Vivências de idosos com doença pulmonar crônica em uso de oxigenoterapia domiciliar prolongada no relacionamento amoroso e sexual / Experiences of older adult with chronic pulmonary disease using long-term home oxygen therapy in romantic and sexual relationships

Resumo Objetivo Compreender os significados atribuídos pela pessoa idosa com Doença Pulmonar Obstrutiva Crônica (DPOC) em uso da Oxigenoterapia Domiciliar Prolongada (ODP) referente ao relacionamento amoroso e a prática sexual. Método Estudo qualitativo, no qual foram realizadas sete entrevistas semidirigidas com pacientes com diagnóstico confirmado de DPOC e em uso de ODP, atendidos em serviço ambulatorial. A técnica de análise de conteúdo foi aplicada com o apoio do software WebQDA 2.0®. Os critérios COREQ foram usados ​​para relatar o método e o resultado. Resultados Duas categorias emergiram: 1- Desestabilização no relacionamento amoroso e na vida sexual do usuário de ODP: revelou que a terapia causa perturbação nos relacionamentos, mudança de parceiro depois que foi prescrita a ODP ou até a ideia de procurar uma pessoa extraconjugal. 2- Vivência e significados da DPOC e da oxigenoterapia durante a relação sexual: o sofrimento com as questões fisiológicas, o quanto o paciente sente falta de ar para ter relação sexual e o impacto disso no desempenho e na frequência, diminuindo esses momentos com o parceiro Conclusão A percepção da pessoa idosa com DPOC em uso da ODP indica que a oxigenoterapia impactou sobre a prática sexual e nos relacionamentos amorosos. Ter boa qualidade nos relacionamentos e na prática sexual é condição fundamental para promover a saúde.

Abstract Objective To understand the meanings attributed by older adult with Chronic Obstructive Pulmonary Disease (COPD) using the Long-Term Home Oxygen Therapy (LTOT) regarding romantic relationships and sexual practice. Method Qualitative study in which seven semi-structured interviews were carried out with patients with a confirmed diagnosis of COPD and using LTOT, treated in an outpatient service. The content analysis technique was applied with the support of the WebQDA2.0 software license. COREQ criteria were used to report method and outcome. Results Two categories emerged: 1- Destabilization in the romantic relationship and in the sexual life of the LTOT user: : revealed that therapy causes relationship breakup, change of partner after prescription of the LTOT or even the idea of ​​looking for an extramarital person; 2- Experience and meanings of COPD and oxygen therapy during sexual intercourse: suffering with physiological problems, how much the patient feels short of breath to have sexual intercourse and the impact of this on performance and frequency, reducing these moments with the partner. Conclusion The perception of elderly people with COPD using LTOT indicates that oxygen therapy had an impact on sexual practice and romantic relationships. Having good quality in relationships and sexual practice is a fundamental condition for health promotion.

Ventilación mecánica no invasiva en ingresados en un centro provisional para pacientes con CO VID-19 moderada / Non-invasive mechanical ventilation in patients admitted to a provisional center for moderate COVID-19 patients

Introducción: La ventilación mecánica no invasiva es una alternativa ventilatoria para los casos con COVID-19. Objetivo: Describir las características y la evolución de la ventilación mecánica no invasiva en los pacientes egresados en el Centro Provisional para pacientes moderados con COVID-19 en Figali, Panamá. Métodos: Estudio descriptivo, retrospectivo, longitudinal. Incluyó a todos los pacientes adultos egresados entre junio y julio del 2021 que recibieron ventilación mecánica no invasiva. Se utilizó un cuestionario cuya fuente primaria fue la historia clínica individual digital. Se emplearon técnicas de la estadística descriptiva. Resultados: De 217 ingresados con COVID-19 moderado, 78 (35,9 por ciento) necesitaron ventilación mecánica no invasiva, iniciada con media al noveno día de síntomas y segundo después del ingreso. De estos, el 62,8 por ciento eran obesos y el 29,5 por ciento hipertensos. En el 56,4 por ciento, la frecuencia respiratoria ≥30 y la disminución de la razón PaO2/FiO2 fueron los indicadores principales que decidieron el inicio de la VMNI. Del total de ventilados, el 62,8 por ciento tuvo un síndrome de distrés respiratorio agudo moderado-grave y esto se relacionó con el fracaso de la ventilación. La ventilación fue exitosa en el 65,4 por ciento. La razón PaO2/FiO2 <150 (62,9 por ciento), la frecuencia respiratoria ≥30 (55,6 por cientpo y el agotamiento físico (51,85 por ciento), indicaron la falla de la ventilación. Conclusiones: La ventilación mecánica no invasiva es un proceder efectivo en pacientes con COVID-19 y distrés respiratorio moderado o severo; aunque su éxito se relaciona con las formas menos graves. La PaO2/FiO2 baja junto a la clínica, fueron indicadores clave para evaluar inicio, éxito o fracaso de la ventilación mecánica no invasiva; no así los valores de PaO2, PaCO2 y SpO2(AU)

Introduction: Non-invasive mechanical ventilation is a ventilatory alternative for COVID-19 cases. Objective: To describe the characteristics and evolution of non-invasive mechanical ventilation (NIMV) in patients discharged from Provisional Center for moderate COVID-19 patients in Figali, Panama. Methods: A descriptive, retrospective, longitudinal stu was carried out in all adult patients discharged from June to July 2021 and who received non-invasive mechanical ventilation. A questionnaire was used using the digital individual medical record as primary source. Descriptive statistics techniques were used. Results: 35.9percent of the patients (78/217) who were admitted required non-invasive mechanical ventilation on the ninth day of symptoms and the second day after admission. 62.8percent (49/78) were obese and 29.5percent (23/78) hypertensive. The respiratory rate ≥30 and the decrease in the PaO2/FiO2 ratio decided the begining of non-invasive mechanical ventilation in 56.4percent (78/217) of those admitted. 62.8percent (49/78) had moderate-severe acute respiratory distress syndrome, and the severity was related to ventilation failure out of the total number of ventilated patients. Ventilation was successful in 65.4percent (51/78). PaO2/FiO2 <150 (62.9percent), respiratory rate ≥30 (55.6percent) and physical exhaustion (51.85percent) decided ventilation failure. Conclusions: Non-invasive mechanical ventilation is an effective procedure in COVID-19 patients and moderate or severe respiratory distress; although its success is related to the less severe forms. Low PaO2/FiO2, together with symptoms, were key indicators to assess the begining, success or failure of NIMV; not so the values of PaO2, PaCO2 and SpO2(AU)

Método madre canguro con oxigenoterapia domiciliaria: cuidados culturales maternos, una mirada desde la enfermería / Kangaroo mother care method with home oxygen therapy: cultural maternity care, a nursing perspective / Método mãe-canguru com oxigenoterapia domiciliar: cuidados culturais maternos, o olhar de enfermagem

Introducción: Un 40% de los niños prematuros son egresados de las unidades neonatales y las familias se ven enfrentados a una situación inesperada. Criar un niño prematuro y bajo peso al nacer en posición canguro en el hogar no es tarea fácil para las madres es un cuidado extremo, significa un reto que será compensado con el crecimiento infantil. Objetivo: describir el significado del cuidado materno cultural del lactante prematuro y/o de bajo peso al nacer con oxígeno domiciliario. Metodología: estudio de tipo cualitativo con abordaje etnográfico, realizado en un Programa Canguro ambulatorio de un hospital de Bogotá Colombia. En la investigación previo consentimiento informado y aprobación institucional, participaron 8 madres, la descripción densa o la saturación de la muestra se dio con 21 entrevistas grabadas en los hogares y transcritas textualmente. Para la recolección y análisis de la información se usó la teoría de la diversidad y de la universalidad de los cuidados culturales de Madeleine Leininger y la entrevista a profundidad de James Spradley. Resultados: El significado que asignan las madres al cuidado del niño/a con oxígeno domiciliario es descrito en 9 dominios: El oxígeno como una necesidad vital, conocimientos culturales, conocimientos y educación sobre la administración de oxígeno domiciliario, trámites y sus dificultades, el desplazamiento de la madre con el niño/a prematuro con oxígeno domiciliario, higiene y vestido, los costos se aumentan, participación del padre y familiar y alteración de las emociones maternas. Conclusiones: En el saber de las madres el cuidar a su hijo con oxígeno domiciliario significa "estar pendiente" e interpretan el oxígeno como una necesidad vital. Se requiere incluir el tema en los programas de pregrado y posgrado de enfermería y generar investigaciones al respecto.

Introduction: Forty percent of premature infants are discharged from neonatal intensive care units, and their families face an unexpected situation. Raising a premature or low-birthweight baby using the kangaroo method at home is not an easy task, and, for mothers, it involves extreme care and is a challenge that will be compensated with the infant's growth. Objective: To describe the cultural meaning assigned by mothers to the care they give to their preterm or low-birthweight infants with home oxygen therapy. Methods: Qualitative study with an ethnographic approach conducted with mothers enrolled in an outpatient kangaroo program in a hospital in Bogotá, Colombia. Eight mothers participated in the research after informed consent and institutional approval were obtained. Thick description or data saturation was achieved with 21 interviews recorded at the participants' homes and transcribed verbatim. For data collection and analysis, Madeleine Leininger's theory of culture care diversity and universality and James Spradley's in-depth interview were used. Results: T h e m e a n i n g assigned by the mothers to the care given to their children with home oxygen therapy is described in nine domains: oxygen as a vital necessity, cultural knowledge, knowledge and education about oxygen therapy administration at home, paperwork and paperwork difficulties, mother's trips with a preterm infant on home oxygen therapy, hygiene and dressing, increased costs, father and other family member involvement, and maternal emotion alterations. Cultural beliefs and practices immersed in the three types of cultural care (preservation, accommodation, and repatterning) are also identified from the analysis of Madeleine Leininger's theory. The technological, religious and physiological, social, cultural, political, economic, and educational factors that influence the culture of the mothers interviewed are evident. Conclusions: In the mothers' minds, caring for their children receiving home oxygen therapy means "being vigilant," and they interpret oxygen as a vital necessity. It is necessary to include the topic in undergraduate and graduate nursing programs and to conduct research on the subject.

Introdução: 40% das crianças prematuras recebem alta das unidades neonatais e as famílias se deparam com uma situação inesperada. Criar um bebê prematuro e/ou de baixo peso ao nascer na posição canguru em casa não é uma tarefa fácil, e para as mães é um cuidado extremo e representa um desafio que será compensado com o crescimento da criança. Objetivo: descrever o significado cultural que as mães atribuem aos cuidados que prestam aos filhos prematuros e/ou de baixo peso com oxigênio domiciliar. Método: estudo qualitativo com abordagem etnográfica, realizado em um programa ambulatorial canguru de um hospital de Bogotá, Colômbia. Oito mães participaram da pesquisa, com Consentimento Livre e Esclarecido e aprovação institucional. A saturação da amostra ocorreu com 21 entrevistas gravadas nos domicílios e transcritas na íntegra. Para a coleta e análise das informações, utilizou-se a teoria da diversidade e universalidade dos cuidados culturais de Madeleine Leininger e a entrevista em profundidade de James Spradley. Resultados: o significado que as mães atribuem ao cuidado da criança com oxigênio domiciliar é descrito em nove domínios: oxigênio como necessidade vital, conhecimentos culturais, conhecimentos e educação sobre administração de oxigênio domiciliar, procedimentos e suas dificuldades, deslocamento do mãe com o prematuro com oxigênio domiciliar, higiene e vestuário, aumento de custos, participação do pai e da família e alteração das emoções maternas; Também são identificadas crenças e práticas culturais imersas nos três tipos de cuidado: preservação, adaptação e reorientação do cuidado cultural a partir da análise com a teoria de Madeleine Leininger e os fatores tecnológicos, religiosos e fisiológicos, sociais, culturais, políticos, econômicos e educacionais que influenciam a cultura das mães entrevistadas. Conclusões: no conhecimento das mães, cuidar do filho com oxigênio domiciliar significa "estar atentas" e elas interpretam o oxigênio como uma necessidade vital. É necessário incluir o tema nos programas de graduação e pós-graduação em enfermagem e gerar pesquisas sobre o assunto.

Avaliação da capacidade física em pacientes hospitalizados com diagnóstico de COVID-19 / Evaluación de la capacidad física en pacientes hospitalizados por Covid-19 / Physical capacity assessment in patients hospitalized with COVID-19 diagnose

RESUMO A infecção por SARS-CoV-2 pode ocasionar a síndrome respiratória aguda grave (SRAG), levando a hipoxemia. A avaliação da capacidade física pode ser realizada anteriormente à alta hospitalar, através de testes de exercícios submáximos. O objetivo deste estudo foi avaliar a capacidade física e a tolerância ao exercício físico por meio do teste de degrau de seis minutos (TD6) em pacientes hospitalizados com diagnóstico de COVID-19 que fizeram uso de suporte de oxigênio (O2) durante a internação. Trata-se de um estudo prospectivo e intervencionista, incluindo pacientes com idade entre 18 e 90 anos, que necessitaram de oxigenoterapia durante a hospitalização. Foi realizada avaliação através do Perme escore, seguida do TD6, com análise da saturação periférica de oxigênio (SpO2), frequência cardíaca (FC), pressão arterial (PA) e percepção subjetiva do esforço através da escala de Borg, antes e imediatamente após o TD6. Foram avaliados 31 pacientes, com idade média de 51,9 anos. O dispositivo de O2 mais utilizado foi o cateter nasal (CN), em 64,5% dos pacientes. Em relação à FC, PA e escala de Borg, pudemos observar um aumento no valor médio dessas variáveis após o TD6. A SpO2 teve uma média menor quando comparada à avaliação inicial do TD6. O teste foi finalizado por 86,9% dos pacientes, sendo que, destes, 48,3% finalizaram com interrupções; 12,9% dos participantes suspenderam o teste. O TD6 foi capaz de avaliar a capacidade física e a tolerância ao exercício, tornando-se uma ferramenta eficaz para avaliação do paciente com COVID-19.

RESUMEN La infección por SARS-CoV-2 puede provocar el síndrome respiratorio agudo severo (SRAS), resultando en hipoxemia. La evaluación de la capacidad física se puede realizar antes del alta hospitalaria mediante pruebas de ejercicio submáximas. El objetivo de este estudio fue evaluar la capacidad física y la tolerancia al ejercicio a través del test de escalón de seis minutos (TE6) en pacientes hospitalizados por Covid-19 que utilizaron soporte de oxígeno (O2) durante la hospitalización. Se trata de un estudio prospectivo e intervencionista, en el que se incluyeron a pacientes con edades entre los 18 y los 90 años, que necesitaron la oxigenoterapia durante su hospitalización. La evaluación se realizó mediante el puntaje de Perme, seguido del TE6, con análisis de saturación de oxígeno periférico (SpO2), frecuencia cardíaca (FC), presión arterial (PA) y esfuerzo percibido mediante la escala de Borg, antes e inmediatamente después del TE6. Se evaluaron a 31 pacientes, con una edad media de 51,9 años. El dispositivo de O2 más utilizado fue el catéter nasal (CN) por el 64,5% de los pacientes. Con relación a la FC, PA y la escala de Borg, se observa un aumento en el valor medio de estas variables después del TE6. La SpO2 tuvo una media más baja en comparación con la evaluación inicial del TE6. El 86,9% de los pacientes completaron el test, de los cuales el 48,3% terminó con interrupciones; y el 12,9% lo suspendió. El TE6 pudo evaluar la capacidad física y la tolerancia al ejercicio, lo que resulta ser una herramienta eficaz para evaluar a los pacientes con Covid-19.

ABSTRACT SARS-CoV-2 infection can cause severe acute respiratory syndrome (SARS), leading to hypoxemia. Physical capacity assessment can be performed before hospital discharge using submaximal exercise testing. This study sought to assess physical capacity and exercise tolerance with the six-minute step test (6MST) in hospitalized COVID-19 patients who required oxygen (O2) support during hospitalization. A prospective, interventional study was conducted with patients aged from 18 to 90 years who required oxygen therapy during hospitalization. Assessment was performed using Perme Score, followed by the 6MST tests, assessing the peripheral oxygen saturation (SpO2), heart rate (HR), blood pressure (BP), and subjective exertion perception by Borg Scale, before and immediately after the 6MST. A total of 31 patients, with a mean age of 51.9 years, were evaluated. Nasal cannula (NC) was the most used device (64.5% of patients). Regarding HR, BP, and Borg Scale, their mean value increased after 6MST. SpO2 showed a lower mean value after 6MST. Out of the 86.9% of patients who completed the test, 48.3% completed it with interruptions, and 12.9% had to suspend it. The 6MST was able to assess physical capacity and exercise tolerance, proving to be an effective tool for evaluating COVID-19 patients.

Outcome of patients with COVID pneumonia on High Flow Nasal Oxygen Therapy

Background & Aims: The coronavirus pandemic has caused a rapid surge in patients requiring intensive care unit (ICU) admission. The mainstay of treatment is supplemental oxygen therapy by an oxygen mask, nonrebreathing mask, high flow nasal oxygen therapy (HFNOT), non-invasive and invasive mechanical ventilation. HFNOT is a relatively newer, easy-to-use technique with better patient compliance. This study aimed to assess the outcome of HFNOT in Corona Virus disease (COVID) patients in ICU. Methods: This record based; retrospective study included 43 reverse transcriptase polymerase chain reaction (RTPCR) confirmed COVID patients whose respiratory support was initiated on HFNOT as per the inclusion criteria. The primary outcome of this study was to assess the number of patients requiring mechanical ventilation (HFNOT failure). The secondary outcome was to assess the association of HFNOT failure with age, co-morbidity index, and severity of illness. Results: Out of forty-three patients, twenty-five patients (58%) required conversion to mechanical ventilation. Eighteen patients (42%) were managed with HFNOT alone. HFNOT failure was more with increasing age and higher comorbidity score (p value<0.05). Conclusion: We concluded that HFNOT can be successfully used in COVID patients in ICU without the need for mechanical ventilation. However, it should be used cautiously in patients with higher 4C mortality scores.

Consideraciones sobre la ventilación mecánica artificial en la neumonía por COVID-19 / Considerations on artificial mechanical ventilation in COVID-19 pneumonia

Objetivo: Analizar las consideraciones sobre la ventilación mecánica artificial en la neumonía por COVID 19. Método: Revisión sistemática. Resultados: Se seleccionaron 15 documentos en base a su relación directa y aporte con el tema investigado. Conclusiones: El proceso de retirada del soporte ventilatorio debe estar basado en la resolución de los problemas clínicos, gasométricos y radiológicos, que constituyeron criterios de ventilación, en el retiro es utilizado alrededor de 40% del tiempo total de la VM. En las modalidades de ventilación a utilizar, algunos autores prefieren modalidades ventilatorias que permitan minimizar la PEEP, otros sin embargo prefieren valorar la ventilación con liberación de presión en la vía aérea (APRV), herramienta con la cual se puede realizar reclutamiento pulmonar, si a los 5 min de ventilación no se lograron las metas propuestas, controlando siempre la hemodinamia.

Objective: To analyze the considerations on artificial mechanical ventilation in COVID 19 pneumonia. Method: systematic review. Results: 15 documents were selected based on their direct relationship and contribution to the investigated topic. Conclusions: The process of withdrawal of ventilatory support should be based on the resolution of clinical, gasometric and radiological problems, which constituted ventilation criteria, in the withdrawal is used about 40% of the total time of MV. In the ventilation modalities to be used, some authors prefer ventilatory modalities that allow minimizing PEEP, others however prefer to value ventilation with airway pressure release (APRV), a tool with which lung recruitment can be performed, if at 5 min of ventilation the proposed goals were not achieved, always controlling hemodynamics.

Prescription de l'oxygène dans le service d'urgence d'un hôpital de référence de Mahajanga

Introduction : L'oxygène est un médicament. Une prescription non appropriée peut occasionner une insuffisance ou un excès d'apport source de dépenses hospitalières dans les pays en développement. L'objectif était d'évaluer la prescription de l'oxygénothérapie dans un service d'urgence et de soins intensifs et d'observer les modalités d'utilisation pour permettre d'ajuster les objectifs et les cibles thérapeutiques en prenant comme référence les recommandations. Matériels et Méthodes : Il s'agit d'une étude prospective descriptive sur trois mois, en 2018, de la prescription de l'oxygène au service des urgences et de soins intensifs dans un hôpital de référence de Mahajanga. Quatre obus et quatre extracteurs étaient les sources d'oxygène pour 18 lits d'accueil, de déchoquage et de soins intensifs. Ni un générateur d'oxygène ni des matériels de ventilation spécifique n'étaient disponibles. L'étude statistique a été réalisée avec le logiciel SPSS® v.20, le test Khi2 utilisé pour la comparaison des valeurs avec un seuil de signification p˂0,05. Résultats : Sur 599 admissions, 244 patients (40,7%) bénéficiant d'un apport en oxygène ont été inclus dans l'étude. L'âge moyen était de 47,6 ans avec prédominance masculine (sex-ratio de 1,4). Une saturation d'au plus 90% a été retrouvée dans 25% des cas. Les 40% des patients ont été référés pour une « oxygénothérapie ¼. Les pathologies en cause étaient neurologiques dans 34,4% des cas, touchant la tranche d'âge de 40 à 60 ans (p=0,006), respiratoires pour 21,7% et cardio-vasculaires dans 13,9%. Les lunettes à oxygène étaient utilisées à 71,7%, l'obus à oxygène à 69,3% dans les premières 24 heures (p=0,001). La mortalité était de 22,5% avec 60,6% des patients décédés qui avaient une saturation en oxygène de 90% au maximum (p=0,05). Conclusion : Un algorithme standard avec une saturation pulsée en oxygène ciblée et des techniques plus appropriées auraient permis d'économiser l'oxygène hospitalier et de réduire la mortalité.

Background: Oxygen is a drug. An inappropriate prescription can lead to insufficient or excessive intake, which is a source of hospital expenditure in low-income countries. The aim of the study was to assess the prescription of oxygen therapy in an emergency and intensive care unit and to observe the modalities of its use to allow adjustment of the therapeutic objectives and targets according to the current recommendations. Materials and Methods: We conducted a prospective descriptive study over three months, in 2018, of the prescription of oxygen in the Emergency and Intensive Care Department, of a referral hospital in Mahajanga. Four oxygen cylinder and 4 concentrators were available as oxygen sources for 18 beds intended for patient reception, destock and intensive care. The hospital did not have an oxygen generator or specific ventilation equipment. The statistical study was carried out with SPSS® v.20 software, the Khi2 test used for the comparison of values with a significance level p˂0.05. Results: Of 599 admissions, 244 patients (40.7%) receiving oxygen were included in the study. The average age was 47.6 years with a male predominance (sex ratio : 1.4). Oxygen saturation ≤90% was found in 25% of cases. The 40% of patients were referred for "oxygen therapy". The main disease were neurological in 34.4%, affecting the age group of 40 to 60 years (p=0.006); respiratory for 21.7% and cardiovascular in 13.9%. Nasal cannulas were used in 71.7%, the oxygen cylinder in 69.3% in the first 24 hours (p=0.001). Mortality was 22.5% of which 60.6% had oxygen saturation ≤90% (p=0.05). Conclusion: Using a standard algorithm with targeted SpO2 and more appropriate techniques would have saved hospital oxygen and reduced mortality.

Subcutaneous terbutaline and oral nifedipine for intrapartum fetal resuscitation: a prospective randomized controlled study / 中华围产医学杂志

Objective:To compare the safety and efficacy of terbutaline and nifedipine for acute intrapartum fetal resuscitation (IUFR).Methods:This was a prospective randomized controlled study involving 110 pregnant women with non-reassuring fetal heart rate tracings (NRFHT) during delivery at Guangzhou Women and Children's Medical Center between January and April 2021. These women were randomly allocated to receive subcutaneous terbutaline sulphate (0.25 mg, terbutaline group) or oral nifedipine (10 mg, nifedipine group), with 55 subjects in each group. Hemodynamic parameters including blood pressure, heart rate, and oxygen saturation before and 5, 15 and 30 min after treatment as well as the success rate of intrapartum resuscitation, the onset time of medication, and the incidence of postpartum hemorrhage were analyzed using t test, Chi-square test or Fisher's exact test. Results:Two groups both showed no significant difference in the mean arterial pressure or oxygen saturation before or after treatment (all P>0.05). The heart rate was not affected in nifedipine group at any time points ( P>0.05). While the patients treated with terbutaline showed accelerated maternal heart rate 5, 15 and 30 min after administration as compared with the baseline[(97.0±20.2), (99.2±13.8), (91.8±12.6) vs (81.7±11.3) bpm, all P<0.001], but it began to decrease at 30 min, with a drop of 6.4 bpm compared with that at 15 min (95% CI: 1.5-11.2, P<0.05). None of the pregnant women had adverse reactions requiring medical intervention. The rates of successful acute resuscitation were similar in the two groups [terbutaline: 78.2% (43/55) vs nifedipine: 70.9% (39/55), χ 2= 0.77, P=0.381]. Terbutaline had a shorter onset time than nifedipine in slowing the frequency of contractions and returning fetal heart rate to class Ⅰ category [2(1-6) vs 6(1-10) min, U=2 348.50, P<0.001]. No significant difference was found between the two groups in terms of NRFHT-indicated cesarean section, assisted vaginal delivery, or second dose of tocolysis within 1 h (all P>0.05) nor in blood loss volume, postpartum hemorrhage rate, low Apgar score, low umbilical artery pH value (pH<7.2), neonatal asphyxia rate, or neonatal intensive care admission rate (all P>0.05). Conclusion:Terbutaline spends less time than nifedipine to take effect and may be an alternative for acute IUFR without significant adverse outcomes.

Analysis of the status quo and influencing factors of nurse′s knowledge, attitude and practice line on adult oxygen inhalation therapy / 中国实用护理杂志

Objective:To investigate the knowledge, attitude and practice of adult oxygen inhalation therapy among nurses and analyze its influencing factors.Methods:A self-designed questionnaire was used to investigate the status of knowledge, attitude and practice of adult oxygen inhalation therapy among 1 410 nurses from many tertiary, secondary and lower hospitals in Chongqing, Jiangsu, Sichuan, Shanxi and other provinces and cities from December 2020 to January 2021 by convenient sampling method.Results:The score of nurses′ knowledge of adult oxygen inhalation therapy was 1-39 (23.10 ±4.82) points, the standard score was (44.42 ±9.27) points, the score of excellent was 0, the score of moderate was 1.8%(25/1 410), the score of poor was 98.2%(1 385/1 410). The score of nurses′ attitude of adult oxygen inhalation therapy was 6-30 (25.06 ±4.37) points, the standard score was (83.53 ±14.58) points, positive attitude accounted for 42.9%(605/1 410), neutral attitude accounted for 54.6%(770/1 410), negative attitude accounted for 2.5%(35/1 410). The score of nurses′ practice of adult oxygen inhalation therapy was 9-54 (33.82 ±6.32) points, and the standard score was (75.12 ±13.99). Positive practice accounted for 21.2%(299/1 410), neutral practice accounted for 70.4%(993/1410) points, negative practice accounted for 8.4%(118/1 410). The knowledge and attitude of nurses to adult oxygen inhalation therapy were positively correlated with practice( r=0.193, 0.554, both P<0.01). Multiple linear regression analysis showed that nurses′ knowledge, attitude and training frequency were the influencing factors of adult oxygen inhalation therapy practice( t=3.17, 23.33, 8.64, all P<0.01). Conclusions:Nurses should strengthen the study and training of adult oxygen inhalation therapy, correct attitude and improve practice, reduce or avoid the occurrence of excessive oxygen therapy and oxygen therapy complications, standardize clinical oxygen therapy to ensure the safety and effectiveness of oxygen therapy.

Effect of oxygen supply via transnasal self-made pharyngeal oxygen catheter on safe apnea time in pediatric patients undergoing tonsil surgery / 中华麻醉学杂志

Objective:To evaluate the effect of oxygen supply via the transnasal self-made pharyngeal oxygen catheter on the safe apnea time in pediatric patients undergoing tonsil surgery. Methods:Sixty American Society of Anesthesiologists physical status Ⅰ or Ⅱ patients of either sex, aged 2-6 yr, weighing 10-20 kg, scheduled for elective tonsillectomy under general anesthesia, were divided into 2 groups ( n=30 each) using a random number table method: transnasal self-made pharyngeal oxygen catheter for oxygen supply group (group NO) and control group (group C). Anesthesia was induced with intravenous midazolam, propofol, fentanyl and cis-atracurium, and then ventilation was performed with a mask, and the mask was removed when the exhaled oxygen concentration (C ETO 2) reached more than 90%.In group NO, the self-made oxygen catheter was implanted into the oropharynx through the nose, and the 100% oxygen at 10 L/min was aspirated through the humidification bottle until the intubation was successful.In group C, the transnasal self-made oxygen catheter was not implanted, and the rest of the protocol was similar to those previously described in group NO.The visual laryngoscope was implanted to simulate difficult airways.When SpO 2 ≤ 95% or the safe apnoea time reached 600 s, the observation of apnea was stopped, and mechanical ventilation was started after successful rapid endotracheal intubation.The safe apnea time (from removing the mask until SpO 2 decreased to 95%), value of C ETO 2 at the end of mask ventilation, and the minimum value of SpO 2 after stopping mask ventilation were recorded.Heat rate and mean arterial pressure were observed and recorded on admission to the operating room, immediately after onset of apnea and immediately after successful endotracheal intubation.The SpO 2, P ETCO 2 and cross-sectional area of gastric antrum were also recorded immediately after onset of apnea and immediately after successful endotracheal intubation, and the rate of increase in P ETCO 2 was calculated.The nasal bleeding, nasal dryness, postoperative pharyngeal discomfort and other adverse reactions were recorded when the self-made pharyngeal oxygen catheter was placed. Results:Compared with group C, the safe apnea time was significantly prolonged, the rate of increase in P ETCO 2 was decreased, the minimum value of SpO 2 after stopping mask ventilation was increased, and the heat rate, mean arterial pressure, SpO 2 and P ETCO 2 were increased immediately after successful intubation ( P<0.05), no significant change was found in C ETO 2 after stopping mask ventilation and cross-sectional area of gastric antrum at each time point in group NO ( P>0.05). No adverse reactions such as nasal bleeding, nasal dryness and postoperative pharyngeal discomfort were found when the self-made pharyngeal oxygen catheter was inserted in group NO. Conclusions:The oxygen supply with the transnasal self-made pharyngeal oxygen catheter technique can prolong the safe apnea time in the pediatric patients undergoing tonsil surgery.

2022 Brazilian Thoracic Association recommendations for long-term home oxygen therapy / Recomendações para oxigenoterapia domiciliar prolongada da Sociedade Brasileira de Pneumologia e Tisiologia (2022)

ABSTRACT Some chronic respiratory diseases can cause hypoxemia and, in such cases, long-term home oxygen therapy (LTOT) is indicated as a treatment option primarily to improve patient quality of life and life expectancy. Home oxygen has been used for more than 70 years, and support for LTOT is based on two studies from the 1980s that demonstrated that oxygen use improves survival in patients with COPD. There is evidence that LTOT has other beneficial effects such as improved cognitive function, improved exercise capacity, and reduced hospitalizations. LTOT is indicated in other respiratory diseases that cause hypoxemia, on the basis of the same criteria as those used for COPD. There has been an increase in the use of LTOT, probably because of increased life expectancy and a higher prevalence of chronic respiratory diseases, as well as greater availability of LTOT in the health care system. The first Brazilian Thoracic Association consensus statement on LTOT was published in 2000. Twenty-two years later, we present this updated version. This document is a nonsystematic review of the literature, conducted by pulmonologists who evaluated scientific evidence and international guidelines on LTOT in the various diseases that cause hypoxemia and in specific situations (i.e., exercise, sleep, and air travel). These recommendations, produced with a view to clinical practice, contain several charts with information on indications for LTOT, oxygen sources, accessories, strategies for improved efficiency and effectiveness, and recommendations for the safe use of LTOT, as well as a LTOT prescribing model.

RESUMO Algumas doenças respiratórias crônicas podem evoluir com hipoxemia e, nessas situações, a oxigenoterapia domiciliar prolongada (ODP) está indicada como opção terapêutica com o objetivo principal de melhorar a qualidade e a expectativa de vida desses pacientes. O oxigênio domiciliar é usado há mais de 70 anos, e a ODP tem como base dois estudos da década de oitenta que demonstraram que o uso de oxigênio melhora a sobrevida de pacientes com DPOC. Existem evidências de que a ODP tem outros efeitos benéficos como melhora da função cognitiva e da capacidade de exercício e redução de hospitalizações. A ODP está indicada para outras doenças respiratórias que cursam com hipoxemia, segundo os mesmos critérios estabelecidos para a DPOC. Tem sido observado aumento no uso da ODP provavelmente pela maior expectativa de vida, maior prevalência de doenças respiratórias crônicas e maior disponibilidade de ODP no sistema de saúde. O primeiro consenso sobre ODP da Sociedade Brasileira de Pneumologia e Tisiologia foi publicado em 2000; após 22 anos, apresentamos esta versão atualizada. Este documento é uma revisão não sistemática da literatura, realizada por pneumologistas que avaliaram evidências científicas e diretrizes internacionais sobre ODP nas diversas doenças que cursam com hipoxemia e em situações específicas (exercício, sono e viagens aéreas). Estas recomendações, tendo em vista a prática clínica, oferecem diversos quadros com informações sobre indicações, fontes de oxigênio, acessórios e estratégias para melhor eficiência, efetividade e uso seguro da ODP, assim como um modelo para sua prescrição.

Oxigenoterapia con cánula nasal de alto flujo: experiencia en un servicio de urgencias de la ciudad de Bogotá / Oxygen therapy with a high-flow nasal cannula: experience in emergency service in the city of Bogotá

El objetivo de este estudio es analizar desenlaces clínicos de oxigenoterapia con cánula nasal de alto flujo (CNAF) en niños con dificultad respiratoria aguda en un servicio de urgencias. Estudio longitudinal, retrospectivo de datos panel en niños con diagnóstico de dificultad respiratoria moderada- severa. El resultado primario de interés fue ingreso a unidad de cuidados intensivos pediátricos (UCIP) o requerir intubación 24 horas posteriores al inicio de la terapia. Se calcularon medidas de frecuencia y tendencia central. Los grupos se compararon con las pruebas Chi2, Fisher, Wilcoxon y Kruskal-Wallis. El análisis de datos panel balanceados identificó puntos de inflexión en las curvas de normalización de respuesta respiratoria. Un total de 339 niños de 0 a 16 años cumplieron los criterios de inclusión. Mayoría hombres (62,24%), mediana de edad 2 años (RIQ= 0,75-3) y neumonía como principal causa de dificultad respiratoria (33,92%). El ingreso a UCIP (14,5%) y la intubación (0,9%) fue baja en la cohorte. En las primeras tres horas con CNAF se evidenció mejoría en los parámetros respiratorios, sin diferencias significativas entre pacientes con y sin respuesta clínica (frecuencia cardiaca p=0,317; frecuencia respiratoria p=0,423; SatO2 p=0,297; FiO2 p=0,116). No se presentaron eventos adversos ni casos de mortalidad. Los resultados sugieren que la oxigenoterapia con CNAF puede ser una alternativa de soporte respiratorio inicial en niños ≤16 años con dificultad respiratoria moderada a severa. La incidencia de intubación e ingreso a UCIP fue baja. La CNAF fue bien tolerada en los diferentes grupos de edad.

Objective: To analyze clinical outcomes of oxygen therapy with a high-flow nasal cannula (HFNC) in children with acute respiratory distress in an emergency department. We design a longitudinal retrospective study of panel data in children with a diagnosis of moderate-severe respiratory distress. The primary outcome of interest was admission to the pediatric intensive care unit (PICU) or requiring intubation 24 hours after initiation of therapy.We calculated the statistics of frequency and central tendency. Finally, the Chi2, Fisher, Wilcoxon and Kruskal-Wallis tests were used to compare groups. Balanced panel data analysis identified inflexion points in the respiratory response normalization curves. Children (n = 339) from zero to 16 years old met the inclusion criteria. Most men (62.24%), median age= 2 years (IQR = 0.75-3) and pneumonia as the main cause of respiratory distress (33.92%). Admission to the PICU (14.5%) and intubation (0.9%) was low in the cohort. In the first three hours with HFNC, improvement in respiratory parameters was evidenced, with no significant differences between patients with and without clinical response (heart rate p = 0.317; respiratory rate p = 0.423; SatO2 p = 0.297; FiO2 p = 0.116). There were no adverse events or mortality cases. The results suggest that oxygen therapy with HFNC can be an alternative for initial respiratory support in children ≤16 years of age with moderate to severe respiratory distress. The incidence of intubation and admission to the PICU was low. The HFNC was well tolerated in the different age groups.

Oxigenoterapia domiciliaria y capacidad aeróbica en pacientes con enfermedad pulmonar intersticial difusa. Estudio transversal / Home Oxygen Therapy And Aerobic Capacity In Patients With Diffuse Interstitial Lung Disease. Cross-Sectional Study

Introducción: La enfermedad pulmonar intersticial difusa es un grupo de enfermedades que causan un trastorno de la capacidad aeróbica y calidad de vida, además, ocasionan una gran tasa de morbimortalidad para esta población. El uso de oxigenoterapia domiciliaria mayor a 15 horas diarias tiene beneficios en pacientes hipoxémicos crónicos, sin embargo, poco se ha comparado su uso con pacientes que no lo reciben. Objetivo: Describir las características clínicas, capacidad aeróbica funcional y calidad de vida relacionada con la salud de dos grupos de pacientes con enfermedad pulmonar intersticial difusa, uno con indicación de oxigenoterapia domiciliaria y otro grupo sin indicación. Métodos: Estudio descriptivo transversal, que incluyó 41 pacientes con enfermedad pulmonar intersticial difusa que firmaron consentimiento informado. En ambos grupos, características demográficas y clínicas, ansiedad/depresión, calidad de vida relacionada con la salud con el cuestionario Saint George y la capacidad aeróbica funcional con la prueba de marcha de seis minutos fueron medidas. Se compararon los grupos con la prueba t de student para muestras independientes. Resultados: El grupo enfermedad pulmonar intersticial difusa con oxigenoterapia domiciliaria presentó mayor porcentaje de antecedente de tabaquismo (p = 0,041), menor distancia caminada en la prueba de marcha de seis minutos (304,1 ± 108,7 vs. 390,3 ± 95,6 p = 0,01), y menor porcentaje de la distancia predicha (58,37 ± 20,45 vs. 73,34 ± 22,90, p = 0,034) frente al grupo enfermedad pulmonar intersticial difusa sin oxigenoterapia domiciliaria. Conclusiones: Los pacientes con enfermedad pulmonar intersticial difusa con indicación de oxigenoterapia domiciliaria presentan menor capacidad aeróbica funcional comparada con pacientes sin indicación(AU)

Introduction: Diffuse interstitial lung disease is a group of diseases that cause a disorder of aerobic capacity and quality of life; in addition, they cause a high rate of morbidity and mortality for this population. The use of home oxygen therapy greater than 15 hours a day has benefits in chronic hypoxemic patients, however, little has been compared to patients who do not receive it. Objective: Describe the clinical characteristics, functional aerobic capacity and health-related quality of life of two groups of patients with diffuse interstitial lung disease, one with indication for home oxygen therapy and another group without indication. Methods: A cross-sectional descriptive study included 41 patients with diffuse interstitial lung disease who signed informed consent. In both groups, demographic and clinical characteristics, anxiety/depression, health quality of life related with the Saint George questionnaire, and functional aerobic capacity with the six-minute gait test were measured. The groups were compared with the student's t-test for independent samples. Results: The diffuse interstitial lung disease group with home oxygen therapy presented a higher percentage of smoking history (p = 0.041), a shorter distance walked in the six-minute gait test (304.1 ± 108.7 vs. 390.3 ± 95.6 p = 0.01), and a lower percentage of the predicted distance (58.37 ± 20.45 vs. 73.34 ± 22.90, p = 0.034) compared to the diffuse interstitial lung disease group without home oxygen therapy. Conclusions: Patients with diffuse interstitial lung disease with indication of home oxygen therapy have lower functional aerobic capacity compared to patients without indication(AU)

Ventilación no invasiva versus oxigenoterapia convencional tras fracaso de la extubación en pacientes de alto riesgo en una unidad de cuidados intensivos: un ensayo clínico pragmático / Noninvasive ventilation versus conventional oxygen therapy after extubation failure in high-risk patients in an intensive care unit: a pragmatic clinical trial

RESUMEN Objetivo: Determinar la efectividad de la ventilación no invasiva frente a oxigenoterapia convencional en pacientes con insuficiencia respiratoria aguda tras fracaso de la extubación. Métodos: Ensayo clínico pragmático realizado una unidad de cuidados intensivos de marzo de 2009 a septiembre de 2016. Se incluyeron pacientes sometidos a ventilación mecánica > 24 horas, y que desarrollaron insuficiencia respiratoria aguda tras extubación programada, siendo asignados a ventilación no invasiva u oxigenoterapia convencional. El objetivo primario fue reducir la tasa de reintubación. Los objetivos secundarios fueron: mejora de los parámetros respiratorios, reducción de las complicaciones, de la duración de la ventilación mecánica, de la estancia en unidad de cuidados intensivos y hospitalaria, así como de la mortalidad en unidad de cuidados intensivos, hospitalaria y a los 90 días. También se analizaron los factores relacionados con la reintubación. Resultados: De un total de 2.574 pacientes, se analizaron 77 (38 en el grupo de ventilación no invasiva y 39 en el grupo de oxigenoterapia convencional). La ventilación no invasiva redujo la frecuencia respiratoria y cardíaca más rápidamente que la oxigenoterapia convencional. La reintubación fue menor en el grupo de ventilación no invasiva [12 (32%) versus 22(56%) en grupo oxigenoterapia convencional, RR 0,58 (IC95% 0,34 - 0,97), p = 0,039], el resto de los parámetros no mostró diferencias significativas. En el análisis multivariante, la ventilación no invasiva prevenía la reintubación [OR 0,17 (IC95% 0,05 - 0,56), p = 0,004], mientras que el fracaso hepático previo a la extubación y la incapacidad para mantener vía aérea permeable predisponían a la reintubación. Conclusión: El empleo de la ventilación no invasiva en pacientes que fracasa la extubación podría ser beneficiosa frente a la oxigenoterapia convencional.

ABSTRACT Objective: To determine the effectiveness of noninvasive ventilation versus conventional oxygen therapy in patients with acute respiratory failure after extubation failure. Methods: A pragmatic clinical trial was conducted in an intensive care unit from March 2009 to September 2016. Patients on mechanical ventilation > 24 hours who developed acute respiratory failure after scheduled extubation were included and were assigned to noninvasive ventilation or conventional oxygen therapy. The primary objective was to reduce the reintubation rate. The secondary objectives were to improve respiratory parameters and reduce complications, the duration of mechanical ventilation, the intensive care unit stay, the hospital stay, and mortality in the intensive care unit, in the hospital, and 90 days after discharge. Factors correlated with reintubation were also analyzed. Results: Of a total of 2,574 patients, 77 were analyzed (38 in the noninvasive ventilation group and 39 in the conventional oxygen therapy group). Noninvasive ventilation reduced the respiratory and cardiac rates more rapidly than conventional oxygen therapy. Reintubation was less common in the noninvasive ventilation group [12 (32%) versus 22 (56%) in the conventional oxygen therapy group, relative risk 0.58 (95%CI 0.34 - 0.97), p = 0.039]. The rest of the parameters did not show significant differences. In the multivariate analysis, noninvasive ventilation protected against reintubation [OR 0.17 (95%CI 0.05 - 0.56), p = 0.004], while liver failure before extubation and the inability to maintain airway patency predisposed patients to reintubation. Conclusion: The use of noninvasive ventilation in patients who failed extubation could be beneficial compared to conventional oxygen therapy.

Práticas clínicas relacionadas a cânulas nasais de alto fluxo em terapia intensiva pediátrica no Brasil em comparação com as de outros países: um inquérito brasileiro / Clinical practices related to high-flow nasal cannulas in pediatric critical care in Brazil compared to other countries: a Brazilian survey

RESUMO Objetivo: Descrever as práticas clínicas atuais relacionadas à utilização de cânula nasal de alto fluxo por intensivistas pediátricos brasileiros e compará-las com as de outros países. Métodos: Para o estudo principal, foi administrado um questionário a intensivistas pediátricos em países das Américas do Norte e do Sul, Ásia, Europa e Austrália/Nova Zelândia. Comparou-se a coorte brasileira com coortes dos Estados Unidos, Canadá, Reino Unido e Índia. Resultados: Responderam ao questionário 501 médicos, dos quais 127 eram do Brasil. Apenas 63,8% dos participantes brasileiros tinham disponibilidade de cânula nasal de alto fluxo, em contraste com 100% dos participantes no Reino Unido, no Canadá e nos Estados Unidos. Coube ao médico responsável a decisão de iniciar a utilização de uma cânula nasal de alto fluxo segundo responderam 61,2% dos brasileiros, 95,5% dos localizados no Reino Unido, 96,6% dos participantes dos Estados Unidos, 96,8% dos médicos canadenses e 84,7% dos participantes da Índia; 62% dos participantes do Brasil, 96,3% do Reino Unido, 96,6% dos Estados Unidos, 96,8% do Canadá e 84,7% da Índia relataram que o médico responsável era quem definia o desmame ou modificava as regulagens da cânula nasal de alto fluxo. Quando ocorreu falha da cânula nasal de alto fluxo por desconforto respiratório ou insuficiência respiratória, 82% dos participantes do Brasil considerariam uma tentativa com ventilação não invasiva antes da intubação endotraqueal, em comparação com 93% do Reino Unido, 88% dos Estados Unidos, 91,5% do Canadá e 76,8% da Índia. Mais intensivistas brasileiros (6,5%) do que do Reino Unido, Estados Unidos e Índia (1,6% para todos) afirmaram utilizar sedativos com frequência concomitantemente à cânula nasal de alto fluxo. Conclusão: A disponibilidade de cânulas nasais de alto fluxo no Brasil ainda não é difundida. Há algumas divergências nas práticas clínicas entre intensivistas brasileiros e seus colegas estrangeiros, principalmente nos processos e nas tomadas de decisão relacionados a iniciar e desmamar o tratamento com cânula nasal de alto fluxo.

ABSTRACT Objective: To describe current clinical practices related to the use of high-flow nasal cannula therapy by Brazilian pediatric intensivists and compare them with those in other countries. Methods: A questionnaire was administered to pediatric intensivists in North and South America, Asia, Europe, and Australia/New Zealand for the main study. We compared the Brazilian cohort with cohorts in the United States of America, Canada, the United Kingdom, and India Results: Overall, 501 physicians responded, 127 of which were in Brazil. Only 63.8% of respondents in Brazil had a high-flow nasal cannula available, in contrast to 100% of respondents in the United Kingdom, Canada, and the United States. The attending physician was responsible for the decision to start a high-flow nasal cannula according to 61.2% respondents in Brazil, 95.5% in the United Kingdom, 96.6% in the United States, 96.8% in Canada, and 84.7% in India. A total of 62% of respondents in Brazil, 96.3% in the United Kingdom, 96.6% in the United States, 96.8% in Canada, and 84.7% in India reported that the attending physician was responsible for the decision to wean or modify the high-flow nasal cannula settings. When high-flow nasal cannula therapy failed due to respiratory distress/failure, 82% of respondents in Brazil would consider a trial of noninvasive ventilation before endotracheal intubation, compared to 93% in the United Kingdom, 88% in the United States, 91.5% in Canada, and 76.8% in India. More Brazilian intensivists (6.5%) than intensivists in the United Kingdom, United States, and India (1.6% for all) affirmed using sedatives frequently with high-flow nasal cannulas. Conclusion: The availability of high-flow nasal cannulas in Brazil is still not widespread. There are some divergences in clinical practices between Brazilian intensivists and their colleagues abroad, mainly in processes and decision-making about starting and weaning high-flow nasal cannula therapy.

Efficacy of constant flow oxygen supply via laryngeal mask airway combined with a thin tube at distal end of airway stenosis for intraoperative ventilation in patients with severe tracheal stenosis undergoing bronchoscopy / 中华麻醉学杂志

Objective:To evaluate the efficacy of constant flow oxygen supply via laryngeal mask airway combined with a thin tube at the distal end of airway stenosis for intraoperative ventilation in the patients with severe tracheal stenosis undergoing bronchoscopy. Methods:Forty patients of either sex, aged 18-70 yr, scheduled for comprehensive interventional therapy with tracheoscope for severe tracheal stenosis, were allocated into 2 groups ( n=20 each) by a random number table method: test group and control group.After routine anesthesia induction, intermittent positive pressure ventilation was supplied via a laryngeal mask airway linked to four-way connector and anesthesia machine.In test group, a 6Fr suction tube was inserted through the four-way connector and placed at the distal end of the stenosis, with 1 L/min flow oxygen supply.Before ventilation with the thin tube (T 0), at 30 min after start of mechanical ventilation (T 1), and at the end of operation (T 2), SpO 2, P ETCO 2, mean airway pressure (Pmean), and minute ventilation (MV) were recorded, monitoring of lung ventilation was implemented using electrical impedance tomography, and the area percentages of the centre of ventilation (CoV), dependent silent spaces (DSS), and non-dependent silent spaces (NSS) were recorded.Blood gas analysis was performed at T 1 to record pH value, PaO 2 and PaCO 2.Hypoxemia was recorded during ventilation. Results:Compared with control group, MV, Pmean and area percentage of NSS were significantly increased and area percentage of DSS was decreased at T 1, 2, P ETCO 2 was decreased and SpO 2 and area percentage of CoV were increased at T 1, pH value and PaO 2 were increased, and PaCO 2 and the incidence of hypoxemia were decreased in test group ( P<0.05). Conclusion:Combination of laryngeal mask airway and a thin tube at the distal end of airway stenosis for constant flow oxygen supply can improve the ventilation efficacy by increasing the oxygen concentration at the distal end of the stenosis and by reopening the collapsed lung tissue at the distal end during interventional therapy with tracheoscope in the patients with severe tracheal stenosis.

Risk factors for retinopathy of prematurity: a systematic review / Fatores de risco para retinopatia da prematuridade: uma revisão sistemática

ABSTRACT To describe the prevalence of risk factors for retinopathy of prematurity and respective stages. Retrospective data were extracted from original articles addressing risk factors for retinopathy of prematurity retrieved from Scientific Electronic Library Online (SciELO), Virtual Health Library (VHL) and National Library of Medicine - NLM (PubMed) databases. In the initial search, 186 articles were found. Following title and abstract reading and application of inclusion and exclusion criteria, 25 articles were selected for this analysis. Variables of interest varied widely between studies. Gestational age and birth weight were listed as risk factors in all studies. Gender analysis revealed small gender-related differences, since approximately 52.9% of affected neonates were males and 47.1% females. As to race/color, approximately 72.7% were white, 12% were brown and 2.7% were black. However, there is a lack of consensus over the significance of these factors. The study revealed that retinopathy of prematurity is a multifactorial disease primarily associated with prematurity, low birth weight and oxygen therapy. Albeit potentially avoidable and reversible, the incidence of the condition is high. Therefore, further studies along the same lines are needed for deeper understanding of risk factors for or retinopathy of prematurity and mitigation of long-term consequences.

RESUMO O objetivo deste estudo foi descrever a prevalência dos fatores de risco associados à retinopatia da prematuridade e aos seus estágios. Para isso, foi realizado uma busca nas bases de dados SciELO, VHL e PubMed® de estudos originais que analisavam os fatores de risco para retinopatia da prematuridade foram encontrados. Inicialmente, encontrou-se 186 artigos. Após a leitura dos títulos e dos resumos e de acordo com os critérios de inclusão e de exclusão, foram escolhidos 25 artigos para compor a base de dados deste estudo. Observa-se que houve uma grande diversidade nas variáveis dos estudos. Em relação aos fatores de risco, todos os artigos mencionaram idade gestacional e peso. Ao analisar o sexo, houve uma pequena discrepância, cerca de 52,9% eram do sexo masculino e 47,1% do feminino. Em relação à raça/cor, aproximadamente 72,7% eram brancos, 12% pardos e 2,7% pretos. No entanto, não há consenso sobre esses aspectos na literatura. O estudo constatou que a retinopatia da prematuridade é uma doença multifatorial, tendo como principais fatores de risco prematuridade, baixo peso ao nascer e oxigenoterapia. Trata-se de uma doença de alta incidência, apesar de ser evitável e reversível, portanto, pesquisas como esta são essenciais para conhecer os fatores associados e, assim, reduzir as consequências a longo prazo da doença.

Topical Oxygen Jet Therapy (TOJT) for treating infected chronic surgical wounds

ABSTRACT Objectives: To evaluate the effectiveness of Topical Oxygen Jet Therapy (TOJT) in the treatment of surgical wounds in adult patients who has clinical signs of infection for over 30 days; and to identify the pathogens causing complicated skin and soft tissue infections. Method: Parallel, randomized clinical trials randomly divided into "Control Group" (CG) and "Treatment Group" (TG), which were followed up for 10 consecutive days. Venous antibiotics and dressings were used in both groups. In addition, TOJT were used on the wounds in the TG. The outcome criteria were based on clinical indicators: Pressure Ulcer Scale for Healing (PUSH) and Visual Analog Scale Pain (VAS). The paired t-test or Wilcoxon, chi-squared or Fisher's exact test, and Student's t-test or Mann-Whitney tests were used with a significance level of 5%. Results: 73 inpatients were included and followed up: 39 in TG and 34, CG. There were no significant differences in socio-demographic variables or of initial laboratory tests, except for blood glucose that was higher in TG than in CG (p = 0.044). Ten days into treatment, both the area of PUSH wounds (p < 0.001) and the pain scale (p = 0.029) were significantly reduced in TG. Staphylococcus aureus was the most prevalent pathogen (40%) with no significant difference between the two groups. Discussion: Although the follow-up time was of only ten days, a significant improvement was observed in TG. As a limitation of the study, the small sample size precluded the comparison of S. aureus infections between the two groups. Conclusion: TOJT accelerated the healing process, reduced pain and contributed to an improvement in the clinical status of the wounds when compared to CG. These findings demonstrate the effectiveness and relevance of the employed technique. It can be easily incorporated as a routine procedure in hospitals without extra investment.

Único paciente grave reportado con COVID-19 en Pinar del Río / The only severely-ill COVID-19 patient reported in Pinar del Río

RESUMEN Introducción: la COVID-19 causada por el SARS-CoV-2 constituye una amenaza para la salud pública mundial; con mayor efecto negativo en pacientes con comorbilidades y deterioro del estado de salud. Caso clínico: paciente femenina, de color de piel blanca, de 59 años de edad con antecedentes patológicos personales de hipertensión arterial, diabetes mellitus tipo II, enfermedad pulmonar obstructiva crónica y exfumadora con confirmación de COVID-19 por PCR-RT, presentó neumopatía aguda inflamatoria como complicación y evolución satisfactoria. Sin fuente de infección precisada, se aislaron todos los contactos, se estudiaron y fueron negativos a la COVID-19. Conclusiones: se concluye con la presentación de este caso que la pandemia actual significa un desafío para la comunidad científica porque no existe un tratamiento específico contra el SARSCoV-2. No obstante, Cuba utiliza en su protocolo diversos medicamentos que han demostrado efectividad en el control de la enfermedad al lograr la evolución clínica satisfactoria de varios casos críticos.

ABSTRACT Introduction: SARS-CoV-2 (COVID-19) is a threat to global public health; with the most negative effect on patients with comorbidities and weak health status. Clinical case: a 59-year-old, white skinned, female patient with personal pathological history of high blood pressure, diabetes mellitus type II, chronic obstructive pulmonary disease and ex-smoker with confirmed positive PCR-RT (COVID-19 carrier), presented acute inflammatory pneumopathy as a complication and satisfactory evolution. Without a precise source of infection, all contacts were isolated, they underwent to studies and resulted negative to COVID-19. Conclusions: with this case report it is concluded that this pandemic is a challenge for the scientific community because there is not a specific treatment against SARSCoV-2. Nevertheless, Cuba makes use of its protocols of treatment where diverse medicines are included; which have demonstrated effectiveness in the control of the disease, achieving a satisfactory clinical evolution of several critical patients.

Significado de ser cuidador de pessoa com oxigenoterapia domiciliar: grounded theory / Significado de ser un cuidador de persona con terapia de oxígeno en casa: grounded theory / Meaning of beingacare giver of a person with home oxygentherapy: grounded theory

Objetivo: compreender o significado de ser cuidador familiar de pessoa com doença pulmonar obstrutiva crônica (DPOC) dependente de oxigenoterapia domiciliar. Método: pesquisa qualitativa fundamentada nos conceitos e pressupostos do Interacionismo Simbólico e da Teoria Fundamentada nos Dados, desenvolvida em domicílio de 20 cuidadores familiares de um município ao Sul de Minas Gerais, por meio de entrevista, observação participante e elaboração de memorando. Resultados: foram construídas as categorias "Se descobrindo como cuidador" e "Mudando a situação de vida em função do papel de cuidador" que resultou deste processo o modelo teórico Ressignificando a vida e o papel de cuidador. Dadas as modificações na vida do cuidador e as atribuições inerentes a essa função, a pessoa busca por novos significados que lhe permitem dar um novo sentido à sua existência. Conclusões: o modelo teórico construído representa o significado de ser cuidador familiar de pessoa com DPOC dependente de oxigenoterapia domiciliar sob categoria central que integrou todas as outras categorias. Este modelo permitiu um entendimento amplo do fenômeno estudado, com base nas perspectivas do próprio cuidador e no contexto no qual ele se insere (AU)

Objective: to understand the meaning of being a family caregiver of a person with chronic obstructive pulmonary disease dependent on home oxygen therapy. Method: Qualitative research based on the concepts and assumptions of Symbolic Interactionism and Data-Based Theory, developed at the home of 20 family caregivers in a municipality in southern Minas Gerais, Brazil,using interviews, participant observation and drafting of a memorandum. Results: From the analysis, the categories "Discovering yourself as a caregiver" and "Changing the situation of life according to the role of caregiver" that resulted from this process the theoretical model signifying life and the role of caregiver. Given the changes in the caregiver's life and the attributions inherent to this role, the person seeks new meanings that allow him or her to give a new meaning to his existence. Conclusions: The constructed theoretical model represents the meaning of being a family caregiver of a person coping with chronic obstructive pulmonary disease (COPD) dependent on home oxygen therapy under a central category that integrated all other categories. This model allowed a broad understanding of the studied phenomenon from the perspectives of the caregiver and in the context in which he or she is inserted (AU)

Objetivo: Entender el significado de ser un cuidador familiar de una persona con enfermedad pulmonar obstructiva crónica dependiente de la oxigenoterapia en el hogar. Método: Investigación cualitativa basada en los conceptos y supuestos del Interaccionismo Simbólico y Teoría Basada en Datos, desarrollado en el hogar de 20 cuidadores familiares en un municipio al sur de Minas Gerais, a través de entrevistas, observación de los participantes y redacción de un memorándum. Resultados: A partir del análisis, las categorías "Descubrirse como cuidador" y "Cambiar la situación de la vida según el papel del cuidador" que resultaron de este proceso el modelo teórico "Resignificante de la vida y el papel del cuidador". Discusión: Dados los cambios en la vida del cuidador y las atribuciones inherentes a este papel, la persona busca nuevos significados que le permitan dar un nuevo significado a su existencia. Conclusiones: El modelo teórico construido representa el significado de ser un cuidador familiar de una persona con EPOC dependiente de la oxigenoterapia casera bajo una categoría central que integró todas las demás categorías. El modelo permitió una amplia comprensión del fenómeno estudiado desde las perspectivas del propio cuidador y en el contexto en el que se inserta (AU)