Estenosis de vena pulmonar tras cirugía de reemplazo valvular / Pulmonary vein stenosis after valve replacement surgery

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Tos ineficaz y técnicas mecánicas de aclaramiento mucociliar / Ineffective cough and mechanical mucociliary clearance techniques

La tos es un mecanismo de defensa fundamental para mantener la vía respiratoria libre de elementos extraños. Cuando la tos es ineficaz, por debilidad muscular o por alteración del normal funcionamiento del sistema mucociliar, se puede dar lugar a situaciones que pongan en riesgo la vida. Cuando un paciente no es capaz de producir tos eficaz es cuando está indicada la aplicación de técnicas que, o bien potencien la tos del paciente, o bien la sustituyan. Actualmente el uso de sistemas mecánicos facilitadores o sustitutivos de la tos es creciente en las unidades de cuidados intensivos, donde con relativa frecuencia encontramos pacientes en esta situación por diversas causas clínicas. Esta revisión se centra en las recomendaciones de práctica clínica actuales con respecto a la indicación y aplicación de la tos asistida mecánica y de la ventilación percutora intrapulmonar (AU)

Cough is a fundamental defense mechanism for keeping the airway free of foreign elements. Life-threatening situations may arise when cough proves ineffective as a result of muscle weakness or altered mucociliary function. When a patient is unable to cough effectively, techniques are required to either reinforce or replace cough capacity. The use of mechanical systems that facilitate or substitute cough function is increasingly common in Intensive Care Units, where it is relatively frequent to find situations of ineffective cough due to different clinical causes. This review examines the current clinical practice recommendations referred to the indication and use of mechanical cough assist and intrapulmonary percussive ventilation systems (AU)

Ineffective cough and mechanical mucociliary clearance techniques. / Tos ineficaz y técnicas mecánicas de aclaramiento mucociliar.

Cough is a fundamental defense mechanism for keeping the airway free of foreign elements. Life-threatening situations may arise when cough proves ineffective as a result of muscle weakness or altered mucociliary function. When a patient is unable to cough effectively, techniques are required to either reinforce or replace cough capacity. The use of mechanical systems that facilitate or substitute cough function is increasingly common in Intensive Care Units, where it is relatively frequent to find situations of ineffective cough due to different clinical causes. This review examines the current clinical practice recommendations referred to the indication and use of mechanical cough assist and intrapulmonary percussive ventilation systems.

Enfermedad de Weston-Hurst en paciente con convulsiones / Weston-Hurst disease in a patient with seizures

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Enseñando soporte vital básico a la población general. Análisis de las intervenciones de los alumnos / Teaching basic life support to the general population. Alumni intervention analysis

OBJETIVOS: Estudiar la tasa de detección e intervención en situaciones de urgencia extrahospitalaria por parte de los alumnos de cursos de soporte vital básico (SVB). Definir variables de los alumnos asociados a una mayor tasa de detección e intervención. Estudio de eficiencia de las intervenciones. DISEÑO: Estudio descriptivo transversal. Ámbito: Comarca del Poniente de Almería. PACIENTES: Alumnos de un plan de formación masiva en SVB a población general «Plan Salvavidas» desarrollado entre 2003 y 2009. Intervención: En 2010 se encuestó a los alumnos del «Plan Salvavidas» sobre si habían presenciado situaciones de urgencia y datos relacionados con dichas situaciones. Variables principales: Tasa de detección de situación de urgencias. Intervención en situaciones de urgencias. Perfil sociodemográfico de intervinientes. RESULTADOS: Tres mil ochocientos sesenta y cuatro alumnos formados fueron llamados por teléfono: obtuvimos respuestas de 1.098, el 63,9% fueron mujeres, la edad media fue 26,61 ± 10,6. Un 11,75% habían presenciado situaciones de urgencia, de media 3 años tras el curso. Un 23,3% de las urgencias fueron paradas cardíacas. Los alumnos intervinieron en un 98% de los casos posibles. La relación de los alumnos con la víctima era inexistente en el 63% de los casos, la mayoría se presenciaron fuera del domicilio. Se asoció a una mayor tasa de detección de situaciones de urgencia: ser trabajador del ámbito sanitario y ser mayor de 18 años. CONCLUSIONES: En nuestra serie la tasa de urgencias extrahospitalarias presenciadas tras los cursos de SVB fue del 11,75%. El intervencionismo fue alto. La población diana más eficiente fueron los trabajadores del ámbito sanitario

OBJECTIVES: The aim of this study was to investigate the rate at which the alumni of basic life support courses witnessed and intervened in out-of-hospital emergency situations, and to identify the variables characterizing those alumni associated with a greater number of witnessing events and interventions. An analysis of the efficiency of the courses was also carried out. DESIGN: A descriptive, cross-sectional study was made. SETTING: A district in the province of Almería (Spain). PATIENTS: Alumni of a mass basic life support training program targeted to the general population «Plan Salvavidas» conducted between 2003-2009. INTERVENTIONS: In 2010 the alumni were administered a telephone survey asking whether they had witnessed an emergency situation since attending the program, with the collection of information related to this emergency situation. Main variables of interest: Rate of out-of-hospital emergencies witnessed by the alumni. Rate of intervention of the alumni in emergency situations. Variables characterizing alumni with a greater likelihood of witnessing an emergency situation. RESULTS: A total of 3,864 trained alumni were contacted by telephone. Of 1,098 respondents, 63.9% were women, and the mean age was 26.61 ± 10.6 years. Of these alumni, 11.75% had witnessed emergency situations, an average of three years after completing the course. Of these emergencies, 23.3% were identified as cardiac arrest. The alumni intervened in 98% of the possible cases. In 63% of the cases, there was no connection between the alumni and the victim. The majority of the emergency situations occurred in the street and in public spaces. A greater likelihood of witnessing an emergency situation was associated with being a healthcare worker and with being over 18 years of age. CONCLUSIONS: The rate of out-of-hospital emergencies witnessed by these alumni after the course was 11.75%. The level of intervention among the alumni was high. The most efficient target population consisted of healthcare workers

Influencia de los factores sociodemográficos en la adquisición de habilidades en soporte vital básico / Influence of sociodemographic factors on the learning of basic life support skills

Objetivos: Evaluar el nivel formativo alcanzado por alumnos de un plan de formación masiva en técnicas de soporte vital básico (SVB) y su relación con factores socioculturales y demográficos. Método: Desde el año 2003 hasta el 2009 se desarrolló un plan de formación masiva en SVB "Plan Salvá Vidas" en el Sureste de Andalucía. Todos los alumnos fueron registrados en una base de datos, que incluía los valores sociodemográficos: edad, género y nivel de estudios, presencia de enfermedades cardiacas en familiares y realización previa de cursos de soporte vital. Los alumnos fueron evaluados según el nivel final de adquisición de conocimientos y habilidades. Resultados: En total se formaron 3.864 alumnos, en 199 cursos. El 63,4% fueron mujeres, la edad media de los alumnos fue 26,1 (11,5) años, el 58,5% de los alumnos sólo había cursado estudios elementales. El 15,1% habían asistido previamente a algún curso relacionado con soporte vital. Un 18,9% de los alumnos tenían un familiar con cardiopatía. El 95,3% superaron los cursos de forma satisfactoria. La edad superior a 50 e inferior a 18 años y un bajo nivel de estudios se correlacionaron con peores resultados docentes (p < 0,001). La realización previa de cursos de soporte vital fue un predictor de mejores resultados (p = 0,011). Tener familiares con cardiopatía no influyó en los resultados (p = 0,118). Conclusión: Los cursos tradicionales de SVB guiados por instructor tienen unos resultados docentes satisfactorios. Las variables sociodemográficas y culturales influyen en sus resultados. Los alumnos mayores de 50 años y menores de 18 obtuvieron peores resultados (AU)

Objectives: To assess the level of skill attained by participants in a large-scale training program in basic life support (BLS) and the relation between achievement and sociodemographic characteristics. Methods: A large-scale BLS training program was implemented in Almeria, in south-eastern Andalusia, Spain, between 2003 and 2009. The following sociodemographic information was recorded for all participants: age, gender, educational level, history of heart disease in relatives, and previous BLS training. The level of achievement (knowledge and skill) was assessed at the end of training. Results: A total of 3864 participants were trained in 199 courses; 63.4% were women, the mean (SD) age was 26.13 (11.47) years, 58.5% had only received elementary school education, 15.1% had received previous BLS training, and 18.9% had a relative with heart disease. Achievement was assessed as satisfactory for 95.3% of the participants. Age over 50 years or under 18 years and a low educational level were correlated with poorer achievement (P<.001). Previous BLS training was a predictor of better results (P=.011). Having a relative with heart disease did not influence achievement (P=.118). Conclusions: Traditional instructor-led BLS training courses give satisfactory results. Sociodemographic characteristics influence achievement in BLS courses. Learners over the age of 50 years or under the age of 18 years achieve poorer results (AU)

[Teaching basic life support to the general population. Alumni intervention analysis]. / Enseñando soporte vital básico a la población general. Análisis de las intervenciones de los alumnos.

OBJECTIVES: The aim of this study was to investigate the rate at which the alumni of basic life support courses witnessed and intervened in out-of-hospital emergency situations, and to identify the variables characterizing those alumni associated with a greater number of witnessing events and interventions. An analysis of the efficiency of the courses was also carried out. DESIGN: A descriptive, cross-sectional study was made. SETTING: A district in the province of Almería (Spain). PATIENTS: Alumni of a mass basic life support training program targeted to the general population «Plan Salvavidas¼ conducted between 2003-2009. INTERVENTIONS: In 2010 the alumni were administered a telephone survey asking whether they had witnessed an emergency situation since attending the program, with the collection of information related to this emergency situation. MAIN VARIABLES OF INTEREST: Rate of out-of-hospital emergencies witnessed by the alumni. Rate of intervention of the alumni in emergency situations. Variables characterizing alumni with a greater likelihood of witnessing an emergency situation. RESULTS: A total of 3,864 trained alumni were contacted by telephone. Of 1,098 respondents, 63.9% were women, and the mean age was 26.61±10.6 years. Of these alumni, 11.75% had witnessed emergency situations, an average of three years after completing the course. Of these emergencies, 23.3% were identified as cardiac arrest. The alumni intervened in 98% of the possible cases. In 63% of the cases, there was no connection between the alumni and the victim. The majority of the emergency situations occurred in the street and in public spaces. A greater likelihood of witnessing an emergency situation was associated with being a healthcare worker and with being over 18 years of age. CONCLUSIONS: The rate of out-of-hospital emergencies witnessed by these alumni after the course was 11.75%. The level of intervention among the alumni was high. The most efficient target population consisted of healthcare workers.

Exploración y abordaje de disfagia secundaria a vía aérea artificial / Exploration and approach to artificial airway dysphagia

El aislamiento de la vía aérea mediante intubación translaríngea o traqueotomía, dificulta, cuando no interrumpe las funciones faríngeas y laríngeas de fonación y deglución; tras retirar el tubo translaríngeo o cánula de traqueotomía, dichas funciones no se recuperan de forma inmediata, observándose con frecuencia disfonía, disfagia y aspiraciones traqueobronquiales. La aspiración de secreciones orofaríngeas, de alimentos, así como de contenido gástrico, pueden dar lugar a infecciones respiratorias nosocomiales, en pacientes frágiles o convalecientes de afecciones severas con un aumento significativo en su morbimortalidad. La incidencia de incompetencia faríngea y laríngea, en pacientes que requieren uso de una vía aérea artificial no está bien determinada. Los estudios realizados hasta el momento sugieren una alta proporción de dichas alteraciones, tanto en pacientes recientemente extubados, como en pacientes traqueotomizados. El conocimiento de los mecanismos fisiopatológicos que condicionan la disfagia en dichos pacientes, junto con las alternativas diagnósticas y terapéuticas centrarán la actual revisión (AU)

Airway isolation by endotracheal intubation or tracheostomy impedes or even interrupts speech and swallowing. Pharyngeal and laryngeal impairment frequently occurs after extubation or de-cannulation, common consequences being dysphonia, dysphagia and the aspiration of oral secretions, food, or fluids. Aspiration often leads to pneumonia and eventually death. Although the literature reports a high frequency of dysphagia following intubation and tracheostomy, the data vary considerably, and the true incidence of oropharyngeal dysphagia following artificial airway isolation remains to be established. We conducted a systematic review of the available evidence, in order to assess oropharyngeal dysphagia physiology, diagnosis and treatment (AU)

[Exploration and approach to artificial airway dysphagia]. / Exploración y abordaje de disfagia secundaria a vía aérea artificial.

Airway isolation by endotracheal intubation or tracheostomy impedes or even interrupts speech and swallowing. Pharyngeal and laryngeal impairment frequently occurs after extubation or de-cannulation, common consequences being dysphonia, dysphagia and the aspiration of oral secretions, food, or fluids. Aspiration often leads to pneumonia and eventually death. Although the literature reports a high frequency of dysphagia following intubation and tracheostomy, the data vary considerably, and the true incidence of oropharyngeal dysphagia following artificial airway isolation remains to be established. We conducted a systematic review of the available evidence, in order to assess oropharyngeal dysphagia physiology, diagnosis and treatment.

Tratamiento de necrólisis epidérmica tóxica con ciclosporina A / Toxic epidermal necrolysis treated with cyclosporin A

El síndrome de Lyell o necrólisis epidérmica tóxica (NET) es una toxicodermia extremadamente grave e infrecuente; se caracteriza por la necrosis y el posterior desprendimiento de la epidermis en grandes áreas cutáneas tras una reacción idiosincrásica a un fármaco. Los pacientes que la padecen presentan idénticas complicaciones fisiopatológicas que los grandes quemados. Tradicionalmente se ha tratado con inmunomoduladores como los corticoides, inmunoglobulinas, ciclofosfamida, talidomida o plasmaférisis, obteniéndose una respuesta variable y enalgunos casos contradictoria.Desde finales de los años noventa, se ha ensayado en series limitadas la ciclosporina A comoinmunomodulador único en pacientes con NET, mejorando resultados en términos de supervivencia respecto a estudios con otros fármacos. En este artículo se presentan 3 casos consecutivos de NET tratados con ciclosporina A (AU)

Lyell’s syndrome or toxic epidermal necrolysis (TEN) is an extremely rare and dangerous severe skin disorder characterized by a high proportion of cutaneous lesions leading tonecrosis and subsequent shedding of the epidermis over large areas of skin after an idiosyncraticreaction triggered by a drug. The patients who suffer it pathophysiologically have similar complications to those seen in major burns.TEN traditionally has been treated with immunomodulators such as glucocorticoids, intravenousgammaglobulin, cyclophosphamide, thalidomide or plasmapheresis. A variable, and sometimes contradictory response, has been obtained in some series.Cyclosporin A has been tested as a single immunomodulator in patients with TEN since the end of the 90 s in a limited number series. The results have improved in regards to survival compared with studies with other drugs.We report three consecutive cases of toxic epidermal necrolysis treated with cyclosporin Ain this article (AU)

Rotura de aorta torácica descendente. Tratamiento endoprotésico / Descending thoracic aortic rupture, endoprosthetic treatment

Resumen La rotura de la aorta, independientemente de su localización y etiología, es unaafección extremadamente grave que conduce a la muerte rápidamente. En el momento actualno hay consenso sobre si el tratamiento endovascular de la rotura de la aorta torácica descendentees superior al tratamiento quirúrgico convencional a medio y largo plazo. En esta serie,de 13 casos, describimos nuestra experiencia y evaluamos los resultados en pacientes tratadosde forma endoprotésica desde enero de 2005 hasta enero de 2009 (AU)

Abstract Aortic rupture, independently of its location and etiology, is an extremely seriouscondition that leads to death rapidly. There is currently no consensus on whether endovasculartreatment of the descending thoracic aortic rupture is superior to conventional surgical repair interms of mid-or long-terms outcome. We describe our experience with 13 patients from January2005 to January 2009 to evaluate the results in patients with descending thoracic aortic ruptureundergoing endoprosthetic management (AU)

[Descending thoracic aortic rupture, endoprosthetic treatment]. / Rotura de aorta torácica descendente. Tratamiento endoprotésico.

Aortic rupture, independently of its location and etiology, is an extremely serious condition that leads to death rapidly. There is currently no consensus on whether endovascular treatment of the descending thoracic aortic rupture is superior to conventional surgical repair in terms of mid-or long-terms outcome. We describe our experience with 13 patients from January 2005 to January 2009 to evaluate the results in patients with descending thoracic aortic rupture undergoing endoprosthetic management.