Estimativa de pacientes hospitalizados por COVID-19 em unidade de terapia intensiva no pico da pandemia em Porto Alegre: Estudo com modelo epidemiológico SEIHDR

Abstract

Objetivo: Estimar o número máximo de casos prevalentes de COVID-19, internados em unidades de terapia intensiva, e o momento deste pico, em Porto Alegre. Métodos: Empregamos um modelo matemático de equações diferenciais denominado SEIHDR (Suscetível, Exposto, Infectado, Hospitalizado, Morto, Recuperados). Analisamos os casos de hospitalização por COVID-19 em Porto Alegre e RS, desde 9 de março até 25 de julho de 2020 a fim de extrair os parâmetros para construir uma curva epidemiológica do total de casos prevalentes hospitalizados e em unidade de terapia intensiva, assim como estimar a prevalência de pacientes em ventilação mecânica invasiva. Finalmente, ajustamos alguns parâmetros desta curva a partir dos casos reais prevalentes de internados em enfermaria e em unidades de terapia intensiva. Resultados: O modelo matemático corrigido para os dados da pandemia até 25 de julho projetou um pico de 1.354 casos prevalentes hospitalizados: 562 pacientes internados na unidade de terapia intensiva com 378 sob ventilação mecânica no dia 12 de setembro de 2020 (37º semana epidemiológica). Ainda, haveria o pico de 62.514 casos prevalentes de infectados com COVID-19 no início do mesmo mês (36º semana epidemiológica. Calculamos para a pandemia um número de reprodução básico de 1,53 e de reprodução efetiva de 1,29 para 25 de julho de 2020. Conclusão: Como o número atual de leitos de unidade de terapia intensiva seria insuficiente para atender a esta demanda, sugerimos um aumento no número de leitos críticos a fim de evitar o colapso do sistema de saúde em Porto Alegre.

Clinical-epidemiological profile of hospitalized patients with the new coronavirus that evolved to death in hospital of infectious diseases / Perfil clínico-epidemiológico de pacientes internados com o novo coronavírus que evoluíram para óbito em hospital de doenças infecciosas

“…In 2020, the MS prepared a protocol that indicated for all types of cases the use of the drugs chloroquine/hydroxychloroquine, disregarding the precaution recommended by several national and international health organizations. 15 However, the best scientific evidence available until April 2020 failed to demonstrate or exclude a beneficial effect of chloroquine/hydroxychloroquine on coronavirus infections in humans or viral negativation by RT-PCR(2), a worrisome finding since such drugs could cause, for example, prolongation of the QT interval. Furthermore, double-blind clinical researches and randomized studies later affirm that the administration of these drugs does not promote improvement in the clinical evolution of patients.…”

“…Furthermore, double-blind clinical researches and randomized studies later affirm that the administration of these drugs does not promote improvement in the clinical evolution of patients. 15 It is worth mentioning that a portion of the sample in this research did not use medications (4.5%), because these individuals arrived at the health service in frank respiratory failure, evolving directly to death, and it was not possible to start a specific drug therapy. This leads us to wonder whether this public had access to the service in a timely manner, i.e., at the beginning of the presentation of signs and symptoms, which may have contributed Clinical-epidemiological profile of hospitalized patients with the new coronavirus that evolved to death in hospital of infectious diseases 6 to this unfavorable prognosis.…”

Quality of life and eating habits of patients with obesity during the COVID-19 pandemic

“…Patients were selected from the preoperative bariatric surgery group, in which they receive guidance on the benefits of changing their lifestyle and the information is self-reported. Another weakness that can be considered in the study is that, during data collection, the state of Rio Grande do Sul had not yet reached the peak of contamination and the population still adjusted to the new norms and routine (44) . This fact needs to be considered to understand the seriousness of the impact that the pandemic will have on obese people, in the long term.…”

Avaliação da oxigenoterapia em pacientes adultos em uma unidade de terapia intensiva de um hospital de ensino

“…The literature does not specify how many daily measurements are necessary, but recommends that blood gas collections be performed in all patients using oxygen support, as well as in those with respiratory decompensation 21 . This method is very effective for monitoring or indicating O₂ use since, with the gasometer, it is possible to analyze the PaO₂, partial carbon dioxide pressure (pCO 2 ), hydrogen potential (pH), bicarbonate (HCO₃) and SatO₂ parameters, The literature shows that 91% of the patients with respiratory failure in the ICU required invasive ventilation and that gasometry is crucial to assist in defining the parameters to be programmed in the mechanical ventilator, thus representing the most frequently employed method in ICUs 22,23 .…”