Is it possible to predict the success of non-invasive positive pressure ventilation in acute respiratory failure due to COPD?

AbstractThere is now sufficient evidence that non-invasive positive pressure ventilation (NIPPV) in selected patients with severe hypercapnic acute respiratory failure due to chronic obstructive pulmonary disease (COPD) is more effective than pharmacological therapy alone. The aim of this study was to identify prognostic factors to predict the success of this technique. Fifty-nine consecutive patients with COPD admitted to a respiratory ward for 75 episodes of acute respiratory failure treated with NIPPV were analysed: success (77%) or failure (23%) were evaluated by survival and the need for endotracheal intubation. There were no significant differences in age, sex, cause of relapse and lung function tests between the two groups. Patients in whom NIPPV was unsuccessful were significantly underweight, had an higher Acute Physiology and Chronic Health Evaluation (APACHE) II score, and a lower serum level of albumin in comparison with those in whom NIPPV was successful. They demonstrated significantly greater abnormalities in pH and P a CO2at baseline and after 2 h of NIPPV. The logistic regression analysis demonstrated that, when all the variables were tested together, a high APACHE II score and a low albumin level continued to have a significant predictive effect. This analysis could predict the outcome in 82% of patients. In conclusion, our study suggests that low albumin serum levels and a high APACHE II score may be important indices in predicting the success of NIPPV

EU ME CHAMO WILLIAM, MESMO QUE ISSO NÃO ESTEJA NO MEU DOCUMENTO: NARRATIVAS SOBRE A TRANSEXUALIDADE

Essa pesquisa tem por objetivo analisar as experiências de vida de uma pessoa trans e as ressonâncias nestas dos preconceitos e estereótipos culturais de sexualidade. Para tanto, entrevistamos William, uma pessoa transexual. William tem 25 anos, nasceu numa cidade do interior do Paraná, com cerca de 20 mil habitantes. Atualmente é aluno do curso de Educação Física de uma instituição privada próxima a sua cidade. A metodologia utilizada para a entrevista consistiu na cartografia, com o seguinte roteiro temático: 1) a “descoberta” da transexualidade; 2) o acesso as primeiras informações; 3) a relação com a família, escola e cotidiano até hoje e 4) as suas expectativas para o próprio futuro. Os resultados permitiram dar a ver a narrativa de uma vida produzida em meio a preconceitos escolares, falta de apoio de professores e de desejos quanto ao futuro (casamento, emprego, vida acadêmica). Frente a esses elementos, acreditamos que uma sociedade mais justa far-se-ia a partir da escuta atenta da pessoa trans, em seus interesses e compreensões de mundo. Palavras-Chave: Transexualidade. Escola. Família. Cotidiano. Futuro.MY NAME IS WILLIAM, EVEN IF THIS IS NOT IN MY DOCUMENT: NARRATIVE ON TRANSEXUALITYABSTRACT: This research aims at analyzing the life experiences of a trans person and the resonances in these of the prejudices and cultural stereotypes of sexuality. To do so, we interviewed William, a transsexual person. William is 25 years old, born in a city in the interior of Paraná, with about 20 thousand inhabitants. He is currently a student of the Physical Education course at a private institution near his city. The methodology used for the interview consisted of cartography, with the following thematic itinerary: 1) the "discovery" of transsexuality; 2) access to the first information; 3) the relationship with the family, school and daily life until today and 4) their expectations for the future itself. The results allowed us to see the narrative of a life produced in the midst of school prejudices, lack of support from teachers and wishes about the future (marriage, employment, academic life). Faced with these elements, we believe that a fairer society would be based on the attentive listening of the trans person, in their interests and world understandings.Keywords: Transsexuality. School. Family. Daily. Future

Subcutaneous dissociative conscious sedation (sDCS) an alternative method for airway regional blocks: a new approach

<p>Abstract</p> <p>Background</p> <p>Predicted difficult airway is a definite indication for awake intubation and spontaneous ventilation. Airway regional blocks which are commonly used to facilitate awake intubation are sometimes impossible or forbidden. On the other hand deep sedation could be life threatening in the case of compromised airway.</p> <p>The aim of this study is evaluating "Subcutaneous Dissociative Conscious Sedation" (sDCS) as an alternative method to airway regional blocks for awake intubation.</p> <p>Methods</p> <p>In this prospective, non-randomized study, 30 patients with predicted difficult airway (laryngeal tumors), who were scheduled for direct laryngoscopic biopsy (DLB), underwent "Subcutaneous Dissociative Conscious Sedation" (sDCS) exerted by intravenous fentanyl 3-4ug/kg and subcutaneous ketamine 0.6-0.7 mg/kg. The tongue and pharynx were anesthetized with lidocaine spray (4%<b>)</b>. 10 minutes after a subcutaneous injection of ketamine direct laryngoscopy was performed. Extra doses of fentanyl 50-100 ug were administered if the patient wasn't cooperative enough for laryngoscopy.</p> <p>Patients were evaluated for hemodynamic stability (heart rate and blood pressure), oxygen saturation (Spo₂), patient cooperation (obedient to open the mouth for laryngoscopy and the number of tries for laryngoscopy), patient comfort (remaining moveless), hallucination, nystagmus and salivation (need for aspiration before laryngoscopy).</p> <p>Results</p> <p>Direct laryngoscopy was performed successfully in all patients. One patient needed extra fentanyl and then laryngoscopy was performed successfully on the second try. All patients were cooperative enough during laryngoscopy. Hemodynamic changes more than 20% occurred in just one patient. Oxygen desaturation (spo₂< 90%) didn't occur in any patient.</p> <p>Conclusions</p> <p>Subcutaneous Dissociative Conscious Sedation (sDCS) as a new approach to airway is an acceptable and safe method for awake intubation and it can be suggested as a noninvasive substitute of low complication rate for regional airway blocks.</p> <p>Registration ID in IRCT</p> <p>IRCT201012075333N1</p