Estrategias de destete y desmonte de cánula nasal de alto flujo en adultos / Adult High-Flow Nasal Cannula Weaning and Disassembly Strategies

Introducción: La cánula nasal de alto flujo es un sistema que utiliza una mezcla de aire-oxígeno humidificado y calentado con un caudal de hasta 70 litros por minuto. Es utilizada mayoritariamente en la insuficiencia respiratoria aguda de origen hipoxémico, donde ha demostrado brindar mayor comodidad y poder resolutivo de la hipoxemia, en comparación con la oxigenoterapia convencional. Aunque se conocen sus indicaciones y estrategia de seguimiento, en la práctica clínica no es claro su proceso de destete/desmonte. Objetivo: Identificar en la bibliografía la literatura existente acerca de estrategias de destete/desmonte de la cánula nasal de alto flujo en adultos. Métodos: Se realizó una revisión bibliográfica en las bases de datos del portal regional de la BVS, PubMed, Web Of Science, Scopus y Google scholar, sin límite de tiempo y es- tructurando una ecuación PIO con palabras clave y operadores booleanos. Se asumieron artículos publicados en inglés y español, texto completo. Resultados: En la bibliografía, aún se reporta discrepancia en el proceso de destete y desmonte de la cánula nasal de alto flujo, pero en la mayoría de los estudios encontrados en esta revisión se propone disminuir la FiO2 primero de forma gradual (5-10%) hasta valores de 30-50% y, posteriormente, el flujo. Para desmontarla, se podría considerar tener una FiO2 entre 30-50%, flujo entre 20-30 litros por minuto, SaO2 >92%, con adecuada mecánica respiratoria y estado de conciencia. Conclusión: Aún no existe unanimidad en el proceso de destete/desmonte en la cánula nasal de alto flujo en el paciente adulto.

Introduction: The high-flow nasal cannula is a system that uses a humidified and heated air-oxygen mixture with a flow rate of up to 70 liters per minute. It is mostly used in acute respiratory failure of hypoxemic origin, where it has been shown to provide greater comfort and resolving power of hypoxemia, compared to conventional oxygen therapy. Although its indications and follow-up strategy are known, in clinical practice the weaning/weaning process is not clear. Objective: To identify in the bibliography the existing literature on weaning/ weaning strategies of high-flow nasal cannula in adults. Methods: A bibliographic review was carried out in the databases of the regional portal of the BVS, PubMed, Web Of Science, Scopus and Google scholar, without time limit and structuring a PIO equation with keywords and boléan connectors. Articles published in English and Spanish, full text, were assumed. Results: The literature still reports discrepancy in the process of weaning and disassembling the high-flow nasal cannula, but most of the studies found in this review propose to decrease the FiO2 first gradually (5-10%) to values of 30-50% and then the flow. To dismantle it, one could consider having a FiO2 between 30-50%, flow between 20-30 liters per minute, SaO2 >92%, with adequate respiratory mechanics and state of consciousness. Conclusion: There is still no unanimity on the weaning/weaning process in the high- flow nasal cannula in the adult patient.

Bronquitis plástica. Caso clínico interesante / Plastic Bronchitis. Interesting Case Report

La bronquitis plástica es una enfermedad infrecuente y poco estudiada. Se caracteriza por la obstrucción parcial o total de la vía aérea inferior por moldes o yesos gomosos y firmes, compuestos por múltiples sustancias como fibrina, mucina y otros, que se acumulan en la luz bronquial. En la actualidad, no hay un consenso de la fisiopatología real. Puede presentarse con síntomas leves como tos, sibilancias y disnea, hasta eventos fatales de insuficiencia respiratoria. Se clasifican en tipo I (inflamatorios) y tipo II (acelulares). La presencia de la bronquitis plástica es una complicación de varias enfermedades y está relacionada con procedimientos correctivos de cardiopatías congénitas (procedimiento de Fontan). El diagnóstico se hace a través de la identificación de los yesos bronquiales, ya sea cuando el paciente los expectora o por broncoscopía. Se han utilizado múltiples terapias que solo tienen evidencias anecdóticas. En los últimos años se han observado buenos resultados con el uso de heparinas, así como el alteplasa nebulizado e instilado por broncoscopia.

Plastic bronchitis is a rare and little-studied disease. It is characterized by partial or total obstruction of the lower airway by rubbery and firm molds or plasters, made up of multiple substances that accumulate in the bronchial lumen. Currently, there is no consensus on real pathophysiology. It can present itself with mild symptoms such as cough, wheezing and dyspnea, to fatal events of respiratory failure. They are classified into type I (inflammatory) and type II (acellular). The presence of plastic bronchitis is a complication of several diseases and in corrective procedures for congenital heart disease (Fontan procedure). Diagnosis is made by identifying bronchial casts, either by the patient expectorating them or by bronchoscopy. Multiple therapies have been used that only have anecdotal evidence. In recent years, good results have been observed with the use of heparins and tPA nebulized and instilled by bronchoscop.

Manejo de la vía aérea ante un caso de paro respiratorio en un escenario clínico simulado. Experiencia en una residencia de pediatría / Airway management during a respiratory arrest in a clinical simulation scenario. Experience at a pediatric residency program

Introducción. La insuficiencia respiratoria es la causa más común de paro cardíaco en pediatría; su reconocimiento y el manejo adecuado son cruciales. La simulación se utiliza para mejorar las habilidades médicas. El objetivo del trabajo fue determinar la proporción de residentes de pediatría que reconocieron un paro respiratorio (PR) pediátrico en un centro de simulación. Métodos. Se realizó un estudio observacional con 77 médicos residentes. Se utilizó un caso simulado de un paciente con dificultad respiratoria que progresa a PR. Resultados. De los 77 participantes, 48 reconocieron el paro respiratorio (62,3 %). El tiempo medio para reconocer el PR fue de 34,43 segundos. Conclusión. El 62,3 % de los participantes logró reconocer el paro respiratorio. Entre aquellos que lo identificaron, el tiempo promedio fue de 34,43 segundos. Se observaron graves deficiencias en algunas de las intervenciones esperadas.

Introduction. Respiratory failure is the most common cause of cardiac arrest in pediatrics. Recognizing and managing it adequately is critical. Simulation is used to improve medical skills. The objective of this study was to establish the proportion of pediatric residents who recognized a respiratory arrest in a child at a simulation center. Methods. This was an observational study in 77 residents. A simulation of a patient with respiratory distress that progressed to respiratory arrest was used. Results. Among the 77 participants, 48 recognized respiratory arrest (62.3%). The mean time to recognize respiratory arrest was 34.43 seconds. Conclusion. Respiratory arrest was recognized by 62.3% of participants. Among those who did so, the average time was 34.43 seconds. Severe failures were noted in some of the expected interventions.

Síndrome de embolia grasa secundario a fracturas de huesos cortos: Presentación de casos / Fat embolism syndrome secondary to short bone fracture. Case presentation

Introducción: Se presenta el caso clínico de un varón de 15 años con fracturas de huesos cortos del pie derecho como consecuencia de un accidente de tránsito. Tras 24 h de evolución, ingresa con disnea, desaturación, pico febril objetivo y posterior desarrollo de insuficiencia respiratoria. Ante la sospecha clínica de síndrome de embolia grasa, se solicita una angiotomografía pulmonar que confirma el diagnóstico. Se trata de una entidad inusual en pacientes con este tipo de fractura. El tratamiento inicial consistió en vigilancia estrecha en la unidad de cuidados intensivos, medidas de soporte con oxígeno suplementario, terapia res-piratoria y manejo quirúrgico de las fracturas. La evolución clínica del paciente fue adecuada y el cuadro respiratorio se resolvió por completo. Conclusiones: El síndrome de embolia grasa secundario a fracturas de huesos cortos es un cuadro infrecuente; por lo tanto, es preciso tener un alto grado de sospecha diagnóstica, no solo en los escenarios más comunes, sino también en este tipo de contextos inusuales y retadores, que permita su identificación temprana y, de esta forma, implementar un manejo oportuno y generar un impacto favorable en los desenlaces clínicos y en la disminución del riesgo de secuelas a largo plazo. Nivel de Evidencia: IV

Introduction: We present the clinical case of a 15-year-old male who sustained fractures to the short bones of his right foot as a result of a traffic accident. After 24 hours of evolution, he was admitted for dyspnea, desaturation, an objective febrile peak, and the development of respiratory failure. Given the clinical suspicion of fat embolism syndrome, pulmonary angiotomography was requested, which confirmed the diagnosis. This is a rare finding in patients with this type of fracture. The initial treatment included close monitoring in the intensive care unit, supportive measures such as supplemental oxygen, respiratory therapy, and surgical fracture management. The patient's clinical progression was adequate, and the respiratory condition resolved completely. Conclusion: Fat embolism syndrome resulting from short bone fractures is a rare condition; therefore, it is necessary to have a high level of diagnostic suspicion, not only in the most common scenarios, but also in these unusual and challenging contexts, which allows for its early detection and, as a result, timely management, which has a positive impact on clinical outcomes and reduces the risk of long-term sequelae. Level of Evidence: IV

Características clínicas y demográficas de los niños hospitalizados con infección por SARS-CoV-2 / Clinical and demographic characteristics of children hospitalized with SARS-CoV-2 infection / Características clínicas e demográficas de crianças hospitalizadas com infecção por SARS CoV-2

Introducción: en marzo de 2020 se registraron los primeros casos de infección por SARS-CoV-2 en Uruguay y se decretó la emergencia sanitaria. Objetivo: describir las características clínicas demográficas de los menores de 15 años hospitalizados con infección por SARS-CoV-2 en el período 13 de marzo de 2020 al 30 de septiembre de 2021 en el Hospital Pediátrico del Centro Hospitalario Pereira Rossell, centro de referencia público de Uruguay. Metodología: estudio descriptivo, retrospectivo, en el que se describen edad, manifestaciones clínicas, comorbilidades, severidad, tratamiento y evolución. Resultados: se hospitalizaron 207 niños con una frecuencia de 1,6%. La mediana (rango intercuartil) de edad fue 1,5 años (3 meses - 8 años); <1 año 44%; 54% de sexo masculino. Presentaron comorbilidades, 59 niños. Fueron sintomáticos, 71%. De los sintomáticos, presentaron síntomas leves 48%. Las manifestaciones clínicas fueron respiratorias en 96 (65%) y no respiratorias en 51 (fiebre sin foco 15, digestivas 19, exantema viral 3, SIM-Ped S 10 y atípicas 3). Treinta niños ingresaron a unidad de cuidados intensivos (UCI) y tres requirieron ventilación invasiva. Estos pacientes presentaron comorbilidades, tuvieron más días de fiebre y necesitaron oxigenoterapia que los que no requirieron UCI. Un paciente de 2 años con comorbilidades falleció. Conclusión: la frecuencia de hospitalizaciones fue de 1,6%. La mayoría de los niños sintomáticos presentaron formas leves. En los sintomáticos las manifestaciones fueron respiratorias. Los hallazgos en esta serie aportan al conocimiento del comportamiento de la infección por SARS-CoV-2 en niños.

Introduction: in March 2020, the first cases of SARS CoV-2 infection were registered in Uruguay and a health emergency was decreed. Objective: To describe the clinical and demographic characteristics of children under 15 years of age hospitalized with SARS-CoV-2 infection from March 13, 2020, to September 30, 2021, at Pereira Rossell Pediatric Hospital, a public reference center in Uruguay. Method: descriptive, retrospective study describing age, clinical manifestations, comorbidities, severity and treatment. Results: a total of 207 children were hospitalized, with a frequency of 1.6%. The median (interquartile range) age was 1.5 years (3 months - 8 years); <1 year accounted for 44%, and 54% were male. Comorbidities were present in 59 children. 71% of them were symptomatic, and among the symptomatic cases, 48% presented mild symptoms. Clinical manifestations were respiratory in 96 (65%) cases and non-respiratory in 51 (fever without a focus 15, gastrointestinal 19, viral exanthem 3, pediatric inflammatory multisystem syndrome 10, and atypical 3). Thirty patients were admitted to the Intensive Care Unit (ICU), and 3 required invasive ventilation. These patients had comorbidities, more days of fever, and required oxygen therapy compared to those who did not need ICU. One 2-year-old patient with comorbidities died. Conclusion: the hospitalization frequency was 1.6%. Most symptomatic children had mild forms of the disease. Among the symptomatic cases, respiratory manifestations were predominant. The findings from this series contribute to the understanding of the behavior of SARS-CoV-2 infection in children.

Introdução: Os primeiros casos de infecção por SARS CoV-2 no Uruguai foram registrados em março de 2020 quando foi decretada a emergência sanitária. Objetivo: descrever as características clínicas e demográficas das crianças menores de 15 anos internadas com infecção por SARS CoV-2 no período 13 de março de 2020 - 30 de setembro de 2021 no Hospital Pediátrico do Centro Hospitalar Pereira Rossell, centro público de referência no Uruguai. Metodologia: estudo descritivo, retrospectivo, incluindo idade, manifestações clínicas, comorbidades, gravidade, tratamento e evolução. Resultados: 207 crianças foram internadas com infecção por SARS CoV-2 correspondendo a frequência de 1,6% do total de crianças hospitalizadas no período estudado. A mediana (intervalo interquartil) de idade foi de 1,5 anos (3 meses - 8 anos) dos quais 44% eram <1 ano 44% e 54% do sexo masculino. 59 crianças apresentaram comorbidades. 71% eram sintomáticas sendo que 48% delas apresentaram sintomas leves. As manifestações clínicas foram respiratórias em 96 (65%) e não respiratórias em 51 (febre sem foco 15, digestiva 19, exantema viral 3, SIM-Ped S 10 e atípico 3). 30 crianças foram internadas na Unidade de Terapia Intensiva e 3 precisaram de ventilação invasiva; esses pacientes apresentavam comorbidades, necessitaram de oxigenoterapia e tiveram mais dias de febre do que aqueles que não necessitaram de UTI. Uma paciente de 2 anos com comorbidades faleceu. Conclusão: a frequência de internações foi de 1,6%. A maioria das crianças sintomáticas apresentou formas leves. Nas sintomáticas as manifestações foram respiratórias. Os achados desta série contribuem para o conhecimento do comportamento da infecção por SARS CoV-2 em crianças.

Conhecimento da equipe de enfermagem da unidade de transplante no reconhecimento da insuficiência respiratória / Knowledge of the transplant unit nursing team at the recognition of respiratory insufficiency / Conocimiento del equipo de enfermería de la unidad de trasplante en el reconocimiento de la insuficiencia respiratoria

O estudo objetivou avaliar o conhecimento da equipe de enfermagem do transplante de células-tronco hematopoiéticas acerca do manejo à Insuficiência Respiratória (IRpA), bem como realizar uma capacitação para tal. Trata-se de uma pesquisa de campo, de caráter descritivo-exploratória, quantitativa. A coleta de dados foi realizada no período de julho e agosto de 2021 e contou com a participação de 20 colaboradores. Foram empregadas duas avaliações teóricas (início e fim) e uma simulação in loco. Os resultados demonstram que os profissionais de enfermagem do setor de transplante de células tronco-hematopoiéticas melhoraram a performance geral nas respostas às questões de urgência e emergência e também no conhecimento específico dos principais sinais e sintomas da IRpA e intervenções na ventilação após o treinamento. O estudo contribuiu para reforçar a necessidade da prática de enfermagem baseada em evidências científicas e a necessidade de educação permanente da equipe para a melhoria das práticas assistenciais.

The study aimed to evaluate the knowledge of the hematopoietic stem cell transplant nursing team about the management of Respiratory Failure , as well as to carry out training for this purpose. This is a field research of descriptive-exploratory, quantitative nature. Data collection was carried out between July and August 2021 and had the participation of 20 employees. Two theoretical evaluations (beginning and end) and an in loco simulation were used. The results show that after being trained nurses in the hematopoietic stem cell transplantation sector, improved their general performance when responding to urgent and emergency questions and in their specific knowledge of the main signs and symptoms of respiratory failure and ventilation interventions. The study contributed to reinforce the need for evidence-based nursing practice and the need for permanent education of the team to improve care practices.

El estudio tuvo como objetivo evaluar el conocimiento del equipo de enfermería de trasplante de progenitores hematopoyéticos sobre el manejo de la Insuficiencia Respiratoria (RIpA), así como realizar capacitaciones para tal fin. Es una investigación de campo, descriptiva-exploratoria, cuantitativa. La recolección de datos se realizó entre julio y agosto de 2021 y tuvo la participación de 20 colaboradores. Se utilizaron dos evaluaciones teóricas (inicio y final) y una simulación in loco. Los resultados muestran que las enfermeras del sector del trasplante de células progenitoras hematopoyéticas, tras la formación, mejoraron su desempeño general en la respuesta a las consultas urgentes y de emergencia, así como su conocimiento específico de los principales signos y síntomas de la IRA y de las intervenciones en ventilación. El estudio contribuyó a reforzar la necesidad de una práctica de enfermería basada en evidencias científicas y la necesidad de educación permanente del equipo para mejorar las prácticas de cuidado.

Cánula nasal de alto flujo en pacientes críticos: una revisión narrativa / High Flow Nasal Cannula in Critically Ill Patients: a Narrative Review

La cánula nasal de alto flujo se ha convertido en una de las principales estrategias de soporte ventilatorio no invasivo en la insuficiencia respiratoria aguda hipoxémica, principalmente después de la pandemia de COVID-19. Sin embargo, su uso se extiende más allá de este escenario y abarca diferentes condiciones clínicas como el período postextubación, período postquirúrgico, insuficiencia respiratoria hipercápnica y soporte vital en pacientes inmunodeprimidos, trasplantados u oncológicos. Los manuscritos que avalan su aplicación han sido ampliamente difundidos y el grado de evidencia es lo suficientemente alto como para recomendar su uso. Por tanto, es necesario destacar sus efectos fisiológicos como el confort, una fracción inspirada de oxígeno precisa, el lavado de CO2 o la optimización del volumen pulmonar de fin de espiración para comprender su mecanismo de acción y mejorar los resultados de los pacientes. El objetivo de esta revisión narrativa es ofrecer un resumen breve y conciso de los efectos y beneficios de aplicar esta terapia en diferentes escenarios clínicos sin la estructura rígida de una revisión sistemática. Con base en estas líneas, el lector curioso puede ampliar la evidencia científica que avala el empleo de la cánula nasal de alto flujo en cada escenario particular. (AU);

High-flow nasal cannula has become one of the main strategies for non-invasive ventilatory support in hypoxemic acute respiratory failure, mainly after the COVID-19 pandemic. However, its use extends beyond this scenario and covers different clinical conditions such as the post-extubation period, post-surgical period, hypercapnic respiratory failure and life support in immunosuppressed, trasplant or cancer patients. Manuscripts that support its application have been widely disseminated and the degree of evidence is high enough to recommend its use. Therefore, it is necessary to highlight its physiological effects such as comfort, precise fraction of inspiratory oxygen, CO2 lavage or optimize end-expiratory lung volume to understand its mechanism of action and improve patients' outcomes. The objective of this narrative review is to offer a brief and concise summary of the benefits of applying this therapy in different clinical scenarios without the rigid structure of a systematic review. Based on these lines, the curious reader can expand the scientific evidence that supports the use of the high-flow nasal cannula in each particular scenario. (AU);

Perioperative mortality and morbidity of hip fractures among COVID-19 infected and non-infected patients: A systematic review and meta-analysis / 中华创伤杂志(英文版)

PURPOSE@#Hip fractures among elderly patients are surgical emergencies. During COVID-19 pandemic time, many such patients could not be operated at early time because of the limitation of the medical resources, the risk of infection and redirection of medical attention to a severe infective health problem.@*METHODS@#A search of electronic databases (PubMed, Medline, CINAHL, EMBASE and the Cochrane Central Register of Controlled Trials) with the keywords "COVID", "COVID-19″, "SARS-COV-2", "Corona", "pandemic", "hip fracture", "trochanteric fracture" and "neck femur fracture" revealed 64 studies evaluating treatment of hip fracture in elderly patients during COVID-19 pandemic time. The 30-day mortality rate, inpatient mortality rate, critical care/special care need, readmission rate and complications rate in both groups were evaluated. Data were analyzed using Review Manager (RevMan) V.5.3.@*RESULTS@#After screening, 7 studies were identified that described the mortality and morbidity in hip fractures in both COVID-19 infected (COVID-19 +) and non-infected (COVID-19 -) patients. There were significantly increased risks of 30-day mortality (32.23% COVID-19 + death vs. 8.85% COVID-19 - death) and inpatient mortality (29.33% vs. 2.62%) among COVID-19 + patients with odds ratio (OR) of 4.84 (95% CI: 3.13 - 7.47, p < 0.001) and 15.12 (95% CI: 6.12 - 37.37, p < 0.001), respectively. The COVID-19 + patients needed more critical care admission (OR = 5.08, 95% CI: 1.49 - 17.30, p < 0.009) and they remain admitted for a longer time in hospital (mean difference = 3.6, 95% CI: 1.74 - 5.45, p < 0.001); but there was no difference in readmission rate between these 2 groups. The risks of overall complications (OR = 17.22), development of pneumonia (OR = 22.25), and acute respiratory distress syndrome/acute respiratory failure (OR = 32.96) were significantly high among COVID-19 + patients compared to COVID-19 - patients.@*CONCLUSIONS@#There are increased risks of the 30-day mortality, inpatient mortality and critical care admission among hip fracture patients who are COVID-19 +. The chances of developing pneumonia and acute respiratory failure are more in COVID-19 + patients than in COVID-19 ‒ patients.

Clinical characteristics of plastic bronchitis and risk factors for recurrence in children / 中国当代儿科杂志

OBJECTIVES@#To study the clinical characteristics of plastic bronchitis (PB) in children and investigate the the risk factors for recurrence of PB.@*METHODS@#This was a retrospective analysis of medical data of children with PB who were hospitalized in Children's Hospital of Chongqing Medical University from January 2012 to July 2022. The children were divided into a single occurrence of PB group and a recurrent PB group and the risk factors for recurrence of PB were analyzed.@*RESULTS@#A total of 107 children with PB were included, including 61 males (57.0%) and 46 females (43.0%), with a median age of 5.0 years, and 78 cases (72.9%) were over 3 years old. All the children had cough, 96 children (89.7%) had fever, with high fever in 90 children. Seventy-three children (68.2%) had shortness of breath, and 64 children (59.8%) had respiratory failure. Sixty-six children (61.7%) had atelectasis and 52 children (48.6%) had pleural effusion. Forty-seven children (43.9%) had Mycoplasma pneumoniae infection, 28 children (26.2%) had adenovirus infection, and 17 children (15.9%) had influenza virus infection. Seventy-one children (66.4%) had a single occurrence of PB, and 36 cases (33.6%) had recurrent occurrence of PB (≥2 times). Multivariate logistic regression analysis showed that involvement of ≥2 lung lobes (OR=3.376) under bronchoscopy, continued need for invasive ventilation after initial removal of plastic casts (OR=3.275), and concomitant multi-organ dysfunction outside the lungs (OR=2.906) were independent risk factors for recurrent occurrence of PB (P<0.05).@*CONCLUSIONS@#Children with pneumonia accompanied by persistent high fever, shortness of breath, respiratory failure, atelectasis or pleural effusion should be highly suspected with PB. Involvement of ≥2 lung lobes under bronchoscopy, continued need for invasive ventilation after initial removal of plastic casts, and concomitant multi-organ dysfunction outside the lungs may be risk factors for recurrent occurrence of PB.

Design and application of decompression fixator to prevent HFNC facial pressure injury / 中华危重病急救医学

As a new respiratory support technique, high-flow nasal cannula oxygen therapy (HFNC) has been widely used in clinical practice in recent years. During HFNC treatment, due to the long time and continuous wearing of nasal stopper and fasteners on the patient face, it is easy to cause medical device-related pressure injury on multiple facial skin. Moreover, when the patient's position changes greatly, because there is no good fixed design at the HFNC nasal stopper, it is easy to shift or turn the nasal stopper outward, causing abnormal ventilation and failure to achieve the purpose of clinical oxygen therapy. To overcome above problems, medical staff in the intensive care unit of department of infectious diseases, Tongji Hospital Tongji Medical College of HUST designed a new type of decompression fixator to prevent HFNC face pressure injury, and obtained national utility model patent (ZL 2022 2 0754626.1). The integrated design structure of the device has the functions of decompression of facial skin and fixation of nasal stopper, which can ensure the effect of oxygen therapy and improve the oxygen therapy experience and patient comfort, which is suitable for clinical promotion.

Expert Consensus on Acute Respiratory Failure in Critically Ill Cancer Patients (2023) / 中国医学科学杂志(英文版)

Objective This consensus aims to provide evidence-based recommendations on common questions in the diagnosis and treatment of acute respiratory failure (ARF) for critically ill cancer patients.Methods We developed six clinical questions using the PICO (Population, Intervention, Comparison, and Outcome) principle in diagnosis and treatment for critical ill cancer patients with ARF. Based on literature searching and meta-analyses, recommendations were devised. The GRADE (Grading of Recommendation Assessment, Development and Evaluation) method was applied to each question to reach consensus in the expert panel. Results The panel makes strong recommendations in favor of (1) metagenomic next-generation sequencing (mNGS) tests may aid clinicians in rapid diagnosis in critically ill cancer patients suspected of pulmonary infections; (2) extracorporeal membrane oxygenation (ECMO) therapy should not be used as a routine rescue therapy for acute respiratory distress syndrome in critically ill cancer patients but may benefit highly selected patients after multi-disciplinary consultations; (3) cancer patients who have received immune checkpoint inhibitor therapy have an increased incidence of pneumonitis compared with standard chemotherapy; (4) critically ill cancer patients who are on invasive mechanical ventilation and estimated to be extubated after 14 days may benefit from early tracheotomy; and (5) high-flow nasal oxygen and noninvasive ventilation therapy can be used as a first-line oxygen strategy for critically ill cancer patients with ARFs. A weak recommendation is: (6) for critically ill cancer patients with ARF caused by tumor compression, urgent chemotherapy may be considered as a rescue therapy only in patients determined to be potentially sensitive to the anticancer therapy after multidisciplinary consultations. Conclusions The recommendations based on the available evidence can guide diagnosis and treatment in critically ill cancer patients with acute respiratory failure and improve outcomes.

Superiority of sugammadex in preventing postoperative pulmonary complications / 中华医学杂志(英文版)

BACKGROUND@#Postoperative pulmonary complications often lead to increased mortality and financial burden. Residual paralysis plays a critical role in postoperative pulmonary complications. This meta-analysis was performed to determine whether sugammadex overmatches neostigmine in reducing postoperative pulmonary complications.@*METHODS@#PubMed, Embase, Web of Science, Medline through Ovid, Cochrane Library, Wanfang, China National Knowledge Infrastructure, and Chinese BioMedical Literature Databases were searched from their inception to 24 June, 2021. Random effects models were used for all analyses. Cochrane risk of bias tool was used to assess the quality of RCTs, while Newcastle Ottawa Quality Assessment Scale was used to assess for the quality of cohort studies.@*RESULTS@#Seventeen studies were included in the meta-analysis. Pooled data from cohort studies showed reversing neuromuscular blocking with sugammadex had less risk of compound postoperative pulmonary complications (relative risk [RR]: 0.73; 95% confidence interval [CI]: 0.60-0.89; P  = 0.002; I2  = 81%), pneumonia (RR: 0.64; 95% CI: 0.48-0.86; I2  = 42%) and respiratory failure (RR: 0.48; 95% CI: 0.41-0.56; I2  = 0%). However, pooled data from RCTs did not show any difference between the two groups in pneumonia (RR: 0.58; 95% CI: 0.24-1.40; I2  = 0%) and no respiratory failure was reported in the included RCTs. The difference was not found between sugammadex and neostigmine about atelectasis in pooled data from either RCTs (RR: 0.85; 95% CI: 0.69-1.05; I2  = 0%) or cohort studies (RR: 1.01; 95% CI: 0.87-1.18; I2  = 0%).@*CONCLUSION@#The evidence of superiority of sugammadex was limited by the confounding factors in cohort studies and small scale of RCTs. Whether sugammadex precedes neostigmine in preventing pulmonary complications after surgery is still unknown. Well-designed RCTs with large scale are needed.@*REGISTRATION@#PROSPERO ( https://www.crd.york.ac.uk/PROSPERO/ ); CRD 42020191575.

Congenital pulmonary alveolar proteinosis in a neonate / 中国当代儿科杂志

The male patient was referred to the hospital at 44 days old due to dyspnea after birth and inability to wean off oxygen. His brother died three days after birth due to respiratory failure. The main symptoms observed were respiratory failure, dyspnea, and hypoxemia. A chest CT scan revealed characteristic reduced opacity in both lungs with a "crazy-paving" appearance. The bronchoalveolar lavage fluid (BALF) showed periodic acid-Schiff positive proteinaceous deposits. Genetic testing indicated a compound heterozygous mutation in the ABCA3 gene. The diagnosis for the infant was congenital pulmonary alveolar proteinosis (PAP). Congenital PAP is a significant cause of challenging-to-treat respiratory failure in full-term infants. Therefore, congenital PAP should be considered in infants experiencing persistently difficult-to-treat dyspnea shortly after birth. Early utilization of chest CT scans, BALF pathological examination, and genetic testing may aid in early diagnosis.

Therapeutic efficacy of volume-guaranteed high frequency oscillation ventilation on respiratory failure in preterm infants with a gestational age of 28-34 weeks: a prospective randomized controlled study / 中国当代儿科杂志

OBJECTIVES@#To investigate the therapeutic efficacy of volume-guaranteed high frequency oscillation ventilation (HFOV-VG) versus conventional mechanical ventilation (CMV) in the treatment of preterm infants with respiratory failure.@*METHODS@#A prospective study was conducted on 112 preterm infants with respiratory failure (a gestational age of 28-34 weeks) who were admitted to the Department of Neonatology, Jiangyin Hospital Affiliated to Medical School of Southeast University, from October 2018 to December 2022. The infants were randomly divided into an HFOV-VG group (44 infants) and a CMV group (68 infants) using the coin tossing method based on the mode of mechanical ventilation. The therapeutic efficacy was compared between the two groups.@*RESULTS@#After 24 hours of treatment, both the HFOV-VG and CMV groups showed significant improvements in arterial blood pH, partial pressure of oxygen, partial pressure of carbon dioxide, and partial pressure of oxygen/fractional concentration of inspired oxygen ratio (P<0.05), and the HFOV-VG group had better improvements than the CMV group (P<0.05). There were no significant differences between the two groups in the incidence rate of complications, 28-day mortality rate, and length of hospital stay (P>0.05), but the HFOV-VG group had a significantly shorter duration of invasive mechanical ventilation than the CMV group (P<0.05). The follow-up at the corrected age of 6 months showed that there were no significant differences between the two groups in the scores of developmental quotient, gross motor function, fine motor function, adaptive ability, language, and social behavior in the Pediatric Neuropsychological Development Scale (P>0.05).@*CONCLUSIONS@#Compared with CMV mode, HFOV-VG mode improves partial pressure of oxygen and promotes carbon dioxide elimination, thereby enhancing oxygenation and shortening the duration of mechanical ventilation in preterm infants with respiratory failure, while it has no significant impact on short-term neurobehavioral development in these infants.

Ventilación no invasiva en sala de hospitalización general / Non-Invasive Ventilation in a Regular Hospital Ward

Introducción: La experiencia clínica ha permitido la ventilación no invasiva fuera de unidades críticas. Describimos el perfil clínico y evolución de pacientes que recibieron ventilación no invasiva en sala general. Material y métodos: Estudio retrospectivo en pacientes con soporte ventilatorio du rante un año en un hospital general. Resultados: Se utilizó ventilación no invasiva en 43 pacientes, 67,4% con hipercap nia. La relación hombre/mujer fue 1:1. La edad y el IMC fueron 68,3 ± 12,4 años y 30,1 ± 12,3 kg/m2 y los diagnósticos principales, enfermedad pulmonar obstructiva crónica, enfermedad neuromuscular y obesidad-hipoventilación. Un tercio inició la ventilación no invasiva en la unidad de cuidados intensivos, y dos tercios usaban ventilación no invasiva en domicilio antes del ingreso por exacerbación de la enfermedad pulmonar obstructiva crónica (39,5%) o progresión de la enfermedad (14%). La estancia hospi talaria fue 12,1 ± 7 d (14 ± 9 en supervivientes y 5,7 ± 3 en pacientes fallecidos). La gasometría arterial al ingreso reveló PaCO2: 52,7 ± 13,7 mmHg; PaO2: 72,2 ± 16,2 mmHg y pH de 7,36 ± 0,08. Se halló pH < 7,35 en el 18,6% y PaCO2 > 45 en el 57,4%. La PaCO2 al alta fue menor (46,1 ± 4,6; p > 0,05). El modo ST se utilizó en 34 (79%) pacientes. El período de ventilación fue 12,7 ± 10,2 días con uso de 6,9 ± 3,1 h/d. Un tercio recibió cuidados paliativos (13,9% de mortalidad). Tres pacientes (7%) fueron transferidos a la unidad de cuidados intensivos por deterioro clínico y treinta y cinco egresaron con ventilación crónica (94,6%). Conclusiones: Hubo escasas transferencias a la unidad de cuidados intensivos. La mortalidad hospitalaria fue baja y los que fallecieron tenían instrucciones anticipadas.

Introduction: Clinical experience has allowed the use of non-invasive ventilation out side the acute-care setting. We describe the clinical profile and evolution of patients who received non-invasive ventilation in a regular ward. Materials and methods: Retrospective study in patients with ventilatory support for one year in a general hospital. Results: Non-invasive ventilation was delivered to 43 patients, 67.4% of which had hy percapnia. The male/female ratio was 1:1. Age and BMI (Body Mass Index) were 68.3 ± 12.4 years and 30.1 ± 12.3 kg/m2, and the main diagnoses were chronic obstructive pulmonary disease, neuromuscular disease and obesity-hypoventilation. One third of patients began non-invasive ventilation in the Intensive Care Unit, and two thirds had been using non-invasive ventilation at their homes before being admitted with exacerba tion of chronic obstructive pulmonary disease (39.5%) or disease progression (14%). Hospital length of stay was 12.1 ± 7 d (14 ± 9 in survivors and 5.7 ± 3 in deceased patients). Arterial blood gas analysis on admission showed: PaCO2 (partial pressure of arterial carbon dioxide), 52.7 ± 13.7 mmHg; PaO2 (partial pressure of arterial oxygen), 72.2 ± 16.2 mmHg, and pH, 7.36 ± 0.08. A pH level < 7.35 was found in 18.6%, and PaCO2 > 45 in 57.4%. PaCO2 values upon discharge were lower (46.1 ± 4.6; p > 0.05). The ST (spontaneous-timed) mode was used in 34 patients (79%). The ventilation period was 12.7 ± 10.2 days, using 6.9 ± 3.1 h/d. One third of patients received palliative care (13.9% of mortality). Three patients (7%) were transferred to the Intensive Care Unit due to clinical decline, and thirty-five were discharged with chronic ventilation (94.6%). Conclusions: there were few referrals to the Intensive Care Unit. Hospital mortality was low, and patients who died had advance directives.

Ventilación mecánica no invasiva en ingresados en un centro provisional para pacientes con CO VID-19 moderada / Non-invasive mechanical ventilation in patients admitted to a provisional center for moderate COVID-19 patients

Introducción: La ventilación mecánica no invasiva es una alternativa ventilatoria para los casos con COVID-19. Objetivo: Describir las características y la evolución de la ventilación mecánica no invasiva en los pacientes egresados en el Centro Provisional para pacientes moderados con COVID-19 en Figali, Panamá. Métodos: Estudio descriptivo, retrospectivo, longitudinal. Incluyó a todos los pacientes adultos egresados entre junio y julio del 2021 que recibieron ventilación mecánica no invasiva. Se utilizó un cuestionario cuya fuente primaria fue la historia clínica individual digital. Se emplearon técnicas de la estadística descriptiva. Resultados: De 217 ingresados con COVID-19 moderado, 78 (35,9 por ciento) necesitaron ventilación mecánica no invasiva, iniciada con media al noveno día de síntomas y segundo después del ingreso. De estos, el 62,8 por ciento eran obesos y el 29,5 por ciento hipertensos. En el 56,4 por ciento, la frecuencia respiratoria ≥30 y la disminución de la razón PaO2/FiO2 fueron los indicadores principales que decidieron el inicio de la VMNI. Del total de ventilados, el 62,8 por ciento tuvo un síndrome de distrés respiratorio agudo moderado-grave y esto se relacionó con el fracaso de la ventilación. La ventilación fue exitosa en el 65,4 por ciento. La razón PaO2/FiO2 <150 (62,9 por ciento), la frecuencia respiratoria ≥30 (55,6 por cientpo y el agotamiento físico (51,85 por ciento), indicaron la falla de la ventilación. Conclusiones: La ventilación mecánica no invasiva es un proceder efectivo en pacientes con COVID-19 y distrés respiratorio moderado o severo; aunque su éxito se relaciona con las formas menos graves. La PaO2/FiO2 baja junto a la clínica, fueron indicadores clave para evaluar inicio, éxito o fracaso de la ventilación mecánica no invasiva; no así los valores de PaO2, PaCO2 y SpO2(AU)

Introduction: Non-invasive mechanical ventilation is a ventilatory alternative for COVID-19 cases. Objective: To describe the characteristics and evolution of non-invasive mechanical ventilation (NIMV) in patients discharged from Provisional Center for moderate COVID-19 patients in Figali, Panama. Methods: A descriptive, retrospective, longitudinal stu was carried out in all adult patients discharged from June to July 2021 and who received non-invasive mechanical ventilation. A questionnaire was used using the digital individual medical record as primary source. Descriptive statistics techniques were used. Results: 35.9percent of the patients (78/217) who were admitted required non-invasive mechanical ventilation on the ninth day of symptoms and the second day after admission. 62.8percent (49/78) were obese and 29.5percent (23/78) hypertensive. The respiratory rate ≥30 and the decrease in the PaO2/FiO2 ratio decided the begining of non-invasive mechanical ventilation in 56.4percent (78/217) of those admitted. 62.8percent (49/78) had moderate-severe acute respiratory distress syndrome, and the severity was related to ventilation failure out of the total number of ventilated patients. Ventilation was successful in 65.4percent (51/78). PaO2/FiO2 <150 (62.9percent), respiratory rate ≥30 (55.6percent) and physical exhaustion (51.85percent) decided ventilation failure. Conclusions: Non-invasive mechanical ventilation is an effective procedure in COVID-19 patients and moderate or severe respiratory distress; although its success is related to the less severe forms. Low PaO2/FiO2, together with symptoms, were key indicators to assess the begining, success or failure of NIMV; not so the values of PaO2, PaCO2 and SpO2(AU)

A importância do conhecimento técnico e científico do enfermeiro no procedimento de intubação traqueal / La importancia del conocimiento técnico y científico de la enfermera en el procedimiento de intubación traqueal / The importance of the technical and scientific knowledge of the nurse in the tracheal intubation procedure

Objetivo: identificar o grau do conhecimento técnico e científico dos enfermeiros no procedimento intubação traqueal. Método: pesquisa de campo com caráter descritivo-exploratória e quantitativa tendo identificado, através do resultado de um questionário aplicado a 23 profissionais enfermeiros, em um Hospital Geral do Vale do Paraíba, o grau de conhecimento técnico e científico sobre o procedimento de intubação traqueal. A coleta dos dados foi realizada nos meses de setembro e outubro de 2021. Resultados: a enfermagem participa e desempenha papel importante no procedimento de intubação, desde os diagnósticos até a avaliação contínua dos principais sinais e sintomas, estabelecendo um plano de cuidados, intervenções e atividades que permitirão fornecer o melhor atendimento ao paciente. Conclusão: O conhecimento do enfermeiro durante o procedimento de intubação traquel é de extrema importância, visando a qualidade da assistência, e a segurança do paciente.(AU)

Objective: To identify the degree of technical and scientific knowledge of nurses in the tracheal intubation procedure. Method: descriptive-exploratory and quantitative field research, having identified, through the result of a questionnaire applied to 23 nursing professionals, in a General Hospital of the Paraíba Valley, the degree of technical and scientific knowledge about the tracheal intubation procedure. Data were collected in September and October 2021. Results: nursing participates and plays an important role in the intubation procedure, from diagnoses to continuous evaluation of the main signs and symptoms, establishing a care plan, interventions and activities that will allow providing the best patient care. Conclusion: The knowledge of nurses during the traquel intubation procedure is extremely important, aiming at the quality of care, and patient safety.(AU)

Objetivo: identificar el grado de conocimiento técnico y científico de las enfermeras en el procedimiento de intubación traqueal. Método: investigación de campo descriptiva-exploratoria y cuantitativa, habiendo identificado, a través del resultado de un cuestionario aplicado a 23 profesionales de enfermería, en un Hospital General del Valle de Paraíba, el grado de conocimiento técnico y científico sobre el procedimiento de intubación traqueal. Los datos fueron recolectados en septiembre y octubre de 2021. Resultados: La enfermería participa y juega un papel importante en el procedimiento de intubación, desde el diagnóstico hasta la evaluación continua de los principales signos y síntomas, estableciendo un plan de cuidados, intervenciones y actividades que permitan brindar la mejor atención al paciente. Conclusión: El conocimiento de las enfermeras durante el procedimiento deintubación de traquel es extremadamente importante, apuntando a la calidad de la atención y la seguridad del paciente.(AU)