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1.
Med Intensiva ; 36(8): 531-9, 2012 Nov.
Artículo en Inglés, Español | MEDLINE | ID: mdl-22398327

RESUMEN

OBJECTIVE: Variables predicting optimal timing for tracheostomy decannulation remain unknown. We aimed to determine whether classifying patients into two groups according to their indications for tracheostomy could identify variables associated with time to decannulation. DESIGN: A prospective, observational cohort study was carried out. LOCATION: Two medical-surgical ICUs. PATIENTS: We included all patients tracheostomized during ICU stay, excluding patients with do-not-resuscitate orders, tracheostomies for long-term airway control, neuromuscular disease, or neurological damage. Patients were classified into two groups: patients tracheostomized due to prolonged weaning and/or prolonged mechanical ventilation (Group 1), and patients tracheostomized due to low level of consciousness or inability to manage secretions (Group 2). INTERVENTIONS: Patients were weaned and decannulated according to established protocols. MAIN VARIABLES: We recorded the following variables: time to tracheostomy, forced vital capacity, peak flow, suctioning requirements, Glasgow Coma Score (GCS), characteristics of respiratory secretions, and swallowing function. Statistical analyses included Cox-proportional multivariate analysis with time to decannulation as the dependent variable. RESULTS: A total of 227 patients were tracheostomized in the ICUs; of these, 151 were finally included in the study. In the multivariate analysis, time to decannulation in Group 1 was associated with the male gender (HR 1.74 (1.04-2.89), p= 0.03), age>60 years (HR 0.58 (0.36-0.91), p= 0.02), high suctioning frequency (HR 0.81 (0.67-0.97), p= 0.02), low forced vital capacity (HR 0.48 (0.28-0.82), p<0.01), and low peak flow (HR 0.25 (0.14-0.46), p<0.01). In Group 2 time to decannulation was associated to GCS >13 (HR 2.73 (1.51-4.91), p<0.01), high suctioning frequency (HR 0.7 (0.54-0.91), p<0.01), and inadequate swallowing (HR 1.97 (1.11-3.52), p=0.02). CONCLUSION: Variables associated with longer time to decannulation in ICU-tracheostomized patients differ with the indications for tracheostomy.


Asunto(s)
Enfermedad Crítica/clasificación , Traqueostomía , Traqueotomía , Desconexión del Ventilador , Estudios de Cohortes , Femenino , Humanos , Masculino , Persona de Mediana Edad , Pronóstico , Estudios Prospectivos , Factores de Tiempo
3.
Rev Med Univ Navarra ; 31(3): 131-4, 1987.
Artículo en Español | MEDLINE | ID: mdl-3333890

RESUMEN

A cross-over study of a tolmetin-paracetamol ester was performed on 6 healthy females. The low biodisponibility obtained might preclude its therapeutic use.


Asunto(s)
Acetaminofén/farmacocinética , Pirroles/farmacocinética , Tolmetina/farmacocinética , Ensayos Clínicos como Asunto , Evaluación de Medicamentos , Humanos
7.
Med. intensiva (Madr., Ed. impr.) ; 36(8): 531-539, nov. 2012. ilus
Artículo en Español | IBECS (España) | ID: ibc-109931

RESUMEN

Objetivos: No se han podido desarrollar modelos predictores de tiempo de decanulación de pacientes traqueotomizados. El objetivo del estudio fue desarrollar variables asociadas al tiempo empleado en decanular a los pacientes, mediante la clasificación de los pacientes según la indicación de la traqueotomía (TRQ). Diseño: Estudio de cohortes prospectivo observacional. Ámbito: Dos UCI médico-quirúrgicas. Pacientes: Se incluyeron todos los pacientes traqueotomizados en UCI, excluyendo aquellos con órdenes de no resucitación, TRQ crónicas, enfermos neuromusculares o con daño cerebral. Fueron clasificados en 2 grupos: traqueotomizados por ventilación mecánica o destete prolongado (Grupo 1) y pacientes traqueotomizados por disminución del nivel de conciencia o incapacidad para manejar las secreciones respiratorias (Grupo 2). Intervenciones: Se empleó un protocolo de destete y decanulación. Variables de interés principales: Se recogieron entre otras las siguientes variables: tiempo hasta decanulación, capacidad vital y flujo espiratorio máximo, necesidades de aspiración, Glasgow (..) (AU)


Objective: Variables predicting optimal timing for tracheostomy decannulation remain unknown. We aimed to determine whether classifying patients into two groups according to their indications for tracheostomy could identify variables associated with time to decannulation. Design: A prospective, observational cohort study was carried out. Location: Two medical-surgical ICUs. Patients: We included all patients tracheostomized during ICU stay, excluding patients with do-not-resuscitate orders, tracheostomies for long-term airway control, neuromuscular disease, or neurological damage. Patients were classified into two groups: patients tracheostomized due to prolonged weaning and/or prolonged mechanical ventilation (Group 1), and patients tracheostomized due to low level of consciousness or inability to manage secretions (Group 2). Interventions: Patients were weaned and decannulated according to established protocols. Main variables: We recorded the following variables: time to tracheostomy, forced vital capacity, peak flow, suctioning requirements, Glasgow Coma Score (GCS), characteristics of respiratory secretions, and swallowing function. Statistical analyses included (..) (AU)


Asunto(s)
Humanos , Traqueotomía/métodos , /métodos , Respiración Artificial/métodos , Estudios Prospectivos , Factores de Riesgo , Estudios de Cohortes
8.
Br J Cancer ; 69(2): 337-41, 1994 Feb.
Artículo en Inglés | MEDLINE | ID: mdl-8297731

RESUMEN

B-cell high-grade lymphomas are heterogeneous in terms of histology, clinical presentation, treatment response and prognosis. As bcl-2 and p53 gene deregulations are frequently involved in several types of lymphoid malignancies, we aimed our investigation at the study of the relation between bcl-2 and p53 expression and survival probability in a group of 119 patients with B-cell high-grade lymphoma. These were obtained from the Virgen de la Salud Hospital, Toledo, Spain (73 cases), John Radcliffe Hospital, Oxford, UK (31 cases), and the Istituto Nazionale dei Tumori, Milan, Italy (15 cases). The relation between bcl-2 protein expression and survival was small, depending on the primary localisation of the tumour (in lymph node of mucosae), and lacked a significant correlation with overall survival. In contrast with this, p53 expression was related to survival probability in our series, this relation being both significant and independent of histological diagnosis. p53-positive patients showed a sudden decrease in life expectancy in the first months after diagnosis. Multivariant regression analysis confirmed that the only parameters significantly related with survival were extranodal origin, which is associated with a better prognosis, and p53 expression, which indicates a poor prognosis. Simultaneous expression of bcl-2 and p53 was associated with a poorer prognosis than p53 alone. This is particularly significant for large B-cell lymphomas presenting in lymph nodes. The cumulative poor effect of both p53 and bcl-2 in large B-cell lymphomas, which is more significant in nodal tumours, could confirm the existence of a multistep genetic deregulation in non-Hodgkin's lymphoma. This indicates that the genetic mechanisms controlling apoptosis and their disregulation are critical steps in the progression of lymphomas.


Asunto(s)
Linfoma de Células B/genética , Linfoma de Células B/mortalidad , Proteínas Proto-Oncogénicas/análisis , Proteína p53 Supresora de Tumor/análisis , Humanos , Linfoma de Células B/clasificación , Linfoma de Células B/patología , Pronóstico , Proteínas Proto-Oncogénicas c-bcl-2 , Análisis de Supervivencia
10.
Nefrología (Madr.) ; 22(1): 91-91, ene. 2002.
Artículo en Es | IBECS (España) | ID: ibc-19366

RESUMEN

No disponible


Asunto(s)
Humanos , Investigación , Hospitales Públicos , España
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