Your browser doesn't support javascript.
loading
Show: 20 | 50 | 100
Results 1 - 20 de 98
Filter
1.
Respirar (Ciudad Autón. B. Aires) ; 16(2): 151-159, Junio 2024.
Article in Spanish | LILACS, UNISALUD, BINACIS | ID: biblio-1556155

ABSTRACT

Introducción: La cánula nasal de alto flujo es un sistema que utiliza una mezcla de aire-oxígeno humidificado y calentado con un caudal de hasta 70 litros por minuto. Es utilizada mayoritariamente en la insuficiencia respiratoria aguda de origen hipoxémico, donde ha demostrado brindar mayor comodidad y poder resolutivo de la hipoxemia, en comparación con la oxigenoterapia convencional. Aunque se conocen sus indicaciones y estrategia de seguimiento, en la práctica clínica no es claro su proceso de destete/desmonte. Objetivo: Identificar en la bibliografía la literatura existente acerca de estrategias de destete/desmonte de la cánula nasal de alto flujo en adultos. Métodos: Se realizó una revisión bibliográfica en las bases de datos del portal regional de la BVS, PubMed, Web Of Science, Scopus y Google scholar, sin límite de tiempo y es- tructurando una ecuación PIO con palabras clave y operadores booleanos. Se asumieron artículos publicados en inglés y español, texto completo. Resultados: En la bibliografía, aún se reporta discrepancia en el proceso de destete y desmonte de la cánula nasal de alto flujo, pero en la mayoría de los estudios encontrados en esta revisión se propone disminuir la FiO2 primero de forma gradual (5-10%) hasta valores de 30-50% y, posteriormente, el flujo. Para desmontarla, se podría considerar tener una FiO2 entre 30-50%, flujo entre 20-30 litros por minuto, SaO2 >92%, con adecuada mecánica respiratoria y estado de conciencia. Conclusión: Aún no existe unanimidad en el proceso de destete/desmonte en la cánula nasal de alto flujo en el paciente adulto.


Introduction: The high-flow nasal cannula is a system that uses a humidified and heated air-oxygen mixture with a flow rate of up to 70 liters per minute. It is mostly used in acute respiratory failure of hypoxemic origin, where it has been shown to provide greater comfort and resolving power of hypoxemia, compared to conventional oxygen therapy. Although its indications and follow-up strategy are known, in clinical practice the weaning/weaning process is not clear. Objective: To identify in the bibliography the existing literature on weaning/ weaning strategies of high-flow nasal cannula in adults. Methods: A bibliographic review was carried out in the databases of the regional portal of the BVS, PubMed, Web Of Science, Scopus and Google scholar, without time limit and structuring a PIO equation with keywords and boléan connectors. Articles published in English and Spanish, full text, were assumed. Results: The literature still reports discrepancy in the process of weaning and disassembling the high-flow nasal cannula, but most of the studies found in this review propose to decrease the FiO2 first gradually (5-10%) to values of 30-50% and then the flow. To dismantle it, one could consider having a FiO2 between 30-50%, flow between 20-30 liters per minute, SaO2 >92%, with adequate respiratory mechanics and state of consciousness. Conclusion: There is still no unanimity on the weaning/weaning process in the high- flow nasal cannula in the adult patient.


Subject(s)
Humans , Respiratory Insufficiency , Cannula/statistics & numerical data , Oxygen Inhalation Therapy , Strategic Planning/statistics & numerical data , Comorbidity , Intensive Care Units , Hypoxia
2.
Respirar (Ciudad Autón. B. Aires) ; 16(2): 161-168, Junio 2024.
Article in Spanish | LILACS, UNISALUD, BINACIS | ID: biblio-1556158

ABSTRACT

La terapia de alto flujo se ha popularizado durante los últimos años, basada en sus efectos fisiológicos, la entrega de una fracción inspirada de oxígeno segura y estable, sumada al flujo calefaccionado y humidificado, lo que hizo posible su utilización en distintos escenarios. Sin embargo, los estudios que muestran estos beneficios y efectos se han realizado, principalmente, con el empleo de una cánula nasal; mientras que las características de esta terapia en los pacientes traqueostomizados no se ha desarrollado suficientemente. Proponemos aquí una revisión narrativa con las características más salientes de la terapia de alto flujo en este subgrupo de pacientes.


High-flow therapy has become popular in recent years, based on its physiological effects, the delivery of a safe and stable inspired fraction of oxygen, combined with heated and humidified flow, which made its use possible in different scenarios. However, studies demonstrating these benefits and effects have been mainly conducted using a nasal cannula, while the characteristics of this therapy in tracheostomized patients have not been sufficiently developed. We propose a narrative review highlighting the most relevant characteristics of high-flow therapy in this subgroup of patients.


Subject(s)
Humans , Male , Female , Respiratory Therapy/methods , Tracheostomy/statistics & numerical data , Respiration, Artificial , Review , Critical Care , Cannula
3.
Respirar (Ciudad Autón. B. Aires) ; 16(1): 67-77, Marzo 2024.
Article in Spanish | LILACS, UNISALUD, BINACIS | ID: biblio-1551223

ABSTRACT

La tasa de reintubación orotraqueal luego de la extubación se registra entre un 10 a 20%. La aplicación de soportes respiratorios no-invasivos (SRNI) posterior a la extuba-ción como cánula nasal de alto-flujo, ventilación no invasiva (dos niveles de presión) y presión positiva continua en la vía aérea demostraron ser seguras y efectivas post ex-tubación. El período pre-destete representa un momento crucial en el manejo de los pa-cientes críticos ya que el fracaso de la extubación, definido como la necesidad de reintu-bación dentro de los 2 a 7 días, demostró peores resultados al aumentar la mortalidad entre un 25-50%. Esta situación conlleva al requerimiento de ventilación mecánica prolongada, neumonía asociada a la ventilación mecánica y estancias prolongadas de internación. Por lo tanto, es esencial identificar a los pacientes que se beneficiarán utilizando SRNI post extubación.


The rate of re-intubation after extubation is recorded at 10-20%. The use of non-invasive respiratory support (NIRS) post-extubation such as high-flow nasal cannula, non-invasive ventilation (bilevel pressure) and continuous positive airway pressure (CPAP) have been shown to be safe and effective post-extubation. The pre-weaning period represents a crucial time in the management of critically ill patients, as extubation failure, defined as the need for reintubation within 2-7 days, showed worse outcomes with mortality increasing by 25-50%. This situation leads to the requirement for prolonged mechanical ventilation, ventilator-associated pneumonia and long lengths of hospital stay. Therefore, it is essential to identify patients who will benefit from NIRS post extubation.


Subject(s)
Humans , Continuous Positive Airway Pressure/statistics & numerical data , Airway Extubation/statistics & numerical data , Noninvasive Ventilation/statistics & numerical data , Cannula/statistics & numerical data , Intubation, Intratracheal/statistics & numerical data , Respiration, Artificial/statistics & numerical data , Risk Factors , Mortality , Review
4.
Chinese Journal of Contemporary Pediatrics ; (12): 37-41, 2024.
Article in Chinese | WPRIM | ID: wpr-1009890

ABSTRACT

OBJECTIVES@#To optimize the oxygen therapy regimens for infants with pulmonary diseases during bronchoscopy.@*METHODS@#A prospective randomized, controlled, and single-center clinical trial was conducted on 42 infants who underwent electronic bronchoscopy from July 2019 to July 2021. These infants were divided into a nasal cannula (NC) group and a modified T-piece resuscitator (TPR) group using a random number table. The lowest intraoperative blood oxygen saturation was recorded as the primary outcome, and intraoperative heart rate and respiratory results were recorded as the secondary outcomes.@*RESULTS@#Compared with the NC group, the modified TPR group had a significantly higher level of minimum oxygen saturation during surgery and a significantly lower incidence rate of hypoxemia (P<0.05). In the modified TPR group, there were 6 infants with mild hypoxemia, 2 with moderate hypoxemia, and 1 with severe hypoxemia, while in the NC group, there were 3 infants with mild hypoxemia, 5 with moderate hypoxemia, and 9 with severe hypoxemia (P<0.05). The modified TPR group had a significantly lower incidence rate of intraoperative respiratory rhythm abnormalities than the NC group (P<0.05), but there was no significant difference in the incidence rate of arrhythmias between the two groups (P>0.05).@*CONCLUSIONS@#Modified TPR can significantly reduce the risk of hypoxemia in infants with pulmonary diseases during electronic bronchoscopy, and TPR significantly decreases the severity of hypoxemia and the incidence of respiratory rhythm abnormalities compared with traditional NC.


Subject(s)
Infant , Humans , Oxygen , Bronchoscopy/adverse effects , Cannula , Prospective Studies , Electronics , Hypoxia/prevention & control , Lung Diseases
5.
Respirar (Ciudad Autón. B. Aires) ; 15(1): 44-73, mar2023.
Article in Spanish | LILACS | ID: biblio-1435423

ABSTRACT

La cánula nasal de alto flujo se ha convertido en una de las principales estrategias de soporte ventilatorio no invasivo en la insuficiencia respiratoria aguda hipoxémica, principalmente después de la pandemia de COVID-19. Sin embargo, su uso se extiende más allá de este escenario y abarca diferentes condiciones clínicas como el período postextubación, período postquirúrgico, insuficiencia respiratoria hipercápnica y soporte vital en pacientes inmunodeprimidos, trasplantados u oncológicos. Los manuscritos que avalan su aplicación han sido ampliamente difundidos y el grado de evidencia es lo suficientemente alto como para recomendar su uso. Por tanto, es necesario destacar sus efectos fisiológicos como el confort, una fracción inspirada de oxígeno precisa, el lavado de CO2 o la optimización del volumen pulmonar de fin de espiración para comprender su mecanismo de acción y mejorar los resultados de los pacientes. El objetivo de esta revisión narrativa es ofrecer un resumen breve y conciso de los efectos y beneficios de aplicar esta terapia en diferentes escenarios clínicos sin la estructura rígida de una revisión sistemática. Con base en estas líneas, el lector curioso puede ampliar la evidencia científica que avala el empleo de la cánula nasal de alto flujo en cada escenario particular. (AU);


High-flow nasal cannula has become one of the main strategies for non-invasive ventilatory support in hypoxemic acute respiratory failure, mainly after the COVID-19 pandemic. However, its use extends beyond this scenario and covers different clinical conditions such as the post-extubation period, post-surgical period, hypercapnic respiratory failure and life support in immunosuppressed, trasplant or cancer patients. Manuscripts that support its application have been widely disseminated and the degree of evidence is high enough to recommend its use. Therefore, it is necessary to highlight its physiological effects such as comfort, precise fraction of inspiratory oxygen, CO2 lavage or optimize end-expiratory lung volume to understand its mechanism of action and improve patients' outcomes. The objective of this narrative review is to offer a brief and concise summary of the benefits of applying this therapy in different clinical scenarios without the rigid structure of a systematic review. Based on these lines, the curious reader can expand the scientific evidence that supports the use of the high-flow nasal cannula in each particular scenario. (AU);


Subject(s)
Humans , Oxygen Inhalation Therapy/methods , Respiratory Insufficiency/therapy , Noninvasive Ventilation , Cannula , Risk , Review , Critical Illness
6.
Chinese Critical Care Medicine ; (12): 762-763, 2023.
Article in Chinese | WPRIM | ID: wpr-982670

ABSTRACT

As a new respiratory support technique, high-flow nasal cannula oxygen therapy (HFNC) has been widely used in clinical practice in recent years. During HFNC treatment, due to the long time and continuous wearing of nasal stopper and fasteners on the patient face, it is easy to cause medical device-related pressure injury on multiple facial skin. Moreover, when the patient's position changes greatly, because there is no good fixed design at the HFNC nasal stopper, it is easy to shift or turn the nasal stopper outward, causing abnormal ventilation and failure to achieve the purpose of clinical oxygen therapy. To overcome above problems, medical staff in the intensive care unit of department of infectious diseases, Tongji Hospital Tongji Medical College of HUST designed a new type of decompression fixator to prevent HFNC face pressure injury, and obtained national utility model patent (ZL 2022 2 0754626.1). The integrated design structure of the device has the functions of decompression of facial skin and fixation of nasal stopper, which can ensure the effect of oxygen therapy and improve the oxygen therapy experience and patient comfort, which is suitable for clinical promotion.


Subject(s)
Humans , Cannula , Pressure Ulcer/prevention & control , Oxygen Inhalation Therapy/methods , Oxygen , Decompression , Respiratory Insufficiency/therapy , Noninvasive Ventilation
7.
Chinese Critical Care Medicine ; (12): 435-437, 2023.
Article in Chinese | WPRIM | ID: wpr-982608

ABSTRACT

Difficulty in swallowing is a common symptom in stroke patients, and nasogastric tubes are routinely used to solve the nutritional support problem of these patients. The existing nasogastric tube have the disadvantages of causing aspiration pneumonia and patient discomfort. The traditional transoral gastric tube has no one-way valve switch and gastric content storage device, and cannot be fixed in the stomach, resulting in reflux of gastric contents, inability to fully understand the digestion and absorption of gastric contents, and accidental dislocation of the gastric tube, affecting further feeding and gastric content detection. For these reasons, the medical staff of the department of gastroenterology and colorectal surgery of Jilin University China-Japan Union Hospital designed a new transoral gastric tube that can extract and store gastric contents, and was granted a national utility model patent of China (ZL 2020 2 1704393.1). The device consists of collection, cannula and fixation modules. The collection module includes three parts. Gastric contents storage capsule, which can clearly visualize the gastric contents; three-way switch, which can be controlled by rotating the pathway, makes the pathway exist in different states, which is convenient for medical personnel to extract gastric juice, as well as perform intermittent oral tube feeding on the patient or close the pipeline, and reduce contamination and prolong the service life of the gastric tube; one-way valve, which can effectively avoid the contents of the reflux back into the stomach. The tube insertion module includes three parts. A graduated tube, which can enable the medical staff to effectively identify the insertion depth; a solid guide head, which makes the insertion of the tube through the mouth more smoothly; the gourd-shaped passageway, which effectively avoids the blockage of the tube. The fixation module is a water-filled balloon, which is properly filled with water and air. After the pipe is inserted through the mouth, it can be injected with water and gas properly to avoid accidental withdrawal of the gastric tube. Intermittent oroesophageal tube feeding of patients with dysphagia after stroke through a transoral gastric tube that can extract and store gastric contents can not only accelerate the recovery process of patients and shorten the hospitalization time, but also transoral enteral nutrition can effectively promote the recovery of patients' systemic systems, which has certain clinical use value.


Subject(s)
Humans , Enteral Nutrition , Aircraft , Cannula , China , Drug Contamination
8.
Rev. chil. fonoaudiol. (En línea) ; 22(1): 1-19, 2023. tab
Article in Spanish | LILACS | ID: biblio-1451269

ABSTRACT

El proceso deglutorio requiere de una adecuada coordinación entre respiración y deglución. En el contexto clínico, el uso de dispositivos ventilatorios no invasivos, como la cánula nasal de alto flujo (CNAF) o la ventilación no invasiva (VNI), ha cobrado gran relevancia durante los últimos años. Sin embargo, existe escasa información respecto a la interferencia que estos dispositivos podrían ocasionar en la fisiología deglutoria. En este contexto, y con el objetivo de describir el impacto de la CNAF y la VNI en la fisiología deglutoria, se realizó una revisión de la literatura en PubMed, Medline, Embase, Web of Science, Lilacs y Scielo. Se incorporaron estudios que incluyeran población ≥18 años, con uso de CNAF o VNI. Se excluyeron estudios en población con antecedentes de disfagia, necesidad de intubación, presencia de enfermedad neurológica, neuromuscular o respiratoria, entre otros. Los resultados de los estudios muestran que la CNAF podría disminuir el número de degluciones (en flujos ≥ 20 L/min; p<0,05),disminuir el tiempo medio de activación de la respuesta deglutoria proporcional al flujo empleado (p<0,05), incrementar el riesgo aspirativo en flujos altos (>40 L/min, p<0,05) e incrementar en promedio la duración del cierre del vestíbulo laríngeo (p<0,001). La VNI modo BiPAP, por su parte, podría aumentar el riesgo aspirativo debido al incremento en la tasa de inspiración post deglución (SW-I, p<0,01). Si bien la evidencia disponible es limitada, los resultados aportan información relevante a considerar en el abordaje de usuarios que utilicen estos dispositivos ventilatorios. Futuras investigaciones deberían ser desarrolladas para fortalecer la evidencia presentada.


Deglutition requires adequatecoordination between breathing and swallowing. In the clinical context, the use of non-invasive ventilatory devices such as high-flow nasal cannulas(HFNC) or non-invasive ventilation (NIV) has become highlyrelevantin recent years. However, there is little information regarding howthese devices could interferewith the physiologyof deglutition. This study aimedto describe the impact of HFNC and NIV on swallowing physiology. To this end, aliterature review was carried out usingPubMed, Medline, Embase, Web of Science, Lilacs,and Scielo. Studies performed onpopulations≥18 years old where HFNC or NIV were used were included. Studies where thepopulation hada history of dysphagia, need for intubation, and presentedneurological, neuromuscular,or respiratory diseases, among others, were excluded. The results show that HFNC could decrease the swallowing rate(with flows≥ 20 L/min; p<.05), decrease the mean activation time of the swallowing reflex in proportion to the flow (p<.05), increase the risk of aspiration when usinghigherflows (>40 L/min, p<0.05),and increase the average duration of the laryngeal vestibuleclosure(p<.001).NIV, particularly BiPAP, could increase the risk of aspiration due to the higherrate of post-swallowing inspiration (SW-I, p<.01). Although the evidence available on this matter is limited, theseresults offerrelevant information that should beconsideredwhen working with patients who use these ventilatory devices. Furtherresearch should be carriedoutto strengthen the evidence that is provided in this study.


Subject(s)
Humans , Adult , Deglutition Disorders/etiology , Deglutition/physiology , Noninvasive Ventilation/adverse effects , Cannula , Oxygen Inhalation Therapy/adverse effects , Continuous Positive Airway Pressure/adverse effects
9.
Neumol. pediátr. (En línea) ; 18(2): 45-47, 2023. tab
Article in Spanish | LILACS | ID: biblio-1444746

ABSTRACT

La cánula nasal de alto flujo (CNAF) es una modalidad ventilatoria no invasiva segura y efectiva, usada ampliamente en patología respiratoria aguda en adultos y niños. Objetivo: presentar casos clínicos pediátricos que utilizaron CNAF por tiempo prolongado por problemas respiratorios crónicos. Descripción de casos clínicos, revisión de fichas clínicas de 5 pacientes que utilizaron CNAF por más de 1 mes, entre los años 2017-2020 en el Complejo Asistencial Dr. Sótero del Río. Aprobado por Comité de Ética. Resultados: 5 pacientes varones de mediana 61 (44 a 212) días de edad al inicio del uso de CNAF. Diagnóstico de base: displasia broncopulmonar (2/5), síndrome de Treacher Collins (1/5), síndrome de cimitarra con hipoplasia pulmonar derecha (1/5) y traqueobroncomalacia severa (1/5). Todos requirieron previamente uso de ventilación invasiva o no invasiva con mediana de 59 (4 a 78) días. A todos se les realizó broncoscopia, saturometría contínua o poligrafía para diagnóstico y titulación de CNAF y oxígeno. Todos mejoraron clínicamente, la SpO2 y el número de apneas. Dos pacientes se enviaron a domicilio con uso de Airvo2 nocturno. La mediana de uso de CNAF fue 165 (34 a 445) días. Conclusiones: el uso prolongado de CNAF es útil en pacientes pediátricos seleccionados, bien tolerado y factible de utilizar en domicilio.


The high-flow nasal cannula (HFNC) is a safe and effective non-invasive ventilation support widely used in acute respiratory pathology in adults and children. Objective: To present pediatric clinical cases that used HFNC for an extended period due to chronic respiratory disease. Description of clinical cases, review of medical records of 5 patients who used HFNC for more than 1 month, between the years 2017-2020 at Complejo Asistencial Dr. Sótero del Río. Approved by the Ethics Committee. Results: 5 male patients with a median age of 61 (44 to 212) days at the start of HFNC use. Underlying diagnoses: bronchopulmonary dysplasia (2/5), Treacher Collins syndrome (1/5), Scimitar syndrome with right pulmonary hypoplasia (1/5), and severe tracheobronchomalacia (1/5). All of them previously required invasive or non-invasive ventilation for a median of 59 (4 to 78) days. All patients underwent bronchoscopy, continuous pulse oximetry or polygraphy for diagnosis and titration of HFNC and oxygen. All showed clinical improvement, including SpO2 levels and the number of apneas. Two patients were discharged with nocturnal use of Airvo 2 at home. The median duration of HFNC use was 165 (34 to 445) days. Conclusions: Prolonged use of HFNC is useful in selected pediatric patients, well tolerated, and feasible for home use.


Subject(s)
Humans , Male , Infant, Newborn , Infant , Respiratory Tract Diseases/therapy , Cannula , Time Factors , Chronic Disease , Sleep Apnea, Obstructive/therapy , Tracheomalacia/therapy , Lung Injury/therapy , Noninvasive Ventilation
10.
Neumol. pediátr. (En línea) ; 18(2): 45-47, 2023. ilus, tab
Article in Spanish | LILACS | ID: biblio-1444644

ABSTRACT

Se realiza comentario de estudio de Israel en el cual analizan 75 pacientes pediátricos que utilizaron cánula nasal de alto flujo (CNAF) en domicilio, evaluando la seguridad, las indicaciones, los parámetros de utilización, la duración del tratamiento, los resultados clínicos y la satisfacción de los padres. Se acompaña de una revisión de la literatura del tema.


A comment is made on a study conducted in Israel analyzing 75 pediatric patients who used high-flow nasal cannula at home, evaluating safety, indications, utilization parameters, treatment duration, clinical outcomes, and parental satisfaction. It is accompanied by a literature review on the topic.


Subject(s)
Humans , Child , Cannula , Home Nursing , Lung Diseases/therapy , Sleep Apnea, Obstructive/therapy , Noninvasive Ventilation , Neuromuscular Diseases/therapy
12.
Rev. am. med. respir ; 22(3): 239-248, set. 2022. graf
Article in Spanish | BINACIS, LILACS | ID: biblio-1407078

ABSTRACT

Es imprescindible poder priorizar la decanulación de los pacientes traqueostomizados. El éxito en el procedimiento podría evitar estadías hospitalarias prolongadas y, por consiguiente, llegar a disminuir la mortalidad. La retirada de la cánula de traqueostomía es un tema muy controversial, dado que, para lograrla, existen diferentes tipos de abordajes y estrategias. Teniendo en cuenta que su uso prolongado debe ser evita do, ya que conlleva a diferentes complicaciones, como traqueomalacia, estenosis traqueal, fistula traqueo-esofágica, alteraciones funcionales en la deglución y la fonación, es de suma importancia poder conocer con exactitud cuáles son las variables que mensurar para que el paciente pueda ser decanulado. Diversos trabajos publicados difieren en cuáles son los mejores indicadores que deben ser observados para lograr el éxito. Por lo tanto, el objetivo de la presente revisión es analizar cuáles son las variables objetivables con mayor eficacia al momento de llevar a cabo la decanulación.


It is essential to prioritize the decannulation of tracheostomized patients. A successful procedure could avoid prolonged hospital stay. Accordingly, there could be a reduction in mortality. Removing the tracheotomy cannula is a very controversial issue, because there are different types of strategies and approaches to do so. The prolonged use of the cannula must be avoided, since it entails different complications such as tracheal malacia, tracheal stenosis, tracheoesophageal fistula, and functionally altered swal lowing and phonation; thus, it is very important to be able to know exactly which are the variables that need to be measured before a patient is decannulated. Several pub lished studies disagree on which are the best indicators that should be observed to be successful. So, the objective of this review was to analyze which are the most effective target variables when performing the decannulation.


Subject(s)
Cannula , Intensive Care Units
13.
Annals of the Academy of Medicine, Singapore ; : 149-160, 2022.
Article in English | WPRIM | ID: wpr-927462

ABSTRACT

INTRODUCTION@#Evidence regarding the efficacy of high-flow nasal cannula (HFNC) oxygenation for preoxygenation and apnoeic oxygenation is conflicting. Our objective is to evaluate whether HFNC oxygenation for preoxygenation and apnoeic oxygenation maintains higher oxygen saturation (SpO2) during rapid sequence intubation (RSI) in ED patients compared to usual care.@*METHODS@#This was a multicentre, open-label, randomised controlled trial in adult ED patients requiring RSI. Patients were randomly assigned 1:1 to either intervention (HFNC oxygenation at 60L/min) group or control (non-rebreather mask for preoxygenation and nasal prongs of at least 15L/min oxygen flow for apnoeic oxygenation) group. Primary outcome was lowest SpO2 during the first intubation attempt. Secondary outcomes included incidence of SpO2 falling below 90% and safe apnoea time.@*RESULTS@#One hundred and ninety patients were included, with 97 in the intervention and 93 in the control group. Median lowest SpO2 during the first intubation attempt was 100% in both groups. Incidence of SpO2 falling below 90% was lower in the intervention group (15.5%) compared to the control group (22.6%) (adjusted relative risk=0.68, 95% confidence interval [CI] 0.37-1.25). Post hoc quantile regression analysis showed that the first quartile of lowest SpO2 during the first intubation attempt was greater by 5.46% (95% CI 1.48-9.45%, P=0.007) in the intervention group.@*CONCLUSION@#Use of HFNC for preoxygenation and apnoeic oxygenation, when compared to usual care, did not improve lowest SpO2 during the first intubation attempt but may prolong safe apnoea time.


Subject(s)
Adult , Humans , Cannula , Emergency Service, Hospital , Intubation, Intratracheal , Rapid Sequence Induction and Intubation , Respiration, Artificial
14.
Int. j. morphol ; 40(4): 1088-1093, 2022. tab
Article in Spanish | LILACS | ID: biblio-1405261

ABSTRACT

RESUMEN: El objetivo del estudio fue determinar si la composición corporal es una condición que influye en el efecto del posicionamiento en prono vigil (PPV) en pacientes con COVID-19 conectados a cánula nasal de alto flujo (CNAF). Se realizó un estudio observacional retrospectivo y se analizaron los resultados terapéuticos de 83 pacientes tratados con CNAF en el servicio de medicina del Hospital El Carmen (HEC), Santiago de Chile. Desde la ficha clínica electrónica (Florence clínico versión 19.3) y registro kinésico, se obtuvo la siguiente información: i) antecedentes del paciente, ii) diagnóstico médico, iii) índice de masa corporal (IMC), iv) características del PPV y v) características del proceso de conexión a CNAF. Se observó que existían diferencias significativas en pacientes con sobrepeso y obesos que usaron el PPV (p=0,001) a través del índice de ROX (IROX) al finalizar el tratamiento con CNAF, ocurriendo de igual manera al evaluar los efectos del PPV y en la PAFI en estos mismos grupos. En conclusión el IMC es un factor más agravante que condiciona la salud de los pacientes con COVID-19, y el IMC elevado puede afectar de manera negativa el tratamiento de estos pacientes. Por otra parte, el uso de PPV y CNAF demostraron ser efectivas en los pacientes con COVID-19.


SUMMARY: The aim of the study was to determine whether body composition is a condition influencing the effect of awake prone positioning (APP) in patients with COVID-19 connected to high-flow nasal cannula (HFNC). We conducted a retrospective observational study and analyzed the therapeutic outcomes of 83 patients treated with HFNC in the medicine department of Hospital El Carmen (HEC), Santiago, Chile. The following information was obtained from the electronic clinical record (Florence clinical version 19.3) and the kinesic registry: i) patient history, ii) medical diagnosis, iii) body mass index (BMI), iv) characteristics of the APP and v) characteristics of the process of connection to CNAF. It was observed that there were significant differences in overweight and obese patients who used the PPV (p=0.001) through the ROX index (IROX) at the end of treatment with CNAF, occurring in the same way when evaluating the effects of the APP and in the PAFI in these same groups. In conclusion, BMI is a further aggravating factor that conditions the health of patients with COVID-19, and elevated BMI can negatively affect the treatment of these patients. On the other hand, the use of APP and CNAF proved to be effective in patients with COVID-19.


Subject(s)
Humans , Male , Female , Adult , Middle Aged , Aged , Body Mass Index , Prone Position , Cannula , COVID-19/therapy , Wakefulness , Body Composition , Nose , Nutritional Status , Retrospective Studies
15.
Rev. colomb. neumol ; 34(1): 11-19, 2022. tab
Article in Spanish | LILACS, COLNAL | ID: biblio-1395753

ABSTRACT

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.


Subject(s)
Humans , Work of Breathing , Cannula , Pulmonary Medicine , Critical Care , COVID-19 , Oxygen Saturation
16.
Neumol. pediátr. (En línea) ; 17(1): 28-33, 2022. ilus, tab
Article in Spanish | LILACS | ID: biblio-1379429

ABSTRACT

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.


Subject(s)
Humans , Male , Female , Infant, Newborn , Infant , Child, Preschool , Child , Adolescent , Oxygen Inhalation Therapy/methods , Respiratory Insufficiency/therapy , Cannula , Intensive Care Units, Pediatric , Retrospective Studies , Longitudinal Studies , Treatment Outcome , Colombia , Emergencies
17.
Prensa méd. argent ; 107(7): 353-359, 20210000. fig
Article in Spanish | LILACS, BINACIS | ID: biblio-1358932

ABSTRACT

Se analiza una de las complicaciones de la lipoaspiración abdominal: la perforación intestinal intra-operatoria por la cánula (instrumental). Se describe la relación entre la cánula, la pared abdominal y el intestino delgado: los tres componentes de esta complicación. Se detallaron las características de las cánulas generalmente empleadas y la técnica quirúrgica de la lipoaspiración abdominal, así como el cuadro clínico ocasionado y cómo tratarlo


One of the complications of abdominal liposuction is analyzed: intra-operative intestinal perforation by the cannula (instrumental). The relationship between the cannula, the abdominal wall and the small intestine is described: the three components of this complication. The characteristics of the cannulas generally used and the surgical technique of abdominal liposuction were detailed, as well as the clinical picture caused and how to treat it.


Subject(s)
Humans , Lipectomy/methods , Medical Errors , Abdominal Wall/pathology , Cannula/adverse effects , Intestinal Perforation/prevention & control , Intraoperative Complications/prevention & control
19.
Rev. bras. ter. intensiva ; 33(3): 384-393, jul.-set. 2021. tab, graf
Article in English, Portuguese | LILACS | ID: biblio-1347302

ABSTRACT

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.


Subject(s)
Humans , Child , Noninvasive Ventilation , Cannula , United States , Brazil , Surveys and Questionnaires , Critical Care
20.
Arch. argent. pediatr ; 119(4): 279-284, agosto 2021. tab, ilus
Article in Spanish | LILACS, BINACIS | ID: biblio-1281012

ABSTRACT

La decanulación es el proceso de retirar la cánula de traqueotomía de forma definitiva, una vez que la patología original que motivó la traqueotomía se haya resuelto o mejorado significativamente.La predicción del éxito de decanulación es difícil debido a la influencia de varios factores. No existe un protocolo universalmente aceptado. Existen diversos protocolos y la elección depende, en gran medida, de cada institución y de la situación individual de cada paciente. Sin embargo, para lograr la decanulación exitosa deben tenerse en cuenta varios criterios esenciales que deben cumplirse independientemente del protocolo elegido.Se señalan las características que debe reunir el paciente apto para la decanulación y se presentan recomendaciones sobre los pasos necesarios para lograr el retiro de la cánula de traqueotomía en el niño de manera segura y minimizando el riesgo de fracaso.


Decannulation is the process of removing the tracheotomy cannula permanently, once the original pathology that led to the tracheotomy has been resolved or significantly improved. The prediction of decannulation success is difficult due to the influence of several factors. There is no universally accepted decannulation protocol. There are several protocols and the choice depends, largely, on each institution and the individual situation of each patient. However, in order to achieve successful decannulation, several essential criteria must be taken into account, which must be fulfilled regardless of the chosen protocol.We indicate the characteristics that the patient must meet for decannulation, and we present recommendations on the necessary steps to achieve the removal of the tracheotomy cannula in a child safely and minimizing the risk of failure.


Subject(s)
Humans , Male , Female , Child, Preschool , Child , Tracheotomy , Device Removal/methods , Pediatrics , Cannula
SELECTION OF CITATIONS
SEARCH DETAIL