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1.
Nursing (Säo Paulo) ; 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
2.
Rev. Ciênc. Méd. Biol. (Impr.) ; 21(1): 123-129, maio 05,2022. ilus, tab, fig
Article in Portuguese | LILACS | ID: biblio-1370805

ABSTRACT

Introdução: a deficiência no sistema por obstrução crônica aos fluxos aéreos é uma doença caracterizada por inflamação, associada a alterações anatômicas e fisiológicas, podendo ocasionar exacerbações respiratórias. A oxigenoterapia tem sido uma alternativa usada em pacientes que possuem insuficiência respiratória decorrente da obstrução crônica, como tentativa de diminuir os sintomas e as complicações geradas. Objetivo: avaliar os efeitos da oxigenoterapia em pacientes com deficiência do sistema respiratório por obstrução crônica, com e sem hipercapnia, quanto aos desfechos pressão parcial de oxigênio, frequência respiratória, tempo de internamento e qualidade de vida.Metodologia: revisão de ensaios clínicos controlados e randomizados (ECR) nas bases de dados PubMed, Cochrane e PEDro. Incluídos estudos originais que utilizaram a oxigenoterapia como intervenção em pacientes com deficiência do sistema respiratório por obstrução crônica aos fluxos aéreos ou que outras síndromes. Resultados: na busca realizada nas bases de dados foram identificados um total de 387 estudos, reduzindo para 87 quando aplicado o descritor "ensaio clínico" e 7 estudos foram incluídos publicados entre os anos de 2004 e 2019. Conclusão: A oxigenoterapia mostrou-se incremento da pressão parcial de oxigênio, frequência respiratória e redução do tempo de internamento com impactos na melhora da qualidade de vida.


Introduction: system deficiency due to chronic airflow obstruction is a disease characterized by inflammation, associated with anatomical and physiological changes, which can cause respiratory exacerbations. Oxygen therapy has been an alternative used in patients who have respiratory failure due to obstruction of the obstruction as an attempt to reduce symptoms and as complications generated. Objective: to evaluate the effects of oxygen therapy in patients with respiratory system deficiency due to chronic obstruction, with and without hypercapnia, in terms of partial oxygen pressure, respiratory rate, length of stay and quality of life. Methodology: review of controlled clinical trials and (RCT) in the PubMed, Cochrane and PEDro databases. Included original studies that used oxygen therapy as an intervention in patients with respiratory system deficiency due to obstruction to flow flows or other syndromes. Results: in the search carried out in the databases, a total of 387 studies were identified, for 87 when the descriptor "clinical trial" was projected and 7 studies were included between the years 2004 and 2019. Conclusion: oxygen therapy showed an increase in pressure partial oxygen, respiratory rate and reduction in hospital stay with impacts on improving the quality due.


Subject(s)
Humans , Oxygen Inhalation Therapy , Respiratory Insufficiency/therapy , Pulmonary Disease, Chronic Obstructive/therapy , Hypercapnia/therapy , Quality of Life , Randomized Controlled Trials as Topic , Length of Stay
3.
Rev. cuba. med ; 61(1)mar. 2022.
Article in Spanish | LILACS-Express | LILACS, CUMED | ID: biblio-1408977

ABSTRACT

Introducción: En Panamá, para asumir la masiva demanda de casos con COVID-19, fueron creados centros temporales para atención médica en algunos establecimientos públicos. Objetivo: Caracterizar clínicamente a pacientes ingresados con COVID-19 moderado. Métodos: Estudio descriptivo, ambispectivo, de serie de casos, realizado entre febrero y abril del 2021. Incluyó todos los ingresos en los 5 primeros meses del Centro de Atención Integral para Casos Moderados por COVID-19 en Figali. Se diseñó un cuestionario para cada paciente con datos recogidos de las historias clínicas individuales electrónicas. Resultados: De 628 pacientes ingresados, el 58,1 por ciento eran hombres y 41,6 por ciento del grupo etario de ≥ 60 años. El 54,94 por ciento ingresó luego de 7 días de síntomas, procedentes principalmente de hoteles de aislamiento (39,65 por ciento) y hospitales (26,43 por ciento). Los síntomas más frecuentes fueron la tos, disnea, fiebre y debilidad. El 84,39 por ciento fueron clasificados como COVID-19 moderados. El 51,75 por ciento requirió del ingreso en la Unidad de Cuidados Respiratorios Especiales y de estos el 3,82 por ciento necesitó ventilación mecánica invasiva. El 67,70 por ciento fue dado de alta al hogar y 14,59 por ciento fue transferido a hospitales de tercer nivel luego de la intubación orotraqueal. Conclusiones: El Centro-Figali brindó atención médica a pacientes con COVID-19 moderados, severos y críticos. Prevalecieron los síntomas generales y respiratorios altos, que se intensificaron en la fase pulmonar de la enfermedad y motivaron el ingreso. Entre los hombres, adultos mayores y pacientes con enfermedades crónicas no transmisibles estuvieron la mayoría de los ingresados y fallecidos(AU)


Introduction: In Panama, temporary centers for medical care were created in some public establishments to meet the massive demand for cases with COVID-19. Objective: To clinically describe hospitalized patients with moderate COVID-19. Methods: A descriptive, ambispective, case series study was conducted from February to April 2021. It included all admissions in the first 5 months of the Comprehensive Care Center for Moderate Cases due to COVID-19 in Figali. A questionnaire was designed for each patient with data collected from individual electronic medical records. Results: Out of 628 admitted patients, 58.1 percent were men and 41.6 percent were in the age group ≥60 years. 54.94 percent were admitted after 7 days of symptoms, mainly from isolation hotels (39.65 percent) and hospitals (26.43 percent). The most frequent symptoms were cough, dyspnea, fever and weakness. 84.39 percent were classified as moderate COVID-19. 51.75 percent required admission to the Special Respiratory Care Unit, and out of these 3.82 percent required invasive mechanical ventilation. 67.70 percent were discharged and 14.59 percent were transferred to third level hospitals after orotracheal intubation. Conclusions: Centro Figali provided medical care to patients with moderate, severe and critical COVID-19. General and upper respiratory symptoms prevailed, which intensified in the pulmonary phase of the disease and led to admission. Among men, older adults and patients with chronic non-communicable diseases were the majority of those admitted and deceased(AU)


Subject(s)
Humans , Male , Female , Respiratory Insufficiency/epidemiology , COVID-19/transmission , Panama , Epidemiology, Descriptive
4.
Rev. chil. enferm. respir ; 38(1): 37-42, mar. 2022. ilus
Article in Spanish | LILACS-Express | LILACS | ID: biblio-1388171

ABSTRACT

Resumen Se han comunicado buenos resultados clínicos al poner en posición prono a pacientes con Síndrome de Distrés Respiratorio Agudo por COVID-19. Objetivo: Describir la maniobra prono, sus resultados clínicos y cuidados asociados, en una mujer de 34 años de edad con 26 semanas de embarazo, que estaba en ventilación mecánica, por un cuadro clínico de neumonía multifocal por COVID-19. Se realizó maniobra prono lateralizada hacia izquierda, en tres etapas, preparación, ejecución y evaluación. Luego de 62 h de prono, se observó una recuperación favorable de la gestante: la relación PaO2/FiO2 aumentó de 151 a 368 mmHg, y disminuyó el compromiso radiológico pulmonar, sin que se detectaran complicaciones fetales. Conclusiones: Esta maniobra que puede beneficiar a pacientes con insuficiencia respiratoria grave, en embarazadas debe ser una técnica protocolizada, con equipos de trabajo experimentados e implementación adecuada.


Good clinical results have been reported when placing patients with acute respiratory distress syndrome due to COVID-19 in a prone position. Objective: To describe the prone maneuver, its clinical results and associated care in a 34-year-old woman with 26 weeks of pregnancy, who was on mechanical ventilation, due to a clinical picture of COVID-19 multifocal pneumonia. Lateralized prone maneuver was carried out to the left, in three stages, preparation, execution and evaluation. After 62 hours of prone, a favorable recovery of the pregnant woman was observed: PaO2/FiO2 ratio increased from 151 to 368 mmHg, and the pulmonary radiological compromise decreased, without fetal complications being detected. Conclusions: This maneuver that might benefit patients with severe respiratory failure, in pregnant women should be a protocolized technique, with experienced work teams and adequate implementation.


Subject(s)
Humans , Female , Pregnancy , Adult , Pregnancy Complications, Infectious/therapy , Respiratory Insufficiency/therapy , Prone Position , Patient Positioning , COVID-19/therapy , Respiration, Artificial/methods , Respiratory Insufficiency/etiology , COVID-19/complications
5.
ABC., imagem cardiovasc ; 35(2): eabc286, 2022. ilus
Article in Portuguese | LILACS | ID: biblio-1400703

ABSTRACT

Massas intracardíacas constituem um desafio diagnóstico, já que os sintomas são comuns a patologias cardiovasculares ou não. Métodos ­ invasivos ou não ­ possibilitam o diagnóstico diferencial e a confirmação histológica, propiciando tratamento adequado. Para melhor compreender a importância da multimodalidade em imagem e a abordagem nos tumores cardíacos , relatamos o caso de um lifoma cardíaco primário, em que a abordagem multidisciplinar permitiu o rápido diagnóstico e seu tratamento, inclusive das intercorrências, com resposta inicial promissora, a despeito da evolução fatal durante a pandemia por SARS-CoV-2.(AU)


Intracardiac masses are a diagnostic challenge since their symptoms can be common to cardiovascular pathologies. Some methods, whether invasive or not, enable differential diagnosis, histological confirmation, and adequate treatment. To better understand the importance of imaging multimodality and the approach to managing cardiac tumors, we investigated a case of a primary cardiac lymphoma in which the multidisciplinary approach allowed rapid diagnosis and treatment, including of intercurrences, with a promising initial response despite fatal progression due to severe acute respiratory syndrome coronavirus 2 infection. (AU)


Subject(s)
Humans , Female , Aged, 80 and over , Lymphoma, Non-Hodgkin/diagnostic imaging , Multimodal Imaging/methods , SARS-CoV-2 , Heart Neoplasms/prevention & control , Pacemaker, Artificial , Respiratory Insufficiency/complications , Biopsy/methods , Magnetic Resonance Spectroscopy/methods , Tomography, X-Ray Computed/methods , Echocardiography, Transesophageal/methods , Electrocardiography/methods
6.
Neumol. pediátr. (En línea) ; 17(1): 28-33, 2022. ilus, tab
Article in Spanish | LILACS | ID: biblio-1379429

ABSTRACT

El objetivo de este estudio es analizar desenlaces clínicos de oxigenoterapia con cánula nasal de alto flujo (CNAF) en niños con dificultad respiratoria aguda en un servicio de urgencias. Estudio longitudinal, retrospectivo de datos panel en niños con diagnóstico de dificultad respiratoria moderada- severa. El resultado primario de interés fue ingreso a unidad de cuidados intensivos pediátricos (UCIP) o requerir intubación 24 horas posteriores al inicio de la terapia. Se calcularon medidas de frecuencia y tendencia central. Los grupos se compararon con las pruebas Chi2, Fisher, Wilcoxon y Kruskal-Wallis. El análisis de datos panel balanceados identificó puntos de inflexión en las curvas de normalización de respuesta respiratoria. Un total de 339 niños de 0 a 16 años cumplieron los criterios de inclusión. Mayoría hombres (62,24%), mediana de edad 2 años (RIQ= 0,75-3) y neumonía como principal causa de dificultad respiratoria (33,92%). El ingreso a UCIP (14,5%) y la intubación (0,9%) fue baja en la cohorte. En las primeras tres horas con CNAF se evidenció mejoría en los parámetros respiratorios, sin diferencias significativas entre pacientes con y sin respuesta clínica (frecuencia cardiaca p=0,317; frecuencia respiratoria p=0,423; SatO2 p=0,297; FiO2 p=0,116). No se presentaron eventos adversos ni casos de mortalidad. Los resultados sugieren que la oxigenoterapia con CNAF puede ser una alternativa de soporte respiratorio inicial en niños ≤16 años con dificultad respiratoria moderada a severa. La incidencia de intubación e ingreso a UCIP fue baja. La CNAF fue bien tolerada en los diferentes grupos de edad.


Objective: To analyze clinical outcomes of oxygen therapy with a high-flow nasal cannula (HFNC) in children with acute respiratory distress in an emergency department. We design a longitudinal retrospective study of panel data in children with a diagnosis of moderate-severe respiratory distress. The primary outcome of interest was admission to the pediatric intensive care unit (PICU) or requiring intubation 24 hours after initiation of therapy.We calculated the statistics of frequency and central tendency. Finally, the Chi2, Fisher, Wilcoxon and Kruskal-Wallis tests were used to compare groups. Balanced panel data analysis identified inflexion points in the respiratory response normalization curves. Children (n = 339) from zero to 16 years old met the inclusion criteria. Most men (62.24%), median age= 2 years (IQR = 0.75-3) and pneumonia as the main cause of respiratory distress (33.92%). Admission to the PICU (14.5%) and intubation (0.9%) was low in the cohort. In the first three hours with HFNC, improvement in respiratory parameters was evidenced, with no significant differences between patients with and without clinical response (heart rate p = 0.317; respiratory rate p = 0.423; SatO2 p = 0.297; FiO2 p = 0.116). There were no adverse events or mortality cases. The results suggest that oxygen therapy with HFNC can be an alternative for initial respiratory support in children ≤16 years of age with moderate to severe respiratory distress. The incidence of intubation and admission to the PICU was low. The HFNC was well tolerated in the different age groups.


Subject(s)
Humans , Male , Female , Infant, Newborn , Infant , Child, Preschool , Child , Adolescent , Oxygen Inhalation Therapy/methods , Respiratory Insufficiency/therapy , Cannula , Intensive Care Units, Pediatric , Retrospective Studies , Longitudinal Studies , Treatment Outcome , Colombia , Emergencies
7.
Article in Chinese | WPRIM | ID: wpr-928625

ABSTRACT

OBJECTIVES@#To study the value of Silverman-Anderson score versus Downes score in predicting respiratory failure in full-term neonates.@*METHODS@#The convenience sampling method was used to select the full-term neonates with lung diseases who were hospitalized in the neonatal intensive care unit from July 2020 to July 2021. According to the diagnostic criteria for neonatal respiratory failure, they were divided into a respiratory failure group (65 neonates) and a non-respiratory failure group (363 neonates). Silverman-Anderson score and Downes score were used for evaluation. The receiver operating characteristic analysis was used to compare the value of the two noninvasive scores in predicting respiratory failure in full-term neonates.@*RESULTS@#Among the 428 full-term neonates, 65 (15.2%) had respiratory failure. The Silverman-Anderson score had a significantly shorter average time spent on evaluation than the Downes score [(90±8) seconds vs (150±13) seconds; P<0.001]. The respiratory failure group had significantly higher points in both the Silverman-Anderson and Downes scores than the non-respiratory failure group (P<0.001). The Silverman-Anderson score had an AUC of 0.876 for predicting respiratory failure, with a sensitivity of 0.908, a specificity of 0.694, and a Youden index of 0.602 at the optimal cut-off value of 4.50 points. The Downes score had an AUC of 0.918 for predicting respiratory failure, with a sensitivity of 0.723, a specificity of 0.953, and a Youden index of 0.676 at the optimal cut-off value of 6.00 points. The Downes score had significantly higher AUC for predicting respiratory failure than the Silverman-Anderson score (P=0.026).@*CONCLUSIONS@#Both Silverman-Anderson and Downes scores can predict the risk of respiratory failure in full-term neonates. The Silverman-Anderson score requires a shorter time for evaluation, while the Downes score has higher prediction efficiency. It is recommended to use Downes score with higher prediction efficiency in general evaluation, and the Silverman-Anderson score requiring a shorter time for evaluation can be used in emergency.


Subject(s)
Humans , Infant, Newborn , Intensive Care Units, Neonatal , Prognosis , ROC Curve , Respiratory Insufficiency/etiology , Risk Factors
8.
Article in Chinese | WPRIM | ID: wpr-935799

ABSTRACT

Allyl alcohol is an intermediate widely used in industrial production activities, which has caused many occupational damage in China. In this paper, the data of a case of skin damage and clinical cure of inhalation pneumonia caused by occupational allyl alcohol exposure were analyzed and summarized. The patient accidentally inhaled large amounts of allyl alcohol at work and had skin exposure, which was mainly manifested as aspiration pneumonia, respiratory failure, eye damage and skin bullae. After short-term hormone shock therapy, mechanical ventilation, infection prevention, local treatment and other comprehensive treatment, the patient was clinically cured. This case suggests that chemical pneumonia and respiratory failure may be caused by inhalation of allyl alcohol, and skin bullae may be caused by skin contact. Early treatment and hormone use should be emphasized.


Subject(s)
Blister , Hormones , Humans , Pneumonia , Propanols , Respiratory Insufficiency
9.
Chinese Journal of Pediatrics ; (12): 124-128, 2022.
Article in Chinese | WPRIM | ID: wpr-935655

ABSTRACT

Objective: To analyze the clinical characteristics and treatment of critically ill children with acute chlorine poisoning and explore the risk factors and effective strategies. Methods: This retrospective study collected the clinical data, including general state, clinical characteristics, treatment and follow-up(till 1 year and 6 months after discharge), of 6 critically ill children who were hospitalized in the Pediatric Intensive Care Unit of Beijing Children's Hospital due to acute chlorine poisoning in August 2019. Results: There were 6 children characterized by severe dyspnea in this accident, among whom 4 were boys and two girls, aged 4-12 years. When the accident occurred, they were within 5 m of the chlorine source. These patients underwent tracheal intubation and mechanical ventilation in 3.5-7.0 h after poisoning. The child who was the closest to the chlorine source (1.5 m) and took the longest time (5 min) to evacuate was the most severe one. He suffered hypoxia which could not be corrected by conventional mechanical ventilation and severe shock, then had veno-arterial extracorporeal membrane oxygenation(ECMO) treatment started 10 h after the accident. All the 6 children in this study survived. Following-up found no growth and developmental abnormality. The pulmonary function tests were normal except for one case with increased small airway resistance due to previous suspected asthma, and the lung CT, electhoencephalogram, and brain magnetic resonance imaging were all normal. Conclusions: Severe chlorine poisoning is mainly characterized by respiratory failure. Mechanical ventilation is often required within a few hours after poisoning. When conventional mechanical ventilation is ineffective, ECMO could save live. Timely treatment could improve prognosis.


Subject(s)
Child , Chlorine , Critical Illness , Extracorporeal Membrane Oxygenation , Female , Humans , Male , Respiratory Insufficiency/therapy , Retrospective Studies
11.
Rev. colomb. neumol ; 34(1): 9-10, 2022.
Article in Spanish | LILACS, COLNAL | ID: biblio-1395749

ABSTRACT

El tratamiento de la insuficiencia respiratoria hipoxémica, con oxigenación mediante cánula nasal de alto flujo CNAF, tiene muchas ventajas. El sistema de humidificación caliente mejora la función mucociliar y la movilización de secreciones. En segundo lugar, el alto flujo logrado por la cánula nasal, puede mejorar la oxigenación, generar una presión positiva de bajo nivel, (efecto PEEP) en las vías respiratorias, reducir la frecuencia respiratoria, atenuar la resistencia inspiratoria y asegurar una FiO2 constante. Tercero, la CNAF permite que el paciente se alimente por vía oral, hable y tosa, lo que hace que sea mucho más cómodo que la oxigenación por mascara (1). Por último, no aumenta el riesgo de complicaciones propias de la ventilación mecánica invasiva, como la neumonía, barotrauma o traqueítis.


Treatment of hypoxemic respiratory failure with high-flow nasal cannula oxygenation has many advantages. The heated humidification system improves mucociliary function and secretion mobilization. Second, the high flow achieved by the nasal cannula can improve oxygenation, generate a low-level positive pressure (PEEP effect) in the airways, reduce respiratory rate, attenuate inspiratory resistance, and ensure constant FiO2. Third, HFNC allows the patient to feed orally, talk, and cough, making it much more comfortable than mask oxygenation (1). Lastly, it does not increase the risk of complications typical of invasive mechanical ventilation, such as pneumonia, barotrauma or tracheitis.


Subject(s)
Humans , Respiratory Insufficiency , Oxygenation
12.
Clin. biomed. res ; 42(1): 7-15, 2022.
Article in Portuguese | LILACS | ID: biblio-1382315

ABSTRACT

Introdução: O suporte ventilatório é usado para o tratamento de pacientes com insuficiência respiratória aguda (IRpA) ou crônica agudizada. A ventilação não-invasiva (VNI) na IRpA pediátrica é amplamente usada em bebês prematuros e crianças, porém até a data atual os estudos têm sido escassos. Portanto, o objetivo do presente estudo foi determinar os fatores de risco associados à falha na VNI em uma unidade de terapia intensiva pediátrica.Métodos: Coorte retrospectiva a partir de prontuários de pacientes admitidos na unidade de terapia intensiva (UTI) Pediátrica de um Hospital de Caxias do Sul, entre maio de 2017 e outubro de 2019, que utilizaram VNI.Resultados: A incidência de falha na VNI foi de 33%. Asma (RR = 1,36; IC95% = 1,08-1,72), uso de VNI em pacientes pós-extubação (RR = 1,97; IC95% = 1,17-3,29), uso contínuo da VNI (RR = 2,44; IC95% = 1,18-5,05), encerramento à noite (RR = 2,52; IC95% = 1,53-4,14), modalidade final ventilação mandatória intermitente sincronizada (SIMV) (RR = 4,20; IC95% = 2,20-7,90), pressão expiratória positiva final (PEEP) no início da ventilação (6,8 ± 1,1; p < 0,01) e fração inspiratória de O2 (FIO2) final (53,10 ± 18,50; p < 0,01) foram associados à falha. Adicionalmente, a pressão arterial sistólica (PAS) inicial (118,68 ± 18,68 mmHg; p = 0,02), a frequência respiratória inicial (FR) (47,69 ± 14,76; p = 0,28) e final (47,54 ± 14,76; p < 0,01) foram associados a falha.Conclusão: A modalidade ventilatória final SIMV, demostra ser o melhor preditor de risco de falha, seguido do turno em que a VNI é finalizada, onde à noite existe maior risco de falha. Além disso, foram preditores de falha, porém com menor robustez, a pressão positiva inspiratória (PIP) final e a FR final.


Introduction: Ventilatory support is used for the treatment of patients with acutely chronic or acute respiratory failure (ARF). Noninvasive ventilation (NIV) in pediatric ARF is widely used in preterm infants and children, but studies to date have been limited. Therefore, the aim of the present study was to determine the risk factors associated with NIV failure in a pediatric intensive care unit.Methods: This retrospective cohort study was based on medical records of patients admitted to the pediatric intensive care unit of a hospital in Caxias do Sul, southern Brazil, between May 2017 and October 2019, who used NIV.Results: The incidence of NIV failure was 33%. Asthma (relative risk [RR] = 1.36; 95% confidence interval [CI] = 1.08-1.72), post-extubation use of NIV (RR = 1.97; 95% CI = 1.17-3.29), continuous use of NIV (RR = 2.44; 95% CI = 1.18-5.05), completion at night (RR = 2.52; 95% CI = 1.53-4.14), final mode synchronized intermittent mandatory ventilation (SIMV) (RR = 4.20; 95% CI = 2.20-7.90), positive end-expiratory pressure at the beginning of ventilation (6.8 ± 1.1; p < 0.01), and final fraction of inspired oxygen (53.10 ± 18.50; p < 0.01) were associated with failure. Additionally, initial systolic blood pressure (118.68 ± 18.68 mmHg; p = 0.02), initial respiratory rate (IRR) (47.69 ± 14.76; p = 0.28), and final respiratory rate (47.54 ± 14.76; p < 0.01) were associated with failure.Conclusion: The final ventilatory mode SIMV proves to be the best failure risk predictor, followed by the shift in which NIV is completed, as there is a greater risk of failure at night. In addition, final positive inspiratory pressure and final respiratory rate were less robust predictors of failure.


Subject(s)
Humans , Male , Female , Infant, Newborn , Infant , Child, Preschool , Child , Respiratory Insufficiency/complications , Intensive Care Units, Pediatric , Respiration, Artificial/adverse effects , Risk Factors , Cohort Studies
13.
Bol. malariol. salud ambient ; 62(2): 306-312, 2022. tab
Article in Spanish | LILACS, LIVECS | ID: biblio-1391339

ABSTRACT

La COVID-19 ha generado mundialmente una morbi-mortalidad considerable, particularmente entre aquellos con comorbilidades crónicas: hipertensión, diabetes y enfermedad cardiovascular. Investigaciones han demostrado que la apnea del sueño puede agravar el pronóstico vital, al causar o agudizar la disfunción endotelial, inflamación, estrés oxidativo, microaspiración y lesiones pulmonares, lo que amplifica el riesgo de hospitalización e incluso de sufrir de insuficiencia respiratoria. Se realizó un estudio descriptivo retrospectivo y transversal, se evaluaron 187 pacientes cardiópatas con clínica sugestiva a apnea obstructiva del sueño con resultaron positivo para SARS-CoV-2, entre 2020-2021.Se aplicaron la metodología de Castro et al., 2021 y cuestionario de STOP-BANG para valorar la disnea y caracterizar la AOS respectivamente. Se corroboró la fuerte asociación entre la enfermedad cardíaca y la presencia de AOS; más de la mitad de los pacientes estudiados presentaron, enfermedad grave por COVID-19, con disnea moderada-grave, que amerito hospitalización con cuidados intensivos, observándose mayor frecuencia en el sexo masculino, con más de 50 años y con IMC >30. Sin embargo, las féminas presentaron valores significativos de STOP-BANG, lo que sugiere a la HTA y obesidad como factores de riesgo para AOS, independiente al sexo. Se recomienda realizar el descarte de AOS como rutina médica, que permita establecer la epidemiología y estrategias para abordaje adecuado de estos pacientes(AU)


COVID-19 has generated considerable morbidity and mortality worldwide, particularly among those with chronic comorbidities: hypertension, diabetes, and cardiovascular disease. Research has shown that sleep apnea can worsen the vital prognosis, by causing or exacerbating endothelial dysfunction, inflammation, oxidative stress, microaspiration and lung damage, which amplifies the risk of hospitalization and even respiratory failure. A retrospective and cross-sectional descriptive study was carried out, 187 heart patients with clinical signs suggestive of obstructive sleep apnea were evaluated and were positive for SARS-CoV-2, between 2020-2021. The methodology of Castro et al., 2021 and questionnaire were applied. STOP-BANG to assess dyspnea and characterize OSA, respectively. The strong association between heart disease and the presence of OSA was confirmed; More than half of the patients studied presented severe disease due to COVID-19, with moderate-severe dyspnea, which required hospitalization with intensive care, with a higher frequency observed in males, over 50 years of age and with BMI >30. However, females presented significant STOP-BANG values, which suggests hypertension and obesity as risk factors for OSA, regardless of gender. It is recommended to rule out OSA as a medical routine, which allows establishing the epidemiology and strategies for an adequate approach to these patients(AU)


Subject(s)
Humans , Male , Female , Middle Aged , Aged , Respiratory Insufficiency , Cardiovascular Diseases , Sleep Apnea, Obstructive , Lung Injury , COVID-19 , Epidemiology , Morbidity , Mortality , Critical Care , Dyspnea
14.
J. bras. pneumol ; 48(1): e20210349, 2022. tab, graf
Article in English | LILACS | ID: biblio-1360534

ABSTRACT

ABSTRACT Objective: To assess the feasibility of using a new helmet interface for CPAP, designated ELMO, to treat COVID-19-related acute hypoxemic respiratory failure (AHRF) outside the ICU. Methods: This was a proof-of-concept study involving patients with moderate to severe AHRF secondary to COVID-19 admitted to the general ward of a public hospital. The intervention consisted of applying CPAP via the ELMO interface integrated with oxygen and compressed air flow meters (30 L/min each) and a PEEP valve (CPAP levels = 8-10 cmH2O), forming the ELMOcpap system. The patients were monitored for cardiorespiratory parameters, adverse events, and comfort. Results: Ten patients completed the study protocol. The ELMOcpap system was well tolerated, with no relevant adverse effects. Its use was feasible outside the ICU for a prolonged amount of time and was shown to be successful in 60% of the patients. A CPAP of 10 cmH2O with a total gas flow of 56-60 L/min improved oxygenation after 30-to 60-min ELMOcpap sessions, allowing a significant decrease in estimated FIO2 (p = 0.014) and an increase in estimated PaO2/FIO2 ratio (p = 0.008) within the first hour without CO2 rebreathing. Conclusions: The use of ELMOcpap has proven to be feasible and effective in delivering high-flow CPAP to patients with COVID-19-related AHRF outside the ICU. There were no major adverse effects, and ELMO was considered comfortable. ELMOcpap sessions significantly improved oxygenation, reducing FIO2 without CO2 rebreathing. The overall success rate was 60% in this pilot study, and further clinical trials should be carried out in the future. (ClinicalTrials.gov identifier: NCT04470258 [http://www.clinicaltrials.gov/])


RESUMO Objetivo: Avaliar a viabilidade do uso de uma nova interface do tipo capacete para CPAP, denominada ELMO, para o tratamento da insuficiência respiratória aguda (IRpA) hipoxêmica por COVID-19 fora da UTI. Métodos: Estudo de prova de conceito envolvendo pacientes com IRpA hipoxêmica moderada a grave secundária à COVID-19, internados na enfermaria geral de um hospital público. A intervenção consistiu na aplicação de CPAP por meio da interface ELMO integrada a fluxômetros de oxigênio e ar comprimido (30 L/min cada) e a uma válvula de PEEP (níveis de CPAP = 8-10 cmH2O), formando o sistema ELMOcpap. Os pacientes foram monitorados quanto a parâmetros cardiorrespiratórios, eventos adversos e conforto. Resultados: Dez pacientes completaram o protocolo do estudo. O sistema ELMOcpap foi bem tolerado, sem efeitos adversos relevantes. Seu uso foi viável fora da UTI por tempo prolongado e mostrou-se bem-sucedido em 60% dos pacientes. Uma CPAP de 10 cmH2O com fluxo total de gás de 56-60 L/min melhorou a oxigenação após sessões de ELMOcpap de 30-60 min, permitindo redução significativa da FIO2 estimada (p = 0,014) e aumento da PaO2/FIO2 estimada (p = 0,008) na primeira hora, sem reinalação de CO2. Conclusões: O uso do ELMOcpap mostrou-se viável e eficaz no fornecimento de CPAP de alto fluxo a pacientes com IRpA hipoxêmica por COVID-19 fora da UTI. Não houve nenhum efeito adverso importante, e o ELMO foi considerado confortável. As sessões de ELMOcpap melhoraram significativamente a oxigenação, reduzindo a FIO2 sem reinalação de CO2. A taxa global de sucesso foi de 60% neste estudo piloto, e novos ensaios clínicos devem ser realizados. (ClinicalTrials.gov identifier: NCT04470258 [http://www.clinicaltrials.gov/])


Subject(s)
Humans , Respiratory Insufficiency/therapy , COVID-19 , Pilot Projects , Feasibility Studies , Proof of Concept Study , SARS-CoV-2 , Intensive Care Units
16.
Rev. argent. cir ; 113(4): 471-476, dic. 2021. graf
Article in Spanish | LILACS, BINACIS | ID: biblio-1356957

ABSTRACT

RESUMEN La traqueobroncomalacia es una enfermedad de la vía aérea central caracterizada por una debilidad de la pared, con disminución dinámica de la luz de la tráquea y grandes bronquios principalmente durante la espiración. Genera síntomas crónicos que pueden evolucionar hasta la falla respiratoria grave, frecuentemente diagnosticados de forma errónea como asma o enfermedad pulmonar obstructiva crónica (EPOC). Presentamos el caso de una paciente femenina de 70 años, con antecedente de artritis reumatoide y múltiples internaciones por cuadros respiratorios infecciosos en los 3 años previos.


ABSTRACT Tracheobroncomalacia is a disease of the central airway due to weakness of the wall with dynamic narrowing of the lumen of the trachea and mainstem bronchi during exhalation. It produces chronic symptoms that can progress to severe respiratory failure, often misdiagnosed as asthma or chronic obstructive pulmonary disease (COPD). We report the case of a 70-year-old female patient with a history of rheumatoid arthritis and multiple hospitalizations for recurrent respiratory infections over the past 3 years.


Subject(s)
Humans , Female , Aged , Tracheobronchomalacia , Tracheomalacia , Respiratory Insufficiency , Asthma , Signs and Symptoms , Trachea , Bronchi , Exhalation , Tracheobronchomalacia/complications , Frailty
17.
Vive (El Alto) ; 4(12): 591-598, dic. 2021.
Article in Spanish | LILACS-Express | LILACS | ID: biblio-1390555

ABSTRACT

El virus por COVID-19 ha causado dificultades tanto físicas, psicológicas como respiratorias, entre los síntomas principales que presenta esta enfermedad resalta insuficiencia respiratoria a la que se suma la fragilidad física en respuesta a largos periodos de encamamiento en Unidad de Cuidados Intensivos. La investigación del caso clínico realizada a una paciente post COVID -19 quien tuvo una estancia prolongada de hospitalización, posteriormente tratada en su domicilio, donde la fisioterapia empleada se basó en la técnica de Facilitación Neuromuscular Propioceptiva combinada con ejercicios respiratorios que tienen como objetivo mejorar la funcionalidad del paciente post COVID-19. Se monitorizó los signos vitales al comienzo y final de la terapia. De igual manera se emplearon patrones bilaterales de F.N.P. en las extremidades superiores e inferiores, combinándose con los ejercicios respiratorios evidenciándose aumento de la capacidad respiratoria y mejorando el nivel de funcionalidad de la paciente. Se realizó una valoración mediante la escala de Borg para la percepción subjetiva de la dificultad respiratoria o del esfuerzo físico realizado.


The COVID-19 virus has caused both physical, psychological and respiratory difficulties, among the main symptoms that this disease presents is respiratory failure to which is added physical fragility in response to long periods of bedridden in the Intensive Care Unit. The clinical case investigation carried out on a post-COVID-19 patient who had a prolonged hospitalization stay, subsequently treated at home, where the physiotherapy used was based on the Proprioceptive Neuromuscular Facilitation technique combined with respiratory exercises that aim to improve the post-COVID-19 patient functionality. Vital signs were monitored at the beginning and end of therapy. Similarly, bilateral F.N.P. patterns were used. in the upper and lower extremities, combining with respiratory exercises, showing an increase in respiratory capacity and improving the level of functionality of the patient. An assessment was made using the Borg scale for the subjective perception of respiratory distress or physical exertion.


O vírus COVID-19 tem causado dificuldades físicas, psicológicas e respiratórias. Os principais sintomas desta doença incluem insuficiência respiratória e fragilidade física em resposta a longos períodos de descanso no leito na Unidade de Terapia Intensiva. O estudo de caso clínico foi realizado em um paciente pósCOVID-19 que teve uma estadia hospitalar prolongada, posteriormente tratado em casa, onde a fisioterapia utilizada foi baseada na técnica de Facilitação Neuromuscular Proprioceptiva combinada com exercícios respiratórios destinados a melhorar a funcionalidade do paciente pósCOVID-19. Os sinais vitais foram monitorados no início e no final da terapia. Da mesma forma, foram utilizados padrões de N.P.F. bilaterais nas extremidades superiores e inferiores, combinados com os exercícios respiratórios, mostrando um aumento na capacidade respiratória e melhorando o nível de funcionalidade do paciente. Foi feita uma avaliação utilizando a escala Borg para a percepção subjetiva da dificuldade respiratória ou do esforço físico realizado.


Subject(s)
Respiratory Insufficiency , Patients , SARS-CoV-2 , COVID-19
18.
San Salvador; MINSAL; oct. 11, 2021. 62 p. ilus.
Non-conventional in Spanish | LILACS, BISSAL | ID: biblio-1352689

ABSTRACT

La enfermedad causada por SARS-CoV-2, COVID-19, se ha transformado en una pandemia global y en uno de los principales problemas de salud pública en nuestro país. Se estima que entre el 5 y 10% de los pacientes requerirá hospitalización en unidades de cuidados intensivos y un 80% necesitará algún tipo de soporte ventilatorio. La COVID-19 es una enfermedad infecciosa que puede causar importantes disfunciones respiratorias y físicas a corto y largo plazo que requieren la implementación de un programa de rehabilitación pulmonar que se adapte a las necesidades de cada paciente y una atención multidisciplinaria. El cuadro fisiopatológico de la falla respiratoria aguda por COVID-19, ha mostrado ser similar al desencadenado en el síndrome de distrés respiratorio agudo (SDRA). Por consiguiente, la recuperación funcional de estos pacientes esté determinada, entre otros factores, por debilidad muscular adquirida y el deterioro cardiorrespiratorio asociado, cuyas secuelas físicas y psicológicas afectan negativamente el pronóstico funcional de los pacientes. A partir de estos factores, emerge la necesidad de diseñar los Lineamientos técnicos para la rehabilitación pulmonar en pacientes post COVID-19 para que puedan ser aplicados a las necesidades de los pacientes afectados por COVID-19, lo cual, constituye un desafío para el SNIS


The disease caused by SARS-CoV-2, COVID-19, has become a global pandemic and one of the main public health problems in our country. It is estimated that between 5 and 10% of patients will require hospitalization in intensive care units and 80% will need some type of ventilatory support. COVID-19 is an infectious disease that can cause significant short and long-term respiratory and physical dysfunctions that require the implementation of a pulmonary rehabilitation program that is tailored to the needs of each patient and multidisciplinary care. The pathophysiological picture of acute respiratory failure due to COVID-19 has been shown to be similar to that triggered in acute respiratory distress syndrome (ARDS). Consequently, the functional recovery of these patients is determined, among other factors, by acquired muscle weakness and the associated cardiorespiratory deterioration, whose physical and psychological sequelae negatively affect the functional prognosis of the patients. From these factors, the need to design the Technical Guidelines for pulmonary rehabilitation in post-COVID-19 patients emerges so that they can be applied to the needs of patients affected by COVID-19, which constitutes a challenge for the NHRS


Subject(s)
Respiratory Insufficiency , Pandemics , SARS-CoV-2 , COVID-19 , Patients
19.
Rev. bras. ter. intensiva ; 33(4): 544-548, out.-dez. 2021. tab, graf
Article in English, Portuguese | LILACS | ID: biblio-1357198

ABSTRACT

RESUMO Objetivo: Avaliar o impacto no número de casos de oxigenação por membrana extracorpórea e as taxas de sobrevivência nos anos seguintes à pandemia de H1N1 de 2009. Métodos: Avaliaram-se dois períodos distintos de utilização de oxigenação por membrana extracorpórea como suporte para insuficiência respiratória em crianças, por meio da análise de conjuntos de dados da Extracorporeal Life Support Organization. Foram construídos modelos autorregressivos integrados de médias móveis para estimar os efeitos da pandemia. O ano de 2009 foi o ano de intervenção (epidemia de H1N1) em um modelo de séries temporais interrompidas. Os dados colhidos entre 2001 e 2010 foram considerados pré-intervenção e os obtidos entre 2010 e 2017 como pós-intervenção. Resultados: Em comparação com o período entre 2001 e 2010, o período entre 2010 e 2017 mostrou aumento das taxas de sobrevivência (p < 0,0001), com melhora significante da sobrevivência quando se realizou oxigenação por membrana extracorpórea nos casos de insuficiência aguda por pneumonia viral. Antes do ponto de nível de efeito (2009), o modelo autorregressivo integrado de médias móveis mostrou aumento de 23 casos de oxigenação por membrana extracorpórea ao ano. Em termos de sobrevivência, a curva mostra que não houve aumento significante das taxas de sobrevivência antes de 2009 (p = 0,41), porém o nível de efeito foi próximo à significância após 2 anos (p = 0,05), com aumento de 6% na sobrevivência. Em 4 anos, ocorreu aumento de 8% (p = 0,03) na sobrevivência, e, 6 anos após 2009, a sobrevivência mostrou aumento de até 10% (p = 0,026). Conclusão: Nos anos após 2009, ocorreu significante e progressivo aumento global das taxas de sobrevivência com oxigenação por membrana extracorpórea para todos os casos, principalmente em razão de melhoras tecnológicas e dos protocolos de tratamento para insuficiência respiratória aguda relacionada à pneumonia viral e a outras condições respiratórias.


ABSTRACT Objective: To evaluate whether there was any impact on the number of pediatric extracorporeal membrane oxygenation runs and survival rates in the years subsequent to the 2009 pandemic. Methods: We studied two different periods of extracorporeal membrane oxygenation support for respiratory failure in children by analyzing datasets from the Extracorporeal Life Support Organization. Autoregressive integrated moving average models were constructed to estimate the effect of the pandemic. The year 2009 was the year of intervention (the H1N1 epidemic) in an interrupted time series model. Data collected from 2001 - 2010 were considered preintervention, and data collected from 2010 - 2017 were considered postintervention. Results: There was an increase in survival rates in the period 2010 - 2017 compared to 2001 - 2010 (p < 0.0001), with a significant improvement in survival when extracorporeal membrane oxygenation was performed for acute respiratory failure due to viral pneumonia. The autoregressive integrated moving average model shows an increase of 23 extracorporeal membrane oxygenation runs per year, prior to the point of the level effect (2009). In terms of survival, the preslope shows that there was no significant increase in survival rates before 2009 (p = 0.41), but the level effect was nearly significant after two years (p = 0.05), with a 6% increase in survival. In four years, there was an 8% (p = 0.03) increase in survival, and six years after 2009, there was up to a 10% (p = 0.026) increase in survival. Conclusion: In the years following 2009, there was a significant, global incremental increase in the extracorporeal membrane oxygenation survival rates for all runs, mainly due to improvements in the technology and treatment protocols for acute respiratory failure related to viral pneumonia and other respiratory conditions.


Subject(s)
Humans , Child , Respiratory Distress Syndrome, Newborn , Respiratory Insufficiency/therapy , Respiratory Insufficiency/epidemiology , Extracorporeal Membrane Oxygenation , Influenza A Virus, H1N1 Subtype , Retrospective Studies , Pandemics
20.
Ludovica pediátr ; 24(1): 25-33, Ene-Jun 2021.
Article in Spanish | LILACS, Redbvs, BINACIS | ID: biblio-1293220

ABSTRACT

Introducción: Las infecciones respiratorias agudas bajas (IRAB), representan la causa más frecuente de consulta e internación en los meses de invierno. La insuficiencia respiratoria aguda es la complicación que motiva la internación de los pacientes y la necesidad de Unidad Terapia Intensiva (UTI).El objetivo del trabajo fue describir los resultados de la implementación de la Terapia de Alto Flujo (TAFO) en pacientes con IRAB grave internados en Terapia Intermedia Métodos: Estudio prospectivo y descriptivo que incluyó pacientes de 1 a 36 meses internados en Terapia Intermedia en el Hospital Sor María Ludovica de la ciudad de La Plata, desde junio de 2018 a septiembre de 2019. Se ingresaron a TAFO pacientes sin respuesta al tratamiento con oxígeno a bajo flujo. El ingreso a UTI se consideró fracaso de la TAFO Resultados: De 760 pacientes internados con IRAB, 91(11,9%) ingresaron a TAFO de los cuales 59 (64,8 %) tuvieron respuesta favorable con disminución de la frecuencia respiratoria (FR), frecuencia cardiaca (FC) y mejoría de la mecánica respiratoria; el resto (35,2%) pasó a UTI por fracaso terapéutico. Presentaron complicaciones a la TAFO el 5,5% de los pacientes Conclusión: La TAFO fue una terapéutica segura, de fácil utilización que, a través de un aporte de oxígeno conocido, permitió la corrección de la hipoxemia, logrando la disminución de la FR, FC y mejoría de la mecánica respiratoria, dándole mayor comodidad al paciente durante su enfermedad


Introduction: Respiratory infections remain the major cause of outpatient consultation and hospital admissions during the winter season. Lower respiratory illness may cause severe acute respiratory insufficiency and hypoxemic respiratory failure, thus determining the need for hospitalization and eventual intensive care (ICU). The purpose of this paper is to describe the results of High Flow Oxygen Therapy (HFOT) implementation for patients with acute lower respiratory infections (ALRI) admitted to intermediate therapy unit. Methods: Prospective and descriptive study which included patients from age 1 to 36 months, hospitalized at intermediate therapy care unit at "Sor María Ludovica", Hospital, in La Plata, from June, 2018 to September, 2019. Patients who did not show any improvement to low flow oxygen therapy were the subjects of this study. Further submission to ICU was considered as HFOT failure Results: From 760 patients hospitalized with ALRI, 91 (11.9%) were admitted to TAFO. Fifty nine, (64.8%) had a favorable response with decreased respiratory and heart frequency rate, and an improvement of the work of breathing. The rest (35.1%) went to ICU due to therapeutic failure. Five point five percent of patients presented complications to TAFO. Conclusion: HFOT was a safe, easy to implement therapy treatment which improved the hypoxemic respiratory failure. This therapy reduced the respiratory and heart rate, and yielded a better and lower respiratory work, making patients more comfortable during illness


Subject(s)
Humans , Infant , Child, Preschool , Respiratory Insufficiency , Bronchiolitis
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