Your browser doesn't support javascript.
loading
Mostrar: 20 | 50 | 100
Resultados 1 - 20 de 1.679
Filtrar
1.
Medicine (Baltimore) ; 99(27): e20701, 2020 Jul 02.
Artigo em Inglês | MEDLINE | ID: mdl-32629642

RESUMO

BACKGROUND: At present, accumulative attention has been paid to coronavirus disease 2019 (COVID-19) due to its global prevalence. Acupuncture may play a beneficial role in patients with breathlessness in COVID-19. This study is designed to determine the efficacy and safety of acupuncture for breathlessness in COVID-19. METHODS: Randomized controlled trials (RCT) will be searched from 7 electronic databases, with the last search update being 30 June 2020. Studies by registers of clinical trials will be additionally searched. Two investigators will independently select studies, extract data and evaluate study quality. Finally, a meta-analysis will be used to evaluate the pooled intervention effect if possible. RESULTS: Our present findings will indicate the application of acupuncture as an adjunctive treatment for dyspnea in COVID-19, which will be published in a peer-reviewed journal. CONCLUSION: Our study will provide a reference foundation for clinical optimization of treatment. PROSPERO REGISTRATION NUMBER: CRD42020182323.


Assuntos
Terapia por Acupuntura , Infecções por Coronavirus/complicações , Dispneia/terapia , Pneumonia Viral/complicações , Betacoronavirus , Terapia Combinada , Dispneia/etiologia , Humanos , Metanálise como Assunto , Pandemias , Revisões Sistemáticas como Assunto
3.
Cochrane Database Syst Rev ; 6: CD007568, 2020 06 02.
Artigo em Inglês | MEDLINE | ID: mdl-32483832

RESUMO

BACKGROUND: People with cancer experience a variety of symptoms as a result of their disease and the therapies involved in its management. Inadequate symptom management has implications for patient outcomes including functioning, psychological well-being, and quality of life (QoL). Attempts to reduce the incidence and severity of cancer symptoms have involved the development and testing of psycho-educational interventions to enhance patients' symptom self-management. With the trend for care to be provided nearer patients' homes, telephone-delivered psycho-educational interventions have evolved to provide support for the management of a range of cancer symptoms. Early indications suggest that these can reduce symptom severity and distress through enhanced symptom self-management. OBJECTIVES: To assess the effectiveness of telephone-delivered interventions for reducing symptoms associated with cancer and its treatment. To determine which symptoms are most responsive to telephone interventions. To determine whether certain configurations (e.g. with/without additional support such as face-to-face, printed or electronic resources) and duration/frequency of intervention calls mediate observed cancer symptom outcome effects. SEARCH METHODS: We searched the following databases: the Cochrane Central Register of Controlled Trials (CENTRAL; 2019, Issue 1); MEDLINE via OVID (1946 to January 2019); Embase via OVID (1980 to January 2019); (CINAHL) via Athens (1982 to January 2019); British Nursing Index (1984 to January 2019); and PsycINFO (1989 to January 2019). We searched conference proceedings to identify published abstracts, as well as SIGLE and trial registers for unpublished studies. We searched the reference lists of all included articles for additional relevant studies. Finally, we handsearched the following journals: Cancer, Journal of Clinical Oncology, Psycho-oncology, Cancer Practice, Cancer Nursing, Oncology Nursing Forum, Journal of Pain and Symptom Management, and Palliative Medicine. We restricted our search to publications published in English. SELECTION CRITERIA: We included randomised controlled trials (RCTs) and quasi-RCTs that compared one or more telephone interventions with one other, or with other types of interventions (e.g. a face-to-face intervention) and/or usual care, with the stated aim of addressing any physical or psychological symptoms of cancer and its treatment, which recruited adults (over 18 years) with a clinical diagnosis of cancer, regardless of tumour type, stage of cancer, type of treatment, and time of recruitment (e.g. before, during, or after treatment). DATA COLLECTION AND ANALYSIS: We used Cochrane methods for trial selection, data extraction and analysis. When possible, anxiety, depressive symptoms, fatigue, emotional distress, pain, uncertainty, sexually-related and lung cancer symptoms as well as secondary outcomes are reported as standardised mean differences (SMDs) with 95% confidence intervals (CIs), and we presented a descriptive synthesis of study findings. We reported on findings according to symptoms addressed and intervention types (e.g. telephone only, telephone combined with other elements). As many studies included small samples, and because baseline scores for study outcomes often varied for intervention and control groups, we used change scores and associated standard deviations. The certainty of the evidence for each outcome was interpreted using the Grading of Recommendations Assessment, Development and Evaluation (GRADE) approach. MAIN RESULTS: Thirty-two studies were eligible for inclusion; most had moderate risk of bias,often related to blinding. Collectively, researchers recruited 6250 people and studied interventions in people with a variety of cancer types and across the disease trajectory, although many participants had breast cancer or early-stage cancer and/or were starting treatment. Studies measured symptoms of anxiety, depression, emotional distress, uncertainty, fatigue, and pain, as well as sexually-related symptoms and general symptom intensity and/or distress. Interventions were primarily delivered by nurses (n = 24), most of whom (n = 16) had a background in oncology, research, or psychiatry. Ten interventions were delivered solely by telephone; the rest combined telephone with additional elements (i.e. face-to-face consultations and digital/online/printed resources). The number of calls delivered ranged from 1 to 18; most interventions provided three or four calls. Twenty-one studies provided evidence on effectiveness of telephone-delivered interventions and the majority appeared to reduce symptoms of depression compared to control. Nine studies contributed quantitative change scores (CSs) and associated standard deviation results (or these could be calculated). Likewise, many telephone interventions appeared effective when compared to control in reducing anxiety (16 studies; 5 contributed quantitative CS results); fatigue (9 studies; 6 contributed to quantitative CS results); and emotional distress (7 studies; 5 contributed quantitative CS results). Due to significant clinical heterogeneity with regards to interventions introduced, study participants recruited, and outcomes measured, meta-analysis was not conducted. For other symptoms (uncertainty, pain, sexually-related symptoms, dyspnoea, and general symptom experience), evidence was limited; similarly meta-analysis was not possible, and results from individual studies were largely conflicting, making conclusions about their management through telephone-delivered interventions difficult to draw. Heterogeneity was considerable across all trials for all outcomes. Overall, the certainty of evidence was very low for all outcomes in the review. Outcomes were all downgraded due to concerns about overall risk of bias profiles being frequently unclear, uncertainty in effect estimates and due to some inconsistencies in results and general heterogeneity. Unsubstantiated evidence suggests that telephone interventions in some capacity may have a place in symptom management for adults with cancer. However, in the absence of reliable and homogeneous evidence, caution is needed in interpreting the narrative synthesis. Further, there were no clear patterns across studies regarding which forms of interventions (telephone alone versus augmented with other elements) are most effective. It is impossible to conclude with any certainty which forms of telephone intervention are most effective in managing the range of cancer-related symptoms that people with cancer experience. AUTHORS' CONCLUSIONS: Telephone interventions provide a convenient way of supporting self-management of cancer-related symptoms for adults with cancer. These interventions are becoming more important with the shift of care closer to patients' homes, the need for resource/cost containment, and the potential for voluntary sector providers to deliver healthcare interventions. Some evidence supports the use of telephone-delivered interventions for symptom management for adults with cancer; most evidence relates to four commonly experienced symptoms - depression, anxiety, emotional distress, and fatigue. Some telephone-delivered interventions were augmented by combining them with face-to-face meetings and provision of printed or digital materials. Review authors were unable to determine whether telephone alone or in combination with other elements provides optimal reduction in symptoms; it appears most likely that this will vary by symptom. It is noteworthy that, despite the potential for telephone interventions to deliver cost savings, none of the studies reviewed included any form of health economic evaluation. Further robust and adequately reported trials are needed across all cancer-related symptoms, as the certainty of evidence generated in studies within this review was very low, and reporting was of variable quality. Researchers must strive to reduce variability between studies in the future. Studies in this review are characterised by clinical and methodological diversity; the level of this diversity hindered comparison across studies. At the very least, efforts should be made to standardise outcome measures. Finally, studies were compromised by inclusion of small samples, inadequate concealment of group allocation, lack of observer blinding, and short length of follow-up. Consequently, conclusions related to symptoms most amenable to management by telephone-delivered interventions are tentative.


Assuntos
Neoplasias/complicações , Telemedicina/métodos , Telefone , Adulto , Ansiedade/etiologia , Ansiedade/terapia , Dor do Câncer/terapia , Depressão/etiologia , Depressão/terapia , Dispneia/etiologia , Dispneia/terapia , Fadiga/etiologia , Fadiga/terapia , Feminino , Humanos , Masculino , Neoplasias/psicologia , Neoplasias/terapia , Ensaios Clínicos Controlados Aleatórios como Assunto , Autocuidado , Disfunções Sexuais Fisiológicas/etiologia , Disfunções Sexuais Fisiológicas/terapia , Estresse Psicológico/etiologia , Estresse Psicológico/terapia , Avaliação de Sintomas , Telefone/estatística & dados numéricos , Fatores de Tempo , Incerteza
4.
Otolaryngol Head Neck Surg ; 163(1): 170-178, 2020 07.
Artigo em Inglês | MEDLINE | ID: mdl-32423368

RESUMO

OBJECTIVE: To identify risk factors associated with intubation and time to extubation in hospitalized patients with coronavirus disease 2019 (COVID-19). STUDY DESIGN: Retrospective observational study. SETTING: Ten hospitals in the Chicago metropolitan area. SUBJECTS AND METHODS: Patients with laboratory-confirmed COVID-19 admitted between March 1 and April 8, 2020, were included. We evaluated sociodemographic and clinical characteristics associated with intubation and prolonged intubation for acute respiratory failure secondary to COVID-19 infection. RESULTS: Of the 486 hospitalized patients included in the study, the median age was 59 years (interquartile range, 47-69); 271 (55.8%) were male; and the median body mass index was 30.6 (interquartile range, 26.5-35.6). During the hospitalization, 138 (28.4%) patients were intubated; 78 (56.5%) were eventually extubated; 21 (15.2%) died; and 39 (28.3%) remained intubated at a mean ± SD follow-up of 19.6 ± 6.7 days. Intubated patients had a significantly higher median age (65 vs 57 years, P < .001) and rate of diabetes (56 [40.6%] vs 104 [29.9%], P = .031) as compared with nonintubated patients. Multivariable logistic regression analysis identified age, sex, respiratory rate, oxygen saturation, history of diabetes, and shortness of breath as factors predictive of intubation. Age and body mass index were the only factors independently associated with time to extubation. CONCLUSION: In addition to clinical signs of respiratory distress, patients with COVID-19 who are older, male, or diabetic are at higher risk of requiring intubation. Among intubated patients, older and more obese patients are at higher risk for prolonged intubation. Otolaryngologists consulted for airway management should consider these factors in their decision making.


Assuntos
Betacoronavirus , Infecções por Coronavirus/complicações , Dispneia/terapia , Pacientes Internados , Intubação Intratraqueal/métodos , Pneumonia Viral/complicações , Respiração Artificial/métodos , Idoso , Infecções por Coronavirus/epidemiologia , Dispneia/etiologia , Feminino , Seguimentos , Humanos , Masculino , Pessoa de Meia-Idade , Pandemias , Pneumonia Viral/epidemiologia , Estudos Retrospectivos , Fatores de Risco , Fatores de Tempo
6.
Lakartidningen ; 1172020 04 03.
Artigo em Sueco | MEDLINE | ID: mdl-32293020

RESUMO

Coronavirus Disease 2019 (COVID-19) can cause severe respiratory failure and distressing symptoms including fever, cough, breathlessness and anxiety. Symptomatic (palliative) treatment is of fundamental importance both in conjuncture with life-sustaining interventions and in end of life care. Based on the evidence to date, there are several treatment options to consider for the relief of fever (acetaminophen, NSAID, oral glucocorticoids), cough (morphine), breathlessness (morphine, oxygen, fan), anxiety (benzodiazepines) and pain (NSAID, morphine). Top priorities include precautions to protect staff and people at-risk from infection and planning how to provide adequate treatment for each individual depending on setting, including palliative care.


Assuntos
Infecções por Coronavirus/terapia , Coronavirus , Dispneia , Febre , Manejo da Dor , Cuidados Paliativos , Pneumonia Viral/terapia , Betacoronavirus , Infecções por Coronavirus/complicações , Tosse/tratamento farmacológico , Tosse/etiologia , Dispneia/etiologia , Dispneia/terapia , Febre/tratamento farmacológico , Febre/etiologia , Humanos , Controle de Infecções/métodos , Pandemias , Pneumonia Viral/complicações
7.
Med Clin North Am ; 104(3): 455-470, 2020 May.
Artigo em Inglês | MEDLINE | ID: mdl-32312409

RESUMO

Respiratory symptoms are common in patients living with serious illness, both in cancer and nonmalignant conditions. Common symptoms include dyspnea (breathlessness), cough, malignant pleural effusions, airway secretions, and hemoptysis. Basic management of respiratory symptoms is within the scope of primary palliative care. There are pharmacologic and nonpharmacologic approaches to treating respiratory symptoms. This article provides clinicians with treatment approaches to these burdensome symptoms.


Assuntos
Tosse/terapia , Estado Terminal/terapia , Dispneia/terapia , Hemoptise/terapia , Derrame Pleural Maligno/tratamento farmacológico , Analgésicos Opioides/administração & dosagem , Analgésicos Opioides/efeitos adversos , Analgésicos Opioides/uso terapêutico , Secreções Corporais/efeitos dos fármacos , Terapia Combinada/métodos , Tosse/epidemiologia , Tosse/etiologia , Tosse/patologia , Dispneia/epidemiologia , Dispneia/etiologia , Dispneia/patologia , Hemoptise/epidemiologia , Hemoptise/etiologia , Hemoptise/patologia , Humanos , Mortalidade/tendências , Cuidados Paliativos/normas , Derrame Pleural Maligno/epidemiologia , Derrame Pleural Maligno/mortalidade , Prevalência , Sistema Respiratório/efeitos dos fármacos , Sistema Respiratório/fisiopatologia , Fatores de Risco
9.
Altern Ther Health Med ; 26(1): 49-56, 2020 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-31221935

RESUMO

Context: Dyspnea is the most common symptom of lung cancer. Acupressure is an important application in the management of dyspnea for lung cancer patients. High-powered, well-planned work is needed on the topic. Objectives: The study was conducted to determine the effects of acupressure on quality of life and dyspnea level for individuals with lung cancer. Design: The study was a randomized, controlled, single-blinded trial. Setting: The study took place in the Oncology Day Treatment Unit of a university hospital in Turkey. Participants: Participants were patients in the unit who were receiving chemotherapy and had experienced dyspnea. Intervention: Patients were divided into 2 groups: (1) an intervention group receiving acupressure, and (2) a control group receiving standard care. The P6-Lu1-Lu10 acupuncture points in the hand, forearm, and chest were used, with acupressure being applied 2 times per day for 4 wk, for a total of 56 sessions. Outcome Measures: Data were collected at baseline and postintervention. Sociodemographic and disease-related data were collected using the Patient Identification Form. Quantitative data were collected with the Modified Borg Dyspnea Scale (Borg scale) and the St George's Respiratory Questionnaire and through measurements of participants' heart rates, respiratory rates, oxygen saturation, and walking distance before and after the 6-mile walk test. Qualitative data were collected using the semistructured "Patients' Views Form on Acupressure Experience." Results: The 4-wk acupressure intervention demonstrated a significant reduction in the participants' levels of dyspnea, and at the same time, significant increases in their quality of life. The quantitative findings of this study were supported with qualitative findings. Conclusions: Acupressure can be a helpful adjunct treatment that enhances the quality of life and reduces dyspnea in individuals with lung cancer. It is an easily applicable method without serious side effects.


Assuntos
Acupressão/métodos , Dispneia/terapia , Neoplasias Pulmonares/terapia , Qualidade de Vida , Dispneia/etiologia , Dispneia/psicologia , Humanos , Neoplasias Pulmonares/complicações , Resultado do Tratamento , Turquia
11.
Ann Otol Rhinol Laryngol ; 129(4): 361-368, 2020 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-31747777

RESUMO

OBJECTIVE: Office-based steroid injection has shown promise for idiopathic subglottic stenosis (iSGS). It is important to understand safety and patient-lived experience. We report patient experience related to airway restriction, voice, and side effects. METHODS: Sixteen patients (51 ± 14 years) with mild-moderate (20-50%) stenosis undergoing office-based transnasal steroid injections were included; fourteen had prior operations. Patients typically underwent three injections, 1 month apart, followed by transnasal tracheoscopy 1 month later to evaluate outcome; number of injections can vary based on disease severity and response. Outcomes were Dyspnea Index (DI), Modified Medical Research Council (MMRC) dyspnea scale, voice handicap index-10 (VHI-10), and degree of stenosis (estimated from procedural video). At each visit, patients were queried about post-injection airway restriction and side effects. Paired t-tests compared values at baseline versus follow-up tracheoscopy. RESULTS: DI decreased (t = 3.938, P = 0.0013), as did MMRC (t = 2.179, P = 0.0457). There was no change in VHI-10 (t = 1.354; P = 0.1957) scores. Airway stenosis decreased (t = 4.331; P = 0.0006); this was not correlated with change in DI (r = 0.267, P = 0.318). Side effects included airway restriction lasting <48 hours (n = 5), cough (n = 3), and nasal pain (n = 2). CONCLUSION: Steroid injections improved upper airway symptoms. Side effects were mild and transient. Improvement in DI did not correlate with percent stenosis.


Assuntos
Dispneia , Glucocorticoides/administração & dosagem , Injeções Intralesionais , Laringoscopia/métodos , Laringoestenose , Distúrbios da Voz , Adulto , Assistência Ambulatorial/métodos , Avaliação da Deficiência , Dispneia/etiologia , Dispneia/terapia , Feminino , Humanos , Injeções Intralesionais/efeitos adversos , Injeções Intralesionais/métodos , Laringoestenose/complicações , Laringoestenose/fisiopatologia , Laringoestenose/psicologia , Laringoestenose/terapia , Masculino , Pessoa de Meia-Idade , Índice de Gravidade de Doença , Resultado do Tratamento , Distúrbios da Voz/diagnóstico , Distúrbios da Voz/etiologia , Distúrbios da Voz/terapia
12.
Ann Emerg Med ; 75(5): 615-626, 2020 05.
Artigo em Inglês | MEDLINE | ID: mdl-31864728

RESUMO

STUDY OBJECTIVE: Palliative patients often visit the emergency department (ED) with respiratory distress during their end-of-life period. The goal of management is alleviating dyspnea and providing comfort. High-flow nasal cannula may be an alternative oxygen-delivering method for palliative patients with do-not-intubate status. We therefore aim to compare the efficacy of high-flow nasal cannula with conventional oxygen therapy in improving dyspnea of palliative patients with do-not-intubate status who have hypoxemic respiratory failure in the ED. METHODS: This randomized, nonblinded, crossover study was conducted with 48 palliative patients aged 18 years or older with do-not-intubate status who presented with hypoxemic respiratory failure to the ED of Siriraj Hospital, Bangkok, Thailand. The participants were randomly allocated to conventional oxygen therapy for 60 minutes, followed by high-flow nasal cannula for 60 minutes (n=24) or vice versa (n=24). The primary outcome was modified Borg scale score. The secondary outcomes were numeric rating scale score of dyspnea and vital signs. RESULTS: Intention-to-treat analysis included 44 patients, 22 in each group. Baseline mean modified Borg scale score was 7.6 (SD 2.2) (conventional oxygen therapy first) and 8.2 (SD 1.8) (high-flow nasal cannula first). At 60 minutes, mean modified Borg scale score in patients receiving conventional oxygen therapy and high-flow nasal cannula was 4.9 (standard of mean 0.3) and 2.9 (standard of mean 0.3), respectively (mean difference 2.0; 95% confidence interval 1.4 to 2.6). Results for the numeric rating scale score of dyspnea were similar to those for the modified Borg scale score. Respiratory rates were lower with high-flow nasal cannula (mean difference 5.9; 95% confidence interval 3.5 to 8.3), and high-flow nasal cannula was associated with a significantly lower first-hour morphine dose. CONCLUSION: High-flow nasal cannula was superior to conventional oxygen therapy in reducing the severity of dyspnea in the first hour of treatment in patients with do-not-intubate status and hypoxemic respiratory failure.


Assuntos
Dispneia/terapia , Serviço Hospitalar de Emergência , Oxigenoterapia , Cuidados Paliativos/métodos , Doente Terminal , Idoso , Cânula , Estudos Cross-Over , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Oxigenoterapia/instrumentação , Tailândia , Resultado do Tratamento
13.
Int J Chron Obstruct Pulmon Dis ; 14: 2787-2798, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31827322

RESUMO

Purpose: Pharmacological therapy and pulmonary rehabilitation are useful for exertional dyspnoea in patients with chronic obstructive pulmonary disease (COPD); however, several patients have no meaningful improvements. Although acupuncture significantly improves exercise intolerance and dyspnoea, the pathophysiological mechanism of these effects is unknown; therefore, we evaluated this mechanism using cardiopulmonary exercise testing in a single-arm, open experimental study. Patients and methods: Sixteen patients with COPD underwent acupuncture once a week for 12 weeks. Primary outcomes were exercise performance parameters, including peak oxygen uptake in the incremental exercise tests (IETs) and the time to the limit of tolerance measured in constant work rate exercise tests (CWRETs) at 70% peak work-rate of the IET. IETs and CWRETs were performed at baseline and at weeks 12, 16, and 24. Results: During the time course, there were significant increases in peak oxygen uptake (p = 0.018) and minute ventilation (V̇E, p = 0.04) in the IETs. At 12 weeks, the endurance time significantly increased (810 ± 470 vs 1125 ± 657 s, p < 0.001) and oxygen uptakes at terminated exercise were significantly lower (771 ± 149 mL/min, p < 0.05) than those at baseline (822 ± 176 mL/min) in CWRETs. The significant decreases in oxygen uptake and minute ventilation and improvements in Borg scale scores were also observed during CWRETs after acupuncture. The decreases at isotime in the Borg scale (r = -0.789, p = 0.0007) and V̇E (r = -0.6736, p = 0.0042) were significantly correlated with the improvement of endurance time. Conclusion: The positive effects of acupuncture on exertional dyspnoea were associated with increased endurance time influenced by improved oxygen utilisation and reduced ventilation during exercise. Acupuncture may be a new intervention for COPD in addition to conventional maintenance therapies.


Assuntos
Terapia por Acupuntura , Dispneia/terapia , Teste de Esforço , Tolerância ao Exercício , Pulmão/fisiopatologia , Doença Pulmonar Obstrutiva Crônica/terapia , Ventilação Pulmonar , Terapia por Acupuntura/efeitos adversos , Idoso , Idoso de 80 Anos ou mais , Dispneia/diagnóstico , Dispneia/fisiopatologia , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Consumo de Oxigênio , Valor Preditivo dos Testes , Doença Pulmonar Obstrutiva Crônica/diagnóstico , Doença Pulmonar Obstrutiva Crônica/fisiopatologia , Recuperação de Função Fisiológica , Fatores de Tempo , Resultado do Tratamento
14.
Int J Chron Obstruct Pulmon Dis ; 14: 2543-2551, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31819392

RESUMO

Introduction: Patients with chronic obstructive pulmonary disease (COPD) are at an increased risk of cardiovascular comorbidities such as pulmonary hypertension or heart failure. Impaired cardiovascular function often has a significant impact on patients with COPD. Oxygen pulse (O2P) is a surrogate for stroke volume. However, studies regarding O2P, health-related quality of life (HRQL), and exercise capacity in patients with COPD are lacking. We aimed to confirm the association between O2P, HRQL, exercise capacity, severe exacerbation of COPD, and other parameters in exercise testing. Materials and methods: This study included 79 patients with COPD who underwent lung function testing, a cardiopulmonary exercise test (CPET), Borg Dyspnea Scale evaluation, completion of the St. George's Respiratory Questionnaire, and echocardiography. Cardiovascular comorbidities, COPD-related hospitalizations, and emergency room visits were recorded. We compared these parameters between two groups of patients: those with normal peak O2P and those with impaired peak O2P. The relationships of peak O2P with CPET and lung function were analyzed using simple linear regression. Results: Patients with normal peak O2P had higher exercise capacity (peak oxygen uptake and work rate), better HRQL, lower dyspnea score, lower COPD-related hospitalizations, and higher circulatory and ventilator parameters than patients with impaired peak O2P. According to a simple linear regression analysis, the anaerobic threshold (AT) and forced expiratory volume in one second (FEV1) showed a significant association with peak O2P, and the Pearson correlation coefficients (Pearson's r) were 0.756 and 0.461, respectively. Conclusion: Peak O2P has a significant impact on exercise capacity, HRQL, dyspnea, COPD-related hospitalization, and circulatory and ventilatory functions in patients with COPD. The AT and FEV1 have strong and moderate associations with peak O2P, respectively. Therefore, peak O2P is an important indicator of disease severity for patients with COPD.


Assuntos
Dispneia/diagnóstico , Teste de Esforço , Pulmão/fisiopatologia , Doença Pulmonar Obstrutiva Crônica/diagnóstico , Idoso , Idoso de 80 Anos ou mais , Progressão da Doença , Dispneia/fisiopatologia , Dispneia/terapia , Tolerância ao Exercício , Feminino , Volume Expiratório Forçado , Humanos , Masculino , Pessoa de Meia-Idade , Consumo de Oxigênio , Valor Preditivo dos Testes , Prognóstico , Doença Pulmonar Obstrutiva Crônica/fisiopatologia , Doença Pulmonar Obstrutiva Crônica/terapia , Ventilação Pulmonar , Qualidade de Vida
15.
Int J Chron Obstruct Pulmon Dis ; 14: 2649-2661, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31819398

RESUMO

Background: Standardization of measures in a common set opens the opportunity to learn from differences in treatment outcomes which can be used for improving the quality of care. Furthermore, a standard set can provide the basis for development of quality indicators and is therefore useful for quality improvement and public reporting purposes. The aim of this study was to develop a standard set of outcome domains and proposed measures for patients with COPD in Dutch primary care physical therapy practice, including a proposal to stratify patients in subgroups. Material and methods: A consensus-driven modified RAND-UCLA appropriateness method was conducted with relevant stakeholders (patients, physical therapists, researchers, policy makers and health insurers) in Dutch primary physical therapy care in eight steps: (1) literature search, (2) first online survey, (3) patient interviews, (4) expert meeting, resulting in a concept standard set and methods to identify subgroups' (5) consensus meeting, (6) expert meeting (7) second online survey and (8) final approval of an advisory board resulting of the approved standard set. Results: Five outcome domains were selected for COPD: physical capacity, muscle strength, physical activity, dyspnea and quality of life. A total of 21 measures were rated and discussed. Finally, eight measures were included, of which four mandatory measures: Characteristics of practices and physical therapists, Clinical COPD Questionnaire (CCQ) for quality of life, Global Perceived Effect (GPE) for experience, 6-mins Walk Test (6-MWT) for physical capacity; two conditional measures: Hand-Held Dynamometer (HHD) (with Microfet™) for Quadriceps strength, Medical Research Council Dyspnea (MRC) for monitoring dyspnea; and two exploratory measures: Accelerometry for physical activity, and the Assessment of Burden of COPD tool (ABC). To identify subgroups, a method described in the Dutch standard of care from the Lung Alliance was included. Conclusion: This study described the development of a standard set of outcome domains and proposed measures for patients with COPD in primary care physical therapy. Each measure was accepted for relevance and feasibility by the involved stakeholders. The set is currently used in daily practice and tested on validity and reliability in a pilot for the development of quality indicators.


Assuntos
Actigrafia/normas , Dispneia/terapia , Teste de Esforço/normas , Pulmão/fisiopatologia , Medidas de Resultados Relatados pelo Paciente , Modalidades de Fisioterapia/normas , Atenção Primária à Saúde/normas , Doença Pulmonar Obstrutiva Crônica/terapia , Consenso , Técnica Delfos , Dispneia/diagnóstico , Dispneia/fisiopatologia , Dispneia/psicologia , Nível de Saúde , Humanos , Saúde Mental , Força Muscular , Dinamômetro de Força Muscular/normas , Países Baixos , Aptidão Física , Valor Preditivo dos Testes , Doença Pulmonar Obstrutiva Crônica/diagnóstico , Doença Pulmonar Obstrutiva Crônica/fisiopatologia , Doença Pulmonar Obstrutiva Crônica/psicologia , Melhoria de Qualidade/normas , Indicadores de Qualidade em Assistência à Saúde/normas , Qualidade de Vida , Resultado do Tratamento
16.
Int J Chron Obstruct Pulmon Dis ; 14: 2745-2752, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31819406

RESUMO

Purpose: Many older adults with a history of smoking and asthma develop clinical features of both asthma and COPD, an entity sometimes called asthma-COPD overlap (ACO). Patients with ACO may be at higher risk of poor health outcomes than those with asthma or COPD alone. However, understanding of ACO is limited in the primary care setting and more information is needed to better inform patient management. We aimed to compare the characteristics of patients with ACO or COPD in Australian general practices. Patients and methods: Data were from the RADICALS (Review of Airway Dysfunction and Interdisciplinary Community-based care of Adult Long-term Smokers) trial, an intervention study of an interdisciplinary community-based model of care. Baseline demographic and clinical characteristics, pre- and post-bronchodilator spirometry, dyspnoea and St. George's Respiratory Questionnaire scores were compared between 60 ACO patients and 212 with COPD alone. Results: Pre-bronchodilator Forced Expiratory Volume in 1 second (mean±SD 58.4±14.3 vs 67.5±20.1% predicted) and Forced Vital Capacity (mean 82.1±16.9 v 91.9±17.2% predicted) were significantly lower in the ACO group (p<0.001), but no difference was found in post-bronchodilator spirometry. Demographic and clinical characteristics, dyspnoea, quality of life, comorbidities and treatment prescribed did not differ significantly between groups. Conclusion: This is the first study describing the clinical characteristics of ACO patients in Australian general practices. Our finding of lower pre-bronchodilator lung function in the ACO group compared to those with COPD reinforces the importance of spirometry in primary care to inform management. Trial registration: Australian New Zealand Clinical Trials Registry ACTRN12614001155684.


Assuntos
Síndrome de Sobreposição da Doença Pulmonar Obstrutiva Crônica e Asma/diagnóstico , Dispneia/diagnóstico , Pulmão/fisiopatologia , Atenção Primária à Saúde , Doença Pulmonar Obstrutiva Crônica/diagnóstico , Idoso , Síndrome de Sobreposição da Doença Pulmonar Obstrutiva Crônica e Asma/epidemiologia , Síndrome de Sobreposição da Doença Pulmonar Obstrutiva Crônica e Asma/fisiopatologia , Síndrome de Sobreposição da Doença Pulmonar Obstrutiva Crônica e Asma/terapia , Austrália/epidemiologia , Ensaios Clínicos como Assunto , Comorbidade , Dispneia/epidemiologia , Dispneia/fisiopatologia , Dispneia/terapia , Feminino , Volume Expiratório Forçado , Humanos , Masculino , Pessoa de Meia-Idade , Valor Preditivo dos Testes , Prognóstico , Doença Pulmonar Obstrutiva Crônica/epidemiologia , Doença Pulmonar Obstrutiva Crônica/fisiopatologia , Doença Pulmonar Obstrutiva Crônica/terapia , Qualidade de Vida , Espirometria , Inquéritos e Questionários , Capacidade Vital
17.
Am J Case Rep ; 20: 1619-1622, 2019 Nov 04.
Artigo em Inglês | MEDLINE | ID: mdl-31680117

RESUMO

BACKGROUND Pulmonary barotrauma is considered as complication of the use of positive-pressure ventilations. Nasal high-flow therapy is increasingly being used as an alternative to them. Nasal high-flow therapy rarely causes pulmonary barotrauma probably because airway pressures are lower when compared with invasive mechanical ventilation. Bronchiolitis obliterans syndrome after allogenic hematopoietic stem cell transplantation is triggered by an alloimmune response in the bronchioles and causes obstruction of the bronchioles. However, the threshold of additional positive pressure has not been determined in a patient with bronchiolitis obliterans syndrome. CASE REPORT A 14-year-old female patient with acute myeloid leukemia at high risk of recurrence received an allogeneic hematopoietic stem cell transplantation from an unrelated bone marrow donor. After engraftment, she developed acute graft-versus-host disease, followed by chronic graft-versus-host disease. Ten months post-transplantation, she developed bronchiolitis obliterans syndrome. She continued to receive nasal supplemental oxygen therapy for persistent dyspnea due to bronchiolitis obliterans syndrome. At month +25, hypercapnia was noted. Therefore, we carefully initiated nasal high-flow therapy for dyspnea and adjusted the oxygen dose to maintain 90% SpO2 to avoid life-threatening apnea. The flow rate was as low as 14 to 20 L/min to avoid the risk of barotrauma and the deterioration of air trapping. Unfortunately, she died of respiratory failure at month +31 post-transplantation. A lung autopsy revealed pulmonary barotrauma. CONCLUSIONS Nasal high-flow therapy, even at low flow rates, may cause fatal pulmonary barotrauma in bronchiolitis obliterans syndrome.


Assuntos
Barotrauma/etiologia , Bronquiolite Obliterante/terapia , Lesão Pulmonar/etiologia , Oxigenoterapia/efeitos adversos , Oxigenoterapia/métodos , Adolescente , Barotrauma/fisiopatologia , Bronquiolite Obliterante/complicações , Dispneia/terapia , Evolução Fatal , Feminino , Doença Enxerto-Hospedeiro/complicações , Transplante de Células-Tronco Hematopoéticas/efeitos adversos , Humanos , Hipercapnia/terapia , Leucemia Mieloide Aguda , Lesão Pulmonar/fisiopatologia , Insuficiência Respiratória
18.
Biomed Res Int ; 2019: 1035730, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31662961

RESUMO

Despite the use of lung protective ventilation (LPV) strategies, a severe form of acute respiratory distress syndrome (ARDS) is unfortunately associated with high mortality rates, which sometimes exceed 60%. Recently, major technical improvements have been applied in extracorporeal life support (ECLS) systems, but as these techniques are costly and associated with very serious adverse events, high-quality evidence is needed before these techniques can become the "cornerstone" in the management of moderate to severe ARDS. Unfortunately, evaluation of previous randomized controlled and observational trials revealed major methodological issues. In this review, we focused on the most important clinical trials aiming at a final conclusion about the effectiveness of ECLS in moderate to severe ARDS patients. Totally, 20 published clinical studies were included in this review. Most studies have important limitations with regard to quality and design. In the 20 included studies (2,956 patients), 1,185 patients received ECLS. Of them, 976 patients received extracorporeal membrane oxygenation (ECMO) and 209 patients received extracorporeal carbon dioxide removal (ECCO2R). According to our results, ECLS use was not associated with a benefit in mortality rate in patients with ARDS. However, when restricted to higher quality studies, ECMO was associated with a significant benefit in mortality rate. Furthermore, in patients with H1N1, a potential benefit of ECLS in mortality rate was apparent. Until more high-quality data are derived, ECLS should be an option as a salvage therapy in severe hypoxemic ARDS patients.


Assuntos
Circulação Extracorpórea/métodos , Oxigenação por Membrana Extracorpórea/métodos , Respiração Artificial/métodos , Síndrome do Desconforto Respiratório do Adulto/terapia , Dispneia/terapia , Circulação Extracorpórea/efeitos adversos , Oxigenação por Membrana Extracorpórea/efeitos adversos , Humanos , Vírus da Influenza A Subtipo H1N1 , Influenza Humana/terapia , Mortalidade , Troca Gasosa Pulmonar , Respiração Artificial/efeitos adversos , Síndrome do Desconforto Respiratório do Adulto/mortalidade , Terapia de Salvação , Resultado do Tratamento
19.
Rev. patol. respir ; 22(3): 98-108, jul.-sept. 2019. tab, graf
Artigo em Espanhol | IBECS | ID: ibc-188996

RESUMO

En los últimos años, hemos asistido a un importante avance en el manejo de los pacientes con enfermedad pulmonar obstructiva crónica (EPOC), lo que ha llevado a un incremento de su supervivencia. Este hecho ha supuesto que tengamos que abordar nuevos retos a los que debemos dar respuesta, incluyendo la atención de estos enfermos al final de su vida. El problema está en la dificultad de detectar al grupo de individuos con EPOC subsidiarios de recibir un abordaje paliativo. Una de las aproximaciones clásicas para valorar la necesidad de esta aproximación es considerar que si el paciente falleciese en los próximos 12 meses no sería una sorpresa. Sin embargo, muchos autores consideran que el uso exclusivo de este criterio no es útil en los individuos con EPOC. En este sentido, se ha descrito que los cambios en ciertos parámetros a los largo del tiempo podrían ayudar a predecir mejor la mortalidad en ese periodo de tiempo. En cualquier caso, una correcta coordinación entre la consulta de EPOC, la planta de hospitalización de Neumología y la unidad de cuidados paliativos podría facilitar la toma de decisiones. En este artículo se abordan aspectos relacionados con la atención y los aspectos terapéuticos de la EPOC al final de la vida, incluyendo los criterios que ayudan a identificar a estos enfermos, los síntomas asociados a la EPOC avanzada y el abordaje de los mismos y cómo realizar el manejo terapéutico en los últimos días de vida del paciente con esta enfermedad


In recent years, we have witnessed an important advance in the management of patients with chronic obstructive pulmonary disease (COPD), which has led to an increase in their survival. This has meant that we have to address new challenges to which we must respond, including the care of these patients at the end of their lives. The problem lies in the difficulty of detecting the group of individuals with COPD that are subsidiary to receiving a palliative approach. One of the classic approaches to assess the need for this approach is to consider that if the patient died in the next 12 months it would not be a surprise. However, many authors consider that the exclusive use of this criterion is not useful in individuals with COPD. In this sense, it has been described that changes in certain parameters over time could help to better predict mortality in that period of time. In any case, a correct coordination between the COPD consultation, the Pneumology hospitalization unit and the palliative care unit could facilitate decision making. This article addresses aspects related to the care and therapeutic aspects of COPD at the end of life, including the criteria that help identify these patients, the symptoms associated with advanced COPD and the approach to them and how to perform therapeutic management in the last days of life of the patient with this disease


Assuntos
Humanos , Doença Pulmonar Obstrutiva Crônica/terapia , Doença Pulmonar Obstrutiva Crônica/psicologia , Cuidados Paliativos na Terminalidade da Vida/métodos , Dispneia/terapia , Fadiga/terapia , Ansiedade/terapia , Depressão/terapia
20.
Ther Adv Respir Dis ; 13: 1753466619866101, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31373259

RESUMO

BACKGROUND AND OBJECTIVE: Endoscopic valve therapy is a treatment modality in patients with advanced emphysema and absent interlobar collateral ventilation (CV). So far, long-term outcome following valve implantation has been insufficiently evaluated. The aim of this study was to investigate the real-world efficacy of this interventional therapy over 3 years. METHODS: From 2006 to 2013, 256 patients with severe emphysema in whom absent CV was confirmed underwent valve therapy. The 3-year effectiveness was evaluated by pulmonary function testing (VC, FEV1, RV, TLC), 6-minute-walk test (6-MWT) and dyspnea questionnaire (mMRC). Long-term outcome was also assessed according to the radiological outcome following valve placement. RESULTS: Of 256 patients treated with valves, 220, 200, 187, 100 and 66 patients completed the 3-month, 6-month, 1-year, 2-year and 3-year follow-up (FU) visit, respectively. All lung function parameters, 6-MWT and mMRC were significantly improved at 3- and 6-month FU. At 1-year FU, patients still experienced a significant improvement of all outcome parameters expect VC (L) and TLC (%). At 2 years, RV (L and %) and TLC (L and %) remained significantly improved compared to baseline. Three years after valve therapy, sustained significant improvement in mMRC was observed and the proportion of patients achieving a minimal clinically important difference from baseline in RV and 6-MWT was still 71% and 46%, respectively. Overall, patients with complete lobar atelectasis exhibited superior treatment outcome with 3-year responder rates to FEV1, RV and 6-MWT of 10%, 79% and 53%, respectively. CONCLUSIONS: Patients treated by valves experienced clinical improvement over 1 year following valve therapy. Afterwards, clinical benefit gradually declines more likely due to COPD progression.


Assuntos
Broncoscopia/instrumentação , Dispneia/terapia , Pulmão/fisiopatologia , Enfisema Pulmonar/terapia , Idoso , Broncoscopia/efeitos adversos , Dispneia/diagnóstico , Dispneia/fisiopatologia , Tolerância ao Exercício , Feminino , Seguimentos , Humanos , Masculino , Pessoa de Meia-Idade , Enfisema Pulmonar/diagnóstico , Enfisema Pulmonar/fisiopatologia , Qualidade de Vida , Recuperação de Função Fisiológica , Estudos Retrospectivos , Índice de Gravidade de Doença , Fatores de Tempo , Resultado do Tratamento
SELEÇÃO DE REFERÊNCIAS
DETALHE DA PESQUISA