Background. Continuous positive airway pressure (CPAP) can be beneficial in acute respiratory failure (ARF) due to coronavirus (COVID-19) pneumonia, but delaying endotracheal intubation (ETI) in nonresponders may increase mortality. We aimed at investigating the performance of composite respiratory indexes as possible predictors of CPAP failure in ARF due to COVID-19. Methods. This was a multicenter, prospective, observational, and cohort study conducted in the respiratory units of three University hospitals in Milan and in a secondary care hospital in Codogno (Italy), on consecutive adult patients with ARF due to COVID-19 pneumonia that underwent CPAP between March 2020 and March 2021. ETI transfer to the intensive care unit or death is defined CPAP failure. Predictors of CPAP failure were assessed before T0 and 1 hour after T1 CPAP initiation and included mROX index (ratio of PaO2/FiO2 to respiratory rate), alveolar-to-arterial (A-a) O2 gradient, and the HACOR (heart rate, acidosis, consciousness, oxygenation, and respiratory rate) score. Results. Three hundred and fifty four patients (mean age 64 years, 73% males) were included in the study; 136 (38.4%) satisfied criteria for CPAP failure. A-a O2 gradient, mROX, and HACOR scores were worse in patients who failed CPAP, both at T0 and T1 ( p < 0.001 for all parameters). The HACOR score was associated with CPAP failure (odds ratio—OR—for every unit increase in HACOR = 1.361; 95%CI: 1.103–1.680; p = 0.004 ; AUROC = 0.742; p < 0.001 ). CPAP failure was best predicted by a threshold of 4.50 (sensitivity = 53% and specificity = 87%). Conclusions. The HACOR score may be a reliable and early predictor of CPAP failure in patients treated for ARF in COVID-19 pneumonia.

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RESUMO Objetivo Este estudo piloto teve como objetivo verificar a influência do uso do biofeedback EMG como método coadjuvante para auxiliar na manutenção dos resultados a longo prazo da terapia da deglutição em idosos com doença de Parkinson em uma abordagem profilática. Métodos Os sujeitos foram avaliados quanto ao nível de ingestão oral (Functional Oral Intake Scale - FOIS), qualidade de vida (questionário SWAL-QOL) e videofluoroscopia da deglutição das consistências sólida, pudim e líquida. A gravidade da disfagia foi avaliada por meio do Dysphagia Outcome and Severity Scale (DOSS). Todos os procedimentos foram realizados antes, após três meses e após seis meses do tratamento fonoaudiológico para disfagia orofaríngea. Resultados Três sujeitos foram tratados com terapia fonoaudiológica profilática e três com terapia convencional fonoaudiológica profilática utilizando biofeedback EMG coadjuvante em um total de 18 sessões. Seis pacientes apresentaram melhora nos níveis de ingestão oral, gravidade da disfagia e qualidade de vida após o programa de reabilitação. O nível de ingestão oral foi mantido seis meses após a terapia convencional para dois pacientes e todos os participantes tratados com biofeedback EMG. Conclusão Ambas as modalidades de terapia profilática mostraram melhora na qualidade de vida, nível de ingestão oral e gravidade da disfagia, mas os benefícios foram mantidos ao longo do tempo apenas para os participantes do grupo experimental.

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It is not known if the degrees of improvement in oxygenation obtained by CPAP can predict clinical outcomes in patients with COVID-19 pneumonia. This was a retrospective study conducted on patients with severe COVID-19 pneumonia treated with CPAP in three University hospitals in Milan, Italy, from March 2020 to March 2021. Arterial gas analysis was obtained before and 1 h after starting CPAP. CPAP failure included either death in the respiratory units while on CPAP or the need for intubation. Two hundred and eleven patients (mean age 64 years, 74% males) were included. Baseline median PaO2, PaO2/FiO2 ratio (P/F), and the alveolar-arterial (A-a) O2 gradient were 68 (57–83) mmHg, 129 (91–179) mmHg and 310 (177–559) mmHg, respectively. Forty-two (19.9%) patients died in the respiratory units and 51 (24.2%) were intubated. After starting CPAP, PaO2/FiO2 increased by 57 (12–113; p < 0.001) mmHg, and (A-a) O2 was reduced by 68 (−25–250; p < 0.001) mmHg. A substantial overlap of PaO2, P/F, and A-a gradient at baseline and during CPAP was observed in CPAP failures and successes; CPAP-associated improvements in oxygenation in both groups were similar. In conclusion, CPAP-associated improvements in oxygenation do not predict clinical outcomes in patients with severe COVID-19 pneumonia.

RESUMO Objetivo: mensurar o tempo total da mastigação e da fase oral da deglutição em idosos saudáveis, considerando diferentes consistências alimentares, a presença de dentes naturais e o tipo de reabilitação oral protética, bem como realizar comparação entre as condições dentárias e as consistências. Métodos: estudo transversal com 57 idosos saudáveis, entre 60 e 82 anos, distribuídos em grupo dentado (D) (n=15) e grupos reabilitados: próteses parciais fixas ou removíveis em uma ou ambas as arcadas (PP) (n=15); prótese total removível maxilar e mandibular (PTR) (n=15); prótese total - prótese removível superior e prótese implanto-suportada inferior (PTIS) (n=12). O tempo de duração (segundos) da mastigação e da fase oral da deglutição foi medido nas consistências: sólida (pão francês), pudim (10 ml) e líquida (10 ml). Resultados: idosos dentados saudáveis apresentaram os intervalos: líquido=1,07±0,35 s; pudim=3,48±1,76 s; e sólido=27,88±7,11 s. Foram observadas diferenças estatisticamente significativas entre os grupos D e PTIS (p=0,0056) e entre D e PTR (p=0,0056) para líquido. Para todos os grupos, houve aumento estatisticamente significante entre as consistências líquida e sólida e entre pastosa e sólida (p<0,001). Conclusões: idosos dentados apresentaram menor tempo de fase oral da deglutição para líquidos do que idosos edêntulos totais reabilitados, mas não diferente dos idosos com prótese parcial. O tempo de mastigação e deglutição do alimento sólido foi maior que o das demais consistências, independente da condição dentária.

Purpose: to measure the total time of mastication and oral phase of swallowing in healthy elderly people, considering different food consistency, the presence of natural teeth, and the type of prosthetic oral rehabilitation, as well to compare dental conditions and consistencies. Methods: a cross-sectional study with 57 healthy elderly people, aged between 60 and 82 years, divided into: dentate group (D) (n=15); and rehabilitated groups; PD: fixed or removable partial dentures in one or both arches (n=15); CRD: maxillary and mandibular complete removable dentures (n=15); ISCD: complete dentures - maxillary removable denture and mandibular implant-supported dentures (n=12). The duration time (seconds) of chewing and of the oral phase of swallowing was measured in the consistencies: solid (a roll slice), pudding (10 ml) and liquid (10 ml). Results: healthy dentate elderly subjects had the following intervals: liquid=1.07±0.35 s; pudding=3.48±1.76 s; and solid=27.88±7.11 s. Statistically significant differences were observed between the D and ISCD groups (p=0.0056) and between D and CRD (p=0.0056) for liquid. For all groups, there was a statistically significant increase between liquid and solid consistencies and between pasty and solid ones (p<0.001). Conclusions: the dentate elderly had shorter oral phase time of swallowing for liquids than the rehabilitated edentulous elderly, but not different from the elderly with partial dentures. Chewing and swallowing time for solid food was longer than that for the other consistencies, regardless of dental condition.

<p>Objective: This project aimed to develop and update a dynamic three-dimensional (3D) graphic video learning object demonstrating a current knowledge of the anatomy and physiology of sucking and swallowing in newborns during breastfeeding. Method: To build and update the 3D computer graphics iconographies of the "Virtual Baby," we defined objectives for the learning object, created a literature review-based script, and organized a guide for structural (static) and functional (dynamic) graphical modeling for the designer. Results: Using 3D computer graphics, we produced a video with static images (anatomical structural) and dynamic sequences (most significant physiological and functional aspects and application of transparency to visualize the anatomical correlations between both). The video showed the anatomy and physiology of sucking and swallowing during breastfeeding. Its updates reflected additional scientific evidence as studies were published. Conclusion: Creation of the Virtual Baby provides a learning tool for visualizing the anatomy and physiology of sucking and swallowing in full-term newborns. The tool addresses the significant morphofunctional aspects of the breastfeeding process, supported by scientific literature, and can be used for student or professional training and in primary health care.<p>