Your browser doesn't support javascript.
loading
Mostrar: 20 | 50 | 100
Resultados 1 - 20 de 7.194
Filtrar
2.
BMC Infect Dis ; 20(1): 810, 2020 Nov 06.
Artigo em Inglês | MEDLINE | ID: mdl-33158426

RESUMO

PURPOSE: The purpose of this study was to explore the clinical features, risk factors, and outcomes of mixed Candida albicans/bacterial bloodstream infections (mixed-CA/B-BSIs) compared with monomicrobial Candida albicans bloodstream infection (mono-CA-BSI) in adult patients in China. METHODS: All hospitalized adults with Candida albicans bloodstream infection (CA-BSI) were recruited for this retrospective observational study from January 1, 2013, to December 31, 2018. RESULTS: Of the 117 patients with CA-BSI, 24 patients (20.5%) had mixed-CA/B-BSIs. The most common copathogens were coagulase-negative Staphylococcus (CNS) (24.0%), followed by Klebsiella pneumoniae (20.0%) and Staphylococcus aureus (16.0%). In the multivariable analysis, a prior ICU stay > 2 days (adjusted odds ratio [OR], 7.445; 95% confidence interval [CI], 1.152-48.132) was an independent risk factor for mixed-CA/B-BSIs. Compared with patients with mono-CA-BSI, patients with mixed-CA/B-BSIs had a prolonged length of mechanical ventilation [17.5 (4.5, 34.8) vs. 3.0 (0.0, 24.5), p = 0.019] and prolonged length of ICU stay [22.0 (14.3, 42.2) vs. 8.0 (0.0, 31.5), p = 0.010]; however, mortality was not significantly different. CONCLUSIONS: There was a high rate of mixed-CA/B-BSIs cases among CA-BSI cases, and CNS was the predominant coexisting species. A prior ICU stay > 2 days was an independent risk factor for mixed -CA/B-BSIs. Although there was no difference in mortality, the outcomes of patients with mixed -CA/B-BSIs, including prolonged length of mechanical ventilation and prolonged length of ICU stay, were worse than those with mono-CA-BSI; this deserves further attention from clinicians.


Assuntos
Bacteriemia/complicações , Candida albicans/isolamento & purificação , Candidíase/complicações , Infecções por Klebsiella/complicações , Klebsiella pneumoniae/isolamento & purificação , Infecções Estafilocócicas/complicações , Staphylococcus aureus/isolamento & purificação , Idoso , Bacteriemia/microbiologia , Bacteriemia/mortalidade , Candidíase/microbiologia , Candidíase/mortalidade , China/epidemiologia , Infecção Hospitalar/microbiologia , Feminino , Humanos , Estimativa de Kaplan-Meier , Infecções por Klebsiella/microbiologia , Infecções por Klebsiella/mortalidade , Masculino , Pessoa de Meia-Idade , Respiração Artificial/efeitos adversos , Estudos Retrospectivos , Fatores de Risco , Infecções Estafilocócicas/microbiologia , Infecções Estafilocócicas/mortalidade
3.
Zhonghua Wei Zhong Bing Ji Jiu Yi Xue ; 32(10): 1213-1216, 2020 Oct.
Artigo em Chinês | MEDLINE | ID: mdl-33198866

RESUMO

OBJECTIVE: To understand the function of diaphragm and analyze the clinical factors affecting the function of diaphragm by measuring twitch tracheal pressure (TwPtr) in patients with mechanical ventilation and in the weaning phase. METHODS: Patients with more than 48 hours of invasive mechanical ventilation admitted to the department of critical care medicine of the First Affiliated Hospital of Guangzhou Medical University from December 2015 to March 2017 were enrolled. After the patient entered the weaning stage, TwPtr of patients was monitored by two-way non repetitive automatic respiratory trigger device, the effects of duration of mechanical ventilation, severe pulmonary infection, sedative application and chronic obstructive pulmonary disease (COPD) on weaning were analyzed. RESULTS: A total of 62 patients were included, of which 45 were male and 17 were female. The average age was (66.8±11.7) years old. Twenty-three cases had severe pneumonia. The absolute value of TwPtr in severe pneumonia group was lower than that in non-severe pneumonia group [cmH2O (1 cmH2O = 0.098 kPa): 10.40±5.81 vs. 14.35±5.22, P = 0.021]. However, there was no significant difference in the duration of mechanical ventilation between the severe pneumonia group and non-severe pneumonia group [days: 26 (17, 43) vs. 15 (11, 36), P = 0.091]. In 62 patients with mechanical ventilation, there was a negative correlation between TwPtr and duration of mechanical ventilation (r = 0.414, P = 0.002), there was also a negative correlation between the duration of mechanical ventilation and TwPtr after the assessment of diaphragm function (r = 0.277, P = 0.039). There was a linear relationship between TwPtr and sedatives (r = 0.220, P = 0.040), but there was no correlation between TwPtr and COPD (r = -0.178, P = 0.166). CONCLUSIONS: For patients in the weaning stage of mechanical ventilation, severe pulmonary infection is one of the factors that affect the diaphragm dysfunction. There is a certain correlation between the diaphragm dysfunction and the use of sedatives.


Assuntos
Doença Pulmonar Obstrutiva Crônica , Respiração Artificial , Idoso , Diafragma , Feminino , Humanos , Pulmão , Masculino , Pessoa de Meia-Idade , Pressão , Respiração Artificial/efeitos adversos , Traqueia , Desmame do Respirador
4.
Zhonghua Wei Zhong Bing Ji Jiu Yi Xue ; 32(10): 1257-1259, 2020 Oct.
Artigo em Chinês | MEDLINE | ID: mdl-33198876

RESUMO

OBJECTIVE: To explore the effective pressure range under continuous cuff pressure monitoring in critical patients with mechanical ventilation, so as to achieve the goal of ensuring ventilation quality and reducing mucosal injury without increasing the incidence of endotracheal catheter displacement and aspiration. METHODS: Ninety critically ill patients with non-pulmonary diseases admitted to the department of intensive care unit (ICU) of Airport Hospital of Tianjin Medical University from June 2017 to June 2019 were enrolled, and divided into three groups according to the random number table, with 30 patients in each group. For all patients in the three groups , the head of the bed was raised by 30 degree angleand the balloon was measured continuously. Cuff pressure in the three groups were maintained at 20, 25 and 30 cmH2O (1 cmH2O = 0.098 kPa) respectively. The patient's air leakage, oxygen saturation, tracheal tube displacement of each group were recorded every hour when the patients were calm. Fiberbronchoscope was used to aspirate sputum during extubation to check for mucosal damage. Chest X-ray examination was used to evaluate pulmonary infection and sputum bacteria culture examination was conducted at the same time. RESULTS: There was no significant difference in gender, age and critical condition among the three groups. The number of patients with airway mucosal injury in the 30 cmH2O group was significantly higher than that in the 20 cmH2O group (cases: 8 vs. 4, P < 0.05). There was no significant difference in airway mucosal injury between Group 20 cmH2O and Group 25, Group 25 cmH2O and Group 30 cmH2O. When the balloon pressure was 20, 25, and 30 cmH2O, there was no significant difference in air bag leakage (cases: 14, 10, 12), trachea catheter displacement (cases: 18, 11, 16), ventilator-associated pneumonia (cases: 3, 4, 3), all P > 0.05, and there was no significant difference in mechanical ventilation time and the hospitalization time [mechanical ventilation time (hours): 77.07±65.34, 80.80±70.20, 77.60±65.23; the length of ICU stay (days): 5.70±3.74, 5.30±4.57, 6.23±3.51, all P > 0.05]. CONCLUSIONS: The cuff pressure of 20 cmH2O will not increase the mechanical ventilation time and hospitalization time of patients, while 20 cmH2O is much safer in airway mucosal injury.


Assuntos
Pneumonia Associada à Ventilação Mecânica , Respiração Artificial , Extubação , Humanos , Pulmão , Respiração Artificial/efeitos adversos , Traqueia
5.
Isr Med Assoc J ; 22(10): 633-638, 2020 10.
Artigo em Inglês | MEDLINE | ID: mdl-33070488

RESUMO

BACKGROUND: In Israel, critically ill patients are ventilated and managed in intensive care units or general wards. OBJECTIVES: To compare the mortality rates and long-term cognitive and functional outcomes of ventilated patients who underwent tracheostomy insertion in the Medical ICU (MICU) versus those cared for in the in-patient wards. METHODS: The study comprised 170 patients who underwent percutaneous dilatational tracheostomy (PDT) over an 18-month period in the MICU (n=102) and in in-patient wards (internal medicine and neurology) (n=68). Telephone interviews were conducted with living patients and/or their relatives at least 6 months after discharge from the hospital. RESULTS: Ward patients were 10 years older than ICU patients undergoing PDT (P = 0.003). The length of stay (LOS) in the wards was longer than in the ICU (P < 0.001), whereas the total LOS in the hospital was similar (P = 0.43). ICU mortality was lower than in the wards (P = 0.001) but hospital mortality was comparable between the two groups (P = 0.17). At 6 months follow-up more ICU patients were fully conscious, weaned from ventilation, and decannulated. More patients in the ICU group were at home and were independent or had mildly impaired activities of daily living. More patients in the ward group were residing in long-term care facilities with functional limitations. CONCLUSIONS: MICU patients who undergo tracheostomy may have a good long-term functional and cognitive outcome. More studies are needed to further assess long-term outcomes in these patients.


Assuntos
Mortalidade Hospitalar/tendências , Unidades de Terapia Intensiva/estatística & dados numéricos , Quartos de Pacientes/estatística & dados numéricos , Respiração Artificial/métodos , Traqueostomia/métodos , Centros Médicos Acadêmicos/estatística & dados numéricos , Adulto , Fatores Etários , Causas de Morte , Transtornos Cognitivos/epidemiologia , Transtornos Cognitivos/etiologia , Transtornos Cognitivos/fisiopatologia , Estudos de Coortes , Cuidados Críticos/métodos , Estado Terminal/terapia , Feminino , Humanos , Israel , Estimativa de Kaplan-Meier , Tempo de Internação , Masculino , Pessoa de Meia-Idade , Prognóstico , Respiração Artificial/efeitos adversos , Estudos Retrospectivos , Medição de Risco , Fatores Sexuais , Estatísticas não Paramétricas , Traqueostomia/estatística & dados numéricos , Resultado do Tratamento , Adulto Jovem
8.
Nan Fang Yi Ke Da Xue Xue Bao ; 40(10): 1465-1471, 2020 Oct 30.
Artigo em Chinês | MEDLINE | ID: mdl-33118515

RESUMO

OBJECTIVE: To elucidate the pathogenic role of leukotriene B4 (LTB4) in pulmonary hyper-permeability and inflammation induced by lung-protective mechanical ventilation (LPMV) in rabbits. METHODS: Thirty-two healthy Japanese white rabbits were randomized into 4 groups for treatment with vehicle or bestatin (a leukotriene A4 hydrolase inhibitor that inhibits LTB4 production) administered intragastrically at the daily dose of 8 mg/kg for 5 days, followed by sham operation (group S and group BS, respectively, in which the rabbits were anesthetized only) or LPMV (group PM and group BPM, respectively, in which the rabbits received ventilation with 50% oxygen at a tidal volume of 8 mL/kg for 5 h). The concentrations of LTB4 and cyclic adenosine monophosphate (cAMP) in the lung tissues were analyzed by ELISA. cAMP content, protein kinase A (PKA) protein expression and the Rap1-GTP protein to total Rap1 protein ratio were determined to assess the activities of cAMP/PKA and Rap1 signaling pathways. The lung injury was evaluated by assessing lung permeability index, lung wet/dry weight ratio, polymorphonuclear leukocyte (PMN) count in bronchoalveolar lavage fluid (BALF), pulmonary myeloperoxidase (MPO) activity and lung histological scores. RESULTS: None of the examined parameters differed significantly between group S and group BS. All the parameters with the exception of lung histological score increased significantly in group PM and group BPM as compared to those in group S (P < 0.05). Compared with those in PM group, the rabbits in group BPM showed significantly reduced LTB4 production in the lungs (P < 0.05), up-regulated cAMP/ PKA and Rap1 signaling pathway activities (P < 0.05), and alleviated lung hyper-permeability and inflammation (P < 0.05). CONCLUSIONS: LPMV can induce LTB4 overproduction to down-regulate cAMP/PKA and Rap1 signaling pathways in the lungs of rabbits, which results in lung hyper-permeability and inflammation. Bestatin can inhibit LTB4 production in the lungs to protect against LPMV-induced lung hyper-permeability and inflammation.


Assuntos
Lesão Pulmonar , Animais , Líquido da Lavagem Broncoalveolar , Leucotrieno B4 , Pulmão , Lesão Pulmonar/etiologia , Lesão Pulmonar/prevenção & controle , Neutrófilos , Coelhos , Respiração Artificial/efeitos adversos
9.
Medicine (Baltimore) ; 99(41): e22386, 2020 Oct 09.
Artigo em Inglês | MEDLINE | ID: mdl-33031274

RESUMO

BACKGROUND: This study will assess the efficacy and safety of ventilator for the management of severe pneumonia (SP). METHODS: This study will search the following electronic databases in MEDLINE, EMBASE, Web of Science, PsycINFO, Cochrane Library, CNKI, and Scopus from the beginning to present without language restrictions. Two authors will screen all records according to the eligibility criteria; assess study quality; and extract all essential data from eligible studies. If sufficient studies are included, we will pool the extracted data and carry out meta-analysis. RESULTS: This study will summarize published studies to assess the efficacy and safety of ventilator for patients with SP. CONCLUSION: The results of this study may supply a genuine understanding of perspective from a scientific basis on ventilator for the management of patients with SP.


Assuntos
Pneumonia/terapia , Respiração Artificial , Ventiladores Mecânicos , Humanos , Gravidade do Paciente , Projetos de Pesquisa , Respiração Artificial/efeitos adversos , Respiração Artificial/instrumentação , Revisões Sistemáticas como Assunto , Ventiladores Mecânicos/efeitos adversos
10.
BMC Infect Dis ; 20(1): 794, 2020 Oct 27.
Artigo em Inglês | MEDLINE | ID: mdl-33109122

RESUMO

BACKGROUND: Pulmonary hemorrhage is an important complication of leptospirosis. Once acute respiratory distress syndrome (ARDS) occurs as a secondary condition, treatment is extremely difficult and the mortality rate is very high. CASE PRESENTATION: The patient was a 49-year-old. He was admitted to the hospital because he had experienced a fever and cough for 4 days. Hemorrhage, respiratory failure, ARDS and other symptoms appeared soon after admission. Due to severe pulmonary hemorrhage secondary to ARDS, mechanical ventilation was performed through tracheal intubation. During intubation, the patient suffered cardiac arrest, and the patient's condition worsened. He was confirmed to have leptospirosis through second-generation sequencing of the alveolar lavage fluid. Finally, we successfully treated the patient with penicillin as an anti-infective medication and venous-venous extracorporeal membrane oxygenation (v-vECMO). To the best of our knowledge, this report is the first to describe the successful application of ECMO in mainland China. CONCLUSIONS: Leptospirosis can induce serious but transient ARDS with a better prognosis than other causes of ARDS. Our patient was successfully treated with V-vECMO.


Assuntos
Oxigenação por Membrana Extracorpórea , Hemorragia/etiologia , Hemorragia/cirurgia , Leptospira/genética , Leptospirose/complicações , Síndrome do Desconforto Respiratório do Adulto/etiologia , Síndrome do Desconforto Respiratório do Adulto/cirurgia , Antibacterianos/uso terapêutico , Líquido da Lavagem Broncoalveolar/microbiologia , China , Humanos , Leptospira/isolamento & purificação , Leptospirose/tratamento farmacológico , Leptospirose/microbiologia , Masculino , Pessoa de Meia-Idade , Penicilinas/uso terapêutico , Prognóstico , Respiração Artificial/efeitos adversos , Síndrome do Desconforto Respiratório do Adulto/tratamento farmacológico , Insuficiência Respiratória/etiologia , Insuficiência Respiratória/cirurgia , Resultado do Tratamento
11.
BMJ Glob Health ; 5(8)2020 08.
Artigo em Inglês | MEDLINE | ID: mdl-32863269

RESUMO

Respiratory viruses can be transmitted through contact, droplet and airborne routes. Viruses that are not naturally airborne may be aerosolised during medical procedures and transmitted to healthcare workers. Most resource-limited healthcare settings lack complex air handling systems to filter air and create pressure gradients that are necessary for minimising viral transmission. This review explores the association between ventilation and the transmission of respiratory viruses like SAR-CoV-2. When used appropriately, both natural and mechanical ventilation can decrease the concentration of viral aerosols, thereby reducing transmission. Although mechanical ventilation systems are more efficient, installation and maintenance costs limit their use in resource-limited settings, whereas the prevailing climate conditions make natural ventilation less desirable. Cost-effective hybrid systems of natural and mechanical ventilation may overcome these limitations.


Assuntos
Betacoronavirus , Infecções por Coronavirus , Ambiente Controlado , Pandemias , Pneumonia Viral , Respiração Artificial , África , Microbiologia do Ar , Infecções por Coronavirus/epidemiologia , Infecções por Coronavirus/prevenção & controle , Infecções por Coronavirus/transmissão , Humanos , Pandemias/prevenção & controle , Isolamento de Pacientes , Quartos de Pacientes , Pneumonia Viral/epidemiologia , Pneumonia Viral/prevenção & controle , Pneumonia Viral/transmissão , Respiração Artificial/efeitos adversos , Respiração Artificial/estatística & dados numéricos
12.
Medicine (Baltimore) ; 99(35): e21595, 2020 Aug 28.
Artigo em Inglês | MEDLINE | ID: mdl-32871875

RESUMO

BACKGROUND: Delirium is a frequent form of acute brain dysfunction in mechanically ventilated patients. Screening tools have been developed to identify delirium, but it is unclear which tool is the most accurate. Therefore, we provide a protocol of systematic evaluation to assess the accuracy of delirium screening tools in mechanically ventilated patients. METHODS: PubMed, PsycINFO, EMBASE, and the Cochrane Library will be searched. Studies involving mechanically ventilated patients which compared diagnostic tools with the Diagnostic and Statistical Manual of Mental Disorders criteria as a reference standard will be included. We will use MetaDiSC and STATA 15.1 to analyze carefully when a network meta-analysis is allowed. RESULTS: This study will provide a high-quality synthesis to assess the accuracy of different screening methods in mechanically ventilated patients. CONCLUSION: The conclusion of our systematic review will provide evidence to judge which screening method is the best for mechanically ventilated patients.


Assuntos
Encéfalo/fisiopatologia , Delírio/etiologia , Programas de Rastreamento/métodos , Respiração Artificial/efeitos adversos , Delírio/diagnóstico , Delírio/prevenção & controle , Testes Diagnósticos de Rotina/estatística & dados numéricos , Manual Diagnóstico e Estatístico de Transtornos Mentais , Feminino , Humanos , Masculino , Metanálise em Rede
13.
J Rehabil Med ; 52(9): jrm00100, 2020 09 16.
Artigo em Inglês | MEDLINE | ID: mdl-32896863

RESUMO

OBJECTIVE: We present a case report that complements the conclusion of Stam et al. in their call to rehabilitation facilities to anticipate and prepare to address post intensive care syndrome in post-Covid-19 patients. METHODS: The case report presented here provides insight into treating mechanically ventilated post-Covid-19 patients. RESULTS: Early intervention with dysphagia therapy and speech therapy and ventilator-compatible speak-ing valves, provided within an interprofessional collaborative team, can mitigate the potentially negative consequences of prolonged intubation, long-term use of cuffed tracheostomy, and post intensive care syndrome resulting from Covid-19. CONCLUSION: Such a treatment approach can be used to address what is important to patients: to be able to speak with family and friends, eat what they want, and breathe spontaneously.


Assuntos
Infecções por Coronavirus/reabilitação , Transtornos de Deglutição/reabilitação , Terapia da Linguagem/métodos , Pneumonia Viral/reabilitação , Pneumologia/métodos , Fonoterapia/métodos , Betacoronavirus , Infecções por Coronavirus/virologia , Cuidados Críticos , Transtornos de Deglutição/etiologia , Humanos , Masculino , Pessoa de Meia-Idade , Pandemias , Equipe de Assistência ao Paciente , Pneumonia Viral/virologia , Respiração , Respiração Artificial/efeitos adversos , Fala , Síndrome , Traqueostomia/efeitos adversos , Traqueostomia/métodos
14.
J Bras Nefrol ; 42(2 suppl 1): 22-31, 2020 Aug 26.
Artigo em Inglês, Português | MEDLINE | ID: mdl-32877495

RESUMO

We produced this document to bring pertinent information to the practice of nephrology, as regards to the renal involvement with COVID-19, the management of acute kidney injury cases, and practical guidance on the provision of dialysis support.As information on COVID-19 evolves at a pace never before seen in medical science, these recommendations, although based on recent scientific evidence, refer to the present moment. The guidelines may be updated when published data and other relevant information become available.


Assuntos
Lesão Renal Aguda/terapia , Betacoronavirus , Infecções por Coronavirus/epidemiologia , Pneumonia Viral/epidemiologia , Terapia de Substituição Renal/normas , Dispositivos de Acesso Vascular/normas , Lesão Renal Aguda/epidemiologia , Lesão Renal Aguda/etiologia , Brasil/epidemiologia , Tomada de Decisão Clínica , Infecções por Coronavirus/tratamento farmacológico , Infecções por Coronavirus/prevenção & controle , Cuidados Críticos , Humanos , Rim/efeitos dos fármacos , Nefrologia/normas , Doenças Profissionais/prevenção & controle , Pandemias/prevenção & controle , Equipamento de Proteção Individual , Pneumonia Viral/tratamento farmacológico , Pneumonia Viral/prevenção & controle , Recuperação de Função Fisiológica , Terapia de Substituição Renal/métodos , Respiração Artificial/efeitos adversos , Sociedades Médicas
15.
PLoS One ; 15(9): e0238679, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32881950

RESUMO

PURPOSE: To investigate the role of lung ultrasound score (LUS) in assessing intubation timing for patients with severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) pneumonia. MATERIALS AND METHODS: Seventy-two patients with critical coronavirus disease 2019 (COVID-19) were admitted to a makeshift intensive care unit (ICU). All patients underwent bedside lung ultrasonography one to two times per day. The patients were either intubated, treated with noninvasive ventilation (NIV), or given high-flow nasal cannula (HFNC) after a discussion with the multidisciplinary group after their conditions worsened. Bedside lung ultrasound was performed daily after intubation, and patients received mechanical ventilation. Lung ultrasound was performed on days 1, 2, 3, 5, and 7 after patients were admitted to the ICU; if the patient was intubated, LUS determination was performed before intubation within 24 h (T1) and on days 1, 2, 5, and 7 after intubation (T2, T3, T4, and T5, respectively).The goal of this study was to evaluate the severity of lung aeration loss in intubated and non-intubated patients with SARS-CoV-2 pneumonia by ultrasound at different time points within one week. RESULTS: A total of 16 patients were included in this study, including nine who were intubated and mechanically ventilated and seven patients without intubation. The number of elderly individuals in the intubated group was higher than in the non-intubated group (P < 0.05). In addition, there were more male than female patients in both groups. Patient characteristics (BMI, SOFA, and PaO2/FiO2 value) were similar between the two groups (P > 0.05). The 28-day mortality rate of intubated patients was higher than that of non-intubated patients; six patients in the intubated group and two patients in the non-intubated group died. Nine intubated patients showed changes in LUS within seven days (n = 9). The mean LUS within 24 h before intubation was 12.8 ± 1.3. LUS was significantly higher on T1 than on T5 (P <0.05), and did not significantly differ from T1 to T4. Comparing LUS between intubated and non-intubated patients on T1 showed that the LUS of intubated patients was significantly higher than that of non-intubated patients (P <0.05). Between the two patient groups, oxygenation index was 140.1 ± 7.7 vs. 137.8 ± 5.9 on T1, and the respiratory rate of the two groups was 26 ± 5 vs. 28 ± 4 breaths/min. Neither oxygenation index nor RR significantly differed between the two groups. CONCLUSION: LUS may be an effective tool for assessing intubation timing in critically ill patients with Covid-19 interstitial pneumonia.


Assuntos
Infecções por Coronavirus/terapia , Intubação Intratraqueal/métodos , Pulmão/diagnóstico por imagem , Pneumonia Viral/terapia , Respiração Artificial/métodos , Ultrassonografia/métodos , Idoso , Infecções por Coronavirus/diagnóstico por imagem , Feminino , Humanos , Intubação Intratraqueal/efeitos adversos , Masculino , Pessoa de Meia-Idade , Pandemias , Pneumonia Viral/diagnóstico por imagem , Respiração Artificial/efeitos adversos , Fatores de Tempo
16.
Rev Assoc Med Bras (1992) ; 66Suppl 2(Suppl 2): 96-101, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32965365

RESUMO

COVID-19, caused by SARS-CoV-2, can present respiratory complications that often lead patients to depend on mechanical ventilation (MV) for several days. It is known that Pneumonia Associated with Mechanical Ventilation (PAMV) is frequent in patients who use this equipment for a long time. As a consequence of COVID-19, its prolonged use can lead to a worse prognosis for the patients. For this reason, in addition to the insufficiency of devices for mechanical ventilation to meet the current demand, it is necessary to adopt measures aimed at preventing complications that may aggravate the patient's clinical condition and, consequently, increase the average hospital stay and the respective hospital care costs. Therefore, the objective of this study was to discuss, in a concise and practical way, and based on the available literature, the importance of adopting adequate oral hygiene protocols for patients on mechanical ventilation. Based on the data obtained, it was identified that the adoption of effective oral hygiene measures, especially under the supervision of dental professionals, can contribute to the reduction of morbidity and mortality associated with MV, resulting in greater availability of mechanical ventilation equipment. Since such equipment is in great demand during the COVID-19 pandemic, the knowledge and implementation of effective oral hygiene measures will undoubtedly have an impact on improving the quality of care offered to patients, therefore benefiting all those in critical health conditions and assisted in ICUs.


Assuntos
Infecções por Coronavirus/terapia , Higiene Bucal , Pandemias , Pneumonia Viral/terapia , Respiração Artificial/efeitos adversos , Betacoronavirus , Infecções por Coronavirus/epidemiologia , Humanos , Unidades de Terapia Intensiva , Antissépticos Bucais/uso terapêutico , Pneumonia Viral/epidemiologia , Qualidade da Assistência à Saúde , Escovação Dentária/métodos
17.
Trials ; 21(1): 781, 2020 Sep 11.
Artigo em Inglês | MEDLINE | ID: mdl-32917259

RESUMO

OBJECTIVES: This study aims to demonstrate the positive effects on oxygenation of flow-controlled ventilation compared to conventionally ventilated patients in patients suffering from Acute respiratory distress syndrome (ARDS) associated with COVID-19.We define ARDS according to the "Berlin" definition integrating the oxygenation index (P/F ratio), the level of Positive End Expiratory Pressure (PEEP), radiological and clinical findings. TRIAL DESIGN: This is a prospective, randomized (1:1 ratio), parallel group feasibility study in adult patients with proven COVID-19 associated ARDS. PARTICIPANTS: All adult patients admitted to the ICU of Hamad Medical Corporation facilities in Qatar because of COVID-19 infection who develop moderate to severe ARDS are eligible. The inclusion criteria are above 18 years of age, proven COVID-19 infection, respiratory failure necessitating intubation and mechanical ventilation, ARDS with a P/F ratio of at least 200mmHg or less and a minimum PEEP 5cmH2O, BMI less 30 kg/ m2. The following exclusion criteria: no written consent, chronic respiratory disease, acute or chronic cardiovascular disease, pregnancy or need for special therapy (prone position and/or Extracorporeal membrane oxygenation). INTERVENTION AND COMPARATOR: After randomisation, the group A patients will be ventilated with the test-device for 48 hours. The settings will be started with the pre-existing-PEEP. The upper pressure will be determined to achieve a tidal volume of 6 ml/kg lean body mass, while the respiratory rate will be set to maintain an arterial pH above 7.2. In group B, the ventilator settings will be adjusted by the attending ICU team in accordance with lung-protective ventilation strategy. All other treatment will be unchanged and according to our local policies/guidelines. MAIN OUTCOMES: The primary end point is PaO2. As this is a dynamic parameter, we will record it every 6-8 hours and analyse it sequentially. RANDOMISATION: The study team screens the ventilated patients who fulfil the inclusion criteria and randomise using a 1:1 allocation ratio after consenting using a closed envelope method. The latter were prepared and sealed in advance by an independent person. BLINDING (MASKING): Due to the technical nature of the study (use of a specific ventilator) blinding is only possible for the data-analysts and the patients. NUMBERS TO BE RANDOMISED (SAMPLE SIZE): The sample size calculation based on the assumption of an effect size (change in PaO2) of 1.5 SDS in the primary endpoint (PaO2), an intended power of 80%, an alpha error of 5% and an equal sample ratio results in n=7 patients needed to treat. However, to compensate for dropouts we will include 10 patients in each group, which means in total 20 patients. TRIAL STATUS: The local registration number is MRC-05-018 with the protocol version number 3. The date of approval is 14th April 2020. Recruitment began 28th May 2020 and is expected to end in September 2020. TRIAL REGISTRATION: The protocol was registered before starting subject recruitment under the title: "Flow controlled ventilation in ARDS associated with COVID-19" in ClinicalTrials.org with the registration number: NCT04399317 . Registered on 22 May 2020. FULL PROTOCOL: The full protocol is attached as an additional file, accessible from the Trials website (Additional file 1). In the interest in expediting dissemination of this material, the familiar formatting has been eliminated; this Letter serves as a summary of the key elements of the full protocol.


Assuntos
Betacoronavirus/patogenicidade , Infecções por Coronavirus/terapia , Pulmão/virologia , Pneumonia Viral/terapia , Respiração Artificial , Síndrome do Desconforto Respiratório do Adulto/terapia , Infecções por Coronavirus/diagnóstico , Infecções por Coronavirus/fisiopatologia , Infecções por Coronavirus/virologia , Estudos de Viabilidade , Interações Hospedeiro-Patógeno , Humanos , Pulmão/fisiopatologia , Pandemias , Pneumonia Viral/diagnóstico , Pneumonia Viral/fisiopatologia , Pneumonia Viral/virologia , Estudos Prospectivos , Catar , Ensaios Clínicos Controlados Aleatórios como Assunto , Respiração Artificial/efeitos adversos , Síndrome do Desconforto Respiratório do Adulto/diagnóstico , Síndrome do Desconforto Respiratório do Adulto/fisiopatologia , Síndrome do Desconforto Respiratório do Adulto/virologia , Fatores de Tempo , Resultado do Tratamento
18.
Clin Imaging ; 67: 207-213, 2020 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-32871424

RESUMO

PURPOSE: We describe the presenting characteristics and hospital course of 11 novel coronavirus (COVID-19) patients who developed spontaneous subcutaneous emphysema (SE) with or without pneumomediastinum (SPM) in the absence of prior mechanical ventilation. MATERIALS AND METHODS: A total of 11 non-intubated COVID-19 patients (8 male and 3 female, median age 61 years) developed SE and SPM between March 15 and April 30, 2020 at a multi-center urban health system in New York City. Demographics (age, gender, smoking status, comorbid conditions, and body-mass index), clinical variables (temperature, oxygen saturation, and symptoms), and laboratory values (white blood cell count, C-reactive protein, D-dimer, and peak interleukin-6) were collected. Chest radiography (CXR) and computed tomography (CT) were analyzed for SE, SPM, and pneumothorax by a board-certified cardiothoracic-fellowship trained radiologist. RESULTS: Eleven non-intubated patients developed SE, 36% (4/11) of whom had SE on their initial CXR. Concomitant SPM was apparent in 91% (10/11) of patients, and 45% (5/11) also developed pneumothorax. Patients developed SE on average 13.3 days (SD: 6.3) following symptom onset. No patients reported a history of smoking. The most common comorbidities included hypertension (6/11), diabetes mellitus (5/11), asthma (3/11), dyslipidemia (3/11), and renal disease (2/11). Four (36%) patients expired during hospitalization. CONCLUSION: SE and SPM were observed in a cohort of 11 non-intubated COVID-19 patients without any known cause or history of invasive ventilation. Further investigation is required to elucidate the underlying mechanism in this patient population.


Assuntos
Infecções por Coronavirus/complicações , Enfisema Mediastínico/etiologia , Pneumonia Viral/complicações , Enfisema Subcutâneo/etiologia , Adulto , Idoso , Idoso de 80 Anos ou mais , Betacoronavirus , Comorbidade , Infecções por Coronavirus/virologia , Feminino , Produtos de Degradação da Fibrina e do Fibrinogênio/metabolismo , Hospitalização , Humanos , Masculino , Enfisema Mediastínico/epidemiologia , Pessoa de Meia-Idade , Pandemias , Pneumonia Viral/virologia , Pneumotórax/epidemiologia , Pneumotórax/etiologia , Respiração Artificial/efeitos adversos , Enfisema Subcutâneo/epidemiologia , Tomografia Computadorizada por Raios X/métodos
19.
J Wound Ostomy Continence Nurs ; 47(5): 430-434, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32868735

RESUMO

BACKGROUND: Medical device-related pressure injuries (MDRPIs) account for more than 30% of all hospital-acquired pressure injuries. The COVID-19 pandemic introduced a large population of patients at risk for MDRPIs due to prolonged intubation and prone positioning. We reviewed our experience with MDRPIs during the 2020 COVID-19 pandemic at an Academic Medical Center. CASES: We evaluated 30 cases of MDRPIs acquired during the peak of our pandemic, April 1 to May 31, 2020, and compared these to injuries seen over a similar time period prior to the pandemic. CONCLUSIONS: Our experiences with MDRPIs during this time has led the WOC team to begin development of a quality improvement project aimed at improving management of high-risk respiratory illness patients requiring intubation and prone positioning.


Assuntos
Betacoronavirus , Infecções por Coronavirus/terapia , Equipamentos e Provisões/efeitos adversos , Pneumonia Viral/terapia , Lesão por Pressão/etiologia , Lesão por Pressão/patologia , Decúbito Ventral , Adulto , Idoso , Idoso de 80 Anos ou mais , Infecções por Coronavirus/complicações , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Pandemias , Posicionamento do Paciente , Pneumonia Viral/complicações , Lesão por Pressão/prevenção & controle , Melhoria de Qualidade , Respiração Artificial/efeitos adversos , Respiração Artificial/instrumentação , Estudos Retrospectivos , Adulto Jovem
20.
J Wound Ostomy Continence Nurs ; 47(5): 435-438, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32868736

RESUMO

Patients admitted to the intensive care unit (ICU) are at a high risk for developing pressure injuries. A patient requiring multiorgan support is at a higher risk for pressure injuries related to immobility, sedation, vasopressors, and hypoxia. To mitigate pressure injuries, our hospital utilizes a bundle approach to prevent skin injury. However, despite efforts to prevent pressure injuries, we found our patients in the ICU with the diagnosis of COVID-19 went on to develop significant pressure and mucosal injuries. This is a case report of 4 patients diagnosed with COVID-19 who developed significant skin and mucosal injuries during their ICU admissions in the month of March 2020. We found that patients developed skin conditions that were initially thought to be deep-tissue injuries (DTIs) early in the admission. The DTIs progressed over the course of the admission in the ICU and evolved to thick adherent eschar that appeared to be unstageable pressure injuries, which extended beyond the soft tissue directly over the bony prominence. We also found that skin damage to the mucosa of the nares, tongue, lips, and urethra presented first as inflammation and then progressed to thick eschar. Despite maximum pressure relief with the use of a pressure-relieving turn and position system, bordered foam dressings, fluidized positioners, specialty beds, and leadership support for twice-a-week skin checks, our patients diagnosed with COVID-19 developed extensive skin damage across the fleshy portion of the buttocks and on the mucosa of the nares, tongue, lips, and urethra during minimal exposure to pressure. Although the initial presentation of the skin damage appeared to be related to pressure, the extent of the skin damage suggests a vascular inflammatory process beyond skin damage related to pressure.


Assuntos
Betacoronavirus , Infecções por Coronavirus/terapia , Equipamentos e Provisões/efeitos adversos , Membrana Mucosa/lesões , Pneumonia Viral/terapia , Lesão por Pressão/etiologia , Lesão por Pressão/patologia , Adulto , Idoso , Infecções por Coronavirus/complicações , Feminino , Humanos , Masculino , Pandemias , Pneumonia Viral/complicações , Lesão por Pressão/prevenção & controle , Respiração Artificial/efeitos adversos , Respiração Artificial/instrumentação
SELEÇÃO DE REFERÊNCIAS
DETALHE DA PESQUISA