Factors related to survival in Intensive Care Unit patients with Covid-19: a study from a single center in Brazil

Introduction: Analysis of the outcome of 268 ICU patients in a single-center, as well the impact of viral infection on patients with preexisting medical conditions and how these factors affected survival and hospital stay. Methodology: Patients admitted to the ICU from March-August, 2020 were retrospectively analyzed under the same protocol at Hospital Alemão Oswaldo Cruz, São Paulo, Brazil. Several factors were considered and the results were presented using 95% confidence intervals. For statistical significance, p <0.05 was adopted. Results: Patient median age was 72 years, 64,2 years for discharged patients and 79.9 years for those deceased (p<0.001). The most common comorbidities were: systemic arterial hypertension, diabetes, thyroid disease, cardiovascular and kidney disease. Predictors of survival through univariate analysis: myalgia (p=0.001), cerebrovascular disease (p=0.002), COPD (p=0.003), dementia (p=0.000), mechanical ventilation (p=0.000), dialysis (0.000), vasopressor use (0.000), SAPS3 (0.000), lymphopenia (p=0.004), elevated D-dimer (P=0.011), time in ICU before tracheostomy (p=0.002), and performing a tracheostomy (p=0.000). The independent predictors of mortality were: advanced age (p=0.003) and tracheostomy performed in ICU (p=0.002). Discussion: COVID-19 affects usually older adults, where there already is a higher fatality rate. Acute respiratory distress syndrome is the primary cause of death and <5% of patients were reported as experiencing co-infection at admission. Conclusion: age, vasopressor use in patients with tracheostomy, and systemic coronary disease, heart failure, neoplasia, and COPD, were found to be significantly associated with COVID-19 severity.

Peribulbar block combined with general anesthesia in babies undergoing laser treatment for retinopathy of prematurity: a retrospective analysis / Bloqueio peribulbar combinado com anestesia geral em bebês submetidos a tratamento a laser para retinopatia da prematuridade: uma análise retrospectiva

Abstract Background and objectives Currently there is no agreement regarding which one is the most adequate anesthetic technique for the treatment of retinopathy of prematurity. Peribulbar block may reduce the incidence of oculocardiac reflex and postoperative apnea. The goal of this study was to report the outcomes of peribulbar block, when combined with general anesthesia, for the laser treatment for retinopathy of prematurity, in premature babies. Methods A retrospective analysis of anesthetic records of all babies who underwent laser treatment for retinopathy of prematurity from January 2008 through December 2015 in a tertiary hospital was performed. Results During that period a total of six babies was submitted to laser treatment for retinopathy of prematurity, all under peribulbar block combined with general anesthesia. A single infratemporal injection of 0.15 mL.kg−1 per eye ropivacaine 1% or 0.75% was performed. At the end of the procedure, all babies resumed spontaneous ventilation. No perioperative complications were reported. Conclusions Peribulbar block was a safe anesthetic technique in our sample considered.

Resumo Justificativa e objetivos Até o momento não há um consenso sobre a técnica anestésica mais adequada para o tratamento de retinopatia da prematuridade. O bloqueio peribulbar pode reduzir a incidência de reflexo oculocardíaco e apneia no pós-operatório. O objetivo deste estudo foi relatar os resultados do bloqueio peribulbar, quando combinado com anestesia geral, para o tratamento a laser de retinopatia da prematuridade em bebês prematuros. Métodos Uma análise retrospectiva dos registros anestésicos de todos os bebês submetidos ao tratamento a laser para retinopatia da prematuridade de janeiro de 2008 a dezembro de 2015 foi realizada em um hospital terciário. Resultados Durante esse período, seis bebês foram submetidos ao tratamento a laser para retinopatia da prematuridade, todos sob bloqueio peribulbar combinado com anestesia geral. Uma injeção infratemporal única de ropivacaína a 1% ou 0,75% (0,15 mL.kg−1) foi administrada por olho. No fim do procedimento, todos os bebês retomaram a ventilação espontânea. Não foram relatadas complicações perioperatórias. Conclusões O bloqueio peribulbar foi uma técnica anestésica segura em nossa amostra considerada.

[Peribulbar block combined with general anesthesia in babies undergoing laser treatment for retinopathy of prematurity: a retrospective analysis]. / Bloqueio peribulbar combinado com anestesia geral em bebês submetidos a tratamento a laser para retinopatia da prematuridade: uma análise retrospectiva.

BACKGROUND AND OBJECTIVES: Currently there is no agreement regarding which one is the most adequate anesthetic technique for the treatment of retinopathy of prematurity. Peribulbar block may reduce the incidence of oculocardiac reflex and postoperative apnea. The goal of this study was to report the outcomes of peribulbar block, when combined with general anesthesia, for the laser treatment for retinopathy of prematurity, in premature babies. METHODS: A retrospective analysis of anesthetic records of all babies who underwent laser treatment for retinopathy of prematurity from January 2008 through December 2015 in a tertiary hospital was performed. RESULTS: During that period a total of six babies was submitted to laser treatment for retinopathy of prematurity, all under peribulbar block combined with general anesthesia. A single infratemporal injection of 0.15mL.kg-1 per eye ropivacaine 1% or 0.75% was performed. At the end of the procedure, all babies resumed spontaneous ventilation. No perioperative complications were reported. CONCLUSIONS: Peribulbar block was a safe anesthetic technique in our sample considered.

Effect of Boussignac continuous positive airway pressure ventilation on Pao2 and Pao2/Fio2 ratio immediately after extubation in morbidly obese patients undergoing bariatric surgery: a randomized controlled trial.

STUDY OBJECTIVE: Pathophysiological changes after laparoscopic Roux-en-Y gastric bypass may increase the risk of pulmonary complications in morbidly obese patients. The purpose of the study was to assess the impact of immediate postextubation use of Boussignac continuous positive airway pressure (CPAP) on arterial oxygenation in morbidly obese patients undergoing laparoscopic Roux-en-Y gastric bypass. The hypothesis is that the use of CPAP may improve oxygenation in the postoperative period when compared to Venturi mask. DESIGN: Randomized controlled study. SETTING: A tertiary referral hospital. PATIENTS: Recruited morbidly obese adult patients undergoing laparoscopic Roux-en-Y gastric bypass. INTERVENTIONS: Boussignac CPAP or Venturi mask was randomly applied immediately after extubation in the operating room and was maintained during the first 2 hours in the recovery room. MEASUREMENTS: Pao2 and Pao2/fraction of inspired oxygen (Fio2) ratio values were measured preoperatively and at 1 (T1), 2 (T2), and 24 hours (T24) after extubation, through arterial blood samples. Secondary outcomes (spirometric parameters) were measured at the same periods. For comparison between groups, Student t test, Mann-Whitney U nonparametric test, and χ(2) test were used. Statistical significance is at P < .05. MAIN RESULTS: Twenty-four patients were included, 12 in each group. There were no differences in preoperative evaluation. There were significant differences between groups in Pao2 and Pao2/Fio2 mean values at T1, T2, and T24, being superior in the Boussignac group. During the 24 hours postextubation, 9% of patients in the Boussignac group and 50% in the Venturi group had a Pao2 less than 60 mm Hg in at least 1 of the evaluations. After extubation, a Pao2/Fio2 ratio value less than 300 was observed in all patients in the Venturi group and in 55% in Boussignac group in at least 1 of the evaluations. There were no differences in spirometric parameters between groups at T1, T2, and T24. CONCLUSIONS: Application of Boussignac CPAP for 2 hours after extubation improved oxygenation but did not improve forced expiratory volume at 1 second and forced vital capacity.

Determinação do fator de proteção solar (in vitro) de produtos magistrais na forma de gel. avaliação dos aspectos sensoriais e físicoquímicos / Determining factor solar protection (in vitro) products in masterful gel method. sensory evaluation of aspects and physical and chemical

A exposição ao sol pode resultar em muitos benefícios para as pessoas como a saúde física e mental, a síntese de vitamina D, o tratamento de icterícia, entre outros. No entanto, também pode causar danos à pele pela exposição excessiva. Os filtros solares são produtos concebidos para absorver os raios ultravioleta A e B. Para avaliar o desempenho destes foram adquiridos em farmácias magistrais cinco produtos (amostras 1, 2 e 3), filtros solares solúveis em água contendo (ácido 2 - fenilbenzimidazol - 5 - sulfónico) e submetidos a ensaios físico-químicos. A análise dos dados revelou que nenhum dos produtos e respectivas amostras (1, 2 e 3) mostrou um valor de pH dentro das especificações (7,2-7,5) necessário para a solubilização completa do filtro solar. O tempo de escoamento relacionado com a viscosidade dos géis mostrou que apenas as amostras do produto D exibiram valores muito semelhantes, ao passo que as amostras da farmácia C apresentaram maiores diferenças. As amostras que correspondem às outras farmácias também mostraram mudanças suaves, contudo, quando aplicado sobre a placa de vidro, não houve percepção visível. Considerando-se o Factor de Proteção Solar (FPS), nas amostras estudadas os FPS encontrados "in vitro" pelo método Mansur (1986b) e modificado por (Renata, 2004), apresentaram valores bem abaixo do FPS rotulado, especialmente produtos C e E não mostraram nenhuma característica do espectro de absorção, indicando a ausência de protetor solar hidrossolúvel.