RESUMO
ABSTRACT Objective: To evaluate the association of biomarkers with successful ventilatory weaning in COVID-19 patients. Methods: An observational, retrospective, and single-center study was conducted between March 2020 and April 2021. C-reactive protein, total lymphocytes, and the neutrophil/lymphocyte ratio were evaluated during attrition and extubation, and the variation in these biomarker values was measured. The primary outcome was successful extubation. ROC curves were drawn to find the best cutoff points for the biomarkers based on sensitivity and specificity. Statistical analysis was performed using logistic regression. Results: Of the 2,377 patients admitted to the intensive care unit, 458 were included in the analysis, 356 in the Successful Weaning Group and 102 in the Failure Group. The cutoff points found from the ROC curves were −62.4% for C-reactive protein, +45.7% for total lymphocytes, and −32.9% for neutrophil/lymphocyte ratio. These points were significantly associated with greater extubation success. In the multivariate analysis, only C-reactive protein variation remained statistically significant (OR 2.6; 95%CI 1.51 - 4.5; p < 0.001). Conclusion: In this study, a decrease in C-reactive protein levels was associated with successful extubation in COVID-19 patients. Total lymphocytes and the neutrophil/lymphocyte ratio did not maintain the association after multivariate analysis. However, a decrease in C-reactive protein levels should not be used as a sole variable to identify COVID-19 patients suitable for weaning; as in our study, the area under the ROC curve demonstrated poor accuracy in discriminating extubation outcomes, with low sensitivity and specificity.
RESUMO Objetivo: Avaliar a associação de biomarcadores com o sucesso do desmame ventilatório em pacientes com COVID-19. Métodos: Trata-se de estudo observacional, retrospectivo e de centro único realizado entre março de 2020 e abril de 2021. Foram avaliados a proteína C-reativa, os linfócitos totais e a relação neutrófilos/linfócitos durante o atrito e a extubação; mediu-se a variação desses valores de biomarcadores. O desfecho primário foi o sucesso da extubação. As curvas ROC foram desenhadas para encontrar os melhores pontos de corte dos biomarcadores segundo a sensibilidade e a especificidade. A análise estatística foi realizada por meio de regressão logística. Resultados: Dos 2.377 pacientes admitidos na unidade de terapia intensiva, 458 foram incluídos na análise, 356 no Grupo Sucesso do desmame e 102 no Grupo Fracasso do desmame. Os pontos de corte encontrados nas curvas ROC foram −62,4% para proteína C-reativa, +45,7% para linfócitos totais e −32,9% para relação neutrófilo/linfócito. Esses pontos foram significativamente associados ao maior sucesso da extubação. Na análise multivariada, apenas a variação da proteína C-reativa permaneceu estatisticamente significativa (RC 2,6; IC95% 1,51 - 4,5; p < 0,001). Conclusão: Neste estudo, uma diminuição nos níveis de proteína C-reativa foi associada ao sucesso da extubação em pacientes com COVID-19. Os linfócitos totais e a relação neutrófilos/linfócitos não mantiveram a associação após a análise multivariada. No entanto, uma diminuição nos níveis de proteína C-reativa não deve ser usada como única variável para identificar pacientes com COVID-19 adequados para o desmame; como em nosso estudo, a área sob a curva ROC demonstrou baixa precisão na discriminação dos resultados de extubação, com baixas sensibilidade e especificidade.
RESUMO
ABSTRACT This study aimed to verify the use of photobiomodulation in swallowing difficulties in individuals who had a severe form of COVID-19. This case report was based on a quasi-experimental, quantitative study, with primary data collected from a non-probabilistic sample of 13 adults (aged ≥ 19 to < 60 years) of both sexes, who had the severe form of COVID-19. Swallowing was assessed with the Dysphagia Risk Assessment Protocol, and the intervention used photobiomodulation. Descriptive statistics were used. It was found that all research participants' risk for dysphagia in water and pudding swallowing tests improved from before to after the intervention. It can be concluded that photobiomodulation had positive results in speech-language-hearing practice to treat swallowing difficulties in adults who were affected by the severe form of COVID-19, intubated, tracheostomized, and needed an alternative feeding route, as the swallowing difficulties improved.
RESUMO O objetivo foi verificar o uso da fotobiomodulação na dificuldade de deglutição em indivíduos que desenvolveram a forma grave da COVID-19. Trata-se de um relato de casos, a partir de um estudo quase experimental, quantitativo, com coleta de dados primários e com amostra não probabilística, realizado com 13 indivíduos adultos (idade ≥ 19 a < 60 anos) de ambos os sexos, que tiveram a forma grave da COVID-19. Foi realizada a avaliação da deglutição pelo Protocolo de Avaliação para o Risco de Disfagia (PARD) e a intervenção com fotobiomodulação. Foi utilizada a estatística descritiva. Verificou-se que todos os participantes da pesquisa apresentaram melhora no risco para disfagia no teste de deglutição de água e de alimento pastoso do momento pré para o pós-intervenção. Pode-se concluir que a utilização da fotobiomodulação na prática fonoaudiológica para tratar a dificuldade de deglutição dos adultos que foram acometidos pela forma grave da COVID-19, intubados, traqueostomizados e necessitaram fazer uso de via alternativa de alimentação, trouxe resultados positivos, com melhora da dificuldade de deglutição.
RESUMO
Abstract Background Postoperative cough may occur after tracheal intubation, but it is indistinct which drug is best at diminishing these events. Additionally, airway reflexes are commonly accompanied by severe hemodynamics responses during emergence. Objectives To evaluate the role of topical airway anesthesia on immediate post-extubation cough/bucking and extubation time. Methods Randomized clinical trials from MEDLINE, EMBASE, CENTRAL, and LILACS published until December 23, 2020 were included. Our primary outcome was postoperative cough/bucking incidence which was compared between local anesthetics and controls. Extubation times were likewise considered. Predisposition appraisal and subgroup, affectability investigations were likewise performed. Results The pooled analysis found a 45% reduction in cough incidence after treatment with topical airway local anesthetic (RR = 0.55; 95% CI: 0.42 to 0.72; p< 0.001). The number needed to treat (NNT) was 4.61. The intervention showed no differences in reduction of the extubation time (mean difference = -0.07; 95% CI: -0.14 to 0.28; p= 0.49). Conclusion Topical airway anesthesia demonstrated better than placebo or no medication in reducing immediate post-extubation cough/bucking. Further studies could have this objective to combine the different ways to perform better outcomes for patients.
Assuntos
Humanos , Tosse/prevenção & controle , Intubação Intratraqueal , Período Pós-Operatório , Extubação , Anestesia Geral , Anestesia Local , Anestésicos LocaisRESUMO
BACKGROUND: Thyromental height (TMH) was first reported as a great single test for prediction of difficult laryngoscopies, although further studies have shown variable estimates of its accuracy. We thus performed this meta-analysis to summarize the predictive values of TMH mainly for prediction of difficult laryngoscopies. METHODS: A search in PubMed, EMBASE, LILACS, and Scielo was conducted in June 2020. We included prospective cohorts fully reported with patients ... 16 years old, providing data on predictive values of TMH for prediction of either difficult laryngoscopies or difficult intubations. Diagnostic properties and association between TMH and Cormack and Lehanes...s classification by direct laryngoscopy were evaluated. A random-effects meta-analysis using hierarchical models was performed. RESULTS: Eight studies evaluating 2844 patients were included. All included studies had high risk of bias and low concern regarding applicability. There was significant heterogeneity among the studies. The pooled diagnostic odds ratio (DOR) and positive (LR+) and negative (LR-) likelihood ratios were as follows: DOR, 57.94 (95% CI: 18.19...184.55); LR+, 11.32 (95% CI: 4.28...29.92); and LR-, 0.23 (95% CI: 0.15...0.35). Summary sensitivity and specificity for studies with common threshold were 82.6 (95% CI: 74...88.8%) and 93.5 (95% CI: 79...98.2%), respectively. The estimated AUC was 81.1%. CONCLUSION: TMH arises as a good predictor of difficult laryngoscopies in adult patients from diverse populations presenting better predictive values than most previously reported bedside tests. However, the high risk of bias throughout the studies may have skewed the results of the individual research as well as the summary points of the present meta-analysis.
Assuntos
Intubação Intratraqueal , Laringoscopia , Humanos , Adulto , Adolescente , Laringoscopia/métodos , Estudos Prospectivos , Intubação Intratraqueal/métodos , Sensibilidade e EspecificidadeRESUMO
Patients with burns to the head and neck may be difficult to intubate or ventilate via facemask. Furthermore, post-burn scarring and microstomia may reduce the success of rescue supraglottic airway placement. While awake tracheal intubation using a flexible intubation scope is considered the optimal technique for these patients, it may not always be feasible in the pediatric population. We report a case of successful management of a difficult airway in a child with extensive post-burn head and neck deformity using a noninvasive positive pressure system to aid with inhalational induction and deep sedation during intubation using a flexible scope.
RESUMO
BACKGROUND: Postoperative cough may occur after tracheal intubation, but it is indistinct which drug is best at diminishing these events. Additionally, airway reflexes are commonly accompanied by severe hemodynamics responses during emergence. OBJECTIVES: To evaluate the role of topical airway anesthesia on immediate post-extubation cough/bucking and extubation time. METHODS: Randomized clinical trials from MEDLINE, EMBASE, CENTRAL, and LILACS published until December 23, 2020 were included. Our primary outcome was postoperative cough/bucking incidence which was compared between local anesthetics and controls. Extubation times were likewise considered. Predisposition appraisal and subgroup, affectability investigations were likewise performed. RESULTS: The pooled analysis found a 45% reduction in cough incidence after treatment with topical airway local anesthetic (RR.á=.á0.55; 95% CI: 0.42 to 0.72; p.á<.á0.001). The number needed to treat (NNT) was 4.61. The intervention showed no differences in reduction of the extubation time (mean difference = -0.07; 95% CI: -0.14 to 0.28; p.á=.á0.49). CONCLUSION: Topical airway anesthesia demonstrated better than placebo or no medication in reducing immediate post-extubation cough/bucking. Further studies could have this objective to combine the different ways to perform better outcomes for patients.
Assuntos
Tosse , Intubação Intratraqueal , Humanos , Tosse/prevenção & controle , Anestésicos Locais , Anestesia Local , Período Pós-Operatório , Extubação , Anestesia GeralRESUMO
Resumo: Introdução: A intubação orotraqueal é um procedimento importante no manejo da via aérea, principalmente quando realizada em situações de emergência. A videolaringoscopia é um artificio que facilita a visualização da glote ao auxiliar a intubação. Objetivo: Este estudo teve como objeto acoplar uma câmera de vídeo a um laringoscópio convencional do tipo Macintosh para possibilitar e orientar o treinamento da intubação orotraqueal. Método: O uso de uma câmera acoplada a um laringoscópio convencional permite a visibilização direta e indireta da glote. As imagens da câmera podem ser transmitidas por wi-fi e compartilhadas para dispositivos e plataformas eletrônicos, visando ao ensino presencial ou remoto da intubação orotraqueal. Resultado: A utilização do dispositivo artesanal como método de ensino de intubação orotraqueal permite ao docente ensinar a teoria do procedimento e orientar e corrigir a execução realizada pelo acadêmico. Esse feedback no treinamento prático pode ser realizado presencialmente ou por via remota. Conclusão: O uso do dispositivo artesanal de videolaringoscopia no ensino médico é uma ferramenta de baixo custo para aperfeiçoar o treinamento de intubação orotraqueal convencional.
Abstract: Introduction: The orotracheal intubation is an important procedure in airway management, especially when performed in emergency situations. Video-laryngoscopy is an artifice that facilitates visualization of the glottis, aiding intubation. Objective: This study aimed to attach a video camera to a conventional Macintosh-type laryngoscope to enable and train intubation or otracheal training. Method: The use of a camera coupled to a conventional laryngoscope allows direct and indirect visualization of the glottis. Camera images can be transmitted over wi-fi and shared to electronic devices and platforms, aiming at teaching in person or remotely about orotracheal intubation. Result: The use of the device as a method of teaching intubation or otracheal, allows teaching to teach the theory of procedure and training the execution performed by the artisanal method. This feedback in the practical training of orotracheal intubation in mannequins can be performed in person or remotely. Conclusion: The use of handcrafted video laryngoscopy device in medical education is a low-cost tool to improve conventional orotracheal intubation training.
RESUMO
Abstract Background Thyromental height (TMH) was first reported as a great single test for prediction of difficult laryngoscopies, although further studies have shown variable estimates of its accuracy. We thus performed this meta-analysis to summarize the predictive values of TMH mainly for prediction of difficult laryngoscopies. Methods A search in PubMed, EMBASE, LILACS, and Scielo was conducted in June 2020. We included prospective cohorts fully reported with patients ≥ 16 years old, providing data on predictive values of TMH for prediction of either difficult laryngoscopies or difficult intubations. Diagnostic properties and association between TMH and Cormack and Lehanes's classification by direct laryngoscopy were evaluated. A random-effects meta-analysis using hierarchical models was performed. Results Eight studies evaluating 2844 patients were included. All included studies had high risk of bias and low concern regarding applicability. There was significant heterogeneity among the studies. The pooled diagnostic odds ratio (DOR) and positive (LR+) and negative (LR-) likelihood ratios were as follows: DOR, 57.94 (95% CI: 18.19-184.55); LR+, 11.32 (95% CI: 4.28-29.92); and LR-, 0.23 (95% CI: 0.15-0.35). Summary sensitivity and specificity for studies with common threshold were 82.6 (95% CI: 74-88.8%) and 93.5 (95% CI: 79-98.2%), respectively. The estimated AUC was 81.1%. Conclusion TMH arises as a good predictor of difficult laryngoscopies in adult patients from diverse populations presenting better predictive values than most previously reported bedside tests. However, the high risk of bias throughout the studies may have skewed the results of the individual research as well as the summary points of the present meta-analysis.
Assuntos
Humanos , Adolescente , Adulto , Adulto Jovem , Intubação Intratraqueal/métodos , Laringoscopia/métodos , Estudos Prospectivos , Sensibilidade e EspecificidadeRESUMO
Introducción: la intubación orotraqueal en pediatría aumenta la supervivencia en patologías graves; sin embargo, una consecuencia es el desarrollo de estenosis subglótica cuya población tiene más riesgo de desarrollarla por diferencias anatómicas con los adultos. La incidencia de estenosis subglótica posterior a intubación orotraqueal ha disminuido en el tiempo según lo reportado en la literatura. En este estudio se evaluó la prevalencia de la patología en nuestra población y su objetivo fue describir las características clínicas, demográficas y diagnósticas en población pediátrica, diagnosticados con estenosis subglótica en el Hospital San Vicente Fundación, posterior a intubación orotraqueal y evaluar la prevalencia del diagnóstico en el período mencionado. Materiales y métodos: se realizó un estudio retrospectivo mediante revisión de historias clínicas de pacientes con códigos CIE 10 de estenosis laríngea o subglótica secundaria a procedimientos y con código CUPS de intubación orotraqueal; se realiza un análisis descriptivo según la distribución de las variables. Resultados: la prevalencia de estenosis subglótica fue del 13 %. La mayoría fueron hombres, la causa principal de intubación fueron las infecciones respiratorias inferiores, principalmente bronquiolitis; las comorbilidades fueron prematuridad, trastorno de deglución y síndrome bronco-obstructivo. Hubo una mediana 19 días de intubación y las estenosis de bajo grado se diagnosticaron más frecuente. Conclusiones: la estenosis subglótica es una complicación de la intubación orotraqueal pediátrica, en este estudio con una prevalencia del 13 %. Los pacientes que desarrollan esta patología requieren la realización de uno o más procedimientos para obtener una vía aérea permeable con estancias hospitalarias prolongadas.
Introduction: Pediatric orotracheal intubation has increased survival rates in severe illnesses; however, one of the consequences maybe the development of subglottic stenosis. This population is at a higher risk of developing it due to anatomical diffe-rences compared to adults. The incidence of subglottic stenosis following orotracheal intubation has decreased over time as reported in the literature. This study aimed to assess the prevalence of this condition in our population and describe the clinical, demographic, and diagnostic characteristics in the pediatric population diagnosed with subglottic stenosis following orotracheal intubation at the San Vicente Fun-dación Hospital. Additionally, it aimed to evaluate the prevalence of this diagnosis during the mentioned period. Materials and Methods: A retrospective study was conducted by reviewing medical records of patients with ICD-10 codes for laryn-geal stenosis and for subglottic stenosis secondary to procedures. Also, the patients with the procedure code for orotracheal intubation were identified. A descriptive analysis was performed based on the distribution of variables. Results: The preva-lence of subglottic stenosis was 13%. There was a majority of male cases, and the primary cause of intubation was lower respiratory tract infection, mainly bronchio-litis. The most frequent comorbidities included prematurity, swallowing disorders, and broncho-obstructive syndrome. Median duration of intubation was 19 days, and lower-grade stenosis was more commonly encountered. Conclusions: Subglottic ste-nosis is a complication of pediatric orotracheal intubation, with a prevalence of 13% in this study. Patients who develop this condition require one or more procedures to establish a patent airway and often experience prolonged hospital stays.
Assuntos
Humanos , Masculino , Feminino , ColômbiaRESUMO
Abstract Patients with burns to the head and neck maybe difficult to intubate or ventilate via facemask. Furthermore, post-burn scarring and microstomia may reduce the success of rescue supraglottic airway placement. While awake tracheal intubation using a flexible intubation scope is considered the optimal technique for these patients, it may not always be feasible in the pediatric population. We report a case of successful management of a difficult airway in a child with extensive post-burn head and neck deformity using a noninvasive positive pressure system to aid with inhalational induction and deep sedation during intubation using a flexible scope.