Asunto(s)
Indoles/uso terapéutico , Enfermedades Pulmonares Intersticiales/tratamiento farmacológico , Enfermedades Pulmonares Intersticiales/etiología , Pulmón/diagnóstico por imagen , Ácido Micofenólico/uso terapéutico , Inhibidores de Proteínas Quinasas/uso terapéutico , Esclerodermia Sistémica/complicaciones , Esclerodermia Sistémica/tratamiento farmacológico , Adulto , Anciano , Anciano de 80 o más Años , Femenino , Humanos , Masculino , Persona de Mediana EdadAsunto(s)
Trastornos Relacionados con Alcohol , Sepsis , Choque Séptico , Humanos , Proyectos Piloto , TiaminaRESUMEN
BACKGROUND: Past studies suggest that airway pressure release ventilation (APRV) is associated with reduced sedative requirements and increased recruitment of atelectatic lung, two factors that might reduce the risk for ventilator-associated pneumonia (VAP). We investigated whether APRV might be associated with a decreased risk for VAP in patients with pulmonary contusion. MATERIALS: Retrospective cohort study. RESULTS: Of 286, 64 (22%) patients requiring mechanical ventilation for >48 hours met criteria for pulmonary contusion and were the basis for this study. Subjects with pulmonary contusion had a significantly higher rate of VAP than other trauma patients, [VAP rate contusion patients: 18.3/1,000, non-contusion patients: 7.7/1,000, incidence rate ratio 2.37 (95% confidence interval [CI], 1.11-4.97), p=0.025]. Univariate analysis showed that APRV (hazard ratio, 0.15 [0.03-0.72; p=0.018]) was associated with a decreased incidence of VAP. Cox proportional hazards regression, using propensity scores for APRV to control for confounding, supported a protective effect of APRV from VAP (hazard ratio, 0.10 [95% CI, 0.02-0.58]; p=0.01). Pao2/FiO2 ratios were higher during APRV compared with conventional ventilation (p<0.001). Subjects attained the goal Sedation Agitation Score for an increased percentage of time during APRV (median [interquartile range (IQR)] 72.7% [33-100] of the time) compared with conventional ventilation (47.2% [0-100], p=0.044), however, dose of sedatives was not different between these subjects. APRV was not associated with hospital mortality (odds ratio 0.57 [95% CI, 0.06-5.5]; p=0.63) or ventilator-free days (No APRV 15.4 vs. APRV 13.7 days, p=0.49). CONCLUSION: Use of APRV in patients with pulmonary contusion is associated with a reduced risk for VAP.
Asunto(s)
Presión de las Vías Aéreas Positiva Contínua , Contusiones/terapia , Lesión Pulmonar/terapia , Neumonía Asociada al Ventilador/prevención & control , Adulto , Femenino , Mortalidad Hospitalaria , Humanos , Incidencia , Masculino , Persona de Mediana Edad , Neumonía Asociada al Ventilador/epidemiología , Distribución de Poisson , Modelos de Riesgos Proporcionales , Sistema de Registros , Estudios Retrospectivos , Factores de Riesgo , Estadísticas no Paramétricas , Índices de Gravedad del TraumaRESUMEN
The reviews of this paper are available via the supplemental material section.
Asunto(s)
Betacoronavirus , Infecciones por Coronavirus/complicaciones , Infecciones por Coronavirus/terapia , Cuidados Críticos , Obesidad/complicaciones , Neumonía Viral/complicaciones , Neumonía Viral/terapia , Adulto , Anciano , COVID-19 , Infecciones por Coronavirus/mortalidad , Femenino , Mortalidad Hospitalaria , Humanos , Tiempo de Internación , Modelos Logísticos , Masculino , Persona de Mediana Edad , Obesidad/mortalidad , Pandemias , Neumonía Viral/mortalidad , Modelos de Riesgos Proporcionales , Estudios Retrospectivos , SARS-CoV-2 , Resultado del TratamientoRESUMEN
BACKGROUND: Bedside ultrasound helps to estimate volume status in critically ill patients and has traditionally relied on diameter, respiratory variation, and collapsibility of the inferior vena cava (IVC) to reflect fluid status. We evaluated collapsibility of the internal jugular vein (IJ) with ultrasound and correlated it with concomitant right heart catheterization (RHC) measurements in patients with presumed pulmonary hypertension. METHODS AND RESULTS: We studied 71 patients undergoing RHC for evaluation of pulmonary hypertension. Using two-dimensional ultrasound (Sonosite, Washington, USA), we measured the diameter of the IJ at rest, during respiratory variation, and during manual compression. Collapsibility index during respiration (respiratory CI) and during manual compression (compression CI) was calculated. We correlated mean right atrial pressure (mRAP) and pulmonary artery occlusion pressure (PAOP) defined by RHC measurements with respiratory and compression CI. A secondary goal was examining correlations between CI calculations and B-type natriuretic peptide (BNP) levels. Baseline characteristics demonstrated female predominance (n = 51; 71.8%), mean age 59.5 years, and BMI 27.3. There were significant correlations between decrease in compression CI and increase in both mRAP (Spearman: - 0.43; p value = 0.0002) and PAOP (Spearman: - 0.35; p value = 0.0027). In contrast, there was no significant correlation between respiratory CI and either mRAP (Spearman: - 0.14; p value = 0.35) or PAOP (Spearman:- 0.12; p value = 0.31). We also observed significant negative correlation between compression CI and BNP (Spearman: - 0.31; p value = 0.01) but not between respiratory CI and BNP (Spearman: - 0.12; p value = 0.35). CONCLUSION: Increasing use of ultrasound has led to innovative techniques for estimating volume status. While prior ultrasound studies have used clinical parameters to estimate fluid status, our study used RHC measurements and demonstrated that compression CI potentially reflects directly measured mRAP and PAOP.