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)

Study of correlation between forced vital capacity and demand for healthcare services in severe asthmatics.

BACKGROUND: Involvement of the small airways may be related to increased severity and increased demand for health care services and incurring in high costs, private or for the healthcare system. The hyperinflation consequent to this involvement reduces lung volumes, such as FVC, FEV1 and SVC. The aim of this study was to evaluate the correlation between the predicted values of FVC, FEV1 and SVC with the demand for healthcare services by severe asthmatics. METHODS: We retrospectively evaluated in order of arrival, the medical records of 98 patients with severe asthma, in step 4 treatment in the intercritical period of the disease, correlating the number of times each patient sought health care services represented by admissions to the ER, ICU and hospital wards due to asthma, in the year before the last spirometry and the predicted values of FVC, FEV1 and SVC. RESULTS: Our sample showed a clear and significant negative correlation between the predicted values of FVC, FEV1 and SVC and demand for healthcare services. CONCLUSION: For this sample we conclude, that reduced forced vital capacity correlated with asthma severity, defined by greater demand for care in the ER, ICU and hospital ward and was more evident in women.

[Primary intracranial Ewing's sarcoma of the mastoid bone. A case report]. / Sarcoma de Ewing intracraneal primario de mastoides. Presentación de un caso.

INTRODUCTION: Ewing s sarcoma (ES) is a tumorous process that is found mainly in long bones and the pelvis, but its primary location is not often the intracranial zone. CASE REPORT: We report the case of a 5 year old patient who visited surgery 30 days before hospital admission with increased volume of the left mastoid bone, torticollis, balance disorders and discoordinated movements. A computerised tomography brain scan confirmed our suspicions of a tumorous lesion that was destroying the left mastoid bone, and was invading the projection of the left hemispherium cerebri and edges of the brain stem (mid brain). The patient was submitted to surgery and a partial excision was performed. A month later, another operation was carried out and the patient died after several days in the intensive care unit from serious respiratory complications. CONCLUSIONS: The tumour marker CD 99 is specifically used to diagnose ES. We think that, when faced with a patient suffering from ES, conduct must always be aggressive, with early surgery and, later, adjuvant therapy.

[Prevalence of Barrett's esophagus in patients with colorectal carcinoma]. / Prevalencia de esófago de Barrett en pacientes con carcinoma colorrectal.

OBJECTIVE: To determine Barrett's esophagus (BO) prevalence in patients diagnosed with colorectal carcinoma (CC) and feasibility-associated factors in a 10 week period from March 1st to June 15, 1999. PLACE: Endoscopy Department, Oncology Hospital, Centro Médico Nacional Siglo XXI, IMSS. METHOD: A prospective, transversal, observational and comparative assay of 48 patients with histologically confirmed diagnosis of colorectal carcinoma in whom high endoscopy with biopsy harvest was performed; otherwise, colonoscopy was performed in eight patients with confirmed BO. RESULTS: Thirty men and 18 women were studied with an average age of 53 years of age. In 100%, colon cancer was determined as adenocarcinoma and location were rectal in 43.7%. Prevalence of BO was 22.9% in addition to 0.74 to 2% in the general population. This implies an odds ratio calculated at 36.43 (p = 0.00000) and 3.09 p = 0.00007), respectively, for risk to present BO concomitant with CC. There was no statistical significance in relation to age, smoking habit, and/or alcoholism. Among eight patients with BO without CCR, only one had a tubulovellous polypus (12.5%) identified. CONCLUSIONS: Although the results were not to conclusive to affirm the association of BA with CCR, the high prevalence found justifies the performance of routine endoscopy in CCR carrier patients with reflux symptoms.