Resultados de un protocolo de manejo sobre la vía aérea artificial en pacientes críticos sometidos a ventilación mecánica / Results of an artificial airway management protocol in critical patients subjected to mechanical ventilation

Objetivo: Conocer los resultados de la implantación de un protocolo de actuación en una unidad de cuidados intensivos (UCI), sobre pacientes críticos que precisan una vía aérea artificial prolongada. Diseño: Estudio de cohorte prospectivo y observacional. Intervención: Se establecieron estrategias de manejo sobre la vía aérea, mediante intubación endotraqueal (IET) o traqueotomía y se elaboraron pautas de actuación sobre el proceso de decanulación. Ámbito: Unidad de Cuidados Intensivos polivalente. Pacientes: Se estudiaron 169 pacientes sometidos a ventilación mecánica (VM); 67 con IET ≥ 10 días de VM y 102 con traqueotomía percutánea (TP) o quirúrgica (TQ). Variables de interés: Estancias UCI y hospitalaria, días de IET y VM, mortalidad, traqueotomía, factores de riesgo anatómicos, complicaciones quirúrgicas, postquirúrgicas y período de decanulación. Resultados: La IET presentó menos días de VM (17 vs. 30 días, p < 0,001), menor estancia en UCI (20 vs. 35 días, p < 0,001) y hospitalaria (34 vs. 51 días, p < 0,001) frente a traqueotomía. Se realizaron más TQ en pacientes con factores de riesgo (47 TP vs. 89% TQ, p < 0,001). La hemorragia leve intraoperatoria fue la complicación más frecuente asociándose a TQ (31 vs. 11%, p = 0,03). La TP se asoció a un menor período con cánula (25 días vs. 34 días, p < 0,04). Conclusiones: Las variantes de actuación del protocolo no presentaron diferencias en cuanto a complicaciones y mortalidad, orientando a su utilidad en el manejo de pacientes de características similares

Objective: To determine the results of the implementation of a protocol in an intensive care unit (ICU) referred to critically ill patients requiring a prolonged artificial airway. Design: A prospective, observational cohort study was carried out. Intervention: Management strategies were established on the airway by endotracheal intubation (ETI) or tracheostomy, and guidelines were developed for action in the decannulation process. Setting: A polyvalent ICU. Patients: We studied 169 patients subjected to mechanical ventilation (MV), 67 with ETI ≥ 10 days of MV and 102 with percutaneous (PT) or surgical tracheostomy (TQ). Variables of interest: ICU and hospital stays, days of ETI and MV, mortality, tracheostomy, anatomical risk factors, surgical complications, and postoperative decannulation period. Results: ETI versus tracheotomy involved fewer days of MV (17 vs. 30 days, p<0.001), a shorter ICU stay (20 vs. 35 days, p<0.001), and a shorter hospital stay (34 vs. 51 days, p<0.001).There were more TQ procedures in patients with risk factors (47% TP vs. 89% TQ, p<0.001). Intraoperative minor bleeding was the most common complication, being associated with TQ (31% vs. 11%, p = 0.03). TP was associated with a shorter cannulationperiod (25 days vs. 34 days, p<0.04). Conclusions: The protocol variants showed no differences in terms of complications and mortality, when orienting application to patients with similar characteristics

[Results of an artificial airway management protocol in critical patients subjected to mechanical ventilation]. / Resultados de un protocolo de manejo sobre la vía aérea artificial en pacientes críticos sometidos a ventilación mecánica.

OBJECTIVE: To determine the results of the implementation of a protocol in an intensive care unit (ICU) referred to critically ill patients requiring a prolonged artificial airway. DESIGN: A prospective, observational cohort study was carried out. INTERVENTION: Management strategies were established on the airway by endotracheal intubation (ETI) or tracheostomy, and guidelines were developed for action in the decannulation process. SETTING: A polyvalent ICU. PATIENTS: We studied 169 patients subjected to mechanical ventilation (MV), 67 with ETI ≥ 10 days of MV and 102 with percutaneous (PT) or surgical tracheostomy (TQ). VARIABLES OF INTEREST: ICU and hospital stays, days of ETI and MV, mortality, tracheostomy, anatomical risk factors, surgical complications, and postoperative decannulation period. RESULTS: ETI versus tracheotomy involved fewer days of MV (17 vs. 30 days, p<0.001), a shorter ICU stay (20 vs. 35 days, p<0.001), and a shorter hospital stay (34 vs. 51 days, p<0.001).There were more TQ procedures in patients with risk factors (47% TP vs. 89% TQ, p<0.001). Intraoperative minor bleeding was the most common complication, being associated with TQ (31% vs. 11%, p = 0.03). TP was associated with a shorter cannulationperiod (25 days vs. 34 days, p<0.04). CONCLUSIONS: The protocol variants showed no differences in terms of complications and mortality, when orienting application to patients with similar characteristics.

[Hearing level and intensive use of mobile phones]. / Nivel auditivo y uso intensivo de teléfonos móviles.

INTRODUCTION: Wide studies and substantial controversies build on utilization of actual mobile phones and appearance of systemic disorders or even tumours, but there is no knowledge about an eventual involvement on early hearing loss. PATIENTS AND METHODS: In a group of three hundred and twenty-three healthy and normoacoustic volunteers who were usual costumers of mobile phones an audiometric evaluation was made at the beginnig of its use and three years later, inquiring about the periods of time per day and year employed on direct contacts with phone. A healthy and normoacoustic control group of non users was studied too. RESULTS: Cases carried out 24.3 +/- 8.2 active contacts, reaching 50.4 +/- 27.8 days of mobile phone employment in three years. Audiometric curve was similar in cases and controls at the beginning of the study. After this follow-up, cases showed an increase on hearing threshold between 1 and 5 dB HL more than controls in speech tones (p<0.001). Moreover, there was a trend to correlate time of phone use to hearing impairment, but this finding did not result statistically significative. CONCLUSIONS: Frequent management of mobile phones in a middle period of time allows to detect a mild hearing loss, but the cause of this disorder keeps unclear.

Nivel auditivo y uso intensivo de teléfonos móviles / Hearing level and intensive use of mobile phones

Introducción: Existen amplios estudios e importantes controversias sobre el empleo de los actuales teléfonos móviles y eventuales afecciones sistémicas o aparición de tumores, pero no se conoce apenas sobre su posible implicación en la generación precoz de hipoacusia. Pacientes y métodos: En 323 voluntarios sanos y normoacúsicos usuarios habituales de telefonía móvil se efectuó evaluación audiométrica al inicio del empleo del aparato y a los tres años del mismo, así como una encuesta sobre el tiempo aproximado de uso diario y anual que efectuaban del sistema. Un grupo control sano y normoacúsico no usuario de telefonía móvil fue igualmente estudiado. Resultados: Los individuos estudiados efectuaron 24,3±8,2 contactos activos entre llamadas realizadas y recibidas, lo que supuso un total de 50,4±27,8 días de empleo del teléfono móvil en tres años. La gráfica audiométrica en casos y controles fue similar al inicio del estudio. En el seguimiento a tres años los casos mostraron una elevación del umbral de audición por vía aérea entre 1 y 5 dB HL más que los controles en las frecuencias conversacionales (p<0,001), aunque no se observó pérdida auditiva. Existió además una tendencia a correlacionar el tiempo de contacto directo con el teléfono y el deterioro en la audición, pero este hallazgo no resultó estadísticamente significativo. Conclusiones: El empleo de telefonía móvil entre usuarios frecuentes a medio plazo permite detectar ligeras pérdidas de audición no observadas en no usuarios, si bien el motivo último de este desorden auditivo no queda demostrado con los datos obtenidos

Introduction: Wide studies and substantial controversies build on utilization of actual mobile phones and appearance of systemic disorders or even tumours, but there is no knowledge about an eventual involvement on early hearing loss. Patients and methods: In a group of three hundred and twenty-three healthy and normoacoustic volunteers who were usual costumers of mobile phones an audiometric evaluation was made at the beginnig of its use and three years later, inquiring about the periods of time per day and year employed on direct contacts with phone. A healthy and normoacoustic control group of non users was studied too. Results: Cases carried out 24.3±8.2 active contacts, reaching 50.4±27.8 days of mobile phone employment in three years. Audiometric curve was similar in cases and controls at the beginning of the study. After this follow-up, cases showed an increase on hearing threshold between 1 and 5 dB HL more than controls in speech tones (p<0.001). Moreover, there was a trend to correlate time of phone use to hearing impairment, but this finding did not result statistically significative. Conclusions: Frequent management of mobile phones in a middle period of time allows to detect a mild hearing loss, but the cause of this disorder keeps unclear