Dysphagia in patients with coronavirus disease undergoing orotracheal intubation.

Objective: To assess the incidence and the risk factors for the development of dysphagia in patients with coronavirus disease 2019 (COVID-19) undergoing orotracheal intubation. Study Design: Prospective cohort study. Methods: In this prospective cohort study, we evaluated consecutive patients diagnosed with COVID-19 and underwent orotracheal intubation were evaluated. During hospitalization, extubated patients were classified as dysphagic and nondysphagic based on bedside functional assessment of swallowing. Patients discharged from hospital were asked to complete the Eating Assessment Tool-10 (EAT-10) questionnaire, followed by an endoscopic examination to identify laryngotracheal lesions, and a fiberoptic endoscopic evaluation of swallowing (FEES). The food consistencies used for FEES were moderately thick, extremely thick, thin, and regular. Results: Based on the functional assessment of swallowing, performed a mean of 5.3 days and a median of 4 days after extubation, the incidence of dysphagia in patients with COVID-19 undergoing orotracheal intubation was 53.6%. In the late evaluation, performed a mean of 102 days after extubation, 12.8% of patients had an EAT-10 score >2. Orotracheal intubation (OTI) duration and tracheostomy were risk factors for the development of dysphagia. There was an association between EAT-10 > 2 and the presence of laryngotracheal lesion, with no difference between lesion type and EAT score >2. Conclusions: The incidence of dysphagia varied according to the time of assessment, being higher the earlier the assessment after extubation. OTI duration and tracheostomy were risk factors for the development of dysphagia, and the presence of laryngotracheal lesions demonstrated an association with dysphagia. Level of Evidence: 3.

Incidence of Laryngotracheal Lesions After Orotracheal Intubation in Coronavirus Disease Patients.

OBJECTIVES/HYPOTHESIS: To evaluate the incidence of lesions and severe sequelae and the risk factors for the development of laryngotracheal lesions after orotracheal intubation (OTI) in coronavirus disease (COVID-19) patients. STUDY DESIGN: Prospective cohort study. METHODS: In this prospective cohort study, we evaluated patients diagnosed with COVID-19 who were consecutively admitted to a tertiary hospital and required OTI from March 1, 2020 to October 31, 2020. Patients discharged were called for outpatient follow-up and endoscopic examination. RESULTS: A total of 1,357 patients diagnosed with COVID-19, as confirmed by nasal swab reverse transcription polymerase chain reaction, were admitted. OTI for mechanical ventilation was required in 421 patients (31%). Of the intubated patients, 172 (40.9%) were discharged and 249 (59.1%) died. Outpatient evaluation by videoendoscopy was performed in 95 patients (55.2%) approximately 100 days after extubation. Laryngotracheal lesions were observed in 38 patients (40%), with 17.9% diagnosed with laryngotracheal stenosis or unilateral immobility while 6.3% had severe stenosis (grades 3 and 4). The factors presenting statistical significance for the development of laryngotracheal lesions were the endotracheal tube (ETT) size; prone position over the OTI period; and the increased leukocyte count, d-dimer, prothrombin time (PT), and international normalized ratio (INR) on the day OTI was performed. CONCLUSIONS: The incidence of laryngotracheal lesion in COVID-19 patients is 40%, with 6.3% of them presenting with severe stenosis. There was a greater risk for the development of laryngotracheal lesions in patients using a larger ETT, kept in a prone position, presenting a greater inflammatory reaction (increased leukocyte count), or developing coagulation disorders (increased d-dimer, PT, and INR). LEVEL OF EVIDENCE: 3 Laryngoscope, 132:1075-1081, 2022.

Investigação da gravidade da Afasia em um hospital de urgência e emergência: estudo de caso / Investigating the gravity of Aphasia in an urgengy and emergency hospital: case study

Objetivo: Investigar a gravidade da afasia em uma paciente com Acidente Vascular Encefálico (AVE), a partir da aplicação de um teste considerado simples e rápido: o Aphasia Rapid Test (ART). Metodologia: a paciente de 63 anos foi admitida no pronto socorro de um hospital de urgência e emergência com hipótese diagnóstica de AVE, consciente e fora de qualquer procedimento invasivo que comprometesse sua comunicação. Resultados: na primeira avaliação, não apresentou alteração de linguagem. Na segunda, apresentou dificuldade na execução das provas de ordens simples e complexas, repetição de palavras e frases, na tarefa verbal de fluência semântica e na avaliação de disartria. Considerações finais: observou-se durante a pesquisa que no início da internação a paciente não apresentava gravidade para afasia, porém com o decorrer da internação evidenciou-se dificuldades na linguagem mostrando gravidade para o quadro de afasia, além disso, dificuldades motoras as quais comprometeram a realização das atividades de vida diária

Objective: Investigate the severity of aphasia in a patient with stroke, by applying a test considered simple and fast: the Aphasia Rapid Test (ART). Methodology: the 63-year-old patient was admitted to the emergency room of an urgent and emergency hospital with a diagnostic hypothesis of stroke, conscious and out of any invasive procedure that compromised her communication. Results: in the first evaluation, there was no change in language. In the second, he presented difficulty in carrying out the tests of simple and complex orders, repetition of words and phrases, in the verbal task of semantic fluency and in the evaluation of dysarthria. Final considerations: it was observed during the research that at the beginning of the hospitalization, the patient did not present severity for aphasia, however, with the course of hospitalization, language difficulties were evident, showing severity for the condition of aphasia, in addition, motor difficulties which compromised carrying out activities of daily living

Alterações glicêmicas e pressóricas em pacientes críticos / Glycemic and pressure changes in critically ill patients

Objetivo: descrever as repercussões das variações glicêmicas e pressóricas de pacientes hipertensos e diabéticos. Método: estudo quantitativo, descritivo e exploratório, com 14 pacientes internados na unidade de terapia intensiva (UTI). Utilizou-se questionário estruturado para coleta de dados. Considerou-se significativo resultado com p < 0,05. Resultados: 78,5% dos pacientes se caracterizavam como hipertensos e 43% diabéticos. O período de internação compreendeu 66±84 dias e o período de ventilação mecânica foi de 70±95 dias. O Acute Physiology and Chronic Health Disease Classification System II (APACHE II) de 26±4 sinalizou a gravidade dos pacientes. Glicemia capilar, tempo de internação e de ventilação mecânica se associaram significativamente ao pior desfecho/óbito (p ≤ 0,05). Conclusão: uma das repercussões das alterações glicêmicas e pressóricas se associou ao risco de lesão renal. Além disso, a inexistência de um controle seguro e eficaz da glicemia conduziu os pacientes ao pior desfecho/óbito. Destaca-se a participação do enfermeiro não apenas para controlar as oscilações glicêmicas, mas também proporcionar um cuidado seguro e auxiliar a tomada de decisão, a fim de aumentar a sobrevida do paciente e garantir uma assistência eficaz e de qualidade.(AU)

Kinetics of gelation and thermal sensitivity of N-isobutyryl chitosan hydrogels.

N-Acylation of chitosan with carboxylic anhydrides in dilute acetic acid/methanol has been a well documented strategy to selectively modify chitosan. Although this reaction is known to lead to irreversible gel formation, the kinetics and mechanism of this process have not so far been addressed. To this purpose, gel formation during the N-isobutyrylation of chitosan was investigated as a function of the reaction stoichiometry (R), chitosan concentration, and temperature by small deformation oscillatory rheology. Gel formation follows closely the chemical reaction and it proceeds predominantly under second-order kinetics as established from the dependence of critical gel time, t(gel), on R and concentration. The activation energy value derived from t(gel) vs 1/T data (E(a) = 68.29 +/- 1.80 kJ/mol) was almost identical to values reported for the chitosan N-acetylation reaction in previous studies. An excess isobutyric anhydride is suggested to be necessary for nucleation and hydrophobic association. The potential application of N-isobutyrylchitosan (NIBC) hydrogels in the design of thermally sensitive materials is also demonstrated.