ABSTRACT
Objetivo: Comparar la vía aérea básica y la vía aérea avanzada con el dispositivo supraglótico I-Gel®, por medio de la capnografía durante la RCP intermedia. Diseño: Estudio piloto experimental aleatorizado por grupos. Emplazamiento: Asistencia extrahospitalaria en unidades de soporte vital básico en la isla de Mallorca. Participantes: Adultos atendidos tras parada cardiorrespiratoria de origen no traumático. Intervenciones: Manejo de la vía aérea avanzado durante la RCP instrumental con I-Gel® o básica con bolsa-válvula-mascarilla, bajo monitorización capnográfica. Mediciones principales: Niveles capnométricos obtenidos según dispositivo empleado, número de inserciones de la I-Gel®, casos sin conseguir una correcta inserción/ventilación por ramas, consecución de ROSC en la RCP y número de ingresos vivos hospitalarios. Resultados: Se reclutaron 23 casos para su análisis. La tasa de éxito de inserción de la I-Gel® fue 92,9% al primer intento, los valores capnométricos medios fueron de 16,3mmHg en grupo control y de 27,4% en el grupo intervención. El 34,8% (n=8) de los pacientes alcanzó recuperación, circulación espontánea en algún momento y el 26,1% (n=6) ingresaron vivos en el hospital. El análisis de supervivencia, atendiendo a la llegada de la unidad y el primer minuto de ventilaciones registrados junto a la variable ingreso vivo hospitalario sugiere una cierta tendencia hacia una mayor supervivencia en la rama intervención (P=0,066). Conclusiones: El uso de la I-Gel® suscita una mejora en la ventilación de los pacientes en PCR, evidenciado por los valores capnométricos medios en el grupo intervención, no encontrándose correlación con variables de resultado de la RCP.(AU)
Objective: To compare the basic airway and the advanced airway with the supraglottic device I-Gel®, by means of capnography during intermediate CPR. Design: Randomized experimental pilot study by groups. Setting: Out-hospital care basic life support units on the Island of Mallorca. Participants: Adults attended after cardiorespiratory arrest of non-traumatic origin. Interventions: Advanced airway management during instrumental CPR with I-Gel® or basic CPR with bag-valve-mask, under capnographic monitoring. Main measurements: Capnometric levels obtained according to the device used, number of insertions of the I-Gel®, cases without achieving correct insertion/ventilation by branches, achievement of ROSC in CPR and number of hospital live admissions. Results: Twenty-three cases were recruited for analysis. The insertion success rate of the I-Gel® was 92.9% at the first attempt, the mean capnometric values were 16.3mmHg in the control group and 27.4% in the intervention group. 34.8% (n=8) of the patients achieved spontaneous circulation recovery at some point and 26.1% (n=6) were admitted to hospital alive. The survival analysis, taking into account the arrival of the unit and the first minute of ventilations recorded together with the variable hospital admission, suggests a certain trend of greater survival in the intervention branch (P=.066). Conclusions: The use of I-Gel® raises an improvement in the ventilation of the patients in PCR, evidenced by the mean capnometric values in the intervention group, finding no correlation with CPR outcome variables.(AU)
Subject(s)
Humans , Male , Female , Laryngeal Masks , Cardiopulmonary Resuscitation , 34628 , Capnography , Heart Arrest , Intubation, Intratracheal , Ventilation/methods , Pilot Projects , Randomized Controlled Trials as Topic , Primary Health CareABSTRACT
OBJECTIVE: To compare the basic airway and the advanced airway with the supraglottic device I-Gel®, by means of capnography during intermediate CPR. DESIGN: Randomized experimental pilot study by groups. SETTING: Out-hospital care basic life support units on the Island of Mallorca. PARTICIPANTS: Adults attended after cardiorespiratory arrest of non-traumatic origin. INTERVENTIONS: Advanced airway management during instrumental CPR with I-Gel® or basic CPR with bag-valve-mask, under capnographic monitoring. MAIN MEASUREMENTS: Capnometric levels obtained according to the device used, number of insertions of the I-Gel®, cases without achieving correct insertion/ventilation by branches, achievement of ROSC in CPR and number of hospital live admissions. RESULTS: Twenty-three cases were recruited for analysis. The insertion success rate of the I-Gel® was 92.9% at the first attempt, the mean capnometric values were 16.3mmHg in the control group and 27.4% in the intervention group. 34.8% (n=8) of the patients achieved spontaneous circulation recovery at some point and 26.1% (n=6) were admitted to hospital alive. The survival analysis, taking into account the arrival of the unit and the first minute of ventilations recorded together with the variable hospital admission, suggests a certain trend of greater survival in the intervention branch (P=.066). CONCLUSIONS: The use of I-Gel® raises an improvement in the ventilation of the patients in PCR, evidenced by the mean capnometric values in the intervention group, finding no correlation with CPR outcome variables.
Subject(s)
Cardiopulmonary Resuscitation , Heart Arrest , Laryngeal Masks , Adult , Humans , Intubation, Intratracheal , Pilot ProjectsABSTRACT
BACKGROUND: Thoracic epidural anesthesia (TEA) is widely used for major surgery, but studies assessing its impact on left ventricular (LV) systolic and diastolic function are limited, and such studies have assessed patients already under general anesthesia and/or receiving volume expansion between examinations. METHODS: Observational study at a secondary university hospital including consecutive awake patients undergoing major abdominal surgery without significant pre-existing cardiac disease. Patients received a pre-emptive intravenous volume loading before epidural catheter placement with puncture between T6-T7 and T8-T9. Hemodynamic and trans-thoracic echocardiography (TTE) parameters were assessed before and after establishing TEA with a 10 mL bolus of 2% lidocaine. Changes in heart rate (HR), mean arterial pressure (MAP), stroke volume (SV), cardiac output (CO), LV systolic function (as evaluated by fractional shortening [FS]; ejection fraction [EF]; Simpson; S prime [S`]), and LV diastolic function were recorded. RESULTS: Twenty-four awake patients were included. After TEA, HR, MAP, SV and CO significantly decreased (15.0%, 29.3%, 6.8% and 22%, respectively; all P<0.01); LV systolic function was also reduced by TEA (FS by 28%, EF-Simpson by 26%, S' by 15.3%, all P<0.001). TEA non-significantly reduced the incidence of diastolic dysfunction, from 65% (N.=15/23) to 43% (N.=10/23) patients (P=0.13) in the 23 complete diastolic function evaluations. CONCLUSIONS: The net effect of TEA in awake patients is a reduction of HR and LV systolic function, which results in a reduction of the CO and the MAP. The effect of TEA on LV diastolic function remains to be addressed by larger studies.
Subject(s)
Anesthesia, Epidural/methods , Echocardiography , Ventricular Function, Left , Adult , Aged , Aged, 80 and over , Arterial Pressure , Cardiac Output , Female , Heart Rate , Humans , Male , Middle Aged , Systole , Thoracic VertebraeABSTRACT
We present a rare asociation between Sweet Syndrome and Gastric Cancer in 72 year old woman, who came to the hospital with a painful skin lesion, bone pain and polyarthralgia. Initially the skin lesion was studied and it showed Neutrophilic Dermatitis/Paniculitis. An abdominal CT Scan showed Retroperitoneal limphadenopathy, 2 weeks after admission developed Acute Emetic Syndrome, that did not improve with standard therapy, a upper endoscopy was done showing Gastric Ulcer and duodenal Infiltrative lesion, pathologic study showd Gastric Adenocarcinoma that went lymphathic and Liver metastases. This is the fourth case with this association reported in international bibliography.
Subject(s)
Humans , Female , Aged , Stomach Neoplasms , Adenocarcinoma , Dermatitis , Neoplasm Metastasis , Sweet SyndromeABSTRACT
Con el prósito de determinar el perfil Epidemiológico del Cáncer de Mama , se realizó un estudio semi-prospectivo en el Consultorio externo de los Modulos 1 y 2 del Instituto Nacional de Enfermedades Neoplásicas de Lima entre mayo 1990 y Enero 1991. Se entrevistaron a 532 pacientes con diagnóstico Anatomopatológico de Carcinoma Mamario. Entraron al estudio 500 mujeres siendo el 85 por ciento de ellas admitidas en el lustro 86-90 y los parámetros revisados fueron demográficos, Clínicos y Factores de Riesgo. Los Hallazgos más significativos en este grupo fueron el Sexo y Edad. El promedio de edad fue 49.42 años. El 12.4 por ciento tuvo antecedente de otro Cáncer el 24 por ciento, siendo el Cáncer Gástrico el más frecuente con un 6.6 por ciento; el 11 por ciento refirió historia personal de Enfermedad benigna, el 3.2 por ciento Quiste Mamario, y el 1.4 por ciento tuvo otras Neoplasias Malignas asociadas; el 33.8 por ciento eran obesas y fue más significativa en las postmenopáusicas. Finalmente encontramos cifras elevadas de Apendicectomizadas (13.8 por ciento), Tonsilectomizadas (10.6 por ciento) y Colecistectomizadas (7.4 por ciento). El Cáncer de Mama es un problema de salud en el Perú, sobre el cual debemos realizar acciones encaminadas a su detección precoz que nos conduzca a disminuir su incidencia, aumentar la sobrevida y mejorar las posibilidades de cura de las pacientes
