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1.
Rev. colomb. anestesiol ; 52(3): 3, July-Sept. 2024. tab
Article in English | LILACS-Express | LILACS | ID: biblio-1576176

ABSTRACT

Abstract Introduction: Factors associated with mortality among mechanically ventilated COVID-19 patients have been scarcely studied in Latin America. Objective: To identify factors associated with mortality in mechanically ventilated COVID-19 patients. Methods: This prospective study was undertaken in a single center between April and October 2020, recruiting COVID-19 patients managed with mechanical ventilation. We excluded patients who died within the first 24 hours after endotracheal intubation. Clinical characteristics, laboratory results, ventilation interventions, and outcomes were collected and compared between the deceased and surviving groups. The association between these factors and hospital death was examined, and relevant covariates were included in a multivariate logistic regression model. Results: A total of 273 patients were included (72.5% male), the mortality rate was 37% (95% CI 31% - 43%), and the median age was 63 years (IQR 52-72). The most frequent comorbidity was hypertension (45%). Factors associated with mortality were: older age (OR 1.08; 95% CI 1.051.11), male gender (OR 2.79; 95% CI 1.30-6.01), immunosuppression (OR 3.98; 95% CI 1.57-10.06), thrombocytopenia (OR 3.84; CI 95% 1.47-10.01), driving pressure (OR 1.20; 95% CI 1.07-1.34) and the use of dialysis (OR 4.94; 95% CI 2.56-9.51). Chronic hypertension (OR 0.35; 95% CI 0.17-0.71) and fever on admission (OR 0.51; 95% CI 0.27-0.98) were found to have a protective effect. Conclusions: Older age, male sex, immunosuppression, thrombocytopenia, increased driving pressure, use of dialysis, absence of fever, or arterial hypertension were associated with an increased risk of mortality among mechanically ventilated COVID-19 patients.


Resumen Introducción: Es poco lo que se han estudiado en América Latina los factores asociados con mortalidad en pacientes con COVID-19 ventilados mecánicamente. Objetivo: Identificar los factores asociados con mortalidad en pacientes con COVID-19 manejados con ventilación mecánica. Métodos: Este estudio prospectivo se adelantó en un solo centro entre los meses de abril y octubre de 2020 e incluyó pacientes con COVID-19 manejados con ventilación mecánica. Se excluyeron pacientes que fallecieron en las primeras 24 horas después de la intubación orotraqueal. Se recopilaron datos de las características clínicas, resultados de laboratorio, intervenciones ventilatorias y desenlaces, y se hizo una comparación entre el grupo de pacientes fallecidos y el grupo de sobrevivientes. Se examinó la asociación entre estos factores y la muerte intrahospitalaria, y las covariables relevantes se incluyeron en un modelo multivariable de regresión logística. Resultados: Se incluyó un total de 273 pacientes (72.5% hombres), la tasa de mortalidad fue del 37% (IC 95% 31% - 43%), la mediana de edad fue de 36 años (RIC 52-72) y la comorbilidad más frecuente fue la hipertensión (45%). Los factores asociados con mortalidad fueron: edad avanzada (OR 1.08; IC 95% 1.05-1.11), género masculino (OR 2.79; IC 95% 1.30-6.01), inmunosupresión (OR 3.98; IC 95% 1.57-10.06), trombocitopenia (OR 3.84; CI 95% 1.47-10.01), presión de distensión (OR 1.20; IC 95% 1.07-1.34) y el uso de diálisis (OR 4.94; IC 95% 2.56-9.51). La presencia de hipertensión (OR 0.35; IC 95% 0.17-0.71) y de fiebre (OR 0.51; IC 95% 0.27-0.98) al momento de la hospitalización demostraron tener un efecto protector. Conclusiones: Se encontró asociación entre la edad avanzada, el sexo masculino, la inmunosupresión, la trombocitopenia, una presión de distensión elevada, el uso de diálisis, la ausencia de fiebre o de hipertensión y un mayor riesgo de mortalidad en pacientes con COVID-19 ventilados mecánicamente.

2.
Med. clín. soc ; 8(2)ago. 2024.
Article in Spanish | LILACS-Express | LILACS | ID: biblio-1575213

ABSTRACT

Introducción: La Vigilancia Centinela de las Infecciones Respiratorias Agudas Graves (IRAG) incluye el monitoreo y caracterización de casos hospitalizados. Objetivo: Describir las características clínico-epidemiológicas y agentes etiológicos de los adultos con IRAG en un hospital centinela en Paraguay. Metodología: Estudio observacional, descriptivo, de corte transversal, con recolección de datos retrospectivos de los pacientes adultos con IRAG hospitalizados en el Hospital Nacional de Itauguá entre junio de 2022 a agosto de 2023. La información se tomó de la base de datos del Sistema Nacional de Vigilancia Epidemiológica. Resultados: Se analizaron los datos de 1598 pacientes con IRAG, 820 varones (51,3%), 875 (54,8%) con 60 o más años, 1054 (66,0%) del departamento Central. El 79.2% (n=1265) de los pacientes presentaba algún factor de riesgo de gravedad o comorbilidad, 764 (47,8%) con hipertensión arterial. El 38.5% (n=632) fue admitido a UCI y la mortalidad fue de 34,7% (n=554). En el 13,8% (n=353) se confirmó SARSCoV-2, rhinovirus (1,7%), influenza A (1,5%), influenza B (0,6%), parainfluenza 3 (0,6%), VSR (0,2%), bocavirus (0,4%) e influenza AH1N1 (0,6%). Hubo significativamente mayor frecuencia de fallecidos en los de 60 años y más (40,7%), con algún factor de riesgo de gravedad (35,5% vs 25,9%) y en los confirmados con COVID-19 (38,2% vs 30,5%). Discusión: SARSCoV-2 sigue siendo el agente etiológico principal de las IRAG. El conocimiento de la epidemiología y los agentes virales es crucial para desarrollar estrategias de prevención y terapéuticas efectivas.


Introduction: Sentinel Surveillance of Severe Acute Respiratory Infections (SARI) includes the monitoring and characterization of hospitalized cases. Objective: To describe the clinical-epidemiological characteristics and etiological agents of adults with SARI in a sentinel hospital in Paraguay. Methodology: Observational, descriptive, cross-sectional study, with retrospective data collection, of adult patients with SARI hospitalized at the National Hospital of Itauguá between June 2022 and August 2023. The information was taken from the database of the National System of Epidemiological surveillance. Results: The data of 1598 patients with SARI were analyzed, 820 men (51.3%), 875 (54.8%) aged 60 or older, 1054 (66.0%) from the Central department. 79.2% (n=1265) of patients had some risk factor or comorbidity, 764 with hypertension (47.8%). 38.5% (n=632) were admitted to the ICU and mortality was 34.7% (n=554). SARSCoV-2 was confirmed in 13.8% (n=353), rhinovirus (1.7%), influenza A (1.5%), influenza B (0.6%), parainfluenza 3 (0.6%), RSV (0.2%), bocavirus (0.4%) and Influenza AH1N1 (0.6%). There was a significantly higher frequency of deaths in those aged 60 years and over (40.7%), with some risk factor (35.5% vs 25.9%), and in those confirmed with covid-19 (38.2% % vs 30.5%). Discussion: SARSCoV-2 continues to be the main etiological agent of SARI in a sentinel hospital in Paraguay. Continued knowledge of the epidemiology and viral agents involved is crucial to developing effective prevention and treatment strategies.

3.
Article | IMSEAR | ID: sea-228626

ABSTRACT

A prevertebral abscess is one of the serious infections of the prevertebral space. Prevertebral abscess cases are reported in children and adults. However, it has not been reported in neonates to date, and our team report a case of prevertebral abscess in a 17-day-old baby. A previously healthy term neonate with no antecedent risk factors and an evident source of infection presented with respiratory failure and repeated extubation failures. On evaluation, bronchoscopy revealed antero-posterior collapse of the trachea; further evaluation by computed tomography scan revealed a prevertebral thoracic abscess which was compressing the trachea. Surgical drainage and IV antibiotics led to complete resolution, and the neonate is doing well on follow-up. Prevertebral thoracic abscess is an uncommon cause of airway compression in the neonates. It is important to consider in the differential diagnosis of airway compression.

4.
Article | IMSEAR | ID: sea-234094

ABSTRACT

Melioidosis is a serious infection caused by the bacterium Burkholderia pseudomallei (B. pseudomallei) mostly found in endemic areas like Southeast Asia. Herein, we presented a case of melioidosis in a 32-year-old man who presented with respiratory distress, was a known case of type 2 diabetes not on any treatment presented to the emergency department (ED) with a history of pustules over skin, shortness of breath, and fever. He was initially misdiagnosed and treated as pulmonary tuberculosis in another hospital prior to his latest presentation. Melioidosis is a severe infection that can be misdiagnosed due to variable presentation and low awareness among healthcare workers of the disease. Diagnosis requires high clinical suspicion, especially in patients who are coming from endemic areas with appropriate risk factors such as diabetes mellitus. Treatment with appropriate antibiotics for a long duration, and outpatient follow-up is vital to reduce the risk of recurrence.

5.
Salud UNINORTE ; 40(1): 160-177, ene.-abr. 2024. tab, graf
Article in English | LILACS-Express | LILACS | ID: biblio-1576819

ABSTRACT

ABSTRACT Currently, research emphasizes psychological support for families and health care providers in the critical care unit, rather than patient care in each of the phases associated with the disease. In this article, we use the clinical case of a patient with COVID-19, critically ill, with multiple complications that lead to the discussion and proposal of protocols for comprehensive psychological care to patients, their families, and health care providers in critical care units. It is crucial, in the efforts required to achieve patient's recovery and medical discharge, to integrate the patient into psychological care programs. Many of the sensations and emotions experienced in the ICU could produce physical reactions that hinder the patient's hemodynamic stability and recovery process. Few studies have been found on the usefulness of psychological or psychiatric care for patients with severe or critical COVID-19. Most of the recently reported studies are focused on psychological care for families and health care providers.


RESUMEN Actualmente, las investigaciones hacen énfasis en el apoyo psicológico a las familias y proveedores de salud en la unidad de cuidados críticos, más que la atención al paciente en cada una de las fases asociadas a la enfermedad. En este artículo, utilizamos un caso clínico de un paciente con COVID-19 que se encontraba en estado crítico con múltiples complicaciones para discutir y proponer protocolos de atención psicológica integral a pacientes, sus familias y proveedores de salud en unidades de cuidados intensivos. Se evidenció que, para lograr la recuperación y el alta médica del paciente, es de mucha utilizad la atención psicológica para él, los proveedores de salud y sus familiares. Muchas de las sensaciones y emociones vividas en la UCI pueden producir reacciones físicas que dificulten la estabilidad hemodinámica y el proceso de recuperación del paciente. Se han encontrado pocos estudios sobre la utilidad de la atención psicológica o psiquiátrica a pacientes con COVID-19 grave o crítico. La mayoría de los estudios informados recientemente se centran en la atención psicológica para familias y proveedores de atención médica.

6.
Arq. Asma, Alerg. Imunol ; 7(4): 410-414, abr.jun.2024. ilus
Article in English, Portuguese | LILACS | ID: biblio-1552726

ABSTRACT

Angioedema hereditário (AEH) é uma condição rara, subdiagnosticada e de elevada morbimortalidade, devido ao caráter de suas manifestações clínicas. O AEH se diferencia do angioedema histaminérgico por não responder aos anti-histamínicos, corticosteroides ou epinefrina. Por esse motivo, é extremamente importante o diagnóstico dessa situação, a fim de instituir a terapia adequada. Tal afecção deve ser suspeitada a partir da história clínica de episódios imprevisíveis e recorrentes de edema que quando se manifesta sob a forma de edema laríngeo, pode levar a óbito por asfixia, se não for adequadamente tratado. Relatamos o caso de uma paciente de 18 anos que, apesar de previamente diagnosticada com AEH tipo 1, ao procurar um serviço de emergência devido a crise de angioedema, não dispunha de medicação específica nem apresentou plano de ação com as opções possíveis para crises. Este caso reforça a necessidade de maior divulgação da doença, além da conscientização de pacientes e familiares sobre a doença e eventuais crises, assim como o acesso as medicações.


Hereditary angioedema (HAE) is a rare, underdiagnosed condition with high morbidity and mortality due to the characteristics of its clinical presentation. HAE differs from histaminergic angioedema by not responding to antihistamines, corticosteroids, or epinephrine. Therefore, early diagnose is crucial to initiate adequate therapy. HAE is suspected in patients with a clinical history of unpredictable and recurrent episodes of edema. When laryngeal edema occurs, it can lead to death from asphyxiation if not treated properly. We report the case of an 18-year-old patient previously diagnosed with HAE type 1 who sought emergency care during an angioedema attack. However, the patient was not taking any specific medication and did not have an action plan to manage attacks. This case highlights the importance of increasing awareness about the disease, educating patients and their families about the disease and potential attacks, and ensuring access to medications.


Subject(s)
Humans , Female , Adolescent
7.
Argentinian j. respiratory physical therapy ; 6(1): 31-37, ene. 2024. graf
Article in Spanish | LILACS-Express | LILACS | ID: biblio-1573907

ABSTRACT

RESUMEN Introducción: Existe evidencia sobre los beneficios del tratamiento no invasivo en la insuficiencia respiratoria aguda (IRA) asociada a la atrofia muscular espinal (AME). Sin embargo, hasta la fecha, no hemos encontrado reportes de casos en nuestro país que describan el manejo no invasivo en la IRA causada por atelectasias masivas en pacientes con AME. El objetivo de este estudio fue describir el abordaje respiratorio no invasivo en un niño con AME tipo II que ingresó con IRA y atelectasia masiva, a un hospital público pediátrico. Presentación del caso: Un niño de 10 años con diagnóstico de AME II ingresó con dificultad respiratoria en el contexto de una atelectasia masiva izquierda. Se implementaron medidas no invasivas, que incluyeron el posicionamiento adecuado, la intensificación de la terapia de higiene bronquial, el aumento del tiempo de ventilación no invasiva y la optimización del equipo de soporte ventilatorio y de la interfaz. Luego de cinco días de tratamiento, se observó una resolución significativa de la atelectasia. Al octavo día, se le otorgó el egreso hospitalario. Conclusión: Se describió el abordaje respiratorio no invasivo en un niño con AME tipo II, el cual resultó favorable para la IRA y la resolución de una atelectasia masiva. Los cuidados respiratorios no invasivos son fundamentales para mejorar la sobrevida y calidad de vida de estos pacientes.


ABSTRACT Introduction: There is evidence supporting the benefits of non-invasive treatment for acute respiratory failure (ARF) associated with spinal muscular atrophy (SMA). However, to date, no case reports describing the non-invasive management of ARF due to massive atelectasis in patients with SMA are available in our country. The aim of this study was to describe the non-invasive respiratory approach in a child with SMA type II who was admitted with ARF and massive atelectasis to a public pediatric hospital. Case presentation: A 10-year-old child diagnosed with SMA type II was admitted with respiratory failure due to massive atelectasis of the left lung. Non-invasive measures, including proper positioning, enhanced use of airway clearance techniques, prolonged non-invasive ventilation, and optimization of ventilatory support equipment and interface, were implemented. After five days of treatment, a significant improvement in atelectasis was observed. On the eighth day, the patient was discharged. Conclusion: We described the non-invasive respiratory approach in a child with SMA type II, which proved to be beneficial in addressing ARF and massive atelectasis. Non-invasive respiratory care is essential for improving both the survival and quality of life of these patients.

8.
Organ Transplantation ; (6): 112-117, 2024.
Article in Chinese | WPRIM | ID: wpr-1005240

ABSTRACT

Objective To summarize the effect of the timing of lung transplantation and related treatment measures on clinical prognosis of patients with paraquat poisoning. Methods Clinical data of a patient with paraquat poisoning undergoing bilateral lung transplantation were retrospectively analyzed. Clinical manifestations, auxiliary examination, diagnosis and treatment of this patient were summarized and analyzed. Results A 17-year-old adolescent was admitted to hospital due to nausea, vomiting, cough and systemic fatigue after oral intake of 20-30 mL of 25% paraquat. After symptomatic support treatment, the oxygen saturation was not improved, and pulmonary fibrosis continued to progress. Therefore, sequential bilateral lung transplantation was performed under extracorporeal membrane oxygenation (ECMO). After postoperative rehabilitation and active prevention and treatment for postoperative complications, the patient was discharged at postoperative 50 d. Conclusions The timing of lung transplantation after paraquat poisoning may be selected when the liver and kidney function start to recover. Active and targeted prevention of potential pathogen infection in perioperative period and early rehabilitation training contribute to improving clinical prognosis of lung transplant recipients.

9.
Organ Transplantation ; (6): 449-455, 2024.
Article in Chinese | WPRIM | ID: wpr-1016911

ABSTRACT

<b>Objective</b> To evaluate clinical efficacy of lung transplantation for lung chronic graft-versus-host disease (cGVHD) after hematopoietic stem cell transplantation (HSCT). <b>Methods</b> Clinical data of 12 patients undergoing lung transplantation for lung cGVHD were retrospectively analyzed. Preoperative clinical manifestations and involved organs of patients were analyzed. The lung function before and after lung transplantation was compared, and the survival of patients after lung transplantation was analyzed. <b>Results</b> Eleven patients underwent HSCT due to primary hematological malignancies, including 9 cases of leukemia, 1 case of myelodysplastic syndrome, 1 case of lymphoma. And 1 case underwent HSCT for systemic lupus erythematosus. Among 12 cGVHD patients, skin involvement was found in 8 cases, oral cavity involvement in 5 cases, gastrointestinal tract involvement in 4 cases and liver involvement in 3 cases. All 12 patients developed severe respiratory failure caused by cGVHD before lung transplantation, including 9 cases of typeⅡ respiratory failure and 3 cases of type Ⅰ respiratory failure. Two patients underwent right lung transplantation, 2 cases of left lung transplantation and 8 cases of bilateral lung transplantation. The interval from HSCT to lung transplantation was 75 (19-187) months. Upon the date of submission, postoperative follow-up time was 18 (7-74) months. Ten patients survived, 1 died from severe hepatitis at postoperative 22 months, and 1 died from gastrointestinal bleeding at postoperative 6 months. No recurrence of primary diseases was reported in surviving patients. <b>Conclusions</b> Lung transplantation is an efficacious treatment for lung cGVHD after HSCT, which may prolong the survival time and improve the quality of life of the recipients.

10.
Article in Chinese | WPRIM | ID: wpr-1018725

ABSTRACT

According to the extracorporeal life support(ECLS)registry report,the use of extracorporeal membrane oxygenation(ECMO)in neonates with severe respiratory failure reached its peak in 1992.With the emergence of new respiratory support methods such as nitric oxide,pulmonary surfactant,and high-frequency ventilation,the number of neonates with ECMO for respiratory support decreased gradually,maintaining at about 1000 cases per year.However,it also means that the neonates who need ECMO support will be in a more severe condition,which requires higher requirements for clinicians.In order to further standardize the technique of neonatal extracorporeal life support,the Extracorporeal Life Support Organization(ELSO)published the guidelines for neonatal respiratory failure in 2020.The guidelines provide suggestions on the technology,patient management and complications during ECMO.This article mainly interprets the patient selection,support mode,technical considerations,management and complications during ECMO.

11.
JOURNAL OF RARE DISEASES ; (4): 232-236, 2024.
Article in Chinese | WPRIM | ID: wpr-1032045

ABSTRACT

Myotonic dystrophy type 1 (DM1) is a multisystem trinucleotide repeat expansion disorder usually referred to the department of neurology with complaints of progressive muscle weakness and myotonia. This article reported a 33-year-old female patient with DM1 presenting with acute respiratory failure.Muscle biopsy in vastus lateralis showed significantly increased internal nuclei. Genetic test show CTG repeat expansions with the size of (847±76) in dystrophia myotonica protein kinase (DMPK) gene on chromosome 19. This case report broadens the clinician′s understanding of the atypical clinical manifestations of DM1, so as to avoid missed diagnosis and misdiagnosis.

12.
China Modern Doctor ; (36): 60-63, 2024.
Article in Chinese | WPRIM | ID: wpr-1038161

ABSTRACT

Objective To investigate the clinical efficacy of tiotropium bromide in the treatment of patients with acute exacerbation of chronic obstructive pulmonary disease(AECOPD)complicated with acute respiratory failure.Methods A total of 106 patients with AECOPD complicated with acute respiratory failure admitted to the First People's Hospital of Huzhou from March 2019 to March 2022 were selected and divided into observation group and control group according to random number table method,with 53 cases in each group.Both groups were given routine treatment.The control group was treated with noninvasive biphasic positive airway pressure ventilation.The observation group was treated with tiotropium bromide on the basis of control group.Both groups were treated for 14 days.The clinical efficacy,lung function,blood gas index,inflammatory factors and adverse reactions were compared between two groups.Results The total effective rate of observation group was significantly higher than that of control group(94.34%vs.79.25%,χ2=5.267,P=0.023).After treatment,forced expiratory volume in one second(FEV1),FEV1/forced vital capacity,peak expiratory flow,pH,percutaneous arterial oxygen saturation and arterial partial pressure of oxygen in observation group were significantly higher than those in control group(P<0.05),while arterial partial pressure of carbon dioxide,interleukin-6,interleukin-8,tumor necrosis factor-α and hypersensitive C-reaction protein were lower than those in control group(P<0.05).There were no significant differences in the incidence of adverse drug reactions and ventilator adverse reactions between two groups(P>0.05).Conclusion Titropium bromide in the treatment of AECOPD complicated with acute respiratory failure can significantly improve the curative effect,improve pulmonary function and arterial blood gas,but attention should be paid to the timely treatment of adverse reactions of dry mouth.

13.
PAMJ clin. med ; 14(10): 1-15, 2024. figures, tables
Article in English | AIM | ID: biblio-1531796

ABSTRACT

Introduction: during the global COVID-19 pandemic, non-invasive ventilation has become a widely utilized method for treating patients experiencing acute respiratory failure. Noninvasive pressure ventilation is frequently employed as a standard approach for managing acute respiratory failure resulting from COVID-19 pneumonia, as opposed to invasive ventilation methods. However, there is a lack of research on its effectiveness. Therefore, this study aimed to determine the risk of mortality among COVID-19 patients receiving non-invasive ventilation. Methods: a multi-centric retrospective cross sectional study was conducted on the records of 402 patients at the Eka Kotebe COVID-19 Center, St. Peter COVID-19 Care Center, and Millennium COVID-19 Treatment Center. The systematic random selection technique was employed in order to select the study unit, and data was extracted from patient charts using a pretested method and validated before being entered into Epi-data Manager 4.6 versions. Descriptive, bivariate, and multivariable analyses were performed using binary logistic regression in SPSS 25. In the multivariate logistic regression, a predictor variable was considered to have a significant connection if its p-value was less than 0.05 at a 95% confidence level. Results: four hundred and two patient records were reviewed during the study period and showed the mean patient´s age was 62.6 years, with male predominance. It revealed that 11.7% [CI: 8.7-15.2] of COVID-19 patients who received non-invasive positive pressure ventilation died, as being critical for COVID-19 patients was a main cause of noninvasive initiation. Patients over the age of 60 were more likely to die among those who received noninvasive ventilation for COVID-19 [AOR = 5.4 95% CI 1.32, 23.1]. Conversely, patients without diabetes were less likely to die [AOR = 0.23 95% CI 0.11, 0.48]. Moreover, patients with a tidal volume greater than 500 ml were more likely to pass away [AOR =2.2 95% CI 1.11,4.43], as were those who were on non-invasive ventilation (NIV) for more than 8 days [AOR = 0.24 95% CI.08, 0.81]. Conclusion: the significance of patients who were given non-invasive ventilators ended up dying. Age, diabetes, and high tidal volumes are linked to a higher risk of death. Non-invasive ventilation for over eight days showed a protective effect. Removing factors that caused NIV and ventilated COVID-19 patients' deaths may reduce mortality.


Subject(s)
Humans , Male , Female , COVID-19 , SARS-CoV-2
14.
São Paulo med. j ; São Paulo med. j;142(1): e2022470, 2024. tab, graf
Article in English | LILACS-Express | LILACS | ID: biblio-1450506

ABSTRACT

ABSTRACT BACKGROUND: Respiratory failure is the most common cause of death in patients with amyotrophic lateral sclerosis (ALS), and morbidity is related to poor quality of life (QOL). Non-invasive ventilation (NIV) may be associated with prolonged survival and QOL in patients with ALS. OBJECTIVES: To assess whether NIV is effective and safe for patients with ALS in terms of survival and QOL, alerting the health system. DESIGN AND SETTING: Systematic review was conducted in accordance with Preferred Reporting Items for Systematic Reviews and Meta-Analyses reporting standards using population, intervention, comparison, and outcome strategies. METHODS: The Cochrane Library, CENTRAL, MEDLINE, LILACS, EMBASE, and CRD databases were searched based on the eligibility criteria for all types of studies on NIV use in patients with ALS published up to January 2022. Data were extracted from the included studies, and the findings were presented using a narrative synthesis. RESULTS: Of the 120 papers identified, only 14 were related to systematic reviews. After thorough reading, only one meta-analysis was considered eligible. In the second stage, 248 studies were included; however, only one systematic review was included. The results demonstrated that NIV provided relief from the symptoms of chronic hypoventilation, increased survival, and improved QOL compared to standard care. These results varied according to clinical phenotype. CONCLUSIONS: NIV in patients with ALS improves the outcome and can delay the indication for tracheostomy, reducing expenditure on hospitalization and occupancy of intensive care unit beds. SYSTEMATIC REVIEW REGISTRATION: PROSPERO database: CRD42021279910 — https://www.crd.york.ac.uk/prospero/display_record.php?RecordID=279910.

15.
Article | IMSEAR | ID: sea-228542

ABSTRACT

Background: Mechanical ventilation constitutes a major therapeutic modality in intensive care, so care of patients requiring ventilatory support is an integral part of the critical care unit. Very less data is available from developing countries regarding use of Mechanical Ventilation, its complication and outcomes which is a challenge for modern day intensivists. Objectives were to study clinical profile of ventilated children in a PICU of tertiary care centre. Methods: Present prospective cross-sectional study was conducted on ventilated children admitted at PICU of Dr. VMGMC hospital, Solapur. The study included demographics, clinical profile, indication for ventilation, length of hospital stays, outcome.Results: Out of 300 children, 170 were males. Most the children were from age group <5 years. Difficulty in breathing was seen in 188 cases, fever in 55%, 100 patients had acute CNS infections, 82 cases had bronchopneumonia, 85 cases respiratory failure was the indication for intubation. The duration of the mechanical ventilation was more in CNS cases, RS cases, sepsis cases. 165 cases got recovered successfully.Conclusions: Mechanical ventilation is one of the major supportive modalities used in critical care all over the world and is also used in many of the sick children in government tertiary care centre. Despite of its life saving advantages, mechanical ventilation is associated with complication. Early use of HHFNC, CPAP/BiPAP and other non-invasive modes of ventilation decrease the need for invasive mechanical ventilation.

16.
Rev. otorrinolaringol. cir. cabeza cuello ; 83(2): 134-140, jun. 2023. ilus, tab
Article in Spanish | LILACS | ID: biblio-1515471

ABSTRACT

Introducción: La parálisis cordal bilateral en aducción es la segunda causa de estridor congénito y genera una grave obstrucción de la vía aérea, debutando con estridor. La traqueotomía ha sido durante mucho tiempo el gold estándar para el tratamiento de esta afección, no exenta de complicaciones. Existen procedimientos que intentan evitar la traqueotomía, como el split cricoideo anterior posterior endoscópico (SCAPE). Objetivo: Presentar experiencia con SCAPE en pacientes pediátricos como tratamiento alternativo de parálisis cordal bilateral en aducción. Material y Método: Análisis retrospectivo de los resultados quirúrgicos obtenidos en pacientes con parálisis cordal bilateral en aducción tratados con SCAPE entre enero de 2016 y diciembre de 2019 en el Hospital Guillermo Grant Benavente de Concepción, Chile. Resultados: Siete pacientes se sometieron a SCAPE. Todos los pacientes presentaban insuficiencia respiratoria severa, cinco requirieron asistencia ventilatoria mecánica. Seis pacientes tenían el diagnóstico de parálisis cordal bilateral (PCB) congénita y uno PCB secundaria a tumor de tronco cerebral. Cuatro pacientes presentaron comorbilidad de la vía aérea: dos pacientes presentaron estenosis subglótica grado I y dos pacientes presentaron laringomalacia que requirió manejo quirúrgico. Los días promedio de intubación fueron once días. Ningún paciente requirió soporte ventilatorio postoperatorio, sólo un paciente recibió oxigenoterapia nocturna debido a hipoventilación secundaria a lesión de tronco. Ningún paciente ha presentado descompensación respiratoria grave. Un 40% ha recuperado movilidad cordal bilateral. Conclusión: Split cricoideo anteroposterior endoscópico es una alternativa eficaz para tratar el PCB en pacientes pediátricos. Nuestro estudio evidencia que es una alternativa a la traqueotomía, con excelentes resultados y menor morbimortalidad.


Introduction: Bilateral vocal fold paralysis in adduction is the second cause of congenital stridor and generates a serious obstruction of the airway. Tracheostomy has long been the gold standard for the treatment of this condition, but it has inherent complications. There are procedures that try to avoid tracheotomy, such as the endoscopic anterior posterior cricoid split (EAPCS). Aim: Present our experience with EAPCS in pediatric patients as a treatment for bilateral vocal fold paralysis in adduction. Material and Method: Retrospective analysis of the surgical results obtained in patients with bilateral vocal cord paralysis in adduction treated with EAPCS between January 2016 and December 2019 at Guillermo Grant Benavente Hospital in Concepción, Chile. Results: Seven patients underwent EAPCS. All patients had severe respiratory failure, five required mechanical ventilation assistance. Six patients were diagnosed with congenital bilateral cord palsy (BCP) and one BCP secondary to a brainstem tumor. Four patients had airway comorbidity: two patients had grade I subglottic stenosis and two patients had laryngomalacia that required surgical management. The average days of intubation were eleven days. No patient required post op invasive/non-invasive ventilation, only one patient received nocturnal oxygen therapy due to hypoventilation secondary to trunk injury. None of the patients has presented severe respiratory decompensation. Forty percent have recovered bilateral chordal mobility. Conclusion: SCAPE is a cutting-edge and effective alternative to treat PCB in pediatric patients. Our study shows that it is an alternative to tracheotomy, with excellent results and lower morbidity and mortality.


Subject(s)
Humans , Male , Female , Infant, Newborn , Infant , Vocal Cord Paralysis/surgery , Cricoid Cartilage/surgery , Laryngoscopy/methods , Stents , Vocal Cord Paralysis/diagnostic imaging , Retrospective Studies
17.
São Paulo med. j ; São Paulo med. j;141(2): 168-176, Mar.-Apr. 2023. tab, graf
Article in English | LILACS-Express | LILACS | ID: biblio-1424661

ABSTRACT

ABSTRACT BACKGROUND: Tocilizumab is an anti-human interleukin 6 receptor monoclonal antibody that has been used to treat coronavirus disease 2019 (COVID-19). However, there is no consensus on its efficacy for the treatment of COVID-19. OBJECTIVE: To evaluate the effectiveness and safety of tocilizumab for treating COVID-19. DESIGN AND SETTING: Systematic Review of randomized controlled trials (RCTs), Universidade Federal de São Paulo (UNIFESP), São Paulo (SP), Brazil. METHODS: We searched MEDLINE via PubMed, EMBASE, CENTRAL, and IBECS for RCTs published up to March 2021. Two authors selected studies and assessed the risk of bias and the certainty of the evidence following Cochrane Recommendations. RESULTS: Eight RCTs with 6,139 participants were included. We were not able to find differences between using tocilizumab compared to standard care on mortality in hospitalized patients with COVID-19 (risk ratio (RR) 0.97, 95% confidence interval (CI) 0.84 to 1.13; 8 trials; 5,950 participants; low-certainty evidence). However, hospitalized patients under tocilizumab plus standard care treatment seemed to present a significantly lower risk of needing mechanical ventilation (risk ratio = 0.78; 95% CI 0.64−0.94 moderate-certainty of evidence). CONCLUSIONS: To date, the best evidence available shows no difference between using tocilizumab plus standard care compared to standard care alone for reducing mortality in patients with COVID-19. However, as a finding with a practical implication, the use of tocilizumab in association to standard care probably reduces the risk of progressing to mechanical ventilation in those patients. REGISTRATION: osf.io/qe4fs.

18.
J. pediatr. (Rio J.) ; J. pediatr. (Rio J.);99(1): 65-71, Jan.-Feb. 2023. tab, graf
Article in English | LILACS-Express | LILACS | ID: biblio-1422017

ABSTRACT

Abstract Objective: To investigate the clinical implications of Golgi glycoprotein 73 (GP73) and granulocyte colony-stimulating factor (G-CSF) in children with bronchopneumonia (BP). Methods: Seventy-two children with BP (observation group) and 81 healthy children (control group) consecutively brought to the present study's hospital between June 2019 and October 2020 were enrolled. GP73 and G-CSF levels were determined to analyze their diagnostic value for pediatric BP. High-sensitivity C-reactive protein (hs-CRP) was also measured. The clinical implications of GP73 and G-CSF in pediatric BP complicated with respiratory failure and their connections with the inflammatory response were discussed. Results: GP73 and G-CSF levels were remarkably higher in the observation group (p< 0.05). The sensitivity and specificity of combined detection (GP73+G-CSF) in predicting pediatric BP were 72.22% and 86.42%, respectively (p < 0.001 ). GP73 and G-CSF, which are closely related to X-ray classification and complications in the observation group, decreased after treatment and were positively correlated with hs-CRP (p < 0.05), especially in children complicated with respiratory failure. Regression analysis identified the independence of the course of the disease, hs-CRP, X-ray classification, GP73, and G-CSF as influencing factors of respiratory failure in children with BP (p < 0.05). Conclusion: GP73 and G-CSF, with elevated levels in children with BP, are strongly linked to disease progression and are independent influencing factors of respiratory failure, which may be the key to diagnosing and treating pediatric BP in the future.

19.
Zhongguo dangdai erke zazhi ; Zhongguo dangdai erke zazhi;(12): 431-435, 2023.
Article in Chinese | WPRIM | ID: wpr-981975

ABSTRACT

The male neonate in this case study was admitted to the hospital at 15 hours of age due to respiratory distress for 15 hours and poor response for 3 hours after resuscitation from asphyxia. The neonate was highly unresponsive, with central respiratory failure and seizures. Serum ammonia was elevated (>1 000 μmol/L). Blood tandem mass spectrometry revealed a significant decrease in citrulline. Rapid familial whole genome sequencing revealed OTC gene mutations inherited from the mother. Continuous hemodialysis filtration and other treatments were given. Neurological assessment was performed by cranial magnetic resonance imaging and electroencephalogram. The neonate was diagnosed with ornithine transcarbamylase deficiency combined with brain injury. He died at 6 days of age after withdrawing care. This article focuses on the differential diagnosis of neonatal hyperammonemia and introduces the multidisciplinary management of inborn error of metabolism.


Subject(s)
Humans , Infant, Newborn , Male , Citrulline , Electroencephalography , Hyperammonemia , Ornithine Carbamoyltransferase Deficiency Disease/therapy , Seizures
20.
Article in Chinese | WPRIM | ID: wpr-1018894

ABSTRACT

Objective:To construct a predict model based on ultrasomics parameters that can identify moderate acute hypoxemic respiratory failure patients at risk of non-invasive respiratory strategies(NIRS) failure and evaluate its value.Methods:This is a prospective observational trial.The patients with moderate acute respiratory failure (100 mmHg≤PaO 2/FiO 2≤200 mmHg) in intensive care unit(ICU) ,emergency and respiratory ward of Changshu Hospital Affiliated to Soochow University from Oct 2020 to Jan 2023 were included, NIRS failure is defined as death or intubation while on therapy.At admission time and 24 h after treatment vital signs,biological and ultrasound parameters were determined.The study subjects were randomly ( random number) divided into a development group (70%) and a validation group (30%).Univariate and multivariate logistic regression was performed.The treatment failure prediction models were constructed according to ultrasonic parameters combined with clinical parameters.The models were also validated by ROC curves, calibration curves, NRI index and decision curve analysis (DCA).The nomograms were drawn. Results:A total of 193 patients were included in the study, 137 were allocated to the development group, and 56 to the validation group, there was no statistically significant difference between the two groups. NIRS failed in 112 (58%) of 193 patients..Univariate analysis revealed that PaO 2/FiO 2, DE at the time of admission and 24 h in the failure group were found to be statistically lower than the success group, RV/LV was higher (all P<0.05). RR, LUS at 24 h in the failure group were higher and ROX index was lower (all P<0.01). In addition, more patients in the failure group received vasopressors ( P= 0.001). Use of vasopressors( OR=4.709, P=0.012), RR( OR=1.254, P=0.035), LUS( OR=1.250, P=0.037), RV/LV( OR=1.057, P=0.008), PaO 2/FiO 2 ( OR=0.950, P=0.001), DE ( OR=0.107, P=0.001) in the development group were independent risk factors for NIRS failure.ROC analysis revealed that model B achieved a larger area under curve (AUC) than model A in the development group, with their AUC values of 0.928 and 0.872 ( P=0.009), AUC of model A and model B in the validation group were 0.867 and 0.932 respectively ( P=0.07).Two prediction models showed a good degree of calibration (all P>0.05). NRI analysis showed significant improvement in the predictive power of model B ( P<0.01). DCA showed that the model B had a good net benefit between the threshold probabilities of 0-80%. Conclusions:Ultrasomics parameters combined with Clinical parameters can effectively predict NIRS failure in moderate acute hypoxemic respiratory failure patients.

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