Evidence-based guides in tracheostomy use in critical patients

Objetivos: Proporcionar guías de traqueostomía para el paciente crítico, basadas en la evidencia científica disponible, y facilitar la identificación de áreas en las cuales se requieren mayores estudios. Métodos: Un grupo de trabajo formado con representantes de 10 países pertenecientes a la Federación Panamericana e Ibérica de Sociedades de Medicina Crítica y Terapia Intensiva y a la Latin American Critical Care Trial Investigators Network(LACCTIN) desarrollaron estas recomendaciones basadas en el sistema Grading of Recommendations Assessment, Development and Evaluation (GRADE). Resultados: El grupo identificó 23 preguntas relevantes entre las 87 preguntas planteadas inicialmente. En la búsqueda inicial de la literatura se identificaron 333 estudios, de los cuales se escogieron un total de 226. El equipo de trabajo generó un total de 19 recomendaciones: 10 positivas (1B = 3, 2C = 3, 2D = 4) y 9 negativas (1B = 8, 2C = 1). En 6 ocasiones no se pudieron establecer recomendaciones. Conclusión: La traqueostomía percutánea se asocia a menor riesgo de infecciones en comparación con la traqueostomía quirúrgica. La traqueostomía precoz solo parece reducir la duración de la ventilación mecánica pero no la incidencia de neumonía, la duración de la estancia hospitalaria o la mortalidad a largo plazo. La evidencia no apoya el uso de broncoscopia de forma rutinaria ni el uso de máscara laríngea durante el procedimiento. Finalmente, el entrenamiento adecuado previo es tanto o más importante que la técnica utilizada para disminuir las complicaciones.(AU)

OBJECTIVES: Provide evidence based guidelines for tracheostomy in critically ill adult patients and identify areas needing further research. METHODS: A task force composed of representatives of 10 member countries of the Pan-American and Iberic Federation of Societies of Critical and Intensive Therapy Medicine and of the Latin American Critical Care Trial Investigators Network developed recommendations based on the Grading of Recommendations Assessment, Development and Evaluation system. RESULTS: The group identified 23 relevant questions among 87 issues that were initially identified. In the initial search, 333 relevant publications were identified of which 226 publications were chosen. The task force generated a total of 19 recommendations: 10 positive (1B=3, 2C=3, 2D=4) and 9 negative (1B=8, 2C=1). A recommendation was not possible in six questions. CONCLUSION: Percutaneous techniques are associated with a lower risk of infections compared to surgical tracheostomy. Early tracheostomy only seems to reduce the duration of ventilator use but not the incidence of pneumonia, the length of stay, or the long-term mortality rate. The evidence does not support the use of routine bronchoscopy guidance or laryngeal masks during the procedure. Finally, proper prior training is as important or even a more significant factor in reducing complications than the technique used.(AU)

Antibiotipos de cepas bacterianas aisladas de pacientes de las Unidades de Cuidados Intensivos / Antibiotypes of bacterial strains isolated from patients at the intensive care units

The indiscriminate use of antibiotics in intensive care units has permitted the selection of multiple resistant bacterial strains in the hospital setting. Antibiograms present the sensitivity or resistance of these strains to drugs in current use. In this study, 100 bacterial strains were isolated from patients on medical and surgical ICU wards. The strains were identified by API-20E and sensitivity testing was performed by the E-test procedure. MIC were further analyzed with the WHONET software wich permits the identification of antibiotypes. Acinetobacter anitratus, Pseudomona aeruginosa and Enterobacter cloacae were the most resistant strains. Nine antibiotypes were determinated for A. Anitratus. Predominant strain presented antibiotypes with multiple resistance to ten antibiotics. P. aeruginosa presented 10 antibiotypes, the predominant one being CTX, CRO, CTX. Antibiotype determination allows phenotypic identification or resistance patterns in particular species as well as facilitates follow up and recognition of its epidemiological distribution

Factores inherentes a la sobrevida y mortalidad de pacientes de cuidados intensivos en Panamá / Factors involved in the survival and mortality of intensive care patients in Panama

Biotechnology has been important for the management of the critical ill patients. Today the treatment is expensive and even more with complications, this work has the purpose to find out about mortality and survival and the associated factors that could promote alterations in the outcome. The authors studied 247 admissions in a six months period, their mortality and survival. We investigated the relationship between the inflammatory systemic response syndrome, the multi systemic organ failure and sepsis, with mortality and survival. We concluded that there is a high mortality related to the septic syndrome. Prevention to avoid the septic syndrome, is the best way to lower the high cost in the intensive care units

Causa de mortalidad en la Unidad de Cuidado Intensivo de Cirugia en La Caja de Seguro Social de Panamá / Cause of mortality in the surgery intensive care unit at the Social Security Branch of Panamá

The authors analyzed the mortality of patients admitted to the Surgical Intensive Care Unit of the Social Security Metropolitan Hospital Complex (SSMHC) in the city of Panama, from January to July 31, 1994. They determined that most of patients were males under 65 years of age and that the main cause of death was multiple trauma with shock. There was also a strong correlation between the syndrome of multiple organ failure, sepsis and death. The 17% mortality indicates an acceptable, good management of the patients admitted to the Surgical Intensive Care Unit of the SSMHC