Avaliação da síndrome do desconforto respiratório agudo na criança utilizando a definição de Berlin

• Ano de defesa: 2015
• Autor(a) principal: Birck, Greice Isabel
• Orientador(a): Garcia, Pedro Celiny Ramos
• Tipo de documento: Dissertação
• Tipo de acesso: Acesso aberto
• Idioma: por
• Instituição de defesa: Pontifícia Universidade Católica do Rio Grande do Sul
• Programa de Pós-Graduação: Programa de Pós-Graduação em Medicina/Pediatria e Saúde da Criança
• Departamento: Faculdade de Medicina
• País: Brasil
• Palavras-chave em Português: MEDICINA; PEDIATRIA; SÍNDROME DO DESCONFORTO RESPIRATÓRIO DO RECÉM-NASCIDO; UNIDADES DE TERAPIA INTENSIVA; VENTILAÇÃO MECÂNICA (MEDICINA)
• Área do conhecimento CNPq: CIENCIAS DA SAUDE::MEDICINA
• Link de acesso: http://tede2.pucrs.br/tede2/handle/tede/5913

The Acute Respiratory Distress Syndrome (ARDS) described for the first in 1967 presents as its main characteristic refractory hypoxemia. Since then, many have tried to define the syndrome and 1994 the American-European Consensus Conference (AECC) established more acccurate criteria for its diagnosis. Due to criticism to that model, in 2012 the Berlin definition was published categorizing three kinds of patients based on the PaO₂/FiO₂ ratio according the severity of the hypoxemia and with a minumum level of PEEP of 5 cmH₂O. From then on it has been established: PaO₂/FiO₂ < 100 mmHg as severe ARDS, 100 < PaO₂/FiO₂ ≤ 200 mmHg as moderate ARDS and 200 < PaO₂/FiO₂ ≤ 300 mmHg as mild ARDS. The mortality rate will be higher according to the severity of the syndrome. The research were done with adults. Objective: To reclassify ARDS patients at Pediatric Intensive Care Unit (PICU) according to the Berlin definition, describe their main characteristics, their clinical evolution focusing on mechanical ventilation (MV) parameters relating them to outcomes, especially mortality rate. Methods: Retrospective study carried out at the PICU at Hospital São Lucas - PUCRS, which is an academic hospital. All hypoxemic patients in MV diagnosed with ARDS were included in the study from February 2011 to December 2013 based on the patients records review. The patients were categorized according to both the AECC criteria and the Berlin definition, and then compared. Results: 28 patients were selected. On the first day of MV, 20 patients were considered severe ARDS, 7 patients with moderate and 1 patient with mild. There were 12 deaths (42.8%) at the end of the 28th day. Among them, 10 patients were classified as severe ARDS and 2 as moderate. Despite the different mortality rate between the groups such difference cannot be statistically proved (p=0.69). The four patients who underwent dialysis died. All patients were on antibiotics and 60% of them on more than one regimen. The mean of the ventilatory parameters were PIP 35 ± 6 PEEP 9 ± 3 and FiO₂ 0.73 ± 0.19. The median of the time of MV was 7 days (IIQ 5-14) and the length of stay at the PICU was 12 (IIQ 6-26). Conclusions: The Berlin definition was useful for identifying the most severe patients in this small sample. Despite the adequate ventilatory management, the mortality rate of ARDS is still high and its reduction, a big challenge. Further studies in Pediatrics are highly recommended.