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1.
PLoS One ; 14(7): e0218925, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31283762

RESUMO

Analyses of the 2009 H1N1 influenza pandemic and post-pandemic years showed high attack rates and severity among indigenous populations. This study presents the characteristics of the first documented influenza outbreak in indigenous peoples in Brazil, that occurred from 30th March to 14th April 2016 in a Guarani village in Southeast Region. Acute respiratory infections were prospectively investigated. The majority of the 73 cases were influenza-like illness (ILI) (63.0%) or severe acute respiratory infection (SARI) (20.5%). The ILI+SARI attack rate (35.9%) decreased with increasing age. There was a high influenza vaccination rate (86.3%), but no statistically significant difference in vaccination rates between severe and non-severe cases was seen (p = 0.334). Molecular analyses of 19.2% of the cases showed 100% positivity for influenza A(H1N1)pdm09 and/or hRSV. Influenza A(H1N1)pdm09 was included in the 6B.1 genetic group, a distinct cluster with 13 amino acid substitutions of A/California/07/2009-like. The hRSV were clustered in the BA-like genetic group. The early arrival of the influenza season overlapping usual hRSV season, the circulation of a drifted influenza virus not covered by vaccine and the high prevalence of risk factors for infection and severity in the village jointly can explain the high attack rate of ARI, even with a high rate of influenza vaccination. The results reinforce the importance of surveillance of respiratory viruses, timely vaccination and controlling risk factors for infection and severity of in the indigenous populations in order to preventing disease and related deaths, particularly in children.


Assuntos
Vacinas contra Influenza/uso terapêutico , Influenza Humana/epidemiologia , Transtornos Respiratórios/epidemiologia , Infecções Respiratórias/epidemiologia , Adolescente , Brasil/epidemiologia , Criança , Pré-Escolar , Surtos de Doenças , Feminino , Humanos , Lactente , Vírus da Influenza A Subtipo H1N1/patogenicidade , Influenza Humana/prevenção & controle , Influenza Humana/virologia , Masculino , Transtornos Respiratórios/prevenção & controle , Transtornos Respiratórios/virologia , Infecções Respiratórias/prevenção & controle , Infecções Respiratórias/virologia , Estações do Ano , Vacinação
2.
Br J Anaesth ; 122(6): e180-e188, 2019 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-30982564

RESUMO

BACKGROUND: Fentanyl is one of the most frequently administered intraoperative drugs and may increase the risk of postoperative respiratory complications (PRCs). METHODS: We performed a pre-specified analysis of 145 735 adult non-cardiac surgical cases under general anaesthesia. Using multivariable logistic regression, we evaluated the association of intraoperative fentanyl dose and PRCs within 3 days after surgery (defined as reintubation, respiratory failure, pneumonia, pulmonary oedema, or atelectasis). We examined effect modification by patient characteristics, surgical site, and anaesthetics used. RESULTS: PRCs within 3 days after surgery occurred in 18 839 (12.9%) patients. In comparison with high intraoperative fentanyl doses [median: 3.85; inter-quartile range (IQR): 3.42-4.50 µg kg-1, quartile 4 (Q4)], low intraoperative fentanyl dose [median: 0.80, IQR: 0.00-1.14 µg kg-1, quartile 1 (Q1)] was significantly associated with lower odds of PRCs [Q1 vs Q4: 10.9% vs 16.2%; adjusted odds ratio (aOR) 0.79; 95% confidence intervals (CI) 0.75-0.84; P<0.001; adjusted absolute risk difference (aARD) -1.7%]. This effect was augmented by thoracic surgery (P for interaction <0.001; aARD -6.2%), high doses of inhalation anaesthetics (P for interaction=0.016; aARD -2.2%) and neuromuscular blocking agents (NMBAs) (P for interaction=0.001; aARD -3.4%). Exploratory analysis demonstrated that compared with no fentanyl, low-dose fentanyl was associated with lower rates of PRCs (decile 2 vs decile 1: aOR 0.82, CI 0.75-0.89, P<0.001). CONCLUSIONS: Intraoperative low-dose fentanyl (about 60-120 µg for a 70 kg patient) was associated with lower risk of postoperative respiratory complications compared with both no fentanyl and high-dose fentanyl. Beneficial effects of low-dose fentanyl were magnified in specific patient subgroups. CLINICAL TRIAL REGISTRATION: NCT03198208.


Assuntos
Analgésicos Opioides/administração & dosagem , Fentanila/administração & dosagem , Complicações Pós-Operatórias/prevenção & controle , Transtornos Respiratórios/prevenção & controle , Adolescente , Adulto , Idoso , Idoso de 80 Anos ou mais , Analgésicos Opioides/efeitos adversos , Anestesia Geral/métodos , Relação Dose-Resposta a Droga , Feminino , Fentanila/efeitos adversos , Humanos , Período Intraoperatório , Masculino , Pessoa de Meia-Idade , Complicações Pós-Operatórias/induzido quimicamente , Sistema de Registros , Transtornos Respiratórios/induzido quimicamente , Estudos Retrospectivos , Adulto Jovem
3.
Indian J Dent Res ; 30(1): 133-134, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-30900673

RESUMO

Total maxillectomy for patients with malignant lesions will often incapacitate the patient both functionally and aesthetically. An immediate surgical obturator prosthesis would be of utmost importance for patients in these critical situations to aid in deglutition, phonetics, respiration and effectively avoiding various post-surgical complications. This article emphasizes on utilizing circum-zygomatic wiring for retention of the immediate surgical obturator in cases of total maxillectomy or edentulous patients.


Assuntos
Maxila/cirurgia , Procedimentos Cirúrgicos Bucais/métodos , Obturadores Palatinos , Procedimentos Cirúrgicos Reconstrutivos/métodos , Fios Ortopédicos , Transtornos de Deglutição/prevenção & controle , Humanos , Boca Edêntula/cirurgia , Complicações Pós-Operatórias/prevenção & controle , Transtornos Respiratórios/prevenção & controle , Transtorno Fonológico/prevenção & controle
4.
Int J Pediatr Otorhinolaryngol ; 120: 20-24, 2019 May.
Artigo em Inglês | MEDLINE | ID: mdl-30743190

RESUMO

OBJECTIVE: Quantify the rates influenza vaccination and RSV prophylaxis for children with airway stenosis and/or other disorders and assess impact on resource utilization. METHODS: This was a retrospective study with data extracted from Duke Enterprise Data Unified Content Explorer (DEDUCE) between January 1, 2006 and December 1, 2017. Children aged 18 years and younger with at least one diagnosis code for airway stenosis and/or disorders were included. The index date was defined as the first date of airway stenosis/disorders diagnosis. Each patient was followed for up to one year after the index date. Influenza vaccination or RSV prophylaxis documented within one year of index date were included. We defined emergency department (ED) visits and/or hospital admissions related to respiratory diagnoses as the primary outcome of increased resource utilization. RESULTS: A total of 2718 patients were included. In our institution, our results have indicated that there are fairly low vaccination documentation rates of influenza vaccination, RSV prophylaxis, or both provided to children with airway stenosis/disorders, 14.1% (389/2718), 1.1% (30/2718), and 0.6% (17/2718), respectively, within the first year after diagnosis. Around 5% (139/2718) and 10% (269/2718) experienced ED visits or hospitalizations related to respiratory issues within the first year after diagnosis, respectively. Among 139 and 269 patients with ED visits or hospitalizations, 34 (25%) and 54 (20%) had multiple visits, respectively. Very few patients had documented influenza vaccination (11/139, 0.4%) or RSV prophylaxis (5/269, 0.18%) before ED visits or hospitalization. CONCLUSIONS: There is little available evidence at this time for strategies to prevent adverse events or complications in children with airway stenosis/disorders. In our institution, our results have indicated that there are fairly low documented rates of influenza vaccination, RSV prophylaxis, or both provided to children with airway stenosis/disorders in the first year after diagnosis. This is an area of significant clinical interest for potentially limiting adverse events and optimizing resource utilization for children with airway stenosis/disorders.


Assuntos
Vacinas contra Influenza/administração & dosagem , Aceitação pelo Paciente de Cuidados de Saúde/estatística & dados numéricos , Transtornos Respiratórios/epidemiologia , Infecções por Vírus Respiratório Sincicial/prevenção & controle , Vacinação/estatística & dados numéricos , Adolescente , Criança , Pré-Escolar , Serviço Hospitalar de Emergência/estatística & dados numéricos , Feminino , Seguimentos , Recursos em Saúde , Hospitalização/estatística & dados numéricos , Humanos , Lactente , Influenza Humana/prevenção & controle , Masculino , Prevalência , Transtornos Respiratórios/prevenção & controle , Vírus Sinciciais Respiratórios/imunologia , Estudos Retrospectivos
5.
PLoS One ; 14(1): e0210350, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-30615663

RESUMO

INTRODUCTION: Chronic respiratory diseases in Tanzania are prevalent and a silent burden to the affected population, and healthcare system. We aimed to explore the availability of services and level of health facilities readiness to provide management of chronic respiratory diseases and its associated factors. METHODS: The current study is a secondary analysis of the 2014-2015 Tanzania Service Provision Assessment Survey data. Facilities were considered to have a high readiness to provide management of chronic respiratory diseases if they scored at least half (≥50%) of the indicators listed in each of the three domains (staff training and guideline, equipment, and basic medicines) as identified by World Health Organization-Service Availability and Readiness Assessment manual. Descriptive, unadjusted and adjusted logistic regression analyses were performed. A P value < 0.05 was taken to indicate statistical significance. RESULTS: Out of 723 facilities included in this analysis, approximately one-tenth had a high readiness to provide management of chronic respiratory diseases. Less than 10% of the facilities had at least one staff who received training for management of chronic respiratory diseases. In an adjusted model, privately owned facilities [AOR = 3.3; 95% CI, 1.5-7.5], hospitals [AOR = 11.6; 95% CI, 5.0-27.2], health centres [AOR = 5.0; 95% CI, 2.4-10.7], and performance of routine management meeting [AOR = 3.3; 95% CI, 1.4-7.8] were significantly associated with high readiness to provide management for chronic respiratory diseases. CONCLUSION: Majority of Tanzanian health facilities have low readiness to provide management for chronic respiratory diseases. There is a need for the Tanzanian government to increase the availability of diagnostic equipment, medication, and to provide refresher training specifically in the lower-level and public health facilities for better management of chronic respiratory diseases and other non-communicable diseases.


Assuntos
Assistência à Saúde/organização & administração , Instalações de Saúde/legislação & jurisprudência , Acesso aos Serviços de Saúde , Necessidades e Demandas de Serviços de Saúde/legislação & jurisprudência , Transtornos Respiratórios/epidemiologia , Transtornos Respiratórios/prevenção & controle , Feminino , Pesquisas sobre Serviços de Saúde , Instalações de Saúde/normas , Instalações de Saúde/provisão & distribução , Humanos , Masculino , Inquéritos e Questionários , Tanzânia/epidemiologia
7.
Paediatr Drugs ; 21(1): 25-31, 2019 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-30478762

RESUMO

BACKGROUND: Upper gastrointestinal endoscopies (UGEs) performed under ketamine sedation may increase the risk of respiratory adverse events (RAEs) due to pharyngeal stimulation. Topical lidocaine prevents general anesthesia-induced laryngospasm. OBJECTIVE: Our objective was to determine whether topical lidocaine may reduce the incidence of RAEs induced by pharyngeal stimulation in UGEs performed on children sedated with ketamine. METHODS: We conducted a single-center prospective study. We included every patient admitted for an elective diagnostic UGE under ketamine sedation who received lidocaine prior to the technique. Patients requiring any other medication were excluded. Our main outcome measure was the number of desaturation episodes. We then compared these results with those obtained in an historic group who did not receive topical lidocaine, in which we registered a total of 54 desaturation episodes. RESULTS: In total, 88 children (52.3% boys) were included. The median age was 7 years [interquartile range (IQR) 3-11]. The mean duration of the procedure was 6.5 ± 2.4 min, and the median initial ketamine dose was 1.76 mg/kg (IQR 1.56-2.03). The total number of desaturation episodes was 3 (3.4%), and two of these occurred prior to the introduction of the endoscope. This result represents a lower incidence than in previously reported series, and a significant decrease (p < 0.0001) with respect to the 54 RAEs registered in the historic group of 87 children. CONCLUSIONS: Topical lidocaine premedication significantly reduced the incidence of RAEs in children during UGEs under ketamine sedation. Our findings should be confirmed by a double-blind randomized controlled trial.


Assuntos
Anestésicos Dissociativos/uso terapêutico , Anestésicos Locais/administração & dosagem , Sedação Consciente/métodos , Endoscopia Gastrointestinal , Ketamina/uso terapêutico , Lidocaína/administração & dosagem , Transtornos Respiratórios/prevenção & controle , Anestesia Local/métodos , Criança , Pré-Escolar , Feminino , Humanos , Incidência , Laringismo/prevenção & controle , Masculino , Faringe/efeitos dos fármacos , Complicações Pós-Operatórias/prevenção & controle , Estudos Prospectivos
8.
Dis Esophagus ; 32(2)2019 02 01.
Artigo em Inglês | MEDLINE | ID: mdl-30295721

RESUMO

This study aims to examine the effect of preoperative inspiratory muscle training (IMT) on pre- and postoperative functional exercise performance in patients undergoing esophagectomy. A subcohort of patients recruited to the PREPARE randomized control trial were studied. Following evaluation of respiratory muscle function (spirometry, maximum inspiratory pressure (MIP), and inspiratory muscle endurance), postoperative mobilization (accelerometry) and postoperative physical functioning (6-minute walk test (6MWT)), participants scheduled for esophagectomy were randomly assigned to either 2 weeks of preoperative IMT or a control group. Measures were repeated on the day before surgery and postoperatively. Sixty participants (mean (standard deviation) age 64.13 (7.8) years; n = 42 male; n = 43 transthoracic esophagectomy; n = 17 transhiatial esophagectomy) were included in the final analysis (n = 28 IMT; n = 32 control). There was a significant improvement in preoperative MIP (P = 0.03) and inspiratory muscle endurance (P = 0.04); however preoperative 6MWT distance did not change. Postoperatively, control participants were more active on postoperative day (POD)1, and from POD1-POD5 (P = 0.04). Predischarge, 6MWT distance was significantly lower in the IMT group (305.61 (116.3) m) compared to controls (380.2 (47.1) m, P = 0.03). Despite an increase in preoperative respiratory muscle function, preoperative IMT does not improve pre- or postoperative physical functioning or postoperative mobilization following esophagectomy.


Assuntos
Exercícios Respiratórios/métodos , Esofagectomia/efeitos adversos , Complicações Pós-Operatórias/fisiopatologia , Cuidados Pré-Operatórios/métodos , Transtornos Respiratórios/fisiopatologia , Acelerometria , Idoso , Feminino , Humanos , Inalação , Masculino , Pessoa de Meia-Idade , Resistência Física , Desempenho Físico Funcional , Complicações Pós-Operatórias/etiologia , Complicações Pós-Operatórias/prevenção & controle , Período Pós-Operatório , Transtornos Respiratórios/etiologia , Transtornos Respiratórios/prevenção & controle , Músculos Respiratórios/fisiopatologia , Resultado do Tratamento , Teste de Caminhada , Caminhada
9.
Paediatr Anaesth ; 29(2): 200-210, 2019 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-30365205

RESUMO

BACKGROUND: Quality improvement methods can identify solutions and make dramatic improvements in patient safety during daily clinical care. The science of quality improvement in healthcare is still a very new concept in developing countries like China. AIMS: We initiated a quality improvement project to minimize adverse respiratory events in our postanesthesia care unit with the guidance of an experienced quality improvement expert from Cincinnati Children's Hospital Medical Center. METHODS: We set up a quality improvement team that included anesthesia safety team members at Shanghai Children's Medical Center, and a quality improvement expert in pediatric anesthesia from Cincinnati Children's Hospital Medical Center. Data from the previous year were reviewed. After using Failure Mode and Effect Analysis to access risks associated with the current process, a Key Driver Diagram and a Smart Aim were developed. Key drivers included establishing a safety culture, resource allocation to meet needs, education and training, standardization of care, improved communication and handoff, and enhanced detection, recognition, and response to adverse events. Using Plan-Do-Study-Act cycles of the improvement model, interventions were conducted to improve the process. The primary outcome was the percentage of postoperative respiratory adverse events in the postanesthesia care unit, and we calculated the average recovery time as a balancing measure. Data were collected and analyzed using a run chart and control chart. RESULTS: The median percentage of respiratory adverse events in postanesthesia care unit decreased from 2.8% to 1.4%. Respiratory adverse events were reduced by over 30% compared to the previous period with no significant change in mean recovery time. CONCLUSION: Using quality improvement methods, we successfully reduced the percentage of respiratory adverse events in the postanesthesia care unit. This helped to establish a safety culture among the anesthesia staff. Quality and safety improvement can be successfully implemented in developing countries like China with collaboration with quality improvement experts from more experienced institutions.


Assuntos
Anestesia/normas , Hospitais Pediátricos/normas , Segurança do Paciente/normas , Complicações Pós-Operatórias/etiologia , Complicações Pós-Operatórias/prevenção & controle , Transtornos Respiratórios/etiologia , Transtornos Respiratórios/prevenção & controle , Anestesia/métodos , Criança , Bases de Dados Factuais , Humanos , Período Pós-Operatório , Melhoria de Qualidade
10.
J Intensive Care Med ; 34(2): 126-132, 2019 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-29112468

RESUMO

BACKGROUND:: Respiratory complications are common after cardiac surgery and the use of extracorporeal circulation is one of the main causes of lung injury. We hypothesized a better postoperative respiratory function in off-pump coronary artery bypass grafting (OPCABG) as compared with "on-pump coronary artery bypass grafting" (ONCABG). METHODS:: This is a retrospective, single-center study at a cardiothoracic intensive care unit (ICU) in a tertiary university hospital. Consecutive data on 339 patients undergoing elective CABG (n = 215 ONCABG, n = 124 OPCABG) were collected for 1 year from the ICU electronic medical records. We compared respiratory variables (Pao2, Pao2/Fio2 ratio, Sao2, and Paco2) at 7 predefined time points (ICU admission, postoperative hours 1, 3, 6, 12, 18, and 24). We also evaluated time to extubation, rates of reintubation, and use of noninvasive ventilation (NIV). We used mixed-effects linear regression models (with time as random effect for clustering of repeated measures) adjusted for a predetermined set of covariates. RESULTS:: The values of Pao2 and Pao2/Fio2 were significantly higher in the OPCABG group only at ICU admission (mean differences: 9.7 mm Hg, 95% confidence interval [CI] 3.1-16.2; and 27, 95% CI 6.1-47.7, respectively). The OPCABG group showed higher Paco2, overall ( P = .02) and at ICU admission (mean difference 1.8 mm Hg, 95% CI: 0.6-3), although mean values were always within normal range in both groups. No differences were seen in Sao2 values, time to extubation, rate of reintubation rate, and use of postoperative NIV. Extubation rate was higher in OPCABG only at postoperative hour 12 (92% vs ONCABG 82%, P = .02). CONCLUSION:: The OPCABG showed only marginal improvements of unlikely clinical meaning in oxygenation as compared to ONCABG in elective low-risk patients.


Assuntos
Gasometria , Ponte de Artéria Coronária sem Circulação Extracorpórea/efeitos adversos , Ponte de Artéria Coronária/efeitos adversos , Troca Gasosa Pulmonar , Transtornos Respiratórios/etiologia , Transtornos Respiratórios/prevenção & controle , Idoso , Feminino , Humanos , Masculino , Complicações Pós-Operatórias , Transtornos Respiratórios/fisiopatologia , Estudos Retrospectivos
12.
J Coll Physicians Surg Pak ; 28(12): 906-909, 2018 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-30501824

RESUMO

OBJECTIVE: To determine the effect of dexamethasone administration to women between 37 to 39 weeks of gestation on neonatal outcome in terms of respiratory morbidity and the need for NICU admission. STUDY DESIGN: An experimental study. PLACE AND DURATION OF STUDY: Department of Obstetrics and Department of Neonatology, Military Hospital, Rawalpindi, Pakistan, from February to July 2017. METHODOLOGY: Women with singleton pregnancies, undergoing elective cesarean section between 37-39 weeks. Neonates were evaluated for any respiratory morbidity and need for NICU admission as well as need of mechanical ventilation, length of hospital stay and final outcome. RESULTS: Out of 535 patients, 240 (44.8%) patients received steroid cover before their elective cesarean section (group 1). Two hundred and ninety-five (55.2%) patients who did not receive steroid cover, were allocated group 2. Mean age of mothers in group 1 was 29.20 +4.50 years and in group 2, it was 29.34 +4.50 years. The mean gestational ages were 37.56 +0.66 weeks and 38.11 +0.79 weeks in groups 1 and 2, respectively. In group 2, 14 (4.74%) newborns developed transient tachypnea of newborn (TTN), which was higher than the newborns in group 1 (04 (1.66%), p = 0.049). Also the number of neonates being admitted to NICU was greater in group 2 than in group 1 [23 (7.79%) vs. 06 (2.5%) respectively, p = 0.007].However, there was no statistically significant difference between the two groups with regard to final outcome, requirement for mechanical ventilation, length of hospital stay and APGAR scores at one and five minutes. CONCLUSION: Steroid cover significantly reduced the risk of respiratory morbidity in babies delivered by elective cesarean section between 37-39 weeks.


Assuntos
Cesárea , Dexametasona/uso terapêutico , Glucocorticoides/uso terapêutico , Cuidado Pré-Natal , Transtornos Respiratórios/prevenção & controle , Adulto , Feminino , Idade Gestacional , Humanos , Recém-Nascido , Tempo de Internação , Paquistão , Gravidez , Respiração Artificial , Adulto Jovem
13.
Rev. esp. anestesiol. reanim ; 65(10): 593-596, dic. 2018. ilus
Artigo em Espanhol | IBECS | ID: ibc-177213

RESUMO

El bloqueo del nervio frénico es una complicación que puede producirse tras la anestesia del plexo braquial por encima de la clavícula. La principal consecuencia de este bloqueo es la parálisis diafragmática ipsolateral, que en ocasiones puede suponer aparición de complicaciones respiratorias postoperatorias. Presentamos un caso clínico de una mujer que tras ser intervenida de una prótesis total de hombro presentó disnea en la unidad de recuperación posquirúrgica. Se realizó una ecografía diafragmática que permitió un diagnóstico rápido de parálisis completa del hemidiafragma ipsolateral. Ante la sospecha de bloqueo del nervio frénico, la ecografía ha demostrado ser una herramienta diagnóstica rápida con alta sensibilidad y especificidad. Su empleo puede anticipar el posible desarrollo de complicaciones inmediatas, y orientarnos para escoger la estrategia terapéutica adecuada para cada caso de una manera precoz. En nuestro caso nos permitió tratar de forma precoz mediante oxigenoterapia, retirada de catéter interescalénico y vigilancia intensiva


Phrenic nerve block is a complication that can occur after brachial plexus anaesthesia above the clavicle. The main consequence of this blockage is ipsolateral diaphragmatic paralysis, which can sometimes lead to the appearance of post-operative respiratory complications. A case is presented on a woman, who after having undergone a total shoulder prosthesis, presented with dyspnoea in the post-operative recovery unit. A diaphragmatic ultrasound was performed that enabled a rapid diagnosis to be made of a complete paralysis of the ipsolateral hemi-diaphragm. Given the suspicion of phrenic nerve block, ultrasound has proven to be a rapid diagnostic tool with high sensitivity and specificity. Its use can anticipate the possible development of immediate complications, and act as a guide in choosing the appropriate therapeutic strategy for each case in an early manner. In this case it enabled us to treat early with oxygen therapy, interscalene catheter removal, and intensive surveillance


Assuntos
Humanos , Feminino , Idoso , Nervo Frênico/fisiopatologia , Paralisia Respiratória/prevenção & controle , Bloqueio Nervoso/efeitos adversos , Transtornos Respiratórios/prevenção & controle , Complicações Pós-Operatórias/prevenção & controle , Diagnóstico Precoce
14.
Anesthesiol Clin ; 36(4): 523-538, 2018 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-30390776

RESUMO

One in 4 deaths occurring within a week of surgery are related to pulmonary complications, making it the second most common serious morbidity after cardiovascular events. The most significant predictors of the postoperative pulmonary complications (PPCs) are American Society of Anesthesiologists physical status, advanced age, dependent functional status, surgical site, and duration of surgery. The overall risk of PPCs can be predicted using scores that incorporate readily available clinical data.


Assuntos
Complicações Pós-Operatórias/prevenção & controle , Cuidados Pré-Operatórios/métodos , Transtornos Respiratórios/prevenção & controle , Apneia Obstrutiva do Sono/diagnóstico , Humanos , Fatores de Risco
16.
Respir Res ; 19(1): 131, 2018 07 03.
Artigo em Inglês | MEDLINE | ID: mdl-29970083

RESUMO

BACKGROUND: Cigarette smoke exposure can affect pulmonary lipid homeostasis and cause a progressive increase in pulmonary antibodies against oxidized low-density lipoproteins (OxLDL). Similarly, increased anti-OxLDL antibodies are observed in atherosclerosis, a pathology also tightly associated with smoking and lipid homeostasis disruption. Several immunization strategies against oxidized lipid species to help with their clearance have been shown to reduce the formation of atherosclerotic lesions. Since oxidized lipids are generated during cigarette smoke exposure, we investigated the impact of a prophylactic immunization protocol against OxLDL on the pulmonary effects of cigarette smoke exposure in mice. METHODS: Mice were immunized systemically with a mixture of human OxLDL (antigen source) and AddaVax (adjuvant) or PBS alone prior to the initiation of acute (2 week) or sub-chronic (8 weeks) cigarette smoke exposure protocols. Anti-OxLDL antibodies were measured in the bronchoalveolar lavage (BAL) fluid and serum by direct ELISA. Pulmonary impacts of cigarette smoke exposure and OxLDL immunization were assessed by measuring BAL inflammatory cells, lung functions, and changes in lung structure and gene levels of matrix/matrix-related genes. RESULTS: Immunization to OxLDL led to a marked increase in circulating and pulmonary antibodies against OxLDL that persisted during cigarette smoke exposure. OxLDL immunization did not exacerbate or reduce the inflammatory response following acute or sub-chronic exposure to cigarette smoke. OxLDL immunization alone had effects similar to cigarette smoke exposure on lung functions but OxLDL immunization and cigarette smoke exposure had no additive effects on these parameters. No obvious changes in lung histology, airspace or levels of matrix and matrix-related genes were caused by OxLDL immunization compared to vehicle treatment. CONCLUSIONS: Overall, this study shows for the first time that a prophylactic immunization protocol against OxLDL can potentially have detrimental effects lung functions, without having additive effects over cigarette smoke exposure. This work sheds light on a complex dynamic between anti-OxLDL antibodies and the pulmonary response to cigarette smoke exposure.


Assuntos
Fumar Cigarros/efeitos adversos , Fumar Cigarros/imunologia , Lipoproteínas LDL/imunologia , Transtornos Respiratórios/imunologia , Transtornos Respiratórios/prevenção & controle , Fumaça/efeitos adversos , Administração por Inalação , Animais , Feminino , Humanos , Imunização , Lipoproteínas LDL/antagonistas & inibidores , Camundongos , Camundongos Endogâmicos BALB C , Transtornos Respiratórios/induzido quimicamente
17.
Anaesthesia ; 73(12): 1478-1488, 2018 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-30019747

RESUMO

There has been increased interest in the prophylactic and therapeutic use of high-flow nasal oxygen in patients with, or at risk of, non-hypercapnic respiratory failure. There are no randomised trials examining the efficacy of high-flow nasal oxygen in high-risk cardiac surgical patients. We sought to determine whether routine administration of high-flow nasal oxygen, compared with standard oxygen therapy, leads to reduced hospital length of stay after cardiac surgery in patients with pre-existing respiratory disease at high risk for postoperative pulmonary complications. Adult patients with pre-existing respiratory disease undergoing elective cardiac surgery were randomly allocated to receive high-flow nasal oxygen (n = 51) or standard oxygen therapy (n = 49). The primary outcome was hospital length of stay and all analyses were carried out on an intention-to-treat basis. Median (IQR [range]) hospital length of stay was 7 (6-9 [4-30]) days in the high-flow nasal oxygen group and 9 (7-16 [4-120]) days in the standard oxygen group (p=0.012). Geometric mean hospital length of stay was 29% lower in the high-flow nasal group (95%CI 11-44%, p = 0.004). High-flow nasal oxygen was also associated with fewer intensive care unit re-admissions (1/49 vs. 7/45; p = 0.026). When compared with standard care, prophylactic postoperative high-flow nasal oxygen reduced hospital length of stay and intensive care unit re-admission. This is the first randomised controlled trial examining the effect of prophylactic high-flow nasal oxygen use on patient-centred outcomes in cardiac surgical patients at high risk for postoperative respiratory complications.


Assuntos
Procedimentos Cirúrgicos Cardíacos/métodos , Oxigenoterapia/métodos , Transtornos Respiratórios/terapia , Idoso , Idoso de 80 Anos ou mais , Anestesia , Cuidados Críticos/estatística & dados numéricos , Feminino , Humanos , Tempo de Internação , Masculino , Pessoa de Meia-Idade , Readmissão do Paciente , Transtornos Respiratórios/prevenção & controle , Insuficiência Respiratória/terapia , Resultado do Tratamento
18.
Arq Bras Cir Dig ; 31(1): e1361, 2018 Jun 21.
Artigo em Inglês, Português | MEDLINE | ID: mdl-29947695

RESUMO

BACKGROUND: Obesity is characterized by excessive accumulation of body fat, which causes damage to the health of individuals, such as breathing difficulties. AIM: To verify the results of non-invasive ventilation as a preventive strategy on the decline of respiratory function and postoperative complications in patients undergoing Roux-en-Y gastric bypass. METHODS: This is a randomized trial, according to CONSORT standards, with obese adults aged 18-40 years. Randomized control group (n=25) only received guidelines regarding posture, early ambulation and cough stimuli, and in the NIV group (n=25), in addition to the aforementioned group, non-invasive ventilation was performed with two pressure levels, once day for 60 min, from the 1st to the 3rd postoperative day (POD). Both groups were evaluated in the preoperative period and in the 1st and 3rd POD for respiratory function, which were: slow vital capacity (VC), inspiratory capacity (IC), minute volume (MV), tidal volume maximal inspiratory muscle strength (Pimax) and peak expiratory flow (PEF). The length of hospital stay and the episodes of postoperative complications were recorded. RESULTS: Of the 50 patients the majority were young adults with degrees of obesity between III and IV. In the intergroup analysis, there was an improvement in the CVL and MV only in the 1st POD in the NIV group, CI in the three moments evaluated in the NIV group and the PFE in the 1st and 3rd PDO also in this group. The most frequent complications were pneumonia, followed by operative wound infection and atelectasis. There was a significant difference between groups, showing a higher occurrence in pneumonia and atelectasis in the control group. The days of hospitalization and intensive care unit were similar. CONCLUSION: It was observed a faster recovery until the 3rd POD in the IC and PEF variables in the NIV group; in addition, there were fewer complications in this group.


Assuntos
Derivação Gástrica , Ventilação não Invasiva/métodos , Obesidade/cirurgia , Cuidados Pós-Operatórios , Complicações Pós-Operatórias/prevenção & controle , Transtornos Respiratórios/prevenção & controle , Adolescente , Adulto , Feminino , Humanos , Masculino , Adulto Jovem
19.
J Laparoendosc Adv Surg Tech A ; 28(11): 1371-1373, 2018 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-29958063

RESUMO

INTRODUCTION: Intraoperative pneumothorax may complicate surgery by obscuring surgical view and cause cardiorespiratory instability during fundoplication with large hiatus hernia. Proactive intraoperative treatment may reduce conversion and drain insertion and facilitate timely completion of surgery. MATERIALS AND METHODS: The authors present effective surgical and anesthetic measures to alleviate pneumothorax, which are helpful for hemodynamic stability and surgical visibility. CONCLUSION: Pneumothorax can complicate surgery by reducing surgical vision and causing cardiorespiratory instability. There is no requirement for laparoscopic or intercostal drainage. The authors provide various techniques to control intraoperative pneumothorax.


Assuntos
Fundoplicatura/métodos , Hérnia Hiatal/cirurgia , Complicações Intraoperatórias/cirurgia , Laparoscopia/métodos , Pneumotórax/cirurgia , Fundoplicatura/efeitos adversos , Refluxo Gastroesofágico/cirurgia , Hemodinâmica , Humanos , Complicações Intraoperatórias/prevenção & controle , Pneumotórax/etiologia , Transtornos Respiratórios/prevenção & controle
20.
World J Surg ; 42(9): 2708-2714, 2018 09.
Artigo em Inglês | MEDLINE | ID: mdl-29926123

RESUMO

BACKGROUND: The prevention of post-operative pulmonary complications (PPC) is targeted by several enhanced recovery (ERAS) items including early mobilisation, prevention of fluid overload and omission of routine nasogastric tubes. The aim of the present study was to assess the impact of ERAS on PPC. METHODS: This was a retrospective analysis of an institutional database including consecutive colorectal ERAS procedures from May 2011 until May 2017. Multiple logistic regressions were performed to identify risk factors for PPC among demographic, surgical characteristics and items related to the ERAS protocol. RESULTS: In total, 1298 patients were included; among them 120 (9.2%) had one or more PPC. Multivariable analysis retained minimally invasive surgery [odds ratio (OR) 0.26; 95% confidence interval (CI) 0.15-0.46] and compliance to the ERAS protocol of ≥ 70% (OR 0.53; CI 0.30-0.94) as protective factors. Emergency surgery (OR 2.70; CI 1.20-6.01), blood loss of ≥ 200 mL (OR 2.06; CI 1.20-3.53) and ASA score of ≥ 3 (OR 2.00; CI 1.12-3.57) were independent risk factors. Median length of hospital stay was significantly longer in patients who experienced respiratory complications (21 [4-183] vs. 6 [1-95] days, p ≤ 0.001). CONCLUSIONS: Minimally invasive surgery and high compliance with the ERAS protocol can help to prevent PPC.


Assuntos
Protocolos Clínicos , Colectomia/efeitos adversos , Protectomia/efeitos adversos , Transtornos Respiratórios/prevenção & controle , Idoso , Deambulação Precoce , Feminino , Hidratação/efeitos adversos , Fidelidade a Diretrizes , Humanos , Intubação Gastrointestinal/efeitos adversos , Tempo de Internação , Masculino , Pessoa de Meia-Idade , Procedimentos Cirúrgicos Minimamente Invasivos , Cooperação do Paciente , Assistência Perioperatória , Recuperação de Função Fisiológica , Transtornos Respiratórios/etiologia , Estudos Retrospectivos , Fatores de Risco
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