ABSTRACT
En El Salvador la neumonía asociada a ventilación mecánica es la tercera infección más frecuente asociada a la atención sanitaria, con un alto impacto por sus costos de atención. Objetivo. Analizar los factores de riesgo para desarrollar neumonía asociada a ventilación mecánica en hospitales de tercer nivel de El Salvador durante el 2022. Metodología. Estudio de casos y controles, la muestra se calculó para un nivel de confianza del 95%, potencia del 80%, Odds ratio (OR) de 2,5, y con una relación de tres controles por caso. Los criterios de inclusión para casos fueron pacientes ventilados que se diagnosticaron como neumonía durante el 2022 con confirmación bacteriológica por cultivo de secreción respiratoria, los controles fueron pacientes con ventilación mecánica mayor a 48 horas sin neumonía posterior a 72 horas de extubación, la información se obtuvo de los expedientes clínicos. Se utilizó un modelo de regresión logística para determinar los factores de riesgo. Resultados. Se revisaron 206 expedientes, 52 casos y 154 controles, el dato de laboratorio más frecuente fue la leucocitosis con un 78,6% de los casos, y el patógeno aislado con mayor frecuencia fue Acinetobacter baumannii con 27,8% de aislamientos; el sexo masculino (OR: 4,94; IC95%: 1,56-15,66), el trauma (OR: 10,52; IC95%: 2,73-40,59) y los días de intubación (OR: 1,24; IC95%: 1,14-1,36) fueron factores independientes de riesgo estadísticamente significativos. Conclusión. El sexo masculino, el antecedente de trauma y los días de intubación fueron factores de riesgo para neumonía asociada a ventilación mecánica en hospitales de tercer nivel de El Salvador.
In El Salvador ventilator associated pneumonia is the third most frequent health care associated infection, it has a high impact because it raises attention costs. Objective. Analize the risk factor for the development of ventilator associated pneumonia in tertiary care hospitals in El Salvador during 2022. Methodology. It was a case-control study, we calculated the sample with a 95% confidence level, 80% statistical power, Odds ratio (OR) of 2.5 and a 3controls per case ratio. Cases were ventilated patients diagnosed with pneumonia between January and December 2022 who have a confirmed microbiological isolation in a respiratory sample, Controls were patients without pneumonia for at least 72 hours after extubation, the information was obtain from the clinical files. We used a logistic regression model to determine risk factors. Results. We reviewed 206 clinical files, 52 cases and 154 controls, the most frequent sign of infection was leukocytosis, it was present in 78.6% of cases. The most isolated pathogen was Acinetobacter baumannii, reported in 27.8% of cultures. Male sex (OR: 4.94 CI95%:1.56-15.66), history of trauma (OR:10.52 CI95%: 2.73-40.59) and intubation days (OR: 1.24; CI95%: 1.14-1.36) were statistically significant independent risk factors. Conclusion. Male gender, history of trauma and intubation days were risk factors for ventilator associated pneumonia in tertiary care hospitals from El Salvador during 2022
Subject(s)
Pneumonia , Respiration, Artificial , Ventilators, Mechanical , Risk Factors , Hospitals , Cross Infection , El SalvadorABSTRACT
O empilhamento de ar é uma técnica realizada com um "AMBU" que vai te permitir encher todo o pulmão de ar. Essa técnica é muito utilizada por pessoas que não conseguem respirar de forma adequada.
Subject(s)
Humans , Respiration, Artificial/instrumentation , Insufflation , Peak Expiratory Flow Rate , Vital Capacity , Practice Guideline , Cough , Amyotrophic Lateral SclerosisABSTRACT
RESUMEN El propósito del estudio fue describir las características del síndrome inflamatorio multisistémico asociado a COVID-19 (SIM-C) en los primeros tres años de pandemia en niños de un hospital pediátrico del Perú. Se realizó un estudio observacional, descriptivo con datos de 73 pacientes y se describieron las características clínicas, laboratoriales, tratamiento y complicaciones según la ola de la pandemia y si tuvieron shock. La mediana de edad fue 6 años, las manifestaciones gastrointestinales y mucocutáneas fueron frecuentes en las tres olas. El fenotipo similar a enfermedad de Kawasaki se presentó en 34 (46,6%) pacientes y 21 (28,8%) pacientes desarrollaron shock. El tratamiento más usado fue la inmunoglobulina (95,9%), ácido acetil salicílico (94,5%) y corticoide (86,3%). Cinco (7%) pacientes tuvieron aneurisma coronario y 17 (23,3%) ingresaron a la unidad de cuidados intensivos (UCI). Los pacientes con shock tuvieron mayor alteración laboratorial y necesidad de ventilación mecánica. En conclusión, el SIM-C ha disminuido en los primeros tres años de pandemia posiblemente por la vacunación de COVID-19 en niños.
ABSTRACT This study aimed to describe the characteristics of multisystemic inflammatory syndrome associated with COVID-19 (MIS-C) in the first three years of the pandemic in children in a pediatric hospital in Peru. We conducted an observational, descriptive study with data from 73 patients and described the clinical and laboratory characteristics, treatment and complications according to the wave of the pandemic and whether they had shock. The median age was 6 years, gastrointestinal and mucocutaneous manifestations were frequent in the three waves. Kawasaki disease-like phenotype was present in 34 (46.6%) patients and 21 (28.8%) patients developed shock. The most commonly used treatment was immunoglobulin (95.9%), followed by acetylsalicylic acid (94.5%) and corticosteroid (86.3%). Five (7%) patients had coronary aneurysm and 17 (23.3%) were admitted to the intensive care unit (ICU). Patients with shock had greater laboratorial alteration and need for mechanical ventilation. In conclusion, MIS-C has decreased in the first three years of the pandemic, possibly due to COVID-19 vaccination in children.
Subject(s)
Humans , Male , Female , Infant , Child, Preschool , Child , Intensive Care Units, Pediatric , COVID-19 , Mucocutaneous Lymph Node Syndrome , Patients , Respiration, ArtificialABSTRACT
RESUMEN Objetivos. Determinar el requerimiento y tiempo para ventilación mecánica y Unidad de Cuidados Intensivos (UCI), hospitalización y tiempo de hospitalización, muerte y discapacidad de las variantes axonales del Síndrome de Guillain-Barré (SGB) en comparación con la variante aguda desmielinizante en pacientes de todas las edades. Materiales y métodos. Revisión sistemática que incluyó pacientes con SGB; la exposición fueron las variantes axonales y el comparador la polineuropatía desmielinizante inflamatoria aguda (AIDP) los desenlaces fueron el requerimiento y tiempo en ventilación mecánica (VM), requerimiento y tiempo en la UCI, tiempo de hospitalización, discapacidad y muerte. Se utilizó la escala NewCasttle-Ottawa (NOS) para evaluar el riesgo de sesgo. Se realizó un metaanálisis para calcular las diferencias de medias y los riesgos relativos (RR) con sus intervalos de confianza (IC) del 95% utilizando varianzas inversas y modelos de efectos aleatorios. Resultados. De los 3116 artículos encontrados, 46 cumplieron los criterios de selección. El tiempo en VM fue 7,42 días (IC95%: 0,36 a 1,48) y el tiempo de hospitalización fue 3,11 (IC95%: 0,73 a 5,49) días en las variantes axonales. Las variantes axonales tuvieron un RR de 0,47 (IC95%: 0,24 a 0,92) para el requerimiento de VM en adultos, pero en niños fue de 1,68 (IC95%: 1,25 a 2,25). Hubo una alta heterogeneidad estadística. Conclusiones. Las variantes axonales tienen en promedio mayor tiempo de VM y de hospitalización, en total y por subgrupos. Se observó un mayor requerimiento de VM para las variantes axonales en niños; mientras que en los adultos fue menor.
ABSTRACT Objectives. To determine the requirement and time to mechanical ventilation and Intensive Care Unit (ICU), hospitalization and hospitalization time, death and disability of the axonal variants of Guillain-Barré Syndrome (GBS) in comparison with the acute demyelinating variant in patients of all the ages. Materials and methods. The systematic review that included patients with GBS. The exposure variable was the axonal variants and the comparator was acute inflammatory demyelinating polyneuropathy (AIDP). The outcomes were the requirement and time on mechanical ventilation (MV), requirement and time in the ICU, hospitalization time, disability and death. The NewCasttle-Ottawa Scale (NOS) was used to assess risk of bias. A meta-analysis was conducted to calculate mean differences and relative risks (RR) with their 95% confidence intervals (CI) using inverse variances and random effects models. Results. Of the 3116 articles found, 46 met the selection criteria. The time on MV was 7.42 days (95% CI: 0.36 to 1.48) and the hospitalization time was 3.11 (95% CI: 0.73 to 5.49) days for the axonal variants. The axonal variants had a RR of 0.47 (95% CI: 0.24 to 0.92) for the requirement of MV in adults, but it was 1.68 (95% CI: 1.25 to 2.25) in children. There was a high statistical heterogeneity. Conclusions. Axonal variants showed, on average, longer MV and hospitalization time, overall and by subgroups. A high MV requirement was found for axonal variants in children; it was lower for adults.
Subject(s)
Respiration, Artificial , Guillain-Barre Syndrome , Intensive Care Units , Mortality , Disability Evaluation , HospitalizationABSTRACT
La retirada de la ventilación mecánica tiene repercusiones fisiológicas que revelan disfunción diastólica subclínica y/o sobrecarga de líquidos. Actualmente, el péptido natriurético tipo B (BNP) y la prohormona N-terminal BNP (NT-proBNP) son biomarcadores sensibles para determinar la insuficiencia cardíaca. Por lo tanto, los valores de BNP o NT-proBNP pueden implementarse para determinar la disfunción cardíaca y fracaso del destete del ventilador. El objetivo del presente reporte es determinar cuál es la utilidad del péptido natriurético (NT-proBNP) como predictor de falla de weaning en pacientes críticos con asistencia ventilatoria mecánica. Se realizó una búsqueda en bases de datos electrónicas y metabuscadores y se recuperaron un total de 176 estudios primarios y secundarios, de los cuales, tras aplicar criterios de inclusión y exclusión, fueron analizadas en profundidad tres revisiones sistemáticas. Dos de las revisiones anteriormente mencionadas son de moderada, y otra de alta calidad de evidencia, luego de un análisis exhaustivo de las mismas. Las conclusiones son similares en los tres estudios. En los mismos se corrobora que la medición y el cambio de los valores del BNP medidos antes y después de la prueba de respiración espontánea, se asoció a fracaso en el destete del respirador por causa cardiaca, siendo una herramienta potencialmente útil y económica para predecir resultados en weaning.
Weaning from mechanical ventilation has physiological re- percussions that reveal subclinical diastolic dysfunction and/ or fluid overload. Currently, B-type natriuretic peptide (BNP) and N-terminal prohormone BNP (NT-proBNP) are sensitive biomarkers for determining heart failure. Therefore, BNP or NT-proBNP values can be implemented to determine cardiac dysfunction and ventilator weaning failure. The objective of this report is to determine the usefulness of natriuretic peptide (NT-proBNP) as a predictor of weaning failure in critically ill patients with mechanical ventilation assistance. A search was carried out in Electronic Databases and Metasearch engines and a total of 176 primary and secondary studies were recovered, of which, after applying inclusion and exclusion criteria, 3 systematic reviews were analyzed in depth. Two of the aforementioned reviews are of moderate quality, and another of high quality of evidence, after an exhaustive analy- sis of them. The conclusions are similar in the three studies. They corroborate that the measurement and change of BNP values measured before and after the spontaneous breathing test was associated with failure to wean from the respirator due to cardiac causes, being a potentially useful and economical tool to predict results in weaning.
Subject(s)
Natriuretic Peptides , Respiration, Artificial , Ventilator WeaningABSTRACT
La tomografía por impedancia eléctrica (TIE) es una modalidad de monitorización funcional respiratoria por imagen, no invasiva y libre de radiación, que permite visualizar en tiempo real la ventilación pulmonar regional y global en pacientes adultos y pediátricos conectados a Ventilación Mecánica (VM). OBJETIVO: Se describe la utilidad de la TIE en dos pacientes críticos pediátricos, en quienes no fue factible realizar medición de mecánica pulmonar, como herramienta para el ajuste de parámetros ventilatorios. CASOS CLÍNICOS: Se presentan dos pacientes pediátricos de 27 y 11 meses con condiciones clínicas diferentes, conectados a VM, en quienes se utilizó la TIE como método de monitoreo de la distribución pulmonar y titulación de la presión positiva al final de la espiración (PEEP) óptima, con el objetivo de obtener una ventilación pulmonar más homogénea. Se presentan mediciones funcionales con diferentes niveles de PEEP y valores de distribución en las distintas regiones de interés (ROI), además de un flujograma de situaciones en las que la TIE podría resultar útil para el ajuste ventilatorio. CONCLUSIÓN: La información funcional proporcionada por la TIE, permitió monitorizar de forma dinámica la VM y optimizar los parámetros ventilatorios, facilitando la implementación de estrategias de protección pulmonar en ambos pacientes, imposibilitados de realizar una medición estática de la mecánica respiratoria.
The Electrical Impedance Tomography (EIT) is a non-invasive and radiation-free respiratory functional imaging monitoring modality that allows real-time visualization of regional and global lung ventilation in adult and pediatric patients connected to mechanical ventilation (MV). OBJECTIVE: This paper describes the utility of EIT in two critical pediatric patients for whom measuring pulmonary mechanics was not feasible. EIT is used as a tool for adjusting ventilatory parameters. CLINICAL CASES: Two pediatric patients aged 27 and 11 months, with different clinical conditions, connected to MV are presented. EIT was used to monitor lung distribution and titrate the optimal Positive End-Expiratory Pressure (PEEP), to achieve more homogeneous lung ventilation. Functional measurements are presented with different PEEP levels and distribution values in different regions of interest (ROI), along with a flowchart illustrating situations where EIT could be useful for ventilatory adjustment. CONCLUSION: The functional information provided by EIT, allowed dynamic monitoring of MV, optimizing ventilatory parameters and facilitating the implementation of lung protective strategies in both patients, unable to undergo static respiratory mechanics measurements.
Subject(s)
Humans , Male , Infant , Child, Preschool , Respiration, Artificial/methods , Respiratory Function Tests , Tomography, X-Ray Computed/methods , Electric Impedance , Positive-Pressure Respiration , Critical Care , Monitoring, PhysiologicABSTRACT
Introdução: a Pneumonia Associada à Ventilação Mecânica é a mais importante e comum infecção que acomete os pacientes em ventilação mecânica. Além disso, é considerada um grave problema de saúde hospitalar, com preocupantestaxas de morbimortalidade.Objetivo: investigar na literatura quais as principais ações de enfermagem para a prevenção da Pneumonia Associada à Ventilação Mecânica. Metodologia:trata-se de um estudo do tipo revisão integrativa da literatura. Após utilizar a estratégia PICO, definiu-se a seguinte pergunta norteadora: "Quais as principais intervenções de enfermagem para a prevenção da Pneumonia Associada à Ventilação Mecânica?". Com a leitura e aplicação dos critérios de seleção, foram utilizados nove artigos. Resultados:as principais intervenções de enfermagem descritas foram elevação da cabeceira entre 30-45 graus, manter pressão do cuff entre 20 e 30 cmH2O, higienização oral com clorexidina 0,12%, higienização das mãos, aspiração de secreções e interrupção diária da sedação. Com relação à adesão dos profissionais, a maioria das intervenções atingiram de 50% a 70% de adesão.Conclusão:as principais medidas preventivas constantes na literatura são utilizadas na prática clínica pelos enfermeiros, e estes demonstram boa adesão sobre os cuidados imprescindíveis para a prevenção da Pneumonia Associada à Ventilação Mecânica (AU).
Introduction:Ventilator-AssociatedPneumoniais the most important and common infection that affects patients on mechanical ventilation. Furthermore, it is considered a serious hospital health problem,with worrying morbidity and mortality rates.Objective:to investigate in the literature which are the main nursing actions for the prevention of Ventilator-Associated Pneumonia. Methodology:this is an integrative literature review study. After using the PICO strategy, the following guiding questionwas defined: "What are the main nursing interventions for preventingVentilator-Associated Pneumonia?". After reading and applying the selection criteria, nine articles were used. Results:the main nursing interventions described were elevation of the headboardbetween 30-45 degrees, maintaining cuff pressure between 20 and 30 cmH2O, oral hygiene with 0.12%chlorhexidine, hand hygiene, suctionof secretions and daily interruption of sedation. Regarding professional adherence, most interventions reached 50% to 70% adherence. Conclusion:the main preventive measures listed in the literature are used in clinical practice by nurses,and they demonstrate good adherence to essential care for the prevention of Ventilator-Associated Pneumonia (AU).
Introducción:la Neumonía Asociada a Ventilación Mecánica es la infección más importante y común que afecta a los pacientes que recibenventilación mecánica. Asimismo, se considera un grave problema de salud hospitalaria,con preocupantes tasas de morbimortalidad.Objetivo: investigar en la literatura cuáles son las principales acciones de enfermería para la prevención de la Neumonía Asociada a Ventilación Mecánica. Metodología:se trata de un estudio de revisión integrativade la literatura. Después de utilizar la estrategia PICO, se definió la siguiente pregunta orientadora: "¿Cuáles son las principales intervenciones de enfermería para la prevención de la Neumonía Asociada a Ventilación Mecánica?".Luegode la lectura y aplicación de los criterios de selección, se utilizaron nueve artículos. Resultados:las principales intervenciones de enfermería descritas fueron elevarla cabeceraentre 30-45 grados, mantenerla presión del manguito entre 20 y 30 cmH2O, higiene bucal conclorhexidina al 0,12%, higiene de manos, aspiración de secreciones e interrupción diaria de la sedación.En cuanto a la adherencia profesional, la mayoría de las intervenciones alcanzaron entre un 50% y un70% de adherencia. Conclusión:las principales medidas preventivas contenidas en la literatura son utilizadas en la práctica clínica por los enfermeros,y muestran una buena adherencia a los cuidados esenciales para la prevención de la Neumonía Asociada a Ventilación Mecánica (AU).
Subject(s)
Humans , Primary Nursing , Ventilation , Pneumonia, Ventilator-Associated/prevention & control , Nursing Care , Respiration, Artificial , Delivery of Health CareABSTRACT
Introducción: En diciembre de 2019, se detectó un brote de enfermedad por un nuevo coronavirus que evolucionó en pandemia con severa morbilidad respiratoria y mortali- dad. Los sistemas sanitarios debieron enfrentar una cantidad inesperada de pacientes con insuficiencia respiratoria. En Argentina, las medidas de cuarentena y control sani - tario retrasaron el primer pico de la pandemia y ofrecieron tiempo para preparar el sis- tema de salud con infraestructura, personal y protocolos basados en la mejor evidencia disponible en el momento. En una institución de tercer nivel de Neuquén, Argentina, se desarrolló un protocolo de atención para enfrentar la pandemia adaptado con la evo- lución de la mejor evidencia y evaluaciones periódicas de la mortalidad hospitalaria. Métodos: Estudio de cohorte observacional para evaluar la evolución de pacientes con COVID-19 con los protocolos asistenciales por la mortalidad hospitalaria global y al día 28 en la Clínica Pasteur de Neuquén en 2020. Resultados: Este informe describe los 501 pacientes diagnosticados hasta el 31 de di- ciembre de 2020. La mortalidad general fue del 16,6% (83/501) y del 12,2% (61/501) al día 28 de admisión. En los 139 (27,7%) pacientes con ventilación mecánica, la mortali- dad general y a los 28 días fue de 37,4% (52/139) y 28,1% (38/139) fallecieron, respec- tivamente. Los factores de riesgo identificados fueron edad, comorbilidades y altos re- querimientos de oxígeno al ingreso. Conclusión: La mortalidad observada en los pacientes hospitalizados en nuestra insti- tución en la primera ola de la pandemia COVID-19 fue similar a los informes internacio- nales y menor que la publicada en Argentina para el mismo período.
Introduction: In December 2019, an outbreak of disease due to a new coronavirus was detected that evolved into a pandemic with severe respiratory morbidity and mortality. Health systems had to face an unexpected number of patients with respiratory failure. In Argentina, quarantine and health control measures delayed the first peak of the pan - demic and offered time to prepare the health system with infrastructure, personnel and protocols based on the best evidence available at the time. In a third level institution of Neuquén, Argentina, a care protocol was developed to confront the pandemic adapted by evolving best evidence and periodic evaluations of hospital mortality. Methods: Observational cohort study to evaluate the evolution of patients hospitalized for COVID-19 with care protocols in terms of overall hospital mortality and at day 28 at the Pasteur Clinic in Neuquén in 2020. Results: This report describes the 501 patients diagnosed until December 31, 2020. Mortality was 16.6% (83/501) and 12.2% (61/501) on day 28 of admission. Among the 139 (27.7%) patients with mechanical ventilation, overall mortality and at 28 days it was 37.4% (52/139) and 28.1% (38/139), respectively. The risk factors identified were age, comorbidities and high oxygen requirements on admission. Conclusion: The mortality observed in patients hospitalized in our institution during the first wave of COVID-19 pandemic was similar to international reports and lower than other publications in Argentina for the same period.
Subject(s)
Humans , Male , Female , Middle Aged , Aged , Respiration, Artificial , SARS-CoV-2 , COVID-19/mortality , Oxygen Inhalation Therapy , Argentina/epidemiology , Tertiary Healthcare , Comorbidity , Risk Factors , Hospital Mortality , Pandemics/statistics & numerical dataABSTRACT
Introducción: La neumonía por COVID-19 puede presentarse con dos patrones radio-lógicos: daño alveolar difuso o neumonía organizativa. Estos patrones tienen diferente evolución y pronóstico en pacientes sin infección por COVID-19. Nuestro objetivo fue evaluar la prevalencia del patrón radiológico de neumonía organizativa y su asociación con los desenlaces clínicos.Métodos: Se realizó un estudio de cohorte retrospectivo que incluyó a pacientes adultos hospitalizados por COVID-19 grave/crítica a los que se les realizó una tomografía computarizada de tórax en los 21 días posteriores al diagnóstico. Los patrones radiológicos fueron revisados y clasificados por dos radiólogos expertos. Resultados: De los 80 pacientes incluidos, el 89% (n=71) presentaron un patrón compatible con neumonía organizativa. Los principales hallazgos radiológicos fueron la distribución multilobar (98,7%) y bilateral (97,6%) con opacidades en vidrio esmerilado (97,6%). El 44% (n=33) de los sujetos requirió ingreso en cuidados intensivos, de los cuales el 24% (n=19) recibió ventilación mecánica. La presencia de neumonía organizativa se asoció de forma independiente con una disminución de las probabilidades de ventilación mecánica o muerte (Odds ratio 0,14; intervalo de confianza del 95%: 0,02 - 0,96; valor de p 0,045) en un modelo multivariado que incluía la edad, el sexo, el IMC y la afectación pulmonar en la TC.Conclusiones: Un patrón radiológico de neumonía organizativa es altamente prevalen-te en pacientes con COVID-19 grave/crítico y se asocia con mejores resultados clínico
Introduction: COVID-19 pneumonia can present with two distinct radiologic patterns: diffuse alveolar damage or organizing pneumonia. These patterns have been linked to different outcomes in non-COVID-19 settings. We sought to assess the prevalence of organizing pneumonia radiologic pattern and its association with clinical outcomes. Methods: We performed a retrospective cohort study including adult patients hospita- lized for severe/critical COVID-19 who underwent chest computed tomography within 21 days of diagnosis. Radiologic patterns were reviewed and classified by two expert radiologists. Results: Among 80 patients included, 89% (n=71) presented a pattern consistent with organizing pneumonia. The main radiologic findings were multilobar (98.7%) and bilateral (97.6%) distribution with ground glass opacities (97.6%). Intensive care admission was required for 44% (n=33) of subjects, of which 24% (n=19) received mechanical ventilation. The presence of organizing pneumonia was independently associated with a decreased odds of mechanical ventilation or death (Odds ratio 0.14; 95% confidence interval 0.02 - 0.96; p value 0.045) in a multivariate model including age, gender, BMI and lung involvement on CT. Conclusion: A radiologic pattern of organizing pneumonia is highly prevalent in patients with severe/critical COVID-19 and is associated with improved clinical outcomes.
Subject(s)
Humans , Male , Female , Middle Aged , Aged , Aged, 80 and over , Pneumonia/diagnostic imaging , SARS-CoV-2 , COVID-19/epidemiology , Argentina/epidemiology , Respiration, Artificial , Comorbidity , Clinical Diagnosis , Polymerase Chain Reaction/methods , Prevalence , Cohort Studies , Critical Illness , COVID-19 Serological TestingABSTRACT
Introducción: SARS-CoV-2 ha causado millones de muertes a nivel global desde su primer caso reportado en China. En Guatemala existen pocos estudios que describan los factores pronósticos. Nuestro objetivo fue determinar los factores asociados de mortalidad a 30 días en pacientes con neumonía (Nm) por SARS-CoV-2 y construir un modelo predictor. Material y Métodos: Estudio retrospectivo en 144 sujetos en el Hospital Roosevelt de marzo a diciembre 2020 con criterios de Nm por SARS-CoV-2. Se revisó el expediente médico para datos clínicos y de laboratorio desde ingreso hasta alta hospitalaria o muerte. Resultados: Se evaluaron 105 hombres y 39 mujeres con media de edad 53 años. El 47% tenía comorbilidades como diabetes mellitus 2 e hipertensión arterial sistémica. Promedio de días de hospitalización: 13. Cuadros leves a moderados de Síndrome de Distrés Respiratorio Agudo (SDRA): 92%. Se indicó ventilación mecánica invasiva (VMI) a 46 pacientes. La mortalidad general fue 35%. Factores asociados a mortalidad a 30 días: edad ≥50 años, inicio de síntomas ≥7 días, SDRA severo, radio NL >4,4, recibir VMI, alteración en LDH y procalcitonina. Nuestro modelo mostró que los mejores predictores de mortalidad eran alteración en procalcitonina (OR: 4,45), recibir VMI (OR: 112) y días de estancia hospitalaria (OR: 1,12) con precisión de 91,5% y área bajo la curva de 94,4%. Conclusiones: Los factores pronósticos de mortalidad en pacientes guatemaltecos con Nm por SARS-CoV-2 son múltiples e incluyen rasgos demográficos, clínicos y serológicos; identificarlos y contar con un modelo pronóstico ayudará a brindar atención médica de precisión.
Introduction: SARS-CoV-2 has caused millions of deaths globally since its first case was reported in China. In Guatemala, few studies describe prognostic factors. Our objective was to determine the factors associated with 30 day mortality in patients with Pneumonia (Nm) due to SARS-CoV-2 and to build a predictor model. Material and Methods: Retrospective study in 144 subjects at Roosevelt Hospital from March to December 2020 with Nm criteria for SARS-CoV-2. The medical record was rviewed, obtaining clinical and laboratory data from admission to hospital discharge or death. Results: 105 men and 39 women with an average age of 53 years were evaluated. 47% had comorbidities, with type 2 diabetes mellitus and systemic arterial hypertension being common. The average number of days of hospitalization was 13. 92% had mild to moderate acute respiratory distress syndrome (ARDS). Invasive mechanical ventila-tion (IMV) was indicated for 46 patients. Overall mortality was 35%. The factors asso-ciated with 30-day mortality were age ≥50 years, the onset of symptoms ≥7 days, severe ARDS, N/L ratio >4.4, receiving IMV, alterations in LDH, and procalcitonin. Our model showed that the best predictors of mortality were altered procalcitonin (OR: 4.45), receiving IMV (OR: 112), and days of hospital stay (OR: 1.12) with precision of 91.5% and area under the curve of 94.4%. Conclusions: The prognostic factors of mortality in Guatemalan patients with Nm due to SARS-CoV-2 are multiple and include demographic, clinical and serological features; identifying them and having a prognostic model will help provide precision medical care.
Subject(s)
Humans , Male , Female , Adult , Middle Aged , Aged , Pneumonia/mortality , Prognosis , SARS-CoV-2 , COVID-19/epidemiology , Oxygen Inhalation Therapy , Respiration, Artificial , Respiratory Distress Syndrome, Newborn/mortality , Comorbidity , Polymerase Chain Reaction , Ultrasonography , Age Factors , Guatemala/epidemiologyABSTRACT
La terapia de alto flujo se ha popularizado durante los últimos años, basada en sus efectos fisiológicos, la entrega de una fracción inspirada de oxígeno segura y estable, sumada al flujo calefaccionado y humidificado, lo que hizo posible su utilización en distintos escenarios. Sin embargo, los estudios que muestran estos beneficios y efectos se han realizado, principalmente, con el empleo de una cánula nasal; mientras que las características de esta terapia en los pacientes traqueostomizados no se ha desarrollado suficientemente. Proponemos aquí una revisión narrativa con las características más salientes de la terapia de alto flujo en este subgrupo de pacientes.
High-flow therapy has become popular in recent years, based on its physiological effects, the delivery of a safe and stable inspired fraction of oxygen, combined with heated and humidified flow, which made its use possible in different scenarios. However, studies demonstrating these benefits and effects have been mainly conducted using a nasal cannula, while the characteristics of this therapy in tracheostomized patients have not been sufficiently developed. We propose a narrative review highlighting the most relevant characteristics of high-flow therapy in this subgroup of patients.
Subject(s)
Humans , Male , Female , Respiratory Therapy/methods , Tracheostomy/statistics & numerical data , Respiration, Artificial , Review , Critical Care , CannulaABSTRACT
Objetivo: Descrever os parâmetros validados por enfermeiros relacionando com a sua prática assistencial na monitorização de pacientes críticos sob ventilação mecânica. Métodos: Estudo descritivo-exploratório, de abordagem quantitativa, cujos dados foram discutidos à luz da Resolução Conselho Federal de Enfermagem n. 639/2020 e de parâmetros clínicos obtidos validados por enfermeiros intensivistas. Resultados: Os parâmetros validados foram discutidos em termos de sua aplicabilidade clínica para o alcance da competência monitorização respiratória, um dos itens presentes na referida resolução como privativa do enfermeiro. Criou-se um quadro com os parâmetros gerais para a monitorização respiratória/ventilatória por enfermeiros, com alvo clínico e local de obtenção do parâmetro no ventilador mecânica, para colaborar com a sua usabilidade. Conclusão: Apresentou-se a aplicabilidade de parâmetros validados por enfermeiros na assistência aos pacientes sob ventilação mecânica. Pondera-se sua contribuição para maior qualidade na assistência, melhores desfechos clínicos, assim como, evitar complicações associadas à ventilação mecânica. (AU)
Objective: To describe the respiratory/ventilatory parameters validated by nurses relating to their care practice in critical patients on mechanical ventilation. Methods: Descriptive-exploratory study with quantitative approach, whose data were discussed based on COFEN Resolution 639/2020 and clinical parameters obtained validated by critical care nurses. Results: The validated parameters were discussed in terms of clinical applicability for achieving the competence "respiratory monitoring", one of the items present in the aforementioned resolution as private nurse care. A framework was created with the general parameters for respiratory/ventilatory monitoring by nurses, with clinical target and location of obtaining the parameter on the mechanical ventilator, to collaborate with its usability. Conclusion: The applicability of parameters validated by nurses in care of mechanically ventilated patients was presented. Its contribution to better quality care and clinical outcomes, as well as avoiding complications associated with mechanical ventilation. (AU)
Objetivo: describir los parámetros respiratorios/ventilatorios validados por enfermeros relacionando con su práctica asistencial en pacientes críticos con ventilación mecánica. Métodos: investigación descriptiva-exploratoria con abordaje cuantitativo, cuyos datos fueron discutidos en la Resolución COFEN 639/2020 y de parámetros clínicos obtenidos y validados por enfermeros intensivistas. Resultados: los parámetros validados fueron discutidos en términos de su aplicabilidad clínica para el alcance de la competencia "monitoreo respiratorio", uno de los ítems presentes en la referida resolución como exclusiva del enfermero. Se creó un cuadro con los parámetros generales para el monitoreo respiratorio/ventilatorio por enfermeros, con objetivo clínico y lugar de obtención del parámetro en el ventilador mecánico, para colaborar con su usabilidad. Conclusión: se presentó la aplicabilidad de parámetros validados por enfermeros en la asistencia a pacientes con ventilación mecánica. Se pondera su contribución para una mayor calidad en la asistencia, mejores desenlaces clínicos y, también, para evitar complicaciones asociadas con la ventilación mecánica. (AU)
Subject(s)
Respiration, Artificial , Respiratory Insufficiency , Coronavirus Infections , Critical Care NursingABSTRACT
Objetivos: Millones de pacientes con COVID-19 fueron internados en terapia intensiva en el mundo, la mitad desarrollaron síndrome de dificultad respiratoria aguda (SDRA) y recibieron ventilación mecánica invasiva (VMI), con una mortalidad del 50%. Analiza-mos cómo edad, comorbilidades y complicaciones, en pacientes con COVID-19 y SDRA que recibieron VMI, se asociaron con el riesgo de morir durante su hospitalización.Métodos: Estudio de cohorte observacional, retrospectivo y multicéntrico realizado en 5 hospitales (tres privados y dos públicos universitarios) de Argentina y Chile, durante el segundo semestre de 2020.Se incluyeron pacientes >18 años con infección por SARS-CoV-2 confirmada RT-PCR, que desarrollaron SDRA y fueron asistidos con VMI durante >48 horas, durante el se-gundo semestre de 2020. Se analizaron los antecedentes, las comorbilidades más fre-cuentes (obesidad, diabetes e hipertensión), y las complicaciones shock, insuficiencia renal aguda (IRA) y neumonía asociada a la ventilación mecánica (NAV), por un lado, y las alteraciones de parámetros clínicos y de laboratorio registrados.Resultados: El 69% era varón. La incidencia de comorbilidades difirió para los diferentes grupos de edad. La mortalidad aumentó significativamente con la edad (p<0,00001). Las comorbilidades, hipertensión y diabetes, y las complicaciones de IRA y shock se asociaron significativamente con la mortalidad. En el análisis multivariado, sólo la edad mayor de 60 años, la IRA y el shock permanecieron asociados con la mortalidad. Conclusiones: El SDRA en COVID-19 es más común entre los mayores. Solo la edad >60 años, el shock y la IRA se asociaron a la mortalidad en el análisis multivariado.
Objectives: Millions of patients with COVID-19 were admitted to intensive care world-wide, half developed acute respiratory distress syndrome (ARDS) and received invasive mechanical ventilation (IMV), with a mortality of 50%. We analyzed how age, comor-bidities and complications in patients with COVID-19 and ARDS who received IMV were associated with the risk of dying during their hospitalization.Methods: Observational, retrospective and multicenter cohort study carried out in 5 hospitals (three private and two public university hospitals) in Argentina and Chile, during the second half of 2020.Patients >18 years of age with SARS-CoV-2 infection confirmed by RT-PCR, who devel-oped ARDS and were assisted with IMV for >48 hours, during the second half of 2020, were included. History, the most frequent comorbidities (obesity, diabetes and hyper-tension) and the complications of shock, acute renal failure (AKI) and pneumonia as-sociated with mechanical ventilation (VAP), on the one hand, and the alterations of re-corded clinical and laboratory parameters, were analyzed.Results: 69% were men. The incidence of comorbidities differed for different age groups. Mortality increased significantly with age (p<0.00001). Comorbidities, hyper-tension and diabetes, and complications of ARF and shock were significantly associat-ed with mortality. In the multivariate analysis, only age over 60 years, ARF and shock remained associated with mortality.Conclusions: ARDS in COVID-19 is more common among the elderly. Only age >60 years, shock and ARF were associated with mortality in the multivariate analysis
Subject(s)
Humans , Male , Female , Adolescent , Adult , Middle Aged , Aged , Aged, 80 and over , Pneumonia/complications , Respiration, Artificial/methods , Respiratory Distress Syndrome, Newborn/complications , Shock/complications , Comorbidity , Renal Insufficiency/complications , SARS-CoV-2 , COVID-19/epidemiology , Argentina/epidemiology , Chile/epidemiology , Risk Factors , Mortality , Multicenter StudyABSTRACT
La tasa de reintubación orotraqueal luego de la extubación se registra entre un 10 a 20%. La aplicación de soportes respiratorios no-invasivos (SRNI) posterior a la extuba-ción como cánula nasal de alto-flujo, ventilación no invasiva (dos niveles de presión) y presión positiva continua en la vía aérea demostraron ser seguras y efectivas post ex-tubación. El período pre-destete representa un momento crucial en el manejo de los pa-cientes críticos ya que el fracaso de la extubación, definido como la necesidad de reintu-bación dentro de los 2 a 7 días, demostró peores resultados al aumentar la mortalidad entre un 25-50%. Esta situación conlleva al requerimiento de ventilación mecánica prolongada, neumonía asociada a la ventilación mecánica y estancias prolongadas de internación. Por lo tanto, es esencial identificar a los pacientes que se beneficiarán utilizando SRNI post extubación.
The rate of re-intubation after extubation is recorded at 10-20%. The use of non-invasive respiratory support (NIRS) post-extubation such as high-flow nasal cannula, non-invasive ventilation (bilevel pressure) and continuous positive airway pressure (CPAP) have been shown to be safe and effective post-extubation. The pre-weaning period represents a crucial time in the management of critically ill patients, as extubation failure, defined as the need for reintubation within 2-7 days, showed worse outcomes with mortality increasing by 25-50%. This situation leads to the requirement for prolonged mechanical ventilation, ventilator-associated pneumonia and long lengths of hospital stay. Therefore, it is essential to identify patients who will benefit from NIRS post extubation.
Subject(s)
Humans , Continuous Positive Airway Pressure/statistics & numerical data , Airway Extubation/statistics & numerical data , Noninvasive Ventilation/statistics & numerical data , Cannula/statistics & numerical data , Intubation, Intratracheal/statistics & numerical data , Respiration, Artificial/statistics & numerical data , Risk Factors , Mortality , ReviewABSTRACT
INTRODUÇÃO: A interação coração-pulmão influenciada pela Ventilação Mecânica (VM), que impacta diretamente no retorno venoso e débito cardíaco através, e não somente, de ajustes da Pressão Positiva Expiratória Final (PEEP) e Pressão média nas vias aéreas (Pmed). Além disso, as pausas inspiratórias para avaliação da mecânica pulmonar interrompem o movimento torácico, pode impactar mais nesta interação. OBJETIVO: Comparar as alterações hemodinâmicas durante os tempos de 0,5 e 2,0 segundos de pausa inspiratória durante as mensurações de mecânica respiratória. MÉTODOS: Trata-se de um estudo transversal, realizado nas unidades de terapia intensivas de um hospital público de Salvador/BA. Foram incluídos pacientes em uso de VM e acima de 18 anos. Os excluídos foram aqueles que apresentassem instabilidade hemodinâmica e hipoxemia sustentada durante a avaliação. Para caracterização amostral, os pacientes foram divididos em grupos daqueles com e sem afecções pulmonares. Os principais dados coletados e analisados foram PEEP, Pmed, Pressão Arterial Sistólica (PAS), Pressão Arterial Diastólica (PAD), Pressão Arterial Média (PAM), Frequência Cardíaca (FC). Para comparação de dados foram utilizados os testes Wilcoxon-Rank e Mann-Whitney para dados pareados e não pareados, respectivamente. RESULTADOS: Foram incluídos 37 pacientes, mediana de idade 63 anos, 19 (51,4%) do sexo masculino, 30 (81,1%) com diagnóstico admissional de natureza clínica. Não foram identificadas alterações hemodinâmicas estatisticamente significantes entre os tempos de pausa inspiratória de 0,5 e 2,0 segundos nas variáveis PAS (p=0,99), PAD (p=0,11), PAM (p=0,29) e FC (p=0,25). CONCLUSÃO: Não foram identificadas variações hemodinâmicas durante as mensurações da mecânica respiratória nas pausas de 0,5 e 2,0 segundos.
INTRODUCTION: The heart-lung interaction is influenced by Mechanical Ventilation (MV), which directly impacts venous return and cardiac output through, but not limited to, adjustments in Positive End-Expiratory Pressure (PEEP) and mean airway pressure (Pmean). Additionally, inspiratory pauses for the assessment of pulmonary mechanics interrupt thoracic movement, potentially further impacting this interaction. OBJECTIVE: To compare hemodynamic changes during 0.5 and 2.0-second inspiratory pauses during respiratory mechanics measurements. METHODS: This is a cross-sectional study conducted in the intensive care units of a hospital in Salvador/BA. Patients on MV and over 18 years old were included. Exclusions were made for those with hemodynamic instability and sustained hypoxemia during the evaluation. For sample characterization, patients were divided into groups with and without pulmonary conditions. The main data collected and analyzed were PEEP, Pmean, Systolic Blood Pressure (SBP), Diastolic Blood Pressure (DBP), Mean Arterial Pressure (MAP), and Heart Rate (HR). For data comparison, Wilcoxon-Rank and Mann-Whitney tests were used for paired and unpaired data, respectively. RESULTS: Thirty-seven patients were included, with a median age of 63 years, 19 (51.4%) males, and 30 (81.1%) with an admission diagnosis of a clinical nature. No statistically significant hemodynamic changes were identified between the 0.5 and 2.0-second inspiratory pause times in the variables SBP (p=0.99), DBP (p=0.11), MAP (p=0.29), and HR (p=0.25). CONCLUSION: No hemodynamic variations were identified during respiratory mechanics measurements at 0.5 and 2.0-second inspiratory pauses.
Subject(s)
Respiratory Mechanics , Respiration, Artificial , Physical Therapy ModalitiesABSTRACT
Introducción: La infección por SARS-CoV-2 puede presentar síndrome de distrés res-piratorio agudo con requerimiento de ventilación mecánica prolongada y retraso en la realización de traqueostomía. Esto trae como consecuencia un incremento en casos de estenosis traqueal y la necesidad de métodos menos invasivos para su abordaje. Métodos: Estudio descriptivo de corte transversal, desde marzo 2020 hasta diciem-bre 2021 en el Hospital Universitario Nacional de Colombia, en adultos con estenosis traqueal postintubación asociado SARS-CoV-2. Se realizó análisis univariado entre los grupos con infección o no por SARS-CoV-2 como control, y reintervención, grado de estenosis, uso de inyección intramucosa con dexametasona intratraqueal o múltiples estenosis como desenlaces de importancia. Se usó test exacto de Fisher, t Student y Man-Whitney según la naturaleza de variables. Se consideró p estadísticamente significativo menor a 0.05.Resultados: Se identificaron 26 pacientes, 20 tenían COVID-19 y 6 no. Se encontraron diferencias en edad (p=0,002), epilepsia (p=0,007) y estenosis múltiple (p= 0,04). En 85% de los casos se utilizó láser blue más dilatación con balón pulmonar, en 35% inyección intramucosa con dexametasona intratraqueal y reintervención en 35%, sin diferencias significativas entre grupos. Conclusiones: Se observó un incremento tres veces mayor de pacientes con estenosis múltiple en el grupo de infección por COVID-19, así mismo se encontró que el método más utilizado en este grupo para la recanalización fue el uso de láser blue más dilatación con balón pulmonar y la innovación en el uso de inyección intramucosa.
Introduction: SARS-CoV-2 infection can lead to acute respiratory distress syndrome with a prolonged need for mechanical ventilation and delayed tracheostomy, resulting in an increase in cases of tracheal stenosis and the necessity for less invasive approaches.Methods: A descriptive cross-sectional study was conducted from March 2020 to December 2021 at the Hospital Universitario Nacional de Colombia, focusing on adults with post-intubation tracheal stenosis associated with SARS-CoV-2. Univariate analysis was performed between groups with or without SARS-CoV-2 infection as a control, considering reintervention, degree of stenosis, use of intratracheal steroids, or multiple stenoses as important outcomes. Fisher's exact test, Student's t-test, and Mann-Whit-ney test were employed based on the nature of variables. A p-value less than 0.05 was considered statistically significant.Results: A total of 26 patients were included, with 20 having COVID-19 and 6 without. Significant differences were found in age (p=0.002), epilepsy (p=0.007), and multiple stenosis (p=0.04). In 85% of cases, laser blue plus balloon pulmonary dilation was used, intratracheal dexamethasone in 35%, and reintervention in 35%, with no significant differences between groups.Conclusions: A threefold increase in subglottic stenosis was observed during the SARS-CoV-2 pandemic, with more instances of multiple stenosis and predominantly the use of laser blue plus balloon pulmonary dilation as a successful recanalization technique. There was a higher use of intratracheal dexamethasone in this group compared to oth-er pathologies causing tracheal stenosis.
Subject(s)
Humans , Male , Female , Adult , Middle Aged , Respiratory Distress Syndrome, Newborn , Tracheal Stenosis/complications , Dyspnea , COVID-19/complications , Respiration, Artificial/methods , Bronchoscopy/methods , Tracheostomy/methods , Colombia , SARS-CoV-2ABSTRACT
Background and Objectives@#A mounting evidence links dysregulated immune response to cases of fatal pneumonia seen in COVID-19 infection. We aimed to validate the COVID-19-associated Hyperinflammatory Syndrome (cHIS) score, a novel clinical tool devised to identify those at risk for adverse outcomes, in a local population and investigate the relationship of cHIS score taken at admission and the risk of mortality and the need of mechanical ventilation@*Methods@#This retrospective cohort study analyzed the sociodemographic, clinical, and laboratory data of 1,881 COVID-19 patients admitted at a tertiary hospital in Davao City, Philippines from January to December 2021. We calculated the cHIS score, composed of six clinical and laboratory criteria from admission, and used multivariate logistic regression to determine the risk of mortality and need of mechanical ventilation.@*Results@#The cHIS score taken at admission, regardless of cut-off value, was a significant predictor of mortality (OR 0.979 [99% CI 0.894-1.064]) and need of mechanical ventilation (OR 0.586 [99% CI 0.4975-0.6745]). Using the Youden Index, a cut-off cHIS score of 3 or more was a better predictor of mortality (sensitivity, 88.59%; specificity, 71.72%), and a cut-off score of 2 or more was a better predictor of need of mechanical ventilation (sensitivity, 84.02%; specificity, 70.82%) than other cut-off cHIS scores.@*Conclusion@#Among COVID-19 patients, the cHIS score at admission correlated with the risk of mortality and the need of mechanical ventilation. Cutoff scores of 3 and 2 had the optimal sensitivities and specificities to predict the risk of mortality and the need of mechanical ventilation, respectively.
Subject(s)
COVID-19 , Inflammation , Mortality , Respiration, Artificial , Cytokine Release SyndromeABSTRACT
Background@#With the surge of COVID-19 infections, there were concerns about shortage of mechanical ventilator in several countries including the Philippines.@*Objective@#To transform a locally made, low-cost, neonatal ventilator into a volume- and pressure-controlled, adult ventilator and to determine its safe use among ventilated, adult patients at the Philippine General Hospital.@*Methods@#The modification of the neonatal ventilator (OstreaVent1) to the adult OstreaVent2 was based on the critical need for adult ventilators, in volume or pressure mode, in the Philippines due to the COVID-19 pandemic. The adult ventilator settings were calibrated and tested for two days to check for consistency and tolerance and then submitted to a third party for certification. Once certified, a safety trial of 10 stable adult patients on mechanical ventilator was conducted. The patients were placed on the OstreaVent2 for four hours while ventilator parameters, patient’s vital signs, and arterial blood gases were monitored at baseline, during, and after placement on the OstreaVent2. A poststudy chest radiograph was also done to rule out pulmonary complications, particularly atelectasis and pneumothorax. @*Results@#The prototype OstreaVent2 received an FDA Certification for Medical Listing after passing its thirdparty certification. Ten patients (60% male) recruited in the study had a mean age of 39.1 ± 11.6 years. Half of the patients had a diagnosis of non-COVID-19 pneumonia. During the 4-hour study period, the patients while on the OstreaVent2, had stable ventilator settings and most of the variabilities were within the acceptable tolerances. Vital signs were stable and arterial blood gases were within normal limits. One patient developed alar flaring which was relieved by endotracheal tube suctioning. No patient was withdrawn from the study. One patient who was already transferred out of the ICU subsequently deteriorated and died three days after transfer to the stepdown unit from a non-ventilator related cause.@*Conclusion@#The new OstreaVent2 is safe to use among adults who need ventilator support. Variabilities in the ventilator’s performance were within acceptable tolerances. Clinical and blood gas measurements of the patients were stable while on the ventilator.
Subject(s)
Respiration, ArtificialABSTRACT
Introduction@#Intensive care unit (ICU) patients are at the greatest risk of acquiring nosocomial infections, partly because of their serious underlying disease, but also by exposure to life-saving invasive procedures. Hospital-acquired infections increase patient morbidity, increase the length of hospital stay and hospital costs, and also increases mortality rate. The basic knowledge of organisms infecting ICU patients is very important to empirically select appropriate antibiotics, so that the most likely infecting organisms are addressed.@*Objective@#The aim of the study was to find out the etiologic agents causing infection in medical intensive care unit patients.@*Results@#In our study of 289 patients, 180 (62.3%) showed a growth of organism during the stay in ICU. The most common site of infection was the respiratory tract in 138 patients (47.8%) with 60 patients (20.8%) showing Acinetobacter baumannii.
Subject(s)
Cross Infection , Intensive Care Units , Acinetobacter baumannii , Respiration, ArtificialABSTRACT
Introducción: La predicción del desenlace de los pacientes tratados con ventilación invasiva por insuficiencia respiratoria aguda es todo un reto. Objetivo: Analizar los parámetros de monitorización ventilatoria asociados a la mortalidad en pacientes con neumonía adquirida en la comunidad grave. Métodos: Se realizó un estudio de casos y controles en pacientes con neumonía adquirida en la comunidad grave, tratados con ventilación invasiva. Los casos fueron los pacientes fallecidos. Las variables cuantitativas se resumieron con la mediana y el rango intercuartil en la comparación entre casos y controles, se empleó la prueba de U de Mann - Whitney. Se computó la presencia de riesgo de mortalidad y su significación estadística mediante el análisis de los odds ratio (OR), sus intervalos de confianza y la prueba ji al cuadrado de Mantel y Haenszel con nivel de significación ɑ = 0,05. Resultados: Los pacientes con las siguientes variables: presión pico ≥ 32 cmH2O (OR = 9,27), presión meseta ≥ 24 cmH2O (OR = 24,10), presión media ≥ 19 cmH2O (OR = 10,21), presión de conducción ≥ 19 cmH2O (OR = 10,98), compliance estática < 20 ml/cmH2O (OR = 5,90) y compliance dinámica < 15 ml/cmH2O (OR = 14,20), tuvieron más probabilidad de fallecer. Conclusiones: Los parámetros de la presión pico, la presión meseta, la presión media, la presión de conducción, la compliance estática y la compliance dinámica están asociados a la mortalidad en pacientes con neumonía adquirida en la comunidad grave.
Introduction: Predicting the outcome in patients treated with invasive ventilation for acute respiratory failure is fully challenging. Objective: To analyze ventilatory monitoring parameters associated with mortality in patients with severe community-acquired pneumonia. Methods: A case-control study was carried out in severely-ill patients with community-acquired pneumonia and treated with invasive ventilation. The cases were the deceased patients. The quantitative variables were summarized using the median and the interquartile range, while the Mann-Whitney U test was used in the comparison between cases and controls. The presence of mortality risk and its statistical significance were computed by odds ratio (OR) analysis, their confidence intervals, as well as the Mantel and Haenszel chi-squared test, with significance level ɑ = 0.05. Results: The patients more likely to die were those with peak pressure ≥ 32 cmH2O (OR = 9.27), plateau pressure ≥ 24 cmH2O (OR = 24.10), mean pressure ≥ 19 cmH2O (OR = 10.21), driving pressure ≥ 19 cmH2O (OR = 10.98), static compliance < 20 ml/cmH2O (OR = 5.90) and dynamic compliance < 15 ml/cmH2O (OR = 14.20). Conclusions: The variables peak pressure, plateau pressure, mean pressure, driving pressure, static compliance and dynamic compliance were concluded to be associated with mortality in patients with severe community-acquired pneumonia.