CINTIA JOHNSTON
Projetos de Pesquisa
Unidades Organizacionais
Instituto da Criança, Hospital das Clínicas, Faculdade de Medicina
16 resultados
Resultados de Busca
Agora exibindo 1 - 10 de 16
- Mechanical ventilation weaning practices in neonatal and pediatric ICUs in Brazil: the Weaning Survey-Brazil(2020) BACCI, Suzi Laine Longo dos Santos; JOHNSTON, Cintia; HATTORI, Wallisen Tadashi; PEREIRA, Janser Moura; AZEVEDO, Vivian Mara Goncalves de OliveiraObjective: 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 cmH(2)O) 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.
conferenceObject EVALUATION OF BURNOUT SYNDROME IN PAEDIATRIC INTENSIVE CARE UNIT DURING COVID-19 PANDEMIC(2022) RODRIGUEZ, I. S.; CARLOTTI, A. D.; GOES, P. F.; ARAGON, D. C.; JOHNSTON, C.; SILVA, C. A.; CARVALHO, W. B.; DELGADO, A. F.- Effect of manual hyperinflation with versus without positive end-expiratory pressure on dynamic compliance in pediatric patients following congenital heart surgery: A randomized controlled trial(2023) GUIMARAES, Jessica Camara; SILVA, Thalis Henrique da; ARAGON, Davi Casale; JOHNSTON, Cintia; GASTALDI, Ada Clarice; CARLOTTI, Ana P. C. P.Background: We aimed to compare the effect of manual hyperinflation with versus without positive end-expiratory pressure (PEEP) on dynamic compliance of the respiratory system in pediatric patients undergoing congenital heart surgery; to assess the safety of the technique in this population.Methods: This was a randomized controlled trial conducted at the pediatric intensive care unit (PICU) of a tertiary-care hospital. Patients admitted to the PICU following cardiac surgery and receiving postoperative mechanical ventilation were randomized to the experimental or control group. Patients in the experimental group (n = 14) underwent manual hyperinflation with a PEEP valve set at 5 cm H2O, once daily, during the first 48 hours after surgery. Patients allocated to the control group (n = 16) underwent manual hyperinflation without PEEP, at the same time points. Lung mechanics was assessed before (T0) and 5 minutes (T5) after manual hyperinflation. The primary endpoint was dynamic compliance. Secondary outcomes included oxygen saturation index, duration of mechanical ventilation, length of stay, 28-day mortality and safety.Results: Demographic and clinical characteristics were comparable in both groups. There was no significant difference in dynamic compliance between times in each group (Day 1: (mean) 0.78 vs 0.81 and 0.70 vs 0.77; Day 2: 0.85 vs 0.78 and 0.67 vs 0.68 mL/kg/cm H2O, in experimental and control groups, respectively; P > .05). Mean deltas of dynamic compliance were not significantly different between groups. The proportion of patients extubated <72 hours after surgery was similar in experimental and control groups (43% vs 50%, respectively; P = .73). Oxygen saturation index, length of stay, and 28-day mortality were not significantly different between groups. None of the patients had hemodynamic instability.Conclusions: Manual hyperinflation was safe and well tolerated in pediatric patients following surgery for congenital heart disease. No significant change in dynamic compliance of the respiratory system or in oxygenation was observed with the use of manual hyperinflation with or without PEEP in this population.
- Primeira recomendação brasileira de fisioterapia para estimulação sensório-motora de recém-nascidos e lactentes em unidade de terapia intensiva(2021) JOHNSTON, Cíntia; STOPIGLIA, Mônica Sanchez; RIBEIRO, Simone Nascimento Santos; BAEZ, Cristiane Sousa Nascimento; PEREIRA, Silvana AlvesAbstract Objective: To present guidelines on sensory motor stimulation for newborns and infants in the intensive care unit. Methods: We employed a mixed methods design with a systematic review of the literature and recommendations based on scientific evidence and the opinions of physiotherapists with neonatal expertise. The research included studies published between 2010 and 2018 in the MEDLINE® and Cochrane databases that included newborns (preterm and term) and infants (between 28 days and 6 months of age) hospitalized in the intensive care unit and submitted to sensory motor stimulation methods. The studies found were classified according to the GRADE score by five physiotherapists in different regions of Brazil and presented at eight Scientific Congresses held to discuss the clinical practice guidelines. Results: We included 89 articles to construct the clinical practice guidelines. Auditory, gustatory and skin-to-skin stimulation stand out for enhancing vital signs, and tactile-kinesthetic massage and multisensory stimulation stand out for improving weight or sucking. Conclusion: Although all modalities have good ratings for pain or stress control, it is recommended that sensory motor stimulation procedures be tailored to the infant’s specific needs and that interventions and be carried out by expert professionals.
- Motor development of infants (6-12 months) with low birth weight(2021) GODOY, Vanessa Cristina Waetge Pires de; SOUZA, Fabiola Isabel Suano de; JOHNSTON, Cintia; STRUFALDI, Maria Wany LouzadaOBJECTIVE: The aim of this study was to describe the motor development (MD) and growth of infants born with low birth weight (LBW) versus adequate birth weight (ABW) by using the Alberta Infant Motor Scale (AIMS). METHODS: The cross-sectional study including LBW infants (aged 6-12 months) followed at an outpatient clinic from a University Hospital in Brazil and a group of infants of the same age with ABW. The variables were recorded as maternal, birth, and infant conditions. The infants were assessed for MD using the AIMS. RESULTS: In total, 98 infants (38 LBW versus 60 ABW) were evaluated and no statistically significant differences were found in demographic characteristics and in the AIMS results. The AIMS results of the total sample were suspicious or abnormal MD in 44 (45%) of total infants. Higher frequency of suspected or abnormal motor behavior was found in the age group between 9 and 12 (54.6%) months. CONCLUSIONS: A frequency of 45% of suspected or abnormal behavior was observed in the evaluated infants, with a higher frequency of occurrence in those aged 9-12 months (54.6%).
- Electrical impedance tomography clues to detect pulmonary thrombosis in a teenager with COVID-19(2022) FORONDA, Flavia Andrea Krepel; FERNANDES, Leonardo Rocha; LAHOZ, Ana Lucia Capelari; JOHNSTON, Cintia; CARVALHO, Werther Brunow deWe report a case of pulmonary thrombosis in a teenager during a hypercoagulable state associated with COVID-19 (coronavirus disease 2019) caused by SARS-CoV-2 (severe acute respiratory syndrome coronavirus 2). A condition rare in children and adolescents, pulmonary thrombosis underdiagnosis likely increases morbidity and mortality. A pulmonary thrombosis diagnosis requires a high level of suspicion and relies on the combination of clinical presentation, D-dimer elevation, and computed tomography (CT) pulmonary angiography or ventilation/perfusion scans, imaging techniques that are difficult to perform. Electrical impedance tomography (EIT) has gained attention, as it provides real-time ventilation distribution analysis. In addition, lung pulsatility images can be obtained through this technique using electrocardiogram gating to filter out ventilation. In this case report, the reduced EIT pulsatility corresponded to the perfusion defect found on the CT scan, information that was obtained at the bedside without radiation or contrast exposure.
- COVID-19 and Liver Damage: Narrative Review and Proposed Clinical Protocol for Critically ill Pediatric Patients(2020) LUGLIO, Michele; TANNURI, Uenis; CARVALHO, Werther Brunow de; BASTOS, Karina Lucio de Medeiros; RODRIGUEZ, Isadora Souza; JOHNSTON, Cintia; DELGADO, Artur FigueiredoSARS-CoV-2 shares nearly 80% of its' genomic sequence with SARS-CoV and MERS-CoV, both viruses known to cause respiratory symptoms and liver impairment. The emergence of pediatric cases of multisystem inflammatory syndrome related to the SARS-CoV-2 infection (PIM-TS) has raised concerns over the issue of hepatic damage and liver enzyme elevation in the critically ill pediatric population with COVID-19. Some retrospective cohorts and case series have shown various degrees of ALT/AST elevation in SARS-CoV-2 infections. A limited number of liver histopathological studies are available that show focal hepatic periportal necrosis. This liver damage was associated with higher levels of inflammatory markers, C-reactive protein (CRP), and pro-calcitonin. Proposed pathophysiological mechanisms include an uncontrolled exacerbated inflammatory response, drug-induced liver injury, direct viral infection and damage to cholangiocytes, hypoxic-ischemic lesions, and micro-thrombosis in the liver. Based on the physiopathological characteristics described, our group proposes a clinical protocol for the surveillance, evaluation, management, and follow-up of critically ill pediatric COVID-19 patients with liver damage.
- Early Mobilization in PICU: Are We on Time?(2019) JOHNSTON, C.; KREBS, V.L.J.; CARVALHO, W.B. de; CARNEIRO-SAMPAIO, M.Purpose of review: Elements based on specific literature to assist in the elaboration of an early mobilization (EM) protocol for severely ill children in a pediatric intensive care unit or in an inpatient care unit. Recent findings: Recent findings have shown that immobility during critical periods of the disease may cause physical, neuromusculoskeletal, metabolic, cognitive, and psychological sequelae that may extend throughout life. Prolonged bed rest is associated with thromboembolic events, decreased protein synthesis and muscle mass, and increased risk of death. Children surviving from serious illnesses have an increased risk of delay in overall recovery, resulting in poor quality of life and increased costs of post-discharge health services in the short, medium, and long term. Summary: Further research is needed to delineate protocols for specific populations in PICU as well as to find associations between interventions in PICU with EM, and with outcome times spent in PICU and hospital, need for care after hospital discharge, death and quality of life, among others. © 2019, Springer Nature Switzerland AG.
- Proposed recommendations for antithrombotic pro-phylaxis for children and adolescents with severe infection and/or multisystem inflammatory syndrome caused by SARS-CoV-2(2020) CARNEIRO, Jorge David Aivazoglou; RAMOS, Gabriel Frizzo; CARVALHO, Werther Brunow de; JOHNSTON, Cintia; DELGADO, Artur Figueiredo
bookPart Abordagem multiprofissional na criança e recém-nascido com COVID-19. Reabilitação para crianças e adolescentes após a COVID-19(2021) LAHOZ, Ana Lúcia Capelari; NICOLAU, Carla Marques; TRAGANTE, Carla Regina; JOHNSTON, Cíntia; SANTOS, Maria Lúcia Barbosa Maia dos; ZAMBERLAN, Patrícia