Your browser doesn't support javascript.
loading
Mostrar: 20 | 50 | 100
Resultados 1 - 20 de 3.499
Filtrar
1.
Zhonghua Jie He He Hu Xi Za Zhi ; 44(2): 101-107, 2021 Feb 12.
Artigo em Chinês | MEDLINE | ID: mdl-33535324

RESUMO

Objective: To explore the value of night pulse oximetry monitoring in the prediction and classification of obstructive sleep apnea hypopnea syndrome (OSAHS). Methods: From January 2018 to December 2019, 580 snoring patients admitted to the Sleep Center of Tianjin Medical University General Hospital were analyzed retrospectively. There were 418 males and 162 females, aging 13-85(49±14) years. All subjects underwent polysomnography, and the apnea hypopnea index (AHI)was 0-101.4(43.06±27.47) times/hour. There were 52 cases in the non-OSAHS group (AHI<5 times/h), 69 cases in the mild OSAHS group (5 times/h30 times/h) was 94.74%±0.76%. Conclusion: Based on the signals recorded by the SpO2 monitor, the methods of using MLR model for AHI prediction and using BPNN model for multi-classification may have higher value for the prediction and classification of OSAHS.


Assuntos
Monitorização Fisiológica/instrumentação , Oximetria/métodos , Polissonografia/métodos , Apneia Obstrutiva do Sono/diagnóstico , Adulto , Idoso , Índice de Massa Corporal , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Estudos Retrospectivos , Sensibilidade e Especificidade , Ronco/diagnóstico
2.
Anaesthesia ; 76(1): 54-60, 2021 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-32592515

RESUMO

Pre-operative anaemia (haemoglobin < 13.0 g.dl-1 ) is a modifiable peri-operative risk-factor. This is screened for using formal laboratory testing. A non-invasive finger-probe sensor that can accurately measure haemoglobin is a possible alternative. This study considers the accuracy of non-invasive haemoglobin measurement using the Rad-67™ Rainbow (Masimo Corp., Irvine, CA, USA) compared with formal laboratory testing and its usefulness in detecting pre-operative anaemia. A total of 392 patients had measurements taken for non-invasive haemoglobin and perfusion index values using the Rad-67 Rainbow, alongside further peri-operative parameters and a formal laboratory haemoglobin test. Bland-Altman and sensitivity analysis showed that the limits of agreement between non-invasive and formal laboratory haemoglobin testing were between -1.95 g.dl-1 and 2.23 g.dl-1 (p < 0.001). The overall performance of non-invasive haemoglobin measurement was better in men than women (ROC 91.1% vs. 78.2%) and less biased in men, mean -0.08 (SD 1.09, 95%Cl -0.23-0.07) compared with women (mean 0.38 (SD 0.99, 95%CI 0.24-0.52)). Pre-operative anaemia was more prevalent in women than men (50.3% vs. 14.4%). The sensitivity of non-invasive anaemia detection (haemoglobin < 13 g.dl-1 ) was 66% for women and 52% for men. A non-invasive haemoglobin value of 14.0 g.dl-1 had an overall 91% sensitivity for detecting pre-operative anaemia (82% in men and 93% in women). The Rad-67 Rainbow is inadequate for the estimation of formal laboratory haemoglobin and lacks sensitivity for detecting pre-operative anaemia, especially in women. Further advancement in technology and accuracy is needed before it can be recommended as a routine pre-operative screening test.


Assuntos
Anemia/diagnóstico , Hemoglobinometria/métodos , Oximetria/métodos , Cuidados Pré-Operatórios/métodos , Adulto , Idoso , Anemia/epidemiologia , Feminino , Humanos , Masculino , Programas de Rastreamento , Pessoa de Meia-Idade , Perfusão , Estudos Prospectivos , Curva ROC , Fatores Sexuais
3.
Monaldi Arch Chest Dis ; 90(4)2020 Dec 23.
Artigo em Inglês | MEDLINE | ID: mdl-33372742

RESUMO

COVID-19 pneumonia has a significant case fatality rate and no effective antiviral drugs are available even after 9 months of the pandemic. The spectrum of COVID-19 disease ranges from asymptomatic cases to severe ARDS with myriad manifestations. Here we report a case of a male patient with severe COVID-19 ARDS who improved after receiving standard therapy but again 'deteriorated' after being stepped down to ward. He complained of worsening shortness of breath and hypoxemia which was found to be mainly positional. After ruling out other causes, he was labeled as a case of platypnea-orthodeoxia syndrome due to underlying lung involvement.  It is important to be aware of this condition in the context of COVID-19 which can be easily diagnosed bedside with pulse oximetry.


Assuntos
Dispneia , Hipóxia , Pulmão , Posicionamento do Paciente/métodos , Pneumonia Viral , Idoso , /fisiopatologia , Deterioração Clínica , Diagnóstico Diferencial , Dispneia/diagnóstico , Dispneia/etiologia , Humanos , Hipóxia/diagnóstico , Hipóxia/etiologia , Pulmão/diagnóstico por imagem , Pulmão/fisiopatologia , Masculino , Oximetria/métodos , Oxigenoterapia/métodos , Administração dos Cuidados ao Paciente , Pneumonia Viral/diagnóstico , Pneumonia Viral/etiologia , Pneumonia Viral/fisiopatologia , Pneumonia Viral/terapia , Testes de Função Respiratória/métodos , Síndrome , Tomografia Computadorizada por Raios X/métodos
4.
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
5.
J Vis Exp ; (162)2020 08 19.
Artigo em Inglês | MEDLINE | ID: mdl-32894267

RESUMO

Near infrared spectroscopy (NIRS) calculates regional tissue oxygenation (rSO2) using the different absorption spectra of oxygenated and deoxygenated hemoglobin molecules. A probe placed on the skin emits light that is absorbed, scattered, and reflected by the underlying tissue. Detectors in the probe sense the amount of reflected light: this reflects the organ-specific ratio of oxygen supply and consumption - independent of pulsatile flow. Modern devices enable the simultaneous monitoring at different body sites. A rise or dip in the rSO2 curve visualizes changes in oxygen supply or demand before vital signs indicate them. The evolution of rSO2 values in relation to the starting point is more important for interpretation than are absolute values. A routine clinical application of NIRS is the surveillance of somatic and cerebral oxygenation during and after cardiac surgery. It is also administered in preterm infants at risk for necrotizing enterocolitis, newborns with hypoxic ischemic encephalopathy and a potential risk of impaired tissue oxygenation. In the future, NIRS could be increasingly used in multimodal neuromonitoring, or applied to monitor patients with other conditions (e.g., after resuscitation or traumatic brain injury).


Assuntos
Estado Terminal , Oximetria/métodos , Espectroscopia de Luz Próxima ao Infravermelho , Criança , Humanos , Lactente , Recém-Nascido , Masculino , Oximetria/instrumentação , Consumo de Oxigênio/fisiologia , Oxiemoglobinas/análise
6.
Anesth Analg ; 131(4): 1012-1024, 2020 10.
Artigo em Inglês | MEDLINE | ID: mdl-32925318

RESUMO

BACKGROUND: Opioid-related adverse events are a serious problem in hospitalized patients. Little is known about patients who are likely to experience opioid-induced respiratory depression events on the general care floor and may benefit from improved monitoring and early intervention. The trial objective was to derive and validate a risk prediction tool for respiratory depression in patients receiving opioids, as detected by continuous pulse oximetry and capnography monitoring. METHODS: PRediction of Opioid-induced respiratory Depression In patients monitored by capnoGraphY (PRODIGY) was a prospective, observational trial of blinded continuous capnography and oximetry conducted at 16 sites in the United States, Europe, and Asia. Vital signs were intermittently monitored per standard of care. A total of 1335 patients receiving parenteral opioids and continuously monitored on the general care floor were included in the analysis. A respiratory depression episode was defined as respiratory rate ≤5 breaths/min (bpm), oxygen saturation ≤85%, or end-tidal carbon dioxide ≤15 or ≥60 mm Hg for ≥3 minutes; apnea episode lasting >30 seconds; or any respiratory opioid-related adverse event. A risk prediction tool was derived using a multivariable logistic regression model of 46 a priori defined risk factors with stepwise selection and was internally validated by bootstrapping. RESULTS: One or more respiratory depression episodes were detected in 614 (46%) of 1335 general care floor patients (43% male; mean age, 58 ± 14 years) continuously monitored for a median of 24 hours (interquartile range [IQR], 17-26). A multivariable respiratory depression prediction model with area under the curve of 0.740 was developed using 5 independent variables: age ≥60 (in decades), sex, opioid naivety, sleep disorders, and chronic heart failure. The PRODIGY risk prediction tool showed significant separation between patients with and without respiratory depression (P < .001) and an odds ratio of 6.07 (95% confidence interval [CI], 4.44-8.30; P < .001) between the high- and low-risk groups. Compared to patients without respiratory depression episodes, mean hospital length of stay was 3 days longer in patients with ≥1 respiratory depression episode (10.5 ± 10.8 vs 7.7 ± 7.8 days; P < .0001) identified using continuous oximetry and capnography monitoring. CONCLUSIONS: A PRODIGY risk prediction model, derived from continuous oximetry and capnography, accurately predicts respiratory depression episodes in patients receiving opioids on the general care floor. Implementation of the PRODIGY score to determine the need for continuous monitoring may be a first step to reduce the incidence and consequences of respiratory compromise in patients receiving opioids on the general care floor.


Assuntos
Analgésicos Opioides/efeitos adversos , Capnografia/métodos , Oximetria/métodos , Insuficiência Respiratória/induzido quimicamente , Insuficiência Respiratória/diagnóstico , Adulto , Idoso , Idoso de 80 Anos ou mais , Algoritmos , Feminino , Humanos , Pacientes Internados , Masculino , Pessoa de Meia-Idade , Modelos Teóricos , Monitorização Fisiológica , Valor Preditivo dos Testes , Estudos Prospectivos , Taxa Respiratória , Fatores de Risco
7.
Respir Res ; 21(1): 249, 2020 Sep 24.
Artigo em Inglês | MEDLINE | ID: mdl-32972411

RESUMO

In the article "The pathophysiology of 'happy' hypoxemia in COVID-19," Dhont et al. (Respir Res 21:198, 2020) discuss pathophysiological mechanisms that may be responsible for the absence of dyspnea in patients with COVID-19 who exhibit severe hypoxemia. The authors review well-known mechanisms that contribute to development of hypoxemia in patients with pneumonia, but are less clear as to why patients should be free of respiratory discomfort despite arterial oxygen levels commonly regarded as life threatening. The authors propose a number of therapeutic measures for patients with COVID-19 and happy hypoxemia; we believe readers should be alerted to problems with the authors' interpretations and recommendations.


Assuntos
Infecções por Coronavirus/fisiopatologia , Dispneia/prevenção & controle , Hipóxia/fisiopatologia , Oxigênio/sangue , Pneumonia Viral/fisiopatologia , Infecções por Coronavirus/epidemiologia , Infecções por Coronavirus/terapia , Feminino , Humanos , Hipóxia/epidemiologia , Masculino , Oximetria/métodos , Pandemias , Pneumonia Viral/epidemiologia , Pneumonia Viral/terapia , Prognóstico , Medição de Risco , Resultado do Tratamento
9.
PLoS One ; 15(8): e0234979, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32857778

RESUMO

The present meta-analysis was based on the available studies to determine the potential role of the initial and regional cerebral oxygen saturation (rSO2) in monitoring the efficiency of cardiopulmonary resuscitation (CPR) and predicting the return of spontaneous circulation (ROSC). Three electronic databases of PubMed, Embase, and the Cochrane Library were searched to identify the studies that investigated the role of rSO2 on ROSC in CA patients throughout May 2018. The weighted mean difference (WMD) with 95% confidence interval (CI) was calculated to estimate the pooled effect using a random-effects model. Sensitivity, subgroup analyses, and publication bias were conducted. A total of 13 studies involving 678 CA patients (300 in-hospital (IH) patients, and 378 out-hospital (OH) patients) were included. The summary WMD suggested that ROSC patients were associated with higher initial rSO2 (WMD: 10.10%; 95% CI: 5.66-14.55; P<0.001) and mean rSO2 (WMD: 14.16%; 95% CI: 10.51-17.81; P<0.001) levels during CA and ROSC as compared to the non-ROSC. The results of meta-regression suggested that the male percentage and the location of cardiac arrest might bias the initial or mean rSO2 and the incidence of ROSC. These significant differences were observed in nearly all subsets. The findings of this study suggested that high initial or mean rSO2 levels were both associated with an increased incidence of ROSC in CA patients undergoing CPR. These correlations might be affected by the percentage of males or the location of cardiac arrest, thereby necessitating further large-scale studies to substantiate whether these correlations differ according to gender and the location of cardiac arrest.


Assuntos
Circulação Sanguínea/fisiologia , Parada Cardíaca/fisiopatologia , Oximetria/métodos , Idoso , Idoso de 80 Anos ou mais , Reanimação Cardiopulmonar , Circulação Cerebrovascular/fisiologia , Feminino , Parada Cardíaca/terapia , Humanos , Masculino , Pessoa de Meia-Idade , Parada Cardíaca Extra-Hospitalar/fisiopatologia , Parada Cardíaca Extra-Hospitalar/terapia , Avaliação de Resultados em Cuidados de Saúde , Oxigênio/sangue , Prognóstico , Espectroscopia de Luz Próxima ao Infravermelho/métodos
11.
Eur J Vasc Endovasc Surg ; 60(5): 647-654, 2020 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-32819817

RESUMO

OBJECTIVE: The aim was to evaluate the potential of near infrared spectrometry (NIRS) monitoring enhanced by autoregulation parameters to detect clamp ischaemia during awake carotid endarterectomy (CEA). METHODS: This was a prospective, hypothesis generating, single centre observational study. Fifty-nine consecutive patients with carotid artery stenosis, of whom 15 (25%) were symptomatic, were enrolled. The patients underwent awake CEA with NIRS monitoring. Regional oxygen saturation (rSO2), relative tissue haemoglobin concentration (rTHb), and mean arterial blood pressure were captured by ICM + software (University of Cambridge Enterprise, Cambridge, UK). The cerebral oxygenation index (COx) and haemoglobin volume index (HVx) were calculated continuously. Two groups were formed depending on neurological symptoms: a symptomatic group with shunt insertion (shunt) and an asymptomatic group (no shunt). RESULTS: Eight patients (14%) became symptomatic and needed intra-operative shunting. The decrease in ipsilateral rSO2 was higher in the shunt group (13.5% vs. 5.3%) and rTHB increased on the non-operated side (+0.05 ± 0.01; p = .016). In symptomatic patients no significant change in rTHB was found during clamping, whereas in asymptomatic patients there was a bilateral increase (ipsilateral: + 0.06 [p = .022]; contralateral: + 0.06 [p = .010]). In asymptomatic patients, ipsilateral COx decreased after clamping (-0.06 ± 0.02; p = .024), indicating functional autoregulation. In symptomatic patients, ipsilateral COx increased to 0.32 (+0.19 ± 0.05; p = .048), indicating loss of autoregulation. Accordingly, pooled ipsilateral and contralateral data showed increasing HVx and COx in symptomatic patients (HVx, p < .001; COx, p = .039). CONCLUSION: In addition to a drop in rSO2, the loss of autoregulatory capacity may be useful in identifying clinically significant clamping ischaemia during CEA under general anaesthesia and may allow optimisation of blood pressure management during awake CEA.


Assuntos
Isquemia Encefálica/diagnóstico , Estenose das Carótidas/cirurgia , Circulação Cerebrovascular/fisiologia , Endarterectomia das Carótidas/efeitos adversos , Complicações Intraoperatórias/diagnóstico , Monitorização Intraoperatória/métodos , Idoso , Idoso de 80 Anos ou mais , Anestesia Geral/efeitos adversos , Pressão Arterial/fisiologia , Isquemia Encefálica/etiologia , Isquemia Encefálica/fisiopatologia , Isquemia Encefálica/prevenção & controle , Circulação Colateral/fisiologia , Estudos de Viabilidade , Feminino , Homeostase/fisiologia , Humanos , Complicações Intraoperatórias/etiologia , Complicações Intraoperatórias/fisiopatologia , Complicações Intraoperatórias/prevenção & controle , Masculino , Oximetria/métodos , Oxigênio/sangue , Estudos Prospectivos , Espectroscopia de Luz Próxima ao Infravermelho , Vigília/fisiologia
12.
Curr Opin Anaesthesiol ; 33(5): 646-650, 2020 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-32769747

RESUMO

PURPOSE OF REVIEW: Intraoperative hypotension (IOH) may render patients at a risk of cerebral hypoperfusion with decreasing cerebral blood flow (CBF), and lead to postoperative neurological injury. On the basis of the literature in recent years, this review attempts to refine the definition of IOH and evaluate its impact on neurological outcomes. RECENT FINDINGS: Although both absolute and relative blood pressure (BP) thresholds, with or without a cumulative period, have been used in collective clinical studies, no definitive threshold of IOH has been established for neurological complications, including perioperative stroke, postoperative cognitive disorder and delirium. The CBF is jointly modulated by multiple pressure processes (i.e. cerebral pressure autoregulation) and nonpressure processes, including patient, surgical and anaesthesia-related confounding factors. The confounding factors and variability in cerebral pressure autoregulation might impede evaluating the effect of IOH on the neurological outcomes. Furthermore, the majority of the evidence presented in this review are cohort studies, which are weak in demonstrating a cause--effect relationship between IOH and neurological complications. The maintenance of target BP based on the monitoring of regional cerebral oxygen saturation (rScO2) or cerebral pressure autoregulation seems to be associated with the decreased incidence of postoperative neurological complications. SUMMARY: Despite the lack of a known threshold value, IOH is a modifiable risk factor targeted to improve neurological outcomes. Ideal BP management is recommended in order to maintain target BP based on the monitoring of rScO2 or cerebral pressure autoregulation.


Assuntos
Circulação Cerebrovascular/fisiologia , Hipotensão/etiologia , Complicações Intraoperatórias , Complicações Pós-Operatórias , Pressão Sanguínea/fisiologia , Estudos de Coortes , Humanos , Oximetria/métodos , Oxigênio/metabolismo , Procedimentos Cirúrgicos Operatórios
13.
Front Med ; 14(5): 664-673, 2020 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-32761491

RESUMO

The Coronavirus disease 2019 (COVID-19) caused by SARS-CoV-2 was identified in December 2019. The symptoms include fever, cough, dyspnea, early symptom of sputum, and acute respiratory distress syndrome (ARDS). Mesenchymal stem cell (MSC) therapy is the immediate treatment used for patients with severe cases of COVID-19. Herein, we describe two confirmed cases of COVID-19 in Wuhan to explore the role of MSC in the treatment of COVID-19. MSC transplantation increases the immune indicators (including CD4 and lymphocytes) and decreases the inflammation indicators (interleukin-6 and C-reactive protein). High-flow nasal cannula can be used as an initial support strategy for patients with ARDS. With MSC transplantation, the fraction of inspired O2 (FiO2) of the two patients gradually decreased while the oxygen saturation (SaO2) and partial pressure of oxygen (PO2) improved. Additionally, the patients' chest computed tomography showed that bilateral lung exudate lesions were adsorbed after MSC infusion. Results indicated that MSC transplantation provides clinical data on the treatment of COVID-19 and may serve as an alternative method for treating COVID-19, particularly in patients with ARDS.


Assuntos
Betacoronavirus/isolamento & purificação , Infecções por Coronavirus , Cuidados Críticos/métodos , Transplante de Células-Tronco Mesenquimais/métodos , Pandemias , Pneumonia Viral , Adulto , Idoso , Células Sanguíneas/fisiologia , Testes de Coagulação Sanguínea/métodos , China , Técnicas de Laboratório Clínico/métodos , Terapia Combinada , Infecções por Coronavirus/diagnóstico , Infecções por Coronavirus/tratamento farmacológico , Infecções por Coronavirus/epidemiologia , Infecções por Coronavirus/fisiopatologia , Infecções por Coronavirus/terapia , Feminino , Humanos , Masculino , Monitorização Imunológica/métodos , Oximetria/métodos , Pneumonia Viral/diagnóstico , Pneumonia Viral/epidemiologia , Pneumonia Viral/fisiopatologia , Pneumonia Viral/terapia , Dados Preliminares , Índice de Gravidade de Doença , Avaliação de Sintomas/métodos , Resultado do Tratamento
14.
Pediatrics ; 146(3)2020 09.
Artigo em Inglês | MEDLINE | ID: mdl-32848028

RESUMO

BACKGROUND AND OBJECTIVES: Preterm infants with necrotizing enterocolitis (NEC) are known to have worse neurodevelopmental outcomes, but there is no substantial evidence to support an underlying pathophysiology. We aimed to examine whether cerebral oxygenation differs in those infants who develop NEC compared to cerebral oxygenation in those who do not. METHODS: We examined 48 infants <30 weeks' gestation admitted to a tertiary level NICU from October 2016 to May 2018. Infants with birth weight less than or equal to the second percentile, abnormal antenatal dopplers or twin-to-twin-transfusion-syndrome were excluded. Cerebral oximetry measurements were performed by using a near-infrared spectroscopy (NIRS) monitor weekly for 60 minutes, allowing measurement of cerebral tissue oxygenation index from the first week of life to 36 weeks postconceptional age. Weekly clinical status was also recorded. NEC was defined as greater than or equal to Bell stage 2. RESULTS: The median birth weight was 884 g (range of 460-1600 g), the median weeks' gestational age was 26 + 3/7 (23 + 0/7 to 29 + 6/7), and 52% were girls. In total, 276 NIRS measurements were completed, and 7 infants developed NEC. NIRS measurements from 1 infant with NEC and 4 infants without NEC who developed hemorrhagic parenchymal infarcts were excluded from analysis. Infants who developed NEC had significantly lower cerebral tissue oxygenation index than those who did not (P = .011), even when adjusted for confounders, including gestational age, birth weight, patent ductus arteriosus, enteral feeds, sex, ethnicity, and hemoglobin. CONCLUSIONS: Infants with NEC have significantly lower cerebral tissue oxygenation throughout their neonatal intensive care stay in comparison with those who did not develop NEC. This is a novel finding and could explain their worse neurodevelopmental outcome.


Assuntos
Encéfalo/metabolismo , Enterocolite Necrosante/metabolismo , Consumo de Oxigênio/fisiologia , Antibioticoprofilaxia , Permeabilidade do Canal Arterial/diagnóstico por imagem , Enterocolite Necrosante/etiologia , Feminino , Idade Gestacional , Humanos , Recém-Nascido , Recém-Nascido Prematuro , Masculino , Oximetria/instrumentação , Oximetria/métodos , Estudos Prospectivos , Espectroscopia de Luz Próxima ao Infravermelho , Fatores de Tempo
15.
Cardiol Young ; 30(9): 1350-1352, 2020 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-32613935
16.
Am J Respir Cell Mol Biol ; 63(4): 510-518, 2020 10.
Artigo em Inglês | MEDLINE | ID: mdl-32609558

RESUMO

Optimal oxygen saturation as measured by pulse oximetry (SpO2) in neonatal lung injury, such as meconium aspiration syndrome (MAS) and persistent pulmonary hypertension of newborn (PPHN), is not known. Our goal was to determine the SpO2 range in lambs with MAS and PPHN that results in the highest brain oxygen delivery (bDO2) and pulmonary blood flow (Qp) and the lowest pulmonary vascular resistance and oxidative stress. Meconium was instilled into endotracheal tubes in 25 near-term gestation lambs, and the umbilical cord was occluded to induce asphyxia and gasping, causing MAS and PPHN. Lambs were randomized into four groups and ventilated for 6 hours with fixed fraction of inspired oxygen (FiO2) = 1.0 irrespective of SpO2, and three groups had FiO2 titrated to keep preductal SpO2 between 85% and 89%, 90% and 94%, and 95% and 99%, respectively. Tissues were collected to measure nitric oxide synthase activity, 3-nitrotyrosine, and 8-isoprostanes. Throughout the 6-hour exposure period, lambs in the 95-99% SpO2 target group had the highest Qp, lowest pulmonary vascular resistance, and highest bDO2 but were exposed to higher FiO2 (0.5 ± 0.21 vs. 0.29 ± 0.17) with higher lung 3-nitrotyrosine (0.67 [interquartile range (IQR), 0.43-0.73] ng/mcg protein vs. 0.1 [IQR, 0.09-0.2] ng/mcg protein) and lower lung nitric oxide synthase activity (196 [IQR, 192-201] mMol nitrite/mg protein vs. 270 [IQR, 227-280] mMol nitrite/mg protein) compared with the 90-94% target group. Brain 3-nitrotyrosine was lower in the 85-89% target group, and brain/lung 8-isoprostane levels were not significantly different. In term lambs with MAS and PPHN, Qp and bDO2 through the first 6 hours are higher with target SpO2 in the 95-99% range. However, the 90-94% target range is associated with significantly lower FiO2 and lung oxidative stress. Clinical trials comparing the 90-94% versus the 95-99% SpO2 target range in term infants with PPHN are warranted.


Assuntos
Hipertensão Pulmonar/metabolismo , Pulmão/metabolismo , Síndrome de Aspiração de Mecônio/metabolismo , Oxigênio/metabolismo , Animais , Animais Recém-Nascidos , Dinoprosta/análogos & derivados , Dinoprosta/farmacologia , Feminino , Hipertensão Pulmonar/tratamento farmacológico , Pulmão/efeitos dos fármacos , Masculino , Síndrome de Aspiração de Mecônio/tratamento farmacológico , Óxido Nítrico/metabolismo , Óxido Nítrico Sintase/metabolismo , Estresse Oxidativo/efeitos dos fármacos , Oximetria/métodos , Síndrome da Persistência do Padrão de Circulação Fetal/tratamento farmacológico , Síndrome da Persistência do Padrão de Circulação Fetal/metabolismo , Gravidez , Artéria Pulmonar/efeitos dos fármacos , Artéria Pulmonar/metabolismo , Ovinos/metabolismo , Tirosina/análogos & derivados , Tirosina/farmacologia , Resistência Vascular/efeitos dos fármacos
17.
Obstet Gynecol ; 136(5): 1025-1029, 2020 11.
Artigo em Inglês | MEDLINE | ID: mdl-32618794

RESUMO

BACKGROUND: There are limited data regarding treatment options for pregnant women with severe coronavirus disease 2019 (COVID-19). CASE: A 35-year-old primigravid patient at 22 weeks of gestation presented with 7 days of fever, cough, anosmia, and dyspnea. Nasopharyngeal swab was positive for the novel coronavirus severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), and a chest X-ray demonstrated bilateral patchy infiltrates. Laboratory evaluation was notable for marked elevation of interleukin-6 and C-reactive protein concentrations. On hospital day 3, owing to increased dyspnea and oxygen requirement, the patient was treated with tocilizumab followed by 5 days of remdesivir. She responded well, recovered to room air, and was discharged home after a 9-day hospitalization. CONCLUSION: Tocilizumab and remdesivir may be effective for treatment of severe COVID-19 in pregnancy, but additional data are needed to guide risk-benefit considerations.


Assuntos
Monofosfato de Adenosina/análogos & derivados , Alanina/análogos & derivados , Anticorpos Monoclonais Humanizados/administração & dosagem , Infecções por Coronavirus , Pulmão/diagnóstico por imagem , Pandemias , Pneumonia Viral , Complicações Infecciosas na Gravidez , Monofosfato de Adenosina/administração & dosagem , Adulto , Alanina/administração & dosagem , Antivirais/administração & dosagem , Betacoronavirus/isolamento & purificação , Proteína C-Reativa/análise , Infecções por Coronavirus/sangue , Infecções por Coronavirus/diagnóstico , Infecções por Coronavirus/tratamento farmacológico , Infecções por Coronavirus/fisiopatologia , Feminino , Humanos , Interleucina-6/sangue , Oximetria/métodos , Pneumonia Viral/sangue , Pneumonia Viral/diagnóstico , Pneumonia Viral/tratamento farmacológico , Pneumonia Viral/etiologia , Pneumonia Viral/fisiopatologia , Gravidez , Complicações Infecciosas na Gravidez/sangue , Complicações Infecciosas na Gravidez/diagnóstico , Complicações Infecciosas na Gravidez/tratamento farmacológico , Radiografia Torácica/métodos , Resultado do Tratamento
18.
Respir Res ; 21(1): 194, 2020 Jul 22.
Artigo em Inglês | MEDLINE | ID: mdl-32698822

RESUMO

RATIONALE: Oxygen saturation to fraction of inspired oxygen ratio (SpO2/FiO2) has been described as potential predictor of poor outcome for COVID-19, without considering its time-varying behavior though. METHODS: Prognostic value of SpO2/FiO2 was evaluated by jointly modeling the longitudinal responses of SpO2/FiO2 and time-to-event data retrieved from 280 severe and critically ill (intensive care) patients with COVID-19. RESULTS: A sharply decrease of SpO2/FiO2 from the first to second measurement for non-survivors was observed, and a strong association between square root SpO2/FiO2 and mortality risk was demonstrated, with a unit decrease in the marker corresponding to 1.82-fold increase in mortality risk (95% CI: 1.56-2.13). CONCLUSIONS: The current study suggested that SpO2/FiO2 could serve as a non-invasive prognostic marker to facilitate early adjustment for treatment, thus improving overall survival.


Assuntos
Infecções por Coronavirus/sangue , Infecções por Coronavirus/mortalidade , Cuidados Críticos/métodos , Estado Terminal/mortalidade , Mortalidade Hospitalar/tendências , Consumo de Oxigênio/fisiologia , Pneumonia Viral/sangue , Pneumonia Viral/mortalidade , Biomarcadores/sangue , China , Estudos de Coortes , Infecções por Coronavirus/diagnóstico , Estado Terminal/terapia , Feminino , Humanos , Unidades de Terapia Intensiva , Estudos Longitudinais , Masculino , Pessoa de Meia-Idade , Oximetria/métodos , Oxigênio/sangue , Pandemias , Pneumonia Viral/diagnóstico , Valor Preditivo dos Testes , Prognóstico
19.
BMJ Open Respir Res ; 7(1)2020 07.
Artigo em Inglês | MEDLINE | ID: mdl-32624494

RESUMO

Since the outbreak of COVID-19 in China in December 2019, a pandemic has rapidly developed on a scale that has overwhelmed health services in a number of countries. COVID-19 has the potential to lead to severe hypoxia; this is usually the cause of death if it occurs. In a substantial number of patients, adequate arterial oxygenation cannot be achieved with supplementary oxygen therapy alone. To date, there has been no clear guideline endorsement of ward-based non-invasive pressure support (NIPS) for severely hypoxic patients who are deemed unlikely to benefit from invasive ventilation. We established a ward-based NIPS service for COVID-19 PCR-positive patients, with severe hypoxia, and in whom escalation to critical care for invasive ventilation was not deemed appropriate. A retrospective analysis of survival in these patients was undertaken. Twenty-eight patients were included. Ward-based NIPS for severe hypoxia was associated with a 50% survival in this cohort. This compares favourably with Intensive Care National Audit and Research Centre survival data following invasive ventilation in a less frail, less comorbid and younger population. These results suggest that ward-based NIPS should be considered as a treatment option in an integrated escalation strategy in all units managing respiratory failure secondary to COVID-19.


Assuntos
Pressão Positiva Contínua nas Vias Aéreas/métodos , Infecções por Coronavirus , Fragilidade , Avaliação Geriátrica/métodos , Pandemias , Pneumonia Viral , Unidades de Cuidados Respiratórios , Insuficiência Respiratória , Idoso de 80 Anos ou mais , Betacoronavirus/isolamento & purificação , Infecções por Coronavirus/epidemiologia , Infecções por Coronavirus/fisiopatologia , Infecções por Coronavirus/terapia , Feminino , Fragilidade/diagnóstico , Fragilidade/fisiopatologia , Fragilidade/terapia , Humanos , Pulmão/diagnóstico por imagem , Masculino , Avaliação de Processos e Resultados em Cuidados de Saúde , Oximetria/métodos , Oximetria/estatística & dados numéricos , Consumo de Oxigênio , Pneumonia Viral/epidemiologia , Pneumonia Viral/fisiopatologia , Pneumonia Viral/terapia , Unidades de Cuidados Respiratórios/métodos , Unidades de Cuidados Respiratórios/organização & administração , Insuficiência Respiratória/etiologia , Insuficiência Respiratória/mortalidade , Insuficiência Respiratória/fisiopatologia , Insuficiência Respiratória/terapia , Análise de Sobrevida , Tomografia Computadorizada por Raios X/métodos , Reino Unido/epidemiologia
20.
Cardiol Young ; 30(9): 1339-1342, 2020 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-32522307
SELEÇÃO DE REFERÊNCIAS
DETALHE DA PESQUISA