RESUMO
Trata-se de síntese de evidências sobre as possibilidades terapêuticas para insuficiência respiratória grave no contexto da pandemia de Covid-19. O tratamento inclui as possibilidades terapêuticas de ventilação não invasiva (VNI), intubação e ventilação mecânica invasiva (VMI). Considera as características dos métodos, suas vantagens e limitações.
This is a synthesis of evidence on the therapeutic possibilities for severe respiratory failure in the context of the Covid-19 pandemic. Treatment includes the therapeutic possibilities of noninvasive ventilation (NIV), intubation, and invasive mechanical ventilation (IMV). It considers the characteristics of the methods, their advantages and limitations.
Assuntos
Humanos , Masculino , Feminino , Gravidez , Recém-Nascido , Lactente , Pré-Escolar , Criança , Adolescente , Adulto , Pessoa de Meia-Idade , Idoso , Idoso de 80 Anos ou mais , Adulto Jovem , Respiração Artificial/métodos , Suporte Ventilatório Interativo/estatística & dados numéricos , Ventilação não Invasiva/métodosRESUMO
NIV could be beneficial in selected patients with severe asthma exacerbation [SAE]. However, its role is still not well defined. To evaluate the efficacy of NIV using proportional assist ventilation [PAV] in severe asthma exacerbation after failure of conventional medical therapt [CMT]. Thirty patients with severe asthma exacerbation were failed to respond on conventional medical therapy. NIV was applied via face mask as a last option before intubation and mechanical ventilation. The mean age was 39.2 +/- 9.7 with female predominance [19 females vs. 11 males]. The successful outcome was achieved in 23/30 patients [76.6%]. Follow up of the mean of respiratory distress and gasometric parameters before recruitment vs. 1 h after NIV in successful group showed statistically significant improvement after NIV application as follows: HR [125.4 vs. 107.4], RR [38.2 vs. 25.4], PH [7.28 vs. 7.36], PaCO2 [55.3 vs. 42.5], PaO2 [58 vs. 87] and PEFR% Predicted [39 vs. 64] respectively [P < 0.001 for all items]. Also, the same improvement was in PEFR, tidal volume, peak inspiratory pressure and triggered breaths% in successful group vs. failure group. NIV can relieve respiratory distress and improve gas exchange in the majority of patients with severe asthma exacerbation who are candidate for intubation after failure of conventional medical therapy