Videolaringoscopia en el abordaje de la vía aérea durante la pandemia de la COVID-19 / Videolaryngoscopy for airway management during the COVID-19 pandemic

Introducción: A finales del año 2019 se reportaron casos de neumonía atípica en Wuhan provocados por un nuevo coronavirus. La intubación endotraqueal puede causar contaminación del personal de salud. Las pautas recientes prefieren la videolaringoscopia porque aumenta las posibilidades de intubación y evita del contacto cercano con el paciente. Objetivos: Describir el abordaje de la vía aérea con videolaringoscopia en pacientes con COVID-19 e identificar las principales complicaciones aparecidas durante la intubación endotraqueal. Métodos: Se realizó un estudio descriptivo, transversal, en el periodo de diciembre de 2020 a febrero de 2021, en el Centro Médico Naval de la Ciudad de México. El universo estuvo conformado por 178 pacientes con COVID-19 que requirieron intubación endotraqueal. Se tomó una muestra de 103 pacientes los cuales fueron atendidos por los médicos cubanos. Resultados: Los pacientes mayores de 60 años representaron el 63,1 por ciento de los casos y el sexo masculino el 65 por ciento El 42,1 por ciento tuvieron un predictor de vía aérea difícil y el 30,1 por ciento, dos o más predictores. Se visualizó completamente la glotis en el 39,8 por ciento de los casos y, parcialmente, en un 57,3 por ciento. La intubación al primer intento se logró en el 73,8 por ciento. Las principales complicaciones encontradas fueron la desaturación (33 por ciento) y la hipotensión arterial (37,9 por ciento). Conclusiones: La videolaringoscopia podría mejorar la visualización de la apertura glótica y la intubación endotraqueal al primer intento. La desaturación y la hipotensión arterial fueron complicaciones que podrían esperarse en los pacientes con la COVID-19 durante este procedimiento(AU)

Introduction: At the end of 2019, cases of atypical pneumonia were reported in Wuhan caused by a new coronavirus. Endotracheal intubation may cause contamination of healthcare personnel. According to recent guidelines, videolaryngoscopy is preferred, because it increases the chances of intubation and avoids close contact with the patient. Objectives: To describe airway management with videolaryngoscopy in patients with COVID-19 and to identify the main complications that appeared during endotracheal intubation. Methods: A descriptive and cross-sectional study was carried out, in the period from December 2020 to February 2021, at the Naval Medical Center in Mexico City. The universe consisted of 178 patients with COVID-19 who required endotracheal intubation. A sample of 103 patients was taken, who were cared for by Cuban doctors. Results: Patients older than 60 years represented 63.1 percent of the cases, while the male sex represented 65 percent. 42.1 percent had one predictor of difficult airway and 30.1 percent had two or more predictors. The glottis was visualized fully in 39.8 percent of cases and partially in 57.3 percent. Intubation on the first attempt was achieved in 73.8 percent. The main complications found were desaturation (33 percent) and arterial hypotension (37.9 percent). Conclusions: Videolaryngoscopy could improve visualization of the glottic opening and endotracheal intubation on the first attempt. Desaturation and hypotension were complications that could be expected in COVID-19 patients during this procedure(AU)

Diagnostic yield and clinical impact of capsule endoscopy in obscure gastrointestinal bleeding during routine clinical practice: a single-center experience

This study assessed the diagnostic yield of capsule endoscopy [CE] and its impact on patients with obscure gastrointestinal bleeding [OGIB]. Between May 2007 and May 2009, 63 patients with OGIB [overt bleeding: 25, and occult blood loss with chronic ferropenic anemia: 38] and normal upper and lower endoscopy were studied by CE. Demographic characteristics, prior diagnostic tests, CE findings, therapeutic interventions, medical treatment and clinical outcomes following CE were evaluated. The overall diagnostic yield was 44.44% of patients and included findings of angiectasia in 11 [17.46%] patients, nonsteroidal anti-inflammatory drugs enteropathy in 6 [9.52%] patients, celiac disease in 3 [4.76%] patients, tumors in 2 [3.17%] patients, and a variety of other diagnoses ranging from varices to ulcers [due to congenital afibrinogenemia and amyloidosis]. The diagnostic yield was notably higher in overt bleeders [15/25, 60%] compared to occult bleeders [13/38, 34.21%; p = 0.044], and in patients with overt bleeding who had CE within the first 10 days [14/16, 87.5%] after the bleeding episode in comparison to overt bleeders who underwent CE >10 days after the bleeding episode [2/16, 11.1%; p < 0.0001]. During follow-up [11.8 +/- 7 months], CE findings led to specific therapy that resolved the underlying disease or improved the clinical condition in 45 of 63 patients, thus having a positive clinical impact of 71.43%. CE has a high diagnostic yield and a positive influence on clinical management in a significant proportion of patients with OGIB. These data further support the role of CE in routine clinical practice