ABSTRACT
No disponible
Subject(s)
Humans , Male , Middle Aged , Pneumothorax/diagnostic imaging , Pneumothorax/therapy , Respiratory Distress Syndrome/therapy , Respiration, Artificial/methods , Respiratory Distress Syndrome/diagnostic imaging , Hypoxia/complications , Bronchoscopy , Therapeutic OcclusionABSTRACT
Objetivo: Analizar la relación y concordancia entre el esfuerzo respiratorio calculado con las señales del respirador (Pmus) y el medido con presión esofágica (Pes), en ventilación mecánica con diferentes niveles de asistencia respiratoria. Diseño: Estudio prospectivo de una cohorte. Ámbito: Unidad de cuidados intensivos polivalente en 2 hospitales terciarios. Pacientes: Pacientes en fase de retirada de la ventilación mecánica. Intervenciones: La presión en la vía aérea, esofágica y flujo respiratorio se registraron en CPAP, ventilación asistida controlada por volumen (ACV) y presión soporte (PS) con asistencia respiratoria completa (ACV1, PS1) y parcial (ACV5, PS5). Variables medidas en Pes y Pmus: amplitud respiratoria (Δ: cmH2O) y el producto presión tiempo por minuto (PTPm: cmH2O·s/m). Resultados: En 10 pacientes se estudiaron 41 registros. La asistencia en CPAP fue de 5cmH2O, PS1 15±5 y PS59±4cmH2O. En ACV1 el flujo inspiratorio fue 1±0,2l/s, reducido a 0,49±0,1l/s para ACV5. El esfuerzo respiratorio disminuyó con el aumento de la asistencia respiratoria: ΔPes (CPAP, ACV5, ACV1, PS5, PS1): 11±3, 6±3, 5±3, 9±6, 7±7 y en ΔPmus 16±5, 10±6, 5±3, 10±6, 5±4cmH2O (p<0,001). PTPm Pes: 213±87, 96±91, 23±24, 206±121, 108±100 (p=0,001) y en Pmus: 293±117, 156±84, 24±32, 233±121, 79±90cmH2O·s/m (p<0,001). Las medidas en Pes y Pmus mostraron una correlación Δ:0,72 y PTPm: 0,87. El análisis de Bland-Altman demostró que la diferencia ΔPes-Pmus puede ser de 16cmH2O y el PTPm de 264 y el error sistemático en Δ: −0,98±4,4 y PTPm −23,69±66,3cmH2O·s/m. Conclusiones: Los parámetros calculados de esfuerzo respiratorio y los medidos directamente presentan diferencias que no son aceptables en la práctica clínica
Objective: Study the relationship and concordance between calculated respiratory effort using the signals of the ventilator (Pmus) and that measured in esophageal pressure (Pes) on mechanical ventilation with different levels of respiratory assistance. Design: Prospective cohort study. Ambit: Intensive Care Unit of 2 universitary hospitals. Patients Patients on weaning time. Procedure: Airway, esophageal and respiratory flow were recorded on CPAP, assist volume control (ACV) and pressure support (PS), with complete (ACV1,PS1) and partial assistance (ACV5,PS5). Measurement: respiratory variations of Pes and Pmus (Δ: cmH2O) and pressure time product (PTPm: cmH2O·s/m). Results: Fourty one records were studied, the assistance was in CPAP of 5cmH2O, PS1 of 15±5 reduced to 9±4cmH2O. In ACV1 the inspiratory flow was 1±0.2l/s, reduced to 0.49±0.1l/s for ACV5. The increase in respiratory assistance decreases respiratory effort, measured in Delta Pes (CPAP, ACV5, ACV1, PS5, PS1): 11±3, 6±3, 5±3, 9±6, 7±7 and in Pmus 16±5, 10±6, 5±3, 10±6, 5±4cmH2O (P<.001). The PTP per minute measured in Pes: 213±87, 96±91, 23±24, 206±121, 108±100 (P=.001) and in Pmus: 293±117, 156±84, 24±32, 233±121, 79±90 (P<.001). The measurements in Pes and Pmus showed the following correlation, in Delta: 0.72 and PTPm, 0.87. The Bland-Altman analysis indicates that the difference between Delta Pes-Pmus can be 16 and the PTPm of 264 and the systematic error in Delta: −0.98±4.4 and PTPm −23.69±66.3cmH2O·s/m. Conclusions: Calculated and measured parameters of respiratory effort showed unacceptable differences in clinical practice
Subject(s)
Humans , Male , Female , Adult , Middle Aged , Aged , Respiration, Artificial/methods , Cohort Studies , Intensive Care Units , Ventilator Weaning/methods , Prospective Studies , Pulmonary Ventilation , Inspiratory Reserve Volume , Respiratory Mechanics , Electrocardiography , Arterial PressureSubject(s)
Pneumothorax/therapy , Postoperative Complications/therapy , Respiratory Distress Syndrome/complications , Carcinoma, Squamous Cell/surgery , Contraindications, Procedure , Drainage/methods , Esophageal Neoplasms/surgery , Esophagectomy/adverse effects , Humans , Hypoxia/etiology , Male , Middle Aged , Pleural Effusion/diagnostic imaging , Pleural Effusion/therapy , Pneumothorax/etiology , Surgical Wound Dehiscence/complications , Ventilator Weaning/adverse effectsABSTRACT
OBJECTIVE: Study the relationship and concordance between calculated respiratory effort using the signals of the ventilator (Pmus) and that measured in esophageal pressure (Pes) on mechanical ventilation with different levels of respiratory assistance. DESIGN: Prospective cohort study. AMBIT: Intensive Care Unit of 2 universitary hospitals. Patients Patients on weaning time. PROCEDURE: Airway, esophageal and respiratory flow were recorded on CPAP, assist volume control (ACV) and pressure support (PS), with complete (ACV1,PS1) and partial assistance (ACV5,PS5). MEASUREMENT: respiratory variations of Pes and Pmus (Δ: cmH2O) and pressure time product (PTPm: cmH2O·s/m). RESULTS: Fourty one records were studied, the assistance was in CPAP of 5cmH2O, PS1 of 15±5 reduced to 9±4cmH2O. In ACV1 the inspiratory flow was 1±0.2l/s, reduced to 0.49±0.1l/s for ACV5. The increase in respiratory assistance decreases respiratory effort, measured in Delta Pes (CPAP, ACV5, ACV1, PS5, PS1): 11±3, 6±3, 5±3, 9±6, 7±7 and in Pmus 16±5, 10±6, 5±3, 10±6, 5±4cmH2O (P<.001). The PTP per minute measured in Pes: 213±87, 96±91, 23±24, 206±121, 108±100 (P=.001) and in Pmus: 293±117, 156±84, 24±32, 233±121, 79±90 (P<.001). The measurements in Pes and Pmus showed the following correlation, in Delta: 0.72 and PTPm, 0.87. The Bland-Altman analysis indicates that the difference between Delta Pes-Pmus can be 16 and the PTPm of 264 and the systematic error in Delta: -0.98±4.4 and PTPm -23.69±66.3cmH2O·s/m. CONCLUSIONS: Calculated and measured parameters of respiratory effort showed unacceptable differences in clinical practice.
Subject(s)
Monitoring, Physiologic/methods , Respiration Disorders/diagnosis , Respiration Disorders/therapy , Respiration, Artificial , Adult , Aged , Female , Humans , Male , Middle Aged , Prospective Studies , Respiration Disorders/physiopathology , Respiratory MechanicsABSTRACT
No disponible
Subject(s)
Humans , Critical Care , Critical Illness/therapy , Respiration, Artificial , Respiratory Muscles/physiopathologyABSTRACT
ObjetivoAnalizar la correlación entre la presión intraabdominal e intratorácica en pacientes con sospecha de hipertensión intraabdominal (HIA).DiseñoEstudio prospectivo observacional de una cohorte.ÁmbitoUnidad de medicina intensiva polivalente de un hospital universitario.PacientesSe incluyó a 27 pacientes medicoquirúrgicos dependientes de ventilación mecánica controlada por fallo respiratorio agudo y con factores de riesgo de hipertensión intraabdominal.Principales variablesMedimos las presiones intraabdominal (PIA), esofágica (Peso) y de la vía aérea en condiciones estáticas (est) y dinámicas (din). Calculamos la distensibilidad del sistema respiratorio (Csr), pulmón (Cp) y pared torácica (Cpt).ResultadosEn 10 pacientes la PIAest fue mayor de 12mmHg (HIA, PIAest, 14±2 [12-21] mmHg) y en el resto fue normal (n=17; PIAest, 8±2 [3-11] mmHg). La Pesoest fue 11±5 (2-27) y Pesodin, 7±4 (2-24) cmH2O. Considerando la presencia o no de HIA, Pesoest fue 9±4 vs. 7±3cmH2O (p=0,2) y Pesodin, 6±2 vs. 4±3cmH2O (p=0,3), respectivamente. La correlación de Pesoest y din con PIAest fue 0,5 (p=0,003) y 0,4 (p=0,03), respectivamente. Los componentes de la distensibilidad del sistema respiratorio estaban disminuidos (Csr, 31±8; Cp, 52±22; Cpt, 105±50ml/cmH2O), Cpt fue significativamente más baja en los pacientes con HIA (81±31 vs. 118±55ml/cmH2O; p=0,02). El coeficiente de correlación entre la PIAest y Cpt fue 0,7 (p<0,001) y de 0,5 (p=0,002) con Csr.ConclusionesLa pared torácica es más rígida en pacientes con hipertensión abdominal. En presencia de factores de riesgo de HIA las presiones en estos compartimentos son muy variables (AU)
Objective: To study the correlation between intraabdominal and intrathoracic pressure inpatients with suspected intraabdominal hypertension.Design: A prospective, observational cohort study.Setting: Polyvalent intensive care unit of a University hospital.Patients: Twenty-seven medical-surgical patient dependent upon controlled mechanical ventilationdue to acute respiratory failure and with several risk factors for intraabdominalhypertension (IAH).Main variables: Intraabdominal (IAP), esophageal (Peso) and airways pressure were measuredunder static (st) and dynamic (dyn) conditions. Respiratory system (Crs), lung (Cl) and chestwall compliance (Ccw)were calculated.Results: In 10 patients IAP > 12mmHg (IAH, IAPst, 14±2 [12-21] mmHg), while in the rest thepressure proved normal (n = 17; IAPst, 8±2 [3-11] mmHg). Peso st was 11±5 (2-27) and Pesodyn 7±4 (2-24) cmH2O. Depending on the presence or absence of IAH, Peso st was 9±4 vs7±3 cmH2O (p = 0.2) and Peso dyn 6±2 vs 4±3 cmH2O (p = 0.3), respectively. The correlationbetween Peso st and dyn with IAPst was 0.5 (p = 0.003) and 0.4 (p = 0.03), respectively. Thecompliance components were decreased (Crs, 31±8; Cl, 52±22 and Ccw, 105±50 ml/cmH2O);Ccw was significantly lower in patients with IAH (81±31 vs 118±55 ml/cmH2O; p = 0.02). Thecorrelation coefficient between IAPst and Ccw was 0.7 (p < 0.001), and 0.5 (p = 0.002) withrespect to Crs.Conclusions: A stiffer chest wall was observed in patients with IAH. In patients with risk factorsfor IAH, pressures in these compartments were highly variable (AU)
Subject(s)
Humans , Blood Pressure Determination/methods , Hypertension/diagnosis , Respiratory Insufficiency/therapy , Respiration, Artificial/adverse effects , Prospective Studies , Risk FactorsABSTRACT
OBJECTIVE: To study the correlation between intraabdominal and intrathoracic pressure in patients with suspected intraabdominal hypertension. DESIGN: A prospective, observational cohort study. SETTING: Polyvalent intensive care unit of a University hospital. PATIENTS: Twenty-seven medical-surgical patient dependent upon controlled mechanical ventilation due to acute respiratory failure and with several risk factors for intraabdominal hypertension (IAH). MAIN VARIABLES: Intraabdominal (IAP), esophageal (Peso) and airways pressure were measured under static (st) and dynamic (dyn) conditions. Respiratory system (Crs), lung (Cl) and chest wall compliance (Ccw)were calculated. RESULTS: In 10 patients IAP > 12 mmHg (IAH, IAPst, 14 ± 2 [12-21] mmHg), while in the rest the pressure proved normal (n = 17; IAPst, 8 ± 2 [3-11] mmHg). Peso st was 11 ± 5 (2-27) and Peso dyn 7 ± 4 (2-24) cmH2O. Depending on the presence or absence of IAH, Peso st was 9 ± 4 vs 7 ± 3 cmH2O (p = 0.2) and Peso dyn 6 ± 2 vs 4 ± 3 cmH2O (p = 0.3), respectively. The correlation between Peso st and dyn with IAPst was 0.5 (p= 0.003) and 0.4 (p = 0.03), respectively. The compliance components were decreased (Crs, 31 ± 8; Cl, 52 ± 22 and Ccw, 105 ± 50 ml/cmH2O); Ccw was significantly lower in patients with IAH (81 ± 31 vs 118 ± 55 ml/cmH2O; p = 0.02). The correlation coefficient between IAPst and Ccw was -0.7 (p < 0.001), and -0.5 (p = 0.002) with respect to Crs. CONCLUSIONS: A stiffer chest wall was observed in patients with IAH. In patients with risk factors for IAH, pressures in these compartments were highly variable.
Subject(s)
Abdominal Cavity , Hypertension/physiopathology , Thorax , Aged , Critical Illness , Female , Humans , Male , Pressure , Prospective StudiesABSTRACT
Objetivo. Describir la efectividad y tolerabilidad delajuste de dosis de meropenem en el tratamiento empíricode infecciones nosocomiales en pacientes críticos ingresadosen Servicios de Medicina Intensiva (SMI).Método. Estudio prospectivo, observacional y multicéntricode pacientes ingresados en 17 SMI con infecciones nosocomialesy tratamiento inicial con meropenem a dosis de1 g cada 8 h. Se ajustó la dosis inicial a 0,5 g cada 8 h cuandocumplían las siguientes condiciones: a) evolución clínicafavorable y b) un aislamiento microbiológico sensible a meropenemo ausencia de microorganismos en los cultivos realizados.Resultados. Se incluyeron 92 pacientes en los que seajustó la dosis de meropenem a 0,5 g cada 8 h. La infeccióntratada más frecuentemente fue la neumonía relacionadacon ventilación mecánica, seguido de las bacteriemias. Losestudios microbiológicos fueron positivos en 53 pacientesen los que predominaron bacterias grampositivas (53,7 %),en especial Staphylococcus aureus sensible a la meticilina,seguido de bacterias gramnegativas (42,7%).En 18 casos los pacientes no fueron evaluables al finaldel tratamiento. De los 74 casos evaluables, 67 (90,5%) presentaronuna evolución favorable (curación: 54 pacientes;mejoría: 13). En 50 de los 53 casos evaluables por Microbiologíase logró la erradicación o supuesta erradicación de losmicroorganismos iniciales y en 3 persistió el patógeno inicial:Acinetobacter baumannii (2 casos) y Pseudomonasaeruginosa (1 caso). Se detectó la aparición de nuevos microorganismosdurante el tratamiento en tres ocasiones: A. baumannii(2 casos) y 1 de S. aureus resistente a la meticilina.Aparecieron efectos adversos en 3 pacientes (4%), ninguno valorado como grave, que no precisaron la retirada del tratamiento.Fallecieron 25 (27,2%) pacientes, 3 de ellos en relacióncon la infección (AU)
Objective. To describe the effectiveness and tolerabilityof the dose adjustment of meropenem in empiricaltreatment of nosocomial infections in critically-ill patientsadmitted to intensive care medicine services.Methods. Prospective, observational and multicenterstudy in patients admitted to 17 intensive care medicineservices with nosocomial infection, who were initiallytreated with meropenem, 1 g every 8 h, were eligible.The initial dose was adjusted to 0.5 g every 8 h if therewere: a) a favorable clinical course, and b) microbiologicalisolation of meropenem-susceptible pathogens or absenceof pathogens in cultures.Results. Ninety-two patients in whom meropenemdoses were adjusted to 0.5 g every 8 h were included.Ventilator-associated pneumonia followed by bacteremiawas the most frequently treated infections. Microbiologicalstudies were positive in 53 patients, with apredominance of gram-positive bacteria (53.7%), especiallymethicillin-susceptible Staphylococcus aureus,followed by gram-negative bacteria (42.7 %). A total of18 patients were not evaluable at the end of treatmentSixty-seven (90.5 %) of the 74 evaluable patients had afavorable clinical course (54 patients cured and 13 improved).In 50 out of 53 microbiologically evaluable cases,eradication or apparent eradication of initial microorganismswas achieved. In 3 cases, the initial pathogenpersisted: Acinetobacter baumannii (2 cases) and Pseudomonasaeruginosa (1 case). On three occasions, new pathogensdeveloped during treatment: A. baumannii (2cases) and methicillin-resistant S. aureus (1 case). Adverseevents occurred in 3 patients (4%), none of whichwas considered severe, and withdrawal of meropenemwas not necessary. A total of 25 (27.2 %) patients died,three of them in relation to the infectious process(AU)
Subject(s)
Humans , Male , Female , Middle Aged , Carbapenems/administration & dosage , Carbapenems/adverse effects , Carbapenems/chemical synthesis , Carbapenems/therapeutic use , Pneumonia, Bacterial/physiopathology , Pneumonia, Bacterial/therapy , Gram-Positive Bacterial Infections/blood , Gram-Positive Bacterial Infections/complications , Gram-Positive Bacterial Infections/epidemiology , Gram-Positive Bacterial Infections/physiopathology , Gram-Positive Bacterial Infections/therapyABSTRACT
Objetivo. El análisis de la constante de tiempo espiratorio (tau) indica el tiempo necesario para que el sistema respiratorio alcance un estado estable. Estudiamos, durante la ventilación mecánica controlada, si el ajuste de la frecuencia respiratoria, según el valor de tau, puede reducir o eliminar la auto-PEEP (presión positiva telespiratoria). Diseño. Estudio clínico prospectivo de una cohorte de pacientes en ventilación mecánica. Ámbito. Unidad de medicina intensiva de un hospital universitario. Pacientes y método. Estudiamos a 17 pacientes con lesión pulmonar aguda (n = 10) o con insuficiencia respiratoria crónica agudizada (n = 7). En ventilación mecánica controlada, medimos la mecánica respiratoria, la auto-PEEP estática y el valor de tau en la fase espiratoria de la curva de volumen (V[t] = V0 e -[t/RC] + b). Conociendo el valor de tau, cambiamos la frecuencia respiratoria manteniendo el volumen por minuto constante (TE = tau × 4, I:E = 0,5) y analizamos el cambio en la auto-PEEP y mecánica respiratoria. Resultados. El valor de la constante b fue 0,02 (0,04) l y se correlacionó con el valor de tau (r = 0,8). En los pacientes con insuficiencia respiratoria crónica agudizada, el valor de tau fue de 1,04 (0,44) s, y la frecuencia respiratoria fue disminuida de 13,49 (2,87) a 11,72 (3,07) respiraciones/min (p = 0,06), sin un descenso significativo en la auto-PEEP (5,29 [5,11] a 4,87 [5,21] cmH2O). En los pacientes con lesión pulmonar aguda, tau fue de 0,53 (0,16) s y la frecuencia respiratoria fue aumentada desde 15,22 (2,74) a 20,62 (7,26) respiraciones/min (p = 0,05), sin modificar significativamente la auto-PEEP (2,80 [2,03] a 2,40 [1,67] cmH2O). Conclusiones. El análisis de la constante de tiempo no permitió disminuir la auto-PEEP en los pacientes con insuficiencia respiratoria crónica agudizada (FRCA). En el grupo con lesión pulmonar aguda fue posible utilizar frecuencias respiratorias elevadas sin aumentar la auto-PEEP (AU)
Subject(s)
Humans , Positive-Pressure Respiration/methods , Respiration, Artificial/methods , Prospective Studies , Respiratory Insufficiency/therapy , Lung Diseases/therapyABSTRACT
OBJECTIVE: To compare the measurements of total resistance and dynamic elastance determined by different techniques of respiratory mechanics analysis based on the time or frequency domains. DESIGN: Prospective study. SETTING: A 12-bed medical and surgical intensive care unit in a 700-bed university hospital. PATIENTS: Eighteen sedoparalyzed patients who needed controlled mechanical ventilation for acute or chronic acute respiratory failure. MEASUREMENTS: The total resistance and dynamic elastance in the time domain were determined by the occlusion technique and by multiple linear regression. The Fourier analysis was used to study the impedance of the respiratory system for elastance and resistance values in the frequency domain. RESULTS: The ANOVA analysis of the elastance variable showed no statistical differences (Ef: 41.4+/-19.0 cmH(2)O/l, Emlr: 40.8+/-17.2 cmH(2)O/l Edyn,occ: 39.5+/-14.0 cmH(2)O/l; ns) and the correlation was very good (r=0.8-0.9). The total resistances were less with multiple linear regression (13.5+/-9.3 cmH(2)O/l per s, p<0.05) than Rmax (17.0+/-11.9 cmH(2)O/l per s) or Rf (17.6+/-10.2 cmH(2)O/l per s). There were no differences between Rmax and Rf (p=0.7) and the correlation between resistances was 0.7-0.9. The agreement analysis for variables without statistical differences showed the following limits: Edyn,occ-f: -17 to 13 cmH(2)O/l; Edyn,occ-mlr: -12 to 9 cmH(2)O/l; Emlr-f: -6 to 8 cmH(2)O/l; Rmax-f: -18 to 19 cmH(2)O/l per s. This last range was related to the autoPEEP level (r=0.9). CONCLUSION: The wide agreement limits show that respiratory mechanics analysis is very dependent on the measurement technique used, particularly for resistance, perhaps due to the higher dependence on frequency.
