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1.
Sci Rep ; 11(1): 17730, 2021 09 06.
Artigo em Inglês | MEDLINE | ID: mdl-34489504

RESUMO

The efficacy of non-invasive ventilation (NIV) in acute respiratory failure secondary to SARS-CoV-2 infection remains controversial. Current literature mainly examined efficacy, safety and potential predictors of NIV failure provided out of the intensive care unit (ICU). On the contrary, the outcomes of ICU patients, intubated after NIV failure, remain to be explored. The aims of the present study are: (1) investigating in-hospital mortality in coronavirus disease 2019 (COVID-19) ICU patients receiving endotracheal intubation after NIV failure and (2) assessing whether the length of NIV application affects patient survival. This observational multicenter study included all consecutive COVID-19 adult patients, admitted into the twenty-five ICUs of the COVID-19 VENETO ICU network (February-April 2020), who underwent endotracheal intubation after NIV failure. Among the 704 patients admitted to ICU during the study period, 280 (40%) presented the inclusion criteria and were enrolled. The median age was 69 [60-76] years; 219 patients (78%) were male. In-hospital mortality was 43%. Only the length of NIV application before ICU admission (OR 2.03 (95% CI 1.06-4.98), p = 0.03) and age (OR 1.18 (95% CI 1.04-1.33), p < 0.01) were identified as independent risk factors of in-hospital mortality; whilst the length of NIV after ICU admission did not affect patient outcome. In-hospital mortality of ICU patients intubated after NIV failure was 43%. Days on NIV before ICU admission and age were assessed to be potential risk factors of greater in-hospital mortality.


Assuntos
COVID-19/terapia , Unidades de Terapia Intensiva/estatística & dados numéricos , Intubação Intratraqueal/métodos , Ventilação não Invasiva/métodos , Insuficiência Respiratória/terapia , Idoso , COVID-19/complicações , COVID-19/virologia , Feminino , Mortalidade Hospitalar , Humanos , Modelos Logísticos , Masculino , Pessoa de Meia-Idade , Análise Multivariada , Avaliação de Resultados em Cuidados de Saúde/métodos , Avaliação de Resultados em Cuidados de Saúde/estatística & dados numéricos , Insuficiência Respiratória/etiologia , Fatores de Risco , SARS-CoV-2/fisiologia
2.
Medicine (Baltimore) ; 100(36): e27188, 2021 Sep 10.
Artigo em Inglês | MEDLINE | ID: mdl-34516521

RESUMO

ABSTRACT: In this study, we investigated the correlation between airway assessment tests, anthropometric measurements, and the Modified Cormack- Lehane Classification (MCLC) assessed by videolaryngoscopy in patients undergoing bariatric surgery.This study included 121 morbidly obese patients undergoing bariatric surgery. The body mass index, Modified Mallampati Score (MMS), thyromental distance, sternomental distance, interincisor distance, and neck, waist, and chest circumferences were recorded. The correlation between the airway assessment tests, anthropometric parameters, and the MCLC were analyzed. The time required for endotracheal intubation (EI) and the attempt required for EI were also recorded.Thirty-three patients were found to be at risk of a difficult EI. The MMS, neck circumference, waist circumference, chest circumference, the time required for EI, and the number of attempts for EI were positively correlated with MCLC (all P < .05). As the MMS increased, the risk of a difficult EI increased (P < .001). The cutoff values of neck, waist, and chest circumference for the risk of a difficult EI were 41.5, 153.5, and 147.5 cm, respectively (P < .05).This study indicates that the high MMS, as well as increased neck, waist, and chest circumference, should be considered EI difficulty in obese patients, even if a videolaryngoscopy is used.


Assuntos
Intubação Intratraqueal , Obesidade Mórbida/cirurgia , Adolescente , Adulto , Idoso , Antropometria , Cirurgia Bariátrica , Índice de Massa Corporal , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Estudos Prospectivos , Reprodutibilidade dos Testes , Adulto Jovem
4.
J Spec Oper Med ; 21(3): 45-50, 2021.
Artigo em Inglês | MEDLINE | ID: mdl-34529804

RESUMO

The use of a nasopharyngeal airway (NPA) as an adjunct airway device can be critically important in emergency medicine. When placed correctly, the device can prevent upper airway obstruction. The goal of our review was to learn whether there is scientific evidence about the correct length and the insertion depth, and also possible facial landmarks, that can predict the appropriate length of the NPA. There has been no real consensus on how to measure the appropriate tube length for the NPA. Several studies have been able to demonstrate correlations between facial landmarks and body dimensions; however, we did not find any scientific evidence on this matter. The reviewed studies do not indicate evidence to support current recommended guidelines. This could potentially lead to both military and civilian emergency training programs not having the most accurate scientific information for training on anatomic structures and also not having a better overall understanding of intraoral dimensions. Emergency personnel should be taught validated scientific knowledge of NPAs so as to quickly determine the correct tube length and how to use anatomic correlations. This might require further studies on the correlations and perhaps radiographic measurements. A further approach includes adjusting the tube to its correct length according to the sufficient assessment and management of the airway problem.


Assuntos
Medicina de Emergência , Militares , Adulto , Humanos , Intubação Intratraqueal
5.
J Int Med Res ; 49(9): 3000605211043245, 2021 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-34521241

RESUMO

OBJECTIVE: Pulmonary complication is common in older patients after surgery. We analyzed risk factors of lower respiratory tract infection after general anesthesia among older patients. METHODS: In this retrospective investigation, we included older patients who underwent surgery with general anesthesia. Logistic regression analyses were performed to determine risk factors of lower respiratory tract infection. RESULTS: A total 418 postoperative patients with general anesthesia were included; the incidence of lower respiratory tract infection was 9.33%. Ten cases were caused by gram-positive bacteria, 26 cases by gram-negative bacteria, and 2 cases by fungus. We found significant differences in age, smoking, diabetes, oral/nasal tracheal intubation, and surgery duration. Logistic regression analysis indicated that age ≥70 years (odds ratio [OR] 2.028, 95% confidence interval [CI] 1.115-3.646), smoking (OR 2.314, 95% CI 1.073-4.229), diabetes (OR 2.185, 95% CI 1.166-4.435), nasotracheal intubation (OR 3.528, 95% CI 1.104-5.074), and duration of surgery ≥180 minutes (OR 1.334, 95% CI 1.015-1.923) were independent risk factors of lower respiratory tract infections. CONCLUSIONS: Older patients undergoing general anesthesia after tracheal intubation have a high risk of lower respiratory tract infections. Clinical interventions should be provided to prevent pulmonary infections in patients with relevant risk factors.


Assuntos
Anestesia Geral , Infecções Respiratórias , Idoso , Anestesia Geral/efeitos adversos , Humanos , Intubação Intratraqueal , Complicações Pós-Operatórias/epidemiologia , Complicações Pós-Operatórias/etiologia , Infecções Respiratórias/epidemiologia , Infecções Respiratórias/etiologia , Estudos Retrospectivos , Fatores de Risco
6.
Scand J Trauma Resusc Emerg Med ; 29(1): 136, 2021 Sep 15.
Artigo em Inglês | MEDLINE | ID: mdl-34526085

RESUMO

BACKGROUND: Rapid Sequence Induction (RSI) is used for emergency tracheal intubation to minimise the risk of pulmonary aspiration of stomach contents. Ketamine and propofol are two commonly used induction agents for RSI in trauma patients. Yet, no consensus exists on the optimal induction agent for RSI in the trauma population. The aim of this study was to compare 30-day mortality in trauma patients after emergency intubation prehospitally or within 30 min after arrival in the trauma centre using either ketamine or propofol for RSI. METHODS: In this investigator-initiated, retrospective study we included adult trauma patients emergently intubated with ketamine or propofol registered in the local trauma registry at Rigshospitalet, a tertiary university hospital that hosts a level-1 trauma centre. The primary outcome was 30-day mortality. Secondary outcomes included hospital and Intensive Care Unit length of stay as well as duration of mechanical ventilation. We analysed outcomes using multivariable logistic regression models adjusting for age, sex, injury severity score, shock (systolic blood pressure < 90 mmHg) and Glasgow Coma Scale score before intubation and present results as odds ratios (ORs) with 95% confidence intervals. RESULTS: From January 1st, 2015 through December 31st, 2019 we identified a total of 548 eligible patients. A total of 228 and 320 patients received ketamine and propofol, respectively. The 30-day mortality for patients receiving ketamine and propofol was 20.2% and 22.8% (P = 0.46), respectively. Adjusted OR for 30-day mortality was 0.98 [0.58-1.66], P = 0.93. We found no significant association between type of induction agent and hospital length of stay, Intensive Care Unit length of stay or duration of mechanical ventilation. CONCLUSIONS: In this study, trauma patients intubated with ketamine did not have a lower 30-day mortality as compared with propofol.


Assuntos
Ketamina , Propofol , Adulto , Humanos , Escala de Gravidade do Ferimento , Intubação Intratraqueal , Indução e Intubação de Sequência Rápida , Estudos Retrospectivos
7.
JNMA J Nepal Med Assoc ; 59(238): 554-557, 2021 Jul 01.
Artigo em Inglês | MEDLINE | ID: mdl-34508397

RESUMO

INTRODUCTION: Laryngoscopy and intubation are stressful as they lead to a rise in heart rate and blood pressure. Though transient, it may be detrimental to the cardiac and neurosurgical patients. There is a need to explore the possibility of obtunding the pressor response to laryngoscopy and intubation with the use of McCoy blade laryngoscope. We aimed to find out the hemodynamic response to laryngoscopy and intubation using McCoy laryngoscope in adult patients undergoing general anesthesia. METHODS: The descriptive cross-sectional study was conducted in 37 American Society of Anesthesiologists' Physical Status I/IIpatients, with normal airway from December 2019- May 2020 in a tertiary care hospital. Ethical approval was obtained from Institutional Research Committee (reference number.: MEMG/IRC/290/GA). Convenience sampling method was used. The mean systolic and diastolic blood pressures were measured at baseline, one, three and five minutes after laryngoscopy and intubation. Data were analyzed using the Statistical Package for the Social Sciences Version 21.0. RESULTS: In the first minute after laryngoscopy and intubation, the rise in mean blood pressure was noted in 14 (37.83%) cases. The peak rise in mean blood pressure was 3%, note done minute after laryngoscopy and intubation. CONCLUSIONS: We noted better attenuation of pressor response to laryngoscopy and intubation using McCoy blade laryngoscope in adult patients undergoing general anesthesia.


Assuntos
Laringoscópios , Laringoscopia , Adulto , Estudos Transversais , Hemodinâmica , Humanos , Intubação Intratraqueal
8.
Respir Res ; 22(1): 245, 2021 Sep 15.
Artigo em Inglês | MEDLINE | ID: mdl-34526033

RESUMO

BACKGROUND: We performed a multicenter, randomized open-label trial in patients with moderate to severe Covid-19 treated with a range of possible treatment regimens. METHODS: Patients were randomly assigned to one of three regimen groups at a ratio of 1:1:1. The primary outcome of this study was admission to the intensive care unit. Secondary outcomes were intubation, in-hospital mortality, time to clinical recovery, and length of hospital stay (LOS). Between April 13 and August 9, 2020, a total of 336 patients were randomly assigned to receive one of the 3 treatment regimens including group I (hydroxychloroquine stat, prednisolone, azithromycin and naproxen; 120 patients), group II (hydroxychloroquine stat, azithromycin and naproxen; 116 patients), and group III (hydroxychloroquine and lopinavir/ritonavir (116 patients). The mean LOS in patients receiving prednisolone was 5.5 in the modified intention-to-treat (mITT) population and 4.4 days in the per-protocol (PP) population compared with 6.4 days (mITT population) and 5.8 days (PP population) in patients treated with Lopinavir/Ritonavir. RESULTS: The mean LOS was significantly lower in the mITT and PP populations who received prednisolone compared with populations treated with Lopinavir/Ritonavir (p = 0.028; p = 0.0007). We observed no significant differences in the number of deaths, ICU admission, and need for mechanical ventilation between the Modified ITT and per-protocol populations treated with prednisolone and Lopinavir/Ritonavir, although these outcomes were better in the arm treated with prednisolone. The time to clinical recovery was similar in the modified ITT and per-protocol populations treated with prednisolone, lopinavir/ritonavir, and azithromycin (P = 0.335; P = 0.055; p = 0.291; p = 0.098). CONCLUSION: The results of the present study show that therapeutic regimen (regimen I) with low dose prednisolone was superior to other regimens in shortening the length of hospital stay in patients with moderate to severe COVID-19. The steroid sparing effect may be utilized to increase the effectiveness of corticosteroids in the management of diabetic patients by decreasing the dosage.


Assuntos
COVID-19/tratamento farmacológico , Glucocorticoides/uso terapêutico , Prednisolona/uso terapêutico , Adulto , Idoso , Antivirais/uso terapêutico , COVID-19/diagnóstico , COVID-19/mortalidade , COVID-19/virologia , Quimioterapia Combinada , Feminino , Glucocorticoides/efeitos adversos , Mortalidade Hospitalar , Humanos , Unidades de Terapia Intensiva , Intubação Intratraqueal , Irã (Geográfico) , Tempo de Internação , Masculino , Pessoa de Meia-Idade , Prednisolona/efeitos adversos , Índice de Gravidade de Doença , Fatores de Tempo , Resultado do Tratamento
9.
Artigo em Inglês | MEDLINE | ID: mdl-34403577

RESUMO

PURPOSE: We developed a virtual reality (VR) endotracheal intubation training that applied 2 interaction modalities (hand-tracking or controllers). It aimed to investigate the differences in usability between using hand tracking and controllers during the VR intervention for intubation training for medical students from February 2021 to March 2021 in Thailand. METHODS: Forty-five participants were divided into 3 groups: video only, video with VR controller training, and video with VR hand tracking training. Pre-test, post-test, and practice scores were used to assess learning outcomes. The System Usability Scale (SUS) and User Satisfaction Evaluation Questionnaire (USEQ) questionnaires were used to evaluate the differences between the VR groups. The sample comprised 45 medical students (undergraduate) who were taking part in clinical training at Walailak University in Thailand. RESULTS: The overall learning outcomes of both VR groups were better than those of the video group. The post-test scores (P=0.581) and practice scores (P=0.168) of both VR groups were not significantly different. Similarly, no significant between-group differences were found in the SUS scores (P=0.588) or in any aspects of the USEQ scores. CONCLUSION: VR enhanced medical training. Interactions using hand tracking or controllers were not significantly different in terms of the outcomes measured in this study. The results and interviews provided a better understanding of support learning and training, which will be further improved and developed to create a self-learning VR medical training system in the future.


Assuntos
Estudantes de Medicina , Realidade Virtual , Humanos , Intubação Intratraqueal , Aprendizagem , Tailândia
14.
JAMA Netw Open ; 4(8): e2120456, 2021 08 02.
Artigo em Inglês | MEDLINE | ID: mdl-34379123

RESUMO

Importance: Prior studies on COVID-19 and pregnancy have reported higher rates of cesarean delivery and preterm birth and increased morbidity and mortality. Additional data encompassing a longer time period are needed. Objective: To examine characteristics and outcomes of a large US cohort of women who underwent childbirth with vs without COVID-19. Design, Setting, and Participants: This cohort study compared characteristics and outcomes of women (age ≥18 years) who underwent childbirth with vs without COVID-19 between March 1, 2020, and February 28, 2021, at 499 US academic medical centers or community affiliates. Follow-up was limited to in-hospital course and discharge destination. Childbirth was defined by clinical classification software procedural codes of 134-137. A diagnosis of COVID-19 was identified using International Statistical Classification of Diseases and Related Health Problems, Tenth Revision (ICD-10) diagnosis of U07.1. Data were analyzed from April 1 to April 30, 2021. Exposures: The presence of a COVID-19 diagnosis using ICD-10. Main Outcomes and Measures: Analyses compared demographic characteristics, gestational age, and comorbidities. The primary outcome was in-hospital mortality. Secondary outcomes included hospital length of stay, intensive care unit (ICU) admission, mechanical ventilation, and discharge status. Continuous variables were analyzed using t test, and categorical variables were analyzed using χ2. Results: Among 869 079 women, 18 715 (2.2%) had COVID-19, and 850 364 (97.8%) did not. Most women were aged 18 to 30 years (11 550 women with COVID-19 [61.7%]; 447 534 women without COVID-19 [52.6%]) and were White (8060 White women [43.1%] in the COVID-19 cohort; 499 501 White women (58.7%) in the non-COVID-19 cohort). There was no significant increase in cesarean delivery among women with COVID-19 (6088 women [32.5%] vs 273 810 women [32.3%]; P = .57). Women with COVID-19 were more likely to have preterm birth (3072 women [16.4%] vs 97 967 women [11.5%]; P < .001). Women giving birth with COVID-19, compared with women without COVID-19, had significantly higher rates of ICU admission (977 women [5.2%] vs 7943 women [0.9%]; odds ratio [OR], 5.84 [95% CI, 5.46-6.25]; P < .001), respiratory intubation and mechanical ventilation (275 women [1.5%] vs 884 women [0.1%]; OR, 14.33 [95% CI, 12.50-16.42]; P < .001), and in-hospital mortality (24 women [0.1%] vs 71 [<0.01%]; OR, 15.38 [95% CI, 9.68-24.43]; P < .001). Conclusions and Relevance: This retrospective cohort study found that women with COVID-19 giving birth had higher rates of mortality, intubation, ICU admission, and preterm birth than women without COVID-19.


Assuntos
COVID-19/mortalidade , Unidades de Terapia Intensiva/estatística & dados numéricos , Nascimento Prematuro/epidemiologia , Centros Médicos Acadêmicos/estatística & dados numéricos , Adolescente , Adulto , COVID-19/terapia , Estudos de Casos e Controles , Cesárea/estatística & dados numéricos , Bases de Dados Factuais , Feminino , Mortalidade Hospitalar , Humanos , Intubação Intratraqueal/estatística & dados numéricos , Tempo de Internação/estatística & dados numéricos , Pessoa de Meia-Idade , Pandemias , Gravidez , Complicações Infecciosas na Gravidez/mortalidade , Complicações Infecciosas na Gravidez/terapia , Estudos Retrospectivos , SARS-CoV-2 , Estados Unidos/epidemiologia , Adulto Jovem
15.
Pan Afr Med J ; 39: 61, 2021.
Artigo em Francês | MEDLINE | ID: mdl-34422184

RESUMO

Enteroscopy has become an indispensable technique for the exploration and, in particular, the treatment of small intestine lesions. It is usually performed following video capsule endoscopy of the small intestine. Three equivalent techniques exist: double balloon enteroscopy, single balloon enteroscopy and spiral enteroscopy. The purpose of this study is to describe the technical feasibility of single balloon enteroscopy as well as its tolerance, indications and the results obtained in our context. We conducted a retrospective and descriptive analysis of the records of patients undergoing single balloon enteroscopy in the Department of Gastroenterology at the Mohammed V Training Military Hospital in Rabat over an 8-year period. Inclusion criteria were: small intestine disease or the suspicion of small intestine disease on imaging tests or video-capsule endoscopy and having undergone single balloon enteroscopy. The variables studied were the technical feasibility of single balloon enteroscopy, its indications, results and complications. Fifty-one (51) patients, including 30 men and 21 women with an average age of 48 years (18 years-91 years), were included in the study. The technique used in all patients was single balloon enteroscopy under general anesthesia with intubation. The mean duration of single balloon enteroscopy via the upper gastrointestinal (GI) tract (antegrade) was 45 min and 60 min via the lower GI tract (retrograde). The small intestine was explored up to the proximal ileum via the upper gastrointestinal (GI) tract and through more than 120cm from IAD via the lower GI tract. The indications included: unexplained digestive bleeding (72%), small intestine wall thickening (17%), the suspicion of small intestine tumor (6%), evaluation of Crohn´s disease (4%) and endoscopic video capsule (ECV) reduction (2%). Diagnosis was made or confirmed in 29 patients, reflecting a diagnostic efficiency of 57%. Angiodysplasia accounted for 70% of the lesions, ulcerations 10%, stenoses 7%, tumors 7%, diverticula 3% and spontaneous ECV reduction 3%. Endoscopic treatment was performed in 20 patients, with a therapeutic efficiency of 39%; it was based on argon plasma coagulation of gastroenteric angiodysplasia lesions. No complications were observed in our case series. Single balloon enteroscopy is a well-tolerated examination which allows for the exploration of a long portion of the small intestine. Multiple and various indications were provided in our study and the diagnostic and therapeutic benefits were satisfactory.


Assuntos
Endoscopia por Cápsula/métodos , Enteropatias/diagnóstico , Enteroscopia de Balão Único/métodos , Adolescente , Adulto , Idoso , Idoso de 80 Anos ou mais , Anestesia Geral/métodos , Estudos de Viabilidade , Feminino , Hospitais Militares , Humanos , Enteropatias/fisiopatologia , Intestino Delgado , Intubação Intratraqueal , Masculino , Pessoa de Meia-Idade , Marrocos , Estudos Retrospectivos , Adulto Jovem
16.
Ned Tijdschr Geneeskd ; 1652021 05 19.
Artigo em Holandês | MEDLINE | ID: mdl-34346609

RESUMO

OBJECTIVE: To determine the safety of the non-intubated and intubated adenotonsillectomy by the Sluder method in children DESIGN: Retrospective database study METHOD: We compared the data of adenotonsillectomy by the Sluder method in children until thirteen years of two teaching hospitals from 2014 until 2017. In the Amphia Hospital the procedure was performed without endotracheal tube placement and without perioperative opioids, in the Haga Hospital the patients were intubated and received perioperative opioids. Primary outcome was reoperation for postoperative haemorrhage. Secondary outcomes included desaturation (saturation ≤ 90% > 1 min), severe hypoxemia (saturation ≤ 85% for ≥ 5 min), airway complications, bradycardia, total postoperative haemorrhages, use of rescue medication, hospital readmission and 30-day mortality. RESULTS: A total of 1370 patients were analysed: 1267 adenotonsillectomies and 103 tonsillectomies. Median operation time was 7 minutes in the non-intubated group versus 12 minutes in the intubated group. The primary outcome occurred in thirteen patients in the group without intubation (2.2%) and eleven times in the group with intubation (1.4%). There was one case of severe hypoxemia in the group without intubation. Desaturation occurred mostly in the group without intubation (26.4%) for a short time (median 0 min, interquartile range 0-1). Bradycardia was seen more in the group with intubation (4.1% vs 2.2%). CONCLUSION: The incidence of postoperative haemorrhage and severe airway complications after adenotonsillectomy by the Sluder method with and without endotracheal tube placement in both groups was comparable.


Assuntos
Tonsilectomia , Adenoidectomia , Criança , Humanos , Hipóxia/epidemiologia , Hipóxia/etiologia , Intubação Intratraqueal , Estudos Retrospectivos , Tonsilectomia/efeitos adversos
17.
19.
N Engl J Med ; 385(7): 668-669, 2021 08 12.
Artigo em Inglês | MEDLINE | ID: mdl-34379937
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