¿Evita la ventilación no invasiva la intubación del paciente crítico? / Does noninvasive ventilation avoid intubation of the critical patient?

En los últimos años hemos asistido a un incremento del uso de la ventilación no invasiva (VNI) en nuestras Unidades de Cuidados Intensivos (UCI). Su uso está indicado principalmente en casos de insuficiencia respiratoria aguda (IRA), con el objetivo de mejorar la oxigenación arterial, aumentar la ventilación alveolar, disminuir el trabajo respiratorio y evitar la intubación traqueal. Por este motivo, hemos diseñado un estudio con los objetivos de cuantificar el número de pacientes que se han beneficiado de la VNI durante su ingreso, saber el tipo de VNI utilizado en estos pacientes y verificar si la utilización de VNI ha evitado la intubación traqueal. Se realizó un estudio observacional descriptivo retrospectivo, en dos UCI polivalentes de un Hospital terciario, con 80 pacientes portadores de VNI durante su ingreso. Un 65% eran hombres y un 35% mujeres. Edad media: ±61 años (47-75). Estancia media: ±10 días (2-18). El modo de VNI utilizado fue el de doble presión positiva con Nellcor Puritan Bennett 840®. El 46% de los pacientes tratados con VNI precisó intubación, alargando su estancia en UCI ± 6 días. La mayoría de los pacientes tratados solo con VNI mostraban antecedentes de enfermedad pulmonar obstructiva crónica (EPOC) y/o eran portadores de VNI con presión positiva continua (CPAP) domiciliaria. Tras este análisis, se llegó a la conclusión de que el tratamiento con VNI no evitó la intubación traqueal en un número considerable de enfermos (37) diagnosticados de IRA y que la VNI resultó eficaz en enfermos con antecedentes de EPOC y/o CPAP domiciliaria (AU)

In recent years we have witnessed an increased use of noninvasive ventilation (NIV) in our intensive care units (ICUs). Its use is intended mainly in cases of acute respiratory failure (ARF), in order to improve arterial oxygenation, increase alveolar ventilation, decrease work of breathing and avoid intubation. For this reason, we designed a study that has aimed to quantify the number of patients who have benefited from NIV during their admission, to know the type of NIV used in these patients and to determine whether the use of NIV has avoided tracheal intubation. We performed a retrospective, observational and descriptive study in two polyvalent ICUs of a tertiary hospital, with 80 patients with NIV during admission. 65% men and 35% women. Mean age: ±61 years (47-75). Average stay: ±10 days (2-18). NIV mode used was double positive pressure with Nellcor Puritan Bennett® 840. A total of 46% of patients treated with NIV required intubation, thus extending their stay in the ICU by ± 6 days. Most patients treated with NIV had a history of chronic obstructive pulmonary disease (COPD) and / or were carriers of VNI with continuous positive pressure (CPAP) at home. Following this analysis, we concluded that treatment with NIV did not prevent tracheal intubation in a considerable number of patients (37) diagnosed with ARF and the NIV was effective in patients with a history of COPD and / or CPAP at home (AU)

Estudio descriptivo de los pacientes asistidos en una unidad de ictus en la Comunidad de Extremadura / A descriptive study of patients seen in a stroke unit in the Community of Extremadura

Presentar la actividad desarrollada en la Unidad de Ictus (UI) del Complejo Hospitalario de Cáceres (CHC). Describir características sociodemográficas y factores de riesgo cardiovascular de nuestros pacientes. Determinar la situación funcional del paciente al alta. Metodología Estudio descriptivo de 432 pacientes que ingresaron consecutivamente en la UI del CHC entre octubre de 2008 y mayo de 2010. Se analizan y determinan distintas variables de estudio (sociodemográficas, factores de riesgo, de dependencia, etc.).Resultados El paciente tipo seria un varón de 71 años de entorno rural, con hipertensión, dislipemia y diabetes, que presenta un ictus isquémico. Al alta de la UI presenta una dependencia funcional leve y su estancia ha sido de 2,8 días en la UI. Conclusiones Todo paciente que padezca un ictus debería ser atendido y beneficiarse de los cuidados ofrecidos en una UI; estas unidades son modelos organizativos que mejoran la atención al paciente en su fase aguda, lo que redunda en menor mortalidad y discapacidad de estos pacientes (AU)

To describe the activity in the stroke unit (SU) of the Hospital de Caceres as well as the demographic characteristics and cardiovascular risk factors in our patients. To determine the patient's functional status at discharge. Material and methods A descriptive study of 432 patients admitted consecutively in the SU of the Hospital de Caceres from October, 2008 to May, 2010 was carried out. The different study variables (demographic, risk factors, dependence) were determined and analyzed. Results The patient prototype was a 71-year old-man from the rural environment, with hypertension, hyperlipidemia, diabetes, who had an ischemic stroke. On medical discharge from the stroke unit (SU), the patient had a mild functional dependence, after and average stay of 2.8 days in the SU. Conclusions All patients who suffers a stroke should be attended by and benefit from the care provided in a SU. These units are organizational models that improve patient care in the acute phase, this resulting in lower mortality and disability in these patients (AU)

[A descriptive study of patients seen in a stroke unit in the Community of Extremadura]. / Estudio descriptivo de los pacientes asistidos en una unidad de ictus en la Comunidad de Extremadura.

OBJECTIVES: To describe the activity in the stroke unit (SU) of the Hospital de Caceres as well as the demographic characteristics and cardiovascular risk factors in our patients. To determine the patient's functional status at discharge. MATERIAL AND METHODS: A descriptive study of 432 patients admitted consecutively in the SU of the Hospital de Caceres from October, 2008 to May, 2010 was carried out. The different study variables (demographic, risk factors, dependence) were determined and analyzed. RESULTS: The patient prototype was a 71-year old-man from the rural environment, with hypertension, hyperlipidemia, diabetes, who had an ischemic stroke. On medical discharge from the stroke unit (SU), the patient had a mild functional dependence, after and average stay of 2.8 days in the SU. CONCLUSIONS: All patients who suffers a stroke should be attended by and benefit from the care provided in a SU. These units are organizational models that improve patient care in the acute phase, this resulting in lower mortality and disability in these patients.