RESUMO
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.
Assuntos
Estado Terminal/terapia , Intubação Intratraqueal , Respiração Artificial , Traqueostomia , Traqueotomia , Idoso , Manuseio das Vias Aéreas/métodos , Manuseio das Vias Aéreas/normas , Protocolos Clínicos , Feminino , Humanos , Unidades de Terapia Intensiva , Intubação Intratraqueal/normas , Tempo de Internação , Masculino , Estudos Prospectivos , Traqueostomia/normas , Traqueotomia/normasRESUMO
Given the rareness of cervical schwannomas, they are often mistaken for other kinds of lesions. We present 2 clinical cases, make comments on the clinical-pathological features involved and point out the essential elements that ensure the differential diagnosis of these tumours.
Assuntos
Neoplasias de Cabeça e Pescoço/diagnóstico , Neurilemoma/diagnóstico , Adolescente , Feminino , Humanos , Masculino , Pessoa de Meia-IdadeRESUMO
Leiomyoma is a benign tumor of smooth muscle origin that is rarely found in oral cavity. We report a case of leiomyoblastoma of the tongue. The interest of this lesion is supported by its location and by the difficulty to determine its biological behavior. About 25% of the oral smooth muscle tumors are malignant, and have been reported "leiomyoma" locally invasive.