RESUMO
Introduction: Cervical spinal cord injury (CSCI) patients on mechanical ventilation often lack standardized guidelines for optimal ventilatory support. This study reviews existing literature to compare outcomes between high tidal volume (HTV) and low tidal volume (LTV) strategies in this unique patient population. Methods: We searched for studies published up to August 30, 2023, in five databases, following a PECO/PICO strategy. We found six studies for quantitative analysis and meta-analyzed five studies. Results: This meta-analysis included 396 patients with CSCI and mechanical ventilation (MV), 119 patients treated with high tidal volume (HTV), and 277 with low tidal volume (LTV). This first meta-analysis incorporates the few studies that show contradictory findings. Our meta-analysis shows that there is no significant statistical difference in developing VAP between both comparison groups (HTV vs. LTV) (OR 0.46; 95% CI 0.13 to 1.66; p > 0.05; I2: 0%), nor are there differences between the presence of other pulmonary complications when treating with HTV such as acute respiratory distress syndrome (ARDS), atelectasis, onset of weaning. Conclusion: In patients with CSCI in MV, the use of HTV does not carry a greater risk of pneumonia compared to LTV; in turn, it is shown as a safe ventilatory strategy as it does not establish an increase in other pulmonary complications such as ARDS, atelectasis, the onset of weaning nor others associated with volutrauma. It is necessary to evaluate the role of HTV ventilation in this group of patients in primary RCT-type studies.
RESUMO
El coronavirus ha generado una suerte de "histeria colectiva" en diversas poblaciones. Por lo tanto, nuestro objetivo fue validar un test que mida el fatalismo ante la posibilidad de contagio por el coronavirus. Se realizó un proceso de validación en cinco fases: Búsqueda de la literatura y construcción del primer borrador, juicio de fondo con 28 expertos, evaluación de forma con 280 personas, piloto para análisis factorial exploratorio en 389 personas (en ambas se contó con 17 ciudades de Perú) y confirmación de la validez del constructo final con 10 expertos. Los estadísticos de KMO (0,779) y Bartlett (572,6; gl = 21; p < 0,001) presentaron resultados aceptables y significativos. La varianza total explicada por los 7 ítems distribuidos en 2 factores es de 58,9%, lo cual es adecuado. Los análisis robustos muestran que la estructura factorial es satisfactoria (X2 = 21,161; p = 0,007; CFI = 0,984; GFI = 0,996; TLI = 0,957; RMSEA = 0,067 y RMSR = 0,033). Se generó una escala de 7 ítems para medir las medidas fatalistas que las personas podrían tener o tomar si es que llegasen a enfermarse del coronavirus
Coronavirus has generated a kind of "mass hysteria" in various populations. A validation process was generated for a test that measures fatalism in the face of the possibility of infection by the coronavirus. A validation process was carried out in five phases: literature search and construction of the first draft, substantive judgement with 28 experts, formal evaluation with 280 people, pilot for exploratory factor analysis in 389 people (in both cases there were 17 cities in Peru) and confirmation of the validity of the final construct with 10 experts. The statisticians of KMO (0.779) and Bartlett (572.6; gl = 21; p < 0.001) presented acceptable and significant results. The total variance explained by the 7 items distributed in 2 factors is 58.9%, which is adequate. Robust analyses show that the factor structure is satisfactory (X2 = 21.161; p = 0.007; IFC = 0.984; GFI = 0.996; TLI = 0.957; RMSEA = 0.067 and RMSR = 0.033). A 7-item scale was generated to measure the fatalistic measures people might have or take if they became ill with the coronavirus
