RESUMO
Una de las características de la afección pulmonar por enfermedad por coronavirus (COVID-19) es la disociación entre la gravedad de la hipoxemia y el mantenimiento de una mecánica respiratoria relativamente conservada. En este contexto se ha establecido una teoría en relación con dos fenotipos de pacientes con síndrome de distrés respiratorio del adulto (SDRA): un fenotipo Low, caracterizado por baja elastancia y baja reclutabilidad, y un fenotipo High, con características de alta elastancia y alta reclutabilidad. Presentamos el caso de un paciente que cursó internación en la Unidad de Terapia Intensiva de Adultos de nuestro hospital, con clínica, mecánica ventilatoria y patrón tomográfico compatible con el fenotipo Low de SDRA por COVID-19. (AU)
Dissociation between severity of hypoxemia and relative preserved respiratory mechanics is a characteristic observed in lung impairment due to coronavirus disease (COVID-19). Patients with COVID-19 that present adult respiratory distress syndrome (ARDS) are identified for one of two phenotypes according to a theory recently established. The Low phenotype is distinguished by low elastance and low recruitability; and the High phenotype, by high elastance and high recruitability. The case describes a patient admitted in the adult Intensive Care Unit of Hospital Italiano de Buenos Aires with observed symptoms, ventilatory mechanics and tomographic pattern that are compatible with Low phenotype of ARDS due to COVID-19. (AU)
Assuntos
Humanos , Masculino , Pessoa de Meia-Idade , Síndrome do Desconforto Respiratório do Recém-Nascido/microbiologia , Infecções por Coronavirus/terapia , Fenótipo , Síndrome do Desconforto Respiratório do Recém-Nascido/genética , Mecânica Respiratória , Infecções por Coronavirus/diagnóstico , Infecções por Coronavirus/fisiopatologia , Tosse/etiologia , Dispneia/etiologia , Febre/etiologia , Hipertensão/complicações , Unidades de Terapia Intensiva , Hipóxia/fisiopatologia , Obesidade/complicaçõesRESUMO
A prospective observational study was conducted in a neonatal intensive care unit to identify factors associated with the development of ventilator-associated pneumonia (VAP) in 170 infants aged less than 30 days who required mechanical ventilation for longer than 48 hours. VAP occurred in 85 infants (50 cases per 100 mechanically-ventilated infants) or 70.3 cases per 1,000 ventilator days. Stepwise logistic regression analysis identified 3 factors independently associated with VAP: umbilical catheterization [adjusted odds ratio (AOR)=2.5; 95% confidence interval (CI)=1.3 to 4.7; p=0.007]; respiratory distress syndrome (AOR=2.0; 95% CI=1.0 to 3.9; p=0.03); and insertion of orogastric tube (AOR=3.0; 95% CI=1.3 to 7.2; p=0.01). Infants with VAP had longer duration on ventilator (14.2 days vs 5.9 days; p<0.001) and longer hospital stay (28.2 days vs 13.8 days; p<0.001). Organisms were isolated in 42 specimens (49.4%) from endotracheal aspirate culture and in 17 specimens (20.0%) from hemoculture; Pseudomonas aeruginosa, Klebsiella pneumoniae and Acinetobacter spp were predominant. Polymicrobial infection was found in 11 specimens (12.9%) from endotracheal aspirate culture. Leukocytosis and blood gas values could not predict the presence of VAP. The mortality of infants with VAP (29.4%) did not differ significantly from that of infants without VAP (30.6%) (p=0.87). Certain clinical interventions might potentially affect the incidence of VAP and outcome associated with VAP.