Respiratory care
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Observational Study
Oxygen Desaturation and Persistence of Symptoms during Activities of Daily Living in Patients following Hospital Discharge for COVID-19.
COVID-19 can cause respiratory and multisystemic impairments, which lead to impaired activities of daily living (ADL). Telemonitoring after discharge from the hospital may help identify the persistence of such limitations during ADLs simulations. The aim of this study was to compare SpO2 , fatigue, and dyspnea through telemonitoring during a battery of 4 ADLs in patients following hospital discharge for COVID-19. ⋯ SpO2 was similar among the ADLs but walking triggered desaturation in a larger number of subjects. The subjects presented with mild-to-intense fatigue and dyspnea during ADLs 30 d after discharge after hospitalization for COVID-19 regardless of desaturation status, which demonstrated that the persistence of symptoms is independent of hypoxemia during exercise.
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Sedation in intensive care is fundamental for optimizing clinical outcomes. For many years the world has been facing high rates of opioid use, and to combat the increasing opioid addiction plans at both national and international level have been implemented.1 The COVID-19 pandemic posed a major challenge for health systems and also increased the use of sedatives and opioid analgesia for prolonged periods of time, and at high doses, in a significant proportion of patients. In our institutions, the shortage of many drugs for intravenous (IV) analgosedation forces us to alternatives to replace out-of-stock drugs or to seek sedation goals, which are difficult to obtain with traditional drugs at high doses.2 METHODS: This was an analytical retrospective cohort study evaluating the follow-up of subjects with inclusion criteria from ICU admission to discharge (alive or dead). Five end points were measured: need for high-dose opioids (≥ 200 µg/h), comparison of inhaled versus IV sedation of opioid analgesic doses, midazolam dose, need for muscle relaxant, and risk of delirium. ⋯ Inhaled sedation was associated with lower doses of opioids, benzodiazepines, and muscle relaxants compared to IV sedation. This therapy should be considered as an alternative in critically ill patients requiring prolonged ventilatory support and where IV sedation is not possible, always under adequate supervision of ICU staff.
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Extubation readiness testing (ERT) is often performed in children with congenital heart disease prior to liberation from mechanical ventilation. The ideal ERT method in this population is unknown. We recently changed our ERT method from variable (10, 8, or 6 cm H2O, depending on endotracheal tube size) to fixed (5 cm H2O) pressure support (PS). Our study assessed the association between this change and time to first extubation and need for re-intubation. ⋯ The use of a fixed PS of 5 cm H2O instead of variable PS during ERT was not associated with longer time to first extubation or extubation failure.