Outcomes of COVID-19 patients treated with continuous positive airway pressure outside ICU

Aim We aim at characterizing a large population of Coronavirus 19 (COVID-19) patients with moderate-to-severe hypoxemic acute respiratory failure (ARF) receiving CPAP outside intensive care unit (ICU), and ascertaining whether the duration of CPAP application increased the risk of mortality for patients requiring intubation. Methods In this retrospective, multicentre cohort study, we included COVID-19 adult patients, treated with CPAP outside ICU for hypoxemic ARF from March 1 st to April 15th, 2020. We collected demographic and clinical data, including CPAP therapeutic goal, hospital length of stay (LOS), and 60- day in-hospital mortality. Results The study includes 537 patients with a median age of 69 (IQR, 60-76) years. Males were 391 (73%). According to predefined CPAP therapeutic goal, 397 (74%) patients were included in full treatment subgroup, and 140 (26%) in the do-not intubate (DNI) subgroup. Median CPAP duration was 4 (IQR, 1-8) days, while hospital LOS 16 (IQR, 9-27) days. Sixty-day in-hospital mortality was overall 34% (95%CI, 0.304-0.384), and 21% (95%CI, 0.169-0.249) and 73% (95%CI, 0.648-0.787) for full treatment and DNI subgroups, respectively. In the full treatment subgroup, in-hospital mortality was 42% (95%CI, 0.345-0.488) for 180 (45%) CPAP failures requiring intubation, while 2% (95%CI, 0.008- 0.035) for the remaining 217 (55%) patients who succeeded. Delaying intubation was associated with increased mortality [HR, 1.093 (95%CI, 1.010-1.184)]. Conclusions We described a large population of COVID-19 patients treated with CPAP outside ICU. Intubation delay represents a risk factor for mortality. Further investigation is needed for early identification of CPAP failures

La escuela como ambiente de formación ciudadana: un abordaje a partir de la Alfabetización Científica y Tecnológica

Trata-se de uma reflexão realizada com o objetivo de compreender o papel da escola na formação cidadã de seus alunos, a partir da abordagem da Alfabetização Científica e Tecnológica. As reflexões guiaram-se por meio da compreensão histórica e os conceitos da Alfabetização Científica e Tecnológica no contexto escolar, além de buscar compreender o desenvolvimento do “ser” professor e aluno neste processo importante de mudança, bem como averiguar as principais habilidades empregadas para a formação cidadã em ambiente escolar por meio desta perspectiva. Verificou-se que o incentivo destas ações aliadas a outras habilidades inerentes ao processo facilita o desenvolvimento de autonomia dos indivíduos, tornando-os capazes de construírem seu conhecimento integrado as próprias necessidades comunitárias, contribuindo para a formação cidadã.This is a reflection carried out with the objective of understanding the role of the school in the citizen training of its students, based on the approach of the Scientific and Technological Literacy. The reflections guided themselves by means of historical understanding and concepts of Scientific Literacy and Technology in the school context, in addition to seeking to understand the development of the “to be” teacher and student in this important process of change, as well as ascertain the mains kills employed for civic education in the school environment by the middle of this perspective. It was found that the incentive of the sections combined with others kills inherent in the process facilitates the development of autonomy of individuals, making the mable to build their knowledge, integrated the needs of the community, contributing to civic education.Se trata de una reflexión realizada con el objetivo de comprender el papel de la escuela en la formación ciudadana de sus alumnos, a partir del abordaje de la Alfabetización Científica y Tecnológica. Las reflexiones se guiaron a través de la comprensión histórica y los conceptos de la Alfabetización Científica y Tecnológica en el contexto escolar, además de buscar comprender el desarrollo del "ser" profesor y alumno en este proceso importante de cambio, así como averiguar las principales habilidades empleadas para la formación ciudadana en ambiente escolar a través de esta perspectiva. Se verificó que el incentivo de estas acciones aliadas a otras habilidades inherentes al proceso facilita el desarrollo de autonomía de los individuos, haciéndolos capaces de construir su conocimiento integrado a las propias necesidades comunitarias, contribuyendo a la formación ciudadana

Early extubation with immediate non-invasive ventilation versus standard weaning in intubated patients for coronavirus disease 2019: a retrospective multicenter study

In patients intubated for hypoxemic acute respiratory failure (ARF) related to novel coronavirus disease (COVID-19), we retrospectively compared two weaning strategies, early extubation with immediate non-invasive ventilation (NIV) versus standard weaning encompassing spontaneous breathing trial (SBT), with respect to IMV duration (primary endpoint), extubation failures and reintubations, rate of tracheostomy, intensive care unit (ICU) length of stay and mortality (additional endpoints). All COVID-19 adult patients, intubated for hypoxemic ARF and subsequently extubated, were enrolled. Patients were included in two groups, early extubation followed by immediate NIV application, and conventionally weaning after passing SBT. 121 patients were enrolled and analyzed, 66 early extubated and 55 conventionally weaned after passing an SBT. IMV duration was 9 [6-11] days in early extubated patients versus 11 [6-15] days in standard weaning group (p\u2009=\u20090.034). Extubation failures [12 (18.2%) vs. 25 (45.5%), p\u2009=\u20090.002] and reintubations [12 (18.2%) vs. 22 (40.0%) p\u2009=\u20090.009] were fewer in early extubation compared to the standard weaning groups, respectively. Rate of tracheostomy, ICU mortality, and ICU length of stay were no different between groups. Compared to standard weaning, early extubation followed by immediate NIV shortened IMV duration and reduced the rate of extubation failure and reintubation