ABSTRACT
Introducción: El decúbito prono fue la estrategia más utilizada en pacientes con CO VID-19 e hipoxemia refractaria. Nuestro objetivo fue describir las características clínicas y evolución de los pacientes con COVID-19 grave que requirieron este procedimiento. Evaluar la relación entre factores de riesgo y mortalidad. Material y métodos: Estudio descriptivo retrospectivo observacional. Se incluyeron los pacientes mayores de 18 años con COVID-19 bajo asistencia respiratoria mecánica que requirieron decúbito prono. Se efectuó seguimiento durante 28 días. Se registraron las complicaciones asociadas al decúbito prono. Se analizaron factores asociados a la mortalidad utilizando regresión de Cox. Resultados: Se realizó decúbito prono en 28 pacientes. La edad promedio fue de 52,43 años y una mediana de índice de Charlson de 1 [0,00, 2,00]. La mediana de días de asistencia respiratoria mecánica fue de 17,00 [RIQ 13,00, 23,00] y un 28,6% logró ser extubado. La mediana de días en UTI fue de 19,50 [RIQ 14.00, 23.50] con una mortalidad del 53,6%. El 35,7% necesitó dos ciclos de decúbito prono con una duración predominante de 24-36 h. El 89,4% tuvo lesiones de úlceras por presión. Los que fallecieron tuvieron menos días de UTI (16 vs. 28; p = 0,006) y solo uno de ellos había logrado ser extubado (1 vs. 7, p = 0,011). No se encontraron factores asociados a la mortalidad en la regresión de Cox. Conclusión: La población estudiada resultó predominantemente masculina y de edad promedio cercana a la quinta década de vida, con una mortalidad aproximada al 50%. No se encontró relación estadísticamente significativa entre factores de riesgo y mortalidad.
Introduction: Prone positioning (PP) was the most used strategy in patients with CO VID-19 and refractory hypoxemia. Our objective was to describe the clinical character istics and evolution of patients with severe Covid-19 who required this procedure. Also to evaluate the relationship between risk factors and mortality. Materials and method: Observational retrospective descriptive study. Patients older than 18 years old with COVID-19 under mechanical ventilation (AVM) who required PP were included. Follow-up was carried out for 28 days. Complications associated with PP were recorded. Factors associated with mortality were analyzed using Cox regression. Results: Prone position was performed in 28 patients. The average age was 52.43 years and a median Charlson Score of 1 [0.00, 2.00]. The median number of days of AVM was 17.00 [IQR 13.00, 23.00] and 28.6% managed to be extubated. The median number of days in the ICU was 19.50 [IQR 14.00, 23.50] with a mortality of 53.6%. 35.7% needed 2 PD cycles with a predominant duration of 24-36 hours. 89.4% had pressure ulcers. Those who died spent fewer days in ICU (16 vs 28; p=0.006) and only one of them had managed to be extubated (1 vs 7, p = 0.011). No factors associated with mortality were found in the Cox regression. Conclusion: The study population consisted predominantly of males in an average age close to the fifth decade, with an approximate mortality of 50%. No statistically significant relationship was found between risk factors and mortality.
Subject(s)
Critical Care , HypoxiaABSTRACT
O extrato aquoso de Stryphnodendron adstringens é tradicionalmente utilizado no Brasil como cicatrizante. Estudo clínico conduzido por seis meses teve por objetivo avaliar a eficácia de um medicamento na forma de pomada, contendo 3% de fitocomplexo fenólico de barbatimão na cicatrização de úlceras de decúbito. Foram submetidos ao protocolo clínico 27 pacientes apresentando um total de 51 úlceras, classificadas de acordo com a área e grau de profundidade (I a III) da lesão. Em média a cicatrização das lesões de grau I e II ocorreu num período de 3 a 6 semanas e as de grau III entre 10 e 18 semanas. Durante a realização do estudo 100% das lesões tratadas com o medicamento cicatrizaram completamente.
ABSTRACT
Objective To study the clinical efficacy of recombinant human epidermal growth factor (rhEGF) in the treatment of sacrococcygeal decubitus ulcers grade Ⅲ with direct polymerizing suture after appling rhEGF to reinforce wound bed preparation (WBP). Methods From January 2007 to October 2009, 60 patients with sacrococcygeal decubitus ulcers Grade Ⅲ, were divided into control group and treatment group. The ulcer size was 3 cm × 4 cm to 10 cm × 12 cm and all ulcers were infected for 15-70 d. Treatment group received traditional dressing change and appling rhEGF to reinforce wound bed preparation. Control group received traditional dressing change only. The operative technique that we used in two groups was direct polymerizing suture. Cure rate of stage Ⅰ and complication morbidities were analyzed. Results Cure rate of stage Ⅰ was 87% in treatment group and 70% in control group. Complication morbidities were 13% in treatment group and 30% in control group. The difference between these two groups was statistically significant (P ＜ 0.05). Conclusion Appling rhEGF to reinforce wound bed preparation before operation could make subsequent treatment more effective and improve the cure ratio of operation with decreasing complications and morbidities. And more, dissecting under fascia possesses the advantages of easiness to perform and rich blood supply.The method of appling rhEGF with direct polymerizing suture is a simple, high efficient approach for the first repairment of sacrococcygeal decubitus ulcers grade Ⅲ, especially desirable for the elderly.
ABSTRACT
Las úlceras por decúbito son una patología frecuente dentro de los hospitales, especialmente dentro de ciertos servicios y en pacientes con factores de riesgo. Son un factor importante de descompensación, llevando incluso a la muerte en algunos casos, además de prolongar la estadía hospitalaria y elevar sus costos. Por esta razón decidimos evaluar la eficacia de la prevención y el manejo de esta patología en nuestro hospital. Se realizó un estudio descriptivo ciego para los médicos que incluyó a todos los pacientes que ingresaron durante el mes de Noviembre de 2007 a una sala de cuidados especiales del servicio de medicina del Hospital Naval Almirante Nef. Se evaluó el riesgo de dichos pacientes de presentar este tipo de úlceras, se vio si ingresaban por esta causa o desarrollaban estas lesiones durante su hospitalización, y las medidas preventivas y de tratamiento recibidas. Se estudió un total de 44 pacientes de los cuales 54,5 por ciento fue evaluado como de alto riesgo. Se vio en este grupo que sólo el 50 por ciento recibió algún tipo de cuidado preventivo extra, el resto tuvo el mismo manejo que aquellos pacientes considerados de bajo riesgo. Del total de pacientes 40,9 por ciento ingresaron con úlceras por decúbito de algún grado y 25 por ciento la desarrolló durante su estadía. Al cabo de una semana de tratamiento 13,7 por ciento mejoró, 17,2 por ciento empeoró y 65,5 por ciento se mantuvo igual. La prevalencia de úlceras por decúbito es elevada en este grupo de pacientes y dado el bajo rendimiento de su terapia es necesario enfocarse en la prevención, lo que hace recomendable que el equipo de salud se capacite y mantenga una vigilancia cercana, habiendo estratificado bien a los pacientes en bajo y alto riesgo.
Decubitus ulcers are frequent in admitted patients, especially in some clinical units and among patients with the presence of risk factors. These ulcers are an important element of decompensation of chronic ailments, extending hospital stay and costs, even causing death in some cases. To evaluate the efficacy of their prevention and management in our hospital, we carried out a blind descriptive study that includes all patients admitted to the special care unit of the Medical Service at the Almirante Nef Naval Hospital during November 2007. We measured the risk to present these ulcers, their presence or absence at admission, their development during hospital stay, the significance of the preventive measures and treatments given. We studied 44 patients, 54,5 per cent categorized as high risk. Only 50 percent of this group received adequate preventive measures, the rest receive similar care as the low risk's patients. Considering all patients, 40,9 percent entered with decubitus ulcers and 25 percent developed them during the stay. After one week of management 13,7 percent were better, 17,2 percent were worse and 65,5 were the same. The prevalence of ulcers is high in this group of patients, and since the results for therapy are poor, prevention is fundamental. Correct classification of the risk, and education of health teams are considered important.
Subject(s)
Humans , Pressure Ulcer/therapy , Chile , Cicatrix/prevention & control , Hospitalization , Single-Blind Method , Pressure Ulcer/prevention & controlABSTRACT
[Objective]To study the influence of VAP(velvet antler polypeptide)-chitosan-honey suspension on decubitus ulcer.[Method]Swines'pressure ulcers were used as decubitus ulcer model.Honey was used as solvent carrier.VAP and chitosan were put into the honey in different proportion.The suspension was applied to the ulcer once a day for seven days.The dressings were changed once every other day.The healing state of the ulcer was observed and the area of the ulcer was calculated.The changes of the ulcer histopathology were observed.[Result]In the group of the suspension proportion of the VAP to the chitosan was 4:1,the wounds had little effusion and the granulation tissues grew fast with the scars falling off early and Absolutely.Pathology results indicated that in the group of the suspension proportion of the VAP to chitosan was 4:1,none necrosis was found,the epithelization was apparent,and the inflammatory cells were fewer.There was no edema,but more newly born blood vessles.[Conclusion]The VAP-chitosan-honey suspension could apparently promote the healing of decubitus ulcer,but the possible mechanism needs to be further studied.