Síndrome respiratória aguda grave: suporte ventilatório em pacientes da rede hospitalar da cidade de Passo Fundo – RS

Abstract

Severe Acute Respiratory Syndrome (SARS) is characterized by the presence of dyspnea or respiratory distress, persistent chest pressure or pain, O2 saturation < 95% on room air, or cyanosis of the lips or face. The Coronavirus Disease Outbreak (COVID-19) caused by the SARS-CoV-2 virus, which was later classified as a pandemic by the World Health Organization (WHO), increased SARS cases in Brazil exponentially, demanding intensive care resources such as mechanical ventilation, both invasive and non-invasive, especially in the more severe presentations of the disease. The most severe form of SARS-CoV-2 infection is characterized by an inflammatory cytokine storm, with hematological and coagulation alterations that often lead the individual to death. The use of ventilatory support is necessary in cases such as SARS that occur both in patients with COVID-19 and in other individuals affected by other respiratory diseases. The aim of this study was to evaluate the prevalence of the use of ventilatory support in patients admitted in 2020 for SARS in hospitals in Passo Fundo-RS, from the sociodemographic profile, identifying the signs and symptoms and the prevalence of risk factors / comorbidities presented. This is a quantitative, observational, cross-sectional, descriptive and analytical study, carried out from December 2020 to April 2022. The sample consisted of all patients admitted from 01/01/2020 to 12/31/2020. We analyzed information from notification forms of the Influenza Epidemiological Surveillance Information System obtained from the Municipal Health Department of Passo Fundo- RS. The independent variables analyzed were the epidemiological week of onset of symptoms, place of care from hospitals located in the city of Passo Fundo-RS, sociodemographic characteristics, signs and symptoms, presence of risk factors / comorbidities, ICU care and final classification of cases. The dependent variables were the use and type of ventilatory support and the possible outcomes of the cases. To calculate the prevalence of outcomes we considered the 95% confidence interval (CI95) and their distribution according to the independent variables from Pearson's chi-square test with statistically significant values of p<0.05. A total of 2,619 cases were registered, mostly males (54.6%), aged 60 years or older (51.4%), white (93.2%), and with elementary school education (53.7%). Among these, 1,887 were caused by SARS-CoV-2 infection (72%). Ventilatory support was used in 73.5% of patients, of which 25.4% were invasive. The use of ventilatory support was higher among males, in patients aged < 18 years, with no education or illiteracy, and in those who lived in other municipalities. Those who had dyspnea, respiratory distress and O2 saturation < 95%, and those with risk factors / comorbidities, including chronic cardiovascular disease, chronic neurological disease, other chronic lung disease and obesity used ventilatory support more often. Of the patients who used invasive ventilatory support, most were men, aged ≥ 60 years, with elementary education, and who did not reside in the city of Passo Fundo-RS. The present study allowed us to identify, from the individuals with a cure or death record, that the SARS lethality rate was 27.0%, being higher in males, in patients aged ≥ 60 years, in those with no education or illiteracy, and in those who lived in other municipalities. In addition, those with dyspnea, respiratory distress, O2 saturation < 95% and fatigue, risk factors / comorbidities, including chronic cardiovascular disease, chronic liver disease, Diabetes Mellitus, chronic neurological disease, other chronic lung disease and chronic kidney disease, who required invasive ventilatory support and who had a confirmed diagnosis of SARS caused by COVID-19 died more often compared with the others. We conclude that gender, age, signs and symptoms related to respiratory problems, and the presence of comorbidities influenced the number of cases that required ventilatory support as well as those that died.