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1.
Rio de Janeiro; SES/RJ; mar.2020. 5 p.
Não convencional em Português | LILACS, CONASS, SES-RJ | ID: biblio-1087816

RESUMO

Este protocolo de tratamento a pacientes de coronavírus foi construído em conjunto com as Sociedades estaduais de Terapia Intensiva (SOTIERJ), Pneumologia (SOPTERJ), Infectologista (SIERJ), CREMERJ e opiniões de especialistas.


Assuntos
Humanos , Infecções por Coronavirus/epidemiologia , China/epidemiologia , Risco , Cuidados Críticos , Prevenção de Doenças , Suporte Ventilatório Interativo , Betacoronavirus
2.
World J Pediatr Congenit Heart Surg ; 10(5): 565-571, 2019 09.
Artigo em Inglês | MEDLINE | ID: mdl-31496404

RESUMO

BACKGROUND: Extubation failure rates for critical patients in pediatric intensive care units (ICUs) range from 5% to 29%. Noninvasive (NIV) ventilation has been shown to decrease extubation failure. We compared reintubation rates and outcomes of patients supported with NIV neurally adjusted ventilation assist (NAVA) versus historical controls supported with high-flow nasal cannula (HFNC). METHODS: Case-control study of infants less than three months of age who underwent cardiac surgery and received NIV support after extubation from January 2011 to May 2017. All patients supported with NIV NAVA after it became available in September 2013 were compared to matched patients extubated to HFNC from prior to September 2013. RESULTS: Forty-two patients identified for the NIV NAVA group were matched with 42 historical controls supported with HFNC. Groups had similar baseline characteristics based on rate of acute kidney injury, number of single ventricle patients, Society of Thoracic Surgeons-European Association for Cardio-Thoracic Surgery (STAT) category, age, weight, bypass time, and duration of intubation. There was no significant difference in reintubation rates within 72 hours (14.3% in the HFNC group and 16.7% in the NIV NAVA group, P = 1.0). Median duration from extubation to coming off NIV support was longer in the NIV NAVA group (3.6 days vs 0.6 days, P < .001). Median time from extubation to ICU discharge was longer in the NIV NAVA group (10.5 vs 6.8 days, P = .02), as was total postoperative ICU length of stay (LOS; 17.6 vs 12.2, P = .01). CONCLUSIONS: Introduction of NIV NAVA for postextubation support did not reduce reintubation rates compared to HFNC. Further study is needed as adoption of NIV NAVA may prolong LOS.


Assuntos
Cânula , Procedimentos Cirúrgicos Cardíacos , Cardiopatias Congênitas/cirurgia , Suporte Ventilatório Interativo , Ventilação não Invasiva , Cuidados Pós-Operatórios/instrumentação , Extubação/efeitos adversos , Estudos de Casos e Controles , Feminino , Humanos , Lactente , Recém-Nascido , Intubação Intratraqueal , Tempo de Internação , Masculino , Período Pós-Operatório , Estudos Retrospectivos , Resultado do Tratamento
4.
PLoS One ; 14(6): e0217089, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31188839

RESUMO

Impairments in cognitive function, mood, and sleep quality occur following ascent to high altitude. Low oxygen (hypoxia) and poor sleep quality are both linked to impaired cognitive performance, but their independent contributions at high altitude remain unknown. Adaptive servoventilation (ASV) improves sleep quality by stabilizing breathing and preventing central apneas without supplemental oxygen. We compared the efficacy of ASV and supplemental oxygen sleep treatments for improving daytime cognitive function and mood in high-altitude visitors (N = 18) during acclimatization to 3,800 m. Each night, subjects were randomly provided with ASV, supplemental oxygen (SpO2 > 95%), or no treatment. Each morning subjects completed a series of cognitive function tests and questionnaires to assess mood and multiple aspects of cognitive performance. We found that both ASV and supplemental oxygen (O2) improved daytime feelings of confusion (ASV: p < 0.01; O2: p < 0.05) and fatigue (ASV: p < 0.01; O2: p < 0.01) but did not improve other measures of cognitive performance at high altitude. However, performance improved on the trail making tests (TMT) A and B (p < 0.001), the balloon analog risk test (p < 0.0001), and the psychomotor vigilance test (p < 0.01) over the course of three days at altitude after controlling for effects of sleep treatments. Compared to sea level, subjects reported higher levels of confusion (p < 0.01) and performed worse on the TMT A (p < 0.05) and the emotion recognition test (p < 0.05) on nights when they received no treatment at high altitude. These results suggest that stabilizing breathing (ASV) or increasing oxygenation (supplemental oxygen) during sleep can reduce feelings of fatigue and confusion, but that daytime hypoxia may play a larger role in other cognitive impairments reported at high altitude. Furthermore, this study provides evidence that some aspects of cognition (executive control, risk inhibition, sustained attention) improve with acclimatization.


Assuntos
Afeto/fisiologia , Cognição/fisiologia , Suporte Ventilatório Interativo/métodos , Oxigênio/administração & dosagem , Apneia do Sono Tipo Central/terapia , Aclimatação , Adulto , Altitude , Feminino , Humanos , Masculino , Polissonografia , Autorrelato , Apneia do Sono Tipo Central/psicologia , Resultado do Tratamento , Adulto Jovem
8.
Crit Care ; 23(1): 135, 2019 Apr 23.
Artigo em Inglês | MEDLINE | ID: mdl-31014366

RESUMO

BACKGROUND: Veno-venous extracorporeal CO2 removal (vv-ECCO2R) and non-invasive neurally adjusted ventilator assist (NIV-NAVA) are two promising techniques which may prevent complications related to prolonged invasive mechanical ventilation in patients with acute exacerbation of COPD. METHODS: A physiological study of the electrical activity of the diaphragm (Edi) response was conducted with varying degrees of extracorporeal CO2 removal to control the respiratory drive in patients with severe acute exacerbation of COPD breathing on NIV-NAVA. RESULTS: Twenty COPD patients (SAPS II 37 ± 5.6, age 57 ± 9 years) treated with vv-ECCO2R and supported by NIV-NAVA were studied during stepwise weaning of vv-ECCO2R. Based on dyspnea, tolerance, and blood gases, weaning from vv-ECCO2R was successful in 12 and failed in eight patients. Respiratory drive (measured via the Edi) increased to 19 ± 10 µV vs. 56 ± 20 µV in the successful and unsuccessful weaning groups, respectively, resulting in all patients keeping their CO2 and pH values stable. Edi was the best predictor for vv-ECCO2R weaning failure (ROC analysis AUC 0.95), whereas respiratory rate, rapid shallow breathing index, and tidal volume had lower predictive values. Eventually, 19 patients were discharged home, while one patient died. Mortality at 90 days and 180 days was 15 and 25%, respectively. CONCLUSIONS: This study demonstrates for the first time the usefulness of the Edi signal to monitor and guide patients with severe acute exacerbation of COPD on vv-ECCO2R and NIV-NAVA. The Edi during vv-ECCO2R weaning was found to be the best predictor of tolerance to removing vv-ECCO2R.


Assuntos
Dióxido de Carbono/efeitos adversos , Hemofiltração/métodos , Suporte Ventilatório Interativo/métodos , Doença Pulmonar Obstrutiva Crônica/terapia , Idoso , Análise de Variância , Gasometria/métodos , Dióxido de Carbono/metabolismo , Feminino , Hemofiltração/tendências , Humanos , Suporte Ventilatório Interativo/tendências , Masculino , Pessoa de Meia-Idade , Ventilação não Invasiva/métodos , Doença Pulmonar Obstrutiva Crônica/fisiopatologia , Escala Psicológica Aguda Simplificada
11.
Crit Care ; 23(1): 2, 2019 01 07.
Artigo em Inglês | MEDLINE | ID: mdl-30616669

RESUMO

BACKGROUND: Prolonged weaning is a major issue in intensive care patients and tracheostomy is one of the last resort options. Optimized patient-ventilator interaction is essential to weaning. The purpose of this study was to compare patient-ventilator synchrony between pressure support ventilation (PSV) and neurally adjusted ventilatory assist (NAVA) in a selected population of tracheostomised patients. METHODS: We performed a prospective, sequential, non-randomized and single-centre study. Two recording periods of 60 min of airway pressure, flow, and electrical activity of the diaphragm during PSV and NAVA were recorded in a random assignment and eight periods of 1 min were analysed for each mode. We searched for macro-asynchronies (ineffective, double, and auto-triggering) and micro-asynchronies (inspiratory trigger delay, premature, and late cycling). The number and type of asynchrony events per minute and asynchrony index (AI) were determined. The two respiratory phases were compared using the non-parametric Wilcoxon test after testing the equality of the two variances (F-Test). RESULTS: Among the 61 patients analysed, the total AI was lower in NAVA than in PSV mode: 2.1% vs 14% (p < 0.0001). This was mainly due to a decrease in the micro-asynchronies index: 0.35% vs 9.8% (p < 0.0001). The occurrence of macro-asynchronies was similar in both ventilator modes except for double triggering, which increased in NAVA. The tidal volume (ml/kg) was lower in NAVA than in PSV (5.8 vs 6.2, p < 0.001), and the respiratory rate was higher in NAVA than in PSV (28 vs 26, p < 0.05). CONCLUSION: NAVA appears to be a promising ventilator mode in tracheotomised patients, especially for those requiring prolonged weaning due to the decrease in asynchronies.


Assuntos
Suporte Ventilatório Interativo/métodos , Vias Neurais/fisiologia , Respiração Artificial/normas , Traqueostomia/métodos , Idoso , Feminino , França , Humanos , Suporte Ventilatório Interativo/instrumentação , Suporte Ventilatório Interativo/normas , Masculino , Pessoa de Meia-Idade , Ventilação não Invasiva/instrumentação , Ventilação não Invasiva/métodos , Respiração com Pressão Positiva/métodos , Estudos Prospectivos , Respiração Artificial/instrumentação , Respiração Artificial/métodos , Índice de Gravidade de Doença , Escala Psicológica Aguda Simplificada , Traqueostomia/normas , Desmame do Respirador/instrumentação , Desmame do Respirador/métodos
12.
J Artif Organs ; 22(2): 118-125, 2019 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-30610519

RESUMO

NAVA may improve veno-venous ECMO weaning in children. This is a retrospective small series, describing for the first time proof-of-principle for the use of NAVA in children on VV ECMO. Six patients (age 1-48 months) needed veno-venous ECMO. Controlled conventional ventilation was replaced with assisted ventilation as soon as lung compliance improved, and could trigger initiation and termination of ventilation. NAVA was then initiated when diaphragmatic electrical activity (EAdi) allowed for triggering. NAVA was possible in all patients. Proportionate to EAdi (1.8-26 µV), initial peak inspiratory pressures ranged from 21 to 34 cm H2O, and the tidal volume (Vt) from 3 to 7 ml/kg. During weaning, peak pressures increased proportionally to EAdi increase (5.2-41 µV), with tidal volumes ranging from 6.6 to 8.6 ml/kg. ECMO was weaned after a median time of 1.75 days on NAVA. Following ECMO weaning, the median duration of mechanical ventilation, and intensive care unit stay were 4.5 days, and 13.5 days, respectively. Survival to hospital discharge was 100%. In conclusion, combining NAVA to ECMO in paediatric respiratory failure is safe and feasible, and may help in a smoother ECMO weaning, since NAVA allows the patient to drive the ventilator and regulate Vt according to needs.


Assuntos
Oxigenação por Membrana Extracorpórea/estatística & dados numéricos , Suporte Ventilatório Interativo , Síndrome do Desconforto Respiratório do Recém-Nascido/terapia , Insuficiência Respiratória/terapia , Pré-Escolar , Diafragma/fisiologia , Feminino , Humanos , Lactente , Pulmão , Masculino , Respiração Artificial , Testes de Função Respiratória , Estudos Retrospectivos , Volume de Ventilação Pulmonar
13.
Pediatr Cardiol ; 40(3): 563-569, 2019 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-30600371

RESUMO

We assessed the feasibility and the impact of NAVA compared to conventional modes of mechanical ventilation in ventilatory and gas exchange parameters in post-operative children with congenital heart disease. Infants and children (age < 18 years) that underwent congenital heart surgery were enrolled. Patients were ventilated with conventional synchronized intermittent mechanical ventilation (SIMV) and subsequently transitioned to NAVA during their cardiovascular intensive care unit (CVICU) stay. The ventilatory and gas exchange parameters for the 24 h pre- and post-transition to NAVA were compared. Additional parameters assessed included pain scores and sedation requirements. Eighty-one patients met inclusion criteria with a median age of 21 days (interquartile range 13 days-2 months). The majority of patients enrolled (75.3%) had complex congenital heart disease with high surgical severity scores. The transition to NAVA was tolerated by all patients without complications. The mean peak inspiratory pressure (PIP) was 1.8 cm H2O lower (p < 0.001) and mean airway pressure (Paw) was 0.5 cm H2O lower (p = 0.009) on NAVA compared to conventional modes of mechanical ventilation. There was no significant difference in patients' respiratory rate, tidal volume, arterial pH, pCO2, and lactate levels between the two modes of ventilation. There was a decreased sedation requirement during the time of NAVA ventilation. Comfort scores did not differ significantly with ventilator mode change. We concluded that NAVA is safe and well-tolerated mode of mechanical ventilation for our cohort of patients after congenital heart surgery. Compared to conventional ventilation there was a statistically significant decrease in PIP and Paw on NAVA.


Assuntos
Cardiopatias Congênitas/terapia , Suporte Ventilatório Interativo/métodos , Pulmão/fisiopatologia , Procedimentos Cirúrgicos Cardíacos , Estudos de Viabilidade , Feminino , Cardiopatias Congênitas/cirurgia , Humanos , Lactente , Recém-Nascido , Suporte Ventilatório Interativo/efeitos adversos , Masculino , Testes de Função Respiratória/métodos , Estudos Retrospectivos
14.
Zhonghua Nei Ke Za Zhi ; 58(1): 43-48, 2019 Jan 01.
Artigo em Chinês | MEDLINE | ID: mdl-30605950

RESUMO

Objective: To compare the trigger delay and work of trigger between neurally adjusted ventilatory assist (NAVA) and pressure support ventilation (PSV) in acute exacerbation of chronic obstructive pulmonary disease (AECOPD) patients with intrinsic positive end-expiratory pressure (PEEP) during mechanical ventilation. Methods: AECOPD patients with intrinsic PEEP (PEEPi) greater than or equal to 3 cmH(2)O (1 cmH(2)O=0.098 kPa) were enrolled during invasive mechanical ventilation. Subjects were ventilated with low, medium and high pressure under either NAVA or PSV mode. Servo Tracker software continuously recorded the waveform of ventilator and respiratory mechanics indexes (including respiratory frequency, inspiratory tidal volume (Vti), minute ventilation volume (VE), peak airway pressure (PIP), inspiratory time), and calculated trigger and expiratory conversion delay time, work of trigger and total work of breath. Results: A total of 14 AECOPD patients were enrolled with the average PEEPi (4.3±1.3) cmH(2)O. PSV inspiratory trigger delay time was positively correlated with PEEPi (r=0.913, P<0.05). Compared with PSV, NAVA significantly decreased trigger delay time in low, medium and high pressure level groups [(48±17) ms vs. (167±86) ms, (63±65) ms vs. (247±240) ms, (63±49) ms vs. (342±192) ms,respectively all P<0.05]. Similar results were shown as to work of trigger [(0.92±0.36) µV∙s vs. (1.22±0.70) µV∙s, (1.08±0.51) µV∙s vs. (1.62±1.25) µV∙s, (1.20±0.96) µV∙s vs. (2.29±1.02) µV∙s, all P<0.05]. Trigger delay time increased according to the increase of pressure level in PSV mode. Conclusion: The presence of PEEPi in AECOPD patients leads to obvious trigger delay under PSV mode, which is positively correlated with PEEPi level. NAVA significantly reduces trigger delay time and work of trigger compared with PSV mode.


Assuntos
Suporte Ventilatório Interativo/métodos , Respiração por Pressão Positiva Intrínseca , Respiração com Pressão Positiva/métodos , Doença Pulmonar Obstrutiva Crônica/terapia , Desmame do Respirador/métodos , Idoso , Gasometria/métodos , Humanos , Unidades de Terapia Intensiva , Doença Pulmonar Obstrutiva Crônica/complicações , Respiração Artificial/instrumentação , Respiração Artificial/métodos , Mecânica Respiratória , Ventiladores Mecânicos
15.
J Pediatr Surg ; 54(3): 434-438, 2019 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-29884552

RESUMO

BACKGROUND: The use of neurally adjusted ventilator assist (NAVA) in congenital diaphragmatic hernia (CDH) patients has been historically deemed unwise, since the trigger for breaths is the electromyographic activity of the diaphragmatic muscle. We report on our NAVA experience in CDH patients. METHODS: We performed an IRB-approved retrospective review of newborns from 1/1/2012-1/1/2017 at a Level I Children's Surgery Center undergoing CDH repair. Data obtained included demographics, defect type and repair, respiratory support, and outcomes. RESULTS: Seven infants with CDH were placed on noninvasive-NAVA (NIV-NAVA) after extubation. All seven patients underwent open transabdominal repair, with five requiring patch repair. All survived to discharge, and one year after birth. When we compared this group to a contemporary cohort of patients who also underwent CDH repair, we found no significant differences in birth weight, postmenstrual age, or gender. However, there was a significantly higher need for inhaled nitric oxide (p = 0.002), high frequency oscillatory ventilation (p = 0.016), and extracorporeal membranous oxygenation support (p = 0.045) in the NIV-NAVA cohort. CONCLUSION: This is the first report of NIV-NAVA being successfully utilized as an adjunct to wean infants from conventional ventilation after CDH repair, even in those who require patch repair or with more significant disease severity. LEVELS OF EVIDENCE: III- Retrospective Comparative Study.


Assuntos
Hérnias Diafragmáticas Congênitas/cirurgia , Herniorrafia/efeitos adversos , Suporte Ventilatório Interativo/métodos , Ventilação não Invasiva/métodos , Diafragma/cirurgia , Estudos de Viabilidade , Feminino , Humanos , Lactente , Recém-Nascido , Suporte Ventilatório Interativo/efeitos adversos , Tempo de Internação/estatística & dados numéricos , Masculino , Ventilação não Invasiva/efeitos adversos , Recidiva , Estudos Retrospectivos , Taxa de Sobrevida , Desmame do Respirador/métodos
16.
Conf Proc IEEE Eng Med Biol Soc ; 2019: 2348-2352, 2019 07.
Artigo em Inglês | MEDLINE | ID: mdl-31946371

RESUMO

The purpose was to develop a bench setup for testing a decision support system (DSS) for proportional assist ventilation (PAV). The test setup was based on a patient simulator connected to a mechanical ventilator with the DSS measurement sensors connected to the respiratory circuit. A test case was developed with parameters of lung mechanics reflecting a patient with mild acute respiratory distress syndrome. Five experiments were performed starting at different levels of percentage support (%Supp) and continuing until the DSS advised to remain at current settings. Final advice ranged from %Supp of 50-70%, indicating some dependence of baseline level, but with resulting patient effort estimates indicating that this may not be clinically important. Further studies are required of test cases reflecting different patient types and in patients.


Assuntos
Suporte Ventilatório Interativo , Síndrome do Desconforto Respiratório do Adulto , Humanos , Projetos Piloto , Respiração Artificial , Mecânica Respiratória , Ventiladores Mecânicos
17.
Crit Care Nurs Clin North Am ; 30(4): 523-531, 2018 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-30447811

RESUMO

The art and science of neonatal ventilation continue to evolve with advances in technology and as a result of evidenced based research. Although some historically administered therapies remain such as nasal continuous positive airway pressure, newer therapies have emerged in the neonatal intensive care unit such as pressure regulated volume control and neurally adjusted ventilatory assist. The challenge for clinicians continues to be which mode will support the patient's medical diagnosis with minimal barotrauma or lung injury. Vigilance and collaborative discussions among the treatment team remain the cornerstones of respiratory care practice parameters in the neonatal intensive care environment.


Assuntos
Pressão Positiva Contínua nas Vias Aéreas/métodos , Recém-Nascido Prematuro , Suporte Ventilatório Interativo/métodos , Síndrome do Desconforto Respiratório do Recém-Nascido/terapia , Humanos , Recém-Nascido , Unidades de Terapia Intensiva Neonatal
20.
Crit Care ; 22(1): 238, 2018 09 27.
Artigo em Inglês | MEDLINE | ID: mdl-30261920

RESUMO

BACKGROUND: Diaphragm dysfunction develops frequently in ventilated intensive care unit (ICU) patients. Both disuse atrophy (ventilator over-assist) and high respiratory muscle effort (ventilator under-assist) seem to be involved. A strong rationale exists to monitor diaphragm effort and titrate support to maintain respiratory muscle activity within physiological limits. Diaphragm electromyography is used to quantify breathing effort and has been correlated with transdiaphragmatic pressure and esophageal pressure. The neuromuscular efficiency index (NME) can be used to estimate inspiratory effort, however its repeatability has not been investigated yet. Our goal is to evaluate NME repeatability during an end-expiratory occlusion (NMEoccl) and its use to estimate the pressure generated by the inspiratory muscles (Pmus). METHODS: This is a prospective cohort study, performed in a medical-surgical ICU. A total of 31 adult patients were included, all ventilated in neurally adjusted ventilator assist (NAVA) mode with an electrical activity of the diaphragm (EAdi) catheter in situ. At four time points within 72 h five repeated end-expiratory occlusion maneuvers were performed. NMEoccl was calculated by delta airway pressure (ΔPaw)/ΔEAdi and was used to estimate Pmus. The repeatability coefficient (RC) was calculated to investigate the NMEoccl variability. RESULTS: A total number of 459 maneuvers were obtained. At time T = 0 mean NMEoccl was 1.22 ± 0.86 cmH2O/µV with a RC of 82.6%. This implies that when NMEoccl is 1.22 cmH2O/µV, it is expected with a probability of 95% that the subsequent measured NMEoccl will be between 2.22 and 0.22 cmH2O/µV. Additional EAdi waveform analysis to correct for non-physiological appearing waveforms, did not improve NMEoccl variability. Selecting three out of five occlusions with the lowest variability reduced the RC to 29.8%. CONCLUSIONS: Repeated measurements of NMEoccl exhibit high variability, limiting the ability of a single NMEoccl maneuver to estimate neuromuscular efficiency and therefore the pressure generated by the inspiratory muscles based on EAdi.


Assuntos
Estado Terminal/terapia , Diafragma/fisiopatologia , Eficiência/fisiologia , Estatística como Assunto/normas , Idoso , Estudos de Coortes , Eletromiografia/métodos , Feminino , Humanos , Unidades de Terapia Intensiva/organização & administração , Suporte Ventilatório Interativo/métodos , Masculino , Pessoa de Meia-Idade , Estudos Prospectivos , Respiração Artificial/métodos , Índice de Gravidade de Doença , Estatística como Assunto/métodos , Trabalho Respiratório/fisiologia
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