Abstract:: Evidence on the treatment strategies for the child population with critical conditions due to COVID-19 is scarce and lacks consensus. Thus, this study aimed to critically review non-pharmacological respiratory strategies for this population. Original studies were searched in six databases considering predefined inclusion criteria. Other studies and recommendations were also included after a manual search. Oxygen therapy, invasive (IMV) and non-invasive (NIV) ventilation were the most frequent addressed interventions. In general, the original studies cited these strategies, but detailed information on parameters used was not provided. The recommendations provided more detailed data, mainly based on experiences with other acute respiratory syndromes in childhood. In the context of oxygen therapy, the nasal catheter was the most recommended strategy for hypoxemia, followed by the high-flow nasal cannula (HFNC). However, the risks of contamination due to the dispersion of aerosols in the case of the HFNC were pointed out. Lung protective IMV with the use of bacteriological or viral filters was recommended in most documents, and there was great variation about PEEP titration. Alveolar recruitment maneuvers were mentioned in a few recommendations. NIV was not consensual between studies, and when selected, several precautions must be taken to avoid contamination. Airway suctioning with closed-circuit was recommended to reduce aerosol spread. Information on prone positioning and physiotherapy was even more scarce. In conclusion, oxygen therapy seems to be essential in the treatment of hypoxemia. If necessary, IMV should not be delayed, and protective strategies are encouraged for adequate pulmonary ventilation. Information about techniques that are adjuvant to ventilatory support is superficial and require further investigation.
Sistemas computacionais de mapeamento facial e rastreamento visual vêm sendo usados em diversas aplicações de interação humano-computador, como educação, entretenimento, segurança e medicina. Na medicina, esses sistemas podem ser usados para acompanhar evolução de pessoas com limitações de locomoção, micro-expressões, atipicidades da visão e acompanhar recém-nascidos prematuros. Este artigo apresenta uma abordagem computacional para mapear a face de crianças e recém-nascidos, identificar a re- gião dos olhos e rastrear o ponto de visão para auxílio em análise clínica. A proposta se divide em: (i) detec- ção facial por meio de modelos convolutivos para a ob- tenção da malha de posicionamento facial e espacial do indivíduo; (ii) identificação da região do sistema visual do indivíduo; e (iii) rastreamento temporal do ponto de visão com o objetivo de obtenção das trajetórias vi- suais em relação a um protocolo clínico aplicado. Os algoritmos foram desenvolvidos sobre um dataset espe- cificamente elaborado para o projeto em questão, sendo os vídeos coletado em ambiente laboratorial. Os resul- tados experimentais preliminares foram validados em função de localização do sistema visual considerando o dataset secundário de Cambridge, obtendo uma taxa média de acurácia ponderada de 74.21% (acurácia de 98,67%), e assertividade de 88,78% para uma métrica especificamente designada para computar a correspon- dência binária em relação ao padrão-ouro com grau de liberdade de raio ???? = 9. A abordagem proposta demostrou preliminarmente a viabilidade de aplicação clínica como ferramenta de suporte e apoio à tomada de decisão da rotina clínica.
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