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Previous issue date: 2011-08-31 / AIM: To verify the effects of an anabolic steroid (nandrolone decanoate) associated to physical therapy in prolonged mechanical ventilation weaning in children.METHODS: This is a historical observational cohort study. Twenty nine children with difficult weaning or that showed high numbers of extubation failure needing repeated ventilatory support were included in the study. As they showed two or more dysfunctions they were classified according to the score: systemic (characterized by malnutrition), respiratory, cardiac, neurologic and musculoskeletal dysfunctions. All children were submitted to respiratory and motor therapy 2 to 3 times a day. Parameters as time and ventilation weaning, extubation failures, weight gain, length of hospitalization and survival were evaluated.RESULTS: The length of mechanical ventilation before and after the use of anabolic steroid was similar (p=0.758). The number of failures before the use of AS was significant higher when compared to after AS (P<0.001). After the use of the drug 20 children (69%) did not show any failure at the moment of mechanical ventilation removal. Twenty six children (89.7%) showed success in weaning and three did not respond to the treatment. After the first dose of AS until mechanical ventilation removal and hospital release the patients showed significant weight gain (p<0.05). Tracheostomized children showed higher length of mechanical ventilation (p<0.001) however, this result did not interfere in mortality rate. After one year of treatment, 73.1% survived. After twenty months the survival probability was of 50.3% and after this period no modifications were observed. All death occurred in this 20 months interval.CONCLUSION: the use of AS associated to a MV weaning protocol can facilitate MV weaning and improve strength and resistance performance of children who stayed for long periods in MV. It promotes weight gain and reduces the number of MV extubation failure and it is efficient in children showing malnutrition with multiple dysfunctions and critically sick. It is not associated to the increase of mortality. / M?TODO: Estudo de coorte hist?rico observacional. Vinte e nove crian?as em desmame dif?cil ou que apresentaram um grande n?mero de falhas de extuba??o, necessitando de suporte ventilat?rio repetidos foram inclu?das no estudo. Como apresentavam duas ou mais disfun??es, foram classificadas conforme escore: disfun??es sist?micas (caracterizada pela desnutri??o), respirat?rias, card?acas, neurol?gicas e musculoesquel?ticas. Todas as crian?as do estudo realizavam fisioterapia respirat?ria e motora de 2 a 3 vezes ao dia. Foram avaliados par?metros de tempo e desmame da ventila??o, falhas de extuba??o, ganho de peso, tempo de interna??o e sobrevida.RESULTADOS: Os tempos de VM pr? e p?s EA foram semelhantes (p=0,758). O n?mero de falhas pr? EA foi significativamente maior que os p?s EA (p<0,001). Ap?s o uso da droga, 20 crian?as (69%) n?o tiveram mais falhas na sa?da da VM. Vinte e seis crian?as (90%) obtiveram sucesso no desmame e 3 n?o responderam ao tratamento. Ap?s a primeira dose do EA at? a sa?da da VM e alta, os pacientes apresentaram significativo ganho de peso (p<0,05). As crian?as traqueostomizadas tiveram um maior tempo de VM (p<0,001), entretanto isto n?o interferiu na mortalidade. Ap?s um ano do tratamento 73,1% do total da amostra sobreviveram. Ap?s os 20 meses a probabilidade de sobrevida foi de 50,3% e ap?s esse per?odo n?o se observou modifica??o. Todos os ?bitos ocorreram neste intervalo de 20 meses.CONCLUS?O: O uso do EA associado a um protocolo de desmame da VM pode facilitar o desmame, e o desempenho de for?a e resist?ncia de crian?as que permanecem longo tempo em VM. Promove incremento de peso, reduz n?mero de falhas na sa?da da VM e mostra-se eficaz, na reabilita??o de crian?as desnutridas, com m?ltiplas disfun??es e criticamente doentes. Sem associa??o com aumento de mortalidade.
| Identifer | oai:union.ndltd.org:IBICT/oai:tede2.pucrs.br:tede/1379 |
| Date | 31 August 2011 |
| Creators | Franz, Fl?via |
| Contributors | Garcia, Pedro Celiny Ramos |
| Publisher | Pontif?cia Universidade Cat?lica do Rio Grande do Sul, Programa de P?s-Gradua??o em Medicina/Pediatria e Sa?de da Crian?a, PUCRS, BR, Faculdade de Medicina |
| Source Sets | IBICT Brazilian ETDs |
| Language | Portuguese |
| Detected Language | English |
| Type | info:eu-repo/semantics/publishedVersion, info:eu-repo/semantics/masterThesis |
| Format | application/pdf |
| Source | reponame:Biblioteca Digital de Teses e Dissertações da PUC_RS, instname:Pontifícia Universidade Católica do Rio Grande do Sul, instacron:PUC_RS |
| Rights | info:eu-repo/semantics/openAccess |
| Relation | 3098206005268432148, 500, 600, -8624664729441623247 |
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