RESUMEN

ABSTRACT Objective: To identify and characterize the population of Pediatric patients referred to our hyperbaric oxygen therapy center. Methods: Retrospective and observational study, including pediatric patients treated with hyperbaric oxygen therapy, from 2006 to 2021, at the hyperbaric medicine reference center in the north of Portugal. Variables of interest were extracted from electronic medical records. Results: Our study included 134 patients. The most frequent reasons for referral were carbon monoxide poisoning (n=59) and sudden sensorineural hearing loss (n=41). In 75 cases (56%), treatment was initiated in an urgent context. Symptom presentation at Emergency Department varied among patients, the most frequent being headache and nausea/vomiting. Concerning carbon monoxide poisoning, the most common sources were water heater, fireplace/brazier, and boiler. Regarding adverse effects, it was identified one case of intoxication by oxygen and four cases of middle ear barotrauma. Conclusions: The most frequent cause for referral was carbon monoxide poisoning. All patients evolved favorably, with few side effects being reported, emphasizing the safety of this therapy. While most pediatricians may not be aware of the potential benefits arising with hyperbaric oxygen therapy, it is of upmost importance to promote them, so that this technique is increasingly implemented.

RESUMO Objetivo: Identificar e caracterizar a população de casos pediátricos encaminhados para o nosso centro de oxigenoterapia hiperbárica. Métodos: Estudo retrospetivo e observacional, que incluiu doentes pediátricos tratados com oxigenoterapia hiperbárica, de 2006 a 2021, no centro de referência de medicina hiperbárica do norte de Portugal. As variáveis de interesse foram extraídas dos processos clínicos eletrônicos. Resultados: O nosso estudo incluiu 134 casos. Os motivos de encaminhamento mais frequentes foram intoxicação por monóxido de carbono (n=59) e surdez súbita neurossensorial (n=41). Em 75 casos (56%) o tratamento foi iniciado em contexto de urgência. Os sintomas de apresentação à admissão variaram entre os diferentes casos, sendo os mais frequentes cefaleias e náuseas/vômitos. No que diz respeito à intoxicação por monóxido de carbono, as fontes mais comuns foram o aquecedor, lareira/braseiro e caldeira. Com relação aos efeitos adversos, foram identificados um caso de intoxicação por oxigênio e quatro casos de barotrauma do ouvido médio. Conclusões: A causa mais frequente de encaminhamento foi a intoxicação por monóxido de carbono. Todos os pacientes evoluíram favoravelmente e foram registrados poucos efeitos adversos, o que enfatiza a segurança desta terapia. Uma vez que a maioria dos pediatras pode não estar informada sobre os potenciais benefícios da oxigenoterapia hiperbárica, é de extrema importância promovê-los para que esta técnica seja cada vez mais implementada.

RESUMEN

OBJECTIVE: The primary objective of this study was to evaluate the impact of high-flow nasal cannula oxygen therapy [HFNC] on the diaphragm thickening fraction. DESIGN: Prospective, descriptive, cohort study SETTING: The study was conducted in the Physiology and Respiratory Care Laboratory, Intensive Care Unit, Hospital Británico de Buenos Aires. PARTICIPANTS: Thirteen healthy subjects >18 years old INTERVENTIONS: High-flow nasal cannula oxygen therapy MAIN VARIABLES OF INTEREST: Demographic data (age and gender), anthropometric data (weight, height, and body mass index), and clinical and respiratory variables (Diaphragm thickening fraction [DTf], esophageal pressure swing, respiratory rate [RR], esophageal pressure-time product per minute [PTPes/min]). RESULTS: Median DTf decreased significantly as flow increased (p < 0.05). The baseline DTf measurement was 21.4 %, 18.3 % with 20 L/m, and 16.4 % with 40 L/m. We also observed a significant decrease in RR as flow increased in HFNC (p < 0.05). In the 8 subjects with recordings, the PTPes/min was 81.3 (±30.8) cmH2O/sec/min and 64.4 (±25.3) cmH2O/sec/min at baseline and 40 L/m respectively (p = 0.044). CONCLUSIONS: The use of high-flow oxygen therapy through nasal cannula of HFNC in healthy subjects decreases the DTf and RR in association with increased flow. In addition, the use of 40 L/m flow may reduce the muscular work associated with respiration.

RESUMEN

Las úlceras de pie diabético afectan alrededor del 20 % de los pacientes. Estas afectan la calidad de vida e incrementan el riesgo de mortalidad, como principales complicaciones. El tratamiento actual incluye la utilización de medicamentos y la desbridación quirúrgica del tejido ulcerado. Dentro de sus terapias coadyuvantes se destaca el uso de la oxigenoterapia hiperbárica que reduce el riesgo de sus complicaciones. Por esto se busca describir el uso de la oxigenoterapia hiperbárica como coadyuvante en el tratamiento de pie diabético. Por lo tanto, se realizó una revisión bibliográfica utilizando bases de datos: PubMed, Elsevier, SciELO, y en los idiomas español e inglés, publicados entre 2018 y 2023. La oxigenoterapia hiperbárica consiste en colocar al paciente en un entorno de mayor presión, con concentraciones de oxígeno cercanas al 100 %, resultando en efectos antiinflamatorios. El abordaje del pie diabético debe ser multidisciplinario con el fin de lograr una pronta recuperación, incluyendo abordaje farmacológico dando manejo al dolor neuropático y a la curación de las infecciones. La oxigenoterapia hiperbárica se ha considerado como tratamiento coadyuvante al aumentar el porcentaje de curación completa a un 33,3 %, facilitando la curación, aumentando y reduciendo el dolor percibido. Se concluye que efectivamente existen publicaciones que respaldan el uso de la oxigenoterapia hiperbárica adicional a la terapéutica convencional ya que mejora la tasa de curación y reduce el riesgo de amputaciones mayores

Diabetic foot ulcers affect about 20 % of patients. They affect the quality of life and increase the risk of mortality, as main complication. Treatment currently includes the use of drugs and surgical debridement of the ulcerated tissue. Among its coadjuvant therapies, the use of hyperbaric oxygen therapy stands out as it reduces the risk of complications. This study seeks to describe the use of hyperbaric oxygen therapy as an adjuvant in the treatment of diabetic foot. A literature review was conducted using databases: PubMed, Elsevier, SciELO, and in Spanish and English languages, published between 2018 and 2023. Hyperbaric oxygen therapy consists of placing the patient in a higher-pressure environment, with oxygen concentrations close to 100 %, resulting in anti-inflammatory effects. The approach to the diabetic foot should be multidisciplinary in order to achieve early recovery, including a pharmacological approach to manage neuropathic pain and cure infections. Hyperbaric oxygen therapy has been considered as a coadjuvant treatment by increasing the percentage of complete healing to 33.3 %, facilitating healing, increasing and reducing the perceived pain. It concluded that there are publications that support the use of hyperbaric oxygen therapy in addition to conventional therapy, because it improves the healing rate and reduces the risk of major amputations

Asunto(s)

RESUMEN

La oxigenoterapia hiperbárica (OHB) puede mejorar la cicatrización de las heridas. La hipoxia, la alteración de la angiogénesis y la inflamación prolongada son condiciones constantes que la OHB favorece su reversibilidad; hace ya muchos años que, en el listado de indicaciones reconocidas por Sociedades Científicas que rigen esta práctica, se encuentra como indicación aceptada para el tratamiento coadyuvante en injertos o colgajos en riesgo isquémico, como también en heridas refractarias; en la última década, paulatinamente, con la difusión y el aumento de las facilidades para acceder a equipos hiperbáricos, las indicaciones se extendieron al área de la cirugía plástica, para tratamiento de complicaciones posoperatorias en tejidos isquémicos o necrosados y también para preacodicionamiento preoperatorio y sostén posoperatorio de cierto grupo de pacientes con mayor riesgo de sufrir una complicación, en las lipotransferencias como coadyuvante para aumento de la preservación de una mayor cantidad de tejido graso. Las publicaciones al respecto son cada día más frecuentes, algunas presentan un pequeño número de casos, otras son estudios de cohorte retrospectivos, con un nivel de evidencia elevado. El objetivo de este artículo es presentar el concepto básico de los efectos de la OHB, referencia al estado actual de las distintas indicaciones en uso en cirugía plástica y medicina cosmética y la experiencia personal al respecto.

Hyperbaric oxygen therapy (HOT) can improve wound healing, hypoxia, alteration of angiogenesis and prolonged infl ammation are constant conditions that HOT favors its reversibility for many years now, in the list of indications recognized by Scientifi c Societies. that govern this practice, is a recognized indication for adjuvant treatment in grafts or fl aps at ischemic risk, as well as in refractory wounds; In the last decade, gradually, with the dissemination and increase in the facilities to access hyperbaric equipment, the indications were extended to the area of plastic surgery, for the treatment of post-operative complications in ischemic or necrotic tissues as well as for preconditioning. operative and post-operative support of a certain group of patients with a higher risk of suff ering a complication, in lipotransferences as an adjuvant to increase the preservation of a greater amount of fatty tissue. Publications in this regard are becoming more frequent every day, some present a small number of cases, others are retrospective cohort studies, with a high level of evidence. The objective of this article is to present the basic concept of the eff ects of HOT, reference to the current state of the diff erent indications in use in plastic surgery, and cosmetic medicine and personal experience in this regard

Asunto(s)

RESUMEN

BACKGROUND AND OBJECTIVES: Self-reported psychological variables related to pain have been posited as the major contributors to the quality of life of fibromyalgia (FM) women and should be considered when implementing therapeutic strategies among this population. The aim of this study was to explore the effect of low-pressure hyperbaric oxygen therapy (HBOT) on psychological constructs related to pain (i.e., pain catastrophism, pain acceptance, pain inflexibility, mental defeat) and quality of life in women with FM. METHODS: This was a randomized controlled trial. Thirty-three women with FM were randomly allocated to a low-pressure hyperbaric oxygen therapy group (HBOTG) (n=17), who received an 8-week intervention (5 sessions per week), and a control group (CG) (n=16). All women were assessed at baseline (T0) and upon completion of the study (T1) for self-perceived pain intensity, pain catastrophism, pain acceptance, pain inflexibility, mental defeat and quality of life. RESULTS: At T1, the HBOTG improved across all variables related to pain (i.e. self-perceived pain intensity, pain catastrophism, pain acceptance, pain flexibility, mental defeat) (p<0.05) and quality of life (p<0.05). In contrast, the CG showed no improvements in any variable. Furthermore, significant differences between the groups were found in quality of life (p<0.05) after the intervention. CONCLUSIONS: HBOT is effective at improving the psychological constructs related to pain (i.e. pain catastrophism, pain acceptance, pain flexibility, mental defeat) and quality of life among women with FM. Clinical Trial Link Clinical Trials gov identifier (NCT03801109).

Asunto(s)

RESUMEN

Tubeless anaesthesia has become widespread in videothoracoscopic surgery, even in major procedures such as lobectomies. There are several advantages in avoiding general anaesthesia and one-lung mechanical ventilation, such as faster recovery and shorter hospital stays. However, hypoxaemia and hypercapnia are the most reported causes of conversion to general anaesthesia. High Flow Oxygen Therapy (HFOT) generates flow-dependent positive end-expiratory pressure, improves oxygenation and also carbon dioxide washout by flow-dependent dead space flushing. For this reason, intraoperative HFOT may reduce the rate of conversion to general anaesthesia. We report our experience with intraoperative HFOT in a 71-year-old female with lung adenocarcinoma undergoing VATS upper left lobectomy.

Asunto(s)

RESUMEN

Introducción La Organización Mundial de la Salud (OMS) recomienda las intervenciones tempranas de rehabilitación y movilización en pacientes hospitalizados por COVID-19. Los beneficios de la fisioterapia precoz, durante la estancia hospitalaria, no han sido probados en ensayos clínicos. Objetivo Evaluar los efectos de la fisioterapia precoz y educación para la salud en pacientes COVID-19 hospitalizados, en relación con los síntomas descritos en estudios previos, analizando diferencias entre grupos respecto a su acondicionamiento físico, necesidad de oxigenoterapia y estancia hospitalaria. Metodología Ensayo clínico aleatorizado con dos brazos, desarrollado en unidades de hospitalización y cuidados respiratorios intermedios (UCRI), con pacientes COVID-19. Se incluyeron 64 sujetos en el grupo experimental (implementación de un programa de fisioterapia precoz tras 48-72 horas de ingreso) y 62 en el grupo control (tratamiento habitual del centro). Variables sociodemográficas y clínicas: escala de disnea modified Medical Research Council (Mmrc), oxigenoterapia, Medical Research Council Scale sum score (MRC-SS), 30 segundos sit to stand test (30 s-STST), fuerza de prensión manual (FPM), Tinetti, escala de fragilidad (FRAIL-España) y escala Post-COVID-19 Functional Status (PCFS). Se evaluaron al ingreso, al alta y a los dos meses del alta. Resultados Los experimentales tuvieron menos días de ingreso y de oxigenoterapia convencional. Al alta, presentan menor riesgo de caída (72,9 vs. 95,8%) y menor debilidad en MRC-SS (2,1 vs. 14,6%). A los dos meses tenían menor fragilidad (5,0 vs. 14,5%), mayor fuerza de prensión manual, menos disnea, mejores resultados en 30s-STST y menos limitaciones post-COVID (86,5 vs. 96,4%) (AU)

Introduction The WHO recommends early rehabilitation and mobilization interventions in patients hospitalized for COVID-19. The benefits of early physiotherapy, during the hospital stay, have not been proven in clinical trials. Objective To evaluate the effects of early physiotherapy and health education in hospitalized COVID-19 patients, in relation to the symptoms described in previous studies, analyzing differences between groups regarding their physical conditioning, need for oxygen therapy and hospital stay. Methodology Randomized clinical trial with two arms, developed in hospitalization and intermediate respiratory care units, with COVID-19 patients. Sixty-four patients included in the experimental group (implementation of an early physiotherapy program after 48–72 h of admission) and 62 patients in the control group (usual treatment of the center). Sociodemographic and clinical variables: mMRC, oxygen therapy, MRC-SS, 30 s-STST, FPM, Tinetti, FRAIL-España and PCFS. They were evaluated on admission, discharge and two months after discharge. Results The experimental patients had fewer days of admission and conventional oxygen therapy. At discharge, they present a lower risk of falling (72.9% vs. 95.8%) and less weakness in MRC-SS (2.1% vs. 14.6%). At two months they had less frailty (5.0% vs. 14.5%), greater hand grip strength, less dyspnea, better results in 30s-STST and fewer post-COVID limitations (86.5% vs. 96.4%). Conclusión The intervention of early physiotherapy in COVID-19 patients and the health education received, prevents muscle weakness during admission, improves physical conditioning at discharge and two months later, and reduces the days of hospital stay (AU)

Asunto(s)

Asunto(s)

RESUMEN

Objetivo: Evaluar la mortalidad y diversos factores clínicos derivados del desarrollo de neumotórax (NTX) y/o neumomediastino (NMD) atraumáticos en pacientes críticos como consecuencia de la debilidad pulmonar asociada a la COVID-19 (DPAC). Diseño: Revisión sistemática con metaanálisis. Ámbito: Unidad de cuidados intensivos (UCI). Participantes: Investigaciones originales en las que se evaluase a pacientes, con o sin necesidad de ventilación mecánica invasiva (VMI), con diagnóstico de COVID-19 que hubiesen desarrollado NTX o NMD atraumáticos al ingreso o durante su estancia hospitalaria. Intervenciones: Se obtuvieron los datos de interés de cada artículo que fueron analizados y evaluados por la Escala Newcastle-Ottawa. El riesgo de las variables de interés principales se evaluó por los datos derivados de los estudios que incluyeron a pacientes que desarrollaron NTX o NMD atraumáticos. Variables de interés principales: Mortalidad, estancia media en la UCI y PaO2/FiO2 media en el momento diagnóstico. Resultados: Se recogieron datos de 12 estudios longitudinales. En el metaanálisis se incluyeron datos de un total de 4.901 pacientes, entre los cuales 1.629 presentaron un episodio de NTX y 253 de NMD atraumáticos. A pesar de encontrar asociaciones significativamente fuertes, la alta heterogeneidad entre los estudios hace que la interpretación de los resultados deba hacerse con cautela. Conclusiones: La mortalidad de los pacientes con COVID-19 fue mayor en los que desarrollaron NTX y/o NMD atraumáticos con respecto a los que no lo hicieron. La media del índice PaO2/FiO2 fue menor en los pacientes que desarrollaron NTX y/o NMD atraumáticos. Proponemos agrupar bajo el término DPAC estos casos. (AU)

Objectives: To assess mortality and different clinical factors derived from the development of atraumatic pneumothorax (PNX) and/or pneumomediastinum (PNMD) in critically ill patients as a consequence of COVID-19-associated lung weakness (CALW). Design: Systematic review with meta-analysis. Setting: Intensive care unit (ICU). Participants: Original research evaluating patients, with or without the need for protective invasive mechanical ventilation (IMV), with a diagnosis of COVID-19 who had developed atraumatic PNX or PNMD on admission or during their hospital stay. Interventions: Data of interest were obtained from each article and analysed and assessed by the Newcastle-Ottawa Scale. The risk of the variables of interest was assessed by data derived from studies including patients who developed atraumatic PNX or PNMD. Main variables of interest: Mortality, mean ICU length of stay and mean PaO2/FiO2 at diagnosis. Results: Data were collected from 12 longitudinal studies. Data from a total of 4,901 patients were included in the meta-analysis. A total of 1,629 patients had an episode of atraumatic PNX and 253 patients had an episode of atraumatic PNMD. Despite finding significantly strong associations, the high heterogeneity between studies means that interpretation of the results should be made with caution. Conclusions: Mortality of COVID-19 patients was higher in those who developed atraumatic PNX and/or PNMD compared to those who did not. The mean PaO2/FiO2 index was lower in patients who developed atraumatic PNX and/or PNMD. We propose to group these cases under the term CAPD. (AU)

Asunto(s)

RESUMEN

El asma es una enfermedad respiratoria crónica frecuente que afecta al 1-18% de la población en diferentes países y secaracteriza por síntomas variables como sibilancias, disnea, opresión torácica, tos y además presentar limitación variable alflujo aéreo espiratorio. Las exacerbaciones moderadas-graves de asma se diagnostican clínicamente por la presencia dedisnea persistente y la obstrucción de las vías respiratorias. En la actualidad, la terapia de oxigenoterapia convencional seutiliza principalmente en entornos clínicos, pero no puede garantizar un soporte respiratorio suficiente, lo que aumenta laprobabilidad de requerir ventilación mecánica no invasiva o en casos donde esté en riesgo la vida del paciente ventilaciónmecánica invasiva. La terapia nasal de alto flujo (TNAF) se introdujo en la práctica clínica y su papel está adquiriendo cadavez más importancia. Sin embargo no se ha descrito su uso en pacientes adultos con exacerbación del asma. Esta revisiónse diseñó para analizar los potenciales fisiológicos de la TNAF y su eficacia en pacientes adultos que cursan exacerbacióndel asma en entornos clínicos.(AU)

Asthma is a common chronic respiratory disease that affects 1-18% of the population in different countries and is characte-rized by variable symptoms such as wheezing, dyspnea, chest tightness, cough, and variable expiratory airflow limitation.Moderate-severe exacerbations of asthma are clinically diagnosed by the presence of persistent dyspnea and airway obs-truction. Currently, conventional oxygen-therapy is mainly used in clinical settings, but it cannot guarantee sufficient respiratorysupport, increasing the likelihood of requiring non-invasive ventilation or in cases where invasive mechanical ventilation islife-threatening. High-flow nasal therapy (HFNT) was introduced into clinical practice and its role is becoming increasinglyimportant. However, its use in adult patients with asthma exacerbation has not been reported. This review aimed to discussthe physiological potentials of HFNT and effectiveness in adult patients with asthma exacerbation in clinical settings.(AU)

Asunto(s)

RESUMEN

OBJECTIVES: To assess mortality and different clinical factors derived from the development of atraumatic pneumothorax (PNX) and/or pneumomediastinum (PNMD) in critically ill patients as a consequence of COVID-19-associated lung weakness (CALW). DESIGN: Systematic review with meta-analysis. SETTING: Intensive Care Unit (ICU). PARTICIPANTS: Original research evaluating patients, with or without the need for protective invasive mechanical ventilation (IMV), with a diagnosis of COVID-19, who developed atraumatic PNX or PNMD on admission or during hospital stay. INTERVENTIONS: Data of interest were obtained from each article and analyzed and assessed by the Newcastle-Ottawa Scale. The risk of the variables of interest was assessed with data derived from studies including patients who developed atraumatic PNX or PNMD. MAIN VARIABLES OF INTEREST: Mortality, mean ICU stay and mean PaO2/FiO2 at diagnosis. RESULTS: Information was collected from 12 longitudinal studies. Data from a total of 4901 patients were included in the meta-analysis. A total of 1629 patients had an episode of atraumatic PNX and 253 patients had an episode of atraumatic PNMD. Despite the finding of significantly strong associations, the great heterogeneity between studies implies that the interpretation of results should be made with caution. CONCLUSIONS: Mortality among COVID-19 patients was higher in those who developed atraumatic PNX and/or PNMD compared to those who did not. The mean PaO2/FiO2 index was lower in patients who developed atraumatic PNX and/or PNMD. We propose grouping these cases under the term COVID-19-associated lung weakness (CALW).

Asunto(s)

RESUMEN

Introducción. Introducción. El uso de humidificadores de burbuja asociados a equipos de oxigenoterapia es una práctica común en los centros hospitalarios de nuestro país. Sin embargo, no se ha evaluado el aporte real de humedad que entregan estos equipos cuando son usados con sistemas de concentración variable a distintas concentraciones de oxígeno. Además, se han descrito problemas de funcionamiento en la entrega de oxígeno cuando se han ocupado este tipo de humidificador. Objetivo. Determinar el aporte real de humedad que entregan los humidificadores de burbuja al ser usados con sistemas de oxigenoterapia de concentración variable. Métodos. Se evaluaron 10 humidificadores de burbuja, marca Hudson RCI®, con válvula liberadora de presión, los cuales se conectaron a un sistema de oxigenoterapia de concentración variable (Marca Hudson RCI®, modelo MULTI-VENT). La medición de la humedad relativa (HR) se realizó en una cámara de acrílico, donde se conectó el inyector del sistema de oxigenoterapia. Para medir H.R. y temperatura se utilizó un higrómetro digital (Veto®, Italia) y un higrómetro análogo (Hygromat®, Alemania). Cada medición requirió un tiempo de 5 minutos para lograr un valor estable. Se realizaron mediciones de la humedad relativa y temperatura entregada por este sistema, con y sin humidificador, a concentraciones de oxígeno de 0.24, 0.26, 0.28, 0.3, 0.35, 0.4 y 0.5. Resultados. Para las la temperatura, no hubo diferencias entre las mediciones realizadas con y sin humidificador de burbuja. Para la humedad relativa, sólo hubo diferencias estadísticamente significativas a concentraciones de oxígeno altas (> 0.35), pero con escaso cambio en la entrega de humedad absoluta. Cuando se utilizó flujos operativos ≥ 6 L/min se activó la válvula liberadora de presión del humidificador. Conclusión. El uso de humidificadores de burbuja asociados a sistemas de oxigenoterapia de concentración variable no genera un aumento significativo de la humedad entregada a concentraciones bajas de oxigeno, por lo cual se podría prescindir de su uso.

Background. The use of bubble humidifiers associated with oxygen therapy equipment is a common practice in hospitals in our country. However, the real contribution of humidity delivered by these equipments when used with variable concentration systems at different oxygen concentrations has not been evaluated. In addition, operating problems have been described in the delivery of oxygen when this type of humidifier has been used. Objetive. Determine the real contribution of humidity delivered by bubble humidifiers when used with variable concentration oxygen therapy systems. Methods. 10 Hudson RCI® brand bubble humidifiers with a pressure release valve were evaluated, which were connected to a variable concentration oxygen therapy system (Hudson RCI® brand, MULTI-VENT model). The relative humidity (RH) was measured in an acrylic chamber, where the injector of the oxygen therapy system was connected. To measure R.H. and temperature, a digital hygrometer (Veto®, Italy) and an analog hygrometer (Hygromat®, Germany) were used. Each measurement required a time of 5 minutes to achieve a stable value. Measurements of the relative humidity and temperature delivered by this system were made, with and without a humidifier, at oxygen concentrations of 0.24, 0.26, 0.28, 0.3, 0.35, 0.4 and 0.5. Results. For temperature, there were no differences between the measurements made with and without a bubble humidifier. For relative humidity, there were only statistically significant differences at high oxygen concentrations (> 0.35), but with little change in absolute humidity delivery. When operating flows ≥ 6 L/min were used, the humidifier pressure relief valve was activated. Conclusion. The use of bubble humidifiers associated with variable concentration oxygen therapy systems does not generate a significant increase in the humidity delivered at low oxygen concentrations, so their use could be dispensed with.

RESUMEN

Objetivo: conocer las complicaciones relacionadas con la traqueotomía en pacientes pos-COVID-19 tratados con distintos dispositivos de oxigenoterapia y los factores asociados. Métodos: se llevó a cabo un estudio observacional retrospectivo en pacientes adultos portadores de una traqueotomía pos-COVID-19, que estuvieron ingresados en la Unidad de Semicríticos de Neumología del Hospital Universitario de Bellvitge (Madrid, España), de agosto de 2021 a mayo de 2022. Variables: sociodemográficas, clínicas, comorbilidades, relacionadas con la traqueotomía y sistemas de oxigenación, complicaciones. Se realizó análisis descriptivo y comparación de variables para identificar factores de riesgo asociados a dichas complicaciones.Resultados: se incluyeron a 28 pacientes. El 85,7% fue hombre. La mediana de edad fue de 65,50. La mediana de días de ingreso en UCI fue de 61,5 días. Las principales comorbilidades: hipertensión arterial (42,9%) y diabetes (35,7%). El 78,6% llevaba dispositivo alto flujo. El 32,1% presentó complicaciones relacionadas con el manejo de la traqueotomía. Las complicaciones más frecuentes fueron la presencia de tapón mucoso (33,3%) y la alteración en la consistencia de secreciones (33,3%). Presentaron más complicaciones los hombres que las mujeres (88,9% vs.11,1%), los pacientes con antecedentes de hábito tabáquico (66,7% vs. 33,3%, p= 0,028). Los pacientes que eran portadores de un dispositivo de alto flujo no presentaron casi ninguna complicación (94,7% frente a 5,3%, p= 0,007). Conclusiones: el uso de dispositivos de oxigenoterapia que incorporen humidificación activa y control de la temperatura es una alternativa útil para reducir las complicaciones asociadas a la pérdida de esta función fisiológica de la anatomía nasofaríngea en los pacientes con traqueotomía.(AU)

Objectives: to understand tracheostomy-related complications in post-COVID-19 patients treated with different oxygen therapy devices and their associated factors.Methods: an observational retrospective study was conducted in adult patients with post-COVID-19 tracheostomy, who were hospitalized at the Respiratory Semi-critical Care Unit of the Bellvitge University Hospital (Barcelona, Spain), from August 2021 to May 2022. The variables were: sociodemographic, clinical, comorbidities, associated with tracheostomy and oxygenation systems, complications. Descriptive analysis was conducted, as well as comparison of variables in order to identify the risk factors associated with said complications. Results: the study included 28 patients; 85.7% were male. Their median age was 65.50. The median number of hospitalization days at ICU was 61.5 days. Their main comorbidities: hypertension (42.9%) and diabetes (35.7%). High-flow devices were used by 78.6% of patients; 32.1% of them presented complications associated with tracheostomy management. The most frequent complications were the presence of mucous plug (33.3%) and an alteration in consistency of secretions (33.3%). Male patients presented more complications than female patients (88.9% vs.11.1%), as well as patients with a smoking history (66.7% vs. 33.3%, p= 0.028). Patients who were carriers of high-flow devices presented almost no complications (94.7% vs. 5.3%, p= 0.007). Conclusions: the use of oxygen therapy devices incorporating active humidification and temperature control is a useful option in order to reduce those complications associated with the loss of this physiological function of the nasopharyngeal anatomy in patients with tracheostomy.(AU)

Asunto(s)

RESUMEN

RESUMEN Introducción: La oxigenoterapia de alto flujo (OAF) y la ventilación no invasiva (VNI) son sistemas no invasivos que se administran post-extubación en pacientes COVID-19 para evitar la reintubación. Sin embargo, la evidencia sobre la elección de alguno de estos dispositivos no está muy clara. El objetivo fue determinar si el grupo que recibió OAF comparado con el grupo que recibió VNI se asocia a menor riesgo de reintubación en adultos con destete difícil y extubados por COVID-19. Material y métodos: Estudio cohorte retrospectivo en 206 registros de pacientes en destete difícil de ventilación mecánica en la Unidad de Cuidados Intensivos (UCI). El resultado primario fue reintubación en pacientes que fracasaron con OAF o VNI post-extubación y los resultados secundarios fueron estancia hospitalaria en UCI y mortalidad a los 90 días. Resultados: Doscientos seis pacientes cumplieron los criterios de inclusión, 102 pacientes en el grupo OAF y 104 pacientes en el grupo VNI. Durante el seguimiento de 72 horas, la tasa de reintubación en el grupo OAF fue mayor [n=24 (64,9%)] comparado con el grupo VNI [n=13 (35,1%)], mostrando en el análisis de Kaplan-Meier diferencias significativas (Log-Rank-Test p=0,005). La regresión de COX mostró mayor riesgo de reintubación en el grupo de OAF frente a VNI (HR 2,74; IC95% 1,42-5,68; p=0,007). No hubo diferencias en los días de hospitalización UCI (p=0,913) ni en mortalidad a los 90 días (Log-Rank-Test p=0,49). Conclusión: Este estudio observacional retrospectivo sugirió que la OAF frente al VNI se asoció a mayor riesgo de reintubación, pero no a mortalidad a los 90 días.

ABSTRACT Introduction: High flow oxygen therapy (HFO) and non-invasive ventilation (NIV) are non-invasive systems that are administered post-extubation in COVID-19 patients to avoid reintubation. However, the evidence on the choice of any of these devices is not very clear. The objective was to determine if the group that received OAF compared to the group that received NIV is associated with a lower risk of reintubation in adults with difficult weaning and extubated due to COVID-19. Material and methods: Retrospective cohort study in 206 records of patients in difficult weaning from mechanical ventilation in the Intensive Care Unit (ICU). The primary outcome was reintubation in patients who failed HFO or post-extubation NIV, and the secondary outcomes were ICU hospital stay and 90-day mortality. Results: Two hundred and six patients met the inclusion criteria, 102 patients in the OAF group and 104 patients in the NIV group. During the 72-h follow-up, the reintubation rate in the HFO group was higher [n=24 (64,9%)] compared to the NIV group [n=13 (35,1%)], showing in the analysis of Kaplan-Meier significant differences (Log-Rank-Test p=0,005). COX regression showed a higher risk of reintubation in the HFO group compared to NIV (HR 2,74; 95%CI 1,42-5,68; p=0,007). There were no differences in ICU hospitalization days (p=0,913) or in 90-day mortality (Log-Rank-Test p=0,49). Conclusion: This retrospective observational study suggested that HFO versus NIV was associated with a higher risk of reintubation, but not with 90-day mortality.

RESUMEN

Objective To evaluate the benefits and harmful effects of conservative versus liberal oxygen therapy in patients admitted to the Intensive Care Unit (ICU). Design A systematic review and meta-analysis was carried out. Setting ICU. Participants Adult patients (aged 18 years or older) were randomized to either a lower oxygenation target strategy (conservative oxygen therapy) or a higher oxygenation target strategy (liberal oxygen therapy) in the ICU. Interventions Patients received different oxygenation target strategies. Results Ten studies involving 5429 adult patients admitted to the ICU were included in the meta-analysis. The pooled results showed no decreased all-cause mortality at 28 days (RR 0.90; 95%CI 0.75–1.09; p=0.28), 90 days (RR 1.02; 95%CI 0.92–1.13; p=0.71) or longest follow-up (RR 0.97; 95%CI 0.88–1.08; p=0.63) among patients administered conservative oxygen therapy. Secondary outcomes were comparable between the two groups. The results of sensitivity analyses and subgroup analyses were consistent with the main analyses. Conclusion No beneficial or harmful effects of conservative oxygen therapy were found compared to liberal oxygen therapy in relation to all-cause mortality among adult patients in the ICU. Conservative oxygen therapy did not reduce all-cause mortality at 28 days, 90 days or longest follow-up. Other important clinical outcomes were also comparable between the two groups (AU)

Objetivo Evaluar los beneficios y los daños de la oxigenoterapia conservadora frente a la liberal para los pacientes de la unidad de cuidados intensivos (UCI). Diseño Revision sistemática y metaanálisis. Lugar UCI. Participantes Los pacientes adultos (de 18 años o más) fueron asignados al azar para recibir una estrategia de objetivo de oxigenación más baja (terapia de oxígeno conservadora) o una estrategia de objetivo de oxigenación más alta (terapia de oxígeno liberal) en la UCI. Intervenciones Los pacientes recibieron diferentes estrategias de objetivos de oxigenación. Resultados En este metaanálisis se incluyeron 10 estudios con 5.429 pacientes adultos ingresados en la UCI. Los resultados agrupados no mostraron una disminución de la mortalidad total a los 28 días (RR 0,90; IC del 95%: 0,75 a 1,09; p=0,28), 90 días (RR 1,02; IC del 95%: 0,92 a 1,13; p=0,71) ni en el seguimiento más prolongado (RR 0,97; IC del 95%: 0,88 a 1,08; p=0,63) para los pacientes tratados con oxigenoterapia conservadora. Los resultados secundarios fueron comparables entre los dos grupos. Los resultados de los análisis de sensibilidad y los análisis de subgrupos fueron consistentes con los análisis principales. Conclusión No se encontraron efectos beneficiosos o perjudiciales de la oxigenoterapia conservadora en comparación con la oxigenoterapia liberal sobre la mortalidad total entre los pacientes adultos en la UCI. La oxigenoterapia conservadora no redujo la mortalidad por todas las causas a los 28 días, a los 90 días ni en el seguimiento más prolongado. Otros resultados clínicos importantes también fueron comparables entre los dos grupos (AU)

Asunto(s)

RESUMEN

Reportamos los dos primeros casos, en Perú, sobre el uso del tratamiento con oxigeno hiperbárico coadyuvante (TOHC) en pacientes con mucormicosis asociado a COVID-19 (MAC). El primer caso es una mujer de 41 años, con dolor en hemicara y región palatina izquierdas con rinorrea purulenta de un mes de evolución. Al examen físico, solo evidencia fístula oroantral. El segundo caso se trata de un varón de 35 años, con disminución de agudeza visual izquierda y dolor palatino con fístula que drena secreción purulenta de cuatro meses de evolución. Ambos pacientes tienen el antecedente de diabetes, tuvieron COVID-19 moderado cuatro meses antes del ingreso, y recibieron corticoterapia por este diagnóstico. Ambos pacientes tuvieron una evaluación tomográfica que mostró compromiso del seno maxilar y tejido óseo circundante, con endoscopia nasal diagnóstica y terapéutica para desbridamiento. Se obtuvieron muestras compatibles con mucormicosis en estudio histológico. Los pacientes fueron tratados con limpieza quirúrgica y anfotericina B desoxicolato, sin embargo, presentaron evoluciones tórpidas. Por lo tanto, se adicionó la TOHC y mostraron una mejoría evidente tras cuatro semanas de tratamiento con controles subsiguientes sin presencia de mucormicosis. Resaltamos la evolución de estos pacientes con TOHC, en una enfermedad con importante morbimortalidad, que ha sido emergente durante la pandemia.

We present the first two cases reported in Peru of the use of adjuvant hyperbaric oxygen therapy (HBOT) in patients with COVID-19-associated mucormycosis (CAM). The first case is a 41-year-old woman, with pain in the left side of the face and palatine region with purulent rhinorrhea for a month. Only an oroantral fistula was found during physical examination. The second case is a 35-year-old male, with decreased left visual acuity and palatal pain with a fistula, draining purulent secretion for four months. Both patients have history of diabetes, had moderate COVID-19 four months prior to admission, and received corticosteroid therapy for this diagnosis. Tomographic evaluation of both patients showed involvement of the maxillary sinus and surrounding bone tissue; both received diagnostic and therapeutic nasal endoscopy for debridement. Histological analysis showed that the samples were compatible with mucormycosis. The patients underwent debridement and were treated with amphotericin B deoxycholate; however, they presented torpid evolution. Then, HBOT was added and the patients showed an evident improvement after four weeks of treatment with subsequent controls without the presence of mucormycosis. We highlight the favorable evolution of these patients while receiving HBOT as treatment for a disease with high morbimortality, which emerged during the pandemic.

Asunto(s)

RESUMEN

OBJECTIVE: To evaluate the benefits and harmful effects of conservative versus liberal oxygen therapy in patients admitted to the Intensive Care Unit (ICU). DESIGN: A systematic review and meta-analysis was carried out. SETTING: ICU. PARTICIPANTS: Adult patients (aged 18 years or older) were randomized to either a lower oxygenation target strategy (conservative oxygen therapy) or a higher oxygenation target strategy (liberal oxygen therapy) in the ICU. INTERVENTIONS: Patients received different oxygenation target strategies. RESULTS: Ten studies involving 5429 adult patients admitted to the ICU were included in the meta-analysis. The pooled results showed no decreased all-cause mortality at 28 days (RR 0.90; 95%CI 0.75-1.09; p = 0.28), 90 days (RR 1.02; 95%CI 0.92-1.13; p = 0.71) or longest follow-up (RR 0.97; 95%CI 0.88-1.08; p = 0.63) among patients administered conservative oxygen therapy. Secondary outcomes were comparable between the two groups. The results of sensitivity analyses and subgroup analyses were consistent with the main analyses. CONCLUSION: No beneficial or harmful effects of conservative oxygen therapy were found compared to liberal oxygen therapy in relation to all-cause mortality among adult patients in the ICU. Conservative oxygen therapy did not reduce all-cause mortality at 28 days, 90 days or longest follow-up. Other important clinical outcomes were also comparable between the two groups.

Asunto(s)

RESUMEN

Resumo Objetivo Compreender os significados atribuídos pela pessoa idosa com Doença Pulmonar Obstrutiva Crônica (DPOC) em uso da Oxigenoterapia Domiciliar Prolongada (ODP) referente ao relacionamento amoroso e a prática sexual. Método Estudo qualitativo, no qual foram realizadas sete entrevistas semidirigidas com pacientes com diagnóstico confirmado de DPOC e em uso de ODP, atendidos em serviço ambulatorial. A técnica de análise de conteúdo foi aplicada com o apoio do software WebQDA 2.0®. Os critérios COREQ foram usados ​​para relatar o método e o resultado. Resultados Duas categorias emergiram: 1- Desestabilização no relacionamento amoroso e na vida sexual do usuário de ODP: revelou que a terapia causa perturbação nos relacionamentos, mudança de parceiro depois que foi prescrita a ODP ou até a ideia de procurar uma pessoa extraconjugal. 2- Vivência e significados da DPOC e da oxigenoterapia durante a relação sexual: o sofrimento com as questões fisiológicas, o quanto o paciente sente falta de ar para ter relação sexual e o impacto disso no desempenho e na frequência, diminuindo esses momentos com o parceiro Conclusão A percepção da pessoa idosa com DPOC em uso da ODP indica que a oxigenoterapia impactou sobre a prática sexual e nos relacionamentos amorosos. Ter boa qualidade nos relacionamentos e na prática sexual é condição fundamental para promover a saúde.

Abstract Objective To understand the meanings attributed by older adult with Chronic Obstructive Pulmonary Disease (COPD) using the Long-Term Home Oxygen Therapy (LTOT) regarding romantic relationships and sexual practice. Method Qualitative study in which seven semi-structured interviews were carried out with patients with a confirmed diagnosis of COPD and using LTOT, treated in an outpatient service. The content analysis technique was applied with the support of the WebQDA2.0 software license. COREQ criteria were used to report method and outcome. Results Two categories emerged: 1- Destabilization in the romantic relationship and in the sexual life of the LTOT user: : revealed that therapy causes relationship breakup, change of partner after prescription of the LTOT or even the idea of ​​looking for an extramarital person; 2- Experience and meanings of COPD and oxygen therapy during sexual intercourse: suffering with physiological problems, how much the patient feels short of breath to have sexual intercourse and the impact of this on performance and frequency, reducing these moments with the partner. Conclusion The perception of elderly people with COPD using LTOT indicates that oxygen therapy had an impact on sexual practice and romantic relationships. Having good quality in relationships and sexual practice is a fundamental condition for health promotion.

RESUMEN

Introducción: Durante la pandemia por SARS-CoV-2, la cánula nasal de alto flujo (CNAF) se usó como soporte en espera de Unidad de terapia intensiva (UTI) o como alternativa a la ventilación invasiva. Objetivos: Primario: Determinar si la cánula nasal de alto flujo evita la intubación oro traqueal. Secundarios: Analizar predictores de éxito al inicio de la cánula nasal de alto flujo y análisis descriptivo de la muestra. Materiales y métodos: Estudio observacional descriptivo retrospectivo. Se incluyeron pacientes mayores de 16 años positivos para SARS-CoV-2, atendidos en guardia y unidad de terapia intensiva, que utilizaron cánula nasal de alto flujo entre octubre de 2020 y marzo 2021. Se recolectaron datos en planillas individuales, analizadas por un profesional externo. Resultados: Se incluyeron en el trabajo 72 pacientes (de 16 a 88 años), 20 mujeres y 52 hombres. El 50 % de la muestra evitó la intubación orotraqueal. El IROX inicio grupo "éxito" vs. grupo "fracaso", p = 0,006. Comparación Irox 12 h grupo "éxito" vs. grupo "fracaso" p < 0,001. Comparación "tiempo desde ingreso a inicio de cánula nasal de alto flujo" grupo "éxito" vs. grupo "fracaso", p = 0,133. Comparación "Delta IROX" grupo "éxito" vs grupo "fracaso" p = 0,092. Conclusión: Se evitó la intubación orotraqueal en el 50 % de los casos. El IROX de inicio y el IROX a las 12 h del uso de cánula nasal de alto flujo fue estadísticamente significativo, lo que es un buen predictor del éxito en esta población. La fecha de inicio de síntomas y el uso de cánula nasal de alto flujo y el delta del IROX durante las pri meras 12 h no fue estadísticamente significativo para el éxito de la terapia. Estos datos son una herramienta útil con el objeto de generar protocolos de selección de pacientes para esta patología.

Introduction: During the SARS-CoV-2 pandemic, the high flow nasal cannula (HFNC) was used as support while waiting for the Intensive Care Unit (ICU) or as an alternative to invasive ventilation. The objective of this work is the description and analysis of the use of CNAF in our population. Objectives: Primary: Determine if HFNC prevents orotracheal intubation. Secondary: Analyze predictors of success at the start of CNAF and a descriptive analysis of the sample Materials and method: Retrospective descriptive observational study. Patients over 16 years of age positive for SARS-CoV-2, treated in Guard and ICU were included. who used CNAF between October 2020 and March 2021 Data was collected in individual forms, analyzed by an external professional. Results: The study included 72 patients (16 to 88 years old), 20 women and 52 men; 50 % of the sample avoided orotracheal intubation. Start IROX, group "success" vs. group "failure" p = 0.006. Comparison Irox.12 h group "success" vs. group "failure" p < 0.001. Comparison "Time from admission to start of CNAF" group "success" vs. group "failure" p = 0.133. Comparison "Delta IROX" group "success" vs. group "failure" p = 0.092. Conclusion: HFNC avoided orotracheal intubation in the 50 % of the cases. The initial IROX and the IROX 12 hours after the use of HFNC were statistically significant, which is a good predictor of success in this population. The date of onset of symptoms and the use of FNAF and IROX delta during the first 12 hours were not statistically significant for the success of the therapy. These data are a useful tool for generating patient selection protocols for this pathology.

RESUMEN

La manera de proveer oxígeno ha sido una idea en permanente evolución que ha gatillado en los médicos la inquietud de implementar distintos dispositivos de soporte, desde la cánula nasal, la máscara de reinhalación y bajo flujo, hasta la presión continua en la vía aérea (CPAP) y la ventilación no invasiva (VNI). Recientemente se ha insertado entre ambos extremos mencionados un nuevo dispositivo que provee oxígeno a alto flujo. El objetivo del presente trabajo fue describir aspectos clínicos y técnicos en la administración de Oxigenoterapia de Alto Flujo (OAF) en pacientes pediátricos del Hospital de Niños de la Santísima Trinidad, en el servicio de UEPE (Unidad estabilización pediátrica en emergencia) 2017 y SIP (sala de internación pediátrica) 500 2018, 2019, en el periodo estival. Se realizó un Estudio descriptivo transversal, retrospectivo. El universo fueron los pacientes pediátricos que recibieron OAF en el Hospital de Niños Santísima Trinidad, en el servicio de UEPE del 2017 y SIP 500 2018, 2019 en el periodo estival. Se utilizó como instrumento la tabla de volcado de datos. Los principales resultados demuestran que se asistieron un total de 697 pacientes. La edad prevalente fue de menores de 6 meses, con un promedio del 60%. Los niños que requerían este tratamiento, en su gran mayoría ingresaban por diagnóstico de bronquiolitis, seguido de BOR (bronquitis obstructiva recurrente).En relación al escore de tal modifcado al ingreso, podemos observar que en el sector de UEPE la media es de 8, mientras que la SIP 500 es de 7. En referente al recurso material, existen varios sistemas de OAF. No hay estudios que demuestren la superioridad de un sistema sobre otro.Por último, se observó que el haber implementado esta técnica en la institución, se logró evitar en gran numero la escalada ventilatoria máxima requerida, ya que en el servicio de UEPE la evolución fue 65% la OAF, mientras que en la SIP 500 en el 2018 fue 72%y en el 2019 fue 79%. Por lo que podemos establecer que la OAF logra una mejoría clínica a través de su impacto en el síndrome funcional respiratorio, así como en el score de Tal modifcado en los niños y permite un tratamiento de estos pacientes en salas de internado general, con mínimos efectos adversos, disminuyendo el ingreso a cuidados intensivos[AU]

Te way to provide oxygen has been an idea in constant evolution that has triggered in doctors the concern to implement different support devices, from the nasal cannula, the rebreathing mask and low flow, to continuous pressure in the airway (CPAP). ) and noninvasive ventilation (NIV). Recently, a new device that provides high-flow oxygen has been inserted between both extremes. Te objective of the present work was to describe clinical and technical aspects in the administration of High Flow Oxygen Terapy (OAF) in pediatric patients of the Santísima Trinidad Children's Hospital, in the UEPE service (Emergency Pediatric Stabilization Unit) 2017 and SIP ( pediatric hospitalization room) 500 2018, 2019, in the summer period. A retrospective cross-sectional descriptive study was carried out. Te universe was the pediatric patients who received HFO at the Santísima Trinidad Children's Hospital, in the UEPE service in 2017 and SIP 500 2018, 2019 in the summer period. Te data dump table was used as an instrument. Te main results show that a total of 697 patients were attended. Te prevalent age was under 6 months, with an average of 60%. Te vast majority of children who required this treatment were admitted due to a diagnosis of bronchiolitis, followed by BOR (recurrent obstructive bronchitis). In relation to the score of such modifed on admission, we can observe that in the UEPE sector the mean is 8, while the SIP 500 is 7. Regarding the material resource, there are several OAF systems. Tere are no studies that demonstrate the superiority of one system over another. Finally, it was observed that having implemented this technique in the institution, the maximum required ventilatory escalation was avoided in large numbers, since in the UEPE service the evolution was 65% of the OAF, while in the SIP 500 in 2018 it was 72% and in 2019 it was 79%. Terefore, we can establish that HFO achieves clinical improvement through its impact on functional respiratory syndrome, as well as on the modifed Tal score in children, and allows treatment of these patients in general hospital wards, with minimal effects. adverse effects, reducing admission to intensive care[AU]

A forma de fornecer oxigênio tem sido uma ideia em constante evolução que desencadeou nos médicos a preocupação em implementar diferentes dispositivos de suporte, desde a cânula nasal, a máscara de reinalação e baixo fluxo, até a pressão contínua nas vias aéreas (CPAP). ) -ventilação invasiva (VNI). Recentemente, um novo dispositivo que fornece oxigênio de alto fluxo foi inserido entre os dois extremos. O objetivo do presente trabalho foi descrever aspectos clínicos e técnicos na administração de Oxigenoterapia de Alto Fluxo (OAF) em pacientes pediátricos do Hospital Infantil Santísima Trinidad, no serviço UEPE (Unidade de Emergência Pediátrica de Estabilização) 2017 e SIP (internação pediátrica quarto) 500 2018, 2019, no período de verão. Foi realizado um estudo descritivo transversal retrospectivo. O universo foram os pacientes pediátricos que receberam HFO no Hospital Infantil Santísima Trinidad, no serviço da UEPE em 2017 e SIP 500 2018, 2019 no período de verão. A tabela de despejo de dados foi utilizada como instrumento. Os principais resultados mostram que foram atendidos um total de 697 pacientes, sendo a idade prevalente inferior a 6 meses, com média de 60%. A grande maioria das crianças que necessitaram desse tratamento foi internada por diagnóstico de bronquiolite, seguido de BOR (bronquite obstrutiva recorrente). Em relação ao escore desta modifcada na admissão, observa-se que no setor da UEPE a média é 8 , enquanto o SIP 500 é 7. Em relação ao recurso material, existem vários sistemas OAF. Não há estudos que demonstrem a superioridade de um sistema sobre o outro. Por fm, observou-se que com a implantação dessa técnica na instituição, evitou-se em grande número o escalonamento ventilatório máximo necessário, pois no serviço da UEPE a evolução foi de 65% de na OAF, enquanto no SIP 500 em 2018 foi de 72% e em 2019 foi de 79%. Portanto, podemos estabelecer que a HFO obtém melhora clínica por meio de seu impacto na síndrome respiratória funcional, bem como no escore de Tal modifcado em crianças, e permite o tratamento desses pacientes em enfermarias de hospital geral, com efeitos mínimos. tratamento intensivo[AU]

Asunto(s)