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1.
Säo Paulo med. j ; 140(1): 12-16, Jan.-Feb. 2022. tab
Article in English | LILACS | ID: biblio-1357469

ABSTRACT

ABSTRACT BACKGROUND: Coronavirus disease 2019 (COVID-19) is an ongoing global health threat. However, currently, no standard therapy has been approved for the disease. OBJECTIVES: To evaluate the clinical effectiveness of convalescent plasma (CP) in patients with acute respiratory distress syndrome (ARDS) due to COVID-19. DESIGN AND SETTING: Retrospective study conducted at Kayseri City Education and Research Hospital, Kayseri, Turkey. METHODS: The case group consisted of adult patients (> 18 years) with ARDS due to COVID-19 who received CP in combination with antiviral and supportive treatment. These patients were compared with others who only received antiviral and supportive treatment. RESULTS: During the study period, a total of 30 patients with ARDS due to COVID-19 were included. Eleven patients (36%) received CP in combination with antiviral and supportive treatment, whereas nineteen patients (64%) in the control group only received antiviral and supportive treatment. On admission, the median age, demographic and clinical data and initial laboratory test results were similar between the groups (P > 0.05). On the 14th day of treatment, the laboratory values remained similar between the groups (P > 0.05). The mortality rates were not significantly different between the groups. CONCLUSION: CP treatment did not affect mortality or lead to clinical improvement for COVID-19 patients with ARDS.


Subject(s)
Humans , Adult , Respiratory Distress Syndrome, Newborn/etiology , Respiratory Distress Syndrome, Newborn/therapy , COVID-19/etiology , Retrospective Studies , Immunization, Passive , SARS-CoV-2
2.
Article in English | WPRIM | ID: wpr-928570

ABSTRACT

OBJECTIVES@#To study the efficacy and safety of early intratracheal administration of budesonide combined with pulmonary surfactant (PS) in preventing bronchopulmonary dysplasia (BPD).@*METHODS@#A prospective randomized controlled trial was designed. A total of 122 infants with a high risk of BPD who were admitted to the neonatal intensive care unit of the Third Affiliated Hospital of Zhengzhou University from January to July 2021 were enrolled. The infants were randomly divided into a conventional treatment group with 62 infants (treated with PS alone at an initial dose of 200 mg/kg, followed by a dose of 100 mg/kg according to the condition of the infant) and an observation group with 60 infants (treated with PS at the same dose as the conventional treatment group, with the addition of budesonide 0.25 mg/kg for intratracheal instillation at each time of PS application). The two groups were compared in terms of the times of PS use, ventilator parameters at different time points, oxygen inhalation, incidence rate and severity of BPD, incidence rate of complications, and tidal breathing pulmonary function at the corrected gestational age of 40 weeks.@*RESULTS@#Compared with the conventional treatment group, the observation group had a significantly lower proportion of infants using PS for two or three times (P<0.05). Compared with the conventional treatment group, the observation group had a significantly lower fraction of inspired oxygen at 24 and 48 hours and 3, 7, and 21 days after administration, significantly shorter durations of invasive ventilation, noninvasive ventilation, ventilator application, and oxygen therapy, a significantly lower incidence rate of BPD, and a significantly lower severity of BPD (P<0.05). There was no significant difference in the incidence rate of glucocorticoid-related complications between the two groups (P>0.05).@*CONCLUSIONS@#Compared with PS use alone in preterm infants with a high risk of BPD, budesonide combined with PS can reduce repeated use of PS, lower ventilator parameters, shorten the duration of respiratory support, and reduce the incidence rate and severity of BPD, without increasing the incidence rate of glucocorticoid-related complications.


Subject(s)
Bronchopulmonary Dysplasia/prevention & control , Budesonide , Humans , Infant , Infant, Newborn , Infant, Premature , Prospective Studies , Pulmonary Surfactants/therapeutic use , Respiration, Artificial , Respiratory Distress Syndrome, Newborn/therapy
3.
Rev. bras. ter. intensiva ; 33(4): 537-543, out.-dez. 2021. tab, graf
Article in English, Portuguese | LILACS | ID: biblio-1357190

ABSTRACT

RESUMO Objetivo: Comparar o comportamento dos índices de troca gasosa conforme o uso de alvos de oxigenação liberais em comparação a conservadores em pacientes com síndrome do desconforto respiratório agudo moderada a grave secundária à COVID-19 e em uso de ventilação mecânica; avaliar a influência da FiO2 elevada na mecânica do sistema respiratório. Métodos: Foram incluídos prospectivamente pacientes consecutivos com idades acima de 18 anos, diagnóstico de COVID-19 e síndrome do desconforto respiratório agudo moderada e grave. Para cada paciente, aplicou-se aleatoriamente dois protocolos de FiO2 para obter SpO2 de 88% a 92% ou 96%. Avaliaram-se os índices de oxigenação e a mecânica do sistema respiratório. Resultados: Foram incluídos 15 pacientes. Todos seus índices foram significantemente afetados pela estratégia de FiO2 (p < 0,05). A proporção PaO2/FiO2 deteriorou, o PA-aO2 aumentou e o Pa/AO2 diminuiu significantemente com a utilização de FiO2 para obter SpO2 96%. Opostamente, a fração de shunt funcional foi reduzida. A mecânica respiratória não foi afetada pela estratégia de FiO2. Conclusão: Uma estratégia com alvos liberais de oxigenação deteriorou significantemente os índices de troca gasosa, com exceção do shunt funcional, em pacientes com síndrome do desconforto respiratório agudo relacionada à COVID-19. A mecânica do sistema respiratório não foi alterada pela estratégia de FiO2. Registro Clinical Trials: NCT04486729.


ABSTRACT Objective: To compare gas exchange indices behavior by using liberal versus conservative oxygenation targets in patients with moderate to severe acute respiratory distress syndrome secondary to COVID-19 under invasive mechanical ventilation. We also assessed the influence of high FiO2 on respiratory system mechanics. Methods: We prospectively included consecutive patients aged over 18 years old with a diagnosis of COVID-19 and moderate-severe acute respiratory distress syndrome. For each patient, we randomly applied two FiO2 protocols to achieve SpO2 88% - 92% or 96%. We assessed oxygenation indices and respiratory system mechanics. Results: We enrolled 15 patients. All the oxygenation indices were significantly affected by the FiO2 strategy (p < 0.05) selected. The PaO2/FiO2 deteriorated, PA-aO2 increased and Pa/AO2 decreased significantly when using FiO2 to achieve SpO2 96%. Conversely, the functional shunt fraction was reduced. Respiratory mechanics were not affected by the FiO2 strategy. Conclusion: A strategy aimed at liberal oxygenation targets significantly deteriorated gas exchange indices, except for functional shunt, in COVID-19-related acute respiratory distress syndrome. The respiratory system mechanics were not altered by the FiO2 strategy. Clinical Trials Register: NCT04486729.


Subject(s)
Humans , Adult , Middle Aged , COVID-19 , Respiratory Distress Syndrome, Newborn/therapy , Blood Gas Analysis , SARS-CoV-2
4.
Rev. bras. ter. intensiva ; 33(3): 461-468, jul.-set. 2021. tab, graf
Article in English, Portuguese | LILACS | ID: biblio-1347304

ABSTRACT

RESUMO A respiração espontânea pode ser prejudicial para pacientes com pulmões previamente lesados, especialmente na vigência de síndrome do desconforto respiratório agudo. Mais ainda, a incapacidade de assumir a respiração totalmente espontânea durante a ventilação mecânica e a necessidade de voltar à ventilação mecânica controlada se associam com mortalidade mais alta. Existe uma lacuna no conhecimento em relação aos parâmetros que poderiam ser úteis para predizer o risco de lesão pulmonar autoinflingida pelo paciente e detecção da incapacidade de assumir a respiração espontânea. Relata-se o caso de um paciente com lesão pulmonar autoinflingida e as correspondentes variáveis, básicas e avançadas, de monitoramento da mecânica do sistema respiratório, além dos resultados fisiológicos e clínicos relacionados à respiração espontânea durante ventilação mecânica. O paciente era um homem caucasiano com 33 anos de idade e história clínica de AIDS, que apresentou síndrome do desconforto respiratório agudo e necessitou ser submetido à ventilação mecânica invasiva após falha do suporte ventilatório não invasivo. Durante os períodos de ventilação controlada, adotou-se estratégia de ventilação protetora, e o paciente mostrou evidente melhora, tanto do ponto de vista clínico quanto radiográfico. Contudo, durante cada período de respiração espontânea sob ventilação com pressão de suporte, apesar dos parâmetros iniciais adequados, das regulagens rigorosamente estabelecidas e do estrito monitoramento, o paciente desenvolveu hipoxemia progressiva e piora da mecânica do sistema respiratório, com deterioração radiográfica claramente correlacionada (lesão pulmonar autoinflingida pelo paciente). Após falha de três tentativas de respiração espontânea, o paciente faleceu por hipoxemia refratária no 29° dia. Neste caso, as variáveis básicas e avançadas convencionais não foram suficientes para identificar a aptidão para respirar espontaneamente ou predizer o risco de desenvolver lesão pulmonar autoinflingida pelo paciente durante a ventilação de suporte parcial.


ABSTRACT Spontaneous breathing can be deleterious in patients with previously injured lungs, especially in acute respiratory distress syndrome. Moreover, the failure to assume spontaneous breathing during mechanical ventilation and the need to switch back to controlled mechanical ventilation are associated with higher mortality. There is a gap of knowledge regarding which parameters might be useful to predict the risk of patient self-inflicted lung injury and to detect the inability to assume spontaneous breathing. We report a case of patient self-inflicted lung injury, the corresponding basic and advanced monitoring of the respiratory system mechanics and physiological and clinical results related to spontaneous breathing. The patient was a 33-year-old Caucasian man with a medical history of AIDS who developed acute respiratory distress syndrome and needed invasive mechanical ventilation after noninvasive ventilatory support failure. During the controlled ventilation periods, a protective ventilation strategy was adopted, and the patient showed clear clinical and radiographic improvement. However, during each spontaneous breathing period under pressure support ventilation, despite adequate initial parameters and a strictly adjusted ventilatory setting and monitoring, the patient developed progressive hypoxemia and worsening of respiratory system mechanics with a clearly correlated radiographic deterioration (patient self-inflicted lung injury). After failing three spontaneous breathing assumption trials, he died on day 29 due to refractory hypoxemia. Conventional basic and advanced monitoring variables in this case were not sufficient to identify the aptitude to breathe spontaneously or to predict the risk and development of patient self-inflicted lung injury during partial support ventilation.


Subject(s)
Humans , Male , Adult , Respiratory Distress Syndrome, Newborn/etiology , Respiratory Distress Syndrome, Newborn/therapy , Lung Injury , Respiration , Respiration, Artificial , Lung
5.
Rev. bras. ter. intensiva ; 33(3): 457-460, jul.-set. 2021. graf
Article in English, Portuguese | LILACS | ID: biblio-1347299

ABSTRACT

RESUMO Uma mulher com 63 anos de idade compareceu ao pronto-socorro com história aguda de febre, prostração e dispneia. Recebeu diagnóstico de quadro grave da COVID-19 e síndrome do desconforto respiratório agudo. Apesar de suporte clínico intensivo, cumpriu os critérios para ser submetida à oxigenação venovenosa por membrana extracorpórea. No dia 34, após 7 dias de desmame da sedação com evolução positiva de seu quadro neurológico, apresentou uma crise tônico-clônica generalizada limitada, não relacionada com desequilíbrio hidroeletrolítico ou metabólico, que levou à necessidade de investigação diagnóstica. Seus exames de imagem cerebral revelaram síndrome da encefalopatia posterior reversível. Este caso enfatiza a questão das complicações neurológicas em pacientes com COVID-19 grave e a importância do diagnóstico e suporte precoces.


ABSTRACT A 63-year-old woman presented to the emergency department with an acute history of fever, prostration and dyspnea. She was diagnosed with severe COVID-19 acute respiratory distress syndrome and, despite optimized critical care support, met the indications for veno-venous extracorporeal membrane oxygenation. On day 34, after 7 days of wean sedation with a positive evolution of neurologic status, she presented a limited generalized tonic-clonic seizure not related to hydroelectrolytic or metabolic imbalance, which led to a diagnostic investigation; her brain imaging tests showed a posterior reversible encephalopathy syndrome. This case emphasizes the issue of neurological complications in patients with severe COVID-19 infection and the importance of early diagnosis and support.


Subject(s)
Humans , Female , Middle Aged , Respiratory Distress Syndrome, Newborn/etiology , Respiratory Distress Syndrome, Newborn/therapy , Extracorporeal Membrane Oxygenation , Posterior Leukoencephalopathy Syndrome/diagnosis , Posterior Leukoencephalopathy Syndrome/etiology , COVID-19 , SARS-CoV-2
6.
J. pediatr. (Rio J.) ; 97(4): 409-413, July-Aug. 2021. tab, graf
Article in English | LILACS | ID: biblio-1287037

ABSTRACT

Abstract Objective This study aimed to identify the predictors and threshold of failure in neonatal acute respiratory distress syndrome. Methods Newborns with severe acute respiratory distress syndrome aged 0-28 days and gestational age ≥36 weeks were included in the study if their cases were managed with non-extra corporal membrane oxygenation treatments. Patients were divided into two groups according to whether they died before discharge. Predictors of non-extra corporal membrane oxygenation treatment failure were sought, and the threshold of predictors was calculated. Results A total of 103 patients were included in the study. A total of 77 (74.8%) survived hospitalization and were discharged, whereas 26 (25.2%) died. Receiver operating characteristic analysis of oxygen index, pH, base excess, and combinations of these indicators demonstrated the advantage of the combination of oxygen index and base excess over the others variables regarding their predictive ability. The area under the curve for the combination of oxygen index and base excess was 0.865. When the cut-off values of oxygen index and base excess were 30.0 and −7.4, respectively, the sensitivity and specificity for predicting death were 77.0% and 84.0%, respectively. The model with base excess added a net reclassification improvement of 0.090 to the model without base excess. Conclusion The combination of oxygen index and base excess can be used as a predictor of outcomes in neonates receiving non-extra corporal membrane oxygenation treatment for acute respiratory distress syndrome. In neonates with acute respiratory distress syndrome, if oxygen index >30 and base excess <−7.4, non-extra corporal membrane oxygenation therapy is likely to lead to death.


Subject(s)
Humans , Infant, Newborn , Infant , Respiratory Distress Syndrome, Newborn/therapy , Respiratory Distress Syndrome, Newborn , Respiratory Insufficiency , Oxygen , Oxygen Inhalation Therapy
8.
Int. j. cardiovasc. sci. (Impr.) ; 34(3): 315-318, May-June 2021. graf
Article in English | LILACS | ID: biblio-1250096

ABSTRACT

Abstract Mechanical ventilation in prone position is an alternative strategy for patients with acute respiratory discomfort syndrome (ARDS) to improve oxygenation in situations when traditional ventilation modalities have failed. However, due to the significant increase in ARDS cases during the SARS-CoV-2 pandemic and the experimental therapeutic use of potentially arrhythmogenic drugs, cardiopulmonary resuscitation in this unusual position could be needed. Therefore, we will review the available scientific evidence of cardiopulmonary resuscitation in prone position.


Subject(s)
Humans , Prone Position , Cardiopulmonary Resuscitation/methods , Respiration, Artificial/methods , Respiratory Distress Syndrome, Newborn/therapy , Electric Countershock/methods , Cardiopulmonary Resuscitation/instrumentation
9.
Rev. bras. ter. intensiva ; 33(1): 48-67, jan.-mar. 2021. tab, graf
Article in English, Spanish | LILACS | ID: biblio-1289052

ABSTRACT

RESUMEN Objetivo: Proponer estrategias agile para este abordaje integral de la analgesia, sedación, delirium, implementación de movilidad temprana e inclusión familiar del paciente con síndrome de dificultad respiratoria aguda por COVID-19, considerando el alto riesgo de infección que existe entre los trabajadores de salud, el tratamiento humanitario que debemos brindar al paciente y su familia, en un contexto de falta estrategias terapéuticas específicas contra el virus globalmente disponibles a la fecha y una potencial falta de recursos sanitarios. Metodos: Se llevó a cabo una revision no sistemática de la evidencia científica en las principales bases de datos bibliográficos, sumada a la experiencia y juicio clínico nacional e internacional. Finalmente, se realizó un consenso de recomendaciones entre los integrantes del Comité de Analgesia, Sedación y Delirium de la Sociedad Argentina de Terapia Intensiva. Resultados: Se acordaron recomendaciones y se desarrollaron herramientas para asegurar un abordaje integral de analgesia, sedación, delirium, implementación de movilidad temprana e inclusión familiar del paciente adulto con síndrome de dificultad respiratoria aguda por COVID-19. Discusión: Ante el nuevo orden generado en las terapias intensivas por la progresión de la pandemia de COVID-19, proponemos no dejar atrás las buenas prácticas habituales, sino adaptarlas al contexto particular generado. Nuestro consenso está respaldado en la evidencia científica, la experiencia nacional e internacional, y será una herramienta de consulta atractiva en las terapias intensivas.


ABSTRACT Objective: To propose agile strategies for a comprehensive approach to analgesia, sedation, delirium, early mobility and family engagement for patients with COVID-19-associated acute respiratory distress syndrome, considering the high risk of infection among health workers, the humanitarian treatment that we must provide to patients and the inclusion of patients' families, in a context lacking specific therapeutic strategies against the virus globally available to date and a potential lack of health resources. Methods: A nonsystematic review of the scientific evidence in the main bibliographic databases was carried out, together with national and international clinical experience and judgment. Finally, a consensus of recommendations was made among the members of the Committee for Analgesia, Sedation and Delirium of the Sociedad Argentina de Terapia Intensiva. Results: Recommendations were agreed upon, and tools were developed to ensure a comprehensive approach to analgesia, sedation, delirium, early mobility and family engagement for adult patients with acute respiratory distress syndrome due to COVID-19. Discussion: Given the new order generated in intensive therapies due to the advancing COVID-19 pandemic, we propose to not leave aside the usual good practices but to adapt them to the particular context generated. Our consensus is supported by scientific evidence and national and international experience and will be an attractive consultation tool in intensive therapies.


Subject(s)
Humans , Respiratory Distress Syndrome, Newborn/therapy , Delirium/therapy , Consensus , Pain Management/standards , COVID-19/complications , Analgesia/standards , Psychomotor Agitation/therapy , Neuromuscular Blockade/methods , Delirium/diagnosis , Early Ambulation , Checklist , Pain Management/methods , COVID-19/drug therapy , Analgesia/methods , Intensive Care Units , Intubation, Intratracheal/methods
10.
Article in English | WPRIM | ID: wpr-887558

ABSTRACT

INTRODUCTION@#Acute respiratory distress syndrome (ARDS) in COVID-19 is associated with a high mortality rate, though outcomes of the different lung compliance phenotypes are unclear. We aimed to measure lung compliance and examine other factors associated with mortality in COVID-19 patients with ARDS.@*METHODS@#Adult patients with COVID-19 ARDS who required invasive mechanical ventilation at 8 hospitals in Singapore were prospectively enrolled. Factors associated with both mortality and differences between high (<40mL/cm H@*RESULTS@#A total of 102 patients with COVID-19 who required invasive mechanical ventilation were analysed; 15 (14.7%) did not survive. Non-survivors were older (median 70 years, interquartile range [IQR] 67-75 versus median 61 years, IQR 52-66; @*CONCLUSION@#COVID-19 ARDS patients with higher compliance on the day of intubation and a longitudinal decrease over time had a higher risk of death.


Subject(s)
COVID-19 , Humans , Lung Compliance , Phenotype , Respiratory Distress Syndrome, Newborn/therapy , SARS-CoV-2
11.
Article in English | WPRIM | ID: wpr-922396

ABSTRACT

OBJECTIVES@#To study the effect of different maintenance doses of caffeine citrate on the success rate of ventilator weaning in very preterm infants (gestational age of ≤32 weeks) with respiratory distress syndrome (RDS).@*METHODS@#A total of 162 preterm infants with RDS who were admitted to the hospital from January 2016 to December 2018 were enrolled in this prospective trial. These infants had a gestational age of ≤32 weeks and required invasive mechanical ventilation. They were randomly divided into a high-dose caffeine group and a low-dose caffeine group, with 81 infants in each group. Within 6 hours after birth, both groups were given caffeine at a dose of 20 mg/kg. After 24 hours, the high- and low-dose caffeine groups were given caffeine at a maintenance dose of 10 mg/kg and 5 mg/kg, respectively. The two groups were compared in terms of re-intubation rate within 48 hours after ventilator weaning, durations of ventilation and oxygen therapy, enteral feeding, weight gain, and the incidence rates of complications and adverse reactions during hospitalization.@*RESULTS@#The high-dose caffeine group had a significantly lower re-intubation rate within 48 hours after ventilator weaning than the low-dose caffeine group (@*CONCLUSIONS@#A high maintenance dose of caffeine can safely and effectively reduce the incidence rate of apnea after ventilator weaning and the failure rate of ventilator weaning in RDS preterm infants with a gestational age of ≤32 weeks, and therefore, it holds promise for clinical application.


Subject(s)
Caffeine , Citrates , Humans , Infant , Infant, Newborn , Infant, Premature , Prospective Studies , Respiratory Distress Syndrome, Newborn/therapy , Ventilator Weaning
12.
Article in Chinese | WPRIM | ID: wpr-879805

ABSTRACT

OBJECTIVE@#To study the clinical effect of an additional maintenance dose (5 mg/kg) of caffeine citrate injection at 1 hour before ventilator weaning in improving the success rate of ventilator weaning in preterm infants (gestational age ≤32 weeks) with respiratory distress syndrome (RDS) on mechanical ventilation.@*METHODS@#A total of 338 preterm infants with RDS (gestational age of ≤32 weeks) who were admitted to the Neonatal Intensive Care Unit of Xiamen Maternal and Child Health Hospital from January 2017 to December 2019 and treated with mechanical ventilation were enrolled. They were randomly divided into an observation group and a routine group, with 169 infants in each group. Both groups received early routine treatment with caffeine. The infants in the observation group received an additional maintenance dose of caffeine citrate injection at 1 hour before ventilator weaning. The two groups were compared in terms of reintubation rate and number of apnea episodes within 48 hours after ventilator weaning, changes in blood gas parameters, blood glucose, heart rate, and mean blood pressure at 2 hours after ventilator weaning, and incidence rates of major complications during hospitalization.@*RESULTS@#Compared with the routine group, the observation group had significantly lower reintubation rate (@*CONCLUSIONS@#An additional maintenance dose of caffeine citrate injection at 1 hour before ventilator weaning is safe and effective in improving the success rate of ventilator weaning in preterm infants with RDS and thus holds promise for clinical application.


Subject(s)
Caffeine , Humans , Infant , Infant, Newborn , Infant, Premature , Maintenance , Prospective Studies , Respiratory Distress Syndrome, Newborn/therapy , Ventilator Weaning
13.
Article in Chinese | WPRIM | ID: wpr-879803

ABSTRACT

OBJECTIVE@#To study the safety of two ventilator weaning strategies after high-frequency oscillatory ventilation (HFOV) for the treatment of neonatal respiratory distress syndrome (NRDS) in preterm infants.@*METHODS@#A prospective randomized controlled trial was conducted for 101 preterm infants with NRDS, with a gestational age of ≤32@*RESULTS@#There was no significant difference in the failure rate of ventilator weaning within 72 hours (8% vs 14%, @*CONCLUSIONS@#For preterm infants with NRDS, the strategy of weaning directly from HFOV is safe and reliable and can reduce the duration of invasive mechanical ventilation, and therefore, it holds promise for clinical application.


Subject(s)
High-Frequency Ventilation , Humans , Infant, Newborn , Infant, Premature , Prospective Studies , Respiration, Artificial , Respiratory Distress Syndrome, Newborn/therapy , Ventilator Weaning
14.
Rev. Paul. Pediatr. (Ed. Port., Online) ; 39: e2019275, 2021. tab, graf
Article in English, Portuguese | LILACS | ID: biblio-1155475

ABSTRACT

ABSTRACT Objective: Acute respiratory distress syndrome (ARDS) can be a devastating condition in children with cancer and alveolar recruitment maneuvers (ARMs) can theoretically improve oxygenation and survival. The study aimed to assess the feasibility of ARMs in critically ill children with cancer and ARDS. Methods: We retrospectively analyzed 31 maneuvers in a series of 12 patients (median age of 8.9 years) with solid tumors (n=4), lymphomas (n=2), acute lymphoblastic leukemia (n=2), and acute myeloid leukemia (n=4). Patients received positive end-expiratory pressure from 25 up to 40 cmH20, with a delta pressure of 15 cmH2O for 60 seconds. We assessed blood gases pre- and post-maneuvers, as well as ventilation parameters, vital signs, hemoglobin, clinical signs of pulmonary bleeding, and radiological signs of barotrauma. Pre- and post-values were compared by the Wilcoxon test. Results: Median platelet count was 53,200/mm3. Post-maneuvers, mean arterial pressure decreased more than 20% in two patients, and four needed an increase in vasoactive drugs. Hemoglobin levels remained stable 24 hours after ARMs, and signs of pneumothorax, pneumomediastinum, or subcutaneous emphysema were absent. Fraction of inspired oxygen decreased significantly after ARMs (FiO2; p=0.003). Oxygen partial pressure (PaO2)/FiO2 ratio increased significantly (p=0.0002), and the oxygenation index was reduced (p=0.01), but all these improvements were transient. Recruited patients' 28-day mortality was 58%. Conclusions: ARMs, although feasible in the context of thrombocytopenia, lead only to transient improvements, and can cause significant hemodynamic instability.


RESUMO Objetivo: A síndrome do desconforto respiratório agudo (SDRA) pode ser uma condição devastadora em crianças com câncer e as manobras de recrutamento alveolar (MRA) podem melhorar a oxigenação e a sobrevida. O objetivo foi avaliar a viabilidade das MRA em crianças gravemente doentes com câncer e SDRA. Métodos: Analisamos retrospectivamente 31 manobras em 12 pacientes (idade mediana de 8,9 anos), com tumores sólidos (n=4), linfomas (n=2) e leucemias linfoide (n=2) e mieloide agudas (n=4). Os pacientes receberam pressão expiratória final positiva de 25 a 40 cmH20, com delta de pressão de 15 cmH2O por 60 segundos. Gasometrias foram analisadas pré e pós-manobras, bem como os parâmetros de ventilação, sinais vitais, hemoglobina, sinais clínicos de sangramento pulmonar e sinais radiológicos de barotrauma. Valores foram comparados com o teste de Wilcoxon. Resultados: A contagem mediana de plaquetas era de 53.200/mm3. Após as manobras, em dois pacientes, a pressão arterial média declinou mais de 20%, e quatro necessitaram de aumento de drogas vasoativas. A hemoglobina permaneceu estável 24 horas após a MRA, sem sinais de pneumotórax, pneumomediastino ou enfisema subcutâneo. Houve diminuição significativa nas frações inspiradas de oxigênio (FiO2; p=0,003). A relação pressão arterial de oxigênio (PaO2)/FiO2 aumentou (p=0,002), e o índice de oxigenação caiu (p=0,01), mas essas melhoras foram transitórias. A mortalidade em 28 dias foi de 58%. Conclusões: As MRA, embora viáveis no contexto da trombocitopenia, levam apenas a melhorias transitórias e podem causar instabilidade hemodinâmica significativa.


Subject(s)
Humans , Child , Respiratory Distress Syndrome, Newborn/therapy , Positive-Pressure Respiration/methods , Neoplasms/complications , Respiratory Distress Syndrome, Newborn/etiology , Blood Gas Analysis , Feasibility Studies , Retrospective Studies , Positive-Pressure Respiration/adverse effects , Health Services Accessibility
15.
Rev. bras. anestesiol ; 70(1): 55-58, Jan.-Feb. 2020. tab, graf
Article in English, Portuguese | LILACS | ID: biblio-1137135

ABSTRACT

Abstract Background: Veno-venous extracorporeal membrane oxygenation is an established therapy for patients with refractory acute respiratory distress syndrome (ARDS). One complication related to the use of veno-venous extracorporeal membrane oxygenation is thrombosis despite proper anticoagulation. We report the diagnosis and management of a clot-obstruction in a single site cannula placed through the internal jugular vein, guided by transesophageal echocardiography. Case report: A 39 year-old male developed acute respiratory distress syndrome and hemodynamic instability after an episode of pulmonary aspiration in the ICU. Eight hours after placement of a single site veno-venous extracorporeal membrane oxygenation, suddenly the perfusionist noticed a reduction in flow. TEE showed a thrombus-like mass obstructing the inflow port in SVC and inflow at IVC was intact. After unsuccessful attempts to reposition the cannula, the team decided to insert additional femoral inflow cannula through the IVC. The single site catheter was then pulled out until its tip was positioned in the right atrium and all three ports of the catheter were switched to the infusion ports. After this, flows and oxygenation improved significantly. Unfortunately, despite all of the efforts, the patient died 2 days later. Discussion: The diagnosis of veno-venous extracorporeal membrane oxygenation cannula obstruction is based on reduced inflow rates, hemodynamic instability and poor oxygenation of blood. TEE allows evaluation of the flows inside the cannula and in this case, an obstruction was found. The management presented points to the fact that in a situation of catheter obstruction caused by a clot, there is a feasible alternative to assure minimal interruption of the hemodynamic support offered by the veno-venous extracorporeal membrane oxygenation.


Resumo Justificativa: A oxigenação por membrana extracorpórea veno-venosa é terapia estabelecida para pacientes com a síndrome do desconforto respiratório agudo. Uma complicação relacionada ao uso da oxigenação por membrana extracorpórea veno-venosa é trombose apesar de anti-coagulação adequada. Relatamos o diagnóstico e conduta em obstrução por coágulo em cânula de acesso único inserida pela veia jugular interna, guiada por ecocardiografia transesofageana. Relato de caso: Paciente do sexo masculino de 39 anos desenvolveu síndrome do desconforto respiratório agudo e instabilidade hemodinâmica após episódio de aspiração pulmonar na UTI. Oito horas após a instalação de oxigenação por membrana extracorpórea veno-venosa de acesso único, o perfusionista notou repentina redução no fluxo. A ETE revelou massa semelhante a um trombo obstruindo o portal de fluxo de entrada na VCS e o fluxo de saída na VCI estava intacto. Após tentativas sem sucesso para reposicionar a cânula, a equipe decidiu inserir cânula de entrada de fluxo adicional pela VCI. O catéter de acesso único foi, então, puxado até que sua ponta se posicionasse no átrio direito e todos os três portais do catéter fossem transferidos para os portais de infusão. A seguir, os fluxos e oxigenação melhoraram significativamente. Infelizmente, apesar dos esforços, o paciente foi a óbito 2 dias depois. Discussão: O diagnóstico de obstrução de cânula da oxigenação por membrana extracorpórea veno-venosa se baseia em velocidades reduzidas de entrada de fluxo, instabilidade hemodinâmica e oxigenação pobre do sangue. A ETE permite a avaliação dos fluxos dentro da cânula, e nesse caso foi encontrada obstrução. A técnica apresentada aponta para o fato de que em situação de obstrução de catéter causada por coágulo, existe alternativa factível para garantir interrrupção mínima do suporte hemodinâmico oferecido pela oxigenação por membrana extracorpórea veno-venosa.


Subject(s)
Humans , Male , Adult , Respiratory Distress Syndrome, Newborn/therapy , Thrombosis/etiology , Extracorporeal Membrane Oxygenation/instrumentation , Cannula/adverse effects , Thrombosis/therapy , Thrombosis/diagnostic imaging , Venae Cavae , Echocardiography, Transesophageal
16.
Article in Chinese | WPRIM | ID: wpr-879797

ABSTRACT

A boy, aged 6 years and 11 months, was admitted due to nephrotic syndrome for 2 years, cough for 1 month, and shortness of breath for 15 days. The boy had a history of treatment with hormone and immunosuppressant. Chest CT after the onset of cough and shortness of breath showed diffuse ground-glass opacities in both lungs. Serum (1, 3)-beta-D glucan was tested positive, and the nucleic acid of cytomegalovirus was detected in respiratory secretions. After the anti-fungal and anti-viral treatment, the child improved temporarily but worsened again within a short period of time.


Subject(s)
Child , Cough/etiology , Cytomegalovirus Infections/therapy , Dyspnea/etiology , Extracorporeal Membrane Oxygenation , Humans , Male , Nephrotic Syndrome/complications , Pneumonia, Pneumocystis/therapy , Respiratory Distress Syndrome, Newborn/therapy
17.
Article in Chinese | WPRIM | ID: wpr-879788

ABSTRACT

OBJECTIVE@#To investigate the epidemiology, clinical features, treatment, and prognostic factors of neonatal acute respiratory distress syndrome (NARDS) through a retrospective study of NARDS based on the Montreux definition.@*METHODS@#A retrospective analysis was performed on the medical records of neonates who were hospitalized from January 2017 and July 2018, among whom 314 neonates who met the Montreux definition were enrolled as subjects. According to oxygen index, they were divided into a mild NARDS group with 130 neonates, a moderate NARDS group with 117 neonates, and a severe NARDS group with 67 neonates. The clinical features were compared among the three groups to investigate the influencing factors for the severities of NARDS and the length of hospital stay.@*RESULTS@#The neonates with NARDS accounted for 2.46% (314/12 789) of the neonates admitted to the neonatal ward during the same period of time and had a mortality rate of 9.6% (30/314). The multivariate ordinal logistic regression analysis showed that the neonates who used pulmonary surfactant (PS) or had a long duration of assisted ventilation tended to have a higher risk of severe NARDS (@*CONCLUSIONS@#Preterm birth, low birth weight/macrosomia, and perinatal infection may be associated with an increased risk of severe NARDS. The neonates requiring invasive ventilation, prolonged assisted ventilation, or PS therapy tend to have a poor prognosis.


Subject(s)
Female , Fetal Macrosomia , Humans , Infant, Low Birth Weight , Infant, Newborn , Pregnancy , Pregnancy Complications, Infectious , Premature Birth , Pulmonary Surfactants , Respiratory Distress Syndrome, Newborn/therapy , Retrospective Studies , Risk Factors
18.
Article in Chinese | WPRIM | ID: wpr-879770

ABSTRACT

OBJECTIVE@#To systematically evaluate the efficacy and safety of high-flow nasal cannula (HFNC) therapy versus nasal continuous positive airway pressure (nCPAP) in the treatment of respiratory distress syndrome (RDS) in neonates.@*METHODS@#PubMed, Embase, Cochrane Library, Web of Science, China Biology Medicine disc, Wanfang Database, CNKI, and Weipu Database were searched for the randomized controlled trials (RCTs) of HFNC versus nCPAP in the treatment of neonatal RDS published up to April 1, 2020. RevMan5.3 software was used to perform a Meta analysis of the eligible RCTs.@*RESULTS@#A total of 12 RCTs were included, with 2 861 neonates in total, among whom 2 698 neonates (94.30%) had a gestational age of ≥28 weeks and 163 (5.70%) had a gestational age of 0.05). For primary respiratory support and post-extubation respiratory support, the HFNC group had a significantly lower incidence rate of nasal injury than the nCPAP group (P0.05).@*CONCLUSIONS@#Based on the current clinical evidence, HFNC has a higher failure rate than nCPAP when used as primary respiratory support for neonates with RDS, and therefore it is not recommended to use HFNC as the primary respiratory support for neonates with RDS. In RDS neonates with a gestational age of ≥28 weeks, HFNC can be used as post-extubation respiratory support in the weaning phase.


Subject(s)
Cannula , China , Continuous Positive Airway Pressure , Humans , Infant, Newborn , Infant, Premature , Respiratory Distress Syndrome, Newborn/therapy
19.
In. Verga, Federico; Burghi, Gastón. Encares de paciente crítico. Montevideo, Oficina del Libro FEFMUR, 2020. p.135-158, graf, tab, ilus.
Monography in Spanish | LILACS, BNUY, UY-BNMED | ID: biblio-1342644
20.
Article in English | LILACS | ID: biblio-1092153

ABSTRACT

ABSTRACT Objective: To report the case of a child who developed acute respiratory distress syndrome (ARDS) from a pulmonary infection by adenovirus. Case description: A female patient aged 2 years and 6 months, weighting 10,295 grams developed fever, productive cough and vomiting, later on progressing to ARDS despite initial therapy in accordance with the institutional protocol for ARDS treatment. The child evolved to refractory hypoxemia and hypercapnia, requiring high parameters of mechanical pulmonary ventilation and use of vasoactive agents. In the treatment escalation, the patient received steroids, inhaled nitric oxide (iNO), was submitted to the prone position, started oscillatory high-frequency ventilation (HFOV) and extracorporeal membrane oxygenation (ECMO) was indicated due to severe refractory hypoxemia. During this time, the patient's clinical response was favorable to HFOV, improving oxygenation index and hypercapnia, allowing the reduction of vasoactive medications and mechanical ventilation parameters, and then the indication of ECMO was suspended. The patient was discharged after 26 days of hospital stay without respiratory or neurological sequelae. Comments: Adenovirus infections occur mainly in infants and children under 5 years of age and represent 2 to 5% of respiratory diseases among pediatric patients. Although most children with adenovirus develop a mild upper respiratory tract disease, more severe cases can occur. ARDS is a serious pulmonary inflammatory process with alveolar damage and hypoxemic respiratory failure; Adenovirus pneumonia in children may manifest as severe pulmonary morbidity and respiratory failure that may require prolonged mechanical ventilation. Exclusive pulmonary recruitment and HFOV are advantageous therapeutic options.


RESUMO Objetivo: Descrever paciente que evoluiu com síndrome do desconforto respiratório agudo (SDRA) a partir de infecção pulmonar por adenovírus. Descrição do caso: Paciente de dois anos e seis meses, sexo feminino, peso de 10295 g, que apresentou com quadro de febre, tosse produtiva e vômitos, evoluindo para SDRA. Apesar da terapêutica inicial em conformidade com o protocolo institucional de tratamento da SDRA, a criança evoluiu para hipoxemia e hipercapnia refratárias, necessitando de elevados parâmetros de ventilação pulmonar mecânica e utilização de agentes vasoativos. No escalonamento da terapêutica, a paciente recebeu terapias adjuvantes, foi iniciada ventilação oscilatória de alta frequência (VOAF) e indicada oxigenação por membrana extracorpórea (OMEC) pela hipoxemia grave refratária. Nesse ínterim, a paciente apresentou resposta clínica favorável à VOAF, melhorando do quadro ventilatório e possibilitando a redução das medicações vasoativas e dos parâmetros de ventilação mecânica. A paciente recebeu alta hospitalar após 26 dias de internação, sem sequelas respiratórias ou neurológicas. Comentários: As infecções por adenovírus ocorrem principalmente em lactentes e crianças com menos de cinco anos de idade e representam de 2 a 5% das doenças respiratórias entre os pacientes pediátricos. Embora a maioria das crianças com infecção por adenovírus desenvolva doença leve do trato respiratório superior, casos mais graves podem ocorrer com comprometimento do trato respiratório inferior. A pneumonia por adenovírus em crianças pode se manifestar com morbidade pulmonar grave e insuficiência respiratória com risco de vida, o que resulta na necessidade de suporte mecânico prolongado. O recrutamento pulmonar exclusivo pela VOAF pode ser uma opção terapêutica útil.


Subject(s)
Humans , Female , Child, Preschool , Pneumonia, Viral/complications , Respiratory Distress Syndrome, Newborn/etiology , Respiratory Distress Syndrome, Newborn/therapy , High-Frequency Ventilation/methods , Extracorporeal Membrane Oxygenation/methods , Adenovirus Infections, Human/complications , Pneumonia, Viral/diagnostic imaging , Methylprednisolone/therapeutic use , Echocardiography , Adenoviridae/isolation & purification , Prone Position , Intubation, Intratracheal , Anti-Inflammatory Agents/therapeutic use
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