[Factors helping in the decision to change intubation for tracheotomy in critical patients]. / Estudio de los factores que ayudan a la decisión del paso de intubación a traqueotomía en pacientes críticos.

We carry out a prospective study in order to determine the prognostic factors in the development of injuries of upper airways, and their influence in the decision to perform a tracheotomy. The time to tracheotomy was previously stated, according to the type of patient (neurological or non-neurological). This study includes the clinical data and the upper airways endoscopic exploration of 654 patients with oro-tracheal intubation and mechanical ventilation for more than 48 hours in a 6 year period. Three endoscopic explorations were carried out in the first month (early exploration), with two additional explorations at six and twelve months (late exploration). Using a multivariable statistical study we have analysed the prognostic factors and the risk groups for the development of later injuries of the upper airway of these patients. The later endoscopic exploration of the upper airways has shown injuries in 30 of 280 cases (11%). In this study, the main factor that determines the development of injuries of the upper airway was the time of intubation. The risk groups to develop later lesions of the upper airways include: patients with pathological background, patients with medical admissions, non-neurological patients and patients with serious lesions in the earlier endoscopic exploration. We conclude that it is necessary to state the time to perform a tracheotomy in patients with oro-tracheal intubation. It must be based on the own experience, the patient's clinical condition and the disease that caused hospital admission.

Estudio de los factores que ayudan a la decisión del paso de intubación a traqueotomía en pacientes críticos / Study of the factors that help in the decision making to pass from intubation to tracheotomy in critical patients

Se realiza un análisis prospectivo para determinar los factores favorecedores del desarrollo de lesiones de la vía aérea y su influencia para llevar a cabo una traqueotomía en pacientes críticos. Se definen los tiempos de paso a traqueotomía en función del tipo de paciente (neurológico o no neurológico). Se recogen 654 pacientes consecutivos sometidos durante más de 48 horas a ventilación mecánica a lo largo de un periodo de 6 años. Se establecieron 3 controles endoscópicos durante el primer mes (exploración precoz) y dos posteriores, a los 6 y 12 meses (exploración tardía).Mediante un estudio estadístico multivariado se analizan los factores pronósticos y grupos de riesgo para el desarrollo de lesiones tardías. En la exploración tardía se observaron lesiones en 30/280 casos (11 por ciento). El principal factor influyente en el desarrollo de lesiones fue el tiempo de intubación. El grupo de riesgo de presentar lesiones tardías incluye: presencia de antecedentes patológicos, ingresos médicos, paciente no neurológico y presencia de lesiones graves en el período precoz. Se concluye que es preciso un calendario que defina el momento de pasar a traqueotomía. Este calendario ha de basarse en la propia experiencia, en las condiciones clínicas del paciente y en el tipo de enfermedad que motivó el ingreso. (AU)

We carry out a prospective study in order to determine the prognostic factors in the development of injuries of upper airways, and their influence in the decision to perform a tracheotomy. The time to tracheotomy was previously stated, according to the type of patient (neurological or non-neurological). This study includes the clinical data and the upper airways endoscopic exploration of 654 patients with oro-tracheal intubation and mechanical ventilation for more than 48 hours in a 6 year period. Three endoscopic explorations were carried out in the first month (early exploration), with two additional explorations at six and twelve months (late exploration). Using a multivariable statistical study we have analysed the prognostic factors and the risk groups for the development of later injuries of the upper airway of these patients. The later endoscopic exploration of the upper airways has shown injuries in 30 of 280 cases (11%). In this study, the main factor that determines the development of injuries of the upper airway was the time of intubation. The risk groups to develop later lesions of the upper airways include: patients with pathological background, patients with medical admissions, non-neurological patients and patients with serious lesions in the earlier endoscopic exploration. We conclude that it is necessary to state the time to perform a tracheotomy in patients with oro-tracheal intubation. It must be based on the own experience, the patient's clinical condition and the disease that caused hospital admission (AU)

[Laryngocele: clinical and therapeutic study of 60 cases]. / Laringoceles: estudio clínico y terapéutico de 60 casos.

Sixty patients with laryngocele were diagnosed in the last seven years: 25 of them without previous laryngeal pathology (group A) and the rest 35 with laryngeal or pharyngeal cancer (group B). The laryngocele was unilateral in the majority of the 25 patients of group A (68%). The internal laryngoceles were the most common type (63%). The initial symptom was hoarseness in 56% of these patients and 20% developed, in their evolution, an acute respiratory distress. The diagnosis was clinical in 16 patients and radiological in the rest. Endoscopically marsupialization with laser-CO2 was performed to remove internal laryngoceles. The mixed and external laryngoceles were completely removed via an external cervical approach without the need to perform any thyrotomy. The diagnosis was radiological by CT in the 35 patients of the group B. In 30 of them the CT was performed to evaluate the local extension of the laryngeal or pharyngeal cancer before its treatment. Supraglottic carcinoma was the most common laryngeal tumor (50%). The anatomic relationship between laryngocele and laryngeal cancer was ipsilateral to each other only in 50% of the patients. In the other 5 patients, no laryngocele was found in the radiological study previous to the treatment of the laryngeal or pharyngeal cancer. The diagnosis was made after chemotherapy and/or radiotherapy treatment.