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1.
J Nurs Care Qual ; 38(1): 33-39, 2023.
Artículo en Inglés | MEDLINE | ID: mdl-35984702

RESUMEN

BACKGROUND: Prepandemic hospital guidelines were unable to support an acute influx of patients with respiratory deterioration. New processes for general care practice were needed to facilitate patient care. PURPOSE: To develop and evaluate guidelines to safely treat patients with COVID-19 respiratory deterioration in the general care setting. METHODS: A quality improvement project with 2 PDSA (Plan-Do-Study-Act) cycles was used to develop guidelines for high-flow oxygen and prone positioning, along with frequent monitoring and collaboration with virtual critical care support. RESULTS: Over 6 months, 126 patients with COVID-19 were cared for on general care units. Zero intubations occurred on the general care units, with 211 patient hospital days spent in general care that previously would have required an intensive care unit bed. CONCLUSIONS: Patients in the general care setting with respiratory decline can safely be managed with appropriate monitoring criteria, oxygen device settings, and nursing support unitizing technology.


Asunto(s)
COVID-19 , Humanos , Unidades de Cuidados Intensivos , Cuidados Críticos , Posicionamiento del Paciente , Oxígeno
2.
J Surg Res ; 281: 45-51, 2023 Jan.
Artículo en Inglés | MEDLINE | ID: mdl-36115148

RESUMEN

INTRODUCTION: Continuous prediction surveillance modeling is an emerging tool giving dynamic insight into conditions with potential mitigation of adverse events (AEs) and failure to rescue. The Epic electronic medical record contains a Deterioration Index (DI) algorithm that generates a prediction score every 15 min using objective data. Previous validation studies show rapid increases in DI score (≥14) predict a worse prognosis. The aim of this study was to demonstrate the utility of DI scores in the trauma intensive care unit (ICU) population. METHODS: A prospective, single-center study of trauma ICU patients in a Level 1 trauma center was conducted during a 3-mo period. Charts were reviewed every 24 h for minimum and maximum DI score, largest score change (Δ), and AE. Patients were grouped as low risk (ΔDI <14) or high risk (ΔDI ≥14). RESULTS: A total of 224 patients were evaluated. High-risk patients were more likely to experience AEs (69.0% versus 47.6%, P = 0.002). No patients with DI scores <30 were readmitted to the ICU after being stepped down to the floor. Patients that were readmitted and subsequently died all had DI scores of ≥60 when first stepped down from the ICU. CONCLUSIONS: This study demonstrates DI scores predict decompensation risk in the surgical ICU population, which may otherwise go unnoticed in real time. This can identify patients at risk of AE when transferred to the floor. Using the DI model could alert providers to increase surveillance in high-risk patients to mitigate unplanned returns to the ICU and failure to rescue.


Asunto(s)
Registros Electrónicos de Salud , Unidades de Cuidados Intensivos , Humanos , Estudios Prospectivos , Estudios de Factibilidad , Estudios Retrospectivos , Mortalidad Hospitalaria
3.
Ann Ig ; 35(1): 49-60, 2023.
Artículo en Inglés | MEDLINE | ID: mdl-35195240

RESUMEN

Background: Co-infection rates increase in patients admitted to the Intensive Care Units. The aim of this study was to examine the Healthcare Associated Infections in critically ill adult patients infected with SARS-CoV-2. Methods: A retrospective observational study in adults with confirmed SARS-CoV-2 infection requiring intensive care unit admission was performed. From February 2020 to September 2021, healthcare records from a total of 118 patients were evaluated. Results: In the study period, 39 patients were diagnosed with at least 1 Healthcare Associated Infection (33.1%). The co-infection/co-colonisation rate >48 hours after admission was 29.0 per 1,000 person/days (95 % CI 19.1-33.9). A total of 94 isolates were identified, the most common being Klebsiella spp, Clostridium difficile, Acinetobacter baumanii and Enterococcus spp. Associated outcomes for Healthcare Associated Infections have been identified: age >64 years (p= .003), length of Intensive Care Unit stay> 7 days (p= .002), Type 2 Diabetes mellitus (p= .019), cardiovascular disease (p= .021), inserted central venous catheter (p= .014), intubation (p< .001), APACHE II score >25 (p< .001), mechanical ventilation 48 hours (p= .003), and inserted urinary catheter (p= .002). The overall fatality rate of patients included in the study was 41.5% (n= 49), and it was found to be significantly higher in patients who acquired a Healthcare Associated Infection (n=26/39, 66.7%) compared to those who did not acquire it (n= 23/79, 29.1%) (OR= 4.87; 95% CI = 2.14-11.10; p< .001). Conclusions: Our study showed high rates of Healthcare Associated Infections in critically ill adults with COVID-19. Associated factors for Healthcare Associated Infections acquisition and fatality in Intensive Care Units patients were identified as a good reason for a revision of existing infection control policies.


Asunto(s)
COVID-19 , Coinfección , Infección Hospitalaria , Diabetes Mellitus Tipo 2 , Adulto , Humanos , Persona de Mediana Edad , COVID-19/epidemiología , Estudios Retrospectivos , Enfermedad Crítica , SARS-CoV-2 , Coinfección/epidemiología , Unidades de Cuidados Intensivos , Infección Hospitalaria/epidemiología
4.
J Intensive Care Med ; 38(1): 21-26, 2023 Jan.
Artículo en Inglés | MEDLINE | ID: mdl-35815883

RESUMEN

Purpose: Elevated ferritin levels are associated with poor outcomes in Covid-19 patients. Optimal timing of ferritin assessment and the merit of longitudinal values remains unclear. Methods: Patients admitted to Henry Ford Hospital with confirmed SARS-CoV-2 were studied. Regression models were used to determine the relation between ferritin and mortality, need for mechanical ventilation, ICU admission, and days on the ventilator. Results: 2265 patients were evaluated. Patients with an initial ferritin of > 490 ng/mL had an increased risk of death (OR 3.4, P < .001), admission to the ICU (OR 2.78, P < .001) and need for mechanical ventilation (OR 3.9, P < .001). There was no difference between admission and Day 1 ICU ferritin levels (611.5 ng/mL vs. 649 ng/mL respectively; P = .07). The decline in ferritin over ICU days 1-4 was similar between survivors and non-survivors. A change in ferritin levels from admission to ICU Day 1 (P = .330), or from ICU Day 1 to 2 (P = .788), did not predict days on the ventilator. Conclusions: Initial Ferritin levels were highly predictive of ICU admission, the need for mechanical ventilation and in-hospital mortality. However, longitudinal measures of ferritin throughout the hospital stay did not provide additional predictive value.


Asunto(s)
COVID-19 , Humanos , COVID-19/terapia , SARS-CoV-2 , Respiración Artificial , Ventiladores Mecánicos , Ferritinas , Unidades de Cuidados Intensivos , Estudios Retrospectivos
5.
J Intensive Care Med ; 38(1): 70-77, 2023 Jan.
Artículo en Inglés | MEDLINE | ID: mdl-36213939

RESUMEN

PURPOSE: We aimed to evaluate the relation between admission COVID-19 associated hyperinflammatory syndrome (cHIS) score and intensive care unit (ICU) outcomes. MATERIALS AND METHODS: Patients with laboratory confirmed COVID-19 admitted to our ICU between 20th March 2020-15th June 2021 were included. Patients who received immunomodulatory treatment except corticosteroids were excluded. Main outcomes were ICU mortality and invasive mechanical ventilation (IMV) requirement after ICU admission. RESULTS: Three hundred and seventy patients with a median (IQR) age of 66 (56-77) were analyzed. Median admission cHIS score was 3 (2-4). A cHIS score ≥3 was found to be associated with ICU mortality (sensitivity = 0.63, specificity = 0.50; p < 0.01) and IMV requirement after ICU admission (sensitivity = 0.61, specificity = 0.51; p < 0.01). Patients with an admission cHIS score ≥3 (n = 199) had worse median admission APACHEII, SOFA scores and PaO2/FiO2 ratio than others (n = 171) (p < 0.01). IMV requirement after ICU admission (38.5% vs 26.1%;p = 0.03), ICU (36.2% vs 25.1%;p = 0.02), hospital (39.1% vs 26.9%;p = 0.01) and 28th day (28.1% vs 19.1%;p = 0.04) mortality were higher in patients with admission cHIS score ≥3 than others (p < 0.01). Age <65 years, malignancy and higher admission SOFA score were independent variables associated with admission cHIS score ≥3. CONCLUSION: Critically-ill COVID-19 patients with admission cHIS score ≥3 have worse disease severity and outcomes than other patients.


Asunto(s)
COVID-19 , Humanos , Anciano , COVID-19/complicaciones , COVID-19/terapia , Enfermedad Crítica/terapia , SARS-CoV-2 , Unidades de Cuidados Intensivos , Hospitalización , Estudios Retrospectivos
6.
J Intensive Care Med ; 38(1): 27-31, 2023 Jan.
Artículo en Inglés | MEDLINE | ID: mdl-36066033

RESUMEN

OBJECTIVE: Endotoxin is a component of Gram-negative bacteria and can be measured in blood using the endotoxin activity assay (EAA). Endotoxin exposure initiates an inflammatory cascade that may contribute to organ dysfunction. Endotoxemia has been reported in previous viral pandemics and we investigated the extent of endotoxemia and its relationship to outcomes in critically ill patients with COVID-19. MATERIALS AND METHODS: We conducted a Prospective Cohort Study of 96 critically-ill COVID-19 patients admitted to the George Washington University Hospital ICU from 25 Mar-6 Jun 2020. EAA and inflammatory markers (ferritin, d dimer, IL-6, CRP) were measured on ICU admission and at the discretion of the clinical team. Clinical outcomes (mortality, LOS, need for renal replacement therapy (RRT), intubation) were measured. Statistical analysis was conducted using descriptive statistics and effect estimates with 95% confidence intervals. Comparisons were made using chi-square tests for categorical variables, and T-tests for continuous variables. RESULTS: A majority of patients (68.8%) had high EAA [≥ 0.60], levels seen in septic shock. Only 3 patients had positive bacterial cultures. EAA levels did not correlate with mortality, higher levels were associated with greater organ failure (cardiovascular, renal) and longer ICU LOS. Among 14 patients receiving RRT for severe AKI, one had EAA < 0.6 (p = 0.043). EAA levels did not directly correlate with other inflammatory markers. CONCLUSIONS: High levels of endotoxin activity were found in a majority of critically-ill COVID-19 patients admitted to the ICU and were associated with greater risk for cardiovascular and renal failure. Further investigation is needed to determine if endotoxin reducing strategies are useful in treating severe COVID-19 infection.


Asunto(s)
Lesión Renal Aguda , COVID-19 , Endotoxemia , Humanos , Endotoxinas , Enfermedad Crítica/terapia , COVID-19/terapia , Estudios Prospectivos , Unidades de Cuidados Intensivos , Biomarcadores , Lesión Renal Aguda/terapia
7.
J Intensive Care Med ; 38(1): 42-50, 2023 Jan.
Artículo en Inglés | MEDLINE | ID: mdl-35611506

RESUMEN

OBJECTIVES: Dysglycemia is associated with poor outcomes in critically ill patients,which is uncertain in patients with diabetes regarding to the situation of glucose control before hospitalization. This study was aimed to investigate the effect of the difference between the level of blood glucose during ICU stay and before admission to ICU upon the outcomes of critically ill patients with diabetes. METHOD: Patients with diabetes expected to stay for more than 24hs were enrolled, HbA1c was converted to A1C-derived average glucose (ADAG) by the equation: ADAG = [ (HbA1c * 28.7) - 46.7 ] * 18-1, blood glucose were measured four times a day during the first 7 days after admission, the mean glucose level(MGL) and SOFA (within 3, 5, and 7days) were calculated for each person, GAPadm and GAPmean was calculated as admission blood glucose and MGL minus ADAG, the incidence of moderate hypoglycemia(MH), severe hypoglycemia (SH), total dosage of glucocorticoids and average daily dosage of insulin, duration of renal replacement therapy(RRT), ventilator-free hours, and non-ICU days were also collected. Patients were divided into survival group and nonsurvival group according to survival or not at 28-day, the relationship between GAP and mortality were analyzed. RESULTS: 431 patients were divided into survival group and nonsurvival group. The two groups had a comparable level of HbA1c, the nonsurvivors had greater APACHE II, SOFA, GAPadm, GAPmean-3, GAPmean-5, GAPmean-7 and higher MH and SH incidences. Less duration of ventilator-free, non-ICU stay and longer duration of RRT were recorded in the nonsurvival group. GAPmean-5 had the greatest predictive power with an AUC of 0.807(95%CI: 0.762-0.851), the cut-off value was 3.6 mmol/L (sensitivity 77.7% and specificity 76.6%). The AUC was increased to 0.852(95%CI: 0.814-0.889) incorporated with SOFA5 (NRI = 11.34%). CONCLUSION: Glycemic GAP between the MGL within 5 days and ADAG was independently associated with 28-day mortality of critically ill patients with diabetes. The predictive power was optimized with addition of SOFA5.


Asunto(s)
Diabetes Mellitus , Hipoglucemia , Humanos , Glucemia , Enfermedad Crítica , Hemoglobina A Glucada/análisis , Glucosa , Estudios Retrospectivos , Unidades de Cuidados Intensivos
8.
J Intensive Care Med ; 38(1): 86-94, 2023 Jan.
Artículo en Inglés | MEDLINE | ID: mdl-35731642

RESUMEN

BACKGROUND: Spontaneous awakening trials (SATs), spontaneous breathing trials (SBTs), delirium assessment/management, early mobility have been termed the ABCDE bundle. The ABCDE bundle has been proven to improve patient outcomes. However, there is often a long gap in dissemination and implementation of evidence-based medicine. OBJECTIVES: To determine the prevalent implementation of and determinants for ABCDE protocol adoption in Pennsylvania. METHODS: We developed a survey of ABCDE bundle protocols. We surveyed factors around implementation including written protocol presence, standardized assessments to guide protocols, timing of creation of protocols, and estimated adherence to protocols. We also collected data on factors that might be determinants for protocol adoption including ICU staffing models, hospital and ICU level factors. We validated the survey tool using the Michigan Health and Hospital Association Keystone ICU collaborative. We then administered the validated survey to a leader of the medical ICU or mixed medical-surgical ICU of all Pennsylvania Hospitals. Multivariable logistic and ordinal regression were used to determine associations between ICU staffing models and hospital and ICU level factors with the presence of ABCDE bundle protocols. RESULTS: In the study cohort of Pennsylvania ICUs (n = 144), we had 100 respondents (69% response). The median number of hospital beds among the respondents was 185 (IQR 111-355) with a median of 14 ICU beds (IQR 10-20). 86% reported spontaneous awakening trial protocols, 60% reported spontaneous breathing trial protocols, 43% reported delirium assessment/management protocols, and 27% reported early mobility protocols. Being a medical ICU compared to a mixed medical-surgical ICU (OR 3.48, 95% CI 1.19-10.21, P = .02) and presence of multidisciplinary rounds (OR 4.97, 95% CI 2.07-11.94, P < .001) were associated with increasing number of ABCDE bundle protocol components. CONCLUSIONS: Variable implementation of ABCDE bundle protocols was present across Pennsylvania. Team communication is important to implementation of these protocols.


Asunto(s)
Delirio , Ambulación Precoz , Humanos , Ambulación Precoz/métodos , Cuidados Críticos/métodos , Delirio/diagnóstico , Delirio/terapia , Unidades de Cuidados Intensivos , Encuestas y Cuestionarios
9.
J Intensive Care Med ; 38(1): 5-10, 2023 Jan.
Artículo en Inglés | MEDLINE | ID: mdl-35892180

RESUMEN

BACKGROUND: Critical illness in patients with chronic liver disease (CLD) is increasing in occurrence, and by virtue of its adverse effect on prognosis, its presence may influence the decision to offer admission to intensive care units (ICU). Our objective was to examine the determinants and outcome of patients with CLD admitted to ICU. METHODS: A retrospective cohort of patients admitted to four adult ICUs in Queensland, Australia from 2017 to 2019. Patients with mild or moderate-severe CLD were defined by the absence and presence of portal hypertension, respectively, and were was determined using granular ICU and state-wide administrative databases. The primary outcome was 90-day all cause case-fatality. RESULTS: We included 3836 patients in the analysis, of which, 60 (2%) had mild liver disease and 132 (3%) had moderate-severe liver disease . Patients with CLD had higher incidence of other co-morbidities with the median adjusted-Charlson co-morbidity index (CCI) was 1 (interquartile range; IQR 0-3) for no CLD, 2 (IQR 1.5-4) for mild CLD, and 3 (IQR 2-5) for moderate-severe CLD. Case-fatality rates at 90 days was 17% for no CLD, 25% for mild CLD, and 41% for moderate-severe CLD. Among those with mild and moderate-severe CLD, an increased co-morbidity burden as measured by an adjusted CCI score of low (0-3), medium (4-5), high (6-7) and very high (>7) resulted in increasing case-fatality rates of 24-40%, 11-28.5%, 33-62%, and 50% respectively. Moderate-severe CLD, but not mild CLD, was independently associated with increased case-fatality at 90 days (Odds Ratio 1.58; 95% confidence interval 1.01-2.48; p = 0.004) after adjusting for medical co-morbidities and severity of illness using logistic regression analysis. CONCLUSIONS: Although patients with moderate-severe CLD have an increased risk for 90-day case-fatality, patients with mild CLD are not at higher risk for death following ICU admission.


Asunto(s)
Enfermedad Crítica , Hipertensión Portal , Adulto , Humanos , Estudios Retrospectivos , Unidades de Cuidados Intensivos , Estudios de Cohortes , Hipertensión Portal/complicaciones
10.
Crit Care Nurs Q ; 46(1): 66-81, 2023.
Artículo en Inglés | MEDLINE | ID: mdl-36415068

RESUMEN

Human gestation and birthing result in many deviations from usual physiology that are nonetheless normal to be seen. However, on occasion, certain complications in the obstetric patient can be life-threatening to both mother and fetus. Timely recognition of these disorders and allocation of the appropriate resources are especially important. These conditions often require an intensive care unit admission for closer monitoring and supportive care. They can affect an array of physiological systems and can lead to significant morbidity. Such complications are discussed in greater detail in this article.


Asunto(s)
Urgencias Médicas , Unidades de Cuidados Intensivos , Embarazo , Femenino , Humanos , Hospitalización
11.
Crit Care Nurs Q ; 46(1): 17-34, 2023.
Artículo en Inglés | MEDLINE | ID: mdl-36415065

RESUMEN

Neurological emergencies carry significant morbidity and mortality, and it is necessary to have a multidisciplinary approach involving the emergency physician, the neurologist, the intensivist, and the critical care nursing staff. These disorders can be broadly divided into noninfectious and infectious etiologies. In this article, we review a few of the neurological emergencies that present to the neurological intensive unit, with emphasis on convulsive status epileptics, myasthenia gravis, Guillain-Barré syndrome, meningitis, encephalitis, and brain abscess.


Asunto(s)
Enfermería de Cuidados Críticos , Urgencias Médicas , Humanos , Unidades de Cuidados Intensivos
12.
Crit Care Nurs Q ; 46(1): 35-47, 2023.
Artículo en Inglés | MEDLINE | ID: mdl-36415066

RESUMEN

Gastrointestinal (GI) emergencies and disorders are among the most common reasons to be admitted to an intensive care unit (ICU). In addition, critically ill patients admitted to the ICU for non-GI-related diseases are frequently at risk of developing GI complications during their hospitalization. This article details the epidemiology/etiology, clinical presentation, diagnostic assessment, and management of the following GI emergencies: upper and lower GI bleed, acute pancreatitis, and ascending cholangitis.


Asunto(s)
Urgencias Médicas , Pancreatitis , Humanos , Enfermedad Aguda , Pancreatitis/diagnóstico , Pancreatitis/terapia , Unidades de Cuidados Intensivos , Enfermedad Crítica
13.
Crit Care Nurs Q ; 46(1): 48-65, 2023.
Artículo en Inglés | MEDLINE | ID: mdl-36415067

RESUMEN

Surgical emergencies are common in the critical care setting and require prompt diagnosis and management. Here, we discuss some of the surgical emergencies involving the gastrointestinal, hepatobiliary, and genitourinary sites. In addition, foreign body aspiration and necrotizing soft-tissue infections have been elaborated. Clinicians should be aware of the risk factors, keys examination findings, diagnostic modalities, and medical as well as surgical treatment options for these potentially fatal illnesses.


Asunto(s)
Urgencias Médicas , Unidades de Cuidados Intensivos , Humanos , Factores de Riesgo
14.
Crit Care Clin ; 39(1): 171-213, 2023 Jan.
Artículo en Inglés | MEDLINE | ID: mdl-36333031

RESUMEN

Clinicians must individualize pharmacotherapy for patients with acute neurological injury based on multiple factors, including age, comorbidities, and chronic medication use. Many pharmacokinetic and pharmacodynamic properties are altered during acute illness, particularly absorption, distribution, metabolism, and elimination, which may result in loss of drug effect or toxicity. This article provides clinicians with general pharmacologic knowledge of the following drug regimens commonly prescribed to neurocritically ill adults: sedatives, analgesics, osmotherapy, antiseizure medications, antishivering agents, vasoactive agents, and antithrombotic reversal agents.


Asunto(s)
Unidades de Cuidados Intensivos , Neurofarmacología , Adulto , Humanos , Hipnóticos y Sedantes/efectos adversos , Analgésicos/farmacología , Enfermedad Crítica , Cuidados Críticos
15.
Crit Care Clin ; 39(1): 123-138, 2023 Jan.
Artículo en Inglés | MEDLINE | ID: mdl-36333027

RESUMEN

Diseases of the peripheral nervous system create an additional diagnostic conundrum within the intensive care setting. Causes are vast, presentations are myriad, and symptoms are often ill-defined or misidentified. Care benefits from a multidisciplinary approach including a neuromuscular specialist, rehabilitation services, and a specialty pharmacist in addition to the neurocritical care team. In general, survivors achieve a good functional recovery relative to their preintensive care unit baseline.


Asunto(s)
Enfermedades Neuromusculares , Humanos , Enfermedades Neuromusculares/diagnóstico , Enfermedades Neuromusculares/terapia , Cuidados Críticos , Debilidad Muscular/diagnóstico , Debilidad Muscular/etiología , Debilidad Muscular/terapia , Unidades de Cuidados Intensivos , Enfermedad Crítica
16.
Crit Care Clin ; 39(1): 153-169, 2023 Jan.
Artículo en Inglés | MEDLINE | ID: mdl-36333029

RESUMEN

Neurologic conditions are often encountered in the general intensive care unit. This article will discuss some of the more common neurologic issues encountered and provide guidance in the assessment and management of these conditions.


Asunto(s)
Unidades de Cuidados Intensivos , Enfermedades del Sistema Nervioso , Humanos , Enfermedades del Sistema Nervioso/diagnóstico , Enfermedades del Sistema Nervioso/terapia , Cuidados Críticos
17.
18.
J Palliat Care ; 38(1): 17-23, 2023 Jan.
Artículo en Inglés | MEDLINE | ID: mdl-34918559

RESUMEN

BACKGROUND: Hospice care for end-of-life patients in the ICU should focus on quality of life. Currently, there are no specific quality-of-life measures for ICU end-of-life patients in China. OBJECTIVE: The aim of this study was to revise and culturally adapt the Taiwanese version of the McGill Quality of Life Questionnaire (MQOL-Taiwan) and to test its reliability and validity to provide an effective instrument for assessing the quality of life of ICU patients at the end of life. METHODS: The revision and cultural adaptation of the MQOL-Taiwan were performed to develop a Chinese version of the McGill Quality of Life Questionnaire for ICU end-of-life patients (MQOL-ICU). A total of 156 ICU doctors, 286 ICU nurses and 120 ICU family members of end-of-life patients were surveyed with the revised scale to evaluate the quality of life of ICU patients at the end of life. The content validity, construct validity, and internal consistency of the scale were measured after the revision. RESULTS: The Chinese version of the MQOL-ICU scale was formed based on the MQOL-Taiwan scale, which includes 8 items. For the Chinese version of the MQOL-ICU, the item-content validity index (I-CVI) ranged from 0.789 to 0.905, and the average scale-level content validity index (S-CVI/Ave) was 0.845. After exploratory factor analysis, the Kaiser-Meyer-Olkin (KMO) value was 0.700, and 3 dominant factors were extracted: physical and psychological symptoms, existential well-being, and support. In addition, 70.385% of the total variance was explained. The internal consistency (Cronbach's α) coefficient of the whole MQOL-ICU was 0.804, and the coefficients for the 3 domains ranged from 0.779 to 0.833. CONCLUSION: The Chinese version of the MQOL-ICU showed good reliability and validity, and it can be used to assess the quality of life of ICU patients at the end of life.


Asunto(s)
Cuidados Paliativos , Calidad de Vida , Humanos , Calidad de Vida/psicología , Reproducibilidad de los Resultados , Cuidados Paliativos/psicología , Encuestas y Cuestionarios , China , Muerte , Unidades de Cuidados Intensivos , Psicometría
19.
Rev. Odontol. Araçatuba (Impr.) ; 43(3): 33-39, set.-dez. 2022. tab
Artículo en Portugués | LILACS, BBO - Odontología | ID: biblio-1381093

RESUMEN

O presente estudo aborda os protocolos odontológicos instituídos na Unidade de Terapia Intensiva COVID de um Hospital do Extremo Sul Catarinense. A cavidade oral, considerada uma abertura para a entrada de microrganismos, possui características favoráveis ao seu crescimento, com temperatura e umidade ideais para sua sobrevivência em longo prazo. A odontologia, por manipular diretamente mucosa oral, fica exposta e vulnerável ao contágio do COVID-19, assim como a equipe multiprofissional que manipula o paciente nas diversas áreas de atenção à saúde, no ambiente hospitalar. A COVID-19 é uma infecção respiratória aguda causada pelo coronavírus SARS-CoV-2, potencialmente grave, de elevada transmissibilidade e de distribuição global. A maioria das pessoas (cerca de 80%) se recupera da doença sem precisar de tratamento hospitalar. Uma em cada seis pessoas infectadas por COVID-19 fica gravemente doente e desenvolve dificuldade de respirar. As pessoas idosas e as que têm outras condições de saúde, como pressão alta, problemas cardíacos e do pulmão, diabetes ou câncer, têm maior risco de ficarem gravemente doentes. No entanto, qualquer pessoa pode pegar a COVID-19 e ficar gravemente doente. Constatou-se que a aplicação de protocolos odontológicos na Unidade de Terapia Intensiva apresenta uma série de vantagens em relação à prevenção da contaminação dos profissionais de saúde, à manutenção da saúde bucal do paciente, aos benefícios gerais para a saúde, à prevenção e ao tratamento de infecções oportunistas, que podem reduzir o tempo de internação do paciente, pois infecção generalizada e pneumonia são doenças nosocomiais também causadas por distúrbios na microbiota oral. Os resultados mostraram que não há cirurgiões dentistas atuando na Unidade de Terapia Intensiva, os protocolos não são específicos para área de odontologia e os equipamentos de proteção individuais são utilizados, porém, não em todos atendimentos(AU)


The present study addresses the dental protocols established in the COVID Intensive Care Unit of a Hospital in Extremo Sul Santa Catarina. The oral cavity, considered an opening for the entry of microorganisms, has characteristics favorable to its growth, with ideal temperature and humidity for its long-term survival. Dentistry, by directly manipulating the oral mucosa, is exposed and vulnerable to COVID-19 contagion, as well as the multidisciplinary team that handles the patient in the different areas of health care, in the hospital environment. COVID-19 is a potentially serious acute respiratory infection caused by the SARS-CoV-2 coronavirus, with high transmissibility and global distribution. Most people (about 80%) recover from the disease without needing hospital treatment. One in six people infected with COVID-19 becomes seriously ill and develops difficulty breathing. Elderly people and those with other health conditions, such as high blood pressure, heart and lung problems, diabetes or cancer, are at increased risk of becoming seriously ill. However, anyone can take COVID-19 and become seriously ill. It was found that the application of dental protocols in the Intensive Care Unit has a number of advantages in relation to the prevention of contamination of health professionals, the maintenance of the patient's oral health, the general benefits for health, prevention and treatment of opportunistic infections, which can reduce the patient's hospital stay, as generalized infection and pneumonia are nosocomial diseases also caused by disorders in the oral microbiota. The results showed that there are no dentists working in the Intensive Care Unit, the protocols are not specific to the field of dentistry and individual protective equipment is used, however, not in all cases(AU)


Asunto(s)
Odontólogos , COVID-19 , Unidades de Cuidados Intensivos , Grupo de Atención al Paciente , Salud Bucal , Transmisión de Enfermedad Infecciosa , Tiempo de Internación , Mucosa Bucal
20.
Washington, D.C.; OPS; 2022-11-23. (OPS/IMS/EIH/COVID-19/22-0037).
No convencional en Español | PAHO-IRIS | ID: phr-56751

RESUMEN

Esta cuarta edición de las directrices, para cuya elaboración se siguió el método GRADE, tiene por objeto proveer recomendaciones actualizadas para el manejo de los pacientes adultos con COVID-19 grave o crítica atendidos en las unidades de cuidados intensivos de la Región de las Américas. Ofrece recomendaciones basadas en la evidencia para la identificación de marcadores y factores de riesgo de mortalidad, el control de la infección, la recogida de muestras, el cuidado de los pacientes (ventilatorio y hemodinámico), el tratamiento farmacológico, la rehabilitación temprana, el uso de imágenes diagnósticas, la prevención de complicaciones y los criterios de egreso. Las recomendaciones se dirigen a todo el personal de salud que atiende a pacientes en los servicios de urgencias y las unidades de cuidados intensivos, así como a tomadores de decisiones y miembros de entidades gubernamentales relacionados con el manejo de pacientes con COVID-19 en la Región de las Américas. La Organización Panamericana de la Salud revisará de forma periódica la evidencia y las recomendaciones correspondientes con el fin de proporcionar la información más actualizada para el manejo de los pacientes críticos con COVID-19, en especial sobre las intervenciones de tratamiento farmacológico como el uso de antivirales, inmunomoduladores, plasma de convalecientes y antibióticos.


Asunto(s)
COVID-19 , Atención Dirigida al Paciente , Unidades de Cuidados Intensivos , Control de Enfermedades Transmisibles , Américas
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