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3.
BMC Infect Dis ; 20(1): 186, 2020 Feb 28.
Artigo em Inglês | MEDLINE | ID: mdl-32111168

RESUMO

BACKGROUND: The presentation of clinical leptospirosis has been historically associated with animal workers, slaughterhouse workers and medical veterinarians. This association has shifted to be related to flooding events and outdoor activities; few cases are related to high-risk factors found in immunosuppressed patients. Scarcely a handful of cases have serological evidence of immune response against Leptospira serovar Bratislava representing serogroup Australis, a serovar associated with poor reproductive performance in swine and horses, and recently with cats. CASE PRESENTATION: Herein, we describe a rare clinical presentation of disseminated Leptospira infection in an immunosuppressed 65-year-old woman. She was admitted to the emergency room with fever, bacteraemia, bilateral uveitis and pulmonary involvement. The patient denied outdoor activities; she only had wide exposure to faeces and urine from cats living in her home. Her medical history included idiopathic thrombocytopenic purpura (ITP) diagnosed at the age of 18. She did not respond to medical treatment, and a splenectomy was performed. At age 60, she was diagnosed with Chronic Myeloid Leukemia (CML), and was treated with a tyrosine kinase inhibitor (TKI) -Imatinib. The patient voluntarily discontinued the treatment for the last 6 months. After extensive workup, no microorganisms were identified by the commonly used stains in microbiology. The diagnosis was performed through dark-field microscopy, microagglutination test (MAT), Leptospira genus-specific PCR, the IS1500 PCR for identification of pathogenic species, and 16S based sequencing for the genus identification. CONCLUSION: Immunosuppressed patients may acquire uncommon infections from ubiquitous microorganisms. In this case, serology evidence of exposure to Leptospira serovar Bratislava by MAT and the presence of the Leptospira genus were identified. It should be on mind for the diagnosis in otherwise healthy patients, and thoroughly search on splenectomised patients exposed to animals. Additionally, this report highlights the usefulness of PCR for diagnosis of this potentially life-threatening illness.


Assuntos
Bacteriemia/diagnóstico , Leptospirose/diagnóstico , Idoso , Bacteriemia/microbiologia , DNA Bacteriano/metabolismo , Feminino , Humanos , Hospedeiro Imunocomprometido , Leptospira/genética , Leptospira/isolamento & purificação , Leptospirose/microbiologia , Pneumonia por Mycoplasma/diagnóstico , Insuficiência Respiratória/diagnóstico , Esplenectomia , Tórax/diagnóstico por imagem , Uveíte/diagnóstico
4.
Pneumologie ; 74(1): 46-49, 2020 Jan.
Artigo em Alemão | MEDLINE | ID: mdl-31958870

RESUMO

In 2017 the German Clinical Guideline for Treating Acute Respiratory Insufficiency with Invasive Ventilation and Extracorporeal Membrane Oxygenation: Evidence-Based Recommendations were released. This article highlights emerging data and new concepts which were introduced since 2017. Among others it summarizes the current progress made in evidence-based recommendations of mechanical ventilation and extracorporeal membrane oxygenation (ECMO). In detail, the new evidence for treating severe ARDS with ECMO, phenotyping of ARDS, early neuromuscular blockade and the application of non-invasive ventilation and high-flow oxygen therapy are discussed.


Assuntos
Oxigenação por Membrana Extracorpórea/métodos , Guias de Prática Clínica como Assunto , Respiração Artificial/métodos , Síndrome do Desconforto Respiratório do Adulto/terapia , Insuficiência Respiratória/diagnóstico , Doença Aguda , Humanos , Pulmão , Síndrome do Desconforto Respiratório do Adulto/diagnóstico , Insuficiência Respiratória/fisiopatologia
5.
Br J Nurs ; 28(22): 1461-1467, 2019 Dec 12.
Artigo em Inglês | MEDLINE | ID: mdl-31835932

RESUMO

This article aims to assist nurses and other health professionals to care for patients who have type 2 respiratory failure as a result of chronic obstructive pulmonary disease, and who require non-invasive ventilation. It outlines findings of a case study that are commonplace in the acute medical setting and aims to highlight important factors that impact on patient care and patient outcome, and to help nursing staff to implement recommended and best practices.


Assuntos
Ventilação não Invasiva/enfermagem , Doença Pulmonar Obstrutiva Crônica/fisiopatologia , Insuficiência Respiratória/diagnóstico , Insuficiência Respiratória/terapia , Idoso , Humanos , Masculino , Avaliação em Enfermagem , Guias de Prática Clínica como Assunto , Insuficiência Respiratória/enfermagem
6.
Pneumologie ; 73(12): 723-814, 2019 Dec.
Artigo em Alemão | MEDLINE | ID: mdl-31816642

RESUMO

Mechanical ventilation (MV) is an essential part of modern intensive care medicine. MV is performed in patients with severe respiratory failure caused by insufficiency of respiratory muscles and/or lung parenchymal disease when/after other treatments, (i. e. medication, oxygen, secretion management, continuous positive airway pressure or nasal highflow) have failed.MV is required to maintain gas exchange and to buy time for curative therapy of the underlying cause of respiratory failure. In the majority of patients weaning from MV is routine and causes no special problems. However, about 20 % of patients need ongoing MV despite resolution of the conditions which precipitated the need for MV. Approximately 40 - 50 % of time spent on MV is required to liberate the patient from the ventilator, a process called "weaning."There are numberous factors besides the acute respiratory failure that have an impact on duration and success rate of the weaning process such as age, comorbidities and conditions and complications acquired in the ICU. According to an international consensus conference "prolonged weaning" is defined as weaning process of patients who have failed at least three weaning attempts or require more than 7 days of weaning after the first spontaneous breathing trial (SBT). Prolonged weaning is a challenge, therefore, an inter- and multi-disciplinary approach is essential for a weaning success.In specialised weaning centers about 50 % of patients with initial weaning failure can be liberated from MV after prolonged weaning. However, heterogeneity of patients with prolonged weaning precludes direct comparisons of individual centers. Patients with persistant weaning failure either die during the weaning process or are discharged home or to a long term care facility with ongoing MV.Urged by the growing importance of prolonged weaning, this Sk2-guideline was first published in 2014 on the initiative of the German Respiratory Society (DGP) together with other scientific societies involved in prolonged weaning. Current research and study results, registry data and experience in daily practice made the revision of this guideline necessary.The following topics are dealt with in the guideline: Definitions, epidemiology, weaning categories, the underlying pathophysiology, prevention of prolonged weaning, treatment strategies in prolonged weaning, the weaning unit, discharge from hospital on MV and recommendations for end of life decisions.Special emphasis in the revision of the guideline was laid on the following topics:- A new classification of subgroups of patients in prolonged weaning- Important aspects of pneumological rehabilitation and neurorehabilitation in prolonged weaning- Infrastructure and process organization in the care of patients in prolonged weaning in the sense of a continuous treatment concept- Therapeutic goal change and communication with relativesAspects of pediatric weaning are given separately within the individual chapters.The main aim of the revised guideline is to summarize current evidence and also expert based- knowledge on the topic of "prolonged weaning" and, based on the evidence and the experience of experts, make recommendations with regard to "prolonged weaning" not only in the field of acute medicine but also for chronic critical care.Important addressees of this guideline are Intensivists, Pneumologists, Anesthesiologists, Internists, Cardiologists, Surgeons, Neurologists, Pediatricians, Geriatricians, Palliative care clinicians, Rehabilitation physicians, Nurses in intensive and chronic care, Physiotherapists, Respiratory therapists, Speech therapists, Medical service of health insurance and associated ventilator manufacturers.


Assuntos
Guias de Prática Clínica como Assunto , Pneumologia/normas , Respiração Artificial/métodos , Insuficiência Respiratória/terapia , Desmame do Respirador/métodos , Desmame do Respirador/normas , Criança , Medicina Baseada em Evidências , Alemanha , Serviços de Assistência Domiciliar , Humanos , Insuficiência Respiratória/diagnóstico , Sociedades Médicas
7.
Turkiye Parazitol Derg ; 43(4): 213-215, 2019 Dec 23.
Artigo em Inglês | MEDLINE | ID: mdl-31865659

RESUMO

The objective of the present study is to present a patient with oral myiasis caused by Calliphoridae larvae. The patient was a 63-year-old male who was transferred from Van Closed Prison to Yüzüncü Yil University, Faculty of Medicine Research and Application Hospital. Five alive larvae localized in different points of gingival region were observed during routine oral cleaning. These larvae belonged to Calliphoridae family. As a result, medical staff should be informed about this infestation and this parasite should be kept in mind especially in risky group of patients and necessary controls should be conducted.


Assuntos
Dípteros , Doenças da Gengiva/parasitologia , Miíase/parasitologia , Animais , Hemorragia Cerebral/complicações , Hemorragia Cerebral/diagnóstico , Dípteros/classificação , Evolução Fatal , Gengiva/parasitologia , Doenças da Gengiva/diagnóstico , Humanos , Hipertensão/complicações , Hipertensão/diagnóstico , Larva , Masculino , Pessoa de Meia-Idade , Miíase/diagnóstico , Respiração Artificial , Insuficiência Respiratória/complicações , Insuficiência Respiratória/diagnóstico , Insuficiência Respiratória/terapia , Turquia
8.
An. pediatr. (2003. Ed. impr.) ; 91(5): 307-316, nov. 2019. tab, graf
Artigo em Espanhol | IBECS | ID: ibc-186768

RESUMO

Introducción: La ventilación no invasiva (VNI) se ha convertido en un tratamiento habitual de la insuficiencia respiratoria aguda (IRA). Nuestro objetivo ha sido identificar factores predictores de fracaso de VNI para detectar precozmente a los pacientes en los que no tendrá éxito. Pacientes y métodos: Estudio de cohortes prospectivo que incluyó a todos los pacientes con IRA que recibieron VNI como tratamiento inicial entre 2005 y 2009, en una unidad de cuidados intensivos pediátricos de 14 camas de un hospital universitario de tercer nivel. Se recogieron datos clínicos e información sobre la VNI, previamente a su inicio, a las 2, 8, 12 y 24 horas. La razón entre saturación de hemoglobina y fracción de oxígeno inspirada (S/F) se calculó retrospectivamente. Se definió fallo de VNI como necesidad de intubación o necesidad de rescate con presión binivel (BLPAP). Se realizaron análisis estadísticos univariable y multivariable. Resultados: Un total de n = 282 pacientes recibieron soporte no invasivo, presión continua = 71, BLPAP = 211. El porcentaje de éxito de la muestra global fue 71%. Los pacientes tratados con BLPAP vs. presión continua, aquellos con S/F más elevados a las 2horas (odds ratio 0,991, IC 95%: 0,986-0,996, p = 0,001) y los mayores de 6 meses (hazard ratio 0,375, IC 95% 0,171-0,820, p = 0,014), presentaron menor riesgo de fracaso. Los pacientes con frecuencias cardíacas más altas y mayor presión positiva inspiratoria en vía aérea a las 2horas (odds ratio 1,021, IC 95%: 1,008-1,034, p = 0,001; hazard ratio 1,214, IC 95%: 1,046-1,408, p = 0,011) presentaron mayor riesgo de fracaso. Conclusiones: La edad < 6 meses, S/F, frecuencia cardíaca y presión positiva inspiratoria en la vía aérea a las 2 horas son factores predictores independientes de fracaso de VNI inicial en pacientes con IRA admitidos en una unidad de cuidados intensivos pediátricos


Introduction: Despite there being limited evidence, non-invasive ventilation (NIV) has become a common treatment for acute respiratory failure (ARF). The aim of this study was to identify the predictive factors of NIV failure, in order to enable early detection of patients failing the treatment. Patients and methods: Prospective cohort study was conducted that included all ARF patients that received NIV as the initial treatment between 2005 and 2009 in a fourteen-bed Paediatric Intensive Care Unit (PICU) of a tertiary university hospital. Information was collected about the NIV, as well as clinical data prior to NIV, at 2, 8, 12, and 24hrs. The haemoglobin saturation (SpO2)/fraction of inspired oxygen (FiO2) ratio (S/F) was retrospectively calculated. NIV failure was defined as the need for intubation or requiring rescue with bi-level pressure (BLPAP). Univariate and multivariate statistical analyses were performed. Results: A total of 282 patients received non-invasive support, with 71 receiving Continuous Pressure (CPAP), and 211 with BLPAP treatment. The overall success rate was 71%. Patients receiving BLPAP vs. CPAP, patients with higher S/F ratios at 2 hours (odds ratio [OR] 0.991, 95% CI 0.986-0.996, P = .001], and patients older than 6 months (Hazard ratio [HZ] 0.375, 95% CI 0.171-0.820, P = .014], were also more likely to fail. Patients with higher heart rates (HR) at 2hours (OR 1.021, 95% CI [1.008-1.034], P = .001) and higher inspiratory positive airway pressure (IPAP) at 2hours were more prone to failure (HZ 1.214, 95% CI [1.046-1.408], P = .011). Conclusions: Age below 6 months, S/F ratio, HR, and IPAP at 2 hours are independent predictive factors for initial NIV failure in paediatric patients with ARF admitted to the PICU


Assuntos
Humanos , Recém-Nascido , Lactente , Pré-Escolar , Criança , Adolescente , Ventilação não Invasiva/métodos , Estudos de Coortes , Infecções Respiratórias , Insuficiência Respiratória/diagnóstico , Unidades de Terapia Intensiva Pediátrica/estatística & dados numéricos , Estudos Prospectivos , Insuficiência Respiratória/complicações , Fatores de Risco , Intubação Intratraqueal/métodos
9.
BMJ Case Rep ; 12(10)2019 Oct 05.
Artigo em Inglês | MEDLINE | ID: mdl-31586958

RESUMO

Bilateral symmetrical weakness of acute onset is not very uncommon and the differential varies widely from life-threatening neurological illnesses to metabolic and electrolyte derangements. We report the case of a young female with severe muscle weakness, respiratory distress and hypokalemia who required immediate intubation on arrival to emergency department. During hospital course, even after normalisation of serum potassium and some improvement in limb weakness, patient failed multiple attempts of extubation because of type II respiratory failure. Subsequently, acetyl cholinesterase antibodies were checked which came out positive, and diagnosis of myasthenia gravis and hypokalemic periodic paralysis was made. She was successfully extubated after intravenous pulse steroids, pyridostigmine and plasmapheresis. Patient was finally discharged home on oral steroids, pyridostigmine and azathioprine. In a patient presenting with hypokalemic weakness, the suspicion of a second disorder should be very high if weakness fails to resolve following correction of hypokalemia.


Assuntos
Paralisia Periódica Hipopotassêmica/diagnóstico , Miastenia Gravis/diagnóstico , Insuficiência Respiratória/diagnóstico , Adulto , Análise Química do Sangue , Colinesterases/sangue , Diagnóstico Diferencial , Evolução Fatal , Feminino , Humanos , Paralisia Periódica Hipopotassêmica/sangue , Paralisia Periódica Hipopotassêmica/complicações , Infusões Intravenosas , Debilidade Muscular/etiologia , Miastenia Gravis/sangue , Miastenia Gravis/complicações , Cloreto de Potássio/administração & dosagem , Cloreto de Potássio/uso terapêutico , Respiração Artificial , Insuficiência Respiratória/complicações
12.
BMJ Case Rep ; 12(8)2019 Aug 30.
Artigo em Inglês | MEDLINE | ID: mdl-31473632

RESUMO

Laryngopyocele is a rare complication involving the laryngocele which can present with acute airway compromise. A 31-year-old man presented with acute onset respiratory distress and dysphagia. He had swelling on either side of upper aspect of the neck with tenderness on left side. Videolaryngoscopy using 70° rigid Hopkins rod telescope showed a swelling in the left pyriform sinus pushing the ipsilateral vocal cord. However, glottic space was adequate. Contract-enhanced CT scan of the neck confirmed left-sided mixed laryngopyocele with contralateral mixed laryngocele. Patient underwent excision of both the lesions in a single stage by transcervical approach. Laryngopyocele in a case of bilateral mixed laryngocele presenting as an impending airway emergency has not been reported in literature. The diagnostic and therapeutic challenges are discussed here along with review of literature.


Assuntos
Obstrução das Vias Respiratórias/diagnóstico , Transtornos de Deglutição/diagnóstico , Laringocele/diagnóstico , Insuficiência Respiratória/diagnóstico , Adulto , Obstrução das Vias Respiratórias/etiologia , Transtornos de Deglutição/etiologia , Diagnóstico Diferencial , Humanos , Laringocele/complicações , Masculino , Insuficiência Respiratória/etiologia
13.
BMJ Case Rep ; 12(8)2019 Aug 13.
Artigo em Inglês | MEDLINE | ID: mdl-31413055

RESUMO

A 79-year-old man, who had significant cardiovascular morbidities, presented with out-of-hospital respiratory arrest. He regained breathing after brief cardiopulmonary resuscitation by his paramedic son. After meticulous investigations, acute cardiovascular events and metabolic causes were ruled out while features of obstructive sleep apnoea were elicited. The findings on in-laboratory polysomnography were compatible with severe obstructive sleep apnoea, with unusually prolonged apnoea duration of up to 2.7 min which most likely accounts for the presentation as 'respiratory arrest'. Thyroid function test for investigation of his weight gain confirmed hypothyroidism. His symptoms improved gradually after positive airway pressure therapy with bi-level support and thyroxine replacement. On further evaluation, his hypothyroidism is believed to be a complication of long-term amiodarone exposure. The case highlights that the combination of obstructive sleep apnoea and hypothyroidism can lead to catastrophic manifestation and the unusually long apnoea could be a feature prompting further workup for possible hypothyroidism.


Assuntos
Hipotireoidismo/diagnóstico , Insuficiência Respiratória/diagnóstico , Apneia Obstrutiva do Sono/diagnóstico , Idoso , Reanimação Cardiopulmonar , Pressão Positiva Contínua nas Vias Aéreas , Diagnóstico Diferencial , Humanos , Hipotireoidismo/complicações , Hipotireoidismo/tratamento farmacológico , Masculino , Polissonografia , Insuficiência Respiratória/complicações , Insuficiência Respiratória/terapia , Apneia Obstrutiva do Sono/complicações , Apneia Obstrutiva do Sono/terapia , Tiroxina/administração & dosagem , Tiroxina/uso terapêutico
14.
Surgery ; 166(6): 1142-1147, 2019 12.
Artigo em Inglês | MEDLINE | ID: mdl-31421870

RESUMO

BACKGROUND: Occasionally, lung transplant candidates improve to the point where they are removed from the transplant list. We sought to determine the characteristics and outcomes of lung transplant candidates who improved to delisting both before and after implementation of the lung allocation score. METHODS: Using the United Network for Organ Sharing database, we reviewed all adult patients listed for lung transplant between 1987 and 2012. The last permanent status change was classified into transplanted, improved to delisting (improved), or deteriorated to delisting (deteriorated). Survival time was calculated using the linked date of death from the Social Security Administration. Survival analysis was performed via the Kaplan-Meier method, and adjusted multivariable logistic regressions identified characteristics predicting improvement to delisting. RESULTS: Of 13,688 candidates, 12,188 (89.0%) were transplanted, 454 (3.3%) improved, and 1,046 (7.6%) deteriorated. The 5-year mortality was greater in improved (hazard ratio = 1.21 [1.07-1.38], P = .002) and deteriorated (hazard ratio = 3.36 [3.11-3.64], P < .001) candidates relative to those transplanted; however, 1-year survival was greater in improved versus transplanted candidates (75.9% vs 67.2%, log rank P < .001). Older, female patients listed for primary pulmonary hypertension and retransplantation were more likely to improve to delisting. The proportion of improved patients varied by hospital quartile volume (P < .001) and the United Network for Organ Sharing geographic region (P < .001). The number of patients improving to delisting decreased after implementation of the lung allocation score. CONCLUSION: Lung transplant candidates improving to delisting faced less short-term but greater long-term mortality relative to transplanted candidates. Given that the improved population decreased dramatically after implementation of the lung allocation score, redefining patient listing criteria appears to have improved patient appropriateness for transplant.


Assuntos
Transplante de Pulmão/estatística & dados numéricos , Seleção de Pacientes , Insuficiência Respiratória/mortalidade , Listas de Espera/mortalidade , Adulto , Progressão da Doença , Feminino , Humanos , Estimativa de Kaplan-Meier , Transplante de Pulmão/normas , Masculino , Pessoa de Meia-Idade , Guias de Prática Clínica como Assunto , Sistema de Registros/estatística & dados numéricos , Insuficiência Respiratória/diagnóstico , Insuficiência Respiratória/cirurgia , Estudos Retrospectivos , Índice de Gravidade de Doença , Fatores de Tempo , Estados Unidos/epidemiologia
16.
Crit Care Nurs Q ; 42(4): 417-430, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31449152

RESUMO

Acute respiratory distress syndrome (ARDS) was first described in 1967 by Ashbaugh and colleagues. Acute respiratory distress syndrome is a clinical syndrome, not a disease, and has no ideal definition or gold standard diagnostic test. There are multiple causes and different pathways of pathogenesis as well as various histological findings. Given these variations, there are many clinical entities that can get confused with ARDS. These entities are discussed in this article as "Mimics of ARDS." It imperative to correctly identify ARDS and distinguish it from other diseases to implement correct management strategy.


Assuntos
Diagnóstico Diferencial , Hipóxia/diagnóstico , Pneumonia/diagnóstico , Síndrome do Desconforto Respiratório do Adulto/diagnóstico , Insuficiência Respiratória/diagnóstico , Humanos
17.
Trials ; 20(1): 450, 2019 Jul 22.
Artigo em Inglês | MEDLINE | ID: mdl-31331372

RESUMO

BACKGROUND: Noninvasive ventilation (NIV) is indicated to treat respiratory acidosis due to exacerbation of chronic obstructive pulmonary disease (COPD). Recent nonrandomized studies also demonstrated some physiological effects of high-flow nasal therapy (HFNT) in COPD patients. We designed a prospective, unblinded, multicenter, randomized controlled trial to assess the noninferiority of HFNT compared to NIV with respect to the reduction of arterial partial pressure of carbon dioxide (PaCO2) in patients with hypercapnic acute respiratory failure with mild-to-moderate respiratory acidosis. METHODS: We will enroll adult patients with acute hypercapnic respiratory failure, as defined by arterial pH between 7.25 and 7.35 and PaCO2 ≥ 55 mmHg. Patients will be randomly assigned 1:1 to receive NIV or HFNT. NIV will be applied through a mask with a dedicated ventilator in pressure support mode. Positive end-expiratory pressure will be set at 3-5 cmH2O with inspiratory support to obtain a tidal volume between 6 and 8 ml/kg of ideal body weight. HFNT will be initially set at a temperature of 37 °C and a flow of 60 L/min. At 2 and 6 h we will assess arterial blood gases, vital parameters, respiratory rate, treatment intolerance and failure, need for endotracheal intubation, time spent under mechanical ventilation (both invasive and NIV), intensive care unit and hospital length of stay, and hospital mortality. Based on an α error of 5% and a ß error of 80%, with a standard deviation for PaCO2 equal to 15 mmHg and a noninferiority limit of 10 mmHg, we computed a sample size of 56 patients. Considering potential drop-outs and nonparametric analysis, the final computed sample size was 80 patients (40 per group). DISCUSSION: HFNT is more comfortable than NIV in COPD patients recovering from an episode of exacerbation. If HFNT would not be inferior to NIV, HFNT could be considered as an alternative to NIV to treat COPD patients with mild-to-moderate respiratory acidosis. TRIAL REGISTRATION: ClinicalTrials.gov, NCT03370666 . Registered on December 12, 2017.


Assuntos
Hipercapnia/terapia , Pulmão/fisiopatologia , Ventilação não Invasiva , Oxigenoterapia/métodos , Doença Pulmonar Obstrutiva Crônica/terapia , Insuficiência Respiratória/terapia , Doença Aguda , Estudos de Equivalência como Asunto , Humanos , Hipercapnia/diagnóstico , Hipercapnia/fisiopatologia , Itália , Estudos Multicêntricos como Assunto , Ventilação não Invasiva/efeitos adversos , Oxigenoterapia/efeitos adversos , Estudos Prospectivos , Doença Pulmonar Obstrutiva Crônica/diagnóstico , Doença Pulmonar Obstrutiva Crônica/fisiopatologia , Insuficiência Respiratória/diagnóstico , Insuficiência Respiratória/fisiopatologia , Fatores de Tempo , Resultado do Tratamento
18.
Br J Anaesth ; 123(3): 378-391, 2019 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-31331649

RESUMO

Respiratory depression is common in patients recovering from surgery and anaesthesia. Failure to recognise and lack of timely institution of intervention can lead to catastrophic cardiorespiratory arrest, anoxic brain injury, and mortality. Opioid-induced respiratory depression (OIRD) is a common and often under-diagnosed cause of postoperative respiratory depression. Other causes include residual anaesthesia, residual muscle paralysis, concurrent use of other sedatives, splinting from inadequate pain control, and obstructive sleep apnoea. Currently used methods to identify and monitor respiratory safety events in the post-surgical setting have serious limitations leading to lack of universal adoption. New tools and technologies currently under development are expected to improve the prediction of respiratory depression especially in patients requiring opioids to alleviate acute postoperative pain. In this narrative review, we discuss the various causes of postoperative respiratory depression, and highlight the advances in monitoring and early recognition of patients who develop this condition with an emphasis on OIRD.


Assuntos
Monitorização Fisiológica/métodos , Cuidados Pós-Operatórios/métodos , Complicações Pós-Operatórias/diagnóstico , Insuficiência Respiratória/diagnóstico , Analgésicos Opioides/efeitos adversos , Analgésicos Opioides/uso terapêutico , Diagnóstico Precoce , Humanos , Monitorização Fisiológica/tendências , Dor Pós-Operatória/tratamento farmacológico , Cuidados Pós-Operatórios/tendências , Complicações Pós-Operatórias/etiologia , Complicações Pós-Operatórias/terapia , Insuficiência Respiratória/etiologia , Insuficiência Respiratória/terapia
19.
Health Qual Life Outcomes ; 17(1): 95, 2019 Jun 03.
Artigo em Inglês | MEDLINE | ID: mdl-31159830

RESUMO

BACKGROUND: Dyspnea is frequent in amyotrophic lateral sclerosis (ALS) and one of the most bothersome symptoms. The recently developed Dyspnea-ALS-Scale (DALS-15) is a disease-specific patient-reported outcome to detect and quantify dyspnea. OBJECTIVES: To analyze in a case-based approach the diagnostic and clinical implications and the benefit of the DALS-15 for individual patients in daily clinical routine. METHODS: Dyspnea was assessed by the 15-item comprising DALS-15 in two patients with ALS. Spirometry was performed and blood gases were analyzed. Results were evaluated in the clinical context of the respective patients. RESULTS: In one patient the presence of dyspnea detected by the DALS-15 indicated noninvasive ventilation (NIV) although forced vital capacity (FVC) and blood gas analysis were well preserved. After NIV implementation, the DALS-15 was helpful to determine the patient's need for medication, the timing of NIV titration and the adaptation of NIV sessions. In another patient, who was anarthric and no longer able to perform spirometry due to severe bulbar impairment, the DALS-15 allowed a standardized assessment of dyspnea-related distress independently of bulbar dysfunction. CONCLUSION: The DALS-15 provides a deeper insight into the respiratory status of individual patients. It helps to diagnose respiratory impairment in patients in whom NIV should be considered although FVC and blood gas results do not reveal indication for NIV. It is also valuable for the guidance of patients in later stages of respiratory impairment when NIV is already implemented, and in patients with severe bulbar dysfunction. The DALS-15 can improve specific symptom management and coordination of care and therefore has the potential to optimize individual treatment in ALS patients with dyspnea.


Assuntos
Esclerose Amiotrófica Lateral/fisiopatologia , Dispneia/diagnóstico , Medidas de Resultados Relatados pelo Paciente , Qualidade de Vida , Insuficiência Respiratória/diagnóstico , Idoso , Esclerose Amiotrófica Lateral/complicações , Esclerose Amiotrófica Lateral/terapia , Progressão da Doença , Dispneia/etiologia , Dispneia/terapia , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Insuficiência Respiratória/etiologia , Insuficiência Respiratória/terapia
20.
Trials ; 20(1): 336, 2019 Jun 08.
Artigo em Inglês | MEDLINE | ID: mdl-31176375

RESUMO

BACKGROUND: The benefit of pulmonary rehabilitation (PR) in symptomatic chronic obstructive pulmonary disease (COPD) is well known. However, advanced patients with chronic respiratory failure (CRF), a category excluded from most studies, are frequently unable to sustain a work-load sufficiently high to obtain the full benefit of PR on exercise tolerance. Recent studies involving heated and humidified high flow oxygen therapy (HFOT) showed positive effects on breathing pattern and ventilatory efficiency during effort. We thus plan to compare, in COPD patients with CRF undergoing a high-intensity exercise programme, the effect of using HFOT versus standard oxygen delivery via Venturi Mask (V-mask), at the same inspiratory oxygen fraction, on improving exercise endurance. METHODS/DESIGN: This is a multicentre randomised controlled trial that will involve 156 COPD inpatients with CRF recruited from seven PR hospitals. Patients will be randomised to one of two groups - V-mask versus HFOT. All patients will undergo the same high-intensity exercise programme using either of the oxygen delivery devices as per their group allocation. Training will consist of 20 sessions, over 1 month (5 sessions per week) within the hospitalisation period. Anthropometric and clinical data, including body mass index, diagnosis, spirometry and comorbidities (Cumulative Rating Scale) will be collected at baseline. At baseline and at the end of the exercise programme (primary assessment time) evaluation will include exercise tolerance (Constant Work Rate Exercise Test) (primary outcome), functional capacity (6-min walk test), maximal inspiratory pressure/maximal expiratory pressure, peripheral muscle strength (biceps and quadriceps) by manual dynamometer, respiratory exchanges (blood gases analysis), disability (Barthel Index and Barthel Dyspnoea Index), impact of disease (COPD Assessment test), and quality of life (Maugeri Respiratory Failure Scale-26). At the end of the training period, patient satisfaction will be evaluated. DISCUSSION: This study will add knowledge about the exercise response in advanced COPD with CRF and verify if an alternative tool, namely HFOT, can increase the benefit obtained from PR. TRIAL REGISTRATION: ClinicalTrials.gov ID NET03322787 Registered: 6 November 2017.


Assuntos
Cânula , Terapia por Exercício , Tolerância ao Exercício , Pulmão/fisiopatologia , Oxigenoterapia/instrumentação , Doença Pulmonar Obstrutiva Crônica/terapia , Respiração , Insuficiência Respiratória/terapia , Administração Intranasal , Humanos , Itália , Estudos Multicêntricos como Assunto , Doença Pulmonar Obstrutiva Crônica/diagnóstico , Doença Pulmonar Obstrutiva Crônica/fisiopatologia , Ensaios Clínicos Controlados Aleatórios como Assunto , Recuperação de Função Fisiológica , Insuficiência Respiratória/diagnóstico , Insuficiência Respiratória/fisiopatologia , Fatores de Tempo , Resultado do Tratamento
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