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1.
Rev. bras. oftalmol ; 83: e0007, 2024. tab
Article in Portuguese | LILACS | ID: biblio-1535602

ABSTRACT

RESUMO Objetivo: Descrever as características clínico-epidemiológicas, técnicas cirúrgicas e resultado do tratamento das lacerações canaliculares operadas em nosso serviço. Métodos: Estudo retrospectivo, realizado de janeiro de 2012 a junho de 2020, considerando-se as lesões de canalículo lacrimal operadas em um serviço de referência. Dados demográficos, características das lesões, detalhes das cirurgias e resultado do tratamento foram obtidos de prontuários eletrônicos e analisados estatisticamente. Resultados: Foram incluídos 26 portadores de lesões canaliculares, com idade entre 2 e 71 anos, sendo 73,1% homens. A lesão acometia o canalículo superior em 53,9%; 80,8% pacientes procuraram pelo serviço nas primeiras 24 horas, e 46,2% tiveram a cirurgia realizada entre 24 e 72 horas após o traumatismo. Todos os pacientes tiveram intubação mono ou bicanalicular, e o tempo transcorrido entre a cirurgia e a retirada do silicone, variou de zero a 183 dias. Após a cirurgia, 21 pacientes (80,8%; p<0,05) não apresentaram complicações, 2 (7,7%) evoluíram com obstrução canalicular, 2 (7,7%) com granuloma e 1 (3,8%) com ectrópio de ponto lacrimal. Conclusão: As lesões de canalículo encontradas em nossa prática são mais comuns em crianças ou homens jovens, acometem mais o canalículo superior e as nossas condutas levam a sucesso no tratamento na maior parte dos casos. As grandes controvérsias no assunto persistem, como o tipo e o tempo de permanência do tubo de silicone na via lacrimal. Somente estudos com grandes amostras podem consolidar esses conceitos.


ABSTRACT Objective: To describe the clinical and epidemiological characteristics, surgical techniques, and results of the canalicular laceration treatment at our service. Methods: A retrospective study was carried out from January 2012 to June 2020, considering canalicular injuries operated at a reference center. Demographic data, lesion characteristics, surgical details, and treatment outcomes were obtained from electronic medical records and were statistically analyzed. Results: Twenty-six cases of people with canalicular lesions aged between 2 to 71 years old were included, of whom 73.1% were men. The superior canaliculus was affected in 53.9%; 80.8% of patients searched for care within the first 24 hours, and 46.2% had the surgery performed between 24-72 hours after trauma. All patients had mono or bicanalicular intubation and the time elapsed between surgery and silicone removal ranged from 0 to 183 days. After surgery, 21 patients (80.8%, p<0.05) did not present any complications, two (7.7%) evolved with canalicular obstruction, two (7.7%) with granuloma, and one (3.8 %) with lacrimal puncta ectropion. Conclusion: In our practice, canalicular injuries are more common in children or young men, affecting mainly the superior canaliculus, and treatment success using our approach can be achieved in most of the cases. However, great controversies remain on the subject, such as type of intubation and when to remove the silicone tube from the lacrimal pathway. Larger series are required to consolidate controversial concepts.


Subject(s)
Humans , Male , Female , Child, Preschool , Child , Adolescent , Adult , Middle Aged , Aged , Eye Injuries/surgery , Eye Injuries/epidemiology , Lacerations/surgery , Lacerations/epidemiology , Lacrimal Apparatus/surgery , Lacrimal Apparatus/injuries , Silicones , Sutures , Stents , Eye Injuries/diagnosis , Retrospective Studies , Lacerations/diagnosis , Electronic Health Records , Slit Lamp Microscopy , Intubation/methods
2.
Rev. cuba. cir ; 62(1)mar. 2023.
Article in Spanish | LILACS, CUMED | ID: biblio-1515265

ABSTRACT

Introducción: La rápida propagación del SARS­CoV­2 ha provocado una pandemia mundial. Si bien puede salvar vidas, la intubación traqueal presenta el riesgo inherente de inducir daño en la mucosa traqueal con estenosis, con una incidencia estimada de 4,9 casos por millón cada año. Objetivo: Caracterizar la presentación de una estenosis traqueal por intubación prolongada en un paciente que sufrió neumonía grave por coronavirus. Presentación del caso: Se asiste a un paciente de 55 años que sufrió neumonía grave por coronavirus y necesitó intubación orotraqueal prolongada. Una vez recuperado comienza con disnea de empeoramiento progresivo. Se diagnostica una estenosis traqueal y se decide tratamiento quirúrgico donde se realiza resección y anastomosis. El paciente no presentó complicaciones y evolucionó satisfactoriamente. Conclusiones: La estenosis traqueal debe reconocerse como una complicación potencial, aun cuando los pacientes se recuperan de una neumonía grave por COVID-19. El diagnóstico definitivo de estenosis traqueal se realiza mediante fibrobroncoscopia. La resección traqueal con anastomosis entre tráquea y tráquea es el procedimiento más comúnmente realizado(AU)


Introduction: The rapid spread of SARS-CoV-2 has resulted in a global pandemic. Although tracheal intubation can save lives, it presents the inherent risk of inducing tracheal mucosal damage with stenosis, with an estimated annual incidence of 4.9 cases per million. Objective: To characterize a case of tracheal stenosis due to prolonged intubation in a patient with severe coronavirus pneumonia. Case presentation: A 55-year-old patient who suffered severe coronavirus pneumonia and required prolonged orotracheal intubation was attended. Once recovered, the patient began with progressively worsening dyspnea. Tracheal stenosis was diagnosed and surgical treatment was decided, in which resection and anastomosis were performed. The patient did not present any complications and evolved satisfactorily. Conclusions: Tracheal stenosis should be recognized as a potential complication, even when patients recover from severe COVID-19 pneumonia. A definitive diagnosis of tracheal stenosis is made by fibrobronchoscopy. Tracheal resection with anastomosis between trachea is the most commonly performed procedure(AU)


Subject(s)
Humans , Male , Middle Aged , Tracheal Stenosis/diagnosis , COVID-19/epidemiology , Intubation/methods
3.
Audiol., Commun. res ; 28: e2692, 2023. tab
Article in Portuguese | LILACS | ID: biblio-1447429

ABSTRACT

RESUMO Objetivo comparar os marcadores de alteração na deglutição de pacientes com e sem COVID-19 e estudar as variáveis preditivas de contraindicação da alimentação por via oral em pacientes com necessidade de intubação orotraqueal prolongada. Métodos estudo caso-controle, retrospectivo, com coleta de prontuário de variáveis clínicas e demográficas e da avaliação clínica da deglutição. As variáveis coletadas foram comparadas estatisticamente entre pacientes com COVID-19 (grupo estudo -GE) e sem COVID-19 (grupo-controle - GC). A análise de regressão de robusta de Poisson foi utilizada para avaliar o efeito da COVID-19 e das demais variáveis na contraindicação da alimentação por via oral. Resultados foram incluídos 351 pacientes, 269 no GE e 82 no GC. Pacientes do GE apresentaram menor idade, quando comparados ao GC (50,7 ± 12,8). O tempo total de intubação orotraqueal foi significativamente maior no GE. Os pacientes do GE apresentaram maior prevalência de tosse fraca, disfonia, piores graus de disfagia e maior ocorrência de contraindicação da alimentação por via oral. Na análise bivariada, verificou-se que os pacientes com COVID-19 apresentaram 65% maior probabilidade dessa contraindicação. Entretanto, quando a COVID-19 foi ajustada com outras variáveis clínicas e demográficas, verificou-se que as estas apresentaram maior influência sobre a contraindicação de alimentação por via oral do que a COVID-19. Conclusão a intubação orotraqueal prolongada teve pior efeito nos marcadores de alteração na deglutição e na reintrodução da via oral de pacientes com COVID-19. A idade maior que 60 anos, tempo de intubação orotraqueal maior que cinco dias, reintubação e delirium demonstraram ser preditivas de contraindicação da alimentação por via oral em pacientes intubados.


ABSTRACT Purpose To compare the swallowing alteration markers in patients with and without COVID-19 and to study the predictive variables of oral feeding contraindication in patients requiring prolonged orotracheal intubation. Methods Retrospective case-control study, with medical record data collection of clinical and demographic variables and the clinical evaluation of swallowing. The collected variables were statistically compared between patients with COVID-19 (SG) and without COVID-19 (CG). Robust Poisson regression analysis was used to evaluate the effect of COVID-19 and other variables on oral feeding contraindication. Results 351 patients were included, 269 in the SG and 82 in the CG. Patients in the SG were younger when compared to the CG (50.7 ± 12.8). The total time of orotracheal intubation was significantly longer in the SG. The patients in the SG had a higher prevalence of weak cough, dysphonia, worse degrees of dysphagia and higher occurrence of contraindication of oral feeding. In the bivariate analysis, it was found that patients with COVID-19 were 65% more likely to have oral feeding contraindication. However, when COVID-19 was adjusted with other clinical and demographic variables, it was found that these variables had a greater influence on the contraindication of the oral feeding than the COVID-19. Conclusion Prolonged orotracheal intubation had a worse effect on alteration markers in swallowing and reintroduction of the oral feeding in COVID-19 patients. Age over 60 years, orotracheal intubation time greater than 5 days, reintubation, and delirium were shown to be predictive of oral feeding contraindication in intubated patients.


Subject(s)
Humans , Respiration, Artificial , Deglutition Disorders , COVID-19/therapy , Intubation/methods , Case-Control Studies , Critical Care , Intensive Care Units
5.
Braz. J. Anesth. (Impr.) ; 73(5): 563-569, 2023. tab
Article in English | LILACS | ID: biblio-1520350

ABSTRACT

Abstract Background and objectives: In this study, we aimed to determine the risk of obstructive sleep apnea (OSA) in patients undergoing elective surgery and its relationship with difficult intubation (DI). Methods: This prospective, descriptive, cross-sectional study was conducted between December 2018 and February 2020 in the anesthesiology and reanimation service of a training and research hospital. The study included patients who were ASA I-II, 18 years of age, and older who underwent elective surgery under general anesthesia. A form regarding the baseline characteristics of the participants as well as STOP-Bang score, Mallampati, and Cormack-Lehane classification was used to collect the data. Results: The study included 307 patients. It was determined that 64.2% of patients had a high risk of OSA. The presence of DI (determined by repeated attempts at intubation) was 28.6% in the high-risk OSA group, while there was no DI in the low-risk OSA group. A statistically significant difference was found between the groups in terms of OSA risk according to the presence of DI according to repeated attempts, Cormack-Lehane classification, and Mallampati classification (p < 0.001). Conclusion: Due to the high rate of DI in patients with a high risk of OSA, the security of the airway in these patients is endangered. Early clinical recognition of OSA can help in designing a safer care plan.


Subject(s)
Sleep Apnea, Obstructive , Intubation , Elective Surgical Procedures , Preoperative Period , Anesthesia, General
6.
Braz. J. Anesth. (Impr.) ; 73(5): 539-547, 2023. tab, graf
Article in English | LILACS | ID: biblio-1520353

ABSTRACT

Abstract Background: Clinical airway screening tests intend to predict difficult airways, but none have a high predictive value. Recent systematic reviews correlate ultrasound with difficult laryngoscopy. This study aimed primarily to correlate ultrasound measurements of anatomical upper airway structures in the sniffing position with difficult direct laryngoscopy. The secondary aim was to observe gender-based differences. Methods: This prospective, cross-sectional, single-center observational study included 209 patients requiring general anesthesia for elective surgery. Preoperatively, we performed six clinical airway assessments and three ultrasound measurements, which were the Distance from Skin to the Hyoid Bone (DSHB), to the Epiglottis (DSE), and to the anterior commissure of the vocal cords (DSAC) in a sniffing position. Benumof's criteria for the "best view at the first attempt" for direct laryngoscopy assessed the difficulty of laryngoscopy. Results: The distance from skin to the epiglottis was the best predictor of direct difficult laryngoscopy (defined as Cormack-Lehane grade > 2b) with a minimum thickness cut-off at 2.70 ± 0.19 cm (sensitivity 91.3%; specificity 96.9%). The skin to the hyoid bone distance cut-off was 1.41 ± 0.30 cm with moderate correlation (sensitivity 80.4%; specificity 60.1%). No correlation was found for the distance to the anterior commissure of the vocal cords. In women compared to men, the skin to the epiglottis distance was more sensitive (92.3% vs. 90.9%) and specific (98.8% vs. 95.2%). Conclusions: DSE in the sniffing position is the most reliable parameter for preoperative airway ultrasound assessment in the Caucasian population, with higher sensitivity and specificity in women, and might be considered as an independent predictor for direct difficult laryngoscopy.


Subject(s)
Airway Management , Intubation , Anesthesia , Ultrasonography , Laryngoscopy
7.
Ann. afr. méd. (En ligne) ; 16(4): 5282-5289, 2023. tables
Article in English | AIM | ID: biblio-1512205

ABSTRACT

Context and objective In intensive care units (ICU), clinicians have little information to identify COVID-19 patients at high risk of poor prognosis requiring intubation. Considering the clinical and biological parameters of the patients during their admission to ICU, we determined the incidence of a pejorative evolution requiring intubation, and secondarily we searched among the starting parameters, which were predictors of the intubation during follow-up Methods We conducted a monocentric retrospective cohort study of adult patients admitted for moderate, severe or critical COVID-19/WHO clinical classification, during the first two waves of the pandemic in Kinshasa/DR Congo. Our primary end point was the incidence of intubation. Potential predictors of intubation were determined by the Cox regression analysis. The relative risk of death was assessed according to treatment with mechanical ventilation. (intubation) Results We included 219 patients (average age of 56.8 ±15.2 years; 75 % men), respectively 37 % in the 1st and 63 % in the 2nd wave of the pandemic.Cumulative incidence of intubation was 24% (1stwave: 26% vs 2nd wave: 24%). One-third of intubations were performed on the first 3 days versus two-thirds beyond the third day. The Cox's regression model showed that among data from the 1st day of ICU admission, those predicting intubation were: age (Hazard ratio: 1.025, CI 95%: 1.005-1.044), obesity (HR: 4.808; CI 95%: 2.660-8.696), corticosteroid therapy (HR: 0.313, CI 95%: 0.102-0.965), ROX index < 4.88 (HR: 2.024, CI 95 %: 1.003-4.080) and black race (HR: 0.502, CI 95%: 0.272-0.928). In total, 54 deaths (25 % of patients) were recorded with a higher relative risk (18.8) in intubated patients. Conclusion A quarter of COVID-19 patients admitted to ICU could worsen and be intubated. The majority of intubations were performed after the third day of admission and mortality was high. The predictors of intubation that have been identified can help anticipate management by being proactive


Subject(s)
Humans , COVID-19 , Incidence , Intensive Care Units , Intubation
8.
MedUNAB ; 25(3): [492-498], 01-12-2022.
Article in Spanish | LILACS | ID: biblio-1436139

ABSTRACT

Introducción. El manejo de la vía aérea difícil anticipada es un reto anestésico que supone la valoración preoperatoria de las características anatómicas y los factores de riesgo específicos del paciente. La intubación difícil se presenta en 1.6 de 1,000 eventos y la intubación fallida en 0.06 de 1,000 eventos. El objetivo de este reporte es mostrar la importancia del uso de dispositivos (específicamente videolaringoscopio) en pacientes con predicción de vía aérea difícil. Presentación del caso. Hombre de 63 años con gran masa facial con extensión a nariz, labio superior, erosión a nivel del maxilar superior que ocupaba cavidad oral, con predictores de ventilación e intubación difícil, programado para rinectomía, osteotomía Lefort II, reconstrucción y traqueostomía, con intubación exitosa con videolaringoscopio en primer intento bajo sedación consciente y ventilación espontánea. Discusión. La vía aérea difícil es un escenario relacionado a factores externos e internos del paciente y a complicaciones pre e intraoperatorias. El videolaringoscopio es una herramienta útil que permite la intubación exitosa y disminuye los posibles eventos adversos (como se observó en el paciente del caso presentado) y es descrito en diferentes reportes de casos con compromiso parcial o total de la vía aérea. Conclusión. La videolaringoscopia, en casos de vía aérea difícil anticipada, está asociada con un menor tiempo de intubación, un buen perfil de seguridad y una alta tasa de éxito, comparable a la del fibrobroncoscopio, se logra la intubación en el primer intento en la mayoría de las veces y, por ello, debería considerarse como primera opción.


Introduction. Management of an anticipated difficult airway is an anesthetic challenge that involves preoperative assessment of the patient's specific anatomic characteristics and risk factors. Difficult intubation occurs in 1.6 of 1,000 events and failed intubation in 0.06 of 1,000 events. The objective of this report is to show the importance of the use of devices (specifically videolaryngoscope) in patients with predicted difficult airway. Case Presentation. 63-year-old man with large facial mass with extensión to the nose, upper lip, erosion at the level of the upper jaw occupying the oral cavity, with predictors of ventilation and difficult intubation, scheduled for rhinectomy, Lefort II osteotomy, reconstruction and tracheostomy, with successful intubation with videolaryngoscope on the first attempt under conscious sedation and spontaneous ventilation. Discussion. Difficult airway is a scenario related to external and internal patient factors and to pre- and intraoperative complications. The videolaryngoscope is a useful tool that allows successful intubation and decreases possible adverse events (as observed in the patient of the case presented) and is described in different reports of cases with partial or total airway compromise. Conclusion. Videolaryngoscopy, in cases of anticipated difficult airway, is associated with a shorter intubation time, a good safety profile and a high success rate, comparable to that of fibrobronchoscopy, intubation is achieved on the first attempt in most cases and should therefore be considered as a first choice.


Introdução. O manejo da via aérea difícil antecipada é um desafio anestésico que envolve a avaliação pré-operatória das características anatômicas e dos fatores de risco específicos do paciente. A intubação difícil ocorre em 1.6 de 1,000 eventos e a intubação falha em 0.06 de 1,000 eventos. O objetivo deste relato é mostrar a importância do uso de dispositivos (especificamente videolaringoscópio) em pacientes com previsão de via aérea difícil. Apresentação do caso. Homem de 63 anos com grande massa facial estendendo-se ao nariz, lábio superior e erosão ao nível do maxilar superior que ocupava a cavidade oral, com preditores de ventilação e intubação difícil, programado para rinectomia, osteotomia Lefort II, reconstrução e traqueostomia, com intubação bem-sucedida, com videolaringoscópio na primeira tentativa sob sedação consciente e ventilação espontânea. Discussão. A via aérea difícil é um cenário relacionado a fatores externos e internos do paciente e a complicações pré e intraoperatórias. O videolaringoscópio é uma ferramenta útil que permite o sucesso da intubação e reduz possíveis eventos adversos (como observado no paciente do caso apresentado) e está descrito em diversos relatos de casos com comprometimento parcial ou total da via aérea. Conclusão. A videolaringoscopia, em casos de via aérea difícil antecipada, está associada a um menor tempo de intubação, um bom perfil de segurança e uma alta taxa de sucesso, comparável à fibrobroncoscopia, a intubação é realizada na primeira tentativa na maioria dos casos e, portanto, deve ser considerada como a primeira opção.


Subject(s)
Airway Management , Laryngoscopy , Carcinoma, Squamous Cell , Intubation , Anesthesia
9.
Rev. colomb. neumol ; 34(2): 93-96, July-Dec. 2022.
Article in Spanish | LILACS, COLNAL | ID: biblio-1412942

ABSTRACT

Desde la aparición de la enfermedad por SARS-CoV-2, han cambiado paradigmas en la ciencia médica y actualmente nos enfrentamos a las repercusiones a largo plazo que algunos de los pacientes desarrollan. Entre el grupo de pacientes que han cursado con neumonía severa-síndrome de dificultad respiratoria aguda (SDRA) por SARS-CoV-2 y que requirieron intubación orotraqueal (IOT), se documentan complicaciones multisistémicas (1-4). En este artículo destacaremos las complicaciones relacionadas con la vía aérea que se presentan en forma de estenosis benignas, siendo las lesiones subglóticas tipo simples o complejas las más frecuentes. A continuación, presentamos el caso de un paciente que presentó estenosis traqueales pos-IOT a causa de una neumonía severa por COVID-19 con diagnóstico, seguimiento y manejo por un grupo multidisciplinario de vía aérea.


Since the appearance of SARSCoV-2 disease, paradigms have changed in medical science, and we are currently facing the long-term repercussions that some of the patients develop. Within the group of patients who have had severe pneumonia - Acute respiratory distress syndrome (ARDS) due to SARSCoV-2 and who required orotracheal intubation (OTI), multisystemic complications are documented (1-4), in In this article, we will highlight airway-related complications that occur in the form of benign stenosis, with simple or complex subglottic lesions being the most common. We present a case of a patient who presented tracheal stenosis post-OTI due to severe COVID-19 pneumonia as main diagnosis, follow-up, and management by a multidisciplinary airway group.


Subject(s)
Humans , Pneumonia , Tracheal Stenosis , Respiratory Distress Syndrome, Newborn , SARS-CoV-2 , COVID-19 , Intubation
10.
MedUNAB ; 25(2): 227-236, 2022/08/01.
Article in Spanish | LILACS | ID: biblio-1395961

ABSTRACT

Introducción. La neumonía nosocomial o neumonía adquirida en el hospital, es una causa importante de infección intrahospitalaria que conlleva una alta morbimortalidad. Ocurre a una tasa de 5 a 10 por cada 1,000 ingresos hospitalarios y se considera la causa más común de infección intrahospitalaria en Europa y Estados Unidos. Más del 90% de los episodios de neumonía que se desarrollan en las unidades de cuidados intensivos (UCI) ocurren en pacientes ventilados. El objetivo del presente estudio es describir la prevalencia y los factores asociados como estancia hospitalaria en UCI, enfermedades concomitantes y situaciones en pacientes mayores de 18 años con neumonía nosocomial con estancia en unidad de cuidados intensivos en una clínica de tercer nivel de la ciudad de Cali, en el periodo enero 2015 y enero 2016. Metodología. Estudio observacional de corte transversal con componente analítico. Se revisaron 353 historias clínicas enfocadas en los factores asociados de neumonía nosocomial en la UCI, con una estancia mayor o igual a 48 horas. El análisis estadístico se realizó con Epi Info versión 7. Resultados. La edad promedio de los casos estudiados fue de 55.17 años. La prevalencia estimada para neumonía nosocomial fue de 26%, con un promedio de estancia en UCI de 9.94 días, una desviación estándar de 8.30 días y días de ventilación mecánica invasiva de 4.27, con una desviación estándar de 7.38 días, en la cual el 26.35% (IC 95%: 22.0-31.1) adquirió neumonía nosocomial en UCI, el 43.06%: (IC 95%: 38.0-48.2) fueron mujeres, requiriendo de ventilación mecánica invasiva el 37.68% (IC 95%: 32.7-42.8). Como antecedentes patológicos de importancia se observó una asociación entre las variables con respecto a la neumonía nosocomial evidenciándose una relación significativa con diabetes mellitus (OR: 25.6; IC: 95% 13.4-48.7), enfermedad renal crónica (OR: 8.4; IC 95%: 4.49-16.0), enfermedad pulmonar obstructiva crónica (OR: 22.2; IC 95% 11.7-42.1), antecedente patológico de sinusitis (OR: 30.9; IC 95%: 7-46.2), utilización de sonda nasogástrica (OR: 13; IC 95%: 5-32) y, finalmente, al correlacionar la mortalidad con este tipo de infección pulmonar (OR: 26.1; IC 95%: 13 -49.1), evidenciando una relación entre las variables. Discusión. Los hallazgos muestran alta frecuencia de esta patología, lo que conlleva múltiples implicaciones en los pacientes como estancia prolongada y mortalidad, las cuales son condiciones que han sido identificadas por diferentes autores. Conclusiones. La neumonía nosocomial es un proceso infeccioso frecuente en la UCI, que tiene una alta morbimortalidad, relacionándose con los días de estancia y ventilación mecánica invasiva.


Introduction. Nosocomial pneumonia, or hospital-acquired pneumonia, is a significant cause of in-hospital infection that leads to high morbimortality. It occurs at a rate of 5 to 10 for every 1,000 hospital admissions and is considered the most common cause of in-hospital infection in Europe and the United States. Over 90% of episodes of pneumonia developed in intensive care units (ICUs) occur in ventilated patients. The objective of this study is to describe the prevalence and associated factors, such as hospitalization in the ICU, concomitant illnesses, and situations in patients older than 18 years of age with nosocomial pneumonia and hospital stay in an intensive care unit in a third-level clinic in the city of Cali, during the period between January 2015 and January 2016. Methodology. A cross-sectional, observational study with an analytical component. 353 medical records were reviewed, focusing on the factors associated with nosocomial pneumonia in the ICU, with hospital stay greater than or equal to 48 hours. The statistical analysis was performed with Epi Info version 7. Results. The average age of the studied cases was 55.17 years. The estimated prevalence for nosocomial pneumonia was 26%, with an average ICU hospital stay of 9.94 days and standard deviation of 8.30 days, and 4.27 days of invasive mechanical ventilation, with a standard deviation of 7.38 days, in which 26.35% (CI 95%: 22.0-31.1) acquired nosocomial pneumonia in the ICU. 43.06%: (CI 95%: 38.0-48.2) were women, of which 37.68% required invasive mechanical ventilation (CI 95%: 32.7-42.8). As an important pathological background, an association was observed between the variables with respect to nosocomial pneumonia, showing a significant relationship with diabetes mellitus (OR: 25.6; CI: 95% 13.4-48.7), chronic kidney disease (OR: 8.4; CI 95%: 4.49-16.0), chronic obstructive pulmonary disease (OR: 22.2; CI 95% 11.7-42.1), pathological backgrounds of sinusitis (OR: 30.9; CI 95%: 7-46.2), the use of nasogastric tube (OR: 13; CI 95%: 5-32) and, finally, correlating mortality with this type of pulmonary infection (OR: 26.1; CI 95%: 13-49.1), showing a relationship between the variables. Discussion. The findings show a high frequency of this pathology, which leads to multiple implications in patients, such as prolonged hospital stay and mortality, which are conditions that have been identified by different authors. Conclusions. Nosocomial pneumonia is a frequent infectious process in the ICU, which has a high morbimortality and is related to hospital stay and invasive mechanical ventilation.


Introdução. A pneumonia nosocomial, ou pneumonia adquirida no hospital, é uma importante causa de infecção hospitalar com alta morbidade e mortalidade. Ocorre a uma taxa de 5 a 10 por 1,000 internações hospitalares e é considerada a causa mais comum de infecção hospitalar na Europa e nos Estados Unidos. Mais de 90% dos episódios de pneumonia que se desenvolvem em unidades de terapia intensiva (UTIs) ocorrem em pacientes ventilados. O objetivo deste estudo é descrever a prevalência e fatores associados, como permanência hospitalar na UTI, doenças concomitantes e situações em pacientes maiores de 18 anos com pneumonia nosocomial internados em unidade de terapia intensiva de uma clínica de nível terciário da cidade de Cali, no período de janeiro de 2015 e janeiro de 2016. Metodologia. Estudo observacional transversal com componente analítico. Foram revisados 353 prontuários com foco em fatores associados de pneumonia nosocomial na UTI, com permanência maior ou igual a 48 horas. A análise estatística foi realizada com o Epi Info versão 7. Resultados. A média de idade dos casos estudados foi de 55.17 anos. A prevalência estimada para pneumonia nosocomial foi de 26%, com média de permanência na UTI de 9.94 dias, desvio padrão de 8.30 dias, e dias de ventilação mecânica invasiva de 4.27, com desvio padrão de 7.38 dias, em que 26.35% (IC 95%: 22.0-31.1) adquiriram pneumonia nosocomial na UTI; 43.06%: (IC 95%: 38.0-48.2) eram mulheres, necesitando de ventilação mecânica invasiva 37.68% (IC 95%: 32.7-42.8). Como antecedentes patológicos importantes, observou-se associação entre as variáveis referentes à pneumonia nosocomial, mostrando relação significativa com diabetes mellitus (OR: 25.6; IC: 95% 13.4-48.7), doença renal crônica (OR: 8.4; IC 95%: 4.49-16.0), doença pulmonar obstrutiva crônica (OR: 22.2; IC 95% 11.7-42.1), história patológica de sinusite (OR: 30.9; IC 95%: 7-46.2), uso de sonda nasogástrica (OR: 13; IC 95%: 5-32) e, por fim, correlação da mortalidade com este tipo de infecção pulmonar (OR: 26.1; IC 95%: 13-49.1), mostrando relação entre as variáveis. Discussão. Os resultados mostram uma alta frequência dessa patologia, que tem múltiplas implicações para os pacientes, como permanência prolongada e mortalidade, que são condições identificadas por diferentes autores. Conclusões. A pneumonia nosocomial é um processo infeccioso frequente na UTI, que apresenta alta morbimortalidade, relacionada aos dias de internação e ventilação mecânica invasiva.


Subject(s)
Pneumonia, Ventilator-Associated , Pneumonia , Respiration, Artificial , Cross Infection , Critical Care Outcomes , Intubation
11.
Nursing (Ed. bras., Impr.) ; 25(290): 8059-8068, julho.2022. tab
Article in English, Portuguese | LILACS, BDENF | ID: biblio-1379841

ABSTRACT

Objetivo: identificar o grau do conhecimento técnico e científico dos enfermeiros no procedimento intubação traqueal. Método: pesquisa de campo com caráter descritivo-exploratória e quantitativa tendo identificado, através do resultado de um questionário aplicado a 23 profissionais enfermeiros, em um Hospital Geral do Vale do Paraíba, o grau de conhecimento técnico e científico sobre o procedimento de intubação traqueal. A coleta dos dados foi realizada nos meses de setembro e outubro de 2021. Resultados: a enfermagem participa e desempenha papel importante no procedimento de intubação, desde os diagnósticos até a avaliação contínua dos principais sinais e sintomas, estabelecendo um plano de cuidados, intervenções e atividades que permitirão fornecer o melhor atendimento ao paciente. Conclusão: O conhecimento do enfermeiro durante o procedimento de intubação traquel é de extrema importância, visando a qualidade da assistência, e a segurança do paciente.(AU)


Objective: To identify the degree of technical and scientific knowledge of nurses in the tracheal intubation procedure. Method: descriptive-exploratory and quantitative field research, having identified, through the result of a questionnaire applied to 23 nursing professionals, in a General Hospital of the Paraíba Valley, the degree of technical and scientific knowledge about the tracheal intubation procedure. Data were collected in September and October 2021. Results: nursing participates and plays an important role in the intubation procedure, from diagnoses to continuous evaluation of the main signs and symptoms, establishing a care plan, interventions and activities that will allow providing the best patient care. Conclusion: The knowledge of nurses during the traquel intubation procedure is extremely important, aiming at the quality of care, and patient safety.(AU)


Objetivo: identificar el grado de conocimiento técnico y científico de las enfermeras en el procedimiento de intubación traqueal. Método: investigación de campo descriptiva-exploratoria y cuantitativa, habiendo identificado, a través del resultado de un cuestionario aplicado a 23 profesionales de enfermería, en un Hospital General del Valle de Paraíba, el grado de conocimiento técnico y científico sobre el procedimiento de intubación traqueal. Los datos fueron recolectados en septiembre y octubre de 2021. Resultados: La enfermería participa y juega un papel importante en el procedimiento de intubación, desde el diagnóstico hasta la evaluación continua de los principales signos y síntomas, estableciendo un plan de cuidados, intervenciones y actividades que permitan brindar la mejor atención al paciente. Conclusión: El conocimiento de las enfermeras durante el procedimiento deintubación de traquel es extremadamente importante, apuntando a la calidad de la atención y la seguridad del paciente.(AU)


Subject(s)
Respiratory Insufficiency , Nursing , Education, Continuing , Intubation
12.
ABCS health sci ; 47: e022231, 06 abr. 2022. tab
Article in English, Portuguese | LILACS | ID: biblio-1402550

ABSTRACT

INTRODUÇÃO: In Intensive Care Units, oral hygiene is a care action directly related to the safety and well-being of the patient, being one of the main ways of preventing Pneumonia Associated with Mechanical Ventilation. Although relevant, the recommendations and standardization on oral hygiene among critically ill patients are diffuse. OBJECTIVE: To construct and validate a standard operating procedure (SOP) for oral hygiene performed by the nursing team for intubated and tracheostomized patients in an Intensive Care Unit (ICU). METHODS: Methodological study developed in five stages: technical-scientific support; construction of SOP; recruitment and selection of experts; validation and presentation of the final version. The SOP was subjected to validation by judges with academic and/or clinical expertise (n=13) from all regions of Brazil, who assessed the validity criteria for each SOP item: Scope, Clarity, Coherence, Criticism, Objectivity, Scientific writing; Relevance, Sequence, and Uniqueness. The Content Validity Indices (CVI) of each validity criterion, SOP item, and the general CVI were calculated. RESULTS: The experts were nurses (38.5%), dentists (38.5%), doctors (15.4%) and physiotherapists (7.7%). None of the SOP items had a CVI lower than 0.80. The general CVI was 0.95 and the experts' suggestions were mostly accepted (78.6%). The final version is available as an infographic, which illustrates the stages of the oral hygiene process of the intubated and tracheostomized patient. CONCLUSION: The constructed SOP has a satisfactory face and content validity, making a final total of 43 items to be used for oral hygiene of intubated and tracheostomy patients.


INTRODUÇÃO: Em Unidades de Terapia Intensiva, a higienização bucal é ação de cuidado diretamente relacionada à segurança do paciente e qualidade do cuidado, sendo uma das principais formas de prevenção da Pneumonia Associada à Ventilação Mecânica. Apesar disso, as recomendações e a padronização sobre a higienização bucal entre pacientes críticos são difusas. OBJETIVO: Construir e validar um procedimento operacional padrão (POP) para higiene bucal realizada pela enfermagem a pacientes intubados e traqueostomizados em Unidade de Terapia Intensiva (UTI). MÉTODOS: Estudo metodológico desenvolvido em cinco etapas: subsídio técnico-científico; construção do POP; recrutamento e seleção de experts; validação de face e conteúdo do POP e apresentação da versão final. O POP foi submetido à validação por juízes com expertise acadêmica e/ou clínica (n=13) de todas as regiões do Brasil, os quais apreciaram os critérios de validade: Abrangência, Clareza, Coerência, Criticidade, Objetividade, Redação científica; Relevância, Sequência e Unicidade. Foram calculados os Índices de Validade de Conteúdo (IVC) de cada critério, item do POP e o IVC geral. RESULTADOS: Os experts eram enfermeiros(as) (38,5%), cirurgiãs-dentistas (38,5%), médicos(as) (15,4%) e fisioterapeuta (7,7%). Nenhum item do POP obteve IVC inferior a 0,80. O IVC geral foi de 0,95 e sugestões dos experts foram majoritariamente acatadas (78,6%). A versão final, disponível como infográfico, contempla ilustrativamente as etapas do processo de higienização bucal do paciente intubado e traqueostomizado. CONCLUSÃO: O POP alcançou validade de face e conteúdo satisfatória. A versão validada possui 43 itens processuais para higiene bucal de pacientes intubados e traqueoestomizados.


Subject(s)
Humans , Male , Female , Adult , Oral Hygiene , Tracheostomy , Clinical Protocols , Pneumonia, Ventilator-Associated/therapy , Intensive Care Units , Intubation , Patient Safety
13.
Rev. epidemiol. controle infecç ; 12(1): 32-40, jan.-mar. 2022. ilus
Article in English, Portuguese | LILACS | ID: biblio-1417216

ABSTRACT

Background and objectives: during orotracheal intubation (OTI), it occurs the exposure to COVID-19 aerosols and consequent contamination of the professionals involved, observing the need to apply preventive measures. The objective is to know, in the scientific literature, which are the main preventive measures for health professionals to aerosols generated during OTI of patients suspected or confirmed for COVID-19. Contents: this is an integrative review, with search in the LILACS, SciELO, BDENF, MEDLINE, PubMed and Cochrane Wiley databases. Primary articles, with full text in Portuguese, Spanish and English, which contemplated the research objective, were selected. Of the 335 articles found, 22 were selected according to the inclusion criteria. In 18 (82%) of articles, they highlighted the use of barrier methods when performing the intubation procedure, such as acrylic box and plastic tarpaulin. In other studies (3; 14%), it was observed the need to include qualified intubation teams in hospital institutions to reduce the contamination of professionals, in addition to the application of checklists that guide the procedure. A single article brought the use of an orthopedic protective cover adapted to protect the intubator. Conclusion: the measures are defended to reduce exposure to aerosols and allow the safety of health professionals. The use of an intubation box must be used with caution, weighing the risks and benefits against the possibility of aerosolization during its use in orotracheal intubation.(AU)


Justificativa e objetivos: durante a intubação orotraqueal (IOT), ocorre a exposição a aerossóis de COVID-19 e consequente contaminação dos profissionais envolvidos, observando a necessidade de aplicação de medidas preventivas. O objetivo é conhecer, na literatura científica, quais são as principais medidas preventivas dos profissionais de saúde aos aerossóis gerados durante a IOT de pacientes suspeitos ou confirmados para COVID-19. Conteúdo: trata-se de uma revisão integrativa, com busca nas bases de dados LILACS, SciELO, BDENF, MEDLINE, PubMed e Cochrane Wiley. Foram selecionados artigos primários, com texto completo em português, espanhol e inglês, que contemplassem o objetivo da pesquisa. Dos 335 artigos encontrados, 22 foram selecionados de acordo com os critérios de inclusão. Em 18 (82%) dos artigos, destacaram o uso de métodos de barreira na realização do procedimento de intubação, como caixa de acrílico e lona plástica. Em outros estudos (3; 14%), observou-se a necessidade de incluir equipes de intubação qualificadas nas instituições hospitalares para reduzir a contaminação dos profissionais, além da aplicação de checklists que orientam o procedimento. Um único artigo trouxe o uso de uma capa protetora ortopédica adaptada para proteger o intubador. Conclusão: defendem-se as medidas para reduzir a exposição aos aerossóis e permitir a segurança dos profissionais de saúde. O uso da caixa de intubação deve ser feito com cautela, ponderando os riscos e benefícios em relação à possibilidade de aerossolização durante seu uso na intubação orotraqueal.(AU)


Justificación y objetivos: durante la intubación orotraqueal (OTI), ocurre la exposición a los aerosoles de COVID-19 y la consecuente contaminación de los profesionales involucrados, observándose la necesidad de aplicar medidas preventivas. El objetivo es conocer, en la literatura científica, cuáles son las principales medidas preventivas de los profesionales de la salud ante los aerosoles generados durante las IOT de pacientes sospechosos o confirmados de COVID-19. Contenido: se trata de una revisión integradora, con búsqueda en las bases de datos LILACS, SciELO, BDENF, MEDLINE, PubMed y Cochrane Wiley. Fueron seleccionados artículos primarios, con texto completo en portugués, español e inglés, que contemplaran el objetivo de la investigación. De los 335 artículos encontrados, 22 fueron seleccionados según los criterios de inclusión. En 18 (82%) de los artículos, destacaron el uso de métodos de barrera al realizar el procedimiento de intubación, como caja de acrílico y lona plástica. En otros estudios (3; 14%), se observó la necesidad de incluir equipos de intubación calificados en las instituciones hospitalarias para reducir la contaminación de los profesionales, además de la aplicación de listas de verificación que orientan el procedimiento. Un solo artículo trajo el uso de una cubierta protectora ortopédica adaptada para proteger al intubador. Conclusión: se defienden las medidas para reducir la exposición a los aerosoles y permitir la seguridad de los profesionales de la salud. El uso de una caja de intubación debe hacerse con precaución, sopesando los riesgos y beneficios frente a la posibilidad de aerosolización durante su uso en la intubación orotraqueal.(AU)


Subject(s)
Humans , COVID-19 , Respiratory Aerosols and Droplets , Intubation
14.
Bol. malariol. salud ambient ; 62(3): 428-435, 2022. tab, graf
Article in Spanish | LILACS, LIVECS | ID: biblio-1395993

ABSTRACT

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


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


Subject(s)
Humans , Male , Female , Adolescent , Adult , Middle Aged , Aged , Prognosis , Respiratory Distress Syndrome, Newborn , Critical Illness , COVID-19/complications , Oxygen Saturation , Patients , Respiration, Artificial , Oxygenation , Cross-Sectional Studies , Risk Factors , Intubation
15.
Rev. chil. fonoaudiol. (En línea) ; 21(1): 1-10, 2022. tab
Article in Spanish | LILACS | ID: biblio-1437123

ABSTRACT

Estudios previos han caracterizado la disfagia en pacientes críticos hospitalizados que requieren intubación y ventilación mecánica invasiva. A raíz de la pandemia COVID-19 es necesario conocer las características deglutorias de pacientes diagnosticados con la enfermedad para su manejo. El objetivo de este estudio es analizar las características deglutorias de pacientes críticos extubados con y sin diagnóstico de COVID-19. Se llevó a cabo un estudio de cohorte retrospectivo con una muestra a conveniencia de 43 sujetos mayores de 15 años, ingresados al Hospital San Juan de Dios (Santiago, Chile) entre el 01 de junio y el 31 de agosto de 2020, intubados con o sin diagnóstico de COVID-19. Del total de sujetos, 22 padecieron de COVID-19 quienes estuvieron significativamente más días intubados que aquellos sin la patología (p=0,002). Inmediatamente posterior a la extubación orotraqueal, más del 90% de la muestra presentó disfagia. No hubo diferencia significativa en el nivel FILS ni asociación significativa en el grado de severidad de la disfagia entre sujetos con y sin COVID-19. Tampoco hubo diferencia significativa en el nivel FILS entre los grupos a los 10 días post-extubación. El nivel FILS a los 10 días aumentó significativamente en aquellos sujetos con COVID-19 (p=0,016) y sin COVID-19 (p=0,004). En la muestra, el nivel FILS y grado de severidad de la disfagia de los pacientes con y sin COVID-19 no mostraron diferencias estadísticas, siendo alto el porcentaje de disfagia en ambos grupos, lo que se podría asociar a la intubación orotraqueal y al tubo orotraqueal. Es necesaria la incorporación del fonoaudiólogo dentro de los equipos de Unidades de Pacientes Críticos para el manejo de los pacientes con COVID-19 y disfagia. Además, se recomienda continuar con más estudios en el área.


Previous research have described the deglutition disorders in critical hospitalised patients who required intubation and mechanical ventilation. In the pandemic context, it is mandatory to study both level and grade of dysphagia in patients suffering from COVID-19. The aim of this study is to analyse the deglutition features of extubated critical patients with and without COVID-19. A retrospective cohort study was performed, considering a convenience sample of 43 patients from 15 years old hospitalised at 'Hospital San Juan de Dios' between June 1st and August 31th 2020, who were intubated, with and without the diagnosis of COVID-19. 22of out 43 patients were diagnosed with COVID-19 who were intubated for significantly more days in comparison with those without COVID-19 (p=.002). After the intratracheal extubation, 90% of the sample was diagnosed with dysphagia. There was no significant difference in the FILS score nor significant association in dysphagia severity between patients with and without COVID-19. After 10 days post extubation, there was no significant difference in the FILS score between both groups. The FILS score increased significantly in the COVID-19 (p=.016) and non-COVID-19 (p=.004) patients after 10 days post extubation. Post extubation, there are no statistical differences in the FILS score and dysphagia severity in critical ill patients with and without COVID-19, with a high percentage of dysphagia in both groups which could be associated with intratracheal intubation and endotracheal tubes. The incorporation of speech and language therapists in Critical Care Units is mandatory. Furthermore, it is recommended to perform extra research in the area.


Subject(s)
Humans , Male , Female , Adult , Middle Aged , Aged , Aged, 80 and over , Deglutition Disorders/diagnosis , Deglutition Disorders/etiology , Deglutition Disorders/physiopathology , Airway Extubation/adverse effects , COVID-19/complications , Respiration, Artificial/adverse effects , Severity of Illness Index , Retrospective Studies , Critical Illness , Deglutition , COVID-19/therapy , Intubation/adverse effects
16.
Rev. cienc. cuidad ; 19(2): 84-98, 2022.
Article in Spanish | LILACS, BDENF, COLNAL | ID: biblio-1373532

ABSTRACT

Objetivo: Determinar las complicaciones detalladas de traqueotomías asociadas a intuba-ciones prolongadas en el adulto. Metodología: Revisión sistemática de los 5 años anteriores con base en los lineamientos PRISMA. Se recurrió a las bases de datos Scopus, Web of Sci-ence, Taylor and Francis y el Portal Regional de la Biblioteca Virtual en Salud. Además, se seleccionó la información a través de palabras clave, tales como: traqueotomía, intubación prolongada, UCI, adulto, complicaciones. Las publicaciones estaban en idioma español e inglés. La información se catalogó según criterios de inclusión y exclusión. Análisis: 24 artículos fueron elegidos. El momento de la traqueotomía (TQ) por intubación prolongada sigue siendo incierto. La TQ temprana demostró mayores beneficios que la TQ tardía. La TQ percutánea demostró menores tasas de estancia en la UCI y en los hospitales, con menos com-plicaciones. La hemorragia y la desaturación fueron complicaciones registradas asociadas a TQ tardía. Conclusión: La TQ percutánea fue la que se eligió en la mayoría de casos por ser eficaz, rápida y segura; además, disminuye la estancia hospitalaria y en la UCI, con menos complicaciones. Se debe precisar que en la mayoría de las publicaciones, al menos uno de estos beneficios no alcanzó significancia estadística. La complicación con mayor frecuencia fue la hemorragia en el sitio de punción


Objective: To determine the detailed complications of tracheotomies associated with pro-longed intubation in adults. Methodology: Systematic review of the previous 5 years based on PRISMA guidelines. The databases Scopus, Web of Science, Taylor and Francis and the Regional Portal of the Virtual Health Library were used to select information through key-words tracheotomy, prolonged intubation, ICU, adult, complications; the publications were in Spanish and English. The information was catalogued according to inclusion and exclusion criteria. Analysis: 24 articles were selected. The timing of tracheostomy (TQ) for prolonged intubation remains uncertain. Early TQ showed greater benefits than late TQ. Percutane-ous TQ demonstrated lower rates of ICU stay, hospital stay, and complications. Hemorrhage and desaturation were mostly reported complications associated with late TQ. Conclusion: Percutaneous TQ was the TQ of choice in most cases because it is effective, fast and safe, decreases hospital stay, ICU and complication rate, most publications at least one of these benefits did not reach statistical significance. The most frequent complication was bleeding at the puncture site


Objetivo: Determinar as complicações detalhadas da traqueostomia associadas à entubação prolongada em adultos. Metodologia: Revisão sistemática dos 5 anos anteriores com base nas diretrizes do PRISMA. As bases de dados Scopus, Web of Science, Taylor e Francis e o Portal Regional da Biblioteca Virtual em Saúde foram usadas para selecionar informações usando palavras-chave traqueostomia, intubação prolongada, UTI, adulto, complicações; as publicações foram em espanhol e inglês. As informações foram catalogadas de acordo com critérios de inclusão e exclusão. Análise: 24 artigos foram selecionados. O momento da traqueostomia (TQ) para entubação prolongada permanece incerto. O TQ precoce demon-strou maior benefício do que o TQ tardio. A TQ percutânea demonstrou taxas mais baixas de internação na UTI, internação hospitalar e complicações. A hemorragia e a dessaturação foram as complicações mais comumente relatadas associadas à TQ tardia. Conclusão: O TQ percutâneo foi o TQ de escolha na maioria dos casos, pois é eficaz, rápido e seguro, diminui a permanência hospitalar, a UTI e a taxa de complicações, a maioria das publicações pelo menos um desses benefícios não alcançou significância estatística. A complicação mais fre-qüente era o sangramento no local da punção


Subject(s)
Tracheotomy , Respiration, Artificial , Adult , Intensive Care Units , Intubation
17.
Fisioter. Bras ; 22(4): 536-549, Nov 2, 2021.
Article in Portuguese | LILACS | ID: biblio-1353378

ABSTRACT

A ventilação mecânica (VM) é um recurso frequentemente utilizado na Unidade de Terapia Intensiva (UTI). No entanto, a necessidade de reintubação após a retirada do suporte ventilatório está associada a desfechos desfavoráveis. Os objetivos deste estudo foram identificar possíveis fatores de risco e desfecho clínico de pacientes reintubados na UTI de um hospital referência em trauma. Foi realizado um estudo de coorte prospectivo no período de 4 meses com pacientes adultos internados na UTI e que permaneceram em VM por pelo menos 24 horas. A amostra foi composta por 100 pacientes divididos em grupo de pacientes não reintubados e pacientes que cursaram com necessidade de retornar à VM. Foram reintubados 27 pacientes, 18 deles reintubados em até 48 horas após extubação. A idade, diabetes, obesidade, tempo de VM até a extubação e frequência respiratória (FR) foram variáveis que apresentaram diferença estatisticamente significativa entre grupos (p < 0,05), porém não puderam ser apontadas como fatores de risco independentes de retorno à ventilação. A reintubação foi associada à necessidade de traqueostomias (TQT) (p < 0,001), maior tempo de permanência em VM (p < 0,001), internação prolongada na UTI (p < 0,001) e mortalidade (p < 0,005). Idade, presença de diabetes, obesidade, maior tempo de VM e FR pré-extubação mais elevada foram as variáveis relacionadas à reintubação. Este evento foi diretamente associado a piores desfechos como necessidade de TQT, maior dependência de VM, internação prolongada na UTI e mortalidade. (AU)


Subject(s)
Humans , Ventilation , Airway Extubation , Respiration, Artificial , Tracheostomy , Risk Factors , Intubation
18.
Rev. Méd. Inst. Mex. Seguro Soc ; 59(5): 423-430, oct. 2021. ilus, tab, graf
Article in Spanish | LILACS | ID: biblio-1357991

ABSTRACT

Introducción: el SARS-CoV-2 fue notificado por la Organización Mundial de la Salud en enero de 2020 como emergencia mundial debido a su intenso contagio y cuadro clínico, que se agrava en personas susceptibles. Objetivo: describir factores asociados a defunción en pacientes con COVID-19 y neumonía hospitalizados en tercer nivel.Material y métodos: estudio de casos y controles no pareado. Se obtuvo información general mediante entrevista; del expediente se tomaron datos de hospitalización, imágenes radiológicas, parámetros de laboratorio y tratamientos. Se empleó estadística descriptiva, t de student, U de Mann-Whitney y chi cuadrada para identificar variables asociadas a defunción, y modelos de regresión logística binaria ajustada para proponer variables de antecedentes del paciente, parámetros clínicos y tratamientos que explicaran la defunción.Resultados: atendimos 5339 pacientes sospechosos de COVID-19: 3117 positivos (59%), 1029 hospitalizados por neumonía y 513 defunciones (16.46%). Para el análisis, se tomaron 1110, se seleccionaron 399 casos de defunción y 357 controles egresados por mejoría. La edad promedio fue 57.8 años; 59% fueron hombres. La estancia hospitalaria en casos fue 9.8 (DE 10.9) y en controles 12.5 (DE 10.2).Conclusiones: las variables asociadas a mortalidad fueron: mayores de 40 años, radiografía de tórax > 50% de afectación, intubación, deshidrogenasa láctica > 500, proteína C reactiva > 10 e insuficiencia orgánica; las asociadas a mejoría: estancia en unidad de cuidados intensivos, uso de antibióticos parenterales de amplio espectro, esteroides y anticoagulante enoxiheparina. El sexo, la diabetes y las comorbilidades no mostraron asociación.


Background: SARS-CoV-2 virus was notified by the World Health Organization in January 2020 as a global emergency, due to its intense transmission, and the clinical picture, that is aggravated in susceptible people.Objective: To describe the factors associated with death in COVID-19 and pneumonia patients hospitalized in a third-level center. Material and methods: An undivided case-control study was conducted. It was conducted an interview to obtain general information; from the medical record were collected hospitalization data, radiological images, laboratory parameters, and treatments used. It was used descriptive statistics. Student's t, Mann-Whitney U, and chi-squared were used to identify variables associated with death, and models of adjusted binary logistic regression to propose which variables of the patient's history, clinical parameters and treatments explained the death. Results: We treated 5339 patients with suspicion of COVID-19: 3117 positive (59%), 1029 hospitalized due to pneumonia, and 513 deaths (16.46%). For the analysis, 1110 patients were taken, 399 death cases were selected and 357 controls discharged due to improvement. The average age was 57.8 years; 59% were male. The hospital stay in cases was 9.8 (SD 10.9), and in controls 12.5 (SD 10.2). Conclusions: The variables associated with mortality were: patients older than 40 years, chest radiography image > 50% involvement, intubation, lactic dehydrogenase > 500, C-reactive protein > 10, and organ failure; variables associated with improvement were: stay in the intensive care unit, use of broad spectrum parenteral antibiotics, steroids, and use of the anticoagulant enoxyheparin. Sex, diabetes, and comorbidities did not show significant association.


Subject(s)
Humans , Male , Female , Pneumonia , Case-Control Studies , Mortality , SARS-CoV-2 , COVID-19 , Association , Logistic Models , Medical Records , Emergencies , Hospitalization , Intensive Care Units , Intubation , Mexico
19.
Rev. medica electron ; 43(4): 1056-1068, 2021. graf
Article in Spanish | LILACS, CUMED | ID: biblio-1341535

ABSTRACT

RESUMEN El manejo de la vía respiratoria es uno de los aspectos más importantes en Anestesia. Entre el 50 y 70 % de los paros cardiacos durante la anestesia general obedecen a dificultades en la intubación. Los pacientes obesos tienen un 30 % más de probabilidades de presentar intubación difícil con respecto a pacientes normopesos. También desarrollan desaturación de oxígeno más rápido, lo que aumenta el riesgo de complicaciones. Teniendo en cuenta lo anterior, se decidió realizar este trabajo, con el objetivo de actualizar sobre el uso de los métodos para el abordaje de la vía respiratoria en dichos pacientes. Se mostraron los criterios y resultados de investigaciones de autores sobre el tema. Se concluye que, a pesar de que el método más utilizado para abordar la vía aérea en obesos es la intubación orotraqueal con visión directa, se debe considerar el uso de máscara laríngea de intubación, fibroscopio flexible y videolaringoscopios, sobre todo en personas superobesas (AU).


ABSTRACT The respiratory tract management is one of the most important topics in anesthesia. Between 50 and 70 % of the heart arrests occurring during general anesthesia are due to intubation difficulties. Obese patients are 30 % more likely of presenting difficult intubation with respect to normal weight patients. They also develop oxygen desaturation faster, increasing the complication risk. Taking into consideration the above reasons, the authors decided to write this article, with the aim of updating on the methods to approach the respiratory tract in those patients. The authors' criteria and research outcomes on the theme are showed. It was concluded that even though the most used method to approach the airway in obese patients is the orotracheal intubation with direct vision, the use of a laryngeal intubation mask, flexible fiberscope and video laryngoscopes should be considered, especially in superobese patients (AU).


Subject(s)
Humans , Male , Female , Airway Management/methods , Obesity/complications , Laryngeal Masks/standards , Intubation/methods , Anesthesia/methods , Obesity/metabolism
20.
Alerta (San Salvador) ; 4(3): 108-103, jul. 29, 2021. ilus
Article in Spanish | LILACS, BISSAL | ID: biblio-1282080

ABSTRACT

La intubación submentoniana es útil en procedimientos quirúrgicos en donde la intubación nasotraqueal está contraindicada y la intubación orotraqueal no es ideal debido a la fijación intermaxilar. Este informe describe dos pacientes masculinos que se presentaron al Hospital Nacional Rosales, en el servicio de Cirugía Maxilofacial de El Salvador, con historia de sufrir accidente de tránsito. El primer caso evidenció al examen radiológico fractura simple y desplazada de sínfisis mandibular, fractura simple huesos propios nasales y desviación del tabique nasal. El segundo caso es un paciente con fractura de sínfisis y doble cóndilo mandibular que presentaba imposibilidad a la apertura bucal. A través de la técnica del cirujano maxilofacial Hernández Altemir (España), el tubo endotraqueal atraviesa una incisión extraoral en la región submentoniana del suelo de la boca, para poder practicar reducción abierta de fracturas faciales, logrando adecuada oclusión, con mínimos cuidados posoperatorios y con una cicatriz estética. Al terminar la cirugía, la posición del tubo endotraqueal regresa a su posición original y el paciente evoluciona satisfactoriamente


Submental intubation is useful in surgical procedures where nasotracheal intubation is contraindicated and orotracheal intubation is not ideal due to intermaxillary fixation. This report describes two male patients who presented to the Rosales National Hospital, in the Maxillofacial Surgery service of El Salvador, with a history of suffering a traffic accident. The first case showed a simple and displaced fracture of the mandibular symphysis, simple nasal bone fracture and deviation of the nasal septum on radiological examination. The second case is a patient with a symphysis fracture and a double mandibular condyle that presented an inability to open the mouth. Through the technique of the maxillofacial surgeon Hernández Altemir (Spain), the endotracheal tube passes through an extraoral incision in the submental region of the floor of the mouth, in order to perform open reduction of facial fractures, achieving adequate occlusion, with minimal postoperative care and with an aesthetic scar. At the end of the surgery, the position of the endotracheal tube returns to its original position and the patient evolves satisfactorily


Subject(s)
Humans , Airway Management , Intubation , Maxillofacial Injuries
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