Resumo: A ventilação mecânica invasiva é recurso fundamental em unidades de terapia intensiva. Sua aplicação ocorre em quase metade dos pacientes dessas unidades. Entretanto, a VMI associa-se a várias complicações, especialmente quando utilizada por período prolongado. Desse modo, preconiza-se que a interrupção do suporte ventilatório seja realizada assim que possível. A intempestividade em realizar tanto o desmame como a extubação pode gerar graves conseqüências ao paciente, incluindo a necessidade de reintubação. Esta, por sua vez, está relacionada à elevada incidência de pneumonia hospitalar, o que leva ao maior tempo de ventilação mecânica, de permanência na terapia intensiva, aumento no custo hospitalar e da mortalidade. Visto que tanto a ventilação mecânica prolongada como sua retirada prematura podem ser prejudiciais, faz-se necessário o reconhecimento do momento ideal do desmame e extubação. Vários índices fisiológicos foram propostos com o intuito de identificar os pacientes capazes de reassumir a ventilação espontânea. Poucos ofereceram poder preditivo satisfatório e o índice de respiração rápida e superficial parece ser o mais útil devido sua simplicidade e confiabilidade. No entanto, o melhor ponto de corte dos índices fisiológicos raramente foi estabelecido por curva ROC, evidenciando a necessidade de novos estudos. Neste trabalho, foram revisados os estudos que demonstraram a importância da utilização de protocolos de desmame e extubação e avaliaram o papel preditivo dos índices propostos. / Abstract: Invasive mechanical ventilation is crucial in intensive care units and its application becomes necessary in almost half of the patients. However it has been associated to several complications especially under prolonged use. Therefore it is reccomended that the discontinuation of ventilator support must be attemped as soon as possible. The premature weaning or extubation also can gerate negative consequences to the patient, including the need of reintubation. This is most related to higher incidence of nosocomial pneumonia, increased IMV use and ICU length of stay, hospital costs and elevated mortality rates. Because of both, prolonged IMV and it's premature discontinuation can be harmful, it is necessary to recognize the optimal moment for weaning and extubation. Many physiological indexes were proposed to distinguish patients ready to breath spontaneously, but fewness demonstrated satisfatory predictive power. Rapid shallow breathing index seems to be the most useful parameter because of its simplicity and reliability. However, in rare studies the best threshold for these indexes was established by ROC curve, making evident the need of further investigations. The present study reviewed articles that demonstrated importance of weaning and extubation protocols utilization and that assessed the predictive role of physiological indexes. / Orientador: Luis Cuadrado Martin / Coorientador: Ana Lúcia Gut / Banca: Letícia Cláudia de Oliveira Antunes / Banca: Silvia Regina Barrile / Mestre

Orientadores: Carlos Roberto Ribeiro de Carvalho, Desanka Dragosavac / Tese (doutorado) - Universidade Estadual de Campinas, Faculdade de Ciencias Medicas / Made available in DSpace on 2018-08-10T10:34:34Z (GMT). No. of bitstreams: 1 Soares_SilviaMariadeToledoPiza_D.pdf: 3044628 bytes, checksum: e56b8278750420c568f9132a7938bd95 (MD5) Previous issue date: 2007 / Resumo: Introdução: Limitação ao fluxo e hiperinsuflação dinâmica são fteqüentemente observadas em pacientes com DPOC. A capacidade inspiratória (CI) tem sido sugerida como um método simples para verificar as alterações no volume pulmonar expiratório final e hiperinsuflação pulmonar. Entretanto, poucos estudos verificaram se a aplicação de pressão positiva contínua nas vias aéreas (CP AP) poderia diminuir a hiperinsuflação pulmonar. Objetivo: Verificar os efeitos imediatos da CP AP no volume pulmonar expiratório final em pacientes com DPOC estável. Método:' Trata-se de um estudo prospectivo, com 21 pacientes, idade 63 + ou - 9 anos, com volume expirado forçado no primeiro segundo de 40,7 + ou - 11,7%, que foram submetidos a um teste gradual de CP AP (4, 7 e 11 cmH20 - Drãger SA VINA ventilator). A CI foi mensurada pela espirometria, antes e depois de cada valor de CPAP. Nos pacientes nos quais os três valores de CPAP resultaram em redução da CI, uma pressão de 2 cmH20 também foi aplicada. Para cada paciente, um valor de CP AP "ótimo" foi definido como o valor correspondente a melhor CI obtida com o teste gradual da CP AP. Este valor "ótimo" de CP AP foi, então, aplicado por 10 min e uma espirometria foi posteriormente realizada. Resultados: Durante o teste gradual da CPAP, seis pacientes (grupo não respondedor) não apresentaram qualquer melhora na CI. Quando o valor de CP AP "ótimo" foi então aplicado nesses indivíduos, foi observado piora significativa da CI de 83,7 + ou - 19,4% para 74 + ou 22,8% (p = 0,0341). Em 15 pacientes (grupo respondedor), a CI aumentou significativamente de 68,6 + ou - 17,9% para 75,3 + ou - 18,0% (p = 0,0002). A capacidade vital lenta foi o único parâmetro espirométrico que também aumentou após a CPAP "ótima" no grupo respondedor (240 rnL, 7,4% do valor predito, p < 0,01). Nenhuma diferença significativa foi observada após a CP AP "ótima" nos pacientes com limitação ao fluxo expiratório (CI pré-CPAP '< ou =' 80% do valor predito) versus pacientes não limitados ao fluxo expiratório (CI pré-CPAP > 80% do valor predito). Entretanto, os pacientes com enfisema pulmonar e CI:S 80%,do valor predito demonstraram um aumento significativo na CI após a CPAP "ótima" (220 rnL, 8,9% do valor predito, p < 0,01). Conclusão: A CPAP pode aumentar a capacidade inspiratória em pacientes selecionados, sugerindo redução no volume pulmonar expiratório final, conseqüente da diminuição na hiperinsuflação pulmonar / Abstract: Bachground: Flow limitation and dynamic hyperinflation are common findings in COPD patients. Inspiratory capacity (IC) has been proposed as a simple method to assess changes in end-expiratory lung volume (EEL V) and lung hyperinflation. However, few studies verified if the application of continuous positive airway pressure (CP AP) could decrease lung hyperinflation. Objective: To assess the immediate effect of the CP AP in EEL V in stable COPD patients. Method: Prospective study of 21 stable COPD patients, age 63 + ou - 9 years, with forced expiratory volume in first second (FEV1) of 40.7 + ou - 11.7%, who were submitted to the gradual test of CP AP (4, 7 and 11 CmH20 - Drãger - SA VINA ventilator). The IC was measured by spirometry, before and after each CP AP leveI. In patients in whom all three CP AP levels resulted in a decreased IC, an additional CP AP test at 2 cmH20 was conducted. For each patient, a "best" CPAP leveI was defined as the one associated with the greater IC observed. This "best" CP AP leveI was then applied during 10 min and subsequent spirometry was performed. Results: During the gradual test of CP AP, 6 patients (non responder group) did not present any improvement of the IC. When the "best" CPAP was then applied in these cases, a significant worsening of the IC was observed of 83.7 + ou - 19.4% to 74 + ou - 22.8% (p = 0.0341). In 15 patients (responder group), the IC increased significantly from 68.6 + ou - 17.9% to 75.3 + ou - 18.0% (p = 0.0002). The slow vital capacity was the only other' spirometric parameter that also increased post "best" CP AP in the responder group (240 mL, 7.4% of the predicted value, p < 0.01). No significant differences in IC were observed after "best" CP AP in patients with expiratory flow limitation (IC pre CP AP '< ou =' 80% of predicted value) versus non EFL patients (IC pre CPAP> 80% ofpredicted value). However, the patients with pulmonary emphysema and IC '< ou =' 80% of predicted value demonstrated a significaht increase in IC after "best' CP AP (220 mL, 8.9% ofthe predicted value, p < 0.01). Conclusion: The CPAP can increase the inspiratory capacity in selected patients, suggesting decrease in the end-expiratory lung volume, consequent of reduction in pulmonary hyperinflation / Doutorado / Pesquisa Experimental / Doutor em Cirurgia

Orientador: Maria Aparecida Marques dos Santos Mezzacappa / Dissertação (mestrado) - Universidade Estadual de Campinas, Faculdade de Ciencias Medicas / Made available in DSpace on 2018-08-15T01:06:38Z (GMT). No. of bitstreams: 1 Carvalho_FabianaLima_M.pdf: 1259789 bytes, checksum: 9c588ae319b00427cf98bb2c4b57058b (MD5) Previous issue date: 2009 / Resumo: Objetivo: Determinar a incidência, os fatores de risco para a extubação acidental (EA) e a presença de periodicidade nas taxas de EA em uma unidade de terapia intensiva neonatal de nível terciário. Métodos: Estudo de coorte prospectivo para determinar a densidade de incidência de extubação acidental por 100 pacientes-dia durante o período de 23 meses, em 222 RN em assistência ventilatória (AV). Foram estudados os fatores de risco para a EA, por intermédio da análise de regressão logística. A presença de periodicidade nas taxas de extubação, segundo as variáveis de interesse, foi investigada pela análise de Cosinor. Resultado: A média da taxa de extubação acidental foi de 5,34/100 pacientes-dia ventilados. As variáveis preditoras que se associaram à extubação acidental foram o uso subsequente da via oral e nasal durante a assistência ventilatória (RR=4,73; IC95% 1,92-11,60), duração da assistência ventilatória (a cada dia RR=1,03; IC95% 1,02-1,04) e o número de pacientes-dia/ventilados (RR=1,01; IC95% 1,01-1,02). Pela regressão múltipla ajustada o tempo total de AV foi o único preditor independente para a extubação acidental nesta amostra (RR=1,02; IC95% 1,01-1,03). O tempo de AV de 10,5 dias apresentou acurácia de 0,79 (IC 95%-0,71-0,87) para a ocorrência de EA. A análise de Cosinor demonstrou periodicidade significativa na taxa geral de EA e no número de pacientes-dia ventilados. Houve correlação significativa entre número de pacientes-dia e a freqüência de EA. Conclusão: O único preditor independente para EA foi a duração da AV. A melhor acurácia para a ocorrência de EA foi obtida aos 10,5 dias de duração da AV. / Abstract: Objective: To determine the incidence, risk factors for accidental extubation (AE) and the presence of periodicity in the rates of AE in a tertiary neonatal intensive care unit. Methods: A prospective cohort study was conducted to identify the density of incidence of accidental extubation (AE) per 100 patient-days during 23 months in 222 infants on mechanical ventilation. The risk factors for AE were determined by logistic regression analysis. The presence of periodicity in rates of extubation, according to the variables of interest was investigated by Cosinor analysis. Results: The average rate of AE was 5.34/100 patient-days ventilated. The predictors associated with accidental extubation were: use of nasal and oral route (RR=4.73, 95% CI 1.92-11.60), duration of ventilatory assistance (VA) (per day, RR=1 .03, 95% CI 1.02-1.04), and the number of patient-days ventilated (RR=1.01; 95% CI 1.01-1.02). Adjusted multiple regression showed that the total time of VA was the only independent predictor for accidental extubation in this sample (RR=1.02, 95% CI 1.01-1.03). The duration of 10.5 days of VA presented an accuracy of 0.79 (CI95% 0.71-0.87) for the occurrence of EA. The Cosinor' analysis showed significant periodicity in the rate of overall EA and in the number of patient-days ventilated. There was significant correlation between the number of patient-days and the frequency of EA. Conclusion: The single independent predictor for EA was the duration of AV. The best accuracy for the occurrence of AE was obtained at 10.5 days of duration of AV. / Mestrado / Saude da Criança e do Adolescente / Mestre em Saude da Criança e do Adolescente

Orientador: Desanka Dragosavac / Dissertação (mestrado) - Universidade Estadual de Campinas, Faculdade de Ciências Médicas / Made available in DSpace on 2018-08-19T13:03:30Z (GMT). No. of bitstreams: 1 DellaVia_Fabiana_M.pdf: 1891187 bytes, checksum: 4def93d7b8f4cf136b7e8e9214f38a3b (MD5) Previous issue date: 2011 / Resumo: INTRODUÇÃO: Os pacientes internados em Unidades de Terapia Intensiva (UTI) que necessitam de ventilação mecânica (VM) estão mais susceptíveis ao desenvolvimento de complicações respiratórias, principalmente a atelectasia e a broncopneumonia. Para que haja reversão ou mesmo prevenção dessas áreas atelectasiadas, são utilizadas técnicas fisioterapêuticas de expansão pulmonar, dentre elas destaca-se a manobra de compressão e descompressão torácica (MCDT). OBJETIVO: Avaliar as alterações respiratórias e hemodinâmicas após aplicação da MCDT nos pacientes em uso de VM. MÉTODO: Tratou-se de um estudo prospectivo, intervencionista, onde foram incluídos 65 pacientes em VM há mais de 24 horas. Todos os pacientes receberam manobras de higiene brônquica e após 30 minutos foram aplicadas 20 repetições da manobra de compressão e descompressão torácica em dez respirações consecutivas no hemitórax direito e depois dez no hemitórax esquerdo. Os dados foram coletados antes, imediatamente após e após um, cinco, dez, 15, 20, 25, 30, 35 e 40 minutos da aplicação da MCDT. Para análise estatística foram utilizados testes: Shapiro Wilks, Anova, Wilcoxon, T - Student, com nível de significância adotado de 5%. RESULTADOS: Foi observado aumento estatisticamente significante do volume corrente inspiratório (pré: 458,2ml ± 132,1; pós 1 min: 557,3 ± 139,1; pós 40 min: 574,4 ± 151), volume minuto corrente (pré: 7,0L/min ± 2,7; pós 1 min: 8,7 ± 3,3; pós 40 min: 8,8 ± 3,8) e oximetria de pulso (pré: 97,4% ± 2,2; pós 1 min: 97,9 ± 1,8; pós 40 min: 98,2 ± 1,6). Ocorreu redução no PetCO2 expirado (pré: 35,1mmHg ± 9,0; pós 1 min: 31,5 ± 8,2; pós 40 min: 31,5 ± 8,2). Não houve alteração significante da freqüência cardíaca (pré: 94,5bpm ± 20,5; pós 1 min: 94,7 ± 20,5 e pós 40 min: 94,9 ± 20,2) e pressão arterial média (pré: 91,2mmHg ± 19,1; pós 1 min: 89,5 ± 17,7 e pós 40 min: 89,0 ± 16,8). CONCLUSÃO: A MCDT possibilita a otimização dos volumes pulmonares e oximetria de pulso e redução do PetCO2 sem promover alterações hemodinâmicas nos pacientes submetidos a ventilação mecânica / Abstract: INTRODUCTION: Patients in Intensive Care Units (ICU) requiring mechanical ventilation (MV) are more likely to develop respiratory complications, especially atelectasis and bronchopneumonia. Reversing or even prevention of these areas of atelectasis, physiotherapeutic techniques are used for lung expansion, chief among which is the maneuver of chest compression and decompression (MCCD). OBJECTIVE: To evaluate the respiratory and hemodynamic changes after application of MCCD in patients submitted to mechanical ventilation (MV). METHOD: It's a prospective and interventionist study of 65 patients submitted to MV after 24 hours. All patients received a bronchial hygiene and after 30 minutes, they were submitted to 20 repetitions of the MCCD during ten consecutive respiratory cycles on right hemithorax and than ten in left hemithorax. The data were collected before, after immediately and after one, five, ten, 15, 20, 25, 30, 35 and 40 minutes following application of the MCCD. RESULTS: There were an significant improvement in the following parameters after MCCD during all phases of data collection until 40 minutes: inspiratory tidal volume (baseline: 458,2ml ± 132,1; post 1 min: 557,3 ± 139,1; post 40 min: 574,4 ± 151 ), minute volume (baseline: 7,0L/min ± 2,7; post 1 min: 8,7 ± 3,3; post 40 min: 8,8 ± 3,8), and pulse oximetry (baseline: 97,4% ± 22; post 1 min: 97,9 ± 1,8; post 40 min: 98,2 ± 1,6) . A reduction occurred in expiratory PetCO2 (baseline: 35,1mmHg ± 9,0; post 1 min: 31,5 ± 8,2; post 40 min: 31,5 ± 8,29). No alteration occurred in heart rate (baseline: 94,5bpm ± 20,5; post 1 min: 94,7 ± 20,5; post 40 min: 94,92 ± 20,20) and mean arterial pressure (baseline: 91,2mmHg ± 19,1; post 1 min: 89,5 ± 17,7; post 40 min: 89 ± 16,8). CONCLUSION: There were positive effects on the MCCD maneuver with increased lung volumes, pulse oximetry and reduction in expiratory PetCO2, without hemodynamic changes in patients submitted to mechanical ventilation / Mestrado / Fisiopatologia Cirúrgica / Mestre em Ciências

Background: Advance care planning (ACP) is a method used for patients to express in advance their preferences, beliefs and values for life-sustaining treatments at the end-of-life. With growing ethnocultural diversity in Canada, health care providers are managing an increasing number of diverse beliefs/values that are commonly associated with preferences for mechanical ventilation (MV) at the end-of-life. The aim of this project is to explore methods used by health care providers to set care plans for MV with ethnocultural populations. Methods: Qualitative analysis of semi-structured interviews with open-ended questions and two clinical vignette components was conducted with eight (8) health care providers who engage in ACP. Participants were recruited using a snowball-sampling approach from five acute-care hospitals within the Ottawa region. Results: Three major themes emerged from collected dataset: 1) Goals of care across illness trajectories, 2) Respecting beliefs, values, and wishes for care, and 3) Cross-cultural support in ACP. Using a value-based approach in ACP was described as an effective method for managing and interpreting diverse beliefs/values that impact decisions for MV. However, organizational, systemic, and personnel barriers that exist continue to hinder the provision of cross-cultural ACP across health settings. Contexte: La planification préalable des soins (PPS) est une méthode utilisée par les patients et les familles pour exprimer à l'avance leurs préférences liées aux traitements de prolongation de vie. En raison de la diversité ethnoculturelle croissante au Canada, les professionnels de la santé sont confrontés à des croyances et valeurs différentes, souvent associées à une préférence pour l’initiation et le maintien de la ventilation mécanique (VM) en fin de vie. L'objectif de ce projet consiste à explorer les stratégies utilisées par les professionnels de la santé lors des discussions associées à la VM auprès d'une clientèle multiculturelle. Méthodes: Huit (8) participants (médecins et infirmières) impliqués dans la PPS ont accepté de participer à une entrevue semi-structurée avec des questions ouvertes et deux scénarios cliniques. Les participants ont été recrutés à l'aide de la méthode d’échantillonnage par réseau (« boule de neige ») de cinq hôpitaux de la région d'Ottawa. Résultats: Trois grands thèmes ont émergé des entrevues: 1) les objectifs de soins à travers les trajectoires de la maladie, 2) le respect des croyances, valeurs et souhaits pour les soins, et 3) le soutien dans la PPS en contexte interculturel. Lors de la PPS, utiliser une approche basée sur les valeurs a été décrite comme une méthode efficace pour interpréter et prendre en compte les diverses croyances et valeurs qui ont une influence sur les décisions liées à la VM. Cependant, les barrières systémiques, organisationnelles et personnelles continuent d'entraver les services associés à la PPS en contexte interculturel dans les établissements de santé.

No description available.

À ce jour, cette thèse n’a pas été déposée. L’Université Clermont Auvergne est donc dans l’impossibilité d’en assurer le traitement, la conservation et la diffusion. / To date, this thesis has not been deposited. The Université Clermont Auvergne is therefore unable to ensure its processing, conservation and dissemination.

Background: Mechanical ventilation and sedation are common in intensive care and can be stressful for the patient as many experience physical and mental complications such as delirium. Nurses in intensive care play an important role in assessing the need for pain relief and sedation. The care environment and communication opportunities are also factors that affect patients' experiences. Aim: The aim of the study was to make patients' experiences of having been mechanically ventilated and/or sedated in an intensive care unit visible. Method: A literature study was chosen to get a picture of the current state of knowledge. Based on a thematic analysis method 15 articles were analyzed. Results: The analysis resulted in the following themes: fear and anxiety with subthemes physical and psychological experiences, security and trust with subthemes environment and communication as well as cognition and memories with subthemes confusion and dreams. Conclusion: It is a difficult experience to be mechanically ventilated and/or sedated in an intensive care unit. Communication difficulties were a prominent experience that affected many patients. Continued research: Continued research is necessary in the subject matter of the study. There is also a need for research on the care environment and communication aids for intensive care patients.  Keywords: Sedation, mechanical ventilation, intensive care and experiences. / Bakgrund: Mekanisk ventilation och sedering är vanligt förekommande inom intensivvården och kan vara påfrestande för patienten då många upplever fysiska och psykiska komplikationer som till exempel delirium. Specialistsjuksköterskor inom intensivvård har en viktig roll vid bedömning av behov av smärtlindring och sedering. Även vårdmiljö och kommunikationsmöjligheter är faktorer som påverkar patienters upplevelser. Syfte: Syftet med studien var att synliggöra patienters upplevelser av att ha varit mekaniskt ventilerade och/eller sederade på en intensivvårdsavdelning. Metod: En litteraturstudie valdes för att få en bild av det aktuella kunskapsläget. Utifrån tematisk analysmetod analyserades 15 artiklar. Resultat: Analysen resulterade i följande teman: rädsla och ångest med subteman fysiska- och psykologiska upplevelser, trygghet och tillit med subteman omgivning och kommunikation samt kognition och minnen med subtema förvirring och drömmar. Slutsats: Det är en svår upplevelse att vara mekaniskt ventilerad och/eller sederad på en intensivvårdsavdelning. Kommunikationssvårigheter var en framträdande upplevelse som påverkade många patienter. Fortsatt forskning: Fortsatt forskning är nödvändig inom ämnet som studien berör. Det finns även behov av forskning kring vårdmiljön samt kommunikationshjälpmedel för intensivvårdspatienter.  Nyckelord: Sedering, mekanisk ventilering, intensivvård och upplevelser.

Critical care patients are often connected to ventilators, to support or replace their breathing. The ventilators deliver a mixture of gas to the patient by applying a specific volume or pressure, and then the patient exhales passively. This thesis is based of the hypothesis that a slower reduction of the expiration pressure could benefit intensive care patients connected to a ventilator. To enable research within the area, a device which can control the expiration is needed. In this thesis project, an expiration valve was controlled to create different pressure patterns during expiration. To facilitate the research and the usage of the expiration control, an application software was created with the purpose to simulate relevant pressure, flow and volume curves. The prototype is an expiration cassette created for the ventilator Servo-i by Maquet Getinge Group. To enable flexibility, the prototype is external and no information is transmitted from or to the ventilator. The prototype has its own flow and pressure sensors. The different pressure patterns which the prototype uses are designed as a linear decrease and as if a constant resistance was added to the system. The user can also create their own pressure pattern, by deciding 20 pressure points in the duration of two seconds. The simulation application was designed with the ability to simulate the same pressure patterns available with the prototype. By using a lung model, it is possible to simulate the ideal pressure, flow and volume in the lungs which can be expected from the chosen expiration control. During the implementation, two different types of lung models were evaluated in order to determine the specificity required. The prototype was tested with settings which were chosen to challenge the performance of the control. Some problematic areas were detected, such as high pressures or large volumes. However, the prototype was judged to perform well enough to be used in animal trials. The lung model used for the simulation application was a simple model of the lung, consisting of a resistor and a capacitor in series. The simulations were compared with the real system with the purpose to get an indication on the difference between theory and reality. The application presents the expected behavior when using the expiration control. However, it should be kept in mind by the user that the application represents a theoretical model.

Background: Patients with severe COVID-19 evolve to acute respiratory distress syndrome (ARDS) and require management in Intensive Care Units (ICU) where they are exposed to immobilization, immunosuppression, malnutrition, nosocomial infections; may develop ICU Acquired Weakness (ICUAW), which increases with the stay and use of mechanical ventilation (MV).There is evidence of the use of different modalities in rehabilitation to mitigate these effects. Goal: To determine the efficacy of a Multimodal Rehabilitation Program (MRP) in reducing the number of days of mechanical ventilation and stay in patients hospitalized for COVID-19 in ICU, as well as to describe its clinical and hospital characteristics. Material and Methods: An quasi-experimental study was designed, with sequential sampling and without blinding. A control and intervention group was formed, with 32 participants each. A Multimodal Rehabilitation Program (MRP) based on four therapeutic modalities was applied and the intervention was quantified through the use of proposed indicators. Results: The variation in days of ICU stay and days of MV were similar in both groups. The Multimodal Rehabilitation Index (iMR) ranged from 0.1 to 2.7 (mean = 1.2, SD = 0.7) and had significance for cut-off points ≤ 0.81 and ≤ 0.94 in mortality (p = 0.02) and Ventilator-free days at 28 days (VFDs-28) (p = 0.01). Conclusions: No statistically significant difference was found in favor of the intervention in terms of days of stay in the ICU and days of MV. Explanatorily, it was reported that iMR was related to (VFDs-28) and mortality in patients with severe COVID-19.