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2.
Cambios rev. méd ; 20(1): 117-132, 30 junio 2021. tabs.
Article in Spanish | LILACS | ID: biblio-1292987

ABSTRACT

La principal función del sistema respira-torio es el intercambio de gases durante la inspiración y expiración, una alteración en cualquier parte de este sistema puede generar problemas respiratorios agudos como en el caso de la insuficiencia respiratoria aguda (IRA), que es la incapacidad pulmonar de cumplir con el intercambio gaseoso de oxígeno y dióxido de carbono entre el aire ambiental y la sangre circu-lante1, está acompañada de varios signos y síntomas como taquipnea, cianosis entre otros2, es de inicio súbito, y cons-tituye la causa de ingreso a las unidades de emergencia, por ello la Organización Mundial de la Salud (OMS) indica que "cientos de millones de personas sufren cada día las consecuencias de enferme-dades respiratorias"3. En los indicadores Básicos-Ecuador 2012 del Ministerio de Salud Pública (MSP) del Ecuador a nivel general registró 4 122 muertes por IRA, correspondió a la Provincia de Pichincha 8254, en el Hospital de Especialidades Carlos Andrade Marín (HECAM), la primera causa de ingreso correspondió a neumonía con el 41,29% en el periodo de enero-septiembre 2018 (Coordinación General de Planificación y Estadísticas HECAM).La ruta planteada constituye una herra-mienta que permite al personal de enfer-mería realizar una evaluación efectiva a través de una valoración inicial, primaria y secundaria, con el propósito de evitar complicaciones durante el cuidado de pa-cientes pediátricos con insuficiencia res-piratoria aguda en la Unidad Pediátricos Área de Emergencia (UPAE).


1. INTRODUCTION The main function of the respiratory system is the exchange of gases during inharing and exhaling processes. An al-teration in any part of this system can generate acute respiratory problems as in the case of acute respiratory failure (ARF), which is the inability of the lung to comply with the gaseous exchange of oxygen and carbon dioxide between the external air and circulating blood1. It is accompanied by various signs and symp-toms such as tachypnea, cyanosis, among others2, is of sudden start, and is the cause of admission to emergency units. This is why the World Health Organization (WHO) indicates that "hundreds of millions of people suffer the consequences of respiratory diseases every day"3. In the Basic Indicators-Ecuador 2012 of the Mi-nistry of Public Health of Ecuador at the general level recorded 4 122 deaths due to ARI, corresponding to the Province of Pichincha 8254, in the Carlos Andrade Marín Specialties Hospital (HECAM). The first cause of admission corresponded to pneumonia with 41,29% in the period January-September 2018 (General Coordination of Planning and Statistics HECAM).The proposed route constitutes a tool that allows the nursing staff to perform an effective evaluation through an initial, primary, and secondary assessment, with the purpose of avoiding complications during the care of pediatric patients with acute respiratory failure in the Pediatric Emergency Area Unit (UPAE).


Subject(s)
Humans , Male , Female , Infant, Newborn , Infant , Child, Preschool , Child , Adolescent , Pediatric Nursing , Respiratory Insufficiency/nursing , Emergency Nursing , Critical Care Nursing , Nursing Care , Pediatrics , Respiration , Respiration, Artificial , Hypoxia
3.
Rev. cuba. invest. bioméd ; 40(1): e884, ene.-mar. 2021.
Article in Spanish | LILACS, CUMED | ID: biblio-1289449

ABSTRACT

La actual pandemia de COVID-19 causada por el virus SARS-CoV-2, se caracteriza por una alta morbilidad y mortalidad. Algunos estudios han reportado que la frecuencia de ictus en pacientes infectados con el virus oscila entre un 5-20 por ciento. A pesar de estas cifras alarmantes, las vías por las cuales el virus llega al sistema nervioso central y los mecanismos fisiopatológicos por los que puede ocurrir un ictus en estos pacientes no han sido totalmente esclarecidos. Numerosos estudios han demostrado que la infección por SARS-CoV-2 está asociada a un estado protrombótico, capaz de causar un tromboembolismo arterial y venoso. Además, se ha reportado una respuesta inflamatoria exacerbada, con reclutamiento de células sanguíneas y una secreción desproporcionada de citoquinas proinflamatorias. También la hipoxia y fenómenos cardioembólicos han sido propuestos como posibles mecanismos. Es esencial definir con exactitud los mecanismos fisiopatológicos que vincula la infección por SARS-CoV-2 con la ocurrencia del ictus, con la finalidad de aplicar tratamientos más específicos y evitar futuras complicaciones(AU)


The actual Coronavirus Disease 2019 (COVID-19) infection is an ongoing pandemic, characterized by high morbidity and mortality produced by SARS-CoV-2 virus. Studies reported a stroke frequency around 5-20 percent in infected patients; however, SNC invasion and pathophysiological mechanisms related to stroke in COVID-19 patients are still unknown. Several studies have demonstrated that SARS-CoV-2 infection is linked to a prothrombotic state causing venous and arterial thromboembolism. Also, an overstated inflammatory response with recruitment of blood cells and disproportioned secretion of proinflammatory cytokines has been reported. Finally, cardioembolism and hypoxia have been proposed as surrogate mechanisms. It is essential to define the pathophysiological mechanisms of stroke during the infection in order to apply more specific treatments to avoid further stroke complications(AU)


Subject(s)
Humans , Cytokines , Bodily Secretions , Stroke , COVID-19 , Hypoxia
4.
Bol. méd. postgrado ; 37(1): 34-43, Ene-Jun 2021. tab, graf
Article in Spanish | LILACS, LIVECS | ID: biblio-1147878

ABSTRACT

Se realizó una investigación experimental tipo ensayo clínico controlado simple ciego con el fin de evaluar la relajación muscular y los predictores de vía aérea difícil en pacientes programados para cirugía general en el Hospital Central Universitario Dr. Antonio María Pineda. La muestra estuvo conformada por 100 pacientes distribuidos aleatoriamente en cuatro grupos de 25 pacientes cada uno. En los grupos Experimental-1 (E-1) y Control-1 (C-1) se utilizó una dosis del bloqueante neuromuscular Bromuro de Rocuronio de 0,6 mg/kg y en los grupos Experimental-2 (E-2) y Control-2 (C-2) de 1 mg/kg. La edad promedio de los pacientes fue de 34,8 ± 9,8 años; en los grupos E-1 y E-2, los predictores de vía aérea difícil predominantes fueron distancia esternomentoniana (32% y 42%), distancia tiromentoniana (24% y 40%), distancia interincisivos clase I (88% y 92 %), circunferencia de cuello  40 cm (16% y 8 %), Mallampati (88% y 40%), extensión atlanto-occipital (28% y 20%) y protrusión mandibular (28% y 20%). En el 72% y 80% de los pacientes de los grupos experimentales y control no hubo intento adicional de intubación orotraqueal (IOT); el tiempo invertido para alcanzar la IOT fue < 1 minuto en el grupo C-2 (64%) y E-2 (72%). Existen diferencias estadísticamente significativas entre el número de intentos para alcanzar la IOT, la presencia de predictores de vía aérea difícil y la dosis de bloqueante neuromuscular utilizada lo que evidencia de que a medida que se aumenta la dosis del medicamento hay mayor posibilidad de éxitos en la IOT, aun cuando estén presentes predictores de vía aérea difícil(AU)


An experimental simple blind controlled clinical trial was carried out to evaluate muscle relaxation and predictors of difficult airway in patients scheduled for general surgery at the Hospital Central Universitario Dr. Antonio María Pineda. The sample consisted of 100 patients randomly distributed into four groups of 25 patients each. Patients from the Experimental-1 (E-1) and Control-1 (C-1) groups received 0.6 mg/kg of the neuromuscular blocking agent Rocuronium Bromide while Experimetal-2 (E-2) and Control-2 (C-2) patients received a dosage of 1 mg/kg. Average age of participants was 34.8 ± 9.8 years. Predictors of difficult airway in E-1 and E-2 were sternomental distance (32% and 42%, thyromental distance (24% and 40%), interincisive distance class 1 (88% and 92%), neck circumference  40 cm (16% and 8%), Mallampati (88% and 40%), atlanto-occipital extension (28% and 20%) and mandibular protrusion (28% and 20%). In 72% and 80% of patients from the E and C groups there was not an additional attempt of orotracheal intubation (OTI); the time invested to reach the OTI was less than one minute in 64% of patients from the C-2 and 72% of the E-2. There are statistically significant differences between the number of attempts to reach the OTI, presence of predictors of difficult airway and the dose of Rocuronium Bromide which means that as the drug dosage increases, there is a greater possibility of success in the OTI, even when predictors of difficult airway are present(AU)


Subject(s)
Humans , Male , Female , Adolescent , Adult , Middle Aged , Aged , Airway Management , Intubation, Intratracheal/mortality , Hypoxia , Muscle Relaxation/drug effects , General Surgery , Central Nervous System , Anesthesia, Endotracheal
5.
Article in English | WPRIM | ID: wpr-878404

ABSTRACT

OBJECTIVES@#To study the hypoxia response gene and microRNA (miRNA) expression profiles in the pathogenesis and progression of oral leukoplakia (OLK).@*METHODS@#Affymetrix GeneChip human transcriptome array 2.0 was used to detect the transcriptome of normal mucosa, low-risk OLK, high-risk OLK, and early squamous cell carcinoma (SCC). Gene ontology function analysis was used to screen genes and key miRNAs whose biological role is hypoxia response. Quantitative reverse transcription polymerase ch-ain reaction (qRT-PCR) was used to verify the expression of hypoxia response genes and miRNAs.@*RESULTS@#A total of 7 different genes of hypoxia response between normal mucosa and low-risk OLK, 10 genes between low-risk and high-risk OLK, and 21 genes between high-risk OLK and SCC were identified. The results of qRT-PCR showed that the expression of hypoxia-inducible factor 1α, chemokine cc-motif ligand 2, and matrix metalloproteinase 3 mRNA and miR-21 in normal mucosa, OLK, and SCC increased in a stepwise manner. The expression difference between OLK and SCC was statistically significant and consistent with the results of transcriptome array.@*CONCLUSIONS@#The hypoxia response gene and related miRNA play roles in the development and progression of OLK.


Subject(s)
Carcinogenesis , Humans , Hypoxia , Leukoplakia, Oral , MicroRNAs , Mouth Neoplasms , Transcriptome
6.
Neotrop. ichthyol ; 19(3): e210037, 2021. tab, graf, ilus
Article in English | ID: biblio-1279497

ABSTRACT

Albeit massive fish mortality has an extraordinary visual impact and is certainly a fatality, we still have rudimentary understanding on how addressing this problem in the Neotropical region. The processes that lead to fish die-off events are complex and sometimes ephemeral, which can lead to incorrect diagnosis. In this review, we discuss these events in Neotropical freshwaters, both in areas impacted by dams and natural environment, with a focus on deaths mediated by the lack of oxygen (anoxia) or the excess of dissolved gases (gas supersaturation). We examine the available knowledge about the related mechanisms, lethal thresholds for dissolved oxygen (DO) and total dissolved gases (TDG) for fish, and the sequelae of gas bubble disease (GBD). An assessment of the main mortality events in Brazil in the last 10 years is also presented, as well as the best practices for monitoring, prevention, and mitigation. Finally, it is concluded that the proliferation of hydroelectric plants in the Neotropical region might contribute to the expansion of these events and, consequently, increasing of impacts on fish conservation. We consider urgent the inclusion of this topic in the licensing processes for new hydropower projects by the environmental agencies.(AU)


Embora mortandades massivas de peixes tenham impacto visual extraordinário e sejam certamente uma fatalidade, estamos ainda engatinhando no entendimento e na solução desse problema. Os processos que levam aos eventos de mortes de peixes são complexos e algumas vezes efêmeros, o que explica diagnoses incorretas. Nessa revisão nós discutimos esses eventos em bacias hidrográficas neotropicais, tanto em barragens como em ambientes naturais, porém com o foco nas mortes por falta de oxigênio (anoxia) ou excesso de gases dissolvidos (supersaturação gasosa). Em particular são examinados o conhecimento disponível acerca dos processos que levam a essas condições, os limiares letais de oxigênio dissolvido (OD) e gases totais dissolvidos (GTD) para os peixes e as sequelas da doença das bolhas de gás (DBG). Uma avaliação dos principais eventos de mortandade que ocorreram no Brasil nos últimos 10 anos é também apresentada, bem como discutidas as melhores práticas para o monitoramento, prevenção e mitigação. Conclui-se, finalmente, que a proliferação de hidrelétricas deve contribuir com a expansão desses eventos e consequentemente com mais um fator de ameaça à biodiversidade. Consideramos urgente a inclusão desse tema nos processos de licenciamento de novos empreendimentos pelo órgão ambiental.(AU)


Subject(s)
Animals , Dams , Mortality , Fishes/physiology , Hypoxia/mortality , Dissolved Oxygen , Water Reservoirs , Biodiversity
7.
Article in Chinese | WPRIM | ID: wpr-879051

ABSTRACT

This project aimed to explore the protective effect of ginsenoside Rg_1 on hypoxia/reoxygenation(H/R)-induced H9 c2 cardiomyocyte injury and its underlying signaling pathway. The H/R model of H9 c2 cardiomyocytes was established and then the cells were divided into different treatment groups. CCK-8(cell counting kit-8) was used to detect the activity of cardiomyocytes; Brdu assay was used to detect the proliferation of H9 c2 cells; the caspase-3 activity was tested, and then the protein expression was assessed by Western blot. Flow cytometry was used to evaluate the apoptosis level of cardiomyocytes. Ginsenoside Rg_1 inhibited H/R-induced cardiomyocyte apoptosis and caspase-3 activity, promoted nuclear transcription of nuclear factor erythroid-2 related factor 2(Nrf2), and enhanced the expression of the downstream heme oxygenase-1(HO-1). Ginsenoside Rg_1 could increase Nrf2 nuclear transcription and HO-1 expression with the increase of concentration(10, 20, 40, 60 μmol·L~(-1)). However, the protective effect of ginsenoside Rg_1 on cardiomyocytes was significantly weakened after the transfection of Nrf2-siRNA. Ginsenoside Rg_1 could protect cardiomyocytes by activating the Nrf2/HO-1 pathway.


Subject(s)
Apoptosis , Ginsenosides/pharmacology , Heme Oxygenase-1/genetics , Humans , Hypoxia , Myocytes, Cardiac , NF-E2-Related Factor 2/genetics
8.
Article in English | WPRIM | ID: wpr-879965

ABSTRACT

Microalgae is an easy-to-obtain natural biological material with many varieties and abundant natural reserves. Microalgae are rich in natural fluorescein, which can be used as a contrast agent for fluorescence imaging and photoacoustic imaging for medical imaging. With its active surface, microalgae can effectively adsorb functional molecules, metal elements, etc., and have good application prospects in the field of drug delivery. Microalgae can generate oxygen through photosynthesis to increase local oxygen concentration, reverse local hypoxia to enhance the efficacy of hypoxic tumors and promote wound healing. In addition, microalgae have good biocompatibility, and different administration methods have no obvious toxicity. This paper reviews the research progress on the biomedical application of microalgae in bioimaging, drug delivery, hypoxic tumor treatment, wound healing.


Subject(s)
Drug Delivery Systems , Humans , Hypoxia , Microalgae , Oxygen , Wound Healing
9.
Article in Chinese | WPRIM | ID: wpr-879817

ABSTRACT

OBJECTIVE@#To study the role of vascular endothelial growth factor-A (VEGF-A) in pulmonary vascular remodeling in neonatal rats with hypoxic pulmonary hypertension (HPH) by regulating survivin (SVV).@*METHODS@#A total of 96 neonatal rats were randomly divided into three groups: HPH+VEGF-A group, HPH group, and control group. Each group was further randomly divided into 3-, 7-, 10-, and 14-day subgroups (@*RESULTS@#The HPH group had a significantly higher mean RVSP than the control and HPH+VEGF-A groups at each time point (@*CONCLUSIONS@#Prophylactic intratracheal administration of exogenous VEGF-A in neonatal rats with HPH can inhibit pulmonary vascular remodeling and reduce pulmonary arterial pressure by upregulating the expression of SVV in the early stage of hypoxia. This provides a basis for the interventional treatment of pulmonary vascular remodeling in neonatal HPH.


Subject(s)
Animals , Animals, Newborn , Hypertension, Pulmonary/etiology , Hypoxia , Pulmonary Artery , Rats , Rats, Wistar , Vascular Endothelial Growth Factor A , Vascular Remodeling
10.
Acta Physiologica Sinica ; (6): 51-61, 2021.
Article in Chinese | WPRIM | ID: wpr-878235

ABSTRACT

In the present study, the composition and content of pulmonary surfactant (PS) were analyzed to explore the hypoxia adaptation mechanism in plateau zokors (Myospalax baileyi) and plateau pikas (Ochotona curzoniae). 36 plateau zokors and plateau pikas were trapped alive at the Laji Mountain in Guide County, Qinghai Province (at the altitude of about 3 600 m), and 36 Sprague-Dawley (SD) rats were purchased from the experimental animal center of Lanzhou University (at the altitude of about 1 500 m). All animals were lavaged after laboratory anesthesia, the blood in lung tissues was fully washed out and the lung tissues were then taken out to obtain the bronchoalveolar lavage fluid by bronchoalveolar lavage. The composition and content of phospholipids in the PS of three different kinds of animals were analyzed by using high performance liquid chromatography; the protein composition, content and types in the PS were analyzed by G-250 Coomassie brilliant blue method, polyacrylamide gel electrophoresis (PAGE) and mass spectrometry; the dissolved oxygen in the PS solutions were determined by using dissolved oxygen electrode. The results showed that the total contents of phospholipids in the PS were successively increased among plateau zokors, plateau pikas and SD rats (P 0.05). The relative content of PSe had no significant differences between plateau zokors and plateau pikas (P > 0.05), but both were significantly higher than that of SD rats (P < 0.01). The serum albumin (SA) was identified in the PS of three kinds of animals, including homologous tetramer protein containing heme, which is composed of hemoglobin β subunit, in plateau zokors and plateau pikas. Immunoglobulin (Ig) heavy chain was found in PS of plateau zokors and SD rats. The content of Ig heavy chain in plateau zokor was significantly higher than that in SD rats (P < 0.01), and the content of protein containing heme was significantly higher than that in plateau pikas (P < 0.05). The amount of dissolved oxygen was successively decreased in the PS among plateau zokors, plateau pikas and SD rats (P < 0.01), but it was significantly higher than that in saline (P < 0.01). These results suggest that the total content of proteins in the PS of plateau zokors and plateau pikas was significantly higher, while the total content of phospholipids was significantly decreased. There were high content of homologous tetramer protein containing heme in the PS of plateau zokors and plateau pikas. The relative content of DPPC, the main component of phospholipids, was significantly increased in plateau zokors. The changes of PS component and content improve the adaptability of the two plateau animals in hypoxia environment.


Subject(s)
Altitude , Animals , Hypoxia , Lagomorpha , Pulmonary Surfactants , Rats , Rats, Sprague-Dawley
11.
Acta Physiologica Sinica ; (6): 26-34, 2021.
Article in Chinese | WPRIM | ID: wpr-878232

ABSTRACT

Intermittent hypoxia (IH) could induce cognitive impairment through oxidative stress and inflammation. However, the degree of cell damage is closely related to the IH stimulus frequency. IH stimulation with different frequencies also induces opposite results on neuronal cell lines. Therefore, this study was aimed to compare the effects of IH stimulation with three different frequencies on murine hippocampal neuronal HT22 cell activity, and to explore the molecular mechanism of the IH stimulus frequency-related neuron injury. HT22 cells were cultured and divided into control group and three IH stimulation groups with different frequencies. Oxygen concentration in the chamber was circulated between 21% and 1% (IH1 group, 6 cycles/h; IH2 group, 2 cycles/h; IH3 group, 0.6 cycle/h). Cell morphology was observed at 6, 12, 24 and 48 h of IH treatment. Cell viability was determined by the CCK-8 kit, lactate dehydrogenase (LDH) content in cell supernatant was determined by LDH kit, oxidative stress level was detected by the reactive oxygen species (ROS) probe, and protein expression levels of hypoxia inducible factor-1α (Hif-1α) and phosphorylated nuclear factor κB (p-NF-κB) were detected by Western blot. The results showed that, compared with control group, cell number and activity in the three IH groups were decreased, LDH content and ROS levels were increased with the prolongation of IH stimulation time, and the changes were most obvious in the IH1 group among those of the three IH groups. Hif-1α expression and the p-NF-κB/NF-κB ratio were also up-regulated with the prolongation of IH stimulation time, and the changes of IH1 group were the most significant. These results suggest that IH stimulation induces oxidative stress injury in HT22 cells, which is related to increased Hif-1α expression and NF-κB phosphorylation. Moreover, the higher frequency of IH stimulation induces more serious cell injury.


Subject(s)
Animals , Cell Hypoxia , Cell Survival , Hypoxia , Hypoxia-Inducible Factor 1, alpha Subunit/genetics , Mice , NF-kappa B/metabolism , Oxidative Stress , Reactive Oxygen Species
12.
Rev. Hosp. Clin. Univ. Chile ; 32(1): 23-28, 2021. ilus, tab
Article in Spanish | LILACS | ID: biblio-1252717

ABSTRACT

Silent hypoxemia is one of the clinical presentations caused by SARS-CoV-2. It is still considered a medical mystery, as there are inconsistencies between arterial oxygen saturation levels and respiratory symptoms; a clinical scenario that had not been seen before. Their main risk is that it delays medical assistance because they do not have breathing difficulties and, when they consult, the lung damage is quite advanced. The early detection of hypoxia can favor the premature diagnosis of COVID-19 pneumonia and start treatment without delay. The pulse oximeter is presented as a useful, inexpensive, and easy-to-use tool for monitoring oxygen saturation at home in mild illness and detecting silent hypoxemia. This work presents the case of a patient with COVID-19 who, thanks to the use of a pulse oximeter at home, was able to detect silent hypoxemia and favored the early diagnosis of SARS-CoV-2 pneumonia. (AU)


Subject(s)
Humans , Female , Aged , Oximetry/trends , COVID-19/complications , Hypoxia/epidemiology , COVID-19/epidemiology , Hypoxia/diagnosis , Hypoxia/physiopathology
13.
Neumol. pediátr. (En línea) ; 16(3): 126-129, 2021. tab, ilus
Article in Spanish | LILACS | ID: biblio-1344717

ABSTRACT

El soporte ventilatorio no invasivo es una herramienta que ha demostrado mejorar la sobrevida de pacientes con falla muscular de la bomba respiratoria y el manejo de enfermedades pulmonares crónicas, incluso la ventilación no invasiva nocturna ha servido de puente hacia el trasplante pulmonar. Se presenta el caso de una adolescente de 14 años con enfermedad pulmonar crónica hipoxémica severa y falla ventilatoria secundaria, que requirió ventilación prolongada y traqueostomía en espera de trasplante pulmonar. Luego de reevaluar indemnidad de la vía aérea fue decanulada a soporte ventilatorio no invasivo, con uso alternado de mascarilla nasal nocturna y pieza bucal diurna, permitiendo descanso muscular respiratorio eficiente, y mejoría de flujo de tos con técnicas de apilamiento de aire. Este plan permitió una decanulación segura y realizar soporte continuo ventilatorio no invasivo con un programa de rehabilitación cardiorrespiratorio. Generalmente, el soporte ventilatorio no invasivo se utiliza en trastornos primarios de la bomba respiratoria. En este caso, se indicó para enfermedad pulmonar crónica hipoxémica, mostrando claros beneficios con oxigenación adecuada, buen rendimiento cardiovascular con mejor tolerancia al ejercicio y entrenamiento en el escenario de preparación al trasplante pulmonar.


Noninvasive Ventilatory Support has demonstrated to improve survival of patients with ventilatory pump muscle failure and nocturnal noninvasive ventilation is useful in chronic lung disease, even bridging to lung transplant. We present a 14 years old girl with severe hypoxemic chronic lung disease and secondary ventilatory failure, who required continuous long-term ventilation and underwent a tracheostomy waiting for lung transplant. After reevaluated the airway patency the patient was decannulated to Noninvasive Ventilation Support, alternating nocturnal nasal mask with diurnal mouth piece in order to provide efficient respiratory muscle rest, made air stacking and improved cough flow. This plan allows safe decannulation to continuous Noninvasive Ventilatory Support tailoring a rehabilitation cardiorespiratory program. Usually, Noninvasive Ventilation Support is prescribed for primary respiratory pump muscles failure, but in this case, it was applied for a hypoxemic chronic lung disease. Clear benefits were observed leading to appropriate oxygenation, good cardiovascular performance with better tolerance to exercise for training in the preparatory scenario of a lung transplant.


Subject(s)
Humans , Female , Adolescent , Respiratory Insufficiency/therapy , Lung Transplantation , Device Removal/methods , Noninvasive Ventilation/methods , Respiratory Insufficiency/diagnostic imaging , Preoperative Care/methods , Tracheostomy , Radiography, Thoracic , Ventilator Weaning , Tomography, X-Ray Computed , Chronic Disease , Hypoxia
14.
Rev. latinoam. enferm. (Online) ; 29: e3397, 2021. tab, graf
Article in English | LILACS, BDENF | ID: biblio-1150012

ABSTRACT

Objective: to describe scientific evidence regarding the use of prone positioning in the care provided to patients with acute respiratory failure caused by COVID-19. Method: this is a scoping review. PRISMA Extension for Scoping Reviews was used to support the writing of this study. The search was conducted in seven databases and resulted in 2,441 studies, 12 of which compose the sample. Descriptive statistics, such as relative and absolute frequencies, was used to analyze data. Results: prone positioning was mainly adopted in Intensive Care Units, lasted from a minimum of 12 up to 16 hours, and its prescription was based on specific criteria, such as PaO2/FiO2 ratio, oxygen saturation, and respiratory rate. The most prevalent complications were: accidental extubation, pressure ulcer, and facial edema. Decreased hypoxemia and mortality rates were the main outcomes reported. Conclusion: positive outcomes outweighed complications. Various cycles of prone positioning are needed, which may cause potential work overload for the health staff. Therefore, an appropriate number of trained workers is necessary, in addition to specific institutional protocols to ensure patient safety in this context.


Objetivo: descrever as evidências científicas acerca da utilização da posição prona na assistência ao paciente com insuficiência respiratória aguda provocada por COVID-19. Método: trata-se de uma scoping review. O instrumento PRISMA Extension for Scoping Reviews foi utilizado para a redação do estudo. As buscas foram realizadas em sete bases de dados, resultando em 2.441 estudos dos quais 12 compõem a amostra. Uma análise descritiva dos dados foi realizada empregando frequências relativas e absolutas. Resultados: a utilização da posição prona ocorreu principalmente em Unidades de Terapia Intensiva, com duração mínima de 12 a 16 horas, e teve como fundamentos de indicação critérios específicos, tais como a relação PaO2/FiO2, a saturação de oxigênio e a frequência respiratória. As complicações mais prevalentes da sua utilização foram: extubação acidental, lesão por pressão e edema facial. Identificou-se a redução da hipoxemia e da mortalidade como principais desfechos evidenciados na amostra. Conclusão: os desfechos positivos sobressaíram-se face às complicações. São necessários vários ciclos de pronação do paciente, fator causador de possível sobrecarga de trabalho da equipe de saúde. Portanto, são importantes um adequado dimensionamento dos profissionais, uma equipe treinada e protocolos institucionais específicos a fim de se garantir a segurança do paciente nesse contexto.


Objetivo: describir las evidencias científicas acerca de la utilización de la posición prona en la atención al paciente con insuficiencia respiratoria aguda provocada por COVID-19. Método: se trata de una revisión de escopo. El instrumento PRISMA Extension for Scoping Reviews fue utilizado para la redacción del estudio. Las búsquedas fueron realizadas en siete bases de datos, resultando en 2.441 estudios de los cuales 12 integran la muestra. Un análisis descriptivo de los datos fue desarrollado empleando frecuencias relativas y absolutas. Resultados: la utilización de la posición prona ocurrió principalmente en Unidades de Terapia Intensiva, con duración mínima de 12 a 16 horas, y tuvo como fundamentos de indicación criterios específicos, tales como la relación PaO2/FiO2, la saturación de oxígeno y la frecuencia respiratoria. Las complicaciones más frecuentes de su uso fueron: desintubación accidental, lesión por presión y edema facial. Se identificó la reducción de la hipoxemia y de la mortalidad como principales resultados evidenciados en la muestra. Conclusión: los resultados positivos se destacaran ante las complicaciones. Son necesarios varios ciclos de pronación del paciente, factor causante de una posible sobrecarga de trabajo del equipo de salud. Por lo tanto, son importantes un adecuado dimensionamiento de los profesionales, un equipo capacitado y protocolos institucionales específicos a fin de garantizar la seguridad del paciente en ese contexto.


Subject(s)
Patient Care Team , Respiratory Distress Syndrome , Respiratory Insufficiency , Respiratory Tract Infections , Prone Position , Coronavirus Infections , Pressure Ulcer , Edema , Alkalies , Equipment and Supplies , Airway Extubation , Critical Care Nursing , Intensive Care Units , Hypoxia
15.
Braz. j. med. biol. res ; 54(3): e10550, 2021. graf
Article in English | LILACS | ID: biblio-1153516

ABSTRACT

Hypoxia-induced apoptosis and inflammation play an important role in cardiovascular diseases including myocardial infarction (MI). miR-369 has been suggested to be a key regulator of cardiac fibrosis. However, the role of miR-369 in regulating hypoxia-induced heart injury remains unknown. Our data indicated that miR-369 expression was significantly down-regulated and TRPV3 was significantly up-regulated in myocardial tissue after MI in rats and in hypoxic-treated neonatal rat cardiomyocytes (NRCMs). In addition, we observed that hypoxia significantly promoted apoptosis and the inflammatory response, accompanied by increased caspase-3 activity and the secretion of the cytokines interleukin (IL)-6, IL-1β, and tumor necrosis factor (TNF)-α. miR-369 overexpression significantly suppressed cell apoptosis and inflammatory factor production triggered by hypoxia, whereas miR-369 inhibition had an opposite effect. Importantly, we identified TRPV3 as a direct target of miR-369-3p. TRPV3 inhibition with small interfering RNA (siRNA) significantly inhibited hypoxia-induced inflammation and apoptosis, which can reverse the injury effects of miR-369 inhibitors. Our findings indicated that miR-369 reduced hypoxia-induced apoptosis and inflammation by targeting TRPV3.


Subject(s)
Animals , Rats , Myocytes, Cardiac , Apoptosis , MicroRNAs , TRPV Cation Channels , Inflammation , Hypoxia
16.
Arch. argent. pediatr ; 118(5): e454-e462, oct 2020. tab, ilus
Article in English, Spanish | LILACS, BINACIS | ID: biblio-1122511

ABSTRACT

La pandemia por COVID-19 ha acaparado la atención mundial. Los distintos países se esfuerzan en optimizar recursos y brindar tratamientos efectivos en la medida que estos son avalados por la evidencia, con un ritmo de producción acorde a la urgencia. En el ámbito pediátrico, el COVID-19 acarrea una baja tasa de gravedad, en comparación con la población adulta. Un 6 % de los casos presentan una evolución grave, que se observa en los pacientes menores de 1 año de edad y/o con patologías subyacentes.Los enfoques terapéuticos en los pacientes pediátricos con COVID-19 no están claros. La escasa casuística en pediatría dificulta realizar recomendaciones en el paciente crítico que estén sustentadas en la evidencia. Esta revisión tiene como objetivo resumir las distintas publicaciones existentes sobre el curso de esta enfermedad y su tratamiento en los pacientes pediátricos críticamente enfermos


The COVID-19 pandemic has grabbed worldwide attention. The different national governments are making an effort to optimize resources and provide effective treatments inasmuch as they are supported by the evidence, at a rate of production in line with the pressing needs. In the field of pediatrics, COVID-19 has a low severity rate compared to the adult population. Approximately 6 % of cases present with a severe course, accounting for patients younger than 1 year and/or with underlying conditions.The therapeutic approach to pediatric patients with COVID-19 is unclear. The small number of pediatric cases hinders the possibility of making evidence-based recommendations for critically-ill patients. The objective of this review is to summarize the different current publications about the clinical course of COVID-19 and its management in critically-ill pediatric patien


Subject(s)
Humans , Male , Female , Infant , Child, Preschool , Child , Critical Illness , Coronavirus Infections , Betacoronavirus , Coronavirus Infections/drug therapy , Severe Acute Respiratory Syndrome , Airway Extubation , Personal Protective Equipment , Intubation, Intratracheal , Hypoxia/therapy
17.
Washington; Organización Panamericana de la Salud; ago 25, 2020. 28 p.
Non-conventional in Spanish | LILACS | ID: biblio-1117908

ABSTRACT

En el transcurso de la pandemia de COVID-19, numerosos países, de ingresos bajos, medianos y alto, han visto agotadas sus reservas de medicamentos esenciales necesarios para el manejo de los pacientes con COVID-19 en las unidades de cuidados intensivos (UCI). El plan de preparación para emergencias sanitarias de los países requiere incluir una lista de medicamentos esenciales y otros dispositivos médicos necesarios en las UCI para afrontar emergencias sanitarias. La lista de medicamentos esenciales para el manejo de pacientes que ingresan a unidades de cuidados intensivos con sospecha o diagnóstico confirmado de COVID-19 es un documento de orientación fundamental que ayuda a los sistemas de salud de los países a priorizar los medicamentos esenciales que deben estar ampliamente disponibles y ser asequibles para manejar los pacientes en las UCI durante las situaciones de emergencia sanitaria, en este caso con sospecha o diagnóstico confirmado de COVID-19. Está dirigida a las autoridades sanitaras y a los encargados del manejo del sistema de salud de los países. Esta lista incluye fundamentalmente los medicamentos considerados esenciales para el manejo de los cuadros clínicos que con se observan con mayor frecuencia en pacientes hospitalizados en UCI a causa de una infección por SARS-CoV-2. No se incluyen la mayoría de los medicamentos que comúnmente se encuentran en las UCI para el manejo de otras patologías, comorbilidades o la estabilización del paciente (p. ej., insulina o antihipertensivos), salvo aquellos que pueden requerirse para el tratamiento o apoyo (p. ej., bloqueantes neuromusculares o anestésicos) de las dolencias generadas por la infección. Tampoco se incluyen medicamentos específicos para el tratamiento de la infección por SARS-CoV-2, puesto que no existe, por el momento, evidencia científica de alta calidad que avale su uso, salvo en el contexto de ensayos clínicos controlados. Un equipo de expertos en el tema realizó una búsqueda de información sobre la atención de pacientes en UCI durante la pandemia de COVID-19, en Medline (a través de PubMed), Cochrane, Tripdatabase, Epistemonikos y en buscadores generales de internet (Google). Se identificaron también revisiones o guías generadas por ministerios de Salud de varios países de la Región de las Américas, la Organización Mundial de la Salud (OMS), la Organización Panamericana de la Salud (OPS), el Instituto Nacional de Salud y Excelencia Clínica (NICE) de Reino Unido, los Centros para el Control y la Prevención de Enfermedades (CDC) de Estados Unidos y los Institutos Nacionales de Salud (NIH) de Estados Unidos.


Subject(s)
Humans , Child , Adult , Pneumonia, Viral/drug therapy , Succinylcholine/therapeutic use , Antipsychotic Agents/therapeutic use , Benzodiazepines/therapeutic use , Patient Care Management/organization & administration , Dexamethasone/therapeutic use , Adrenal Cortex Hormones/therapeutic use , Coronavirus Infections/drug therapy , Drugs, Essential/supply & distribution , Dexmedetomidine/therapeutic use , Severe Acute Respiratory Syndrome/drug therapy , Antipyretics/therapeutic use , Pandemics/prevention & control , Betacoronavirus/drug effects , Haloperidol/therapeutic use , Analgesics, Opioid/therapeutic use , Intensive Care Units/organization & administration , Anti-Infective Agents/therapeutic use , Pneumonia, Viral/prevention & control , Respiration, Artificial/nursing , Shock, Septic/prevention & control , Thromboembolism/prevention & control , Coronavirus Infections/prevention & control , Evidence-Based Medicine , Intubation/nursing , Hypoxia/drug therapy
18.
Washington; Organización Panamericana de la Salud; Aug. 7, 2020.
Non-conventional in English, Spanish | LILACS, BRISA | ID: biblio-1118290

ABSTRACT

En este documento se presentan consideraciones técnicas y regulatorias para el uso de oxímetros de pulso como herramienta en el monitoreo clínico de pacientes con COVID-19. Asimismo, se resume la evidencia disponible sobre la eficacia, efectividad y seguridad de los diferentes tipos de oxímetros de pulso, sus limitaciones y recomendaciones de utilización. Está destinado a profesionales de la salud, así como a autoridades sanitarias y demás tomadores de decisiones sobre el uso de tecnologías sanitarias para la atención y cuidado de pacientes con COVID-19.


This document presents technical and regulatory considerations for the use of pulse oximeters as a tool in clinical monitoring of COVID-19 patients. It also summarizes available evidence on the efficacy, effectiveness, and safety of different types of pulse oximeters, their limitations, and recommendations for use. It is intended for health professionals, as well as health authorities and other decision makers responsible for health technologies for the care of COVID-19 patients.


Subject(s)
Humans , Pneumonia, Viral/complications , Oximetry/standards , Coronavirus Infections/complications , Hypoxia/diagnosis , Hypoxia/virology , Monitoring, Physiologic/standards
19.
Lima; IETSI; 9 jul. 2020.
Non-conventional in Spanish | LILACS, BRISA | ID: biblio-1119643

ABSTRACT

INTRODUCIÓN La hipoxemia, (una disminución anormal de la presión parcial de oxígeno en la sangre arterial por debajo de 60 mmHg), es una condición presente en diversas condiciones clínicas, incluyendo COVID-19. Para el tratamiento de la hipoxemia, se requiere la administración de oxígeno medicinal (también denominado oxígeno suplementario), gas que forma parte de la lista modelo de medicamentos esenciales de la Organización Mundial de la Salud (OMS). El oxígeno medicinal no solo tiene el objetivo de revertir la hipoxia tisular (daño fisiológico causado por falta de oxígeno en un determinado tejido) sino que también aumenta las probabilidades de sobrevida en pacientes afectados con esta condición. Por ello, la OMS señala que es necesario que en los establecimientos de salud se cuente con un suministro seguro de oxígeno, siendo necesario que figure en los presupuestos de asistencia sanitaria y exista en los establecimientos de salud (OMS 2016). En Perú, el oxígeno medicinal está considerado en el grupo de medicamentos denominados gases medicinales. La Dirección General de Medicamentos Insumos y Drogas (DIGEMID), señala que el oxígeno medicinal debe tener una concentración de entre 99 a 100 % de O2 (MINSA 2018). Sin embargo, en el contexto de la pandemia de COVID-19, se ha autorizado el uso del oxígeno medicinal de concentración no menor al 93 % (Presidente de la República 2020). Cabe precisar que la definición de oxígeno medicinal al 93 % contempla al oxígeno extraído del aire mediante un proceso de tamizado molecular (U.S. Pharmacopeia 2018). TECNOLOGÍA DE INTERÉS: La OMS señala que los concentradores de oxígeno representan una opción adecuada y favorable para suministrar oxígeno para el tratamiento de pacientes en países en desarrollo, especialmente cuando los cilindros y otros sistemas convencionales son inapropiados o no estén disponibles. También señala que los concentradores de oxígeno pueden ser considerados como una fuente de este gas medicinal aun disponiéndose de suministro de oxígeno por los métodos convencionales cuando el acceso a este gas pueda verse reducido por la falta de accesorios, suministro eléctrico y la escasez de personal calificado (OMS 2016). METODOLOGÍA: Se realizó una búsqueda sistemática de la literatura hasta el día 9 de julio de 2020 con respecto al uso de concentradores de oxígeno en el contexto de COVID-19. Para ello se emplearon las bases de datos bibliográficas: PubMed, Medline vía OVID y LILACS. Asimismo, se realizó una búsqueda manual avanzada en el motor de búsqueda Google, y en páginas web de sociedades o instituciones tales como: Organización Mundial de la Salud. RESULTADOS: Como resultado de la búsqueda, no se encontraron guías de práctica clínica, evaluaciones de tecnologías sanitarias, revisiones sistemáticas o estudios primarios que evalúen el uso de concentradores de oxígeno en el contexto de COVID-19. Tampoco se han publicado series que describan la experiencia de uso de este dispositivo médico en el contexto de la pandemia por COVID-19. A la fecha, se han publicado documentos técnicos de la OMS respecto al empleo de tecnologías sanitarias para suplir la necesidad de oxígeno en el tratamiento de pacientes con COVID-19 y una guía de la National Health Service del Reino Unido donde se describe al concentrador de oxígeno entre las alternativas de suministro de oxígeno para uso en pacientes con COVID-19 que requieren oxigenoterapia. CONCLUSIONES: En el contexto de la emergencia sanitaria nacional debido a la pandemia de COVID-19, la alta demanda de administración de oxígeno suplementario para la atención de un grupo rápidamente creciente de pacientes, impone la necesidad de explorar el uso de alternativas tecnológicas sanitarias que puedan servir como suministro de este gas en aras de resguardar la salud pública y la vida de la población. Así, se ha realizado el presente reporte breve el cual informa acerca del uso hospitalario de los concentradores de oxígeno, sus características tecnológicas y sus usos para oxigenoterapia, a la luz de la literatura técnica disponible al 9 de julio de 2020. De acuerdo con los documentos técnicos incluidos en el presente reporte breve, es razonable proponer que los concentradores de oxígeno constituyen una alternativa viable en entornos de escasos recursos o disponibilidad limitada de otras fuentes de oxígeno más avanzadas. Siendo que tienen una capacidad limitada de proveer flujos y concentraciones de oxígeno, la utilidad de este equipo médico estaría orientada principalmente para la oxigenoterapia de bajo flujo, la misma que debe ser prescrita por el equipo médico tratante de acuerdo con las necesidades del paciente.


Subject(s)
Humans , Oxygen Inhalation Therapy/methods , Coronavirus Infections/therapy , Hypoxia/etiology , Technology Assessment, Biomedical , Health Evaluation
20.
Rev. Hosp. Ital. B. Aires (2004) ; 40(2): 53-55, jun. 2020. ilus
Article in Spanish | LILACS | ID: biblio-1102484

ABSTRACT

Una de las características de la afección pulmonar por enfermedad por coronavirus (COVID-19) es la disociación entre la gravedad de la hipoxemia y el mantenimiento de una mecánica respiratoria relativamente conservada. En este contexto se ha establecido una teoría en relación con dos fenotipos de pacientes con síndrome de distrés respiratorio del adulto (SDRA): un fenotipo Low, caracterizado por baja elastancia y baja reclutabilidad, y un fenotipo High, con características de alta elastancia y alta reclutabilidad. Presentamos el caso de un paciente que cursó internación en la Unidad de Terapia Intensiva de Adultos de nuestro hospital, con clínica, mecánica ventilatoria y patrón tomográfico compatible con el fenotipo Low de SDRA por COVID-19. (AU)


Dissociation between severity of hypoxemia and relative preserved respiratory mechanics is a characteristic observed in lung impairment due to coronavirus disease (COVID-19). Patients with COVID-19 that present adult respiratory distress syndrome (ARDS) are identified for one of two phenotypes according to a theory recently established. The Low phenotype is distinguished by low elastance and low recruitability; and the High phenotype, by high elastance and high recruitability. The case describes a patient admitted in the adult Intensive Care Unit of Hospital Italiano de Buenos Aires with observed symptoms, ventilatory mechanics and tomographic pattern that are compatible with Low phenotype of ARDS due to COVID-19. (AU)


Subject(s)
Humans , Male , Middle Aged , Respiratory Distress Syndrome/microbiology , Coronavirus Infections/therapy , Phenotype , Respiratory Distress Syndrome/genetics , Respiratory Mechanics , Coronavirus Infections/diagnosis , Coronavirus Infections/physiopathology , Cough/etiology , Dyspnea/etiology , Fever/etiology , Hypertension/complications , Intensive Care Units , Hypoxia/physiopathology , Obesity/complications
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