Respiratory Physiotherapy in ALS Patients in Brazil During COVID-19 Pandemic (original) (raw)
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International Journal of Current Research in Medical Sciences, 2020
Novel coronavirus also known as severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), generated a high worldwide demand for intensive care units and mechanical ventilation equipment, due to the severity of cases of respiratory failure. In the Brazilian state of Amazonas, the infection reached 50% of the national incidence coefficient. In this scenario, we describe the case of a 71-year-old male Amazon's capital citizen with a history of hypertension and obesity who presented a transfer to a hospital facility with worsening fevers, cough, and respiratory distress. Images showed bilateral ground-glass opacities consistent with COVID-19, with more than 50% of involvement. The RT-PCR and IgM / IgG were positive. The patient was treated in intensive care unit (ICU), using medications from the institutional protocol for COVID-19 and, from the beginning until discharge from the ICU, he used non-invasive oxygen therapy with capsule equipment protection for aerosol retention in the hospital environment. After 11 days, the patient was discharged with SatO 2 > 95%, without signs of changes in physiological functions. Early NIV can be considered an alternative for the management of critically ill patients, avoiding complications from hospitalization for longer and the risk of using mechanical ventilation.
Intensive Care Unit Management of SARS-COV-2 Patients: A Narrative Review
Gomal Journal of Medical Sciences, 2022
The 2019 Coronavirus disease is a public health emergency of international concern (PHEIC). COVID-19 causes acute respiratory distress syndrome (ARDS) in certain individuals. In such individuals, non-invasive and invasive ventilation methods are used to treat acute respiratory distress syndrome. Non-invasive ventilation approaches must be used initially before introducing intrusive mechanical ventilation techniques. Non-invasive methods used in the therapy of COVID -19 associated acute respiratory syndrome include high-flow nasal cannula, bi-level positive air pressure (BiPAP), and helmet ventilation. Before employing any of these non-invasive methods, the risk of viral aerosol transmission to healthcare and paramedical personnel must be considered. When non-invasive procedures are used, the load on hospital ventilatory equipment can be reduced. If at all possible, avoid intubating the patient too soon. The clinical appearance of the patient, as well as vital indicators such as oxyg...
Mechanical ventilation in patients with SARS-CoV-2 pneumonia
Journal of Cardiology & Current Research, 2020
Mini review The coronavirus (CoV) belongs to a family of viruses that can cause a variety of clinical presentations, including catarrhal symptoms, cough, fever, respiratory distress, and conditions such as pneumonia, among others. 1,2 World Health Organization (WHO) used the new term coronavirus 2019 (CoVID-19) to refer to a coronavirus that affects the lower respiratory tract. 3 This virus emerges in Wuhan, China, in late 2019. 4,5 The current reference name for the virus disease is severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2). It is a zoonotic disease with an animal reservoir and evidence of personto-person transmission. 6 Transmission of this virus occurs mainly through respiratory droplets, which resemble the spread of the flu. With droplet transmission, the virus is released in respiratory secretions when a person with an active infection coughs, sneezes, or speaks, and can infect another person if it comes into direct contact with the mucous membranes. 7 Infection can also occur if a person touches an infected surface and then touches his eyes, nose, or mouth. Worldwide, more than 29million confirmed COVID-19 cases have been reported with 926,544 deaths, 51% of which correspond to the Americas. 8 The average incubation period is 5.2days, and the first signs include nonspecific flu-like symptoms, with a variable condition of the respiratory tract, which can manifest as tracheobronchitis, bronchiolitis, in some cases reaching a very serious organizing pneumonia that requires invasive mechanical ventilation (IMV). 9 Some groups based on careful observations have hypothesized that patients present with different clinical patterns that depend mainly on 3 factors: (1) severity of infection and host response, physiological reserve and comorbidities (2) ventilatory response to hypoxemia and (3) the delay from the onset of symptoms and evaluation in the hospital. About 4.4% of patients require IMV during the first 14days after symptoms start and reach a high mortality rate (40%). 10,11
Ventilation Techniques and Risk for Transmission of Coronavirus Disease, Including COVID-19
Annals of Internal Medicine, 2020
Background: Mechanical ventilation is used to treat respiratory failure in coronavirus disease 2019 (COVID-19). Purpose: To review multiple streams of evidence regarding the benefits and harms of ventilation techniques for coronavirus infections, including that causing COVID-19. Data Sources: 21 standard, World Health Organization-specific and COVID-19-specific databases, without language restrictions, until 1 May 2020. Study Selection: Studies of any design and language comparing different oxygenation approaches in patients with coronavirus infections, including severe acute respiratory syndrome (SARS) or Middle East respiratory syndrome (MERS), or with hypoxemic respiratory failure. Animal, mechanistic, laboratory, and preclinical evidence was gathered regarding aerosol dispersion of coronavirus. Studies evaluating risk for virus transmission to health care workers from aerosol-generating procedures (AGPs) were included. Data Extraction: Independent and duplicate screening, data abstraction, and risk-of-bias assessment (GRADE for certainty of evidence and AMSTAR 2 for included systematic reviews). Data Synthesis: 123 studies were eligible (45 on COVID-19, 70 on SARS, 8 on MERS), but only 5 studies (1 on COVID-19, 3 on SARS, 1 on MERS) adjusted for important confounders. A study in hospitalized patients with COVID-19 reported slightly higher mortality with noninvasive ventilation (NIV) than with invasive mechanical ventilation (IMV), but 2 opposing studies, 1 in patients with MERS and 1 in patients with SARS, suggest a reduction in mortality with NIV (very-low-certainty evidence). Two studies in patients with SARS report a reduction in mortality with NIV compared with no mechanical ventilation (low-certainty evidence). Two systematic reviews suggest a large reduction in mortality with NIV compared with conventional oxygen therapy. Other included studies suggest increased odds of transmission from AGPs. Limitation: Direct studies in COVID-19 are limited and poorly reported. Conclusion: Indirect and low-certainty evidence suggests that use of NIV, similar to IMV, probably reduces mortality but may increase the risk for transmission of COVID-19 to health care workers.
Ventilatory modalities for patients with SARS-COV-2: A literature review
Seven Editora eBooks, 2023
Ventilatory modes are different ways of interacting the device in the patient's respiratory cycle, and some variants can change, such as frequency, pressure, volume, support if the device does all the stimulation of the drive or not, and if the patient will do it spontaneously or totally dependent on the mechanical ventilator to survive. The objective of the study was to describe the most appropriate ventilatory modes for patients diagnosed with SARS-CoV-2 (Severe Acute Respiratory Syndrome Coronavirus) with the best response to the condition. In addition, recognizing the patient's pulmonary plasticity and evaluating the most appropriate Positive Expiratory Pressure (PEEP) for an improvement in the clinical condition. The method used was a literature review using scientific research, published in databases on the Scientific Electronic Library Online (Scielo) and National Library of Medicine (NLM) platforms. The result of the research showed that patients with SARS-CoV-2 are not intubated early, because if there is no evidence for this, the patient may have permanent and irreversible lesions. Thus, it is concluded that each patient has his or her own individuality, and should be taken into account his or her previous comorbidities, requiring an evaluation of the patient's respiratory drive and pulmonary plasticity, as well as the application of mini PEEP titration.
Management of hospitalized patients during the COVID-19 pandemic: review
Research, Society and Development
SARS-CoV-2 is the leading agent of the current pandemic and is the cause of severe acute respiratory syndrome. Thus, hospital procedures are considered factors of high risk of contamination, with a high possibility of causing viral spread, in addition to nosocomial contamination. This article was developed with the objective of presenting a review of the current protocols that aim to guide on the approach of patients with COVID-19, as well as the recommendations recommended in relation to aerosol-generating medical procedures. To this end, a study of narrative literature review was carried out. In order to prevent infections, as current recommendations recommend the mandatory use of masks, aprons, gloves and eye protection. Regarding orotraqueal intubation and mechanical ventilation, you should choose the most experienced doctor on the team and prefer “fast sequence intubation”. In the case of a tracheostomy, it must be performed following all the steps defined in the protocols. In ...
Optimal Preparation for Safe Airway Management During Covid-19
ACTA SCIENTIFIC MEDICAL SCIENCES, 2020
Airway management is the core skill of anesthesiologists, intensive care units, and emergency care providers. Clinicians assured that oxygenation is not possible without an open and safe airway. The Severe Acute Respiratory Syndrome-Corona-2 Virus (SARSCoV-2), which causes COVID-19, is encapsulated with single-stranded ribonucleic acid and is highly contagious. Authors believed that the transfer of the virus occurs primarily through direct contact with the patient or contaminated surfaces or through the spread of droplets (i.e., relatively large particles deposited in the air) and smaller particles staying longer in the air. Any airway management or procedures in emergency, operation theatre, and intensive care departments can produce aerosols to increase the risk of contamination. For the above reason, healthcare professionals who are treating patients with COVID-19 are at risk of developing the disease. The purpose of the current study is to review the methods that reduce the risk of an airborne viral spread, maximize the early attempt success, and encourage the use of indirect glottic visualization with video laryngoscopy (VL). The mentioned measures are approved to reduce personnel exposure in all adult COVID 19 patients who are requiring airway management in all emergency departments, hospital wards, and ICUs. The author highlights the needed measures that require to be taken for the safety of the health care workers associated with the airway procedure while providing high-quality patient care to the COVID-19, suspected, or confirmed patients
The Medical Journal of Australia, 2020
An outbreak in Wuhan, China, in 2019 of the novel Coronavirus has led to a pandemic of COVID-19 disease. More than 80% of confirmed cases report a mild febrile illness, however, 17% of confirmed cases develop severe COVID-19 with acute respiratory distress syndrome (ARDS): 4% requiring mechanical ventilation and 4% having sepsis.(1)(2) Like other patient groups with ARDS, patients with severe COVID-19 are likely to be considered for emergency tracheal intubation and mechanical ventilation to support potential recovery from their illness. From recent reported data in Wuhan and Northern Italy, at least 10% of reported positive COVID-19 cases require ICU involvement, many requiring urgent tracheal intubation for profound and sudden hypoxia.(2) As the incidence of COVID-19 infection rises in the community, an increasing number of patients who have mild or asymptomatic disease as an incidental comorbidity but are nonetheless infective, may still present for urgent surgery. Risks to healthcare workers Transmission of COVID-19 is primarily through droplet spread. These droplets are affected by gravity and may cause direct transmission from close contact or contribute to surface contamination (where the virus may remain active for hours to days).(3) However, some events (see Table 1) can generate aerosols composed of smaller virus containing particles suspended in air. These airborne particles may travel greater distances and be inhaled, increasing the risk of transmission. The process of caring for severe COVID-19 patients and performing aerosol-generating procedures (AGPs) in this group presents an increased risk of infection to healthcare
Archives of Physical Medicine and Rehabilitation, 2004
Severe acute respiratory syndrome (SARS) is a new respiratory viral epidemic that originated in China but has affected many parts of the world, with devastating impact on economies and the practice of medicine and rehabilitation. A novel coronavirus has been implicated, with transmission through respiratory droplets. Rehabilitation was significantly affected by SARS, because strict infection control measures run counter to principles such as multidisciplinary interactions, patients encouraging and learning from each other, and close physical contact during therapy. Immunocompromised patients who may silently carry SARS are common in rehabilitation and include those with renal failure, diabetes, and cancer. Routine procedures such as management of feces and respiratory secretions (eg, airway suctioning, tracheotomy care) have been classified as high risk. Personal protection equipment presented not only a physical but also a psychologic barrier to therapeutic human contact. Visitor restriction to decrease chances of disease transmission are particularly difficult for long-staying rehabilitation patients. At the height of the epidemic, curtailment of patient movement stopped all transfers for rehabilitation, and physiatrists had to function as general internists. Our experiences strongly suggest that rehabilitation institutions should have emergency preparedness plans because such epidemics may recur, whether as a result of nature or of bioterrorism.
Mechanical ventilation in SARS-CoV-2 patients: state of art
Colombian Journal of Anesthesiology, 2021
COVID-19-associated infection leads to a pathology of yet unknown clinical behavior, confronting the clinician with various challenges. An extensive search was conducted based on review articles on SARS-CoV-2 infection and studies including mechanical ventilation management strategies in order to complete this narrative review. Evidenced-based treatment for SARS-CoV2 infection is still in the works. We have some tools from our knowledge from past experiences indicating that a step-wise management approach should be used, without neglecting other joint therapeutic measures for improved clinical outcomes of a condition with a high mortality. The current recommendations indicate that patients with severe acute respiratory failure due to SARS-CoV-2 should be managed with protective mechanical ventilation measures. No strong evidence is yet available on the individualization of mechanical ventilation therapy according to phenotypes.