Incidencia de trastornos deglutorios post-extubación en cuidados intensivos, mediante evaluación fibroscópica / Incidence of Post-extubation Swallowing Disorders at the Critical Care Unit, by means of Fiberoptic Evaluation

Introducción: La Fibroscópica de Trastornos Deglutorios (FEES) es una técnica que permite estudiar la fisiología de la deglución. Puede realizarse junto a la cama del paciente, haciendo esta técnica muy atractiva para realizar en Cuidados Intensivos (UCI), evitando el traslado fuera de la unidad para dicha evaluación. Objetivo: Factibilidad de realizar FEES en la cabecera de la cama en la UCI, y evaluar la incidencia de los trastornos deglutorios en pacientes extubados. Materiales y Métodos: Estudio de cohorte prospectiva, analítico y comparativo en pacientes luego de 24 hs post extubación por un periodo de 6 meses evaluación, incluyéndose todos los pacientes en forma consecutiva, que recibieron ventilación mecánica por un periodo ≥ 48 hs comenzando el reclutamiento desde marzo de 2015. Resultados: Se incluyeron en el protocolo 31 pacientes. La incidencia de los trastornos deglutorios en pacientes extubados que requirieron VM fue del 58% IC 95% (0,407-0,735) con 18 trastornos de 31 casos evaluados. Entre los pacientes con y sin trastornos deglutorios definidos por FEES, las diferencias significativas entre los grupos fueron el tiempo post extubación hasta la realización del FEES, la capacidad de tolerar el FEES en posición de 90° vs 60º, la anormalidad en la escala de Langmore y el movimiento anormal de las cuerdas vocales. La complicación registrada en los dos grupos fue la presencia de saturación de pulso < 90%. Conclusión: Este estudio demuestra que la implementación de FEES, como método de detección de trastornos deglutorios (en la cabecera del paciente) se puede aplicar en forma segura.

Introduction: The Fiberoptic Endoscopic Evaluation of Swallowing (FEES) is a technique that allows the study of the physiology of swallowing. This technique can be applied at the patient's bedside, making it a very attractive choice for the critical care unit (CCU), since it is not necessary to transfer the patient to another place in order to carry out the evaluation. Objective: Feasibility to carry out the FEES at the patient's bedside at the CCU and assess the incidence of swallowing disorders in extubated patients. Materials and Methods: Comparative, prospective, analytical cohort study conducted 24 hours after extubation for a period of 6 months, including consecutively all the patients who received mechanical ventilation for a period ≥ 48 hours. The enrollment began in March, 2015. Results: 31 patients were included in the protocol. The incidence of swallowing disorders in extubated patients who required mechanical ventilation (MV) was 58%, 95% CI [confidence interval] (0.407-0.735) with 18 patients presenting disorders out of 31 evaluated cases. The significant differences between the groups of patients with and without swallowing disorders defined by the FEES were: the post-extubation time until the FEES, the capacity to tolerate the FEES at upright sitting position (90°) vs. semi-upright sitting position (60°), the abnormality of the Langmore scale and the abnormal movement of the vocal cords. The complication registered in both groups was the presence of oxygen saturation < 90%. Conclusion: This study shows that the implementation of the FEES as a method for detecting swallowing disorders (at the patient's bedside) is safe.

Incidence of Post-extubation Swallowing Disorders at the Critical Care Unit, by means of Fiberoptic Evaluation

Introduction: The Fiberoptic Endoscopic Evaluation of Swallowing (FEES) is a technique that allows the study of the physiology of swallowing. This technique can be applied at the patient's bedside, making it a very attractive choice for the critical care unit (CCU), since it is not necessary to transfer the patient to another place in order to carry out the evaluation. Objective: Feasibility to carry out the FEES at the patient's bedside at the CCU and assess the incidence of swallowing disorders in extubated patients. Materials and Methods: Comparative, prospective, analytical cohort study conducted 24 hours after extubation for a period of 6 months, including consecutively all the patients who received mechanical ventilation for a period ≥ 48 hours. The enrollment began in March, 2015. Results: 31 patients were included in the protocol. The incidence of swallowing disorders in extubated patients who required mechanical ventilation (MV) was 58%, 95% CI [confidence interval] (0.407-0.735) with 18 patients presenting disorders out of 31 evaluated cases. The significant differences between the groups of patients with and without swallowing disorders defined by the FEES were: the post-extubation time until the FEES, the capacity to tolerate the FEES at upright sitting position (90°) vs. semi-upright sitting position (60°), the abnormality of the Langmore scale and the abnormal movement of the vocal cords. The complication registered in both groups was the presence of oxygen saturation < 90%. Conclusion: This study shows that the implementation of the FEES as a method for detecting swallowing disorders (at the patient's bedside) is safe

Mortality and morbidity from moderate to severe traumatic brain injury in Argentina.

UNLABELLED: After adopting the Guidelines for the Management of Severe Head Injury, critical care physicians in Argentina reduced the mortality rate of patients with traumatic brain injury (TBI). However, there is no in-hospital or postdischarge rehabilitation services for persons with TBI in Argentina. Thus, severely disabled survivors were being discharged to home without follow-up or long-term care. OBJECTIVES: The objectives of this project were to establish a structure for conducting research about TBI in Argentina, and to conduct a prospective, observational study of outcomes from TBI in hospitals that had adopted the acute care guidelines. The goal was to document outcomes for people treated in a medical system that does not provide TBI rehabilitation. The focus of this report is mortality and morbidity during the acute care and hospital ward treatment of TBI in Argentina. METHODS: We established a data-collection system in 5 hospitals in Argentina, using instruments and protocols developed by the NIDRR-funded TBI Model System program. Data-collection intervals were established to be comparable with intervals used in the TBI Model System program. The Argentine team consists of 11 neurocritical care physicians and 1 project manager/translator. All patient evaluation, data collection and entry, quality control, and local administration were conducted by this group. RESULTS: Over 31 months, 278 patients were entered into the study. Approximately 61% were discharged from acute care directly to home. The in-hospital mortality rate was 31%. Seventy-six percent of expired patients died from secondary complications such as sepsis and pneumonia, and 93% while in the hospital. DISCUSSION: TBI is a major public health concern in Argentina. However, rehabilitation for TBI is not a part of this country's medical system. The greatest proportion of expired patients in the Argentine sample died of secondary complications such as pneumonia or sepsis, which may have been avoided employing basic medical rehabilitation. The next research questions to be addressed in this population should be designed to identify solutions to the immediate need for rehabilitation, including treatment efficacy questions as well as questions about systems for delivering treatments.

Valoración de los criterios de gravedad en la pancreatitis aguda grave / Evaluation of the prognostic criteria on the severe acute pancreatitis

Objetivo: establecer la correlación entre criterios de Ranson, score Apache II y Tomografía axial computada (TAC) con la evaluación clínica en pacientes con pancreatitis aguda grave (PAG). Métodos: se evaluaron restrospectivamente 21 pacientes con diagnóstico de PAG (> 2 criterios pronósticos de Ranson). Todos los pacientes fueron categorizados con score Apache II y criterios pronóstico de Ranson. Se les efectuó TAC abdominal. Se correlacionó estadísticamente Criterios de Ranson Vs. Apache II Vs. TAC y cada uno de ellos con curso clínico y mortalidad. Conclusiones: la presencia de 5 o más criterios pronósticos de Ranson se correlacionó con la mortalidad. La TAC demostró ser el método más sensible en relación al curso clínico y mortalidad (p < 0,05). La evaluación combinada Ranson/TAC en pacientes con PAG permite una mejor valoración pronóstica

Valoración de los criterios de gravedad en la pancreatitis aguda grave / Evaluation of the prognostic criteria on the severe acute pancreatitis

Objetivo: establecer la correlación entre criterios de Ranson, score Apache II y Tomografía axial computada (TAC) con la evaluación clínica en pacientes con pancreatitis aguda grave (PAG). Métodos: se evaluaron restrospectivamente 21 pacientes con diagnóstico de PAG (> 2 criterios pronósticos de Ranson). Todos los pacientes fueron categorizados con score Apache II y criterios pronóstico de Ranson. Se les efectuó TAC abdominal. Se correlacionó estadísticamente Criterios de Ranson Vs. Apache II Vs. TAC y cada uno de ellos con curso clínico y mortalidad. Conclusiones: la presencia de 5 o más criterios pronósticos de Ranson se correlacionó con la mortalidad. La TAC demostró ser el método más sensible en relación al curso clínico y mortalidad (p < 0,05). La evaluación combinada Ranson/TAC en pacientes con PAG permite una mejor valoración pronóstica (AU)