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1.
Crit Care Sci ; 36: e20240210en, 2024.
Article in English, Portuguese | MEDLINE | ID: mdl-38775567

ABSTRACT

BACKGROUND: Driving pressure has been suggested to be the main driver of ventilator-induced lung injury and mortality in observational studies of acute respiratory distress syndrome. Whether a driving pressure-limiting strategy can improve clinical outcomes is unclear. OBJECTIVE: To describe the protocol and statistical analysis plan that will be used to test whether a driving pressure-limiting strategy including positive end-expiratory pressure titration according to the best respiratory compliance and reduction in tidal volume is superior to a standard strategy involving the use of the ARDSNet low-positive end-expiratory pressure table in terms of increasing the number of ventilator-free days in patients with acute respiratory distress syndrome due to community-acquired pneumonia. METHODS: The ventilator STrAtegy for coMmunIty acquired pNeumoniA (STAMINA) study is a randomized, multicenter, open-label trial that compares a driving pressure-limiting strategy to the ARDSnet low-positive end-expiratory pressure table in patients with moderate-to-severe acute respiratory distress syndrome due to community-acquired pneumonia admitted to intensive care units. We expect to recruit 500 patients from 20 Brazilian and 2 Colombian intensive care units. They will be randomized to a driving pressure-limiting strategy group or to a standard strategy using the ARDSNet low-positive end-expiratory pressure table. In the driving pressure-limiting strategy group, positive end-expiratory pressure will be titrated according to the best respiratory system compliance. OUTCOMES: The primary outcome is the number of ventilator-free days within 28 days. The secondary outcomes are in-hospital and intensive care unit mortality and the need for rescue therapies such as extracorporeal life support, recruitment maneuvers and inhaled nitric oxide. CONCLUSION: STAMINA is designed to provide evidence on whether a driving pressure-limiting strategy is superior to the ARDSNet low-positive end-expiratory pressure table strategy for increasing the number of ventilator-free days within 28 days in patients with moderate-to-severe acute respiratory distress syndrome. Here, we describe the rationale, design and status of the trial.


Subject(s)
Community-Acquired Infections , Positive-Pressure Respiration , Respiratory Distress Syndrome , Humans , Brazil/epidemiology , Colombia/epidemiology , Community-Acquired Infections/therapy , Intensive Care Units , Pneumonia/therapy , Positive-Pressure Respiration/methods , Prospective Studies , Respiratory Distress Syndrome/therapy , Respiratory Distress Syndrome/physiopathology , Tidal Volume , Randomized Controlled Trials as Topic , Multicenter Studies as Topic
2.
Crit. Care Sci ; 36: e20240210en, 2024. tab, graf
Article in English | LILACS-Express | LILACS | ID: biblio-1557666

ABSTRACT

ABSTRACT Background: Driving pressure has been suggested to be the main driver of ventilator-induced lung injury and mortality in observational studies of acute respiratory distress syndrome. Whether a driving pressure-limiting strategy can improve clinical outcomes is unclear. Objective: To describe the protocol and statistical analysis plan that will be used to test whether a driving pressure-limiting strategy including positive end-expiratory pressure titration according to the best respiratory compliance and reduction in tidal volume is superior to a standard strategy involving the use of the ARDSNet low-positive end-expiratory pressure table in terms of increasing the number of ventilator-free days in patients with acute respiratory distress syndrome due to community-acquired pneumonia. Methods: The ventilator STrAtegy for coMmunIty acquired pNeumoniA (STAMINA) study is a randomized, multicenter, open-label trial that compares a driving pressure-limiting strategy to the ARDSnet low-positive end-expiratory pressure table in patients with moderate-to-severe acute respiratory distress syndrome due to community-acquired pneumonia admitted to intensive care units. We expect to recruit 500 patients from 20 Brazilian and 2 Colombian intensive care units. They will be randomized to a driving pressure-limiting strategy group or to a standard strategy using the ARDSNet low-positive end-expiratory pressure table. In the driving pressure-limiting strategy group, positive end-expiratory pressure will be titrated according to the best respiratory system compliance. Outcomes: The primary outcome is the number of ventilator-free days within 28 days. The secondary outcomes are in-hospital and intensive care unit mortality and the need for rescue therapies such as extracorporeal life support, recruitment maneuvers and inhaled nitric oxide. Conclusion: STAMINA is designed to provide evidence on whether a driving pressure-limiting strategy is superior to the ARDSNet low-positive end-expiratory pressure table strategy for increasing the number of ventilator-free days within 28 days in patients with moderate-to-severe acute respiratory distress syndrome. Here, we describe the rationale, design and status of the trial.


RESUMO Contexto: Em estudos observacionais sobre a síndrome do desconforto respiratório agudo, sugeriu-se que a driving pressure é o principal fator de lesão pulmonar induzida por ventilador e de mortalidade. Não está claro se uma estratégia de limitação da driving pressure pode melhorar os desfechos clínicos. Objetivo: Descrever o protocolo e o plano de análise estatística que serão usados para testar se uma estratégia de limitação da driving pressure envolvendo a titulação da pressão positiva expiratória final de acordo com a melhor complacência respiratória e a redução do volume corrente é superior a uma estratégia padrão envolvendo o uso da tabela de pressão positiva expiratória final baixa do protocolo ARDSNet, em termos de aumento do número de dias sem ventilador em pacientes com síndrome do desconforto respiratório agudo devido à pneumonia adquirida na comunidade. Métodos: O estudo STAMINA (ventilator STrAtegy for coMmunIty acquired pNeumoniA) é randomizado, multicêntrico e aberto e compara uma estratégia de limitação da driving pressure com a tabela de pressão positiva expiratória final baixa do protocolo ARDSnet em pacientes com síndrome do desconforto respiratório agudo moderada a grave devido à pneumonia adquirida na comunidade internados em unidades de terapia intensiva. Esperamos recrutar 500 pacientes de 20 unidades de terapia intensiva brasileiras e duas colombianas. Eles serão randomizados para um grupo da estratégia de limitação da driving pressure ou para um grupo de estratégia padrão usando a tabela de pressão positiva expiratória final baixa do protocolo ARDSnet. No grupo da estratégia de limitação da driving pressure, a pressão positiva expiratória final será titulada de acordo com a melhor complacência do sistema respiratório. Desfechos: O desfecho primário é o número de dias sem ventilador em 28 dias. Os desfechos secundários são a mortalidade hospitalar e na unidade de terapia intensiva e a necessidade de terapias de resgate, como suporte de vida extracorpóreo, manobras de recrutamento e óxido nítrico inalado. Conclusão: O STAMINA foi projetado para fornecer evidências sobre se uma estratégia de limitação da driving pressure é superior à estratégia da tabela de pressão positiva expiratória final baixa do protocolo ARDSnet para aumentar o número de dias sem ventilador em 28 dias em pacientes com síndrome do desconforto respiratório agudo moderada a grave. Aqui, descrevemos a justificativa, o desenho e o status do estudo.

3.
Article in English | MEDLINE | ID: mdl-37396195

ABSTRACT

[This corrects the article DOI: 10.1017/ash.2023.136.].

4.
Article in English | MEDLINE | ID: mdl-37179767

ABSTRACT

Objective: Data are scarce regarding hospital infection control committees and compliance with infection prevention and control (IPC) recommendations in Brazil, a country of continental dimensions. We assessed the main characteristics of infection control committees (ICCs) on healthcare-associated infections (HAIs) in Brazilian hospitals. Methods: This cross-sectional study was conducted in ICCs of public and private hospitals distributed across all Brazilian regions. Data were collected directly from the ICC staff by completing an online questionnaire and during on-site visits through face-to-face interviews. Results: In total, 53 Brazilian hospitals were evaluated from October 2019 to December 2020. All hospitals had implemented the IPC core components in their programs. All centers had protocols for the prevention and control of ventilator-associated pneumonia as well as bloodstream, surgical site, and catheter-associated urinary tract infections. Most hospitals (80%) had no budget specifically allocated to the IPC program; 34% of the laundry staff had received specific IPC training; and only 7.5% of hospitals reported occupational infections in healthcare workers. Conclusions: In this sample, most ICCs complied with the minimum requirements for IPC programs. The main limitation regarding ICCs was the lack of financial support. The findings of this survey support the development of strategic plans to improve IPCs in Brazilian hospitals.

5.
Lasers Med Sci ; 38(1): 90, 2023 Mar 22.
Article in English | MEDLINE | ID: mdl-36947266

ABSTRACT

The present study aimed to evaluate photobiomodulation effects on oxidative stress in type 2 diabetes mellitus (DM2). Thirty-one male Wistar rats were used and divided into 4 groups: group 1 - animals without diabetes mellitus 2 without laser 21 J/cm2 (C-SHAM), group 2 - animals with diabetes mellitus 2 without laser 21 J/cm2 (C-DM2), group 3 - animals without diabetes mellitus 2 with laser 21 J/cm2 (L-SHAM), group 4 - animals with diabetes mellitus 2 with laser 21 J/cm2 (L-DM2). The protocol was performed 5 days/week, for 6 weeks. The animals that received photobiomodulation had one dose irradiated at two spots in the right gastrocnemius muscle. Twenty-four hours after the last intervention, the animals were euthanized. Heart, diaphragm, liver, right gastrocnemius, plasma, kidneys, weighed, and stored for further analysis. In rats with DM2, photobiomodulation promoted a decrease in thiobarbituric acid reactive substance assay (TBARS) in plasma levels. On the other hand, photobiomodulation demonstrated an increase in non-protein thiol levels (NPSH) in the heart, diaphragm and gastrocnemius. Moreover, photobiomodulation produced in the heart, diaphragm and plasma levels led to an increase in superoxide dismutase (SOD). Interestingly, photobiomodulation was able to increase superoxide dismutase in rats without DM2 in the heart, diaphragm, gastrocnemius and kidneys. These findings suggested that 6 weeks of photobiomodulation in rats with DM2 promoted beneficial adaptations in oxidative stress, with a decrease in parameters of oxidant activity and an increase in antioxidant activity.


Subject(s)
Diabetes Mellitus, Experimental , Diabetes Mellitus, Type 2 , Rats , Male , Animals , Rats, Wistar , Diabetes Mellitus, Type 2/radiotherapy , Diabetes Mellitus, Experimental/radiotherapy , Oxidative Stress , Superoxide Dismutase/metabolism , Thiobarbituric Acid Reactive Substances
6.
Tomazini, Bruno M; Nassar Jr, Antonio Paulo; Lisboa, Thiago Costa; Azevedo, Luciano César Pontes de; Veiga, Viviane Cordeiro; Catarino, Daniela Ghidetti Mangas; Fogazzi, Debora Vacaro; Arns, Beatriz; Piastrelli, Filipe Teixeira; Dietrich, Camila; Negrelli, Karina Leal; Jesuíno, Isabella de Andrade; Reis, Luiz Fernando Lima; Mattos, Renata Rodrigues de; Pinheiro, Carla Cristina Gomes; Luz, Mariane Nascimento; Spadoni, Clayse Carla da Silva; Moro, Elisângela Emilene; Bueno, Flávia Regina; Sampaio, Camila Santana Justo Cintra; Silva, Débora Patrício; Baldassare, Franca Pellison; Silva, Ana Cecilia Alcantara; Veiga, Thabata; Barbante, Leticia; Lambauer, Marianne; Campos, Viviane Bezerra; Santos, Elton; Santos, Renato Hideo Nakawaga; Laranjeiras, Ligia Nasi; Valeis, Nanci; Santucci, Eliana; Miranda, Tamiris Abait; Patrocínio, Ana Cristina Lagoeiro do; Carvalho, Andréa de; Sousa, Eduvirgens Maria Couto de; Sousa, Ancelmo Honorato Ferraz de; Malheiro, Daniel Tavares; Bezerra, Isabella Lott; Rodrigues, Mirian Batista; Malicia, Julliana Chicuta; Silva, Sabrina Souza da; Gimenes, Bruna dos Passos; Sesin, Guilhermo Prates; Zavascki, Alexandre Prehn; Sganzerla, Daniel; Medeiros, Gregory Saraiva; Santos, Rosa da Rosa Minho dos; Silva, Fernanda Kelly Romeiro; Cheno, Maysa Yukari; Abrahão, Carolinne Ferreira; Oliveira Junior, Haliton Alves de; Rocha, Leonardo Lima; Nunes Neto, Pedro Aniceto; Pereira, Valéria Chagas; Paciência, Luis Eduardo Miranda; Bueno, Elaine Silva; Caser, Eliana Bernadete; Ribeiro, Larissa Zuqui; Fernandes, Caio Cesar Ferreira; Garcia, Juliana Mazzei; Silva, Vanildes de Fátima Fernandes; Santos, Alisson Junior dos; Machado, Flávia Ribeiro; Souza, Maria Aparecida de; Ferronato, Bianca Ramos; Urbano, Hugo Corrêa de Andrade; Moreira, Danielle Conceição Aparecida; Souza-Dantas, Vicente Cés de; Duarte, Diego Meireles; Coelho, Juliana; Figueiredo, Rodrigo Cruvinel; Foreque, Fernanda; Romano, Thiago Gomes; Cubos, Daniel; Spirale, Vladimir Miguel; Nogueira, Roberta Schiavon; Maia, Israel Silva; Zandonai, Cassio Luis; Lovato, Wilson José; Cerantola, Rodrigo Barbosa; Toledo, Tatiana Gozzi Pancev; Tomba, Pablo Oscar; Almeida, Joyce Ramos de; Sanches, Luciana Coelho; Pierini, Leticia; Cunha, Mariana; Sousa, Michelle Tereza; Azevedo, Bruna; Dal-Pizzol, Felipe; Damasio, Danusa de Castro; Bainy, Marina Peres; Beduhn, Dagoberta Alves Vieira; Jatobá, Joana DArc Vila Nova; Moura, Maria Tereza Farias de; Rego, Leila Rezegue de Moraes; Silva, Adria Vanessa da; Oliveira, Luana Pontes; Sodré Filho, Eliene Sá; Santos, Silvana Soares dos; Neves, Itallo de Lima; Leão, Vanessa Cristina de Aquino; Paes, João Lucidio Lobato; Silva, Marielle Cristina Mendes; Oliveira, Cláudio Dornas de; Santiago, Raquel Caldeira Brant; Paranhos, Jorge Luiz da Rocha; Wiermann, Iany Grinezia da Silva; Pedroso, Durval Ferreira Fonseca; Sawada, Priscilla Yoshiko; Prestes, Rejane Martins; Nascimento, Glícia Cardoso; Grion, Cintia Magalhães Carvalho; Carrilho, Claudia Maria Dantas de Maio; Dantas, Roberta Lacerda Almeida de Miranda; Silva, Eliane Pereira; Silva, Antônio Carlos da; Oliveira, Sheila Mara Bezerra de; Golin, Nicole Alberti; Tregnago, Rogerio; Lima, Valéria Paes; Silva, Kamilla Grasielle Nunes da; Boschi, Emerson; Buffon, Viviane; Machado, André SantAna; Capeletti, Leticia; Foernges, Rafael Botelho; Carvalho, Andréia Schubert de; Oliveira Junior, Lúcio Couto de; Oliveira, Daniela Cunha de; Silva, Everton Macêdo; Ribeiro, Julival; Pereira, Francielle Constantino; Salgado, Fernanda Borges; Deutschendorf, Caroline; Silva, Cristofer Farias da; Gobatto, Andre Luiz Nunes; Oliveira, Carolaine Bomfim de; Dracoulakis, Marianna Deway Andrade; Alvaia, Natália Oliveira Santos; Souza, Roberta Machado de; Araújo, Larissa Liz Cardoso de; Melo, Rodrigo Morel Vieira de; Passos, Luiz Carlos Santana; Vidal, Claudia Fernanda de Lacerda; Rodrigues, Fernanda Lopes de Albuquerque; Kurtz, Pedro; Shinotsuka, Cássia Righy; Tavares, Maria Brandão; Santana, Igor das Virgens; Gavinho, Luciana Macedo da Silva; Nascimento, Alaís Brito; Pereira, Adriano J; Cavalcanti, Alexandre Biasi.
Rev. bras. ter. intensiva ; 34(4): 418-425, out.-dez. 2022. tab, graf
Article in Portuguese | LILACS-Express | LILACS | ID: biblio-1423667

ABSTRACT

RESUMO Objetivo: Descrever o IMPACTO-MR, um estudo brasileiro de plataforma nacional em unidades de terapia intensiva focado no impacto das infecções por bactérias multirresistentes relacionadas à assistência à saúde. Métodos: Descrevemos a plataforma IMPACTO-MR, seu desenvolvimento, critérios para seleção das unidades de terapia intensiva, caracterização da coleta de dados, objetivos e projetos de pesquisa futuros a serem realizados na plataforma. Resultados: Os dados principais foram coletados por meio do Epimed Monitor System® e consistiram em dados demográficos, dados de comorbidades, estado funcional, escores clínicos, diagnóstico de internação e diagnósticos secundários, dados laboratoriais, clínicos e microbiológicos e suporte de órgãos durante a internação na unidade de terapia intensiva, entre outros. De outubro de 2019 a dezembro de 2020, 33.983 pacientes de 51 unidades de terapia intensiva foram incluídos no banco de dados principal. Conclusão: A plataforma IMPACTO-MR é um banco de dados clínico brasileiro de unidades de terapia intensiva focado na pesquisa do impacto das infecções por bactérias multirresistentes relacionadas à assistência à saúde. Essa plataforma fornece dados para o desenvolvimento e pesquisa de unidades de terapia intensiva individuais e ensaios clínicos observacionais e prospectivos multicêntricos.


ABSTRACT Objective: To describe the IMPACTO-MR, a Brazilian nationwide intensive care unit platform study focused on the impact of health care-associated infections due to multidrug-resistant bacteria. Methods: We described the IMPACTO-MR platform, its development, criteria for intensive care unit selection, characterization of core data collection, objectives, and future research projects to be held within the platform. Results: The core data were collected using the Epimed Monitor System® and consisted of demographic data, comorbidity data, functional status, clinical scores, admission diagnosis and secondary diagnoses, laboratory, clinical, and microbiological data, and organ support during intensive care unit stay, among others. From October 2019 to December 2020, 33,983 patients from 51 intensive care units were included in the core database. Conclusion: The IMPACTO-MR platform is a nationwide Brazilian intensive care unit clinical database focused on researching the impact of health care-associated infections due to multidrug-resistant bacteria. This platform provides data for individual intensive care unit development and research and multicenter observational and prospective trials.

7.
Rev Bras Ter Intensiva ; 34(3): 335-341, 2022.
Article in Portuguese, English | MEDLINE | ID: mdl-36351065

ABSTRACT

OBJECTIVE: To compare the lung mechanics and outcomes between COVID-19-associated acute respiratory distress syndrome and non-COVID-19-associated acute respiratory distress syndrome. METHODS: We combined data from two randomized trials in acute respiratory distress syndrome, one including only COVID-19 patients and the other including only patients without COVID-19, to determine whether COVID-19-associated acute respiratory distress syndrome is associated with higher 28-day mortality than non-COVID-19 acute respiratory distress syndrome and to examine the differences in lung mechanics between these two types of acute respiratory distress syndrome. RESULTS: A total of 299 patients with COVID-19-associated acute respiratory distress syndrome and 1,010 patients with non-COVID-19-associated acute respiratory distress syndrome were included in the main analysis. The results showed that non-COVID-19 patients used higher positive end-expiratory pressure (12.5cmH2O; SD 3.2 versus 11.7cmH2O SD 2.8; p < 0.001), were ventilated with lower tidal volumes (5.8mL/kg; SD 1.0 versus 6.5mL/kg; SD 1.2; p < 0.001) and had lower static respiratory compliance adjusted for ideal body weight (0.5mL/cmH2O/kg; SD 0.3 versus 0.6mL/cmH2O/kg; SD 0.3; p = 0.01). There was no difference between groups in 28-day mortality (52.3% versus 58.9%; p = 0.52) or mechanical ventilation duration in the first 28 days among survivors (13 [IQR 5 - 22] versus 12 [IQR 6 - 26], p = 0.46). CONCLUSION: This analysis showed that patients with non-COVID-19-associated acute respiratory distress syndrome have different lung mechanics but similar outcomes to COVID-19-associated acute respiratory distress syndrome patients. After propensity score matching, there was no difference in lung mechanics or outcomes between groups.


OBJETIVO: Comparar a mecânica pulmonar e os desfechos entre a síndrome do desconforto respiratório agudo associada à COVID-19 e a síndrome do desconforto respiratório agudo não associada à COVID-19. MÉTODOS: Combinamos dados de dois ensaios randomizados sobre a síndrome do desconforto respiratório agudo, um incluindo apenas pacientes com COVID-19 e o outro incluindo apenas pacientes sem COVID-19, para determinar se a síndrome do desconforto respiratório agudo associada à COVID-19 está associada à maior mortalidade aos 28 dias do que a síndrome do desconforto respiratório agudo não associada à COVID-19 e também examinar as diferenças na mecânica pulmonar entre esses dois tipos de síndrome do desconforto respiratório agudo. RESULTADOS: Foram incluídos na análise principal 299 pacientes com síndrome do desconforto respiratório agudo associada à COVID-19 e 1.010 pacientes com síndrome do desconforto respiratório agudo não associada à COVID-19. Os resultados mostraram que os pacientes sem COVID-19 utilizaram pressão positiva expiratória final mais alta (12,5cmH2O; DP 3,2 versus 11,7cmH2O; DP 2,8; p < 0,001), foram ventilados com volumes correntes mais baixos (5,8mL/kg; DP 1,0 versus 6,5mL/kg; DP 1,2; p < 0,001) e apresentaram menor complacência respiratória estática ajustada para o peso ideal (0,5mL/cmH2O/kg; DP 0,3 versus 0,6mL/cmH2O/kg; DP 0,3; p = 0,01). Não houve diferença entre os grupos quanto à mortalidade aos 28 dias (52,3% versus 58,9%; p = 0,52) ou à duração da ventilação mecânica nos primeiros 28 dias entre os sobreviventes (13 [IQ 5 - 22] dias versus 12 [IQ 6 - 26] dias; p = 0,46). CONCLUSÃO: Esta análise mostrou que os pacientes com síndrome do desconforto respiratório agudo não associada à COVID-19 têm mecânica pulmonar diferente, mas desfechos semelhantes aos dos pacientes com síndrome do desconforto respiratório agudo associada à COVID-19. Após pareamento por escore de propensão, não houve diferença na mecânica pulmonar e nem nos desfechos entre os grupos.


Subject(s)
COVID-19 , Respiratory Distress Syndrome , Humans , Propensity Score , COVID-19/complications , Randomized Controlled Trials as Topic , Respiratory Distress Syndrome/therapy , Lung , Respiration, Artificial/methods , Respiratory Mechanics
8.
Rev. bras. ter. intensiva ; 34(3): 335-341, jul.-set. 2022. tab, graf
Article in Portuguese | LILACS-Express | LILACS | ID: biblio-1407748

ABSTRACT

RESUMO Objetivo: Comparar a mecânica pulmonar e os desfechos entre a síndrome do desconforto respiratório agudo associada à COVID-19 e a síndrome do desconforto respiratório agudo não associada à COVID-19. Métodos: Combinamos dados de dois ensaios randomizados sobre a síndrome do desconforto respiratório agudo, um incluindo apenas pacientes com COVID-19 e o outro incluindo apenas pacientes sem COVID-19, para determinar se a síndrome do desconforto respiratório agudo associada à COVID-19 está associada à maior mortalidade aos 28 dias do que a síndrome do desconforto respiratório agudo não associada à COVID-19 e também examinar as diferenças na mecânica pulmonar entre esses dois tipos de síndrome do desconforto respiratório agudo. Resultados: Foram incluídos na análise principal 299 pacientes com síndrome do desconforto respiratório agudo associada à COVID-19 e 1.010 pacientes com síndrome do desconforto respiratório agudo não associada à COVID-19. Os resultados mostraram que os pacientes sem COVID-19 utilizaram pressão positiva expiratória final mais alta (12,5cmH2O; DP 3,2 versus 11,7cmH2O; DP 2,8; p < 0,001), foram ventilados com volumes correntes mais baixos (5,8mL/kg; DP 1,0 versus 6,5mL/kg; DP 1,2; p < 0,001) e apresentaram menor complacência respiratória estática ajustada para o peso ideal (0,5mL/cmH2O/kg; DP 0,3 versus 0,6mL/cmH2O/kg; DP 0,3; p = 0,01). Não houve diferença entre os grupos quanto à mortalidade aos 28 dias (52,3% versus 58,9%; p = 0,52) ou à duração da ventilação mecânica nos primeiros 28 dias entre os sobreviventes (13 [IQ 5 - 22] dias versus 12 [IQ 6 - 26] dias; p = 0,46). Conclusão: Esta análise mostrou que os pacientes com síndrome do desconforto respiratório agudo não associada à COVID-19 têm mecânica pulmonar diferente, mas desfechos semelhantes aos dos pacientes com síndrome do desconforto respiratório agudo associada à COVID-19. Após pareamento por escore de propensão, não houve diferença na mecânica pulmonar e nem nos desfechos entre os grupos.


ABSTRACT Objective: To compare the lung mechanics and outcomes between COVID-19-associated acute respiratory distress syndrome and non-COVID-19-associated acute respiratory distress syndrome. Methods: We combined data from two randomized trials in acute respiratory distress syndrome, one including only COVID-19 patients and the other including only patients without COVID-19, to determine whether COVID-19-associated acute respiratory distress syndrome is associated with higher 28-day mortality than non-COVID-19 acute respiratory distress syndrome and to examine the differences in lung mechanics between these two types of acute respiratory distress syndrome. Results: A total of 299 patients with COVID-19-associated acute respiratory distress syndrome and 1,010 patients with non-COVID-19-associated acute respiratory distress syndrome were included in the main analysis. The results showed that non-COVID-19 patients used higher positive end-expiratory pressure (12.5cmH2O; SD 3.2 versus 11.7cmH2O SD 2.8; p < 0.001), were ventilated with lower tidal volumes (5.8mL/kg; SD 1.0 versus 6.5mL/kg; SD 1.2; p < 0.001) and had lower static respiratory compliance adjusted for ideal body weight (0.5mL/cmH2O/kg; SD 0.3 versus 0.6mL/cmH2O/kg; SD 0.3; p = 0.01). There was no difference between groups in 28-day mortality (52.3% versus 58.9%; p = 0.52) or mechanical ventilation duration in the first 28 days among survivors (13 [IQR 5 - 22] versus 12 [IQR 6 - 26], p = 0.46). Conclusion: This analysis showed that patients with non-COVID-19-associated acute respiratory distress syndrome have different lung mechanics but similar outcomes to COVID-19-associated acute respiratory distress syndrome patients. After propensity score matching, there was no difference in lung mechanics or outcomes between groups.

9.
J Cosmet Dermatol ; 15(4): 393-398, 2016 Dec.
Article in English | MEDLINE | ID: mdl-27090205

ABSTRACT

BACKGROUND: Striae distensae are linear atrophic dermal scars with associated epidermal atrophy. This recurrent skin disorder causes a significant cosmetic and psychologic concern and remains a therapeutic challenge, especially when they are mature and hypopigmented (striae alba). AIMS: In this prospective single-center study, we evaluated the efficacy, safety, and patient's satisfaction of galvanopuncture for the treatment of striae alba. PATIENTS/METHODS: Thirty-two female subjects with striae alba present on the buttocks were treated with galvanopuncture once a week over a period of 10 weeks. Photographs and a percentage category scale were used to assess striae improvement and patient's satisfaction. Biochemical analyses were performed to assess possible systemic inflammatory effects or oxidative stress induction by the treatment. RESULTS: All patients achieved a substantial increase in clinical improvement in their striae within 10 treatment sessions. Galvanopuncture did not induce any inflammatory effect; however, it reduced oxidative injury. CONCLUSION: The use of galvanopuncture for the treatment of striae alba demonstrated a significant improvement in the lesions with visible results. This study supports the high degree of patient's satisfaction and demonstrate the safe and effective use of galvanopuncture in the treatment of striae alba on several skin types.


Subject(s)
Electric Stimulation Therapy/methods , Inflammation/blood , Oxidative Stress , Striae Distensae/therapy , Adult , C-Reactive Protein/metabolism , Cholesterol, HDL/blood , Cholesterol, LDL/metabolism , Electric Stimulation Therapy/adverse effects , Electric Stimulation Therapy/instrumentation , Female , Humans , Inflammation/diagnosis , Inflammation/etiology , Lipoproteins, LDL/blood , Needles , Nitric Oxide/blood , Patient Satisfaction , Pilot Projects , Prospective Studies , Thiobarbituric Acid Reactive Substances/metabolism , Tumor Necrosis Factor-alpha/blood , Young Adult
10.
Physiother Theory Pract ; 28(8): 617-23, 2012 Nov.
Article in English | MEDLINE | ID: mdl-22404697

ABSTRACT

BACKGROUND: Low-frequency pulsed current (LFPC) and Russian current (RC), a type of kilohertz-frequency alternating current, have been frequently used for muscle strengthening in rehabilitation programs. Despite the popularity of these current types, it is unclear which is most effectively able to generate a similar submaximal torque with minimal discomfort and current amplitude. OBJECTIVE: To compare discomfort and current amplitude between LFPC and RC to achieve a knee extensor torque of 10% of the maximal isometric voluntary contraction (MIVC). METHODS: Twenty-two healthy subjects were subjected to three electrically elicited knee extensor submaximal contractions (10% MIVC) that were sustained for 10 seconds. The current amplitude required to achieve 10% MIVC and subjective discomfort were assessed directly by the electrical stimulator and with the Visual Analogue Pain Scale, respectively. A paired t-test was used to determine differences between the electrical currents (α = 0.05). RESULTS: LFPC required significantly lower current amplitude (15%) and a lower discomfort level (50%) to achieve 10% of MIVC compared to RC. CONCLUSION: LFPC current seems to be more effective than RC with respect to discomfort level and current amplitude to produce 10% of MIVC.


Subject(s)
Electric Stimulation Therapy/adverse effects , Electric Stimulation Therapy/methods , Isometric Contraction , Knee Joint/physiology , Muscle Strength , Muscle, Skeletal/physiology , Pain/etiology , Adult , Biomechanical Phenomena , Female , Humans , Male , Pain/diagnosis , Pain Measurement , Time Factors , Torque , Treatment Outcome , Young Adult
11.
Lasers Surg Med ; 40(7): 500-8, 2008 Sep.
Article in English | MEDLINE | ID: mdl-18727002

ABSTRACT

BACKGROUND AND OBJECTIVE: In the classic model of pleurisy there is little evidence about the anti-inflammatory effects of low-level laser therapy (LLLT) as well the dosage characteristics, such as wavelength, total energy, number and pattern of treatment. In this study we investigated the potential effects of LLLT on modulating the pro-inflammatory and anti-inflammatory mediators of acute inflammation in a rat pleurisy model. STUDY DESIGN/MATERIALS AND METHODS: A sample of 48 female Wistar rats were divided into control and experiential groups. An inflammation was induced by carrageenan (0.2 ml) injected into the pleural cavity. At 1, 2, and 3 hours after induction a continuous wave (20 mW) diode laser of the InGaAlP (660 nm) type was used in the four laser groups with different doses and treatment patterns. One group received a single dose of 2.1 J and the other three groups received a total energy of 0.9, 2.1, and 4.2 J. Four hours later the exudate volume, total and differential leukocytes, protein concentration, NO, IL-6, IL-10, TNF-alpha, and MCP-1 were measured from the aspirated liquid. RESULTS: All the treatment patterns and quantity of energy studied show significant reduction of the exudate volume (P<0.05). Using energy of 0.9 J only NO, IL-6, MCP-1 and IL-10 are significantly reduced (P<0.05). On the other hand, higher energies (2.1 and 4.2 J) significantly reduce all variables independently of the treatment pattern. The neutrophil migration has a straight correlation with the TNF-alpha (r = 0.551) and NO (r = 0.549) concentration. CONCLUSIONS: LLLT-660 nm induced an anti-inflammatory effect characterized by inhibition of either total or differential leukocyte influx, exudation, total protein, NO, IL-6, MCP-1, IL-10, and TNF-alpha, in a dose-dependent manner. Under these conditions, laser treatment with 2.1 J was more effective than 0.9 and 4.2 J.


Subject(s)
Low-Level Light Therapy , Pleurisy/radiotherapy , Animals , Carrageenan/administration & dosage , Female , Inflammation/complications , Inflammation/radiotherapy , Pleurisy/chemically induced , Pleurisy/complications , Rats , Rats, Wistar
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