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1.
S Afr Med J ; 110(5): 355-359, 2020 04 16.
Artigo em Inglês | MEDLINE | ID: mdl-32657716

RESUMO

Since the World Health Organization declared coronavirus disease 2019 (COVID-19) a Public Health Emergency of International Concern, COVID-19 infection and the associated mortality have increased exponentially, globally. South Africa (SA) is no exception. Concerns abound over whether SA's healthcare system can withstand a demand for care that is disproportionate to current resources, both in the state and private health sectors. While healthcare professionals in SA have become resilient and adept at making difficult decisions in the face of resource limitations, a surge in COVID-19 cases could place a severe strain on the country's critical care services and necessitate unprecedented rationing decisions. This could occur at two critical points: access to ventilation, and withdrawal of intensive care in non- responsive or deteriorating cases. The ethical dimensions of decision-making at both junctures merit urgent consideration.


Assuntos
Infecções por Coronavirus , Cuidados Críticos , Serviço Hospitalar de Emergência/organização & administração , Alocação de Recursos para a Atenção à Saúde/tendências , Pandemias , Pneumonia Viral , Alocação de Recursos , Triagem , Betacoronavirus/isolamento & purificação , Infecções por Coronavirus/epidemiologia , Infecções por Coronavirus/terapia , Cuidados Críticos/ética , Cuidados Críticos/métodos , Cuidados Críticos/organização & administração , Emergências/epidemiologia , Necessidades e Demandas de Serviços de Saúde/tendências , Humanos , Pneumonia Viral/epidemiologia , Pneumonia Viral/terapia , Alocação de Recursos/ética , Alocação de Recursos/organização & administração , África do Sul/epidemiologia , Triagem/ética , Triagem/organização & administração , Ventiladores Mecânicos/provisão & distribução
4.
BMC Infect Dis ; 20(1): 500, 2020 Jul 11.
Artigo em Inglês | MEDLINE | ID: mdl-32652938

RESUMO

BACKGROUND: The rapid spread of coronavirus disease 2019 (COVID-19) was declared as an emerging public health threat by the World Health Organization. As various measures have been taken successfully to combat the epidemic caused by SARS-CoV-2, a growing number of fully recovered patients have been discharged from hospitals. However, some of them have relapsed. Little is known about the causes that triggered the relapse. CASE PRESENTATION: We report a case of a 40 years old man who suffered from recurrent pulmonary infection with progression of lesions on chest computed tomography (CT), elevated levels of ferritin and IL2R, reduced lymphocyte count and positive oropharyngeal swab test for SARS-CoV-2 again after 5 days discharge from hospital. The anti-SARS-CoV-2 antibody level of this patient was very low at the time of relapse, suggesting a weak humoral immune response to the virus. Total exon sequencing revealed mutations in TRNT1 gene, which may be responsible for B cell immunodeficiency. Therefore, uncleared SARS-CoV-2 at his first discharge was likely to lead to his recurrence. However, viral superinfection and non-infectious organizing pneumonia could not be completely excluded. CONCLUSION: COVID-19 relapse may occur in a part of discharged patients with low titers of anti-SARS-CoV-2 antibodies. These patients should be maintained in isolation for longer time even after discharge. A more sensitive method to detect SARS-CoV-2 needs to be established and serological testing for specific antibodies may be used as a reference to determine the duration of isolation.


Assuntos
Infecções por Coronavirus/complicações , Pneumonia Viral/etiologia , Pneumonia Viral/terapia , Adulto , Formação de Anticorpos , Antivirais/uso terapêutico , Linfócitos B/imunologia , Betacoronavirus/imunologia , Betacoronavirus/patogenicidade , Infecções por Coronavirus/tratamento farmacológico , Infecções por Coronavirus/patologia , Hospitais , Humanos , Imunidade Humoral , Indóis/uso terapêutico , Masculino , Nucleotidiltransferases/genética , Pandemias , Alta do Paciente , Pneumonia Viral/complicações , Pneumonia Viral/tratamento farmacológico , Pneumonia Viral/patologia , Recidiva , Ventiladores Mecânicos
5.
Nat Commun ; 11(1): 3280, 2020 07 01.
Artigo em Inglês | MEDLINE | ID: mdl-32612128

RESUMO

The atmospheric pressure that decreases with altitude affects lung physiology. However, these changes in physiology are not usually considered in ventilator design and testing. We argue that high altitude human populations require special attention to access the international supply of ventilators.


Assuntos
Altitude , Infecções por Coronavirus/terapia , Desenho de Equipamento , Pneumonia Viral/terapia , Ventiladores Mecânicos/provisão & distribução , Pressão Atmosférica , Betacoronavirus , Infecções por Coronavirus/fisiopatologia , Humanos , Pulmão/fisiologia , Pandemias , Pneumonia Viral/fisiopatologia
7.
Intern Med J ; 50(6): 761-763, 2020 06.
Artigo em Inglês | MEDLINE | ID: mdl-32537930

RESUMO

Mechanical ventilation as a resource is limited and may lead to poor outcomes in at-risk populations. Critical care supports may not be preferred by those at risk of deterioration in the COVID-19 setting. Patient-centred communication and shared decision-making should continue to remain central to clinical practice.


Assuntos
Comunicação , Infecções por Coronavirus/psicologia , Infecções por Coronavirus/terapia , Tomada de Decisão Compartilhada , Alocação de Recursos para a Atenção à Saúde/estatística & dados numéricos , Assistência Centrada no Paciente/métodos , Relações Médico-Paciente , Pneumonia Viral/psicologia , Pneumonia Viral/terapia , Ventiladores Mecânicos/provisão & distribução , Infecções por Coronavirus/epidemiologia , Humanos , Pandemias , Educação de Pacientes como Assunto , Pneumonia Viral/epidemiologia , Guias de Prática Clínica como Assunto
8.
Emerg Med Pract ; 22(7): 1-20, 2020 07.
Artigo em Inglês | MEDLINE | ID: mdl-32559026

RESUMO

There are a variety of ventilator options available to the emergency clinician, and decisions on choosing optimal settings will depend on the clinical circumstances. Understanding the latest literature in ventilator management can improve patient outcomes by ensuring optimal oxygenation and ventilation and reducing the potential for ventilator-induced lung injury. This article reviews the most appropriate ventilator settings for a variety of conditions in intubated adult patients presenting to the emergency department, and gives recommendations on monitoring the ventilated patient and making ventilator adjustments. An update on managing COVID-19-associated acute respiratory distress syndrome is also included.


Assuntos
Lesão Pulmonar Aguda/prevenção & controle , Infecções por Coronavirus/terapia , Serviço Hospitalar de Emergência/organização & administração , Monitorização Fisiológica/métodos , Pneumonia Viral/terapia , Respiração Artificial/instrumentação , Síndrome do Desconforto Respiratório do Adulto/terapia , Lesão Pulmonar Aguda/etiologia , Adulto , Infecções por Coronavirus/epidemiologia , Segurança de Equipamentos , Feminino , Seguimentos , Humanos , Masculino , Pessoa de Meia-Idade , Pandemias , Pneumonia Viral/epidemiologia , Respiração Artificial/efeitos adversos , Síndrome do Desconforto Respiratório do Adulto/virologia , Medição de Risco , Resultado do Tratamento , Ventiladores Mecânicos
9.
Zhonghua Wei Zhong Bing Ji Jiu Yi Xue ; 32(5): 575-580, 2020 May.
Artigo em Chinês | MEDLINE | ID: mdl-32576350

RESUMO

OBJECTIVE: To explore the patient-ventilator interaction of neurally adjusted ventilatory assist (NAVA) in patients with severe neurological diseases. METHODS: A prospective study was conducted. Sixteen severe neurological patients with tracheotomy admitted to neurosurgery intensive care unit (NSICU) of Yijishan Hospital of the First Affiliated Hospital of Wannan Medical College from September 2019 to February 2020 were enrolled. According to the random number table method, they were treated with pressure support ventilation (PSV) mode followed by NAVA mode or NAVA mode followed by PSV mode mechanical ventilation. Each mode was ventilated for 24 hours. The number of auto-triggering, ineffective trigger, double trigger, inspiratory trigger delay, premature cycling, late cycling, and patient-ventilator asynchronous time (inspiratory trigger delay time, premature cycling time, and late cycling time) within 1 minute were recorded every 8 hours for 3 minutes. The average number of asynchronies per minute, asynchrony index (AI), total AI, asynchrony time, arterial blood gas analysis, and coefficient variation (CV%) of respiratory mechanics parameters of each asynchrony type between the two modes were compared. RESULTS: There were significant decrease in the number or AI of auto-triggering, ineffective trigger, inspiratory trigger delay, premature cycling, and late cycling with NAVA mode ventilation compared with PSV mode ventilation [auto-triggering times (times/min): 0.00 (0.00, 0.00) vs. 0.00 (0.00, 0.58), auto-triggering AI: 0.00 (0.00, 0.00) vs. 0.00 (0.00, 0.02), ineffective trigger times (times/min): 0.00 (0.00, 0.33) vs. 1.00 (0.33, 2.17), ineffective trigger AI: 0.00 (0.00, 0.02) vs. 0.05 (0.02, 0.09), inspiratory trigger delay times (times/min): 0.00 (0.00, 0.58) vs. 0.67 (0.33, 1.58), inspiratory trigger delay AI: 0.00 (0.00, 0.02) vs. 0.05 (0.02, 0.09), premature cycling times (times/min): 0.00 (0.00, 0.33) vs. 0.33 (0.08, 1.00), premature cycling AI: 0.00 (0.00, 0.01) vs. 0.02 (0.00, 0.05), late cycling times (times/min): 0.00 (0.00, 0.00) vs. 1.17 (0.00, 4.83), late cycling AI: 0.00 (0.00, 0.00) vs. 0.07 (0.00, 0.25), all P < 0.05]. But there was significant increase in the number or AI of double trigger with NAVA mode ventilation as compared with PSV mode ventilation [times (times/min): 1.00 (0.33, 2.00) vs. 0.00 (0.00, 0.00), AI: 0.04 (0.02, 0.11) vs. 0.00 (0.00, 0.00), both P < 0.05]. Total AI and incidence of total AI > 0.1 showed significant decrease during NAVA mode ventilation as compared with PSV mode ventilation [total AI: 0.08 (0.04, 0.14) vs. 0.22 (0.18, 0.46), incidence of total AI > 0.1: 37.50% (6/16) vs. 93.75% (15/16), both P < 0.01]. There was no significant difference in asynchronous time or arterial blood gas analysis between the two modes. There were significant increases in variances of peak airway pressure (Ppeak) and expiratory tidal volume (VTe) during NAVA mode ventilation as compared with PSV mode ventilation [Ppeak coefficient of variation (CV%): 11.25 (7.12, 15.17)% vs. 0.00 (0.00, 2.82)%, VTe CV%: (8.93±5.53)% vs. (4.71±2.61)%, both P < 0.05]. CONCLUSIONS: Compared with PSV mode, NAVA mode can reduce the occurrence of patient-ventilator asynchronous events, reduce the AI and the occurrence of serious patient-ventilator asynchronous events, so as to improve the patient-ventilator interaction. NAVA and PSV modes can achieve the same gas exchange effect. At the same time, NAVA mode has potential advantages in avoiding insufficient or excessive ventilation support, diaphragm protection and prevention of ventilator-induced lung injury.


Assuntos
Suporte Ventilatório Interativo , Humanos , Respiração com Pressão Positiva , Estudos Prospectivos , Respiração Artificial , Traqueotomia , Ventiladores Mecânicos
10.
IEEE Pulse ; 11(3): 31-34, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32584770

RESUMO

As the number of coronavirus 2019 disease (COVID-19) cases in the United States began mounting in the early weeks of March, health care workers raised the alarm about a looming shortage of ventilators to treat patients. On March 30, 2020, Ford Motor Company announced plans to produce 50,000 ventilators in 100 days [1], and General Motors followed suit on April 8, stating that it would deliver out 6,000 ventilators by the end of May and another 24,000 by August [2].


Assuntos
Betacoronavirus , Infecções por Coronavirus/terapia , Pneumonia Viral/terapia , Ventiladores Mecânicos/provisão & distribução , Engenharia Biomédica , Pressão Positiva Contínua nas Vias Aéreas/economia , Pressão Positiva Contínua nas Vias Aéreas/instrumentação , Infecções por Coronavirus/epidemiologia , Custos e Análise de Custo , Desenho de Equipamento/economia , Humanos , Pandemias , Pneumonia Viral/epidemiologia , Impressão Tridimensional/economia , Estados Unidos/epidemiologia , United States Food and Drug Administration , Ventiladores Mecânicos/economia
13.
Gac Med Mex ; 156(3): 249-252, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32539019

RESUMO

Introduction: Simultaneous mechanical ventilation of several patients with a single ventilator might reduce the deficit of these devices for the care of patients with acute respiratory failure due to Covid-19. Objective: To communicate the results of a mechanical ventilation exercise with a ventilator in a lung simulator, and simultaneously in two and four. Results: No statistically significant differences were observed between programmed, recorded and measured positive end-expiratory pressure, mean airway pressure and peak pressure, except when simultaneously ventilating four lung simulators. Conclusions: Simultaneous mechanical ventilation should be implemented by medical personnel with experience in the procedure, be restricted to two patients and carried out in the intensive care unit.


Assuntos
Infecções por Coronavirus/terapia , Pneumonia Viral/terapia , Respiração Artificial/métodos , Ventiladores Mecânicos/provisão & distribução , Infecções por Coronavirus/fisiopatologia , Desenho de Equipamento , Humanos , Unidades de Terapia Intensiva , Pandemias , Pneumonia Viral/fisiopatologia , Respiração com Pressão Positiva , Respiração Artificial/instrumentação , Insuficiência Respiratória/terapia , Insuficiência Respiratória/virologia
15.
A A Pract ; 14(8): e01253, 2020 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-32496430

RESUMO

The coronavirus disease 2019 (COVID-19) pandemic has rapidly exposed health care system inadequacies. Hospital ventilator shortages in Italy compelled US physicians to consider creative solutions, such as using Y-pieces or T-pieces, to preclude the need to make decisions of life or death based on medical equipment availability. We add to current knowledge and testing capacity for ventilator splitters by reporting the ability to examine the functionality of ventilator splitters by using 2 high-fidelity lung simulators. Data obtained by the high-fidelity lung simulators included: tidal volume, respiratory rate, minute ventilation, peak inspiratory pressure, peak plateau pressure, and positive end-expiratory pressure.


Assuntos
Infecções por Coronavirus/terapia , Pneumonia Viral/terapia , Respiração Artificial/instrumentação , Ventiladores Mecânicos/provisão & distribução , Infecções por Coronavirus/epidemiologia , Desenho de Equipamento , Humanos , Manequins , Pandemias , Pneumonia Viral/epidemiologia , Respiração com Pressão Positiva , Taxa Respiratória/fisiologia , Volume de Ventilação Pulmonar
16.
J Korean Med Sci ; 35(23): e223, 2020 Jun 15.
Artigo em Inglês | MEDLINE | ID: mdl-32537957

RESUMO

BACKGROUND: The mortality risk of coronavirus disease 2019 (COVID-19) is higher in patients with older age, and many elderly patients are reported to require advanced respiratory support. METHODS: We reviewed medical records of 98 patients aged ≥ 65 years who were hospitalized with COVID-19 during a regional outbreak in Daegu/Gyeongsangbuk-do province of Korea. The outcome measures were in-hospital mortality and the treatment with mechanical ventilation (MV) or high-flow nasal cannula (HFNC). RESULTS: The median age of the patients was 72 years; 55.1% were female. Most (74.5%) had at least one underlying condition. Overall case fatality rate (CFR) was 20.4%, and median time to death after admission was 8 days. The CFR was 6.1% among patients aged 65-69 years, 22.7% among those aged 70-79 years, and 38.1% among those aged ≥ 80 years. The CFR among patients who required MV was 43.8%, and the proportion of patients received MV/HFNC was 28.6%. Nosocomial acquisition, diabetes, chronic lung diseases, and chronic neurologic diseases were significant risk factors for both death and MV/HFNC. Hypotension, hypoxia, and altered mental status on admission were also associated with poor outcome. CRP > 8.0 mg/dL was strongly associated with MV/HFNC (odds ratio, 26.31; 95% confidence interval, 7.78-88.92; P < 0.001), and showed better diagnostic characteristics compared to commonly used clinical scores. CONCLUSION: Patients aged ≥ 80 years had a high risk of requiring MV/HFNC, and mortality among those severe patients was very high. Severe initial presentation and laboratory abnormalities, especially high CRP, were identified as risk factors for mortality and severe hospital course.


Assuntos
Infecções por Coronavirus/mortalidade , Infecções por Coronavirus/patologia , Hipóxia/patologia , Pneumonia Viral/mortalidade , Pneumonia Viral/patologia , Respiração Artificial/estatística & dados numéricos , Insuficiência Respiratória/mortalidade , Fatores Etários , Idoso , Idoso de 80 Anos ou mais , Betacoronavirus , Proteína C-Reativa/análise , Feminino , Hospitalização , Humanos , Unidades de Terapia Intensiva , Masculino , Pandemias , República da Coreia , Estudos Retrospectivos , Fatores de Risco , Resultado do Tratamento , Ventiladores Mecânicos/estatística & dados numéricos
17.
A A Pract ; 14(7): e01243, 2020 May.
Artigo em Inglês | MEDLINE | ID: mdl-32539282

RESUMO

The coronavirus disease 2019 (COVID-19) pandemic created an unprecedented need for mechanical ventilation in critically ill patients. To meet this increased demand, some facilities were forced to use anesthesia gas machines (AGMs) as intensive care unit (ICU) ventilators. While an off-label use, AGM manufacturers, the Anesthesia Patient Safety Foundation, and the American Society of Anesthesiologists have guidelines for AGM use in the ICU, however, there is scant literature describing their use. This article describes our experiences at New York University Langone Medical Center using AGMs in the ICU for ventilating critically ill COVID-19 patients.


Assuntos
Anestesiologia/instrumentação , Infecções por Coronavirus/terapia , Pneumonia Viral/terapia , Respiração Artificial/instrumentação , Respiração Artificial/métodos , Ventiladores Mecânicos/provisão & distribução , Betacoronavirus , Infecções por Coronavirus/epidemiologia , Cuidados Críticos , Hospitais Universitários , Humanos , Unidades de Terapia Intensiva , Cidade de Nova Iorque/epidemiologia , Enfermeiras Anestesistas , Uso Off-Label , Pandemias , Pneumonia Viral/epidemiologia , Recursos Humanos
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