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1.
Arq. ciências saúde UNIPAR ; 26(2): 127-133, maio-ago. 2022.
Article in Portuguese, French | LILACS | ID: biblio-1372962

ABSTRACT

Objetivo: caracterizar a prática clínica e identificar as barreiras relacionadas à mobilização precoce em uma Unidade de Terapia Intensiva. Método: estudo observacional analítico e prospectivo que incluiu pacientes em ventilação mecânica por mais de 24 horas. Foram coletados diariamente dados clínicos, critérios de segurança, barreiras e atividades realizadas nos atendimentos de fisioterapia. Posteriormente a amostra foi dividida de acordo com a realização de sedestação à beira do leito. Utilizou-se teste T para comparação entre grupos e para associação teste Qui-quadrado ou Exato de Fischer quando necessário. Resultados: participaram 54 indivíduos com média de idade 51,33±14,85 anos e SAPSIII médio de 63,47±13,37 pontos. A mobilização foi realizada em 1356 sessões, em sua maioria atividades passivas. Nenhuma atividade fora do leito foi realizada com pacientes em ventilação mecânica. As principais barreiras foram sedação, nível de consciência e procedimentos médicos. A não sedestação à beira do leito foi associada à ausência de critérios de segurança, que impediram a mobilização, e ocorrência de óbito. Conclusão: A mobilização foi realizada na maioria das sessões, porém poucas atividades foram realizadas fora do leito. Durante o período de ventilação mecânica nenhuma atividade foi realizada fora do leito. As barreiras mais citadas foram sedação, nível de consciência e procedimentos médicos.


Purpose: characterize the clinical practice and identify barriers related to early mobilization in an Intensive Care Unit. Method: analytical and prospective observational study that included patients on mechanical ventilation for more than 24 hours. Clinical data, safety criteria, barriers and activities performed in physical therapy consultations were collected on a daily basis. Subsequently, the sample was divided according to the performance of the patient sitting at the bedside. The T-test was used for comparison between groups and the Chi-square test or Fisher's exact test were used when necessary. Results: a total of 54 individuals participated, with a mean age of 51.33±14.85 years and mean SAPSIII of 63.47±13.37 points. Mobilization was performed in 1356 sessions, mostly passive activities. No out-of-bed activities were performed with patients on mechanical ventilation. The main barriers were sedation, level of consciousness, and medical procedures. Failure to sit at the bedside was associated with the absence of safety criteria, which prevented mobilization, and the occurrence of death. Conclusion: Mobilization was performed in most sessions, but few activities were performed outside the bed. During the period of mechanical ventilation, no activity was performed outside the bed. The barriers most frequently mentioned were sedation, level of consciousness, and medical procedures.


Subject(s)
Humans , Male , Female , Middle Aged , Health Knowledge, Attitudes, Practice , Early Ambulation , Intensive Care Units , Respiration, Artificial , Physical Therapy Modalities , Consciousness , Death , Mobility Limitation , Deep Sedation , Physical Therapists , Methods
2.
Säo Paulo med. j ; 140(3): 463-473, May-June 2022. tab, graf
Article in English | LILACS | ID: biblio-1377389

ABSTRACT

ABSTRACT BACKGROUND: For critically ill patients, physicians tend to administer sufficient or even excessive oxygen to maintain oxygen saturation at a high level. However, the credibility of the evidence for this practice is unclear. OBJECTIVE: To determine the effects of different oxygen therapy strategies on the outcomes of mechanically ventilated intensive care unit (ICU) patients. DESIGN AND SETTING: Systematic review of the literature and meta-analysis conducted at Jiangxi Provincial People's Hospital, Affiliated to Nanchang University, Nanchang, China. METHODS: We systematically searched electronic databases such as PubMed and Embase for relevant articles and performed meta-analyses on the effects of different oxygen therapy strategies on the outcomes of mechanically ventilated ICU patients. RESULTS: A total of 1802 patients from five studies were included. There were equal numbers of patients in the conservative and liberal groups (n = 910 in each group). There was no significant difference between the conservative and liberal groups with regard to 28-day mortality (risk ratio, RR = 0.88; 95% confidence interval, CI = 0.59-1.32; P = 0.55; I2 = 63%). Ninety-day mortality, infection rates, ICU length of stay, mechanical ventilation-free days up to day 28 and vasopressor-free days up to day 28 were comparable between the two strategies. CONCLUSIONS: It is not necessary to use liberal oxygen therapy strategies to pursue a higher level of peripheral oxygen saturation for mechanically ventilated ICU patients. Conservative oxygen therapy was not associated with any statistically significant reduction in mortality.


Subject(s)
Humans , Oxygen , Respiration, Artificial , Oxygen Inhalation Therapy , Prognosis , Critical Illness/therapy , Intensive Care Units , Length of Stay
3.
Rev. Ciênc. Méd. Biol. (Impr.) ; 21(1): 25-30, maio 05,2022. tab
Article in Portuguese | LILACS | ID: biblio-1370544

ABSTRACT

Objetivo: determinar a incidência, os fatores associados e o impacto das complicações pulmonares no pós-operatório de cirurgia cardíaca pediátrica. Metodologia: estudo de coorte, prospectivo, que incluiu lactentes e crianças submetidas à cirurgia cardíaca em um hospital pediátrico, no período de novembro de 2016 a julho de 2019. Foram coletados dados dos prontuários referentes ao sexo, idade, presença de outras malformações associadas, tipo de cardiopatia, ocorrência de complicações pulmonares, tempo de ventilação mecânica (VM) e de internamento na unidade de terapia intensiva (UTI) e óbito. Resultados: a amostra foi constituída por 111 lactentes e crianças, mediana da idade de 13 meses (7-32 meses), 54,1% do sexo feminino. Quanto ao tipo de cardiopatia, 80,2% foram cianogênicas. As complicações pulmonares ocorreram em 44,1% dos casos, sendo a mais frequente a atelectasia. A mediana do tempo de VM foi 8 horas (1-48h) e 45 (40,5%) permaneceram na VM por mais de 24h. A mediana do tempo de internamento na UTI foi de 7 dias (4-12dias). Evoluíram a óbito 7 (14,3%) pacientes. Conclusão: a amostra investigada apresentou incidência elevada de complicações pulmonares no pós-operatório de cirurgia cardíaca


Objective: to determine the incidence, associated factors and impact of pulmonary complications in the postoperative period of pediatric cardiac surgery. Methodology: prospective cohort study, which included infants and children undergoing cardiac surgery in a pediatric hospital, from November 2016 to July 2019. Data were collected from medical records regarding sex, age, presence of other associated malformations, type of heart disease, occurrence of pulmonary complications, duration of mechanical ventilation (MV) and admission to the intensive care unit (ICU) stay and death. Results: the sample consisted of 111 infants and children, median age 13 months (7-32 months), 54.1% female. As for the type of heart disease, 80.2% were acyanotic. Pulmonary complications occurred in 44.1% of cases, with atelectasis being the most frequent. The median time on mechanical ventilation (MV) was 8 hours (1-48h) and 45 (40.5%) remained on MV for more than 24h. The median length of stay in the ICU was 7 days (4-12 days). 7 (14.3%) patients died. Conclusion: the investigated sample had a high incidence of pulmonary complications in the postoperative period of cardiac surgery


Subject(s)
Humans , Male , Female , Infant , Child, Preschool , Thoracic Surgery , Intensive Care Units, Pediatric , Heart Defects, Congenital , Hospitals, Pediatric , Respiration, Artificial , Prospective Studies , Heart Diseases
4.
MedUNAB ; 25(1): 9-30, 202205.
Article in Spanish | LILACS | ID: biblio-1372572

ABSTRACT

Introducción. La COVID-19 ha sido una de las enfermedades que ha generado mayor carga de enfermedad en el siglo XXI. A la fecha, se estiman más de 280 millones de casos a nivel global. Aún se desconocen muchos aspectos de esta condición, lo que ocasiona controversias sobre el abordaje de pacientes críticamente enfermos. La traqueostomía es una intervención que ha demostrado ser beneficiosa en el manejo de enfermedades respiratorias, sin embargo, existe un vacío en la evidencia sobre la efectividad y seguridad de esta intervención en pacientes críticamente enfermos de COVID-19. Por lo anterior, el objetivo de este estudio consistió en relacionar el tiempo transcurrido desde el inicio del cuadro clínico, durante la intubación y los días de ventilación mecánica, hasta la realización de la traqueostomía, con la supervivencia de pacientes con síntomas sugestivos de COVID-19. Metodología. Estudio retrospectivo de corte transversal, realizado entre marzo del año 2020 y febrero del año 2021 en dos centros hospitalarios de cuarto nivel de la ciudad de Cartagena, Colombia. Incluyó pacientes mayores de 18 años que ingresaron a la unidad de cuidados intensivos por requerimiento de ventilación mecánica invasiva por sintomatología respiratoria viral. Se excluyeron aquellos con historias clínicas incompletas e internados por otras causas respiratorias. Resultados. Un total de 122 pacientes fueron incluidos en el estudio con una mediana de edad de 63 años (RIQ 22; 20-89), siendo el 66.4% (n=81) hombres. No se encontró una correlación significativa entre el número de días desde el inicio del cuadro clínico hasta realización de la traqueostomía (p=0.12), ni entre el tiempo transcurrido desde la intubación endotraqueal hasta la realización de la traqueostomía, con respecto a la supervivencia (p=0.53). Pero sí entre el número de días de ventilación mecánica invasiva y el desenlace final (p=0.02). Discusión. Aunque se ha reportado que la traqueostomía es uno de los procedimientos que acarrea mayores riesgos en el manejo del paciente con sintomatología respiratoria severa, durante la pandemia por COVID-19 la literatura describe que esta intervención aumenta la supervivencia, disminuye el tiempo de requerimiento de ventilación mecánica y reduce la estancia en unidad de cuidados intensivos. El número de complicaciones es muy bajo en comparación al beneficio que otorga y se observó que el comportamiento local es muy similar al reportado en la literatura. Conclusiones. El tiempo desde el inicio de los síntomas o de la intubación endotraqueal hasta la realización de traqueostomía no se correlaciona con la supervivencia de pacientes con sintomatología respiratoria sugestiva de COVID-19 que se encuentran bajo ventilación mecánica y traqueostomizados.


Introduction. COVID-19 has generated one of the highest disease burdens in the 21st century. To date, there are more than 280 million estimated cases globally. Many aspects of this condition are still unknown, which causes controversy in how to approach critically ill patients. Tracheostomy is an intervention that has been shown to be beneficial in the management of respiratory disease, however, there is an evidence gap on the effectiveness and safety of this intervention in critically ill COVID-19 patients. Consequently, the aim of this study was to relate the time elapsed from the onset of the clinical condition, during intubation and days of mechanical ventilation, to performing the tracheostomy, with the survival of patients with symptoms suggestive of COVID-19. Methodology. Retrospective cross-sectional study, conducted between March 2020 and February 2021 in two fourth-level hospitals in the city of Cartagena, Colombia. It included patients older than 18 years who were admitted to the intensive care unit due to the need for invasive mechanical ventilation for viral respiratory symptoms. Those with incomplete medical records and hospitalized for other respiratory causes were excluded. Results. A total of 122 patients were included in the study with a median age of 63 years (IQR 22; 20-89), with 66.4% (n = 81) being male. No significant correlation was found between the number of days from the onset of the clinical condition to the performance of tracheostomy (p = 0.12), nor between the time elapsed from endotracheal intubation to the performance of tracheostomy, with respect to survival (p = 0.53). However, there was a relationship between the number of days of invasive mechanical ventilation and the final outcome (p = 0.02). Discussion. Although it has been reported that tracheostomy is one of the riskiest procedures in the management of patients with severe respiratory symptoms, during the COVID-19 pandemic the literature describes that this intervention increases survival, decreases the time required for mechanical ventilation and reduces the length of stay in the intensive care unit. The number of complications is very low in comparison to the benefit it confers, and it was observed that the local behavior is very similar to that reported in the literature. Conclusions. Time from symptom onset or endotracheal intubation to the performance of tracheostomy does not correlate with survival in patients with respiratory symptomatology suggestive of COVID-19 who are mechanically ventilated and tracheostomized.


Introdução. A COVID-19 tem sido uma das doenças que gerou a maior carga de doenças no século XXI. Até o momento, mais de 280 milhões de casos são estimados globalmente. Muitos aspectos dessa condição ainda são desconhecidos, o que gera controvérsias sobre a abordagem de pacientes gravemente doentes. A traqueostomia é uma intervenção que tem se mostrado benéfica no manejo de doenças respiratórias, porém, há uma lacuna nas evidências sobre a eficácia e segurança dessa intervenção em pacientes críticos com COVID-19. Portanto, o objetivo deste estudo foi relacionar o tempo decorrido desde o início do quadro clínico, durante a intubação e os dias de ventilação mecânica, até a realização da traqueostomia, com a sobrevivência de pacientes com sintomas sugestivos de COVID-19. Metodologia. Estudo transversal retrospectivo, realizado entre março de 2020 e fevereiro de 2021 em dois hospitais de quarto nível na cidade de Cartagena, Colômbia. Foram incluídos pacientes maiores de 18 anos que foram admitidos na unidade de terapia intensiva por necessidade de ventilação mecânica invasiva devido a sintomas respiratórios virais. Foram excluídos aqueles com historial clínico incompleto e internados por outras causas respiratórias. Resultados. Um total de 122 pacientes foram incluídos no estudo com idade média de 63 anos (IQR 22; 20-89), sendo 66.4% (n=81) homens. Não foi encontrada correlação significativa entre o número de dias desde o início do quadro clínico até a traqueostomia (p=0.12), ou entre o tempo decorrido da intubação endotraqueal até a traqueostomia, com relação à sobrevivência (p=0.53). Mas sim entre o número de dias de ventilação mecânica invasiva e o desfecho final (p=0.02). Discussão. Embora tenha sido relatado que a traqueostomia é um dos procedimentos de maior risco no manejo de pacientes com sintomas respiratórios graves, durante a pandemia de COVID-19 a literatura descreve que essa intervenção aumenta a sobrevivência, diminui o tempo necessário para a ventilação mecânica e reduz a permanência na unidade de terapia intensiva. O número de complicações é muito baixo em relação ao benefício que proporciona e observou-se que o comportamento local é muito semelhante ao relatado na literatura. Conclusões. O tempo desde o início dos sintomas ou intubação endotraqueal até a realização de uma traqueostomia não se correlaciona com a sobrevivência de pacientes com sintomas respiratórios sugestivos de COVID-19 que estão sob ventilação mecânica e traqueostomizados.


Subject(s)
Tracheostomy , Coronavirus Infections , Respiration, Artificial , Respiratory Tract Diseases , Colombia , COVID-19
5.
Medwave ; 22(3): e002550, 29-04-2022.
Article in English, Spanish | LILACS | ID: biblio-1368126

ABSTRACT

Los avances tecnológicos de la ventilación mecánica han sido parte esencial del aumento de la sobrevida en las unidades de cuidados intensivos. Desde la conexión a la ventilación mecánica, comúnmente se utiliza ventilación controlada sin la consecuente participación de los músculos respiratorios del paciente, con el fin de favorecer la protección pulmonar. El retiro de la ventilación mecánica implica un periodo de transición hacia la respiración espontánea, utilizando principalmente ventilación mecánica asistida. En esta transición, el desafío de los clínicos es evitar la sub y sobre asistencia ventilatoria, minimizando el esfuerzo respiratorio excesivo, daño diafragmático y pulmonar inducidos por la ventilación mecánica. La monitorización con balón esofágico permite mediciones objetivas de la actividad muscular respiratoria en tiempo real, pero aún hay limitaciones para su aplicación rutinaria en pacientes ventilados mecánicamente en la unidad de cuidados intensivos. Al igual que el balón esofágico, la electromiografía de los músculos respiratorios y la ecografía diafragmática son herramientas que permiten monitorizar la actividad muscular de la respiración, siendo mínimamente invasivas y con requerimiento de entrenamiento específico. Particularmente, durante la actual pandemia de enfermedad por coronavirus se ha extendido el uso de herramientas no invasivas disponibles en los ventiladores mecánicos para monitorizar el impulso (drive), esfuerzo y trabajo respiratorio, para promover una ventilación mecánica ajustada a las necesidades del paciente. Consecuentemente, el objetivo de esta revisión es identificar las definiciones conceptuales de impulso, esfuerzo y trabajo respiratorio utilizadas en el contexto de la unidad de cuidados intensivos, e identificar las maniobras de medición no invasivas disponibles en los ventiladores de cuidados intensivos para monitorizar impulso, esfuerzo y trabajo respiratorio. La literatura destaca que, aunque los conceptos de impulso, esfuerzo y trabajo respiratorio se perciben intuitivos, no existe una definición clara. Asimismo, destacados autores los definen como conceptos diferentes.


Technological advances in mechanical ventilation have been essential to increasing the survival rate in intensive care units. Usually, patients needing mechanical ventilation use controlled ventilation to override the patient's respiratory muscles and favor lung protection. Weaning from mechanical ventilation implies a transition towards spontaneous breathing, mainly using assisted mechanical ventilation. In this transition, the challenge for clinicians is to avoid under and over assistance and minimize excessive respiratory effort and iatrogenic diaphragmatic and lung damage. Esophageal balloon monitoring allows objective measurements of respiratory muscle activity in real time, but there are still limitations to its routine application in intensive care unit patients using mechanical ventilation. Like the esophageal balloon, respiratory muscle electromyography and diaphragmatic ultrasound are minimally invasive tools requiring specific training that monitor respiratory muscle activity. Particularly during the coronavirus disease pandemic, non invasive tools available on mechanical ventilators to monitor respiratory drive, inspiratory effort, and work of breathing have been extended to individualize mechanical ventilation based on patient's needs. This review aims to identify the conceptual definitions of respiratory drive, inspiratory effort, and work of breathing and to identify non invasive maneuvers available on intensive care ventilators to measure these parameters. The literature highlights that although respiratory drive, inspiratory effort, and work of breathing are intuitive concepts, even distinguished authors disagree on their definitions.


Subject(s)
Humans , Work of Breathing , Pandemics , Respiration, Artificial , Ventilators, Mechanical , Critical Care
6.
Med. infant ; 29(1): 38-43, Marzo 2022. ilus
Article in Spanish | LILACS, BINACIS, UNISALUD | ID: biblio-1367206

ABSTRACT

La Injuria Pulmonar Autoinducida por el Paciente (p-SILI) es una entidad recientemente reconocida. Clásicamente, el daño producido por la ventilación mecánica (VM) se asoció al uso de presión positiva, y para disminuirlo se crearon distintas estrategias conocidas como parámetros de protección pulmonar. Sin embargo, es importante reconocer los potenciales efectos deletéreos de la ventilación espontánea dependientes de la injuria pulmonar previa que sufra el paciente y del esfuerzo que realice. En este artículo se explican los distintos mecanismos que pueden producir p-SILI y las estrategias descritas en la literatura para prevenirla (AU)


Patient self-inflicted lung injury (p-SILI) is a recently recognized disorder. Classically, damage produced by mechanical ventilation (MV) was associated with the use of positive pressure, and different strategies known as lung protection parameters were created to reduce it. Nevertheless, it is important to recognize the potential deleterious effects of the effort made during spontaneous breathing due to previous lung injury suffered by the patient. This article explains the different mechanisms that may produce p-SILI and the prevention strategies described in the literature. (AU)


Subject(s)
Respiration, Artificial/methods , Respiratory Distress Syndrome, Newborn , Intensive Care Units, Pediatric , Tidal Volume , Positive-Pressure Respiration/methods , Lung Injury/physiopathology , Lung Injury/prevention & control
7.
Rev. chil. enferm. respir ; 38(1): 37-42, mar. 2022. ilus
Article in Spanish | LILACS-Express | LILACS | ID: biblio-1388171

ABSTRACT

Resumen Se han comunicado buenos resultados clínicos al poner en posición prono a pacientes con Síndrome de Distrés Respiratorio Agudo por COVID-19. Objetivo: Describir la maniobra prono, sus resultados clínicos y cuidados asociados, en una mujer de 34 años de edad con 26 semanas de embarazo, que estaba en ventilación mecánica, por un cuadro clínico de neumonía multifocal por COVID-19. Se realizó maniobra prono lateralizada hacia izquierda, en tres etapas, preparación, ejecución y evaluación. Luego de 62 h de prono, se observó una recuperación favorable de la gestante: la relación PaO2/FiO2 aumentó de 151 a 368 mmHg, y disminuyó el compromiso radiológico pulmonar, sin que se detectaran complicaciones fetales. Conclusiones: Esta maniobra que puede beneficiar a pacientes con insuficiencia respiratoria grave, en embarazadas debe ser una técnica protocolizada, con equipos de trabajo experimentados e implementación adecuada.


Good clinical results have been reported when placing patients with acute respiratory distress syndrome due to COVID-19 in a prone position. Objective: To describe the prone maneuver, its clinical results and associated care in a 34-year-old woman with 26 weeks of pregnancy, who was on mechanical ventilation, due to a clinical picture of COVID-19 multifocal pneumonia. Lateralized prone maneuver was carried out to the left, in three stages, preparation, execution and evaluation. After 62 hours of prone, a favorable recovery of the pregnant woman was observed: PaO2/FiO2 ratio increased from 151 to 368 mmHg, and the pulmonary radiological compromise decreased, without fetal complications being detected. Conclusions: This maneuver that might benefit patients with severe respiratory failure, in pregnant women should be a protocolized technique, with experienced work teams and adequate implementation.


Subject(s)
Humans , Female , Pregnancy , Adult , Pregnancy Complications, Infectious/therapy , Respiratory Insufficiency/therapy , Prone Position , Patient Positioning , COVID-19/therapy , Respiration, Artificial/methods , Respiratory Insufficiency/etiology , COVID-19/complications
8.
Arch. argent. pediatr ; 120(1): e29-e33, feb 2022. ilus
Article in Spanish | LILACS, BINACIS | ID: biblio-1353754

ABSTRACT

La purpurina es un pigmento en polvo de cobre, que se utiliza con frecuencia en actividades artesanales y manualidades escolares. La ingestión o inhalación de esta sustancia provoca un cuadro de intoxicación por cobre potencialmente fatal en niños. Se describe el caso de un niño de 15 meses con intoxicación por cobre, que se presenta con dificultad respiratoria aguda, alteración del sensorio y anemia hemolítica. El inicio temprano del tratamiento mediante broncoscopia y lavado bronquial con posterior intubación endotraqueal y ventilación mecánica, lograron la remisión completa del cuadro respiratorio sin secuelas. Ante una ingestión y/o inhalación de purpurina, debe indicarse de inmediato la broncoscopia con lavado bronquial, aún en ausencia de síntomas respiratorios.


Glitter is a powdered copper pigment frequently used in craft and decorative activities especially in schools and kindergartens.Ingestion or inhalation of this substance can cause acute, potentially fatal copper poisoning in children. We describe a case of a 15-month-old child with copper poisoning, presenting with acute respiratory distress, neurological impairment, and hemolytic anemia. Early onset of treatment by bronchoscopy and bronchial lavage with subsequent endotracheal intubation and mechanical ventilation, achieved complete remission of the respiratory symptoms without sequelae. In presence of glitter ingestion or inhalation, bronchoscopy with bronchial lavage should be indicated early even in the absence of respiratory symptoms.


Subject(s)
Humans , Male , Infant , Respiratory Distress Syndrome, Newborn , Poisoning , Powders , Respiration, Artificial , Bronchoscopy , Copper , Eating
9.
Rev. flum. odontol ; 1(57): 135-146, jan.-abr. 2022.
Article in Portuguese | LILACS, BBO | ID: biblio-1391489

ABSTRACT

A instalação de ventilação mecânica permite a manutenção da vida no processo de recuperação de pacientes hospitalizados que necessitam de auxílio respiratório. No entanto, a presença do ventilador no meio bucal propicia o acúmulo de debris e a retenção de placa. A cavidade oral é um meio rico em microrganismos e, em casos de pacientes entubados, o biofilme bucal pode abrigar patógenos respiratórios que levam ao desenvolvimento da Pneumonia Associada a Ventiladores (PAV). Essa infecção é a mais comum das infecções secundárias desenvolvidas em pacientes entubados e aumenta as chances de morbidade e mortalidade, bem como prolonga a hospitalização e seus custos. O objetivo desta revisão da literatura foi avaliar o impacto da higiene bucal na prevenção de PAV em pacientes entubados. Utilizando os descritores "Oral care", "Intubated Patients" e "Cross Infection" na base de dados PubMed, foram encontrados 143 artigos. Destes, foram selecionados os estudos gratuitos publicados entre 2015 e 2020, que envolviam pesquisa em humanos adultos e jovens adultos. Foram descartados aqueles em que os pacientes em CTI e UTI não estavam entubados, restando 12 artigos para serem lidos integralmente. Segundo a literatura, a higienização da cavidade oral se mostra eficaz na redução de incidência da PAV, sendo o método mais utilizado a limpeza química com Clorexidina em concentrações variando de 0,12% a 2%, podendo ser complementada com a higienização mecânica. Assim, a implementação de um protocolo de higiene bucal para pacientes entubados é de fundamental importância para diminuir as chances de desenvolvimento de PAV.


The use of mechanical ventilation allows the maintenance of life in the recovery process of hospitalized patients who need respiratory assistance. However, the presence of the ventilator in the oral cavity environment promotes the accumulation of debris and plaque retention. The oral cavity is a medium rich in microorganisms and, in the context of intubated patients, the oral biofilm can harbor respiratory pathogens that may lead to the development of Ventilator Associated Pneumonia (VAP). This condition is one of the main secondary infections associated with the intubated patients, and its ocurrence increases the morbimortality, the lenght of hospitalization and its costs. The aim of this literature review is to assess the impact of oral hygiene on the prevention on VAP in intubated patients. Using the descriptors "Oral care", "Intubated Patients" and "Cross Infection" in the PubMed database, 143 articles were found. Of these, we selected free studies published between 2015 and 2020, which involved research in human adults and young adults. We descarted the ones in which the patients in the ITU or ICU were not intubated, leaving 12 articles to be read in full. According to the literature review, cleaning the oral cavity is effective in reducing the incidence of VAP, the most used method being chemical cleaning with chlorhexidine at concentrations ranging from 0.12% to 2%, which can be complemented with mechanical cleaning. Thus, the implementation of an oral hygiene protocol for intubated patients is fundamental to reduce the chances of developing VAP.


Subject(s)
Oral Hygiene , Respiration, Artificial , Pneumonia, Ventilator-Associated/prevention & control
10.
Article in English | WPRIM | ID: wpr-928594

ABSTRACT

OBJECTIVES@#To explore the optimal maintenance dose of caffeine citrate for preterm infants requiring assisted ventilation and caffeine citrate treatment.@*METHODS@#A retrospective analysis was performed on the medical data of 566 preterm infants (gestational age ≤34 weeks) who were treated and required assisted ventilation and caffeine citrate treatment in the neonatal intensive care unit of 30 tertiary hospitals in Jiangsu Province of China between January 1 and December 31, 2019. The 405 preterm infants receiving high-dose (10 mg/kg per day) caffeine citrate after a loading dose of 20 mg/kg within 24 hours after birth were enrolled as the high-dose group. The 161 preterm infants receiving low-dose (5 mg/kg per day) caffeine citrate were enrolled as the low-dose group.@*RESULTS@#Compared with the low-dose group, the high-dose group had significant reductions in the need for high-concentration oxygen during assisted ventilation (P=0.044), the duration of oxygen inhalation after weaning from noninvasive ventilation (P<0.01), total oxygen inhalation time during hospitalization (P<0.01), the proportion of preterm infants requiring noninvasive ventilation again (P<0.01), the rate of use of pulmonary surfactant and budesonide (P<0.05), and the incidence rates of apnea and bronchopulmonary dysplasia (P<0.01), but the high-dose group had a significantly increased incidence rate of feeding intolerance (P=0.032). There were no significant differences between the two groups in the body weight change, the incidence rates of retinopathy of prematurity, intraventricular hemorrhage or necrotizing enterocolitis, the mortality rate, and the duration of caffeine use (P>0.05).@*CONCLUSIONS@#This pilot multicenter study shows that the high maintenance dose (10 mg/kg per day) is generally beneficial to preterm infants in China and does not increase the incidence rate of common adverse reactions. For the risk of feeding intolerance, further research is needed to eliminate the interference of confounding factors as far as possible.


Subject(s)
Caffeine/therapeutic use , Citrates , Humans , Infant , Infant, Newborn , Infant, Premature , Respiration, Artificial , Retrospective Studies
11.
Article in English | WPRIM | ID: wpr-928570

ABSTRACT

OBJECTIVES@#To study the efficacy and safety of early intratracheal administration of budesonide combined with pulmonary surfactant (PS) in preventing bronchopulmonary dysplasia (BPD).@*METHODS@#A prospective randomized controlled trial was designed. A total of 122 infants with a high risk of BPD who were admitted to the neonatal intensive care unit of the Third Affiliated Hospital of Zhengzhou University from January to July 2021 were enrolled. The infants were randomly divided into a conventional treatment group with 62 infants (treated with PS alone at an initial dose of 200 mg/kg, followed by a dose of 100 mg/kg according to the condition of the infant) and an observation group with 60 infants (treated with PS at the same dose as the conventional treatment group, with the addition of budesonide 0.25 mg/kg for intratracheal instillation at each time of PS application). The two groups were compared in terms of the times of PS use, ventilator parameters at different time points, oxygen inhalation, incidence rate and severity of BPD, incidence rate of complications, and tidal breathing pulmonary function at the corrected gestational age of 40 weeks.@*RESULTS@#Compared with the conventional treatment group, the observation group had a significantly lower proportion of infants using PS for two or three times (P<0.05). Compared with the conventional treatment group, the observation group had a significantly lower fraction of inspired oxygen at 24 and 48 hours and 3, 7, and 21 days after administration, significantly shorter durations of invasive ventilation, noninvasive ventilation, ventilator application, and oxygen therapy, a significantly lower incidence rate of BPD, and a significantly lower severity of BPD (P<0.05). There was no significant difference in the incidence rate of glucocorticoid-related complications between the two groups (P>0.05).@*CONCLUSIONS@#Compared with PS use alone in preterm infants with a high risk of BPD, budesonide combined with PS can reduce repeated use of PS, lower ventilator parameters, shorten the duration of respiratory support, and reduce the incidence rate and severity of BPD, without increasing the incidence rate of glucocorticoid-related complications.


Subject(s)
Bronchopulmonary Dysplasia/prevention & control , Budesonide , Humans , Infant , Infant, Newborn , Infant, Premature , Prospective Studies , Pulmonary Surfactants/therapeutic use , Respiration, Artificial , Respiratory Distress Syndrome, Newborn/therapy
12.
Chinese Medical Journal ; (24): 779-789, 2022.
Article in English | WPRIM | ID: wpr-927568

ABSTRACT

Neurocritical care (NCC) is not only generally guided by principles of general intensive care, but also directed by specific goals and methods. This review summarizes the common pulmonary diseases and pathophysiology affecting NCC patients and the progress made in strategies of respiratory support in NCC. This review highlights the possible interactions and pathways that have been revealed between neurological injuries and respiratory diseases, including the catecholamine pathway, systemic inflammatory reactions, adrenergic hypersensitivity, and dopaminergic signaling. Pulmonary complications of neurocritical patients include pneumonia, neurological pulmonary edema, and respiratory distress. Specific aspects of respiratory management include prioritizing the protection of the brain, and the goal of respiratory management is to avoid inappropriate blood gas composition levels and intracranial hypertension. Compared with the traditional mode of protective mechanical ventilation with low tidal volume (Vt), high positive end-expiratory pressure (PEEP), and recruitment maneuvers, low PEEP might yield a potential benefit in closing and protecting the lung tissue. Multimodal neuromonitoring can ensure the safety of respiratory maneuvers in clinical and scientific practice. Future studies are required to develop guidelines for respiratory management in NCC.


Subject(s)
Humans , Lung , Lung Diseases/etiology , Positive-Pressure Respiration/methods , Respiration, Artificial/adverse effects , Tidal Volume
13.
Article in English | WPRIM | ID: wpr-927462

ABSTRACT

INTRODUCTION@#Evidence regarding the efficacy of high-flow nasal cannula (HFNC) oxygenation for preoxygenation and apnoeic oxygenation is conflicting. Our objective is to evaluate whether HFNC oxygenation for preoxygenation and apnoeic oxygenation maintains higher oxygen saturation (SpO2) during rapid sequence intubation (RSI) in ED patients compared to usual care.@*METHODS@#This was a multicentre, open-label, randomised controlled trial in adult ED patients requiring RSI. Patients were randomly assigned 1:1 to either intervention (HFNC oxygenation at 60L/min) group or control (non-rebreather mask for preoxygenation and nasal prongs of at least 15L/min oxygen flow for apnoeic oxygenation) group. Primary outcome was lowest SpO2 during the first intubation attempt. Secondary outcomes included incidence of SpO2 falling below 90% and safe apnoea time.@*RESULTS@#One hundred and ninety patients were included, with 97 in the intervention and 93 in the control group. Median lowest SpO2 during the first intubation attempt was 100% in both groups. Incidence of SpO2 falling below 90% was lower in the intervention group (15.5%) compared to the control group (22.6%) (adjusted relative risk=0.68, 95% confidence interval [CI] 0.37-1.25). Post hoc quantile regression analysis showed that the first quartile of lowest SpO2 during the first intubation attempt was greater by 5.46% (95% CI 1.48-9.45%, P=0.007) in the intervention group.@*CONCLUSION@#Use of HFNC for preoxygenation and apnoeic oxygenation, when compared to usual care, did not improve lowest SpO2 during the first intubation attempt but may prolong safe apnoea time.


Subject(s)
Adult , Cannula , Emergency Service, Hospital , Humans , Intubation, Intratracheal , Rapid Sequence Induction and Intubation , Respiration, Artificial
14.
Acta Paul. Enferm. (Online) ; 35: eAPE0326345, 2022. tab
Article in Portuguese | LILACS, BDENF | ID: biblio-1374004

ABSTRACT

Resumo Objetivo Avaliar o efeito do uso de ventilação mecânica com pressão positiva expiratória final (PEEP) na função renal dos pacientes internados em Unidade de Terapia Intensiva (UTI). Métodos Estudo de coorte retrospectivo, quantitativo, desenvolvido na UTI de um hospital público de Brasília, Distrito Federal. A amostra foi constituída de 52 prontuários de pacientes internados na UTI de novembro de 2016 a dezembro de 2018. A coleta dos dados foi realizada por meio de um questionário com dados demográficos, clínicos e laboratoriais. Os pacientes foram alocados em grupos: (1) PEEP ≤ 5 cmH2O, (2) PEEP > 5 cmH2O e < 10 cmH2O e (3) PEEP ≥ 10 cmH2O. Resultados A média de idade dos pacientes foi de 59 anos e 50% deles tinha mais de 63 anos. Constatou-se que 63,16% dos pacientes que estavam em ventilação mecânica com pressão positiva ao final da expiração ≥ 10 cmH2O evoluíram no estágio 1 (menor gravidade de lesão renal aguda (LRA)) e 21,5% no estágio 2 (moderada gravidade). Ainda assim, um pequeno percentual (5,8%) de pacientes evoluiu a óbito. Pacientes sem sucesso no desmame da ventilação mecânica apresentaram 10,24 vezes a chance de evoluir com LRA. Conclusão o emprego da ventilação mecânica pode determinar danos à função renal dos pacientes internados em unidade de terapia intensiva e que aqueles com maior necessidade de oferta de PEEP evoluíram com diferentes gravidades e persistência da LRA.


Resumen Objetivo Evaluar el efecto del uso de la ventilación mecánica con presión positiva espiratoria final (PEEP) en la función renal de los pacientes internados en Unidad de Cuidados Intensivos (UTI). Métodos Estudio de corte retrospectivo, cuantitativo, desarrollado en la UCI de un hospital público de Brasília, Distrito Federal. La amuestra estuvo constituida por 52 prontuarios de pacientes internados en la UCI de noviembre de 2016 a diciembre de 2018. La recolección de los datos se realizó por medio de un cuestionario con datos demográficos, clínicos y laboratoriales. Los pacientes fueron distribuidos en grupos: (1) PEEP ≤ 5 cmH2O, (2) PEEP > 5 cmH2O y < 10 cmH2O y (3) PEEP ≥ 10 cmH2O. Resultados El promedio de edad de los pacientes era de 59 años y el 50 % de ellos tenía más de 63 años. Se constató que el 63,16 % de los pacientes que estaban en ventilación mecánica con presión positiva al final de la expiración ≥ 10 cmH2O evolucionaron en la etapa 1 (menor gravedad de lesión renal aguda (LRA)) y 21,5 % en la etapa 2 (moderada gravedad). Aun así, un pequeño porcentaje (5,8 %) de pacientes falleció. Pacientes sin éxito en la descontinuación de la ventilación mecánica presentaron 10,24 veces la posibilidad de evolucionar con LRA. Conclusión el uso de la ventilación mecánica puede determinar daños a la función renal de los pacientes internados en una unidad de cuidados intensivos y que los que tengan una mayor necesidad de oferta de PEEP evolucionaron con distintas gravedades y persistencia de la LRA.


Abstract Objective To assess the effect of using mechanical ventilation with positive end-expiratory pressure (PEEP) on the renal function of patients admitted to the Intensive Care Unit (ICU). Methods This is a quantitative retrospective cohort study developed in the ICU of a public hospital in Brasília, Distrito Federal. The sample consisted of 52 medical records of patients admitted to the ICU from November 2016 to December 2018. Data collection was performed through a questionnaire with demographic, clinical and laboratory data. Patients were allocated in two groups: (1) PEEP ≤ 5 cmH2O, (2) PEEP > 5 cmH2O and < 10 cmH2O, and (3) PEEP ≥ 10 cmH2O. Results The mean age of patients was 59 years and 50% of them were over 63 years. It was found that 63.16% of patients who were on mechanical ventilation with positive end-expiratory pressure ≥ 10 cmH2O evolved in stage 1 (less severe acute kidney injury (AKI)) and 21.5% in stage 2 (moderate gravity). Even so, a small percentage (5.8%) of patients died. Patients who were unsuccessful in weaning from mechanical ventilation had a 10.24-fold chance of developing AKI. Conclusion mechanical ventilation use can cause damage to the renal function of patients hospitalized in the intensive care unit and that those with greater need to offer PEEP evolved with different severities and persistence of AKI.


Subject(s)
Humans , Male , Female , Middle Aged , Respiration, Artificial , Medical Records , Positive-Pressure Respiration, Intrinsic , Acute Kidney Injury/complications , Acute Kidney Injury/epidemiology , Intensive Care Units , Time Factors , Surveys and Questionnaires , Retrospective Studies
15.
Clin. biomed. res ; 42(1): 7-15, 2022.
Article in Portuguese | LILACS | ID: biblio-1382315

ABSTRACT

Introdução: O suporte ventilatório é usado para o tratamento de pacientes com insuficiência respiratória aguda (IRpA) ou crônica agudizada. A ventilação não-invasiva (VNI) na IRpA pediátrica é amplamente usada em bebês prematuros e crianças, porém até a data atual os estudos têm sido escassos. Portanto, o objetivo do presente estudo foi determinar os fatores de risco associados à falha na VNI em uma unidade de terapia intensiva pediátrica.Métodos: Coorte retrospectiva a partir de prontuários de pacientes admitidos na unidade de terapia intensiva (UTI) Pediátrica de um Hospital de Caxias do Sul, entre maio de 2017 e outubro de 2019, que utilizaram VNI.Resultados: A incidência de falha na VNI foi de 33%. Asma (RR = 1,36; IC95% = 1,08-1,72), uso de VNI em pacientes pós-extubação (RR = 1,97; IC95% = 1,17-3,29), uso contínuo da VNI (RR = 2,44; IC95% = 1,18-5,05), encerramento à noite (RR = 2,52; IC95% = 1,53-4,14), modalidade final ventilação mandatória intermitente sincronizada (SIMV) (RR = 4,20; IC95% = 2,20-7,90), pressão expiratória positiva final (PEEP) no início da ventilação (6,8 ± 1,1; p < 0,01) e fração inspiratória de O2 (FIO2) final (53,10 ± 18,50; p < 0,01) foram associados à falha. Adicionalmente, a pressão arterial sistólica (PAS) inicial (118,68 ± 18,68 mmHg; p = 0,02), a frequência respiratória inicial (FR) (47,69 ± 14,76; p = 0,28) e final (47,54 ± 14,76; p < 0,01) foram associados a falha.Conclusão: A modalidade ventilatória final SIMV, demostra ser o melhor preditor de risco de falha, seguido do turno em que a VNI é finalizada, onde à noite existe maior risco de falha. Além disso, foram preditores de falha, porém com menor robustez, a pressão positiva inspiratória (PIP) final e a FR final.


Introduction: Ventilatory support is used for the treatment of patients with acutely chronic or acute respiratory failure (ARF). Noninvasive ventilation (NIV) in pediatric ARF is widely used in preterm infants and children, but studies to date have been limited. Therefore, the aim of the present study was to determine the risk factors associated with NIV failure in a pediatric intensive care unit.Methods: This retrospective cohort study was based on medical records of patients admitted to the pediatric intensive care unit of a hospital in Caxias do Sul, southern Brazil, between May 2017 and October 2019, who used NIV.Results: The incidence of NIV failure was 33%. Asthma (relative risk [RR] = 1.36; 95% confidence interval [CI] = 1.08-1.72), post-extubation use of NIV (RR = 1.97; 95% CI = 1.17-3.29), continuous use of NIV (RR = 2.44; 95% CI = 1.18-5.05), completion at night (RR = 2.52; 95% CI = 1.53-4.14), final mode synchronized intermittent mandatory ventilation (SIMV) (RR = 4.20; 95% CI = 2.20-7.90), positive end-expiratory pressure at the beginning of ventilation (6.8 ± 1.1; p < 0.01), and final fraction of inspired oxygen (53.10 ± 18.50; p < 0.01) were associated with failure. Additionally, initial systolic blood pressure (118.68 ± 18.68 mmHg; p = 0.02), initial respiratory rate (IRR) (47.69 ± 14.76; p = 0.28), and final respiratory rate (47.54 ± 14.76; p < 0.01) were associated with failure.Conclusion: The final ventilatory mode SIMV proves to be the best failure risk predictor, followed by the shift in which NIV is completed, as there is a greater risk of failure at night. In addition, final positive inspiratory pressure and final respiratory rate were less robust predictors of failure.


Subject(s)
Humans , Male , Female , Infant, Newborn , Infant , Child, Preschool , Child , Respiratory Insufficiency/complications , Intensive Care Units, Pediatric , Respiration, Artificial/adverse effects , Risk Factors , Cohort Studies
16.
Acta de Otorrinolaringología Cir. Cabeza cuello. ; 50(2): 117-123, 20220000. ilus, tab, graf
Article in Spanish | LILACS, COLNAL | ID: biblio-1382301

ABSTRACT

Introducción: existe aún una controversia sobre los efectos en los parámetros ventilatorios en pacientes sometidos a una traqueotomía, y los estudios en casos de pacientes con SARS-CoV-2 son escasos. Objetivo: describir los cambios en los parámetros ventilatorios en pacientes operados de traqueotomía por SARS-CoV-2 en la unidad de cuidados intensivos (UCI). Métodos: se realizó un estudio retrospectivo, descriptivo y longitudinal en el que se incluyeron las variables como edad, sexo, comorbilidades, tiempo de intubación, parámetros ventilatorios, gasométricos y el índice de Kirby. Se utilizó estadística descriptiva con medidas de tendencia central y medidas de dispersión. Resultados: se recibieron 493 casos con COVID-19, 133 (26,35 %) ingresaron, 21 fueron operados en la UCI; el género masculino fue 76 % y edad de 56 años; la obesidad y la hipertensión fueron las comorbilidades más comunes, todos con PCR positivo; los parámetros ventilatorios preoperatorios fueron presión positiva al final de la espiración (PEEP) de 7,61 y fracción inspirada de oxígeno (FiO2) de 41,42, la gasometría fue pH de 7,42, presión parcial de oxígeno (pO2) de 95,04, presión parcial de dióxido de carbono (pCO2) de 41,47, bicarbonato (HCO3) de 29,14, saturación de oxígeno (SatO2) de 94,7 %, el índice de Kirby x = 235; y los posoperatorios (PEEP de 7,19 y FiO2 de 40,6), la gasometría fue de pH de 7.44, pO2 de 43,7, pCO2 de 87,7, HCO3 de 27,4, SatO2 de 95,23 %. Fallecieron tres pacientes, dos pacientes complicados con sangrado y un caso con decanulación accidental. El tiempo promedio de ventilación mecánica de fue de 5,7 días. Conclusiones: la traqueotomía generó cambios muy sutiles en los parámetros ventilatorios y gasométricos; sin embargo, la liberación de la ventilación mecánica fue en promedio menor a una semana, desocupando espacio en la UCI.


Introduction: Controversy continues to exist regarding the effects on ventilatory parameters in patients undergoing tracheostomy, and studies in cases with SARS-CoV-2 are scarce. Objective: To describe changes in ventilatory parameters in patients undergoing tracheostomy for SARS-CoV-2 in the intensive care unit. Methods: A retrospective, descriptive, longitudinal study was carried out. Variables such as age, sex, comorbidities, time of IOT, ventilatory parameters, blood gases and the Kirby index were included. Descriptive statistics with measures of central tendency and measures of dispersion were used. Results: n = 493 COVID-19 cases were received, n = 133 (26.35%) were admitted, 21 were operated on in the ICU, male gender was 76%, age 56 years, obesity and hypertension were the most common comorbidities, all With CRP +, the preoperative ventilatory parameters x (PEEP 7.61) and (FiO2 41.42), the blood gas was (pH 7.42), (pO2 95.04), (pCO2 41.47), ( HCO3 29.14), (Saturation O2 94.7%) and the Kirby index x = 235 and postoperative x (PEEP 7.19) and (FiO2 40.6), the blood gas was (pH 7.44), (pO2 43.7), (pCO2 87.7), (HCO3 27.4), (Saturation O2 95.23%). n = 3 died, two patients with bleeding complications and one case with accidental decannulation. The mean time of mechanical ventilation was n = 5.7 days. Conclusions: The tracheostomy generated very subtle changes in the ventilatory and gasometric parameters, however, the release of mechanical ventilation was on average less than one week, emptying space in the ICU.


Subject(s)
Humans , Tracheotomy , Respiration, Artificial , Respiratory Distress Syndrome, Newborn , Coronavirus Infections
17.
Neumol. pediátr. (En línea) ; 17(1): 9-11, 2022. ilus
Article in Spanish | LILACS | ID: biblio-1379403

ABSTRACT

La principal función del aparato respiratorio es permitir el intercambio gaseoso, el cual se produce en las unidades alveolares. Para definir y conocer la ventilación alveolar, es necesario estar familiarizado con los volúmenes y capacidades pulmonares, además de conocer los principios fisiológicos que nos permiten medirlos y/o estimarlos. El objetivo de este artículo es revisar estos conceptos, para aumentar el entendimiento de la fisiología del aparato respiratorio.


The main function of the respiratory system is to allow gas exchange, which occurs in the alveolar units. To define and know alveolar ventilation, it is necessary to be familiarized with lung volumes and capacities, in addition to understand the physiological principles that allow us measure and / or estimate them. The objective of this article is to review these concepts, to increase the understanding of the physiology of the respiratory system.


Subject(s)
Humans , Respiration, Artificial , Respiratory Physiological Phenomena
18.
Rev. cienc. cuidad ; 19(2): 84-98, 2022.
Article in Spanish | LILACS, BDENF, COLNAL | ID: biblio-1373532

ABSTRACT

Objetivo: Determinar las complicaciones detalladas de traqueotomías asociadas a intuba-ciones prolongadas en el adulto. Metodología: Revisión sistemática de los 5 años anteriores con base en los lineamientos PRISMA. Se recurrió a las bases de datos Scopus, Web of Sci-ence, Taylor and Francis y el Portal Regional de la Biblioteca Virtual en Salud. Además, se seleccionó la información a través de palabras clave, tales como: traqueotomía, intubación prolongada, UCI, adulto, complicaciones. Las publicaciones estaban en idioma español e inglés. La información se catalogó según criterios de inclusión y exclusión. Análisis: 24 artículos fueron elegidos. El momento de la traqueotomía (TQ) por intubación prolongada sigue siendo incierto. La TQ temprana demostró mayores beneficios que la TQ tardía. La TQ percutánea demostró menores tasas de estancia en la UCI y en los hospitales, con menos com-plicaciones. La hemorragia y la desaturación fueron complicaciones registradas asociadas a TQ tardía. Conclusión: La TQ percutánea fue la que se eligió en la mayoría de casos por ser eficaz, rápida y segura; además, disminuye la estancia hospitalaria y en la UCI, con menos complicaciones. Se debe precisar que en la mayoría de las publicaciones, al menos uno de estos beneficios no alcanzó significancia estadística. La complicación con mayor frecuencia fue la hemorragia en el sitio de punción


Objective: To determine the detailed complications of tracheotomies associated with pro-longed intubation in adults. Methodology: Systematic review of the previous 5 years based on PRISMA guidelines. The databases Scopus, Web of Science, Taylor and Francis and the Regional Portal of the Virtual Health Library were used to select information through key-words tracheotomy, prolonged intubation, ICU, adult, complications; the publications were in Spanish and English. The information was catalogued according to inclusion and exclusion criteria. Analysis: 24 articles were selected. The timing of tracheostomy (TQ) for prolonged intubation remains uncertain. Early TQ showed greater benefits than late TQ. Percutane-ous TQ demonstrated lower rates of ICU stay, hospital stay, and complications. Hemorrhage and desaturation were mostly reported complications associated with late TQ. Conclusion: Percutaneous TQ was the TQ of choice in most cases because it is effective, fast and safe, decreases hospital stay, ICU and complication rate, most publications at least one of these benefits did not reach statistical significance. The most frequent complication was bleeding at the puncture site


Objetivo: Determinar as complicações detalhadas da traqueostomia associadas à entubação prolongada em adultos. Metodologia: Revisão sistemática dos 5 anos anteriores com base nas diretrizes do PRISMA. As bases de dados Scopus, Web of Science, Taylor e Francis e o Portal Regional da Biblioteca Virtual em Saúde foram usadas para selecionar informações usando palavras-chave traqueostomia, intubação prolongada, UTI, adulto, complicações; as publicações foram em espanhol e inglês. As informações foram catalogadas de acordo com critérios de inclusão e exclusão. Análise: 24 artigos foram selecionados. O momento da traqueostomia (TQ) para entubação prolongada permanece incerto. O TQ precoce demon-strou maior benefício do que o TQ tardio. A TQ percutânea demonstrou taxas mais baixas de internação na UTI, internação hospitalar e complicações. A hemorragia e a dessaturação foram as complicações mais comumente relatadas associadas à TQ tardia. Conclusão: O TQ percutâneo foi o TQ de escolha na maioria dos casos, pois é eficaz, rápido e seguro, diminui a permanência hospitalar, a UTI e a taxa de complicações, a maioria das publicações pelo menos um desses benefícios não alcançou significância estatística. A complicação mais fre-qüente era o sangramento no local da punção


Subject(s)
Tracheotomy , Respiration, Artificial , Adult , Intensive Care Units , Intubation
19.
Rev. bras. oftalmol ; 81: e0047, 2022. tab
Article in Portuguese | LILACS | ID: biblio-1387966

ABSTRACT

RESUMO Com o advento do cenário pandêmico causado pelo SARS-CoV-2, no início do ano de 2020, foi notado um vasto quadro clínico entre os indivíduos infectados. Dentre os sintomas oculares mais comuns ocasionados pela COVID-19, o olho seco tornou-se bastante prevalente nesse meio. O estudo do tipo revisão narrativa busca avaliar os fatores de risco associados ao surgimento ou à intensificação dos quadros de olho seco na população durante o período pandêmico. A partir da análise bibliográfica, foi descrita a influência da ventilação por pressão positiva, do uso de máscaras de forma incorreta e de telas eletrônicas e da ansiedade e da depressão como fatores predisponentes ao desenvolvimento da doença do olho seco. No entanto, ainda é notada a necessidade de estudos mais explicativos para estabelecer a relação direta entre a causalidade dos fatores.


ABSTRACT With the advent of the pandemic scenario caused by SARS-CoV-2 in the beginning of the year 2020, a vast clinical picture was noticed among the infected individuals. Among the most common eye symptoms caused by Covid-19, dry eye (DE) has become quite prevalent in this environment. The narrative review study seeks to assess the risk factors associated with the emergence or intensification of DE conditions in the population during the pandemic period. A literature review showed the influence of positive pressure ventilation, incorrect use of masks, as well as electronic screens, in addition to anxiety and depression as predisposing factors for the development of dry eye disease. However, the need for more explanatory studies and for establishing a direct relationship between the causality of the factors is still noted.


Subject(s)
Humans , Dry Eye Syndromes/etiology , COVID-19/complications , Anxiety/complications , Respiration, Artificial/adverse effects , Risk Factors , Computer Terminals , Depression/complications , Pandemics , Screen Time , SARS-CoV-2 , Masks/adverse effects
20.
Bol. malariol. salud ambient ; 62(2): 251-259, 2022. tab, graf
Article in Spanish | LILACS, LIVECS | ID: biblio-1380171

ABSTRACT

La ventilación mecánica invasiva como estrategia terapéutica no está exenta de complicaciones. Es imperativo tener parámetros de ventilación protectiva en aquellos pacientes que están sometidos a ello. Se pretende demostrar si la potencia mecánica como parámetro ventilatorio tiene validez pronóstica de mortalidad en pacientes críticos con ventilación mecánica invasiva prolongada. Material y Métodos: Se realizó un estudio transversal analítico de pacientes críticos en ventilación mecánica invasiva prolongada debido a Síndrome de Distrés Respiratorio Agudo por COVID-19 que ingresaron a la Unidad de Cuidados Intensivos del Hospital Regional Docente de Trujillo durante el periodo de marzo 2020 a marzo del 2021. Resultados: La potencia mecánica, como parámetro ventilatorio, se asocia a mortalidad (RPa 1.061; IC 95% 1.037-1.085; p=0.00) al igual que la presión plateau y siendo la driving pressure y compliance estática factores protectores para mortalidad. La potencia mecánica como parámetro ventilatorio tiene validez pronóstica para mortalidad severa por COVID-19(AU)


Invasive mechanical ventilation as a therapeutic strategy is not without complications. It is imperative to have protective ventilation parameters in those patients who are subjected to it. We aim to demonstrate whether mechanical power as a ventilatory parameter has prognostic validity for mortality in critically ill patients with prolonged invasive mechanical ventilation. Material and Methods: An analytical cross-sectional study was carried out of critically ill patients on prolonged invasive mechanical ventilation due to Acute Respiratory Distress Syndrome due to COVID-19 who were admitted to the Intensive Care Unit of the Hospital Regional de Trujillo during the March 2020 to March 2021 period. Results: Mechanical power, as a ventilatory parameter, is associated with mortality (RPa 1.061; 95% CI 1.037-1.085; p = 0.00) as well as plateau pressure, and driving pressure and static compliance are protective factors for mortality. Mechanical power as a ventilatory parameter has prognostic validity for mortality in critically ill patients with invasive mechanical ventilation due to severe acute respiratory distress syndrome due to COVID-19(AU)


Subject(s)
Humans , Male , Female , Adult , Middle Aged , Aged , Respiration, Artificial , Respiratory Distress Syndrome, Newborn/mortality , COVID-19 , Respiratory Therapy , Intensive Care Units
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