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1.
Sensors (Basel) ; 20(17)2020 Aug 28.
Artigo em Inglês | MEDLINE | ID: mdl-32872310

RESUMO

The non-invasive estimation of blood oxygen saturation (SpO2) by pulse oximetry is of vital importance clinically, from the detection of sleep apnea to the recent ambulatory monitoring of hypoxemia in the delayed post-infective phase of COVID-19. In this proof of concept study, we set out to establish the feasibility of SpO2 measurement from the ear canal as a convenient site for long term monitoring, and perform a comprehensive comparison with the right index finger-the conventional clinical measurement site. During resting blood oxygen saturation estimation, we found a root mean square difference of 1.47% between the two measurement sites, with a mean difference of 0.23% higher SpO2 in the right ear canal. Using breath holds, we observe the known phenomena of time delay between central circulation and peripheral circulation with a mean delay between the ear and finger of 12.4 s across all subjects. Furthermore, we document the lower photoplethysmogram amplitude from the ear canal and suggest ways to mitigate this issue. In conjunction with the well-known robustness to temperature induced vasoconstriction, this makes conclusive evidence for in-ear SpO2 monitoring being both convenient and superior to conventional finger measurement for continuous non-intrusive monitoring in both clinical and everyday-life settings.


Assuntos
Meato Acústico Externo , Hipóxia/diagnóstico , Monitorização Fisiológica/instrumentação , Oximetria/instrumentação , Fotopletismografia/instrumentação , Dispositivos Eletrônicos Vestíveis , Adulto , Betacoronavirus/fisiologia , Infecções por Coronavirus/sangue , Infecções por Coronavirus/diagnóstico , Infecções por Coronavirus/terapia , Estudos de Equivalência como Asunto , Estudos de Viabilidade , Feminino , Dedos , Humanos , Hipóxia/sangue , Masculino , Monitorização Fisiológica/métodos , Oximetria/métodos , Oxigênio/análise , Oxigênio/sangue , Pandemias , Fotopletismografia/métodos , Pneumonia Viral/sangue , Pneumonia Viral/diagnóstico , Pneumonia Viral/terapia , Adulto Jovem
2.
BMJ Case Rep ; 13(9)2020 Sep 07.
Artigo em Inglês | MEDLINE | ID: mdl-32900744

RESUMO

COVID-19 caused by SARS-CoV-2 may present with a wide spectrum of symptoms ranging from mild upper respiratory tract infection like illness to severe pneumonia and death. Patients may have severe hypoxaemia without proportional features of respiratory distress, also known as 'silent' or 'apathetic' hypoxia. We present a case of a 56-year-old man with COVID-19 who presented to the fever clinic of our institution with fever and cough without any respiratory distress but low oxygen saturation. The patient deteriorated over the next 2 days but eventually recovered of his illness in due course of time. This case demonstrates 'silent hypoxia' as a possible presentation in COVID-19 and emphasises the importance of meticulous clinical examination including oxygen saturation measurements in suspected or confirmed patients.


Assuntos
Infecções por Coronavirus/complicações , Hipóxia/virologia , Pneumonia Viral/complicações , Humanos , Hipóxia/diagnóstico , Masculino , Pessoa de Meia-Idade , Pandemias
3.
Washington; Organización Panamericana de la Salud; Aug. 7, 2020.
Não convencional em Inglês, Espanhol | LILACS, BRISA/RedTESA | ID: biblio-1118290

RESUMO

En este documento se presentan consideraciones técnicas y regulatorias para el uso de oxímetros de pulso como herramienta en el monitoreo clínico de pacientes con COVID-19. Asimismo, se resume la evidencia disponible sobre la eficacia, efectividad y seguridad de los diferentes tipos de oxímetros de pulso, sus limitaciones y recomendaciones de utilización. Está destinado a profesionales de la salud, así como a autoridades sanitarias y demás tomadores de decisiones sobre el uso de tecnologías sanitarias para la atención y cuidado de pacientes con COVID-19.


This document presents technical and regulatory considerations for the use of pulse oximeters as a tool in clinical monitoring of COVID-19 patients. It also summarizes available evidence on the efficacy, effectiveness, and safety of different types of pulse oximeters, their limitations, and recommendations for use. It is intended for health professionals, as well as health authorities and other decision makers responsible for health technologies for the care of COVID-19 patients.


Assuntos
Humanos , Pneumonia Viral/complicações , Oximetria/normas , Infecções por Coronavirus/complicações , Hipóxia/diagnóstico , Hipóxia/virologia , Monitorização Fisiológica/normas
4.
BMJ Case Rep ; 13(8)2020 Aug 03.
Artigo em Inglês | MEDLINE | ID: mdl-32747596
5.
BMC Med ; 18(1): 260, 2020 08 19.
Artigo em Inglês | MEDLINE | ID: mdl-32814566

RESUMO

BACKGROUND: The current target oxygen saturation range for patients with COVID-19 recommended by the National Institutes of Health is 92-96%. MAIN BODY: This article critically examines the evidence guiding current target oxygen saturation recommendation for COVID-19 patients, and raises important concerns in the extrapolation of data from the two studies stated to be guiding the recommendation. Next, it examines the influence of hypoxia on upregulation of ACE2 (target receptor for SARS-CoV-2 entry) expression, with supporting transcriptomic analysis of a publicly available gene expression profile dataset of human renal proximal tubular epithelial cells cultured in normoxic or hypoxic conditions. Finally, it discusses potential implications of specific clinical observations and considerations in COVID-19 patients on target oxygen saturation, such as diffuse systemic endothelitis and microthrombi playing an important pathogenic role in the wide range of systemic manifestations, exacerbation of hypoxic pulmonary vasoconstriction in the setting of pulmonary vascular endothelitis/microthrombi, the phenomenon of "silent hypoxemia" with some patients presenting to the hospital with severe hypoxemia disproportional to symptoms, and overburdened health systems and public health resources in many parts of the world with adverse implications on outpatient monitoring and early institution of oxygen supplementation. CONCLUSIONS: The above factors and analyses, put together, call for an urgent exploration and re-evaluation of target oxygen saturation in COVID-19 patients, both in the inpatient and outpatient settings. Until data from such trials become available, where possible, it may be prudent to target an oxygen saturation at least at the upper end of the recommended 92-96% range in COVID-19 patients both in the inpatient and outpatient settings (in patients that are normoxemic at pre-COVID baseline). Home pulse oximetry, tele-monitoring, and earlier institution of oxygen supplementation for hypoxemic COVID-19 outpatients could be beneficial, where public health resources allow for their implementation.


Assuntos
Betacoronavirus , Infecções por Coronavirus/sangue , Hipóxia/prevenção & controle , Oxigênio/sangue , Pneumonia Viral/sangue , Biomarcadores/sangue , Infecções por Coronavirus/diagnóstico , Infecções por Coronavirus/fisiopatologia , Infecções por Coronavirus/terapia , Humanos , Hipóxia/sangue , Hipóxia/diagnóstico , Hipóxia/etiologia , Oximetria , Pandemias , Pneumonia Viral/diagnóstico , Pneumonia Viral/fisiopatologia , Pneumonia Viral/terapia , Guias de Prática Clínica como Assunto , Telemedicina
6.
BMJ Case Rep ; 13(7)2020 Jul 07.
Artigo em Inglês | MEDLINE | ID: mdl-32641442

RESUMO

We report on a patient with coronavirus disease 2019 (COVID-19) and decompensated cirrhosis who experienced a favourable outcome of severe immune thrombocytopaenic purpura (ITP) after administration of intravenous immunoglobulin and high-dose dexamethasone. The present case suggests that it is reasonable to evoke ITP in case of profound thrombocytopaenia in a patient with COVID-19.


Assuntos
Infecções por Coronavirus , Glucocorticoides/administração & dosagem , Imunoglobulinas Intravenosas/administração & dosagem , Cirrose Hepática Alcoólica , Obesidade , Pandemias , Pneumonia Viral , Púrpura Trombocitopênica Idiopática , Adulto , Betacoronavirus/isolamento & purificação , Comorbidade , Infecções por Coronavirus/diagnóstico , Infecções por Coronavirus/epidemiologia , Infecções por Coronavirus/fisiopatologia , Humanos , Hipóxia/diagnóstico , Hipóxia/etiologia , Fatores Imunológicos/administração & dosagem , Cirrose Hepática Alcoólica/diagnóstico , Cirrose Hepática Alcoólica/epidemiologia , Masculino , Obesidade/diagnóstico , Obesidade/epidemiologia , Oxigenoterapia/métodos , Pneumonia Viral/diagnóstico , Pneumonia Viral/epidemiologia , Pneumonia Viral/fisiopatologia , Púrpura Trombocitopênica Idiopática/diagnóstico , Púrpura Trombocitopênica Idiopática/etiologia , Púrpura Trombocitopênica Idiopática/fisiopatologia , Púrpura Trombocitopênica Idiopática/terapia , Radiografia Torácica/métodos , Tomografia Computadorizada por Raios X/métodos , Resultado do Tratamento
7.
Pediatrics ; 146(2)2020 08.
Artigo em Inglês | MEDLINE | ID: mdl-32641358

RESUMO

BACKGROUND: Currently, car seat tolerance screens (CSTSs) are recommended for all infants born prematurely in the United States. Although many late-preterm infants are cared for exclusively in newborn nurseries (NBNs), data on implementation of CSTS in nurseries are limited. Our objective for this study was to determine management strategies and potential variation in practice of CSTS in NBNs across the nation. METHODS: We surveyed NBNs across 35 states using the Better Outcomes through Research for Newborns (BORN) network to determine what percentage perform CSTSs, inclusion and failure criteria, performance characteristics, follow-up of failed CSTSs including use of car beds, and provider attitudes toward CSTS. RESULTS: Of the 84 NBNs surveyed, 90.5% performed predischarge CSTSs. The most common failure criteria were saturation <90%, bradycardia <80 beats per minute, and apnea >20 seconds. More than 55% noted hypotonia as an additional inclusion criterion for testing, and >34% tested any infant who had ever required supplemental oxygen. After an initial failed CSTS, >93% of NBNs retested in a car seat at a future time point, whereas only ∼1% automatically discharged infants in a car bed. When asked which infants should undergo predischarge CSTS, the most common recommendations by survey respondents included infants with hypotonia (83%), airway malformations (78%), hemodynamically significant congenital heart disease (63%), and prematurity (61%). CONCLUSIONS: There is a large degree of variability in implementation of CSTS in NBNs across the United States. Further guidance on screening practices and failure criteria is needed to inform future practice and policy.


Assuntos
Apneia/etiologia , Automóveis , Bradicardia/etiologia , Sistemas de Proteção para Crianças/efeitos adversos , Hipóxia/etiologia , Equipamentos para Lactente/efeitos adversos , Recém-Nascido Prematuro/fisiologia , Programas de Rastreamento , Berçários para Lactentes , Atitude do Pessoal de Saúde , Tamanho Corporal , Feminino , Fidelidade a Diretrizes , Pesquisas sobre Serviços de Saúde , Hemodinâmica , Humanos , Hipóxia/diagnóstico , Lactente , Recém-Nascido , Masculino , Programas de Rastreamento/enfermagem , Programas de Rastreamento/estatística & dados numéricos , Oximetria , Oxigênio/sangue , Pressão Parcial , Postura , Utilização de Procedimentos e Técnicas , Estados Unidos
8.
Medicina (Kaunas) ; 56(8)2020 Jul 27.
Artigo em Inglês | MEDLINE | ID: mdl-32727107

RESUMO

Treatment of acute respiratory distress syndrome (ARDS) due to COVID-19 pneumonia (CARDS) represents a clinical challenge, requiring often invasive mechanical ventilation (IMV). Since the pathogenesis of CARDS it probably involves a direct viral attack to pulmonary and endothelium cells, and immune-mediated inflammation with dysfunctional coagulation, it was suggested to interfere with interleukin-6 (IL-6) activity by using the IL-6 receptor monoclonal antibody tocilizumab (TCZ). We reported the case of a 54-year-old 100 kg male COVID-19 patient (BMI 29) with severe respiratory insufficiency featuring dyspnea and hypoxia (SpO2 89% on room; PaO2 53 mmHg). Despite treatment with antiviral and non-invasive ventilation (NIV), after 24 h there was a progressive worsening of clinical conditions with higher fever (40 °C), increased dyspnea, and hypoxia (PaO2/FiO2 or P/F ratio of 150). The patient was at the limit to be sedated and intubated for IMV. He was treated with tocilizumab (8 mg/Kg i.v., single shot 800 mg) and NIV in the prone positioning. After only 96 h, the clinical, laboratory, and imaging findings showed incredible improvement. There was an important gain in oxygenation (P/F 300), a decrease of C-reactive protein values, and a decrease of the fever. Both the neutrophil-to-lymphocyte ratio (NLR) and the derived NLR ratio dropped down to 44%. Chest imaging confirmed the favorable response. This case suggested that for CARDS management efforts are needed for reducing its underlying inflammatory processes. Through a multiprofessional approach, the combination of IL-6-targeting therapies with calibrated ventilatory strategies may represent a winning strategy for improving outcomes.


Assuntos
Anticorpos Monoclonais Humanizados/uso terapêutico , Infecções por Coronavirus/complicações , Pneumonia Viral/complicações , Síndrome do Desconforto Respiratório do Adulto/etiologia , Administração Intravenosa , Anticorpos Monoclonais Humanizados/administração & dosagem , Antivirais/uso terapêutico , Betacoronavirus/isolamento & purificação , Terapia Combinada , Dispneia/diagnóstico , Humanos , Hipóxia/diagnóstico , Masculino , Pessoa de Meia-Idade , Ventilação não Invasiva/métodos , Pandemias , Síndrome do Desconforto Respiratório do Adulto/diagnóstico por imagem , Síndrome do Desconforto Respiratório do Adulto/terapia , Tomografia Computadorizada por Raios X/métodos , Resultado do Tratamento
10.
Int J Infect Dis ; 99: 100-101, 2020 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-32663601

RESUMO

OBJECTIVE: To assess the degree of hypoxia and subjective dyspnea elicited by a 6-minute walking test (6MWT) in COVID-19 patients prior to discharge. METHODS: A 6MWT was performed in 26 discharge-ready COVID-19 patients without chronic pulmonary disease or cardiac failure. Heart rate, oxyhemoglobin saturation (SpO2), respiratory rate, and subjective dyspnea measured on the Borg CR-10 scale were measured before and immediately after the 6MWT, with continuous monitoring of SpO2 and heart rate during the 6MWT. The 6MWT was terminated if SpO2 dropped below 90%. A historical cohort of 204 patients with idiopathic pulmonary fibrosis (IPF) was used for comparison. RESULTS: 13 (50%) of the COVID-19 patients developed exercise-induced hypoxia (SpO2 < 90%) during the 6MWT, of which one third had pulmonary embolism. COVID-19 patients experienced less hypoxia-related dyspnea during the 6MWT compared with patients with IPF. CONCLUSION: The 6MWT is a potential tool in the diagnosis of asymptomatic exercise-induced hypoxia in hospitalized COVID-19 patients prior to discharge. Due to important methodological limitations, further studies are needed to confirm our findings and to investigate their clinical consequences.


Assuntos
Betacoronavirus , Infecções por Coronavirus/complicações , Hipóxia/diagnóstico , Hipóxia/etiologia , Alta do Paciente , Pneumonia Viral/complicações , Teste de Esforço , Humanos , Pandemias
15.
Am J Respir Crit Care Med ; 202(3): 356-360, 2020 08 01.
Artigo em Inglês | MEDLINE | ID: mdl-32539537

RESUMO

Patients with coronavirus disease (COVID-19) are described as exhibiting oxygen levels incompatible with life without dyspnea. The pairing-dubbed happy hypoxia but more precisely termed silent hypoxemia-is especially bewildering to physicians and is considered as defying basic biology. This combination has attracted extensive coverage in media but has not been discussed in medical journals. It is possible that coronavirus has an idiosyncratic action on receptors involved in chemosensitivity to oxygen, but well-established pathophysiological mechanisms can account for most, if not all, cases of silent hypoxemia. These mechanisms include the way dyspnea and the respiratory centers respond to low levels of oxygen, the way the prevailing carbon dioxide tension (PaCO2) blunts the brain's response to hypoxia, effects of disease and age on control of breathing, inaccuracy of pulse oximetry at low oxygen saturations, and temperature-induced shifts in the oxygen dissociation curve. Without knowledge of these mechanisms, physicians caring for patients with hypoxemia free of dyspnea are operating in the dark, placing vulnerable patients with COVID-19 at considerable risk. In conclusion, features of COVID-19 that physicians find baffling become less strange when viewed in light of long-established principles of respiratory physiology; an understanding of these mechanisms will enhance patient care if the much-anticipated second wave emerges.


Assuntos
Betacoronavirus , Infecções por Coronavirus/complicações , Infecções por Coronavirus/diagnóstico , Dispneia/virologia , Hipóxia/diagnóstico , Hipóxia/virologia , Pneumonia Viral/complicações , Pneumonia Viral/diagnóstico , Infecções por Coronavirus/sangue , Dispneia/sangue , Dispneia/diagnóstico , Humanos , Hipóxia/sangue , Masculino , Pessoa de Meia-Idade , Oximetria , Oxigênio/sangue , Pandemias , Pneumonia Viral/sangue
16.
Neurology ; 95(10): 454-457, 2020 09 08.
Artigo em Inglês | MEDLINE | ID: mdl-32586898

Assuntos
Infarto Cerebral/diagnóstico por imagem , Infecções por Coronavirus/diagnóstico por imagem , Globo Pálido/diagnóstico por imagem , Hipóxia/diagnóstico , Pneumonia Viral/diagnóstico por imagem , Betacoronavirus , Infarto Cerebral/complicações , Infarto Cerebral/metabolismo , Infarto Cerebral/fisiopatologia , Infecções por Coronavirus/complicações , Infecções por Coronavirus/metabolismo , Infecções por Coronavirus/fisiopatologia , Diabetes Mellitus Tipo 2/complicações , Diabetes Mellitus Tipo 2/metabolismo , Cetoacidose Diabética/complicações , Cetoacidose Diabética/metabolismo , Diagnóstico Diferencial , Feminino , Humanos , Coma Hiperglicêmico Hiperosmolar não Cetótico/complicações , Coma Hiperglicêmico Hiperosmolar não Cetótico/metabolismo , Hipertensão/complicações , Hipertensão/fisiopatologia , Hipóxia/complicações , Hipóxia/metabolismo , Hipóxia-Isquemia Encefálica/diagnóstico , Leucoencefalite Hemorrágica Aguda/diagnóstico , Pulmão/diagnóstico por imagem , Imagem por Ressonância Magnética , Pessoa de Meia-Idade , Pandemias , Pneumonia Viral/complicações , Pneumonia Viral/metabolismo , Pneumonia Viral/fisiopatologia , Insuficiência Respiratória/complicações , Insuficiência Respiratória/metabolismo , Insuficiência Respiratória/fisiopatologia , Choque/complicações , Choque/metabolismo , Choque/fisiopatologia , Veia Subclávia/diagnóstico por imagem , Tomografia Computadorizada por Raios X , Trombose Venosa/complicações , Trombose Venosa/diagnóstico por imagem
17.
Seizure ; 79: 49-52, 2020 Jul.
Artigo em Inglês | MEDLINE | ID: covidwho-273964

RESUMO

Neurotropic and neuroinvasive capabilities of coronaviruses have been described in humans. Neurological problems found in patients with coronavirus infection include: febrile seizures, convulsions, loss of consciousness, encephalomyelitis, and encephalitis. Coronavirus disease (COVID-19) is caused by SARS-CoV2. In severe cases, patients may develop severe pneumonia, acute respiratory distress syndrome, and acute cardiac injury. While seizures and status epilepticus have not been widely reported in the past five months since the onset of COVID-19 pandemic, patients with COVID-19 may have hypoxia, multiorgan failure, and severe metabolic and electrolyte disarrangements; hence, it is plausible to expect clinical or subclinical acute symptomatic seizures to happen in these patients. One should be prepared to treat seizures appropriately, if they happen in a patient who is already in a critical medical condition and suffers from organ failure.


Assuntos
Betacoronavirus , Infecções por Coronavirus/complicações , Pneumonia Viral/complicações , Convulsões/etiologia , Convulsões/virologia , Infecções por Coronavirus/diagnóstico , Humanos , Hipóxia/diagnóstico , Hipóxia/etiologia , Hipóxia/virologia , Insuficiência de Múltiplos Órgãos/diagnóstico , Insuficiência de Múltiplos Órgãos/etiologia , Pandemias , Pneumonia Viral/diagnóstico , Convulsões/diagnóstico , Síndrome Respiratória Aguda Grave/complicações , Síndrome Respiratória Aguda Grave/diagnóstico
18.
Mayo Clin Proc ; 95(6): 1138-1147, 2020 06.
Artigo em Inglês | MEDLINE | ID: covidwho-46197

RESUMO

OBJECTIVE: To identify markers associated with in-hospital death in patients with coronavirus disease 2019 (COVID-19)-associated pneumonia. PATIENTS AND METHODS: A retrospective cohort study was conducted of 140 patients with moderate to critical COVID-19-associated pneumonia requiring oxygen supplementation admitted to the hospital from January 28, 2020, through February 28, 2020, and followed up through March 13, 2020, in Union Hospital, Wuhan, China. Oxygen saturation (SpO2) and other measures were tested as predictors of in-hospital mortality in survival analysis. RESULTS: Of 140 patients with COVID-19-associated pneumonia, 72 (51.4%) were men, with a median age of 60 years. Patients with SpO2 values of 90% or less were older and were more likely to be men, to have hypertension, and to present with dyspnea than those with SpO2 values greater than 90%. Overall, 36 patients (25.7%) died during hospitalization after median 14-day follow-up. Higher SpO2 levels after oxygen supplementation were associated with reduced mortality independently of age and sex (hazard ratio per 1-U SpO2, 0.93; 95% CI, 0.91 to 0.95; P<.001). The SpO2 cutoff value of 90.5% yielded 84.6% sensitivity and 97.2% specificity for prediction of survival. Dyspnea was also independently associated with death in multivariable analysis (hazard ratio, 2.60; 95% CI, 1.24 to 5.43; P=.01). CONCLUSION: In this cohort of patients with COVID-19, hypoxemia was independently associated with in-hospital mortality. These results may help guide the clinical management of patients with severe COVID-19, particularly in settings requiring strategic allocation of limited critical care resources. TRIAL REGISTRATION: Chictr.org.cn Identifier: ChiCTR2000030852.


Assuntos
Betacoronavirus/isolamento & purificação , Infecções por Coronavirus , Hipóxia , Oxigenoterapia , Pandemias , Pneumonia Viral , China , Infecções por Coronavirus/complicações , Infecções por Coronavirus/diagnóstico , Infecções por Coronavirus/mortalidade , Infecções por Coronavirus/fisiopatologia , Feminino , Mortalidade Hospitalar , Humanos , Hipóxia/diagnóstico , Hipóxia/etiologia , Hipóxia/terapia , Masculino , Pessoa de Meia-Idade , Avaliação de Processos e Resultados em Cuidados de Saúde , Consumo de Oxigênio , Oxigenoterapia/métodos , Oxigenoterapia/estatística & dados numéricos , Pneumonia Viral/sangue , Pneumonia Viral/complicações , Pneumonia Viral/diagnóstico , Pneumonia Viral/etiologia , Pneumonia Viral/mortalidade , Pneumonia Viral/fisiopatologia , Pneumonia Viral/terapia , Prognóstico , Estudos Retrospectivos , Medição de Risco/métodos , Fatores de Risco , Índice de Gravidade de Doença
19.
Mayo Clin Proc ; 95(6): 1138-1147, 2020 06.
Artigo em Inglês | MEDLINE | ID: mdl-32376101

RESUMO

OBJECTIVE: To identify markers associated with in-hospital death in patients with coronavirus disease 2019 (COVID-19)-associated pneumonia. PATIENTS AND METHODS: A retrospective cohort study was conducted of 140 patients with moderate to critical COVID-19-associated pneumonia requiring oxygen supplementation admitted to the hospital from January 28, 2020, through February 28, 2020, and followed up through March 13, 2020, in Union Hospital, Wuhan, China. Oxygen saturation (SpO2) and other measures were tested as predictors of in-hospital mortality in survival analysis. RESULTS: Of 140 patients with COVID-19-associated pneumonia, 72 (51.4%) were men, with a median age of 60 years. Patients with SpO2 values of 90% or less were older and were more likely to be men, to have hypertension, and to present with dyspnea than those with SpO2 values greater than 90%. Overall, 36 patients (25.7%) died during hospitalization after median 14-day follow-up. Higher SpO2 levels after oxygen supplementation were associated with reduced mortality independently of age and sex (hazard ratio per 1-U SpO2, 0.93; 95% CI, 0.91 to 0.95; P<.001). The SpO2 cutoff value of 90.5% yielded 84.6% sensitivity and 97.2% specificity for prediction of survival. Dyspnea was also independently associated with death in multivariable analysis (hazard ratio, 2.60; 95% CI, 1.24 to 5.43; P=.01). CONCLUSION: In this cohort of patients with COVID-19, hypoxemia was independently associated with in-hospital mortality. These results may help guide the clinical management of patients with severe COVID-19, particularly in settings requiring strategic allocation of limited critical care resources. TRIAL REGISTRATION: Chictr.org.cn Identifier: ChiCTR2000030852.


Assuntos
Betacoronavirus/isolamento & purificação , Infecções por Coronavirus , Hipóxia , Oxigenoterapia , Pandemias , Pneumonia Viral , China , Infecções por Coronavirus/complicações , Infecções por Coronavirus/diagnóstico , Infecções por Coronavirus/mortalidade , Infecções por Coronavirus/fisiopatologia , Feminino , Mortalidade Hospitalar , Humanos , Hipóxia/diagnóstico , Hipóxia/etiologia , Hipóxia/terapia , Masculino , Pessoa de Meia-Idade , Avaliação de Processos e Resultados em Cuidados de Saúde , Consumo de Oxigênio , Oxigenoterapia/métodos , Oxigenoterapia/estatística & dados numéricos , Pneumonia Viral/sangue , Pneumonia Viral/complicações , Pneumonia Viral/diagnóstico , Pneumonia Viral/etiologia , Pneumonia Viral/mortalidade , Pneumonia Viral/fisiopatologia , Pneumonia Viral/terapia , Prognóstico , Estudos Retrospectivos , Medição de Risco/métodos , Fatores de Risco , Índice de Gravidade de Doença
20.
Medicine (Baltimore) ; 99(19): e20031, 2020 May.
Artigo em Inglês | MEDLINE | ID: mdl-32384462

RESUMO

BACKGROUND: It has not been determined that demand valve oxygen therapy is effective for nocturnal hypoxia. A portable oxygen concentrator with an auto-demand oxygen delivery system (auto-DODS; standard, high, and extra high) has recently been developed to improve oxygenation and comfort. This oxygen concentrator can supply a pulsed flow when it detects apnoea. The aim of this study is to demonstrate that this newly developed portable oxygen concentrator with an auto-demand function is non-inferior to a continuous-flow oxygen concentrator for nocturnal hypoxemia. METHODS: Twenty patients with chronic obstructive pulmonary disease or interstitial pneumonia will be randomized to receive a portable oxygen concentrator with an auto-DODS or a continuous-flow oxygen concentrator during sleep. The primary endpoint is mean oxygen saturation (SpO2) during the total sleep time. The secondary endpoints are the ratios of time that the oxygen concentrator spends in each sensitivity mode (standard, high, and extra-high) and at a constant pulse rate to the total sleep time, the total time and ratio of time for which SpO2 is less than 90% during the total sleep time, the lowest value of SpO2 during the total sleep time, the mean and highest pulse rate during the total sleep time, the apnoea index during the total sleep time, the total sleep duration itself, and comfort and reliability as measured by numerical rating scale and questionnaires. DISCUSSION: If the auto-DODS demonstrates non-inferiority to continuous flow in oxygenation during sleep, the auto-DODS can be used even at night, and the patient will need only 1 device. TRIAL REGISTRATION: The study was registered on Aug 23, 2019 (jRCTs052190042).


Assuntos
Hipóxia , Doenças Pulmonares Intersticiais/complicações , Nebulizadores e Vaporizadores , Oxigenoterapia , Doença Pulmonar Obstrutiva Crônica/complicações , Adulto , Estudos Cross-Over , Feminino , Humanos , Hipóxia/sangue , Hipóxia/diagnóstico , Hipóxia/etiologia , Hipóxia/terapia , Masculino , Oximetria/métodos , Oxigenoterapia/instrumentação , Oxigenoterapia/métodos , Polissonografia/métodos , Ensaios Clínicos Controlados Aleatórios como Assunto , Recuperação de Função Fisiológica , Reprodutibilidade dos Testes , Teste de Caminhada/métodos
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