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1.
Estima (Online) ; 19(1): e0521, jan.-dez. 2021.
Artigo em Português | BDENF - Enfermagem | ID: biblio-1178332

RESUMO

Objetivo:relatar o caso de um paciente crítico com COVID-19 e mostrar os principais achados relacionados à lesão considerada Acute skin failure (ASF), bem como realizar seu diagnóstico diferencial com lesão por pressão (LP) evitável. Método: estudo observacional do tipo relato de caso, desenvolvido em um hospital de São Paulo, na unidade de terapia intensiva (UTI) exclusiva a pessoas diagnosticadas com COVID-19. Os dados foram coletados de um único paciente, entre os meses de março e setembro de 2020. Resultados: paciente com complicações da COVID-19 evoluiu com lesão de pele, inicialmente definida como LP e posteriormente reclassificada como ASF. Os seguintes achados corroboraram o diagnóstico: ventilação mecânica invasiva prolongada, insuficiências respiratória, renal e cardíaca e sepse de foco respiratório. Além disso, outros fatores agravantes, como o uso de droga vasoativa, instabilidade hemodinâmica com intolerância ao mínimo reposicionamento, jejum prolongado e coagulopatia intravascular disseminada associada à infecção pelo coronavírus. Conclusão: o relato mostra que existem dificuldades para o diagnóstico diferencial entre ASF e LP na prática clínica. Trata-se de conceito novo, sendo fundamental que o profissional de saúde reconheça os principais fatores associados ao aparecimento da ASF, muitos dos quais também estão relacionados ao desenvolvimento das LP, ressaltando a necessidade de análise individualizada dessas lesões, e garantia da implementação de intervenções adequadas para prevenção e tratamento.


Assuntos
Infecções por Coronavirus , Lesão por Pressão , Unidades de Terapia Intensiva , Cuidados de Enfermagem
2.
Sci Rep ; 11(1): 11524, 2021 06 01.
Artigo em Inglês | MEDLINE | ID: mdl-34075155

RESUMO

Nearly 5% of patients suffering from COVID-19 develop acute respiratory distress syndrome (ARDS). Extravascular lung water index (EVLWI) is a marker of pulmonary oedema which is associated with mortality in ARDS. In this study, we evaluate whether EVLWI is higher in patients with COVID-19 associated ARDS as compared to COVID-19 negative, ventilated patients with ARDS and whether EVLWI has the potential to monitor disease progression. EVLWI and cardiac function were monitored by transpulmonary thermodilution in 25 patients with COVID-19 ARDS subsequent to intubation and compared to a control group of 49 non-COVID-19 ARDS patients. At intubation, EVLWI was noticeably elevated and significantly higher in COVID-19 patients than in the control group (17 (11-38) vs. 11 (6-26) mL/kg; p < 0.001). High pulmonary vascular permeability index values (2.9 (1.0-5.2) versus 1.9 (1.0-5.2); p = 0.003) suggested a non-cardiogenic pulmonary oedema. By contrast, the cardiac parameters SVI, GEF and GEDVI were comparable in both cohorts. High EVLWI values were associated with viral persistence, prolonged intensive care treatment and in-hospital mortality (23.2 ± 6.7% vs. 30.3 ± 6.0%, p = 0.025). Also, EVLWI showed a significant between-subjects (r = - 0.60; p = 0.001) and within-subjects correlation (r = - 0.27; p = 0.028) to Horowitz index. Compared to non COVID-19 ARDS, COVID-19 results in markedly elevated EVLWI-values in patients with ARDS. High EVLWI reflects a non-cardiogenic pulmonary oedema in COVID-19 ARDS and could serve as parameter to monitor ARDS progression on ICU.


Assuntos
COVID-19/complicações , Água Extravascular Pulmonar/imunologia , Edema Pulmonar/mortalidade , Síndrome do Desconforto Respiratório/mortalidade , Adulto , Idoso , Idoso de 80 Anos ou mais , COVID-19/diagnóstico , COVID-19/imunologia , COVID-19/mortalidade , Permeabilidade Capilar , Progressão da Doença , Água Extravascular Pulmonar/virologia , Feminino , Mortalidade Hospitalar , Humanos , Unidades de Terapia Intensiva/estatística & dados numéricos , Tempo de Internação/estatística & dados numéricos , Pulmão/irrigação sanguínea , Pulmão/fisiopatologia , Masculino , Pessoa de Meia-Idade , Monitorização Fisiológica/métodos , Monitorização Fisiológica/estatística & dados numéricos , Prognóstico , Edema Pulmonar/diagnóstico , Edema Pulmonar/imunologia , Edema Pulmonar/virologia , Respiração Artificial , Síndrome do Desconforto Respiratório/diagnóstico , Síndrome do Desconforto Respiratório/etiologia , Síndrome do Desconforto Respiratório/terapia , Medição de Risco/métodos , SARS-CoV-2/isolamento & purificação , Índice de Gravidade de Doença , Termodiluição/métodos , Termodiluição/estatística & dados numéricos , Adulto Jovem
3.
J Pak Med Assoc ; 71(5): 1326-1331, 2021 May.
Artigo em Inglês | MEDLINE | ID: mdl-34091608

RESUMO

OBJECTIVE: Comparing BAL and antibiotic therapy with antibiotic therapy itself for treating VAP patients in ICU. METHODS: In this randomized clinical trial, the first group was treated using antibiotics and closed-suction was performed daily, using 50 cc of sterile normal saline. The second group was treated with antibiotics and daily closed-suction with 50 cc of sterile normal saline, plus bronchoscopic suction every other day. Patients of both groups were followed and investigated one, 3, 7, and 10 days after initial diagnosis. RESULTS: Mean blood leukocyte count and body temperature was measured in groups one (no bronchoscopy) and two (with bronchoscopy) in first, 3rd, 7th, and 10th days which was higher in the second group. Mean treatment status was also measured using APACHE II index. There was also a statistically significant difference in 3rd day (p-value < 0.05). There was also no difference in final culture result or mortality rate between two groups. CONCLUSIONS: According to the results of this study like lower body temperature, higher leukocyte count reduction, and lower APACHE II scores in the second group, treated with bronchoscopic suction, adding bronchoscopy seems to be more useful than normal method.


Assuntos
Pneumonia Associada à Ventilação Mecânica , Broncoscopia , Humanos , Unidades de Terapia Intensiva , Pneumonia Associada à Ventilação Mecânica/terapia , Respiração Artificial , Sucção
4.
BMJ Case Rep ; 14(6)2021 Jun 16.
Artigo em Inglês | MEDLINE | ID: mdl-34135074

RESUMO

Bacterial endocarditis remains a challenging condition to manage owing to its variety of different presentations. This report describes a 55-year-old woman with endocarditis who presented confused with shoulder and back pain. Initial diagnosis was made difficult by a negative echocardiogram but aided by striking peripheral stigmata. She was treated for infective endocarditis as she met all five Duke's minor criteria for infective endocarditis. Gallium scan was a useful investigation in identifying lumbar spine and acromioclavicular joint septic foci. This case highlights the challenges of diagnosing endocarditis. It also describes how gallium scans can be useful in identifying occult septic emboli in these patients.


Assuntos
Endocardite Bacteriana , Endocardite , Ecocardiografia , Endocardite/diagnóstico por imagem , Endocardite/tratamento farmacológico , Endocardite Bacteriana/diagnóstico por imagem , Endocardite Bacteriana/tratamento farmacológico , Feminino , Humanos , Unidades de Terapia Intensiva , Pessoa de Meia-Idade
5.
Sci Rep ; 11(1): 11778, 2021 06 03.
Artigo em Inglês | MEDLINE | ID: mdl-34083700

RESUMO

The COVID-19 pandemic has generated many concerns about cross-contamination risks, particularly in hospital settings and Intensive Care Units (ICU). Virus-laden aerosols produced by infected patients can propagate throughout ventilated rooms and put medical personnel entering them at risk. Experimental results found with a schlieren optical method have shown that the air flows generated by a cough and normal breathing were modified by the oxygenation technique used, especially when using High Flow Nasal Canulae, increasing the shedding of potentially infectious airborne particles. This study also uses a 3D Computational Fluid Dynamics model based on a Lattice Boltzmann Method to simulate the air flows as well as the movement of numerous airborne particles produced by a patient's cough within an ICU room under negative pressure. The effects of different mitigation scenarii on the amount of aerosols potentially containing SARS-CoV-2 that are extracted through the ventilation system are investigated. Numerical results indicate that adequate bed orientation and additional air treatment unit positioning can increase by 40% the number of particles extracted and decrease by 25% the amount of particles deposited on surfaces 45s after shedding. This approach could help lay the grounds for a more comprehensive way to tackle contamination risks in hospitals, as the model can be seen as a proof of concept and be adapted to any room configuration.


Assuntos
Microbiologia do Ar , COVID-19/transmissão , Tosse/virologia , Síndrome do Desconforto Respiratório/virologia , Aerossóis , Humanos , Unidades de Terapia Intensiva , Modelos Teóricos , Imagem Óptica , Ventilação/métodos
6.
BMC Infect Dis ; 21(1): 534, 2021 Jun 07.
Artigo em Inglês | MEDLINE | ID: mdl-34098888

RESUMO

BACKGROUND: Prone positioning (PP) is a standard of care for patients with moderate-severe acute respiratory distress syndrome (ARDS). While adverse events associated with PP are well-documented in the literature, research examining the effect of PP on the risk of infectious complications of intravascular catheters is lacking. METHOD: All consecutive ARDS patients treated with PP were recruited retrospectively over a two-year period and formed the exposed group. Intensive care unit (ICU) patients during the same period without ARDS for whom PP was not conducted but who had an equivalent disease severity were matched 1:1 to the exposed group based on age, sex, centre, length of ICU stay and SAPS II (unexposed group). Infection-related catheter complications were defined by a composite criterion, including catheter tip colonization or intravascular catheter-related infection. RESULTS: A total of 101 exposed patients were included in the study. Most had direct ARDS (pneumonia). The median [Q1-Q3] PP session number was 2 [1-4]. These patients were matched with 101 unexposed patients. The mortality rates of the exposed and unexposed groups were 31 and 30%, respectively. The incidence of the composite criterion was 14.2/1000 in the exposed group compared with 8.2/1000 days in the control group (p = 0.09). Multivariate analysis identified PP as a factor related to catheter colonization or infection (p = 0.04). CONCLUSION: Our data suggest that PP is associated with a higher risk of CVC infectious complications.


Assuntos
Infecções Relacionadas a Cateter/etiologia , Posicionamento do Paciente/efeitos adversos , Síndrome do Desconforto Respiratório/complicações , Idoso , Cuidados Críticos , Feminino , Humanos , Incidência , Unidades de Terapia Intensiva , Masculino , Pessoa de Meia-Idade , Decúbito Ventral , Síndrome do Desconforto Respiratório/terapia , Estudos Retrospectivos , Índice de Gravidade de Doença
7.
Rev Bras Enferm ; 74(suppl 5): e20200928, 2021.
Artigo em Inglês, Português | MEDLINE | ID: mdl-34105699

RESUMO

OBJECTIVE: to describe the development of a website about the main healthcare-associated infections and the respective bundles to prevent these diseases, oriented toward intensive care unit nursing. METHODS: experience report describing the development of technological innovation by nurses, using computational tools and technological production methodological research and following the product development process. RESULTS: nurses developed an educational website which can be accessed through computers, tablets, and smartphones at the electronic address irastis.com and focuses on healthcare-associated infections. FINAL CONSIDERATIONS: digital technologies have contributed to fulfill demands in health care, research, and education. The developed website has the potential to support reduction in healthcare-associated infection rates, since it makes preventive measures for these infections available and refers users to publication environments that systematize the implementation of the bundles.


Assuntos
Enfermagem de Cuidados Críticos , Cuidados Críticos , Unidades de Terapia Intensiva , Internet , Atenção à Saúde , Humanos
8.
Medicine (Baltimore) ; 100(22): e26056, 2021 Jun 04.
Artigo em Inglês | MEDLINE | ID: mdl-34087847

RESUMO

ABSTRACT: Elderly patients who undergo major abdominal surgery are being in increasing numbers. Intensive care unit (ICU) survival is critical for surgical decision-making process. Activities of daily living (ADL) are associated with clinical outcomes in the elderly. We aimed to investigate the relationship between ADL and postoperative ICU survival in elderly patients following elective major abdominal surgery.We conducted a retrospective cohort study involving patients aged ≥65 years admitted to the surgical intensive care unit (SICU) following elective major abdominal surgery. Data from all patients were extracted from the electronic medical records. The Barthel Index (BI) was used to assess the level of dependency in ADL at the time of hospital admission.ICU survivors group had higher Barthel Index (BI) scores than non-survivors group (P < .001). With the increase of BI score, postoperative ICU survival rate gradually increased. The ICU survivals in patients with BI 0-20, BI 21-40, BI 41-60, BI 61-80 and BI 81-100 were 55.7%, 67.6%, 72.4%, 83.3% and 84.2%, respectively. In logistic regression, The Barthel Index (BI) was significantly correlated with the postoperative ICU survival in elderly patients following elective major abdominal surgery (OR = 1.33, 95% CI: 1.20-1.47, P = .02). The area under the receiver operating characteristic (ROC) curve of Barthel Index in predicting postoperative ICU survival was 0.704 (95% CI, 0.638-0.771). Kaplan-Meier survival curve in BI≥30 patients and BI < 30 patients showed significantly different.Activity of daily living upon admission was associated with postoperative intensive care unit survival in elderly patients following elective major abdominal surgery. The Barthel Index(BI) ≥30 was associated with increased postoperative ICU survival. For the elderly with better functional status, they could be given more surgery opportunities. For those elderly patients BI < 30, these results provide useful information for clinicians, patients and their families to make palliative care decisions.


Assuntos
Atividades Cotidianas , Procedimentos Cirúrgicos do Sistema Digestório/estatística & dados numéricos , Procedimentos Cirúrgicos Eletivos/estatística & dados numéricos , Unidades de Terapia Intensiva/estatística & dados numéricos , Sobreviventes/estatística & dados numéricos , Idoso , Idoso de 80 Anos ou mais , Feminino , Humanos , Masculino , Período Pós-Operatório , Prognóstico , Fatores de Risco , Fatores de Tempo
9.
BMJ Open ; 11(6): e046909, 2021 06 03.
Artigo em Inglês | MEDLINE | ID: mdl-34083342

RESUMO

OBJECTIVES: In Europe, there is a distinction between two different healthcare organisation systems, the tax-based healthcare system (THS) and the social health insurance system (SHI). Our aim was to investigate whether the characteristics, treatment and mortality of older, critically ill patients in the intensive care unit (ICU) differed between THS and SHI. SETTING: ICUs in 16 European countries. PARTICIPANTS: In total, 7817 critically ill older (≥80 years) patients were included in this study, 4941 in THS and 2876 in the SHI systems. PRIMARY AND SECONDARY OUTCOMES MEASURES: We chose generalised estimation equations with robust standard errors to produce population average adjusted OR (aOR). We adjusted for patient-specific variables, health economic data, including gross domestic product (GDP) and human development index (HDI), and treatment strategies. RESULTS: In SHI systems, there were higher rates of frail patients (Clinical Frailty Scale>4; 46% vs 41%; p<0.001), longer length of ICU stays (90±162 vs 72±134 hours; p<0.001) and increased levels of organ support. The ICU mortality (aOR 1.50, 95% CI 1.09 to 2.06; p=0.01) was consistently higher in the SHI; however, the 30-day mortality (aOR 0.89, 95% CI 0.66 to 1.21; p=0.47) was similar between THS and SHI. In a sensitivity analysis stratifying for the health economic data, the 30-day mortality was higher in SHI, in low GDP per capita (aOR 2.17, 95% CI 1.42 to 3.58) and low HDI (aOR 1.22, 95% CI 1.64 to 2.20) settings. CONCLUSIONS: The 30-day mortality was similar in both systems. Patients in SHI were older, sicker and frailer at baseline, which could be interpreted as a sign for a more liberal admission policy in SHI. We believe that the observed trend towards ICU excess mortality in SHI results mainly from a more liberal admission policy and an increase in treatment limitations. TRIAL REGISTRATION NUMBERS: NCT03134807 and NCT03370692.


Assuntos
Cuidados Críticos , Unidades de Terapia Intensiva , Idoso , Estado Terminal , Atenção à Saúde , Europa (Continente) , Mortalidade Hospitalar , Humanos , Tempo de Internação , Estudos Retrospectivos
10.
Ann Med ; 53(1): 874-884, 2021 12.
Artigo em Inglês | MEDLINE | ID: mdl-34096808

RESUMO

BACKGROUND: Statins are widely used to treat people with metabolic and cardiovascular disorders. The effect of statins on coronavirus disease 2019 (COVID-19) is unclear. To investigate the association between statins and COVID-19 outcomes and, if possible, identify the subgroup population that benefits most from statin use. MATERIALS AND METHODS: A systematic review and meta-analysis of published studies that included statin users and described COVID-19 outcomes through 10 November 2020. This study used the generic inverse variance method to perform meta-analyses with random-effects modelling. The main outcomes were evaluation of the need for invasive mechanical ventilator (IMV) support, the need for intensive care unit (ICU) care and death. All outcomes were measured as dichotomous variables. RESULTS: A total of 28 observational studies, covering data from 63,537 individuals with COVID-19, were included. The use of statins was significantly associated with decreased mortality (odds ratio [OR] = 0.71, 95% confidence interval [CI]: 0.55-0.92, I2=72%) and the need for IMV (OR = 0.81, 95% CI: 0.69-0.95, I2=0%) but was not linked to the need for ICU care (OR = 0.91, 95% CI: 0.55-1.51, I2=66%). Subgroup analysis further identified five types of studies in which statin users had even lower odds of death. CONCLUSIONS: The use of statins was significantly associated with a reduced need for IMV and decreased mortality among individuals with COVID-19. Statins may not need to be discontinued because of concern for COVID-19 on admission. Further randomized controlled trial (RCTs) are needed to clarify the causal effect between statin use and severe COVID-19 outcomes.Key messagesParticipants in five types of studies were shown to have even lower odds of death when taking statins.The use of statins was significantly associated with a reduced need for invasive mechanical ventilation and decreased all-cause mortality among individuals with COVID-19. However, statin use did not prevent participants from needing care in the intensive care unit.The results justify performing randomized controlled trials (RCTs) to validate the benefits of statins on COVID-19 outcomes.


Assuntos
COVID-19/mortalidade , Inibidores de Hidroximetilglutaril-CoA Redutases/administração & dosagem , Respiração Artificial/estatística & dados numéricos , COVID-19/terapia , Doenças Cardiovasculares/tratamento farmacológico , Humanos , Unidades de Terapia Intensiva/estatística & dados numéricos , Ensaios Clínicos Controlados Aleatórios como Assunto
11.
Medicina (Kaunas) ; 57(6)2021 May 22.
Artigo em Inglês | MEDLINE | ID: mdl-34067299

RESUMO

Background and Objectives: Fluid disbalance is associated with adverse outcomes in critically ill patients with acute kidney injury (AKI). In this study, we intended to assess fluid status using bioimpedance analysis (BIA) and central venous pressure (CVP) measurement and to evaluate the association between hyperhydration and hypervolemia with the outcomes of severe AKI. Materials and Methods: A prospective study was conducted in the Hospital of the Lithuanian University of Health Sciences Kauno Klinikos. Forty-seven patients treated at the Intensive Care Unit (ICU) with severe AKI and a need for renal replacement therapy (RRT) were examined. The hydration level was evaluated according to the ratio of extracellular water to total body water (ECW/TBW) of bioimpedance analysis and volemia was measured according to CVP. All of the patients were tested before the first hemodialysis (HD) procedure. Hyperhydration was defined as ECW/TBW > 0.39 and hypervolemia as CVP > 12 cm H2O. Results: According to bioimpedance analysis, 72.3% (n = 34) of patients were hyperhydrated. According to CVP, only 51.1% (n = 24) of the patients were hypervolemic. Interestingly, 69.6% of hypovolemic/normovolemic patients were also hyperhydrated. Of all study patients, 57.4% (n = 27) died, in 29.8% (n = 14) the kidney function improved, and in 12.8% (n = 6) the demand for RRT remained after in-patient treatment. A tendency of higher mortality in hyperhydrated patients was observed, but no association between hypervolemia and outcomes of severe AKI was established. Conclusions: Three-fourths of the patients with severe AKI were hyperhydrated based on bioimpedance analysis. However, according to CVP, only half of these patients were hypervolemic. A tendency of higher mortality in hyperhydrated patients was observed.


Assuntos
Injúria Renal Aguda , Injúria Renal Aguda/diagnóstico , Injúria Renal Aguda/terapia , Pressão Venosa Central , Humanos , Unidades de Terapia Intensiva , Estudos Prospectivos , Terapia de Substituição Renal
12.
Artigo em Inglês | MEDLINE | ID: mdl-34072557

RESUMO

Although patients who recovered from acute coronavirus disease 2019 (COVID-19) may have prolonged disabilities, follow-up data of those who have survived COVID-19 related acute respiratory distress syndrome (ARDS) is still very scarce. Therefore, COVID-19-ARDS survivors requiring invasive mechanical ventilation (IMV) were followed six months after discharge. Pulmonary function tests (PFTs), 6-min walk test (6MWT) and echocardiography were performed. Quality of life (QoL), depression and anxiety were assessed using validated questionnaires. Patients were compared based on respiratory mechanics and CT-phenotype during intensive care unit (ICU) stay. Eighteen patients were included (61 ± 7 years; ICU-stay: 34 ± 16 days; IMV: 30 ± 15 days). At follow-up (197 ± 15 days after discharge), PFTs did not reveal significant limitations (VC: 92 ± 16%; FEV1: 92 ± 20%; DLco/VA: 81 ± 16%). Cardiac systolic function was normal in all patients, but 50% of them had diastolic dysfunction. 6MWT was under the lower limit of normal in only two patients. Eight patients (44%) reported tiredness, six (33%) suffered from fatigue and one patient (6%) had depression and anxiety. Surprisingly, patients with worse respiratory mechanics during IMV reported fewer symptoms and less exertional dyspnea at follow-up. In conclusion, patients with COVID-19-ARDS have the possibility to fully recover regarding pulmonary function and exercise capacity, which seems to be independent of disease severity during ICU stay.


Assuntos
COVID-19 , Síndrome do Desconforto Respiratório , Seguimentos , Humanos , Unidades de Terapia Intensiva , Qualidade de Vida , Respiração Artificial , Síndrome do Desconforto Respiratório/terapia , SARS-CoV-2
13.
PLoS One ; 16(6): e0252347, 2021.
Artigo em Inglês | MEDLINE | ID: mdl-34086717

RESUMO

BACKGROUND: Dysphagia appears to be common in patients with severe COVID-19. Information about the characteristics of dysphagia and laryngeal findings in COVID-19 patients treated in the intensive care unit (ICU) is still limited. OBJECTIVES: The aim of this study was to evaluate oropharyngeal swallowing function and laryngeal appearance and function in patients with severe COVID-19. METHOD: A series of 25 ICU patients with COVID-19 and signs of dysphagia were examined with fiberendoscopic evaluation of swallowing (FEES) during the latter stage of ICU care or after discharge from the ICU. Swallowing function and laryngeal findings were assessed with standard rating scales from video recordings. RESULTS: Pooling of secretions was found in 92% of patients. Eleven patients (44%) showed signs of silent aspiration to the trachea on at least one occasion. All patients showed residue after swallowing to some degree both in the vallecula and hypopharynx. Seventy-six percent of patients had impaired vocal cord movement. Erythema of the vocal folds was found in 60% of patients and edema in the arytenoid region in 60%. CONCLUSION: Impairment of oropharyngeal swallowing function and abnormal laryngeal findings were common in this series of patients with severe COVID-19 treated in the ICU. To avoid complications related to dysphagia in this patient group, it seems to be of great importance to evaluate the swallowing function as a standard procedure, preferably at an early stage, before initiation of oral intake. Fiberendoscopic evaluation of swallowing is preferred due to the high incidence of pooling of secretion in the hypopharynx, silent aspiration, and residuals. Further studies of the impact on swallowing function in short- and long-term in patients with COVID-19 are warranted.


Assuntos
COVID-19 , Transtornos de Deglutição , Deglutição , Unidades de Terapia Intensiva , Laringe , SARS-CoV-2 , Adulto , Idoso , COVID-19/complicações , COVID-19/patologia , COVID-19/fisiopatologia , COVID-19/terapia , Transtornos de Deglutição/etiologia , Transtornos de Deglutição/patologia , Transtornos de Deglutição/fisiopatologia , Feminino , Humanos , Laringe/patologia , Laringe/fisiopatologia , Masculino , Pessoa de Meia-Idade , Estudos Prospectivos , Índice de Gravidade de Doença
14.
Crit Care ; 25(1): 197, 2021 06 07.
Artigo em Inglês | MEDLINE | ID: mdl-34099016

RESUMO

BACKGROUND: Hospitalized patients with COVID-19 admitted to the intensive care unit (ICU) and requiring mechanical ventilation are at risk of ventilator-associated bacterial infections secondary to SARS-CoV-2 infection. Our study aimed to investigate clinical features of Staphylococcus aureus ventilator-associated pneumonia (SA-VAP) and, if bronchoalveolar lavage samples were available, lung bacterial community features in ICU patients with or without COVID-19. METHODS: We prospectively included hospitalized patients with COVID-19 across two medical ICUs of the Fondazione Policlinico Universitario A. Gemelli IRCCS (Rome, Italy), who developed SA-VAP between 20 March 2020 and 30 October 2020 (thereafter referred to as cases). After 1:2 matching based on the simplified acute physiology score II (SAPS II) and the sequential organ failure assessment (SOFA) score, cases were compared with SA-VAP patients without COVID-19 (controls). Clinical, microbiological, and lung microbiota data were analyzed. RESULTS: We studied two groups of patients (40 COVID-19 and 80 non-COVID-19). COVID-19 patients had a higher rate of late-onset (87.5% versus 63.8%; p = 0.01), methicillin-resistant (65.0% vs 27.5%; p < 0.01) or bacteremic (47.5% vs 6.3%; p < 0.01) infections compared with non-COVID-19 patients. No statistically significant differences between the patient groups were observed in ICU mortality (p = 0.12), clinical cure (p = 0.20) and microbiological eradication (p = 0.31). On multivariable logistic regression analysis, SAPS II and initial inappropriate antimicrobial therapy were independently associated with ICU mortality. Then, lung microbiota characterization in 10 COVID-19 and 16 non-COVID-19 patients revealed that the overall microbial community composition was significantly different between the patient groups (unweighted UniFrac distance, R2 0.15349; p < 0.01). Species diversity was lower in COVID-19 than in non COVID-19 patients (94.4 ± 44.9 vs 152.5 ± 41.8; p < 0.01). Interestingly, we found that S. aureus (log2 fold change, 29.5), Streptococcus anginosus subspecies anginosus (log2 fold change, 24.9), and Olsenella (log2 fold change, 25.7) were significantly enriched in the COVID-19 group compared to the non-COVID-19 group of SA-VAP patients. CONCLUSIONS: In our study population, COVID-19 seemed to significantly affect microbiological and clinical features of SA-VAP as well as to be associated with a peculiar lung microbiota composition.


Assuntos
COVID-19/complicações , Pneumonia Associada à Ventilação Mecânica/microbiologia , Infecções Estafilocócicas/etiologia , Staphylococcus aureus/isolamento & purificação , Idoso , Antibacterianos/uso terapêutico , Líquido da Lavagem Broncoalveolar/microbiologia , COVID-19/mortalidade , COVID-19/terapia , Feminino , Mortalidade Hospitalar , Hospitalização , Humanos , Unidades de Terapia Intensiva , Itália , Modelos Logísticos , Pulmão/microbiologia , Masculino , Pessoa de Meia-Idade , Escores de Disfunção Orgânica , Pneumonia Associada à Ventilação Mecânica/tratamento farmacológico , Pneumonia Associada à Ventilação Mecânica/etiologia , Estudos Prospectivos , Respiração Artificial , Infecções Estafilocócicas/tratamento farmacológico
15.
Pan Afr Med J ; 38: 246, 2021.
Artigo em Inglês | MEDLINE | ID: mdl-34104294

RESUMO

Introduction: the coronavirus disease (COVID-19) is a disease that originated from Wuhan in December 2019. It rapidly spread across the globe causing high mortality especially among the elderly. Africa though not spared has limited studies regarding its effects on its population. We therefore sought to describe the epidemiological and clinical characteristics of COVID-19 in Douala, Cameroon. Methods: we conducted a single-centre, retrospective, and observational study by reviewing records of patients managed for COVID-19 between the 8th March 2020 and 31st, May 2020. Cases were confirmed by real-time reverse transcriptase - polymerase chain reaction and were analysed for epidemiological, demographic, clinical, and radiological features. Outcomes were either clinical improvement by Day-28 or in-hospital mortality. Results: we analyzed 282 case files, 192 were males (M: F=2: 1). The mean age was 52 (+/- 15) years. Hypertension and diabetes accounted for 75% of the chronic medical conditions identified. Main presenting complaints were dyspnea, cough, asthenia, and fever (55-60%). Radiographic analysis showed a ground-glass appearance in 85% of cases. Chloroquine/Hydroxychloroquine was the most (91.8%) frequently used drug in management protocols, 35% needed oxygen supplementation while 6 patients were intubated. Severe pneumonia (11.3%) was the commonest complication. They were 91 admissions in the intensive care unit. The average length of hospital stay was 10 (+/- 5) days. The mortality rate was 32%. Conclusion: our findings are concordant with universally reported data of COVID-19 hospitalised patients. These parameters are essential in designing effective prevention and control programs aimed at reducing the impact of the COVID-19 pandemic particularly in countries with limited resources.


Assuntos
COVID-19/terapia , Hospitalização/estatística & dados numéricos , Unidades de Terapia Intensiva/estatística & dados numéricos , Tempo de Internação/estatística & dados numéricos , Adulto , Idoso , COVID-19/tratamento farmacológico , COVID-19/epidemiologia , COVID-19/mortalidade , Camarões/epidemiologia , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Reação em Cadeia da Polimerase em Tempo Real , Estudos Retrospectivos , Reação em Cadeia da Polimerase Via Transcriptase Reversa , Adulto Jovem
16.
Tidsskr Nor Laegeforen ; 141(9)2021 06 08.
Artigo em Inglês, Norueguês | MEDLINE | ID: mdl-34107655

RESUMO

BACKGROUND: The intermediate care unit at Akershus University Hospital treats patients with incipient or manifest organ failure. Selecting patients who might benefit from treatment in an intermediate care unit is challenging. Few data are available on long-term survival of patients treated in medical intermediate care units and on how assumed favourable and unfavourable prognostic factors predict long-term survival in this population. MATERIAL AND METHOD: Comorbidity, reason for admission and whether an infection was a direct or contributory reason for the admission were prospectively registered for patients in the unit in 2014 and 2016. We registered mortality up to six years after the admission and conducted a logistic regression analysis with three-year survival as the outcome variable. RESULTS: Of the 2 170 included patients, 153 (7 %) died in the intermediate care unit. Of the 2 017 patients who were discharged alive from the intermediate care unit, 55 % were still alive three years later, including 28 % of older patients aged over 80 years and 23 % of patients with cancer. Age, malignancy, other comorbidity and infection were predictors of mortality. INTERPRETATION: Many patient groups in an intermediate care unit have a poor long-term prognosis. However, people older than 80 years, cancer patients or patients with another serious comorbidity may live long after their stay in an intermediate care unit, and the fact of belonging to these groups should not be an independent reason for withholding treatment.


Assuntos
Hospitalização , Unidades de Terapia Intensiva , Idoso , Comorbidade , Mortalidade Hospitalar , Humanos , Alta do Paciente , Prognóstico , Estudos Retrospectivos
17.
Br J Nurs ; 30(11): 634-642, 2021 Jun 10.
Artigo em Inglês | MEDLINE | ID: mdl-34109816

RESUMO

BACKGROUND: Although the mental health burden in healthcare workers caused by COVID-19 has gained increasing attention both within the profession and through public opinion, there has been a lack of data describing their experience; specifically, the mental wellbeing of healthcare workers in the intensive care unit (ICU), including those redeployed. AIMS: The authors aimed to compare the mental health status of ICU healthcare workers (physicians, nurses and allied health professionals) affected by various factors during the COVID-19 pandemic; and highlight to policymakers areas of staff vulnerabilities in order to improve wellbeing strategies within healthcare systems. METHODS: An online survey using three validated scales was conducted in France, the UK, Italy, Mainland China, Taiwan, Egypt and Belgium. FINDINGS: The proportion of respondents who screened positive on the three scales across the countries was 16-49% for depression, 60-86% for insomnia and 17-35% for post-traumatic stress disorder. The authors also identified an increase in the scores with longer time spent in personal protective equipment, female gender, advancing age and redeployed status. CONCLUSION: The high prevalence of mental disorders among ICU staff during the COVID-19 crisis should inform local and national wellbeing policies.


Assuntos
COVID-19 , Saúde Global , Unidades de Terapia Intensiva , Transtornos Mentais , Recursos Humanos em Hospital , COVID-19/epidemiologia , COVID-19/terapia , Feminino , Saúde Global/estatística & dados numéricos , Inquéritos Epidemiológicos , Humanos , Transtornos Mentais/epidemiologia , Recursos Humanos em Hospital/psicologia , Recursos Humanos em Hospital/estatística & dados numéricos
18.
Zhonghua Wei Zhong Bing Ji Jiu Yi Xue ; 33(5): 546-551, 2021 May.
Artigo em Chinês | MEDLINE | ID: mdl-34112290

RESUMO

OBJECTIVE: To analyze the effect of target-oriented treatment based on nutrition-oriented information software on nutritional standards of adult patients with severe traumatic brain injury (sTBI). METHODS: Adult patients with sTBI admitted to the department of emergency intensive care unit (EICU) of Huzhou First People's Hospital were enrolled. Taking the online time of information software as the node on March 1st 2019, the patients who underwent early standardized enteral nutrition (EN) process from March 1st 2018 to February 28th 2019 were taken as the control group. The patients who received nutrition management by the nutritional support management system software for critical patients from March 1st 2019 to February 29th 2020 were used as the experimental group. The software was integrated with critical information system software. The effects of nutritional support in two groups were evaluated, including starting time of EN; total energy supply, total protein supply, energy compliance rate on 7 days and 14 days; the total albumin. And the related indicators of critical illness management were evaluated, including the survival rate of intensive care unit (ICU) at 28 days, duration of invasive mechanical ventilation (IMV), successful rates of weaning from IMV, rapid shallow breath index (RSBI) after spontaneous breathing test (SBT), serum cholinesterase on 7 days and 14 days, etc. RESULTS: Fifty-one patients with sTBI were included in the analysis, 28 in the control group and 23 in the experimental group. There were no significant differences in baseline data between the two groups, such as gender, age, body mass index (BMI), acute physiology and chronic health evaluation II (APACHE II) score, sequential organ failure assessment (SOFA) score, nutritional risk score (NUTRIC), etc., which were comparable. Compared with the control group, the starting time of EN in experimental group was significantly earlier (hours: 26.82±8.33 vs. 36.73±12.86, P = 0.046). The total protein supply on 7 days and 14 days [g×kg-1×d-1: 1.87 (1.36, 1.92) vs. 1.02 (0.87, 1.67), 2.63 (1.49, 1.92) vs. 1.23 (0.89, 1.92), both P < 0.05], the total energy supply on 14 days (kJ×kg-1×d-1: 154.26±68.16 vs. 117.99±112.42, P = 0.033), the energy compliance rate on 14 days [80.0% (16/20) vs. 35.7% (10/28), P = 0.002], and the serum cholinesterase on 14 days [U/L: 5 792.5 (4 621.0, 8 131.0) vs. 4 689.7 (3 639.0, 7 892.0), P = 0.048] in experimental group were significantly increased. There were no significant differences in other indicators between the two groups [total energy supply on 7 days (kJ×kg-1×d-1): 91.50±30.50 vs. 92.88±28.16, P = 0.184; energy compliance rate on 7 days: 34.7% (8/23) vs. 21.4% (6/28), P = 0.288; total albumin (g): 97.80±46.29 vs. 114.29±52.68, P = 0.086; 28-day survival rate of ICU: 87.0% vs. 78.6%, P = 0.081; duration of IMV (days): 14.33±7.68 vs. 15.68±6.82, P = 0.074; successful rates of weaning from IMV: 69.6% vs. 67.9%, P = 0.895; RSBI after SBT (breaths×min-1×L-1): 26.84±10.69 vs. 33.68±8.94, P = 0.052; serum cholinesterase on 7 days (U/L): 4 289.7 (2 868.0, 7 291.0) vs. 3 762.2 (2 434.0, 6 892.0), P = 0.078]. CONCLUSIONS: The development and clinical application of nutrition support information software is helpful for the standardized implementation of the nutritional support treatment process for adult patients with sTBI, which is worthy of further clinical research and promotion.


Assuntos
Lesões Encefálicas Traumáticas , Respiração Artificial , Adulto , Lesões Encefálicas Traumáticas/terapia , Estudos de Coortes , Humanos , Unidades de Terapia Intensiva , Software
19.
Zhonghua Wei Zhong Bing Ji Jiu Yi Xue ; 33(5): 557-562, 2021 May.
Artigo em Chinês | MEDLINE | ID: mdl-34112292

RESUMO

OBJECTIVE: To explore the value of radiographic assessment of lung edema (RALE) score in evaluating the severity and prognosis of patients with acute respiratory distress syndrome (ARDS). METHODS: A retrospective study was conducted. Patients with ARDS admitted to the department of intensive care unit (ICU) of Affiliated Nantong Third Hospital of Nantong University from January 2016 to November 2020 were enrolled. Clinical data of those patients were collected, and two senior radiologists who did not know the outcome of the patients independently scored each chest radiograph, the mean value of which was taken as the RALE score. The patients were divided into death group and survival group according to the 28-day prognosis. The differences of the basic data, PaO2/FiO2, sequential organ failure assessment (SOFA) score, acute physiology and chronic health evaluation II (APACHE II) score and RALE score between groups were analyzed. ARDS patients were classified according to the Berlin standard and RALE scores were compared between groups. Then, the correlations between RALE score and PaO2/FiO2, SOFA score, APACHE II score were analyzed. The prognostic capacity of RALE score for 28-day prognosis of ARDS patients were analyzed by Kaplan-Meier survival curve. RESULTS: Of the 98 ARDS patients, 62 were included in the final analysis, 39 patients survived and 23 patients died. The 28-day mortality was 37.1%. Compared with the survival group, patients in the death group were older (years old: 72.83±12.21 vs. 64.44±14.68), had lower PaO2/FiO2 [mmHg (1 mmHg = 0.133 kPa): 122.66±48.32 vs. 150.26±50.40], and higher SOFA score and greater difference of RALE score between the third day and the first day after admission (D3-D1 RALE score) (SOFA score: 11.26±3.91 vs. 9.04±3.72, D3-D1 RALE score: 1.35±6.42 vs. -2.74±7.35), with statistically significant differences (all P < 0.05). However, there were no significant differences in gender, cause of ARDS, APACHE II score, and RALE scores on the first and the third day of admission (D1 RALE, D3 RALE) between the two groups. Among the 62 patients, there were 11 mild cases (17.7%), 36 moderate cases (58.1%), and 15 severe cases (24.2%). The D1 RALE score of patients with mild and moderate ARDS were lower than those of patients with severe ARDS (19.09±3.65, 22.58±6.79 vs. 27.07±5.23, both P < 0.05). Correlation analysis showed that D1 RALE score was negatively correlated with PaO2/FiO2 (r = -0.385, P = 0.002), and positively correlated with SOFA score and APACHE II score (r1 = 0.433, r2 = 0.442, both P < 0.001). Kaplan-Meier survival curve analysis showed that the 28-day survival rate of ARDS patients in D3-D1 RALE score ≥ -1 group was significantly higher than that in D3-D1 RALE score < -1 group (73.08% vs. 55.56%; log-rank test: χ2 = 3.979, P = 0.046). CONCLUSIONS: The RALE score is a simple and reliable non-invasive evaluation index, which can be used to evaluate the severity of ARDS patients. The difference of RALE score in early stage is helpful to identify ARDS patients with poor prognosis.


Assuntos
Síndrome do Desconforto Respiratório , Berlim , Edema , Humanos , Unidades de Terapia Intensiva , Pulmão , Prognóstico , Curva ROC , Síndrome do Desconforto Respiratório/diagnóstico por imagem , Estudos Retrospectivos
20.
Zhonghua Wei Zhong Bing Ji Jiu Yi Xue ; 33(5): 563-567, 2021 May.
Artigo em Chinês | MEDLINE | ID: mdl-34112293

RESUMO

OBJECTIVE: To determine the risk factors of extubation failure and its effect on the prognosis of patients who had successfully passed a spontaneous breathing trial (SBT). METHODS: The clinical data of patients with mechanical ventilation more than 24 hours who passed SBT admitted to department of intensive care unit (ICU) of First Hospital of Qinhuangdao from November 2018 to November 2019 were retrospectively analyzed. According to the outcome of weaning within 48 hours after weaning, patients were divided into weaning success group and weaning failure group. The baseline data, the presence of basic cardiopulmonary diseases, B-type natriuretic peptide (BNP), fluid balance, albumin and hemoglobin within 24 hours before weaning, the time of mechanical ventilation before weaning, rapid shallow breathing index (RSBI) during SBT, oxygenation index, cough peak flow at the end of SBT, and prognostic indicators were collected. The outcome of weaning was taken as the dependent variable, and the observation factors were taken as the independent variable for univariate analysis. The factors with statistical significance in univariate analysis were analyzed by binary Logistic regression to determine the influencing factors of weaning failure. RESULTS: Of the 204 patients, 167 (81.9%) were successfully weaned, and 37 (18.1%) failed. Compared with the weaning success group, the total duration of mechanical ventilation and the length of ICU stay in the weaning failure group were significantly longer [days: 13.0 (7.5, 23.5) vs. 5.0 (3.0, 8.0), 17.0 (12.5, 31.0) vs. 10.0 (6.0, 15.0), both P < 0.01], and the tracheotomy rate and mortality were significantly higher (32.4% vs. 0%, 51.4% vs. 0%, both P < 0.01). Univariate analysis showed that there were significant differences in age, proportion of patients with cardiopulmonary diseases, BNP and cough peak flow between weaning failure group and weaning success group [age (years old): 70.65±15.78 vs. 62.69±15.82, cardiopulmonary diseases: 62.2% vs. 24.6%, BNP (ng/L): 416.87 (32.70, 1 225.80) vs. 45.36 (10.00, 273.60), cough peak flow (L/min): 59.89±9.06 vs. 83.84±16.52, all P < 0.01]. However, there were no significant differences in gender, acute physiology and chronic health evaluation II (APACHE II) at admission, mechanical ventilation time before weaning, albumin, hemoglobin, oxygenation index, RSBI and fluid balance 24 hours before weaning between weaning failure group and weaning success group [male: 51.4% vs. 68.3%, APACHE II: 16.70±6.65 vs. 15.67±6.28, mechanical ventilation time before weaning (days): 6.0 (2.5, 11.0) vs. 5.0 (3.0, 8.0), albumin (g/L): 27.78±4.15 vs. 27.76±4.46, hemoglobin (g/L): 102.43±15.80 vs. 100.61±17.19, oxygenation index (mmHg, 1 mmHg = 0.133 kPa): 359.33±79.83 vs. 365.75±78.23, RSBI (times×L-1×min-1): 50.73±24.97 vs. 46.76±15.53, positive fluid balance: 70.3% vs. 69.5%, all P > 0.05]. The results of binary Logistic regression analysis showed that age ≥ 75 years old [odds ratio (OR) = 3.099, 95% confidence interval (95%CI) was 1.003-9.574, P = 0.049], presence of cardiopulmonary diseases (OR = 3.599, 95%CI was 1.126-11.498, P = 0.031), BNP within 24 hours before weaning (OR = 1.002, 95%CI was 1.000-1.003, P = 0.005) were the risk factors of extubation failure, while cough peak flow at the end of SBT was the protective factor (OR = 0.869, 95%CI was 0.823-0.917, P = 0.000). CONCLUSIONS: For patients who had successfully passed SBT, age ≥ 75 years old, the presence of cardiopulmonary diseases and an increased level of BNP within 24 hours were the risk factors of extubation failure. In addition, the higher the cough peak flow at the end of SBT, the lower the risk of weaning failure will be.


Assuntos
Extubação , Desmame do Respirador , Humanos , Unidades de Terapia Intensiva , Masculino , Respiração Artificial , Estudos Retrospectivos
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