Early Tracheostomy May Reduce the Length of Hospital Stay.

Introduction: There is evidence that prolonged invasive mechanical ventilation has negative consequences for critically ill patients and that performing tracheostomy (TQT) could help to reduce these consequences. The ideal period for performing TQT is still not clear in the literature since few studies have compared clinical aspects between patients undergoing early or late TQT. Objective: To compare the mortality rate, length of stay in the intensive care unit, length of hospital stay, and number of days free of mechanical ventilation in patients undergoing TQT before or after ten days of orotracheal intubation. Methods: A retrospective cohort study carried out by collecting data from patients admitted to an intensive care unit between January 2008 and December 2017. Patients who underwent TQT were divided into an early TQT group (i.e., time to TQT ≤ 10 days) or late TQT (i.e., time to TQT > 10 days) and the clinical outcomes of the two groups were compared. Results: Patients in the early TQT group had a shorter ICU stay than the late TQT group (19 ± 16 vs. 32 ± 22 days, p < 0.001), a shorter stay in the hospital (42 ± 32 vs. 52 ± 50 days, p < 0.001), a shorter duration of mechanical ventilation (17 ± 14 vs. 30 ± 18 days, p < 0.001), and a higher proportion of survivors in the ICU outcome (57% vs. 46%, p < 0.001). Conclusion: Tracheostomy performed within 10 days of mechanical ventilation provides several benefits to the patient and should be considered by the multidisciplinary team as a part of their clinical practice.

Analysis of cerebral blood flow and intracranial hypertension in critical patients with non-hepatic hyperammonemia.

Hyperammonemia in adults is generally associated with cerebral edema, decreased cerebral metabolism, and increased cerebral blood flow. The aim of this study was to evaluate the association between non-hepatic hyperammonemia and intracranial hypertension assessed by Doppler flowmetry and measurement of the optic nerve sheath. A prospective cohort study in critically ill patients hospitalized in intensive care units of a University Hospital between March 2015 and February 2016. Clinical data and severity scores were collected and the Glasgow coma scale was recorded. Serial serum ammonia dosages were performed in all study patients. Transcranial Doppler evaluation was carried out for the first 50 consecutive results of each stratum of ammonemia: normal (<35 µmol/L), mild hyperammonemia (≥35 µmol/L and < 50 µmol/L), moderate hyperammonemia (≥50 µmol/L and < 100 µmol/L), and severe hyperammonemia (≥100 µmol/L). The measurement of the optic nerve sheath was performed at the same time as the Doppler examination if the patient scored less than 8 on the Glasgow coma scale. There was no difference in flow velocity in the cerebral arteries between patients with and without hyperammonemia. Patients with hyperammonemia presented longer ICU stay. Optic nerve sheath thickness was higher in the group with severe hyperammonemia and this group presented an association with intracranial hypertension. Higher mortality was observed in the severe hyperammonemia group. There was an association between severe hyperammonemia and signs of intracranial hypertension. No correlation was found between ammonia levels and cerebral blood flow velocity through the Doppler examination.

Corpo estranho retido intra-abdominal com interessante seqüela / Retained surgical sponge with interesting sequel

O esquecimento de compressa ou gaze cirúrgica intra-abdominal é uma complicação operatória rara, com escassos relatos na literatura. Em 50por cento dos casos produzem sintomatologia após cinco anos e a mesma dependerá da natureza do corpo estranho. o corpo estranho é encapsulado, promovendo uma resposta exsudativa como consequente tentativa do organismo de eliminá-lo. A compressa cirúrgica pode promover uma erosão com fistulização para dentro de uma víscera, sendo seu tratamento cirúrgico. No presente caso relata-se o diagnóstico, mediante exame endoscópico, de um corpo estranho intra-abdominal com migração para o trato digestivo e seu tratamento operatório