Navegando por Palavras-chave "Hipoxemia"

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    Effects of prone position on the oxygenation of patients with acute respiratory distress syndrome
    (Associação Paulista de Medicina - APM, 2006-02-01) Rossetti, Heloisa Baccaro [UNIFESP]; Machado, Flávia Ribeiro [UNIFESP]; Valiatti, Jorge Luis dos Santos [UNIFESP]; Amaral, José Luiz Gomes do [UNIFESP]; Universidade Federal de São Paulo (UNIFESP)
    CONTEXT AND OBJECTIVE: Acute respiratory distress syndrome (ARDS) is characterized by arterial hypoxemia, and prone position (PP) is one possible management strategy. The objective here was to evaluate the effects of PP on oxygenation. DESIGN AND SETTING: Non-randomized, open, prospective, controlled clinical trial, in a surgical intensive care unit at a tertiary university hospital. METHODS: Forty-one ARDS patients underwent PP for three-hour periods. Arterial partial oxygen pressure (PaO2) was measured immediately before changing to PP, after 30, 60, 120 and 180 minutes in PP and 60 minutes after returning to dorsal recumbent position (DP). The paired-t and Dunnett tests were used. RESULTS: A notable clinical improvement in oxygenation (> 15%) was detected in 78.0% of patients. This persisted for 60 minutes after returning to DP in 56% and lasted for 12 and 48 hours in 53.6% and 46.3%, respectively. Maximum improvement was seen after 30 minutes in 12.5% of responding patients and after 180 minutes in 40.6%. No statistically significant associations between PP response and age, gender, weight, PEEP level, tidal volume, respiratory rate, PaO2/FiO2 or duration of mechanical ventilation were detected. One accidental extubation and four cases of deterioration through oxygenation were detected. The 48-hour mortality rate was 17%. CONCLUSIONS: For a significant number of ARDS patients, PP may rapidly enhance arterial oxygenation and its inclusion for management of severe ARDS is justified. However, it is not a cost-free maneuver and caution is needed in deciding on using PP.
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    Evaluation of 6-minute walk test (6MWT) in adults with sickle cell disease in São Paulo/SP
    (Universidade Federal de São Paulo (UNIFESP), 2017-03-01) Norvil, Wesny [UNIFESP]; Figueiredo, Maria Stella [UNIFESP]; http://lattes.cnpq.br/0736747630522639; http://lattes.cnpq.br/6652873085167567; Universidade Federal de São Paulo (UNIFESP)
    Introduction: Sickle-cell Disease (SCD) is the hematological disease, with the most hereditary, monogenic and autosomal features in the world. Its pathophysiology involves hemolysis and vaso-occlusion, which can affect several organs, including the lung. It is observed that hypoxemia in the steady state is a common manifestation in SCD and it has been proven an association with the level of anemia and the degree of hemolysis in previous studies. The 6-minutes-walking test (6MWT) is a simple functional capacity test that evaluates the exercise tolerance according to the distance covered in 6 minutes and with monitoring of the behavior of oxygen saturation and blood pressure. It has been gaining importance in sickle cell disease, since lots of results were found showing the impact of baseline oxygen(O2) desaturation in the 6MWT performance in children with sickle cell disease whereas just a few have been found in adults. Objective: In this current study we aimed at evaluating hypoxemia in sickle-cell adults though the 6MWT and its relation with the clinical-laboratory parameters. Methods: A cross-sectional, analytical and descriptive study was performed in 44 patients with SCD and 19 healthy controls based on the 6MWT and clinical-laboratory data. Results: The group of patients covered a shorter distance [median (interquartile): 416.9m (406.6-444.8)] than controls [652.5m (634.4-665.0); p<0001]. No individual in the control group had baseline or post-test desaturation. Moderate O2 desaturation at rest (defined as SpO2<95%) was observed in 25.0% (n=11) of the patients. The distance walked by the patients showed a positive correlation with hemoglobin (r=0.461, 95% CI: 0.170- 0.678, p=0.002) and negative with reticulocytes count (r=-0.352, 95% CI:-0.601- - 0.041; p=0.023). Patients with moderate desaturation at rest had odds of increase 6.5-fold of post-test desaturation development (OR: 6.5; 95% CI: 1.47-28.71; p=0.021). When evaluating the patients in relation to the absence (G1) or presence (G2) of post-test desaturation (defined as decline O2≥3% from baseline), 14 (31.8%) of the individuals belonging to G2 were observed. Regarding the hemolytic biomarkers, G2 presented a lower HbF level (p=0.041), lower BMI (p=0.007), higher reticulocytes count (p=0.007) and DHL (p=0.002) compared with G1. Conclusion: It was detected a high prevalence of moderate desaturation at steady state as well as post 6MWT in adults with SCD. Desaturation was associated with elevation of hemolysis biomarkers, suggesting being associated with the greater severity of the disease. The detection of these abnormalities in the 6MWT underscores the importance of considering this non-invasive test as a means of monitoring patients with FD, although additional studies are needed to elucidate the role of 6MWT in adults with SCD.