Marcapasos diafragmático como alternativa a la ventilación mecánica en el paciente con lesión medular cervical / Diaphragmatic pacemaker as an alternative to mechanical ventilation in patients with cervical spinal injury

Objetivo Comprobar que el marcapasos diafragmático es una forma de soporte respiratorio que puede usarse para facilitar la retirada del respirador volumétrico en pacientes con lesión medular cervical y parálisis diafragmática, mediante su comparación con el respirador volumétrico tradicional. Diseño Análisis retrospectivo de una base de datos prospectiva y de tipo caso-control apareado por edad. Ámbito Unidad de Cuidados Intensivos y Unidad de Cuidados Intermedios Respiratorios del Hospital Nacional de Parapléjicos de Toledo. Pacientes Se han recogido los datos de todos los pacientes dados de alta del hospital con soporte respiratorio permanente mediante respirador volumétrico o marcapasos diafragmático con un periodo de seguimiento de 25 años y se han realizado entrevistas personales para valorar la calidad de vida relacionada con la salud. Para las comparaciones estadísticas se han usado tests de comparaciones y de supervivencia. Intervenciones Cuestionario de calidad de vida. Variables de interés Datos demográficos y clínicos, estancia hospitalaria, mortalidad, readaptación familiar y calidad de vida relacionada con la salud. Resultados Hemos examinado las historias clínicas de 101 pacientes, 37 con marcapasos y 64 con un respirador volumétrico. Nuestros resultados muestran tanto una duración del ingreso en UCI y de la hospitalización como una reintegración familiar sin diferencias significativas, con tendencia a una mayor supervivencia en los pacientes con marcapasos (18,18 frente a 9,67 años por el método de Kaplan-Meier, p<0,001), aunque esta diferencia deja de ser estadísticamente significativa (p=0,06) tras controlar (..) (AU)

Objective To verify that the diaphragmatic pacemaker is a form of respiratory support that can be used to replace a volumetric respirator in cervical spinal injury patients with cervical spinal lesion and diaphragmatic paralysis by means of its comparison with the traditional volumetric respirator. Design Retrospective study of a prospective database and age-matched case-control study. Setting Intensive Care Unit and Intermediate Care Respiratory Unit, Paraplegics National Hospital, Toledo (Spain).Patients We collected data on all patients discharged from the Hospital with permanent respiratory support by volumetric respirator or diaphragmatic pacemaker during a follow-up period of 25 years. Personal interviews were conducted to evaluate health-related quality of life. Comparison and survival tests were used for statistical comparisons. Interventions Quality of life questionnaire. Main variables The main variables collected were demographic data, hospital stay, mortality, family reintegration and health-related quality of life. Results We evaluated the clinical records of 101 patients, 37 in the pacemaker-group and 64 in the volumetric respirator-group. Our results show that ICU admission duration and hospitalization as well as family reintegration, without significant differences, with a tendency to greater survival in pacemaker patients (18.18 versus 9.67 years by the Kaplan-Meier method, p<0.001). However, this difference becomes non-significant (p=0.06) after adjustment of the groups by age. Furthermore, better quality of life was found in these same patients with pacemakers in terms of security, communication, sociability, comfort and mobility in the patients. Conclusions Diaphragmatic pacemaker ventilation is an effective alternative to mechanical ventilation with similar efficacy that improve quality of life in patients with severe respiratory failure due to cervical spinal cord injury (AU)

[Diaphragmatic pacemaker as an alternative to mechanical ventilation in patients with cervical spinal injury]. / Marcapasos diafragmático como alternativa a la ventilación mecánica en el paciente con lesión medular cervical.

OBJECTIVE: To verify that the diaphragmatic pacemaker is a form of respiratory support that can be used to replace a volumetric respirator in cervical spinal injury patients with cervical spinal lesion and diaphragmatic paralysis by means of its comparison with the traditional volumetric respirator. DESIGN: Retrospective study of a prospective database and age-matched case-control study. SETTING: Intensive Care Unit and Intermediate Care Respiratory Unit, Paraplegics National Hospital, Toledo (Spain). PATIENTS: We collected data on all patients discharged from the Hospital with permanent respiratory support by volumetric respirator or diaphragmatic pacemaker during a follow-up period of 25 years. Personal interviews were conducted to evaluate health-related quality of life. Comparison and survival tests were used for statistical comparisons. INTERVENTIONS: Quality of life questionnaire. MAIN VARIABLES: The main variables collected were demographic data, hospital stay, mortality, family reintegration and health-related quality of life. RESULTS: We evaluated the clinical records of 101 patients, 37 in the pacemaker-group and 64 in the volumetric respirator-group. Our results show that ICU admission duration and hospitalization as well as family reintegration, without significant differences, with a tendency to greater survival in pacemaker patients (18.18 versus 9.67 years by the Kaplan-Meier method, p<0.001). However, this difference becomes non-significant (p=0.06) after adjustment of the groups by age. Furthermore, better quality of life was found in these same patients with pacemakers in terms of security, communication, sociability, comfort and mobility in the patients. CONCLUSIONS: Diaphragmatic pacemaker ventilation is an effective alternative to mechanical ventilation with similar efficacy that improve quality of life in patients with severe respiratory failure due to cervical spinal cord injury.

[Pleural effusion after spinal fixation surgery in patients with traumatic spinal cord injury]. / Derrame pleural tras cirugía de fijación espinal en pacientes con lesión medular traumática.

The present study was designed with to determine the prevalence of pleural effusion after posterior approach for spinal fixation in patients with traumatic spinal fracture with underlying spinal cord lesion. The study included 20 patients over two years. The postoperative monitoring has been done in the Intensive Care Unit and have been practiced complementary examinations control, including chest x-ray study. The prevalence of pleural effusion was 75%, the time of diagnosis was within the first 48 hours after the operation. The pleural effusion does not preference for either side, and has generally been small claims. Only 4 patients it has been need drainage due to respiratory symptoms restrictive, and the outcome have been favourable in rest of the cases at conservative treatment.

Derrame pleural tras cirugía de fijación espinal en pacientes con lesión medulartraumática / Pleural effusion after spinal fixation surgery in patients with traumatic spinal cord injury

El presente estudio se ha diseñado con la finalidadde determinar la prevalencia del derrame pleural trasla intervención de fijación espinal por vía posterior enpacientes con fractura espinal traumática con lesiónsubyacente de la médula espinal. Se han incluido 20pacientes intervenidos a lo largo de dos años. Todosellos han cursado el postoperatorio en la Unidad de CuidadosIntensivos y se les ha practicado exámenes complementariosde control, que incluye estudio radiológicodel tórax. La prevalencia de derrame pleural ha sidodel 75%. El momento del diagnóstico ha sido dentro delas primeras 48 horas tras la intervención. El derrameno muestra predominio de ninguno de los dos lados yen general ha sido de escasa cuantía. Sólo en 4 casos seha precisado su drenaje por ocasionar sintomatologíarespiratoria restrictiva, y en el resto de los casos la evoluciónha sido favorable con medidas conservadoras (AU)

The present study was designed with to determinethe prevalence of pleural effusion after posterior approachfor spinal fixation in patients with traumatic spinalfracture with underlying spinal cord lesion. The studyincluded 20 patients over two years. The postoperativemonitoring has been done in the Intensive Care Unitand have been practiced complementary examinationscontrol, including chest x-ray study. The prevalence ofpleural effusion was 75%, the time of diagnosis waswithin the first 48 hours after the operation. The pleuraleffusion does not preference for either side, and hasgenerally been small claims. Only 4 patients it has beenneed drainage due to respiratory symptoms restrictive,and the o utcome have been favourable in rest of thecases at conservative treatment (AU)