Repercussões clínicas e laboratoriais do CPAP nasal em recém-nascidos pré-termo

Abstract

Objective

To evaluate the efficacy and the problems associated with the use of nasal continuous positive airway pressure (CPAP).

Methods

Ninety-six preterm newborns needing nasal CPAP either as initial ventilatory support or for weaning from mechanical ventilation were studied prospectively.

Results

The nasal CPAP was used in children weighing from 480 to 2450 g and with corrected gestational age of 24 to 39 weeks. It was indicated in cases of apnea (12.5%), hyaline membrane disease (32.3%), pneumonia (4.2%), transient tachypnea (22%), and weaning from mechanical ventilation (29%). The last indication was more frequent in children with lower weight (P<0.01). Median time in nasal CPAP was 60.3 hours. After the installation of nasal CPAP, there was a significant improvement in the respiratory distress, which was not shown in the blood gases. The percentage of children that were fed and presented nasal hyperemia, nasal bleeding, and abdominal distention was directly proportional to how long they had been in nasal CPAP. Children weighting £ 1000 g had higher incidence of abdominal distention (P<0.01), and those weighing between 1500 and 2500 g had higher difficulty in maintaining nasal CPAP (P=0.04). The treatment was successful in 37% of children weighing £ 1000 g, 59% of those weighing 1000 to 1500 g, and 83% of those weighing from 1500 to 2500 g.

Conclusions

Nasal CPAP is a good option for ventilatory assistance in preterm babies. It is a safe therapy in general, with topic complications; it does not prevent patients from being fed during its use. Furthermore, it was successful in 59% of the studied patients.

Resumen

Objetivo

Avaliar a eficácia e os problemas associados à aplicação do CPAP nasal.Métodos: Estudaram-se prospectivamente 96 pré-termos que necessitaram de CPAP nasal como suporte ventilatório inicial ou para desmame do respirador.

Resultados

O CPAP nasal foi aplicado em crianças com peso entre 480g e 2450g e idade gestacional corrigida de 24 a 39 semanas. Foi indicado por apnéia (12,5%), membrana hialina (32,3%), pneumonia (4,2%), taquipnéia transitória do recém-nascido (22%) e desmame do respirador (29%), sendo que neste caso, a indicação foi mais freqüente quanto menor a criança (p<0,01). A mediana do tempo de permanência em CPAP foi de 60,3h. Após a instalação do CPAP nasal, houve melhora significativa da dificuldade respiratória, que não se refletiu nos gases sangüíneos.

Conclusões

O CPAP nasal é uma boa opção para suporte ventilatório de pré-termos. É uma terapêutica segura com complicações geralmente tópicas, não impede que o paciente se alimente durante o seu uso e foi um método de assistência ventilatória efetivo em 59% dos paciente estudados.