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1.
BMC Pulm Med ; 20(1): 269, 2020 Oct 16.
Artigo em Inglês | MEDLINE | ID: mdl-33066765

RESUMO

BACKGROUND: Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) that causes coronavirus disease 2019 (COVID-19) has spread to almost 100 countries, infected over 31 M patients and resulted in 961 K deaths worldwide as of 21st September 2020. The major clinical feature of severe COVID-19 requiring ventilation is acute respiratory distress syndrome (ARDS) with multi-functional failure as a result of a cytokine storm with increased serum levels of cytokines. The pathogenesis of the respiratory failure in COVID-19 is yet unknown, but diffuse alveolar damage with interstitial thickening leading to compromised gas exchange is a plausible mechanism. Hypoxia is seen in the COVID-19 patients, however, patients present with a distinct phenotype. Intracellular levels of nitric oxide (NO) play an important role in the vasodilation of small vessels. To elucidate the intracellular levels of NO inside of RBCs in COVID-19 patients compared with that of healthy control subjects. METHODS: We recruited 14 COVID-19 infected cases who had pulmonary involvement of their disease, 4 non-COVID-19 healthy controls (without pulmonary involvement and were not hypoxic) and 2 hypoxic non-COVID-19 patients subjects who presented at the Masih Daneshvari Hospital of Tehran, Iran between March-May 2020. Whole blood samples were harvested from patients and intracellular NO levels in 1 × 106 red blood cells (RBC) was measured by DAF staining using flow cytometry (FACS Calibour, BD, CA, USA). RESULTS: The Mean florescent of intensity for NO was significantly enhanced in COVID-19 patients compared with healthy control subjects (P ≤ 0.05). As a further control for whether hypoxia induced this higher intracellular NO, we evaluated the levels of NO inside RBC of hypoxic patients. No significant differences in NO levels were seen between the hypoxic and non-hypoxic control group. CONCLUSIONS: This pilot study demonstrates increased levels of intracellular NO in RBCs from COVID-19 patients. Future multi-centre studies should examine whether this is seen in a larger number of COVID-19 patients and whether NO therapy may be of use in these severe COVID-19 patients.


Assuntos
Dióxido de Carbono/metabolismo , Infecções por Coronavirus/metabolismo , Eritrócitos/metabolismo , Hipóxia/metabolismo , Óxido Nítrico/metabolismo , Oxigênio/metabolismo , Pneumonia Viral/metabolismo , Adulto , Idoso , Idoso de 80 Anos ou mais , Doenças Assintomáticas , Betacoronavirus , Gasometria , Estudos de Casos e Controles , Infecções por Coronavirus/sangue , Infecções por Coronavirus/complicações , Feminino , Citometria de Fluxo , Humanos , Hipóxia/sangue , Hipóxia/etiologia , Masculino , Pessoa de Meia-Idade , Pandemias , Pressão Parcial , Projetos Piloto , Pneumonia Viral/sangue , Pneumonia Viral/complicações , Doença Pulmonar Obstrutiva Crônica/sangue , Doença Pulmonar Obstrutiva Crônica/complicações , Doença Pulmonar Obstrutiva Crônica/metabolismo , Vasodilatação , Adulto Jovem
2.
Rev Med Suisse ; 16(711): 1970-1973, 2020 Oct 21.
Artigo em Francês | MEDLINE | ID: mdl-33085252

RESUMO

Arterial punctures are frequent procedures performed by hospital internists. It provides crucial information on acid-base status, oxygenation and the quality of gas exchanges. Nevertheless, this intervention is often painful and carries potential risks. This review aims to summarize the literature about this subject and to address the accuracy of the results obtained by point-of-care analysis.


Assuntos
Artérias/metabolismo , Gasometria/métodos , Punções/efeitos adversos , Humanos , Dor/etiologia , Sistemas Automatizados de Assistência Junto ao Leito
3.
Emerg Med Clin North Am ; 38(4): 903-917, 2020 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-32981625

RESUMO

Care of the critically ill pregnant patient is anxiety-provoking for those unprepared, as the emergency physician must consider not only the welfare of the immediate patient, but of the fetus as well. Familiarity with the physiologic changes of pregnancy and how they affect clinical presentation and management is key. Although some medications may be safer in pregnancy than others, stabilizing the pregnant patient is paramount. Emergency physicians should target pregnancy-specific oxygen and ventilation goals and hemodynamics and should be prepared to perform a perimortem cesarean section, should the mother lose pulses, to increase chances for maternal and fetal survival.


Assuntos
Complicações na Gravidez/terapia , Ressuscitação/métodos , Manuseio das Vias Aéreas , Gasometria , Cesárea , Contraindicações de Medicamentos , Estado Terminal , Serviço Hospitalar de Emergência , Feminino , Monitorização Fetal , Parada Cardíaca/etiologia , Parada Cardíaca/terapia , Humanos , Hipnóticos e Sedativos/administração & dosagem , Intubação Intratraqueal , Troca Materno-Fetal , Ventilação não Invasiva , Circulação Placentária , Gravidez/fisiologia , Complicações na Gravidez/diagnóstico , Insuficiência Respiratória/terapia , Choque/terapia
4.
Zhonghua Wei Zhong Bing Ji Jiu Yi Xue ; 32(8): 976-981, 2020 Aug.
Artigo em Chinês | MEDLINE | ID: mdl-32912413

RESUMO

OBJECTIVE: To judge the type of acid-base balance disorder automatically according to the results of arterial blood gas analysis by using the IF function editing formula in an Excel spreadsheet. METHODS: The four-step analysis was used to carry out programmatically through establishing acid-base balance disorder analysis process: (1) the acid and base types were determined according to pH value and the primary or main type of acid-base balance disorder was determined according to the pH value combined with blood carbon dioxide pressure (PaCO2), HCO3- and their change rate; (2) the expected compensation formula was selected to determine whether there was mixed acid-base imbalance, according to the primary or main acid-base imbalance type; (3) the potential HCO3- should be calculated to replace the measured HCO3- when the primary acid-base imbalance was divided into two parts according to the prior two steps: respiratory acidosis or respiratory alkalosis accompanied with anion gap (AG) increased-metabolic acidosis and compared with the compensatory interval calculated by the predicted compensatory formula for acid or alkali to determine whether there were triple acid-base imbalance (TABD); (4) while the following two parts were judged: metabolic acidosis accompanied with AG increased-metabolic acidosis according to the prior two steps, ΔAG↑/ΔHCO3-↓ should be calculated to determine whether there was metabolic alkalosis or metabolic acidosis with normal AG. The results of arterial blood gas analysis were judged by using the editing formula of IF function in Excel 2003 spreadsheet. A total of 96 patients admitted to the department of intensive care unit (ICU) of Xuzhou Central Hospital were enrolled. According to the results of arterial blood gas analysis, the type of acid-base imbalance of patients was judged by both artificial judgment (artificial group) and Excel spreadsheet automatic judgment (Excel spreadsheet group). The artificial group was composed by 2 associate chief physicians from neonatal intensive care unit (NICU) and 1 attending respiratory physician. If the results were inconsistent, the decision should be made after discussion. In the Excel spreadsheet group, data were input by one NICU attending physician and checked by another. The differences in the results and the time spent in judging the type of acid-base imbalance between the two groups were compared. RESULTS: Forty-two types of acid-base imbalance were obtained by using the four-step analysis method and inputting relevant parameters such as pH, PaCO2, actual HCO3-, Na+, Cl- and compensation time limited into the Excel spreadsheet for blood gas analysis. Data analyses of 96 patients showed that the accuracy of using Excel spreadsheets to automatically determine the type of acid-base imbalance was higher than artificial group, but there was no statistically significant difference between the two groups [normal and simple acid-base imbalance: 100% (26/26) vs. 100% (26/26), mixed acid-base imbalance: 100% (51/51) vs. 96.08% (49/51), TABD: 100% (19/19) vs. 89.47% (17/19), all P > 0.05], and it took less time to judge the results of blood gas analysis by the Excel spreadsheet group compared with the artificial group (s: normal and simple acid-base imbalance: 31.13±4.70 vs. 74.20±16.53, mixed acid-base imbalance: 31.59±5.49 vs. 138.10±22.26, TABD: 30.98±5.40 vs. 308.40±78.12, all P < 0.01). CONCLUSIONS: The automatic judging Excel spreadsheet with blood gas analysis can quickly and accurately determine the type of acid-base imbalance in arterial blood gas analysis.


Assuntos
Desequilíbrio Ácido-Base , Gasometria , Equilíbrio Ácido-Base , Alcalose , Alcalose Respiratória , Humanos , Software
5.
Medicine (Baltimore) ; 99(36): e21806, 2020 Sep 04.
Artigo em Inglês | MEDLINE | ID: mdl-32899010

RESUMO

BACKGROUND: DM is a common chronic metabolic disease. COVID-19 is an infectious disease infected by enveloped single-stranded RNA coronavirus. Meanwhile, DM is a common comorbidity of SARS-CoV-2 infection. The virus can directly or indirectly damage the pancreatic islets and cause stress hyperglycemia by causing cytokine storms, acute inflammatory reactions, binding to the ACE2 receptor, etc. At the same time, hyperglycemia is a risk factor for severe infection and an independent risk factor for mild to severe disease. However, there is no evidence-based medicine to confirm the relationship between hyperglycemia and the infection of COVID-19 in diabetic patients. Therefore, we will conduct a systematic review and meta-analysis to synthesize the existing clinical evidence. METHODS AND ANALYSIS: We will retrieve each database from December 2019 to July 2020. Chinese literature comes from CNKI, Wanfang, VIP, CBM databases. English literature mainly searches Cochrane Library, PubMed, Web of Science, EMBASE. At the same time, we will look for clinical trial registration and gray literature. This study only included clinical randomized controlled trials. The reviewers independently conduct literature selection, data analysis, bias risk assessment, subgroup and sensitivity analysis. The primary outcomes include fasting blood glucose, 2-hour postprandial blood glucose, glycated hemoglobin, fasting insulin, adverse effects, etc. Finally, we will conduct a meta-analysis through Review Manager software version 5.3. RESULTS: The results will be published in peer-reviewed journals. CONCLUSION: This study will explore the relationship between hyperglycemia and COVID-19 infection in diabetic patients. It will provide evidence-based support for clinical regulation of blood glucose and combating the COVID-19 epidemic. REGISTRATION NUMBER: INPLASY202060114.


Assuntos
Infecções por Coronavirus/epidemiologia , Diabetes Mellitus/epidemiologia , Hiperglicemia/epidemiologia , Pneumonia Viral/epidemiologia , Betacoronavirus , Gasometria , Hemoglobina A Glicada , Humanos , Pandemias , Ensaios Clínicos Controlados Aleatórios como Assunto , Projetos de Pesquisa , Fatores de Risco , Índice de Gravidade de Doença
6.
BMC Cardiovasc Disord ; 20(1): 415, 2020 09 14.
Artigo em Inglês | MEDLINE | ID: mdl-32928149

RESUMO

BACKGROUND: Methanol is widely used in industry; however, methanol poisoning is not common. In this regard, a number of outbreaks have been recently reported due to inappropriate processing of alcoholic beverages. Shiraz, a city located in the southern part of Iran, faced one of such outbreaks in 2020 during COVID-19 pandemic. There is no sufficient literature on the electrocardiographic findings in methanol toxicity. This study aimed to address this gap in the literature. METHOD: A total of 356 cases with methanol toxicity referred to Shiraz University of Medical Science Tertiary Hospitals (Faghihi and Namazi) in March and April, 2020. The clinical findings of blindness and impaired level of consciousness, lab data such as arterial blood gas, electrolytes, and creatinine, and the most common findings from ECGs were collected. RESULTS: The most common ECG findings were J point elevation (68.8%), presence of U wave (59.2%), QTc prolongation (53.2% in males and 28.6% in females), and fragmented QRS (33.7%). An outstanding finding in this study was the presence of myocardial infarction in 5.3% of the cases. This finding, to the best of our knowledge, has only been reported in a few case reports. Brugada pattern (8.1%) and Osborn wave (3.7%) were the other interesting findings. In multivariate analysis, when confounding factors were adjusted, myocardial infarction, atrioventricular conduction disturbances, sinus tachycardia, and the prolonged QTC > 500 msecond were four independent factors correlated with methanol toxicity severity measured with arterial blood PH on arterial blood gas measurements, with odds ratios of 12.82, 4.46, 2.32 and 3.15 (P < 0.05 for all), respectively. CONCLUSION: Electrocardiographic variations during methanol intoxication are remarkable and well-correlated with poisoning severity. Myocardial infarction was an egregious and yet a common concerning finding in this sample, which need to be ruled out in methanol toxicity.


Assuntos
Bloqueio Atrioventricular/induzido quimicamente , Cegueira/induzido quimicamente , Transtornos da Consciência/induzido quimicamente , Síndrome do QT Longo/induzido quimicamente , Metanol/envenenamento , Infarto do Miocárdio/induzido quimicamente , Solventes/envenenamento , Taquicardia Sinusal/induzido quimicamente , Adolescente , Adulto , Idoso , Bebidas Alcoólicas , Bloqueio Atrioventricular/sangue , Bloqueio Atrioventricular/fisiopatologia , Betacoronavirus , Cegueira/sangue , Cegueira/fisiopatologia , Gasometria , Síndrome de Brugada/sangue , Síndrome de Brugada/induzido quimicamente , Síndrome de Brugada/fisiopatologia , Transtornos da Consciência/sangue , Transtornos da Consciência/fisiopatologia , Infecções por Coronavirus , Eletrocardiografia , Feminino , Contaminação de Alimentos , Humanos , Concentração de Íons de Hidrogênio , Irã (Geográfico) , Síndrome do QT Longo/sangue , Síndrome do QT Longo/fisiopatologia , Masculino , Pessoa de Meia-Idade , Análise Multivariada , Infarto do Miocárdio/sangue , Infarto do Miocárdio/fisiopatologia , Pandemias , Pneumonia Viral , Envenenamento/sangue , Envenenamento/fisiopatologia , Fatores Sexuais , Taquicardia Sinusal/sangue , Taquicardia Sinusal/fisiopatologia , Adulto Jovem
8.
Eur J Cardiothorac Surg ; 58(3): 646-647, 2020 09 01.
Artigo em Inglês | MEDLINE | ID: mdl-32754730

RESUMO

Pneumomediastinum is a rare clinical finding, but one which can be the source of significant concern for clinicians. By presenting 3 such cases, we highlight that pneumomediastinum can complicate the course of a severe coronavirus disease 2019 infection but emphasize that conservative management is the first-line method of treatment, with gradual resorption of the air from the tissues. It is important to be alert to the development of pneumothorax, which will require drainage.


Assuntos
Tratamento Conservador , Infecções por Coronavirus/complicações , Progressão da Doença , Enfisema Mediastínico/etiologia , Enfisema Mediastínico/terapia , Pneumonia Viral/complicações , Idoso , Antibacterianos/uso terapêutico , Gasometria , Técnicas de Laboratório Clínico/métodos , Pressão Positiva Contínua nas Vias Aéreas/métodos , Infecções por Coronavirus/diagnóstico , Seguimentos , Humanos , Masculino , Enfisema Mediastínico/diagnóstico por imagem , Pessoa de Meia-Idade , Pandemias , Pneumonia Viral/diagnóstico , Radiografia Torácica/métodos , Doenças Raras , Medição de Risco , Amostragem , Fatores de Tempo , Tomografia Computadorizada por Raios X/métodos , Resultado do Tratamento
9.
Ann Clin Lab Sci ; 50(4): 528-535, 2020 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-32826251

RESUMO

The COVID-19 outbreak has had a high impact on diagnostic laboratory services recently. The current literature has focused on reviewing tests that are specifically related to the diagnosis of COVIDS-19 infection using either molecular testing or immunoassays detecting viral antigens or antibodies. In this short communication review, we aimed to summarize the most common non-specific laboratory tests that may be requested in patients with suspected COVID-19 infection to help in the assessment of different organs and other vital laboratory tests to avoid complications as a consequence of COVID-19 infection.


Assuntos
Betacoronavirus , Técnicas de Laboratório Clínico/métodos , Infecções por Coronavirus/diagnóstico , Pneumonia Viral/diagnóstico , Biomarcadores/sangue , Contagem de Células Sanguíneas , Análise Química do Sangue , Testes de Coagulação Sanguínea , Gasometria , Infecções por Coronavirus/sangue , Infecções por Coronavirus/urina , Citocinas/sangue , Humanos , Mediadores da Inflamação/sangue , Pandemias , Pneumonia Viral/sangue , Pneumonia Viral/urina
10.
Neurol Sci ; 41(10): 2671-2674, 2020 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-32734396

RESUMO

INTRODUCTION: The relationship between dyspnea and COVID-19 is unknown. In COVID-19 patients, the higher prevalence of neurological symptoms and the lack of dyspnea may suggest common underlying pathogenetic mechanisms. The aim of this preliminary study is to address whether there is a lack of dyspnea in COVID-19 patients and if there is a relationship between neurological symptoms and the perception of dyspnea. METHODS: A structured interview regarding the occurrence of subjective neurological symptoms was performed and coupled with a questionnaire about the intensity and qualities of dyspnea. Respiratory rate (RR) and an arterial blood gas on room air were concurrently evaluated. RESULTS: Twenty-two patients (age 68.4 ± 13.9 years, 13 males and 9 females) were included and divided into two groups according to the Borg dyspnea scale: dyspneic patients BU ≥ 1(DYSP) and non-dyspneic patients BU < 1 (NDYSP). The prevalence of dyspnea overall was 31.8%. The prevalence of neurological symptoms, dyspnea descriptors, RR, pH, PaCO2, PaO2, or lactate was similar between groups. CONCLUSION: This study confirms that the prevalence of dyspnea is low in non-severe COVID-19 patients, but contrary to our hypothesis of a relationship between shortness of breath and neurological symptoms, we have not been able to find any evidence of an impairment in dyspnea perception, either in the DYSP or NDYSP group.


Assuntos
Betacoronavirus , Infecções por Coronavirus/diagnóstico , Autoavaliação Diagnóstica , Dispneia/diagnóstico , Doenças do Sistema Nervoso/diagnóstico , Percepção , Pneumonia Viral/diagnóstico , Idoso , Idoso de 80 Anos ou mais , Gasometria/métodos , Gasometria/psicologia , Infecções por Coronavirus/complicações , Infecções por Coronavirus/psicologia , Dispneia/etiologia , Dispneia/psicologia , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Doenças do Sistema Nervoso/etiologia , Doenças do Sistema Nervoso/psicologia , Pandemias , Pneumonia Viral/complicações , Pneumonia Viral/psicologia
11.
PLoS One ; 15(8): e0237596, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32785283

RESUMO

Blood was collected from wild captured green and Kemp's ridley turtles off the west coast of Florida, USA. Blood gases and biochemical values were analyzed using a point of care (POC) device in the field. Analytes include pH, partial pressure of carbon dioxide (pCO2), partial pressure of oxygen (pO2), total carbon dioxide (TCO2), bicarbonate (HCO3), base excess (BE), oxygen saturation (sO2), lactate, sodium (Na), potassium (K), chloride (Cl), total carbon dioxide (TCO2), anion gap, ionized calcium, glucose, blood urea nitrogen (BUN), creatinine (Crea), hematocrit (Hct), and hemoglobin (Hb). These are novel data for wild healthy Kemp's ridley turtles, and results for green turtles were generally consistent with past studies of green turtles with exceptions primarily in blood gas values. Ninety percent of the green turtles had fibropapillomatosis (FP), but none of the blood analytes were correlated with disease severity. Only BUN was correlated with weight of green turtles, and there was no correlation between blood parameters and weight of Kemp's ridley turtles. This study provides data that are useful in understanding the physiologic status of sea turtles specific to this region, allowing for comparisons to other populations, life stages, and disease states.


Assuntos
Gasometria/veterinária , Nitrogênio da Ureia Sanguínea , Oxigênio/metabolismo , Tartarugas/metabolismo , Veias/metabolismo , Animais , Bicarbonatos/análise , Dióxido de Carbono/análise , Potássio/análise , Sódio/análise , Tartarugas/classificação
12.
Univ. salud ; 22(2): 102-111, mayo-ago. 2020. tab, graf
Artigo em Espanhol | LILACS, COLNAL | ID: biblio-1115959

RESUMO

Introducción: La cánula nasal de alto flujo en adultos ofrece un tratamiento alternativo a la oxigenoterapia convencional. Objetivo: Establecer el comportamiento clínico y gasométrico de pacientes con falla respiratoria aguda que habitan a 2.600 msnm, tratados con cánula nasal de alto flujo en cuidado intensivo adulto. Materiales y métodos: Estudio piloto cuasi experimental pretest-postest intrasujeto, tamaño de muestra 14 pacientes calculado a través de Epidat. Tipo de muestreo no probabilístico por conveniencia, durante catorce meses. Resultados: El 78% de los pacientes fueron mujeres, la edad promedio fue 68 años, y el diagnóstico principal fue enfermedad pulmonar obstructiva crónica (EPOC) en el 71,42% de los casos. Se administró un flujo de oxígeno promedio de 30 Lt/min para pacientes con (EPOC), para el resto de diagnósticos se programaron flujos mayores. El trabajo respiratorio disminuyó posterior al uso de cánula nasal de alto flujo, la presión arterial de oxígeno mejoró paulatinamente en pacientes con falla hipoxémica y el índice de oxigenación incrementó progresivamente en los dos tipos de falla respiratoria. Conclusiones: La cánula nasal de alto flujo es una opción terapéutica útil en el manejo de la falla respiratoria aguda a 2.600 msnm, permitiendo mejoría de la oxigenación y disminución del trabajo respiratorio.


Introduction: High-flow nasal cannula offers an alternative treatment approach to conventional oxygen therapy in adults. Objective: To establish the clinical and gasometric behavior of patients with acute respiratory failure who live at 2,600 m.a.s.l. and are treated with high-flow nasal cannula in an adult intensive care unit. Materials and methods: Quasi-experimental pilot study with a pretest-posttest within-subject design and a sample size of 14 patients calculated through Epidat. A non-probabilistic convenience sampling was conducted for fourteen months. Results: 78% of the patients were women and their average age was 68 years. Chronic Obstructive Pulmonary Disease (COPD) was diagnosed in 71.42% of the cases. An oxygen flow rate of 30 L/min was administered to patients with Chronic Obstructive Pulmonary Disease, while higher rates were used for the rest of the diagnoses. Nasal cannula treatment led to (i) a decreased respiratory function, (ii) a gradually improved arterial blood pressure in patients with hypoxemic failure, (iii) and a progressively increased oxygenation rate. Conclusions: High-flow nasal cannula is a useful therapeutic option in the management of patients with acute respiratory failure living at 2,600 m.a.s.l. because it improves oxygenation and reduces respiratory function.


Assuntos
Insuficiência Respiratória , Cânula , Gasometria , Trabalho Respiratório , Doença Pulmonar Obstrutiva Crônica
13.
Eur Rev Med Pharmacol Sci ; 24(15): 8219-8225, 2020 08.
Artigo em Inglês | MEDLINE | ID: mdl-32767353

RESUMO

OBJECTIVE: At the end of 2019, the Novel Severe Acute Respiratory Syndrome Coronavirus-2 (SARS-CoV-2), spread rapidly from China to the whole world. Circadian rhythms can play crucial role in the complex interplay between viruses and organisms, and temporized schedules (chronotherapy) have been positively tested in several medical diseases. We aimed to compare the possible effects of a morning vs. evening antiviral administration in COVID patients. PATIENTS AND METHODS: We retrospectively evaluated all patients admitted to COVID internal medicine units with confirmed SARS-CoV-2 infection, and treated with darunavir-ritonavir (single daily dose, for seven days). Age, sex, length of stay (LOS), pharmacological treatment, and timing of antiviral administration (morning or evening), were recorded. Outcome indicators were death or LOS, and laboratory parameters, e.g., variations in C-reactive protein (CRP) levels, ratio of arterial oxygen partial pressure (PaO2, mmHg) to fractional inspired oxygen (FiO2) (PaO2/FiO2), and leucocyte count. RESULTS: The total sample consisted of 151 patients, 33 (21.8%) of whom were selected for antiviral treatment. The mean age was 61.8±18.3 years, 17 (51.5%) were male, and the mean LOS was 13.4±8.6 days. Nine patients (27.3%) had their antiviral administration in the morning, and 24 (72.7%) had antiviral administration in the evening. No fatalities occurred. Despite the extremely limited sample size, morning group subjects showed a significant difference in CRP variation, compared to that in evening group subjects (-65.82±33.26 vs. 83.32±304.89, respectively, p<0.032). No significant differences were found for other parameters. CONCLUSIONS: This report is the first study evaluating temporized morning vs. evening antiviral administration in SARS-CoV-2 patients. The morning regimen was associated with a significant reduction in CRP values. Further confirmations with larger and multicenter samples of patients could reveal novel potentially useful insights.


Assuntos
Antivirais/administração & dosagem , Infecções por Coronavirus/tratamento farmacológico , Darunavir/administração & dosagem , Cronoterapia Farmacológica , Mortalidade Hospitalar , Tempo de Internação/estatística & dados numéricos , Pneumonia Viral/tratamento farmacológico , Ritonavir/administração & dosagem , Adulto , Idoso , Idoso de 80 Anos ou mais , Betacoronavirus , Gasometria , Proteína C-Reativa , Infecções por Coronavirus/metabolismo , Quimioterapia Combinada , Humanos , Itália , Contagem de Leucócitos , Pessoa de Meia-Idade , Oxigênio/metabolismo , Pandemias , Pressão Parcial , Pneumonia Viral/metabolismo , Estudos Retrospectivos
14.
J Extra Corpor Technol ; 52(2): 112-117, 2020 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-32669737

RESUMO

The optimal setting to achieve a suitable PaCO2 value of 35-45 mmHg upon initiating cardiopulmonary bypass (CPB) in the pediatric population is undefined in the literature. Sweep gas is set upon initiating and modified throughout CPB to reduce potential complications related to compensatory metabolic acidosis or metabolic alkalosis and associated cerebral blood flow fluctuations. This study retrospectively examined 1,077 CPB cases for which PaCO2 values were no less than 30 mmHg and no greater than 50 mmHg on the pre-CPB blood gas result. Through an observation of the results, we attempted to determine the optimal sweep gas setting upon initiating CPB to obtain a physiologic PaCO2 value of 35-45 mmHg. The probability of achieving an optimal PaCO2 value was modeled as a function of the average sweep gas to blood flow ratio during the period before the first blood gas on CPB. The median sweep gas to blood flow ratio (V/Q) was .64 (.51; .76), with a median first PaCO2 value on CPB of 42 mmHg (38.8; 45). A .6 V/Q had an odds ratio (OR) of 1.57 of obtaining a PaCO2 value between 35 and 45 mmHg on the first CPB blood gas when compared with a .4 V/Q (Figure 1Figure 1.Bivariate associations between PaCO2 and the V/Q ratio. (A) Spike histogram with loess curve showing the proportion of patients with a first PaCO2 value on CPB between 35 and 45 mmHg according to the V/Q ratio. (B) Scatterplot and loess curve (gray line) for PaCO2 on CPB according to the V/Q ratio. Dashed lines indicate the target range of 35-45 mmHg. (C) Model-based estimate of the predicted probability and 95% CI for PaCO2 on CPB between 35 and 45 mmHg according to the V/Q ratio obtained from logistic regression. (D) Model-based estimate of the predicted PaCO2 on CPB according to the V/Q ratio obtained from ordinal regression. Prop, proportion.). A .9 V/Q had a 1.76 OR when compared with a .4 and a 1.12 OR when compared with .6. Using a .6 V/Q ratio achieved a PaCO2 value within normal physiologic limits with no significant advantage to a higher V/Q ratio overall. However, younger or smaller patients required a higher V/Q to achieve similar probabilities of being within limits and similar PaCO2 values when compared with the older or larger patients.


Assuntos
Ponte Cardiopulmonar , Circulação Cerebrovascular , Gasometria , Dióxido de Carbono , Cognição , Humanos , Lactente , Estudos Retrospectivos
15.
Crit Care Med ; 48(8): 1129-1134, 2020 08.
Artigo em Inglês | MEDLINE | ID: mdl-32697482

RESUMO

OBJECTIVES: Severe cases of coronavirus disease 2019 develop the acute respiratory distress syndrome, requiring admission to the ICU. This study aimed to describe specific pathophysiological characteristics of acute respiratory distress syndrome from coronavirus disease 2019. DESIGN: Prospective crossover physiologic study. SETTING: ICU of a university-affiliated hospital from northern Italy dedicated to care of patients with confirmed diagnosis of coronavirus disease 2019. PATIENTS: Ten intubated patients with acute respiratory distress syndrome and confirmed diagnosis of coronavirus disease 2019. INTERVENTIONS: We performed a two-step positive end-expiratory pressure trial with change of 10 cm H2O in random order. MEASUREMENTS AND MAIN RESULTS: At each positive end-expiratory pressure level, we assessed arterial blood gases, respiratory mechanics, ventilation inhomogeneity, and potential for lung recruitment by electrical impedance tomography. Potential for lung recruitment was assessed by the recently described recruitment to inflation ratio. In a subgroup of seven paralyzed patients, we also measured ventilation-perfusion mismatch at lower positive end-expiratory pressure by electrical impedance tomography. At higher positive end-expiratory pressure, respiratory mechanics did not change significantly: compliance remained relatively high with low driving pressure. Oxygenation and ventilation inhomogeneity improved but arterial CO2 increased despite unchanged respiratory rate and tidal volume. The recruitment to inflation ratio presented median value higher than previously reported in acute respiratory distress syndrome patients but with large variability (median, 0.79 [0.53-1.08]; range, 0.16-1.40). The FIO2 needed to obtain viable oxygenation at lower positive end-expiratory pressure was significantly correlated with the recruitment to inflation ratio (r = 0.603; p = 0.05). The ventilation-perfusion mismatch was elevated (median, 34% [32-45%] of lung units) and, in six out of seven patients, ventilated nonperfused units represented a much larger proportion than perfused nonventilated ones. CONCLUSIONS: In patients with acute respiratory distress syndrome from coronavirus disease 2019, potential for lung recruitment presents large variability, while elevated dead space fraction may be a specific pathophysiological trait. These findings may guide selection of personalized mechanical ventilation settings.


Assuntos
Betacoronavirus , Infecções por Coronavirus/complicações , Pneumonia Viral/complicações , Respiração com Pressão Positiva/métodos , Síndrome do Desconforto Respiratório do Adulto/terapia , Adulto , Idoso , Idoso de 80 Anos ou mais , Gasometria , Estudos Cross-Over , Feminino , Hospitais Universitários , Humanos , Itália , Masculino , Pessoa de Meia-Idade , Oxigênio/sangue , Pandemias , Estudos Prospectivos , Síndrome do Desconforto Respiratório do Adulto/etiologia , Síndrome do Desconforto Respiratório do Adulto/fisiopatologia , Mecânica Respiratória
16.
Monaldi Arch Chest Dis ; 90(3)2020 Jul 15.
Artigo em Inglês | MEDLINE | ID: mdl-32672430

RESUMO

Italy is currently experiencing an epidemic of coronavirus disease 2019 (Covid-19). Aim of our study is to identify the best predictors of Intensive Care Unit (ICU) admission in patients with Covid-19. We examined 28 patients admitted to the Emergency Department (ED) and subsequently confirmed as cases of Covid-19. Patients received, at the admission to the ED, a diagnostic work-up including: patient history, clinical examination, an arterial blood gas analysis (whenever possible performed on room air), laboratory blood tests, including serum concentrations of interleukin-6 (IL-6), lung ultrasound examination and a computed tomography (CT) scan of the thorax. For each patient, as gas exchange index through the alveolocapillary membrane, we determined the alveolar-arterial oxygen gradient (AaDO⁠2) and the alveolar-arterial oxygen gradient augmentation (AaDO⁠2 augmentation). For each patient, as measurement of hypoxemia, we determined oxygen saturation (SpO2), partial pressure of oxygen in arterial blood (PaO⁠2), PaO⁠2 deficit and the ratio between arterial partial pressure of oxygen by blood gas analysis and fraction of inspired oxygen (P/F). Patients were assigned to ICU Group or to Non-ICU Group basing on the decision to intubate. Areas under the curve (AUC) and receiver operating characteristic (ROC) curve were used to compare the performance of each test in relation to prediction of ICU admission. Comparing patients of ICU Group (10 patients) with patients of Non-ICU Group (18 patients), we found that the first were older, they had more frequently a medical history of malignancy and they were more frequently admitted to ED for dyspnea. Patients of ICU Group had lower oxygen saturation, PaO⁠2, P/F and higher heart rate, respiratory rate, AaDO⁠2, AaDO⁠2 augmentation and lactate than patients of Non-ICU Group. ROC curves demonstrate that age, heart rate, respiratory rate, dyspnea, lactate, AaDO2, AaDO2 augmentation, white blood cell count, neutrophil count and percentage, fibrinogen, C-reactive protein, lactate dehydrogenase, glucose level, international normalized ratio (INR), blood urea and IL-6 are useful predictors of ICU admission. We identified several predictors of ICU admission in patients with Covid-19. They can act as fast tools for the early identification and timely treatment of critical cases since their arrival in the ED.


Assuntos
Betacoronavirus , Infecções por Coronavirus/diagnóstico , Infecções por Coronavirus/terapia , Cuidados Críticos , Pneumonia Viral/diagnóstico , Pneumonia Viral/terapia , Adulto , Idoso , Idoso de 80 Anos ou mais , Gasometria , Infecções por Coronavirus/complicações , Serviço Hospitalar de Emergência , Feminino , Hospitalização , Humanos , Itália , Masculino , Pessoa de Meia-Idade , Pandemias , Pneumonia Viral/complicações , Valor Preditivo dos Testes , Curva ROC , Fatores de Risco
17.
ACS Chem Neurosci ; 11(16): 2416-2421, 2020 08 19.
Artigo em Inglês | MEDLINE | ID: mdl-32600045

RESUMO

Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) has been established as a cause of severe alveolar damage and pneumonia in patients with advanced Coronavirus disease (COVID-19). The consolidation of lung parenchyma precipitates the alterations in blood gases in COVID-19 patients that are known to complicate and cause hypoxemic respiratory failure. With SARS-CoV-2 damaging multiple organs in COVID-19, including the central nervous system that regulates the breathing process, it is a daunting task to compute the extent to which the failure of the central regulation of the breathing process contributes to the mortality of COVID-19 affected patients. Emerging data on COVID-19 cases from hospitals and autopsies in the last few months have helped in the understanding of the pathogenesis of respiratory failures in COVID-19. Recent reports have provided overwhelming evidence of the occurrence of acute respiratory failures in COVID-19 due to neurotropism of the brainstem by SARS-CoV-2. In this review, a cascade of events that may follow the alterations in blood gases and possible neurological damage to the respiratory regulation centers in the central nervous system (CNS) in COVID-19 are related to the basic mechanism of respiratory regulation in order to understand the acute respiratory failure reported in this disease. Though a complex metabolic and respiratory dysregulation also occurs with infections caused by SARS-CoV-1 and MERS that are known to contribute toward deaths of the patients in the past, we highlight here the role of systemic dysregulation and the CNS respiratory regulation mechanisms in the causation of mortalities seen in COVID-19. The invasion of the CNS by SARS-CoV-2, as shown recently in areas like the brainstem that control the normal breathing process with nuclei like the pre-Bötzinger complex (pre-BÖTC), may explain why some of the patients with COVID-19, who have been reported to have recovered from pneumonia, could not be weaned from invasive mechanical ventilation and the occurrences of acute respiratory arrests seen in COVID-19. This debate is important for many reasons, one of which is the fact that permanent damage to the medullary respiratory centers by SARS-CoV-2 would not benefit from mechanical ventilators, as is possibly occurring during the management of COVID-19 patients.


Assuntos
Infecções por Coronavirus/fisiopatologia , Hipóxia/fisiopatologia , Pneumonia Viral/fisiopatologia , Centro Respiratório/fisiopatologia , Insuficiência Respiratória/fisiopatologia , Betacoronavirus , Gasometria , Infecções por Coronavirus/metabolismo , Infecções por Coronavirus/mortalidade , Humanos , Hipóxia/metabolismo , Pandemias , Pneumonia Viral/metabolismo , Pneumonia Viral/mortalidade , Centro Respiratório/metabolismo , Centro Respiratório/virologia , Insuficiência Respiratória/metabolismo , Insuficiência Respiratória/mortalidade , Tropismo Viral
18.
Arch Pathol Lab Med ; 144(10): 1209-1216, 2020 10 01.
Artigo em Inglês | MEDLINE | ID: mdl-32649215

RESUMO

CONTEXT.­: Point-of-care testing allows rapid analysis and short turnaround times. To the best of our knowledge, the present study assesses, for the first time, clinical, operative, and economic outcomes of point-of-care blood gas analysis in a nephrology department. OBJECTIVE.­: To evaluate the impact after implementing blood gas analysis in the nephrology department, considering clinical (differences in blood gas analysis results, critical results), operative (turnaround time, elapsed time between consecutive blood gas analysis, preanalytical errors), and economic (total cost per process) outcomes. DESIGN.­: A total amount of 3195 venous blood gas analyses from 688 patients of the nephrology department before and after point-of-care blood gas analyzer installation were included. Blood gas analysis results obtained by ABL90 FLEX PLUS were acquired from the laboratory information system. Statistical analyses were performed using SAS 9.3 software. RESULTS.­: During the point-of-care testing period, there was an increase in blood glucose levels and a decrease in pCO2, lactate, and sodium as well as fewer critical values (especially glucose and lactate). The turnaround time and the mean elapsed time were shorter. By the beginning of this period, the number of preanalytical errors increased; however, no statistically significant differences were found during year-long monitoring. Although there was an increase in the total number of blood gas analysis requests, the total cost per process decreased. CONCLUSIONS.­: The implementation of a point-of-care blood gas analysis in a nephrology department has a positive impact on clinical, operative, and economic terms of patient care.


Assuntos
Gasometria/economia , Nefropatias/sangue , Nefrologia/economia , Sistemas Automatizados de Assistência Junto ao Leito/economia , Testes Imediatos/economia , Humanos
19.
Medicine (Baltimore) ; 99(29): e21066, 2020 Jul 17.
Artigo em Inglês | MEDLINE | ID: mdl-32702849

RESUMO

INTRODUCTION: Sepsis is the most common etiology of acute lung injury (ALI) or acute respiratory distress syndrome (ARDS). Capillary leakage caused by lung endothelial injury is the central cause of ARDS. The results of research in modern medicine in reducing endothelial damage and restoring endothelial functions are limited. In the previous clinical observations, we found that the Fusu mixture not only improves the clinical symptoms but also reduces the leakage of pulmonary capillaries. Therefore, the purpose of this study is to determine the clinical efficacy of the Fusu mixture combined with Western medicine in the treatment of ARDS caused by sepsis and to explore the mechanism of traditional Chinese medicine. METHODS: This is a prospective, single-center, randomized, single-blind, and controlled clinical study involving 620 eligible patients. The patients will be randomly divided into 2 groups: the Western medicine treatment group and the combination of Chinese and Western medicine treatment group. After 14 days of intervention, the clinical efficacy and safety of the Fusu mixture on sepsis-induced ARDS patients will be observed. The primary outcome will be measured as 28-day mortality. The secondary outcome indices include inflammatory markers (CRP, PCT, IL-6, TNF - α), APACHE II score, SOFA score, days without a ventilator, blood gas analysis (Lac, PaO2 / FiO2), intensive care unit hospital stay time, intensive care unit mortality. Simultaneously, the analysis of the exploratory results will be carried out to analyze the possible mechanism of Fusu mixture in the treatment of sepsis-induced ARDS by the high-throughput sequencing and bioinformatics. DISCUSSION: The purpose of this study is to evaluate the clinical efficacy of Fusu mixture in the treatment of sepsis-induced ARDS and explore its possible mechanism of action. If successful, it will provide evidence-based adjuvant therapy for the clinical treatment of ARDS.


Assuntos
Síndrome do Desconforto Respiratório do Adulto/tratamento farmacológico , Síndrome do Desconforto Respiratório do Adulto/etiologia , Sepse/complicações , Adulto , Gasometria , Síndrome de Vazamento Capilar/complicações , Síndrome de Vazamento Capilar/etiologia , Feminino , Humanos , Masculino , Medicina Tradicional Chinesa/métodos , Medicina Tradicional Chinesa/normas , Pessoa de Meia-Idade , Estudos Prospectivos , Síndrome do Desconforto Respiratório do Adulto/fisiopatologia , Sepse/tratamento farmacológico , Sepse/fisiopatologia , Método Simples-Cego , Resultado do Tratamento
20.
Cuad. Hosp. Clín ; 61(1): [12], jul. 2020. ilus.
Artigo em Espanhol | LILACS, LIBOCS | ID: biblio-1118900

RESUMO

INTRODUCCIÓN: la presión barométrica determina la presión parcial de los gases tanto en el medio ambiente como a nivel alveolar pulmonar, por lo que, para una determinada presión barométrica, la presión de oxígeno y dióxido de carbono es distinta. OBJETIVO: el objetivo del presente estudio es caracterizar los valores de gasometría arterial en residentes adultos sanos a muy alta altitud en la ciudad de El Alto. METODOLOGÍA: Estudio serie de casos, realizado durante la gestión 2019 en 22 (73%) mujeres y 8 varones (27%), con una media de edad de 36.07 años. El estudio contó con la aprobación del Comité de Ética Hospitalario. RESULTADOS: a 4150 metros sobre el nivel del mar, el pH tiende hacia la alcalosis (7.43) así como la PaO2 es menor (58.69mmHg), el valor de PaCO2 (26.14mmHg) es menor correspondiente a una ciudad con mayor altitud, el valor de bicarbonato sérico (20.14mmol/L) se encuentra disminuido en compensación a la disminución de la PaCO2 y el valor de la SatO2% (91.7%) es menor al reportado a nivel del mar. Hay que destacar que el índice PaO2/FiO2 no concuerda con el cálculo realizado según la fórmula propuesta dentro de la definición de los Criterios de Berlín. Se evidencia también que, en la muestra, si bien la correlación entre la PaO2 y la SatO2% resulta como alta, no resulta perfectamente lineal. CONCLUSIÓN: resulta imperativo precisar las características propias a la fisiología correspondientes a cada altitud, buscando aplicar parámetros propios como los de la gasometría arterial para el tratamiento de las enfermedades prevalentes en cada región, así como desarrollar investigaciones específicas a gran altura, ensayar posibilidades y documentarlas.


INTRODUCTION: barometric pressure determines the partial pressure of gases both in the environment and at the pulmonary alveolar level, so for a given barometric pressure, the pressure of oxygen and carbon dioxide is different. The objective of this paper is to characterize arterial blood gas values in healthy adult residents at very high altitude in the city of El Alto. METHODOLOGY: case series study, carried out during 2019; 22 volunteers (73%) women and 8 men (27%), mean age 36.07 years are included. The study was approved by the Hospital Bioethics Committee. RESULTS: at 4150 meter above sea level, pH tends towards alkalosis (7.43) as well as PaO2 is lower (58.69mmHg), the value of PaCO2 (26.14mmHg) is lower corresponding to a city with higher altitude, the value of serum bicarbonate (20.14mmol/L) is lower in compensation at the decrease in PaCO2 and the value of SatO2% (91.7%) is lower than that reported at sea level. The PaO2/FiO2 index does not match the calculation made according to the proposed formula within the definition of the Berlin Criteria. It is also evident that, although the correlation between PaO2 and SatO2% is high, it is not perfectly linear. CONCLUSION: it is imperative to precise the characteristics corresponding to the physiology corresponding to each altitude, looking forward to apply these parameters, such as those of arterial blood gas, in the treatment of prevalent diseases for each region, and so as develop specific studies at high altitude, also testing and reporting them.


Assuntos
Masculino , Feminino , Adulto , Pressão Atmosférica , Gasometria , Altitude , Sangue
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