant und ähnelte über den Messzeitraum dem von Kälbern. Es wurden bei den Crias im Vergleich zu Fohlen, Kälbern und Lämmern niedrigere pCO2-Werte festgestellt. Die Sauerstoffsättigung ähnelte der von Equidenfohlen, über den Messzeitraum fällt die Konzentration im Mittel geringfügig ab, bei den anderen Vergleichstierarten steigt sie an. Die Glukosekonzentrationen waren postnatal höher als bei anderen Haustierneonaten (3-8 h p.n.: 4,4 – 8,2; 24 h p.n.: 7,3 – 12,8; 72 h p.n.: 7,3 – 16,2 mmol/l). Laktat kann nicht, wie es beim Equidenfohlen postuliert wird, als Indikator für den Gesundheitszustand eines Alpaka-Crias genutzt werden. Hämatologisch sind die spezielle Form und die hohe Anzahl der Alpakaerythrozyten, die hohe Zahl an Leukozyten und Thrombozyten (speziell bei den Crias), sowie die hohe MCHC zu nennen. Schlussfolgerungen: Es konnten teilweise bisher fehlende Daten zur venösen Blutgasanalyse für die Beurteilung der Stoffwechsellage neugeborener Alpakacrias etabliert werden. Das mobile Blutgasgerät epoc® stellt eine für die Anwendung geeignete Alternative dar.

<p>UVOD: Anestezija je povezana sa promenama ventilacije, koje počinju sa prvim datim lekom, a mogu da traju i danima posle hirur&scaron;ke intervencije. Hipoksemija je najočiglednija posledica ove promene. U anesteziolo&scaron;koj praksi i perioperativnom tretmanu bolesnika kiseonička terapija zauzima značajno mesto. Jo&scaron; uvek ne postoje jasne, na dokazima zasnovane, smernice za upotrebu kiseoničke terapije u postoperativnom periodu. Razlog verovatno leži u činjenici da veliki broj faktora može da utiče na ishod lečenja hirur&scaron;kog bolesnika i zato je te&scaron;ko ispitati njihove pojedinačne uticaje. Kiseonička terapija tretira ili prevenira nastanak hipoksije obezbeđujući inspiratornu koncentraciju kiseonika veću od iste u vazduhu. Kod najvećeg broja pacijenata u postoperativnom periodu ne postoji potreba za strogom kontrolom inspiratorne koncentracije kiseonika, a administracija kiseoničke terapije sprovodi se primenom uređaja niskog protoka i varijabilne performanse, kao &scaron;to su nazalna kanila i kiseonička maska za lice. Brojna istraživanja poslednjih decenija poku&scaron;ala su da daju odgovor na pitanja da li postoji stvarna razlika u primeni ova dva uređaja, posebno u svetlu razvoja hipoksemije u postoperativnom periodu. Prednosti primene nazalne kanile su bolje prihvatanje od strane bolesnika u poređenju sa maskom, obično zbog manje izraženog osećaja klaustrofobije pri upotrebi nazalne kanile. Nazalna kanila, ne zahteva uklanjanje prilikom nege usne duplje ili per os unosa &scaron;to obezbeđuje kontinuitet u isporuci kiseonika. Nedostaci nazalne kanile vezani su za otežanu primenu kod bolesnika sa nazogastričnom sondom ili otežanim disanjem na nos. Pri protocima većim od 4 litre u mnuti može izazvati nelagodnost na nosnoj sluznici bolesnika. Literaturni podaci, ukazuju da se primenom kiseoničke maske ipak postižu veće inspiratorne koncentracije kiseonika, te da se epizode desaturacije i hipoksemije znatno ređe javljaju. Međutim, postoje i istraživanja koja ukazuju na mogućnost ponovnog udisanja vazduha iz mrtvog prostora maske, pri nižim protocima &scaron;to može uticati na parcijalni pritisak ugljen-dioksida u arterijskoj krvi. CILJEVI: Ciljevi istraživanja su da se ispitata učestalost javljanja hipoksemije unutar 48 sati od ekstubacije kod bolesnika u jedinici intezivne terapije, zatima da se ispita pojava desaturacije, da se utvrditi učestalost potrebe za primenom neinvazivne mehaničke ventilacije pozitivnim pritiskom kod bolesnika u jedinici intezivne terapije kod kojih se primenjuje kiseonička terapija putem nazalne kanile, odnosno kiseoničke maske. Takođe, cilj je i da se ispita da li postoji povezanost preoperativnih karakteristika bolesnika sa eventualnim izborom jednog od dva uređaja za primenu kiseoničke terapije u ranom postoperativnom periodu. METODOLOGIJA: Na Klinici za anesteziju i intenzivnu terapiju Kliničkog centra Vojvodine sprovedeno je prospektivno istraživanje kojim je obuhvaćeno 160 pacijenata nakon elektivnih hrur&scaron;kih procedura, koji su nakon operativnog zahvata praćeni u jedinici intenzivne terapije. Pacijenti su randomizovani u dve grupe (grupa M &ndash; kiseonička maska i grupa N &ndash; nazalna kanila) u odnosu na uređaj kojim je sprovođena postoperativna kiseonička terapija. Za sve pacijente uključene u studiju evidentirana je pol, starost, telesna masa, telesna visina, izračunat indeks telesne mase. Evidentiran je i ASA status, kao i NYHA status. U istraživanje nisu uključeni pacijenti sa plućnim komorbiditetima. Iz istraživanja su isključeni svi oni bolesnici kod kojih je do&scaron;lo do respiratornih komplikacija u perioperativnom periodu, kao i onih kod kojih je bila prisutna hemodinamska nestabilnost. Postoperativno svi pacijenti su sedirani, na mehaničkoj ventilaciji sme&scaron;teni u jedinicu intenzivne terapije. Nakon prevođenja na spontano disanje i ekstubacije započinjana je primena kiseonika putem kiseoničke maske za lice (6 l/min) odnosno nazalne kanile (4 l/min). Sprovođen je kontinuirani monitoring vitalnih parametara, saturacije hemoglobina kiseonikom, kao i novo ugljen-dioksida na kraju ekspirijuma. Kod svih pacijenata u četiri vremena rađene su gasne analize arterijske krvi. Svi praćeni parametri poređeni su između dve ispitivane grupe pacijenata. Za statističku obradu podataka kori&scaron;ćen je programski paket Statistical Package for Social Sciences - SPSS 21. Numerička obeležja su prikazana putem srednjih vrednosti (aritmetička sredina) i mera varijabiliteta (opseg vrednosti, standardna devijacija), a atributivna obeležja kori&scaron;ćenjem frekvencija i procenata. Komparacija vrednosti numeričkih obeležja između dve grupe vr&scaron;ena je primenom Studentovog t- testa, odnosno neparametrijskog Mann- Whitney testa. Testiranje razlike frekvencija atributivnih obeležja vr&scaron;eno je primenom &chi;2 testa. U cilju ispitivanja povezanosti dva ili vi&scaron;e obeležja, odnosno generisanja adekvatnih statističkih modela, kori&scaron;ćena je multivarijantna regresiona analiza. Statistički značajnim se smatraju vrednosti nivoa značajnosti p&lt;0.05. REZULTATI: U odnosu na preoperativne karakteristike ispitivanih pacijenata nije nađena statistički značajna razlika u distribuciji pacijenata u dve ispitivane grupe u odnosu na pol (2 test; 2=0,378;p=0,539), starost (T test; t=1,958; p=0,053), APACHE II skor na prijemu (Mann-Whitney test; U=1220,500; p=0,837), indeks telesne mase (T test; t=1,380; p=0,171), pu&scaron;ačkim navikama (2 test; 2=0,644;p=0,422), vrednostima preoperativnog hemoglobina (T test; t=0,442; p=0,660), saturacije hemoglobina kiseonikom (T test; t=0,883; p=0,380). Razlike nije bilo ni u pogledu trajanja mehaničke ventilacije (Mann-Whitney test; U=1114,500; p=0,345). Hipoksemija (parcijalni pritisak kiseonika u arterijskoj krvi manji od 65 mmHg) nije registrovana ni kod jednog od pacijenata u obe ispitivane grupe. Vrednsti SpO2 &lt; 92%, registrovane su kod ukupno 24 pacijenta u svim analiziranim vremenima (24%). Najveći broj pacijenata kod kojih je registrovana niska vrednost detektovan je u prvom satu nakon ekstubacije kada je vrednost manja od 92% registrovana kod 5 pacijenata (5%) i to kod 3 pacijenta u grupi M (6%) i 2 pacijenta u grupi N (4%). Između vizita 2. i 3. vrednosti satutracije manje od 92% registrovana je kod 19 pacijenata (19%), kod 8 pacijenata u grupi M (16%) i kod 11 pacijenata u grupi N (22%). U periodu između vizita 3. i 4. vrednosti saturacije niže od 92% registrovane su kod 19 (19%) pacijenata i to kod 10 pacijenata u grupi M (20%) i kod 9 pacijenata u grupi N (18%). Statistički značajna razlika zabeležena je u sve tri vizite (vizita 2, 3, 4) u vrednosti parcijalnog pritiska kiseonika u arterijskoj krvi. Tako su pacijenti u grupi kod kojih je primenjivana maska imali statistički značajno veće vrednosti parcijalnog pritiska kiseonika. Istovremeno pacijenti kod kojih je kiseonička terapija primenjivana putem maske imali su značajno veće vrednosti saturacije hemoglobina kiseonikom i ova razlika je bila statistički značajna u svim posmatranim vizitama. U prvih 48 sati nakon operacije neinvazivna mehanička ventilacija primenjena je kod 80 pacijenata. Kod svih pacijenata indikacija za primenu je bila pojava desaturacije. U odnosu na distribuciju pacijenata po ispitivanim grupama nije bilo statistički značajne razlike u broju pacijenata koji su zahtevali neinvazivnu mehaničku ventilaciju (2 test; 2=2,250; p=0,134). Pacijenti u grupi N proveli su vi&scaron;e minuta (srednja vrednost 56,85 +/- 19,80 minuta) na neinvazivnoj ventilaciji od pacijenata u grupi M (srednja vrednost 33,14 +/- 10,65 minuta), a ova razlika je statistički značajna (T test; t=2,923; p=0,009). Na osnovu multivarijantne regresione analize, pacijenti koji su kiseoničku terapiju primali putem nazalne kanile, sa porastom indeksa telesne mase imali su niže vrednosti parcijalnog pritiska kiseonika u arterijskoj krvi (r2=0,392). ZAKLJUČCI: Kiseonička maska za lice i nazalna kanila obezbeđuju adekvatnu primenu kiseoničke terapije u smislu prevencije nastanka hipoksemije u ranom postoperativnom periodu. Primenom kiseoničke maske za lice ostvaruju se vi&scaron;e vrednosti parcijalnog pritiska kiseonika u arterijskoj krvi. Epizode desaturacije če&scaron;će se javljaju kod pacijenata kod kojih se u ranom postoperativnom periodu primenjuje kiseonička terapija putem nazalne kanile. Pacijenti kod kojih se primenjuje kiseonička terapija putem maske ostvaruju veće vrednosti saturacije hemoglobina kiseonikom. Pacijenti kod kojih je kiseonička terapija u ranom postoperativnom periodu primenjivana putem nazalne kanile zahtevali su dužu primenu neinvazivne mehaničke ventilacije pluća. Kod pacijenata sa većim vrednostima indeksa telesne mase, za primenu kiseoničke terapije u ranom postoperativnom periodu, kiseonička maska za lice će obezbediti bolju oksigenaciju.</p> / <p>INTRODUCTION: Anesthesiology is associated with vicissitudes in ventilation, which start with application of first medicine and last for days following surgical intervention. Hypoxemia is a most common side effect of vicissitudes in ventilation. Oxygen therapy is important in anesthesiology and post-operative treatment of a patient. There are no clear evidence-based guidelines for application of oxygen therapy in post-operative period. Numerous factors influence patient&rsquo;s treatment outcome and it is difficult to examine each factor&rsquo;s independent impact. Oxygen therapy treats or prevents occurrence of hypoxemia by providing inspiratory concentration of oxygen greater than the amount found in air. Most patients in post-operative period don&rsquo;t require vigilant control of inspiratory concentration of oxygen, and administration of oxygen therapy is implemented with a low flow device with variable performances such as nasal cannula and oxygen face mask. Various research attempts where made in the last decades to discover an evident difference between these two devices, especially in cases where hypoxemia occurred in post-operative period. One advantage to using nasal cannula over oxygen face mask is that its better perceived by a patient as it reduces feeling of claustrophobia. Nasal cannula doesn&rsquo;t need to be removed during oral cavity care or &ldquo;per os&rdquo; intake which ensures continuous oxygen delivery. The drawback to using nasal cannula is that its challenging to insert it in a patient with nasogastric tube or difficult nasal breathing. Also, patient can experience nasal discomfort if the oxygen flow is bigger than four litters per minute. Literature data shows that application of oxygen trough the face mask achieves greater inspiratory concentrations of oxygen, and reduces the occurrence of desaturation and hypoxemia. Still, there is research which points out to the possibility of breathing in from dead space in the mask, in lower flows, which can partially affect pressure of carbon dioxide in artery blood. AIM: Aim of the research is to examine frequency of hypoxemia and non-invasive mechanical ventilation in patients treated with oxygen therapy via nasal cannula or oxygen face mask during the first 48 hours following patient extubating in intensive care unit. Also, aim is to examine correlation between patients&rsquo; pre-operative characteristics and the choice of one of the two devices for oxygen therapy in early postoperative period. METHODOLOGY: Clinic for Anesthesiology and Intensive Therapy at the Clinical Center of Vojvodina conducted this research on 160 patients who underwent elective surgical procedures and received post-operative care in Intensive Care Unit. Patients were randomly assigned to two groups (Group M with oxygen face mask and Group N with nasal cannula) relative to device which was used for post-operative oxygen therapy. Information recorded for all the patients included in the study constituted their gender, age, weight, hight, and body max index. ASA status, as well as NYHA status were also recorded. Research excluded any patient who experienced respiratory complications in post-operative period as well as those who experienced hemodynamic instability. Postoperatively all patients were sedated and on mechanical ventilation therapy in intensive care unit. After transition to spontaneous breathing and extubating, oxygen therapy was applied using oxygen mask (6 l/min) or nasal cannula (4 l/min). Vital parameters were continuously monitored as well as hemoglobin oxygen saturation, and carbon dioxide at the end of the expirium. Gas analysis of artery blood was carried out four times for all participants in the study. All parameters were compared between two examined patient groups. Statistical analysis was carried out using Statistical Package for Social Sciences - SPSS 21. Numerical features are depicted using arithmetic mean and variability rate, and attributive features are depicted with frequency and percentages. Comparison of the values of numerical characteristics between the two groups was performed using Student&#39;s t-test, that is, a non-parametric Mann-Whitney test. The frequency difference in attributive characteristics was tested using &chi;2 test. To generate adequate statistical model, multivariate regression analysis was applied to examine the link between two or more of features. Significant values are determined if level of significance is p&lt;0.05. RESULTS: Preoperative characteristics of the patient showed no significant differences between the two study groups. Characteristics were recorded with respect to gender (2 test; 2 = 0.378; p = 0.539), age (t-test; t = 1,958, p = 0,053 ), APACHE II score on admission (Mann-Whitney test; U = 1220.500; p = 0.837), body mass index (t-test; t = 1.380, p = 0.171), smoking habits (2 test; 2 = 0.644; p = 0.422), the values of the preoperative hemoglobin (t-test; t = 0.442, p = 0.660), and hemoglobin oxygen saturation (t-test; t = 0.883, p = 0.380). Difference was discovered in regards to duration of mechanical ventilation (Mann-Whitney test; U = 1114.500; p = 0.345). Hypoxemia (partial oxygen pressure in the arterial blood of less than 65 mmHg) was not registered in any of the patients in both study groups. Value SpO2&lt; 92%, was registered in 24 patients during every round (24%). Patients who registered value lower than 92% experienced it in the first hour post extubation. This was observed in 5 patients in total (5%) where 3 patients from group M (6%) and 2 from group N (4%). Between 2nd and 3rd rounds, saturation values lower than 92% were recorded in 19 patients (19%): 8 from group M (16%) and 11 from group N (22%). In the period between the 3rd and 4th rounds the value of saturation lower than 92% was detected in 19 (19%) patients: 10 from group M (20%) and 9 from group N (18%). Statistically significant difference was noted in all three rounds (rounds 2, 3, 4) in the values of the partial oxygen pressure in arterial blood. Thus, patients from the group treated with an oxygen face mask had significantly higher values of partial oxygen pressure. In addition patients treated by oxygen face mask had significantly higher levels of oxygen saturated hemoglobin, and this difference was statistically significant in all observed rounds. In the first 48 hours after surgery noninvasive mechanical ventilation was performed in 80 patients. Common indication for oxygen therapy in all patients was desaturation. There were no statistically significant differences in the number of patients who required non-invasive mechanical ventilation in either of the groups (2 test; 2 = 2.250; p = 0.134). Patients in group N received several minutes more (mean value of 56.85 +/- 19.80 minutes) of the non-invasive ventilation than patients in the group M (mean value of 33.14 +/- 10.65 minutes), and this difference was statistically significant (t-test; t = 2,923, p = 0,009). Based on the multivariate regression analysis, the patients who received oxygen therapy via nasal cannula, with the increase in body mass index had lower values of partial oxygen pressure in arterial blood (r2 = 0.392). CONCLUSION: Both face mask and nasal cannula ensure adequate application of oxygen therapy to prevent hypoxemia in the early postoperative period. Oxygen face mask achieves higher value of partial oxygen pressure in arterial blood. Episodes of desaturation more frequently occur in patients who receive oxygen therapy with nasal cannula in early postoperative period. Patients who receive oxygen therapy via oxygen face mask achieve higher hemoglobin oxygen saturation values. Patients who undergo oxygen therapy in the early postoperative period using nasal cannula require longer application of non-invasive mechanical ventilation. Patients with higher body mass index receive better oxygenation in the early postoperative period if facial mask is the device of choice.</p>

Acid maltase deficiency (AMD) is a rare autosomal recessive genetic disorder that results in an accumulation of glycogen in the lysosomal storage vacuoles. It is classified as a glycogen storage disease (type II) and is also known as Pompe's disease. The prognosis of the patient with AMD is poor and the main cause of death is respiratory failure. We report a female patient whose respiratory insufficiency was documented to occur most severely during rapid eye movement sleep and who benefited clinically from the institution of nocturnal noninvasive bilevel positive airway pressure.