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2.
Acta otorrinolaringol. esp ; 71(6): 386-392, nov.-dic. 2020. tab
Artigo em Espanhol | IBECS | ID: ibc-188375

RESUMO

La alta incidencia de insuficiencia respiratoria aguda en el contexto de la pandemia por COVID-19 ha conllevado el uso de ventilación mecánica hasta en un 15%. Dado que la traqueotomía es un procedimiento quirúrgico frecuente, este documento de consenso, elaborado por tres Sociedades Científicas, la SEMICYUC, la SEDAR y la SEORL-CCC, tiene como objetivo ofrecer una revisión de las indicaciones y contraindicaciones de traqueotomía, ya sea por punción o abierta, esclarecer las posibles ventajas y exponer las condiciones ideales en que deben realizarse y los pasos que considerar en su ejecución. Se abordan situaciones regladas y urgentes, así como los cuidados posoperatorios


The current COVID-19 pandemic has rendered up to 15% of patients under mechanical ventilation. Because the subsequent tracheotomy is a frequent procedure,the three societies mostly involved (SEMICYUC, SEDAR and SEORL-CCC) have setup a consensus paper that offers an overview about indications and contraindications of tracheotomy, be it by puncture or open, clarifying its respective advantages and enumerating the ideal conditions under which they should be performed, as well as the necessary steps. Regular and emergency situations are displayed together with the postoperative measures


Assuntos
Humanos , Sociedades Médicas , Traqueotomia/métodos , Traqueotomia/normas , Infecções por Coronavirus/cirurgia , Pneumonia Viral/cirurgia , Betacoronavirus , Pandemias , Insuficiência Respiratória/cirurgia , Insuficiência Respiratória/virologia , Respiração Artificial/métodos
3.
Artigo em Espanhol | LILACS | ID: biblio-1148365

RESUMO

A la fecha de redacción de este artículo, más de 500 mil personas han sido afectadas por el virus SARS-CoV-2 en Chile, manifestando diferentes grados de la enfermedad COVID-19. Aquellas que sobrellevan condiciones más severas generan una condición que requiere soporte ventilatorio invasivo y tratamiento en unidades de cuidados intensivos, que de prolongarse en el tiempo deriva en la necesidad de una traqueostomía. A pesar de los beneficios que posee esta en la recuperación de personas con dificultades respiratorias, su implementación se asocia a alteraciones deglutorias que se suman a las generadas por COVID-19. Condición que supone un desafío para los/as fonoaudiólogos/as, quienes están expuestos/as al virus debido a su proceder en estructuras del tracto aerodigestivo y la realización de procedimientos potencialmente generadores de aerosol. El objetivo de este artículo es entregar orientaciones y herramientas clínicas para la intervención en la deglución de personas con traqueostomía y COVID-19. Estas emanan de un análisis pragmático de la evidencia disponible a la fecha, interpretadas bajo nuestra experiencia de atender a más de 561 personas con dicha condición. Se espera contribuir a la rehabilitación de la deglución en personas con COVID-19 y traqueostomía. Para ello se expone sobre las características de la deglución en esta población, su tratamiento, consideraciones para el uso de técnicas específicas, y orientaciones para la mejora de la calidad de vida mediante la mantención y/o recuperación de la funcionalidad deglutoria. Siempre bajo un esquema centrado en el cuidado y protección de las personas hospitalizadas y el equipo de salud.


At the time of writing this article, more than a million people have been affected by the SARS-CoV-2 virus in Chile, displaying different degrees of COVID-19 disease. Severe infections generate a condition that requires invasive ventilatory support and treatment in intensive care units, which, when extended in time, makes necessary conducting a tracheostomy. Despite its benefits for the recovery of patients with respiratory difficulties, it is linked to swallowing disorders that add to the problems generated by COVID-19. This represents a challenge for speech pathologists, who are potentially exposed to the virus because they work on structures of the aerodigestive tract and becuase they conduct procedures that may be aerosol-generating. The aim of this article is to provide guidance and clinical tools for swallowing-intervention in people with tracheostomies and COVID-19. Thees tools spring from a pragmatic analysis of the currently available evidence , interpreted based on our experience of caring more than561 infected patients. We hope to contribute to the rehabilitation of swallowing of patients with COVID-19 and a tracheostomy. The characteristics of swallowing in this population, its treatment, considerations for the use of specific techniques, and guidelines for improving the quality of life through the maintenance and/or recovery of swallowing functionality are discussed, focused caring and protecting hospitalized patients and the health team.


Assuntos
Humanos , Pneumonia Viral/cirurgia , Traqueostomia/efeitos adversos , Transtornos de Deglutição/etiologia , Infecções por Coronavirus/cirurgia , Fonoaudiologia/normas , Pneumonia Viral/complicações , Pneumonia Viral/reabilitação , Qualidade de Vida , Transtornos de Deglutição/reabilitação , Infecções por Coronavirus/complicações , Infecções por Coronavirus/reabilitação , Cuidados Críticos , Fonoaudiologia/métodos , Pandemias , Betacoronavirus
4.
Rev. chil. fonoaudiol. (En línea) ; 19: 1-9, nov. 2020. ilus
Artigo em Espanhol | LILACS | ID: biblio-1148401

RESUMO

La enfermedad COVID-19 fue declarada pandemia por la Organización Mundial de la Salud. Su presentación más severa genera una condición que requiere tratamiento en unidades de cuidados intensivos, condición que al prolongarse en el tiempo requiere la implementación de una traqueostomía para facilitar la entrega de soporte ventilatorio invasivo. Si bien este dispositivo posee importantes ventajas que favorecen la recuperación y rehabilitación, también es cierto que genera diversas complicaciones en la comunicación de las personas, condición que se suma a los efectos propios del COVID-19 y la frecuente historia de intubación endotraqueal previa. El objetivo de este artículo es proveer orientaciones y herramientas clínicas para el tratamiento de la fonación para la comunicación en personas con traqueostomía y COVID-19. Se considera para ello las recomendaciones de la literatura existentes a la fecha, bajo un análisis pragmático y basado en nuestra experiencia de atender a más de 561 personas con esta condición. Se exponen las características de la comunicación en esta población, su tratamiento, consideraciones para el uso de técnicas específicas y orientaciones para la mejora de la calidad de vida. Siempre con un enfoque orientado al cuidado y protección de las/os usuarias/os y el equipo de salud, en particular fonoaudiólogas y fonoaudiólogos del país.


The COVID-19 disease was declared a pandemic by the World Health Organization. When most severe, it generates a condition that requires treatment in intensive care units, which, when extended in time, requires implementing of a tracheostomy to facilitate invasive ventilatory support. Although ventilatory support has important advantages that favor recovery and rehabilitation, it generates various complications for patients' communication, a condition that adds to the effects of COVID-19 and the frequent history of previous endotracheal intubation. The aim of this article is to provide guidance and clinical tools for the treatment of phonation to facilitate communication in people with tracheostomy and COVID-19. For this, the recommendations of the existing available literature are considered, under a pragmatic analysis and based on our experience of treating more than 561 infected patients. The characteristics of communication in this population, its treatment, considerations for the use of specific techniques and guidelines to improve quality of life are exposed. Always with an approach oriented to the care and protection of users and the health team, in particular speech-language pathologists in the country.


Assuntos
Humanos , Pneumonia Viral/cirurgia , Traqueostomia/efeitos adversos , Distúrbios da Voz/etiologia , Infecções por Coronavirus/cirurgia , Transtornos da Comunicação/etiologia , Fonoaudiologia/normas , Fonação , Pneumonia Viral/complicações , Pneumonia Viral/reabilitação , Qualidade de Vida , Relações Hospital-Paciente , Distúrbios da Voz/reabilitação , Infecções por Coronavirus/complicações , Infecções por Coronavirus/reabilitação , Comunicação , Transtornos da Comunicação/reabilitação , Cuidados Críticos , Fonoaudiologia/métodos , Pandemias , Betacoronavirus , Intubação Intratraqueal
5.
Spinal Cord Ser Cases ; 6(1): 92, 2020 09 30.
Artigo em Inglês | MEDLINE | ID: mdl-32999271

RESUMO

INTRODUCTION: We observed individuals affected by spinal cord dysfunction (SCD) after coronavirus disease 2019 (COVID-19). The aim of our report is to provide our initial experience with individuals experiencing SCD after COVID-19 in a referral center in Northern Italy, from February 21 to July 15, 2020. CASE PRESENTATION: We report on three men with SCD after COVID-19. Case 1, aged 69 years, experienced T10 AIS B paraplegia upon awakening due to spinal cord ischemia from T8 to conus medullaris, besides diffuse thromboses, 27 days after the onset of COVID-19 symptoms. Case 2, aged 56 years, reported progressive cervicalgia 29 days after COVID-19 onset associated with C3 AIS C tetraplegia. Magnetic resonance imaging (MRI) revealed a C4-C6 spinal epidural abscess (SEA) requiring a C3-C4 left hemilaminectomy. Case 3, aged 48 years, reported backache together with lower limb muscle weakness on day 16 after being diagnosed with COVID-19. Exam revealed T2 AIS A paraplegia and an MRI showed a T1-T7 SEA. He underwent a T3-T4 laminectomy. Prior to SCD, all three individuals suffered from respiratory failure due to COVID-19, required mechanical ventilation, had cardiovascular risk factors, experienced lymphopenia, and received tocilizumab (TCZ). DISCUSSION: To our knowledge, this is the first report of SCD after COVID-19. Based on our experience, we did not observe a direct viral infection, but there were two different etiologies. In Case 1, the individual developed spinal cord ischemia, whereas in Cases 2 and 3 SEAs were likely related to the use of TCZ used to treat COVID-19.


Assuntos
Betacoronavirus , Infecções por Coronavirus/diagnóstico por imagem , Pneumonia Viral/diagnóstico por imagem , Doenças da Medula Espinal/diagnóstico por imagem , Medula Espinal/diagnóstico por imagem , Idoso , Infecções por Coronavirus/complicações , Infecções por Coronavirus/cirurgia , Humanos , Laminectomia , Masculino , Pessoa de Meia-Idade , Pandemias , Pneumonia Viral/complicações , Pneumonia Viral/cirurgia , Medula Espinal/cirurgia , Doenças da Medula Espinal/etiologia , Doenças da Medula Espinal/cirurgia
6.
Drug Des Devel Ther ; 14: 3995-4001, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-33061304

RESUMO

The coronavirus disease 2019 (COVID-19) global pandemic continues and antiviral agents and vaccines are currently under investigation. Mesenchymal stem cell (MSC)-based therapy can be a suitable option for management of patients with COVID-19 at the urgent time of virus outbreak. Currently, MSCs are being explored against the novel infectious disease due to their therapeutic properties of anti-inflammation, immunomodulation and tissue repair and regeneration, albeit the precise mechanisms of MSC action toward COVID-19 remain unclear. To date, rigorous results from clinical trials using MSCs in human have been weakly positive. The pervasive uncertainty of using MSC therapeutic products as an effective combatant against COVID-19 requires rigorous resolution on several fronts, including MSC fate after infusion, safety issue, homing capability, and MSC resistance to the disease microenvironment. Focusing on these facets, a few important ones will be critically analyzed and addressed in this article for the development of safe and effective MSC-based therapies for COVID-19.


Assuntos
Betacoronavirus/patogenicidade , Infecções por Coronavirus/cirurgia , Transplante de Células-Tronco Mesenquimais , Pneumonia Viral/cirurgia , Animais , Betacoronavirus/imunologia , Infecções por Coronavirus/diagnóstico , Infecções por Coronavirus/imunologia , Infecções por Coronavirus/virologia , Interações Hospedeiro-Patógeno , Humanos , Transplante de Células-Tronco Mesenquimais/efeitos adversos , Pandemias , Pneumonia Viral/diagnóstico , Pneumonia Viral/imunologia , Pneumonia Viral/virologia , Resultado do Tratamento
11.
Eur J Cardiothorac Surg ; 58(4): 745-751, 2020 Oct 01.
Artigo em Inglês | MEDLINE | ID: mdl-32951058

RESUMO

OBJECTIVES: Coronavirus disease 2019 (COVID-19) is a global pandemic. Critically ill patients often require prolonged intubation for mechanical ventilation to support breathing; thus, the artificial airway must be managed by tracheotomy. Therefore, studies exploring appropriate and safe methods for tracheotomy that minimize the risks of nosocomial transmission are important. METHODS: A retrospective analysis of the clinical characteristics of 14 critically ill patients with COVID-19, who underwent bedside tracheotomy from March to April 2020 was conducted to summarize the indications for tracheotomy and key points related to personal protective equipment and surgical procedures. RESULTS: All 14 patients were diagnosed with COVID-19 and were critically ill. All tracheotomies were performed in the late phase of the infection course. The interval between the infection and tracheotomy was 33 days, and the median interval between intubation and tracheotomy was 25.5 days. The reverse transcription-polymerase chain reaction results of secretions from the operative incision and inside the tracheotomy tube were negative. Twelve patients improved after tracheotomy, with SpO2 levels maintained above 96%. One patient died of progressive respiratory failure; another patient died of uncontrolled septic shock. No medical staff who participated in the tracheotomy was infected. CONCLUSIONS: Tracheotomy in critically ill patients with COVID-19 who meet the indications for tracheotomy potentially represents a safer approach to manage the airway and help improve the treatment outcomes. A tracheotomy performed in the late phase of the disease has a relatively low risk of infection. Adherence to key steps in the tracheotomy procedure and donning adequate personal protection will help medical staff avoid infection.


Assuntos
Manuseio das Vias Aéreas/métodos , Betacoronavirus , Infecções por Coronavirus/cirurgia , Controle de Infecções/métodos , Pneumonia Viral/cirurgia , Traqueotomia/métodos , Idoso , Idoso de 80 Anos ou mais , Betacoronavirus/isolamento & purificação , China , Técnicas de Laboratório Clínico , Infecções por Coronavirus/diagnóstico , Infecções por Coronavirus/terapia , Infecções por Coronavirus/transmissão , Estado Terminal , Infecção Hospitalar/prevenção & controle , Feminino , Humanos , Controle de Infecções/instrumentação , Transmissão de Doença Infecciosa do Paciente para o Profissional/prevenção & controle , Masculino , Pessoa de Meia-Idade , Pandemias , Equipamento de Proteção Individual , Pneumonia Viral/diagnóstico , Pneumonia Viral/terapia , Pneumonia Viral/transmissão , Estudos Retrospectivos , Resultado do Tratamento
12.
Antimicrob Agents Chemother ; 64(11)2020 10 20.
Artigo em Inglês | MEDLINE | ID: mdl-32868327

RESUMO

Remdesivir has reported efficacy against severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) in vitro and in vivo Drug-drug interactions limit therapeutic options in transplant patients. Remdesivir and its metabolite GS-441524 are excreted principally in urine. In intensive care unit (ICU) settings, in which multiple-organ dysfunctions can occur rapidly, hemodialysis may be a viable option for maintaining remdesivir treatment, while improving tolerance, by removing both remdesivir's metabolite (GS-441524) and sulfobutylether ß-cyclodextrin sodium (SEBCD). Additional studies may prove informative, particularly in the evaluations of therapeutic options for coronavirus disease 2019 (COVID-19).


Assuntos
Monofosfato de Adenosina/análogos & derivados , Alanina/análogos & derivados , Antivirais/administração & dosagem , Betacoronavirus/efeitos dos fármacos , Infecções por Coronavirus/terapia , Furanos/urina , Pneumonia Viral/terapia , Pirróis/urina , Triazinas/urina , beta-Ciclodextrinas/urina , Monofosfato de Adenosina/administração & dosagem , Monofosfato de Adenosina/efeitos adversos , Monofosfato de Adenosina/química , Monofosfato de Adenosina/metabolismo , Alanina/administração & dosagem , Alanina/efeitos adversos , Alanina/química , Alanina/metabolismo , Antivirais/efeitos adversos , Antivirais/química , Antivirais/metabolismo , Infecções por Coronavirus/tratamento farmacológico , Infecções por Coronavirus/cirurgia , Infecções por Coronavirus/virologia , Interações Medicamentosas , Furanos/efeitos adversos , Furanos/química , Humanos , Unidades de Terapia Intensiva , Transplante de Pulmão , Insuficiência de Múltiplos Órgãos , Pandemias , Pneumonia Viral/cirurgia , Pneumonia Viral/virologia , Pirróis/efeitos adversos , Pirróis/química , Diálise Renal , Transplantados , Triazinas/efeitos adversos , Triazinas/química , beta-Ciclodextrinas/efeitos adversos , beta-Ciclodextrinas/química
14.
Rev. otorrinolaringol. cir. cabeza cuello ; 80(3): 376-384, set. 2020. tab
Artigo em Espanhol | LILACS | ID: biblio-1144903

RESUMO

Resumen La traqueostomía es un procedimiento generador de aerosoles, lo que cobra particular importancia en la pandemia por SARS-CoV-2, causante de COVID-19, al tener un importante riesgo de contagio asociado si no implementamos adecuadamente las modificaciones necesarias para disminuir los aerosoles formados. A medida que el número de pacientes infectados aumente, también lo hará la necesidad de realizar traqueostomías, por lo que es fundamental estar preparados. Todos los ámbitos del procedimiento, desde la selección del paciente hasta el cuidado postoperatorio tienen modificaciones importantes para permitir realizar una cirugía y seguimiento seguro, tanto para el paciente como para los trabajadores de salud involucrados. En este artículo se realiza una revisión narrativa de la literatura disponible hasta mediados de abril de 2020 y se describen los principales cambios a considerar, tanto previo, durante y después de la cirugía de traqueostomía. Con respecto a la técnica quirúrgica, la decisión puede ser controversial entre una traqueostomía abierta y percutánea según las fuentes citadas, pero con las actuales modificaciones a ambas, se deberían considerar equivalentes en la cantidad de aerosoles generados, por lo que la elección debería estar basada en la experiencia local. Está desaconsejado innovar en una técnica con la que el cirujano esté poco familiarizado por el potencial riesgo de infección que significa para todas las personas involucradas en el procedimiento en este tipo de pacientes.


Abstract Tracheostomy is an aerosol-generating procedure, which is particularly important during the COVID-19 pandemic caused by SARS-CoV-2, since it presents a significant risk of infection if we do not properly implement the necessary modifications to decrease aerosolization. As the number of infected patients increases, so will the demand for performing tracheostomies, therefore being prepared is fundamental. Every aspect of the procedure, from patient selection to postoperative care have significant modifications to allow for a safe surgery and follow-up, both for the patient and the health workers involved. In this article, a literature review of the available information until mid-april is performed and the main changes to consider before, during and after the surgery are described. Regarding the surgical technique, there is no clear consensus between open and percutaneous tracheostomy depending on the sources cited, but with the current modifications to both, they should be considered equivalent in the aerosolization generated, therefore the decision should be based on the local experience. Innovating in a technique in which the physician is unfamiliar is discouraged due to the potential risk of infection for everyone involved in the procedure in this type of patients.


Assuntos
Humanos , Pneumonia Viral/cirurgia , Traqueostomia/métodos , Infecções por Coronavirus , Cuidados Pós-Operatórios , Aerossóis , Pandemias , Betacoronavirus
15.
Spine (Phila Pa 1976) ; 45(19): 1386-1394, 2020 Oct 01.
Artigo em Inglês | MEDLINE | ID: mdl-32756271

RESUMO

STUDY DESIGN: Case series. OBJECTIVE: For each of the most frequent clinical scenarios, the authors reached a consensus on how should be timing and indications be optimized to reduce risk while maintaining the expected outcomes under the Covid-19 pandemics. SUMMARY OF BACKGROUND DATA: The organization of health care has been changed by the Covid-19 pandemic with a direct impact on Spine Oncology Surgery. Emergency surgery is still a priority, but in case of spinal tumors it should be better defined which conditions require emergency treatment. METHODS: An expert panel with general spine surgeons, oncological spine surgeons, and radiation oncologists was formed to analyze the most frequent scenarios in spinal musculoskeletal oncology during Covid-19 pandemics. RESULTS: Spine metastases can be found incidentally during follow-up or can clinically occur by increasing pain, pathologic fracture, and/or neurological symptoms. Primary spine tumors are much more rare and very rarely present with acute onset. The first step is to suspect this rare condition, to avoid to treat a primary tumor as it were a metastasis. Most complex surgery, like en bloc resection, associated with high morbidity and mortality rate for the treatment of low grade malignancy like chordoma or chondrosarcomas, if intensive care unit availability is reduced, can be best delayed some weeks, as not impacting on prognosis, due to the slow growth rate of these conditions. The currently accepted protocols for Ewing sarcoma (ES) and osteogenic sarcoma must be performed for local and systemic disease control. For ES, after the first courses of chemotherapy, radiotherapy can be selected instead of surgery, during Covid-19, to the end of the full course of chemotherapy. In immunocompromised patients, (treated by chemotherapy), it is necessary to avoid contact with affected or exposed people. CONCLUSION: Even more than during normal times, a multidisciplinary approach is mandatory to share the decision to modify a treatment strategy. LEVEL OF EVIDENCE: 5.


Assuntos
Betacoronavirus , Infecções por Coronavirus/cirurgia , Oncologia/normas , Pandemias , Pneumonia Viral/cirurgia , Neoplasias da Coluna Vertebral/cirurgia , Cirurgiões/normas , Adulto , Tomada de Decisão Clínica/métodos , Infecções por Coronavirus/diagnóstico por imagem , Infecções por Coronavirus/epidemiologia , Feminino , Humanos , Masculino , Oncologia/métodos , Pessoa de Meia-Idade , Pandemias/prevenção & controle , Equipe de Assistência ao Paciente/normas , Pneumonia Viral/diagnóstico por imagem , Pneumonia Viral/epidemiologia , Prognóstico , Procedimentos Cirúrgicos Reconstrutivos/métodos , Procedimentos Cirúrgicos Reconstrutivos/normas , Neoplasias da Coluna Vertebral/diagnóstico por imagem , Neoplasias da Coluna Vertebral/epidemiologia , Cirurgiões/psicologia
16.
Acta Neurochir (Wien) ; 162(10): 2335-2339, 2020 10.
Artigo em Inglês | MEDLINE | ID: mdl-32779028

RESUMO

BACKGROUND: COVID-19 pandemic has disrupted the global health systems worldwide. According to the tremendous rate of interhuman transmission via aerosols and respiratory droplets, severe measures have been required to contain contagion spread. Accordingly, medical and surgical maneuvers involving the respiratory mucosa and, among them, transnasal transsphenoidal surgery have been charged of maximum risk of spread and contagion, above all for healthcare professionals. METHOD: Our department, according to the actual COVID-19 protocol national guidelines, has suspended elective procedures and, in the last month, only three patients underwent to endoscopic endonasal procedures, due to urgent conditions (a pituitary apoplexy, a chondrosarcoma causing cavernous sinus syndrome, and a pituitary macroadenoma determining chiasm compression). We describe peculiar surgical technique modifications and the use of an endonasal face mask, i.e., the nose lid, to be applied to the patient during transnasal procedures for skull base pathologies as a further possible COVID-19 mitigation strategy. RESULTS: The nose lid is cheap, promptly available, and can be easily assembled with the use of few tools available in the OR; this mask allows to both operating surgeon and his assistant to perform wider surgical maneuvers throughout the slits, without ripping it, while limiting the nostril airflow. CONCLUSIONS: Transnasal surgery, transgressing respiratory mucosa, can definitely increase the risk of virus transmission: we find that adopting further precautions, above all limiting high-speed drill can help preventing or at least reducing aerosol/droplets. The creation of a non-rigid face mask, i.e., the nose lid, allows the comfortable introduction of instruments through one or both nostrils and, at the same time, minimizes the release of droplets from the patient's nasal cavity.


Assuntos
Condrossarcoma/cirurgia , Infecções por Coronavirus/cirurgia , Endoscópios , Máscaras , Apoplexia Hipofisária/cirurgia , Neoplasias Hipofisárias/cirurgia , Pneumonia Viral/cirurgia , Infecções por Coronavirus/prevenção & controle , Infecções por Coronavirus/transmissão , Desenho de Equipamento , Feminino , Fidelidade a Diretrizes , Humanos , Masculino , Pandemias/prevenção & controle , Pneumonia Viral/prevenção & controle , Pneumonia Viral/transmissão
19.
Respir Care ; 65(11): 1773-1783, 2020 11.
Artigo em Inglês | MEDLINE | ID: mdl-32759372

RESUMO

The COVID-19 pandemic has profoundly affected health care delivery worldwide. A small yet significant number of patients with respiratory failure will require prolonged mechanical ventilation while recovering from the viral-induced injury. The majority of reports thus far have focused on the epidemiology, clinical factors, and acute care of these patients, with less attention given to the recovery phase and care of those patients requiring extended time on mechanical ventilation. In this paper, we review the procedures and methods to safely care for patients with COVID-19 who require tracheostomy, gastrostomy, weaning from mechanical ventilation, and final decannulation. The guiding principles consist of modifications in the methods of airway care to safely prevent iatrogenesis and to promote safety in patients severely affected by COVID-19, including mitigation of aerosol generation to minimize risk for health care workers.


Assuntos
Infecções por Coronavirus , Remoção de Dispositivo/métodos , Gastrostomia , Controle de Infecções , Pandemias , Pneumonia Viral , Traqueostomia , Desmame do Respirador/métodos , Betacoronavirus , Infecções por Coronavirus/complicações , Infecções por Coronavirus/cirurgia , Infecções por Coronavirus/terapia , Cuidados Críticos/métodos , Cuidados Críticos/normas , Gastrostomia/instrumentação , Gastrostomia/métodos , Humanos , Controle de Infecções/instrumentação , Controle de Infecções/métodos , Controle de Infecções/normas , Pneumonia Viral/complicações , Pneumonia Viral/cirurgia , Pneumonia Viral/terapia , Respiração Artificial/métodos , Risco Ajustado , Traqueostomia/instrumentação , Traqueostomia/métodos
20.
AORN J ; 112(3): 217-224, 2020 09.
Artigo em Inglês | MEDLINE | ID: mdl-32857402

RESUMO

The novel coronavirus SARS-CoV-2 first appeared in Wuhan, China, in December 2019 and led to the Coronavirus Disease 2019 (COVID-19), which quickly spread globally. Protocols for surgical patients with COVID-19 were lacking, particularly for pregnant women undergoing cesarean deliveries. Perioperative nurses at Tongji Hospital in Wuhan retrospectively analyzed the perioperative nursing process, including OR preparation, intraoperative care, and OR cleanup, for women with COVID-19 undergoing cesarean deliveries. Preparation involved altering the layout of the surgical suite, educating staff members, providing personal protective equipment, and creating new in-house guidelines to help protect personnel and patients. This article describes how perioperative personnel strategized to prevent the transmission of COVID-19 in the OR and presents a multiple-case summary of six pregnant patients with COVID-19 who underwent cesarean deliveries at Tongji Hospital in January and February 2020.


Assuntos
Cesárea/estatística & dados numéricos , Infecções por Coronavirus/terapia , Transmissão de Doença Infecciosa do Paciente para o Profissional/prevenção & controle , Assistência Perioperatória/métodos , Pneumonia Viral/terapia , Resultado da Gravidez/epidemiologia , Betacoronavirus , China , Infecções por Coronavirus/cirurgia , Feminino , Humanos , Pandemias , Equipamento de Proteção Individual/estatística & dados numéricos , Pneumonia Viral/cirurgia , Gravidez , Complicações Infecciosas na Gravidez/terapia
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