PREVALÊNCIA DE COMPLICAÇÕES RESPIRATÓRIAS NA UNIDADE DE TERAPIA INTENSIVA ADULTO

Introduction: Patients admitted to the Intensive Care Unit (ICU) are subject to a high demand for invasive mechanisms that increase the chances of developing complications. Objectives: to identify the main respiratory complications in the adult ICU. Materials and Methods: 104 medical records of patients admitted to the ICU were analyzed. The following programs were used for data accounting: Statistical Package for Social Science (SPSS) software, version 25®, Shapiro-Wilk test, Mann-Whitney test. Results: There was an average predominance of 51.9% women and 48.1% men, with a mean age of 65.22 ± 20.83 years. The average length of stay in the ICU is 14.23±12.89. The total length of stay 21.45±18.05. The duration of use of mechanical ventilation was 40% for a period of 1 to 7 days, 21.7% for more than 20 days, 16.7% for a period of 10 to 15 days, 15% for a period of 7 to 10 days, 6.7% from 15 to 20 days. Where 49.5% had respiratory complications (n ​​= 50), among the most prevalent complications in the analyzed sample are pneumonia in 18.8%, sepsis or septic shock in 16.7%. Conclusion: It was found that the most prevalent respiratory complication was pneumonia, which may be related to the use of mechanical ventilation, a fact that demonstrates the need for increased care to prevent this complication. Based on the results, prospective studies with more robust samples are needed to confirm such trends.Introdução: Os pacientes internados na Unidade de Terapia Intensiva (UTI) estão sujeitos à alta demanda de mecanismos invasivos que aumentam as chances de desenvolverem complicações. Objetivos: identificar as principais complicações respiratórias na UTI adulto. Materiais e Métodos: Foram analisados 104 prontuários de pacientes que foram internados na UTI. Foram utilizados os seguintes programas para a contabilização dos dados: software Statistical Package for the Social Science (SPSS), versão 25®, teste de Shapiro-Wilk, teste de Mann-Whitney. Resultados: Evidenciou-se a predominância média de mulheres 51,9% e homens de 48,1%, sendo a média da idade de 65,22 ± 20,83 anos. O tempo médio de internação na UTI é de 14,23±12,89. O tempo total de internação 21,45±18,05. O tempo de utilização da ventilação mecânica foi de 40% pelo período de 1 a 7 dias, 21,7% acima de 20 dias, 16,7% pelo período de 10 a 15 dias, 15% pelo período de 7 a 10 dias, 6,7% de 15 a 20 dias. Onde 49,5% apresentaram complicações respiratórias (n = 50), dentre as complicações de maior prevalência na amostra analisada estão a pneumonia em 18,8%, sepse ou choque séptico 16,7%. Conclusão: Foi verificado que a complicação respiratória mais prevalente foi à pneumonia, podendo estar relacionada ao uso de ventilação mecânica, fato que demonstra necessidade de aumento de cuidados para prevenção de tal complicação. A partir dos resultados tornam-se necessárias pesquisas prospectivas e com amostras mais robustas para confirmação de tais tendências

O PACIENTE COM TRANSTORNO MENTAL: A PERCEPÇÃO DE FAMILIARES CUIDADORES ACERCA DESSA CONDIÇÃO

This is a qualitative and descriptive study, whose objective was to verify the perception of caregivers about patients with mental disorders treated in the public health network in the city of Montes Claros-MG. The work was developed at the Psychosocial Care Center (CAPS). The data were obtained through a focal group and analyzed through the discourse analysis technique. After data collection, categories related to the difficulties and challenges encountered by caregivers, patient behavior and caregiver overload emerged. It was concluded that the family caregiver of the mentally ill person presents suffering and lack of information. This demonstrates the need to bring the health team closer to the caregiver, since this interaction may contribute to the process of mitigating the responsibility of caring.Trata-se de um estudo qualitativo e descritivo, cujo o objetivo foi verificar a percepção de cuidadores acerca de pacientes com transtornos mentais atendidos na rede pública de saúde na cidade de Montes Claros-MG. O trabalho foi desenvolvido no centro de atenção psicossocial (CAPS). Os dados foram obtidos através da realização de um grupo focal e analisados através da técnica de análise do discurso. Após a coleta de dados surgiram categorias relacionadas as dificuldades e desafios encontrados pelos cuidadores, comportamento do paciente e sobrecarga dos cuidadores. Concluiu-se que o familiar cuidador do portador de transtorno mental apresenta sofrimento e carência de informação. Isso demonstra a necessidade da aproximar a equipe de saúde ao cuidador, pois essa interação poderá contribuir no processo de amenização da responsabilidade do ato de cuida

Repercussões Respiratórias no Pós – Operatório de Câncer de Mama

Introduction: Cancer is defined as a disorderly proliferation of cells that can spread and invade tissues and/or organs throughout the body, when a genetic mutation occurs, the deoxyribonucleic acid (DNA) undergoes an erroneous change of orders on how to multiply, classified as cancer cells, named according to their multiplication speed and ability to spread to other tissues. Objective: Check the respiratory repercussions in the postoperative period of breast câncer. Method: This is a descriptive, cross-sectional study with quantitative analysis, carried out with 20 female individuals in the postoperative period of breast cancer who were undergoing treatment at a Specialty Outpatient Clinic in Montes Claros - Minas Gerais. The instruments used were the MRC scale, which assesses the level of dyspnea during physical activity, cirtometry, which assesses chest expansion, and a manovacuometer, which measures respiratory muscle strength. Results: The average age of the participants was 50.40 ± 5.50, it was observed that 90.0% of the participants feel short of breath only during intense exercises, according to the MRC scale, in the cirtometry all the subjects showed a reduction in expandability thoracic. A significant decrease in respiratory muscle strength was observed, the average percentage achieved in forced inspiration was 86.77% and in forced expiration its average percentage was 71.75%. Conclusion: It is concluded that patients with breast cancer who underwent a surgical procedure may have respiratory changes, that is, the population studied showed changes in muscle strength and changes in expansion, but there was no association between the level of chest expansion and type of surgery.Introdução: O câncer é definido como uma proliferação de células desordenadas que pode se espalhar e invadir tecidos e/ou órgãos por todo o corpo, quando ocorre uma mutação genética. Objetivo: Verificar as repercussões respiratórias no pós-operatório do câncer de mama. Método: Trata-se de um estudo de caráter descritivo, corte transversal e análise quantitativa, realizado com 20 indivíduos do sexo feminino no pós-operatório do câncer de mama que estavam em tratamento em um Ambulatório de Especialidade em Montes Claros - Minas Gerais. Os instrumentos utilizados foram a escala de MRC que avalia o nível de dispneia durante atividade física, cirtometria que avalia a expansibilidade torácica e manovacuômetro que mensura a força muscular respiratória. Resultados: A idade média das participantes foi de 50,40 ± 5,50, observou-se que 90,0% das participantes sente falta de ar só durante exercícios intensos, segundo a escala de MRC, na cirtometria todos os sujeitos apresentaram redução da expansibilidade torácica. Foi observado uma diminuição significativa na força muscular respiratória, a média percentual alcançada na inspiração forçada foi de 86,77% e na expiração forçada sua média percentual foi de 71,75%. Conclusão: Conclui-se que pacientes portadoras de CA de mama que foram submetidas a um procedimento cirúrgico podem apresentar alterações respiratórias, ou seja, a população estudada apresentou alteração de força muscular e alteração da expansibilidade, porém não houve associação entre nível de expansibilidade torácica e tipo de cirurgia. &nbsp

O câncer e a criança: um impacto familiar

The aim of this work is a bibliographic review concerning the children living with cancer and their family, in order to identify the themes that have been already studied and to understand the impact on the family during the phases of childhood cancer. The information acquisition was based on documents from the Ministry of Health and on scientific studies available on the following databases: the Google Scholar, the Health virtual Library, the Scielo, the CAPES Journals, the MEDLINE, the LILACS and the Cochrane. The choice of the documents and journals was mainly justified by its link with the childhood health theme. The systematic of the studies research covered the period from 1999 to 2015. The keywords used for the research’s strategy were: childhood health, childhood cancer, family caregivers and grief. The results were presented in three themes: childhood cancer impact on the family, adaptation process of the family facing the sickness and the mourning regarding the death of the sick child. The review enabled to identify the need for special follow-up of the person, which is in direct contact with the child, usually the mother, since the moment of the diagnostic, until after the death.O objetivo desse estudo é revisar a literatura relativa à criança com câncer e sua família, a fim de identificar temas que têm sido pesquisados, e compreender o impacto causado na família durante as fases do câncer infantil. O levantamento de dados foi embasado em documentos do Ministério da Saúde e em trabalhos científicos disponibilizados no Google Acadêmico, Biblioteca virtual da Saúde, Scielo, Periodicos Capes, MEDLINE, LILACS e Cochrane. A escolha dos documentos e periódicos se deu pela sua relação com os temas Saúde da criança. A busca sistematizada de trabalhos abrangeram o período de 1999 a 2015. A estratégia de busca desse referencial utilizou as seguintes palavras-chave: Saúde da Criança, Câncer Infantil, Cuidadores Familiares e Luto. Os resultados foram apresentados em três temas: impacto do câncer infantil na familiar; processo de adaptação da família diante da doença e o luto diante da morte da criança. A revisão demonstrou que uma necessidade de acompanhamento especial a pessoa em contato direto com a criança, geralmente a mãe, desde o momento do diagnostico, e até após a morte

Impact of COVID-19 on cardiovascular testing in the United States versus the rest of the world

Objectives: This study sought to quantify and compare the decline in volumes of cardiovascular procedures between the United States and non-US institutions during the early phase of the coronavirus disease-2019 (COVID-19) pandemic. Background: The COVID-19 pandemic has disrupted the care of many non-COVID-19 illnesses. Reductions in diagnostic cardiovascular testing around the world have led to concerns over the implications of reduced testing for cardiovascular disease (CVD) morbidity and mortality. Methods: Data were submitted to the INCAPS-COVID (International Atomic Energy Agency Non-Invasive Cardiology Protocols Study of COVID-19), a multinational registry comprising 909 institutions in 108 countries (including 155 facilities in 40 U.S. states), assessing the impact of the COVID-19 pandemic on volumes of diagnostic cardiovascular procedures. Data were obtained for April 2020 and compared with volumes of baseline procedures from March 2019. We compared laboratory characteristics, practices, and procedure volumes between U.S. and non-U.S. facilities and between U.S. geographic regions and identified factors associated with volume reduction in the United States. Results: Reductions in the volumes of procedures in the United States were similar to those in non-U.S. facilities (68% vs. 63%, respectively; p = 0.237), although U.S. facilities reported greater reductions in invasive coronary angiography (69% vs. 53%, respectively; p < 0.001). Significantly more U.S. facilities reported increased use of telehealth and patient screening measures than non-U.S. facilities, such as temperature checks, symptom screenings, and COVID-19 testing. Reductions in volumes of procedures differed between U.S. regions, with larger declines observed in the Northeast (76%) and Midwest (74%) than in the South (62%) and West (44%). Prevalence of COVID-19, staff redeployments, outpatient centers, and urban centers were associated with greater reductions in volume in U.S. facilities in a multivariable analysis. Conclusions: We observed marked reductions in U.S. cardiovascular testing in the early phase of the pandemic and significant variability between U.S. regions. The association between reductions of volumes and COVID-19 prevalence in the United States highlighted the need for proactive efforts to maintain access to cardiovascular testing in areas most affected by outbreaks of COVID-19 infection

Reduction of cardiac imaging tests during the COVID-19 pandemic: The case of Italy. Findings from the IAEA Non-invasive Cardiology Protocol Survey on COVID-19 (INCAPS COVID)

Background: In early 2020, COVID-19 massively hit Italy, earlier and harder than any other European country. This caused a series of strict containment measures, aimed at blocking the spread of the pandemic. Healthcare delivery was also affected when resources were diverted towards care of COVID-19 patients, including intensive care wards. Aim of the study: The aim is assessing the impact of COVID-19 on cardiac imaging in Italy, compare to the Rest of Europe (RoE) and the World (RoW). Methods: A global survey was conducted in May–June 2020 worldwide, through a questionnaire distributed online. The survey covered three periods: March and April 2020, and March 2019. Data from 52 Italian centres, a subset of the 909 participating centres from 108 countries, were analyzed. Results: In Italy, volumes decreased by 67% in March 2020, compared to March 2019, as opposed to a significantly lower decrease (p &lt; 0.001) in RoE and RoW (41% and 40%, respectively). A further decrease from March 2020 to April 2020 summed up to 76% for the North, 77% for the Centre and 86% for the South. When compared to the RoE and RoW, this further decrease from March 2020 to April 2020 in Italy was significantly less (p = 0.005), most likely reflecting the earlier effects of the containment measures in Italy, taken earlier than anywhere else in the West. Conclusions: The COVID-19 pandemic massively hit Italy and caused a disruption of healthcare services, including cardiac imaging studies. This raises concern about the medium- and long-term consequences for the high number of patients who were denied timely diagnoses and the subsequent lifesaving therapies and procedures

Impact of COVID-19 on Diagnostic Cardiac Procedural Volume in Oceania: The IAEA Non-Invasive Cardiology Protocol Survey on COVID-19 (INCAPS COVID)

Objectives: The INCAPS COVID Oceania study aimed to assess the impact caused by the COVID-19 pandemic on cardiac procedure volume provided in the Oceania region. Methods: A retrospective survey was performed comparing procedure volumes within March 2019 (pre-COVID-19) with April 2020 (during first wave of COVID-19 pandemic). Sixty-three (63) health care facilities within Oceania that perform cardiac diagnostic procedures were surveyed, including a mixture of metropolitan and regional, hospital and outpatient, public and private sites, and 846 facilities outside of Oceania. The percentage change in procedure volume was measured between March 2019 and April 2020, compared by test type and by facility. Results: In Oceania, the total cardiac diagnostic procedure volume was reduced by 52.2% from March 2019 to April 2020, compared to a reduction of 75.9% seen in the rest of the world (p&lt;0.001). Within Oceania sites, this reduction varied significantly between procedure types, but not between types of health care facility. All procedure types (other than stress cardiac magnetic resonance [CMR] and positron emission tomography [PET]) saw significant reductions in volume over this time period (p&lt;0.001). In Oceania, transthoracic echocardiography (TTE) decreased by 51.6%, transoesophageal echocardiography (TOE) by 74.0%, and stress tests by 65% overall, which was more pronounced for stress electrocardiograph (ECG) (81.8%) and stress echocardiography (76.7%) compared to stress single-photon emission computerised tomography (SPECT) (44.3%). Invasive coronary angiography decreased by 36.7% in Oceania. Conclusion: A significant reduction in cardiac diagnostic procedure volume was seen across all facility types in Oceania and was likely a function of recommendations from cardiac societies and directives from government to minimise spread of COVID-19 amongst patients and staff. Longer term evaluation is important to assess for negative patient outcomes which may relate to deferral of usual models of care within cardiology

International Impact of COVID-19 on the Diagnosis of Heart Disease

Background: The coronavirus disease 2019 (COVID-19) pandemic has adversely affected diagnosis and treatment of noncommunicable diseases. Its effects on delivery of diagnostic care for cardiovascular disease, which remains the leading cause of death worldwide, have not been quantified. Objectives: The study sought to assess COVID-19's impact on global cardiovascular diagnostic procedural volumes and safety practices. Methods: The International Atomic Energy Agency conducted a worldwide survey assessing alterations in cardiovascular procedure volumes and safety practices resulting from COVID-19. Noninvasive and invasive cardiac testing volumes were obtained from participating sites for March and April 2020 and compared with those from March 2019. Availability of personal protective equipment and pandemic-related testing practice changes were ascertained. Results: Surveys were submitted from 909 inpatient and outpatient centers performing cardiac diagnostic procedures, in 108 countries. Procedure volumes decreased 42% from March 2019 to March 2020, and 64% from March 2019 to April 2020. Transthoracic echocardiography decreased by 59%, transesophageal echocardiography 76%, and stress tests 78%, which varied between stress modalities. Coronary angiography (invasive or computed tomography) decreased 55% (p &lt; 0.001 for each procedure). In multivariable regression, significantly greater reduction in procedures occurred for centers in countries with lower gross domestic product. Location in a low-income and lower–middle-income country was associated with an additional 22% reduction in cardiac procedures and less availability of personal protective equipment and telehealth. Conclusions: COVID-19 was associated with a significant and abrupt reduction in cardiovascular diagnostic testing across the globe, especially affecting the world's economically challenged. Further study of cardiovascular outcomes and COVID-19–related changes in care delivery is warranted