Mechanical ventilation in Spain, 1998-2016: Changes in the disconnection of mechanical ventilation.

PURPOSE: To evaluate changes in the disconnection of mechanical ventilation in Spain from 1998 to 2016. DESIGN: Post-hoc analysis of four cohort studies. AMBIT: 138 Spanish ICUs. PATIENTS: 2141 patients scheduled extubated. INTERVENTIONS: None. VARIABLES OF INTEREST: Demographics, reason for mechanical ventilation, complications, methods for disconnection, failure on the first attempt at disconnection, duration of weaning, reintubation, post-reintubation tracheotomy, ICU stay and mortality. RESULTS: There was a significant increase (p < 0.001) in the use of gradual reduction of support pressure. The adjusted probability of using the gradual reduction in pressure support versus a spontaneous breathing trial has increased over time, both for the first attempt at disconnection (taking the 1998 study as a reference: odds ratio 0.99 in 2004, 0.57 in 2010 and 2.43 in 2016) and for difficult/prolonged disconnection (taking the 1998 study as a reference: odds ratio 2.29 in 2004, 1.23 in 2010 and 2.54 in 2016). The proportion of patients extubated after the first attempt at disconnection has increased over time. There is a decrease in the ventilation time dedicated to weaning (from 45% in 1998 to 36% in 2016). However, the duration in difficult/prolonged weaning has not decreased (median 3 days in all studies, p = 0.435). CONCLUSIONS: There have been significant changes in the mode of disconnection of mechanical ventilation, with a progressive increase in the use of gradual reduction of pressure support. No relevant changes in outcomes have been observed.

Mechanical ventilation in Spain, 1998-2016: Epidemiology and outcomes. / Ventilación mecánica en España, 1998-2016: epidemiología y desenlaces.

PURPOSE: To evaluate changes in the epidemiology of mechanical ventilation in Spain from 1998 to 2016. DESIGN: A post hoc analysis of four cohort studies was carried out. SETTING: A total of 138 Spanish ICUs. PATIENTS: A sample of 4293 patients requiring invasive mechanical ventilation for more than 12h or noninvasive ventilation for more than 1h. INTERVENTIONS: None. VARIABLES OF INTEREST: Demographic variables, reason for mechanical ventilation, variables related to ventilatory support (ventilation mode, tidal volume, PEEP, airway pressures), complications during mechanical ventilation, duration of mechanical ventilation, ICU stay and ICU mortality. RESULTS: There was an increase in severity (SAPSII: 43 points in 1998 vs. 47 points in 2016), changes in the reason for mechanical ventilation (decrease in chronic obstructive pulmonary disease and acute respiratory failure secondary to trauma, and increase in neurological disease and post-cardiac arrest). There was an increase in noninvasive mechanical ventilation as the first mode of ventilatory support (p<0.001). Volume control ventilation was the most commonly used mode, with increased support pressure and pressure-regulated volume-controlled ventilation. A decrease in tidal volume was observed (9ml/kg actual b.w. in 1998 and 6.6ml/kg in 2016; p<0.001) as well as an increase in PEEP (3cmH2O in 1998 and 6cmH2O in 2016; p<0.001). In-ICU mortality decreased (34% in 1998 and 27% in 2016; p<0.001), without geographical variability (median OR 1.43; p=0.258). CONCLUSIONS: A significant decrease in mortality was observed in patients ventilated in Spanish ICUs. These changes in mortality could be related to modifications in ventilation strategy to minimize ventilator-induced lung injury.

Mechanical ventilation in Spain, 1998-2016: changes in the disconnection of mechanical ventilation. / Ventilación mecánica en España, 1998-2016: cambios en la desconexión de la ventilación mecánica.

PURPOSE: To evaluate changes in the disconnection of mechanical ventilation in Spain from 1998 to 2016. DESIGN: Post-hoc analysis of four cohort studies. AMBIT: 138 Spanish ICUs. PATIENTS: 2141 patients scheduled extubated. INTERVENTIONS: None. VARIABLES OF INTEREST: Demographics, reason for mechanical ventilation, complications, methods for disconnection, failure on the first attempt at disconnection, duration of weaning, reintubation, post-reintubation tracheotomy, ICU stay and mortality. RESULTS: There was a significant increase (p<0.001) in the use of gradual reduction of support pressure. The adjusted probability of using the gradual reduction in pressure support versus a spontaneous breathing trial has increased over time, both for the first attempt at disconnection (taking the 1998 study as a reference: odds ratio 0.99 in 2004, 0.57 in 2010 and 2.43 in 2016) and for difficult/prolonged disconnection (taking the 1998 study as a reference: odds ratio 2.29 in 2004, 1.23 in 2010 and 2.54 in 2016). The proportion of patients extubated after the first attempt at disconnection has increased over time. There is a decrease in the ventilation time dedicated to weaning (from 45% in 1998 to 36% in 2016). However, the duration in difficult/prolonged weaning has not decreased (median 3 days in all studies, p=0.435). CONCLUSIONS: There have been significant changes in the mode of disconnection of mechanical ventilation, with a progressive increase in the use of gradual reduction of pressure support. No relevant changes in outcomes have been observed.

Design of an accurate wireless data logger for vibration analysis with Android interface.

In this work a new accurate wireless data logger using the Android interface was developed to monitor vibrations at low-cost. The new data logger is completely autonomous and extremely reduced in size. This instrument enables data collection wirelessly and the ability to display it on any tablet or smartphone with operating system Android. The prototype allows the monitoring of any industrial system with minimal investment in material and installation costs. The data logger is capable of making 12.8 kSPS enough to sample up to 5 kHz signals. The basic specification of the data logger includes a high resolution 1-axis piezoelectric accelerometer with a working range of ±30 G. In addition to the acceleration measurements, temperature can also be recorded. The data logger was tested during a 6-month period in industrial environments. The details of the specific hardware and software design are described. The proposed technology can be easily transferred to many other areas of industrial monitoring.

[Gait training in incomplete spinal cord injuries with body weight support]. / Entrenamiento de la marcha en lesiones medulares incompletas con soporte del peso corporal.

INTRODUCTION: A spinal cord injury implies the loss of or alteration to the gait pattern. Stimulating the pattern generating centres in the sublesional spinal cord determines the appearance of flexion and extension automatisms that are useful for gait training in patients with spinal cord injuries. These centres can be stimulated using a treadmill and supporting the body weight by means of a harness. AIMS: To be able to trigger spinal cord automatisms and to stimulate pattern generating centres. To determine the value of an electromechanical system for mobilising the lower limbs as a complement to the treadmill and body weight support. To study changes in muscle tone. PATIENTS AND METHODS: A short gait training programming was carried out with ten individuals with incomplete spinal cord injuries who satisfied eligibility-exclusion criteria using a treadmill in association with a body weight support system and an electromechanical system for mobilising the lower limbs. RESULTS AND CONCLUSIONS: Spinal cord flexion and extension automatisms were stimulated and an important improvement in spasticity was achieved. Longer programmes are needed in order to evidence changes in the gait pattern and in muscular balance.

[Mortality and hospital stay adjusted for severity as indicators of effectiveness and efficiency of attention to intensive care unit patients]. / Mortalidad y estancia hospitalaria ajustada por gravedad como indicadores de efectividad y eficiencia de la atención de pacientes en Unidades de Cuidados Intensivos.

OBJECTIVE: To evaluate effectiveness and efficiency of ICU care using the APACHE III model customized for Spain. DESIGN: Prospective, observational, multi-centre cohort study. SETTING: Nine Spanish ICUs. PATIENTS: One thousand two hundred and eleven patients admitted consecutively. Patients under 16 years of age, patients admitted for less than 24 hours, patients admitted for definitive pacemaker implant and ICU readmissions within the same hospital stay were excluded. PRIMARY ENDPOINTS: All the necessary endpoints to calculate the APACHE III score and predicted mortality risk were collected. The Standardized Mortality Ratio (SMR) was calculated. The Actual Weighted Hospital Days (AWHD) was calculated according to the patient's status and patient's location (ward or ICU). The Weighted Hospital Days Predicted (WHDP) was calculated according to the multiple regression model that provided the best explanation of the hospital stay. Later, the Standardized Resource Use Performance Index (SRUPI), computed as AWHD/WHDP, was calculated for each hospital. RESULTS: The SMR was 0.9 (95% CI: 0.82-0.99), SRUPI was greater than 1 in 3 of 9 hospitals, According the SMR and SRUPI only one hospital was qualified as an outlier. CONCLUSIONS; In this study, no relationship was found between quality of care and use of resources. Moreover, this methodology may be a useful tool in order to detect deviations from the standard of care and use of resources, and in this way to lead to the analysis of different causes, the differences among hospitals being taken into account.

[Evaluation of the reproducibility of the data collection for the APACHE II, APACHE III adapted for Spain and the SAPS II in nine intensive care units in Spain]. / Evaluación de la reproducibilidad de la recogida de datos para el APACHE II, APACHE III adaptado para España y SAPS II en 9 Unidades de Cuidados Intensivos en España.

OBJECTIVE: To assess reproducibility in data collection and its influence on the calculation of the severity scoring and mortality risk in APACHE II, APACHE III adapted for Spain and SAPS II. DESIGN: Multicenter, prospective, observational cohort study. SETTING: Nine Spanish Intensive Care Units (ICUs). PATIENTS: 1,211 consecutive patients admitted during the study period were included. Those patients under 16 years of age, those with a stay in the ICU of less than 24 hours, those admitted for scheduled pacemaker implant and those readmitted to the ICU within the same hospital admission were excluded. INTERVENTION: None. ENDPOINTS OF INTEREST: The data needed to calculate the severity and mortality risk scores were collected. A total of 10% of the patients were chosen by simple random sampling and the same data were collected by an independent group of intensive care physicians. Finally, the data obtained by the two groups of intensivists were compared. RESULTS: Significant differences were detected in the acute physiology score (APS) and severity score used for the calculation of APACHE III and SAPS II, and the predicted risk of death calculated for SAPS II. The percentage of agreement on admission diagnosis to the ICU was 50% for both APACHE II and III models. Nonetheless, in most of the patients (76.58% for APACHE II and 79.82% for APACHE III), the difference in the predicted risk of death due to the different assignation of diagnoses on admission to the ICU was less than 10%. CONCLUSIONS: In this study, APS was the most influential factor on the reproducibility of severity scores and risk of death prediction. Admission diagnosis assignment had no significant impact on the reproducibility of the predicted mortality risk.

The flow-volume loop in tetraplegics.

We have studied the FVC and maximum flow-volume loop in 20 tetraplegics and the results have been compared with the predicted normal values. The FVC in sitting position is reduced at approximately half the normal predicted values and is significantly lower than in supine and Trendelenburg. At high lung volumes the flows are reduced at half the normal values. At low lung volumes the reduction is smaller (71.5 per cent).

An institutional outbreak of hepatitis B related to a human biting carrier.

An outbreak of hepatitis B in a residential institution for the mentally retarded was studied. Initially one overt case of hepatitis was noted. A serologic screen of students and employees revealed a total of 12 individuals positive for hepatitis B surface antigen (HBsAg). Subtyping by radioimmunoassay subsequently demonstrated that the population of HBsAg-positive individuals could be subdivided into two groups, based on the HBsAg subtype: adw2 or ayw3. The five individuals with subtype adw2 all were carriers. The ayw3 group, in contrast, were acutely infected except for one carrier with persistent hepatitis B e antigen. Both the ayw3 carrier and several of the acutely infected individuals were aggressive biters. Human biting, a frequent occurrence in the classroom studied, was one probable mode of transmission in this outbreak. The resolution of the outbreak was achieved by rapid screening for HBsAg with subtyping of positive patients and careful observation of the setting for putative modes of transmission.