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Background: Although lung expansion therapy with positive end‐expiratory pressure (PEEP) following heart surgery is associated with positive clinical outcomes, whether such therapy can improve oxygenation and diminish the occurrence of lung complications when performed during heart surgery with extracorporeal circulation (ECC) is not yet clear. Objective: Analyze the impact of lung expansion therapy with PEEP at 20 cmH2O for 60 s during elective heart surgery. Methods: A randomized clinical trial was conducted. The experimental group (EG) (n = 27) received PEEP at 20 cmH2O for 60 s during heart surgery at the moment in which ECC was ended. No intraoperative maneuver was performed in the control group (CG) (n = 15). Results: The incidence of atelectasis upon hospitalization and the pre‐maneuver oxygenation index (PaO2/FiO2) were similar between the groups. A lower incidence of atelectasis in the immediate postoperative period (7.4%, p = 0.03) and shorter time on noninvasive mechanical ventilation (TNIMV) (5.78 ± 2.54, p = 0.01) were found in the EG compared with the CG. Conclusions: The application of PEEP at 20 cmH2O for 60 s during heart surgery reduces the incidence of atelectasis in the immediate postoperative period and shortens the TNIMV. This maneuver proved to be safe, with no adverse events. [ABSTRACT FROM AUTHOR]

Background: It has been reported that the manual chest compression and decompression (MCCD) maneuver can increase lung volume in patients receiving invasive mechanical ventilation (IMV), but some important questions related to this maneuver require answers: how long the effects of MCCD on lung volume remain, and whether there are effects on other respiratory and hemodynamic variables. Methods: Patients receiving IMV support in an intensive care unit (ICU) with signs of hypoventilation, hypoexpansion, or atelectasis were eligible to receive the MCCD maneuver. Immediately before the maneuver, respiratory and hemodynamic parameters were collected. Then, 20 MCCD maneuvers were performed while measured the same parameters. After 10 min, all parameters were measured again. The primary outcome was the tidal volume (Vt) during the MCCD maneuver and after 10 min compared to the previous Vt. Results: Of the 255 patients who were mechanically ventilated in the study period, 105 patients composed the final cohort. The MCCD increased inspiratory tidal volume (iVt), expiratory tidal volume (eVt), and chest dynamic compliance (Cdyn) during the application of the maneuver, but after 10 min, these parameters returned to their basal levels. The MCCD maneuver did not change the peak pressure, respiratory rate, peripheral oxygen saturation (SpO2), heart rate, or blood pressure. There was no difference in increased iVt in patients with sedation, respiratory comorbidity, or obesity. Further, there was no association between the iVt response to the MCCD and the admission diagnosis, and no correlation with the ICU length of stay, IMV duration, or APACHE II score. Implications of Physiotherapy Practice: We concluded that MCCD increased iVt, eVt, and Cdyn during the application of the maneuver, but this effect was not observed after 10 min. Randomized controlled trials should be performed in the future to investigate the mechanism involved in increasing Vt and the possible impact of the MCCD maneuver on ICU outcomes. [ABSTRACT FROM AUTHOR]

Objective: The aim of this study was to describe practices for weaning from mechanical ventilation (MV), in terms of the use of protocols, methods, and criteria, in pediatric ICUs (PICUs), neonatal ICUs (NICUs), and mixed neonatal/pediatric ICUs (NPICUs) in Brazil. Methods: This was a cross-sectional survey carried out by sending an electronic questionnaire to a total of 298 NICUs, PICUs, and NPICUs throughout Brazil. Results: Completed questionnaires were assessed for 146 hospitals, NICUs accounting for 49.3% of the questionnaires received, whereas PICUs and NPICUs accounted for 35.6% and 15.1%, respectively. Weaning protocols were applied in 57.5% of the units. In the NICUs and NPICUs that used weaning protocols, the method of MV weaning most commonly employed (in 60.5% and 50.0%, respectively) was standardized gradual withdrawal from ventilatory support, whereas that employed in most (53.0%) of the PICUs was spontaneous breathing trial (SBT). During the SBTs, the most common ventilation mode, in all ICUs, was pressure-support ventilation (10.03 ± 3.15 cmH2O) with positive end-expiratory pressure. The mean SBT duration was 35.76 ± 29.03 min in the NICUs, compared with 76.42 ± 41.09 min in the PICUs. The SBT parameters, weaning ventilation modes, and time frame considered for extubation failure were not found to be dependent on the age profile of the ICU population. The findings of the clinical evaluation and arterial blood gas analysis are frequently used as criteria to assess readiness for extubation, regardless of the age group served by the ICU. Conclusions: In Brazil, the clinical practices for weaning from MV and extubation appear to vary depending on the age group served by the ICU. It seems that weaning protocols and SBTs are used mainly in PICUs, whereas gradual withdrawal from ventilatory support is more widely used in NICUs and NPICUs. [ABSTRACT FROM AUTHOR]

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Congenital heart disease is considered the most common malformation found in neonatology. The aim of this study was to characterize the congenital heart diseases of premature newborns in the Neonatal Intensive Care Unit (NICU) of a high-risk maternity unit. This was an observational retrospective, descriptive character study carried out in a maternity school, reference in high-risk gestation in the state of Rio Grande do Norte. The study was carried out with premature infants admitted to NICU, who presented some cardiological findings when performing the echocardiogram examination. Data collection was performed through the records of infants hospitalized from December 2016 to December 2017. A total of 371 records were evaluated. Fifty-eight infants were diagnosed with congenital heart disease, and 38 of them had Persistence of the ductus arteriosus. The main diagnosed cardiopathies caused low pulmonary flow. About half of the pregnant women with cardiac infants presented some complications during pregnancy, and the most frequent was Urinary Tract Infection; 55 infants needed some ventilatory support, 14 had at least one extubation failure during the hospitalization period, and 8 presented atelectasis. Persistence of the ductus arteriosus was the most common cardiologic finding, and the most frequent congenital heart diseases were those that decreased pulmonary flow, diagnosed mostly in premature infants who needed some ventilation support, but who were discharged from hospital. [ABSTRACT FROM AUTHOR]

Objective: The objective of this study was to describe the results of anatomic pulmonary resections performed by video-assisted thoracoscopy in Brazil. Methods: Thoracic surgeons (members of the Brazilian Society of Thoracic Surgery) were invited, via e-mail, to participate in the study. Eighteen surgeons participated in the project by providing us with retrospective databases containing information related to anatomic pulmonary resections performed by video-assisted thoracoscopy. Demographic, surgical, and postoperative data were collected with a standardized instrument, after which they were compiled and analyzed. Results: The surgeons provided data related to a collective total of 786 patients (mean number of resections per surgeon, 43.6). However, 137 patients were excluded because some data were missing. Therefore, the study sample comprised 649 patients. The mean age of the patients was 61.7 years. Of the 649 patients, 295 (45.5%) were male. The majority--521 (89.8%)--had undergone surgery for neoplasia, which was most often classified as stage IA. The median duration of pleural drainage was 3 days, and the median hospital stay was 4 days. Of the 649 procedures evaluated, 598 (91.2%) were lobectomies. Conversion to thoracotomy was necessary in 30 cases (4.6%). Postoperative complications occurred in 124 patients (19.1%), the most common complications being pneumonia, prolonged air leaks, and atelectasis. The 30-day mortality rate was 2.0%, advanced age and diabetes being found to be predictors of mortality. Conclusions: Our analysis of this representative sample of patients undergoing pulmonary resection by video-assisted thoracoscopy in Brazil showed that the procedure is practicable and safe, as well as being comparable to those performed in other countries. [ABSTRACT FROM AUTHOR]

BACKGROUND: Early physiotherapy reduces pulmonary complications after lung resection in adult patients. However, the effectiveness and the techniques used in postoperative physiotherapy in children undergoing lung resection have not been well described. Therefore, the standardization of a physiotherapeutic attendance after lung resection in children is necessary. METHODS: This was a retrospective and prospective, interventional, descriptive, and quantitative study. We evaluated 123 pédiatrie subjects undergoing lung resection. Fifty-two children were prospectively submitted to a standardized physiotherapy protocol that included a mask with a positive expiratory pressure of 10 cm H2O, expiratory rib cage compression, coughing, lifting the upper limbs, and ambulation, starting within the first 4 hours after surgery and continuing 3 times each day. A historical control group of 71 subjects received physiotherapeutic techniques without specific standardization and with variability in the start date and number of days attended. We recorded the presence of postoperative complications, prolonged air leak, postoperative bronchoscopy, the time of chest tube removal, and hospital stay following surgery. RESULTS: The group that received a standardized protocol of physiotherapy had fewer instances of atelectasis than the control group (15.4% vs 7.6%, P = .01). Subjects in the control group were more likely than those in the intervention group to require Fiberoptic bronchoscopy for bronchial toilet (n = 14 [19.7%] vs n = 5 [9.6%], P ≥ .001). There was no difference in the time of drainage or hospital stay between the groups. CONCLUSIONS: Implementation of a standardized physiotherapeutic protocol after lung resection in children decreases atelectasis but does not reduce the time of chest tube removal or the duration of hospital stay. [ABSTRACT FROM AUTHOR]

To study cases of foreign bodies (FB) in the tracheobronchial tree investigating the clinical and radiological FB characteristics, complications and endoscopic and surgical intervention. Medical and radiological records review of all FB aspiration cases treated at São Paulo State University Hospital over the last 30 years. One hundred and sixty-four FB cases were analyzed; 57% were male, 84% of these were under 16 years old. The most common clinical manifestations were coughing (68.3%) and choking (54.9%). The most common FBs were seeds (peanut, bean, maize) and also small metal or plastic objects. Radiography was normal in 21.3%, atelectasis was present in 40.9%, hyperinsufflation in 17.1% and the FB was radio-opaque in 20.7%. FB time in the bronchial tree varied from hours to years. The most serious complications, as fibroatelectasis and difficult resolution pneumonia, were caused by the long time that the FB remained in the bronchial tree. FB extraction was by endoscopy in 89% of cases, while 6% required surgical extraction or resection of destroyed part of lung, and 5% spontaneously eliminated the FB. There was no mortality in this series. Coughing and choking were the commonest clinical findings. Most FBs were dried seeds. Complications were due to delays in diagnosis, and most would not have existed if the doctor had given credence to the history. Radiography can be normal as most FBs are radiotransparent. FB extraction was by endoscopy, but a few cases required surgery and others were spontaneously eliminated. [ABSTRACT FROM AUTHOR]

The article describes the findings of a 1- to 24-month follow-up of emphysema patients undergoing transbronchoscopic placement of one-way endobronchial valves. The sample for the study comprised of nineteen heterogeneous emphysema patients from Hospital de Clinicas de Porto Alegre, Brazil. The findings suggest that the treatment of severe heterogeneous emphysema predominantly affecting the upper lobes using transbronchoscopic pulmonary emphysema treatment is a safe procedure.