Análise comparativa entre o protocolo de tratamento de bronquiolite viral aguda em hospital de referência brasileiro e guidelines mundiais com suas respectivas evoluções clínicas
Tipo
TCC
Data de publicação
2024-11-14
Periódico
Citações (Scopus)
Autores
Arendt, Amanda Janzen
Oku, Raquel Akemi
Oku, Raquel Akemi
Orientador
Ribas, Maurício Marcondes
Título da Revista
ISSN da Revista
Título de Volume
Membros da banca
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Resumo
Introdução: A bronquiolite viral aguda (BVA) é uma infecção do trato respiratório inferior, causada principalmente pelo vírus sincicial respiratório (VSR). É comum em crianças menores de 2 anos. A gravidade está relacionada à prematuridade, exposição ao tabaco, aleitamento materno incompleto e comorbidades. A maioria dos casos são tratados em domicílio, mas alguns requerem internação para manejo de complicações respiratórias. Apesar da alta incidência e impacto no sistema de saúde, ainda não há tratamento específico e os países divergem em seus protocolos com relação à terapêutica adotada e os risco-benefícios das medicações. Objetivos: Comparar o protocolo de tratamento da BVA no Hospital Universitário Evangélico Mackenzie do Paraná (HUEM), e guidelines mundiais, relacionando a evolução clínica dos pacientes com a eficácia do protocolo utilizado, verificando a existência de um tratamento mais eficaz para essa doença. Metodologia: Estudo retrospectivo, individuado, observacional, transversal e descritivo com coleta de dados a partir de prontuários do HUEM por meio do sistema MVPEP. Os pacientes foram atendidos no serviço de pediatria entre junho de 2022 e junho de 2023, com os CIDs J18.0, J21, J21.0, J21.9 e J22. A análise estatística foi realizada por meio do Software R no Microsoft Excel. Os dados do HUEM foram comparados com os guidelines mundiais obtidos nas bases de dados PubMed, Web of Science e Scopus. Resultados: Dos 110 prontuários analisados, observou-se uma taxa de sobrevida de 100%. A doença acometeu mais meninos entre 3 a 6 meses de idade. Em relação aos tratamentos, 70% receberam Beta-2 agonistas, 68% solução salina hipertônica e oxigenoterapia foi administrada em 60% dos casos. Antibioticoterapia foi administrada para 30% dos pacientes, principalmente beta-lactâmicos. Fisioterapia respiratória e oxigenoterapia foram mais frequentes em crianças de 0 a 2 meses. O uso de antibiótico e solução salina hipertônica foram mais frequentes nos pacientes internados. Além disso, observou-se que o tempo de internação foi maior nos pacientes que receberam corticoide sistêmico e antibioticoterapia, sendo que neste houve maior probabilidade de necessitarem de cuidados em UTI. As crianças eram previamente saudáveis em 86,36% dos casos, entretanto, aquelas com comorbidades como broncodisplasia e cardiopatia tiveram tempo de internação mais prolongado. A hiper-reatividade brônquica foi observada em 94% dos pacientes, independente do tratamento ou idade da criança. Conclusão: A comparação e a correlação com evoluções clínicas evidenciaram que a solução salina hipertônica tem o potencial de reduzir tempo de internação, mas esse dado precisa de mais estudo para ser comprovado. O uso de broncodilatadores, por mais que seja difundido, ainda tem eficácia inconclusiva, e o corticoide, apesar das controvérsias, pode ser útil em casos graves ou relacionados ao rinovírus. A oxigenoterapia foi consenso nos guidelines e a antibioticoterapia recomendada apenas em casos de infecção bacteriana associada. Apesar do protocolo do HUEM estar alinhado com diretrizes globais, nenhuma medicação destacou-se como mais eficaz. Reforça-se a necessidade de pesquisas futuras para aprimorar o tratamento dessa doença, incluindo antivirais e vacinas, a fim de que melhores resultados sejam alcançados, além de um menor custo assistencial.
Introduction: Acute viral bronchiolitis (AVB) is a lower respiratory tract infection primarily caused by respiratory syncytial virus (RSV). It is common in children under 2 years old, with severity linked to prematurity, tobacco exposure, incomplete breastfeeding, and comorbidities. Most cases are treated at home, but some require hospitalization for handling of respiratory complications. Despite its high incidence and impact on healthcare systems, there is no specific treatment, and countries vary in their protocols regarding the risks and benefits of medications. Objectives: To compare the AVB treatment protocol used at Hospital Universitário Evangélico Mackenzie (HUEM), with global guidelines, relating the paciente clinical evolution with the effectiveness of the protocol, and identifying a potentially more effective treatment. Methodology: This was a retrospective, individual, observational, cross-sectional, and descriptive study with data collected from HUEM patient records through the MVPEP system. The patients were treated in the pediatric service between June 2022 and June 2023 with ICD codes J18.0, J21, J21.0, J21.9, and J22. Statistical analysis was performed using R Software in Microsoft Excel. HUEM data were compared to global guidelines obtained from PubMed, Web of Science, and Scopus databases. Results: Of the 110 records analyzed, a 100% survival rate was observed. The disease affected more boys aged 3 to 6 months. Regarding treatments, 70% received Beta-2 agonists, 68% received hypertonic saline, and oxygen therapy was administered in 60% of cases. Antibiotic therapy, mainly beta-lactams, was administered to 30% of patients. Respiratory physiotherapy and oxygen therapy were more common in children aged 0 to 2 months. Antibiotic and hypertonic saline use were more frequent among hospitalized patients. Moreover, hospitalization duration was longer for patients who received systemic corticosteroids and antibiotic therapy, with a higher likelihood of requiring ICU care. The children were previously healthy in 86.36% of cases; however, those with comorbidities like bronchopulmonary dysplasia and heart disease had a longer hospital stay. Bronchial hyperreactivity was observed in 94% of patients, regardless of treatment or age. Conclusion: The comparison and correlation with clinical evolution indicated that the hypertonic saline has the potential to reduce hospitalization period, though further study is needed to confirm this. The use of bronchodilators, regardless of how widespread it is, still has inconclusive efficacy, while corticosteroids, despite controversies, may be useful in severe cases or those related to rhinovirus. Oxygen therapy was a consensus across guidelines, and antibiotics were recommended only for associated bacterial infections. Even though HUEM's protocol aligns with global guidelines, no medication stood out as the most effective. The need fo future research to improve the treatment of this disease, including antivirals and vacines, is reinforced, so that better results are achieved, in addition to lower care costs.
Introduction: Acute viral bronchiolitis (AVB) is a lower respiratory tract infection primarily caused by respiratory syncytial virus (RSV). It is common in children under 2 years old, with severity linked to prematurity, tobacco exposure, incomplete breastfeeding, and comorbidities. Most cases are treated at home, but some require hospitalization for handling of respiratory complications. Despite its high incidence and impact on healthcare systems, there is no specific treatment, and countries vary in their protocols regarding the risks and benefits of medications. Objectives: To compare the AVB treatment protocol used at Hospital Universitário Evangélico Mackenzie (HUEM), with global guidelines, relating the paciente clinical evolution with the effectiveness of the protocol, and identifying a potentially more effective treatment. Methodology: This was a retrospective, individual, observational, cross-sectional, and descriptive study with data collected from HUEM patient records through the MVPEP system. The patients were treated in the pediatric service between June 2022 and June 2023 with ICD codes J18.0, J21, J21.0, J21.9, and J22. Statistical analysis was performed using R Software in Microsoft Excel. HUEM data were compared to global guidelines obtained from PubMed, Web of Science, and Scopus databases. Results: Of the 110 records analyzed, a 100% survival rate was observed. The disease affected more boys aged 3 to 6 months. Regarding treatments, 70% received Beta-2 agonists, 68% received hypertonic saline, and oxygen therapy was administered in 60% of cases. Antibiotic therapy, mainly beta-lactams, was administered to 30% of patients. Respiratory physiotherapy and oxygen therapy were more common in children aged 0 to 2 months. Antibiotic and hypertonic saline use were more frequent among hospitalized patients. Moreover, hospitalization duration was longer for patients who received systemic corticosteroids and antibiotic therapy, with a higher likelihood of requiring ICU care. The children were previously healthy in 86.36% of cases; however, those with comorbidities like bronchopulmonary dysplasia and heart disease had a longer hospital stay. Bronchial hyperreactivity was observed in 94% of patients, regardless of treatment or age. Conclusion: The comparison and correlation with clinical evolution indicated that the hypertonic saline has the potential to reduce hospitalization period, though further study is needed to confirm this. The use of bronchodilators, regardless of how widespread it is, still has inconclusive efficacy, while corticosteroids, despite controversies, may be useful in severe cases or those related to rhinovirus. Oxygen therapy was a consensus across guidelines, and antibiotics were recommended only for associated bacterial infections. Even though HUEM's protocol aligns with global guidelines, no medication stood out as the most effective. The need fo future research to improve the treatment of this disease, including antivirals and vacines, is reinforced, so that better results are achieved, in addition to lower care costs.
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Palavras-chave
bronquiolite , tratamento , guidelines , bronchiolitis , treatment , guidelines