Patología dermatológica facial asociada al uso de la mascarilla durante la pandemia causada por el virus Sars-CoV-2 / Facial dermatological pathology associated with use of the mask during the pandemic caused by the Sars-CoV-2 virus

The use of facemask has become a key element to prevent the infection of Covid-19. Its prolonged use, both, by health personnel and the general population, has caused the appearance of multiple adverse effects at the facial level; highlighting the report of symptoms such as discomfort with the mask, facial itching, redness, erythema, among others. The appearance of dermatological diseases such as acne, allergic and irritative contact dermatitis, and exacerbation of pre-existing pathologies such as acne, rosacea and seborrheic dermatitis are also frequent. Knowledge of these complications is important for their prevention and proper management. (AU)

Olho seco e COVID-19: uma revisão narrativa / Dry eyes and COVID-19: a narrative review

RESUMO Com o advento do cenário pandêmico causado pelo SARS-CoV-2, no início do ano de 2020, foi notado um vasto quadro clínico entre os indivíduos infectados. Dentre os sintomas oculares mais comuns ocasionados pela COVID-19, o olho seco tornou-se bastante prevalente nesse meio. O estudo do tipo revisão narrativa busca avaliar os fatores de risco associados ao surgimento ou à intensificação dos quadros de olho seco na população durante o período pandêmico. A partir da análise bibliográfica, foi descrita a influência da ventilação por pressão positiva, do uso de máscaras de forma incorreta e de telas eletrônicas e da ansiedade e da depressão como fatores predisponentes ao desenvolvimento da doença do olho seco. No entanto, ainda é notada a necessidade de estudos mais explicativos para estabelecer a relação direta entre a causalidade dos fatores.

ABSTRACT With the advent of the pandemic scenario caused by SARS-CoV-2 in the beginning of the year 2020, a vast clinical picture was noticed among the infected individuals. Among the most common eye symptoms caused by Covid-19, dry eye (DE) has become quite prevalent in this environment. The narrative review study seeks to assess the risk factors associated with the emergence or intensification of DE conditions in the population during the pandemic period. A literature review showed the influence of positive pressure ventilation, incorrect use of masks, as well as electronic screens, in addition to anxiety and depression as predisposing factors for the development of dry eye disease. However, the need for more explanatory studies and for establishing a direct relationship between the causality of the factors is still noted.

Manifestación de impétigo y herpes zóster relacionado con el uso de mascarilla durante la pandemia de COVID-19. Informe de caso / Mask-related manifestation of impetigo and herpes zoster during the COVID-19 pandemic. Case report

Objetivo: Presentar un caso clínico en el que el paciente cursa impétigo que podría estar relacionado con el uso de mascarillas faciales por un tiempo prolongado. Caso clínico: Se reporta el tratamiento y la evolución de un caso clínico en un paciente adulto que consultó en un centro clínico privado por la presencia de lesiones vesiculares en la región labial superior con aumento de volumen generalizado en ambos labios. El cuadro clínico es compatible con infección por impétigo y herpes zóster asociado al uso prolongado de una mascarilla de tela. Se describe la importancia del empleo correcto de estas mascarillas que se están usando como medida de protección personal en el contexto de la pandemia por COVID-19, ya que las mismas pueden contribuir a generar infecciones faciales si no se mantiene una higiene apropiada (AU)

Aim: To present a clinical case in which the patient has impetigo that could be related to the use of facial masks for a long time. Clinical case: The treatment and evolution of a clinical case of an adult patient who attended a private clinical centre due to the presence of vesicular lesions in the upper labial region with generalized increase volume in both lips is reported. The clinical presentation is compatible with impetigo and herpes zoster infection associated with prolonged use of a cloth mask. The importance of the correct use of cloth masks that are being used as a personal protection measure in the context of the COVID-19 pandemic is described, since they can contribute to facial infections if proper hygiene is not observed (AU))

Uso de parches protectores faciales no reduce la presión facial en un modelo simulado de ventilación mecánica no invasiva / Face protective patches do not reduce facial pressure ulcers in a simulated model of non-invasive ventilation

La ventilación mecánica no invasiva (VMNI) tiene como complicación frecuente el desarrollo de úlceras faciales por presión (UPP). Su prevención considera el uso empírico de parches protectores entre piel y mascarilla, para disminuir la presión ejercida por ésta. Objetivos: Evaluar el efecto de los parches protectores sobre la presión ejercida por la mascarilla facial, y su impacto en los parámetros ventilatorios programados. Método: Modelo simulado de VMNI binivelada usando mascarilla facial total en fantoma con vía aérea fisiológica (ALS PRO+) en posición supina. Se midió la presión en frente, mentón y pómulos, usando 3 tipos de parches protectores de uso habitual versus un grupo control, utilizando sensores de presión (Interlinks Electronics®). Se evaluaron los valores obtenidos con el modelo de mascarilla-parches protectores en las variables programadas flujo máximo inspiratorio (FMI), volumen corriente espirado (Vte) y presión positiva inspiratoria (IPAP), con ventilador Trilogy 100, Respironics®. La programación y registro de las variables fue efectuada en 8 oportunidades en cada grupo por operadores independientes. Resultados: No se observó disminución de la presión facial con ninguno de los parches protectores respecto al grupo control. Moltoprén aumentó la presión facial en todos los puntos de apoyo (p < 0,001), aumentó fuga, disminuyó FMI, Vte e IPAP (p < 0,001). Parches de hidrocoloide aumentaron la presión facial sólo en pómulo izquierdo, aumentaron la fuga y disminuyeron FMI. Parches de poliuretano no generaron cambios en la presión facial ni en variables ventilatorias. Conclusión: El uso de parches protectores de moltoprén, hidrocoloide y poliuretano transparente no contribuyó a la disminución de la presión facial. Se observó un efecto deletéreo de los parches de moltoprén e hidrocoloide sobre la administración de variables ventilatorias, concluyendo que el no uso de los parches protectores permitió una mejor administración de los parámetros programados.

Noninvasive ventilation (NIV) frequently involves the development of facial pressure ulcers (FPU). Its prevention considers the empirical use of protective patches between skin and mask, in order to reduce the pressure exerted by it. Objectives: To evaluate the effect of protective patches on the pressure exerted by the facial mask, and its impact on the programmed ventilatory parameters. Method: Bilevel NIV simulated model using full face mask in phantom with a physiological airway (ALS PRO +) in supine position. Forehead, chin and cheekbones pressure were measured using 3 types of standard protective patches versus a control group using pressure sensors (Interlinks Electronics®). The values obtained with the protective patches-mask model were evaluated in the programmed variables maximum inspiratory flow (MIF)), expired tidal volume (Vte) and positive inspiratory pressure (IPAP), with Trilogy 100 ventilator, Respironics®. The programming and recording of the variables was carried out in 8 opportunities in each group by independent operators. Results: There was no decrease in facial pressure with any of the protective patches compared to the control group. Moltopren increased facial pressure at all support points (p < 0.001), increased leakage, it decreased MIF, Vte and IPAP (p < 0.001). Hydrocolloid patches increased facial pressure only in the left cheekbone, increased leakage and decreased MIF. Polyurethane patches did not produce changes in facial pressure or ventilatory variables. Conclusion: The use of protective patches of moltopren, hydrocolloid and polyurethane transparent did not contribute to the decrease of the facial pressure. A deleterious effect of the moltopren and hydrocolloid patches was observed on the administration of ventilatory variables, concluding that the non-use of the protective patches allowed a better administration of the programmed parameters.

Performance of ICU ventilators during noninvasive ventilation with large leaks in a total face mask: a bench study / Desempenho de ventiladores de UTI durante ventilação não invasiva com grandes vazamentos em máscara facial total: estudo em simulador mecânico

Objective: Discomfort and noncompliance with noninvasive ventilation (NIV) interfaces are obstacles to NIV success. Total face masks (TFMs) are considered to be a very comfortable NIV interface. However, due to their large internal volume and consequent increased CO2 rebreathing, their orifices allow proximal leaks to enhance CO2 elimination. The ventilators used in the ICU might not adequately compensate for such leakage. In this study, we attempted to determine whether ICU ventilators in NIV mode are suitable for use with a leaky TFM. Methods: This was a bench study carried out in a university research laboratory. Eight ICU ventilators equipped with NIV mode and one NIV ventilator were connected to a TFM with major leaks. All were tested at two positive end-expiratory pressure (PEEP) levels and three pressure support levels. The variables analyzed were ventilation trigger, cycling off, total leak, and pressurization. Results: Of the eight ICU ventilators tested, four did not work (autotriggering or inappropriate turning off due to misdetection of disconnection); three worked with some problems (low PEEP or high cycling delay); and one worked properly. Conclusions: The majority of the ICU ventilators tested were not suitable for NIV with a leaky TFM. .

Objetivo: O desconforto e a falta de adaptação às interfaces de ventilação não invasiva (VNI) são obstáculos ao sucesso da VNI. A máscara facial total (MFT) é uma interface de VNI considerada muito confortável. No entanto, devido a seu grande volume interno e, consequentemente, ao aumento da reinalação de CO2, a MFT tem orifícios que permitem vazamentos proximais para melhorar a eliminação de CO2. É possível que os ventiladores usados na UTI não compensem esse vazamento adequadamente. Neste estudo, buscamos determinar se ventiladores de UTI com módulo de VNI podem ser usados com MFT com grandes vazamentos. Métodos: Estudo em simulador mecânico conduzido em um laboratório universitário de pesquisa. Oito ventiladores de UTI equipados para realizar VNI e um ventilador específico para VNI foram conectados a uma MFT com grandes vazamentos. Todos foram testados com dois níveis de positive end-expiratory pressure (PEEP, pressão expiratória final positiva) e três níveis de pressão de suporte. As variáveis analisadas foram disparo do ventilador, ciclagem, vazamento total e pressurização. Resultados: Dos oito ventiladores de UTI, quatro não funcionaram (autodisparo ou desligamento inapropriado por detecção incorreta de desconexão), três funcionaram com alguns problemas (valores baixos de PEEP ou grande atraso na ciclagem do ventilador) e apenas um funcionou adequadamente. Conclusões: A maioria dos ventiladores de UTI testados mostrou-se inadequada para VNI com MFT com grandes vazamentos. .

Barotrauma ocular durante mergulho autônomo / Ocular barotrauma during scuba diving

Relato de um caso de barotrauma ocular bilateral relacionado ao mergulho autônomo, com hemorragia conjuntival e periocular. Alguns conceitos de física e cuidados durante o mergulho são reportados para um melhor entendimento da fisiopatogenia do quadro, de modo que se possa melhor orientar os pacientes quanto à prevenção.

Report of a case of bilateral ocular barotrauma related to scuba diving, with conjunctival and periocular hemorrhage. Some concepts about Physics and caution are provided to better understanding the pathophysiology of the barotrauma, so proper orientation regarding prevention might be provided.

Influência das máscaras facial total, facial e nasal nos efeitos adversos agudos durante ventilação não-invasiva / Influence of total face, facial and nasal masks on short-term adverse effects during noninvasive ventilation

OBJECTIVE: Failure of noninvasive ventilation (NIV) has been associated with short-term adverse effects related to the use of masks. The aim of this study was to compare the incidence, type and intensity of adverse effects, as well as the comfort, of total face masks (TFMs), facial masks (FMs) and nasal masks (NMs) during NIV. METHODS: This was a randomized crossover trial involving 24 healthy volunteers submitted to six sessions of NIV in bilevel positive airway pressure mode using the TFM, FM and NM masks at low and moderate-to-high pressure levels. A written questionnaire was applied in order to evaluate eleven specific adverse effects related to the use of the masks. Comfort was assessed using a visual analog scale. The CO2 exhaled into the ventilator circuit was measured between the mask and the exhalation port. RESULTS: The performance of the TFM was similar to that of the NM and FM in terms of comfort scores. Higher pressure levels reduced comfort and increased adverse effects, regardless of the mask type. When the TFM was used, there were fewer air leaks and less pain at the nose bridge, although there was greater oronasal dryness and claustrophobia. Air leaks were most pronounced when the FM was used. The partial pressure of exhaled CO2 entering the ventilator circuit was zero for the TFM. CONCLUSIONS: The short-term adverse effects caused by NIV interfaces are related to mask type and pressure settings. The TFM is a reliable alternative to the NM and FM. Rebreathing of CO2 from the circuit is less likely to occur when a TFM is used.

OBJETIVO: Falhas da ventilação não-invasiva (VNI) têm sido relacionadas a efeitos adversos agudos do uso de máscaras. O objetivo deste estudo foi comparar a incidência, tipo e intensidade de eventos adversos e conforto das máscaras facial total (MFT), facial (MF) e nasal (MN). MÉTODOS: Estudo randomizado, tipo cruzado, em 24 voluntários sadios submetidos a seis períodos de VNI, modo bilevel positive airway pressure em ajustes de baixa e moderada a alta pressão. Foi aplicado um questionário de avaliação de onze eventos adversos especificamente relacionados ao uso das máscaras. O conforto foi avaliado por escala visual analógica. O CO2 exalado no circuito foi medido entre a conexão da máscara e o orifício de exalação. RESULTADOS: A MFT teve desempenho similar a MF e MN quanto a escores de conforto. A aplicação de pressões mais altas reduziu o conforto e aumentou a incidência e a intensidade dos eventos adversos, independentemente do tipo de máscara. A MFT teve melhor desempenho quanto a vazamentos e dor no nariz e pior resultado quanto ao ressecamento oronasal e claustrofobia. A MF teve o pior resultado quanto a vazamentos. A pressão parcial do CO2 exalado no circuito permaneceu em zero com a MFT. CONCLUSÕES: Os eventos adversos agudos causados pelas interfaces de VNI são relacionados ao tipo de máscara e aos parâmetros de pressão. A MFT é uma alternativa confiável às MF e MN. A reinalação de CO2 a partir do circuito é menos provável de ocorrer com a MFT.

Non invasive ventilation in COPD.

Non invasive ventilation refers to the technique of providing ventilatory support without a direct conduit to the airway. It is a promising new technique, which is particularly useful in patients with COPD. Patients with COPD are prone to develop acute exacerbations, which pushes them into acute respiratory failure. Under these circumstances, tracheal intubation and mechanical ventilation is associated with significant morbidity and mortality. A number of well conducted studies support the fact that non invasive positive pressure ventilation (NIPPV) in these circumstances reduces rates of intubation, mortality, complications and duration of hospital stay. The biggest advantage of these techniques is their simplicity, ease of implementation and improved patient comfort allowing them to retain important functions like speech, cough and swallowing. NIPPV should be instituted early in the course of acute respiratory failure due to COPD before irreversible fatigue sets in. The current thinking is that NIPPV rests the respiratory muscles allowing other therapies time to be effective. Facilities for NIPPV should be available in all hospitals admitting patients with respiratory failure. Patients with severe, stable COPD who are hypercapnic and are deteriorating despite maximal conventional treatment should definitely be offered a trial of NIPPV. In such patients NIPPV has been shown to improve quality of life, reverse blood gas abnormalities, improve exercise tolerance and reduce hospital admissions. Physicians must familiarize themselves with this promising new ventilatory technique.