Cinara Andreolio

Bio: Cinara Andreolio is an academic researcher from Universidade Federal do Rio Grande do Sul. The author has contributed to research in topics: Medicine & Mechanical ventilation. The author has an hindex of 4, co-authored 6 publications receiving 40 citations.

Progress and perspectives in pediatric acute respiratory distress syndrome

Abstract: Acute respiratory distress syndrome is a disease of acute onset characterized by hypoxemia and infiltrates on chest radiographs that affects both adults and children of all ages. It is an important cause of respiratory failure in pediatric intensive care units and is associated with significant morbidity and mortality. Nevertheless, until recently, the definitions and diagnostic criteria for acute respiratory distress syndrome have focused on the adult population. In this article, we review the evolution of the definition of acute respiratory distress syndrome over nearly five decades, with a special focus on the new pediatric definition. We also discuss recommendations for the implementation of mechanical ventilation strategies in the treatment of acute respiratory distress syndrome in children and the use of adjuvant therapies.

Vancomycin-associated Nephrotoxicity and Risk Factors in Critically Ill Children Without Preexisting Renal Injury.

Abstract: Background:A recent systematic review concluded that critically ill pediatric patients have higher odds of vancomycin-related nephrotoxicity [odds ratio (OR): 3.61, 95% CI: 1.21–10.74]. We aimed to assess the incidence and risk factors for vancomycin-associated nephrotoxicity in critically ill child

Prolonged infusion of dexmedetomidine in critically-ill children

Abstract: Objective To describe main indications, doses, length of infusion and side effects related to dexmedetomidine infusion.

Characteristics and progression of children with acute viral bronchiolitis subjected to mechanical ventilation.

Abstract: Objective: To analyze the characteristics of children with acute viral bronchiolitis subjected to mechanical ventilation for three consecutive years and to correlate their progression with mechanical ventilation parameters and fluid balance. Methods: Longitudinal study of a series of infants (< one year old) subjected to mechanical ventilation for acute viral bronchitis from January 2012 to September 2014 in the pediatric intensive care unit. The children's clinical records were reviewed, and their anthropometric data, mechanical ventilation parameters, fluid balance, clinical progression, and major complications were recorded. Results: Sixty-six infants (3.0 ± 2.0 months old and with an average weight of 4.7 ± 1.4kg) were included, of whom 62% were boys; a virus was identified in 86%. The average duration of mechanical ventilation was 6.5 ± 2.9 days, and the average length of stay in the pediatric intensive care unit was 9.1 ± 3.5 days; the mortality rate was 1.5% (1/66). The peak inspiratory pressure remained at 30cmH2O during the first four days of mechanical ventilation and then decreased before extubation (25 cmH2O; p < 0.05). Pneumothorax occurred in 10% of the sample and extubation failure in 9%, which was due to upper airway obstruction in half of the cases. The cumulative fluid balance on mechanical ventilation day four was 402 ± 254mL, which corresponds to an increase of 9.0 ± 5.9% in body weight. Thirty-seven patients (56%) exhibited a weight gain of 10% or more, which was not significantly associated with the ventilation parameters on mechanical ventilation day four, extubation failure, duration of mechanical ventilation or length of stay in the pediatric intensive care unit. Conclusion: The rate of mechanical ventilation for acute viral bronchiolitis remains constant, being associated with low mortality, few adverse effects, and positive cumulative fluid balance during the first days. Better fluid control might reduce the duration of mechanical ventilation.

The Relevance of Airway Resistance in Children Requiring Mechanical Ventilatory Support.

Abstract: OBJECTIVES To describe pulmonary resistance in children undergoing invasive mechanical ventilation (MV) for different causes. DESIGN A cross-sectional study. SETTING Two PICUs in the South region of Brazil. PATIENTS Children 1 month to 15 years old undergoing MV for more than 24 hours were included. We recorded ventilator variables and measured pulmonary mechanics (inspiratory and expiratory resistance, auto positive end-expiratory pressure [PEEP], and dynamic and static compliance) in the first 48 hours of MV. INTERVENTIONS Measurements of the respiratory mechanics variables during neuromuscular blockade. MEASUREMENTS AND MAIN RESULTS A total of 113 children were included, 5 months (median [interquartile range (IQR) [2.0-21.5 mo]) old, and median (IQR) weight 6.5 kg (4.5-11.0 kg), with 60% male. Median (IQR) peak inspiratory pressure (PIP) was 30 cm H2O (26-35 cm H2O), and median (IQR) PEEP was 5 cm H2O (5-7 cm H2O). The median (IQR) duration of MV was 7 days (5-9 d), and mortality was nine of 113 (8%). The median (IQR) inspiratory and expiratory resistances were 94.0 cm H2O/L/s (52.5-155.5 cm H2O/L/s) and 117 cm H2O/L/s (71-162 cm H2O/L/s), with negative association with weight and age (Spearman -0.850). When we assess weight, in smaller children (< 10 kg) had increased pulmonary resistance, with mean values over 100 mH2O/L/s, which were higher than larger children (p < 0.001). CONCLUSIONS Increased pulmonary resistance is prevalent in the pediatric population undergoing invasive MV. Especially in children less than 1 year old, this variable should be considered when defining a ventilatory strategy.

High-Frequency Oscillation for Acute Respiratory Distress Syndrome

Abstract: *John Radcliffe Hospital and the †University of Oxford, Oxford, ‡Bristol Royal Infirmary, Bristol, §Queen Elizabeth Hospital, Birmingham, and ||Warwick Clinical Trials, University of Warwick, Warwick, and ¶Intensive Care National Audit and Research Centre, London, UK; and #Department of Critical Care Medicine, Sunnybrook Health Sciences Centre and the Department of Anesthesiology, University of Toronto, Toronto, Ontario, Canada. Copyright * 2013 by Lippincott Williams & Wilkins DOI: 10.1097/01.SA.0000435572.01496.5c

Dexmedetomidine as Single Continuous Sedative During Noninvasive Ventilation: Typical Usage, Hemodynamic Effects, and Withdrawal.

Abstract: Objectives:Dexmedetomidine use in pediatric critical care is increasing. Its prolonged effects as a single continuous agent for sedation are not well described. The aim of the current study was to describe prolonged dexmedetomidine therapy without other continuous sedation, specifically the hemodyna

Comparison of Prevalence and Outcomes of Pediatric Acute Respiratory Distress Syndrome Using Pediatric Acute Lung Injury Consensus Conference Criteria and Berlin Definition.

Abstract: Objectives Our objective was to compare the prevalence and outcomes of pediatric ARDS using the Pediatric Acute Lung Injury Consensus Conference (PALICC) criteria and Berlin definitions. Methods We screened case records of all children aged 1 month to 17 years of age admitted to the Pediatric Intensive Care Unit (PICU) over a 3 year period (2015- 2017) for presence of any respiratory difficulty at admission or during PICU stay. We applied both PALICC and Berlin criteria to these patients. Data collection included definition and outcome related variables. Data were compared between the 'PALICC only group' and the 'Berlin with or without PALICC' group using Stata 11. Results Of a total of 615 admissions, 246 were identified as having respiratory difficulty at admission or during PICU stay. A total of 61 children (prevalence 9.9%; 95% CI: 7.8 to 12.4) fulfilled the definition of ARDS with either of the two criteria. While 60 children (98%) fulfilled PARDS criteria, only 26 children (43%) fulfilled Berlin definition. There was moderate agreement between the two definitions (Kappa: 0.51; 95% CI: 0.40 to 0.62; observed agreement 85%). Greater proportion of patients had severe ARDS as per Oxygenation Index criteria in the 'Berlin with or without PALICC group' as compared to the 'PALICC only' group (36.3% vs. 17.2%). There was no difference between the groups with regard to key clinical outcomes such as duration of ventilation (7 vs. 8 days) or mortality [57.1% vs. 57.7%: RR (95% CI): 0.99 (0.64 to 1.5)]. Conclusion In comparison to Berlin definition, the PALICC criteria identified more number of patients with ARDS. Proportion with severe ARDS and complications was greater in the 'Berlin with or without PALICC' group as compared to the 'PALICC only' group. There were no differences in clinical outcomes between the groups. Key words: PARDS; Berlin definition; pediatric ARDS; Acute respiratory distress syndrome; Oxygenation index; oxygen saturation index

Dexmedetomidine Use in a Pediatric Intensive Care Unit: A Retrospective Cohort Study.

Abstract: Background: Use of dexmedetomidine in critically ill pediatric patients is increasing despite limited data on effects on mechanical ventilation times, use of other sedatives, adverse effects, and w...

Pharmacokinetic Drug-Drug Interactions among Antiepileptic Drugs, Including CBD, Drugs Used to Treat COVID-19 and Nutrients.

Abstract: Anti-epileptic drugs (AEDs) are an important group of drugs of several generations, ranging from the oldest phenobarbital (1912) to the most recent cenobamate (2019). Cannabidiol (CBD) is increasingly used to treat epilepsy. The outbreak of the SARS-CoV-2 pandemic in 2019 created new challenges in the effective treatment of epilepsy in COVID-19 patients. The purpose of this review is to present data from the last few years on drug-drug interactions among of AEDs, as well as AEDs with other drugs, nutrients and food. Literature data was collected mainly in PubMed, as well as google base. The most important pharmacokinetic parameters of the chosen 29 AEDs, mechanism of action and clinical application, as well as their biotransformation, are presented. We pay a special attention to the new potential interactions of the applied first-generation AEDs (carbamazepine, oxcarbazepine, phenytoin, phenobarbital and primidone), on decreased concentration of some medications (atazanavir and remdesivir), or their compositions (darunavir/cobicistat and lopinavir/ritonavir) used in the treatment of COVID-19 patients. CBD interactions with AEDs are clearly defined. In addition, nutrients, as well as diet, cause changes in pharmacokinetics of some AEDs. The understanding of the pharmacokinetic interactions of the AEDs seems to be important in effective management of epilepsy.