Stepwise PEEP recruitment maneuvers can open collapsed ARDS lungs. Higher levels of PEEP are necessary to maintain the lungs open and assure homogenous ventilation in ARDS. In the near future, thoracic CT associated with high-performance monitoring of regional ventilation (electrical impedance tomography) may be used at the bedside to determine the optimal mechanical ventilation of ARDS patients.
Objective: Although COPD is a prevalent disease, it is undertreated, and there are no
available data regarding previous treatment of COPD in Brazil. This study aimed to
determine the appropriateness of maintenance treatment in COPD patients prior to
their hospitalization and to identify variables associated with inappropriate
treatment. Methods: This was an observational, cross-sectional, analytical study involving 50
inpatients with COPD at two hospitals in the city of Florianópolis, Brazil. The
patients completed a questionnaire on parameters related to the maintenance
treatment of COPD. Non-pharmacological management and pharmacological treatment
were assessed based on the recommendations made by the Global Initiative for
Chronic Obstructive Lung Disease (GOLD) in 2011 and by the Brazilian National
Ministry of Health in the chronic respiratory diseases section of its
Caderno de Atenção Básica (CAB, Primary Care Guidebook). Results: In most of the patients, the COPD was classified as being severe or very severe.
Regarding non-pharmacological management, 33% of the patients were smokers, only
32% had been advised to receive the flu vaccine, 28% had received pneumococcal
vaccine, and only 6.5% of the patients in the B, C, and D categories received
pulmonary rehabilitation. Regarding GOLD and CAB recommendations, pharmacological
treatment was inappropriate in 50% and 74% of the patients, respectively. Based on
GOLD recommendations, 38% were undertreated. A low level of education, low income,
not receiving oxygen therapy, and not receiving the flu vaccine were associated
with inappropriate treatment. Conclusions: The application of various non-pharmacological management recommendations was
unsatisfactory. Regarding the GOLD recommendations, the high rate of inappropriate
maintenance treatment was mainly due to undertreatment. In Brazil, even in severe
COPD cases, optimizing treatment to achieve greater benefits continues to be a
challenge.
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