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1.
Fisioter. Bras ; v.22(4): 536-549, Nov 2, 2021.
Article in Portuguese | LILACS | ID: biblio-1353378

ABSTRACT

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


Subject(s)
Humans , Ventilation , Airway Extubation , Respiration, Artificial , Tracheostomy , Risk Factors , Intubation
2.
Infectio ; 25(3): 182-188, jul.-set. 2021. tab, graf
Article in English | LILACS, COLNAL | ID: biblio-1250090

ABSTRACT

Abstract The article presents a general overview on COVID-19 transmission in the context of public transport, particularly applicable to decision making in Latin America. Based on recent findings on COVID-19 transmission and the relative importance of each factor (droplets, fomites, and aerosol routes) in such transmission, we seek to update the discussion on the topic that has generally been based on social distance as the only parameter for reducing the risk of transmission and broadens the vision to integrate ventilation, users' behavior (mask and eye protection use, silence while in the transport system) and travel distance. Recommendations to improve mobility conditions reducing the risk of COVID-19 contagion are provided.


Resumen El artículo presenta una revisión de transmisión de COVID-19 en el contexto de transporte público, con aplicación particular para toma de decisiones en América Latina. Con base en los hallazgos recientes sobre transmisión de Covid-19 y la importancia relativa de cada factor (gotículas, fómites y rutas de aerosoles) en dicha transmisión, buscamos actualizar la discusión sobre el tema que generalmente se ha basado en la "distancia social" como parámetro único de reducción de riesgo de transmisión y amplía esta visión para integrar la ventilación, el comportamiento de usuarios (uso de mascarilla, protección ocular, silencio), y la distancia de viaje. Se indican al final recomendaciones para mejorar las condiciones de movilidad en general sin aumentar el riesgo de contagio de Covid-19.


Subject(s)
Humans , Male , Female , Transportation , Health Strategies , COVID-19 , Travel , Ventilation , Vision, Ocular , Urban Sanitation , Protection , Latin America
3.
São Paulo; s.n; HSPM; 2021.
Thesis in Portuguese | LILACS, ColecionaSUS, SMS-SP, HSPM-Producao, SMS-SP | ID: biblio-1349286

ABSTRACT

RESUMO Introdução: O acometimento pulmonar avaliado por tomografia de tórax é parâmetro usualmente utilizado para auxiliar diagnóstico, avaliação de prognóstico e manejo da COVID-19. Diversos estudos científicos desde o início da pandemia direcionam a aplicação e interpretação dos achados tomográficos para a prática clínica. Este estudo se propõe a descrever o grau e aspecto do acometimento pulmonar encontrado em pacientes hospitalizados por COVID-19 e a associação das alterações encontradas ao desfecho de necessidade de ventilação mecânica invasiva, levando em consideração também aspectos clínico-laboratoriais específicos. Métodos: A partir de um estudo observacional, retrospectivo e unicêntrico, conduzido no Hospital do Servidor Público Municipal de São Paulo, com levantamento de dados secundários em prontuário e sistemas informatizados de exames, analisou-se dados de 164 pacientes adultos internados por COVID-19 no período de março a dezembro de 2020. Analisou-se o acometimento pulmonar à admissão hospitalar. Também foi feita breve análise de características clínicas dos pacientes, comorbidades e alterações de saturação de oxigênio, contagem de linfócitos e D-Dímero presentes à admissão. Estes dados foram relacionados ao desfecho de ventilação invasiva e, secundariamente, ao desfecho de alta ou óbito ao fim da internação. Resultados: Não houve relação de sexo e idade com desfecho primário. Hipertensão foi a comorbidade mais frequente (56,7%), não associada ao desfecho primário. Obesidade foi significativamente mais frequente nos pacientes que evoluíram para suporte ventilatório invasivo (50%) do que nos que não necessitaram (30%), com média de IMC de 31,3 kg/m² e 28,5kg/m² para cada grupo, respectivamente. Os pacientes apresentaram majoritariamente as lesões pulmonares típicas de COVID-19. As opacificações em vidro fosco com distribuição periférica e basal foram as lesões mais comuns independente do desfecho, porém significativamente mais frequente naqueles que não necessitaram de suporte ventilatório invasivo, enquanto a distribuição central e periférica foi significativamente associada ao desfecho primário desfavorável de necessidade de ventilação mecânica invasiva. O acometimento pulmonar superior a 50% à admissão evidenciou 2,2 vezes maior risco de evoluir para ventilação mecânica invasiva do que o acometimento de até 50% do parênquima pulmonar. O acometimento pulmonar superior a 50% também representou 1,8 vezes maior risco de evolução a óbito intra-hospitalar. Conclusão: Os achados pulmonares tomográficos à admissão hospitalar podem predizer o desfecho de necessidade de ventilação mecânica invasiva na internação. A distribuição das opacidades em vidro fosco e a porcentagem de acometimento pulmonar foram os fatores estatisticamente relevantes para esta avaliação. A porcentagem de parênquima acometido e a necessidade de ventilação mecânica invasiva foram diretamente associados ao desfecho de alta ou óbito ao fim da internação. Palavras-chave: COVID-19. Tomografia. Ventilação Mecânica.


Subject(s)
Humans , Male , Female , Ventilation , Tomography , COVID-19
4.
Rev. cuba. invest. bioméd ; 40(supl.1): e1185, 2021.
Article in Spanish | LILACS, CUMED | ID: biblio-1289480

ABSTRACT

Introducción: Una característica de los pacientes con síndrome de dificultad respiratoria aguda asociada a la COVID -19, sobre todo los más graves, es la presencia de hipoxemia refractaria, que puede demandar terapia adyuvante a la ventilación mecánica artificial, entre ellos, el posicionamiento prono del paciente. Objetivo: Exponer la evidencia disponible sobre los cambios producidos en el sistema respiratorio por la implementación del posicionamiento prono en pacientes con soporte ventilatorio invasivo por síndrome de dificultad respiratoria aguda asociado a la COVID -19 y su impacto sobre la mortalidad. Métodos: Se realizó una revisión bibliográfica temática, observacional y retrospectiva, en el período comprendido de febrero a julio del 2020. Se utilizó el motor de búsqueda Google Académico y posteriormente se consultaron las bases de datos bibliográficas: CUMED, LILACS, SciELO, PubMed/Medline, EBSCO, Cochrane Library y Web of Science. En la estrategia de búsqueda se emplearon como palabras clave: "posición prona", "síndrome de distrés respiratorio agudo", "ventilación mecánica", según el descriptor de Ciencias de la Salud (DeCS). Los criterios de selección incluyeron artículos en idiomas inglés y español, de procedencia extranjera o nacional, en la temática consecuente con las palabras clave utilizadas, fecha de publicación en la presente centuria y de preferencia durante el último quinquenio. Conclusiones: Las guías actuales recomiendan el establecimiento precoz de la ventilación mecánica invasiva en posición prono para pacientes con síndrome de dificultad respiratoria aguda moderado -grave, inducido por COVID-19 durante 12 a 16 horas diarias, con el fin de mejorar la oxigenación, el reclutamiento pulmonar y la disminución de la mortalidad(AU)


Introduction: A characteristic of patients with acute respiratory distress syndrome associated to COVID-19, particularly the most severely affected, is the presence of refractory hypoxemia, which may require adjuvant therapy alongside artificial mechanical ventilation, including prone positioning of the patient. Objective: Present the available evidence about the changes undergone by the respiratory system with the implementation of prone positioning in patients with invasive ventilation support due to acute respiratory distress associated to COVID-19, as well as its impact on mortality. Methods: An observational retrospective bibliographic review about the topic was conducted from February to July 2020, initially with the search engine Google Scholar, and then in the bibliographic databases CUMED, LILACS, SciELO, PubMed/Medline, EBSCO, Cochrane Library and Web of Science. The search was based on key terms such as "prone position", "acute respiratory distress syndrome", "mechanical ventilation", obtained from the Health Sciences Descriptors (DeCS). Selection criteria included papers written in English or Spanish, of a foreign or national origin, about the topic suggested by the search terms used, published in the present century, preferably in the last five years. Conclusions: Current guidelines recommend early use of invasive mechanical ventilation in prone position for patients with COVID-19-induced moderate-severe acute respiratory distress syndrome for 12-16 hours daily to improve oxygenation and pulmonary recruitment, and reduce mortality(AU)


Subject(s)
Humans , Male , Female , Respiration, Artificial , Respiratory Distress Syndrome, Newborn , Ventilation , Prone Position , Retrospective Studies , Observational Study
5.
s.l; s.n; jul. 2020.
Non-conventional in Portuguese | LILACS, ColecionaSUS | ID: biblio-1102877

ABSTRACT

Este documento visa orientar os gestores das organizações privadas quanto à prevenção e acompanhamento das condições de saúde de seus colaboradores, visando prevenir a disseminação da Covid-19 nos ambientes de trabalho. Neste protocolo são apresentadas diretrizes para a realização de ações de prevenção, triagem, testagem, conduta e comunicação de casos suspeitos. As ações de acompanhamento das condições de saúde por parte das organizações privadas devem estar vinculadas às diretrizes e recomendações do Sistema Público de Vigilância em Saúde.


Subject(s)
Humans , Health Status , Triage/standards , Occupational Health/standards , Coronavirus Infections/prevention & control , Protocols/methods , Social Isolation , Ventilation/methods , Epidemiological Monitoring , Hand Hygiene/methods
7.
Santa Tecla, La Libertad; ITCA Editores; ene. 2020. 90 p. ^c28 cm.ilus., tab., graf..
Monography in Spanish | LILACS, BISSAL | ID: biblio-1222433

ABSTRACT

Se desarrolló una propuesta de intervención arquitectónica y constructiva de iluminación natural, ventilación y confort térmico para el área de rehabilitación del edificio de la Fundación Teletón Pro Rehabilitación FUNTER. Se diseñó una propuesta de interiorismo para uso eficiente de espacios, mobiliario, iluminación artificial, texturas y colores apropiados para el desarrollo de terapias. Se realizó un estudio de eficiencia energética para proponer medidas de ahorro y uso eficiente de la energía en el edificio. Se diseñó una nueva distribución de espacios en la zona de terapia y se aplicaron criterios de bioclimatismo pasivo, como la ventilación cruzada, ventilación cenital y la apertura de áreas de ventilación basándose en el análisis de vientos del sitio para mejorar la sensación térmica interna. La implementación de un jardín sensorial ayudará a los pacientes de terapia de marcha a interactuar en un área más cercana a las superficies reales del ambiente.


An architectural and constructive intervention proposal for natural lighting, ventilation and thermal comfort was developed for the rehabilitation area of ​​the Teletón Pro Rehabilitation Foundation FUNTER building. An interior design proposal was designed for the efficient use of spaces, furniture, artificial lighting, textures and appropriate colors for the development of therapies. An energy efficiency study was carried out to propose measures for saving and efficient use of energy in the building. A new distribution of spaces was designed in the therapy area and passive bioclimatic criteria were applied, such as cross ventilation, overhead ventilation and the opening of update areas in the site wind analysis to improve the internal thermal sensation. Implementing a sensory garden will help gait therapy patients interact in an area closer to the actual surfaces of the environment.


Subject(s)
Disabled Persons/rehabilitation , Facility Design and Construction , Interior Design and Furnishings , Therapeutics , Ventilation , Lighting , Health of the Disabled , Usage Remodeling
8.
Article in English | WPRIM | ID: wpr-880302

ABSTRACT

The severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), a new zoonotic agent that emerged in December 2019, causes coronavirus disease 2019 (COVID-19). This infection can be spread by asymptomatic, presymptomatic, and symptomatic carriers. SARS-CoV-2 spreads primarily via respiratory droplets during close person-to-person contact in a closed space, especially a building. This article summarizes the environmental factors involved in SARS-CoV-2 transmission, including a strategy to prevent SARS-CoV-2 transmission in a building environment. SARS-CoV-2 can persist on surfaces of fomites for at least 3 days depending on the conditions. If SARS-CoV-2 is aerosolized intentionally, it is stable for at least several hours. SARS-CoV-2 is inactivated rapidly on surfaces with sunlight. Close-contact aerosol transmission through smaller aerosolized particles is likely to be combined with respiratory droplets and contact transmission in a confined, crowded, and poorly ventilated indoor environment, as suggested by some cluster cases. Although evidence of the effect of aerosol transmission is limited and uncertainty remains, adequate preventive measures to control indoor environmental quality are required, based on a precautionary approach, because COVID-19 has caused serious global damages to public health, community, and the social economy. The expert panel for COVID-19 in Japan has focused on the "3 Cs," namely, "closed spaces with poor ventilation," "crowded spaces with many people," and "close contact." In addition, the Ministry of Health, Labour and Welfare of Japan has been recommending adequate ventilation in all closed spaces in accordance with the existing standards of the Law for Maintenance of Sanitation in Buildings as one of the initial political actions to prevent the spread of COVID-19. However, specific standards for indoor environmental quality control have not been recommended and many scientific uncertainties remain regarding the infection dynamics and mode of SARS-CoV-2 transmission in closed indoor spaces. Further research and evaluation are required regarding the effect and role of indoor environmental quality control, especially ventilation.


Subject(s)
Aerosols , Air Pollution, Indoor/prevention & control , Betacoronavirus/physiology , COVID-19 , Coronavirus Infections/transmission , Crowding , Environment, Controlled , Humans , Pandemics/prevention & control , Pneumonia, Viral/transmission , SARS-CoV-2 , Ventilation
9.
Rev. colomb. anestesiol ; 47(4): 245-248, Oct-Dec. 2019. graf
Article in English | LILACS, COLNAL | ID: biblio-1042735

ABSTRACT

Abstract We report an unexpected difficult airway in a patient with unrecognized lingual tonsillar hypertrophy. A 54-year-old hypertensive woman presented for resection of a mediastinal mass under general anesthesia (GA). After induction, mask ventilation was impossible. Laryngeal mask airway (LMA) was used, achieving suboptimal ventilation. Fiberoptic intubation through LMA was attempted but tube advancement was hindered by a protrudingmass. Finally, intubation was achieved using the Frova introducer. After completion of the surgery, the patient was transferred, intubated, to the postanesthesia care unit. Ear, nose, and throat assessment concluded that the mass was a hyper-trophied lingual tonsil. Unexpected lingual tonsillar hypertrophy can complicate GA, making mask ventilation, and even intubation impossible. It is considered a frequent cause of unexpected difficult airway. Diagnosis cannot be made by standard airway physical examination. Once recognized, fiberoptic intubation is mandatory in subsequent surgeries.


Resumen Presentamos el caso de una vía aérea difícil imprevista debido a hipertrofia de la amígdala lingual no conocida. Mujer de 54 años, hipertensa, que ingresa para resección de masa mediastínica bajo anestesia general. Tras la inducción, la ventilación mediante mascarilla facial resultó imposible. Se coloca mascarilla laríngea (ML) y se consigue ventilación de forma subóptima. Se intenta intubación guiada por fibroscopia a su través, pero se objetiva masa protruyente que impide la progresión del tubo. Finalmente se intuba mediante introductor Frova. Tras finalizar la cirugía, la paciente se traslada intubada a la Unidad de Reanimación Postanestésica (URPA). Se realiza evaluación por otorrinolaringología (ORL), que concluye que la masa corresponde a una amígdala lingual hipertrófica. La hipertrofia de la amígdala lingual puede complicar la anestesia, dificultando la ventilación e intubación. Se considera una causa frecuente de vía aérea difícil imprevista. El diagnóstico no puede realizarse mediante exploración anestésica estándar. Una vez conocida, las intubaciones siguientes deben ser guiadas por fibroscopia.


Subject(s)
Humans , Female , Middle Aged , Pharynx , Amygdalin , Hypertrophy , Otolaryngology , Tongue , Palatine Tonsil , Ventilation , Laryngeal Masks
10.
Fisioter. Bras ; 20(4): 476-484, Set 3, 2019.
Article in Portuguese | LILACS | ID: biblio-1281499

ABSTRACT

Introdução: A procura pelas Unidades de Pronto Atendimento (UPA) vem em um crescente, com atendimento 24 horas e extremamente resolutivo. É um serviço importante na classificação de atenção ao usuário, com grande rotatividade de pacientes. Objetivo: Traçar o perfil dos pacientes submetidos à ventilação mecânica invasiva (VMI) que são internados na UPA na região central do estado. Métodos: Estudo quantitativo, com análise descritiva de prontuários de pacientes internados na UPA submetidos à VMI, no período de fevereiro a junho de 2017. Resultados: Amostra de 14 prontuários, 57,2% (n = 8) do sexo feminino e 64,3% (n = 9) com idade superior a 60 anos. O diagnóstico inicial mais frequente foram as complicações respiratórias 62% (n = 13). Entre patologias de base, a hipertensão arterial sistêmica teve maior incidência 36% (n = 9). Quanto às manifestações clínicas no momento da intubação, a mais frequente foi a hipoxemia 33,4% (n = 4) e o principal motivo da intubação foi rebaixamento de sensório 57,1% (n = 8). A permanência na unidade em 42,8% (n = 6) dos casos durou menos de 24 horas. Conclusão: Predominaram pacientes mulheres idosas, apresentando como diagnóstico inicial complicações respiratórias, tempo de permanência na unidade após VMI menos de 24 horas e a maioria dos prontuários sem prescrição de fisioterapia. (AU)


Introduction: The demand on Emergency Care Units (UPA) is increasing, with 24-hour service and extremely resolute. It is an important service in the classification of attention to the user, with great patient turnover. Objective: To outline the profile of patients undergoing invasive mechanical ventilation (IMV) admitted to the UPA in the central region of Rio Grande do Sul State. Methods: Quantitative study, with descriptive analysis of medical records of patients who underwent IMV admitted to the UPA, from February to June 2017. Results: A sample of 14 medical records, 57.2% (n = 8) female and 64.3% (n = 9) aged over 60 years has been analyzed. The most frequent initial diagnosis was respiratory complications 62% (n = 13). Among the basic pathologies, systemic arterial hypertension had a higher incidence with 36% (n = 9). Among the clinical manifestations at the time of intubation the most frequent was hypoxemia (33.4%) (n = 4) and the main reason for intubation was the low level of consciousness (n = 8). Unit stay in 42.8% (n = 6) of the cases lasted less than 24 hours. Conclusion: Predominant old female patients, presenting as initial diagnosis respiratory complications, length of stay in the unit after IMV less than 24 hours and most of the medical records did not have physical therapy prescription. (AU)


Subject(s)
Humans , Male , Female , Respiration, Artificial , Emergency Medical Services , Ventilation , Brazil , Physical Therapy Specialty , Evaluation Studies as Topic
11.
Ciênc. Saúde Colet ; 24(8): 3079-3088, ago. 2019. graf
Article in Portuguese | LILACS | ID: biblio-1011896

ABSTRACT

Resumo A poluição do ar em ambientes fechados é agravada pela queima de lenha em fogões rústicos e ambientes pouco ventilados. A exposição aos poluentes emitidos por este tipo de combustível resulta no aumento da morbidade e da mortalidade. No Brasil, os estudos e as estimativas são escassos. Visando entender esta problemática, o objetivo deste trabalho foi investigar o uso de lenha utilizando as séries de dados das agências governamentais para estimar o número de pessoas expostas. Os resultados apontam que a lenha é o segundo combustível mais usado para cozinhar, sendo utilizada por uma parcela significativa da população, em torno de 30 milhões de brasileiros. Um fator decisivo no maior uso deste combustível é o nível socioeconômico da população associada ao preço do gás liquefeito de petróleo (GLP). Os estudos realizados no país registraram concentrações altas de partículas durante a queima da lenha, excedendo os limites sugeridos pela Organização Mundial da Saúde (OMS). Também foram observadas associações entre a exposição aos poluentes gerados pela queima e o agravamento dos mais diversos problemas de saúde, dentre eles doenças respiratórias e câncer. A substituição da lenha e outros combustíveis sólidos por combustíveis mais limpos deve ser a meta do governo para minimizar custos com a saúde.


Abstract Indoor air pollution is exacerbated by the burning of firewood in rustic stoves and poorly ventilated environments. Exposure to the pollutants emitted by this type of fuel results in increased morbidity and mortality. In Brazil, studies and estimates regarding these conditions are scarce. In order to understand this problem, the objective of this work was to investigate the use of firewood using the data series of government agencies to estimate the number of exposed people. The results indicated that firewood is the second most used fuel for cooking, being used by a significant portion of the population, more than 30 million Brazilians. A decisive factor in the increased use of this fuel is the socioeconomic level of the population associated with the price of liquefied petroleum gas (LPG). The studies carried out in the country recorded high concentrations of particles during firewood burning, exceeding the limits suggested by the World Health Organization (WHO). Associations were also observed between the exposure to the pollutants generated by the burning and the aggravation of health problems, among them respiratory diseases and cancer. Replacing fuelwood and other solid fuels with cleaner fuels should be the government's goal to minimize health costs.


Subject(s)
Humans , Environmental Monitoring/methods , Air Pollution, Indoor/analysis , Cooking/statistics & numerical data , Environmental Exposure/analysis , Respiratory Tract Diseases/etiology , Respiratory Tract Diseases/epidemiology , Socioeconomic Factors , Ventilation/standards , Wood , Brazil/epidemiology , Air Pollution, Indoor/adverse effects , Environmental Exposure/adverse effects , Neoplasms/etiology , Neoplasms/epidemiology
12.
Av. enferm ; 37(1): 75-82, ene.-abr. 2019. tab
Article in Portuguese | LILACS, BDENF, COLNAL | ID: biblio-1011390

ABSTRACT

Resumo Objetivo: Identificar a prevalência de persistência do canal arterial (PCA) em neonatos em um hospital público. Metodologia: Trata-se de um estudo quantitativo, observacional e de caráter descritivo. Foram coletados dados de 313 prontuários de recém-nascidos, observando a ocorrência do diagnóstico de PCA em uma amostra de neonatos internados em um hospital público do norte de Minas Gerais no período de agosto de 2015 a agosto de 2016, até o 7° dia de vida. As seguintes variáveis foram analisadas: idade gestacional, peso ao nascer, Apgar 1' e 5', desconforto respiratório, uso de equipamentos de suporte ventilatório e utilização de medicamentos para a função respiratória. Os dados coletados foram processados estatisticamente através do programa Minitab. Resultados: Neste estudo, percebe-se que a incidência da PCA é maior em prematuro quando a relação idade gestacional e peso ao nascer são inversamente proporcionais à PCA. A prevalência neste estudo foi de 2,6 % de recém nascidos com a cardiopatia, sendo que destes foi observado o desconforto respiratório em 43 % de neonatos. Conclusão: A prevalência do canal arterial na amostra foi relativamente baixa, dentre os fatores associados ao aparecimento da cardiopatia, mas as alterações no quinto minuto de Apgar mostraram ser estatisticamente significantes. Sendo assim, identificar a ocorrência do diagnóstico da PCA e conhecer as repercussões respiratórias, assim como proposto nesse estudo, pode auxiliar na programação da assistência e, em especial, favorecer a melhoria da conduta de enfermagem.


Resumen Objetivo: Identificar la prevalencia de persistencia del canal arterial (PCA) en neonatos en un hospital público. Metodología: Se trata de un estudio cuantitativo, observacional y de carácter descriptivo. Se recogieron datos de 313 prontuarios de recién nacidos, observando la ocurrencia del diagnóstico de PCA en una muestra de neonatos internos en un hospital público del norte de Minas Gerais en el período de agosto de 2015 a agosto de 2016, hasta el 7° día de vida, analizando las variables: edad gestacional, peso al nacer, Apgar 1' y 5', malestar respiratorio, uso de equipos de soporte ventilatorio y utilización de medicamentos para la función respiratoria. Los datos recolectados fueron procesados estadísticamente a través del programa Minitab. Resultados: En este estudio se percibe que la incidencia de la PCA es mayor en prematuros, donde la relación edad gestacional y peso al nacer son inversamente proporcionales a la PCA. La prevalencia en este estudio fue de 2,6 % recién nacidos con la cardiopatía, siendo que de estos se observó la incomodidad respiratoria en el 4,3 % de neonatos. Conclusión: La prevalencia del canal arterial en la muestra fue relativamente baja, entre los factores asociados a la aparición de la cardiopatía, las alteraciones en el quinto minuto de Apgar mostraron ser estadísticamente significantes. Siendo así, identificar la ocurrencia del diagnóstico de la PCA y conocer las repercusiones respiratorias, así como es propuesto en ese estudio, puede auxiliar en la programación de la asistencia y, en particular, favorecer la mejora de la conducta de enfermería.


Abstract Objective: To identify the prevalence of persistence of the arterial canal (PAC) in newborns in a public hospital. Methodology: This is a quantitative, observational and descriptive study. Data from 313 compendiums of newborns were collected, noting the occurrence of the diagnosis of PAC in a sample of inmate newborns at a public hospital in the north of Minas Gerais, Brazil, in the period between August 2015 and August 2016, up to the 7th day of life. The following variables were analyzed: gestational age, birth weight, Apgar 1' and 5', respiratory discomfort, use of ventilation support equipment and use of medication for respiratory function. The collected data were statistically processed through the Minitab program. Results: The incidence of the PAC is higher in premature infants, where the relationship of gestational age and birth weight are inversely proportional to the PAC. The prevalence in this study was 2,6 % of newborns with heart disease, and it was observed respiratory discomfort in 43 % of them. Conclusion: The prevalence of arterial canal in the sample was relatively low; among the factors associated with the occurrence of heart disease, alterations in the fifth minute of Apgar were statistically significant. Being so, identifying the occurrence of the diagnosis of PAC and knowing the respiratory impact can aid in the programming of assistance and, in particular, favor the improvement of the conduct of nursing.


Subject(s)
Humans , Infant, Newborn , Ventilation , Infant, Newborn , Nursing , Ductus Arteriosus , Heart Diseases , Hospitals, Public
14.
Article in English | WPRIM | ID: wpr-759546

ABSTRACT

BACKGROUND: Congenital central hypoventilation syndrome (CCHS) is a rare disorder characterized by alveolar hypoventilation and autonomic dysregulation. Patients with CCHS have adequate ventilation while awake but exhibit hypoventilation while asleep. More severely affected patients exhibit hypoventilation both when awake and when asleep. CASE: Here, we report a case of successful spinal anesthesia and postoperative epidural analgesia in a patient with CCHS who underwent orthostatic surgery. CONCLUSIONS: In patients with CCHS, anesthesia is used with the goal of minimizing respiratory depression to avoid prolonged mechanical ventilation. Regional anesthesia should be considered where appropriate. Continuous oxygen saturation and end-tidal carbon dioxide monitoring must be available.


Subject(s)
Analgesia, Epidural , Anesthesia , Anesthesia, Conduction , Anesthesia, Spinal , Hypoxia , Carbon Dioxide , Humans , Hypoventilation , Oxygen , Respiration, Artificial , Respiratory Insufficiency , Ventilation
15.
Article in English | WPRIM | ID: wpr-759545

ABSTRACT

BACKGROUND: The trans-tracheal rapid insufflation of oxygen (TRIO) device is less commonly used and is an alternative to trans-tracheal jet ventilation for maintaining oxygenation in a “cannot intubate, cannot oxygenate” (CICO) scenario. CASE: We report the successful use of this device to maintain oxygenation after jet ventilator failure in a parturient who presented with the CICO scenario during the procedure for excision of laryngeal papilloma. CONCLUSIONS: A stepwise approach to the airway plan and preparation for an event of failure is essential for good materno-fetal outcomes. The TRIO device may result in inadequate ventilation that can lead to hypercarbia and respiratory acidosis. Hence, it should only be used as a temporizing measure before a definitive airway can be secured.


Subject(s)
Acidosis, Respiratory , Airway Management , Airway Obstruction , Anesthesia, Obstetrical , High-Frequency Jet Ventilation , Insufflation , Oxygen , Papilloma , Ventilation , Ventilators, Mechanical
16.
Article in English | WPRIM | ID: wpr-759503

ABSTRACT

BACKGROUND: As lung ultrasound (LUS) can be used to identify regional lung ventilation and collapse, we hypothesize that LUS can be better than auscultation in assessing lung isolation and determining double lumen tube (DLT) position. METHODS: A randomized controlled study was conducted in tertiary care cancer institute from November 2014 to December 2015, including 100 adult patients undergoing elective thoracic surgeries. Patients with tracheostomy, difficult airway and pleural-based pathologies were excluded. After anesthesia induction and DLT insertion, patients were randomized into group A (auscultation) and group B (LUS). Regional ventilation was assessed by experienced anesthesiologists using the respective method for each group. Final confirmation of DLT position with a bronchoscope was performed by a blinded anesthesiologist. Contingency tables were plotted to determine sensitivity, specificity, positive predictive value (PPV), negative predictive value (NPV), and accuracy for each method. RESULTS: Data from 91 patients were analyzed (group A = 47, group B = 44). Compared with auscultation, LUS had significantly higher sensitivity (94.1% vs. 73.3%, P = 0.010), PPV (57.1% vs. 35.5%, P = 0.044), NPV (93.8% vs. 75.0%, P = 0.018), accuracy (70.5% vs. 48.9%, P = 0.036) and required longer median time (161.5 vs. 114 s, P < 0.001) for assessment of DLT position. Differences in specificity (55.6% vs. 37.5%, P = 0.101) and area under curve (0.748; 95% CI: 0.604–0.893 vs. 0.554, 95% CI: 0.379–0.730; P = 0.109) were not significant. CONCLUSIONS: Compared to auscultation, LUS is a superior method for assessing lung isolation and determining DLT position.


Subject(s)
Adult , Anesthesia , Area Under Curve , Auscultation , Bronchoscopes , Double-Blind Method , Humans , Lung , Methods , One-Lung Ventilation , Pathology , Prospective Studies , Sensitivity and Specificity , Tertiary Healthcare , Tracheostomy , Ultrasonography , Ventilation
17.
Article in English | WPRIM | ID: wpr-759501

ABSTRACT

BACKGROUND: Geriatric patients are susceptible to respiratory and hemodynamic adverse events during endotracheal intubation and extubation due to anatomic and physiological changes with aging. Supraglottic airway devices (SADs) provide reduced airway morbidity and increased hemodynamic stability in adults. However, studies that have compared the clinical performance of SADs in geriatric patients are limited. Therefore, we evaluated the clinical performance of airway management with i-gel® and laryngeal mask airway Supreme (LMA Supreme™) in geriatric patients. METHODS: The subjects were American Society of Anesthesiologists physical status classification I–III geriatric (65–85 years) patients who underwent elective surgery with general anesthesia and were randomly allocated into the i-gel® group and the LMA Supreme™ group. We compared the time for successful insertion on a first attempt as a primary outcome, and the secondary outcomes were success rate, ease of insertion, maneuver for successful ventilation, oropharyngeal leak pressure, gastric insufflation, fiberoptic view grades, ventilator problems, and adverse events. RESULTS: Insertion time was significantly shorter for the i-gel® than the LMA Supreme™ (21.4 ± 6.8 vs. 29.3 ± 9.9 s; P = 0.011). The i-gel® was also easier to insert than the LMA Supreme™ (P = 0.014). Gastric insufflation was less frequent with the i-gel® than the LMA Supreme™ (0% vs. 31.3%; P = 0.013). Other measurements were comparable between groups. CONCLUSIONS: Both devices can be safely applied to geriatric patients with similar success rates and oropharyngeal leak pressures. However, inserting the i-gel® was faster and easier compared to the LMA Supreme™ in geriatric patients.


Subject(s)
Adult , Aging , Airway Management , Anesthesia, General , Classification , Hemodynamics , Humans , Insufflation , Intubation , Intubation, Intratracheal , Laryngeal Masks , Prospective Studies , Ventilation , Ventilators, Mechanical
18.
Article in English | WPRIM | ID: wpr-762845

ABSTRACT

BACKGROUND: Sternal rigid plate fixation (RPF) has been adopted in recent years in high-risk cases to reduce complications associated with steel wire cerclage, the traditional approach to sternal closure. While sternal RPF has been associated with lower complication rates than wire cerclage, it has its own complication profile that requires evaluation, necessitating a critical examination from a national perspective. This study will report the outcomes and associated risk factors of sternal RPF using a national database. METHODS: Patients undergoing sternal RPF from 2005 to 2016 in the American College of Surgeons-National Surgical Quality Improvement Program were identified. Demographics, perioperative information, and complication rates were reviewed. Logistic regression analysis was performed to identify risk factors for postoperative complications. RESULTS: There were 381 patient cases of RPF identified. The most common complications included bleeding (28.9%), mechanical ventilation >48 hours (16.5%), and reoperation/readmission (15.2%). Top risk factors for complications included dyspnea (odds ratio [OR], 2.672; P48 hours, and reoperation/readmission, each of which affected over 15% of the study population. Smokers remain at an increased risk for surgical site infection and sternal dehiscence despite RPF's purported benefit to minimize these outcomes. Complications of primary versus delayed sternal RPF are roughly equivalent, but individual patients may perform better with one versus the other based on identified risk factors.


Subject(s)
Bone Plates , Demography , Dyspnea , Heart Failure , Hemorrhage , Humans , Logistic Models , Postoperative Complications , Quality Improvement , Respiration, Artificial , Risk Factors , Steel , Sternum , Surgical Wound Infection , Treatment Outcome , Ventilation , Wound Healing , Wounds and Injuries
19.
Article in English | WPRIM | ID: wpr-762653

ABSTRACT

OBJECTIVE: To update evidence on the effects of breathing exercises (BEs) on ventilation, exercise capacity, dyspnea, and quality of life (QoL) in chronic obstructive pulmonary disease (COPD) patients. METHODS: Randomized controlled trials investigating the effects of BEs in COPD patients published through May 2018, were retrieved from five electronic databases (MEDLINE, CINAHL, Cochrane, Scopus, and ScienceDirect). Risk of bias and quality of evidence were assessed, using Cochrane Collaboration’s tool, and the Grading of Recommendation Assessment, Development, and Evaluation (GRADE) approach, respectively. RESULTS: Nineteen studies (n=745), were included. Quality of evidence, was low to moderate. When compared to the control groups, respiratory rate significantly (p≤0.001) improved in the pursed-lip breathing (PLB), ventilatory feedback (VF) plus exercise, diaphragmatic breathing exercise (DBE), and combined BEs. Additionally, PLB significantly improved tidal volume (p0.05). CONCLUSION: PLB, VF plus exercise, DBE, combined BEs, and singing could be used to improve ventilation and QoL. Based on low to moderate quality of evidence, use of these BEs to improve ventilation and QoL in COPD patients is conditional (Registration No. CRD42018102995).


Subject(s)
Bias , Breathing Exercises , Dyspnea , Humans , Inspiratory Capacity , Pulmonary Disease, Chronic Obstructive , Quality of Life , Respiration , Respiratory Rate , Singing , Tidal Volume , Ventilation
20.
Article in English | WPRIM | ID: wpr-762588

ABSTRACT

Deletion on the short arm of chromosome 18 is a rare disorder characterized by intellectual disability, growth retardation, and craniofacial malformations (such as prominent ears, microcephaly, ptosis, and a round face). The phenotypic spectrum is wide, encompassing a range of abnormalities from minor congenital malformations to holoprosencephaly. We present a case of a 2-year-old girl with ptosis, a round face, broad neck with low posterior hairline, short stature, and panhypopituitarism. She underwent ventilation tube insertion for recurrent otitis media with effusion. Brain magnetic resonance imaging showed an ectopic posterior pituitary gland and a shallow, small sella turcica with poor visualization of the pituitary stalk. Cytogenetic and chromosomal microarray analysis revealed a de novo deletion on the short arm of chromosome 18 (arr 18p11.32p11.21[136,227–15,099,116]x1). She has been treated with recombinant human growth hormone (GH) therapy since the age of 6 months after diagnosis of GH deficiency. Her growth rate has improved without any side effects from the GH treatment. This case expands the phenotypic spectrum of 18p deletion syndrome and emphasizes the positive impact of GH therapy on linear growth in this syndrome characterized by growth deficiency. Further studies are required to define the genotype-phenotype correlation according to size and loci of the deletion in 18p deletion syndrome and to predict prognosis.


Subject(s)
Arm , Brain , Child, Preschool , Chromosomes, Human, Pair 18 , Cytogenetics , Diagnosis , Ear , Female , Genetic Association Studies , Growth Hormone , Holoprosencephaly , Human Growth Hormone , Humans , Intellectual Disability , Magnetic Resonance Imaging , Microarray Analysis , Microcephaly , Neck , Otitis Media with Effusion , Pituitary Gland , Pituitary Gland, Posterior , Prognosis , Sella Turcica , Ventilation
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