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1.
Pan Afr Med J ; 38: 52, 2021.
Artigo em Inglês | MEDLINE | ID: mdl-33854681

RESUMO

Kawasaki disease is a generalized systemic vasculitis, which primarily affects medium-sized arteries. Kawasaki disease shock syndrome is a rare but severe presentation of this disease. This report describes a case of delayed diagnosis of Kawasaki disease shock syndrome in a 13-year-old boy who presented with cervical adenophlegmon, persistent fever, injected conjunctiva, rash, and hypotension. Echocardiography revealed the presence of bilateral coronary aneurysms. Early recognition of Kawasaki disease shock syndrome can be difficult; however, delay in diagnosis and treatment can increase the risk of coronary artery disease.


Assuntos
Aneurisma Coronário/diagnóstico por imagem , Síndrome de Linfonodos Mucocutâneos/diagnóstico , Choque/diagnóstico , Adolescente , Aneurisma Coronário/etiologia , Diagnóstico Tardio , Ecocardiografia , Humanos , Masculino , Síndrome de Linfonodos Mucocutâneos/complicações , Choque/etiologia
2.
Pan Afr Med J ; 38: 150, 2021.
Artigo em Inglês | MEDLINE | ID: mdl-33912320

RESUMO

We report a case of a 5-month-old female infant who presented with a cardiorespiratory distress and shock. After thoracic computed tomography (CT) scan, a right sided Bochdalek hernia was diagnosed with massive herniation of the abdominal viscera causing mediastinal shift. The girl underwent emergency laparotomy, which confirmed the right sided diaphragmatic hernia with herniation of small bowel and colon. After reduction of herniated contents, the defect in the diaphragm was closed. The patient had an uneventful post-operative cause. This case demonstrates that an undiagnosed Bochdalek hernia can appear with such a severe, life-threatening and misleading presentation.


Assuntos
Hérnias Diafragmáticas Congênitas/diagnóstico por imagem , Laparotomia/métodos , Feminino , Hérnias Diafragmáticas Congênitas/complicações , Hérnias Diafragmáticas Congênitas/cirurgia , Humanos , Lactente , Choque/etiologia , Tomografia Computadorizada por Raios X
3.
Acute Med ; 20(1): 74-77, 2021.
Artigo em Inglês | MEDLINE | ID: mdl-33749696

RESUMO

A 49-year old male with a past medical history of myocardial infarction and compartment syndromes requiring fasciotomies presented on five occasions with hypovolemic shock. We describe his admissions and presumptive diagnoses which required large volumes of intravenous fluids, admission to intensive care for vasopressors and renal replacement therapy. The presentations were always precipitated by a prodrome of fatigue and pre-syncopal episodes. On his last admission, a diagnosis of Idiopathic systemic capillary leak syndrome (ISCLS), also known as Clarkson's Disease, was reached. He is currently receiving high dose intravenous immunoglobulins on a monthly basis.


Assuntos
Síndrome de Vazamento Capilar , Choque , Síndrome de Vazamento Capilar/complicações , Síndrome de Vazamento Capilar/diagnóstico , Síndrome de Vazamento Capilar/terapia , Humanos , Imunoglobulinas Intravenosas , Masculino , Pessoa de Meia-Idade , Choque/etiologia , Choque/terapia
5.
Med Sci Monit ; 27: e926751, 2021 Feb 11.
Artigo em Inglês | MEDLINE | ID: mdl-33571171

RESUMO

BACKGROUND Coronavirus disease 2019 (COVID-19) is spreading rapidly worldwide, and scientists are trying to find a way to overcome the disease. We explored the risk factors that influence patient outcomes, including treatment regimens, which can provide a reference for further treatment. MATERIAL AND METHODS A retrospective cohort study analysis was performed using data from 97 patients with COVID-19 who visited Wuhan Union Hospital from February 2020 to March 2020. We collected data on demographics, comorbidities, clinical manifestations, laboratory tests, treatment methods, outcomes, and complications. Patients were divided into a recovered group and a deceased group. We compared the differences between the 2 groups and analyzed risk factors influencing the treatment effect. RESULTS Seventy-six patients recovered and 21 died. The average age and body mass index (BMI) of the deceased group were significantly higher than those of the recovered group (69.81±6.80 years vs 60.79±11.28 years, P<0.001 and 24.95±3.14 kg/m² vs 23.09±2.97 kg/m², P=0.014, respectively). The combination of antiviral drugs and supportive therapy appears to be associated with the lowest mortality (P<0.05). Multivariate Cox regression analysis revealed that age, BMI, H-CRP, shock, and acute respiratory distress syndrome (ARDS) were independent risk factors for patients with COVID-19 (P<0.05). CONCLUSIONS Elderly patients and those with a high BMI, as well as patients who experience shock and ARDS, may have a higher risk of death from COVID-19. The combination of antiviral drugs and supportive therapy appears to be associated with lower mortality, although further research is needed.


Assuntos
/tratamento farmacológico , /mortalidade , Choque/mortalidade , Fatores Etários , Idoso , Antivirais/uso terapêutico , /virologia , China/epidemiologia , Quimioterapia Combinada/métodos , Medicamentos de Ervas Chinesas/uso terapêutico , Feminino , Mortalidade Hospitalar , Humanos , Estimativa de Kaplan-Meier , Masculino , Pessoa de Meia-Idade , Prognóstico , /terapia , Estudos Retrospectivos , Fatores de Risco , /patogenicidade , Choque/etiologia , Choque/terapia , Resultado do Tratamento , gama-Globulinas/uso terapêutico
6.
BMJ Case Rep ; 14(2)2021 Feb 09.
Artigo em Inglês | MEDLINE | ID: mdl-33563677

RESUMO

We report the case of an 11-year-old boy brought to our emergency department 2 hours after a viper bite to his right hand. He suffered severe pain and rapidly progressive swelling with signs of haemodynamic compromise in keeping with distributive shock. The oedema progressed from his right wrist upwards to his forearm and upper arm with compartment syndrome ultimately resulting. He underwent fasciotomy of the right upper limb and antivenom serum was given. The patient required vasopressors for 48 hours and a total of nine surgical interventions were necessary. In the event of a snakebite, it is essential to promptly recognise the signs of severity, complications and indications for the administration of antivenom serum. We intend to highlight this rare shock aetiology and the need for emergency management if severe clinical signs are present. Early administration of antivenom serum is essential and it should be available in all emergency departments.


Assuntos
Síndromes Compartimentais/etiologia , Síndromes Compartimentais/cirurgia , Traumatismos da Mão/etiologia , Traumatismos da Mão/cirurgia , Choque/tratamento farmacológico , Choque/etiologia , Mordeduras de Serpentes/complicações , Animais , Antivenenos/uso terapêutico , Criança , Humanos , Masculino , Mordeduras de Serpentes/tratamento farmacológico , Venenos de Víboras/toxicidade , Viperidae
9.
BMJ Case Rep ; 14(1)2021 Jan 20.
Artigo em Inglês | MEDLINE | ID: mdl-33472808

RESUMO

We report a rare case of cardiac angiosarcoma in a young boy who presented with cardiac tamponade. His initial symptoms were non-specific. He was initially being managed in the line of fungal infection, with a possibility of malignancy. Cardiac imaging was also not conclusive and he worsened on antibiotics and antifungals and succumbed to the illness. After his death tissue biopsy from heart and lung was done and histopathological examination revealed the diagnosis of metastatic angiosarcoma. The case highlights the importance of considering the diagnosis of cardiac angiosarcoma in the patients presenting with haemorrhagic pericardial effusion and non-specific symptoms.


Assuntos
Tamponamento Cardíaco/etiologia , Neoplasias Cardíacas/complicações , Hemangiossarcoma/complicações , Derrame Pericárdico/etiologia , Tamponamento Cardíaco/diagnóstico por imagem , Tamponamento Cardíaco/terapia , Drenagem , Ecocardiografia , Evolução Fatal , Átrios do Coração , Neoplasias Cardíacas/diagnóstico por imagem , Neoplasias Cardíacas/patologia , Hemangiossarcoma/diagnóstico por imagem , Hemangiossarcoma/patologia , Hemangiossarcoma/secundário , Humanos , Neoplasias Pulmonares/complicações , Neoplasias Pulmonares/diagnóstico por imagem , Neoplasias Pulmonares/secundário , Imagem por Ressonância Magnética , Masculino , Derrame Pericárdico/diagnóstico por imagem , Derrame Pericárdico/terapia , Choque/etiologia , Tomografia Computadorizada por Raios X , Adulto Jovem
10.
BMJ Case Rep ; 14(1)2021 Jan 27.
Artigo em Inglês | MEDLINE | ID: mdl-33504529

RESUMO

A 47-year-old woman was admitted to our clinic for intensive pain in the left flank region. The transvaginal ultrasound showed a left adnexal solid mass with ascites. She had undergone surgical removal of skin melanoma in 2008, but in September 2019, intracardiac metastasis resulting from it had been discovered. CT performed in March 2020 had been negative for other metastases. A full abdomen ultrasound was not performed. During the night, the patient began to show signs and symptoms of hypovolaemic shock. The patient was urgently transferred to the operating room for a video laparoscopy. A vast left retroperitoneal haematoma was diagnosed along with voluminous enlargement of the left ovary. We proceeded with a left adnexectomy and blood transfusion. Subsequent contrast-enhanced CT revealed a left subcapsular, perirenal haematoma and a voluminous retroperitoneal haematoma. Kidney metastasis was also seen. The final histological diagnosis was metastatic amelanotic malignant melanoma of the ovary.


Assuntos
Hemorragia/diagnóstico por imagem , Nefropatias/diagnóstico por imagem , Neoplasias Renais/secundário , Melanoma Amelanótico/secundário , Melanoma/secundário , Neoplasias Ovarianas/secundário , Neoplasias Cutâneas/patologia , Transfusão de Sangue , Feminino , Hemorragia/etiologia , Humanos , Nefropatias/etiologia , Neoplasias Renais/complicações , Neoplasias Renais/diagnóstico por imagem , Melanoma/complicações , Melanoma/diagnóstico por imagem , Melanoma/cirurgia , Melanoma Amelanótico/complicações , Melanoma Amelanótico/diagnóstico por imagem , Melanoma Amelanótico/cirurgia , Pessoa de Meia-Idade , Neoplasias Ovarianas/diagnóstico por imagem , Neoplasias Ovarianas/cirurgia , Espaço Retroperitoneal , Choque/etiologia , Tomografia Computadorizada por Raios X
12.
Emerg Med Clin North Am ; 38(4): 819-839, 2020 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-32981620

RESUMO

Pediatric cardiac arrest is a relatively rare but devastating presentation in infants and children. In contrast to adult patients, in whom a primary cardiac dysrhythmia is the most likely cause of cardiac arrest, pediatric patients experience cardiovascular collapse most frequently after an initial respiratory arrest. Aggressive treatment in the precardiac arrest state should be initiated to prevent deterioration and should focus on support of oxygenation, ventilation, and hemodynamics, regardless of the presumed cause. Unfortunately, outcomes for pediatric cardiac arrest, whether in hospital or out of hospital, continue to be poor.


Assuntos
Parada Cardíaca/terapia , Ressuscitação/métodos , Manuseio das Vias Aéreas , Glicemia/análise , Criança , Maus-Tratos Infantis/terapia , Cardioversão Elétrica , Eletroencefalografia , Serviço Hospitalar de Emergência , Epinefrina/uso terapêutico , Oxigenação por Membrana Extracorpórea , Parada Cardíaca/etiologia , Cardiopatias Congênitas/terapia , Frequência Cardíaca , Humanos , Hipotermia/complicações , Hipotermia/terapia , Hipotermia Induzida , Pneumopatias/terapia , Pais , Exame Físico , Envenenamento/terapia , Avaliação de Processos em Cuidados de Saúde , Valores de Referência , Insuficiência Respiratória/terapia , Taxa Respiratória , Ordens quanto à Conduta (Ética Médica) , Sepse/terapia , Choque/etiologia , Choque/terapia , Vasoconstritores/uso terapêutico , Ferimentos e Lesões/terapia
13.
Rev Paul Pediatr ; 38: e2020165, 2020.
Artigo em Português, Inglês | MEDLINE | ID: mdl-32876282

RESUMO

OBJECTIVE: Recently, there have been reports of children with severe inflammatory syndrome and multiorgan dysfunction associated with elevated inflammatory markers. These cases are reported as presenting the Multisystem Inflammatory Syndrome in Children (MIS-C) associated with COVID-19. In this study, we describe with parental permission a case of MIS-C in an infant with severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection. CASE DESCRIPTION: A seven-month-old infant, with SARS-CoV-2 infection and a history of extreme preterm birth and very low weight at birth, with an initial course of mild respiratory symptoms and abrupt progression to vasoplegic shock, myocarditis and hyperinflammation syndrome, shown by high levels of troponin I, ferritin, CRP, D-dimer and hypoalbuminemia. Despite the intensive care provided, the child developed multiple organ dysfunction and died. COMMENTS: Patients with a history of extreme prematurity may present with MIS-C in the presence of COVID-19 and are a group of special concern.


Assuntos
Betacoronavirus/isolamento & purificação , Infecções por Coronavirus , Insuficiência de Múltiplos Órgãos , Pandemias , Pneumonia Viral , Ressuscitação , Choque , Síndrome de Resposta Inflamatória Sistêmica , Deterioração Clínica , Técnicas de Laboratório Clínico/métodos , Infecções por Coronavirus/sangue , Infecções por Coronavirus/diagnóstico , Infecções por Coronavirus/fisiopatologia , Infecções por Coronavirus/terapia , Evolução Fatal , Feminino , Humanos , Lactente , Recém-Nascido de Baixo Peso , Recém-Nascido , Doenças do Recém-Nascido , Insuficiência de Múltiplos Órgãos/etiologia , Insuficiência de Múltiplos Órgãos/terapia , Pneumonia Viral/sangue , Pneumonia Viral/fisiopatologia , Pneumonia Viral/terapia , Nascimento Prematuro , Respiração Artificial/métodos , Ressuscitação/métodos , Fatores de Risco , Choque/etiologia , Choque/terapia , Síndrome de Resposta Inflamatória Sistêmica/terapia , Síndrome de Resposta Inflamatória Sistêmica/virologia , Tomografia Computadorizada por Raios X/métodos
14.
JAMA ; 324(13): 1317-1329, 2020 10 06.
Artigo em Inglês | MEDLINE | ID: mdl-32876697

RESUMO

Importance: Evidence regarding corticosteroid use for severe coronavirus disease 2019 (COVID-19) is limited. Objective: To determine whether hydrocortisone improves outcome for patients with severe COVID-19. Design, Setting, and Participants: An ongoing adaptive platform trial testing multiple interventions within multiple therapeutic domains, for example, antiviral agents, corticosteroids, or immunoglobulin. Between March 9 and June 17, 2020, 614 adult patients with suspected or confirmed COVID-19 were enrolled and randomized within at least 1 domain following admission to an intensive care unit (ICU) for respiratory or cardiovascular organ support at 121 sites in 8 countries. Of these, 403 were randomized to open-label interventions within the corticosteroid domain. The domain was halted after results from another trial were released. Follow-up ended August 12, 2020. Interventions: The corticosteroid domain randomized participants to a fixed 7-day course of intravenous hydrocortisone (50 mg or 100 mg every 6 hours) (n = 143), a shock-dependent course (50 mg every 6 hours when shock was clinically evident) (n = 152), or no hydrocortisone (n = 108). Main Outcomes and Measures: The primary end point was organ support-free days (days alive and free of ICU-based respiratory or cardiovascular support) within 21 days, where patients who died were assigned -1 day. The primary analysis was a bayesian cumulative logistic model that included all patients enrolled with severe COVID-19, adjusting for age, sex, site, region, time, assignment to interventions within other domains, and domain and intervention eligibility. Superiority was defined as the posterior probability of an odds ratio greater than 1 (threshold for trial conclusion of superiority >99%). Results: After excluding 19 participants who withdrew consent, there were 384 patients (mean age, 60 years; 29% female) randomized to the fixed-dose (n = 137), shock-dependent (n = 146), and no (n = 101) hydrocortisone groups; 379 (99%) completed the study and were included in the analysis. The mean age for the 3 groups ranged between 59.5 and 60.4 years; most patients were male (range, 70.6%-71.5%); mean body mass index ranged between 29.7 and 30.9; and patients receiving mechanical ventilation ranged between 50.0% and 63.5%. For the fixed-dose, shock-dependent, and no hydrocortisone groups, respectively, the median organ support-free days were 0 (IQR, -1 to 15), 0 (IQR, -1 to 13), and 0 (-1 to 11) days (composed of 30%, 26%, and 33% mortality rates and 11.5, 9.5, and 6 median organ support-free days among survivors). The median adjusted odds ratio and bayesian probability of superiority were 1.43 (95% credible interval, 0.91-2.27) and 93% for fixed-dose hydrocortisone, respectively, and were 1.22 (95% credible interval, 0.76-1.94) and 80% for shock-dependent hydrocortisone compared with no hydrocortisone. Serious adverse events were reported in 4 (3%), 5 (3%), and 1 (1%) patients in the fixed-dose, shock-dependent, and no hydrocortisone groups, respectively. Conclusions and Relevance: Among patients with severe COVID-19, treatment with a 7-day fixed-dose course of hydrocortisone or shock-dependent dosing of hydrocortisone, compared with no hydrocortisone, resulted in 93% and 80% probabilities of superiority with regard to the odds of improvement in organ support-free days within 21 days. However, the trial was stopped early and no treatment strategy met prespecified criteria for statistical superiority, precluding definitive conclusions. Trial Registration: ClinicalTrials.gov Identifier: NCT02735707.


Assuntos
Anti-Inflamatórios/administração & dosagem , Infecções por Coronavirus/tratamento farmacológico , Hidrocortisona/administração & dosagem , Pneumonia Viral/tratamento farmacológico , Respiração Artificial/estatística & dados numéricos , Corticosteroides/uso terapêutico , Adulto , Anti-Inflamatórios/efeitos adversos , Betacoronavirus , Infecções por Coronavirus/mortalidade , Infecções por Coronavirus/terapia , Término Precoce de Ensaios Clínicos , Feminino , Humanos , Hidrocortisona/efeitos adversos , Unidades de Terapia Intensiva , Masculino , Pessoa de Meia-Idade , Pandemias , Pneumonia Viral/mortalidade , Pneumonia Viral/terapia , Choque/tratamento farmacológico , Choque/etiologia , Resultado do Tratamento
15.
Intensive Care Med ; 46(10): 1863-1872, 2020 10.
Artigo em Inglês | MEDLINE | ID: mdl-32816098

RESUMO

PURPOSE: An ongoing outbreak of coronavirus disease 2019 (COVID-19) emerged in Wuhan since December 2019 and spread globally. However, information about critically ill patients with COVID-19 is still limited. We aimed to describe the clinical characteristics and outcomes of critically ill patients with COVID-19 and figure out the risk factors of mortality. METHODS: We extracted data retrospectively regarding 733 critically ill adult patients with laboratory-confirmed COVID-19 from 19 hospitals in China through January 1 to February 29, 2020. Demographic data, symptoms, laboratory values, comorbidities, treatments, and clinical outcomes were collected. The primary outcome was 28-day mortality. Data were compared between survivors and non-survivors. RESULTS: Of the 733 patients included in the study, the median (IQR) age was 65 (56-73) years and 256 (34.9%) were female. Among these patients, the median (IQR) APACHE II score was 10 (7 to 14) and 28-day mortality was 53.8%. Respiratory failure was the most common organ failure (597 [81.5%]), followed by shock (20%), thrombocytopenia (18.8%), central nervous system (8.6%) and renal dysfunction (8%). Multivariate Cox regression analysis showed that older age, malignancies, high APACHE II score, high D-dimer level, low PaO2/FiO2 level, high creatinine level, high hscTnI level and low albumin level were independent risk factors of 28-day mortality in critically ill patients with COVID-19. CONCLUSION: In this case series of critically ill patients with COVID-19 who were admitted into the ICU, more than half patients died at day 28. The higher percentage of organ failure in these patients indicated a significant demand for critical care resources.


Assuntos
Infecções por Coronavirus/complicações , Infecções por Coronavirus/mortalidade , Estado Terminal , Unidades de Terapia Intensiva , Pneumonia Viral/complicações , Pneumonia Viral/mortalidade , Idoso , Betacoronavirus , China/epidemiologia , Infecções por Coronavirus/epidemiologia , Infecções por Coronavirus/virologia , Surtos de Doenças , Feminino , Humanos , Nefropatias/epidemiologia , Nefropatias/etiologia , Masculino , Pessoa de Meia-Idade , Doenças do Sistema Nervoso/epidemiologia , Doenças do Sistema Nervoso/etiologia , Pandemias , Pneumonia Viral/epidemiologia , Pneumonia Viral/virologia , Modelos de Riscos Proporcionais , Insuficiência Respiratória/epidemiologia , Insuficiência Respiratória/etiologia , Estudos Retrospectivos , Fatores de Risco , Choque/epidemiologia , Choque/etiologia , Trombocitopenia/epidemiologia , Trombocitopenia/etiologia
16.
Anaesth Crit Care Pain Med ; 39(5): 563-569, 2020 10.
Artigo em Inglês | MEDLINE | ID: mdl-32781167

RESUMO

PURPOSE: To survey haemodynamic monitoring and management practices in intensive care patients with the coronavirus disease 2019 (COVID-19). METHODS: A questionnaire was shared on social networks or via email by the authors and by Anaesthesia and/or Critical Care societies from France, Switzerland, Belgium, Brazil, and Portugal. Intensivists and anaesthetists involved in COVID-19 ICU care were invited to answer 14 questions about haemodynamic monitoring and management. RESULTS: Globally, 1000 questionnaires were available for analysis. Responses came mainly from Europe (n = 460) and America (n = 434). According to a majority of respondents, COVID-19 ICU patients frequently or very frequently received continuous vasopressor support (56%) and had an echocardiography performed (54%). Echocardiography revealed a normal cardiac function, a hyperdynamic state (43%), hypovolaemia (22%), a left ventricular dysfunction (21%) and a right ventricular dilation (20%). Fluid responsiveness was frequently assessed (84%), mainly using echo (62%), and cardiac output was measured in 69%, mostly with echo as well (53%). Venous oxygen saturation was frequently measured (79%), mostly from a CVC blood sample (94%). Tissue perfusion was assessed biologically (93%) and clinically (63%). Pulmonary oedema was detected and quantified mainly using echo (67%) and chest X-ray (61%). CONCLUSION: Our survey confirms that vasopressor support is not uncommon in COVID-19 ICU patients and suggests that different haemodynamic phenotypes may be observed. Ultrasounds were used by many respondents, to assess cardiac function but also to predict fluid responsiveness and quantify pulmonary oedema. Although we observed regional differences, current international guidelines were followed by most respondents.


Assuntos
Betacoronavirus , Infecções por Coronavirus/terapia , Cuidados Críticos/métodos , Pesquisas sobre Serviços de Saúde , Monitorização Hemodinâmica , Pandemias , Pneumonia Viral/terapia , África/epidemiologia , América/epidemiologia , Ásia/epidemiologia , Austrália/epidemiologia , Cardiotônicos/uso terapêutico , Infecções por Coronavirus/complicações , Infecções por Coronavirus/epidemiologia , Infecções por Coronavirus/fisiopatologia , Gerenciamento Clínico , Ecocardiografia/estatística & dados numéricos , Europa (Continente)/epidemiologia , Hidratação , Hemodinâmica/efeitos dos fármacos , Humanos , Oxigênio/sangue , Pneumonia Viral/complicações , Pneumonia Viral/epidemiologia , Pneumonia Viral/fisiopatologia , Utilização de Procedimentos e Técnicas , Edema Pulmonar/etiologia , Edema Pulmonar/fisiopatologia , Choque/etiologia , Choque/fisiopatologia , Vasoconstritores/uso terapêutico
17.
A A Pract ; 14(6): e01221, 2020 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-32784326

RESUMO

The rapid spread of Coronavirus Disease 2019 (COVID-19) has sparked a search for effective therapies. The discovery that the virus binds the angiotensin-converting enzyme 2 (ACE2) receptor has led to investigation of the renin-angiotensin system for possible therapeutic targets. We present a case of an elderly woman with multiple comorbidities who developed severe acute respiratory distress syndrome (ARDS), a cardiomyopathy, and vasodilatory shock secondary to COVID-19 and was treated with exogenous angiotensin II. She rapidly demonstrated significant hemodynamic improvement without noted adverse effects. Thus, we propose further investigation into possible benefits of angiotensin II in shock secondary to COVID-19.


Assuntos
Angiotensina II/uso terapêutico , Betacoronavirus , Infecções por Coronavirus/complicações , Pneumonia Viral/complicações , Choque/tratamento farmacológico , Choque/etiologia , Vasoconstritores/uso terapêutico , Idoso de 80 Anos ou mais , Feminino , Humanos , Pandemias
18.
Pediatr Res ; 88(5): 705-716, 2020 11.
Artigo em Inglês | MEDLINE | ID: mdl-32634818

RESUMO

BACKGROUND: Fewer children than adults have been affected by the COVID-19 pandemic, and the clinical manifestations are distinct from those of adults. Some children particularly those with acute or chronic co-morbidities are likely to develop critical illness. Recently, a multisystem inflammatory syndrome (MIS-C) has been described in children with some of these patients requiring care in the pediatric ICU. METHODS: An international collaboration was formed to review the available evidence and develop evidence-based guidelines for the care of critically ill children with SARS-CoV-2 infection. Where the evidence was lacking, those gaps were replaced with consensus-based guidelines. RESULTS: This process has generated 44 recommendations related to pediatric COVID-19 patients presenting with respiratory distress or failure, sepsis or septic shock, cardiopulmonary arrest, MIS-C, those requiring adjuvant therapies, or ECMO. Evidence to explain the milder disease patterns in children and the potential to use repurposed anti-viral drugs, anti-inflammatory or anti-thrombotic therapies are also described. CONCLUSION: Brief summaries of pediatric SARS-CoV-2 infection in different regions of the world are included since few registries are capturing this data globally. These guidelines seek to harmonize the standards and strategies for intensive care that critically ill children with COVID-19 receive across the world. IMPACT: At the time of publication, this is the latest evidence for managing critically ill children infected with SARS-CoV-2. Referring to these guidelines can decrease the morbidity and potentially the mortality of children effected by COVID-19 and its sequalae. These guidelines can be adapted to both high- and limited-resource settings.


Assuntos
Betacoronavirus , Infecções por Coronavirus/terapia , Cuidados Críticos/normas , Unidades de Terapia Intensiva Pediátrica/normas , Pandemias , Pneumonia Viral/terapia , Adolescente , África/epidemiologia , América/epidemiologia , Antivirais/uso terapêutico , Ásia/epidemiologia , Reanimação Cardiopulmonar/métodos , Reanimação Cardiopulmonar/normas , Criança , Pré-Escolar , Terapia Combinada , Comorbidade , Infecções por Coronavirus/complicações , Infecções por Coronavirus/tratamento farmacológico , Infecções por Coronavirus/epidemiologia , Cuidados Críticos/métodos , Infecção Hospitalar/prevenção & controle , Europa (Continente)/epidemiologia , Oxigenação por Membrana Extracorpórea/normas , Feminino , Humanos , Lactente , Recém-Nascido , Controle de Infecções/métodos , Controle de Infecções/normas , Masculino , Pneumonia Viral/complicações , Pneumonia Viral/epidemiologia , Respiração Artificial/normas , /terapia , Choque/etiologia , Choque/terapia , Síndrome de Resposta Inflamatória Sistêmica/epidemiologia , Síndrome de Resposta Inflamatória Sistêmica/terapia
19.
Int J Med Sci ; 17(12): 1744-1750, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32714077

RESUMO

Many studies have reported the risk factors for exacerbations in patients with 2019 novel coronavirus (2019-nCoV). This study aims to perform the meta-analysis of risk factors for the exacerbation of the novel coronavirus-infected pneumonia (NCIP). PubMed, Embase and Google scholar have been searched. We included the cohort studies involving risk factors for the exacerbation of NCIP. This meta-analysis compared the risk factors of patients between intensive care (ICU) group and non-ICU group. Two cohort studies were included in this study. After comparing the patients between intensive care (ICU) group and non-ICU group, several important factors were found to significantly increase the risk of exacerbations in patients with NCIP, and they included hypertension (RR=2.34; 95% CI=1.21 to 4.51; P=0.01), cardiovascular diseases (RR=2.28; 95% CI=1.13 to 4.58; P=0.02), COPD (RR=7.65; 95% CI=1.24 to 47.13; P=0.03), dyspnea (RR=2.89; 95% CI=2.05 to 4.08; P<0.00001), myalgia or fatigue (RR=1.24; 95% CI=1.01 to 1.52; P=0.04), but several factors such as gender, Huanan Seafood Wholesale Market exposure, diabetes, chronic liver disease, malignancy, fever, cough, expectoration, headache and diarrhoea appeared to have no obvious effect on the exacerbation of pneumonia. In addition, as the exacerbation of pneumonia, some complications had the high probability to occur according to the meta-analysis of acute respiratory distress syndrome (ARDS) (RR=13.95; 95% CI=6.20 to 31.41; P<0.00001), shock (RR=24.29; 95% CI=4.66 to 126.69; P=0.0002), acute cardiac injury (RR=10.32; 95% CI=3.05 to 34.96; P=0.0002) and acute kidney injury (RR=5.90; 95% CI=1.32 to 26.35; P=0.02) between two groups. Several risk factors were confirmed to significantly improve the risk of exacerbation in patients with NCIP, which was very important for the exacerbation prediction and treatment of these patients.


Assuntos
Betacoronavirus , Infecções por Coronavirus/epidemiologia , Pandemias , Pneumonia Viral/epidemiologia , Lesão Renal Aguda/epidemiologia , Lesão Renal Aguda/etiologia , Adulto , Idoso , China/epidemiologia , Estudos de Coortes , Comorbidade , Diabetes Mellitus/epidemiologia , Progressão da Doença , Dispneia/epidemiologia , Dispneia/etiologia , Exposição Ambiental , Fadiga/epidemiologia , Fadiga/etiologia , Feminino , Cardiopatias/epidemiologia , Cardiopatias/etiologia , Humanos , Hipertensão/epidemiologia , Hepatopatias/epidemiologia , Masculino , Pessoa de Meia-Idade , Neoplasias/epidemiologia , /etiologia , Fatores de Risco , Choque/epidemiologia , Choque/etiologia , Avaliação de Sintomas
20.
Int Heart J ; 61(4): 795-798, 2020 Jul 30.
Artigo em Inglês | MEDLINE | ID: mdl-32684603

RESUMO

To investigate the association of shock on admission with predicting intensive care unit (ICU) mortality, hospital mortality, and neurological outcomes of post cardiac arrest patients.This was a retrospective study of cardiac arrest (CA) patients admitted to ICU. Student's t test and Chi-square test were performed to compare the difference of non-shock and shock group. Multivariable regression analysis was performed to investigate shock and its association with ICU mortality, hospital mortality, and neurologic outcomes and linear regression analysis to explore its correlation with length of stay in hospital.A total of 374 CA patients were analyzed, with 200 (53.5%) patients in the presence of shock on admission. Shock was significantly associated with higher ICU mortality (OR 2.42, 95% CI 1.60 to 3.68; P < 0.001), hospital mortality (OR 2.33, 95% CI 1.54 to 3.54; P < 0.001), and more unfavorable neurological outcomes (OR 1.98, 95% CI 1.30 to 3.02; P = 0.001). After adjusting for confounding factors, shock was still an independent predictor of ICU mortality (OR 2.40, 95% CI 1.30 to 4.43; P = 0.005).Shock on admission of CA patients was significantly associated with ICU mortality.


Assuntos
Parada Cardíaca/mortalidade , Choque/mortalidade , Idoso , Bélgica/epidemiologia , Feminino , Parada Cardíaca/complicações , Humanos , Unidades de Terapia Intensiva/estatística & dados numéricos , Masculino , Pessoa de Meia-Idade , Estudos Retrospectivos , Choque/etiologia
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