RESUMO

OBJECTIVES: To evaluate potential airborne asbestos exposures during brake maintenance and repair activities on a P&H overhead crane, and during subsequent handling of the mechanic's clothing. METHODS: Personal (n = 27) and area (n = 61) airborne fiber concentrations were measured during brake tests, removal, hand sanding, compressed air use, removal and reattachment of chrysotile-containing brake linings, and reinstallation of the brake linings. The mechanic's clothing was used to measure potential exposure during clothes handling. RESULTS: All brake linings contained between 19.9% to 52.4% chrysotile asbestos. No amphibole fibers were detected in any bulk or airborne samples. The average full-shift airborne chrysotile concentration was 0.035 f/cc (PCM-equivalent asbestos-specific fibers, or PCME). Average task-based personal air samples collected during brake maintenance, sanding, compressed air use, and brake lining removal tasks ranged from 0 to 0.48 f/cc (PCME). The calculated 30-minute time-weighted average (TWA) airborne chrysotile concentration associated with 5-15 minutes of clothes handling was 0-0.035 f/cc PCME. CONCLUSION: The results indicated that personal and area TWA fiber concentrations measured during all crane brake maintenance and clothes handling tasks were below the current OSHA 8-h TWA Permissible Exposure Limit for asbestos of 0.1 f/cc. Further, no airborne asbestos fibers were measured during routine brake maintenance tasks following the manufacturer's maintenance manual procedures. All short-term airborne chrysotile concentrations measured during non-routine tasks were below the current 30-minute OSHA excursion limit for asbestos of 1 f/cc. This study adds to the available data regarding chrysotile exposure potential during maintenance on overhead cranes.

Assuntos

Poluentes Ocupacionais do Ar , Asbestos Serpentinas , Exposição Ocupacional , Exposição Ocupacional/análise , Poluentes Ocupacionais do Ar/análise , Humanos , Asbestos Serpentinas/análise , Manutenção , Exposição por Inalação/análise , Monitoramento Ambiental/métodos , Automóveis , Amianto/análise

RESUMO

INTRODUCTION: Patient adherence to maintenance medication is critical for improving clinical outcomes in asthma and is a recommended guiding factor for treatment strategy. Previously, the APPaRENT studies assessed patient and physician perspectives on asthma care; here, a post-hoc analysis aimed to identify patient factors associated with good adherence and treatment prescription patterns. METHODS: APPaRENT 1 and 2 were cross-sectional online surveys of 2866 adults with asthma and 1883 physicians across Argentina, Australia, Brazil, Canada, China, France, Italy, Mexico, and the Philippines in 2020-2021. Combined data assessed adherence to maintenance medication, treatment goals, use of asthma action plans, and physician treatment patterns and preferences. Multivariable logistic regression models assessed associations between patient characteristics and both treatment prescription (by physicians) and patient treatment adherence. RESULTS: Patient and physician assessments of treatment goals and adherence differed, as did reporting of short-acting ß2-agonist (SABA) prescriptions alongside maintenance and reliever therapy (MART). Older age and greater patient-reported severity and reliever use were associated with better adherence. Patient-reported prescription of SABA with MART was associated with household smoking, severe or poorly controlled asthma, and living in China or the Philippines. CONCLUSIONS: Results revealed an important disconnect between patient and physician treatment goals and treatment adherence, suggesting that strategies for improving patient adherence to maintenance medication are needed, focusing on younger patients with milder disease. High reliever use despite good adherence may indicate poor disease control. Personalised care considering patient characteristics alongside physician training in motivational communication and shared decision-making could improve patient management and outcomes.

Assuntos

Asma , Adesão à Medicação , Humanos , Asma/tratamento farmacológico , Estudos Transversais , Masculino , Feminino , Adulto , Pessoa de Meia-Idade , Adesão à Medicação/estatística & dados numéricos , Filipinas , Médicos/psicologia , Efeitos Psicossociais da Doença , China , Austrália , Canadá , México , Agonistas de Receptores Adrenérgicos beta 2/uso terapêutico , Brasil , Argentina , Fatores Etários , Antiasmáticos/uso terapêutico , Padrões de Prática Médica , França , Inquéritos e Questionários , Cooperação e Adesão ao Tratamento/estatística & dados numéricos , Itália

RESUMO

BACKGROUND: Chronic obstructive pulmonary disease (COPD) is an increasingly concerning global public health issue due to its high burden of morbidity and mortality. Pulmonary rehabilitation (PR) is a comprehensive intervention to improve patients' physical and psychological conditions, commonly involving oxygen supplementation. The potential benefits of high-flow nasal cannula (HFNC) have recently sparked interest as oxygen therapy. In this context, this study aims to assess the effects of HFNC during the exercise training component of a PR program in people with COPD. METHODS: Systematic review (CRD42022330929). We included randomised controlled trials (RCTs), including crossover RCTs with adults with stable COPD. We included trials using oxygen therapy with HFNC during the exercise training component of a PR programme. PRIMARY OUTCOMES: disease-specific health-related quality of life (HRQoL), exercise capacity (EC) and adverse events. SECONDARY OUTCOMES: treatment adherence, breathlessness and future exacerbations. RESULTS: We included five studies with 300 participants with moderate to severe COPD. The certainty of the evidence was primarily low or very low for all outcomes of interest due to risk of bias, inconsistency or imprecision. HFNC has little to no difference in HRQoL (4 studies, 129 participants, MD 0.17, 95% CI -1.20 to 1.54; I2 50%). HFNC may result in little to no difference in EC (3 studies, 212 participants, mean difference 18.73, 95% CI -20.49 to 28.94; I2 56%), and we are uncertain about the effect of HFNC on breathlessness (4 studies; 244 participants, MD of -0.07, 95% CI -0.4 to 0.26; I2 63%). Only one study with 44 participants reported a participant's withdrawal because of progressive dyspnoea during lower limb exercise. CONCLUSIONS: We are uncertain about the effect of HFNC during the exercise component of a PR programme in HRQoL, EC or dyspnoea compared to usual care or conventional supplementary oxygen. Non-domiciliary oxygen patients showed improvements in HRQoL, EC and dyspnoea.

Assuntos

Cânula , Oxigenoterapia , Doença Pulmonar Obstrutiva Crônica , Qualidade de Vida , Humanos , Doença Pulmonar Obstrutiva Crônica/reabilitação , Tolerância ao Exercício , Terapia por Exercício/métodos , Ensaios Clínicos Controlados Aleatórios como Assunto

RESUMO

Introducción. La nueva era de la cirugía es cada vez más dependiente de la tecnología, y un ejemplo de ello es el uso generalizado de electrocauterio como parte primordial de la práctica quirúrgica. El humo quirúrgico es un subproducto de la disección y la coagulación de los tejidos producidas por los equipos de energía, que representa múltiples riesgos potenciales para la salud del grupo quirúrgico, sin embargo, se han minimizado los peligros causados por la exposición de manera frecuente y acumulativa a este aerosol. Métodos. Se realizó un análisis crítico, desde una posición reflexiva de la información disponible, estableciendo los posibles riesgos relacionados con la exposición al humo quirúrgico. Discusión. Es visible la necesidad imperativa de establecer directrices nacionales, pautas normativas y recomendaciones estandarizadas para cumplir con las exigencias dadas por los sistemas de gestión en salud ocupacional y seguridad del trabajo, cuyo objetivo principal es hacer efectivo el uso de mascarillas quirúrgicas apropiadas, la implementación de programa de vigilancia epidemiológica ambiental en sala de cirugía, la priorización del uso constante de aspiradores y sistemas de evacuación, y la ejecución de programas educativos de sensibilización dirigidos al personal implicado. De igual manera, se abre la inquietud de la necesidad de nuevos estudios para definir con mayor precisión el peligro de este aerosol. Conclusión. Se recomienda de manera responsable utilizar todas las estrategias preventivas existentes para intervenir en salas de cirugía los riesgos minimizados y olvidados del humo quirúrgico.

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Introduction. The new era of surgery is increasingly dependent on technology, and an example of this is the widespread use of electrocautery as a primary part of surgical practice. Surgical smoke is a byproduct of the dissection and coagulation of tissues produced by energy equipment, which represents multiple potential health risks for the surgical group; however, the dangers caused by cumulative exposure have been minimized. Methods. A critical analysis was carried out from a reflective position of the available information, establishing the possible risks related to exposure to surgical smoke. Discussion. The imperative need to establish national normative guidelines and standardized recommendations to comply with the demands given by the occupational health and work safety management systems, whose main objective is to make effective the use of appropriate surgical masks, implementation of environmental epidemiological surveillance program in the operating room, prioritizing the constant use of vacuum cleaners and evacuation systems, and carrying out educational awareness programs aimed at the personnel involved. Likewise, there is concern about the need for new studies to more precisely define the danger of this aerosol. Conclusion. It is recommended to responsibly use all existing preventive strategies to intervene in operating rooms to minimize the forgotten risks of surgical smoke.

Assuntos

Humanos , Lesão por Inalação de Fumaça , Exposição Ocupacional , Eletrocoagulação , Salas Cirúrgicas , Risco à Saúde Humana , Respiradores N95

RESUMO

The aim of this study was to determine the minimum anesthetic concentration of isoflurane (MACISO) and sevoflurane (MACSEVO) and evaluate the cardiorespiratory changes induced by varying fractions of inspired oxygen (FiO2) in Magellanic penguins (Spheniscus magellanicus). Twenty adult penguins (3.53 ± 0.44 kg) of undetermined sex were used. Both MACISO (n = 9) and MACSEVO (n = 13) were established using an up-and-down design. Next, twelve mechanically ventilated penguins were maintained at 1 MACISO or 1 MACSEVO (n = 6 per group) with the FiO2 initially set at 1.0. Three FiO2 values (0.6, 0.4 and 0.2) were then held constant during anesthesia for 20 minutes each. Arterial blood samples were collected for gas analysis after the 20-minute period for each FiO2. Mean ± SD MACISO was 1.93 ± 0.10% and MACSEVO was 3.53 ± 0.13%. Other than heart rate at 0.6 FiO2 (86 ± 11 beats/minute in MACISO and 132 ± 37 beats/minute in MACSEVO; p = 0.041), no significant cardiorespiratory differences were detected between groups. In both groups, decreasing the FiO2 produced increased pH values and reduced partial pressures of carbon dioxide and bicarbonate. Partial pressures of oxygen (PaO2) gradually lowered from 1.0 FiO2 through 0.2 FiO2, though hypoxemia (PaO2 < 80 mmHg) occurred only with the latter FiO2. The MACISO and the MACSEVO for the Magellanic penguin fell within the upper range of reported avian MAC estimates. To prevent hypoxemia in healthy, mechanically ventilated, either isoflurane- or sevoflurane-anesthetized Magellanic penguins, a minimum FiO2 of 0.4 should be used.

Assuntos

Anestésicos Inalatórios , Isoflurano , Oxigênio , Sevoflurano , Spheniscidae , Animais , Spheniscidae/fisiologia , Isoflurano/farmacologia , Isoflurano/administração & dosagem , Sevoflurano/farmacologia , Anestésicos Inalatórios/farmacologia , Anestésicos Inalatórios/administração & dosagem , Oxigênio/sangue , Frequência Cardíaca/efeitos dos fármacos , Masculino , Anestesia por Inalação/veterinária , Feminino , Gasometria/veterinária

RESUMO

This systematic review aimed to analyze the available studies that identified overweight and/or obesity as a risk factor for mortality, use of respiratory support, and changes in biochemical markers in adults hospitalized with SARS-CoV-2. The PubMed, Web of Science, and Scopus databases were searched using PRISMA guidelines until January 2024. The protocol was registered with PROSPERO (code: CRD42024501551). Of the 473 articles, only 8 met the inclusion criteria (e.g., adult individuals aged 18 or over diagnosed with COVID-19 individuals with overweight and/or obesity). In addition, the Downs and Black tool was used to assess the quality of the studies. The studies analyzed totaled 9782 adults hospitalized for COVID-19, indicating that overweight and obesity are present in more than half of adults. Diseases such as diabetes mellitus and hypertension are more prevalent in adults with obesity. The systematic review also highlighted that a higher incidence of respiratory support is related to a higher incidence of hospitalization in intensive care units and that adults with overweight and obesity have a higher risk of mortality from COVID-19. Biochemical markers such as procalcitinin, C-reactive protein, and interleukin-6 are associated with the severity of COVID-19 infection. This systematic review exposed overweight and/or obesity as a risk factor for worse COVID-19 disease, as well as for the need for intensive care, respiratory support, mortality, and changes in essential blood markers.

Assuntos

COVID-19 , SARS-CoV-2 , Adulto , Humanos , Biomarcadores , COVID-19/complicações , Obesidade/complicações , Obesidade/epidemiologia , Sobrepeso/complicações , Fatores de Risco

RESUMO

In patients with chronic obstructive pulmonary disease (COPD), single lung transplantation (SLT) is sometimes performed as an alternative to bilateral lung transplantation due to limited organ availability. However, the postoperative management of SLT presents challenges, including complications related to the distinct compliance of each lung. This case report presents the case of a 65-year-old male patient who underwent SLT and was in the weaning period from mechanical ventilation. High-flow oxygen therapy (HFOT) was administered, and the physiological effects were measured using electrical impedance tomography (EIT). The results demonstrated that the application of HFOT increased air trapping and overdistention in the native lung without benefiting the transplanted lung. HFOT through a tracheostomy tube or nasal cannula resulted in a more heterogeneous distribution of ventilation, with increased end expiratory lung impedance, prolonged expiratory time constants, and an increase in silent spaces. The drop in tidal impedance after applying HFOT did not indicate hypoventilation but rather overdistention and air trapping in the native lung, while the transplanted lung showed evidence of hypoventilation. These findings suggest that HFOT may not be beneficial for SLT patients and could potentially worsen outcomes. However, due to the limited scope of this case report, further prospective studies with larger patient cohorts are needed to confirm these results.

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En pacientes con enfermedad pulmonar obstructiva crónica (EPOC), el trasplante pulmonar unilateral (SLT, por sus siglas en inglés) se realiza como alternativa a la disponibilidad limitada de donantes para el trasplante pulmonar bilateral. Sin embargo, el manejo postoperatorio del SLT presenta desafíos, incluyendo complicaciones relacionadas con la distinta complacencia de cada pulmón. Este reporte presenta el caso de un paciente varón de 65 años que fue sometido a un SLT y se encontraba en el proceso de destete de la ventilación mecánica. Se administró terapia de oxígeno de alto flujo (HFOT, por sus siglas en inglés) y se midieron los efectos fisiológicos utilizando la tomografía de impedancia eléctrica (EIT, por sus siglas en inglés). Los resultados demostraron que la aplicación de HFOT aumentó la retención de aire y la hiperinflación en el pulmón nativo sin beneficiar al pulmón trasplantado. Tanto la HFOT a través de un tubo de traqueostomía como a través de cánula nasal resultaron en una distribución más heterogénea de la ventilación, con un aumento en la impedancia pulmonar al final de la espiración, prolongación de las constantes de tiempo espiratorias y un aumento en los espacios silentes. La disminución de la impedancia tidal después de aplicar HFOT no indicó hipoventilación, sino más bien hiperinsuflación y retención de gas en el pulmón nativo, mientras que el pulmón trasplantado mostró evidencia de hipoventilación. Estos hallazgos sugieren que el HFOT puede no ser beneficioso para los pacientes con SLT y podría empeorar los resultados. Sin embargo, debido al alcance limitado de este informe de caso, se necesitan estudios prospectivos con cohortes de pacientes más amplias para confirmar estos resultados.

Assuntos

Hipoventilação , Transplante de Pulmão , Masculino , Humanos , Idoso , Impedância Elétrica , Estudos Prospectivos , Tomografia Computadorizada por Raios X , Pulmão/diagnóstico por imagem , Oxigênio , Tomografia/métodos

RESUMO

RESUMEN El control de la saturación de oxígeno durante el ingreso hospitalario es un desafío cotidiano para el médico tratante, ya sea en contexto de una exacerbación de EPOC o cualquier enfermedad aguda que curse con insuficiencia respiratoria. El ajuste de flujo del oxígeno administrado al paciente es en la mayoría de los casos manual, habitual mente sin una prescripción médica clara del rango de SpO2 deseado, lo que implica una sobrecarga del servicio de enfermería con el riesgo de realizar un aporte inade cuado de este, ya sea por sobreadministración o por aporte insuficiente. El presente trabajo tiene como objetivo describir una experiencia preliminar con la administración automatizada del flujo de O2 mediante el uso del dispositivo O2matic. Se estudió un grupo de pacientes adultos con insuficiencia respiratoria aguda quienes se encontraban internados usando oxigenoterapia continua con flujímetros convencionales y controles manuales periódicos de enfermería, por lo que se indica, luego, iniciar oxigenoterapia en forma controlada usando el dispositivo O2matic durante 30 min. Se ha observado que el flujo de oxígeno alcanzado utilizando el dispositivo de control automático O2ma tic ha sido menor al flujo utilizado en el control manual, con diferencias significativas entre ambos valores hallados, con adecuada seguridad y tolerancia del paciente. Que la automatización de la oxigenoterapia durante el ingreso hospitalario pueda reducir la duración de la admisión, y posiblemente mejorar la supervivencia entre pacientes con insuficiencia respiratoria aguda queda aún por determinar, por lo que son necesarios futuros estudios aleatorizados con una muestra mayor de pacientes.

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ABSTRACT The control of oxygen saturation during hospital admission is a daily challenge for the treating physician, whether in the context of a COPD exacerbation or any acute disease that occurs with respiratory failure. The adjustment of the oxygen flow administered to the patient is mostly manual, usually without a clear medical prescription for the desired SpO2 range, implying an overload of the nursing service with the risk of making an inad equate contribution, either over-administering it or providing it incorrectly. insufficient. The objective of this work is to describe a preliminary experience with the automated administration of the O2 flow through the use of the O2matic device. A group of adult patients with acute respiratory failure who were hospitalized using continuous oxygen therapy with conventional flowmeters and periodic nursing manual controls was studied, after which it was indicated to start oxygen therapy in a controlled manner using the O2matic device for 30 minutes. It was observed that the oxygen flow achieved using the O2matic automatic control device has been lower than the flow used in manual control, with significant differences between both values found, with adequate safety and patient tolerance. Whether the automation of oxygen therapy during hospital admission could reduce the length of admission, and possibly improve survival among patients with acute respiratory failure remains to be determined, requiring future randomized studies with a larger sample of patients.

RESUMO

The extensive use of inhalational anesthetics contributes to both indoor and outdoor (environmental) pollution. The influence of genetic susceptibility on DNA damage and oxidative stress and the possible modulation of gene expression have not yet been investigated upon occupational exposure to waste anesthetic gases (WAGs). This study assessed 8-oxoguanine DNA glycosylase 1 (OGG1) and superoxide dismutase 2 (SOD2) gene expression, which are related to oxidized DNA repair and antioxidant capacity, respectively, and the influence of their polymorphisms (OGG1 rs1052133 and SOD2 rs4880) in 100 professionals highly exposed to WAGs and 93 unexposed volunteers (control group). Additionally, X-ray repair cross complementing 1 (XRCC1 rs25487 and rs1799782) and ataxia telangiectasia mutated (ATM rs600931) gene polymorphisms as well as genetic instability (micronucleus-MN and nuclear bud-NBUD) and oxidative stress (malondialdehyde-MDA and ferric reducing antioxidant power-FRAP) biomarkers were assessed in the groups (control and exposed) and in the subgroups of the exposed group according to job occupation (anesthesiologists versus surgeons/technicians). Except for the ATM TT controls (associated with increased FRAP), there were no influences of OGG1, XRCC1, ATM, and SOD2 polymorphisms on MN, NBUD, MDA, and FRAP values in exposed or control subjects. No significant difference in the expression of either gene evaluated (OGG1 and SOD2) was found between the exposed and control groups. Increased OGG1 expression was observed among OGG1 -/Cys individuals only in the control group. Among the exposed group, anesthesiologists had a greater duration of WAG exposure (both h/week and years) than surgeons/technicians, which was associated with increased MDA and decreased antioxidant capacity (FRAP) and SOD2 expression (redox status). Higher expression of OGG1 was found in -/Cys surgeons/technicians than in anesthesiologists with the same genotype. Increased antioxidant capacity was noted in the surgeons/technicians carrying the ATM T allele and in those carrying XRCC1 -/Gln. Increased MN was influenced by OGG1 -/Cys in surgeons/technicians. Anesthesiologists with ATM CC exhibited increased MN, and those carrying the C allele (CC/CT genotype) exhibited increased NBUD. SOD2 polymorphism did not seem to be relevant for WAG exposure. These findings contribute to advancing the knowledge on genetic susceptibility/gene expression/genetic instability/oxidative stress, including differences in job occupation considering the workload, in response to occupational exposure to WAGs.

Assuntos

Antioxidantes , Exposição Ocupacional , Humanos , Polimorfismo Genético , Dano ao DNA , Reparo do DNA , Genótipo , Predisposição Genética para Doença , Oxirredução , Expressão Gênica , Estudos de Casos e Controles , Proteína 1 Complementadora Cruzada de Reparo de Raio-X/genética

RESUMO

Introducción: La Intubación orotraqueal (IOT) profiláctica en pacientes con sospecha de Injuria Inhalatoria (II) es una práctica clínica extendida en nuestro país. La misma puede estar asociada a complicaciones y a un aumento de los costos asistenciales. Objetivo: caracterizar a la población de pacientes que ingresaron con IOT al Centro Nacional de Quemados, determinar la incidencia de Intubación orotraqueal no necesaria (IOTNN) así como las complicaciones vinculadas a la misma. Método: Estudio retrospectivo, observacional, analítico. Se incluyeron todos los pacientes con quemadura térmica ingresados al CENAQUE con vía aérea artificial entre enero de 2015 y julio 2023. Se determinaron características demográficas, circunstancias de la injuria, lugar y técnico que realizo la IOT, porcentaje de superficie corporal total quemada (SCTQ), scores de severidad, días de ARM, estado al alta y diagnóstico de II por fibrobroncoscopía. Se analizaron las complicaciones asociadas a la IOT y ARM. Dichas variables fueron contrastadas entre el grupo extubado exitosamente en las primeras 48 horas (IOTNN) y aquellos extubados luego de las 48 horas (IOTP). Resultados: Se incluyeron 562 pacientes. La incidencia de IOTNN fue 41,7% e II 46,7%. Se observaron diferencias significativas entre IOTNN y IOTP para edad [34 (24-48) versus 45 (30-62); p <0,001, para SCTQ [4% (1-11) versus 20% (6-36); p <0,001], ABSI [4 (3-5) versus 7 (5-9) p<0,001], Rev. Baux [48 (33-62) versus 77 (60-99), p <0,001], incidencia de II (32% versus 56,6%, p <0,001). La aspiración de VA (30% versus 20,2% p 0,018), extubación durante el traslado (2% versus 0% p 0,043) e incidencia de NA (Neumonía aspirativa) y NAVP (neumonía asociada a la ventilación mecánica precoz) (56,3% versus 15% p <0,001) fueron mayores en el grupo IOTP. Conclusiones: La IOTNN en los pacientes con quemaduras es frecuente en nuestro medio y se asocia a complicaciones. La misma es realizada por médicos sin formación en el manejo de la vía aérea.

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Introduction: Prophylactic Orotracheal Intubation (OTI) in patients with suspected Inhalation Injury (II) is a widespread clinical practice in our country. It can be associated with complications and increased healthcare costs. Objective: To characterize the population of patients admitted with OTI to the National Burn Center, determine the incidence of unnecessary Orotracheal Intubation (UOTI), and the associated complications. Method: Retrospective, observational, analytical study. All patients with thermal burns admitted to the National Burn Center (CENAQUE) with an artificial airway between January 2015 and July 2023 were included. Demographic characteristics, injury circumstances, location, and technician performing the OTI, percentage of total body surface area burned (TBSA), severity scores, days on mechanical ventilation, discharge status, and diagnosis of II by fibrobronchoscopy were determined. Complications associated with OTI and mechanical ventilation were analyzed. These variables were compared between the group extubated successfully within the first 48 hours (UOTI) and those extubated after 48 hours (necessary OTI, NOTI). Results: 562 patients were included. The incidence of UOTI was 41,7% and II 46,7%. Significant differences were observed between UOTI and NOTI in age [34 (24-48) versus 45 (30-62); p <0.001], TBSA [4% (1-11) versus 20% (6-36); p <0,001], ABSI [4 (3-5) versus 7 (5-9) p<0,001], Baux score [48 (33-62) versus 77 (60-99), p <0,001], incidence of II (32% versus 56.6%, p <0,001). Aspiration of the airway (30% versus 20,2% p 0,018), extubation during transport (2% versus 0% p 0,043), and incidence of aspiration pneumonia (AP) and early ventilator-associated pneumonia (VAP) (56,3% versus 15% p <0,001) were higher in the NOTI group. Conclusions: UOTI in burn patients is frequent in our setting and is associated with complications. It is performed by physicians without training in airway management.

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Introdução: A intubação orotraqueal (IOT) profilática em pacientes com suspeita de lesão por inalação (LI) é uma prática clínica difundida em nosso país. Esta prática pode estar associada a complicações e ao aumento dos custos assistenciais. Objetivo: Caracterizar a população de pacientes que ingressaram com IOT no Centro Nacional de Queimados, determinar a incidência de intubação orotraqueal desnecessária (IOTD) e as complicações associadas. Método: Estudo retrospectivo, observacional, analítico. Foram incluídos todos os pacientes com queimadura térmica admitidos no CENAQUE com via aérea artificial entre janeiro de 2015 e julho de 2023. Foram determinadas características demográficas, circunstâncias da lesão, local e técnico que realizou a IOT, porcentagem da superfície corporal total queimada (SCTQ), escores de gravidade, dias de ventilação mecânica, estado na alta e diagnóstico de LI por fibrobroncoscopia. Complicações associadas à IOT e à ventilação mecânica foram analisadas. Essas variáveis foram comparadas entre o grupo extubado com sucesso nas primeiras 48 horas (IOTD) e aqueles extubados após 48 horas (IOTP). Resultados: Foram incluídos 562 pacientes. A incidência de IOTD foi de 41,7% e LI de 46,7%. Diferenças significativas foram observadas entre IOTD e IOTP em relação à idade [34 (24-48) versus 45 (30-62); p <0,001], SCTQ [4% (1-11) versus 20% (6-36); p <0,001], ABSI [4 (3-5) versus 7 (5-9) p<0,001], índice de Baux [48 (33-62) versus 77 (60-99), p <0,001], incidência de LI (32% versus 56,6%, p <0,001). A aspiração de via aérea (30% versus 20,2% p 0,018), extubação durante o transporte (2% versus 0% p 0,043) e incidência de pneumonia aspirativa (PA) e pneumonia associada à ventilação mecânica precoce (NAVM) (56,3% versus 15% p <0,001) foram maiores no grupo IOTP. Conclusões: A IOTD em pacientes com queimaduras é frequente em nosso meio e está associada a complicações. A mesma é realizada por médicos sem formação no manejo da via aérea.

Assuntos

Queimaduras por Inalação , Manuseio das Vias Aéreas/efeitos adversos , Intubação Intratraqueal , Uruguai , Estudos Retrospectivos , Estudo Observacional

RESUMO

Abstract In patients with chronic obstructive pulmonary dis ease (COPD), single lung transplantation (SLT) is some times performed as an alternative to bilateral lung trans plantation due to limited organ availability. However, the postoperative management of SLT presents challenges, including complications related to the distinct compli ance of each lung. This case report presents the case of a 65-year-old male patient who underwent SLT and was in the weaning period from mechanical ventilation. High-flow oxygen therapy (HFOT) was administered, and the physiological effects were measured using electrical impedance tomography (EIT). The results demonstrated that the application of HFOT increased air trapping and overdistention in the native lung without benefiting the transplanted lung. HFOT through a tracheostomy tube or nasal cannula resulted in a more heterogeneous distri bution of ventilation, with increased end expiratory lung impedance, prolonged expiratory time constants, and an increase in silent spaces. The drop in tidal impedance after applying HFOT did not indicate hypoventilation but rather overdistention and air trapping in the native lung, while the transplanted lung showed evidence of hypoventilation. These findings suggest that HFOT may not be beneficial for SLT patients and could potentially worsen outcomes. However, due to the limited scope of this case report, further prospective studies with larger patient cohorts are needed to confirm these results.

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Resumen En pacientes con enfermedad pulmonar obstructiva crónica (EPOC), el trasplante pulmonar unilateral (SLT, por sus siglas en inglés) se realiza como alternativa a la disponibilidad limitada de donantes para el trasplante pulmonar bilateral. Sin embargo, el manejo postoperato rio del SLT presenta desafíos, incluyendo complicaciones relacionadas con la distinta complacencia de cada pul món. Este reporte presenta el caso de un paciente varón de 65 años que fue sometido a un SLT y se encontraba en el proceso de destete de la ventilación mecánica. Se administró terapia de oxígeno de alto flujo (HFOT, por sus siglas en inglés) y se midieron los efectos fisiológicos utilizando la tomografía de impedancia eléctrica (EIT, por sus siglas en inglés). Los resultados demostraron que la aplicación de HFOT aumentó la retención de aire y la hiperinflación en el pulmón nativo sin beneficiar al pulmón trasplantado. Tanto la HFOT a través de un tubo de traqueostomía como a través de cánula nasal resultaron en una distribución más heterogénea de la ventilación, con un aumento en la impedancia pulmonar al final de la espiración, prolongación de las constantes de tiempo espiratorias y un aumento en los espacios silentes. La disminución de la impedancia tidal después de aplicar HFOT no indicó hipoventilación, sino más bien hiperinsuflación y retención de gas en el pulmón nativo, mientras que el pulmón trasplantado mostró evidencia de hipoventilación. Estos hallazgos sugieren que el HFOT puede no ser beneficioso para los pacientes con SLT y podría empeorar los resultados. Sin embargo, debido al alcance limitado de este informe de caso, se necesitan estudios prospectivos con cohortes de pacientes más amplias para confirmar estos resultados.

RESUMO

SUMMARY OBJECTIVE: The aim of this study was to evaluate the efficacy of long-term oxygen therapy as a strategy to reduce hospitalization time in patients affected by COVID-19. METHODS: Between April and December 2021, COVID-19 patients with stable clinical conditions needing supplementary oxygen therapy during hospitalization were oriented to have hospital discharge with long-term oxygen therapy and reassessment after 15 days. RESULTS: A total of 62 patients were evaluated and, 15 days after discharge, 69% of patients had suspended long-term oxygen therapy, with no difference between the groups admitted to the intensive care unit or the ward (p=0.319). Among the individuals who needed to maintain long-term oxygen therapy, in addition to worse P/F ratio (265±57 vs. 345±51; p<0.001) and lower partial pressure of oxygen (55±12 vs. 72±11 mmHg; p<0.001), were those more obese (37±8 vs. 30±6 kg/m2; p=0.032), needed more time for invasive mechanical ventilation (46±27 vs. 20±16 days; p=0.029), had greater persistence of symptoms (p<0.001), and shorter time between the onset of symptoms and the need for hospitalization (7 [2-9] vs. 10 [6-12] days; p=0.039). CONCLUSION: Long-term oxygen therapy is an effective strategy for reducing hospitalization time in COVID-19 patients, regardless of gravity. Additionally, more obese patients with persistence of respiratory symptoms, faster disease evolution, and more days of invasive mechanical ventilation needed to maintain the long-term oxygen therapy longer.

RESUMO

Purpose: Chronic obstructive pulmonary disease (COPD) affects millions of people around the world. Poor adherence to treatment contributes to increased severity of symptoms, morbidity, and mortality. The objective of this study was to establish the adherence of patients diagnosed with COPD by their devices for inhalation in a group of patients, Colombia. Patients and Methods: This was a cross-sectional study of patients treated in the Colombian health system. Adherence to inhalation devices was evaluated with the TAI-10 instrument (Inhaler Adherence Test). A score of 50 points was considered good adherence. Results: A total of 500 patients from 84 cities were identified, with a median age of 79.0 years, and 59.2% were women. A total of 45% had GOLD B COPD, and 56.6% had good adherence. Average adherence was 47.4±5.3 points, and no significant differences were found according to inhalation devices (p=0.949). Training performed by specialist physicians (OR: 1.75; 95% CI: 1.17-2.62), use of an inhaler for less than 1 year (OR: 1.59; 95% CI: 1.04-2.43), use of short-acting ß2-adrenergic agonists (OR: 1.58; 95% CI: 1.05-2.38) and increased satisfaction with the inhalation device (OR: 1.09; 95% CI: 1.04-1.14) were associated with good adherence, while those from the central region (OR: 0.55; 95% CI: 0.36-0.83), who had a COPD evolution time of less than 5 years (OR: 0.57; 95% CI: 0.37-0.98) and had diabetes mellitus (OR: 0.60; 95% CI: 0.37-0.98) had lower adherence. Conclusion: Adherence to treatment with inhaled bronchodilators and glucocorticoids were not very high, with no significant differences by type of inhalation device. Satisfaction and training by specialists increased adherence.

RESUMO

Air pollution in opencast coal mine areas is a critical issue, resulting in harmful severe effects on human health. Therefore, it is essential to understand the air pollution factors and to assess the risks to humans. This study evaluated the potential risks (carcinogen and non-carcinogen) of inhalation exposure to PM10-bound heavy metals and Polycyclic Aromatic Hydrocarbons (PAHs) in an open pit mine in northern Colombia. During February-May 2022, PM10 samples were collected at eight sites. Heavy metals (i.e., Al, Cr(VI), Mn, Cu, Zn, As, Pb) and PAHs (thirteen priority PAHs, and one non-priority PAH) levels linked to PM10 were analyzed by X-ray fluorescence and gas chromatography-mass spectrometry, respectively. PM10 concentrations were found to range between 4.70 and 59.90 µg m-3. Out of the three different zones of the study area (i.e., North Zone, South Zone, and Populated Zone), the North Zone recorded the highest daily average concentrations of Cr(VI) (104.16 ng m-3), Mn (28.39 ng m-3), Cu (33.75 ng m-3), Zn (57.99 ng m-3), As (44.92 ng m-3), and Pb (27.13 ng m-3). The fraction of the analyzed heavy metals at all monitoring sites was 82%-89% for Al, followed by Cr(VI) with 3%-6%. Cr(VI) was the major contributor to the carcinogenic risk values, while Cu, Cr(VI), and As were the main drivers for the non-carcinogenic risk. The average cancer risk range for heavy metals was 3.30 × 10-04 -5.47 × 10-04. On the other hand, the cancer risk for PAHs exposure was acceptable. The average incremental lifetime cancer risk (ILCR) values varied between 2.87 × 10-07 and 4.21 × 10-07. Benzo[a]pyrene contributed to 54%-56% of the total risk from inhalation of PM10-bound PAHs, while Indeno[1,2,3-cd]pyrene contributed to 16%-19%. Based on the Monte Carlo sensitivity analysis, exposure to Cr(VI) was the main factor affecting cancer risk in the North, South, and Populated Zones. A suitable risk assessment and management plan requires understanding PM10-bound heavy metals and PAHs concentration levels as well as their potential health risks, mainly in open-cast coal mine zones. Our study found that people living near open-pit mines face potential health risks, so it is crucial to establish policies and regulations to control emission sources.

Assuntos

Poluentes Atmosféricos , Metais Pesados , Neoplasias , Hidrocarbonetos Policíclicos Aromáticos , Humanos , Material Particulado/análise , Poluentes Atmosféricos/análise , Monitoramento Ambiental/métodos , Hidrocarbonetos Policíclicos Aromáticos/análise , América Latina , Chumbo/análise , Medição de Risco , Carcinógenos/análise , Metais Pesados/análise , Carvão Mineral/análise , China

RESUMO

Background: The ROX index (iROX) obtained from pulse oximetry saturation/inspired fraction of oxygen and respiratory rate, predicts success with high-flow nasal cannula (HFNC), however its performance for low-flow oxygenation devices (DOBF) is unknown. Objective: To determine suitability of iROX at 12 hours as a predictor of mechanical ventilation (VMI) in hospitalized patients with severe COVID-19 and DOBF. Material and methods: An historical cohort was performed. Adults with COVID-19, hospitalized, with supplemental oxygen supply are included, excluding patients with pathologies in chronic stages that could alter the results, calculating the iROX at 12 hours, obtaining the cut-off point using a ROC curve and Youden index, the risk of VMI is prolonged using relative risk (RR), with 95% confidence intervals (95%CI). Confounding variables were evaluated to determine the performance of the iROX. The dependent variable mechanical ventilation recorded as reported in the file and the independent iROX obtained in the same way as the previous one. Results: 63 patients with a median age of 62 years were included. The best iROX cut-off point at 12 hours was 5.35. With this cut-off point, VMI was associated with a RR of 8.75 (95% CI 2.36-32.35). In the multivariate model with an OR of 9.26; (95% CI, 2.39 - 35.78), after initiation of DOBF was consistently associated with an increased risk of intubation. Conclusion: In hospitalized patients with severe COVID-19, an iROX < 5.35 at 12 hours appears to be a predictor for the onset of VMI.

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Introducción: el índice ROX (iROX) obtenido a partir de la saturación por oximetría de pulso/fracción inspirada de oxígeno y frecuencia respiratoria, pronostica el éxito con cánulas nasales de alto flujo (CNAF), pero se desconoce su desempeño para dispositivos de oxigenación de bajo flujo (DOBF). Objetivo: determinar el punto de corte y el desempeño del iROX a las 12 horas como predictor para el inicio de la ventilación mecánica (VMI) en los pacientes hospitalizados con COVID-19 grave y DOBF. Material y métodos: se realizó un estudio tipo cohorte histórica, en el que se incluyeron pacientes adultos con COVID-19, hospitalizados, con aporte de oxígeno suplementario. Se excluyeron los pacientes con patologías en etapas crónicas que pudieran alterar los resultados, calculando el iROX a las 12 horas y obteniendo el punto de corte mediante una curva ROC e índice de Youden, determinando el riesgo de VMI usando riesgo relativo (RR), con intervalos de confianza de 95% (IC95%). Evaluando otras variables confusoras para conocer el desempeño del iROX. La variable dependiente fue ventilación mecánica, obtenida por lo reportado en el expediente y la independiente el iROX, obtenida igual que la anterior. Resultados: se incluyeron 63 pacientes con una mediana de edad de 62 años. El mejor punto de corte del iROX a las 12 horas fue de 5.35. Con este punto de corte se asoció a VMI con un RR de 8.75 (IC95%: 2.36-32.35). En el modelo multivariado con un OR de 9.26; (IC95%: 2.39-35.78), después del inicio del DOBF se asoció consistentemente con un mayor riesgo de intubación. Conclusión: en pacientes hospitalizados con COVID-19 grave, un iROX < 5.35 a las 12 horas es un predictor para el inicio de la VMI.

Assuntos

COVID-19 , Humanos , Pessoa de Meia-Idade , Cânula , Oxigênio , Respiração Artificial

RESUMO

Spontaneous pneumomediastinum (SPM) is the presence of air in the mediastinal interstices in the absence of any surgical or medical procedure, chest trauma, or mechanical ventilation. SPM can occur during vigorous Valsalva maneuvers, such as weight lifting, coughing fits, hyperemesis gravidarum, and so on, or during inhalation of illicit substances or toxic agents, as a result of an abrupt increase in pressure in the tracheal tree. Preexisting underlying lung disease may be a contributing factor. In the present case, we report for the first time an SPM due to accidental overexposure to paint thinner in a 15-year-old male from a low-income rural family. He was offered a job painting the inside of a house, which he accepted to earn some money for the family household. However, due to his inexperience, he overdosed on a can of paint with thinner. About 2 h after starting work, he began to feel increasingly severe chest pain and had to be rushed to the local level one basic hospital by his parents. Physical examination revealed subcutaneous emphysema over the supraclavicular area and crackles in the precordial area. Chest radiographs showed a pneumomediastinum. In retrospect, the patient denied coughing or sneezing attacks after exposure. He was transferred to a regional tertiary hospital for further diagnostic evaluation to rule out airway/esophageal perforation. Chest computed tomography confirmed underlying SPM and subcutaneous emphysema. The oesophagogram and bronchoscopy were unremarkable. SPM, possibly secondary to overexposure to thinner vapors, a hydrocarbon-based compound, was the final diagnosis. The patient was discharged asymptomatic on day 5.

RESUMO

Purpose: The aim of this research was to evaluate the technique of using inhaled drugs in patients with a confirmed history of COPD and describe errors in inhaler technique. Patients and Methods: Descriptive cross-sectional study was conducted in patients with a history of COPD using inhalation therapy, attending pulmonology consultation between August 2020 and April 2021 in Armenia, Colombia. A non-probabilistic sample of 80 adult participants was calculated, and the inhalation technique was evaluated (depending on the device used) using a scale validated for Colombia. Descriptive analysis of the qualitative variables was performed using frequencies and percentages. The Chi-Square test and Fisher's exact test (in corresponding cases) were used to look for association relationships between categorical variables. Results: A total of 80 participants were evaluated, of which 66.3% (n = 53) were male, and 32.5% were older than 80 years. Clinically, 30.0% (n = 24) were classified as Modified Medical Research Council Dyspnea Scale (mMRC) grade 3, and 51.2% (n = 41) had at least one exacerbation per year. The main comorbidity was hypertension (40.3%). Pressurized metered-dose inhalers with spacer were the most used device at 22.7% (n = 39). Incorrect technique (at least one error in the steps of the inhalation technique used) was found in 48.7%. The most frequent error among all the techniques was the failure to perform pre-inspiratory exhalation. No significant differences were observed between the development of the technique and the characteristics of the participants. Conclusion: Nearly half of the patients who use inhalation devices make errors in the technique. Patient education and training of healthcare personnel represent a fundamental pillar in mitigating the incorrect use of these devices.

RESUMO

OBJECTIVE: To determine the minimum alveolar concentration (MAC) of sevoflurane in Holstein steers using electric stimulation. STUDY DESIGN: Prospective experimental study. ANIMALS: A total of 15 Holstein steers aged 7.3 ± 1.2 months and weighing 121 ± 25 kg. METHODS: Animals were anesthetized with sevoflurane at 8% in oxygen at 5 L minute-1 via facemask and were intubated with an orotracheal tube of a compatible size. After 15 minutes of stabilization of the initial expired concentration of sevoflurane (Fe'Sevo) at 2.6%, electrical stimulation on the thoracic limb was initiated with a sequence of 2 × 10 ms followed by 2 × 3 second electrical currents of 50 V and 50 Hz, 5 seconds apart. Following each stimulus with a negative response, the Fe'Sevo was decreased by 0.2% and a 15 minute interval was awaited before the next stimulus. The procedure was repeated until the first Fe'Sevo value with a positive motor response was obtained. The Fe'Sevo was then increased by 0.1%, followed by a new stimulus, until a negative response was obtained. The value of MAC was calculated as the arithmetic mean between the lowest Fe'Sevo associated with a negative motor response and the highest Fe'Sevo associated with a positive response. RESULTS: The mean MAC for the 15 steers was 2.0 ± 0.3%, which corresponds to 2.1 ± 0.3% at sea level. CONCLUSIONS: Based on the proposed methodology, the MAC of sevoflurane for healthy Holstein steers is 2.1 ± 0.3% at sea level. CLINICAL RELEVANCE: This Fe'Sevo value can be used to guide depth of anesthesia in steers weighing approximately 120 kg in clinical practice.

Assuntos

Anestesia , Anestésicos Inalatórios , Éteres Metílicos , Animais , Sevoflurano , Estudos Prospectivos , Anestesia/veterinária , Alvéolos Pulmonares

RESUMO

The objective of this study was to evaluate the clinical biochemistry behavior of Black-Tufted Marmosets (Callithrix penicillatta) submitted to blood collection without sedation and after general anesthesia with anesthetics isoflurane or sevoflurane. Blood collections were performed on (M1) day before anesthesia by physical restraint, and (M2) after anesthesia. There were four groups: Isoflurane (GI) and Sevoflurane (GS) using an anesthetic box. GIM: isoflurane induction with mask for a shorter period. Control group (GP): physical restraint in both moments. Plasma was separated and frozen to measure clinic biochemistry values. Urea was higher at M2 in groups GI and GP. AST was higher in M2 in GI, GS, and GP and only GI showed an increase in CK in M2. Glucose was higher in M1 in the GI, GS, and GP groups and fructosamine was higher in M2 in the GI. Stress caused by physical restraint can cause biochemical changes and these must be considered when interpreting the exams. Both the inhalational anesthetic isoflurane and sevoflurane did not cause clinically significant changes in clinical biochemistry results.

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O objetivo desse estudo foi avaliar o comportamento da bioquímica clínica de saguis-do-tufo-preto (Callithrix penicillatta) submetidos à coleta sanguínea sem sedação e após anestesia geral, com os anestésicos isoflurano ou sevoflurano. As coletas de sangue foram realizadas: (M1) dia antes da anestesia por contenção física e (M2) após anestesia. Foram definidos quatro grupos: isoflurano (GI) e sevoflurano (GS), utilizando caixa anestésica; GIM: indução com isoflurano com máscara por um período menor; grupo controle (GCF): contenção física em ambos os momentos. O plasma com EDTA foi separado e congelado para realizar dosagem da bioquímica clínica. A ureia foi maior no M2 nos grupos GI e GCF. A AST foi maior no M2 nos GI, GS e GCF e somente o GI apresentou aumento de CK no M2. A glicose foi maior no M1 nos grupos GI, GS e GCF, e a frutosamina foi maior no M2 no GI. O estresse causado pela contenção física pode causar alterações bioquímicas e essas devem ser levadas em consideração na interpretação dos exames. Tanto o anestésico inalatório isoflurano quanto o sevoflurano não causaram alterações clinicamente significantes nos resultados da bioquímica clínica.

Assuntos

Animais , Bioquímica , Callithrix , Sevoflurano , Isoflurano , Anestésicos

RESUMO

Pulmonary embolism is a common and potentially fatal disease, with a significant burden on health and survival. Right ventricular dysfunction and hemodynamic instability are considered two key determinants of mortality in pulmonary embolism, which can reach up to 65% in severe cases. Therefore, timely diagnosis and management are of paramount importance to ensure the best quality of care. However, hemodynamic and respiratory support, both major constituents of management in pulmonary embolism, associated with cardiogenic shock or cardiac arrest, have been given little attention in recent years, in favor of other novel advances such as systemic thrombolysis or direct oral anticoagulants. Moreover, it has been implied that current recommendations regarding this supportive care lack enough robustness, further complicating the problem. In this review, we critically discuss and summarize the current literature concerning the hemodynamic and respiratory support in pulmonary embolism, including fluid therapy, diuretics, pharmacological support with vasopressors, inotropes and vasodilators, oxygen therapy and ventilation, and mechanical circulatory support with veno-arterial extracorporeal membrane oxygenation and right ventricular assist devices, while also providing some insights into contemporary research gaps.