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Submitted by Nadir Basilio (nadirsb@uninove.br) on 2018-07-20T19:48:50Z No. of bitstreams: 1 André Gustavo Moura Guimarães.pdf: 1691381 bytes, checksum: b4f575802538a0af96f868e24171236c (MD5) / Made available in DSpace on 2018-07-20T19:48:50Z (GMT). No. of bitstreams: 1 André Gustavo Moura Guimarães.pdf: 1691381 bytes, checksum: b4f575802538a0af96f868e24171236c (MD5) Previous issue date: 2018-03-06 / Introduction: neonatal pain results in neurobiological effects, and changes in behavioral reactions of children who were born prematurely. There is no clear description about the pain caused by chest physiotherapy technique, nor about the possible non-pharmacological interventions to prevent it. Objective: to evaluate neonatal pain and physiological parameters during the chest physiotherapy in premature neonates (PTNB) in neonatal intensive care. Method: a randomized controlled trial, not blinded, in which 120 PTNB in mechanical ventilation were studied. They were randomized into four groups: control group (CG), diaphragmatic stimulation group (EDG), manual hyperinflation group (MHG), thoracic vibration group (VTG), containing 30 individuals in each one. The protocol consisted of 3 phases, the first phase being considered the control, and the other associated with non-pharmacological techniques to reduce pain: application of the technique (phase 1), application of technique + facilitated tucking (phase 2), application of technique + glucose (phase 3). Heart rate (HR), respiratory rate (RR), SpO2, Behavioral pain scale Indicators of Infant Pain (BIIP, ranges from 0 to 10) and Neonatal Infant Pain Scale (NIPS, ranges from 0 -7) were recorded at pre, during and after (15 minutes) the procedures described. Results: 62 (51.66%) RNPT were female, and most considered small for gestational age (83, 69%). Physiological variables (HR, FR, and SpO2) behaved in a similar manner in all groups (CG, MHG, EDG, VTG), being greater in phase 1, however these variables were reduced at phase 2 and 3 (p < 0.05). This means that during the application of non-pharmacological intervention (facilitated tucking or glucose) there was reduction of those variables. BIIP and NIPS scales showed increased in all of the groups in the phase 1 during the application of the techniques, however, similar to the physiological variables, these scales had reduced scores when applied to facilitated tucking (phase 2) or glucose (phase 3), p < 0.05. The number of individuals who have had pain assessed by BIIP (> 3 points) at the moment after in the phase 1 was 83 (69%), in phase 2 was 22 (18%), and in phase 3 of 34 (28%), p < 0.001. Conclusions: The chest physiotherapy techniques can increase the pain in PTNB, however, the non-pharmacological techniques, such as facilitated tucking and glucose, were able to reduce it. / Introdução: A dor neonatal desencadeia efeitos neurobiológicos agudamente, e alterações nas reações comportamentais da criança nascida prematuramente. Não há descrição clara sobre a dor ocasionada por técnicas manuais de fisioterapia respiratória, tampouco sobre as possíveis intervenções não farmacológicas na prevenção da mesma. Objetivo: Avaliar a dor neonatal e parâmetros fisiológicos durante a fisioterapia respiratória em neonatos prematuros na UTI neonatal. Metodologia: ensaio clínico randomizado controlado, não cego, no qual foram estudados 120 recém-nascidos prematuros (RNPT), de ambos os sexos, em ventilação mecânica. Foram randomizados em quatro grupos: grupo controle (GC), grupo estimulação diafragmática (GED), grupo hiperinsuflação manual (GHM), grupo vibração torácica (GVT), contendo 30 indivíduos em cada. O protocolo constou de 3 fases, sendo a primeira fase considerada a controle, e as demais associadas a técnicas não farmacológicas de redução da dor: aplicação da técnica (fase 1), aplicação da técnica e contenção (fase 2), aplicação da técnica e glicose (fase 3). A frequência cardíaca (FC), respiratória (FR), SpO2, escala de dor Behavioral Indicators of Infant Pain (BIIP, varia de 0 a 10) e Neonatal Infant Pain Scale (NIPS, varia de 0 -7) foram registradas pré, durante e após (15 minutos) dos procedimentos em cada fase descrita. Resultados: 62 (51,66%) dos RNPT do sexo feminino, e a maioria considerados pequenos para idade gestacional (83 69%). As variáveis fisiológicas (FC, FR, e SpO2) se comportaram de maneira semelhante, em todos os grupos, sendo maior na fase 1, reduzindo nas fases 2 e 3 (p<0,05). Durante a aplicação de intervenção não farmacológica (contenção ou glicose) houve redução daquelas variáveis. As escalas BIIP e NIPS mostraram aumento em todos dos grupos na fase 1 durante a aplicação das técnicas, sendo reduzida a dor quando aplicado a contenção (fase 2) ou a glicose (fase 3), p< 0,05. O número de indivíduos que tiveram dor avaliado pela BIIP (> 3 pontos) no momento após na fase 1 foi 83 (69%), na fase 2 foi 22 (18%), e na fase 3 de 34 (28%) p< 0,001. Conclusões: As técnicas de manuais de fisioterapia respiratória demonstraram gerar dor nos RNPT, entretanto, técnicas não farmacológicas como contenção e glicose foram capazes de reduzi-la.

This review will focus on the therapeutic uses of antioxidant liposomes. Antioxidant liposomes have a unique ability to deliver both lipid- and water-soluble antioxidants to tissues. This review will detail the varieties of antioxidants which have been incorporated into liposomes, their modes of administration, and the clinical conditions in which antioxidant liposomes could play an important therapeutic role. Antioxidant liposomes should be particularly useful for treating diseases or conditions in which oxidative stress plays a significant pathophysiological role because this technology has been shown to suppress oxidative stress. These diseases and conditions include cancer, trauma, irradiation, retinotherapy or prematurity, respiratory distress syndrome, chemical weapon exposure, and pulmonary infections.

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Acute respiratory distress syndrome (ARDS) is in the center of the scientific debate both for its complex pathophysiology and for the discussion about the remedies that could contribute to its healing. The intricate interplay of different body systems that characterizes ARDS is mirrored by two main research threads, one centered on the pathophysiological mechanisms of the disease and the other on the new approaches to lung imaging. In this Special Issue of the Journal of Clinical Medicine are presented studies using imaging technologies based on electrical impedance tomography, synchrotron radiation computed tomography and intravital probe-based confocal laser endomicroscopy. The studies on the pathophysiological mechanisms pertain to the evaluation of the biomarkers of the disease and the platelet disfunction during extracorporeal membrane oxygenation. These contributions witness the intensity of ARDS research as many of the key problems of the disease are only in part resolved.

Enteral nutrition (EN) is often delayed in critically ill patients despite strong evidence to support that early enteral nutrition feeding is beneficial in this population. Adverse outcomes in critically ill patients in which nutrition is delayed include a longer length of stay and time on the ventilator, and a higher incidence of pneumonia and hospital mortality. The purpose of this literature review was to evaluate the current evidence regarding trophic enteral feeds in mechanically ventilated adult patients with acute respiratory distress syndrome (ARDS)/acute lung injury (ALI) and associated clinical outcomes. A retrospective literature review was performed to identify articles published on the topic of trophic feeds in mechanically ventilated adult patients with ALI/ARDS, with a focus on associated clinical outcomes. The studies included in this literature review indicated that the dose and timing of enteral nutrition in critically ill patients with ARDS/ALI had an effect on clinical outcomes. It is possible that additional variables such as the level of organ dysfunction and varying definitions for trophic enteral nutrition also influenced clinical outcomes. The United States (U.S.) and Canadian guidelines for nutrition supportrecommend either trophic or full EN for patients with ARDS/ALI on the basis that these two feeding strategies have similar patient outcomes over the first week of hospitalization. After reviewing the literature, we conclude that caution is warranted when following this recommendation. Regressions suggest full calorie enteral nutrition administered early in the course of critical illness significantly increased the odds of mortality, whereas full calorie enteral nutrition administered later reduced the odds of mortality.

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Design and development / Respiratory distress syndrome (RDS) is a major cause of mortality and long-term morbidity annually affecting 14% preterm infants worldwide. Therapies have been developed to overcome this common disorder; however, limitations exist with these treatments that often lead to complications including bronchopulmonary dysplasia (BPD). One approach to address RDS is to implement a microfluidic oxygenator that serves as a respiratory support system for preterm neonates while the lungs fully develop, extra-uterine. This artificial lung assist device (LAD) is characterised by its non-invasiveness (given that it is connected via umbilical vessels), pumpless configuration, ambient air operation, portability and low priming volume. Furthermore, the LAD is formed by single oxygenator units (SOU) that are stacked in a parallel array which allows for usage on different body weights. The objective of this thesis is to design an electrochemical system to provide an in-situ enriched O2 environment able to supply 1.9 ml O2/min for use in the SOU while maintaining the simplicity of operation of the oxygenator. An inexpensive, electrically powered and compact device was envisioned allowing for a higher permeation flux to fully oxygenate the blood. Moreover, the system would be easy to manufacture, low maintenance and avoid the risk of gas contamination. In the initial work, different designs of electrolytic cells were developed and tested. The two- chamber design connected by a gel membrane showed an O2 production 10 times higher than with previous designs with 42 mg O2/L. Subsequently, different supporting electrolytes were tested. NaOH demonstrated a better performance and no degradation of the electrode in contrast to NaCl and Na2SO4. Stainless steel mesh (SSM) and graphite sheet electrodes were then tested; it was observed that stainless steel produced 3.4 times more dissolved oxygen (DO) than graphite with 28.3 mg O2/L. Experimentation with electrolysis of water showed that the DO in water reached stability 3 min after the electrolysis process was initiated measuring a change of DO of 29 mg/L at 3 A. Furthermore, an active oxygenation (AO) system was developed for in-vitro experiments via electrolysis of water and compared to a passive oxygenation (PO) system exposing blood to enriched O2 air and ambient air, respectively. It was demonstrated that AO provided 300% greater oxygenation to blood than PO. The electrolysis chamber designed for the microfluidic oxygenator allows the oxygenator to maintain its essential characteristics of simplicity and low cost while increasing the rate of oxygenation of blood. Preterm neonates suffering from RDS need an artificial lung that can partially support the oxygenation of their blood. Thus, combining the oxygenator with the O2 generation in-situ system enables a greater blood O2 uptake of 300% making possible the development of an efficient artificial lung. / Thesis / Master of Applied Science (MASc)

A clinical need exists for a blood oxygenator and pumping system for the support of neonates with respiratory deficiencies. Such systems now available for support of adults are not suitable for neonatal patients. In vitro evaluation of a new blood oxygenator and blood pumping system was performed. The data obtained suggested that this system may be applicable to neonates. In vivo studies with rabbits to further analyze the new system were done. Preliminary data from these studies indicate that the new blood oxygenator and blood pump system may be applicable to supporting neonates with respiratory deficiencies. Suggestions for future development of this system are presented. / Master of Science