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1.
Clin Geriatr Med ; 37(3): 417-427, 2021 08.
Artigo em Inglês | MEDLINE | ID: mdl-34210447

RESUMO

As in other adults, continuous positive airway pressure treatment for obstructive sleep apnea should be the mainstay of treatment. Benefits include improvements in sleepiness and quality of life, as well as improvements in hypertension control, arrhythmias, cardiovascular risk, and mortality. This article discusses issues in prescribing this treatment, including those related specifically to elderly individuals.


Assuntos
Pressão Positiva Contínua nas Vias Aéreas/métodos , Qualidade de Vida , Apneia Obstrutiva do Sono/terapia , Idoso , Humanos , Fases do Sono/fisiologia , Resultado do Tratamento
2.
Clin Geriatr Med ; 37(3): 445-456, 2021 08.
Artigo em Inglês | MEDLINE | ID: mdl-34210449

RESUMO

Obstructive sleep apnea (OSA) presents as repetitive interruptions of ventilation >10 seconds during sleep as a result of upper airway obstruction resulting in increased respiratory effort. Intermittent hypoxia causes physiologic changes resulting in increased catecholamine production, increased total peripheral resistance, tachycardia, and increased venous return, leading to increased cardiac output, hypertension, tachyarrhythmias, left ventricular hypertrophy, and heart failure. OSA causes an abnormal dip on 24-hour ambulatory blood pressure monitoring. Definitive diagnosis is made by polysomnography. Continuous positive airway pressure (CPAP) remains the first-line treatment. Effective treatment using CPAP reduces blood pressure and is indispensable for proper management of atrial fibrillation.


Assuntos
Doenças Cardiovasculares/etiologia , Pressão Positiva Contínua nas Vias Aéreas/efeitos adversos , Hipertensão/etiologia , Apneia Obstrutiva do Sono/terapia , Idoso , Fibrilação Atrial/etiologia , Pressão Positiva Contínua nas Vias Aéreas/métodos , Eletrocardiografia Ambulatorial , Humanos , Polissonografia , Apneia Obstrutiva do Sono/complicações , Taquicardia Ventricular/etiologia
5.
Heart Surg Forum ; 24(2): E249-E255, 2021 03 05.
Artigo em Inglês | MEDLINE | ID: mdl-33798054

RESUMO

OBJECTIVE: This study aimed to evaluate the application of synchronized nasal intermittent positive pressure ventilation (SNIPPV) in the respiratory weaning of infants after congenital heart surgery. METHODS: We retrospectively analyzed the clinical data of 63 infants who were extubated from mechanical ventilation after congenital heart surgery between January 2020 and September 2020. The data, including demographics, anatomic diagnosis, radiology and laboratory test results, and perioperative variables were recorded. RESULTS: The extubation failure rate within 48 h after extubation was significantly lower in the SNIPPV group than in the nasal continuous positive airway pressure (NCPAP) group. The PaO2 level and PaO2/FiO2 ratio within 48 h after extubation were higher in the SNIPPV group than in the NCPAP group (P < .05). Meanwhile, the PaCO2 level within 48 h was significantly lower in the SNIPPV group (P < .05). Compared with the NCPAP group, the median duration of postoperative noninvasive support and the duration from extubation to hospital discharge were shorter in the SNIPPV group; the total hospital cost was lower in the SNIPPV group. No significant differences were observed between the two groups concerning VAP, pneumothorax, feeding intolerance, sepsis, mortality, and other complications (P > .05). CONCLUSION: SNIPPV was shown to be superior to NCPAP in avoiding reintubation after congenital heart surgery in infants and significantly improved oxygenation and reduced PaCO2 retention after extubation. Further studies are needed to confirm the efficacy and safety of SNIPPV as a routine weaning strategy.


Assuntos
Procedimentos Cirúrgicos Cardíacos , Pressão Positiva Contínua nas Vias Aéreas/métodos , Cardiopatias Congênitas/cirurgia , Ventilação com Pressão Positiva Intermitente/métodos , Desmame do Respirador/métodos , Extubação/métodos , Feminino , Seguimentos , Humanos , Lactente , Masculino , Estudos Retrospectivos
6.
BMC Nephrol ; 22(1): 144, 2021 04 21.
Artigo em Inglês | MEDLINE | ID: mdl-33882842

RESUMO

BACKGROUND: SARS-CoV-2 (COVID-19) is a novel coronavirus associated with high mortality rates. The use of Continuous Positive Airway Pressure (CPAP) has been recognised as a management option for severe COVID-19 (NHS, Specialty guides for patient management during the coronavirus pandemic Guidance for the role and use of non-invasive respiratory support in adult patients with coronavirus (confirmed or suspected), https://www.nice.org.uk/guidance/ng159 ). We offered ward-based CPAP to COVID-19, dialysis patients not suitable for escalation to ICU. The aim of the study was to evaluate the use of CPAP for COVID-19 dialysis patients compared to non-dialysis COVID-19 patients outside of the intensive care setting. We further aimed to investigate factors associated with improved outcomes. METHODS: Data was collected from a single centre (Royal Preston Hospital, UK), from March to June 2020. Treatment outcomes were compared for dialysis and non-dialysis dependent patients who received CPAP with limitations on their escalation and resuscitation status. Kaplan-Meier survival curves and Cox regression models were used to compare outcomes. The primary study outcome was 30 day mortality. Confounders including length of admission, systemic anticoagulation and ultrafiltration volumes on dialysis were also analysed. RESULTS: Over the study period, 40 dialysis patients tested positive for COVID-19, with 30 requiring hospital admission. 93% (n = 28) required supplementary oxygen and 12% (n = 9) required CPAP on the ward. These patients were compared to a serial selection of 14 non-dialysis patients treated with CPAP during the same period. Results showed a significant difference in 30 day survival rates between the two groups: 88.9% in the dialysis group vs. 21.4% in the non-dialysis group. Statistical modelling showed that anticoagulation was also an important factor and correlated with better outcomes. CONCLUSION: This is to the best of our knowledge, the largest series of COVID-19 dialysis patients treated with CPAP in a ward-based setting. In general, dialysis dependent patients have multiple co-morbidities including cardiovascular disease and diabetes mellitus making them vulnerable to COVID-19 and not always suitable for treatment in ICU. We showed a significantly lower 30 day mortality rate with the use of CPAP in the dialysis group (11.1%) compared to the non-dialysis group (78.6%). Despite a small sample size, we believe this study provides impetus for further work clarifying the role of CPAP in treating COVID-19 dialysis dependent patients.


Assuntos
COVID-19/terapia , Pressão Positiva Contínua nas Vias Aéreas/métodos , Falência Renal Crônica/terapia , Insuficiência Respiratória/terapia , Idoso , Idoso de 80 Anos ou mais , Anticoagulantes/uso terapêutico , COVID-19/complicações , Feminino , Unidades Hospitalares , Hospitalização , Humanos , Unidades de Terapia Intensiva , Falência Renal Crônica/complicações , Masculino , Pessoa de Meia-Idade , Mortalidade , Nefrologia , Diálise Renal , SARS-CoV-2 , Taxa de Sobrevida
7.
Medicine (Baltimore) ; 100(15): e25438, 2021 Apr 16.
Artigo em Inglês | MEDLINE | ID: mdl-33847645

RESUMO

BACKGROUND: Obstructive sleep apnea (OSA) is correlated with atrial fibrillation (AF). Over the past decade, there has been an increasing interest in the relationship between OSA with continuous positive airway pressure (CPAP) and progression or recurrence of AF. METHODS: This investigation was an analysis of studies searched in the Cochrane Library, PubMed, EMBASE, EBSCO, OVID, and Web of Science databases from inception to July 2020 to evaluate the recurrence or progression of AF in CPAP users, CPAP nonusers, and patients without OSA. RESULTS: Nine studies with 14,812 patients were recruited. CPAP therapy reduced the risk of AF recurrence or progression by 63% in a random-effects model (24.8% vs 40.5%, risk ratio [RR] = 0.70, 95% confidence interval [CI] = 0.57-0.85, P = .035). Compared with non-OSA patients, AF recurrence or progression was much higher in CPAP nonusers (40.6% vs 21.1%, RR = 1.70, 95% CI = 1.19-2.43, P = .000). However, AF recurrence or progression in the CPAP group was similar to that in the non-OSA group (24.0% vs 21.1%, RR = 1.13, 95% CI = 0.87-1.47, P = .001). Begg correlation test and Egger regression test revealed no publication bias in this analysis. CONCLUSIONS: OSA is a salient factor in the progression or recurrence of AF. CPAP therapy for OSA may contribute to reduction of AF in patients for whom radiofrequency ablation or direct current cardioversion is not performed. TRIAL REGISTRATION: The protocol for this meta-analysis was registered on PROSPERO with a registration No. CRD42019135229.


Assuntos
Fibrilação Atrial/epidemiologia , Pressão Positiva Contínua nas Vias Aéreas/métodos , Apneia Obstrutiva do Sono/epidemiologia , Apneia Obstrutiva do Sono/terapia , Idoso , Índice de Massa Corporal , Diabetes Mellitus/epidemiologia , Feminino , Humanos , Hipertensão/epidemiologia , Masculino , Pessoa de Meia-Idade
8.
Adv Respir Med ; 89(2): 197-202, 2021.
Artigo em Inglês | MEDLINE | ID: mdl-33871045

RESUMO

Coronavirus disease 2019 (COVID-19) caused by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) is currently considered a significant threat to global health and global economy. This new rapidly spreading virus causes enormous stress to healthcare systems as large number of patients present with respiratory failure, needing intubation and mechanical ventilation. While the industry is racing to meet the rising demand for ventilators, all the alternative respiratory support modalities are employed to save lives in hospitals around the globe. We hereby report 6 patients who were diagnosed with SARS-CoV-2 and treated with continuous positive airway pressure in a negative pressure isolated room in a tertiary center in western Greece. The rapid progression of mild flu-like symptoms to respiratory failure in all patients was controlled with the use of continuous positive airway pressure making this strategy a reasonable alternative to respiratory failure due to SARS-CoV-2 as it may avert intubation and mechanical ventilation.


Assuntos
COVID-19/terapia , Pressão Positiva Contínua nas Vias Aéreas/métodos , Insuficiência Respiratória/terapia , Idoso , COVID-19/complicações , Feminino , Grécia , Humanos , Masculino , Pessoa de Meia-Idade , Oxigenoterapia/métodos , Insuficiência Respiratória/etiologia
10.
Chest ; 160(1): 175-186, 2021 07.
Artigo em Inglês | MEDLINE | ID: mdl-33667491

RESUMO

BACKGROUND: SARS-CoV-2 aerosolization during noninvasive positive-pressure ventilation may endanger health care professionals. Various circuit setups have been described to reduce virus aerosolization. However, these setups may alter ventilator performance. RESEARCH QUESTION: What are the consequences of the various suggested circuit setups on ventilator efficacy during CPAP and noninvasive ventilation (NIV)? STUDY DESIGN AND METHODS: Eight circuit setups were evaluated on a bench test model that consisted of a three-dimensional printed head and an artificial lung. Setups included a dual-limb circuit with an oronasal mask, a dual-limb circuit with a helmet interface, a single-limb circuit with a passive exhalation valve, three single-limb circuits with custom-made additional leaks, and two single-limb circuits with active exhalation valves. All setups were evaluated during NIV and CPAP. The following variables were recorded: the inspiratory flow preceding triggering of the ventilator, the inspiratory effort required to trigger the ventilator, the triggering delay, the maximal inspiratory pressure delivered by the ventilator, the tidal volume generated to the artificial lung, the total work of breathing, and the pressure-time product needed to trigger the ventilator. RESULTS: With NIV, the type of circuit setup had a significant impact on inspiratory flow preceding triggering of the ventilator (P < .0001), the inspiratory effort required to trigger the ventilator (P < .0001), the triggering delay (P < .0001), the maximal inspiratory pressure (P < .0001), the tidal volume (P = .0008), the work of breathing (P < .0001), and the pressure-time product needed to trigger the ventilator (P < .0001). Similar differences and consequences were seen with CPAP as well as with the addition of bacterial filters. Best performance was achieved with a dual-limb circuit with an oronasal mask. Worst performance was achieved with a dual-limb circuit with a helmet interface. INTERPRETATION: Ventilator performance is significantly impacted by the circuit setup. A dual-limb circuit with oronasal mask should be used preferentially.


Assuntos
COVID-19 , Pressão Positiva Contínua nas Vias Aéreas , Transmissão de Doença Infecciosa/prevenção & controle , Ventilação não Invasiva , Filtros de Ar , Benchmarking/métodos , COVID-19/terapia , COVID-19/transmissão , Pressão Positiva Contínua nas Vias Aéreas/efeitos adversos , Pressão Positiva Contínua nas Vias Aéreas/instrumentação , Pressão Positiva Contínua nas Vias Aéreas/métodos , Procedimentos Clínicos/normas , Procedimentos Clínicos/tendências , Humanos , Transmissão de Doença Infecciosa do Paciente para o Profissional/prevenção & controle , Ventilação não Invasiva/efeitos adversos , Ventilação não Invasiva/instrumentação , Ventilação não Invasiva/métodos , Projetos de Pesquisa , Testes de Função Respiratória/métodos , SARS-CoV-2 , Resultado do Tratamento , Ventiladores Mecânicos
11.
Medicine (Baltimore) ; 100(8): e24368, 2021 Feb 26.
Artigo em Inglês | MEDLINE | ID: mdl-33663049

RESUMO

BACKGROUND: The association between obstructive sleep apnea-hypopnea syndrome (OSAHS) and plasma/serum ghrelin levels remains controversial. We performed a meta-analysis to evaluate the difference in plasma/serum ghrelin levels between OSAHS patients and controls. METHODS: Database of PubMed, SCI, and Elsevier were searched entirely. Two independents identified eligible studies of ghrelin levels in OSAHS patients. ReviewManager (version 5.3) was adopted for data synthesis. RESULTS: The meta-analysis A pooled the comparison of ghrelin concentrations in OSAHS patients and controls, which included 7 studies and involving 446 participants. The result of the meta-analysis A indicated that plasma/serum ghrelin levels were no significant differences between the OSAHS group and the control group (standard mean difference (SMD) = 0.08, 95% confidence interval (CI) = -0.12 to 0.28, P = .43). As a supplementary, meta-analysis B pooled the comparison of plasma/serum ghrelin levels in OSAHS patients before and after continuous positive airway pressure (CPAP) therapy, which included 155 participants from 4 studies, it revealed that plasma/serum ghrelin levels were no significant differences between before and after CPAP therapy (SMD = 0.12, 95%CI = -0.07 to 0.31, P = .22). CONCLUSION: The meta-analysis A demonstrated that plasma/serum ghrelin levels were no significant differences between the OSAHS group and the control group. The meta-analysis B showed plasma/serum ghrelin levels have no significant changes after CPAP therapy in OSAHS patients.


Assuntos
Grelina/sangue , Apneia Obstrutiva do Sono/sangue , Pressão Positiva Contínua nas Vias Aéreas/métodos , Humanos , Projetos de Pesquisa , Apneia Obstrutiva do Sono/terapia
12.
Sci Rep ; 11(1): 5559, 2021 03 10.
Artigo em Inglês | MEDLINE | ID: mdl-33692464

RESUMO

During the COVID-19 pandemic, the need for noninvasive respiratory support devices has dramatically increased, sometimes exceeding hospital capacity. The full-face Decathlon snorkeling mask, EasyBreath (EB mask), has been adapted to deliver continuous positive airway pressure (CPAP) as an emergency respiratory interface. We aimed to assess the performance of this modified EB mask and to test its use during different gas mixture supplies. CPAP set at 5, 10, and 15 cmH2O was delivered to 10 healthy volunteers with a high-flow system generator set at 40, 80, and 120 L min-1 and with a turbine-driven ventilator during both spontaneous and loaded (resistor) breathing. Inspiratory CO2 partial pressure (PiCO2), pressure inside the mask, breathing pattern and electrical activity of the diaphragm (EAdi) were measured at all combinations of CPAP/flows delivered, with and without the resistor. Using the high-flow generator set at 40 L min-1, the PiCO2 significantly increased and the system was unable to maintain the target CPAP of 10 and 15 cmH2O and a stable pressure within the respiratory cycle; conversely, the turbine-driven ventilator did. EAdi significantly increased with flow rates of 40 and 80 L min-1 but not at 120 L min-1 and with the turbine-driven ventilator. EB mask can be safely used to deliver CPAP only under strict constraints, using either a high-flow generator at a flow rate greater than 80 L min-1, or a high-performance turbine-driven ventilator.


Assuntos
COVID-19/terapia , Pressão Positiva Contínua nas Vias Aéreas/instrumentação , Respiração Artificial/instrumentação , Adulto , Pressão Positiva Contínua nas Vias Aéreas/métodos , Mergulho , Feminino , Voluntários Saudáveis , Humanos , Masculino , Máscaras , Pandemias , Respiração , Respiração Artificial/métodos , SARS-CoV-2/patogenicidade , Ventiladores Mecânicos
13.
BMJ Case Rep ; 14(2)2021 Feb 05.
Artigo em Inglês | MEDLINE | ID: mdl-33547124

RESUMO

We report a case of aortoenteric fistula 2 years following endovascular aortic aneurysm repair (EVAR) for mycotic aneurysm presenting as upper gastrointestinal bleeding. Initial CT angiogram did not reveal the bleeding or connection to bowel, but endoscopy was suspicious of endograft in the duodenum. Management required a multidisciplinary approach. To stabilise the patient and to control bleeding, a 'bridging' endograft extension was performed. This was followed by open surgical removal of the EVAR endograft and lower limb in situ revascularisation. During postoperative recovery, the patient developed atypical, staged multisystemic symptoms (cardiac, pulmonary and neurological). With increasing awareness of the COVID-19 pandemic, the patient was found SARS-CoV-2-positive, which explained the progression of his symptoms. This was also reflected on other case reports in literature later.


Assuntos
Aneurisma Infectado/cirurgia , Aneurisma da Aorta Abdominal/cirurgia , COVID-19/complicações , Procedimentos Endovasculares/métodos , Fístula Intestinal/complicações , Fístula Vascular/complicações , Idoso , Antibacterianos/uso terapêutico , Aorta/diagnóstico por imagem , Aorta/cirurgia , COVID-19/diagnóstico , COVID-19/terapia , Teste de Ácido Nucleico para COVID-19/métodos , Angiografia por Tomografia Computadorizada/métodos , Pressão Positiva Contínua nas Vias Aéreas/métodos , Humanos , Fístula Intestinal/diagnóstico por imagem , Fístula Intestinal/cirurgia , Masculino , SARS-CoV-2 , Fístula Vascular/diagnóstico por imagem , Fístula Vascular/cirurgia
14.
Crit Care ; 25(1): 80, 2021 02 24.
Artigo em Inglês | MEDLINE | ID: mdl-33627169

RESUMO

BACKGROUND: Respiratory failure due to COVID-19 pneumonia is associated with high mortality and may overwhelm health care systems, due to the surge of patients requiring advanced respiratory support. Shortage of intensive care unit (ICU) beds required many patients to be treated outside the ICU despite severe gas exchange impairment. Helmet is an effective interface to provide continuous positive airway pressure (CPAP) noninvasively. We report data about the usefulness of helmet CPAP during pandemic, either as treatment, a bridge to intubation or a rescue therapy for patients with care limitations (DNI). METHODS: In this observational study we collected data regarding patients failing standard oxygen therapy (i.e., non-rebreathing mask) due to COVID-19 pneumonia treated with a free flow helmet CPAP system. Patients' data were recorded before, at initiation of CPAP treatment and once a day, thereafter. CPAP failure was defined as a composite outcome of intubation or death. RESULTS: A total of 306 patients were included; 42% were deemed as DNI. Helmet CPAP treatment was successful in 69% of the full treatment and 28% of the DNI patients (P < 0.001). With helmet CPAP, PaO2/FiO2 ratio doubled from about 100 to 200 mmHg (P < 0.001); respiratory rate decreased from 28 [22-32] to 24 [20-29] breaths per minute, P < 0.001). C-reactive protein, time to oxygen mask failure, age, PaO2/FiO2 during CPAP, number of comorbidities were independently associated with CPAP failure. Helmet CPAP was maintained for 6 [3-9] days, almost continuously during the first two days. None of the full treatment patients died before intubation in the wards. CONCLUSIONS: Helmet CPAP treatment is feasible for several days outside the ICU, despite persistent impairment in gas exchange. It was used, without escalating to intubation, in the majority of full treatment patients after standard oxygen therapy failed. DNI patients could benefit from helmet CPAP as rescue therapy to improve survival. TRIAL REGISTRATION: NCT04424992.


Assuntos
COVID-19/complicações , Pressão Positiva Contínua nas Vias Aéreas/métodos , Surtos de Doenças , Hipóxia/terapia , Pneumonia Viral/terapia , Idoso , COVID-19/epidemiologia , Estudos de Viabilidade , Feminino , Humanos , Hipóxia/virologia , Unidades de Terapia Intensiva , Masculino , Pessoa de Meia-Idade , Ventilação não Invasiva , Pneumonia Viral/virologia , Resultado do Tratamento
16.
Hypertension ; 77(3): 980-992, 2021 03 03.
Artigo em Inglês | MEDLINE | ID: mdl-33461313

RESUMO

It is unknown whether obesity modifies the effect of obstructive sleep apnea (OSA) and positive airway pressure (PAP) therapy on cardiac remodeling and NT-proBNP (N-terminal pro-B-type natriuretic peptide) levels. We compared NT-proBNP and cardiac magnetic resonance imaging in adults without OSA (n=56) and nonobese (n=73; body mass index <30 kg/m2) and obese (n=136; body mass index ≥30 kg/m2) adults with OSA. We also investigated these traits in nonobese (n=45) and obese (n=78) participants with OSA adherent to 4 months of PAP treatment. At baseline, left ventricular mass to end-diastolic volume ratio, a measure of left ventricular concentricity, was greater in both nonobese and obese participants with OSA compared with those without OSA. Participants with OSA and obesity exhibited reduced phasic right atrial function. No significant differences in baseline NT-proBNP were observed across groups. The effect of PAP treatment on NT-proBNP and left atrial volume index was significantly modified by obesity. In nonobese participants, PAP therapy was associated with a decrease in NT-proBNP (P<0.0001) without a change in left atrial volume index, whereas in obese participants, PAP was associated with an increase in left atrial volume index (P=0.006) without a change in NT-proBNP. OSA was associated with left ventricular concentric remodeling independent of obesity and right atrial dysfunction in participants who were obese. PAP treatment was associated with reduced NT-proBNP in nonobese participants with OSA, but left atrial enlargement in obese participants with OSA, suggesting that PAP-induced reduction in BNP release (which is known to occur during obstructive apnea episodes) may lead to volume retention in obese participants with OSA. Registration: URL: https://www.clinicaltrials.gov; Unique identifier: NCT01578031.


Assuntos
Biomarcadores/sangue , Pressão Positiva Contínua nas Vias Aéreas/métodos , Coração/fisiopatologia , Imageamento por Ressonância Magnética/métodos , Obesidade/fisiopatologia , Apneia Obstrutiva do Sono/terapia , Adulto , Remodelamento Atrial/fisiologia , Índice de Massa Corporal , Feminino , Coração/diagnóstico por imagem , Humanos , Masculino , Pessoa de Meia-Idade , Peptídeo Natriurético Encefálico/sangue , Fragmentos de Peptídeos/sangue , Polissonografia/métodos , Apneia Obstrutiva do Sono/diagnóstico , Apneia Obstrutiva do Sono/fisiopatologia , Remodelação Ventricular/fisiologia
17.
Am J Otolaryngol ; 42(2): 102866, 2021.
Artigo em Inglês | MEDLINE | ID: mdl-33418179

RESUMO

Obstructive sleep apnea (OSA) has become increasingly prevalent in the United States. While continuous positive airway pressure (CPAP) therapy remains the gold standard for treatment, surgical intervention can enhance compliance and improve outcomes for those intolerant of CPAP. Since the majority of OSA patients have multilevel obstruction, it is critical that otolaryngologists understand each patient's pattern and anatomic level of obstruction before solidifying a treatment plan. This publication serves as a comprehensive review of evaluation, characterization, and management of OSA. Further, the authors outline their departmental algorithm for identifying ideal surgical candidates and tailoring corresponding surgical interventions.


Assuntos
Pressão Positiva Contínua nas Vias Aéreas/métodos , Seleção de Pacientes , Apneia Obstrutiva do Sono/cirurgia , Apneia Obstrutiva do Sono/terapia , Algoritmos , Feminino , Humanos , Masculino , Procedimentos Cirúrgicos Otorrinolaringológicos , Cooperação do Paciente , Polissonografia , Apneia Obstrutiva do Sono/diagnóstico , Apneia Obstrutiva do Sono/patologia
18.
Ann Am Thorac Soc ; 18(6): 1020-1026, 2021 06.
Artigo em Inglês | MEDLINE | ID: mdl-33395553

RESUMO

Rationale: Treatment with noninvasive ventilation (NIV) in coronavirus disease (COVID-19) is frequent. Shortage of intensive care unit (ICU) beds led clinicians to deliver NIV also outside ICUs. Data about the use of NIV in COVID-19 is limited.Objectives: To describe the prevalence and clinical characteristics of patients with COVID-19 treated with NIV outside the ICUs. To investigate the factors associated with NIV failure (need for intubation or death).Methods: In this prospective, single-day observational study, we enrolled adult patients with COVID-19 who were treated with NIV outside the ICU from 31 hospitals in Lombardy, Italy.Results: We collected data on demographic and clinical characteristics, ventilatory management, and patient outcomes. Of 8,753 patients with COVID-19 present in the hospitals on the study day, 909 (10%) were receiving NIV outside the ICU. A majority of patients (778/909; 85%) patients were treated with continuous positive airway pressure (CPAP), which was delivered by helmet in 617 (68%) patients. NIV failed in 300 patients (37.6%), whereas 498 (62.4%) patients were discharged alive without intubation. Overall mortality was 25%. NIV failure occurred in 152/284 (53%) patients with an arterial oxygen pressure (PaO2)/fraction of inspired oxygen (FiO2) ratio <150 mm Hg. Higher C-reactive protein and lower PaO2/FiO2 and platelet counts were independently associated with increased risk of NIV failure.Conclusions: The use of NIV outside the ICUs was common in COVID-19, with a predominant use of helmet CPAP, with a rate of success >60% and close to 75% in full-treatment patients. C-reactive protein, PaO2/FiO2, and platelet counts were independently associated with increased risk of NIV failure.Clinical trial registered with ClinicalTrials.gov (NCT04382235).


Assuntos
COVID-19/terapia , Pressão Positiva Contínua nas Vias Aéreas/métodos , Mortalidade Hospitalar , Hipóxia/terapia , Intubação Intratraqueal/estatística & dados numéricos , Ventilação não Invasiva/métodos , Quartos de Pacientes , Insuficiência Respiratória/terapia , Idoso , Cânula , Feminino , Humanos , Unidades de Terapia Intensiva , Itália , Masculino , Pessoa de Meia-Idade , Oxigenoterapia , Estudos Prospectivos , SARS-CoV-2 , Falha de Tratamento
19.
Pulmonology ; 27(4): 305-312, 2021.
Artigo em Inglês | MEDLINE | ID: mdl-33516668

RESUMO

COVID-19 related Acute Respiratory Failure, may be successfully treated with Conventional Oxygen therapy, High Flow Nasal Cannula, Continuous Positive Airway Pressure or Bi-level Positive-Pressure ventilation. Despite the accumulated data in favor of the use of different Non-invasive Respiratory therapies in COVID-19 related Acute Respiratory Failure, it is not fully understood when start, escalate and de-escalate the best respiratory supportive option for the different timing of the disease. Based on the current published experience with Non-invasive Respiratory therapies in COVID-19 related Acute Respiratory Failure, we propose an algorithm in deciding when to start, when to stop and when to wean different NIRT. This strategy may help clinicians in better choosing NIRT during this second COVID-19 wave and beyond.


Assuntos
COVID-19/terapia , Pressão Positiva Contínua nas Vias Aéreas/métodos , Hipóxia/terapia , Ventilação não Invasiva/métodos , Oxigenoterapia/métodos , Insuficiência Respiratória/terapia , Algoritmos , Gasometria , Cânula , Humanos , Intubação Intratraqueal , Posicionamento do Paciente , Respiração com Pressão Positiva/métodos , Decúbito Ventral , Respiração Artificial , Taxa Respiratória , SARS-CoV-2
20.
J Appl Physiol (1985) ; 130(3): 877-891, 2021 03 01.
Artigo em Inglês | MEDLINE | ID: mdl-33444117

RESUMO

The worldwide pandemic caused by the SARS-CoV-2 virus has resulted in over 84,407,000 cases, with over 1,800,000 deaths when this paper was submitted, with comorbidities such as gender, race, age, body mass, diabetes, and hypertension greatly exacerbating mortality. This review will analyze the rapidly increasing knowledge of COVID-19-induced lung pathophysiology. Although controversial, the acute respiratory distress syndrome (ARDS) associated with COVID-19 (CARDS) seems to present as two distinct phenotypes: type L and type H. The "L" refers to low elastance, ventilation/perfusion ratio, lung weight, and recruitability, and the "H" refers to high pulmonary elastance, shunt, edema, and recruitability. However, the LUNG-SAFE (Large Observational Study to Understand the Global Impact of Severe Acute Respiratory Failure) and ESICM (European Society of Intensive Care Medicine) Trials Groups have shown that ∼13% of the mechanically ventilated non-COVID-19 ARDS patients have the type-L phenotype. Other studies have shown that CARDS and ARDS respiratory mechanics overlap and that standard ventilation strategies apply to these patients. The mechanisms causing alterations in pulmonary perfusion could be caused by some combination of 1) renin-angiotensin system dysregulation, 2) thrombosis caused by loss of endothelial barrier, 3) endothelial dysfunction causing loss of hypoxic pulmonary vasoconstriction perfusion control, and 4) hyperperfusion of collapsed lung tissue that has been directly measured and supported by a computational model. A flowchart has been constructed highlighting the need for personalized and adaptive ventilation strategies, such as the time-controlled adaptive ventilation method, to set and adjust the airway pressure release ventilation mode, which recently was shown to be effective at improving oxygenation and reducing inspiratory fraction of oxygen, vasopressors, and sedation in patients with COVID-19.


Assuntos
Lesão Pulmonar Aguda/etiologia , Lesão Pulmonar Aguda/patologia , COVID-19/complicações , COVID-19/patologia , Lesão Pulmonar Aguda/virologia , Animais , Pressão Positiva Contínua nas Vias Aéreas/métodos , Humanos , Hipóxia/patologia , Hipóxia/virologia , Pulmão/patologia , Pulmão/virologia , Síndrome do Desconforto Respiratório/patologia , Síndrome do Desconforto Respiratório/virologia , SARS-CoV-2/patogenicidade , Vasoconstrição/fisiologia
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