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1.
Medicine (Baltimore) ; 100(20): e25973, 2021 May 21.
Artigo em Inglês | MEDLINE | ID: mdl-34011084

RESUMO

INTRODUCTION: Endobronchial ultrasound-guided transbronchial needle aspiration (EBUS-TBNA) is less commonly used in nonmalignant diseases. In particular, its application in mediastinal cystic lesions has been reported less frequently. EBUS-TBNA is a reassuringly safe procedure with an overall complication rate less than 2%, and serious adverse event rate of 0.14% to 0.16%. The most common complications are infections (mediastinal cyst infection most seen). PATIENT CONCERNS: A 28-year-old male presented to the hospital with mediastinal cyst that was incidentally discovered by computed tomography. There was no past history of the patient reviewed. DIAGNOSIS: The cyst was identified as a round, anechoic structure by EBUS and serous fluid was aspirated. The carcino-embryonic antigen, mycobacterium tuberculosis DNA and cultures in the fluid were negative. Cytology analysis showed lots of lymphocytes and no malignant cells. The diagnosis of lymphangioma was confirmed based on the computed tomography and EBUS presentation, the nature of the aspirated fluid and the large number of mature lymphocytes within the cystic fluid. INTERVENTIONS: Twenty-six hours after EBUS-TBNA, the patient complained of a fever with the highest temperature of 39°C, accompanied by a right-side chest pain, no other symptoms of were reported. The following examinations confirmed the diagnosis of pneumonia, pleurisy, mediastinitis and mediastinal cyst infection, while cultures from cyst and right pleural effusion were both negative. The patient was treated with Teicoplanin+Imipenem/cilastatin, and ultrasound guided transcutaneous catheterization drainage of mediastinal cyst and pleural effusion were performed. OUTCOMES: Seven days after the treatments, the patient's symptoms resolved, the complete blood count, C-reactive protein, erythrocyte sedimentation rate were lowered. The size of the cyst was slightly reduced on 17 June compared to that before EBUS-TBNA. Although the surgical resection of the cyst was recommended, the patient declined. After extracted the two drainage tubes, the patient was discharged on June 22. The patient was followed up by telephone 6 months after discharge and he remained asymptomatic. CONCLUSIONS: EBUS-TBNA is a useful diagnostic and therapeutic tool for the management of mediastinal cysts. However, considering the possibility of serious complications, the clinical procedure should be carried out scrupulously with appropriate patient selection and strict aseptic principles.


Assuntos
Broncoscopia/efeitos adversos , Cisto Mediastínico/cirurgia , Mediastinite/etiologia , Pleurisia/etiologia , Pneumonia/etiologia , Infecção da Ferida Cirúrgica/etiologia , Adulto , Antibacterianos/uso terapêutico , Broncoscopia/métodos , Terapia Combinada , Drenagem , Quimioterapia Combinada , Endossonografia , Humanos , Achados Incidentais , Masculino , Cisto Mediastínico/diagnóstico por imagem , Cisto Mediastínico/microbiologia , Mediastinite/diagnóstico , Mediastinite/terapia , Pleurisia/diagnóstico , Pleurisia/terapia , Pneumonia/diagnóstico , Pneumonia/terapia , Infecção da Ferida Cirúrgica/diagnóstico , Infecção da Ferida Cirúrgica/terapia , Tomografia Computadorizada por Raios X , Resultado do Tratamento
4.
PLoS One ; 16(1): e0245696, 2021.
Artigo em Inglês | MEDLINE | ID: mdl-33481845

RESUMO

Data on adverse events from research bronchoscopy with bronchoalveolar lavage (BAL) in patients with cystic fibrosis (CF) is lacking. As research bronchoscopy with BAL is useful for isolation of immune cells and investigation of CF lung microbiome, we sought to investigate the safety of bronchoscopy in adult patients with CF. Between November 2016 and September 2019, we performed research bronchoscopies on CF subjects (32) and control subjects (82). Control subjects were nonsmokers without respiratory disease. CF subjects had mild or moderate obstructive lung disease (FEV1 > 50% predicted) and no evidence of recent CF pulmonary exacerbation. There was no significant difference in the age or sex of each cohort. Neither group experienced life threatening adverse events. The number of adverse events was similar between CF and control subjects. The most common adverse events were sore throat and cough, which occurred at similar frequencies in control and CF subjects. Fever and headache occurred more frequently in CF subjects. However, the majority of fevers were seen in CF subjects with FEV1 values below 65% predicted. We found that CF subjects had similar adverse event profiles following research bronchoscopy compared to healthy subjects. While CF subjects had a higher rate of fevers, this adverse event occurred with greater frequency in CF subjects with lower FEV1. Our data demonstrate that research bronchoscopy with BAL is safe in CF subjects and that safety profile is improved if bronchoscopies are limited to subjects with an FEV1 > 65% predicted.


Assuntos
Lavagem Broncoalveolar , Broncoscopia , Fibrose Cística/diagnóstico , Doença Pulmonar Obstrutiva Crônica/diagnóstico , Segurança , Adolescente , Adulto , Lavagem Broncoalveolar/efeitos adversos , Lavagem Broncoalveolar/métodos , Broncoscopia/efeitos adversos , Broncoscopia/métodos , Fibrose Cística/patologia , Feminino , Humanos , Masculino , Pessoa de Meia-Idade
6.
Mycoses ; 64(1): 55-59, 2021 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-32918497

RESUMO

OBJECTIVES: With the outbreak of coronavirus disease 2019 (COVID-19), clinicians have used personal protective equipment to avoid transmission of severe acute respiratory syndrome coronavirus 2. However, they still face occupational risk of infection, when treating COVID-19 patients. This may be highest during invasive diagnostic procedures releasing aerosols and droplets. Thereby, the use of diagnostic procedures for Covid-19 associated aspergillosis may be delayed or impeded, as use of bronchoscopy has been discouraged. This leads to avoidance of a crucial procedure for diagnosing invasive aspergillosis. We intent to visualise aerosol and droplet spread and surface contamination during bronchoscopy and address which measures can avoid exposure of health-care workers. METHODS: We created a simulation model to visualise aerosol and droplet generation as well as surface contamination by nebulising fluorescent solution detected by using ultraviolet light- and slow-motion capture. We repurposed covers for ultrasound transducers or endoscopic cameras to prevent surface and ambient air contamination. RESULTS: In our bronchoscopy simulation model, we noticed extensive aerosol generation, droplet spread and surface contamination. Exposure of health-care workers and contamination of surfaces can be efficiently reduced by repurposing covers for ultrasound transducers or endoscopic cameras to seal the tube opening during bronchoscopy in mechanically ventilated patients. CONCLUSION: Adequate personal protective equipment and safety strategies allow to minimise contamination during bronchoscopy in mechanically ventilated COVID-19 patients.


Assuntos
Broncoscopia/efeitos adversos , Broncoscopia/normas , /transmissão , Controle de Infecções/métodos , Controle de Infecções/normas , Aspergilose Pulmonar/diagnóstico , Simulação por Computador , Humanos , Pandemias/prevenção & controle , Guias de Prática Clínica como Assunto
7.
J Surg Res ; 260: 38-45, 2021 04.
Artigo em Inglês | MEDLINE | ID: mdl-33316758

RESUMO

BACKGROUND: Urgent guidance is needed on the safety for providers of percutaneous tracheostomy in patients diagnosed with COVID-19. The objective of the study was to demonstrate that percutaneous dilational tracheostomy (PDT) with a period of apnea in patients requiring prolonged mechanical ventilation due to COVID-19 is safe and can be performed for the usual indications in the intensive care unit. METHODS: This study involves an observational case series at a single-center medical intensive care unit at a level-1 trauma center in patients diagnosed with COVID-19 who were assessed for tracheostomy. Success of a modified technique included direct visualization of tracheal access by bronchoscopy and a blind dilation and tracheostomy insertion during a period of patient apnea to reduce aerosolization. Secondary outcomes include transmission rate of COVID-19 to providers and patient complications. RESULTS: From April 6th, 2020 to July 21st, 2020, 2030 patients were admitted to the hospital with COVID-19, 615 required intensive care unit care (30.3%), and 254 patients required mechanical ventilation (12.5%). The mortality rate for patients requiring mechanical ventilation was 29%. Eighteen patients were assessed for PDT, and 11 (61%) underwent the procedure. The majority had failed extubation at least once (72.7%), and the median duration of intubation before tracheostomy was 15 d (interquartile range 13-24). The median positive end-expiratory pressure at time of tracheostomy was 10.8. The median partial pressure of oxygen (PaO2)/FiO2 ratio on the day of tracheostomy was 142.8 (interquartile range 104.5-224.4). Two patients had bleeding complications. At 1-week follow-up, eight patients still required ventilator support (73%). At the most recent follow-up, eight patients (73%) have been liberated from the ventilator, one patient (9%) died as a result of respiratory/multiorgan failure, and two were discharged on the ventilator (18%). Average follow-up was 20 d. None of the surgeons performing PDT have symptoms of or have tested positive for COVID-19. CONCLUSIONS: and relevance: PDT for patients with COVID-19 is safe for health care workers and patients despite higher positive end-expiratory pressure requirements and should be performed for the same indications as other causes of respiratory failure.


Assuntos
Broncoscopia/efeitos adversos , Transmissão de Doença Infecciosa do Paciente para o Profissional/prevenção & controle , Complicações Pós-Operatórias/epidemiologia , Respiração Artificial/efeitos adversos , Traqueostomia/efeitos adversos , Adulto , Idoso , Extubação/estatística & dados numéricos , Broncoscopia/instrumentação , Broncoscopia/métodos , Broncoscopia/normas , /mortalidade , /estatística & dados numéricos , Feminino , Seguimentos , Mortalidade Hospitalar , Humanos , Transmissão de Doença Infecciosa do Paciente para o Profissional/estatística & dados numéricos , Unidades de Terapia Intensiva/normas , Unidades de Terapia Intensiva/estatística & dados numéricos , Masculino , Pessoa de Meia-Idade , Complicações Pós-Operatórias/etiologia , Respiração Artificial/instrumentação , Respiração Artificial/métodos , Respiração Artificial/estatística & dados numéricos , Estudos Retrospectivos , Índice de Gravidade de Doença , Fatores de Tempo , Traqueostomia/instrumentação , Traqueostomia/métodos , Traqueostomia/normas , Resultado do Tratamento
8.
Medicine (Baltimore) ; 99(52): e23170, 2020 Dec 24.
Artigo em Inglês | MEDLINE | ID: mdl-33350722

RESUMO

ABSTRACT: This retrospective study aimed to investigate bronchospasm after tracheobronchial foreign body removal. Bronchoscopy is the main clinical treatment for removing airway foreign bodies, but postoperative airway spasm is very common. In our study, we perform a risk factor analysis of bronchospasm after tracheobronchial foreign body removal. The sample was composed of 261 children with airway foreign bodies who had undergone clinical bronchoscopy for foreign body removal under general anesthesia were enrolled from the department of otolaryngology, the First Hospital of Jilin University from 2014 to 2019, of which 78 in the left bronchus, 107 in the right bronchus, 51 in the main bronchus, and 25 in the subglottis. All patients were confirmed by radiographic examination or pulmonary auscultation. All their medical records and clinical data were retrospectively analyzed; single factor and multiple factor analyses of bronchospasm were performed. The logistic regression analysis showed that age, foreign body retention time and operation time were independent risk factors for postoperative airway spasm. A history of pneumonia was not an independent risk factor for postoperative airway spasm. We should pay more attention in the preoperative period according to the specific situation of child; the right means of anesthesia and appropriate hormonal drugs should be chosen to prevent the occurrence of postoperative airway spasm.


Assuntos
Brônquios , Espasmo Brônquico/etiologia , Broncoscopia/efeitos adversos , Corpos Estranhos/cirurgia , Complicações Pós-Operatórias/etiologia , Traqueia , Criança , Pré-Escolar , Feminino , Humanos , Lactente , Masculino , Estudos Retrospectivos , Medição de Risco , Fatores de Risco
9.
Medicine (Baltimore) ; 99(43): e22772, 2020 Oct 23.
Artigo em Inglês | MEDLINE | ID: mdl-33120787

RESUMO

Lung cancer is 1 of the leading causes of cancer-related deaths and bronchoscopy is an essential tool for the diagnosis. The diagnostic yield varies based on the characteristics of the lesion and bronchoscopic techniques employed. There is limited data regarding outcomes of patients suspected of thoracic malignancies with a non-diagnostic initial bronchoscopy. The goal of the study was to evaluate the outcomes of patients with a non-diagnostic bronchoscopy for suspected thoracic malignancies and to evaluate variables predictive of a diagnostic bronchoscopy.Retrospective analysis of adult patients at BronxCare Hospital Center who underwent bronchoscopy for suspected thoracic malignancy. The study period was January 2012 to February 2019. Exclusion criteria included patients who underwent only inspection bronchoscopy or bronchoalveolar lavage as the diagnostic yield for malignancy with these techniques is low. All other bronchoscopic procedures were included that is, endobronchial biopsies, transbronchial biopsies, and endobronchial ultrasound guided-transbronchial needle aspiration. Bronchoscopy was considered diagnostic when a specific histopathological diagnosis was established.311 patients underwent bronchoscopy to rule out malignancy. A diagnosis was obtained in 153 (49.2%) patients, 81 (52.9%) had primary lung cancer and 14 (9.15%) other malignancies. 158 (50.8%) patients had initial non-diagnostic bronchoscopy; 86 (54.43%) were lost to follow up. Of the remaining 72 (45.57%) patients, radiological resolution or stability was observed in 51 (70.8%) patients. Primary lung cancer was found in 13 (18.05%) patients and other malignancies in 5 (6.94%). Predictive of a diagnostic bronchoscopy was the performance of endobronchial biopsies and endobronchial ultrasound guided-transbronchial needle aspiration.This study highlights some of the barriers to the timely diagnosis of thoracic malignancies. Following patients with a non-diagnostic procedure as well as all those patients with diagnosed malignancies it of the utmost importance. In patients available for follow up, close to 25% of additional cases with treatable malignancy could be identified and patients diagnosed with cancer could receive timely treatment.


Assuntos
Broncoscopia/estatística & dados numéricos , Neoplasias Torácicas/diagnóstico por imagem , Neoplasias Torácicas/patologia , Idoso , Broncoscopia/efeitos adversos , Broncoscopia/métodos , Aspiração por Agulha Fina Guiada por Ultrassom Endoscópico , Feminino , Humanos , Neoplasias Pulmonares/diagnóstico por imagem , Neoplasias Pulmonares/patologia , Masculino , Pessoa de Meia-Idade , Estudos Retrospectivos
10.
PLoS One ; 15(9): e0239114, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32956379

RESUMO

BACKGROUND: In recent years, transbronchial cryobiopsy (TBCB) has come to be increasingly used in interventional pulmonology units as it obtains larger and better-quality samples than conventional transbronchial lung biopsy (TBLB) with forceps. No multicenter studies have been performed, however, that analyse and compare TBCB and TBLB safety and yield according to the interstitial lung disease (ILD) classification. OBJECTIVES: We compared the diagnostic yield and safety of TBCB with cryoprobe sampling versus conventional TBLB forceps sampling in the same patient. METHOD: Prospective multicenter clinical study of patients with ILD indicated for lung biopsy. Airway management with orotracheal tube, laryngeal mask and rigid bronchoscope was according to the protocol of each centre. All procedures were performed using fluoroscopy and an occlusion balloon. TBLB was followed by TBCB. Complications were recorded after both TBLB and TBCB. RESULTS: Included were 124 patients from 10 hospitals. Airway management was orotracheal intubation in 74% of cases. Diagnostic yield according to multidisciplinary committee results for TBCB was 47.6% and for TBLB was 19.4% (p<0.0001). Diagnostic yield was higher for TBCB compared to TBLB for two groups: idiopathic interstitial pneumonias (IIPs) and ILD of known cause or association (OR 2.5; 95% CI: 1.4-4.2 and OR 5.8; 95% CI: 2.3-14.3, respectively). Grade 3 (moderate) bleeding after TBCB occurred in 6.5% of patients compared to 0.8% after conventional TBLB. CONCLUSIONS: Diagnostic yield for TBCB was higher than for TBLB, especially for two disease groups: IIPs and ILD of known cause or association. The increased risk of bleeding associated with TBCB confirms the need for safe airway management and prophylactic occlusion-balloon use. TRIAL REGISTRATION: clinicaltrials.gov identifier: NCT02464592.


Assuntos
Broncoscopia/instrumentação , Criocirurgia/instrumentação , Fluoroscopia/instrumentação , Doenças Pulmonares Intersticiais/diagnóstico , Hemorragia Pós-Operatória/epidemiologia , Idoso , Biópsia/efeitos adversos , Biópsia/instrumentação , Biópsia/métodos , Broncoscopia/efeitos adversos , Broncoscopia/métodos , Broncoscopia/estatística & dados numéricos , Criocirurgia/efeitos adversos , Criocirurgia/métodos , Feminino , Fluoroscopia/efeitos adversos , Fluoroscopia/métodos , Humanos , Pulmão/patologia , Doenças Pulmonares Intersticiais/patologia , Masculino , Pessoa de Meia-Idade , Hemorragia Pós-Operatória/etiologia , Estudos Prospectivos
11.
BMC Pulm Med ; 20(1): 243, 2020 Sep 11.
Artigo em Inglês | MEDLINE | ID: mdl-32917185

RESUMO

BACKGROUND: Factors affecting the safety of bronchoscopy in patients with malignant hematologic disorders have not been well described. We evaluated the safety of bronchoscopy and describe factors affecting its complication rate in such patients. METHODS: Between January 2009 and December 2018, 316 bronchoscopies in 282 patients with malignant hematologic disorders and pulmonary infiltrates were performed at our institution. The bronchoscopic procedure used and its complications were evaluated. RESULTS: The most common underlying disease was acute myeloid leukemia (134/282 patients, 47.5%). Platelet transfusion was performed the day before or the day of bronchoscopy in 42.4%, supplemental oxygen was administered before the procedure in 23.1%, and midazolam was used in 74.4%. Thirty-five bronchoscopies (11.1%) were complicated by hemoptysis and 7 patients developed pneumothorax, 4 of whom required thoracic drainage. Two patients (0.6%) were intubated within 48 h of the procedure and prolonged oxygen desaturation (> 48 h) occurred in 3.8%. Multivariate analysis showed that only use of midazolam significantly reduced the risk of prolonged oxygen desaturation (hazard ratio 0.28, 95% confidence interval 0.09-0.85, p = 0.03). Transbronchial lung biopsy significantly increased the risk of hemoptysis (hazard ratio 10.40, 95% confidence interval 4.18-25.90, p = 0.00), while use of midazolam significantly reduced the risk (hazard ratio 0.31, 95% confidence interval 0.14-0.73, p = 0.01). CONCLUSIONS: Bronchoscopy is relatively safe in patients with malignant hematologic disorders. Caution and judicious use of sedatives may improve the patient's procedural tolerance and lower complications.


Assuntos
Broncoscopia/efeitos adversos , Neoplasias Hematológicas/complicações , Complicações Pós-Operatórias/etiologia , Idoso , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Estudos Retrospectivos
12.
Eur Respir J ; 56(4)2020 10.
Artigo em Inglês | MEDLINE | ID: mdl-32859682
13.
Medicine (Baltimore) ; 99(28): e20930, 2020 Jul 10.
Artigo em Inglês | MEDLINE | ID: mdl-32664089

RESUMO

Surgical lung biopsy is regarded as the golden standard for the diagnosis of idiopathic interstitial pneumonias (IIPs). Here, we attempted to show the diagnostic accuracy of multidisciplinary classifications based on transbronchial pathology including transbronchial lung cryobiopsy (TBLC) , bronchoalveolar lavage fluid (BALF) and endobronchial ultrasound-guided transbronchial needle aspiration biopsy (EBUS-TBNA).Patients with suspected interstitial lung diseases admitted from June 1, 2016 to December 31, 2018 were involved. Patients with known causes of interstitial lung diseases and typical idiopathic pulmonary fibrosis diagnosed through clinical, radiological information were excluded. Patients with atypical idiopathic pulmonary fibrosis and possible IIPs accepted transbronchial pathological evaluation. Initial multidisciplinary diagnosis (MDD) classifications were made depending on clinical, radiological and transbronchial pathological information by a multidisciplinary team (MDT). The final MDD classifications were confirmed by subsequent therapeutic effects. All patients were followed up for at least 6 months.A total of 70 patients were finally involved. The samples of lung parenchyma extracted through TBLC were enough for confirmation of pathological diagnoses in 68.6% (48/70) cases. Samples of 6 cases were extracted by EBUS-TBNA. Bacteriological diagnoses were positive in 1 case by BALF. Pathological diagnoses of 77.1% (54/70) cases were achieved through TBLC, EBUS-TBNA and BALF. During the follow up study, the pulmonary lesions of 60% patients were improved, 11.43% were relapsed when glucocorticoid was reduced to small dose or withdrawal, 14.29% were leveled off and 8.57% were progressed. The diagnoses of 4 patients with progressed clinical feature were revised. As a result, 94.3% initial MDD classifications based on transbronchial pathology were consistent with the final MDD, and the difference of diagnostic yield wasn't significant between initial and final MDD (Z = -1.414, P = .157).Classifications of IIPs based on transbronchial pathology were useful and quite agreed with final MDD.


Assuntos
Broncoscopia/métodos , Pneumonias Intersticiais Idiopáticas/classificação , Pneumonias Intersticiais Idiopáticas/patologia , Biópsia Guiada por Imagem/métodos , Idoso , Biópsia/tendências , Líquido da Lavagem Broncoalveolar/microbiologia , Broncoscopia/efeitos adversos , Broncoscopia/tendências , Aspiração por Agulha Fina Guiada por Ultrassom Endoscópico/métodos , Feminino , Seguimentos , Glucocorticoides/uso terapêutico , Hospitalização , Humanos , Pneumonias Intersticiais Idiopáticas/diagnóstico por imagem , Pneumonias Intersticiais Idiopáticas/tratamento farmacológico , Fibrose Pulmonar Idiopática/patologia , Comunicação Interdisciplinar , Pulmão/diagnóstico por imagem , Pulmão/patologia , Doenças Pulmonares Intersticiais/diagnóstico por imagem , Doenças Pulmonares Intersticiais/patologia , Masculino , Pessoa de Meia-Idade , Recidiva , Tomografia Computadorizada por Raios X/métodos
14.
Rev Esp Anestesiol Reanim ; 67(9): 504-510, 2020 11.
Artigo em Inglês, Espanhol | MEDLINE | ID: mdl-32532430

RESUMO

The current COVID-19 pandemic has rendered up to 15% of patients under mechanical ventilation. Because the subsequent tracheotomy is a frequent procedure, the three societies mostly involved (SEMICYUC, SEDAR and SEORL-CCC) have setup a consensus paper that offers an overview about indications and contraindications of tracheotomy, be it by puncture or open, clarifying its respective advantages and enumerating the ideal conditions under which they should be performed, as well as the necessary steps. Regular and emergency situations are displayed together with the postoperative measures.


Assuntos
Betacoronavirus , Consenso , Infecções por Coronavirus/epidemiologia , Pneumonia Viral/epidemiologia , Sociedades Médicas , Traqueostomia/normas , Anestesiologia , Broncoscopia/efeitos adversos , Broncoscopia/normas , Contraindicações de Procedimentos , Unidades de Cuidados Coronarianos , Procedimentos Cirúrgicos Eletivos/normas , Emergências , Humanos , Unidades de Terapia Intensiva , Otolaringologia , Procedimentos Cirúrgicos Otorrinolaringológicos , Pandemias , Cuidados Pós-Operatórios/métodos , Cuidados Pós-Operatórios/normas , Respiração Artificial/normas , Ressuscitação , Espanha/epidemiologia , Fatores de Tempo , Traqueostomia/efeitos adversos , Traqueostomia/métodos
15.
Acta Med Port ; 33(9): 583-592, 2020 Sep 01.
Artigo em Português | MEDLINE | ID: mdl-32568064

RESUMO

The new SARS-CoV-2 pandemic is an example of an international public health emergency, which is associated with considerable social and economic challenges. At the healthcare level there is the risk that nosocomial outbreaks can be local amplifiers. Adequate infection control practices are of critical importance, which include proper use of personal protective equipment. This equipment must be appropriate to the pathogen transmission route that, in the case of SARS-CoV-2, occurs through droplet and contact routes. The infected individual, when talking, coughing or sneezing, spreads droplets containing the virus, directly contaminating other individuals within one to two meters of distance, as well as the surrounding environment. Airborne transmission may occur when aerosol-generating procedures are performed. Concerning respiratory protection, there is currently weak evidence that the use of respirators provides better protection than surgical masks for SARS-CoV-2 or other viruses (with the exception of aerosol-generating procedures, in which case the use of a respirator is recommended). Eye protection should be guaranteed whenever there is a risk of splashes, droplets or aerosols. The use of different, or higher than necessary, level of personal protective equipment, for the transmission route of the agent, is a form of misuse and can affect its supply for situations when it is clearly indicated. The adequate provision of protective equipment, as well as training of healthcare professionals in its correct use, is highly recommended to ensure safety of care.


Assuntos
Betacoronavirus , Infecções por Coronavirus/prevenção & controle , Infecção Hospitalar/prevenção & controle , Dispositivos de Proteção dos Olhos , Pessoal de Saúde , Controle de Infecções , Pandemias/prevenção & controle , Equipamento de Proteção Individual , Pneumonia Viral/prevenção & controle , Microbiologia do Ar , Broncoscopia/efeitos adversos , Infecções Comunitárias Adquiridas/prevenção & controle , Infecções por Coronavirus/epidemiologia , Infecções por Coronavirus/transmissão , Infecção Hospitalar/epidemiologia , Infecção Hospitalar/transmissão , Face , Humanos , Higiene , Controle de Infecções/instrumentação , Controle de Infecções/métodos , Transmissão de Doença Infecciosa do Paciente para o Profissional/prevenção & controle , Intubação Intratraqueal/efeitos adversos , Máscaras/classificação , Máscaras/provisão & distribuição , Equipamento de Proteção Individual/provisão & distribuição , Pneumonia Viral/epidemiologia , Pneumonia Viral/transmissão , Equipamentos Cirúrgicos/efeitos adversos
16.
Acta Otorrinolaringol Esp ; 71(6): 386-392, 2020.
Artigo em Espanhol | MEDLINE | ID: mdl-32513456

RESUMO

The current COVID-19 pandemic has rendered up to 15% of patients under mechanical ventilation. Because the subsequent tracheotomy is a frequent procedure, the three societies mostly involved (SEMICYUC, SEDAR and SEORL-CCC) have setup a consensus paper that offers an overview about indications and contraindications of tracheotomy, be it by puncture or open, clarifying its respective advantages and enumerating the ideal conditions under which they should be performed, as well as the necessary steps. Regular and emergency situations are displayed together with the postoperative measures.


Assuntos
Betacoronavirus , Consenso , Infecções por Coronavirus/epidemiologia , Pneumonia Viral/epidemiologia , Sociedades Médicas , Traqueostomia/normas , Anestesiologia , Broncoscopia/efeitos adversos , Broncoscopia/normas , Contraindicações de Procedimentos , Unidades de Cuidados Coronarianos , Procedimentos Cirúrgicos Eletivos/normas , Emergências , Humanos , Unidades de Terapia Intensiva , Otolaringologia , Procedimentos Cirúrgicos Otorrinolaringológicos , Pandemias , Cuidados Pós-Operatórios/métodos , Cuidados Pós-Operatórios/normas , Respiração Artificial/normas , Ressuscitação , Espanha , Fatores de Tempo , Traqueostomia/efeitos adversos , Traqueostomia/métodos
18.
Arch Bronconeumol ; 56 Suppl 2: 19-26, 2020 07.
Artigo em Inglês, Espanhol | MEDLINE | ID: mdl-32362384

RESUMO

This consensus document has been drawn up by the Techniques and Transplantation and Nursing areas of the Spanish Society of Pulmonology and Thoracic Surgery (SEPAR) and the Spanish Society of Respiratory Endoscopy (AEER) with the aim of providing information on the safe and effective use of bronchoscopy in patients with suspected or confirmed COVID-19 infection. Our priority is to ensure the safety of our patients, the health workers caring for them, and the community in general. At this stage in the pandemic, our information on the use of bronchoscopy in patients of this type is based on the experience of hospitals in other countries, and scientific publications are scarce. The objective of this document is to compile these experiences, based on recommendations from official agencies, in a document offering guidance in daily clinical practice.


Assuntos
Betacoronavirus , Broncoscopia/métodos , Consenso , Infecções por Coronavirus/diagnóstico , Pneumonia Viral/diagnóstico , Broncoscópios/normas , Broncoscopia/efeitos adversos , Infecções por Coronavirus/epidemiologia , Infecções por Coronavirus/prevenção & controle , Desinfecção/métodos , Pessoal de Saúde , Humanos , Pandemias/prevenção & controle , Equipamento de Proteção Individual/normas , Pneumonia Viral/epidemiologia , Pneumonia Viral/prevenção & controle , Roupa de Proteção/normas , Pneumologia , Sociedades Médicas , Espanha , Manejo de Espécimes/métodos
19.
Int J Pediatr Otorhinolaryngol ; 134: 110057, 2020 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-32388322

RESUMO

OBJECTIVES: Children admitted with stridor and respiratory distress comprise a complex patient group that requires the otolaryngologist to decide when to assess and intervene with direct laryngoscopy and bronchoscopy (DLB). Historically, the diagnosis of viral upper respiratory tract infection (URTI) can lead to postponement of surgery due to concerns of perioperative complications related to acute illness. Respiratory viral panels (RVP) are often used to confirm the presence of recent or active viral infection and can affect the differential diagnosis of upper airway obstruction. This study examined whether positive RVP testing is associated with perioperative complications and operative findings in pediatric patients undergoing inpatient DLB. METHODS: A retrospective chart review of 132 pediatric patient encounters was performed. Viral testing results, DLB indication, DLB findings, and perioperative complications were compared. RESULTS: Sixty encounters (45.5%) involved a positive RVP, and 72 (54.5%) involved a negative RVP. Those with positive RVP were less likely to have a preoperative structural airway diagnosis (P =.0250) and more likely to have a history of recurrent upper respiratory infections (P =.0464). The most common reason for DLB was the need to assess the airway due to concern for structural pathology. Anatomic abnormalities were seen in a majority of encounters (77.3%) Laryngospasm occurred in 1 (1.7%) RVP positive and 1 (1.4%) RVP negative encounter, and 2 (2.8%) RVP negative encounters required reintubation. No other major complications were observed. No association was noted between RVP results and incidence of major or minor complication. CONCLUSIONS: Major perioperative complications after surgical intervention with DLB for the management of complex, inpatient children with stridor and respiratory distress are rare. RVP positivity, specific pathogens identified on RVP, and presence of URI symptoms were not associated with perioperative complications.


Assuntos
Insuficiência Respiratória/etiologia , Sons Respiratórios/etiologia , Anormalidades do Sistema Respiratório/diagnóstico por imagem , Infecções Respiratórias/diagnóstico , Viroses/diagnóstico , Broncoscopia/efeitos adversos , Pré-Escolar , Diagnóstico Diferencial , Feminino , Humanos , Lactente , Complicações Intraoperatórias/etiologia , Laringismo/diagnóstico por imagem , Laringismo/etiologia , Laringoscopia/efeitos adversos , Masculino , Complicações Pós-Operatórias/etiologia , Insuficiência Respiratória/cirurgia , Anormalidades do Sistema Respiratório/complicações , Infecções Respiratórias/complicações , Infecções Respiratórias/virologia , Estudos Retrospectivos , Medição de Risco , Viroses/complicações
20.
Med Intensiva ; 44(8): 493-499, 2020 11.
Artigo em Espanhol | MEDLINE | ID: mdl-32466990

RESUMO

The current COVID-19 pandemic has rendered up to 15% of patients under mechanical ventilation. Because the subsequent tracheotomy is a frequent procedure, the three societies mostly involved (SEMICYUC, SEDAR and SEORL-CCC) have setup a consensus paper that offers an overview about indications and contraindications of tracheotomy, be it by puncture or open, clarifying its respective advantages and enumerating the ideal conditions under which they should be performed, as well as the necessary steps. Regular and emergency situations are displayed together with the postoperative measures.


Assuntos
Betacoronavirus , Consenso , Infecções por Coronavirus/epidemiologia , Pneumonia Viral/epidemiologia , Sociedades Médicas , Traqueostomia/normas , Anestesiologia , Broncoscopia/efeitos adversos , Broncoscopia/normas , Contraindicações de Procedimentos , Unidades de Cuidados Coronarianos , Procedimentos Cirúrgicos Eletivos/normas , Emergências , Humanos , Unidades de Terapia Intensiva , Otolaringologia , Procedimentos Cirúrgicos Otorrinolaringológicos , Pandemias , Cuidados Pós-Operatórios/métodos , Cuidados Pós-Operatórios/normas , Respiração Artificial/normas , Ressuscitação , Espanha/epidemiologia , Fatores de Tempo , Traqueostomia/efeitos adversos , Traqueostomia/métodos
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