Abstract
The use of lung ultrasound in the detection of pneumothorax is becoming routine in emergency departments and intensive care units in the United States and Europe [1]. The interposition of the visceral and parietal pleura (pleural-lung interface) produces pulmonary artifacts easily visualized by ultrasound and described initially by Lichtenstein and Meziere [2]. In evaluating the lung for pneumothorax, the most important finding is the presence or absence of lung sliding. The presence of pleural sliding essentially rules out a pneumothorax in the analyzed region and the absence of lung sliding indicates a high suspicion of disease. Organizations such as the American College of Emergency Physicians (ACEP) have demonstrated the short learning curve and prompt application to clinical practice of this use of lung ultrasound. There is already evidence, both in Brazil and beyond, that knowledge retention based on an educational model using computer simulation would be particularly useful in training Brazilian physicians in lung ultrasound if it was proven to be effective.
Highlights
Noninvasive ventilation is a safe and effective method to treat acute respiratory failure, minimizing the respiratory workload and oxygenation
Many interventions are known to decrease the incidence of ventilator-associated pneumonia, which has great impact on mortality, length of stay and costs in intensive care units
One of them is the aspiration of the secretions that pool above the cuff of the endotracheal tube [1]
Summary
Noninvasive ventilation is a safe and effective method to treat acute respiratory failure, minimizing the respiratory workload and oxygenation. Previous studies have indicated risk factors for ICU readmission; sepsis, respiratory insufficiency, medical admission, organ dysfunctions and age are associated with this outcome. Logistic regression analysis showed that need for mechanical ventilation (odds ratio = 7.76; 95% CI = 4.56 to 12.85), presence of metastasis (odds ratio = 2.87; 95% CI = 2.06 to 5.28), occurrence of acute renal failure (odds ratio = 2.92; 95% CI = 1.67 to 9.46) and higher SOFA scores 72 hours after admission (odds ratio = 6.76; 95% CI = 5.56 to 13.85) were independently associated with increased hospital mortality. Conclusion This prospective analysis of 3,400 patients with cancer needing intensive care shows high survival rates and good quality of life after ICU admission These data encourage intensive care treatment in oncologic patients to prevent, detect and cure organ dysfunction. Adult critically ill patients need invasive mechanical ventilation support due to distinct causes that vary from an elective highrisk surgery to post cardiorespiratory arrest
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