ABSTRACT
Background: The outcome oí' mechanically ventilated patients can be inñuenced byfactors such as the indication of mechanical ventilation (MV) and ventilator parameters. Aim: To describe the characterístics of patients receiving MV in Chilean critical care uníts. Material and methods: Prospective cohort of consecutive adult patients admitted to 19 intensive care uníts ([CU) from 9 Chilean cities who received MV for more than 12 hours between September lst, 2003, and September 28th, 2003. Demographic data, severity of illness, reason for the initiation of MV, ventilation modes and settings as well as weaning strategies were registered at the initiation and then, daily throughout the course of MV for up to 28 days. ¡CU and hospital mortality were recorded. Resulte: Of 588 patients admitted, 156 (26.5 percent) received MV (57 percent males). Mean age and Simplified Acute Physiology Score-II (SAPSII) were 54.6±18years and 40.6±16.4 points respectively The most common indications for MV were acute respiratory failure (71.1 percent) and coma (22.4 percent). Assist-control mode (71.6 percent) and synchronized intermittent mandatory ventilation (SIMV) (14,2 percent) were the most frequently used. T-tube was the main weaning strategy. Mean duration of MV and length of stay in ICU were 7.8±8.7 and 11.1± 14 days respectively. OverallICUmortality was 33.9 percent (53patients). The main factors independently associated with increased mortality were (1) SAPS II ≥ 60 points (Odds Patio (OR), 10.5; 95 percent CI, 1.04-106.85) and (2) plateaupressure ≥ 30 cm Hfi atsecond day (OR, 3.9; 95 percent CI, 1.17-12.97). Conclusions: Conditionspresent at the onsetofMVand ventilator management were similar to those reported in the literature. Magnitude ofmultiorgan dysfunction and high plateau pressures are the most important factors associated with mortality).
Subject(s)
Adult , Female , Humans , Male , Middle Aged , Hospital Mortality , Intensive Care Units/statistics & numerical data , Respiration, Artificial/mortality , Respiratory Insufficiency/therapy , Chile/epidemiology , Epidemiologic Methods , Positive-Pressure Respiration/mortality , Pulmonary Disease, Chronic Obstructive/therapy , Respiratory Distress Syndrome/diagnosis , Respiratory Insufficiency/mortality , Urban Population , Ventilator Weaning/statistics & numerical dataABSTRACT
La comprensión y entendimiento de trastornos del desarrollo que afectan a las estructuras bucales, se logra mediante el conocimiento de su embriología, histología y la revisión de conceptos genéticos actuales. Estos defectos se pueden presentar desde el nacimiento y algunos de ellos siguen patrones de herencia por lo que se debe de ser cuidadoso al diferenciar trastornos hereditarios de los congénitos. La amelogénesis imperfecta es un desarrollo defectuoso del esmalte, representa el clásico trastorno hereditario que afecta a esta estructura, teniendo presente su no incidencia con cualquier otro trastorno de tipo sindromico, metabólico o sistémico. Actualmente se conocen tres tipos de amelogénesis imperfecta; de tipo hipoplásico, hipomaduración e hipocalcificado, las cuales pueden presentar una variedad de hasta once fenotipos, según el tipo de herencia mendeliana. El aspecto del esmalte afectado puede presentar defectos que van desde los imperceptibles hasta los que afectan muy notablemente la apariencia y función dental. Según David Bixler, este tipo de trastornos ocasionan en el paciente severos daños en su desarrollo psicológico y social, llegando a afectar en la mayoría de los casos la autoestima del niño o adolescente. (David Bixler, 1998). El odontólogo debe conocer alternativas de tratamiento que brinden al paciente una solución estética y funcional a este padecimiento. Antiguamente, la única alternativa de solución que se le ofrecía al paciente era la extracción total o parcial de la dentadura afectada y posteriormente la confección de una prótesis total o parcial, situación que además de drástica resultaba traumática para el paciente. (Dominique Bouvier, 1999). La presente investigación bibliografica describe alternativas de tratamiento que proporcionan soluciones estéticas y funcionales a pacientes que presentan amelogénesis imperfecta; revisando materiales y técnicas antiguas de restauración como lo son las amalgamas de plata y coronas de acero cromado, y materiales mas recientemente desarrollados como cementos de ionómero de vidrio, compomeros, resinas composites y la porcelana dental en sus diferentes aplicaciones clínicas (carillas y coronas); que son esencialmente las mejores alternativas para tratar la amelogénesis imperfecta. Es necesario mencionar la ausencia de referencias documentales en cuanto a los tratamientos y/o técnicas específicas para cada tipo de amelogénesis imperfecta, ya que en cada caso es el odontólogo quien debe decidir el material y la técnica adecuada, según las características clínicas y condiciones bajo las que se presenta el paciente.
The understanding and understanding of developmental disorders that affect oral structures is achieved through knowledge of their embryology, histology and the review of current genetic concepts. These defects can occur from birth and some of them follow inheritance patterns, so care must be taken when differentiating inherited from congenital disorders. Amelogenesis imperfecta is a defective development of the enamel, it represents the classic hereditary disorder that affects this structure, taking into account its non-incidence with any other syndromic, metabolic or systemic disorder. Three types of amelogenesis imperfecta are currently known; hypoplastic, hypomaturated and hypocalcified, which can present a variety of up to eleven phenotypes, depending on the type of Mendelian inheritance. The appearance of the affected enamel can present defects that range from the imperceptible to those that affect the appearance and tooth function in a very noticeable way. According to David Bixler, this type of disorder causes serious damage to the psychological and social development of the patient, affecting in most cases the self-esteem of the child or adolescent. (David Bixler, 1998). The dentist must know treatment alternatives that provide the patient with an aesthetic and functional solution to this condition. In the past, the only alternative solution that was offered to the patient was the total or partial extraction of the affected teeth and later the realization of a total or partial prosthesis, a situation that was also drastic for the patient. (Dominique Bouvier, 1999). The present bibliographic research describes treatment alternatives that provide aesthetic and functional solutions to patients with amelogenesis imperfecta; review old restorative materials and techniques such as silver amalgams and chrome steel crowns, and more recently developed materials such as glass ionomer cements, compomers, composite resins and dental porcelain in their different clinical applications (veneers and crowns); which are essentially the best alternatives for the treatment of amelogenesis imperfecta. It is necessary to mention the absence of documentary references on the treatments and / or specific techniques for each type of amelogenesis imperfecta, since in each case it is the dentist who must decide the appropriate material and technique, according to the clinical characteristics and conditions under those presented by the patient.