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1.
Medicina (Kaunas) ; 57(4)2021 Mar 24.
Artículo en Inglés | MEDLINE | ID: mdl-33804963

RESUMEN

Background: Establishing the diagnosis of COVID-19 and Pneumocystisjirovecii pulmonary coinfection is difficult due to clinical and radiological similarities that exist between the two disorders. For the moment, fungal coinfections are underestimated in COVID-19 patients. Case presentation: We report the case of a 52-year-old male patient, who presented to the emergency department for severe dyspnea and died 17 h later. The RT-PCR test performed at his admission was negative for SARS-CoV-2. Retesting of lung fragments collected during autopsy revealed a positive result for SARS-CoV-2. Histopathological examination showed preexisting lesions, due to comorbidities, as well as recent lesions: massive lung thromboses, alveolar exudate rich in foam cells, suprapleural and intra-alveolar Pneumocystisjirovecii cystic forms, and bilateral adrenal hemorrhage. Conclusion: COVID-19 and P.jirovecii coinfection should be considered, particularly in critically ill patients, and we recommend the systematic search for P. jirovecii in respiratory samples.


Asunto(s)
/patología , Pulmón/patología , Neumonía por Pneumocystis/patología , Insuficiencia Respiratoria/patología , Trombosis/patología , Lesión Renal Aguda/complicaciones , Insuficiencia Hepática Crónica Agudizada/complicaciones , Enfermedades de las Glándulas Suprarrenales/complicaciones , Enfermedades de las Glándulas Suprarrenales/patología , Autopsia , Coinfección/patología , Exudados y Transudados , Resultado Fatal , Fibrosis , Células Espumosas/patología , Hemorragia/complicaciones , Hemorragia/patología , Humanos , Hipertensión/complicaciones , Hepatopatías Alcohólicas/complicaciones , Masculino , Persona de Mediana Edad , Isquemia Miocárdica/complicaciones , Neumonía por Pneumocystis/complicaciones , Arteria Pulmonar/patología , Venas Pulmonares/patología , Insuficiencia Respiratoria/etiología , Trombosis/etiología
2.
BMJ Case Rep ; 14(3)2021 Mar 25.
Artículo en Inglés | MEDLINE | ID: mdl-33766961

RESUMEN

COVID-19 affects a wide spectrum of organ systems. We report a 52-year-old man with hypertension and newly diagnosed diabetes mellitus who presented with hypoxic respiratory failure due to COVID-19 and developed severe brachial plexopathy. He was not treated with prone positioning respiratory therapy. Associated with the flaccid, painfully numb left upper extremity was a livedoid, purpuric rash on his left hand and forearm consistent with COVID-19-induced microangiopathy. Neuroimaging and electrophysiological data were consistent with near diffuse left brachial plexitis with selective sparing of axillary, suprascapular and pectoral fascicles. Given his microangiopathic rash, elevated D-dimers and paucifascicular plexopathy, we postulate a patchy microvascular thrombotic plexopathy. Providers should be aware of this significant and potentially under-recognised neurologic complication of COVID-19.


Asunto(s)
Neuropatías del Plexo Braquial/etiología , /complicaciones , Brazo/patología , Neuropatías del Plexo Braquial/diagnóstico , Diabetes Mellitus , Exantema/complicaciones , Productos de Degradación de Fibrina-Fibrinógeno/análisis , Humanos , Hipertensión/complicaciones , Imagen por Resonancia Magnética , Masculino , Persona de Mediana Edad , Neuralgia/complicaciones , Posicionamiento del Paciente/efectos adversos , Insuficiencia Respiratoria/etiología , /aislamiento & purificación
3.
Neurophysiol Clin ; 51(2): 183-191, 2021 Mar.
Artículo en Inglés | MEDLINE | ID: mdl-33685769

RESUMEN

OBJECTIVE: To assess whether patients with acute inflammatory demyelinating polyneuropathy (AIDP) associated with SARS-CoV-2 show characteristic electrophysiological features. METHODS: Clinical and electrophysiological findings of 24 patients with SARS-CoV-2 infection and AIDP (S-AIDP) and of 48 control AIDP (C-AIDP) without SARS-CoV-2 infection were compared. RESULTS: S-AIDP patients more frequently developed respiratory failure (83.3% vs. 25%, P=0.000) and required intensive care unit (ICU) hospitalization (58.3% vs. 31.3%, P=0.000). In C-AIDP, distal motor latencies (DMLs) were more frequently prolonged (70.9% vs. 26.2%, P=0.000) whereas in S-AIDP distal compound muscle action potential (dCMAP) durations were more frequently increased (49.5% vs. 32.4%, P=0.002) and F waves were more often absent (45.6% vs. 31.8%, P=0.011). Presence of nerves with increased dCMAP duration and normal or slightly prolonged DML was elevenfold higher in S-AIDP (31.1% vs. 2.8%, P=0.000);11 S-AIDP patients showed this pattern in 2 nerves. CONCLUSION: Increased dCMAP duration, thought to be a marker of acquired demyelination, can also be oserved in critical illness myopathy. In S-AIDP patients, an increased dCMAP duration dissociated from prolonged DML, suggests additional muscle fiber conduction slowing, possibly due to a COVID-19-related hyperinflammatory state. Absent F waves, at least in some S-AIDP patients, may reflect α-motor neuron hypoexcitability because of immobilization during the ICU stay. These features should be considered in the electrodiagnosis of SARS-CoV-2 patients with weakness, to avoid misdiagnosis.


Asunto(s)
/complicaciones , Síndrome de Guillain-Barré/etiología , Síndrome de Guillain-Barré/fisiopatología , Potenciales de Acción , Adulto , Anciano , Anciano de 80 o más Años , Cuidados Críticos/estadística & datos numéricos , Electrodiagnóstico , Fenómenos Electrofisiológicos , Femenino , Hospitalización/estadística & datos numéricos , Humanos , Masculino , Persona de Mediana Edad , Neuronas Motoras , Músculo Esquelético/fisiopatología , Conducción Nerviosa , Insuficiencia Respiratoria/etiología , Células Receptoras Sensoriales
5.
Ugeskr Laeger ; 183(9)2021 03 01.
Artículo en Danés | MEDLINE | ID: mdl-33734078

RESUMEN

COVID-19 is the infectious disease caused by SARS-CoV-2. This is a review of the current treatment strategies available for patients with COVID-19 during hospital admission. Patients requiring hospitalisation frequently suffer from respiratory failure and may require oxygen therapy. Insufficient response to oxygen may be an indication, that other modalities such as high-flow nasal cannula, continuous positive airway pressure or mechanical ventilation are needed. The only medical treatments currently being used are remdesivir and dexamethasone.


Asunto(s)
/terapia , Terapia por Inhalación de Oxígeno/métodos , Respiración Artificial/métodos , Insuficiencia Respiratoria/terapia , /diagnóstico , Humanos , Pacientes Internos , Insuficiencia Respiratoria/etiología
6.
Rev Neurol ; 72(6): 203-212, 2021 03 16.
Artículo en Inglés, Español | MEDLINE | ID: mdl-33710610

RESUMEN

INTRODUCTION: The coronavirus disease 2019 (COVID-19) pandemic is a major worldwide health disorder. There is an increasing number of neurological complications recognized with COVID-19 including patients with GBS and its variants. DEVELOPMENT: A review of the clinical cases of GBS associated to COVID-19 infection published in the last months has been developed. We included 48 patients (31 men, mean age 56.4 years). The most common COVID-19 symptoms were cough (60.4%) and fever (56.3%). Mean time from COVID-19 symptoms to neurologic manifestations was 12.1 days, but in nine patients (18.8%) developed GBS within seven days. Eleven patients (22.9%) presented cranial nerve involvement in the absence of muscle weakness; 36 presented the classic sensory motor variant (75%) and one had a pure motor variant (2.1%). The electrodiagnostic pattern was considered demyelinating in 82.4% of the generalized variants. The presence of hyposmia/dysgeusia was associated with a latency shorter than seven days to GBS onset of symptoms (30% vs 15.6%), and cranial nerve involvement in the absence of weakness (30.8% vs 17.1%). Most patients (87.5%) were treated with intravenous immunoglobulin. Neurological outcome was favorable in 64.6%; 29.2% had respiratory failure and 4.2% died shortly after being admitted. CONCLUSIONS: GBS in patients with SARS-CoV-2 infection resembles clinically and electrophysiology the classical forms. Further studies are necessary to understand whether GBS frequency is actually increased due to SARS-CoV-2 infection and explore pathogenic mechanisms.


Asunto(s)
/complicaciones , Síndrome de Guillain-Barré/etiología , Pandemias , Adolescente , Adulto , Anciano , Autoanticuerpos/sangre , Autoanticuerpos/inmunología , Autoantígenos/inmunología , Enfermedades de los Nervios Craneales/etiología , Disgeusia/etiología , Femenino , Gangliósidos/inmunología , Síndrome de Guillain-Barré/líquido cefalorraquídeo , Síndrome de Guillain-Barré/inmunología , Síndrome de Guillain-Barré/terapia , Humanos , Inmunoglobulinas Intravenosas/uso terapéutico , Masculino , Persona de Mediana Edad , Plasmaféresis , Insuficiencia Respiratoria/etiología , Estudios Retrospectivos , Evaluación de Síntomas , Resultado del Tratamiento , Adulto Joven
8.
Medicine (Baltimore) ; 100(10): e25054, 2021 Mar 12.
Artículo en Inglés | MEDLINE | ID: mdl-33725891

RESUMEN

ABSTRACT: Waterproofing spray-associated pneumonitis (WAP) proceeds to acute respiratory failure and is characterized by diffuse bilateral ground-glass opacities on computed tomography; however, the detailed characteristics of WAP are unknown. Therefore, this study identified the characteristics of WAP from comparisons with those of acute eosinophilic pneumonia (AEP) and hypersensitivity pneumonitis (HP), which show similar features to WAP.Adult patients with WAP, AEP, and HP treated in Fukujuji Hospital from 1990 to 2018 were retrospectively enrolled. Furthermore, data from patients with WAP were collected from publications in PubMed and the Japan Medical Abstracts Society and combined with data from our patients.Thirty-three patients with WAP, eleven patients with AEP, and thirty patients with HP were reviewed. Regarding age, sex, smoking habit, and laboratory findings (white blood cell count, C-reactive protein level, and serum Krebs von den Lungen-6 level), WAP and AEP were not significantly different, while WAP and HP were significantly different. The duration from symptom appearance to hospital visit was shorter in patients with WAP (median 1 day) than in patients with AEP (median 3 days, P = .006) or HP (median 30 days, P < .001). The dominant cells in the bronchoalveolar lavage fluid of patients with WAP, AEP, and HP were different (macrophages, eosinophils, and lymphocytes, respectively).The characteristic features of WAP were rapid disease progression and macrophage dominance in the bronchoalveolar lavage fluid, and these characteristics can be used to distinguish among WAP, AEP, and HP.


Asunto(s)
Lesión Pulmonar Aguda/diagnóstico , Alveolitis Alérgica Extrínseca/diagnóstico , Polímeros de Fluorocarbono/efectos adversos , Eosinofilia Pulmonar/diagnóstico , Insuficiencia Respiratoria/etiología , Lesión Pulmonar Aguda/sangre , Lesión Pulmonar Aguda/inducido químicamente , Lesión Pulmonar Aguda/complicaciones , Adolescente , Adulto , Anciano , Alveolitis Alérgica Extrínseca/sangre , Líquido del Lavado Bronquioalveolar/citología , Líquido del Lavado Bronquioalveolar/inmunología , Proteína C-Reactiva/análisis , Diagnóstico Diferencial , Progresión de la Enfermedad , Femenino , Humanos , Exposición por Inhalación/efectos adversos , Recuento de Leucocitos , Macrófagos/inmunología , Masculino , Persona de Mediana Edad , Mucina-1/sangre , Eosinofilia Pulmonar/sangre , Estudios Retrospectivos , Adulto Joven
9.
Chest ; 159(3): e159-e162, 2021 03.
Artículo en Inglés | MEDLINE | ID: mdl-33678285

RESUMEN

CASE PRESENTATION: A 78-year-old woman was admitted to the ED with a 10-day history of diarrhea and recent onset of dry cough, fever, and asthenia. She had a medical history of obesity (BMI 32) and arterial hypertension treated with irbesartan. In the context of a large-scale lockdown in France during the COVID-19 pandemic, she only had physical contact with her husband, who did not report any symptoms. She required mechanical ventilation because of severe hypoxemia within 1 hour after admission to the ED.


Asunto(s)
/métodos , Pulmón/diagnóstico por imagen , Respiración Artificial/métodos , Insuficiencia Respiratoria , Tomografía Computarizada por Rayos X/métodos , Anciano , /epidemiología , /terapia , Comorbilidad , Diagnóstico Diferencial , Diarrea/diagnóstico , Diarrea/etiología , Femenino , Humanos , Obesidad/diagnóstico , Obesidad/epidemiología , Insuficiencia Respiratoria/diagnóstico , Insuficiencia Respiratoria/etiología , Insuficiencia Respiratoria/terapia , Resultado del Tratamiento
10.
Ned Tijdschr Geneeskd ; 1652021 02 16.
Artículo en Holandés | MEDLINE | ID: mdl-33651518

RESUMEN

Awake prone positioning in COVID-19 patients with respiratory failure has been applied worldwide. We hypothesize that early intervention of awake prone positioning in this patient category might avoid invasive mechanical ventilation and referral to ICU. We observed approximately 30 patients in Suriname in whom awake prone positioning was applied. Also, we reviewed the existing literature on awake prone positioning and discussion of the advantages and disadvantages of this relatively simple intervention. Prospective studies show an improvement in oxygenation, albeit sometimes temporary, but not a reduction in mortality rate or intubation. Mean duration of symptoms in these studies is 10-11 days. Awake prone positioning in COVID-19 patients with a longer duration of symptoms does not improve survival or need for intubation. No prospective studies on early prone position in COVID-19 patients have been conducted yet.


Asunto(s)
/complicaciones , Posicionamiento del Paciente/métodos , Insuficiencia Respiratoria/etiología , Insuficiencia Respiratoria/terapia , Vigilia , /fisiopatología , Humanos , Pulmón/fisiopatología , Masculino , Posición Prona , Estudios Prospectivos , Insuficiencia Respiratoria/fisiopatología , Suriname , Factores de Tiempo
11.
JAMA Netw Open ; 4(3): e210414, 2021 03 01.
Artículo en Inglés | MEDLINE | ID: mdl-33651109

RESUMEN

Importance: Face masks have been associated with effective prevention of diffusion of viruses via droplets. However, the use of face masks among children, especially those aged younger than 3 years, is debated, and the US Centers for Disease Control and American Academy of Physicians recommend the use of face mask only among individuals aged 3 years or older. Objective: To examine whether the use of surgical facial masks among children is associated with episodes of oxygen desaturation or respiratory distress. Design, Setting, and Participants: This cohort study was conducted from May through June 2020 in a secondary-level hospital pediatric unit in Italy. Included participants were 47 healthy children divided by age (ie, group A, aged ≤24 months, and group B, aged >24 months to ≤144 months). Data were analyzed from May through June 2020. Interventions: All participants were monitored every 15 minutes for changes in respiratory parameters for the first 30 minutes while not wearing a surgical face mask and for the next 30 minutes while wearing a face mask. Children aged 24 months and older then participated in a walking test for 12 minutes. Main Outcomes and Measures: Changes in respiratory parameters during the use of surgical masks were evaluated. Results: Among 47 children, 22 children (46.8%) were aged 24 months or younger (ie, group A), with 11 boys (50.0%) and median (interquartile range [IQR]) age 12.5 (10.0-17.5) months, and 25 children (53.2%) were aged older than 24 months to 144 months or younger, with 13 boys (52.0%) and median (IQR) age 100.0 (72.0-120.0) months. During the first 60 minutes of evaluation in the 2 groups, there was no significant change in group A in median (IQR) partial pressure of end-tidal carbon dioxide (Petco2; 33.0 [32.0-34.0] mm Hg; P for Kruskal Wallis = .59), oxygen saturation (Sao2; 98.0% [97.0%-99.0%]; P for Kruskal Wallis = .61), pulse rate (PR; 130.0 [115.0-140.0] pulsations/min; P for Kruskal Wallis = .99), or respiratory rate (RR; 30.0 [28.0-33.0] breaths/min; P for Kruskal Wallis = .69) or for group B in median (IQR) Petco2 (36.0 [34.0-38.0] mm Hg; P for Kruskal Wallis = .97), Sao2 (98.0% [97.0%-98.0%]; P for Kruskal Wallis = .52), PR (96.0 [84.0-104.5] pulsations/min; P for Kruskal Wallis test = .48), or RR (22.0 [20.0-25.0] breaths/min; P for Kruskal Wallis = .55). After the group B walking test, compared with before the walking test, there was a significant increase in median (IQR) PR (96.0 [84.0-104.5] pulsations/min vs 105.0 [100.0-115.0] pulsations/min; P < .02) and RR (22.0 [20.0-25.0] breaths/min vs 26.0 [24.0-29.0] breaths/min; P < .05). Conclusions and Relevance: This cohort study among infants and young children in Italy found that the use of facial masks was not associated with significant changes in Sao2 or Petco2, including among children aged 24 months and younger.


Asunto(s)
/prevención & control , Máscaras/efectos adversos , Pandemias , Respiración , Insuficiencia Respiratoria/etiología , Dióxido de Carbono/fisiología , Preescolar , Femenino , Humanos , Lactante , Italia , Masculino , Oxígeno/sangre , Oxígeno/fisiología , Presión Parcial , Pruebas de Función Respiratoria , Frecuencia Respiratoria
13.
Mycoses ; 64(4): 457-464, 2021 Apr.
Artículo en Inglés | MEDLINE | ID: mdl-33569857

RESUMEN

BACKGROUND: COVID-19-associated pulmonary aspergillosis (CAPA) has emerged as an invasive fungal disease, often affecting previously immunocompetent, mechanically ventilated, intensive care unit (ICU) patients. Incidence rates of 3.8%-33.3% have been reported depending on the geographic area, with high (47%) mortality. OBJECTIVES: Here, we describe a single-centre prospective case series with CAPA cases from both the first (March-May, n = 5/33) and second (mid-September through mid-December, n = 8/33) COVID-19 wave at a 500-bed teaching hospital in the Netherlands. PATIENTS/METHODS: In the first COVID-19 wave, a total of 265 SARS-CoV-2 PCR-positive patients were admitted to our hospital of whom 33 needed intubation and mechanical ventilation. In the second wave, 508 SARS-CoV-2 PCR-positive patients were admitted of whom 33 needed mechanical ventilation. Data were prospectively collected. RESULTS: We found a significant decrease in COVID-19 patients needing mechanical ventilation in the ICU in the second wave (p < .01). From these patients, however, a higher percentage were diagnosed with CAPA (24.2% vs 15.2%), although not significant (p = .36). All CAPA patients encountered in the second wave received dexamethasone. Mortality between both groups was similarly high (40%-50%). Moreover, we found environmental TR34 /L98H azole-resistant Aspergillus fumigatus isolates in two separate patients. CONCLUSIONS: In this series, 19.7% (n = 13/66) of mechanically ventilated SARS-CoV-2 patients were diagnosed with CAPA. In addition, we found a significant reduction in COVID-19 patients needing mechanical ventilation on the ICU in the second wave. Numbers are too small to determine whether there is a true difference in CAPA incidence in mechanically ventilated patients between the two waves, and whether it could be attributed to dexamethasone SARS-CoV-2 therapy.


Asunto(s)
/complicaciones , Aspergilosis Pulmonar/epidemiología , /aislamiento & purificación , Anciano , Estudios de Cohortes , Femenino , Humanos , Unidades de Cuidados Intensivos , Masculino , Países Bajos/epidemiología , Reacción en Cadena de la Polimerasa , Estudios Prospectivos , Aspergilosis Pulmonar/complicaciones , Aspergilosis Pulmonar/etiología , Aspergilosis Pulmonar/mortalidad , Respiración Artificial , Insuficiencia Respiratoria/etiología , Insuficiencia Respiratoria/terapia , /genética
14.
N Engl J Med ; 384(10): 915-923, 2021 03 11.
Artículo en Inglés | MEDLINE | ID: mdl-33626251

RESUMEN

BACKGROUND: Type 1 spinal muscular atrophy is a rare, progressive neuromuscular disease that is caused by low levels of functional survival of motor neuron (SMN) protein. Risdiplam is an orally administered, small molecule that modifies SMN2 pre-messenger RNA splicing and increases levels of functional SMN protein. METHODS: We report the results of part 1 of a two-part, phase 2-3, open-label study of risdiplam in infants 1 to 7 months of age who had type 1 spinal muscular atrophy, which is characterized by the infant not attaining the ability to sit without support. Primary outcomes were safety, pharmacokinetics, pharmacodynamics (including the blood SMN protein concentration), and the selection of the risdiplam dose for part 2 of the study. Exploratory outcomes included the ability to sit without support for at least 5 seconds. RESULTS: A total of 21 infants were enrolled. Four infants were in a low-dose cohort and were treated with a final dose at month 12 of 0.08 mg of risdiplam per kilogram of body weight per day, and 17 were in a high-dose cohort and were treated with a final dose at month 12 of 0.2 mg per kilogram per day. The baseline median SMN protein concentrations in blood were 1.31 ng per milliliter in the low-dose cohort and 2.54 ng per milliliter in the high-dose cohort; at 12 months, the median values increased to 3.05 ng per milliliter and 5.66 ng per milliliter, respectively, which represented a median of 3.0 times and 1.9 times the baseline values in the low-dose and high-dose cohorts, respectively. Serious adverse events included pneumonia, respiratory tract infection, and acute respiratory failure. At the time of this publication, 4 infants had died of respiratory complications. Seven infants in the high-dose cohort and no infants in the low-dose cohort were able to sit without support for at least 5 seconds. The higher dose of risdiplam (0.2 mg per kilogram per day) was selected for part 2 of the study. CONCLUSIONS: In infants with type 1 spinal muscular atrophy, treatment with oral risdiplam led to an increased expression of functional SMN protein in the blood. (Funded by F. Hoffmann-La Roche; ClinicalTrials.gov number, NCT02913482.).


Asunto(s)
Compuestos Azo/administración & dosificación , Fármacos Neuromusculares/administración & dosificación , Pirimidinas/administración & dosificación , Atrofias Musculares Espinales de la Infancia/tratamiento farmacológico , Proteína 1 para la Supervivencia de la Neurona Motora/sangre , Administración Oral , Compuestos Azo/efectos adversos , Compuestos Azo/farmacocinética , Relación Dosis-Respuesta a Droga , Femenino , Humanos , Lactante , Masculino , Fármacos Neuromusculares/efectos adversos , Fármacos Neuromusculares/farmacocinética , Supervivencia sin Progresión , Pirimidinas/efectos adversos , Pirimidinas/farmacocinética , Empalme del ARN , Insuficiencia Respiratoria/etiología , Infecciones del Sistema Respiratorio/etiología , Atrofias Musculares Espinales de la Infancia/complicaciones , Atrofias Musculares Espinales de la Infancia/mortalidad , Proteína 1 para la Supervivencia de la Neurona Motora/genética
15.
Heart Lung ; 50(3): 425-429, 2021.
Artículo en Inglés | MEDLINE | ID: mdl-33621840

RESUMEN

BACKGROUND: In Covid-19 pneumonia, high mortality rates reported in intubated patients have raised non-invasive methods of respiratory support. OBJECTIVE: We aimed to evaluate the impact of HFNC application on intubation requirement, intensive care length of stay, and short-term mortality in patients with COVID-19 pneumonia. MATERIAL-METHOD: Patients receiving oxygen by reservoir mask or HFNC therapy in our intensive care units due to COVID-19 pneumonia were included in the study. Group H consisted of patients who received HFNC, and Group K consisted of patients who received conventional oxygen therapy (COT). The number of patients intubated, duration of intensive care stay and short-term mortality were recorded. RESULTS: 43 patients were included. The short-term mortality and the number of patients with intubation need was lower in Group H. There was no significant difference between the Groups in the length of intensive care stay. CONCLUSION: Administration of HFNC in respiratory failure secondary to COVID-19 pneumonia decreases the need for intubation and mortality.


Asunto(s)
Insuficiencia Respiratoria , Cánula , Cuidados Críticos , Humanos , Tiempo de Internación , Terapia por Inhalación de Oxígeno , Insuficiencia Respiratoria/etiología , Insuficiencia Respiratoria/terapia
16.
Respir Physiol Neurobiol ; 287: 103639, 2021 05.
Artículo en Inglés | MEDLINE | ID: mdl-33588090

RESUMEN

INTRODUCTION: Some COVID-19 patients develop respiratory failure requiring admission to intensive care unit (ICU). We aim to evaluate the effects of pulmonary rehabilitation (PR) post-ICU in COVID-19 patients. METHODS: Twenty-one COVID-19 patients were evaluated pre- and post-PR and compared retrospectively to a non-COVID-19 group of 21 patients rehabilitated after ICU admission due to respiratory failure. RESULTS: PR induced greater 6-min walking distance improvement in COVID-19 patients (+205 ± 121 m) than in other respiratory failure patients post-ICU (+93 ± 66 m). The sooner PR was performed post-ICU, the better patients recovered. CONCLUSIONS: PR induced large functional improvements in COVID-19 patients post-ICU although significant physical and psychosocial impairments remained post-PR.


Asunto(s)
Ejercicios Respiratorios , /rehabilitación , Terapia por Ejercicio , Recuperación de la Función , Insuficiencia Respiratoria/etiología , Insuficiencia Respiratoria/rehabilitación , Anciano , Anciano de 80 o más Años , Cuidados Críticos , Femenino , Humanos , Unidades de Cuidados Intensivos , Masculino , Persona de Mediana Edad , Estudios Retrospectivos , Resultado del Tratamiento , Prueba de Paso
17.
Medicine (Baltimore) ; 100(4): e24043, 2021 Jan 29.
Artículo en Inglés | MEDLINE | ID: mdl-33530199

RESUMEN

RATIONALE: Respiratory dysfunction resulting from unilateral diaphragmatic paralysis during neck trauma is very rare in adults. We describe the symptoms, diagnosis and treatment of 1 patient with chronic respiratory insufficiency, in whom the diaphragmatic paralysis was associated with phrenic nerve injury due to penetrating neck trauma. PATIENT CONCERNS: A 50-year-old worker was admitted because of left penetrating neck trauma. Imaging investigations demonstrated elevation of the left hemidiaphragm and the C5 and C6 roots avulsion. He complained of gradually worsening dyspnea on exertion 2 months later. DIAGNOSES: The patient was diagnosed with chronic respiratory dysfunction secondary to diaphragmatic paralysis, which caused by phrenic nerve injury. INTERVENTIONS: A conventional video-assisted thoracoscopic diaphragm plication was performed after failed conservative management. OUTCOMES: The respiratory status improved markedly, and he did well without recurrence until 2 years' follow-up. LESSONS: The possibilities of phrenic nerve palsy and diaphragmatic paralysis should not be overlooked during the evaluation of neck trauma.


Asunto(s)
Traumatismos del Cuello/complicaciones , Insuficiencia Respiratoria/etiología , Parálisis Respiratoria/etiología , Heridas Penetrantes/complicaciones , Humanos , Masculino , Persona de Mediana Edad , Nervio Frénico/lesiones , Parálisis Respiratoria/cirugía , Toracoscopía/métodos
18.
BMJ Case Rep ; 14(2)2021 Feb 04.
Artículo en Inglés | MEDLINE | ID: mdl-33541967

RESUMEN

A 29-year-old pregnant woman presented at 26 weeks of gestation with fever and cough for 4 days. On admission, her nasopharyngeal swab confirmed COVID-19. As her respiratory distress worsened, she was shifted to the intensive care unit (ICU). Since the patient was unable to maintain saturation even on high settings of mechanical ventilation, she underwent venovenous extracorporeal membrane oxygenation (VV-ECMO) and was monitored in surgical ICU by a multidisciplinary team. The obstetrical team was on standby to perform urgent delivery if needed. Her condition improved, and she was weaned off after 5 days on extracorporeal membrane oxygenation. She was observed in the antenatal ward for another week and discharged home with the mother and fetus in good condition. VV-ECMO can be considered as rescue therapy for pregnant women with refractory hypoxaemia of severe respiratory failure due to COVID-19. It can save two lives, the mother and fetus.


Asunto(s)
/terapia , Oxigenación por Membrana Extracorpórea/métodos , Complicaciones Infecciosas del Embarazo/terapia , /terapia , Adulto , Femenino , Humanos , Unidades de Cuidados Intensivos , Embarazo , Complicaciones Infecciosas del Embarazo/virología , Segundo Trimestre del Embarazo , Respiración Artificial , Insuficiencia Respiratoria/etiología , Insuficiencia Respiratoria/terapia , Resultado del Tratamiento
20.
JAMA ; 325(8): 742-750, 2021 02 23.
Artículo en Inglés | MEDLINE | ID: mdl-33620405

RESUMEN

Importance: Sepsis is a common syndrome with substantial morbidity and mortality. A combination of vitamin C, thiamine, and corticosteroids has been proposed as a potential treatment for patients with sepsis. Objective: To determine whether a combination of vitamin C, thiamine, and hydrocortisone every 6 hours increases ventilator- and vasopressor-free days compared with placebo in patients with sepsis. Design, Setting, and Participants: Multicenter, randomized, double-blind, adaptive-sample-size, placebo-controlled trial conducted in adult patients with sepsis-induced respiratory and/or cardiovascular dysfunction. Participants were enrolled in the emergency departments or intensive care units at 43 hospitals in the United States between August 2018 and July 2019. After enrollment of 501 participants, funding was withheld, leading to an administrative termination of the trial. All study-related follow-up was completed by January 2020. Interventions: Participants were randomized to receive intravenous vitamin C (1.5 g), thiamine (100 mg), and hydrocortisone (50 mg) every 6 hours (n = 252) or matching placebo (n = 249) for 96 hours or until discharge from the intensive care unit or death. Participants could be treated with open-label corticosteroids by the clinical team, with study hydrocortisone or matching placebo withheld if the total daily dose was greater or equal to the equivalent of 200 mg of hydrocortisone. Main Outcomes and Measures: The primary outcome was the number of consecutive ventilator- and vasopressor-free days in the first 30 days following the day of randomization. The key secondary outcome was 30-day mortality. Results: Among 501 participants randomized (median age, 62 [interquartile range {IQR}, 50-70] years; 46% female; 30% Black; median Acute Physiology and Chronic Health Evaluation II score, 27 [IQR, 20.8-33.0]; median Sequential Organ Failure Assessment score, 9 [IQR, 7-12]), all completed the trial. Open-label corticosteroids were prescribed to 33% and 32% of the intervention and control groups, respectively. Ventilator- and vasopressor-free days were a median of 25 days (IQR, 0-29 days) in the intervention group and 26 days (IQR, 0-28 days) in the placebo group, with a median difference of -1 day (95% CI, -4 to 2 days; P = .85). Thirty-day mortality was 22% in the intervention group and 24% in the placebo group. Conclusions and Relevance: Among critically ill patients with sepsis, treatment with vitamin C, thiamine, and hydrocortisone, compared with placebo, did not significantly increase ventilator- and vasopressor-free days within 30 days. However, the trial was terminated early for administrative reasons and may have been underpowered to detect a clinically important difference. Trial Registration: ClinicalTrials.gov Identifier: NCT03509350.


Asunto(s)
Antiinflamatorios/uso terapéutico , Ácido Ascórbico/uso terapéutico , Hidrocortisona/uso terapéutico , Respiración Artificial , Sepsis/tratamiento farmacológico , Tiamina/uso terapéutico , Vitaminas/uso terapéutico , Adulto , Anciano , Enfermedad Crítica , Método Doble Ciego , Quimioterapia Combinada , Terminación Anticipada de los Ensayos Clínicos , Femenino , Humanos , Tiempo de Internación , Masculino , Persona de Mediana Edad , Puntuaciones en la Disfunción de Órganos , Insuficiencia Respiratoria/etiología , Insuficiencia Respiratoria/terapia , Sepsis/complicaciones , Sepsis/mortalidad , Sepsis/terapia , Resultado del Tratamiento , Vasoconstrictores/uso terapéutico
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