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1.
N Engl J Med ; 384(9): 808-817, 2021 03 04.
Artigo em Inglês | MEDLINE | ID: mdl-33657293

RESUMO

BACKGROUND: Infection and increased systemic inflammation cause organ dysfunction and death in patients with decompensated cirrhosis. Preclinical studies provide support for an antiinflammatory role of albumin, but confirmatory large-scale clinical trials are lacking. Whether targeting a serum albumin level of 30 g per liter or greater in these patients with repeated daily infusions of 20% human albumin solution, as compared with standard care, would reduce the incidences of infection, kidney dysfunction, and death is unknown. METHODS: We conducted a randomized, multicenter, open-label, parallel-group trial involving hospitalized patients with decompensated cirrhosis who had a serum albumin level of less than 30 g per liter at enrollment. Patients were randomly assigned to receive either targeted 20% human albumin solution for up to 14 days or until discharge, whichever came first, or standard care. Treatment commenced within 3 days after admission. The composite primary end point was new infection, kidney dysfunction, or death between days 3 and 15 after the initiation of treatment. RESULTS: A total of 777 patients underwent randomization, and alcohol was reported to be a cause of cirrhosis in most of these patients. A median total infusion of albumin of 200 g (interquartile range, 140 to 280) per patient was administered to the targeted albumin group (increasing the albumin level to ≥30 g per liter), as compared with a median of 20 g (interquartile range, 0 to 120) per patient administered to the standard-care group (adjusted mean difference, 143 g; 95% confidence interval [CI], 127 to 158.2). The percentage of patients with a primary end-point event did not differ significantly between the targeted albumin group (113 of 380 patients [29.7%]) and the standard-care group (120 of 397 patients [30.2%]) (adjusted odds ratio, 0.98; 95% CI, 0.71 to 1.33; P = 0.87). A time-to-event analysis in which data were censored at the time of discharge or at day 15 also showed no significant between-group difference (hazard ratio, 1.04; 95% CI, 0.81 to 1.35). More severe or life-threatening serious adverse events occurred in the albumin group than in the standard-care group. CONCLUSIONS: In patients hospitalized with decompensated cirrhosis, albumin infusions to increase the albumin level to a target of 30 g per liter or more was not more beneficial than the current standard care in the United Kingdom. (Funded by the Health Innovation Challenge Fund; ATTIRE EudraCT number, 2014-002300-24; ISRCT number, N14174793.).


Assuntos
Albuminas/uso terapêutico , Cirrose Hepática/terapia , Albumina Sérica , Adulto , Albuminas/administração & dosagem , Albuminas/efeitos adversos , Ascite/etiologia , Ascite/terapia , Feminino , Hospitalização , Humanos , Infusões Intravenosas , Cirrose Hepática/sangue , Cirrose Hepática/complicações , Cirrose Hepática/mortalidade , Cirrose Hepática Alcoólica/sangue , Cirrose Hepática Alcoólica/terapia , Masculino , Pessoa de Meia-Idade , Edema Pulmonar/etiologia , Falha de Tratamento
2.
BMJ Case Rep ; 14(2)2021 Feb 09.
Artigo em Inglês | MEDLINE | ID: mdl-33563668

RESUMO

Sympathetic crash acute pulmonary edema (SCAPE) is a life-threatening injury, which requires early recognition and intervention to prevent mortality. We present a case of 18-year-old woman with no previous comorbidity, presenting with SCAPE who was successfully resuscitated and eventually diagnosed with renal artery stenosis. Pickering syndrome is a rare cause of hypertensive emergency and should be considered in a young patient presenting with SCAPE in emergency department.


Assuntos
Edema Pulmonar/diagnóstico , Edema Pulmonar/etiologia , Obstrução da Artéria Renal/complicações , Obstrução da Artéria Renal/diagnóstico , Adolescente , Reanimação Cardiopulmonar , Diagnóstico Diferencial , Serviço Hospitalar de Emergência , Feminino , Parada Cardíaca/etiologia , Parada Cardíaca/terapia , Humanos , Síndrome
3.
Medicine (Baltimore) ; 100(7): e24622, 2021 Feb 19.
Artigo em Inglês | MEDLINE | ID: mdl-33607797

RESUMO

RATIONALE: Unilateral cardiogenic pulmonary edema is a rare disease. A common cause is mitral valve and asymmetrical blood regurgitation that is primarily directed toward the upper right pulmonary vein, causing mean capillary pressure to increase on the right side and leading to right pulmonary edema. PATIENT CONCERNS: A 41-year-old man was diagnosed with pneumonia after presenting with a 2-day history of cough and shortness of breath. Computed tomography indicated right pulmonary edema. He was managed with noninvasive ventilation; however, his condition continued to deteriorate, and he was transferred to the intensive care unit after tracheal intubation. DIAGNOSIS: Acute posterior mitral valve prolapses; unilateral cardiogenic pulmonary edema. INTERVENTION: Emergency mitral valve replacement was performed. During the operation, 2 ruptures of the chordae tendineae in the P2 scallop of the posterior mitral valve were found, and a No. 29 St. Jude mechanical mitral valve was implanted. OUTCOMES: Cardiotonic and diuretic drugs were administered postoperatively. Tracheal intubation was removed on day 7; the patient was transferred to the general ward on day 11 and discharged on day 23 postoperatively. LESSONS: Unilateral cardiogenic pulmonary edema is easily misdiagnosed. Computed tomographic (CT) imaging presentation, brain natriuretic peptide, and cardiac color Doppler ultrasound can assist in determining a differential diagnosis. Early surgical treatment is recommended for patients with acute mitral valve prolapse.


Assuntos
Prolapso da Valva Mitral/complicações , Edema Pulmonar/etiologia , Adulto , Cordas Tendinosas/cirurgia , Diagnóstico Diferencial , Implante de Prótese de Valva Cardíaca , Humanos , Masculino , Prolapso da Valva Mitral/cirurgia , Edema Pulmonar/diagnóstico por imagem , Tomografia Computadorizada por Raios X
4.
Expert Rev Cardiovasc Ther ; 19(2): 165-176, 2021 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-33432851

RESUMO

Introduction: Acute heart failure (AHF) is one of the leading causes of hospital admissions and is characterized by systemic and pulmonary congestion, which often precedes the overt clinical signs and symptoms. Echocardiography in the management of chronic HF is well described; however, there are less evidence regarding echocardiography and lung ultrasound (LUS) in the acute setting.Areas covered: We have summarized current evidence regarding the use of echocardiography and LUS for assessing congestion in patients with AHF. We discuss the value and reliability of handheld/pocketsize ultrasound devices in AHF.Expert opinion: Echocardiography is an essential tool for the diagnostic work up in patients with AHF. No individual parameter reliably detects congestion, thus the physician must integrate several measurements from the right and left heart. Novel methods and advances in cardiac imaging and clinical chemistry make it possible to detect congestion at an early stage. LUS is particularly helpful in assessing congestion, and it has demonstrated diagnostic, therapeutic, and prognostic value in AHF. LUS is relatively easy to learn and allows for quick assessment of the presence of pulmonary congestion and pleural effusion. We recommend integration of LUS for routine management of patients with AHF.


Assuntos
Insuficiência Cardíaca/diagnóstico por imagem , Pulmão/diagnóstico por imagem , Edema Pulmonar/diagnóstico por imagem , Ecocardiografia/métodos , Insuficiência Cardíaca/terapia , Hospitalização , Humanos , Prognóstico , Edema Pulmonar/etiologia , Reprodutibilidade dos Testes , Ultrassonografia/métodos
5.
BMJ Case Rep ; 14(1)2021 Jan 18.
Artigo em Inglês | MEDLINE | ID: mdl-33462059

RESUMO

The ongoing SARS-CoV-2 (COVID-19) pandemic has presented many difficult and unique challenges to the medical community. We describe a case of a middle-aged COVID-19-positive man who presented with pulmonary oedema and acute respiratory failure. He was initially diagnosed with acute respiratory distress syndrome. Later in the hospital course, his pulmonary oedema and respiratory failure worsened as result of severe acute mitral valve regurgitation secondary to direct valvular damage from COVID-19 infection. The patient underwent emergent surgical mitral valve replacement. Pathological evaluation of the damaged valve was confirmed to be secondary to COVID-19 infection. The histopathological findings were consistent with prior cardiopulmonary autopsy sections of patients with COVID-19 described in the literature as well as proposed theories regarding ACE2 receptor activity. This case highlights the potential of SARS-CoV-2 causing direct mitral valve damage resulting in severe mitral valve insufficiency with subsequent pulmonary oedema and respiratory failure.


Assuntos
/complicações , Insuficiência da Valva Mitral/etiologia , Doença Aguda , Fibrilação Atrial/complicações , Fibrilação Atrial/fisiopatologia , Cordas Tendinosas/diagnóstico por imagem , Ecocardiografia , Eletrocardiografia , Implante de Prótese de Valva Cardíaca , Humanos , Masculino , Pessoa de Meia-Idade , Insuficiência da Valva Mitral/diagnóstico por imagem , Insuficiência da Valva Mitral/fisiopatologia , Insuficiência da Valva Mitral/cirurgia , Edema Pulmonar/etiologia , Edema Pulmonar/fisiopatologia , Edema Pulmonar/terapia , Insuficiência Respiratória/etiologia , Insuficiência Respiratória/fisiopatologia , Insuficiência Respiratória/terapia , Índice de Gravidade de Doença , Choque Cardiogênico/etiologia , Choque Cardiogênico/fisiopatologia
6.
BMJ Case Rep ; 14(1)2021 Jan 25.
Artigo em Inglês | MEDLINE | ID: mdl-33495169

RESUMO

Infective endocarditis is associated with a variety of clinical signs, but its association with multisystem vasculitis is rarely reported. A high index of suspicion is necessary to differentiate a primary autoimmune vasculitis from an infectious cause as the wrong treatment can lead to significant morbidity and mortality. We present a 71-year-old female patient with negative blood cultures, on antibiotics for recent bacteraemia, who presented with cutaneous and renal leucocytoclastic vasculitis. Workup revealed a vegetation adjacent to her right atrial pacemaker lead consistent with infective endocarditis and her vasculitis completely resolved with appropriate antibiotics.


Assuntos
Lesão Renal Aguda/diagnóstico , Endocardite Bacteriana/diagnóstico , Dermatopatias Vasculares/diagnóstico , Infecções Estafilocócicas/diagnóstico , Vasculite/diagnóstico , Lesão Renal Aguda/etiologia , Lesão Renal Aguda/imunologia , Lesão Renal Aguda/terapia , Idoso , Antibacterianos/uso terapêutico , Anticorpos Anticitoplasma de Neutrófilos/imunologia , Bacteriemia/complicações , Bacteriemia/tratamento farmacológico , Ceftriaxona/uso terapêutico , Endocardite Bacteriana/complicações , Endocardite Bacteriana/tratamento farmacológico , Feminino , Humanos , Edema Pulmonar/etiologia , Edema Pulmonar/terapia , Diálise Renal , Insuficiência Respiratória/etiologia , Insuficiência Respiratória/terapia , Rifampina/uso terapêutico , Dermatopatias Vasculares/etiologia , Dermatopatias Vasculares/imunologia , Dermatopatias Vasculares/patologia , Infecções Estafilocócicas/complicações , Infecções Estafilocócicas/tratamento farmacológico , Vasculite/etiologia , Vasculite/imunologia , Vasculite/patologia
7.
Medicine (Baltimore) ; 100(1): e24240, 2021 Jan 08.
Artigo em Inglês | MEDLINE | ID: mdl-33429827

RESUMO

RATIONALE: Negative pressure pulmonary edema (NPPE) is associated with serious postoperative complications. Compact nasal packing is always done after an open rhinoplasty procedure which makes it difficult to achieve positive pressure ventilation via a mask if NPPE arises. PATIENT CONCERNS: A 21-year-old healthy man got an open rhinoplasty, septal perforation repair, and revisional septal reconstruction. After surgery, he became so agitated that it was difficult to calm him. We decided to remove the endotracheal tube. On arrival at the post-anesthesia care unit, he was cyanotic and his SpO2 had decreased to about 2%. We attempted positive pressure ventilation using mask bagging; however, it was ineffective due to the nasal packing. DIAGNOSES: Negative pressure pulmonary edema. INTERVENTIONS: Emergent reintubation was immediately done and Ambu bagging was commenced. A considerable pinkish secretion came out of the tube. A T-piece was applied to him using 15 L/min of oxygen supply. The patient was eventually transferred to the intensive care unit of our hospital. OUTCOMES: On postoperative day (POD) 1, a decision was made to extubate, and the oxygen supply was shifted to 3L/min using a venturi-mask. On POD 2, a chest posteroanterior radiograph was taken and indicated no active lung lesion. The patient was subsequently discharged without any complications. He had no symptoms on POD 6, 11, and 18 at follow-up visits to our outpatient clinic. LESSONS: Anesthesiologists should be alert to the possibility of NPPE and its treatment because of its rapid onset but positive clinical outcome if there is a proper intervention. In nasal surgery cases in particular, early re-intubation should be conducted and extubation should be done to fully awaken the patients.


Assuntos
Extubação/efeitos adversos , Intubação Intratraqueal/efeitos adversos , Edema Pulmonar/diagnóstico , Rinoplastia , Diagnóstico Diferencial , Humanos , Masculino , Complicações Pós-Operatórias/diagnóstico , Complicações Pós-Operatórias/etiologia , Edema Pulmonar/diagnóstico por imagem , Edema Pulmonar/etiologia , Adulto Jovem
8.
Medicine (Baltimore) ; 99(51): e23713, 2020 Dec 18.
Artigo em Inglês | MEDLINE | ID: mdl-33371120

RESUMO

ABSTRACT: Shoulder arthroscopy requires a large of irrigation for a better surgical view, leading circulatory overload. This study was performed to prove whether pulmonary edema will be lead by a large of irrigation.General anesthesia with interscalene block was induced before operation. The primary outcome was ultrasound evaluation of B lines from the time before nerve block to the time 10 hours after operation. The secondary outcomes included oxygenation index, arterial partial pressure of carbon dioxide, visual analogue scale, muscle strength grade.A total of 93 patients were evaluated. Before surgery, B lines failed to be detected. While the highest total incidence of B lines was 49.4%, occurred at 4 hours after surgery. The highest incidences of severe and moderate pulmonary edema were 3.2% (P = .081) and 9.7% (P = .002), respectively. B lines were also found on both the affected and healthy side. During operation, the incidence of type 1 respiratory failure was 5.4% (P = .023) and that of both type 1 and 2 respiratory failure were 6.5% (P = .013). Pain was relieved in 6 hours after surgery (VAS < 3). At 12 hours after operation, the VAS of resting and motion were 4.68 ±â€Š2.27, 6.90 ±â€Š2.43, respectively. While the grade of muscle strength was 4.48 ±â€Š0.51 at 12 hours after operation.There is a high incidence of pulmonary edema in shoulder arthroscopy, and ultrasound is a convenient tool to evaluate this complication. Pain is relieved in 6 hours after surgery by nerve block. While muscle strength can also recover at 12 hours after surgery.


Assuntos
Artroscopia/efeitos adversos , Artroscopia/métodos , Edema Pulmonar/etiologia , Edema Pulmonar/patologia , Articulação do Ombro/cirurgia , Adulto , Idoso , Anestesia Geral/métodos , Bloqueio do Plexo Braquial/métodos , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Força Muscular/fisiologia , Oxigênio/sangue , Medição da Dor , Dor Pós-Operatória/terapia , Edema Pulmonar/diagnóstico por imagem , Ultrassonografia
9.
Kardiologiia ; 60(7): 136-140, 2020 Aug 11.
Artigo em Russo | MEDLINE | ID: mdl-33155952

RESUMO

A 29-year old female patient without a history of cardiovascular diseases was admitted on emergency to a surgical hospital with acute calculous cholecystitis in 3 months after uncomplicated term birth. During laparoscopic cholecystectomy, she developed arterial hypotension with pulmonary edema, which required intravenous sympathomimetics. On the next day, after improvement of the condition and stabilization of hemodynamics, cardiac ultrasound showed diffuse left ventricular (LV) hypokinesis with the ejection fraction (EF) of 38 %. Electrocardiogram detected transient left bundle branch block followed by persistent negative T waves in leads I, aVL, and V2 V6. Troponin I concentration was increased to 1.2 ng /ml. Beta-blocker and angiotensin-converting enzyme inhibitor were administered. At 10 days, the LV contractile function completely recovered with LV EF of 59 %. Magnetic resonance imaging did not reveal any signs of myocardial infarction or myocarditis. A differential diagnosis was performed between peripartum cardiomyopathy and Takotsubo syndrome. Considering the fast recovery of LV systolic function, the patient was discharged with a diagnosis of Takotsubo syndrome.


Assuntos
Cardiomiopatias , Hipotensão , Edema Pulmonar , Cardiomiopatia de Takotsubo , Adulto , Cardiomiopatias/diagnóstico , Feminino , Humanos , Período Periparto , Edema Pulmonar/diagnóstico , Edema Pulmonar/etiologia , Cardiomiopatia de Takotsubo/complicações , Cardiomiopatia de Takotsubo/diagnóstico
10.
Am J Respir Crit Care Med ; 202(8): 1081-1087, 2020 10 15.
Artigo em Inglês | MEDLINE | ID: mdl-33054329

RESUMO

Protective ventilation strategies for the injured lung currently revolve around the use of low Vt, ostensibly to avoid volutrauma, together with positive end-expiratory pressure to increase the fraction of open lung and reduce atelectrauma. Protective ventilation is currently applied in a one-size-fits-all manner, and although this practical approach has reduced acute respiratory distress syndrome deaths, mortality is still high and improvements are at a standstill. Furthermore, how to minimize ventilator-induced lung injury (VILI) for any given lung remains controversial and poorly understood. Here we present a hypothesis of VILI pathogenesis that potentially serves as a basis upon which minimally injurious ventilation strategies might be developed. This hypothesis is based on evidence demonstrating that VILI begins in isolated lung regions manifesting a Permeability-Originated Obstruction Response (POOR) in which alveolar leak leads to surfactant dysfunction and increases local tissue stresses. VILI progresses topographically outward from these regions in a POOR-get-POORer fashion unless steps are taken to interrupt it. We propose that interrupting the POOR-get-POORer progression of lung injury relies on two principles: 1) open the lung to minimize the presence of heterogeneity-induced stress concentrators that are focused around the regions of atelectasis, and 2) ventilate in a patient-dependent manner that minimizes the number of lung units that close during each expiration so that they are not forced to rerecruit during the subsequent inspiration. These principles appear to be borne out in both patient and animal studies in which expiration is terminated before derecruitment of lung units has enough time to occur.


Assuntos
Prevenção Primária/métodos , Atelectasia Pulmonar/prevenção & controle , Edema Pulmonar/prevenção & controle , Lesão Pulmonar Induzida por Ventilação Mecânica/prevenção & controle , Lesão Pulmonar Induzida por Ventilação Mecânica/fisiopatologia , Doença Aguda , Fenômenos Biomecânicos , Doença Crônica , Feminino , Humanos , Masculino , Monitorização Fisiológica , Prognóstico , Atelectasia Pulmonar/etiologia , Edema Pulmonar/etiologia , Testes de Função Respiratória
11.
Leg Med (Tokyo) ; 47: 101782, 2020 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-32916471

RESUMO

Chlorine gas exposure occurs in chemical warfare, industrial and household accidents. In forensic science, the generation of chlorine gas by mixing sodium hypochlorite detergent and strong acid detergent cannot be overlooked because of the possibility of suicide method (NaClO + 2HCl â†’ NaCl + H2O + Cl2). Though typical autopsy findings are obtained in chlorine exposure, such as pulmonary edema, useful biomarkers don't exist. In this research, we developed an analytical method of 3-chloro-l-tyrosine (Cl-Tyr) in blood as a novel marker of chlorine poisoning utilizing gas chromatography-mass spectrometry (GC-MS). Cl-Tyr was purified using protein precipitation and cation-exchange solid phase extraction, derivatized by the silylation agent and subjected to GC-MS. The quantification range was 10-200 ng/mL and good reproducibility was obtained. We applied the developed method to analyze Cl-Tyr in autopsy sample, which is suspected of chlorine poisoning, and detected 59.7 ng/mL Cl-Tyr in left heart blood. To our knowledge, this is the first report of determination of the chlorinated biomolecule in the human autopsy sample from chlorine poisoning.


Assuntos
Autopsia , Cloro/envenenamento , Ciências Forenses , Envenenamento/diagnóstico , Tirosina/análogos & derivados , Biomarcadores/sangue , Transtorno Depressivo , Cromatografia Gasosa-Espectrometria de Massas/métodos , Humanos , Masculino , Pessoa de Meia-Idade , Edema Pulmonar/etiologia , Suicídio , Tirosina/sangue
13.
Medicine (Baltimore) ; 99(38): e22296, 2020 Sep 18.
Artigo em Inglês | MEDLINE | ID: mdl-32957388

RESUMO

RATIONALE: The increasing incidence of cardiac comorbidities in the elderly population has led to an increasing demand for vigilance of cardiac dysfunction induced by surgery. Favorable outcomes can be ensured in such cases by an increased awareness of cardiogenic complications, early identification of the problem, and appropriate treatment. PATIENT CONCERNS: This study presents 2 cases of acute pulmonary edema (PE) that were likely caused by ischemic heart disease and diastolic dysfunction in postoperative patients, following vitrectomy, in the post-anesthetic care unit. DIAGNOSES: Chest x-ray and computed tomography indicated PE. INTERVENTIONS: Following the diagnosis of PE, patients were intubated and transferred to the intensive care unit where 20 mg furosemide was injected and 10 µg/kg/min dobutamine was infused intravenously. OUTCOMES: On postoperative day 2, the patients' vital signs were stable and there were no signs of respiratory disturbance. LESSONS: Physicians should be alert to the potential development of PE as a postoperative complication in patients with left ventricular (LV) diastolic dysfunction and ischemic heart disease, even if the patient has undergone a procedure with mild hemodynamic change and minimal surgical stimulation such as vitrectomy. We propose that physicians treating elderly patients with LV diastolic dysfunction and ischemic heart disease undergoing vitrectomy should consider the use of intraoperative transthoracic echocardiogram or transesophageal echocardiogram with continuous monitoring of blood pressure, using devices such as arterial catheter devices.


Assuntos
Complicações Pós-Operatórias/etiologia , Edema Pulmonar/etiologia , Vitrectomia/efeitos adversos , Idoso , Ecocardiografia Transesofagiana , Eletrocardiografia , Humanos , Masculino , Isquemia Miocárdica/complicações , Isquemia Miocárdica/diagnóstico por imagem , Edema Pulmonar/diagnóstico por imagem , Tomografia Computadorizada por Raios X , Disfunção Ventricular Esquerda/complicações , Disfunção Ventricular Esquerda/diagnóstico por imagem
14.
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
20.
Heart Fail Clin ; 16(3): 271-282, 2020 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-32503751

RESUMO

Noninvasive positive pressure ventilation (NIPPV), which can be applied without endotracheal airway or tracheostomy, has been used as the first-line device for patients with acute decompensated heart failure (ADHF) and cardiogenic pulmonary edema. Positive airway pressure (PAP) devices include continuous PAP, bilevel PAP, and adaptive servoventilation. NIPPV can provide favorable physiologic benefits, including improving oxygenation, respiratory mechanics, and pulmonary and systemic hemodynamics. It can also reduce the intubation rate and improve clinical symptoms, resulting in good quality of life and mortality.


Assuntos
Insuficiência Cardíaca , Respiração com Pressão Positiva/métodos , Edema Pulmonar , Doença Aguda , Insuficiência Cardíaca/complicações , Insuficiência Cardíaca/terapia , Humanos , Ventilação não Invasiva/métodos , Edema Pulmonar/etiologia , Edema Pulmonar/terapia , Resultado do Tratamento
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