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OBJECTIVE: Post-extubation dysphagia in critically ill patients is known to affect about 18 per cent of mixed medical-surgical intensive care unit patients. This study investigated the incidence of post-extubation dysphagia in adult intensive care unit patients with coronavirus disease 2019. METHOD: This study was a retrospective analysis of consecutive intensive care unit patients prospectively screened for dysphagia. Systematic screening of all extubated intensive care unit patients at our tertiary centre was performed using the Bernese intensive care unit dysphagia algorithm. The primary outcome measure was the incidence of post-extubation dysphagia. RESULTS: A total of 231 critically ill adult coronavirus disease 2019 positive patients were included, and 81 patients remained in the final analysis after exclusion criteria were applied (e.g. patients transferred). Dysphagia screening positivity was 25 of 81 (30.9 per cent), with 28.2 per cent (22 of 78) having confirmed dysphagia by specialist examination within 24 hours (n = 3 lost to follow up). CONCLUSION: In this observational study, it was observed that the incidence of dysphagia in adult critically ill coronavirus disease 2019 patients was about 31 per cent (i.e. increased when compared with a historical pre-pandemic non-coronavirus disease 2019 intensive care unit cohort).
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COVID-19 , Trastornos de Deglución , Humanos , Adulto , Enfermedad Crítica/epidemiología , Estudios Retrospectivos , Trastornos de Deglución/diagnóstico , Trastornos de Deglución/epidemiología , Trastornos de Deglución/etiología , COVID-19/complicaciones , COVID-19/epidemiología , Incidencia , Cuidados Críticos , Unidades de Cuidados IntensivosRESUMEN
OBJECTIVE: Metabolic acidosis is associated with high mortality. Despite theoretical benefits of sodium-bicarbonate (SB), current evidence remains controversial. We investigated SB-related effects on outcomes in ICU patients with metabolic acidosis. DESIGN: Retrospective analysis. SETTING: Academic medical center. PATIENTS OR PARTICIPANTS: 971 ICU patients with metabolic acidosis defined as arterial pH<7.3 and CO2<45mmHg treated between 2012 and 2016. A propensity score (PS) was estimated using logistic regression. Patients were matched in pairs using the PS. INTERVENTIONS: 441 patients were treated with SB 8.4% (SB-group) and n=530 patients were not (control group). MAIN VARIABLES OF INTEREST: Primary outcome was all-cause mortality at ICU-discharge. Average Treatment Effect (ATE), Average Treatment effect in Treated (ATT), and estimated relative survival effects at 20 days were computed. RESULTS: In the full cohort, we observed considerable differences in pH, base excess, additional acidosis-related indices, and ICU mortality (controls 31% vs. SB-group 56%, p<.001) at baseline between the two groups. After PS-matching (n=174 in each group), no significant difference in ICU mortality was observed (controls 32% vs. SB-group 41%; p=.07). Odds ratios (OR) for ATE and ATT showed no association with ICU mortality (OR ATE: 1.08, 95%-CI 0.99-1.17; p=.08; OR ATT 1.09; 95%-CI 0.99-1.2; p=.09). Hazard ratios at 20-days (multivariable HR, matched sample n=348: 1.16, 95%-CI 0.86-1.56, p=.33) showed similar survival in the two study groups. CONCLUSIONS: We did not observe effects of SB infusion on all-cause mortality in critically ill patients with metabolic acidosis.
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BACKGROUND: Minimising perioperative bleeding is a key goal of "patient blood management" programs. One component of respective strategies includes preventive inhibition of fibrinolysis using protease inhibitors, such as tranexamic acid (TXA). TXA inhibits plasminogen activation and plasmin-induced fibrin degradation. OBJECTIVES: The present article provides an overview of the existing literature and TXA applications in the prophylaxis of perioperative bleeding. METHODS: Literature search in PubMed/MEDLINE (U.S. National Library of Medicine®, Bethesda, MD, USA). RESULTS: TXA reduces perioperative blood loss and transfusion requirements in several randomized controlled trials (RCTs) and meta-analyses in the field of hip and knee arthroplasty for both intravenous and topical use. Moreover, evidence favours use of TXA in complex spine surgery and reconstructive surgery (e.â¯g. craniosynostosis in children). Single RCTs showed benefits of TXA in abdominal hysterectomy, open prostatectomy, liver surgery and actively bleeding trauma patients. For prophylaxis of peripartum haemorrhage (PPH) following vaginal delivery or Caesarean section, TXA cannot be routinely recommended, although evidence points to benefits in actively bleeding patients. A recommendation exists for the treatment of (active) PPH. For prophylactic perioperative administration, different dosage regimens exist for adults. Most often an initial i.â¯v. bolus of 1â¯g or 10-15â¯mg/kg body weight with/without repetition after 6â¯h or continuous infusions over 8â¯h is administered. Increased rates of thromboembolic events were not noted. CONCLUSION: Protease inhibitors such as TXA reduce perioperative blood loss and transfusion requirements in selected surgical fields.
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Antifibrinolíticos , Pérdida de Sangre Quirúrgica/prevención & control , Cuidados Intraoperatorios/métodos , Ácido Tranexámico/administración & dosificación , Antifibrinolíticos/administración & dosificación , Femenino , Humanos , Masculino , Estados UnidosRESUMEN
The purpose of this paper is to provide background information on radiotherapy, and to present dental hygiene protocols for the treatment of head and neck radiation patients. These patients experience specific oral complications or sequelae that require specialized care. To assist the treating dental hygienist in understanding the genesis of these complications, a brief history of the use of radiotherapy and its effects on mammalian tissue is included. Complications may include mucositis, candidiasis, xerostomia, loss of taste, trismus, severe caries, nutritional deficit, and osteoradionecrosis. Management protocols are presented for the prevention and treatment of these complications. Maximum protocol effectiveness and long-term success may only be attained by education of and communication with the patient. As the number of head and neck radiation patients increases daily, a thorough understanding of the disease and treatment process is becoming more necessary for all oral healthcare providers.
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Enfermedades de la Boca/prevención & control , Radioterapia/efectos adversos , Protocolos Clínicos , Higienistas Dentales , Neoplasias de Cabeza y Cuello/radioterapia , Humanos , Enfermedades de la Boca/etiología , Enfermedades de la Boca/terapia , Educación del Paciente como AsuntoRESUMEN
This study evaluated the long-term effect of an ultrasonic toothbrush used as part of a daily oral hygiene regimen on supragingival plaque, gingivitis, and gingival bleeding. Compared with a conventional toothbrush, the ultrasonic toothbrush was significantly more effective in reducing plaque formation (p < 0.05), removing plaque (p < 0.05), and reducing gingivitis (p < 0.05) during the 6-month study period.