Your browser doesn't support javascript.
Mostrar: 20 | 50 | 100
Resultados 1 - 20 de 86
Filtrar
Añadir filtros

Base de datos
Intervalo de año
1.
BMJ Case Rep ; 14(3)2021 Mar 25.
Artículo en Inglés | MEDLINE | ID: covidwho-1153656

RESUMEN

COVID-19 affects a wide spectrum of organ systems. We report a 52-year-old man with hypertension and newly diagnosed diabetes mellitus who presented with hypoxic respiratory failure due to COVID-19 and developed severe brachial plexopathy. He was not treated with prone positioning respiratory therapy. Associated with the flaccid, painfully numb left upper extremity was a livedoid, purpuric rash on his left hand and forearm consistent with COVID-19-induced microangiopathy. Neuroimaging and electrophysiological data were consistent with near diffuse left brachial plexitis with selective sparing of axillary, suprascapular and pectoral fascicles. Given his microangiopathic rash, elevated D-dimers and paucifascicular plexopathy, we postulate a patchy microvascular thrombotic plexopathy. Providers should be aware of this significant and potentially under-recognised neurologic complication of COVID-19.


Asunto(s)
Neuropatías del Plexo Braquial/etiología , /complicaciones , Brazo/patología , Neuropatías del Plexo Braquial/diagnóstico , Diabetes Mellitus , Exantema/complicaciones , Productos de Degradación de Fibrina-Fibrinógeno/análisis , Humanos , Hipertensión/complicaciones , Imagen por Resonancia Magnética , Masculino , Persona de Mediana Edad , Neuralgia/complicaciones , Posicionamiento del Paciente/efectos adversos , Insuficiencia Respiratoria/etiología , /aislamiento & purificación
3.
J Nurs Adm ; 51(4): E13-E17, 2021 Apr 01.
Artículo en Inglés | MEDLINE | ID: covidwho-1140039

RESUMEN

AIM: To identify strategies to improve time to prone in ICUs during the coronavirus disease 2019 (COVID-19) pandemic for patients meeting the criteria for prone position ventilation. BACKGROUND: Healthcare systems worldwide experienced an influx of COVID-19 patients, especially in critical care. COVID-19 patients are at risk of acute respiratory distress syndrome (ARDS). Prone position ventilation is the standard of care for mechanically ventilated patients with moderate to severe ARDS. Prone maneuvers in and of itself are time-consuming and labor-intensive, posing additional risks to patients. APPROACH: Our academic medical center developed a travel proning team to address the rapid increase in COVID-19 patients with ARDS necessitating prone positioning. EVALUATION: Over a period of 30 days, 420 ICU patients were intubated, 131 had moderate to severe ARDS and underwent prone positioning. Patients were placed in prone position or returned to supine position more than 834 times over 38 days. At the highest point, 37 procedures were done in 24 hours. CONCLUSION: This quality initiative demonstrated that utilization of a traveling proning team provides efficiency in time to prone. Developing a travel prone team allowed for efficiency in time to prone, supported the ICU clinical teams, and enhanced interdisciplinary collaboration, which is essential during times of crisis.


Asunto(s)
/enfermería , Grupo de Atención al Paciente , Posicionamiento del Paciente/métodos , Posición Prona , Respiración Artificial/enfermería , /enfermería , /complicaciones , Humanos , Unidades de Cuidados Intensivos , /etiología
4.
BMJ Case Rep ; 14(3)2021 Mar 16.
Artículo en Inglés | MEDLINE | ID: covidwho-1138313

RESUMEN

A 31-year-old pregnant woman presented with symptomatic COVID-19, which was complicated by progressive hypoxaemia requiring intensive care and emergent delivery by caesarean section. Afterward, she was successfully supported with mechanical ventilation and prone positioning and ultimately recovered. We review literature regarding complications of COVID-19 affecting pregnancy and evidence-based treatment strategies.


Asunto(s)
/terapia , Cesárea , Posicionamiento del Paciente/métodos , Complicaciones Infecciosas del Embarazo/terapia , Respiración Artificial/métodos , Adulto , Femenino , Humanos , Embarazo , Posición Prona
5.
Crit Care Med ; 49(3): 490-502, 2021 03 01.
Artículo en Inglés | MEDLINE | ID: covidwho-1135909

RESUMEN

OBJECTIVES: Prone position ventilation is a potentially life-saving ancillary intervention but is not widely adopted for coronavirus disease 2019 or acute respiratory distress syndrome from other causes. Implementation of lung-protective ventilation including prone positioning for coronavirus disease 2019 acute respiratory distress syndrome is limited by isolation precautions and personal protective equipment scarcity. We sought to determine the safety and associated clinical outcomes for coronavirus disease 2019 acute respiratory distress syndrome treated with prolonged prone position ventilation without daily repositioning. DESIGN: Retrospective single-center study. SETTING: Community academic medical ICU. PATIENTS: Sequential mechanically ventilated patients with coronavirus disease 2019 acute respiratory distress syndrome. INTERVENTIONS: Lung-protective ventilation and prolonged protocolized prone position ventilation without daily supine repositioning. Supine repositioning was performed only when Fio2 less than 60% with positive end-expiratory pressure less than 10 cm H2O for greater than or equal to 4 hours. MEASUREMENTS AND MAIN RESULTS: Primary safety outcome: proportion with pressure wounds by Grades (0-4). Secondary outcomes: hospital survival, length of stay, rates of facial and limb edema, hospital-acquired infections, device displacement, and measures of lung mechanics and oxygenation. Eighty-seven coronavirus disease 2019 patients were mechanically ventilated. Sixty-one were treated with prone position ventilation, whereas 26 did not meet criteria. Forty-two survived (68.9%). Median (interquartile range) time from intubation to prone position ventilation was 0.28 d (0.11-0.80 d). Total prone position ventilation duration was 4.87 d (2.08-9.97 d). Prone position ventilation was applied for 30.3% (18.2-42.2%) of the first 28 days. Pao2:Fio2 diverged significantly by day 3 between survivors 147 (108-164) and nonsurvivors 107 (85-146), mean difference -9.632 (95% CI, -48.3 to 0.0; p = 0·05). Age, driving pressure, day 1, and day 3 Pao2:Fio2 were predictive of time to death. Thirty-eight (71.7%) developed ventral pressure wounds that were associated with prone position ventilation duration and day 3 Sequential Organ Failure Assessment. Limb weakness occurred in 58 (95.1%) with brachial plexus palsies in five (8.2%). Hospital-acquired infections other than central line-associated blood stream infections were infrequent. CONCLUSIONS: Prolonged prone position ventilation was feasible and relatively safe with implications for wider adoption in treating critically ill coronavirus disease 2019 patients and acute respiratory distress syndrome of other etiologies.


Asunto(s)
/complicaciones , Evaluación de Procesos y Resultados en Atención de Salud , Posicionamiento del Paciente , Respiración Artificial/métodos , Insuficiencia Respiratoria/terapia , Centros Médicos Académicos , Adulto , Anciano , Femenino , Humanos , Masculino , Persona de Mediana Edad , Posición Prona , Insuficiencia Respiratoria/etiología , Estudios Retrospectivos , Estados Unidos/epidemiología
7.
Monaldi Arch Chest Dis ; 91(2)2021 03 05.
Artículo en Inglés | MEDLINE | ID: covidwho-1119586

RESUMEN

There is limited evidence on the efficacy of awake prone positioning (PP) in non-ventilated patients with COVID-19 who have hypoxemia. We, therefore, aim to describe our experience with the use of early proning in awake, non-intubated patients with confirmed COVID-19. In our retrospective observational study, 23 patients with confirmed positive PCR test results for Severe Acute respiratory Syndrome Coronavirus-2 (SARS-CoV-2) and hypoxemia that required oxygen therapy with or without non-invasive ventilation were treated with PP. Patients were classified into mild, moderate and severe COVID-19 disease. There were no targeted number of hours for proning per day and patients were kept in prone position according to their tolerance. The primary outcome measure was the avoidance of intubation and secondary outcomes were in-hospital mortality, length of hospital stays and complications related to PP. The mean (standard deviation) age of our cohort was 54.5 (11.7) years, and the majority were males (21/23, 91.3%). Sixty-one per cent (14/23) of the patients were suffering from severe disease and 82.6% (19/23) had bilateral lung involvement with interstitial infiltrates. Majority of the patients were prone positioned for a median of 6 days (IQR 4 - 8). Only one patient required transfer to ICU for mechanical ventilation and subsequently died due to severe ARDS. All 22 patients showed progressive improvement in oxygen requirement and PF ratio, mostly after 3-5 days of proning. The mean length of hospital stay was 12 days. All patients, except one, were discharged in stable conditions, on room air or on a minimal oxygen requirement of 1-2 liters. No major complication of PP was recorded. Awake prone positioning is a valuable and safe therapeutic adjunct that can be applied in patients with moderate-to-severe COVID-19. It can also be included in the home-based management protocols of COVID-19 to improve patient outcomes and mitigate the burden on health care facilities.


Asunto(s)
/terapia , Países en Desarrollo , Posicionamiento del Paciente , Posición Prona , Adulto , /mortalidad , Femenino , Mortalidad Hospitalaria , Humanos , Masculino , Persona de Mediana Edad , Terapia por Inhalación de Oxígeno , Pakistán , Respiración Artificial , Estudios Retrospectivos , Resultado del Tratamiento , Vigilia
8.
J Emerg Nurs ; 47(2): 279-287.e1, 2021 Mar.
Artículo en Inglés | MEDLINE | ID: covidwho-1071601

RESUMEN

INTRODUCTION: In March and April 2020 of the coronavirus disease 2019 pandemic, site clinical practice guidelines were implemented for prone positioning of patients with suspected coronavirus disease 2019 in hypoxic respiratory distress who are awake, alert, and spontaneously breathing. The purpose of this pandemic disaster practice improvement project was to measure changes in pulse oximetry associated with prone positioning of patients with coronavirus disease 2019 infection in adult acute respiratory distress or adult respiratory distress syndrome, who are awake, alert, spontaneously breathing, and nonintubated. METHODS: A retrospective chart review of patients who were coronavirus disease 2019 positive in the emergency department from March 30, 2020 to April 30, 2020 was conducted for patients with a room air pulse oximetry <90% and a preprone position pulse oximetry ≤94% who tolerated prone positioning for at least 30 minutes. The primary outcome was the change in pulse oximetry associated with prone positioning, measured on room air, with supplemental oxygen, and approximately 30 minutes after initiating prone positioning. Median and mean differences were compared with the Wilcoxon signed-rank test and paired t-test. RESULTS: Of the 440 patients with coronavirus disease 2019, 31 met inclusion criteria. Median pulse oximetry increased as 83% (interquartile range, 75%-86%) on room air, 90% (interquartile range, 89%-93%) with supplemental oxygen, and 96% (interquartile range, 94%-98%) with prone positioning (z = -4.48, P < .001). A total of 45% (n = 14) were intubated during their hospital stay, and 26% (n = 8) of the included patients died. DISCUSSION: In patients with coronavirus disease 2019 who are awake, alert, and spontaneously breathing, an initially low pulse oximetry reading improved with prone positioning. Future studies are needed to determine the association of prone positioning with subsequent endotracheal intubation and mortality.


Asunto(s)
/complicaciones , Posicionamiento del Paciente/métodos , /terapia , Femenino , Humanos , Hipoxia/complicaciones , Hipoxia/diagnóstico , Hipoxia/terapia , Intubación Intratraqueal , Masculino , Registros Médicos , Persona de Mediana Edad , New Jersey , Oximetría , Posición Prona , Estudios Retrospectivos
9.
Crit Care Med ; 49(3): e219-e234, 2021 03 01.
Artículo en Inglés | MEDLINE | ID: covidwho-1069322

RESUMEN

BACKGROUND: The coronavirus disease 2019 pandemic continues to affect millions worldwide. Given the rapidly growing evidence base, we implemented a living guideline model to provide guidance on the management of patients with severe or critical coronavirus disease 2019 in the ICU. METHODS: The Surviving Sepsis Campaign Coronavirus Disease 2019 panel has expanded to include 43 experts from 14 countries; all panel members completed an electronic conflict-of-interest disclosure form. In this update, the panel addressed nine questions relevant to managing severe or critical coronavirus disease 2019 in the ICU. We used the World Health Organization's definition of severe and critical coronavirus disease 2019. The systematic reviews team searched the literature for relevant evidence, aiming to identify systematic reviews and clinical trials. When appropriate, we performed a random-effects meta-analysis to summarize treatment effects. We assessed the quality of the evidence using the Grading of Recommendations, Assessment, Development, and Evaluation approach, then used the evidence-to-decision framework to generate recommendations based on the balance between benefit and harm, resource and cost implications, equity, and feasibility. RESULTS: The Surviving Sepsis Campaign Coronavirus Diease 2019 panel issued nine statements (three new and six updated) related to ICU patients with severe or critical coronavirus disease 2019. For severe or critical coronavirus disease 2019, the panel strongly recommends using systemic corticosteroids and venous thromboprophylaxis but strongly recommends against using hydroxychloroquine. In addition, the panel suggests using dexamethasone (compared with other corticosteroids) and suggests against using convalescent plasma and therapeutic anticoagulation outside clinical trials. The Surviving Sepsis Campaign Coronavirus Diease 2019 panel suggests using remdesivir in nonventilated patients with severe coronavirus disease 2019 and suggests against starting remdesivir in patients with critical coronavirus disease 2019 outside clinical trials. Because of insufficient evidence, the panel did not issue a recommendation on the use of awake prone positioning. CONCLUSION: The Surviving Sepsis Campaign Coronavirus Diease 2019 panel issued several recommendations to guide healthcare professionals caring for adults with critical or severe coronavirus disease 2019 in the ICU. Based on a living guideline model the recommendations will be updated as new evidence becomes available.


Asunto(s)
Corticoesteroides/uso terapéutico , Cuidados Críticos , Dexametasona/uso terapéutico , Manejo de la Enfermedad , Unidades de Cuidados Intensivos , Guías de Práctica Clínica como Asunto , Adenosina Monofosfato/análogos & derivados , Adenosina Monofosfato/uso terapéutico , Alanina/análogos & derivados , Alanina/uso terapéutico , Anticoagulantes , Medicina Basada en la Evidencia , Hemodinámica , Humanos , Hidroxicloroquina , Inmunización Pasiva , Posicionamiento del Paciente , Ventilación
10.
Ann Am Thorac Soc ; 18(2): 300-307, 2021 02.
Artículo en Inglés | MEDLINE | ID: covidwho-1058320

RESUMEN

Rationale: Prone positioning reduces mortality in patients with severe acute respiratory distress syndrome (ARDS), a feature of severe coronavirus disease 2019 (COVID-19). Despite this, most patients with ARDS do not receive this lifesaving therapy.Objectives: To identify determinants of prone-positioning use, to develop specific implementation strategies, and to incorporate strategies into an overarching response to the COVID-19 crisis.Methods: We used an implementation-mapping approach guided by implementation-science frameworks. We conducted semistructured interviews with 30 intensive care unit (ICU) clinicians who staffed 12 ICUs within the Penn Medicine Health System and the University of Michigan Medical Center. We performed thematic analysis using the Consolidated Framework for Implementation Research. We then conducted three focus groups with a task force of ICU leaders to develop an implementation menu, using the Expert Recommendations for Implementing Change framework. The implementation strategies were adapted as part of the Penn Medicine COVID-19 pandemic response.Results: We identified five broad themes of determinants of prone positioning, including knowledge, resources, alternative therapies, team culture, and patient factors, which collectively spanned all five Consolidated Framework for Implementation Research domains. The task force developed five specific implementation strategies, including educational outreach, learning collaborative, clinical protocol, prone-positioning team, and automated alerting, elements of which were rapidly implemented at Penn Medicine.Conclusions: We identified five broad themes of determinants of evidence-based use of prone positioning for severe ARDS and several specific strategies to address these themes. These strategies may be feasible for rapid implementation to increase use of prone positioning for severe ARDS with COVID-19.


Asunto(s)
/terapia , Posicionamiento del Paciente/normas , Brechas de la Práctica Profesional , Mejoramiento de la Calidad , /terapia , Adulto , Práctica Clínica Basada en la Evidencia , Femenino , Humanos , Ciencia de la Implementación , Unidades de Cuidados Intensivos , Masculino , Persona de Mediana Edad , Posicionamiento del Paciente/métodos , Posición Prona , Investigación Cualitativa
12.
BMC Pulm Med ; 21(1): 38, 2021 Jan 22.
Artículo en Inglés | MEDLINE | ID: covidwho-1044906

RESUMEN

BACKGROUND: Clinical management of COVID-19 requires close monitoring of lung function. While computed tomography (CT) offers ideal way to identify the phenotypes, it cannot monitor the patient response to therapeutic interventions. We present a case of ventilation management for a COVID-19 patient where electrical impedance tomography (EIT) was used to personalize care. CASE PRESENTATION: The patient developed acute respiratory distress syndrome, required invasive mechanical ventilation, and was subsequently weaned. EIT was used multiple times: to titrate the positive end-expiratory pressure, understand the influence of body position, and guide the support levels during weaning and after extubation. We show how EIT provides bedside monitoring of the patient´s response to various therapeutic interventions and helps guide treatments. CONCLUSION: EIT provides unique information that may help the ventilation management in the pandemic of COVID-19.


Asunto(s)
/diagnóstico por imagen , Impedancia Eléctrica , Pulmón/diagnóstico por imagen , Posicionamiento del Paciente/métodos , Respiración Artificial/métodos , Tomografía/métodos , /fisiopatología , Humanos , Masculino , Persona de Mediana Edad , Respiración con Presión Positiva/métodos , /terapia , Desconexión del Ventilador/métodos
13.
Rev Lat Am Enfermagem ; 29: e3397, 2021.
Artículo en Inglés, Portugués, Español | MEDLINE | ID: covidwho-1027886

RESUMEN

OBJECTIVE: to describe scientific evidence regarding the use of prone positioning in the care provided to patients with acute respiratory failure caused by COVID-19. METHOD: this is a scoping review. PRISMA Extension for Scoping Reviews was used to support the writing of this study. The search was conducted in seven databases and resulted in 2,441 studies, 12 of which compose the sample. Descriptive statistics, such as relative and absolute frequencies, was used to analyze data. RESULTS: prone positioning was mainly adopted in Intensive Care Units, lasted from a minimum of 12 up to 16 hours, and its prescription was based on specific criteria, such as PaO2/FiO2 ratio, oxygen saturation, and respiratory rate. The most prevalent complications were: accidental extubation, pressure ulcer, and facial edema. Decreased hypoxemia and mortality rates were the main outcomes reported. CONCLUSION: positive outcomes outweighed complications. Various cycles of prone positioning are needed, which may cause potential work overload for the health staff. Therefore, an appropriate number of trained workers is necessary, in addition to specific institutional protocols to ensure patient safety in this context.


Asunto(s)
Humanos , Posicionamiento del Paciente , Posición Prona , Respiración Artificial
14.
Emerg Med J ; 37(9): 565-566, 2020 Sep.
Artículo en Inglés | MEDLINE | ID: covidwho-1024248

RESUMEN

We report the experience of prone ventilation in selected patients treated with helmet non-invasive ventilation (NIV) continuous positive airway pressure (CPAP) for acute respiratory failure in COVID-19 pneumonia. Preliminary results showed an improvement in the PaO2 value and PaO2/FiO2 ratio after 1 hour of prone ventilation. No variation of the lung ultrasound pattern before and after prone ventilation has been detected. At the time of writing, we attempted proning with helmet NIV CPAP in 10 patients. In 4 out of 10 patients, the attempt failed due to lack of compliance of the patient, scarce pain control even with ongoing treatment and refusal by the patient to prone positioning.


Asunto(s)
Presión de las Vías Aéreas Positiva Contínua/métodos , Infecciones por Coronavirus , Ventilación no Invasiva/métodos , Pandemias , Neumonía Viral , Posición Prona , Insuficiencia Respiratoria , Anciano , Betacoronavirus/aislamiento & purificación , Infecciones por Coronavirus/complicaciones , Infecciones por Coronavirus/epidemiología , Infecciones por Coronavirus/fisiopatología , Infecciones por Coronavirus/terapia , Servicio de Urgencia en Hospital/estadística & datos numéricos , Femenino , Humanos , Italia/epidemiología , Masculino , Consumo de Oxígeno , Terapia por Inhalación de Oxígeno/métodos , Posicionamiento del Paciente , Neumonía Viral/complicaciones , Neumonía Viral/epidemiología , Neumonía Viral/etiología , Neumonía Viral/fisiopatología , Neumonía Viral/terapia , Insuficiencia Respiratoria/etiología , Insuficiencia Respiratoria/fisiopatología , Insuficiencia Respiratoria/terapia , Resultado del Tratamiento
15.
BMC Pulm Med ; 21(1): 25, 2021 Jan 12.
Artículo en Inglés | MEDLINE | ID: covidwho-1024364

RESUMEN

BACKGROUND: Intermittent Prone Positioning (IPP) for Acute Respiratory Distress Syndrome (ARDS) decreases mortality. We present a program for IPP using expedient materials for settings of significant limitations in both overwhelmed established ICUs and particularly in low- and middle-income countries (LMICs) treating ARDS due to COVID-19 caused by SARS CoV-2. METHODS: The proning program evolved based on the principles of High Reliability Organizations (HROs) and Crew Resource Management (CRM). Patients with severe ARDS [PaO2:FiO2 ratio (PFr) ≤ 150 on FiO2 ≥ 0.6 and PEEP ≥ 5 cm H2O] received IPP. Patients were placed prone 16 h each day. When PFr was ≥ 200 for > 8 h supine IPP ceased. IPP used available materials without requiring additional work from the bedside team. Changes in PFr, PaCO2, and the SaO2:FiO2 ratio (SaFr) positionally were evaluated using t-statistics and ANOVA with Bonferroni correction (p < 0.017). RESULTS: Between 14APR2020 and 09MAY2020, at the peak of deaths in New York, there were 202 IPPs in 29 patients. Patients were 58.5 ± 1.7 years of age (37, 73), 76% male and had a body mass index (BMI) of 27.8 ± 0.8 (21, 38). Pressor agents were used in 76% and 17% received dialysis. The PFr prior to IPP was 107.5 ± 5.6 and 1 h after IPP was 155.7 ± 11.2 (p < 0.001 compared to pre-prone). PFr after the patients were placed supine was 131.5 ± 9.1 (p = 0.02). Pre-prone PaCO2 was 60.0 ± 2.5 and the 1-h post-prone PaCO2 was 67.2 ± 3.1 (p = 0.02). Supine PaCO2 after IPP was 60.4 ± 3.4 (p = 0.90). The SaFr prior to IPP was 121.3 ± 4.2 and the SaFr 1 h after positioning was 131.5 ± 5.1 (p = 0.03). The post-IPP supine SaFr was 139.7 ± 5.9 (p < 0.001). With ANOVA and Bonferroni correction there were statistically significant changes in PFr (p < 0.001) and SaFr (p < 0.001) and no significant changes in PaCO2 over the four time points measured. Using regression coefficients, the SaFrs predicted by PFrs of 150 and 200 at baseline are 133.2 and 147.3, respectively. CONCLUSIONS: An IPP program for patients with COVID-19 ARDS can be instituted rapidly, safely, and effectively during an overwhelming mass casualty scenario. This approach may be equally applicable in both traditionally austere environments in LMICs and in otherwise capable centers facing situational resource limitations.


Asunto(s)
/complicaciones , Hipoxia/etiología , Hipoxia/terapia , Posicionamiento del Paciente/métodos , Posicionamiento del Paciente/normas , Insuficiencia Respiratoria/etiología , Insuficiencia Respiratoria/terapia , Adulto , Anciano , Protocolos Clínicos , Femenino , Humanos , Masculino , Persona de Mediana Edad , Posición Prona , Estudios Prospectivos , Índice de Severidad de la Enfermedad
16.
BMC Anesthesiol ; 21(1): 9, 2021 01 08.
Artículo en Inglés | MEDLINE | ID: covidwho-1015835

RESUMEN

BACKGROUND: Pneumonia induced by 2019 Coronavirus (COVID-19) is characterized by hypoxemic respiratory failure that may present with a broad spectrum of clinical phenotypes. At the beginning, patients may have normal lung compliance and be responsive to noninvasive ventilatory support, such as CPAP. However, the transition to more severe respiratory failure - Severe Acute Respiratory Syndrome (SARS-CoV-2), necessitating invasive ventilation is often abrupt and characterized by a severe V/Q mismatch that require cycles of prone positioning. The aim of this case is to report the effect on gas exchange, respiratory mechanics and hemodynamics of tripod (or orthopneic sitting position) used as an alternative to prone position in a patient with mild SARS-CoV-2 pneumonia ventilated with helmet CPAP. CASE PRESENTATION: A 77-year-old awake and collaborating male patient with mild SARS-CoV-2 pneumonia and ventilated with Helmet CPAP, showed sudden worsening of gas exchange without dyspnea. After an unsuccessful attempt of prone positioning, we alternated three-hours cycles of semi-recumbent and tripod position, still keeping him in CPAP. Arterial blood gases (PaO2/FiO2, PaO2, SaO2, PaCO2 and A/a gradient), respiratory (VE, VT, RR) and hemodynamic parameters (HR, MAP) were collected in the supine and tripod position. Cycles of tripod position were continued for 3 days. The patient had a clinically important improvement in arterial blood gases and respiratory parameters, with stable hemodynamic and was successfully weaned and discharged to ward 10 days after pneumonia onset. CONCLUSIONS: Tripod position during Helmet CPAP can be applied safely in patients with mild SARS-CoV-2 pneumonia, with improvement of oxygenation and V/Q matching, thus reducing the need for intubation.


Asunto(s)
/diagnóstico por imagen , Presión de las Vías Aéreas Positiva Contínua/métodos , Posicionamiento del Paciente/métodos , Mecánica Respiratoria/fisiología , Anciano , Humanos , Masculino , Resultado del Tratamiento
17.
J Radiat Res ; 62(1): 163-171, 2021 Jan 01.
Artículo en Inglés | MEDLINE | ID: covidwho-1003611

RESUMEN

The immobilization of patients with a bite block (BB) carries the risk of interpersonal infection, particularly in the context of pandemics such as COVID-19. Here, we compared the intra-fractional patient setup error (intra-SE) with and without a BB during fractionated intracranial stereotactic irradiation (STI). Fifteen patients with brain metastases were immobilized using a BB without a medical mask, while 15 patients were immobilized without using a BB and with a medical mask. The intra-SEs in six directions (anterior-posterior (AP), superior-inferior (SI), left-right (LR), pitch, roll, and yaw) were calculated by using cone-beam computed tomography images acquired before and after the treatments. We analyzed a total of 53 and 67 treatment sessions for the with- and without-BB groups, respectively. A comparable absolute mean translational and rotational intra-SE was observed (P > 0.05) in the AP (0.19 vs 0.23 mm with- and without-BB, respectively), SI (0.30 vs 0.29 mm), LR (0.20 vs 0.29 mm), pitch (0.18 vs 0.27°), roll (0.23 vs 0.23°) and yaw (0.27 vs 22°) directions. The resultant planning target volume (PTV) margin to compensate for intra-SE was <1 mm. No statistically significant correlation was observed between the intra-SE and treatment times. A PTV margin of <1 mm was achieved even when patients were immobilized without a BB during STI dose delivery.


Asunto(s)
Irradiación Craneana , Fraccionamiento de la Dosis de Radiación , Inmovilización/instrumentación , Máscaras/efectos adversos , Pandemias , Posicionamiento del Paciente/instrumentación , Radiocirugia , Errores de Configuración en Radioterapia , Adulto , Anciano , Anciano de 80 o más Años , Neoplasias Encefálicas/diagnóstico por imagen , Neoplasias Encefálicas/radioterapia , Neoplasias Encefálicas/secundario , Diseño de Equipo , Femenino , Humanos , Masculino , Persona de Mediana Edad , Planificación de la Radioterapia Asistida por Computador/métodos , Estudios Retrospectivos , Tomografía Computarizada por Rayos X
18.
Monaldi Arch Chest Dis ; 90(4)2020 Dec 23.
Artículo en Inglés | MEDLINE | ID: covidwho-1000398

RESUMEN

COVID-19 pneumonia has a significant case fatality rate and no effective antiviral drugs are available even after 9 months of the pandemic. The spectrum of COVID-19 disease ranges from asymptomatic cases to severe ARDS with myriad manifestations. Here we report a case of a male patient with severe COVID-19 ARDS who improved after receiving standard therapy but again 'deteriorated' after being stepped down to ward. He complained of worsening shortness of breath and hypoxemia which was found to be mainly positional. After ruling out other causes, he was labeled as a case of platypnea-orthodeoxia syndrome due to underlying lung involvement.  It is important to be aware of this condition in the context of COVID-19 which can be easily diagnosed bedside with pulse oximetry.


Asunto(s)
Disnea , Hipoxia , Pulmón , Posicionamiento del Paciente/métodos , Neumonía Viral , Anciano , /fisiopatología , Deterioro Clínico , Diagnóstico Diferencial , Disnea/diagnóstico , Disnea/etiología , Humanos , Hipoxia/diagnóstico , Hipoxia/etiología , Pulmón/diagnóstico por imagen , Pulmón/fisiopatología , Masculino , Oximetría/métodos , Terapia por Inhalación de Oxígeno/métodos , Manejo de Atención al Paciente , Neumonía Viral/diagnóstico , Neumonía Viral/etiología , Neumonía Viral/fisiopatología , Neumonía Viral/terapia , Pruebas de Función Respiratoria/métodos , Síndrome , Tomografía Computarizada por Rayos X/métodos
19.
Can J Anaesth ; 68(4): 541-545, 2021 04.
Artículo en Inglés | MEDLINE | ID: covidwho-996470

RESUMEN

Many patients with coronavirus disease (COVID-19) will develop acute respiratory distress syndrome (ARDS). Prone positioning is an important non-pharmacologic strategy that should be considered for all invasively ventilated patients with moderate to severe ARDS (including those with COVID-19). Prone positioning offers several physiologic and clinical benefits, including improving hypoxemia, matching ventilation with perfusion, reducing regional hyperinflation, and improving survival. To safely offer prone positioning, appropriate training, simulation, and health system planning should be undertaken. In this review, we offer ten tips, based on the Alberta provincial prone positioning strategy during COVID-19, to safely implement and improve the appropriate use of prone positioning. We provide special considerations for its use during the COVID-19 pandemic or future respiratory pandemics.


Asunto(s)
Coronavirus , Alberta , Humanos , Pandemias , Posicionamiento del Paciente , Posición Prona , Respiración Artificial , /terapia
SELECCIÓN DE REFERENCIAS
DETALLE DE LA BÚSQUEDA