Fisiología respiratoria. Neumología de altura: saturación de oxígeno, edema pulmonar y pruebas de función pulmonar / Respiratory physiology - High -altitude pneumology: oxygen saturation, pulmonary edema and pulmonary function tests

En las alturas, sobre todo a 2500 metros sobre el nivel del mar, la cantidad absoluta de oxígeno va decreciendo y por lo tanto la cantidad disponible para el intercambio gaseoso disminuye, produciéndose una vasoconstricción hipóxica pulmonar (VHP). La VHP asociada a la hipoxia hipobárica de la altura produce un aumento de la presión pulmonar que es mayor en los lactantes y a mayores alturas. No hay valores únicos de saturación de oxígeno (SatO2) en la altura, porque ésta va disminuyendo según el mayor nivel de altura, aumenta con la edad, y la brecha entre la vigilia y sueño es grande (sobre todo en los primeros meses de vida). El 25% de los niños sanos que viven en altura tienen valores de SatO2 significativamente menores que el 75% restante. Los valores normales de los índices de apnea/hipopnea son distintos a los de nivel del mar. El edema pulmonar de las alturas es una patología frecuente, que se produce por un incremento desproporcionado en la VHP reflejando una hiperactividad del lecho vascular pulmonar ante la exposición aguda a la hipoxia hipobárica. Tiene cuatro fenotipos, es infrecuente en menores de 5 años y rara vez es mortal, la sospecha clínica y el manejo oportuno con oxigeno es la clave. Finalmente, en la altura los valores normales de la función pulmonar de la espirometría, oscilometría de impulso y capacidad de difusión son distintos que a nivel del mar.

At high altitude, especially > 2,500 meters above sea level, the absolute amount of oxygen decreases and therefore the amount available for gas exchange decreases, producing hypoxic pulmonary vasoconstriction (VHP). VHP associated with high-altitude hypobaric hypoxia produces an increase in pulmonary pressure that is greater in infants and at higher altitudes. There are no single values of oxygen saturation (SatO2) at altitude, because it decreases with the highest level of altitude, increases with age, and the gap between wakefulness and sleep is large (especially in the first months of life). Around 25% of healthy children living at altitude have SatO2 values significantly lower than the remaining 75%. The normal values of the apnea/hypopnea indices are different from those at sea level. High altitude pulmonary edema is a frequent pathology that is produced by a disproportionate increase in VHP reflecting hyperactivity of the pulmonary vascular bed in the face of acute exposure to hypobaric hypoxia, it has four phenotypes, it is uncommon in children under 5 years of age, and it is rarely fatal, the clinical suspicion and timely management with oxygen is the key. Finally, at high altitude, the normal values of lung function from spirometry, impulse oscillometry, and diffusing capacity are different from those at sea level.

A 12-month Follow-Up Study of Pulp Oxygen Saturation in Deciduous Molars After Selective and Nonselective Carious-Tissue Removal: A Randomized Pilot Trial

ABSTRACT Objective: To compare the pulp vitality of deciduous molars before and after selective caries removal (SCR) or nonselective caries removal to hard dentin (NSCR) over one year, using oxygen saturation percentage (%SaO2). Material and Methods: Deciduous molars with deep occlusal/proximal-occlusal caries lesions were randomized to SCR (n=22) or NSCR groups (n=22). After the caries removal, the teeth were protected with calcium hydroxide cement and restored with composite resin (Filtek Z250). The pulp condition diagnosis was evaluated at baseline, immediately after caries removal, and follow-up (7 days, 1-, 6- and 12-months) by %SaO2. Pulp exposure and pulp necrosis were primary outcomes, and %SaO2 was secondary. Results: Intraoperative pulp exposure occurred in four teeth of the NSCR group (18.2%) and one tooth of the SCR group (4.5%) (p>0.05). Two cases of pulp necrosis occurred in the NSCR group (10%). No difference in %SaO2 pulp was observed in the inter-and intragroup comparison over time (p>0.05). Conclusion: Advantageously, the %SaO2 minimizes preoperatory pulp vitality diagnosis subjectivity before SCR/ NSCR treatments. Furthermore, the pilot study results suggest the pulp response of deciduous molars, when evaluated by clinical, radiographic, and pulp %SaO2 seems not to differ between teeth treated with SCR or NSCR.

Malformaciones arteriovenosas pulmonares: presentación de un caso clínico pediátrico y revisión de la literatura / Pulmonary arteriovenous malformations: presentation of a pediatric case and review of the literature

Las malformaciones arteriovenosas pulmonares (MAVP) consisten en comunicaciones directas entre el sistema arterial y el sistema venoso pulmonar, sin paso de la sangre por el lecho capilar, produciéndose un cortocircuito de derecha a izquierda extracardíaco, pueden ser congénitas o adquiridas. Algunos casos pueden ser asintomáticos, en cambio en otros pueden ocasionar diversas manifestaciones clínicas y se pueden asociar a complicaciones severas. En niños se observa una baja incidencia y son más frecuentes las formas congénitas. La MAVP se debe sospechar por las manifestaciones clínicas y las imágenes de la radiografía de tórax (RxTx) y su confirmación se realiza mediante una AngioTomografía Computada (TC) de tórax. La embolización endovascular es actualmente el tratamiento de elección, con excelentes resultados, aunque requiere de un seguimiento posterior y de un operador experimentado. Reportamos el caso de una niña que ingresó con clínica muy sugerente, incluyendo: disnea, acropaquia, cianosis periférica, e hipoxemia refractaria. Sin embargo, inicialmente el cuadro clínico fue confundido con una crisis asmática. La Angio-TC de tórax confirmó el diagnóstico y el tratamiento mediante embolización endovascular resultó exitoso.

Pulmonary arteriovenous malformations (PAVM) are communications between the arterial and the pulmonary venous system, without passage of blood through the capillary bed, causing a left to right extracardiac shunt. Some cases may be asymptomatic, while others may cause various clinical manifestations and may be associated with severe complications. In children a low incidence is observed, and congenital forms are more frequent. PAVM should be suspected by clinical manifestations and chest x-ray imaging and confirmed by chest Computed Tomography Angiography (CTA). Endovascular embolization is currently the treatment of choice, with excellent results, although it requires subsequent follow-up. We report a patient who was admitted with a very suggestive clinical history, including: dyspnea, clubbing, peripheral cyanosis, and severe hypoxemia, refractory to oxygen therapy. However, initially the clinical picture was confounded with an asthmatic crisis. CTA confirmed the diagnosis and treatment by endovascular embolization was successful.

Perfil epidemiológico de óbitos decorrentes da Covid-19 em um município do sudoeste do Paraná / Epidemiological profile of death resulting from Covid-19 in a municipality in southwest of Paraná / Perfil epidemiológico de las muertes por Covid-19 en un municipio del suroeste de Paraná

Introdução: No final do ano de 2019 surgiu na China uma doença infectocontagiosa de característica respiratória e alto grau de disseminação até então desconhecida. No Brasil o primeiro caso de Covid-19 foi confirmado no final de fevereiro de 2020 e a primeira morte em meados de março. Segundo dados da plataforma Coronavírus Brasil, em 17 de março de 2021, houve registro de 11.603.535 casos confirmados e 282.127 óbitos. Objetivo: Descrever o perfil de pessoas que morreram tendo como causa básica do óbito a Covid-19, em um município do Sudoeste do Paraná, entre os anos de 2020 e 2021. Metodologia: Trata-se de um estudo transversal, descritivo, documental de caráter quantitativo que foi realizado na prefeitura municipal de Francisco Beltrão. Resultados: Houve prevalência de óbitos em pacientes do sexo masculino, idosos, com presença de alguma comorbidade associada, sendo hipertensão a mais citada (50,8%). Os sintomas mais prevalentes foram tosse (74,4%), dispneia (56,3%) e saturação < 95% (48,3%), necessitando ainda de hospitalização em algum período da doença (94,1%), sendo os leitos de Sistema Único de Saúde os mais procurados (74,4%). Quanto à taxa de ocupação 49,6% dos casos necessitou apenas de leitos de enfermaria e 42% unidades de terapia intensiva. Discussão: Diversas pesquisas apontam que o sexo masculino é o mais acometido por condições graves de saúde, devido à demora na busca de assistência médica. No que se refere à idade, neste estudo, a prevalência de óbitos se deu entre 71 e 75 anos (15,1%) o que justifica que o envelhecimento é um fator de risco elevado para complicações da doença. Durante a análise dos dados, notou- se que grande parte dos pacientes que tiveram como desfecho o óbito, possuíam algum fator associado, dentre os mais citados, verificou-se a Hipertensão Arterial Sistêmica (50,8%) Diabetes Mellitus (24,8%), doenças cardiovasculares (23,9%) e obesidade (14,7%). No que diz respeito à hospitalização, nesse estudo notou-se que 74,4% da amostra foram hospitalizadas em leitos de SUS, 18,5% em hospitais particulares e 7,1% não possuíam essa informação. Conclusão: É possível observar a importância do estudo epidemiológico para identificar o perfil da população em risco, podendo auxiliar no planejamento do atendimento, rastreamento e controle da doença, além de conhecer a evolução da patologia, a fim de buscar ações adequadas para seu enfrentamento.

Introduction: At the end of 2019, a previously unknown infectious disease with respiratory characteristics and a high degree of dissemination emerged in China. In Brazil the first case of Covid-19 was confirmed in late February 2020 and the first death in mid-March. According to data from the Coronavirus Brazil platform, as of March 17, 2021, 11,603,535 confirmed cases and 282,127 deaths were recorded. Objective: To describe the profile of people who died with Covid-19 as the underlying cause of death in a city in southwestern Paraná between the years 2020 and 2021. Methodology: This is a cross-sectional, descriptive, documental, quantitative study carried out at the Francisco Beltrão City Hall. Results: There was a prevalence of deaths in male patients, elderly, with the presence of some associated comorbidity, hypertension being the most cited (50.8%). The most prevalent symptoms were cough (74.4%), dyspnea (56.3%) and saturation < 95% (48.3%), requiring hospitalization in some period of the disease (94.1%), and the Unified Health System beds were the most sought (74.4%). As for the occupancy rate, 49.6% of the cases required only ward beds and 42% intensive care units. Discussion: Several studies show that men are the most affected by serious health conditions, due to the delay in seeking medical assistance. Regarding age, in this study, the prevalence of deaths was between 71 and 75 years (15.1%), which justifies that aging is a high risk factor for disease complications. During data analysis, it was noted that most patients who died had some associated factor, among the most cited were systemic arterial hypertension (50.8%), diabetes mellitus (24.8%), cardiovascular diseases (23.9%) and obesity (14.7%). Regarding hospitalization, in this study it was noted that 74.4% of the sample were hospitalized in SUS beds, 18.5% in private hospitals, and 7.1% did not have this information. Conclusion: It is possible to observe the importance of the epidemiological study to identify the profile of the population at risk, which can help in planning care, tracking and control of the disease, besides knowing the evolution of the pathology in order to seek appropriate actions for its confrontation

Introducción: A finales del año 2019 apareció en China una enfermedad infecto- contagiosa de característica respiratoria y alto grado de diseminación desconocida hasta entonces. En Brasil se confirmó el primer caso de Covid-19 a finales de febrero de 2020 y la primera muerte a mediados de marzo. Según los datos de la plataforma Coronavirus Brasil, hasta el 17 de marzo de 2021, había 11.603.535 casos confirmados y 282.127 muertes. Objetivo: Describir el perfil de las personas fallecidas con Covid-19 como causa subyacente de muerte en una ciudad del sudoeste de Paraná entre los años 2020 y 2021. Metodología: Se trata de un estudio transversal, descriptivo, documental de carácter cuantitativo que se realizó en la prefectura municipal de Francisco Beltrão. Resultados: Hubo una prevalencia de muertes en pacientes masculinos, de edad avanzada, con presencia de alguna comorbilidad asociada, siendo la hipertensión la más citada (50,8%). Los síntomas más prevalentes fueron la tos (74,4%), la disnea (56,3%) y la saturación < 95% (48,3%), requiriendo hospitalización en algún periodo de la enfermedad (94,1%), siendo las camas del Sistema Único de Salud las más solicitadas (74,4%). En cuanto a la tasa de ocupación, el 49,6% de los casos sólo necesitaban camas de sala y el 42% unidades de cuidados intensivos. Discusión: Varias investigaciones señalan que el género masculino es el más afectado por las condiciones de salud graves, debido al retraso en la búsqueda de asistencia médica. En cuanto a la edad, en este estudio, la prevalencia de muertes se produjo entre los 71 y los 75 años (15,1%), lo que justifica que el envejecimiento sea un factor de riesgo elevado para las complicaciones de la enfermedad. Durante el análisis de los datos, se observó que la mayoría de los pacientes que fallecieron tenían algún factor asociado, entre los más citados estaban la Hipertensión Arterial Sistémica (50,8%), la Diabetes Mellitus (24,8%), las enfermedades cardiovasculares (23,9%) y la obesidad (14,7%). En lo que respecta a la hospitalización, en este estudio se observó que el 74,4% de la muestra estaba hospitalizada en camas del SUS, el 18,5% en hospitales privados y el 7,1% no tenía esta información. Conclusión: Es posible observar la importancia del estudio epidemiológico para identificar el perfil de la población en riesgo, pudiendo ayudar en la planificación de la atención, el rastreo y el control de la enfermedad, además de conocer la evolución de la patología, con el fin de buscar las acciones adecuadas para su enfrentamiento.

Anomalía de Ebstein en recién nacido / Ebstein's anomaly in newborn

Introducción: La anomalía de Ebstein es una rara malformación con presentación sintomática respiratoria leve a grave a causa de defectos cardiacos congénitos manifestados durante la niñez. Objetivo: Exponer el caso en el cual el diagnóstico oportuno de esta enfermedad permitió el tratamiento integral del paciente. Presentación del caso: Recién nacido a término, quien a las siete horas de su nacimiento presentó saturación de oxígeno disminuida, examen físico sin cianosis, soplo pansistólico en la auscultación y cardiomegalia detectada por rayos X de tórax. Se realizó ecocardiograma que permitió diagnosticar al bebé como portador de la enfermedad de Ebstein con manifestaciones leves. Una vez que tiene mejoría clínica, se le proporcionó el alta médica con indicación de valoración por cardiología pediátrica. Conclusiones: La anomalía de Ebstein puede comenzar en el período neonatal con sintomatología de severidad variable. La sospecha clínica permite la confirmación diagnóstica y el seguimiento estrecho, sobre todo en casos severos(AU)

Introduction: Ebstein's anomaly is a rare malformation with mild to severe respiratory symptomatic presentation due to congenital heart defects manifested during childhood. Objective: To present the case in which the timely diagnosis of this disease allowed the comprehensive treatment of the patient. Case presentation: Full-term newborn, who at seven hours of birth presented decreased oxygen saturation, physical examination without cyanosis, pansystolic murmur in auscultation and cardiomegaly detected by chest X-rays. An echocardiogram was performed to diagnose the baby as a carrier of Ebstein's disease with mild manifestations. Once he had clinical improvement, he was discharged with an indication for assessment by pediatric cardiology. Conclusions: Ebstein's anomaly may begin in the neonatal period with symptoms of variable severity. Clinical suspicion allows for diagnostic confirmation and close follow-up, especially in severe cases(AU)

Relación entre manifestaciones neurológicas y severidad de la COVID-19. Hospital San Vicente de Paúl. Ecuador 2021 / Relationship between neurological manifestations and severity of COVID-19. San Vicente de Paul Hospital. Ecuador 2021

Introducción: El SARS-CoV-2 afecta principalmente al sistema respiratorio, pero el daño producido por este virus también se extiende a otros sistemas, incluido el sistema nervioso, y los mecanismos de infección neurológica pueden ser directos o indirectos. Objetivo: Determinar la relación entre las manifestaciones neurológicas y la severidad de la enfermedad en pacientes sintomáticos positivos a la COVID-19. Hospital San Vicente de Paúl. 2021. Material y Métodos: Estudio observacional de corte transversal, empleando el registro de historias clínicas de los pacientes hospitalizados con la COVID-19 y manifestaciones neurológicas, las cuales se clasificaron en manifestaciones del sistema nervioso central y manifestaciones del sistema nervioso periférico. Resultados: 74,1 por ciento pacientes presentaron manifestaciones neurológicas, el mayor porcentaje se concentró en pacientes que desarrollaron enfermedad grave (15 [60 por ciento], SNC; 91 [77,1 por ciento], SNP; 125 [65,4 por ciento], SNC y SNP). La presencia conjunta de manifestaciones neurológicas centrales y periféricas se asoció significativamente con la COVID-19 crítica (P valor= 0,011; OR: 2,005). El índice de mortalidad alcanzó 2,69 por ciento. Conclusiones: Las manifestaciones neurológicas en pacientes hospitalizados con la COVID-19 son muy frecuentes, y la COVID-19 crítica tiene mayor probabilidad de presentar manifestaciones neurológicas(AU)

Introduction: SARS-CoV-2 mainly affects the respiratory system, but the damage caused by this virus also extends to other systems, including the nervous system, and the mechanisms of neurological infection can be direct or indirect. Objective: To determine the relationship between neurological manifestations and disease severity in symptomatic COVID-19 positive patients at San Vicente de Paul Hospital in 2021. Material and Methods: A cross-sectional observational study was conducted using medical records of patients hospitalized with COVID-19 and neurological manifestations, which were classified into manifestations of the central nervous system and manifestations of the peripheral nervous system. Results: The results show that 74,1 percent of patients presented neurological manifestations; the highest percentage was concentrated in patients who developed severe disease (15 [60 percent], CNS; 91 [77,1 percent], PNS; 125 [65,4 percent], CNS and PNS). The joint presence of central and peripheral neurological manifestations was significantly associated with critical COVID-19 (P value= 0,011; OR: 2,005). The mortality rate reached 2,69 percent. Conclusions: Neurological manifestations in hospitalized COVID-19 patients are very common, and critical COVID-19 is more likely to have neurological manifestations(AU)

Factores de riesgo de ingreso a unidad de cuidados intensivos o mortalidad en adultos hospitalizados por COVID-19 en altura / Risk factors for intensive care unit admission or mortality in adults hospitalized for COVID-19 at high altitude

RESUMEN Objetivo. Determinar los factores de riesgo de ingreso a unidad de cuidados intensivos (UCI) o mortalidad en pacientes hospitalizados por COVID-19 en un hospital de Puno, Perú. Materiales y métodos. Estudio de cohorte retrospectivo en adultos hospitalizados entre abril y diciembre del 2020. Se evaluaron características sociodemográficas, funciones vitales, comorbilidades, tratamiento recibido y su asociación con el ingreso a UCI o mortalidad (desenlace adverso). Se utilizó regresión de Poisson con varianza robusta para calcular riesgos relativos (RR) crudos y ajustados con sus intervalos de confianza al 95% (IC95%). Resultados. Se analizaron 348 historias clínicas. La mediana de edad en años fue 42,5 (RIC: 30,0; 58,0); el 38,2% fueron varones, y el 35,3% falleció o ingresó a UCI. Los que ingresaron con una saturación de oxígeno ≤ 75%, tuvieron 2,79 veces la probabilidad de tener el desenlace adverso (p < 0,001), en comparación con los que ingresaron con una saturación ≥ 85%; los que ingresaron con un valor entre 75-79% tuvieron 2,92 veces la probabilidad de tener el desenlace adverso (p < 0,001); asimismo, los que ingresaron con saturación entre 80-84% tuvieron 1,70 veces la probabilidad de presentar el desenlace adverso; sin embargo la diferencia no fue estadísticamente significativa (p=0,066). Además, hubo mayor riesgo de desenlace adverso en pacientes de sexo masculino RR= 1,75 (p<0,001), edad > 40 años RR 3,5 (p=0,001), taquipnea RR=1,66 (p=0,010), o con diabetes, RR = 1,53 (p=0,011). Conclusiones . Los factores de riesgo para ingresar a UCI o mortalidad por COVID-19 fueron el sexo masculino, edad mayor de 40 años, saturación baja, diabetes y taquipnea.

ABSTRACT Objective. To determine the risk factors for admission to the intensive care unit (ICU) or mortality in patients hospitalized for COVID-19 in a hospital in Puno, Peru. Materials and methods. Retrospective cohort study in adults hospitalized between April and December 2020. We evaluated Sociodemographic characteristics, vital functions, comorbidities, treatment received and its association with admission to ICU or mortality (adverse outcome). Poisson regression with robust variance was used to calculate crude and adjusted relative risks (RR) with their 95% confidence intervals (95%CI). Results. A total of 348 medical records were analyzed. The median age in years was 42.5 (IQR: 30.0; 58.0); 38.2% were male, and 35.3% died or were admitted to the ICU. Those admitted with an oxygen saturation ≤ 75% were 2.79 times more likely to have the adverse outcome (p < 0.001), compared to those admitted with a saturation ≥ 85%; those admitted with a value between 75-79% were 2.92 times more likely to have the adverse outcome (p < 0.001); likewise, those admitted with saturation between 80-84% were 1.70 times more likely to have the adverse outcome; however, the difference was not statistically significant (p=0.066). In addition, male patients, RR= 1.75 (p<0.001); those aged > 40 years, RR 3.5 (p=0.001); those with tachypnea, RR=1.66 (p=0.010); or with diabetes, RR = 1.53 (p=0.011) had higher risk of presenting the adverse outcome. Conclusions. The risk factors for ICU admission or mortality due to COVID-19 were male sex, age over 40 years, low saturation, diabetes and tachypnea.

O uso de aplicativo de celular para medir frequência cardíaca e saturação periférica de oxigênio / The use of cellular application to measure heart rate and peripheral oxygen saturation

Avaliar a associação da medida de frequência cardíaca (FC) e saturação periférica de oxigênio (SpO2 ) utilizando um aplicativo de celular e um monitor multiparamétrico. Métodos: Estudo experimental e randomizado entre participantes saudáveis. Investigou o aplicativo Samsung Health® e o monitor multiparamétrico da marca Midway®, modelo: PM-60. O estudo foi estruturado em quatro etapas. Para análise estatística, aplicou correlação de Pearson e Spearman, com nível de significância de 5%. Resultados: Dos 150 participantes a idade média foi de 22,3±4,5 anos, o sexo feminino foi predominante (71,3%). Verificouse forte correlação da FC medida pelo monitor com a FC do aplicativo de celular (r=0,93) indicando correlação positiva (p<0,001). A SpO2 medida por monitor multiparamétrico e pelo aplicativo de celular revelou um r=0,05 (p=0,51), o que atesta uma correlação nula e não significativa. Conclusão: Não houve correlação entre a medida da SpO2 do monitor multiparamétrico e do aplicativo Samsung Health®, não sendo confiável a utilização deste aplicativo para monitorar e gerenciar o sinal vital SpO2 em pessoas saudáveis. A FC medida com o aplicativo é significativa, e pode ser utilizada para monitorar e gerenciar esse sinal vital.

Assess the association of the measure of heart rate (HR) and oxygen saturation (SpO2 ) using a mobile application and a multiparameter monitor. Methods: Study experimental and randomized healthy participants. Investigated the application Samsung Health® and multiparameter monitor Midway® make, model: PM-60. The study was divided into four stages. Statistical analysis was applied Pearson and Spearman correlation with 5% significance level. Results: Of the 150 participants average age was 22.3±4.5 years, females were predominant (71.3%). There was a strong correlation HR measured by the monitor application to cell FC (r=0.93) indicating a positive correlation (p<0.001). SpO2 measured by multiparameter monitor and the mobile application revealed r=0.05 (p=0.51), which demonstrates a zero and no significant correlation. Conclusion: There was no correlation between the SpO2 measurement of the multiparameter monitor and the Samsung Health® app, not being trusted to use this application to monitor and manage the vital sign SpO2 in healthy people. The HR measured with the application is significant, and can be used to monitor and manage this vital sign.

Factores asociados a mortalidad en pacientes con Covid-19 en un hospital público / Factors associated with mortality in patients with Covid-19 in a public hospital

El objetivo del estudio fue determinar los factores asociados a mortalidad hospitalaria en pacientes con enfermedad por coronavirus 2019 (COVID-19). Se realizó un estudio observacional, analítico, de casos y controles. Se incluyeron pacientes hospitalizados con diagnóstico de la COVID-19 por prueba serológica y/o prueba molecular entre el marzo y agosto del 2020. Para el análisis estadístico se empleó la prueba de Mann Whitney y para el análisis de los factores asociados se utilizó regresión logística. La significancia de p-valor fue < 0,05. Se incluyó 814 pacientes, 556 (68,3%) fueron varones y 246 (30,2%) mayores de 60 años. La presencia de alguna comorbilidad se evidenció en 29,6 % (241 pacientes); 35,8% (292) fallecieron. La mediana de la edad de los fallecidos fue mayor en comparación a los sobrevivientes (59 vs 49; p>0,01). Las comorbilidades asociadas a la COVID-19 fueron: la obesidad (OR= 2,14; IC 95%: 1,38 ­ 3,32) y la hipertensión arterial (OR=1,86; IC 95%: 1,06-3,24). Asimismo, niveles de saturación de oxígeno menor al 85% al ingreso al hospital (OR= 3,58; IC 95%: 2,82- 4,53); la edad mayor a 60 años (OR=1,96; IC 95%: 1,54- 2,50) y el sexo masculino (OR= 1,64; IC95; 1,12-2,39) fueron asociados a mayor mortalidad. Finalmente, los factores asociados a mortalidad hospitalaria fueron saturación de oxígeno menor al 85% al ingreso al hospital, mayor de 60 años de edad, obesidad e hipertensión arterial(AU)

The objective of the study was to determine the factors associated with hospital mortality in patients with coronavirus disease 2019 (COVID-19). An observational, analytical, case-control study was conducted. Hospitalized patients diagnosed with COVID-19 by serological test and/or molecular test between March and August 2020 were included. The Mann Whitney test was used for statistical analysis and logistic regression was used for the analysis of associated factors. The significance of p-value was <0.05. A total of 814 patients were included, 556 (68.3%) were men and 246 (30.2%) were older than 60 years. The presence of some comorbidity was evidenced in 29.6% (241 patients); 35.8% (292) died. The median age of the deceased was higher compared to the survivors (59 vs. 49; p>0.01). The comorbidities associated with COVID-19 were: obesity (OR= 2.14; 95% CI: 1.38-3.32) and arterial hypertension (OR=1.86; 95% CI: 1.06- 3.24). Likewise, oxygen saturation levels less than 85% at hospital admission (OR= 3.58; 95% CI: 2.82-4.53); age over 60 years (OR=1.96; 95% CI: 1.54-2.50) and male gender (OR= 1.64; 95% CI: 1.12-2.39) were associated with greater mortality. Finally, the factors associated with hospital mortality were oxygen saturation less than 85% at hospital admission, older than 60 years of age, obesity, and arterial hypertension(AU)

Predictores de fracaso con cánula nasal de alto flujo de oxígeno en pacientes COVID-19 / Predictors of failure with high-flow nasal cannula oxygen in COVID-19 patients

Introducción: El COVID-19 ha generado retos por la alta demanda de servicios, haciendo necesario buscar alternativas de soporte ventilatorio que permitan responder a las necesidades de la población. Es importante disponer de herramientas que permitan detectar precozmente el fracaso de estrategias ventilatorias no invasivas e identificar tempranamente la necesidad de intubación. Objetivo: identificar las variables asociadas a fracaso en el tratamiento con cánula de alto flujo (CNAF) en pacientes con COVID-19. Materiales y Métodos: estudio observacional analítico, corte transversal con 68 pacientes de la unidad de cuidados intensivos con COVID-19, que recibieron tratamiento con CNAF. Las variables de estudio se evaluaron en tres momentos, a las 24, 48 y 72 horas, llevando a cabo un análisis bivariado y multivariado entre los que fracasaron y los que tuvieron éxito. Resultados: en el análisis bivariado las variables que presentaron una relación estadísticamente significativa a las 24h fueron el no presentar un aumento del trabajo respiratorio (Wresp) (p=0.000) y saturación de oxígeno (SatO2) normal (p=0.006). A las 48h: no aumento en Wresp (p=0.014), SatO2 normal (p=0.005), presión arterial de oxígeno/fracción inspirada de oxígeno (PAFI) leve o moderado (p=0.039). A las 72h fracasaron: PAFI severa (p=0.000), aumento de Wresp (p=0.001) y el índice de ROX menor a 4.88 (p=0.023). De acuerdo con el análisis multivariado las variables predictoras de fracaso a las 24h fueron: FIO2, SatO2, Wresp y a las 48h FIO2 y SatO2. Conclusiones: el aumento de FIO2>70 %, presentar incremento del Wresp y SpO2 menor de 88 % son variables asociadas a fracaso de la CNAF y facilitan tomar decisiones clínicas sobre avanzar o no hacia un soporte ventilatorio invasivo.

Introduction: COVID-19 has generated challenges due to the high demand for health care services, making it necessary to seek ventilatory support alternatives that allow us to fulfill the needs of the population. It is important to have tools that allow to detect the failure of non-invasive ventilatory strategies early and to identify the need for intubation on time. Objective: Identify the variables associated with failure of high-flow nasal cannula treatment (HFNC) on COVID-19 patients. Materials and Methods: Analytical observational, cross-sectional study of 68 patients in the intensive care unit with COVID-19, who received treatment with HFNC. The variables of the study were evaluated at three time points, at 24, 48 and 72 hours. A bivariate and multivariate analysis was performed between those who failed and those who were successful. Results: In the bivariate analysis, the variables that presented a statistically significant relationship at 24h were: No increase in work of breathing (WOB) (p=0.000), normal oxygen saturation (SatO2) (p=0.006). At 48h: No increase in WOB (p=0.014), normal SatO2 (p=0.005), mild to moderate partial pressure arterial oxygen/fraction inspired oxygen ratio (P/F ratio) (p=0.039). At 72h failed: severe P/F ratio (p=0.000), Increased WOB (p=0.001) and ROX index less than 4.88 (p=0.023). According to multivariate analysis the predictive variables for the therapeutic failure at 24h were: FIO2, SatO2, WOB; at 48h: FIO2 and SatO2. Conclusions: Increased FIO2>70%, increased WOB and SpO2 less than 88% are variables associated with failure of HFNC, and facilitate clinical decisions on whether or not to progress with invasive ventilatory support.

Saturación de oxígeno versus índice de oxigenación: predictores de mortalidad en pacientes críticos con síndrome distrés respiratorio agudo por COVID-19 / Oxygen saturation versus oxygenation index: predictors of mortality in critically ill patients with acute respiratory distress syndrome due to COVID-19

El COVID-19 es la causa más frecuente de SDRA generando cuadros clínicos leves, moderados y graves, en esta última, los pacientes podrían evolucionar a la necesidad de intubación orotraqueal y soporte ventilatorio avanzado; reportándose mortalidad de 26-90%, en estos casos. Es por ello, la necesidad de identificar factores de riesgos y herramientas predictores de mortalidad. En este estudio se determinó la validez diagnóstica de los índices de saturación de oxígeno y oxigenación como predictores de pronóstico de mortalidad en pacientes con SDRA severo por COVID-19 que requirieron de ventilación mecánica invasiva. Material y métodos: estudio transversal, analítico y retrospectivo. La muestra estuvo constituida por 176 historias clínicas de pacientes críticos. Se realizó análisis bivariado, y multivariado, además de determinar especificidad, sensibilidad, VPP, VPN y AUC. Resultados: 57,37% (101/176) de los pacientes fallecieron, con predominio del sexo masculino 79% (80/101); con edad promedio de 56 años. El lactato (p=0,115), no mostró asociación estadísticamente significativa. Contrariamente, en el análisis multivariado, el sexo masculino (p=0.04), glicemia (p=0,02) y, OI (p=0.00), arrojaron asociación. En cuanto a los índices, OSI registró sensibilidad y especificidad de 33% y 96% respectivamente; mientras que, IO tuvo 33,6% de sensibilidad y, 97,33% de especificidad; AUC 0,773 (IC: 0,677-0,868); es decir más del 77,3% de probabilidad de pronóstico a mortalidad. Conclusión: OSI y OI son adecuados predictores de mortalidad, teniendo OI mejor validez diagnóstico. Además, se ratifica, al sexo masculino y, aumento de valores glicémicos, como factores asociados a riesgo de desarrollar cuadros graves por COVID-19(AU)

COVID-19 is the most frequent cause of ARDS, generating mild, moderate and severe clinical symptoms, in the latter, patients could evolve to the need for orotracheal intubation and advanced ventilatory support; reporting mortality of 26-90% in these cases. This is why there is a need to identify risk factors and predictive tools for mortality. In this study, the diagnostic validity of the oxygen saturation and oxygenation indices as predictors of mortality prognosis in patients with severe ARDS due to COVID-19 who required invasive mechanical ventilation was determined. Material and methods: cross-sectional, analytical and retrospective study. The sample consisted of 176 medical records of critically ill patients. Bivariate and multivariate analyzes were performed, in addition to determining specificity, sensitivity, PPV, NPV, and AUC. Results: 57.37% (101/176) of the patients died, with a predominance of males 79% (80/101); with an average age of 56 years. Lactate (p=0.115) did not show a statistically significant association. Results: 57.37% (101/176) of the patients died, with a predominance of males 79% (80/101); with an average age of 56 years. Lactate (p=0.115) did not show a statistically significant association. Regarding the indices, OSI registered sensitivity and specificity of 33% and 96%, respectively; while IO had 33.6% sensitivity and 97.33% specificity; AUC 0.773 (CI: 0.677-0.868); that is, more than 77.3% probability of prognosis for mortality. Conclusion: OSI and OI are adequate predictors of mortality, with OI having better diagnostic validity. In addition, the male sex and increased glycemic values are confirmed as factors associated with the risk of developing serious conditions due to COVID-19(AU)

Respuesta fisiológica con la técnica Masaje al Bebe Canguro, en un programa ambulatorio de Bogotá / Physiological response with the Kangaroo Baby Massage technique, in an outpatient program in Bogotá

La presente investigación tuvo como fin medir la respuesta fisiológica (frecuencia cardiaca, saturación de oxígeno y temperatura) del niño(a) prematuro(a) o con bajo peso al nacer, con la aplicación de la técnica "Masaje al Bebé Canguro-MBC", con el animo de demostrar la seguridad de esta técnica en estos parámetros fisiológicos en el recién nacido. Por lo tanto, se efectuó un estudio cuantitativo, con diseño preexperimental de preprueba/posprueba con un solo grupo entre enero y junio del 2019 en un Programa Canguro Ambulatorio de Bogotá. Resultados: Se acogieron un total de 63 bebés canguro. Se realizó análisis estadístico con SPSS, descriptivo e inferencial con prueba de normalidad de Kolmogorov-Smirnov y métodos paramétricas t-student y no paramétricas Friedman. La frecuencia cardiaca presentó un aumento en el índice siendo la media inicial de 147.22±7.17 lpm y de 147.54±7.96 lpm después de la intervención, aunque este no fue significativo (p=0.603). Por su parte, la oximetría presentó un aumento al ser la mediana inicial de 92% y después del MBC 93% variación que fue significativa (p=0.000). Finalmente la temperatura inicial y después presentó una mediana de 36.6°C con un índice inicial de 36.59±0.169°C y de 36.62±0.163°C después de la intervención, aunque este no fue significativo (p=0.182). Se realizó un modelo de regresión ajustado a las variables fisiológicas no encontrandose factores predictores estadísticamente significativos. Desde el modelo de Callista Roy el MBC tuvo una respuesta adaptativa eficaz. Conclusiones: La técnica de MBC tiene un efecto favorable y seguro en la frecuencia cardiaca, saturación de oxigeno y temperatura sin alteración de los parámetros normales con buena adaptación según el modelo de Callista Roy.

The purpose of this research was to measure the physiological response (heart rate, oxygen saturation and temperature) of the premature or low birth weight child, with the application of the "Kangaroo Baby MassageKBM" technique. , with the aim of demonstrating the safety of this technique in these physiological parameters in the newborn. Therefore, a quantitative study, with a pre-experimental pre-test/post-test design, was carried out with a single group between January and June 2019 in a Kangaroo Outpatient Program in Bogotá. Results: A total of 63 kangaroo babies were received. Statistical analysis was performed with SPSS, descriptive and inferential with the Kolmogorov-Smirnov normality test and parametric tstudent and non-parametric Friedman methods. The heart rate presented an increase in the index, the initial mean being 147.22±7.17 bpm and 147.54±7.96 bpm after the intervention, although this was not significant (p=0.603). On the other hand, oximetry showed an increase as the initial median was 92% and after the KBM was 93%, a variation that was significant (p=0.000). Finally, the temperature presented initial and after median 36.6°C an increase with an initial index of 36.59±0.169°C and 36.62±0.163°C after the intervention, although this was not significant (p=0.182). A regression model adjusted to the physiological variables was performed, and no statistically significant predictive factors were found. From Callista Roy's model, the KBM had an effective adaptive response. Conclusions: The KBM technique has a favorable and safe effect on heart rate, oxygen saturation and temperature without alteration of normal parameters with good adaptation according to the Callista Roy model.

Oxigenación de músculos respiratorios y locomotores durante el test cardiopulmonar en pacientes con circulación de fontan: serie de casos / Patients with fontan: oxygen consumption in respiratory and Locomotor muscles during excersie testing

Resumen: Antecedentes: Los pacientes con circulación de Fontan (PCF) presentan limitación cardíaca durante el esfuerzo máximo lo que repercute en menor capacidad de ejercicio (VO2-peak). La rehabilitación cardiovascular (RC) revierte este desacondicionamiento, al aumentar el gasto cardíaco y diferencia arteriovenosa de oxígeno, aspectos evaluados con monitorización invasiva y gases exhalados. La valoración no invasiva de la saturación muscular de oxígeno (SmO2) es un método de reciente aplicación para evaluar la limitación muscular al ejercicio. En PCF esta limitación puede atribuirse a la mayor acción de músculos respiratorios (cambios ventilatorios) y/o locomotores (carga periférica). Objetivo: Evaluar el trabajo de músculos respiratorios y locomotores durante el ejercicio físico máximo e incremental mediante los cambios en la SmO2. Métodos: A seis PCF (5 hombres; 13.8±2.9 años; 158±9cm; 49.8±13.3 kg) se les valoró el VO2-peak (23.0±4.5mL·kg-1·min-1) mediante ciclo-ergoespirometría sincrónicamente con SmO2 en músculos respiratorios (SmO2-m.Intercostales) y locomotores (SmO2-m.Vastus-Laterallis) mediante espectroscopía cercana al rango infrarrojo durante el test cardiopulmonar. Resultados: SmO2-m.Intercostales disminuyó desde el 60% del VO2-peak (p<0.05), mientras que SmO2-m.Vastus-Laterallis no cambió. La ventilación pulmonar (VE) aumentó progresivamente, siendo significativo a partir del 60% VO2-peak (p<0.05). La mayor desoxigenación de SmO2-m.Intercostales (∆SmO2) se asoció con los máximos cambios en ventilación pulmonar (∆VE) en ejercicio (rho=0.80; p=0.05). Conclusiones: Durante un protocolo de esfuerzo, los pacientes con circulación de Fontan presentan mayor trabajo muscular respiratorio que locomotor. Los cambios en la ventilación pulmonar se asocian a mayor extracción de oxígeno en la musculatura respiratoria, reforzando la necesidad de incorporar el entrenamiento respiratorio en la rehabilitación cardiovascular.

Abstract: Background: During a maximum incremental exercise patients with Fontan circulation (PFC) show cardiac limitation reducing aerobic exercise capacity (VO2-peak). Cardiovascular rehabilitation (CR) reverses this deconditioning by increasing cardiac output and arteriovenous oxygen difference, aspects that can be evaluated by invasive methods and analyzing the exhaled gases. Non-invasive assessment of muscle oxygen saturation (SmO2) is a novel method for recording local oxygen levels. By this technology, it is possible to evaluate the muscle limitation to exercise. In PFC, that limitation could be attributed to higher contractions of respiratory (ventilatory changes) and/ or locomotor muscles (peripheral load). Objective: To evaluate in PFC the changes at SmO2 of respiratory and locomotor muscles during a maximum and incremental exercise protocol (cardiopulmonary test, VO2-peak). Methods: Six PFC (5 men; 13.8±2.9 years; 158±9 cm; 49.8±13.3 kg) were assessed during the VO2peak test (23.0±4.5mL·kg-1·min-1) by cyclo-ergospirometry synchronously with SmO2 at respiratory (SmO2-m.Intercostales) and locomotor (SmO2-m. Vastus-Laterallis) muscles by Near-Infrared Spectroscopy (NIRS). Results: SmO2-m.Intercostales decreased from 60% of VO2-peak (p<0.05), while SmO2-m.Vastus-Laterallis did not change. Minute ventilation (VE) increased progressively, showing changes to rest at 60% of VO2-peak (p<0.05). The higher deoxygenation of SmO2-m.Intercostales (∆SmO2) correlated to maximum changes of lung ventilation (∆VE) (rho=0.80; p=0.05). Conclusions: During an incremental and maximum exercise protocol, patients with Fontan circulation have more work at respiratory than locomotor muscles. Changes in VE are direct associated with greater extraction of oxygen at respiratory muscles, reinforcing the incorporation of respiratory muscle training in cardiovascular rehabilitation.

Suitability of the muscle O2 resaturation parameters most used for assessing reactive hyperemia: a near-infrared spectroscopy study / Adequação de parâmetros de ressaturação muscular de O2 mais utilizados na avaliação da hiperemia reativa: um estudo por espectroscopia no infravermelho próximo

Abstract Background There is a spectrum of possibilities for analyzing muscle O2 resaturation parameters for measurement of reactive hyperemia in microvasculature. However, there is no consensus with respect to the responsiveness of these O2 resaturation parameters for assessing reactive hyperemia. Objectives This study investigates the responsiveness of the most utilized muscle O2 resaturation parameters to assess reactive hyperemia in the microvasculature of a clinical group known to exhibit impairments of tissue O2 saturation (StO2). Methods Twenty-three healthy young adults, twenty-nine healthy older adults, and thirty-five older adults at risk of cardiovascular disease (CVD) were recruited. Near-infrared spectroscopy (NIRS) was used to assess StO2 after a 5-min arterial occlusion challenge and the following parameters were analyzed: StO2slope_10s, StO2slope_30s, and StO2slope_until_baseline (upslope of StO2 over 10s and 30s and until StO2 reaches the baseline value); time to StO2baseline and time to StO2max (time taken for StO2 to reach baseline and peak values, respectively); ∆StO2reperfusion (the difference between minimum and maximum StO2 values); total area under the curve (StO2AUCt); and AUC above the baseline value (StO2AUC_above_base). Results Only StO2slope_10s was significantly slower in older adults at risk for CVD compared to healthy young individuals (p < 0.001) and to healthy older adults (p < 0.001). Conversely, time to StO2max was significantly longer in healthy young individuals than in older adult at CVD risk. Conclusions Our findings suggest that StO2slope_10s may be a measure of reactive hyperemia, which provides clinical insight into microvascular function assessment.

Resumo Contexto Existe um espectro de possibilidades na análise dos parâmetros de ressaturação de O2 muscular como uma medida de hiperemia reativa na microvasculatura. No entanto, não há consenso com relação à responsividade desses parâmetros de ressaturação de O2 para avaliação de hiperemia reativa. Objetivos Este estudo investigou a capacidade de resposta dos parâmetros de ressaturação muscular de O2 mais utilizados para avaliar a hiperemia reativa na microvasculatura de um grupo clínico conhecido por apresentar comprometimento da saturação de O2 (StO2). Métodos Foram recrutados 23 jovens saudáveis, 29 idosos saudáveis e 35 idosos com risco para doença cardiovascular. A espectroscopia no infravermelho próximo foi usada para avaliar a StO2 após um teste de oclusão arterial de 5 minutos, no qual os seguintes parâmetros foram analisados: StO2slope_10s, StO2slope_30s e StO2slope_until_baseline (inclinação da StO2 em 10 s, 30 s e até StO2 atingir valores basais); tempo para StO2baseline e tempo para StO2máx (o tempo necessário para StO2 atingir os valores da linha de base e o máximo, respectivamente); ∆StO2reperfusão (a diferença entre o valor de StO2mínimo e StO2máximo); área total sob a curva (StO2AUCt); e área sob a curva acima do valor da linha de base (StO2AUC_above_base). Resultados Apenas StO2slope_10s foi significativamente mais lento em idosos em risco de doença cardiovascular comparados com indivíduos jovens saudáveis (p < 0,001) e idosos saudáveis (p < 0,001). Por outro lado, o tempo para StO2max foi significativamente maior em indivíduos jovens saudáveis do que em idosos em risco de doença cardiovascular. Conclusões Nossos achados sugerem que StO2slope_10s pode ser uma medida de hiperemia reativa, que fornece informações clínicas sobre a avaliação da função microvascular.

Clinical values of cerebral oxygen saturation monitoring in patients with septic shock / 中南大学学报(医学版)

OBJECTIVES@#Sepsis associated encephalopathy (SAE) is a common neurological complication of sepsis. Delirium is a common symtom of SAE. The pathophysiology of SAE is still unclear, but several likely mechanisms have been proposed, such as mitochondrial and endothelial dysfunction, neurotransmission disturbances, derangements of calcium homeostasis, cerebral microcirculation dysfunction, and brain hypoperfusion. Near-infrared spectroscopy (NIRS) is a non-invasive measure for regional cerebral oxygen saturation (rSO@*METHODS@#A total of 48 septic patients who admitted to the intensive care unit (ICU) of Xiangya Hospital, Central South University from August 2017 to May 2018, were retrospectively study. Septic shock was diagnosed according to the criteria of sepsis 3.0 defined by the American Association of Critical Care Medicine and the European Society of Critical Care Medicine. NIRS monitoring was performed during the first 6 hours admitted to ICU with sensors placed on the bilateral forehead of patients. The maximum (rSO@*RESULTS@#The overall 28-day mortality of septic shock patients was 47.92% (23/48), and the incidence of delirium was 18.75% (9/48). The rSO@*CONCLUSIONS@#Cerebral anoxia and hyperoxia, as well as the large fluctuation of cerebral oxygen saturation are important factors that affect the outcomes and the incidence of delirium in septic shock patients, which should be paid attention to in clinical practice. Dynamic monitoring of cerebral oxygen saturation and maintain its stability may be of great significance in patients with septic shock.

Review of Physiological Parameters Monitoring Technology in the ICU / 中国医疗器械杂志

Physiological parameters monitoring is essential to direct medical staff to evaluate, diagnose and treat critical patients quantitatively. ECG, blood pressure, SpO2, respiratory rate and body temperature are the basic vital signs of patients in the ICU. The measuring methods are relatively mature at present, and the trend is to be wireless and more accurate and comfortable. Hemodynamics, oxygen metabolism and microcirculation should be taken seriously during the treatment of acute critical patients. The related monitoring technology has made significant progress in recent years, the trend is to reduce the trauma and improve the accuracy and usability. With the development of machine vision and data fusion technology, the identification of patient behavior and deterioration has become hot topics. This review is focused on current parameters monitoring technologies, aims to provide reference for future related research.

Obstructive sleep apnea and metabolic syndrome: an association study based on a large sample clinical database / 中华耳鼻咽喉头颈外科杂志

Objective: To investigate the prevalence and associated risk factors of metabolic syndrome (MS) in patients with obstructive sleep apnea (OSA). Methods: From July 2007 to June 2017, a total of 8 155 adult subjects, including 6 484 males and 1 671 females, aged 18-90 (43.13±12.28), body mass index 14.61~59.56 (25.59±3.98) kg/m2,who were admitted to the Department of Otorhinolaryngology head and Neck surgery of The Sixth People's Hospital affiliated to Shanghai Jiao Tong University, were retrospectively analyzed. All patients underwent polysomnography and biochemical tests. Subjects were divided into four groups (non-OSA, mild OSA, moderate OSA, and severe OSA) according to OSA severity. The prevalence of MS was expressed as percentage, and the correlation between OSA and MS and its characteristic pathophysiological indicators was evaluated by logistic regression model after adjusting for factors such as gender, age, BMI, neck circumference, hip circumference, smoking and alcohol consumption, and was expressed by odds ratio (OR). SPSS 25.0 software was used for statistical analysis. Results: The overall prevalence of MS was 43.6%, and that of non-/mild/moderate/severe OSA group was 18.6%, 30.4%, 43.8%, 57.1%.Logistic regression showed that patients with mild/moderate/severe OSA had an increased risk of MS compared with non-OSA patients, with adjusted OR values and confidence intervals of 1.27 (1.05-1.54), 1.84 (1.53-2.22), and 2.08 (1.76-2.46), respectively (P<0.01).In addition, indicators of OSA anoxic burden [oxygen drop index(Toxygen=7.1), minimum blood oxygen(Tminimum=56.3), blood oxygen saturation below 90% cumulative time ratio (TCT90=10.6) ]were closely associated with MS disease(P<0.01), but sleep fragmentation index (arousals index) was not significantly associated with MS disease. Conclusion: The risk of MS gradually increases with the severity of OSA, and the indicators reflecting OSA hypoxia burden are closely related to MS disease.

Efficacy of Han-uvulopalatopharyngoplasty (HUPPP) combined with radiofrequency ablation of tongue base or HUPPP with traction of tongue base on moderate to severe patients with obstructive sleep apnea hypopnea syndrome (OSAHS):a multicenter randomized controlled trial / 中华耳鼻咽喉头颈外科杂志

Objective: To compare the therapeutic efficacy of Han-uvulopalatopharyngoplasty (HUPPP) combined with radiofrequency ablation of tongue base or HUPPP with traction of tongue base on moderate to severe patients with obstructive sleep apnea hypopnea syndrome (OSAHS). Methods: This is a multicenter randomized controlled trial. From March 2017 to July 2019, moderate to severe OSAHS patients from three clinical center in Shanghai who were intolerant to continuous positive airway pressure (CPAP) and with velopharyngeal and glossopharyngeal plane obstruction were enrolled in this study. According to the surgical type, they were 1∶1 randomized to HUPPP plus radiofrequency ablation of tongue base group (Ablation group) or HUPPP plus traction of tongue base group (Traction group). All patients completed over-night standard Polysomnography (PSG), upper-airway assessment (Friedman classification, Müller test, CT and cephalometric examination), preoperative routine examination, Epworth Sleepiness Scale (ESS) and Quebec sleep questionnaire (QSQ). Six to 12 months after operation, all the above-mentioned examinations were repeatedly performed. Changes of aforementioned variables before and after operation were assessed. Results: A total of 43 patients with moderate to severe OSAHS were enrolled in this study. One patient lost to follow-up, the remaining 21 were allocated to Ablation group and 21 were allocated to Traction group. The total therapeutic efficacy of all patients was 69.05% (61.90% in Ablation group and 76.19% in Traction group), but there was no statistical significance between the two groups (P= 0.317). The value of sleep scale score (ESS and QSQ), objective sleep variables (apnea-hypopnea index, oxygen saturation, percentage of time with blood oxygen less than 90% in total sleep time, oxygen desaturation index and micro-arousals) and upper airway cross-sectional area (palatopharyngeal and retrolingual area) of the two groups were improved (P<0.05), but the differences between the two groups were not statistically significant (P>0.05). Conclusion: For moderate to severe OSAHS who had glossopharyngeal plane obstruction, both HUPPP plus radiofrequency ablation of tongue base or HUPPP plus traction of tongue base are effective treatment for OSAHS, and the curative effect is similar. The choice of surgical type could be selected according to patient's or surgical conditions.

Response of patients with acute respiratory failure caused by COVID-19 to awake-prone position outside the intensive care unit based on pulmonary involvement

OBJECTIVES: Since there are difficulties in establishing effective treatments for COVID-19, a vital way to reduce mortality is an early intervention to prevent disease progression. This study aimed to evaluate the performance of patients with COVID-19 with acute hypoxic respiratory failure according to pulmonary impairment in the awake-prone position, outside of the intensive care unit (ICU). METHODS: A prospective observational cohort study was conducted on COVID-19 patients under noninvasive respiratory support. Clinical and laboratory data were obtained for each patient before the treatment and after they were placed in the awake-prone position. To identify responders and non-responders after the first prone maneuver, receiver operating characteristic curves with sensitivity and specificity of the PaO2/FiO2 and SpO2/FiO2 indices were analyzed. The maneuver was considered positive if the patient did not require endotracheal intubation for ventilatory assistance. RESULTS: Forty-eight patients were included, and 64.6% were categorized as responders. The SpO2/FiO2 index was effective for predicting endotracheal intubation in COVID-19 patients regardless of lung parenchymal damage (area under the curve 0.84, cutoff point 165, sensitivity 85%, specificity 75%). Responders had better outcomes with lower hospital mortality (hazard ratio [HR]=0.107, 95% confidence interval [CI]: 0.012-0.93) and a shorter length of stay (median difference 6 days, HR=0.30, 95% CI: 0.13-0.66) after adjusting for age, body mass index, sex, and comorbidities. CONCLUSIONS: The awake-prone position for COVID-19 patients outside the ICU can improve oxygenation and clinical outcomes regardless of the extent of pulmonary impairment. Furthermore, the SpO2/FiO2 index discriminates responders from non-responders to the prone maneuver predicting endotracheal intubation with a cutoff under or below 165.

Recomendación de experto: apneas respiratorias y parámetros de sueño en el recién nacido y lactantes menores de 3 meses / Expert consensus: management of respiratory apneas and sleep parameters in newborn and infants under 3 months

El diagnóstico de apneas en lactantes menores de tres meses constituye un gran desafío y es un área en pleno desarrollo. Es por esto, que diferentes especialistas en sueño, pertenecientes a dos Sociedades Científicas de Chile: la Comisión de Sueño, de la Sociedad Chilena de Neumología Pediátrica (SOCHINEP) y el Grupo de Trabajo Trastornos del Sueño en Pediatría de la Sociedad de Psiquiatría y Neurología de la Infancia y Adolescencia (SOPNIA), se han puesto de acuerdo en proponer un consenso básico sobre los parámetros de sueño y del manejo de las apneas en los menores de 3 meses de vida. El objetivo, es que podamos contribuir al manejo de estos pacientes, con un lenguaje y manejo similar, y valores de referencia apropiados para ese grupo etario, respaldado con las últimas investigaciones al respecto.

Sleep apnea diagnosis in infants younger than 3 months has been a major challenge for modern medicine. Using current literature, experts from the Chilean Society of Pediatric Pulmonology Sleep Commission, and the Chilean Society of Psychiatry and Neurology for Children and Adolescents, have produced a national state-of-the-art consensus. The main goal of this statement is to unify our language in this matter, based on the latest evidence.