Ventilación mecánica simultánea con un solo ventilador a varios pacientes / Simultaneous mechanical ventilation of several patients with a single ventilator

Resumen Introducción: La ventilación mecánica simultánea a varios pacientes con un solo ventilador podría disminuir el déficit de esos dispositivos para atender a los enfermos con insuficiencia respiratoria aguda por Covid-19. Objetivo: Comunicar los resultados de un ejercicio de ventilación mecánica con un ventilador en un simulador de pulmón, y simultáneamente en dos y cuatro simuladores. Resultados: No se observaron diferencias estadísticamente significativas entre la presión positiva al final de la espiración, presión media de la vía aérea y presión pico programadas, registradas y medidas, excepto al ventilar simultáneamente cuatro simuladores de pulmón. Conclusiones: La ventilación mecánica simultánea debe ser instaurada por personal médico con experiencia en el procedimiento, restringirse a dos pacientes y ser realizada en la unidad de cuidados intensivos.

Abstract Introduction: Simultaneous mechanical ventilation of several patients with a single ventilator might reduce the deficit of these devices for the care of patients with acute respiratory failure due to Covid-19. Objective: To communicate the results of a mechanical ventilation exercise with a ventilator in a lung simulator, and simultaneously in two and four. Results: No statistically significant differences were observed between positive end-expiratory pressure, mean airway pressure, and programmed, recorded and measured peak pressure, except when simultaneously ventilating four lung simulators. Conclusions: Simultaneous mechanical ventilation should be implemented by medical personnel with experience in the procedure, be restricted to two patients and carried out in the intensive care unit.

Insuficiencia respiratoria aguda en el Síndrome de Guillain Barré

Introducción: el síndrome de Guillain Barré (SGB) frecuentemente afecta a los músculos respiratorios por lo que el ingreso de pacientes afectos de esta patología debe ser a una sala de Terapia Intensiva para monitoreo y asistencia respiratoria mecánica. Objetivo: determinar las características clínicas y complicaciones de los pacientes con SGB ingresados a terapia intensiva. Material y métodos: diseño observacional descriptivo retrospectivo que incluyó a varones y mujeres, mayores de edad, portadores de SGB, ingresados al Departamento de Medicina Interna del Hospital Nacional entre abril 2000 y agosto 2013. Se describen la necesidad de asistencia respiratoria mecánica (ARM), las complicaciones asociadas y el desenlace. Resultados: se incluyeron 35 pacientes, con predominio del sexo masculino (65%). Los eventos desencadentes del SGB más frecuentes fueron las infecciones respiratorias (31%) y las vacunaciones (25%). La insuficiencia respiratoria aguda se presentó en 42%. La neumonía asociada a respirador fue la complicación prevalente y la mortalidad global fue 8,5%.

Introduction: Guillain-Barré syndrome (GBS) frequently affects respiratory muscles and thus, patients with this pathology have to be admitted into Intensive Care Unit for monitoring and mechanical respiratory support. Objective: To determine the clinical characteristics and complications of GBS patients admitted into intensive care. Material and methods: Retrospective descriptive observational design that included adult men and women, carriers of GBS, and admitted into the Department of Internal Medicine of the National Hospital between April, 2000 and August, 2013. The need of mechanical respiratory support (MPS), associated complications and outcome are described. Results: Thirty five patients were included, with majority of men (65%). The most frequent triggering events of GBS were respiratory infections (31%) and vaccinations (25%). Acute respiratory insufficiency was seen in 42% of the cases. Ventilator associated pneumonia was the prevailing complication and global mortality was 8.5%.

Risk factors and prognosis of critically ill cancer patients with postoperative acute respiratory insuffi ciency / 世界急诊医学杂志（英文）

BACKGROUND: This study aimed to investigate the risk factors and outcome of critically ill cancer patients with postoperative acute respiratory insuffi ciency.METHODS: The data of 190 critically ill cancer patients with postoperative acute respiratory insuffi ciency were retrospectively reviewed. The data of 321 patients with no acute respiratory insuffi ciency as controls were also colected. Clinical variables of the fi rst 24 hours after admission to intensive care unit were colected, including age, sex, comorbid disease, type of surgery, admission type, presence of shock, presence of acute kidney injury, presence of acute lung injury/acute respiratory distress syndrome, acute physiologic and chronic health evaluation (APACHE II) score, sepsis-related organ failure assessment (SOFA), and PaO2/FiO2 ratio. Duration of mechanical ventilation, length of intensive care unit stay, intensive care unit death, length of hospitalization, hospital death and one-year survival were calculated.RESULTS: The incidence of acute respiratory insufficiency was 37.2% (190/321). Multivariate logistic analysis showed a history of chronic obstructive pulmonary diseases (P=0.001), surgery-related infection (P=0.004), hypo-volemic shock (P<0.001), and emergency surgery (P=0.018), were independent risk factors of postoperative acute respiratory insufficiency. Compared with the patients without acute respiratory insuffi ciency, the patients with acute respiratory insuffi ciency had a prolonged length of intensive care unit stay (P<0.001), a prolonged length of hospitalization (P=0.006), increased intensive care unit mortality (P=0.001), and hospital mortality (P<0.001). Septic shock was shown to be the only independent prognostic factor of intensive care unit death for the patients with acute respiratory insufficiency (P=0.029, RR: 8.522, 95%CI: 1.243-58.437, B=2.143, SE=0.982, Wald=4.758). Compared with the patients without acute respiratory insufficiency, those with acute respiratory insuffi ciency had a shortened one-year survival rate (78.7% vs. 97.1%,P<0.001).CONCLUSION: A history of chronic obstructive pulmonary diseases, surgery-related infection, hypovolemic shock and emergency surgery were risk factors of critically ill cancer patients with postoperative acute respiratory insuffi ciency. Septic shock was the only independent prognostic factor of intensive care unit death in patients with acute respiratory insufficiency. Compared with patients without acute respiratory insufficiency, those with acute respiratory insufficiency had adverse short-term outcome and a decreased one-year survival rate.

Ventilación mecánica no invasiva y falla respiratoria aguda, variables de éxito y fracaso / Noninvasive ventilation and acute respiratory failure: variables in the success or failure

Introducción: La VMNI se utiliza en una gran variedad de condiciones clínicas, siendo necesario, determinar las variables que condicionan el éxito o fracaso de la VMNI en insuficiencia respiratoria aguda (IRA) tipo I y II, y en falla postextubación (FPEXT). Material y método: A fin de analizar las variables responsables del éxito o fracaso de la VMNI en IRA, y desarrollar un modelo predictivo precoz, del éxito de la VMNI; se analizaron 102 pacientes (edad 56,5 +/- 17,2 años, 64 por ciento hombres, con APACHE II: 14,7 +/-6,5); que utilizaron VMNI, en modalidad Bilevel. Se registraron parámetros demográficos, clínicos y gasométricos, basales y a la hora de inicio de la VMNI. Los datos fueron analizados con regresión lineal, tablas de contigencia, pruebas de normalidad Shapiro Wilks, Cramer Von Mises, Durbin-Watson; razón de verosimilitud, Chi cuadrado y árbol de clasificación. Resultados: La aplicación de la VMNI fue exitosa en 82,4 por ciento de los casos. El éxito no está supeditado al tipo de IRA; puesto que tanto en IRA I y II es >80 por ciento de los casos, con una leve tendencia hacia mejores resultados con VMNI en IRA tipo II (p= 0,93). En FPEXT,y en IRA, se logra evitar la intubación, en el 78 por ciento y 87 por ciento respectivamente. Se observan 6 variables, que mediante un flujograma propuesto, permiten predecir con el 96 por ciento de exactitud, el éxito o fracaso de la VMNI, en ambos tipos de IRA y en FPEXT. Además se aporta con un modelo que permite calcular la FiO2 administrada en equipos de VMNI sin blender de O2 (p = 0.09). Conclusiones: La VMNI es una herramienta eficaz en el manejo precoz de ambos tipos de IRA y FPEXT, evitando la conexión a VMI.No se encontraron variables individuales, que logren predecir el éxito o fracaso de la VMNI de manera significativa en ambos tipos de IRA, como tampoco en FPEXT. Sin embargo, la combinación de 6 variables permite, a través del flujograma propuesto...

Noninvasive ventilation (NIV) is used in a variety of clinical conditions, it is important to determine the variables that decide the success or failure of NIV in Acute Respiratory Failure (ARF) type I and II, and also in failure after extubation (FAE). Material and Methods: The aims of this study were asses with the variables in the success or failure of NIV in ARF, and develop an early prediction model of success or failure in the NIV. We analyzed 102 patients (age 56, 5 +/- 17,2 years; 64 percent men; APACHE II 14,7 +/- 6,5) who used NIV in bilevel mode. We recorded demographic, clinical and blood gas prior and an hour later, to the initiation of the NIV. Data were analyzed whit linear regression, contingency tables, Shapiro Wilks normality tests, Cramer Von Mises, Durbin-Watson, like hood ratio, chi square and classification tree. Results: the application of NIV was successful in 82, 4 percent of cases. The success does not depend of the type of ARF, since both of ARF have a success in >80 percent of cases, with a slight trend towards better outcome whit NIV to treat ARF type II(p=0,93). In FAE and in both ARF, intubations were avoided in 78 percent and 87 percent respectively. Six variables are obtained, through a proposed flow chart, whit 96 percent of accuracy, allows predicting success of NIV, in both types of ARF and in FAE. In addition, we delivered a new model that calculates the FiO2administrated in ventilators without an O2 blender (p =0.09). Conclusion: The noninvasive ventilator assistant is an effective tool in early management of both types of ARF, avoiding the connection to invasive ventilation, or reintubation. There were no isolated variables that are able to predict the success or failure of NIV significantly in both types of ARF, nor in FAE. However, the combination of 6 variables can, through the proposed flow chart, anticipates the evolution of the patients in the NIV.