[Development of a quality guarantee system for mechanical ventilation (register in a multi-purpose CCU)]. / Desarrollo de un sistema de garantía de calidad en ventilación mecánica (registro en una UCC polivalente).

OBJECTIVE: 1. Obtaining information about the demographic distribution of patients undergoing long-term mechanical ventilation. 2. Defining our reference standards for mechanical ventilation, length of UCC and complications related to mechanical ventilation (MV), comparable with the international standards. Detailed follow-up of pneumonias associated to mechanical ventilation and incidence of accidental extubation (AE). DESIGN: Prospective, descriptive. Period between July 1998 and December 2000. AREA OF STUDY: Multi-purpose critical care unit (12 beds). INDIVIDUALS UNDER STUDY: Patients hospitalized in the critical care unit with any pathology in need of mechanical ventilation. RESULTS: During the period of study 1058 patients were hospitalized in the critical care unit (CCU), 287 (27%) of which needed mechanical ventilation (MV). 29% of the patients were women. The age and APACHE II were as median (percentile 25 and 75) 68 (57-76) and 26 (20-31) respectively. The reasons that made MV necessary were: acute respiratory failure 70%, intensified acute exacerbation of chronic respiratory failure 11%, coma 18% and neuromuscular illness 1%. The density of average incidence of accidental extubation (AE) was 15.7/1000 days of MV, the AE was associated to a longer duration of MV, longer stay in CCU and in the hospital and a greater incidence of pneumonia associated to MV, but it was not associated to an increment in mortality. The density of incidence of pneumonia associated to MV was 12.6/1000 days of MV, being the germ more frequently responsible the pseudomona aeruginosa.

[Variance of the quality of life one year after leaving the ICU and mechanic ventilation]. / Variación de la calidad de vida al año de alta del ingreso en UCI y ventilación mecánica.

The quality of life is a parameter used as a method to evaluate the social welfare result. It allows us to measure how entering in an ICU and mechanic ventilation (MV) influences the quality of life of patients in relation to their previous basal situation. To do so we have based ourselves on Barthel's functional scale; having the patient/family fill in a questionnaire on entrance to the ICU, one month later and a year after leaving it. The study is done on 135 patients who needed MV. A month after leaving the ICU 80 had survived, a year later we have only been able to interview on the phone 45 patients (4 exitus vs 41 alive), out if the remaining (35) patients we know from their clinical histories that 21 of them were alive one year later, only 3 exitus, and we do not have any further registers of the other 11 patients. The same as other studies have shown, the sick people who have a previous worse quality of life (Barthel < or = 75) are the ones who one month later have lost the most independence to carry out everyday activities (Barthel 45 33), although those who survive a year after have recovered the same level of autonomy they had previous to entering the ICU. Regarding the subjective evaluation of their stay in the unit, 18 patients (43%) have no memory of their stay in the unit, and out of the remaining 23, 17 have good memories and are satisfied with the treatment received by the staff.4 out of the questioned patients declared not wanting to enter the ICU, due to a subjective feeling of worsening in their quality of life (although they all had a Barthel > 70 which is equal to an independent quality of life).Also, a total of 22 patients take more medication than before entering the ICU: 2 1 medicines more per day.

Desarrollo de un sistema de garantía de calidad en ventilación mecánica (registro en una UCC polivalente) / Development of a quality guarantee system for mechanical ventilation (register in a multi-purpose CCU)

Objetivo. 1. Conocer los aspectos demográficos de los pacientes sometidos a ventilación mecánica prolongada. 2. Definir unos estándares de referencia de tiempo de ventilación mecánica, estancia en UCI y complicaciones relacionadas con la ventilación mecánica (VM), comparables con los estándares internacionales. Seguimiento detallado de neumonías asociadas a ventilación mecánica y de incidencia de extubación accidental (EA).Diseño. Prospectivo, descriptivo. Período entre julio de 1998 y diciembre de 2000.Ámbito del estudio. Unidad de Cuidados Críticos polivalente (12 camas).Sujetos de estudio. Pacientes ingresados en la UCC por cualquier patología que precisaron VM. Resultados. Durante el período de estudio ingresaron en la Unidad de Cuidados Críticos (UCC) 1.058 pacientes, de los que 287 (27 per cent) precisaron VM. Un 29 per cent de ellos fueron mujeres. La edad y Apache II fueron como mediana (percentil 25 y percentil 75) 68 (57-76) y 26 (20-31) respectivamente. El motivo de ventilación mecánica fue: insuficiencia respiratoria aguda (IRA) 70 per cent, insuficiencia respiratoria crónica reagudizada (IRCA) 11 per cent, coma 18 per cent y enfermedad neuromuscular 1 per cent. La densidad de incidencia media de EA fue 15,7/1.000 días de VM; la EA se asoció con mayor duración de VM, mayor tiempo de estancia en UCI y en el Hospital y mayor incidencia de neumonía asociada a VM, pero no se asoció con un aumento en la mortalidad. La densidad de incidencia de neumonía asociada a VM fue 12,6/1.000 días de VM, siendo el germen responsable con mayor frecuencia la Pseudomona aeruginosa (AU)