Oximetry at admission as a predictor of tomographic and functional impairment after 3-6 months in hospitalized patients with COVID-19.

OBJECTIVE: To investigate characteristics that may be associated with radiologic and functional findings following discharge in patients with severe coronavirus disease 2019 (COVID-19). METHODS: This single-center, prospective, observational cohort study comprised patients aged >18 years who were hospitalized with COVID-19 pneumonia, between May and October 2020. After 3 to 6 months of discharge, patients were clinically evaluated and underwent spirometry, a 6-minute walk test (6MWT), and chest computed tomography (CT). Statistical analysis was performed using association and correlation tests. RESULTS: A total of 134 patients were included (25/114 [22%] were admitted with severe hypoxemia). On the follow-up chest CT, 29/92 (32%) had no abnormalities, regardless of the severity of the initial involvement, and the mean 6MWT distance was 447 m. Patients with desaturation on admission had an increased risk of remaining CT abnormalities: patients with SpO2 between 88 and 92% had a 4.0-fold risk, and those with SpO2 < 88% had a 6.2-fold risk. The group with SpO2 < 88% also walked shorter distances than patients with SpO2 between 88 and 92%. CONCLUSION: Initial hypoxemia was found to be a good predictor of persistent radiological abnormalities in follow-up and was associated with low performance in 6MWT.

Comparação entre três métodos de obtenção do índice de respiração rápida e superficial em pacientes submetidos ao desmame da ventilação mecânica / Comparison among three methods to measure the rapid shallow breathing index in patients submitted to weaning from mechanical ventilation

JUSTIFICATIVA E OBJETIVOS: Esta pesquisa justifica-se na necessidade de maior conhecimento a respeito das técnicas de desmame ventilatório utilizadas em pacientes sob ventilação mecânica prolongada. O objetivo deste estudo foi comparar a obtenção do índice de respiração rápida e superficial (IRRS) nas modalidades PSV de 10 cmH2O e PEEP de 5 cmH2O (PSV10); CPAP de 5 cmH2O (CPAP5) e em ventilação espontânea (ESP), correlacionando com sucesso ou insucesso na retirada da ventilação mecânica (VM). MÉTODO: Estudo prospectivo incluindo 54 pacientes em VM há mais de 48 horas, submetidos ao IRRS em três modos ventilatórios: PSV10, CPAP5 e ESP nos momentos pré e pós-nebulização, utilizando tubo-T. Os pacientes foram retirados da VM quando o IRRS era < 105. RESULTADOS: Não houve diferença estatisticamente significativa entre os valores do IRRS obtidos nos momentos pré e pós-nebulização. Houve diferença estatística significativa dos valores do IRRS entre CPAP5 e PSV10 (p = 0,008) e entre a modalidade ESP e PSV10 (p = 0,01) no momento pré-nebulização e dos valores do IRRS obtidos entre CPAP5 e PSV10 (p = 0,01) no momento pós-nebulização. CONCLUSÕES: Neste estudo pode-se observar que o valor do IRRS foi superestimado quando obtido na modalidade PSV10. Foi constatado também que não houve necessidade de nebulização de 30 minutos antes da extubação traqueal quando o desmame é realizado com a técnica de redução gradativa da PSV. Este estudo sugeriu que o IRRS foi capaz de prever o sucesso do desmame; entretanto, incapaz de determinar o insucesso quando seu valor fosse < 105. Recomenda-se que o IRRS seja analisado em associação com outros parâmetros preditivos de desmame.

BACKGROUND AND OBJECTIVES: To compare the attainment of the rapid shallow breathing index (IRRS) in modalities PSV 10 cmH2O and PEEP 5 cmH2O (PSV10), CPAP 5 cmH2O (CPAP5) and spontaneous breathing (SB), correlating them with success on failure in the withdrawal of mechanical ventilation (MV). METHODS: Prospective study including 54 patients in MV > 48 hours, submitted to the IRRS in three ventilatory modalities: PSV10, CPAP5 and SB at the moments before and after T-tube spontaneous breathing. The patients were removed from MV when IRRS was < 105. RESULTS: There wasn't statistically significant difference between IRRS values at the moments before and after T-tube SB. There was statistically significant difference IRRS value between the modalities CPAP5 and PSV10 (p = 0.008), and between the modalities SB and PSV10 (p = 0.01) at the moment before T-Tube SB and of IRRS value, gotten between CPAP5 and PSV10 (p = 0.01) at the moment after T-tube SB. CONCLUSIONS: From this sample, it can be observed that IRRS values are overestimated when gotten in modality PSV10. It was also evidenced that there is no need of a 30 min T-tube SB before extubation, when the weaning is performed with the technique of gradual reduction of PSV. This study suggested that IRRS is able to predict weaning success; however it is not able to determine failure when it was < 105. It is recommended that IRRS must be analyzed in association with other predictive weaning parameters.

[Comparison among three methods to measure the rapid shallow breathing index in patients submitted to weaning from mechanical ventilation]. / Comparação entre três métodos de obtenção do índice de respiração rápida e superficial em pacientes submetidos ao desmame da ventilação mecânica.

BACKGROUND AND OBJECTIVES: To compare the attainment of the rapid shallow breathing index (IRRS) in modalities PSV 10 cmH2O and PEEP 5 cmH2O (PSV10), CPAP 5 cmH2O (CPAP5) and spontaneous breathing (SB), correlating them with success on failure in the withdrawal of mechanical ventilation (MV). METHODS: Prospective study including 54 patients in MV > 48 hours, submitted to the IRRS in three ventilatory modalities: PSV10, CPAP5 and SB at the moments before and after T-tube spontaneous breathing. The patients were removed from MV when IRRS was < 105. RESULTS: There wasn't statistically significant difference between IRRS values at the moments before and after T-tube SB. There was statistically significant difference IRRS value between the modalities CPAP5 and PSV10 (p = 0.008), and between the modalities SB and PSV10 (p = 0.01) at the moment before T-Tube SB and of IRRS value, gotten between CPAP5 and PSV10 (p = 0.01) at the moment after T-tube SB. CONCLUSIONS: From this sample, it can be observed that IRRS values are overestimated when gotten in modality PSV10. It was also evidenced that there is no need of a 30 min T-tube SB before extubation, when the weaning is performed with the technique of gradual reduction of PSV. This study suggested that IRRS is able to predict weaning success; however it is not able to determine failure when it was < 105. It is recommended that IRRS must be analyzed in association with other predictive weaning parameters.