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1.
Am J Emerg Med ; 39: 158-161, 2021 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-33059983

RESUMO

BACKGROUND: Initial recommendations discouraged high flow nasal cannula (HFNC) in COVID-19 patients, driven by concern for healthcare worker (HCW) exposure. Noting high morbidity and mortality from early invasive mechanical ventilation, we implemented a COVID-19 respiratory protocol employing HFNC in severe COVID-19 and HCW exposed to COVID-19 patients on HFNC wore N95/KN95 masks. Utilization of HFNC increased significantly but questions remained regarding HCW infection rate. METHODS: We performed a retrospective evaluation of employee infections in our healthcare system using the Employee Health Services database and unit records of employees tested between March 15, 2020 and May 23, 2020. We assessed the incidence of infections before and after the implementation of the protocol, stratifying by clinical or non-clinical role as well as inpatient COVID-19 unit. RESULTS: During the study period, 13.9% (228/1635) of employees tested for COVID-19 were positive. Forty-six percent of infections were in non-clinical staff. After implementation of the respiratory protocol, the proportion of positive tests in clinical staff (41.5%) was not higher than that in non-clinical staff (43.8%). Of the clinicians working in the high-risk COVID-19 unit, there was no increase in infections after protocol implementation compared with clinicians working in COVID-19 units that did not use HFNC. CONCLUSION: We found no evidence of increased COVID-19 infections in HCW after the implementation of a respiratory protocol that increased use of HFNC in patients with COVID-19; however, these results are hypothesis generating.


Assuntos
/epidemiologia , Pessoal de Saúde/estatística & dados numéricos , Ventilação não Invasiva/métodos , Doenças Profissionais/epidemiologia , Cânula , Humanos , Massachusetts/epidemiologia , Ventilação não Invasiva/instrumentação , Exposição Ocupacional , Estudos Retrospectivos , Centros de Atenção Terciária
2.
Am J Emerg Med ; 39: 154-157, 2021 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-33067061

RESUMO

AIM: Noninvasive ventilation (NIV) is known to reduce intubation in patients with acute hypoxemic respiratory failure (AHRF). We aimed to assess the outcomes of NIV application in COVID-19 patients with AHRF. MATERIALS & METHODS: In this retrospective cohort study, patients with confirmed diagnosis of COVID-19 and AHRF receiving NIV in general wards were recruited from two university-affiliated hospitals. Demographic, clinical, and laboratory data were recorded at admission. The failure of NIV was defined as intubation or death during the hospital stay. RESULTS: Between April 8 and June 10, 2020, 61 patients were enrolled into the final cohort. NIV was successful in 44 out of 61 patients (72.1%), 17 patients who failed NIV therapy were intubated, and among them 15 died. Overall mortality rate was 24.6%. Patients who failed NIV were older, and had higher respiratory rate, PaCO2, D-dimer levels before NIV and higher minute ventilation and ventilatory ratio on the 1-st day of NIV. No healthcare workers were infected with SARS-CoV-2 during the study period. CONCLUSIONS: NIV is feasible in patients with COVID-19 and AHRF outside the intensive care unit, and it can be considered as a valuable option for the management of AHRF in these patients.


Assuntos
/complicações , Ventilação não Invasiva/métodos , Insuficiência Respiratória/terapia , Idoso , Feminino , Humanos , Hipóxia/etiologia , Intubação Intratraqueal/estatística & dados numéricos , Tempo de Internação , Masculino , Pessoa de Meia-Idade , Insuficiência Respiratória/mortalidade , Insuficiência Respiratória/virologia , Taxa Respiratória , Estudos Retrospectivos , Federação Russa/epidemiologia
3.
J Intensive Care Med ; 36(1): 9-17, 2021 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-32912049

RESUMO

Infection with the novel 2019 coronavirus (SARS-CoV-2) is associated with the development of a viral pneumonia with severe hypoxemia and respiratory failure. In many cases these patients will require mechanical ventilation; but in others the severity of disease is significantly less and may not need invasive support. High flow nasal cannula (HFNC) is a widely used modality of delivering high concentrations of oxygen and airflow to patients with hypoxemic respiratory failure, but its use in patients with SARS-CoV-2 is poorly described. Concerns with use of HFNC have arisen including aerosolization of viral particles to healthcare workers (HCW) to delaying intubation and potentially worsening of outcomes. However, use of HFNC in other coronavirus pandemics and previous experimental evidence suggest HFNC is low risk and may be effective in select patients infected with SARS-CoV-2. With the significant increase in resource utilization in care of patients with SARS-CoV-2, identification of those that may benefit from HFNC allowing allocation of ventilators to those more critically ill is of significant importance. In this manuscript, we review pertinent literature regarding the use of HFNC in the current SARS-CoV-2 pandemic and address many concerns regarding its use.


Assuntos
Ventilação não Invasiva/métodos , Oxigenoterapia/métodos , Insuficiência Respiratória , /complicações , Humanos , Seleção de Pacientes , Insuficiência Respiratória/etiologia , Insuficiência Respiratória/terapia
4.
Monaldi Arch Chest Dis ; 90(4)2020 Dec 03.
Artigo em Inglês | MEDLINE | ID: mdl-33305555

RESUMO

The novel coronavirus (SARS-CoV-2) has distinct clinical manifestations that can vary from an asymptomatic condition to severe acute respiratory failure. Phenotypes are attributable to different pathophysiological mechanisms and require different treatment strategies. The assessment and identification of different phenotypes can guide therapy configurations such as oxygen therapy, non-invasive ventilation, airway management, and tracheal intubation. Further studies are essential to provide information on the influence of phenotypes in the decision of rehabilitation strategies. The sequelae left in the respiratory system of COVID-19 survivors and its limitations will be a challenge for rehabilitation services worldwide. Lung injuries are directly related to the phenotypes presented, and depending on the degree of these injuries, rehabilitation strategies can be targeted. We believe that differentiating patients, according to their respective phenotypes, can improve decision-making in treatment and individualized rehabilitation.


Assuntos
/epidemiologia , Medicina Física e Reabilitação/métodos , /genética , Manuseio das Vias Aéreas/métodos , /virologia , Tomada de Decisão Clínica , Humanos , Intubação Intratraqueal/métodos , Ventilação não Invasiva/métodos , Oxigênio/uso terapêutico , Fenótipo , Síndrome Respiratória Aguda Grave/complicações , Síndrome Respiratória Aguda Grave/terapia , Síndrome Respiratória Aguda Grave/virologia
5.
Medicine (Baltimore) ; 99(46): e23243, 2020 Nov 13.
Artigo em Inglês | MEDLINE | ID: mdl-33181713

RESUMO

BACKGROUND: This study uses a method of systematic evaluation to evaluate the safety and effectiveness of heated humidified high-flow nasal cannula (HHHFNC) as an initial ventilation method in the treatment of neonatal respiratory distress syndrome (NRDS) scientifically. In the field of evidence-based medicine, this study provides a theoretical reference and basis for choosing appropriate initial non-invasive ventilation methods in the treatment of NRDS, thereby providing assistance for clinical treatment. METHODS: The main electronic network databases were searched by computer, including 4 Chinese databases: CNKI, WangFang Data, CQVIP, SinoMed and 3 English databases: PubMed, The Cochrane Library and EMBASE, the time range of retrieval from the beginning of each database to September 1, 2020. The content involves all the published randomized controlled trials on the effectiveness of HHHFNC compared with NCPAP as an initial ventilation method in the treatment of NRDS. Using a search method that combines medical subject words and free words. Based on the Cochrane risk bias assessment tool, 2 researchers independently screen the literature, and then extract the data we needed in the literature, and cross-check. If it is difficult to decide whether to include literature, then turning to a third researcher for help and making a final decision after discussion, and using RevMan 5.3 and STATA 13.0 to analyze the relative data. RESULTS: Based on the method of meta-analysis, this study analyzes the pre-determined outcome indicators through scientific statistical analysis, and compares the effectiveness and safety of HHHFNC compared with NCPAP as an initial ventilation method in the treatment of NRDS. All results will be published in peer-reviewed high-quality professional academic journals. CONCLUSION: Based on evidence-based medicine, this study will obtain the establishing evidence of comparison that the clinical effectiveness and safety of HHHFNC compared with NCPAP as an initial ventilation method in the treatment of NRDS through the existing data and data, which provides the evidence support of evidence-based medicine in the treatment of NRDS. OSF REGISTRATION NUMBER: September 17, 2020. osf.io/f6at4 (https://osf.io/f6at4).


Assuntos
Cânula/normas , Protocolos Clínicos , Umidificadores/normas , Oxigenoterapia/métodos , Síndrome do Desconforto Respiratório do Recém-Nascido/tratamento farmacológico , Humanos , Recém-Nascido , Metanálise como Assunto , Ventilação não Invasiva/métodos , Ventilação não Invasiva/normas , Oxigênio/administração & dosagem , Oxigênio/uso terapêutico , Oxigenoterapia/normas , Revisões Sistemáticas como Assunto
7.
Rev Mal Respir ; 37(9): 756-765, 2020 Nov.
Artigo em Francês | MEDLINE | ID: mdl-33169687

RESUMO

BACKGROUND: Chronic obstructive pulmonary disease (COPD) is a major cause of morbidity and mortality, especially in cases of chronic hypercapnic respiratory failure. Following a prolonged debate, the indication and benefits of noninvasive ventilation (NIV) have been recently established. Although improved ventilation and reduction in hyperinflation appear to underlie the positive effect on NIV in COPD, only a few studies have focused on specific ventilatory algorithms for improving PaCO2. METHODS: The main objective of this study is to analyze the impact of Löwenstein's ventilatory algorithms, supposed to allow a better management of hyperinflation and its consequences on alveolar ventilation and blood gas parameters. This is an interventional study in routine care, prospective, single blind, randomized with cross over. The primary endpoint will be the transcutaneous partial pressure of nocturnal carbon dioxide. Secondary endpoints will be: abnormal respiratory events occurring during nocturnal NIV; the objective quality of sleep via polysomnography; the tolerance of ventilation and the subjective quality of sleep evaluated by auto questionnaires. EXPECTED RESULTS: The results of this study will clarify whether is it necessary to explore more the impact of the ventilatory modes developed by Löwenstein, dedicated to hypercapnic COPD patients, requiring a long-term NIV.


Assuntos
Algoritmos , Hipercapnia/terapia , Ventilação não Invasiva , Doença Pulmonar Obstrutiva Crônica/terapia , Ensaios Clínicos Controlados Aleatórios como Assunto/métodos , Dióxido de Carbono/análise , Dióxido de Carbono/sangue , Estudos Cross-Over , Serviços de Assistência Domiciliar , Humanos , Hipercapnia/complicações , Hipercapnia/patologia , Monitorização Fisiológica/métodos , Monitorização Fisiológica/normas , Ventilação não Invasiva/métodos , Seleção de Pacientes , Polissonografia , Estudos Prospectivos , Doença Pulmonar Obstrutiva Crônica/complicações , Doença Pulmonar Obstrutiva Crônica/diagnóstico , Doença Pulmonar Obstrutiva Crônica/patologia , Ensaios Clínicos Controlados Aleatórios como Assunto/normas , Projetos de Pesquisa , Insuficiência Respiratória/etiologia , Insuficiência Respiratória/patologia , Insuficiência Respiratória/terapia , Tamanho da Amostra , Índice de Gravidade de Doença , Método Simples-Cego , Sono/fisiologia
8.
Expert Rev Med Devices ; 17(11): 1211-1220, 2020 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-33103939

RESUMO

Background: The current SARS-CoV-2 pandemic has provoked the collapse of some health systems due to insufficient intensive care unit capacity. The use of continuous positive airway pressure (CPAP) and high-flow nasal oxygen (HFNO) therapies has been limited in consideration of the risk of occupational infection in health-care professionals. Aims: In preclinical experimental simulations, evaluate occupational and environmental safety of the newly developed isolation system for aerosol-transmitted infections (ISATI). Method: Simulations were conducted to test ISATI's capability to isolate aerosolized molecular (caffeine), and biological (SARS-CoV-2 synthetic RNA) markers. Caffeine deposition was analyzed on nitrocellulose sensor discs by proton nuclear magnetic resonance spectroscopy. Synthetic SARS-CoV-2 detection was performed by reverse transcription-polymerase chain reaction. Results: ISATI demonstrated efficacy in isolating molecular and biological markers within the enclosed environment in simulated conditions of CPAP, HFNO and mechanical ventilation therapy. Neither the molecular marker nor substantial amounts of synthetic SARS-CoV-2 RNA were detected in the surrounding environment, outside ISATI, indicating appropriate occupational safety for health-care professionals. Conclusion: Aerosolized markers were successfully contained within ISATI in all experimental simulations, offering occupational and environmental protection against the dissemination of aerosolized microparticles under CPAP or HFNO therapy conditions, which are indicated for patients with acute respiratory infections.


Assuntos
/terapia , Ventilação não Invasiva , Aerossóis , Pressão Positiva Contínua nas Vias Aéreas/instrumentação , Pressão Positiva Contínua nas Vias Aéreas/métodos , Pessoal de Saúde , Humanos , Ventilação não Invasiva/instrumentação , Ventilação não Invasiva/métodos , Oxigênio , Oxigenoterapia
9.
Neuquén; s.n; sept. 2020.
Não convencional em Espanhol | BRISA/RedTESA | ID: biblio-1120652

RESUMO

CONTEXTO: Ante el avance de la pandemia COVID-19 muchas provincias argentinas se encuentran en el límite de saturación de su capacidad sanitaria, especialmente para los pacientes más críticos que requieren hospitalización, oxigenoterapia y asistencia respiratoria mecánica (ARM). Se han analizado distintas alternativas en los pacientes con hipoxemias moderadas a severas que no corrigen con máscara reservorio. METODOLOGÍA: Un equipo multidisciplinario e independiente de conflictos de interés con el proveedor de esta tecnología, y de tecnologías alternativas realizó una evaluación de tecnología sanitaria enfocada en responder las preguntas clínicas: 1. ¿Cuál es la eficacia de los cascos para ventilación no invasiva en los pacientes internados con COVID-19? 2. ¿Cuál es la seguridad de los cascos para ventilación no invasiva en los pacientes internados con COVID-19? 3. ¿Cuál es el costo y la factibilidad de incorporar cascos para ventilación no invasiva en los pacientes internados con COVID-19? 4. ¿Cuál es el potencial impacto en la red prestacional pública de los cascos para ventilación no invasiva en los pacientes internados con COVID-19? Se realizó una búsqueda bibliográfica en las principales bases de datos, en buscadores genéricos de internet, y financiadores de salud. Se dio prioridad a las Revisiones Sistemáticas (RS), evaluaciones de tecnologías sanitarias (ETS), evaluaciones económicas (EE), guías de práctica clínica (GPC), políticas de cobertura (PC) de diferentes sistemas de salud, ensayos clínicos aleatorizados (ECA), y estudios observacionales, desde 2000 hasta agosto 2020 sin ninguna restricción de idioma. RESULTADOS: Descripción de la Tecnología: Este informe se centra en el casco marca ECLERIS, por tratarse de un dispositivo médico "de pared" que no requiere equipamiento mecánico complejo, por ser fabricado en Argentina, cuenta con autorización de la Administración Nacional de Medicamentos, Alimentos y Tecnología Médica (ANMAT), y su adquisición es más factible en el contexto de pandemia. Tecnologías Alternativas: En el presente informe la tecnología no se compara con equipos de ARM, sino con la mejor alternativa disponible cuando estos ya no se encuentran disponibles, qué es escenario asumido. Estas alternativas pueden ser aquellos dispositivos que ofrecen oxígeno suplementario a presión atmosférica (máscaras y máscaras reservorio). No se compara en este caso la VNI con el respirador, ya que en este escenario se asume agotada la capacidad de respiradores. Pese a lo cual se incluirán en las búsquedas y análisis de estudios o guías que analicen la comparación entre VNI y ARM para buscar información sobre seguridad. Acerca del contexto, se analiza su utilización en salas de internación, guardia de emergencias y derivaciones en ambulancia. CONCLUSIÓN: La mayoría de las autoridades sanitarias recomiendan, cuando está disponible, la intubación precoz y ARM en los pacientes con neumonía grave y SDRA por COVID. Al analizar la eficacia en los pocos estudios identificados (de baja calidad), estos preferencian la VNI en contraposición a la intubación temprana, basada en evidencia indirecta (proveniente de pacientes con SARS y MERS) y en un estudio descriptivo de SARS-Cov2. En esos contextos mostrarían disminución de la mortalidad, aunque es necesario realizar más estudios. En el presente informe los cascos de VNI tipo ECLERIS no se comparan con equipos de ARM, sino con la mejor alternativa cuando estos ya no se encuentran disponibles, que es el escenario asumido y esperado. Estas alternativas pueden ser aquellos dispositivos que ofrecen oxígeno suplementario a presión atmosférica (máscaras y máscaras reservorio). La capacidad de limitar el tratamiento a pacientes seleccionados puede amplificar los beneficios potenciales reduciendo la tasa de fracaso. Si la combinación de hCPAP y la posición prona redujera la tasa de intubación, el sistema de salud podría mejorar la asignación de camas de UCI, otorgando un mejor tratamiento a todos los pacientes que necesitan asistencia ventilatoria.


Assuntos
Humanos , Infecções por Coronavirus/terapia , Ventilação não Invasiva/métodos , Hipóxia/complicações , Argentina , Avaliação da Tecnologia Biomédica , Análise Custo-Benefício
10.
Cardiorenal Med ; 10(6): 470-475, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32987381

RESUMO

With the global spread of SARS-Cov-2 infections, increasing numbers of COVID-19 cases have been reported in transplant recipients. However, reports are lacking concerning the treatment and prognosis of COVID-19 pneumonia in renal transplant recipients with acute cardiorenal syndrome. We report here the complete clinical course of a renal transplant recipient with critical COVID-19 pneumonia. In the early phase of SARS-Cov-2 infection, the patient exhibited extensive lung lesions and significant acute kidney and heart injuries, which required treatment in the ICU. After correcting the arrhythmia and heart failure, the patient recovered quickly from the acute kidney injury with a treatment of intensive diuresis and strict control of fluid intake. Without cessation of oral immunosuppressive agents, the patient presented a delayed and low antibody response against SARS-Cov-2 and reappeared positive for the virus twice after being discharged. Nevertheless, the patient's pneumonia continued to improve and he fully recovered in 69 days. This effectively treated case may be meaningful and referable for the treatment of COVID-19 pneumonia in other transplant recipients with acute cardiorenal syndrome.


Assuntos
/complicações , Síndrome Cardiorrenal/etiologia , Transplante de Rim/efeitos adversos , /genética , Doença Aguda , Formação de Anticorpos/imunologia , /epidemiologia , Síndrome Cardiorrenal/tratamento farmacológico , Diuréticos/uso terapêutico , Humanos , Hospedeiro Imunocomprometido/imunologia , Imunossupressores/uso terapêutico , Masculino , Pessoa de Meia-Idade , Ventilação não Invasiva/métodos , Pneumonia Viral/complicações , Pneumonia Viral/epidemiologia , Pneumonia Viral/virologia , Transplantados , Resultado do Tratamento , Equilíbrio Hidroeletrolítico
11.
BMJ Open Respir Res ; 7(1)2020 09.
Artigo em Inglês | MEDLINE | ID: mdl-32928787

RESUMO

The SARS-CoV-2 can lead to severe illness with COVID-19. Outcomes of patients requiring mechanical ventilation are poor. Awake proning in COVID-19 improves oxygenation, but on data clinical outcomes is limited. This single-centre retrospective study aimed to assess whether successful awake proning of patients with COVID-19, requiring respiratory support (continuous positive airways pressure (CPAP) or high-flow nasal oxygen (HFNO)) on a respiratory high-dependency unit (HDU), is associated with improved outcomes. HDU care included awake proning by respiratory physiotherapists. Of 565 patients admitted with COVID-19, 71 (12.6%) were managed on the respiratory HDU, with 48 of these (67.6%) requiring respiratory support. Patients managed with CPAP alone 22/48 (45.8%) were significantly less likely to die than patients who required transfer onto HFNO 26/48 (54.2%): CPAP mortality 36.4%; HFNO mortality 69.2%, (p=0.023); however, multivariate analysis demonstrated that increasing age and the inability to awake prone were the only independent predictors of COVID-19 mortality. The mortality of patients with COVID-19 requiring respiratory support is considerable. Data from our cohort managed on HDU show that CPAP and awake proning are possible in a selected population of COVID-19, and may be useful. Further prospective studies are required.


Assuntos
Pressão Positiva Contínua nas Vias Aéreas/métodos , Infecções por Coronavirus/terapia , Oxigenoterapia/métodos , Posicionamento do Paciente/métodos , Pneumonia Viral/terapia , Decúbito Ventral , Idoso , Idoso de 80 Anos ou mais , Betacoronavirus , Infecções por Coronavirus/mortalidade , Progressão da Doença , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Ventilação não Invasiva/métodos , Razão de Chances , Pandemias , Pneumonia Viral/mortalidade , Estudos Retrospectivos , Resultado do Tratamento , Reino Unido , Vigília
12.
Sci Rep ; 10(1): 15117, 2020 09 15.
Artigo em Inglês | MEDLINE | ID: mdl-32934263

RESUMO

Due to the expanding use of non-invasive ventilation (NIV) in amyotrophic lateral sclerosis (ALS), the question of enteral nutrition is increasingly raised in NIV users ALS patients. Here, we aimed to determine the prognostic factors for survival after gastrostomy placement in routine NIV users, taking into consideration ventilator dependence. Ninety-two routine NIV users ALS patients, who underwent gastrostomy insertion for severe dysphagia and/or weight loss, were included. We used a Cox proportional hazards model to identify factors affecting survival and compared time from gastrostomy to death and 30-day mortality rate between dependent (daily use ≥ 16 h) and non-dependent NIV users. The hazard of death after gastrostomy was significantly affected by 3 factors: age at onset (HR 1.047, p = 0.006), body mass index < 20 kg/m2 at the time of gastrostomy placement (HR 2.012, p = 0.016) and recurrent accumulation of airway secretions (HR 2.614, p = 0.001). Mean time from gastrostomy to death was significantly shorter in the dependent than in the non-dependent NIV users group (133 vs. 250 days, p = 0.04). The 30-day mortality rate was significantly higher in dependent NIV users (21.4% vs. 2.8%, p = 0.03). Pre-operative ventilator dependence and airway secretion accumulation are associated with worse prognosis and should be key decision-making criteria when considering gastrostomy tube placement in NIV users ALS patients.


Assuntos
Esclerose Amiotrófica Lateral/patologia , Gastrostomia/métodos , Ventilação não Invasiva/métodos , Adolescente , Adulto , Idoso , Idoso de 80 Anos ou mais , Esclerose Amiotrófica Lateral/cirurgia , Feminino , Seguimentos , Humanos , Masculino , Pessoa de Meia-Idade , Prognóstico , Estudos Retrospectivos , Capacidade Vital , Adulto Jovem
13.
J Trauma Acute Care Surg ; 89(6): 1092-1098, 2020 12.
Artigo em Inglês | MEDLINE | ID: mdl-32925581

RESUMO

BACKGROUND: Invasive mechanical ventilation (IMV) is a lifesaving strategy for critically ill patients with coronavirus disease 2019 (COVID-19). We aim to report the case series of critical patients receiving IMV in Wuhan and to discuss the timing of IMV in these patients. METHODS: Data of 657 patients admitted to emergency intensive care unit of Zhongnan Hospital and isolated isolation wards of Wuhan Union Hospital from January 1 to March 10, 2020, were retrospectively reviewed. All medical records of 40 COVID-19 patients who required IMV were collected at different time points, including baseline (at admission), before receiving IMV, and before death or hospital discharge. RESULTS: Among 40 COVID-19 patients with IMV, 31 died, and 9 survived and was discharged. The median age was 70 years (interquartile range [IQR], 62-76 years), and nonsurvivors were older than survivors. The median period from the noninvasive mechanic ventilation (NIV) or high-flow nasal cannula oxygen therapy (HFNC) to intubation was 7 hours (IQR, 2-42 hours) in IMV survivors and 54 hours (IQR, 28-143 hours) in IMV nonsurvivors. We observed that, when the time interval from NIV/HFNC to intubation was less than 50 hours (about 2 calendar days), together with Acute Physiology and Chronic Health Evaluation II (APACHE II) score of less than 10 or pneumonia severity index (PSI) score of less than 100, mortality can be reduced to 60% or less. Prolonged interval from NIV/HFNC to intubation and high levels of APACHE II and PSI before intubation were associated with higher mortality in critically ill patients. Multiple organ damage was common among these nonsurvivors in the course of treatment. CONCLUSION: Early initial intubation after NIV/HFNC might have a beneficial effect in reducing mortality for critically ill patients meeting IMV indication. Considering APACHE II and PSI scores might help physicians in decision making about timing of intubation for curbing subsequent mortality. LEVEL OF EVIDENCE: Therapeutic, level V.


Assuntos
Infecções por Coronavirus/terapia , Estado Terminal/terapia , Mortalidade Hospitalar , Ventilação não Invasiva/métodos , Oxigênio/administração & dosagem , Pneumonia Viral/terapia , APACHE , Idoso , Betacoronavirus , China , Infecções por Coronavirus/mortalidade , Estado Terminal/mortalidade , Feminino , Hospitalização , Humanos , Unidades de Terapia Intensiva , Masculino , Pessoa de Meia-Idade , Oxigenoterapia/métodos , Pandemias , Pneumonia Viral/mortalidade , Estudos Retrospectivos , Fatores de Tempo
14.
BMJ Case Rep ; 13(9)2020 Sep 08.
Artigo em Inglês | MEDLINE | ID: mdl-32907872

RESUMO

COVID-19 has challenged all medical professionals to optimise non-invasive positive pressure ventilation (NIV) as a means of limiting intubation. We present a case of a middle-aged man with a voluminous beard for religious reasons who developed progressive hypoxic respiratory failure secondary to COVID-19 infection which became refractory to NIV. After gaining permission to trim the patient's facial hair by engaging with the patient, his family and religious leaders, his mask fit objectively improved, his hypoxaemia markedly improved and an unnecessary intubation was avoided. Trimming of facial hair should be considered in all patients on NIV who might have any limitations with mask fit and seal that would hamper ventilation, including patients who have facial hair for religious reasons.


Assuntos
Betacoronavirus , Infecções por Coronavirus/terapia , Cuidados Críticos/métodos , Ventilação não Invasiva/métodos , Pneumonia Viral/terapia , Insuficiência Respiratória/terapia , Idoso , Encefalopatias/etiologia , Infecções por Coronavirus/complicações , Cabelo , Humanos , Intubação Intratraqueal , Masculino , Pandemias , Pneumonia Viral/complicações , Religião e Medicina , Insuficiência Respiratória/etiologia , Traqueostomia
15.
BMJ Case Rep ; 13(9)2020 Sep 08.
Artigo em Inglês | MEDLINE | ID: mdl-32907873

RESUMO

A 71-year-old man presented to the emergency department (ED) with low oxygen saturations and symptoms consistent with COVID-19 infection. Apart from a small left-sided ischaemic stroke 10 years prior with very minor residual deficit, he had been well and in full-time employment until development of symptoms. Within minutes of commencing non-invasive ventilation (NIV) in the ED, he developed a complete left-sided paralysis and hemineglect. This case highlights the significance of the prothrombotic complications associated with COVID-19 infection. It also raises the question whether pressure changes upon commencing NIV could lead to clot migration.


Assuntos
Betacoronavirus , Infecções por Coronavirus/complicações , Ventilação não Invasiva/métodos , Pneumonia Viral/complicações , Acidente Vascular Cerebral/diagnóstico por imagem , Acidente Vascular Cerebral/etiologia , Doença Aguda , Idoso , Infecções por Coronavirus/terapia , Evolução Fatal , Fibrinolíticos/uso terapêutico , Humanos , Masculino , Pandemias , Pneumonia Viral/terapia , Respiração com Pressão Positiva/métodos , Acidente Vascular Cerebral/tratamento farmacológico , Terapia Trombolítica/métodos , Ativador de Plasminogênio Tecidual/uso terapêutico , Tomografia Computadorizada por Raios X/métodos
17.
Clin Chest Med ; 41(3): 529-545, 2020 09.
Artigo em Inglês | MEDLINE | ID: mdl-32800204

RESUMO

Both hypoxemic and hypercapnic respiratory failure occur in patients with progressive chronic obstructive pulmonary disease (COPD). The presence of respiratory failure predicts worse prognosis and higher mortality. Supplemental oxygen therapy (SOT) and noninvasive ventilation (NIV) have been increasingly used to treat these abnormalities, aiming to improve both prognosis and quality of life. This review provides an overview of the evidence and current recommendations for the use of SOT and NIV in COPD.


Assuntos
Ventilação não Invasiva/métodos , Oxigenoterapia/métodos , Doença Pulmonar Obstrutiva Crônica/terapia , Qualidade de Vida/psicologia , Feminino , Humanos , Masculino
18.
Respiration ; 99(8): 667-677, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32756065

RESUMO

BACKGROUND: Coronavirus disease 2019 (COVID-19) is a potentially fatal disease that is of great global public health concern. OBJECTIVE: We explored the clinical management of inpatients with COVID-19 in Italy. METHODS: A self-administered survey was sent by email to Italian physicians caring for adult patients with COVID-19. A panel of experts was selected according to their clinical curricula and their responses were analyzed. RESULTS: A total of 1,215 physicians completed the survey questionnaire (17.4% response rate). Of these, 188 (15.5%) were COVID-19 experts. Chest computed tomography was the most used method to detect and monitor COVID-19 pneumonia. Most of the experts managed acute respiratory failure with CPAP (56.4%), high flow nasal cannula (18.6%), and non-invasive mechanical ventilation (8%), while an intensivist referral for early intubation was requested in 17% of the cases. Hydroxychloroquine was prescribed as an antiviral in 90% of cases, both as monotherapy (11.7%), and combined with protease inhibitors (43.6%) or azithromycin (36.2%). The experts unanimously prescribed low-molecular-weight heparin to patients with severe COVID-19 pneumonia, and half of them (51.6%) used a dose higher than standard. The respiratory burden in patients who survived the acute phase was estimated as relevant in 28.2% of the cases, modest in 39.4%, and negligible in 9%. CONCLUSIONS: In our survey some major topics, such as the role of non-invasive respiratory support and drug treatments, show disagreement between experts, likely reflecting the absence of high-quality evidence studies. Considering the significant respiratory sequelae reported following COVID-19, proper respiratory and physical therapy programs should be promptly made available.


Assuntos
Antibacterianos/uso terapêutico , Antivirais/uso terapêutico , Infecções por Coronavirus/terapia , Hospitalização , Pneumonia Viral/terapia , Padrões de Prática Médica , Inibidores de Proteases/uso terapêutico , Respiração Artificial/métodos , Insuficiência Respiratória/terapia , Adulto , Idoso , Anticoagulantes/uso terapêutico , Azitromicina/uso terapêutico , Betacoronavirus , Cânula , Cardiologia , Pressão Positiva Contínua nas Vias Aéreas/métodos , Infecções por Coronavirus/complicações , Infecções por Coronavirus/diagnóstico , Infecções por Coronavirus/tratamento farmacológico , Cuidados Críticos , Heparina de Baixo Peso Molecular/uso terapêutico , Humanos , Hidroxicloroquina/uso terapêutico , Unidades de Terapia Intensiva , Medicina Interna , Itália , Pulmão/diagnóstico por imagem , Pessoa de Meia-Idade , Ventilação não Invasiva/métodos , Pandemias , Médicos , Pneumonia Viral/complicações , Pneumonia Viral/diagnóstico , Pneumologia , Encaminhamento e Consulta , Insuficiência Respiratória/etiologia , Inquéritos e Questionários , Tomografia Computadorizada por Raios X
19.
Medicine (Baltimore) ; 99(34): e21778, 2020 Aug 21.
Artigo em Inglês | MEDLINE | ID: mdl-32846806

RESUMO

BACKGROUND: There are some clinical reports on dysphagia in patients with chronic obstructive pulmonary disease (COPD); however, its pathophysiology remains largely unknown.Changes in respiratory function occur in patients with COPD causing a decrease in tidal volume and an increase in respiratory rate (tachypnea). In addition, it leads to lack of coordination between respiration and swallowing.A new treatment called nasal high flow (NHF) has been introduced for patients with COPD, replacing the traditional non-invasive ventilation (NIV) procedure. The NHF therapy involves inhalation of high flow of humidified air, which reduces respiratory effort in patients with COPD. Furthermore, NHF therapy facilitates swallowing of saliva even during respiratory management. A recent clinical study reported that high-flow nasal cannula oxygen therapy for 6 weeks improved the health-related quality of life and reduced hypercapnia in patients with stable COPD. Taken together, NHF therapy is gaining attention in the clinical management of patients with COPD.Therefore, in this study, we aim to examine the efficacy of NHF therapy on the coordination between breathing and swallowing of saliva during daytime nap in patients with COPD. METHODS/DESIGN: This open-label, investigator-initiated, single center study will evaluate the efficacy of NHF therapy on the coordination between breathing and swallowing of saliva during the daytime nap in COPD patients with forced expiratory volume in 1 second (FEV1%) of <70% during treatment at the Nagasaki University Hospital Respiratory Rehabilitation Center. Evaluations will be performed during the 90 to 180 minute "daytime nap" in the measurement room of the hospital. The primary endpoint will be the rate of appearance of the expiratory phase after swallowing of saliva and the frequency of swallowing during the measurement period. DISCUSSION: The purpose of this study is to obtain evidence regarding the utility of NHF as a potential therapeutic device for COPD patients to prevent aspiration of saliva during the sleep stage of daytime nap. The utility will be assessed by comparing the decrease in incidence rates of the expiratory phase after swallowing of saliva in the NHF device group and the control group, wherein this device was not used.


Assuntos
Deglutição/fisiologia , Ventilação não Invasiva/métodos , Doença Pulmonar Obstrutiva Crônica/fisiopatologia , Doença Pulmonar Obstrutiva Crônica/terapia , Mecânica Respiratória/fisiologia , Cânula , Humanos , Ventilação não Invasiva/efeitos adversos , Projetos de Pesquisa , Saliva
20.
Front Med ; 14(5): 674-680, 2020 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-32761492

RESUMO

We report the clinical and laboratory findings and successful management of seven patients with critical coronavirus disease 2019 (COVID-19) requiring mechanical ventilation (MV). The patients were diagnosed based on epidemiological history, clinical manifestations, and nucleic acid testing. Upon diagnosis with COVID-19 of critical severity, the patients were admitted to the intensive care unit, where they received early noninvasive-invasive sequential ventilation, early prone positioning, and bundle pharmacotherapy regimen, which consists of antiviral, anti-inflammation, immune-enhancing, and complication-prophylaxis medicines. The patients presented fever (n = 7, 100%), dry cough (n = 3, 42.9%), weakness (n = 2, 28.6%), chest tightness (n = 1, 14.3%), and/or muscle pain (n = 1, 14.3%). All patients had normal or lower than normal white blood cell count/lymphocyte count, and chest computed tomography scans showed bilateral patchy shadows or ground glass opacity in the lungs. Nucleic acid testing confirmed COVID-19 in all seven patients. The median MV duration and intensive care unit stay were 9.9 days (interquartile range, 6.5-14.6 days; range, 5-17 days) and 12.9 days (interquartile range, 9.7-17.6 days; range, 7-19 days), respectively. All seven patients were extubated, weaned off MV, transferred to the common ward, and discharged as of the writing of this report. Thus, we concluded that good outcomes for patients with critical COVID-19 can be achieved with early noninvasive-invasive sequential ventilation and bundle pharmacotherapy.


Assuntos
Antivirais/administração & dosagem , Infecções por Coronavirus , Estado Terminal/terapia , Ventilação não Invasiva/métodos , Pandemias , Pneumonia Viral , Betacoronavirus/isolamento & purificação , Quimioprevenção/métodos , Técnicas de Laboratório Clínico/métodos , Infecções por Coronavirus/complicações , Infecções por Coronavirus/diagnóstico , Infecções por Coronavirus/tratamento farmacológico , Infecções por Coronavirus/fisiopatologia , Infecções por Coronavirus/terapia , Cuidados Críticos/métodos , Feminino , Humanos , Pulmão/diagnóstico por imagem , Masculino , Pessoa de Meia-Idade , Avaliação de Processos e Resultados em Cuidados de Saúde , Pneumonia Viral/complicações , Pneumonia Viral/fisiopatologia , Pneumonia Viral/terapia , Insuficiência Respiratória/etiologia , Insuficiência Respiratória/terapia , Tomografia Computadorizada por Raios X/métodos , Desmame do Respirador/métodos
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