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Anaesthesia ; 76(1): 19-26, 2021 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-32406071


Over 30,000 adult cardiac operations are carried out in the UK annually. A small number of these patients need to return to theatre in the first few days after the initial surgery, but the exact proportion is unknown. The majority of these resternotomies are for bleeding or cardiac tamponade. The Association of Cardiothoracic Anaesthesia and Critical Care carried out a 1-year national audit of resternotomy in 2018. Twenty-three of the 35 centres that were eligible participated. The overall resternotomy rate (95%CI) within the period of admission for the initial operation in these centres was 3.6% (3.37-3.85). The rate varied between centres from 0.69% to 7.6%. Of the 849 patients who required resternotomy, 127 subsequently died, giving a mortality rate (95%CI) of 15.0% (12.7-17.5). In patients who underwent resternotomy, the median (IQR [range]) length of stay on ICU was 5 (2-10 [0-335]) days, and time to tracheal extubation was 20 (12-48 [0-2880]) hours. A total of 89.3% of patients who underwent resternotomy were transfused red cells, with a median (IQR [range]) of 4 (2-7 [1-1144]) units of red blood cells. The rate (95%CI) of needing renal replacement therapy was 23.4% (20.6-26.5). This UK-wide audit has demonstrated that resternotomy after cardiac surgery is associated with prolonged intensive care stay, high rates of blood transfusion, renal replacement therapy and very high mortality. Further research into this area is required to try to improve patient care and outcomes in patients who require resternotomy in the first 24 h after cardiac surgery.

Procedimentos Cirúrgicos Cardíacos/mortalidade , Procedimentos Cirúrgicos Cardíacos/estatística & dados numéricos , Reoperação/mortalidade , Reoperação/estatística & dados numéricos , Esternotomia/mortalidade , Esternotomia/estatística & dados numéricos , Idoso , Idoso de 80 Anos ou mais , Extubação , Tamponamento Cardíaco/etiologia , Tamponamento Cardíaco/cirurgia , Cuidados Críticos/estatística & dados numéricos , Transfusão de Eritrócitos/mortalidade , Transfusão de Eritrócitos/estatística & dados numéricos , Feminino , Humanos , Incidência , Tempo de Internação , Masculino , Auditoria Médica , Pessoa de Meia-Idade , Hemorragia Pós-Operatória/cirurgia , Terapia de Substituição Renal/mortalidade , Terapia de Substituição Renal/estatística & dados numéricos , Reino Unido/epidemiologia
Anaesthesia ; 76(1): 36-44, 2021 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-32743803


Sevoflurane and desflurane are the most commonly used volatile anaesthetics for maintenance of anaesthesia. In this study, we aimed to evaluate the relationship between choice of volatile anaesthetic and early postoperative respiratory complications, and to address a critical knowledge gap in safety outcomes between these two commonly used agents. We performed a retrospective analysis of adult (non-cardiac surgery) patients who received sevoflurane or desflurane for the maintenance of general anaesthesia at our institution between 2005 and 2018. We evaluated the association between desflurane exposure (when compared with sevoflurane) and the primary outcome of postoperative respiratory complications, defined by early post-extubation desaturation (Sp O2  < 90%) or re-intubation within 7 days postoperatively. Multivariable regression analyses were performed and adjusted for confounding factors, including patient, anaesthetic and surgical factors. Propensity matched, interaction and sub-group analyses were performed to assess outcomes in high-risk groups: morbidly obese (BMI > 35 kg.m-2 ); elderly (age > 65 years); and high risk of respiratory complications as well as the primary outcome at 24 h. Desflurane was used for 23,830 patients and sevoflurane for 84,608 patients. Patients exposed to desflurane did not demonstrate a reduced risk of postoperative respiratory complications when compared with sevoflurane (adjusted odds ratio 0.99, 95%CI 0.94-1.04, p = 0.598). These findings were consistent across all sub-groups of high-risk patients and in the propensity score matched cohort. In summary, desflurane use was not associated with reduced postoperative respiratory complications when compared with sevoflurane. In the context of environmental and cost concerns with volatile anaesthetic agents, our study provides important data to support organisational decisions regarding the use of desflurane.

Anestésicos Inalatórios/efeitos adversos , Desflurano/efeitos adversos , Complicações Pós-Operatórias/epidemiologia , Transtornos Respiratórios/epidemiologia , Sevoflurano/efeitos adversos , Adulto , Fatores Etários , Idoso , Extubação , Estudos de Coortes , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Obesidade Mórbida/complicações , Complicações Pós-Operatórias/terapia , Pontuação de Propensão , Transtornos Respiratórios/terapia , Fatores de Risco , Resultado do Tratamento
Zhonghua Wei Zhong Bing Ji Jiu Yi Xue ; 32(10): 1257-1259, 2020 Oct.
Artigo em Chinês | MEDLINE | ID: mdl-33198876


OBJECTIVE: To explore the effective pressure range under continuous cuff pressure monitoring in critical patients with mechanical ventilation, so as to achieve the goal of ensuring ventilation quality and reducing mucosal injury without increasing the incidence of endotracheal catheter displacement and aspiration. METHODS: Ninety critically ill patients with non-pulmonary diseases admitted to the department of intensive care unit (ICU) of Airport Hospital of Tianjin Medical University from June 2017 to June 2019 were enrolled, and divided into three groups according to the random number table, with 30 patients in each group. For all patients in the three groups , the head of the bed was raised by 30 degree angleand the balloon was measured continuously. Cuff pressure in the three groups were maintained at 20, 25 and 30 cmH2O (1 cmH2O = 0.098 kPa) respectively. The patient's air leakage, oxygen saturation, tracheal tube displacement of each group were recorded every hour when the patients were calm. Fiberbronchoscope was used to aspirate sputum during extubation to check for mucosal damage. Chest X-ray examination was used to evaluate pulmonary infection and sputum bacteria culture examination was conducted at the same time. RESULTS: There was no significant difference in gender, age and critical condition among the three groups. The number of patients with airway mucosal injury in the 30 cmH2O group was significantly higher than that in the 20 cmH2O group (cases: 8 vs. 4, P < 0.05). There was no significant difference in airway mucosal injury between Group 20 cmH2O and Group 25, Group 25 cmH2O and Group 30 cmH2O. When the balloon pressure was 20, 25, and 30 cmH2O, there was no significant difference in air bag leakage (cases: 14, 10, 12), trachea catheter displacement (cases: 18, 11, 16), ventilator-associated pneumonia (cases: 3, 4, 3), all P > 0.05, and there was no significant difference in mechanical ventilation time and the hospitalization time [mechanical ventilation time (hours): 77.07±65.34, 80.80±70.20, 77.60±65.23; the length of ICU stay (days): 5.70±3.74, 5.30±4.57, 6.23±3.51, all P > 0.05]. CONCLUSIONS: The cuff pressure of 20 cmH2O will not increase the mechanical ventilation time and hospitalization time of patients, while 20 cmH2O is much safer in airway mucosal injury.

Pneumonia Associada à Ventilação Mecânica , Respiração Artificial , Extubação , Humanos , Pulmão , Respiração Artificial/efeitos adversos , Traqueia
Anesth Analg ; 131(5): e238, 2020 11.
Artigo em Inglês | MEDLINE | ID: mdl-33094987
Metas enferm ; 23(8): 7-18, oct. 2020. graf, tab
Artigo em Espanhol | IBECS | ID: ibc-196929


OBJETIVO: conocer los puntos clave del fast-track en los pacientes intervenidos de cirugía torácica MÉTODO: revisión narrativa. Se usaron las bases de datos: CINHAL, Pubmed y Cochrane Library Plus. Términos de búsqueda: fast-track, thoracic surgery and ERAS. CRITERIOS DE INCLUSIÓN: estudios que trataran sobre fast-track en cirugía torácica (no resección traqueal ni cirugías de mediastino), mayores de 18 años, publicados en los 10 últimos años, idiomas inglés o español. RESULTADOS: se seleccionaron 17 artículos. Los resultados se dividieron en tres partes: 1) Periodo prequirúrgico, en el cual se da mucha importancia a la deshabituación tabáquica, la información que se le proporciona al paciente sobre la cirugía y su proceso evolutivo, el concepto "prehabilitación", el cribaje de malnutrición, enfermedades pulmonares y anemia, entre otros. 2) Proceso intraoperatorio, muy enfocado a la minimización de las técnicas quirúrgicas más agresivas, utilizar técnicas anestésicas más favorecedoras para el paciente, mantener la normotermia del paciente, hacer una ventilación protectora y reducir la carga de sueroterapia. 3) Periodo postquirúrgico, donde se reduce el tiempo de dieta absoluta del paciente, se favorece la movilización, se intenta controlar el dolor para evitar complicaciones, conocer los criterios de alta y ayudar a aumentar el empoderamiento del paciente para su correcta recuperación y evolución. CONCLUSIÓN: es importante conocer el papel de la figura enfermera en la implementación de un protocolo fast-track, ya que ayuda a reducir el estrés quirúrgico, disminuye los costes y la estancia hospitalaria, favorece al empoderamiento del paciente mediante una recuperación postquirúrgica precoz y trata al enfermo desde una perspectiva enfermera más holística

OBJECTIVE: to understand the fast-track key points in patients undergoing thoracic surgery. METHOD: a narrative review. The following databases were used: CINHAL, Pubmed and Cochrane Library Plus. Search terms: fast-track, thoracic surgery and ERAS. Inclusion criteria: studies dealing with fast-track in thoracic surgery (neither tracheal resection nor mediastinum surgery), >18-year-old, published in the past 10 years, in English or Spanish. RESULTS: seventeen (17) articles were selected. Results were classified into three parts: 1) Preoperative stage, assigning high importance to smoking cessation, information provided to patients about the surgery and its evolution process, the concept of "prehabilitation", screening for malnutrition, pulmonary conditions and anaemia, among others; 2) Intraoperative process, highly focused on minimizing the most aggressive surgical techniques, using anesthetic techniques more beneficial for patients, maintaining the patient in normothermia, conducting protective ventilation, and reducing the saline therapy load; 3) Postoperative period, where the time of absolute diet for the patient is reduced, mobilization is encouraged, pain is controlled to some extent in order to prevent complications, discharge criteria are understood, and patient empowerment is encouraged for their correct recovery and evolution. CONCLUSION: it is important to understand the role of the nurse in the implementation of a fast-track protocol, because it helps to reduce surgical stress, there is a reduction in cost and hospital stay, patient empowerment is encouraged through early postsurgical recovery, and the patient is treated from a more holistic nursing perspective

Humanos , Cirurgia Torácica/métodos , Período Perioperatório/enfermagem , Extubação/instrumentação , Papel do Profissional de Enfermagem , Enfermagem Holística , Pneumonectomia/métodos , Empoderamento para a Saúde , Complicações Pós-Operatórias/enfermagem
Arch. argent. pediatr ; 118(5): e454-e462, oct 2020. tab, ilus
Artigo em Inglês, Espanhol | LILACS, BINACIS | ID: biblio-1122511


La pandemia por COVID-19 ha acaparado la atención mundial. Los distintos países se esfuerzan en optimizar recursos y brindar tratamientos efectivos en la medida que estos son avalados por la evidencia, con un ritmo de producción acorde a la urgencia. En el ámbito pediátrico, el COVID-19 acarrea una baja tasa de gravedad, en comparación con la población adulta. Un 6 % de los casos presentan una evolución grave, que se observa en los pacientes menores de 1 año de edad y/o con patologías subyacentes.Los enfoques terapéuticos en los pacientes pediátricos con COVID-19 no están claros. La escasa casuística en pediatría dificulta realizar recomendaciones en el paciente crítico que estén sustentadas en la evidencia. Esta revisión tiene como objetivo resumir las distintas publicaciones existentes sobre el curso de esta enfermedad y su tratamiento en los pacientes pediátricos críticamente enfermos

The COVID-19 pandemic has grabbed worldwide attention. The different national governments are making an effort to optimize resources and provide effective treatments inasmuch as they are supported by the evidence, at a rate of production in line with the pressing needs. In the field of pediatrics, COVID-19 has a low severity rate compared to the adult population. Approximately 6 % of cases present with a severe course, accounting for patients younger than 1 year and/or with underlying conditions.The therapeutic approach to pediatric patients with COVID-19 is unclear. The small number of pediatric cases hinders the possibility of making evidence-based recommendations for critically-ill patients. The objective of this review is to summarize the different current publications about the clinical course of COVID-19 and its management in critically-ill pediatric patien

Humanos , Masculino , Feminino , Lactente , Pré-Escolar , Criança , Estado Terminal , Infecções por Coronavirus , Betacoronavirus , Infecções por Coronavirus/tratamento farmacológico , Síndrome Respiratória Aguda Grave , Extubação , Equipamento de Proteção Individual , Intubação Intratraqueal , Hipóxia/terapia
Zhongguo Gu Shang ; 33(8): 716-20, 2020 Aug 25.
Artigo em Chinês | MEDLINE | ID: mdl-32875760


OBJECTIVE: To study and compare the effect of indwelling drainage tube and extubation time on occult hemorrhage and functional recovery after total hip arthroplasty(THA). METHODS: From July 2017 to June 2018, 123 patients who underwent THA in our hospital for the first time were selected as the subjects of study. According to whether the drainage tube was retained or not and the time of extubation, they were divided into three groups:in group A, 41 patients (24 males, 17 females, age 53 to 77 years) did not put drainage tube after THA;in group B, 41 patients were removed 24 hours after THA, 26 males and 15 females, aged 55 to 74 years;in group C, 41 patients were removed 48 hours after THA, 25 males and 16 females, aged 52 to 75 years. The VAS score of pain 72 hours after THA, the total and recessive blood loss, the time of starting functional exercise, and the incidence of postoperative limb swelling were recorded. All the patients were followed up for one year after discharge. Harris hip score was used to evaluate the degree of hip function recovery one year after operation. RESULTS: The occult blood loss of group A, B and C were(513.6±25.3), (521.7±33.4), (519.3±29.8) ml, respectively, with no significant difference(P>0.05). There was no significant difference in blood loss in operation among the three groups(P>0.05). In group B and C, the postoperative apparent blood loss was more than that in group A (P<0.05). There was no significant difference in VAS scores of the three groups before and 72 hours after operation (P>0.05). The time of getting out of bed in group A was shorter than that in group B and C (P<0.05), and that in group B was shorter than that in group C(P<0.05). The Harris hip score at 1 year after operationof the three groups was significantly higher than that of before operation (P<0.05). There was no significant difference in Harris hip score before and after operation among three groups (P>0.05). There was no significant difference in the incidence of complications among three groups (P>0.05). CONCLUSION: Whether the drainage tube is left or not and the time of extubation have no significant effect on the latent blood loss and functional recovery after THA, but without drainage tube after THA can reduce the apparent blood loss, patients can get out of bed at 6 hours after THA, which is more conducive to the recovery and nursing of patients.

Artroplastia de Quadril , Idoso , Extubação , Drenagem , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Recuperação de Função Fisiológica , Resultado do Tratamento
Medicine (Baltimore) ; 99(38): e21970, 2020 Sep 18.
Artigo em Inglês | MEDLINE | ID: mdl-32957315


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.

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
Zhonghua Shao Shang Za Zhi ; 36(9): 880-882, 2020 Sep 20.
Artigo em Chinês | MEDLINE | ID: mdl-32972077


In November 4, 2016, a 1 year and 3 months old male patient with face and neck scald complicated with severe scald of oropharynx was admitted to Guangzhou Red Cross Hospital 1 hour after injury. The child developed upper respiratory tract obstruction 2 hours after injury, therefore tracheotomy and intubation were performed immediately to establish an artificial airway, and symptomatic treatments such as anti-infection, fluid replacement, and dressing change were conducted. On the 10th day after injury, the child had difficult breathing during the test tube blocking before extubation, and it was difficult to extubate. Symptomatic treatments such as ventilator assisted ventilation and strengthened anti-infection were continued. On the 17th day after injury, extubation plan was adjusted. Thirty minutes before extubation, phenobarbital was injected intramuscularly for sedation, and atropine was used to reduce airway secretions, after which extubation was successful. After 21 days of treatment, the child was cured and discharged. In the treatment of this case, high attention was paid to the important influence of children's mental factors among causes of difficult extubation, which provided a reference for clinical treatment of extubation in children with tracheal tube after tracheotomy.

Extubação , Traqueotomia , Humanos , Lactente , Masculino , Orofaringe , Respiração Artificial , Traqueostomia
Rev. Hosp. Ital. B. Aires (2004) ; 40(3): 84-89, sept. 2020. tab
Artigo em Espanhol | LILACS | ID: biblio-1128897


Introducción: la discontinuación de la ventilación mecánica invasiva en las Unidades de Cuidados Intensivos es un objetivo fundamental y primario, en pos de evitar las complicaciones asociadas a ella. El uso de ventilación no invasiva en este contexto resulta de utilidad en tres escenarios específicos: a) como prevención de fallo de extubación, b) como cambio de interface, c) en fallo instalado. No existe evidencia suficiente sobre el tiempo de uso habitual de la VNI en esta subpoblación, las variables que se utilizan para elegirla, las causas de fallo de la VNI y la mortalidad asociada en estos pacientes. Objetivos: describir epidemiológicamente a los pacientes adultos con uso de VNI posextubación y su evolución hasta el alta hospitalaria. Describir la indicación de VNI, el tiempo de uso, las tasas de reintubación y mortalidad intrahospitalaria. Materiales y métodos: cohorte retrospectiva de pacientes internados en la UCI de adultos del Hospital Italiano de San Justo que utilizaron VNI posextubación. A partir de la historia clínica electrónica se registraron variables epidemiológicas previas al ingreso en la UCI y datos evolutivos durante la internación. El período analizado abarca desde el 17 de diciembre de 2016 hasta el 01 de agosto de 2018. Resultados: se incluyeron 48 pacientes en el presente estudio. La mediana de edad fue de 76 años (RIQ 62,75-83,25). El 58,33% eran hombres. El índice de comorbilidad de Charlson tuvo un valor de mediana de 5 (RIQ 3-6). Del total de pacientes reclutados, 33 utilizaron VNI como prevención de fallo de extubación (68,75%), 13 como cambio de interface (27,08%) y solo 2 como fallo instalado (4,16%). La mediana de días de uso de VNI fue 1 (RIQ 0-5) en prevención de fallo, 1 (RIQ 1-2) en cambio de interface y en fallo instalado 13,5 días (RIQ 8,75-18,25). Ocho pacientes fueron reintubados (16,66%). La mortalidad fue del 9,1% en el grupo de prevención de fallo y 7,7% en el grupo de cambio de interface, respectivamente. En cuanto al grupo que la usó a partir del fallo instalado, la tasa de mortalidad fue del 50% (total de dos pacientes). Conclusiones: la VNI como método de discontinuación de la VMI se utiliza principalmente tanto para la prevención de fallo como para cambio de interfaz. El tiempo de uso de VNI posextubación es, en general, limitado. Se necesitan futuros trabajos que identifiquen las horas requeridas de uso de VNI posextubación. (AU)

Introduction: the discontinuation of invasive mechanical ventilation in the intensive care unit is a fundamental and primary objective, both of which aim to avoid the complications associated with it. The use of non-invasive ventilation in this context may follow three specific scenarios: a) as prevention of extubation failure, b) as interface change, c) in overt failure. There is not enough evidence on the time of use of NIV in this subpopulation, the variables used to guide its use, the causes of NIV failure and the associated mortality in these patients. Objectives: to describe the use of NIV after extubation in adult critically ill patients. Further, we aim to describe the time of NIV use, the mortality and reintubation rate of each subgroup. Materials and methods: retrospective cohort study including adult patients admitted to the ICU at Hospital Italiano de San Justo, who received NIV post-extubation. Using the electronic health database, epidemiological variables were recorded prior to admission to the ICU and follow-up data during the hospitalization. The period analyzed was from December 17, 2016 to August 1, 2018. Results: 48 patients were included in the present analysis. Median age was 76 years (RIQ 62.75-83.25) and 58.33% were men. The Charlson comorbidity index had a median value of 5 (RIQ 3-6). Of the total number of patients recruited, 33 used NIV as prevention of extubation failure (68.75%), 13 as interface change (27.08%). ) and only 2 as overt extubation failure (4.16%).The median number of days of NIV use was 1 (RIQ 0-5) in failure prevention and 1 (RIQ 1-2) in the change of interface group. 8 patients were reintubated (16.66%). 9.1% and 7.7% of patients died in the groups that used NIV as prevention of extubation failure and change of interface respectively. Conclusions: NIV is frequently used in adult patients following extubation in our centre. Further studies are warranted to depict the necessary time of use to better allocate resources within the intensive care unit. (AU)

Humanos , Masculino , Feminino , Pessoa de Meia-Idade , Idoso , Extubação/estatística & dados numéricos , Ventilação não Invasiva/estatística & dados numéricos , Alta do Paciente , Argentina/epidemiologia , Estudos de Coortes , Mortalidade , Extubação/instrumentação , Extubação/mortalidade , Ventilação não Invasiva/instrumentação , Ventilação não Invasiva/mortalidade , Ventilação não Invasiva/tendências , Unidades de Terapia Intensiva/estatística & dados numéricos , Intubação Intratraqueal/estatística & dados numéricos
Rev Col Bras Cir ; 47: e20202533, 2020.
Artigo em Português, Inglês | MEDLINE | ID: mdl-32844914


PURPOSE: to trauma quality indicators as a tool to identify opportunities of improvement in elderly trauma patient's' treatment. METHODS: prospective analysis of data collected between 2014-2015, and stored in the iTreg software (by Ecossistemas). Trauma victims, aged older than 60 years and trauma quality indicators were assessed, based on those supported by SBAIT in 2013: (F1) Acute subdural hematoma drainage after 4 hours from admission, in patients with GCS<9; (F2) emergency room transference without definitive airway and GCS <9; (F3) Re-intubation within 48 hours from extubation; (F4) Admission-laparotomy time greater than 60 min. in hemodynamically uinstable patients with abdominal bleeding; (F5) Unprogrammed reoperation; (F6) Laparotomy after 4 hours from admission; (F7) Unfixed femur diaphyseal fracture; (F8) Non-operative treatment for abdominal gunshot; (F9) Admission-tibial exposure fracture treatment time greater than 6 hours; (F10) Surgery after 24 from admission. The indicators, treatments, adverse effects and deaths were analyzed, using the SPSS software, and the chi-squared and Fisher tests were used to calculate the statistical relevance. RESULTS: from the 92 cases, 36 (39,1%) had complications and 15 (16,3%) died. The adequate use of quality indicator's were substantially different among those who survived (was of 12%) compared to those who died (55,6%). The incidence of complications was of 77,8% (7/9) in patients with compromised indicators and 34,9% (28/83) in those without (p=0.017). CONCLUSIONS: trauma quality indicators are directly related with the occurrence of complications and deaths, in elderly trauma patients.

Extubação , Hematoma Subdural Agudo/cirurgia , Laparotomia , Centros de Traumatologia/normas , Ferimentos e Lesões/cirurgia , Idoso , Atenção , Feminino , Cirurgia Geral , Hemorragia , Humanos , Masculino , Pessoa de Meia-Idade , Estudos Prospectivos , Estudos Retrospectivos , Resultado do Tratamento
Crit Care ; 24(1): 489, 2020 08 06.
Artigo em Inglês | MEDLINE | ID: mdl-32762701


BACKGROUND: High-flow nasal cannula (HFNC) oxygen therapy is being increasingly used to prevent post-extubation hypoxemic respiratory failure and reintubation. However, evidence to support the use of HFNC in chronic obstructive pulmonary disease (COPD) patients with hypercapnic respiratory failure after extubation is limited. This study was conducted to test if HFNC is non-inferior to non-invasive ventilation (NIV) in preventing post-extubation treatment failure in COPD patients previously intubated for hypercapnic respiratory failure. METHODS: COPD patients with hypercapnic respiratory failure who were already receiving invasive ventilation were randomized to HFNC or NIV at extubation at two large tertiary academic teaching hospitals. The primary endpoint was treatment failure, defined as either resumption of invasive ventilation or switching to the other study treatment modality (NIV for patients in the NFNC group or vice versa). RESULTS: Ninety-six patients were randomly assigned to the HFNC group or NIV group. After secondary exclusion, 44 patients in the HFNC group and 42 patients in the NIV group were included in the analysis. The treatment failure rate in the HFNC group was 22.7% and 28.6% in the NIV group-risk difference of - 5.8% (95% CI, - 23.8-12.4%, p = 0.535), which was significantly lower than the non-inferior margin of 9%. Analysis of the causes of treatment failure showed that treatment intolerance in the HFNC group was significantly lower than that in the NIV group, with a risk difference of - 50.0% (95% CI, - 74.6 to - 12.9%, p = 0.015). One hour after extubation, the mean respiratory rates of both groups were faster than their baseline levels before extubation (p < 0.050). Twenty-four hours after extubation, the respiratory rate of the HFNC group had returned to baseline, but the NIV group was still higher than the baseline. Forty-eight hours after extubation, the respiratory rates of both groups were not significantly different from the baseline. The average number of daily airway care interventions in the NIV group was 7 (5-9.3), which was significantly higher than 6 (4-7) times in the HFNC group (p = 0.006). The comfort score and incidence of nasal and facial skin breakdown of the HFNC group was also significantly better than that of the NIV group [7 (6-8) vs 5 (4-7), P < 0.001] and [0 vs 9.6%, p = 0.027], respectively. CONCLUSION: Among COPD patients with severe hypercapnic respiratory failure who received invasive ventilation, the use of HFNC after extubation did not result in increased rates of treatment failure compared with NIV. HFNC also had better tolerance and comfort than NIV. TRIAL REGISTRATION: ( ChiCTR1800018530 ). Registered on 22 September 2018,

Extubação , Cânula , Ventilação de Alta Frequência/métodos , Ventilação não Invasiva , Oxigenoterapia/métodos , Doença Pulmonar Obstrutiva Crônica/terapia , Idoso , Feminino , Humanos , Masculino , Insuficiência Respiratória/prevenção & controle , Falha de Tratamento