Falla de extubación en la Terapia Intensiva de un Hospital Universitario. Estudio retrospectivo / Failure of extubation in the Intensive therapy of a University Hospital. study retrospective

Introducción: Aproximadamente un 40% del tiempo que un paciente está en ventilación mecánica corresponde al proceso de destete. La tasa de falla de extubación planeada es del 2-25%. La reintubación y su demora se asocian a complicaciones que incrementan la tasa de mortalidad y de la estancia en las Unidades cerrada y hospitalaria. Objetivo: Conocer la tasa de falla de extubación y analizar las características de estos pacientes en la Terapia Intensiva de un Hospital universitario. Pacientes y Métodos: Se incluyeron pacientes >18 años que ingresaron en la Terapia Intensiva del Hospital de Clínicas "José de San Martín" entre junio de 2013 y mayo de 2014, que fueron extubados de forma planeada y recibieron ventilación mecánica invasiva, por lo menos, 12 horas. Resultados: Se analizaron 139 pacientes. La tasa de falla de extubación fue del 14,4%. El grupo que falló presentó una media de tiempo hasta la reintubación de 18,2 h (DE ± 13.4). La neumonía asociada a la ventilación mecánica fue mayor en el grupo de falla (p = 0,001), al igual que los días de ventilación mecánica (p = 0,05), la estancia en terapia intensiva (p = 0,05), la mortalidad en terapia intensiva (p = 0,008) y hospitalaria (p = 0,003). Conclusiones: La tasa de falla de extubación coincide con lo reportado en la bibliografía. Los pacientes que fallaron tuvieron tasas mayores de neumonía asociada a la ventilación mecánica, de días de ventilación mecánica, de estancia en terapia intensiva, y de mortalidad en terapia intensiva y hospitalaria (AU)

Introduction: Approximately 40% of the time that a patient is mechanically ventilated is dedicated to the weaning process. The failure rate of planned extubation is 2-25%. Reintubation delay and extubation failure are associated with poor clinical outcomes, including an increase in the mortality rate and prolonged hospital and Intensive Care Unit stay. Objective: To analyze the extubation failure rate and determine the impact of extubation failure on patient outcomes in a University Hospital. Patients and Methods: Patients >18 years old admitted to Hospital de Clínicas "José de San Martín", between June 2013 and May 2014, who have receive mechanic ventilation for more than 12 hours, and with planned extubation. Results: A total of 139 patients were studied. Extubation failure rate was 14.4%. The mean time to reintubation of the group that failed was 18.2 hours (SD ± 13.4). Mechanical ventilation-associated pneumonia was greater in the failure group (p = 0.001), as well as days with the mechanical ventilation (p = 0.05), the Intensive Care Unit stay (p = 0.05), the Intensive Care Unit mortality rate (p = 0.008) and the hospital mortality rate (p = 0.003). Conclusions: The extubation failure rate coincides with that reported in the literature. Patients who failed had greater rates of mechanical ventilation-associated pneumonia, mechanical ventilated days, intensive care unit stay, and Intensive Care Unit and hospital mortality (AU)

[Rotavirus diarrhea. Impact in a pediatric hospital of Buenos Aires]. / Diarrea por rotavirus. Impacto en un hospital de niños de Buenos Aires.

Anticipating the use of the rotavirus vaccine, we performed this study in order to estimate the rotavirus disease burden in a pediatric hospital. We studied 648 children < 3 years of age between September/97 and August/98, assisted at the Outpatient Diarrhea Unit, or hospitalized due to acute diarrhea in our Hospital. We found rotavirus associated to 36% of the diarrhea cases studied in the Outpatient Clinics, and in 45% of the hospitalized children. We estimate the assistance of 1674 rotavirus diarrheas per year in the Outpatient Clinics, but only 14 of them required hospitalization. The study describes a peak of rotavirus diarrheas between March and June, and another peak of rotavirus-negative diarrheas between January and March (probably due to bacterial diarrheas). Rotavirus disease presented a higher frequency between 6 to 23 months of age; only 10% of the 233 rotavirus cases occurred in children older than 24 months and 13% in infants less than 6 months of age. The situation described is significant because the recently licensed rotavirus vaccine is being used in 3 doses at 2, 4 and 6 months and could have prevented most of the rotavirus cases observed during this study.

Diarrea por rotavirus. Impacto en un hospital de niños de Buenos Aires. / [Rotavirus diarrhea. Impact in a pediatric hospital of Buenos Aires]

Anticipating the use of the rotavirus vaccine, we performed this study in order to estimate the rotavirus disease burden in a pediatric hospital. We studied 648 children < 3 years of age between September/97 and August/98, assisted at the Outpatient Diarrhea Unit, or hospitalized due to acute diarrhea in our Hospital. We found rotavirus associated to 36

of the diarrhea cases studied in the Outpatient Clinics, and in 45

of the hospitalized children. We estimate the assistance of 1674 rotavirus diarrheas per year in the Outpatient Clinics, but only 14 of them required hospitalization. The study describes a peak of rotavirus diarrheas between March and June, and another peak of rotavirus-negative diarrheas between January and March (probably due to bacterial diarrheas). Rotavirus disease presented a higher frequency between 6 to 23 months of age; only 10

of the 233 rotavirus cases occurred in children older than 24 months and 13

in infants less than 6 months of age. The situation described is significant because the recently licensed rotavirus vaccine is being used in 3 doses at 2, 4 and 6 months and could have prevented most of the rotavirus cases observed during this study.