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1.
Rev Assoc Med Bras (1992) ; 66(4): 498-501, 2020 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-32578785

RESUMO

The emergence of the Coronavirus Disease 2019 (COVID-19) pandemic shows a rapid increase in cases and deaths. The World Health Organization (WHO) has shown that more than 200.000 confirmed cases have been identified in more than 166 countries/territories. Public health authorities in Brasil have reported 532 confirmed cases by March 19. Approximately 5% of the patients will require intensive care unit treatment with oxygen therapy and mechanical ventilation. Limited data are available about rehabilitation protocols for severe illness and intensive care treatment of COVID-19 increase. Thus, we aim to show current information about COVID-19, describing symptoms and the respiratory management for critical patients and preventive care. Physical therapists and all health care professionals need to recognize the challenges they will face in the coming months.


Assuntos
Betacoronavirus , Infecções por Coronavirus/terapia , Fisioterapeutas/normas , Modalidades de Fisioterapia/normas , Pneumonia Viral/terapia , Brasil , Infecções por Coronavirus/fisiopatologia , Infecções por Coronavirus/prevenção & controle , Cuidados Críticos/normas , Humanos , Pandemias/prevenção & controle , Pneumonia Viral/fisiopatologia , Pneumonia Viral/prevenção & controle , Guias de Prática Clínica como Assunto/normas , Síndrome do Desconforto Respiratório do Adulto/terapia , Terapia Respiratória/normas
2.
Monaldi Arch Chest Dis ; 90(2)2020 Jun 23.
Artigo em Inglês | MEDLINE | ID: mdl-32573175

RESUMO

There is a need of consensus about the pulmonary rehabilitation (PR) in patients with COVID-19 after discharge from acute care. To facilitate the knowledge of the evidence and its translation into practice, we developed suggestions based on experts' opinion. A steering committee identified areas and questions sent to experts. Other international experts participated to a RAND Delphi method in reaching consensus and proposing further suggestions. Strong agreement in suggestions was defined when the mean agreement was >7 (1 = no agreement and 9 = maximal agreement). Panelists response rate was >95%. Twenty-three questions from 4 areas: Personnel protection equipment, phenotypes, assessments, interventions, were identified and experts answered with 121 suggestions, 119 of which received high level of concordance. The evidence-based suggestions provide the clinicians with current evidence and clinical experts opinion. This framework can be used to facilitate clinical decision making within the context of the individual patient. Further studies will evaluate the clinical usefulness of these suggestions.


Assuntos
Infecções por Coronavirus/reabilitação , Modalidades de Fisioterapia , Pneumonia Viral/reabilitação , Insuficiência Respiratória/reabilitação , Terapia Respiratória/métodos , Assistência Ambulatorial , Betacoronavirus , Infecções por Coronavirus/complicações , Infecções por Coronavirus/fisiopatologia , Técnica Delfos , Teste de Esforço , Humanos , Unidades de Terapia Intensiva , Itália , Estado Nutricional , Pandemias , Equipamento de Proteção Individual , Pneumonia Viral/complicações , Pneumonia Viral/fisiopatologia , Qualidade de Vida , Testes de Função Respiratória , Insuficiência Respiratória/etiologia , Insuficiência Respiratória/fisiopatologia , Transtornos de Estresse Pós-Traumáticos
3.
J Pak Med Assoc ; 70(Suppl 3)(5): S60-S63, 2020 May.
Artigo em Inglês | MEDLINE | ID: mdl-32515384

RESUMO

The current pandemic of COVID-19 has infected around 2.5 million people with more than 125,000 deaths across the globe till date, and numbers are still rising. The causative organism is a virus of corona family. The International Committee on Taxonomy of Viruses (ICTV) named it severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) due to its similarities with the virus was caused SARS outbreak (SARS-CoV). Although most of the patients present with less severe symptoms like rhinitis, cough, fever, and mild flu-like symptoms, it may progress to severe acute respiratory illness, pneumonia or acute respiratory distress syndrome (ARDS) mainly in immunocompromised hosts. Severe infections mainly involve lungs, and compromise its capacity of ventilation. Respiratory and mechanical ventilation is one of the important parts of management.


Assuntos
Betacoronavirus , Infecções por Coronavirus , Pandemias , Pneumonia Viral , Terapia Respiratória , Infecções por Coronavirus/epidemiologia , Infecções por Coronavirus/fisiopatologia , Infecções por Coronavirus/terapia , Humanos , Pneumonia Viral/epidemiologia , Pneumonia Viral/fisiopatologia , Pneumonia Viral/terapia , Síndrome do Desconforto Respiratório do Adulto
4.
Medicine (Baltimore) ; 99(18): e19826, 2020 May.
Artigo em Inglês | MEDLINE | ID: mdl-32358353

RESUMO

BACKGROUND: Chronic obstructive pulmonary disease (COPD) is an irreversible disease characterized by cough, sputum production, and dyspnea, and has a high prevalence and mortality. Pulmonary rehabilitation (PR) is a management that improves the quality of life for COPD patients; however, PR is not readily accessible. Therefore, we developed lung-conduction exercises (LCE) that can be performed without any limitations. LCE consists of breathing, stretching, and tapping to relieve dyspnea in COPD patients. METHODS/DESIGN: This randomized, assessor-blind, multicenter trial aims to recruit 54 patients with moderate and severe COPD. Subjects will be randomly allocated to a control group (only medication), an LCE group (medication + LCE, 5 times a week), or a PR group (medication + PR, 5 times a week). The 6-minute walk distance, pulmonary function tests (forced expiratory volume at 1 second, forced vital capacity, and forced expiratory volume at 1 second/forced vital capacity), modified Borg scale, modified medical research council dyspnea scale, COPD assessment test, and St. George respiratory questionnaire will be measured before starting the trial and after the 4th and 8th weeks to determine motor performance, lung function, and dyspnea. CONCLUSION: We aim to demonstrate that LCE is effective in improving symptoms and psychosomatic stability in COPD patients. Therefore, this trial will play an important role in fortifying the foundation of clinical application.


Assuntos
Exercícios Respiratórios/métodos , Terapia por Exercício/métodos , Doença Pulmonar Obstrutiva Crônica/terapia , Terapia Respiratória/métodos , Adulto , Idoso , Idoso de 80 Anos ou mais , Feminino , Humanos , Pulmão/fisiopatologia , Masculino , Pessoa de Meia-Idade , Doença Pulmonar Obstrutiva Crônica/fisiopatologia , Ensaios Clínicos Controlados Aleatórios como Assunto , Testes de Função Respiratória , Método Simples-Cego , Resultado do Tratamento
5.
Monaldi Arch Chest Dis ; 90(2)2020 May 19.
Artigo em Inglês | MEDLINE | ID: mdl-32431134

RESUMO

Due to COVID-19 outbreak, to lighten the burden of acute and critical care hospitals, some respiratory rehabilitation departments have been used to host patients with COVID-19 in the post-acute phase. This new and unexpected situation required a change of roles and scheduling of the rehabilitation teams. In this manuscript we describe the unexpected and urgent organizational change of the Cardio-Pulmonary Rehabilitation (CPR) service during the COVID-19 emergency in a Northern Italian rehabilitation hospital, focusing on the Respiratory Physiotherapists' (RPTs) role. A quick three-days complete reorganization of the entire hospital was needed. A COVID-19 care team including a multidisciplinary panel of physicians, nurses, and RPTs was quickly performed to manage 90 beds for post acute patients with COVID-19. Within the team, the RPTs changed their shifts, so as to be available 16h per day, 7 days out of 7. Remodelled tasks in charge of RPTs were: oxygen therapy daily monitoring, non invasive ventilation (NIV) and continuous positive airways pressure (CPAP) delivery, pronation and postural changes to improve oxygenation, reconditioning with leg/arm cranking and exercises, initial and final patients' functional assessment by short-physical performance battery (SPPB) and 1-minute sit-to-stand test (1-STS) to evaluate motor conditions and exercise-induced oxygen desaturation. Three "what-to-do" algorithms were developed to guide: i) oxygen de-escalation by reducing inhaled fraction of oxygen (FiO2); ii) oxygenation improvement through the use of Venturi mask; iii) reconditioning and physical activity. One-hundred seventy patients were treated in one month. As main topics, RPTs have been involved in oxygen therapy management in almost a third of the admitted patients, reconditioning exercises in 60% of the cases, and initial and final functional motor capacity assessment in all patients. Details of activities performed by the RPT in one typical working day are also shown. Our reorganization has exploited the professional skills and clinical expertise of the RPTs. This re-organization can provide practical insights to other facilities that are facing this crisis, and may be a starting point for implementing post-COVID-19 rehabilitation. Future studies will have to improve and review this organization.


Assuntos
Betacoronavirus , Infecções por Coronavirus/reabilitação , Pneumonia Viral/reabilitação , Insuficiência Respiratória/reabilitação , Terapia Respiratória/métodos , Pressão Positiva Contínua nas Vias Aéreas , Infecções por Coronavirus/complicações , Humanos , Itália , Ventilação não Invasiva , Pandemias , Modalidades de Fisioterapia , Pneumonia Viral/complicações , Respiração Artificial , Insuficiência Respiratória/terapia , Terapia Respiratória/tendências
7.
Complement Ther Clin Pract ; 39: 101166, 2020 May.
Artigo em Inglês | MEDLINE | ID: mdl-32379637

RESUMO

BACKGROUND: Different degrees of disorders are reported in respiratory function, physical function and psychological function in patients with corona virus disease 2019 (COVID-19), especially in elderly patients. With the experience of improved and discharged COVID-19 patients, timely respiratory rehabilitation intervention may improve prognosis, maximize functional preservation and improve quality of life (QoL), but there lacks of studies worldwide exploring the outcome of this intervention. OBJECTIVE: To investigate the effects of 6-week respiratory rehabilitation training on respiratory function, QoL, mobility and psychological function in elderly patients with COVID-19. METHODS: This paper reported the findings of an observational, prospective, quasi-experimental study, which totally recruited 72 participants, of which 36 patients underwent respiratory rehabilitation and the rest without any rehabilitation intervention. The following outcomes were measured: pulmonary function tests including plethysmography and diffusing lung capacity for carbon monoxide (DLCO), functional tests (6-min walk distance test), Quality of life (QoL) assessments (SF-36 scores), activities of daily living (Functional Independence Measure, FIM scores), and mental status tests (SAS anxiety and SDS depression scores). RESULTS: After 6 weeks of respiratory rehabilitation in the intervention group, there disclosed significant differences in FEV1(L), FVC(L), FEV1/FVC%, DLCO% and 6-min walk test. The SF-36 scores, in 8 dimensions, were statistically significant within the intervention group and between the two groups. SAS and SDS scores in the intervention group decreased after the intervention, but only anxiety had significant statistical significance within and between the two groups. CONCLUSIONS: Six-week respiratory rehabilitation can improve respiratory function, QoL and anxiety of elderly patients with COVID-19, but it has little significant improvement on depression in the elderly.


Assuntos
Infecções por Coronavirus/reabilitação , Pneumonia Viral/reabilitação , Terapia Respiratória , Atividades Cotidianas , Idoso , Ansiedade/etiologia , Ansiedade/terapia , Betacoronavirus , Infecções por Coronavirus/complicações , Infecções por Coronavirus/psicologia , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Pandemias , Pneumonia Viral/complicações , Pneumonia Viral/psicologia , Estudos Prospectivos , Qualidade de Vida , Testes de Função Respiratória , Terapia Respiratória/métodos , Caminhada
8.
Rev Mal Respir ; 37(6): 505-510, 2020 Jun.
Artigo em Francês | MEDLINE | ID: mdl-32410773

RESUMO

The French-language Respiratory Medicine Society (SPLF) proposes a guide for the follow-up of patients who have presented with SARS-CoV-2 pneumonia. The proposals are based on known data from previous epidemics, on acute lesions observed in SARS-CoV-2 patients and on expert opinion. This guide proposes a follow-up based on three categories of patients: (1) patients managed outside hospital for possible or proven SARS-CoV-2 infection, referred by their physician for persistent dyspnoea; (2) patients hospitalized for SARS-CoV-2 pneumonia in a medical unit; (3) patients hospitalized for SARS-CoV-2 pneumonia in an intensive care unit. The subsequent follow-up will have to be adapted to the initial assessment. This guide emphasises the possibility of others causes of dyspnoea (cardiac, thromboembolic, hyperventilation syndrome…). These proposals may evolve over time as more knowledge becomes available.


Assuntos
Assistência ao Convalescente/métodos , Infecções por Coronavirus/terapia , Pneumonia Viral/terapia , Assistência ao Convalescente/normas , Assistência Ambulatorial/métodos , Assistência Ambulatorial/normas , Doenças Cardiovasculares/prevenção & controle , Infecções por Coronavirus/complicações , Infecções por Coronavirus/reabilitação , Cuidados Críticos/métodos , Cuidados Críticos/normas , Técnicas de Diagnóstico do Sistema Respiratório/normas , Gerenciamento Clínico , Serviços Médicos de Emergência/métodos , Serviços Médicos de Emergência/normas , Prioridades em Saúde , Hospitalização , Humanos , Pacientes Internados , Pacientes Ambulatoriais , Pandemias , Pneumonia Viral/complicações , Pneumonia Viral/reabilitação , Terapia Respiratória/métodos , Terapia Respiratória/normas , Avaliação de Sintomas/métodos , Avaliação de Sintomas/normas , Tromboembolia/prevenção & controle , Trombofilia/tratamento farmacológico , Trombofilia/etiologia
9.
Monaldi Arch Chest Dis ; 90(1)2020 Mar 26.
Artigo em Inglês | MEDLINE | ID: mdl-32236089

RESUMO

Respiratory physiotherapy in patients with COVID-19 infection in acute setting: a Position Paper of the Italian Association of Respiratory Physiotherapists (ARIR) On February 2020, Italy, especially the northern regions, was hit by an epidemic of the new SARS-Cov-2 coronavirus that spread from China between December 2019 and January 2020. The entire healthcare system had to respond promptly in a very short time to an exponential growth of the number of subjects affected by COVID-19 (Coronavirus disease 2019) with the need of semi-intensive and intensive care units.


Assuntos
Betacoronavirus , Infecções por Coronavirus/terapia , Controle de Infecções/métodos , Ventilação não Invasiva/métodos , Modalidades de Fisioterapia , Pneumonia Viral/etiologia , Respiração Artificial/métodos , Síndrome do Desconforto Respiratório do Adulto/terapia , Insuficiência Respiratória/terapia , Terapia Respiratória/métodos , Infecções por Coronavirus/reabilitação , Cuidados Críticos , Dispneia/etiologia , Humanos , Hipóxia/complicações , Hipóxia/etiologia , Controle de Infecções/normas , Transmissão de Doença Infecciosa do Paciente para o Profissional/prevenção & controle , Itália , Ventilação não Invasiva/normas , Pandemias , Pneumonia Viral/reabilitação , Pneumonia Viral/terapia , Pronação , Respiração Artificial/normas , Síndrome do Desconforto Respiratório do Adulto/etiologia , Síndrome do Desconforto Respiratório do Adulto/reabilitação , Insuficiência Respiratória/etiologia , Insuficiência Respiratória/reabilitação , Dispositivos de Proteção Respiratória , Terapia Respiratória/normas
10.
Zhonghua Jie He He Hu Xi Za Zhi ; 43(4): 288-296, 2020 Apr 12.
Artigo em Chinês | MEDLINE | ID: mdl-32294813

RESUMO

Definite evidence has shown that the novel coronavirus (COVID-19) could be transmitted from person to person, so far more than 1 700 bedside clinicians have been infected. A lot of respiratory treatments for critically ill patients are deemed as high-risk factors for nosocomial transmission, such as intubation, manual ventilation by resuscitator, noninvasive ventilation, high-flow nasal cannula, bronchoscopy examination, suction and patient transportation, etc, due to its high possibility to cause or worsen the spread of the virus. As such, we developed this consensus recommendations on all those high-risk treatments, based on the current evidence as well as the resource limitation in some areas, with the aim to reduce the nosocomial transmission and optimize the treatment for the COVID-19 pneumonia patients. Those recommendations include: (1)Standard prevention and protection, and patient isolation; (2)Patient wearing mask during HFNC treatment; (3)Using dual limb ventilator with filters placed at the ventilator outlets, or using heat-moisture exchanger (HME) instead of heated humidification in single limb ventilator with HME placed between exhalation port and mask; avoid using mask with exhalation port on the mask; (4)Placing filter between resuscitator and mask or artificial airway; (5)For spontaneous breathing patients, placing mask for patients during bronchoscopy examination; for patients receiving noninvasive ventilation, using the special mask with bronchoscopy port to perform bronchoscopy; (6)Using sedation and paralytics during intubation, cuff pressure should be maintained between 25-30 cmH(2)O(1 cmH(2)O=0.098 kPa); (7)In-line suction catheter is recommended and it can be used for one week; (8)Dual-limb heated wire circuits are recommended and only changed with visible soiled; (9)For patients who need breathing support during transportation, placing an HME between ventilator and patient; (10)PSV is recommended for implementing spontaneous breathing trial (SBT), avoid using T-piece to do SBT. When tracheotomy patients are weaned from ventilator, HME should be used, avoid using T-piece or tracheostomy mask. (11)Avoid unnecessary bronchial hygiene therapy; (12) For patients who need aerosol therapy, dry powder inhaler metered dose inhaler with spacer is recommended for spontaneous breathing patients; while vibrating mesh nebulizer is recommended for ventilated patients and additional filter is recommended to be placed at the expiratory port of ventilation during nebulization.


Assuntos
Infecções por Coronavirus/prevenção & controle , Infecções por Coronavirus/terapia , Infecção Hospitalar/prevenção & controle , Pandemias/prevenção & controle , Pneumonia Viral/prevenção & controle , Pneumonia Viral/terapia , Terapia Respiratória/normas , Betacoronavirus , Broncoscopia , Consenso , Infecções por Coronavirus/transmissão , Estado Terminal , Infecção Hospitalar/virologia , Filtração , Humanos , Máscaras , Pneumonia Viral/transmissão , Ventiladores Mecânicos
11.
Zhonghua Jie He He Hu Xi Za Zhi ; 43(4): 308-314, 2020 Apr 12.
Artigo em Chinês | MEDLINE | ID: mdl-32294814

RESUMO

COVID-19 is a highly infectious respiratory infection disease, which leads to dysfunction of respiratory, physical, and psychological of the patients. pulmonary rehabilitation is an important intervention for clinical patients as well as cure patients. With the deeper cognition of COVID-19 and accumulation of clinical experience, we proposed the recommendations for pulmonary rehabilitation of COVID-19 in adults based on the opinions of front-line clinical experts involved in the management of this epidemic and a review of the relevant literature and evidences: (1)for the inpatients with COVID-19, pulmonary rehabilitation would relieve the symptoms of dyspnea, anxiety, and depression; eventually improve physical function and the quality of life; (2)For severe/critical inpatients, the early performance of pulmonary rehabilitation is not suggested. (3)For isolating patients, the pulmonary rehabilitation guidence should be conducted through education video, instruction manual or remote consultation. (4)Assessment and monitor should be performed throughout the entire pulmonary rehabilitation process.(5)Taking proper grading protection following the guideline. These recommendations can serve as a clinical practice guidence and basis for pulmonary rehabilitation of COVID-19.


Assuntos
Infecções por Coronavirus/reabilitação , Infecções por Coronavirus/terapia , Pneumonia Viral/reabilitação , Pneumonia Viral/terapia , Terapia Respiratória/normas , Adulto , Betacoronavirus , Humanos , Pandemias , Guias de Prática Clínica como Assunto , Qualidade de Vida
12.
Turk J Med Sci ; 50(SI-1): 585-591, 2020 04 21.
Artigo em Inglês | MEDLINE | ID: mdl-32293831

RESUMO

Coronavirus disease 2019 (COVID-19) stands out as the major pandemic that we have experienced in the last century. As it affects every social structure, it brought the importance of intensive care support once again to the agenda of healthcare system after causing severe acute respiratory syndrome. The precautions to be taken against this virus, where our knowledge is extremely small, intensive care units take an indispensable place in pandemic planning. In this review, we aimed to emphasize the crucial points regarding intensive care management of COVID-19 patients, which we have written not only for intensivists but also for all healthcare professionals.


Assuntos
Infecções por Coronavirus/terapia , Estado Terminal/terapia , Unidades de Terapia Intensiva/organização & administração , Pneumonia Viral/terapia , Betacoronavirus , Reanimação Cardiopulmonar , Humanos , Controle de Infecções/métodos , Pandemias , Terapia Respiratória , Sepse/complicações , Choque/complicações
13.
Turk J Med Sci ; 50(SI-1): 592-603, 2020 04 21.
Artigo em Inglês | MEDLINE | ID: mdl-32304191

RESUMO

Coronavirus disease (COVID-19) was firstly reported at the end of 2019. The disease rapidly spread all around the world in a few months and was declared a worldwide pandemic by WHO in March 2020. By April 9, there were 1,436,198 confirmed COVID-19 cases in the world, nearly with 6% mortality rate. This novel infectious disease causes respiratory tract illness that may generally occur as mild upper respiratory tract disease or pneumonia. In older patients and/or patients with underlying conditions, it may result in acute respiratory distress syndrome, multi organ failure and even death. According to the current literature, children account approximately for 1%­5% of diagnosed COVID-19 cases. Generally, COVID-19 seems to be a less severe disease for children than adults. Approximately 90% of pediatric patients are diagnosed as asymptomatic, mild, or moderate disease. However, up to 6.7% of cases may be severe. Severe illness is generally seen in patients smaller than 1 year of age and patients who have underlying disesases. The epidemiological and clinical patterns of COVID-19 and treatment approaches in pediatric patients still remain unclear although many pediatric reports are published. This review aims to summarize the current epidemics, clinical presentations, diagnosis, and treatment of COVID-19 in pediatric patients.


Assuntos
Infecções por Coronavirus/diagnóstico , Infecções por Coronavirus/fisiopatologia , Infecções por Coronavirus/terapia , Pediatria , Pneumonia Viral/diagnóstico , Pneumonia Viral/fisiopatologia , Pneumonia Viral/terapia , Adolescente , Antivirais/uso terapêutico , Betacoronavirus , Criança , Pré-Escolar , Técnicas de Laboratório Clínico , Infecções por Coronavirus/tratamento farmacológico , Humanos , Lactente , Recém-Nascido , Pandemias , Terapia Respiratória , Fatores de Risco
15.
Telemed J E Health ; 26(4): 487-494, 2020 04.
Artigo em Inglês | MEDLINE | ID: mdl-32233973

RESUMO

Satisfactory outcome was observed in one mild case and one severe case of COVID-19 pneumonia after the use of the online/offline multidisciplinary quarantine observation form, online monitoring, and classified diagnosis and treatment, as well as strict compliance with quarantine measures. Conditions of both patients were improved, and cross-infection and disease onset clustering were not observed. The multidisciplinary self-quarantine model provides early judgment, identification, and treatment of disease, improves compliance with early rehabilitation, increases confidence in recovery, and enhances self-management capabilities. This model is applicable to the current novel coronavirus pneumonia epidemic and can actively promote the management of suspected or confirmed mild cases, monitoring of critical cases, and self-management of discharged patients. The application of this new management model is worthy of being promoted in our specialized treatment facilities and in countries with severe epidemics.


Assuntos
Infecções por Coronavirus/diagnóstico por imagem , Internet , Pneumonia Viral/diagnóstico por imagem , Quarentena/métodos , Autogestão , Telemedicina , Adulto , Betacoronavirus , Infecções por Coronavirus/complicações , Infecções por Coronavirus/reabilitação , Tosse/etiologia , Epidemias , Febre/etiologia , Humanos , Controle de Infecções/métodos , Transmissão de Doença Infecciosa do Paciente para o Profissional , Masculino , Monitorização Fisiológica , Pandemias , Equipe de Assistência ao Paciente , Médicos , Pneumonia Viral/complicações , Pneumonia Viral/reabilitação , Terapia Respiratória , Comportamento de Redução do Risco , Índice de Gravidade de Doença , Telemedicina/métodos , Tomografia Computadorizada por Raios X
17.
BMJ ; 368: m540, 2020 Mar 11.
Artigo em Inglês | MEDLINE | ID: mdl-32161042

RESUMO

OBJECTIVE: To identify, appraise, and synthesise the best available evidence on the efficacy of perioperative interventions to reduce postoperative pulmonary complications (PPCs) in adult patients undergoing non-cardiac surgery. DESIGN: Systematic review and meta-analysis of randomised controlled trials. DATA SOURCES: Medline, Embase, CINHAL, and CENTRAL from January 1990 to December 2017. ELIGIBILITY CRITERIA: Randomised controlled trials investigating short term, protocolised medical interventions conducted before, during, or after non-cardiac surgery were included. Trials with clinical diagnostic criteria for PPC outcomes were included. Studies of surgical technique or physiological or biochemical outcomes were excluded. DATA EXTRACTION AND SYNTHESIS: Reviewers independently identified studies, extracted data, and assessed the quality of evidence. Meta-analyses were conducted to calculate risk ratios with 95% confidence intervals. Quality of evidence was summarised in accordance with GRADE methods. The primary outcome was the incidence of PPCs. Secondary outcomes were respiratory infection, atelectasis, length of hospital stay, and mortality. Trial sequential analysis was used to investigate the reliability and conclusiveness of available evidence. Adverse effects of interventions were not measured or compared. RESULTS: 117 trials enrolled 21 940 participants, investigating 11 categories of intervention. 95 randomised controlled trials enrolling 18 062 participants were included in meta-analysis; 22 trials were excluded from meta-analysis because the interventions were not sufficiently similar to be pooled. No high quality evidence was found for interventions to reduce the primary outcome (incidence of PPCs). Seven interventions had low or moderate quality evidence with confidence intervals indicating a probable reduction in PPCs: enhanced recovery pathways (risk ratio 0.35, 95% confidence interval 0.21 to 0.58), prophylactic mucolytics (0.40, 0.23 to 0.67), postoperative continuous positive airway pressure ventilation (0.49, 0.24 to 0.99), lung protective intraoperative ventilation (0.52, 0.30 to 0.88), prophylactic respiratory physiotherapy (0.55, 0.32 to 0.93), epidural analgesia (0.77, 0.65 to 0.92), and goal directed haemodynamic therapy (0.87, 0.77 to 0.98). Moderate quality evidence showed no benefit for incentive spirometry in preventing PPCs. Trial sequential analysis adjustment confidently supported a relative risk reduction of 25% in PPCs for prophylactic respiratory physiotherapy, epidural analgesia, enhanced recovery pathways, and goal directed haemodynamic therapies. Insufficient data were available to support or refute equivalent relative risk reductions for other interventions. CONCLUSIONS: Predominantly low quality evidence favours multiple perioperative PPC reduction strategies. Clinicians may choose to reassess their perioperative care pathways, but the results indicate that new trials with a low risk of bias are needed to obtain conclusive evidence of efficacy for many of these interventions. STUDY REGISTRATION: Prospero CRD42016035662.


Assuntos
Procedimentos Clínicos , Complicações Pós-Operatórias/prevenção & controle , Doenças Respiratórias/prevenção & controle , Analgesia Epidural , Expectorantes/uso terapêutico , Hidratação , Hemodinâmica , Humanos , Cuidados Intraoperatórios , Modalidades de Fisioterapia , Terapia Respiratória , Vasoconstritores/uso terapêutico
18.
Prog Cardiovasc Dis ; 63(2): 79-91, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32199901

RESUMO

Antiretroviral therapy (ART) prevented premature mortality and improved the quality of life among people living with the human immunodeficiency virus (PLWH), such that now more than half of PLWH in the United States are 50 years of age and older. Increased longevity among PLWH has resulted in a significant rise in chronic, comorbid diseases. However, the implementation of guideline-based interventions for preventing, treating, and managing such age-related, chronic conditions among the HIV population is lacking. The PRECluDE consortium supported by the Center for Translation Research and Implementation Science at the National Heart, Lung, and Blood Institute catalyzes implementation research on proven-effective interventions for co-occurring heart, lung, blood, and sleep diseases and conditions among PLWH. These collaborative research studies use novel implementation frameworks with HIV, mental health, cardiovascular, and pulmonary care to advance comprehensive HIV and chronic disease healthcare in a variety of settings and among diverse populations.


Assuntos
Fármacos Anti-HIV/uso terapêutico , Infecções por HIV/tratamento farmacológico , Sobreviventes de Longo Prazo ao HIV , Ciência da Implementação , Doenças não Transmissíveis/prevenção & controle , Serviços Preventivos de Saúde , Pesquisa Médica Translacional , Adolescente , Adulto , Idoso , Fármacos Anti-HIV/efeitos adversos , Anti-Hipertensivos/uso terapêutico , Doença Crônica , Comorbidade , Difusão de Inovações , Feminino , Infecções por HIV/diagnóstico , Infecções por HIV/epidemiologia , Infecções por HIV/virologia , Comportamentos Relacionados com a Saúde , Nível de Saúde , Humanos , Inibidores de Hidroximetilglutaril-CoA Redutases/uso terapêutico , Masculino , Pessoa de Meia-Idade , Doenças não Transmissíveis/epidemiologia , Fatores de Proteção , Terapia Respiratória , Medição de Risco , Fatores de Risco , Comportamento de Redução do Risco , Carga Viral , Adulto Jovem
19.
Int J Nanomedicine ; 15: 1117-1128, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32110011

RESUMO

Introduction: Antibiotic-resistant bacteria kill 25,000 people every year in the EU. Patients subject to recurrent lung infections are the most vulnerable to severe or even lethal infections. For these patients, pulmonary delivery of antibiotics would be advantageous, since inhalation can achieve higher concentration in the lungs than iv administration and can provide a faster onset of action. This would allow for the delivery of higher doses and hence reduce the number of treatments required. We report here about a new nanosystem (M33-NS) obtained by capturing SET-M33 peptide on single-chain dextran nanoparticles. SET-M33 is a non-natural antimicrobial peptide synthesized in branched form. This form gives the peptide resistance to degradation in biological fluids. SET-M33 has previously shown efficacy in vitro against about one hundred of Gram-negative multidrug and extensively drug-resistant clinical isolates and was also active in preclinical infection models of pneumonia, sepsis and skin infections. Methods: The new nanosystem was evaluated for its efficacy in bacteria cells and in a mouse model of pneumonia. Toxicity and genotoxicity were also tested in vitro. Biodistribution and pharmacokinetic studies in healthy rats were carried out using a radiolabeled derivative of the nanosystem. Results: The M33-nanosystem, studied here, showed to be effective against Pseudomonas aeruginosa in time-kill kinetic experiments. Cytotoxicity towards different animal cell lines was acceptable. Lung residence time of the antimicrobial peptide, administered via aerosol in healthy rats, was markedly improved by capturing SET-M33 on dextran nanoparticles. M33-NS was also efficient in eradicating pulmonary infection in a BALB/c mouse model of pneumonia caused by P. aeruginosa. Discussion: This study revealed that the encapsulation of the antimicrobial peptide in dextran nanoparticles markedly improved lung residence time of the peptide administered via aerosol. The result has to be considered among the aims of the development of a new therapeutic option for patients suffering recurrent infections, that will benefit from high local doses of persistent antimicrobials.


Assuntos
Antibacterianos/administração & dosagem , Nanopartículas/administração & dosagem , Peptídeos/administração & dosagem , Infecções por Pseudomonas/tratamento farmacológico , Administração por Inalação , Animais , Antibacterianos/farmacologia , Dextranos , Sistemas de Liberação de Medicamentos/métodos , Feminino , Humanos , Camundongos Endogâmicos BALB C , Testes de Sensibilidade Microbiana , Nanopartículas/química , Peptídeos/síntese química , Peptídeos/farmacologia , Pneumonia Bacteriana/tratamento farmacológico , Pseudomonas aeruginosa/efeitos dos fármacos , Ratos , Terapia Respiratória , Distribuição Tecidual
20.
PLoS One ; 15(1): e0227379, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-31978126

RESUMO

The inspiratory muscles contribute to balance via diaphragmatic contraction and by increasing intra-abdominal pressure. We have shown inspiratory muscle training (IMT) improves dynamic balance significantly with healthy community-dwellers. However, it is not known how the magnitude of balance improvements following IMT compares to that of an established balance program. This study compared the effects of 8-week of IMT for community-dwellers, to 8-week of the Otago exercise program (OEP) for care-residents, on balance and physical performance outcomes. Nineteen healthy community-dwellers (74 ± 4 years) were assigned to self-administered IMT. Eighteen, healthy care-residents (82 ± 4 years) were assigned to instructor-led OEP. The IMT involved 30 breaths twice-daily at ~50% of maximal inspiratory pressure (MIP). The OEP group undertook resistance and mobility exercises for ~60 minutes, twice-weekly. Balance and physical performance were assessed using the mini Balance Evaluation System Test (mini-BEST) and time up and go (TUG). After 8-week, both groups improved balance ability significantly (mini-BEST: IMT by 24 ± 34%; OEP by 34 ± 28%), with no between-group difference. Dynamic balance sub-tasks improved significantly more for the IMT group (P < 0.01), than the OEP group and vice versa for static balance sub-tasks (P = 0.01). The IMT group also improved MIP (by 66 ± 97%), peak inspiratory power (by 31 ± 12%) and TUG (by -11 ± 27%); whereas the OEP did not. IMT and OEP improved balance ability similarly, with IMT eliciting greater improvement in dynamic balance, whilst OEP improved static balance more than IMT. Unlike IMT, the OEP did not provide additional benefits in inspiratory muscle function and TUG performance. Our findings suggest that IMT offers a novel method of improving dynamic balance in older adults, which may be more relevant to function than static balance and potentially a useful adjunct to the OEP in frailty prevention.


Assuntos
Envelhecimento/fisiologia , Exercícios Respiratórios/métodos , Pressões Respiratórias Máximas/métodos , Equilíbrio Postural , Músculos Respiratórios/fisiologia , Terapia Respiratória/métodos , Idoso , Idoso de 80 Anos ou mais , Exercício Físico , Terapia por Exercício , Feminino , Humanos , Masculino , Força Muscular , Resistência Física
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