Your browser doesn't support javascript.
loading
Mostrar: 20 | 50 | 100
Resultados 1 - 20 de 4.236
Filtrar
1.
Isr Med Assoc J ; 22(12): 733-735, 2020 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-33381942

RESUMO

BACKGROUND: Patients diagnosed with coronavirus disease-19 (COVID-19) who deteriorate to respiratory failure and require mechanical ventilation may later need to be weaned from the ventilator and undergo a rehabilitation process. The rate of weaning COVID-19 patients from mechanical ventilation is unknown. OBJECTIVES: To present our experience with ventilator weaning of COVID-19 patients in a dedicated facility. METHODS: A retrospective cohort study was conducted of 18 patients hospitalized in a COVID-19 dedicated ventilator weaning unit. RESULTS: Eighteen patients were hospitalized in the dedicated unit between 6 April and 19 May 2020. Of these, 88% (16/18) were weaned and underwent decannulation, while two patients deteriorated and were re-admitted to the intensive care unit. The average number of days spent in our department was 12. There was no statistically significant correlation between patient characteristics and time to weaning from ventilation or with the time to decannulation. CONCLUSIONS: Despite the high mortality of COVID-19 patients who require mechanical ventilation, most of the patients in our cohort were weaned in a relatively short period of time. Further large-scale studies are necessary to assess the cost effectiveness of dedicated COVID-19 departments for ventilator weaning.


Assuntos
/terapia , Unidades de Terapia Intensiva , Pandemias , Respiração Artificial/métodos , Desmame do Respirador/métodos , Adulto , Idoso , Feminino , Seguimentos , Humanos , Israel/epidemiologia , Tempo de Internação/tendências , Masculino , Pessoa de Meia-Idade , Prognóstico , Estudos Retrospectivos , Adulto Jovem
2.
Medicine (Baltimore) ; 99(50): e23602, 2020 Dec 11.
Artigo em Inglês | MEDLINE | ID: mdl-33327327

RESUMO

BACKGROUND: COVID-19 has spread globally since its outbreak in late 2019. It mainly attacks people's respiratory system. Many patients with severe COVID-19 require a ventilator to support breathing, and their lung function is often impaired to varying degrees after ventilator weaning. Acupuncture has been reported to improve respiratory function, but there is no evidence that it can improve respiratory function in ventilator users with COVID-19 after they are removed from the machine. The protocol of the systematic review and meta-analysis will clarify safety and effectiveness of acupuncture on respiratory rehabilitation after weaning from the ventilator during the treatment of COVID-19. METHODS: We will search PubMed, EMBASE, MEDLINE, the Cochrane Library, Chinese National Knowledge Infrastructure, Chinese Biomedical Literature Database, Chinese Science and Technology Periodical Database, Wanfang Database, Clinical Trials and Chinese Clinical Trial Registry. Relevant English language and Chinese language literature will be included. A combination of subject words and free text words will be applied in the searches. The complete process will include study selection, data extraction, risk of bias assessment, and meta-analyses. We will use subgroup analysis and sensitivity analysis to explore the sources of heterogeneity if there is heterogeneity. We will use funnel charts to assess the risk of bias. Endnote X9.3 will be used to manage data screening. The statistical analysis will be completed by RevMan5.2 or Stata/SE 15.1 software. RESULTS: This study will assess safety and effectiveness of acupuncture for rehabilitation on respiratory function after weaning from the ventilator during the treatment of COVID-19. CONCLUSIONS: The conclusion of this study will give evidence to prove safety and effectiveness of acupuncture for rehabilitation on respiratory after weaning from the ventilator during the treatment of COVID-19. REGISTRATION: PROSPERO CRD42020206889.


Assuntos
Terapia por Acupuntura/métodos , Desmame do Respirador/métodos , Ensaios Clínicos como Assunto , Humanos , Metanálise como Assunto , Projetos de Pesquisa , Revisões Sistemáticas como Assunto , Resultado do Tratamento
3.
Anaesthesiol Intensive Ther ; 52(5): 366-372, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-33327694

RESUMO

INTRODUCTION: COVID-19 infection has resulted in thousands of critically ill patients admitted to ICUs and treated with mechanical ventilation. Percutaneous tracheostomy is a well-known technique utilised as a strategy to wean critically ill patients from mechanical ventilation. Worldwide differences exist in terms of methods, operators, and settings, and questions remain regarding timing and indications. If tracheostomy is to be performed in COVID-19 patients, a safe environment is needed for optimal care. MATERIAL AND METHODS: We present a guidewire dilating forceps tracheostomy procedure in COVID-19 patients that was optimised including apnoea-moments, protective clothing, checklists, and clear protocols. We performed a retrospective analysis of the outcome after tracheostomy in COVID-19 patients between March 2020 and May 2020. RESULTS: The follow-up of the first 16 patients, median age 62 years, revealed a median intubation time until tracheostomy of 18 days and median cannulation time of 20 days. The overall perioperative complication rate and complication rate while cannulated was 19%, mainly superficial bleeding. None of the healthcare providers involved in performing the procedure developed any symptoms of the disease. CONCLUSIONS: This COVID-19-centred strategy based on flexibility, preparation, and cooperation between healthcare providers with different backgrounds facilitated percutaneous tracheostomy in COVID-19 patients without an increase in the overall complication rate or evidence of risk to healthcare providers. Our findings provide initial evidence that tracheostomy can be performed safely as a standard of care for COVID-19 patients requiring prolonged mechanical ventilation as was standard practice in ICU patients prior to the COVID-19 pandemic to promote ventilator weaning and patient recovery.


Assuntos
/cirurgia , Procedimentos Cirúrgicos Minimamente Invasivos/métodos , Traqueostomia/métodos , Idoso , Anestesia , Broncoscopia , Lista de Checagem , Cuidados Críticos , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Procedimentos Cirúrgicos Minimamente Invasivos/instrumentação , Equipamento de Proteção Individual , Hemorragia Pós-Operatória/epidemiologia , Hemorragia Pós-Operatória/terapia , Respiração Artificial , Estudos Retrospectivos , Instrumentos Cirúrgicos , Traqueostomia/instrumentação , Desmame do Respirador
5.
Anaesthesiol Intensive Ther ; 52(5): 373-376, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-33242934

RESUMO

INTRODUCTION: A high-flow nasal cannula (HFNC) is an alternative device for oxygena-tion, which improves gas exchange and reduces the work of breathing. Postextubation respiratory failure causes increased morbidity and mortality. HFNC has been widely employed during the COVID-19 pandemic. The purpose of this paper is to report a single-centre experience on the effectiveness and safety of HFNC in weaning COVID-19 patients. MATERIAL AND METHODS: Nine patients showed severe acute respiratory failure and interstitial pneumonia due to SARS-CoV-2. After mechanical ventilation (5 Helmet CPAP, 4 invasive mechanical ventilation), they were de-escalated to HFNC. Settings were: 34-37°C, flow from 50 to 60 L min-1. FiO2 was set to achieve appropriate SpO2. RESULTS: Nine patients (4 females; age 63 ± 13.27 years; BMI 27.2 ± 4.27) showed a baseline PaO2/FiO2 of 109 ± 45 mm Hg. After a long course of ventilation all patients improved (PaO2/FiO2 336 ± 72 mm Hg). Immediately after initiation of HFNC (2 hours), PaO2/FiO2 was 254 ± 69.3 mm Hg. Mean ROX index at two hours was 11.17 (range: 7.38-14.4). It was consistent with low risk of HFNC failure. No difference was observed on lactate. After 48 hours of HFNC oxygen therapy (day 3), mean PaO2/FiO2 increased to 396 ± 83.5 mm Hg. All patients recovered from respiratory failure after 7 ± 4.1 days. CONCLUSIONS: HFNC might be helpful in weaning COVID-19 respiratory failure. Effectiveness and comfort should be assessed between 2 and 48 hours. Clinical outcomes, oxygenation, and ROX index should be considered, to rule out the need for intubation. Further evidence is required for firm conclusions.


Assuntos
Extubação/métodos , Cateterismo , Cavidade Nasal , Oxigenoterapia/métodos , Insuficiência Respiratória/etiologia , Insuficiência Respiratória/terapia , Adulto , Idoso , Extubação/efeitos adversos , Estudos Transversais , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Ventilação não Invasiva , Pneumonia/etiologia , Pneumonia/terapia , /terapia , Resultado do Tratamento , Desmame do Respirador
7.
Zhonghua Wei Zhong Bing Ji Jiu Yi Xue ; 32(10): 1213-1216, 2020 Oct.
Artigo em Chinês | MEDLINE | ID: mdl-33198866

RESUMO

OBJECTIVE: To understand the function of diaphragm and analyze the clinical factors affecting the function of diaphragm by measuring twitch tracheal pressure (TwPtr) in patients with mechanical ventilation and in the weaning phase. METHODS: Patients with more than 48 hours of invasive mechanical ventilation admitted to the department of critical care medicine of the First Affiliated Hospital of Guangzhou Medical University from December 2015 to March 2017 were enrolled. After the patient entered the weaning stage, TwPtr of patients was monitored by two-way non repetitive automatic respiratory trigger device, the effects of duration of mechanical ventilation, severe pulmonary infection, sedative application and chronic obstructive pulmonary disease (COPD) on weaning were analyzed. RESULTS: A total of 62 patients were included, of which 45 were male and 17 were female. The average age was (66.8±11.7) years old. Twenty-three cases had severe pneumonia. The absolute value of TwPtr in severe pneumonia group was lower than that in non-severe pneumonia group [cmH2O (1 cmH2O = 0.098 kPa): 10.40±5.81 vs. 14.35±5.22, P = 0.021]. However, there was no significant difference in the duration of mechanical ventilation between the severe pneumonia group and non-severe pneumonia group [days: 26 (17, 43) vs. 15 (11, 36), P = 0.091]. In 62 patients with mechanical ventilation, there was a negative correlation between TwPtr and duration of mechanical ventilation (r = 0.414, P = 0.002), there was also a negative correlation between the duration of mechanical ventilation and TwPtr after the assessment of diaphragm function (r = 0.277, P = 0.039). There was a linear relationship between TwPtr and sedatives (r = 0.220, P = 0.040), but there was no correlation between TwPtr and COPD (r = -0.178, P = 0.166). CONCLUSIONS: For patients in the weaning stage of mechanical ventilation, severe pulmonary infection is one of the factors that affect the diaphragm dysfunction. There is a certain correlation between the diaphragm dysfunction and the use of sedatives.


Assuntos
Doença Pulmonar Obstrutiva Crônica , Respiração Artificial , Idoso , Diafragma , Feminino , Humanos , Pulmão , Masculino , Pessoa de Meia-Idade , Pressão , Respiração Artificial/efeitos adversos , Traqueia , Desmame do Respirador
9.
Cir Cir ; 88(6): 805-817, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-33254199

RESUMO

The severe acute respiratory syndrome (SARS-Cov-2) is a clinical entity generated by this new virus a Coronavirus (COVID-19). Disease called COVID-19 (CoronaVIrus Disease 2019) by the World Health Organization. Its presentation is acute respiratory failure characterized by hyperinflation of the lung that leads to an increase in capillaries and epithelial permeability, with loss of ventilation of lung tissue and increases lung stiffness. These disturbances lead to imbalances between ventilation and perfusion ratio, which ultimately result in hypoxemia and impaired carbon dioxide clearance. For this review, a search of PubMed and Trip Database was performed. Due to the scarcity of publications, a specific search algorithm was not used. The objective is to review, the evidence and the recommendations of national and international experts, of the hemodynamic and ventilatory management of these patients.


Assuntos
/terapia , Hemodinâmica , Respiração , /sangue , /fisiopatologia , Oxigenação por Membrana Extracorpórea , Humanos , Hipóxia/etiologia , Pulmão/patologia , Fenótipo , Respiração por Pressão Positiva Intrínseca , Decúbito Ventral/fisiologia , Respiração Artificial/métodos , Índice de Gravidade de Doença , Decúbito Dorsal/fisiologia , Fatores de Tempo , Ultrassonografia , Desmame do Respirador , Disfunção Ventricular Esquerda/diagnóstico
11.
Respir Med ; 172: 106130, 2020 10.
Artigo em Inglês | MEDLINE | ID: mdl-32896798

RESUMO

INTRODUCTION: Patients with severe COVID-19 can develop ventilator-dependent acute hypoxic respiratory failure (VDAHRF), which is associated with a higher mortality rate. We evaluated the clinical course of hospitalized COVID-19 patients and compared them with the patients who received invasive mechanical ventilation. Characteristics of intubated patients who were successfully weaned from the ventilator were compared with the patients who failed to be extubated or died in the hospital. OBJECTIVE: To investigate the clinical course of hospitalized COVID-19 patients, and assess the possible predictors of the disease severity leading to VDAHRF. METHODS: This is a single-center, retrospective study. The first 129 patients (18 years or older) with COVID-19 admitted to Monmouth Medical Center from March 1st to April 25th, 2020 were included. RESULTS: Out of 129 patients, 23.25% (n = 30) required invasive mechanical ventilation, and of those, six patients were successfully weaned from the ventilator. Multivariable logistic regression analysis showed increased odds of intubation associated with hypoxemia (odds ratio 17.23, 95% CI 5.206-57.088; p < 0.0001), elevated d-dimer by one unit mg/L of FEU (odds ratio 1.515, 95% CI 5.206-57.088; p = 0.0430) and elevated ferritin by one unit ng/ml (odds ratio 1.001, 95% CI 1.000-1.001, p = 0.0051) on admission, adjusted for other covariates. CONCLUSIONS: Patients who required invasive mechanical ventilation were more likely to have older age, male gender, coronary artery disease, diabetes, and obesity. The patients who were successfully weaned from the ventilator were more likely to be younger in age, and none of them had heart failure or CAD.


Assuntos
Infecções por Coronavirus , Pandemias , Pneumonia Viral , Respiração Artificial , Medição de Risco/métodos , Desmame do Respirador/estatística & dados numéricos , Fatores Etários , Idoso , Betacoronavirus/isolamento & purificação , Comorbidade , Infecções por Coronavirus/diagnóstico , Infecções por Coronavirus/mortalidade , Infecções por Coronavirus/terapia , Feminino , Hospitalização/estatística & dados numéricos , Humanos , Masculino , Pessoa de Meia-Idade , Mortalidade , Pneumonia Viral/diagnóstico , Pneumonia Viral/mortalidade , Pneumonia Viral/terapia , Prognóstico , Respiração Artificial/métodos , Respiração Artificial/estatística & dados numéricos , Estudos Retrospectivos , Fatores de Risco , Índice de Gravidade de Doença , Estados Unidos/epidemiologia
12.
N Engl J Med ; 383(11): 1009-1017, 2020 09 10.
Artigo em Inglês | MEDLINE | ID: mdl-32905673

RESUMO

BACKGROUND: When patients with a tracheostomy tube reach a stage in their care at which decannulation appears to be possible, it is common practice to cap the tracheostomy tube for 24 hours to see whether they can breathe on their own. Whether this approach to establishing patient readiness for decannulation leads to better outcomes than one based on the frequency of airway suctioning is unclear. METHODS: In five intensive care units (ICUs), we enrolled conscious, critically ill adults who had a tracheostomy tube; patients were eligible after weaning from mechanical ventilation. In this unblinded trial, patients were randomly assigned either to undergo a 24-hour capping trial plus intermittent high-flow oxygen therapy (control group) or to receive continuous high-flow oxygen therapy with frequency of suctioning being the indicator of readiness for decannulation (intervention group). The primary outcome was the time to decannulation, compared by means of the log-rank test. Secondary outcomes included decannulation failure, weaning failure, respiratory infections, sepsis, multiorgan failure, durations of stay in the ICU and hospital, and deaths in the ICU and hospital. RESULTS: The trial included 330 patients; the mean (±SD) age of the patients was 58.3±15.1 years, and 68.2% of the patients were men. A total of 161 patients were assigned to the control group and 169 to the intervention group. The time to decannulation was shorter in the intervention group than in the control group (median, 6 days [interquartile range, 5 to 7] vs. 13 days [interquartile range, 11 to 14]; absolute difference, 7 days [95% confidence interval, 5 to 9]). The incidence of pneumonia and tracheobronchitis was lower, and the duration of stay in the hospital shorter, in the intervention group than in the control group. Other secondary outcomes were similar in the two groups. CONCLUSIONS: Basing the decision to decannulate on suctioning frequency plus continuous high-flow oxygen therapy rather than on 24-hour capping trials plus intermittent high-flow oxygen therapy reduced the time to decannulation, with no evidence of a between-group difference in the incidence of decannulation failure. (REDECAP ClinicalTrials.gov number, NCT02512744.).


Assuntos
Remoção de Dispositivo , Oxigenoterapia , Sucção , Traqueostomia , Estado Terminal , Feminino , Humanos , Análise de Intenção de Tratamento , Estimativa de Kaplan-Meier , Masculino , Pessoa de Meia-Idade , Oxigenoterapia/métodos , Fatores de Tempo , Desmame do Respirador
14.
Medicine (Baltimore) ; 99(38): e21970, 2020 Sep 18.
Artigo em Inglês | MEDLINE | ID: mdl-32957315

RESUMO

The main objective of this study was to evaluate the outcomes of extremely elderly patients receiving orotracheal intubation and mechanical ventilation after planned extubation. This retrospective cohort study included extremely elderly patients (>90 years) who received mechanical ventilation and passed planned extubation. We reviewed all intensive care unit patients in a medical center between January 1, 2010, and December 31, 2017. There were 19,518 patients (aged between 20 and 105 years) during the study period. After application of the exclusion criteria, there were 213 patients who underwent planned extubation: 166 patients survived, and 47 patients died. Compared with the mortality group, the survival group had lower Acute Physiology and Chronic Health Evaluation II scores and higher Glasgow Coma Scale (GCS) scores, with scores of 19.7 ±â€Š6.5 (mean ±â€Šstandard deviation) vs 22.2 ±â€Š6.0 (P = .015) and 9.5 ±â€Š3.5 vs 8.0 ±â€Š3.0 (P = .007), respectively. The laboratory data revealed no significant difference between the survival and mortality groups except for blood urea nitrogen (BUN) and hemoglobin. After multivariate logistic regression analysis, a lower GCS, a higher BUN level, weaning beginning 3 days after intubation and reintubation during hospitalization were associated with poor prognosis. In this cohort of extremely elderly patients undergoing planned extubation, a lower GCS, a higher BUN level, weaning beginning 3 days after intubation and reintubation during hospitalization were associated with mortality.


Assuntos
Extubação/mortalidade , Intubação Intratraqueal/estatística & dados numéricos , Respiração Artificial/estatística & dados numéricos , Desmame do Respirador/estatística & dados numéricos , APACHE , Fatores Etários , Idoso de 80 Anos ou mais , Nitrogênio da Ureia Sanguínea , Índice de Massa Corporal , Comorbidade , Escala de Coma de Glasgow , Humanos , Unidades de Terapia Intensiva/estatística & dados numéricos , Prognóstico , Estudos Retrospectivos , Fatores de Risco , Fatores Sexuais
15.
Zhonghua Jie He He Hu Xi Za Zhi ; 43(9): 778-783, 2020 Sep 12.
Artigo em Chinês | MEDLINE | ID: mdl-32894912

RESUMO

Objective: To evaluate the value of the diaphragmatic thickening fraction (DTF) combined with the maximum inspiratory pressure (MIP) for the prediction of weaning success in mechanically ventilated patients. Methods: Patients admitted to the intensive care unit (ICU) of Yijishan Hospital of Wannan Medical College and on mechanical ventilation for 24 hours from June 2018 to April 2019 were selected as the study subjects. A low-level pressure support ventilation (PSV) method was applied to conduct a spontaneous breathing test (SBT) for 30 minutes after the patients met the screening conditions for clinical weaning; and the patients were weaned when they met the clinical weaning criteria. Before weaning, the patient's MIP was measured. The right hemidiaphragmatic excursion (DE) and the thickness of the diaphragm at the end of inspiration and at the end of exhalation were measured by ultrasound, and the DTF was calculated. The statistical relationship between the DTF, DE and MIP was analyzed. The predictive value for the success of weaning was calculated with the DTF, DE and MIP and was evaluated by the area under the receiver operating characteristic curve (AUC). Results: A total of 73 patients were included in this study, including 57 patients who were successfully weaned, and 16 patients who experienced failure. The DTF of the successful weaning group (35%, 8%) was significantly higher than that of the failed weaning group (25%±5%), and the difference was statistically significant (t=6.401, P<0.01). The MIP (34±9 cmH(2)O) in the successful weaning group was significantly higher than that in the failed weaning group (23±3 cmH(2)O), and the difference was statistically significant (t=7.186, P<0.01). The ROCs for the DTF, MIP, and diaphragmatic displacement were 0.907, 0.896, and 0.749, respectively. A DTF ≥ 27.78%, with a sensitivity of 92.98%, a specificity of 81.25%, and an AUC of 0.907 (95% CI: 0.816-0.963), was used as the standard to predict the success of weaning. An MIP>26.5 cmH(2)O, with a sensitivity of 80.7%, a specificity of 93.75%, and an AUC of 0.896 (95% CI: 0.803-0.955), was used as the standard to predict the success of weaning. The AUC of DTF ≥ 27.78% and MIP ≥ 26.5 cmH(2)O was 0.920 (95% CI:0.832-0.971), and the specificity increased to 87.7%, but the sensitivity was slightly reduced to 87.5%. Conclusions: The DTF and MIP play a crucial role in determining the appropriate time and predicting the outcome of weaning of mechanical ventilation patients. Compared with the DTF and MIP alone, the DTF combined with MIP greatly improved the accuracy of predicting successful weaning.


Assuntos
Diafragma , Respiração Artificial , Humanos , Pressões Respiratórias Máximas , Valor Preditivo dos Testes , Estudos Prospectivos , Desmame do Respirador
16.
Nervenarzt ; 91(12): 1122-1129, 2020 Dec.
Artigo em Alemão | MEDLINE | ID: mdl-32776234

RESUMO

Neurological and neurosurgical early rehabilitation patients are often so critically ill that they must be weaned from mechanical ventilation in addition to early rehabilitative treatment. The German Society for Neurorehabilitation (DGNR) carried out a survey and asked neurological weaning units to provide information on structural characteristics of the facility, including personnel and technical resources and the number of cases and outcome based on anonymous data. In total 36 weaning units from 11 federal states with a total of 496 beds participated in the survey. From 2516 weaning cases documented in 2019, 2097 (83.3%) could primarily be successfully weaned from mechanical ventilation and only 120 (4.8%) had to be discharged with home ventilation. The mortality in this sample was 11.0% (n = 276). The results of the survey demonstrate that prolonged weaning during early neurological and neurosurgical rehabilitation is an important and effective component of healthcare provision for critically ill patients in Germany.


Assuntos
Reabilitação Neurológica , Alemanha , Recursos em Saúde , Humanos , Respiração Artificial , Resultado do Tratamento , Desmame do Respirador
17.
Front Med ; 14(5): 674-680, 2020 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-32761492

RESUMO

We report the clinical and laboratory findings and successful management of seven patients with critical coronavirus disease 2019 (COVID-19) requiring mechanical ventilation (MV). The patients were diagnosed based on epidemiological history, clinical manifestations, and nucleic acid testing. Upon diagnosis with COVID-19 of critical severity, the patients were admitted to the intensive care unit, where they received early noninvasive-invasive sequential ventilation, early prone positioning, and bundle pharmacotherapy regimen, which consists of antiviral, anti-inflammation, immune-enhancing, and complication-prophylaxis medicines. The patients presented fever (n = 7, 100%), dry cough (n = 3, 42.9%), weakness (n = 2, 28.6%), chest tightness (n = 1, 14.3%), and/or muscle pain (n = 1, 14.3%). All patients had normal or lower than normal white blood cell count/lymphocyte count, and chest computed tomography scans showed bilateral patchy shadows or ground glass opacity in the lungs. Nucleic acid testing confirmed COVID-19 in all seven patients. The median MV duration and intensive care unit stay were 9.9 days (interquartile range, 6.5-14.6 days; range, 5-17 days) and 12.9 days (interquartile range, 9.7-17.6 days; range, 7-19 days), respectively. All seven patients were extubated, weaned off MV, transferred to the common ward, and discharged as of the writing of this report. Thus, we concluded that good outcomes for patients with critical COVID-19 can be achieved with early noninvasive-invasive sequential ventilation and bundle pharmacotherapy.


Assuntos
Antivirais/administração & dosagem , Infecções por Coronavirus , Estado Terminal/terapia , Ventilação não Invasiva/métodos , Pandemias , Pneumonia Viral , Betacoronavirus/isolamento & purificação , Quimioprevenção/métodos , Técnicas de Laboratório Clínico/métodos , Infecções por Coronavirus/complicações , Infecções por Coronavirus/diagnóstico , Infecções por Coronavirus/tratamento farmacológico , Infecções por Coronavirus/fisiopatologia , Infecções por Coronavirus/terapia , Cuidados Críticos/métodos , Feminino , Humanos , Pulmão/diagnóstico por imagem , Masculino , Pessoa de Meia-Idade , Avaliação de Processos e Resultados em Cuidados de Saúde , Pneumonia Viral/complicações , Pneumonia Viral/fisiopatologia , Pneumonia Viral/terapia , Insuficiência Respiratória/etiologia , Insuficiência Respiratória/terapia , Tomografia Computadorizada por Raios X/métodos , Desmame do Respirador/métodos
18.
Respir Care ; 65(11): 1773-1783, 2020 11.
Artigo em Inglês | MEDLINE | ID: mdl-32759372

RESUMO

The COVID-19 pandemic has profoundly affected health care delivery worldwide. A small yet significant number of patients with respiratory failure will require prolonged mechanical ventilation while recovering from the viral-induced injury. The majority of reports thus far have focused on the epidemiology, clinical factors, and acute care of these patients, with less attention given to the recovery phase and care of those patients requiring extended time on mechanical ventilation. In this paper, we review the procedures and methods to safely care for patients with COVID-19 who require tracheostomy, gastrostomy, weaning from mechanical ventilation, and final decannulation. The guiding principles consist of modifications in the methods of airway care to safely prevent iatrogenesis and to promote safety in patients severely affected by COVID-19, including mitigation of aerosol generation to minimize risk for health care workers.


Assuntos
Infecções por Coronavirus , Remoção de Dispositivo/métodos , Gastrostomia , Controle de Infecções , Pandemias , Pneumonia Viral , Traqueostomia , Desmame do Respirador/métodos , Betacoronavirus , Infecções por Coronavirus/complicações , Infecções por Coronavirus/cirurgia , Infecções por Coronavirus/terapia , Cuidados Críticos/métodos , Cuidados Críticos/normas , Gastrostomia/instrumentação , Gastrostomia/métodos , Humanos , Controle de Infecções/instrumentação , Controle de Infecções/métodos , Controle de Infecções/normas , Pneumonia Viral/complicações , Pneumonia Viral/cirurgia , Pneumonia Viral/terapia , Respiração Artificial/métodos , Risco Ajustado , Traqueostomia/instrumentação , Traqueostomia/métodos
19.
Lima; IETSI; 24 ago. 2020.
Não convencional em Espanhol | LILACS, BRISA/RedTESA | ID: biblio-1119647

RESUMO

INTRODUCCIÓN: Uno de los mayores intereses en el campo de la salud y en torno a la pandemia de COVID-19 es el desarrollo de estrategias para reducir la transmisión de la infección por SARS-CoV-2, incluyendo la protección de los trabajadores de salud, grupo de riesgo frente a la infección por este virus (Ng et al. 2020). La extubación es un procedimiento generador de aerosoles debido a la respuesta refleja del sistema respiratorio durante esta actividad, manifestada como la presencia de tos en algunos pacientes a los que se les realiza destete del ventilador mecánico (Brewster et al. 2020). Realizar la extubación requiere la proximidad de los trabajadores de salud con los pacientes, los cuales, incluyendo los casos de pacientes con COVID-19, suelen seguir siendo infecciosos al momento de la extubación (Brewster et al. 2020, Zhou et al. 2020, Ng et al. 2020), por lo que realizar esta actividad incrementaría la probabilidad de transmisión de esta infección viral. Ante ello, diversos grupos relacionados a la anestesiología señalan como útil el empleo de medicación que reduzca la generación de tos durante la extubación, que, junto a otras medidas de protección, disminuiría la probabilidad de transmisión de la infección por SARS-CoV-2 (Brown et al. 2020, Cook et al. 2020, D'Silva et al. 2020, Tan Li et al 2020). En EsSalud, se dispone de lidocaína y fentanilo, medicamentos descritos en la literatura científica como útiles para reducir la tos en pacientes a los que se les realizará el destete de la ventilación mecánica. Sin embargo, algunos especialistas argumentan que estos agentes sedantes podrían causar depresión respiratoria, retraso en el despertar e incrementar el riesgo de delirio si son administrados por periodos largos. Adicionalmente, los especialistas argumentan que dexmedetomidina es una alternativa que ofrecería la ventaja un despertar más rápido y una menor incidencia de delirio, además de reducir la incidencia de tos durante la extubación, estos efectos facilitarían la extubación del paciente y disminuiría la transmisión del SARS-CoV-2 al equipo médico tratante en la UCI. En ese sentido, el presente documento tuvo como objetivo evaluar la eficacia y seguridad de dexmedetomidina comparado con lidocaína y fentanilo para destete de ventilación mecánica invasiva en pacientes con COVID-19. TECNOLOGÍA DE INTERÉS: Dexmedetomidina es un agonista selectivo de los receptores alfa-2 con efectos ansiolíticos, sedantes (mediados por la inhibición del locus coeruleus, el núcleo noradrenérgico predominante, situado en el tronco cerebral) y analgésicos, produciendo además un efecto simpaticolítico al disminuir la liberación de noradrenalina en las terminaciones nerviosas simpáticas. METODOLOGÍA: Se buscó la evidencia disponible al 24 de agosto del 2020 en las siguientes bases de datos bibliográficas: PubMed, The Cochrane Library y LILACS. Asimismo, se realizó una búsqueda en sitios web pertenecientes a grupos que realizan evaluaciones de tecnologías sanitarias y guías de práctica clínica, incluyendo: The Canadian Agency for Drugs and Technologies in Health (CADTH), Scottish Medicines Consortium (SMC), The National Institute for Health and Care Excellence (NICE), Institute for Quality and Efficiency in Healthcare (IQWiG), Haute Authorité de Santé (HAS), Institute for Clinical and Economic Review (ICER) y el portal BRISA (Base Regional de Informes de Evaluación de Tecnologías en Salud de las Américas). Adicionalmente, se realizó búsqueda de evidencia en sitios web de organizaciones internacionales en anestesiología o de instituciones que estén desarrollando protocolos para el manejo de pacientes con COVID-19. RESULTADOS: En la búsqueda de la evidencia no se identificaron estudios que evalúen la eficacia y seguridad de dexmedetomidina, comparado con lidocaína y fentanilo, para el destete de ventilación mecánica invasiva, en pacientes con COVID-19. Sin embargo, se identificaron: tres GPC o consensos de expertos elaborados por la Safe Airway Society, Alfred ICU y la Difficult Airway Society e instituciones colaboradoras; una RS con metaanálisis en red realizada por Tung et al., así como dos ensayos clínicos controlados, aleatorizados (ECA) que no fueron incluidos en la RS. Se debe precisar que esta RS y estos ECA no fueron realizados en la población de interés del presente reporte breve (pacientes con COVID-19); por lo que fueron incluidos como evidencia indirecta. CONCLUSIONES: En el presente documento, se evaluó la mejor evidencia científica disponible hasta la actualidad sobre eficacia y seguridad de dexmedetomidina comparado con lidocaína y fentanilo para destete de ventilación mecánica en pacientes con COVID-19. Se encontraron: tres GPC o consensos de expertos, una RS y dos ECA. La RS y los ECA incluidos aportan al reporte breve como evidencia indirecta; al no haber sido desarrollados en pacientes con COVID-19. Las guías de la Safe Airway Society (SAS), Alfred ICU y de la Difficult Airway Society (DAS) e instituciones colaboradoras que fueron elaboradas para dar recomendaciones para el proceso de extubación en pacientes con COVID-19, hacen mención a dexmedetomidina (SAS, Alfred ICU), opioides como el fentanilo (SAS y DAS) y la lidocaína (SAS, DAS) para reducir la tos durante el proceso de extubación, aunque precisan la ausencia de evidencia sobre el uso de este medicamentos en pacientes con COVID-19, señalando que se debe evaluar el balance riesgo-beneficio para el uso de los mismos. En general, las recomendaciones descritas en estos documentos proceden de consensos por opinión de expertos, y no establecen una preferencia de un medicamento sobre los otros. En cuanto a los resultados de la RS con MA en red de Tung et al., y los ECA de Kothari et al., y Hu et al., no han podido encontrar evidencia que apoye la hipótesis que el efecto de la dexmedetomidina sea superior al de lidocaína y fentanilo sobre el manejo de la tos (esto es, no se encontraron diferencias entre estos). Estos resultados deben ser interpretados con cautela debido a que la población de estudio de los mismos no son pacientes COVID-19. No obstante, la información que proporcionan puede ayudar a tener una idea del efecto que se podría esperar con el uso de cada uno de los medicamentos mencionados, tanto en eficacia como en seguridad. Al respecto, frente a una ausencia de diferencia entre dexmedetomidina en comparación con lidocaína y fentanilo, se tiene evidencia que la primera tiene un mayor riesgo de bradicardia que los dos últimos. Esto se condice con la literatura previa acerca de dicho medicamento (dexmedetomidina), donde además se describe que los adultos mayores y personas con comorbilidades presentan una mayor proporción de eventos de bradicardia atribuibles al uso de dexmedetomidina lo que, siendo que estos grupos poblacionales son los más afectados por COVID-19, sería esperable una mayor presencia de bradicardia como evento adverso en pacientes con COVID-19 que reciben dexmedetomidina, lo que llama a la precaución cuando se considera el uso de esta tecnología en estos pacientes. De este modo, la mejor evidencia disponible a la fecha (24 de agosto del 2020), procedente de tres GPC o consensos de expertos, una RS con metaanálisis en red y dos ECA, apunta a que el balance de riesgo-beneficio del empleo de dexmedetomidina comparado con el uso de lidocaína o fentanilo, en la reducción de la tos durante el destete de ventilación mecánica en pacientes con COVID-19 es de alta incertidumbre, especialmente por el hecho que la dexmedetomidina está asociada a un mayor riesgo de reacciones adversas frente a los otros dos medicamentos, especialmente en lo referente a bradicardia. Por ello, con este cuerpo de evidencia, el IETSI no ha encontrado sustento técnico que pueda apoyar una recomendación a favor del uso de dexmedetomidina por sobre el de lidocaína o fentanilo en pacientes COVID-19 para reducir la tos al momento de la extubación.


Assuntos
Humanos , Respiração Artificial/métodos , Desmame do Respirador/instrumentação , Fentanila/administração & dosagem , Infecções por Coronavirus/tratamento farmacológico , Dexmedetomidina/administração & dosagem , Betacoronavirus/efeitos dos fármacos , Lidocaína/administração & dosagem , Avaliação da Tecnologia Biomédica , Avaliação em Saúde
20.
Rev Lat Am Enfermagem ; 28: e3334, 2020.
Artigo em Português, Espanhol, Inglês | MEDLINE | ID: mdl-32813785

RESUMO

OBJECTIVE: to clinically validate the nursing diagnosis of Dysfunctional Ventilatory Weaning Response in adult patients admitted to Intensive Care Units. METHOD: a concurrent cohort performed with 93 patients admitted to Intensive Care Units. The incidence and incidence density of the diagnosis were estimated, its related factors were identified based on bivariate analysis and clinical indicators for determining its occurrence, according to the global and temporal presentation. RESULTS: the overall incidence of the diagnosis was 44.09% and the incidence density was 14.49 occurrences for every 100 extubations/day. The factors related to the diagnosis were the following: age, clinical severity, fluid balance, oliguria, hemodialysis, edema in upper/lower limbs, anasarca, number of antibiotics, hypothermia, hyperthermia, amount of secretion, muscle retraction, anxiety score, heart rate, use of vasopressors and non-invasive ventilation after extubation. The clinical indicators most frequently identified for determining the diagnosis were the following: tachypnea, drop of saturation and tachycardia. Temporal progression in the severity of these manifestations was found. CONCLUSION: the Dysfunctional Ventilatory Weaning Response is a common finding in critically ill patients. Some components of the diagnosis of the NANDA-International (2018) version could be clinically validated. It is noteworthy that there are variables not yet described in the taxonomy, demonstrating the need to review this nursing diagnosis.


Assuntos
Estado Terminal , Desmame do Respirador , Adulto , Estudos de Coortes , Humanos , Unidades de Terapia Intensiva , Diagnóstico de Enfermagem , Respiração Artificial
SELEÇÃO DE REFERÊNCIAS
DETALHE DA PESQUISA