Tracheal deviation due to hematoma after central venous catheter placement / Desviación traqueal secundaria a hematoma tras colocación de vía central

No disponible

Compliance-guided versus FiO2-driven positive-end expiratory pressure in patients with moderate or severe acute respiratory distress syndrome according to the Berlin definition / Presión positiva al final de la espiración guiada por la complianza versus FiO2 aplicada en pacientes con distrés respiratorio agudo moderado o severo según la definición de Berlín

Objective: To study the effect of setting positive end-expiratory pressure (PEEP) in an individualized manner (based on highest static compliance) compared to setting PEEP according to FiO2 upon mortality at 28 and 90 days, in patients with different severity acute respiratory distress syndrome (ARDS). Setting: A Spanish medical---surgical ICU. Design: A post hoc analysis of a randomized controlled pilot study. Patients: Patients with ARDS. Interventions: Ventilation with low tidal volumes and pressure limitation at 30 cm H2O, randomized in two groups according to the method used to set PEEP: FiO2-guided PEEP group according to FiO2 applied and compliance-guided group according to the highest compliance. Primary variables of interest: Demographic data, risk factors and severity of ARDS, APACHE II and SOFA scores, daily Lung Injury Score, ventilatory measurements, ICU and hospital stay, organ failure and mortality at day 28 and 90 after inclusion. Results: A total of 159 patients with ARDS were evaluated, but just 70 patients were included. Severe ARDS patients showed more organ dysfunction-free days at 28 days (12.83 ± 10.70 versus 3.09 ± 7.23; p = 0.04) and at 90 days (6.73 ± 22.31 vs. 54.17 ± 42.14, p = 0.03), and a trend toward lower 90-days mortality (33.3% vs. 90.9%, p = 0.02), when PEEP was applied according to the best static compliance. Patients with moderate ARDS did not show these effects. Conclusions: In patients with severe ARDS, individualized PEEP selection based on the best static compliance was associated to lower mortality at 90 days, with an increase in organ dysfunction-free days at 28 and 90 days (AU)

Objetivo: Estudiar el efecto de programar la presión positiva al final de la espiración (PEEP) de manera individualizada (basada en la mejor complianza estática) comparada con la programada según la FiO2 sobre la mortalidad a 28 y 90 días, en pacientes con diferente gravedad de síndrome de distrés respiratorio agudo (SDRA). Ámbito: UCI española médico-quirúrgica. Diseño: Análisis post hoc de un estudio piloto controlado y aleatorizado. Pacientes: Pacientes con SDRA. Intervenciones: Ventilación con volúmenes tidales bajos y presión limitada a 30 cmH2O, divididos en función de la manera de programar la PEEP: según la fracción inspirada de oxígeno o la mejor complianza estática pulmonar. Variables de interés principales: Datos demográficos, factores de riesgo y gravedad del SDRA, escalas APACHE II y SOFA, Escala de Daño Pulmonar diaria, parámetros ventilatorios, estancia en UCI y hospitalaria, fracaso orgánico y mortalidad a día 28 y 90. Resultados: Valoramos 159 pacientes con SDRA, de los que se incluyeron 70. En los pacientes con SDRA grave, observamos un mayor número de días sin fracaso multiorgánico a los 28 (12,83 ± 10,70 vs. 3,09 ± 7,23, p = 0,04) y 90 días (6,73 ± 22,31 vs. 54,17 ± 42,14, p = 0,03), y una menor mortalidad a 90 días (33,3% vs. 72,7%, p = 0,16), cuando la PEEP se programaba según la mejor complianza estática. No encontramos dichos efectos en el SDRA moderado. Conclusiones: En pacientes con SDRA grave, programar la PEEP según la mejor complianza estática se asocia a una menor mortalidad a 90 días y a un aumento de los días libres de fracaso multiorgánico a 28 y 90 días (AU)

Compliance-guided versus FiO2-driven positive-end expiratory pressure in patients with moderate or severe acute respiratory distress syndrome according to the Berlin definition.

OBJECTIVE: To study the effect of setting positive end-expiratory pressure (PEEP) in an individualized manner (based on highest static compliance) compared to setting PEEP according to FiO2 upon mortality at 28 and 90 days, in patients with different severity acute respiratory distress syndrome (ARDS). SETTING: A Spanish medical-surgical ICU. DESIGN: A post hoc analysis of a randomized controlled pilot study. PATIENTS: Patients with ARDS. INTERVENTIONS: Ventilation with low tidal volumes and pressure limitation at 30cmH2O, randomized in two groups according to the method used to set PEEP: FiO2-guided PEEP group according to FiO2 applied and compliance-guided group according to the highest compliance. PRIMARY VARIABLES OF INTEREST: Demographic data, risk factors and severity of ARDS, APACHE II and SOFA scores, daily Lung Injury Score, ventilatory measurements, ICU and hospital stay, organ failure and mortality at day 28 and 90 after inclusion. RESULTS: A total of 159 patients with ARDS were evaluated, but just 70 patients were included. Severe ARDS patients showed more organ dysfunction-free days at 28 days (12.83±10.70 versus 3.09±7.23; p=0.04) and at 90 days (6.73±22.31 vs. 54.17±42.14, p=0.03), and a trend toward lower 90-days mortality (33.3% vs. 90.9%, p=0.02), when PEEP was applied according to the best static compliance. Patients with moderate ARDS did not show these effects. CONCLUSIONS: In patients with severe ARDS, individualized PEEP selection based on the best static compliance was associated to lower mortality at 90 days, with an increase in organ dysfunction-free days at 28 and 90 days.