RESUMO
There is a new global pandemic that emerged in China in 2019 that is threatening different populations with severe acute respiratory failure. The disease has enormous potential for transmissibility and requires drastic governmental measures, guided by social distancing and the use of protective devices (gloves, masks, and facial shields). Once the need for admission to the ICU is characterized, a set of essentially supportive therapies are adopted in order to offer multi-organic support and allow time for healing. Typically, patients who require ventilatory support have bilateral infiltrates in the chest X-ray and chest computed tomography showing ground-glass pulmonary opacities and subsegmental consolidations. Invasive ventilatory support should not be postponed in a scenario of intense ventilatory distress. The treatment is, in essence, supportive.
Assuntos
Betacoronavirus , Infecções por Coronavirus , Pandemias , Pneumonia Viral , COVID-19 , China , Humanos , Unidades de Terapia Intensiva , SARS-CoV-2RESUMO
SUMMARY There is a new global pandemic that emerged in China in 2019 that is threatening different populations with severe acute respiratory failure. The disease has enormous potential for transmissibility and requires drastic governmental measures, guided by social distancing and the use of protective devices (gloves, masks, and facial shields). Once the need for admission to the ICU is characterized, a set of essentially supportive therapies are adopted in order to offer multi-organic support and allow time for healing. Typically, patients who require ventilatory support have bilateral infiltrates in the chest X-ray and chest computed tomography showing ground-glass pulmonary opacities and subsegmental consolidations. Invasive ventilatory support should not be postponed in a scenario of intense ventilatory distress. The treatment is, in essence, supportive.
RESUMO Há uma nova pandemia global que surgiu na China em 2019 e está ameaçando diferentes populações com insuficiência respiratória aguda grave. A doença tem um enorme potencial de transmissibilidade e requer medidas governamentais drásticas, orientadas para o distanciamento social e pelo uso de dispositivos de proteção (luvas, máscaras e escudos faciais). Uma vez caracterizada a necessidade de admissão na UTI, um conjunto de terapias essencialmente de suporte é adotado para oferecer suporte multiorgânico e permitir tempo para a cura. Normalmente, os pacientes que necessitam de suporte ventilatório apresentam infiltrados bilaterais na radiografia de tórax e na tomografia computadorizada de tórax, mostrando opacidades pulmonares em vidro fosco e consolidações subsegmentares. O suporte ventilatório invasivo não deve ser adiado em um cenário de intenso sofrimento ventilatório. O tratamento é essencialmente de suporte orgânico.
Assuntos
Humanos , Pneumonia Viral , Pandemias , Betacoronavirus , China , Infecções por Coronavirus , Unidades de Terapia IntensivaRESUMO
CONTEXT AND OBJECTIVE: Quality of life (QoL) is considered important as an outcome measurement, especially for long-term diseases such as chronic renal failure. The present study searched for predictors of QoL in a sample of patients undergoing dialysis in southern Brazil. DESIGN AND SETTING: This was a cross-sectional study developed in three southern Brazilian dialysis facilities. METHODS: Health-related QoL of patients on hemodialysis or peritoneal dialysis was measured using the generic Short Form-36 (SF-36) health survey questionnaire. The results were correlated with sociodemographic, clinical and laboratory variables. The analysis was adjusted through multiple linear regression. RESULTS: A total of 140 patients were assessed: 94 on hemodialysis and 46 on peritoneal dialysis. The mean age was 54.2 +/- 15.4 years, 48% were men and 76% were white. The predictors of higher (better) physical component summary in SF-36 were: younger age (beta-0.16; 95% confidence interval, CI: -0.27 to -0.05), shorter time on dialysis (beta-0.06; 95% CI: -0.09 to -0.02) and lower Khan comorbidity-age index (beta 5.16; 95% CI: 1.7-8.6). The predictors of higher mental component summary were: being employed (beta 8.4; 95% CI: 1.7-15.1), being married or having a marriage-like relationship (beta 4.56; 95% CI: 0.9-8.2), being on peritoneal dialysis (beta 4.9; 95% CI: 0.9-8.8) and not having high blood pressure (beta 3.9; 95% CI: 0.3-7.6). CONCLUSIONS: Age, comorbidity and length of time on dialysis were the main predictors of physical QoL, whereas socioeconomic issues especially determined mental QoL.
Assuntos
Nível de Saúde , Falência Renal Crônica/psicologia , Qualidade de Vida , Diálise Renal/psicologia , Idoso , Brasil , Estudos Transversais , Feminino , Humanos , Falência Renal Crônica/terapia , Modelos Lineares , Masculino , Pessoa de Meia-Idade , Diálise Peritoneal , Fatores Socioeconômicos , Inquéritos e QuestionáriosRESUMO
CONTEXT AND OBJECTIVE: Quality of life (QoL) is considered important as an outcome measurement, especially for long-term diseases such as chronic renal failure. The present study searched for predictors of QoL in a sample of patients undergoing dialysis in southern Brazil. DESIGN AND SETTING: This was a cross-sectional study developed in three southern Brazilian dialysis facilities. METHODS: Health-related QoL of patients on hemodialysis or peritoneal dialysis was measured using the generic Short Form-36 (SF-36) health survey questionnaire. The results were correlated with sociodemographic, clinical and laboratory variables. The analysis was adjusted through multiple linear regression. RESULTS: A total of 140 patients were assessed: 94 on hemodialysis and 46 on peritoneal dialysis. The mean age was 54.2 ± 15.4 years, 48 percent were men and 76 percent were white. The predictors of higher (better) physical component summary in SF-36 were: younger age (β-0.16; 95 percent confidence interval, CI: -0.27 to -0.05), shorter time on dialysis (β-0.06; 95 percent CI: -0.09 to -0.02) and lower Khan comorbidity-age index (β 5.16; 95 percent CI: 1.7-8.6). The predictors of higher mental component summary were: being employed (β 8.4; 95 percent CI: 1.7-15.1), being married or having a marriage-like relationship (β 4.56; 95 percent CI: 0.9-8.2), being on peritoneal dialysis (β 4.9; 95 percent CI: 0.9-8.8) and not having high blood pressure (β 3.9; 95 percent CI: 0.3-7.6). CONCLUSIONS: Age, comorbidity and length of time on dialysis were the main predictors of physical QoL, whereas socioeconomic issues especially determined mental QoL.
CONTEXTO E OBJETIVO: A qualidade de vida (QoL) é considerada uma importante medida de desfecho, especialmente no manejo de doenças de longa evolução, como a doença renal crônica. O presente estudo avaliou os preditores de QoL em uma amostra de pacientes tratados por diálise. TIPO DE ESTUDO E LOCAL: Estudo transversal com coleta de dados em três centros de diálise do sul do Brasil. MÉTODOS: Avaliação de pacientes tratados por diálise, com aplicação do questionário genérico SF-36 (Short Form-36) e correlação com variáveis demográficas, socioeconômicas, clínicas e laboratoriais. A análise foi ajustada por regressão linear múltipla. RESULTADOS: Foram avaliados 140 pacientes, 94 tratados por hemodiálise e 46 por diálise peritoneal, com idade 54.2 ± 15,4 anos, 48 por cento homens e 76 por cento brancos. A dimensão física do SF-36 esteve associada à idade (β -0,17 intervalo de confiança, IC 95 por cento -0,27-0,58), ao tempo em diálise (β-0,05 IC 95 por cento -0,08-0,01) e ao índice de idade-comorbidade de Khan mais elevado (β 5,52 IC 95 por cento 2,1-8,9). A dimensão mental esteve associada a ocupação remunerada (β 8,4 IC 95 por cento 1,7-15,1), união estável (β 4,56 IC 95 por cento 0,9-8,2), tratamento por diálise peritoneal (β 4,9 IC 95 por cento 0,9-8,8) e ao fato de não ser hipertenso (β 3,9 IC 95 por cento 0,3-7,6). CONCLUSÕES: Os pacientes mais jovens, tratados por diálise há menos tempo e com um menor número de comorbidades apresentaram melhor QoL do ponto de vista físico. A QoL mental foi melhor em pacientes que desempenham atividade remunerada, são casados, tratados por diálise peritoneal e não-hipertensos.