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INTRODUCTION: The objective of this study is to assess the failure of therapies with HFNO (high-flow nasal oxygen), CPAP, Bilevel, or combined therapy in patients with hypoxemic acute respiratory failure due to SARS-CoV-2 during their hospitalization. METHODS: This was a retrospective and observational study of SARS-CoV-2-positive patients who required non-invasive respiratory support (NIRS) at the Reina Sofía General University Hospital of Murcia between March 2020 and May 2021. RESULTS: Of 7355 patients, 197 (11.8%) were included; 95 of them failed this therapy (48.3%). We found that during hospitalization in the ward, the combined therapy of HFNO and CPAP had an overall lower failure rate and the highest treatment with Bilevel (p = 0.005). In the comparison of failure in therapy without two levels of airway pressure, HFNO, CPAP, and combined therapy of HFNO with CPAP, (35.6% of patients) presented with 24.2% failure, compared to those who had two levels of pressure with Bilevel and combined therapy of HFNO with Bilevel (64.4% of patients), with 75.8% associated failure (OR: 0, 374; CI 95%: 0.203-0.688. p = 0.001). CONCLUSIONS: The use of NIRS during conventional hospitalization is safe and effective in patients with respiratory failure secondary to SARS-CoV-2 infection. The therapeutic strategy of Bilevel increases the probability of failure, with the combined therapy strategy of CPAP and HFNO being the most promising option.
Assuntos
Humanos , Feminino , Idoso , Choque/etiologia , Ruptura Esplênica/complicações , Ruptura Espontânea , Evolução FatalRESUMO
Objetivo. Cuantifi car la mejoría del dolor cervical tras una pauta de ejercicios de rehabilitación y evaluarsu repercusión en la capacidad para realizar actividades cotidianas de la vida diaria.Diseño. Estudio observacional de carácter longitudinal.Participantes. Pacientes adultos con edades comprendidas entre 20-65 años que acudieron a consulta con dolor cervical (n = 56) entre Enero-Marzo de 2006 y fueron tratados mediante ejercicios de rehabilitación. Selección mediante muestreo no probabilístico en dos consultas de atención primaria.Emplazamiento. Centro de salud urbano.Mediciones. Características del dolor e intensidad mediante escala visual analógica (EVA), consumode analgésicos, estado psíquico (Escala de Ansiedad/Depresión de Goldberg), repercusión del dolorcervical mediante The Northwick Park Neck Questionnaire (NPQ) al inicio y tras la realización durantedos semanas de ejercicios de rehabilitación isotónicos e isométricos y variables sociodemográficas.Resultados. La puntuación media en la EVA (rango 0 a 10) descendió de 4,5±1,9 DE a 3,9±2,4 DE (p=0,02). La puntuación inicial media NPQ fue de 32,7±17,5 DE y tras 2 semanas de 25,1±15,4 DE (p<0,001). La repercusión de los ejercicios de rehabilitación en las actividades diarias (dormir, leer, coger peso, trabajar, actividades sociales, conducir, etc.) se evaluó mediante la reducción en la puntuación NPQ, la cual se produjo en el 69,6% de los pacientes, siendo ≥20% en el 14,3% y ≥10% enel 39,3%. Dicha reducción fue signifi cativamente superior (p<0,05) en pacientes con menor tiempo deevolución del cuadro doloroso y de carácter continuo, mayor intensidad en la EVA y consumo previo de analgésicos.Conclusiones. Moderada repercusión de los ejercicios de rehabilitación en la intensidad del dolor cervicaly en la capacidad para realizar actividades diarias. La mejoría es superior en los pacientes que presentan dolor cervical más intenso, de carácter continuo y menor tiempo de evolución
Objective. To quantify cervical pain improvement after rehabilitation exercises and to evaluate its impactfor to develop daily life activities.Design. Observational and longitudinal study.Subjects. Patients with age range 20-65 who have consulted by pain to doctor.Setting. Urban health centre .Principal measurement. Pain profile and intensity by visual analogical score (VAS), analgesic consumption,physic state by Goldberg depression and anxiety score, cervical pain impact by Northwick Park Neck Questionnaire (NPQ) before and after two week following rehabilitation isometrics and isotonic exercises and social-demographic variables.Results. The average level in VAS (0-10 rang) has decreased from 4.5 ± 1.9 SD to 3.9 ± 2.4 SD(p=0.02). The beginning average level NPQ was 32.7 ± 17.5 SD and after 2 weeks, 25.1 ± 15.4 SD(p<0.001). The impact of rehabilitation exercises in daily activities (to sleep, to read, to fatten, to work,social relations, to drive, etc ) has been tested by reduction of NPQ level in 69.6 % of patients, ≥ 20 %in 14.3 % and ≥ 10 % in 39.3 %. The reduction was signifi cantly higher (p<0.005) in patients with lesspain evolution and continuous profi le, higher intensity of VAS and analgesic consumption.Conclusions. It has been showed a moderate impact in pain intensity and capability for to developdaily activities by rehabilitation exercises. There is a higher improvement in patients who suffer a moreintense, continue and with less evolution cervical pain
