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1.
Crit Care ; 25(1): 58, 2021 02 11.
Artigo em Inglês | MEDLINE | ID: mdl-33573680

RESUMO

PURPOSE: Whether the use of high-flow nasal oxygen in adult patients with COVID-19 associated acute respiratory failure improves clinically relevant outcomes remains unclear. We thus sought to assess the effect of high-flow nasal oxygen on ventilator-free days, compared to early initiation of invasive mechanical ventilation, on adult patients with COVID-19. METHODS: We conducted a multicentre cohort study using a prospectively collected database of patients with COVID-19 associated acute respiratory failure admitted to 36 Spanish and Andorran intensive care units (ICUs). Main exposure was the use of high-flow nasal oxygen (conservative group), while early invasive mechanical ventilation (within the first day of ICU admission; early intubation group) served as the comparator. The primary outcome was ventilator-free days at 28 days. ICU length of stay and all-cause in-hospital mortality served as secondary outcomes. We used propensity score matching to adjust for measured confounding. RESULTS: Out of 468 eligible patients, a total of 122 matched patients were included in the present analysis (61 for each group). When compared to early intubation, the use of high-flow nasal oxygen was associated with an increase in ventilator-free days (mean difference: 8.0 days; 95% confidence interval (CI): 4.4 to 11.7 days) and a reduction in ICU length of stay (mean difference: - 8.2 days; 95% CI - 12.7 to - 3.6 days). No difference was observed in all-cause in-hospital mortality between groups (odds ratio: 0.64; 95% CI: 0.25 to 1.64). CONCLUSIONS: The use of high-flow nasal oxygen upon ICU admission in adult patients with COVID-19 related acute hypoxemic respiratory failure may lead to an increase in ventilator-free days and a reduction in ICU length of stay, when compared to early initiation of invasive mechanical ventilation. Future studies should confirm our findings.


Assuntos
/complicações , Ventilação não Invasiva , Oxigenoterapia/métodos , /terapia , Idoso , Cânula , Feminino , Humanos , Unidades de Terapia Intensiva , Masculino , Pessoa de Meia-Idade , Estudos Prospectivos , Resultado do Tratamento
2.
PLoS One ; 16(2): e0246123, 2021.
Artigo em Inglês | MEDLINE | ID: mdl-33577565

RESUMO

BACKGROUND: Nasal High Flow (NHF) therapy delivers flows of heated humidified gases up to 60 LPM (litres per minute) via a nasal cannula. Particles of oral/nasal fluid released by patients undergoing NHF therapy may pose a cross-infection risk, which is a potential concern for treating COVID-19 patients. METHODS: Liquid particles within the exhaled breath of healthy participants were measured with two protocols: (1) high speed camera imaging and counting exhaled particles under high magnification (6 participants) and (2) measuring the deposition of a chemical marker (riboflavin-5-monophosphate) at a distance of 100 and 500 mm on filter papers through which air was drawn (10 participants). The filter papers were assayed with HPLC. Breathing conditions tested included quiet (resting) breathing and vigorous breathing (which here means nasal snorting, voluntary coughing and voluntary sneezing). Unsupported (natural) breathing and NHF at 30 and 60 LPM were compared. RESULTS: Imaging: During quiet breathing, no particles were recorded with unsupported breathing or 30 LPM NHF (detection limit for single particles 33 µm). Particles were detected from 2 of 6 participants at 60 LPM quiet breathing at approximately 10% of the rate caused by unsupported vigorous breathing. Unsupported vigorous breathing released the greatest numbers of particles. Vigorous breathing with NHF at 60 LPM, released half the number of particles compared to vigorous breathing without NHF.Chemical marker tests: No oral/nasal fluid was detected in quiet breathing without NHF (detection limit 0.28 µL/m3). In quiet breathing with NHF at 60 LPM, small quantities were detected in 4 out of 29 quiet breathing tests, not exceeding 17 µL/m3. Vigorous breathing released 200-1000 times more fluid than the quiet breathing with NHF. The quantities detected in vigorous breathing were similar whether using NHF or not. CONCLUSION: During quiet breathing, 60 LPM NHF therapy may cause oral/nasal fluid to be released as particles, at levels of tens of µL per cubic metre of air. Vigorous breathing (snort, cough or sneeze) releases 200 to 1000 times more oral/nasal fluid than quiet breathing (p < 0.001 with both imaging and chemical marker methods). During vigorous breathing, 60 LPM NHF therapy caused no statistically significant difference in the quantity of oral/nasal fluid released compared to unsupported breathing. NHF use does not increase the risk of dispersing infectious aerosols above the risk of unsupported vigorous breathing. Standard infection prevention and control measures should apply when dealing with a patient who has an acute respiratory infection, independent of which, if any, respiratory support is being used. CLINICAL TRIAL REGISTRATION: ACTRN12614000924651.


Assuntos
Expiração , Oxigenoterapia/efeitos adversos , Oxigenoterapia/métodos , Adulto , Testes Respiratórios/métodos , Cânula , Feminino , Humanos , Masculino , Microscopia de Vídeo , Nariz/química , Respiração , Taxa Respiratória
3.
Zhonghua Er Ke Za Zhi ; 59(1): 20-26, 2021 Jan 02.
Artigo em Chinês | MEDLINE | ID: mdl-33396999

RESUMO

Objective: To investigate the efficacy of high flow nasal cannula (HFNC) in children with acute respiratory failure. Methods: A prospective study was conducted. A total of 153 patients aged from 1 to 14 years with acute respiratory failure were enrolled, who were admitted to pediatric intensive care unit (PICU) of Shanghai Children's Hospital from January 2018 to December 2019. HFNC success was defined as no need for invasive mechanical ventilation and successfully withdrawn from HFNC, while HFNC failure was defined as need for invasive mechanical ventilation. HFNC at a flow rate of 2 L/(kg·min) (maximum ≤ 60 L/min) with inhaled oxygen concentration (FiO2) between 0.30 and 1.00 was applied to maintain percutaneous oxygen saturation (SpO2) of 0.94-0.97. Parameters including arterial partial pressure of oxygen (PaO2), partial pressure of carbon dioxide in artery (PaCO2), SpO2 and PaO2/FiO2 were collected before and during the application of HFNC at 1 h, 6 h, 12 h, 24 h and 48 h, as well as over 48 h after HFNC withdrawn. Comparison between the groups was performed by student t test, Mann-Whitney U test or chi-square test. The sensitivity and specificity of the above parameters in predicting HFNC success were evaluated by receiver operating characteristic (ROC) curve. Results: A total of 153 children (70 males and 83 females) were enrolled. Among them, 131 (85.6%) cases were successfully weaned off from HFNC and 22 (14.4%) failed. The duration of HFNC was 57 (38, 95) hours in the successful group, and the PaO2/FiO2 before HFNC application and after HFNC was withdrawn were 187 (170, 212) mmHg (1 mmHg=0.133 kPa) and 280 (262, 292) mmHg, respectively. The duration of HFNC in the failure group was 19 (9, 49) hours, and the PaO2/FiO2 before HFNC application and after HFNC withdrawn were 176 (171, 189) mmHg and 159 (156, 161) mmHg, respectively. The values of PaO2/FiO2 were significantly higher in the successful group than those in the failed group at using HFNC initially 1 h (196 (182, 211) vs. 174 (160, 178) mmHg, Z =-5.105, P<0.01), 6 h (213 (203, 220) vs. 168 (157, 170) mmHg, Z =-6.772, P<0.01), 12 h (226 (180, 261) vs. 165 (161, 170) mmHg, Z =-4.308, P<0.01), 24 h (229 (195, 259) vs. 165 (161, 170) mmHg, Z=-4.609, P<0.01) and 48 h (249 (216, 273) vs. 163 (158, 169) mmHg, Z =-4.628, P<0.01) after the HFNC application, and over 48 h after HFNC was withdrawn (277 (268, 283) vs. 157 (154, 158) mmHg, Z=-3.512, P<0.01). Moreover, the PaO2 levels were significantly higher in the successful group than those in the failed group using HFNC initially at 1 h (73.7 (71.0, 76.7) vs. 70.0 (66.2, 71.2) mmHg, Z=-4.587, P<0.01) and 6 h (79.0 (75.0, 82.0) vs. 71.0 (62.0, 72.0) mmHg, Z=-5.954, P<0.01) after HFNC application. Also, the SpO2 levels showed the same differences at 1 h (0.96 (0.95, 0.96) vs. 0.94 (0.92, 0.94), Z =-4.812, P<0.01) and 6 h (0.96 (0.95, 0.97) vs. 0.94(0.91, 0.95), Z=-5.024, P<0.01) after HFNC application. Forty eight hours after HFNC was withdrawn, the PaO2 (88.0 (81.7, 95.0) vs. 63.7 (63.3, 66.0) mmHg, Z =-3.032, P<0.01) and SpO2 (0.96 (0.94, 0.98) vs. 0.91 (0.90, 0.92), Z=-3.957, P<0.01) were also significantly higher in the successful group. Regarding the HFNC complications, there was one case with atelectasis and one with pneumothorax in the failure group. HFNC was used as sequential oxygen therapy after extubation in 79 children, successful in all. ROC curve showed that the area under curve of PaO2/FiO2 in predicting HFNC success was 0.990, and the optimal cut-off value was 232 mmHg with the 95%CI of 0.970-1.000 (P<0.01). Conclusions: HFNC could be used as a respiratory support strategy for children with mild to moderate respiratory failure and as a sequential oxygen therapy after extubation. The PaO2/FiO2 when HFNC withdrow is the optimal index to evaluate the success of HFNC application.


Assuntos
Oxigênio , Insuficiência Respiratória , Adolescente , Idoso , Cânula , Criança , Pré-Escolar , China , Feminino , Humanos , Lactente , Masculino , Oxigenoterapia , Estudos Prospectivos , Insuficiência Respiratória/terapia
4.
Anaesthesia ; 76(1): 118-127, 2021 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-32592510

RESUMO

Apnoeic oxygenation refers to oxygenation in the absence of any patient or ventilator effort to move the lungs. This phenomenon was first described in humans in the mid-20th century but has seen renewed interest in the last decade following the demonstration of apnoeic oxygenation with low-flow, and subsequently high-flow, nasal oxygen. This narrative review summarises our understanding of apnoeic oxygenation in the paediatric population. We examine the evidence supporting oxygenation via tracheal tube, modified laryngoscopes and nasal cannulae. The evidence for prolongation of safe apnoea time at induction of anaesthesia is also appraised. We explore the capacity for carbon dioxide clearance, flow rate selection with high-flow nasal oxygen and complications associated with the technique. It remains uncertain whether apnoeic oxygenation in paediatric patients results in a meaningful clinical benefit compared with standard care for outcomes such as the number of tracheal intubation attempts or the incidence of hypoxaemia. In particular, the role of apnoeic oxygenation in paediatric difficult airway management is unclear as this has not been the targeted focus of any published research to date.


Assuntos
Manuseio das Vias Aéreas/métodos , Anestesia/métodos , Apneia , Oxigenoterapia/métodos , Pediatria/métodos , Adolescente , Cânula , Criança , Pré-Escolar , Humanos , Lactente , Recém-Nascido , Cavidade Nasal
5.
BMC Pulm Med ; 20(1): 324, 2020 Dec 24.
Artigo em Inglês | MEDLINE | ID: mdl-33357219

RESUMO

BACKGROUND: It had been shown that High-flow nasal cannula (HFNC) is an effective initial support strategy for patients with acute respiratory failure. However, the efficacy of HFNC for patients with COVID-19 has not been established. This study was performed to assess the efficacy of HFNC for patients with COVID-19 and describe early predictors of HFNC treatment success in order to develop a prediction tool that accurately identifies the need for upgrade respiratory support therapy. METHODS: We retrospectively reviewed the medical records of patients with COVID-19 treated by HFNC in respiratory wards of 2 hospitals in Wuhan between 1 January and 1 March 2020. Overall clinical outcomes, the success rate of HFNC strategy and related respiratory variables were evaluated. RESULTS: A total of 105 patients were analyzed. Of these, 65 patients (61.9%) showed improved oxygenation and were successfully withdrawn from HFNC. The PaO2/FiO2 ratio, SpO2/FiO2 ratio and ROX index (SpO2/FiO2*RR) at 6h, 12h and 24h of HFNC initiation were closely related to the prognosis. The ROX index after 6h of HFNC initiation (AUROC, 0.798) had good predictive capacity for outcomes of HFNC. In the multivariate logistic regression analysis, young age, gender of female, and lower SOFA score all have predictive value, while a ROX index greater than 5.55 at 6 h after initiation was significantly associated with HFNC success (OR, 17.821; 95% CI, 3.741-84.903 p<0.001). CONCLUSIONS: Our study indicated that HFNC was an effective way of respiratory support in the treatment of COVID-19 patients. The ROX index after 6h after initiating HFNC had good predictive capacity for HFNC outcomes.


Assuntos
/terapia , Hipóxia/terapia , Oxigenoterapia/métodos , Oxigênio/administração & dosagem , Oxigênio/sangue , Idoso , /fisiopatologia , Cânula , Feminino , Humanos , Hipóxia/fisiopatologia , Hipóxia/virologia , Masculino , Pessoa de Meia-Idade , Pressão Parcial , Taxa Respiratória , Estudos Retrospectivos , Resultado do Tratamento
6.
Trials ; 21(1): 940, 2020 Nov 23.
Artigo em Inglês | MEDLINE | ID: mdl-33225990

RESUMO

OBJECTIVES: To assess the effect of prone positioning therapy on intubation rate in awake patients with COVID-19 and acute respiratory failure. TRIAL DESIGN: This is a two-center parallel group, superiority, randomized (1:1 allocation ratio) controlled trial. PARTICIPANTS: All patients admitted to the Hospital Civil de Guadalajara and Hospital General de Occidente in Mexico for COVID-19 associated acute respiratory failure and in need of supplementary oxygen through high-flow nasal cannula are screened for eligibility. INCLUSION CRITERIA: all adult patients admitted to the COVID-19 unit who test positive for COVID-19 by PCR-test and in need for oxygen are eligible for inclusion. Randomization starts upon identification of requirement of a fraction of inspired oxygen ≥30% for an oxygen capillary saturation of ≥90% Exclusion criteria: less than 18 years-old, pregnancy, patients with immediate need of invasive mechanical ventilation (altered mental status, fatigue), vasopressor requirement to maintain median arterial pressure >65 mmHg, contraindications for prone positioning therapy (recent abdominal or thoracic surgery or trauma, facial, pelvic or spine fracture, untreated pneumothorax, do-not-resuscitate or do-not-intubate order, refusal or inability of the patient to enroll in the study. INTERVENTION AND COMPARATOR: Patients of the intervention group will be asked to remain in a prone position throughout the day as long as possible, with breaks according to tolerance. Pillows will be offered for maximizing comfort at chest, pelvis and knees. Monitoring of vital signs will not be suspended. Inspired fraction of oxygen will be titrated to maintain a capillary saturation of 92%-95%. For patients in the control group, prone positioning will be allowed as a rescue therapy. Staff intensivists will monitor the patient's status in both groups on a 24/7 basis. All other treatment will be unchanged and left to the attending physicians. MAIN OUTCOMES: Endotracheal intubation rate for mechanical ventilation at 28 days. RANDOMISATION: Patients will be randomly allocated to either prone positioning or control group at 1:1 ratio. Such randomization will be computer generated and stratified by center with permuted blocks and length of 4. BLINDING (MASKING): Due to logistical reasons, only principal investigators and the data analyst will be blinded to group assignment. NUMBERS TO BE RANDOMISED (SAMPLE SIZE): With an intubation rate of 60% according to recent reports from some American centers, and assuming a decrease to 40% to be clinically relevant, we calculated a total of 96 patients per group, for a beta error of 0.2, and alpha of 0.5. Therefore, we plan to recruit 200 patients, accounting for minimal losses to follow up, with 100 non-intubated patients in the prone position group and a 100 in the control group. TRIAL STATUS: The local registration number is 048-20, with the protocol version number 2.0. The date of approval is 3rd May 2020. Recruitment started on 3rd May and is expected to end in December 2020. TRIAL REGISTRATION: The protocol was retrospectively registered under the title: "Prone Positioning in Non-intubated Patients With COVID-19 Associated Acute Respiratory Failure. The PRO-CARF trial" in ClinicalTrials.gov with the registration number: NCT04477655. Registered on 20 July 2020. FULL PROTOCOL: The full protocol is attached as an additional file, accessible from the Trials website (Additional file 1). In the interest in expediting dissemination of this material, the familiar formatting has been eliminated; this Letter serves as a summary of the key elements of the full protocol. The study protocol has been reported in accordance with the Standard Protocol Items: Recommendations for Clinical Interventional Trials (SPIRIT) guidelines (Additional file 2).


Assuntos
Infecções por Coronavirus/complicações , Intubação Intratraqueal/instrumentação , Oxigênio/uso terapêutico , Pneumonia Viral/complicações , Decúbito Ventral/fisiologia , Insuficiência Respiratória/etiologia , Doença Aguda , Adulto , Betacoronavirus/genética , Cânula/efeitos adversos , Cânula/provisão & distribução , Estudos de Casos e Controles , Infecções por Coronavirus/epidemiologia , Infecções por Coronavirus/virologia , Feminino , Hospitalização , Humanos , Intubação Intratraqueal/estatística & dados numéricos , Masculino , México/epidemiologia , Oxigênio/administração & dosagem , Oxigênio/sangue , Oxigênio/provisão & distribução , Pandemias , Posicionamento do Paciente/métodos , Pneumonia Viral/epidemiologia , Pneumonia Viral/virologia , Insuficiência Respiratória/fisiopatologia , Insuficiência Respiratória/terapia
7.
BMJ Open ; 10(11): e041520, 2020 11 11.
Artigo em Inglês | MEDLINE | ID: mdl-33177145

RESUMO

INTRODUCTION: Prone positioning (PP) is an effective first-line intervention to treat patients with moderate to severe acute respiratory distress syndrome (ARDS) receiving invasive mechanical ventilation, as it improves gas exchanges and reduces mortality. The use of PP in awake spontaneous breathing patients with ARDS secondary to COVID-19 was reported to improve oxygenation in few retrospective trials with small sample size. High-level evidence of awake PP for hypoxaemic patients with COVID-19 patients is still lacking. METHODS AND ANALYSIS: The protocol of this meta-trial is a prospective collaborative individual participant data meta-analysis of randomised controlled open label superiority trials. This design is particularly adapted to a rapid scientific response in the pandemic setting. It will take place in multiple sites, among others in USA, Canada, Ireland, France and Spain. Patients will be followed up for 28 days. Patients will be randomised to receive whether awake PP and nasal high flow therapy or standard medical treatment and nasal high flow therapy. Primary outcome is defined as the occurrence rate of tracheal intubation or death up to day 28. An interim analysis plan has been set up on aggregated data from the participating research groups. ETHICS AND DISSEMINATION: Ethics approvals were obtained in all participating countries. Results of the meta-trial will be submitted for publication in a peer-reviewed journal. Each randomised controlled trial was registered individually, as follows: NCT04325906, NCT04347941, NCT04358939, NCT04395144 and NCT04391140.


Assuntos
Infecções por Coronavirus/terapia , Hipóxia/terapia , Oxigenoterapia/métodos , Posicionamento do Paciente/métodos , Pneumonia Viral/terapia , Decúbito Ventral , Betacoronavirus , Cânula , Estudos de Equivalência como Asunto , Humanos , Metanálise como Assunto , Pandemias , Ensaios Clínicos Controlados Aleatórios como Assunto , Vigília
8.
Medicine (Baltimore) ; 99(46): e23243, 2020 Nov 13.
Artigo em Inglês | MEDLINE | ID: mdl-33181713

RESUMO

BACKGROUND: This study uses a method of systematic evaluation to evaluate the safety and effectiveness of heated humidified high-flow nasal cannula (HHHFNC) as an initial ventilation method in the treatment of neonatal respiratory distress syndrome (NRDS) scientifically. In the field of evidence-based medicine, this study provides a theoretical reference and basis for choosing appropriate initial non-invasive ventilation methods in the treatment of NRDS, thereby providing assistance for clinical treatment. METHODS: The main electronic network databases were searched by computer, including 4 Chinese databases: CNKI, WangFang Data, CQVIP, SinoMed and 3 English databases: PubMed, The Cochrane Library and EMBASE, the time range of retrieval from the beginning of each database to September 1, 2020. The content involves all the published randomized controlled trials on the effectiveness of HHHFNC compared with NCPAP as an initial ventilation method in the treatment of NRDS. Using a search method that combines medical subject words and free words. Based on the Cochrane risk bias assessment tool, 2 researchers independently screen the literature, and then extract the data we needed in the literature, and cross-check. If it is difficult to decide whether to include literature, then turning to a third researcher for help and making a final decision after discussion, and using RevMan 5.3 and STATA 13.0 to analyze the relative data. RESULTS: Based on the method of meta-analysis, this study analyzes the pre-determined outcome indicators through scientific statistical analysis, and compares the effectiveness and safety of HHHFNC compared with NCPAP as an initial ventilation method in the treatment of NRDS. All results will be published in peer-reviewed high-quality professional academic journals. CONCLUSION: Based on evidence-based medicine, this study will obtain the establishing evidence of comparison that the clinical effectiveness and safety of HHHFNC compared with NCPAP as an initial ventilation method in the treatment of NRDS through the existing data and data, which provides the evidence support of evidence-based medicine in the treatment of NRDS. OSF REGISTRATION NUMBER: September 17, 2020. osf.io/f6at4 (https://osf.io/f6at4).


Assuntos
Cânula/normas , Protocolos Clínicos , Umidificadores/normas , Oxigenoterapia/métodos , Síndrome do Desconforto Respiratório do Recém-Nascido/tratamento farmacológico , Humanos , Recém-Nascido , Metanálise como Assunto , Ventilação não Invasiva/métodos , Ventilação não Invasiva/normas , Oxigênio/administração & dosagem , Oxigênio/uso terapêutico , Oxigenoterapia/normas , Revisões Sistemáticas como Assunto
9.
Ther Adv Respir Dis ; 14: 1753466620963016, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-33070706

RESUMO

The worldwide spread of coronavirus disease 2019 (COVID-19), caused by the new severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), was declared a pandemic by the World Health Organization (WHO) in March 2020. According to clinical studies carried out in China and Italy, most patients experience mild or moderate symptoms; about a fifth of subjects develop a severe and critical disease, and may suffer from interstitial pneumonia, possibly associated with acute respiratory distress syndrome (ARDS) and death.In patients who develop respiratory failure, timely conventional oxygen therapy through nasal catheter plays a crucial role, but it can be used only in mild forms. Continuous positive airway pressure (CPAP) support or non-invasive mechanical ventilation (NIV) are uncomfortable, and require significant man-machine cooperation. Herein we describe our experience of five patients with COVID-19, who were treated with high-flow nasal cannula (HFNC) after failure of CPAP or NIV, and discuss the role of HFNC in COVID-19 patients. Our findings suggest that HFNC can be used successfully in selected patients with COVID-19-related ARDS.The reviews of this paper are available via the supplemental material section.


Assuntos
Betacoronavirus , Cânula , Infecções por Coronavirus/complicações , Infecções por Coronavirus/terapia , Oxigenoterapia/instrumentação , Pneumonia Viral/complicações , Pneumonia Viral/terapia , Insuficiência Respiratória/terapia , Idoso , Idoso de 80 Anos ou mais , Estudos de Coortes , Pressão Positiva Contínua nas Vias Aéreas , Infecções por Coronavirus/diagnóstico , Feminino , Humanos , Itália , Masculino , Pessoa de Meia-Idade , Ventilação não Invasiva , Pandemias , Pneumonia Viral/diagnóstico , Insuficiência Respiratória/diagnóstico , Insuficiência Respiratória/virologia , Resultado do Tratamento
12.
Annu Int Conf IEEE Eng Med Biol Soc ; 2020: 4450-4453, 2020 07.
Artigo em Inglês | MEDLINE | ID: mdl-33018982

RESUMO

Capnometry is a method to measure carbon dioxide (CO2) in exhaled gas and has been used to monitor patient's respiratory status. During moderate or deep sedation, monitoring for the presence of exhaled CO2 is recommended for evaluating the adequacy of ventilation. Oxygen administration is usually given to patients with a nasal cannula to avoid hypoxia during sedation. However, the flow of oxygen administration can interfere with CO2 measurement. We developed a nasal cannula type adapter called cap-ONE nasal adapter system based on the mainstream capnography which is designed to monitor CO2 while supplying oxygen. In this study, we evaluated the basic performance of the system as compared with a conventional device using a spontaneous breathing model. The cap-ONE nasal adapter system could accurately measure PetCO2 without being disturbed by oxygen flow and efficiently supply oxygen.


Assuntos
Cânula , Capnografia , Dióxido de Carbono , Expiração , Humanos , Oxigênio
13.
Artigo em Inglês | MEDLINE | ID: mdl-33019085

RESUMO

Many of the surgical devices for minimally invasive surgery have struggled to navigate in tight spaces and to safely address to surgical sites. This research demonstrates a scalable steerable cannula for 360° arthroscopic capsular release (ACR) of the glenohumeral joint. The steerable cannula mainly consists of the pre-curved inner tube of nitinol, the straight outer tube of stainless steel, and the controller part. Using anisotropic patterns and heat treatment, the inner tube has a high degree of curvature. The mechanism controls the distal end with the two degrees of freedom. The inner tube can be translated and rotated relative to the outer tube. The steerable cannula was designed to avoid the axillary nerve under the inferior glenoid to minimize the risk of iatrogenic injury while keeping flexed to match the bony curvature of the glenohumeral joint. The cylindrical cannula can fit various surgical tools and can be sterilized after use. In porcine shoulder test and workspace analysis, the proposed cannula addressed the inferior glenoid that is not reachable by the conventional rigid cannula. Thus, the proposed mechanism can navigate through the narrow and curved anatomical space of the glenoid cavity and reduce the unreachable area for ACR.Clinical Relevance- The propose cannula can be used for 360° arthroscopic capsular release (ACR) in minimally invasive surgery (MIS). This cannula can prevent damage to the axillary nerves which is one of the main complications of ACR. The mechanism has the potentials to reduce the unreachable area in MIS for knee and hip joints.


Assuntos
Liberação da Cápsula Articular , Articulação do Ombro , Animais , Artroscopia , Cânula , Procedimentos Cirúrgicos Minimamente Invasivos , Articulação do Ombro/cirurgia , Suínos
14.
Rev. esp. cir. ortop. traumatol. (Ed. impr.) ; 64(5): 318-325, sept.-oct. 2020. tab, graf
Artigo em Espanhol | IBECS | ID: ibc-197610

RESUMO

INTRODUCCIÓN: Las infecciones osteoarticulares representan una complicación mayor en cirugía ortopédica. Se pretende identificar el porcentaje de cánulas de succión colonizadas y determinar la relación entre el tiempo de uso en cirugía y la colonización de estas. MATERIALES Y MÉTODOS: Estudio descriptivo y prospectivo que analiza 546 cánulas de succión utilizadas en cirugía ortopédica limpia en un centro de trauma, entre noviembre del 2017 a marzo del 2018. El extremo distal de la cánula fue cultivado para determinar la proporción de colonización. RESULTADOS: El 7,3% de las cánulas cultivadas tuvieron cultivos positivos para gérmenes patógenos, de los cuales el más frecuente fue Staphylococcus epidermidis con 27,5%. Además, se encontró asociación entre la colonización y el tiempo de uso de la cánula. La posibilidad de colonización de cánulas usadas entre 60 minutos o más, es mayor que en las que se usaron menos de 60 minutos; entre 60 y 90 minutos la posibilidad es dos veces mayor OR= 2,2 (IC:95% 1,1 - 4,1) y en las cánulas usadas por más de 90 minutos es 8 veces mayor OR= 8,49 (IC:95% 1,77 - 40,86). CONCLUSIONES: La proporción de colonización de las cánulas es menor a lo reportado en la literatura. El mayor tiempo de uso de la cánula en la cirugía aumenta el riesgo de la colonización de estas. Se considera realizar estudios de seguimiento para determinar si la colonización de las cánulas de succión se asocia a un incremento de infección postoperatoria


INTRODUCTION: Osteoarticular infections represent a major complication in orthopaedic surgery. The aim is to identify the percentage of suction cannulas colonised and to determine the relationship between the time they are used in surgery and the colonisation of these cannulas. MATERIALS AND METHODS: Descriptive and prospective study that analysed 546 suction cannulas used in clean orthopaedic surgery in a trauma centre, between November 2017 and March 2018. The distal end of the cannula was cultured to determine the colonisation rate. RESULTS: 7.3% of the cultured cannulas were positive for pathogens, the most frequent being Staphylococcus epidermidis at 27.5%. In addition, an association was found between colonisation and the length of time the cannula was used. The possibility of colonisation of cannulas used for between 60minutes or more, is greater than those used for less than 60 minutes; between 60 and 90 minutes the possibility is twice as high OR= 2.2 (CI:95% 1.1 - 4.1) and in cannulas used for more than 90 minutes it is 8 times higher OR= 8.49 (CI:95% 1.77 - 40.86). CONCLUSIONS: The colonisation rate of cannulas is lower than reported in the literature. The longer the cannula is used in surgery increases the risk of their colonisation. Follow-up studies are being considered to determine whether suction cannula colonisation is associated with increased postoperative infection


Assuntos
Humanos , Cânula/microbiologia , Sucção/instrumentação , Procedimentos Ortopédicos/estatística & dados numéricos , Doenças Ósseas Infecciosas/cirurgia , Contagem de Colônia Microbiana/métodos , Infecções Relacionadas a Cateter/microbiologia , Staphylococcus epidermidis/isolamento & purificação , Infecção da Ferida Cirúrgica/microbiologia
15.
J Int Med Res ; 48(8): 300060520951040, 2020 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-32865072

RESUMO

Spontaneous epistaxis in patients with COVID-19 can represent a clinical challenge with respect to both the risk of contamination and the treatment options. We herein present the data of 30 patients with COVID-19 who developed spontaneous epistaxis while hospitalized at Eastern Piedmont Hospital during March and April 2020. All patients received low-molecular-weight heparin during their hospital stay and required supplementary oxygen therapy either by a nasal cannula or continuous positive airway pressure. Both conditions can represent risk factors for developing epistaxis. Prevention of crust formation in patients with rhinitis using a nasal lubricant should be recommended. If any treatment is required, appropriate self-protection is mandatory.


Assuntos
Infecções por Coronavirus/patologia , Epistaxe/patologia , Oxigenoterapia/métodos , Pneumonia Viral/patologia , Idoso , Betacoronavirus , Cânula , Pressão Positiva Contínua nas Vias Aéreas , Epistaxe/virologia , Feminino , Heparina/efeitos adversos , Humanos , Masculino , Pessoa de Meia-Idade , Mucosa Nasal/lesões , Pandemias
18.
Monaldi Arch Chest Dis ; 90(4)2020 Sep 22.
Artigo em Inglês | MEDLINE | ID: mdl-32960000

RESUMO

Patients of chronic obstructive pulmonary disease (COPD) during COVID-19 pandemic have higher morbidity. Treatment of these patients require aerosolization procedures like nebulization and noninvasive modalities for ventilation like non-invasive ventilation (NIV) and high flow nasal cannula (HFNC). Role of these procedures in corona virus transmission when treating a case of acute exacerbation of chronic obstructive pulmonary disease should be further studied.


Assuntos
Betacoronavirus , Infecções por Coronavirus/prevenção & controle , Hospitalização , Controle de Infecções/organização & administração , Pandemias/prevenção & controle , Pneumonia Viral/prevenção & controle , Doença Pulmonar Obstrutiva Crônica/complicações , Doença Pulmonar Obstrutiva Crônica/terapia , Cânula , Infecções por Coronavirus/epidemiologia , Infecções por Coronavirus/transmissão , Progressão da Doença , Humanos , Ventilação não Invasiva , Pneumonia Viral/epidemiologia , Pneumonia Viral/transmissão
19.
Am J Cardiol ; 134: 91-98, 2020 11 01.
Artigo em Inglês | MEDLINE | ID: mdl-32943194

RESUMO

Many patients having orthotopic heart transplantation (OHT) have previously had a left ventricular assist device (LVAD). Such a scenario allows the study of the position of the LVAD cannula in the explanted heart. We studied the explanted hearts in 105 patients who had had a LVAD inserted earlier and later underwent OHT at Baylor University Medical Center from January 2005 to September 2019, and compared the patients in whom the margins of the LVAD cannula contacted the mural endocardium with those in whom it did not. The margins of the orifice of the LVAD cannula contacted the left ventricular (LV) mural endocardium in 38 (36%) patients (considered potentially hazardous insertion) whereas in 67 (64%) patients there was no contact (considered "ideal" insertion). Comparison of the patients with ideal cannular insertion to those with potentially hazardous insertion disclosed insignificant differences in age at LVAD insertion or OHT; gender; interval between the LVAD insertion and OHT; body mass index; underlying cardiac disease; whether or not the heart floated in a container of formaldehyde, and the type of LVAD inserted. The margins of the LVAD cannula contacted the LV mural endocardium significantly more in patients with smaller mean heart weights than those with larger mean heart weights. In conclusion, of the 105 patients studied, the cannula of the LVAD resided in the LV cavity at an angle that allowed the margins of the orifice of the cannula to contact the mural endocardium in 38 (36%), a situation that at least potentially could cause partial obstruction of its orifice. Nevertheless, comparison of the 38 patients with nonideal cannular insertion to the 67 with ideal cannular insertion disclosed only 1 significant difference between the 2 groups.


Assuntos
Cânula , Endocárdio/patologia , Insuficiência Cardíaca/terapia , Transplante de Coração , Ventrículos do Coração/patologia , Coração Auxiliar , Adulto , Idoso , Cardiomiopatia Dilatada/complicações , Feminino , Coração , Insuficiência Cardíaca/etiologia , Humanos , Masculino , Pessoa de Meia-Idade , Isquemia Miocárdica/complicações , Miocárdio/patologia , Tamanho do Órgão , Adulto Jovem
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