Comparación de la utilización de broncoldilatadores: nebulizaciones e inhaladores IDM en el tratamiento de la crisis asmática en niños. Hospital Pediátrico Baca Ortiz
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2013
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Universidad de Guayaquil. Facultad de Ciencias Médicas. Escuela de Graduados
Resumen
El asma es una enfermedad crónica que afecta tanto a niños como adultos. Según la OMS, alrededor de 300 millones de personas presentan la enfermedad a nivel mundial. En nuestro país, según el estudio ISAAC (Internacional Study Asthma Allergy in Childhood ), la prevalencia de asma es del 16% en niños de 6 a 7 años y adolecentes. A pesar de los avances en el tratamiento del asma, las crisis o exacerbaciones son relativamente frecuentes. Su tratamiento se realiza en base a broncodilatadores de acción corta a través de la vía aérea, pero existe controversia entre la administración del broncodilatador mediante nebulizador vs inhalador IDM. Metodología. La presente es una investigación de intervención que compara dos esquemas de tratamiento de la crisis asmática en niños, de 2 a 14 años 11 meses de edad que acudieron al servicio de emergencias del Hospital Pediátrico Baca Ortiz con diagnostico de crisis asmática. Se conformaron dos grupos de 23 de pacientes cada uno. Un grupo recibió broncodilatadores mediante la vía nebulizada, y otro broncodilatadores mediante la utilización de un inhalador IDM, con ayuda de una cámara espaciadora. Para determinar la eficacia del tratamiento, en cada grupo se realizó la medición de las siguientes variables: frecuencia respiratoria, oximetría, puntaje de Wood Downes, oximetría, medición del Flujo Espiratorio Máximo (mayores de 5 años), estas variables se midieron al inicio, a los 60 y 120 minutos del tratamiento. Además se comparó el número de pacientes dados de alta a los 60 y 120 minutos en cada grupo y finalmente el número de pacientes con fracaso terapéutico después de 120 minutos de tratamiento. Resultados: Los dos grupos de pacientes estudiados no mostraron diferencias sexo, peso, talla; igual que en las cifras basales de las variables: frecuencia respiratoria, oximetría, valor de pico flujo, puntaje de Wood Downes, presentaron valores de p superiores a 0.05 para un IC de 95%. Igualmente, el análisis a los 60 y 120 minutos de tratamiento de las variables: oximetría, valor de pico flujo, puntaje de Wood Downes, no presentaron diferencias estadísticamente significativas, ya que sus valores p fueron superiores a 0.05 para un IC del 95%. Finalmente, las variables: alta a los 60 y 120 minutos, y fracaso terapéutico a los 120 minutos no presentaron diferencias significativas (valores p superiores a 0.05) para un IC del 95%. Se concluye que los dos esquemas presentan similar eficacia en el tratamiento de la crisis asmática en niños.
Asthma is a chronic disease that affects both children and adults. According to WHO, a 300 million people from all ages currently suffering this disease. In Ecuador, the, asthma prevalence is 16% in children between 6-7 years and adolescents ( SAAC: International Study Asthma Allergy in Childhood). Despite advances in asthma treatment, the exacerbations are common. The treatment is based on rapid-acting beta2 agonist, but there is controversy between the administration of bronchodilator by nebulizer vs pressured metered-dose (pMDI) in children. Methods. This study was made in order to compare the efficacy of the nebulizer administration of salbutamol and pressured metered-dose (pMDI) in children between 2 and 14 years 11 months of age who presented at emergency room. 46 children were randomly selected; they were divided in two groups, 23 patients each. The first group received rapid-acting beta2 agonist via nebulizer, and the second group received pressured metered-dose (pMDI) with spacer. The patients were assessed: respiratory rate, pulse oximetry, Wood Downes score, oximetry, peak flow measurement (over 5 years), these variables were measured at baseline, at 60 minutes and 120 minutes of treatment. Additionally, we compared the number of patients discharged at 60 and 120 minutes in each group and finally the number of patients with treatment failure after 120 minutes of treatment. Results: The two groups of patients studied showed no differences in sex, weight, height, and in baseline values of the variables: respiratory rate, oximetry, peak flow value, Wood Downes score, the p values was higher than 0.05 for a 95% CI. Similarly, we analysided at 60 and 120 minutes of treatment the following variables: oximetry, peak flow value, Wood Downes score, no statistically significant differences, because their p values were greater than 0.05 for 95% CI. Finally, were analyzed the variables: clinical outcome at 60 and 120 minutes, and therapeutic failure at 120 minutes, the results showed no significant differences (p values greater than 0.05) for 95% CI. We conclude that the two groups showed similar efficacy in the treatment of asthma exacerbation in children.
Asthma is a chronic disease that affects both children and adults. According to WHO, a 300 million people from all ages currently suffering this disease. In Ecuador, the, asthma prevalence is 16% in children between 6-7 years and adolescents ( SAAC: International Study Asthma Allergy in Childhood). Despite advances in asthma treatment, the exacerbations are common. The treatment is based on rapid-acting beta2 agonist, but there is controversy between the administration of bronchodilator by nebulizer vs pressured metered-dose (pMDI) in children. Methods. This study was made in order to compare the efficacy of the nebulizer administration of salbutamol and pressured metered-dose (pMDI) in children between 2 and 14 years 11 months of age who presented at emergency room. 46 children were randomly selected; they were divided in two groups, 23 patients each. The first group received rapid-acting beta2 agonist via nebulizer, and the second group received pressured metered-dose (pMDI) with spacer. The patients were assessed: respiratory rate, pulse oximetry, Wood Downes score, oximetry, peak flow measurement (over 5 years), these variables were measured at baseline, at 60 minutes and 120 minutes of treatment. Additionally, we compared the number of patients discharged at 60 and 120 minutes in each group and finally the number of patients with treatment failure after 120 minutes of treatment. Results: The two groups of patients studied showed no differences in sex, weight, height, and in baseline values of the variables: respiratory rate, oximetry, peak flow value, Wood Downes score, the p values was higher than 0.05 for a 95% CI. Similarly, we analysided at 60 and 120 minutes of treatment the following variables: oximetry, peak flow value, Wood Downes score, no statistically significant differences, because their p values were greater than 0.05 for 95% CI. Finally, were analyzed the variables: clinical outcome at 60 and 120 minutes, and therapeutic failure at 120 minutes, the results showed no significant differences (p values greater than 0.05) for 95% CI. We conclude that the two groups showed similar efficacy in the treatment of asthma exacerbation in children.
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Estado asmático, Broncodilatadores, Nebulizadores, Pediatría, Hospital Pediátrico Baca Ortiz, Cantón Quito, Ecuador, Inhaladores IDM