ABSTRACT
Introducción: la mortalidad de los pacientes oncológicos ingresados en unidades de cuidados intensivos es elevada, pero no difiere de la mortalidad de otras entidades donde el ingreso no está debatido. Objetivos: el objetivo de este trabajo es describir nuestra experiencia en el manejo de la ventilación mecánica no invasiva en pacientes oncológicos con limitación del esfuerzo terapéutico a la intubación orotraqueal. Material y métodos: presentamos dos casos de pacientes oncológicos ingresados en nuestra unidad de reanimación con limitación del esfuerzo terapéutico para la intubación endotraqueal. Resultados: esta modalidad ventilatoria en pacientes no susceptibles de intubación orotraqueal puede permitir obtener hasta un 70% de éxitos. Estas técnicas de soporte respiratorio pueden realizarse en diferentes salas del hospital por la gran portabilidad de la nueva generación de respiradores, y presentan la ventaja añadida de su uso sencillo, con una muy baja curva de aprendizaje para el personal sanitario. Conclusiones: el papel de la ventilación mecánica no invasiva en aquellos pacientes oncológicos, terminales o con orden de no intubar por diferentes razones médicas o familiares, puede tener un gran auge en los próximos años, y debemos tenerlo presente como una opción más en el tratamiento en estos pacientes (AU)
Background: mortality is high in cancer patients admitted to intensive care units, but not unlike that in other conditions where admission is not controversial. Objectives: the purpose of this study is to assess the possibility of increasing non-invasive mechanical ventilation in patients with cancer and therapeutic limitations to tracheal intubation. Material and methods: we present two cases of cancer patients admitted to our critical care unit with life-support technique limitations. Results: some studies indicate that this therapeutic trial may have a success rate of up to 70%. Such respiratory support techniques can be carried out in different hospital wards given the great mobility of new generation respirators; furthermore, they have the added advantage of being easy to use, with a very low learning curve for healthcare personnel. Conclusions: the role of non-invasive mechanical ventilation in end stage cancer patients or patients not intubated because of various medical or family reasons may significantly increase in upcoming years, and we should consider it an option for patient treatment (AU)
Subject(s)
Humans , Intubation, Intratracheal , Neoplasms/therapy , Palliative Care/methods , Minimally Invasive Surgical ProceduresABSTRACT
Postoperative analgesia may be complicated by the occurrence of acute opiate tolerance and hyperalgesia. We present the case of a patient who underwent gynecological surgery that was complicated by intense pain in the immediate postoperative period. The pain was attributed to the development of acute opiate tolerance caused by the brief infusion of a high dose of remifentanil. The opiate tolerance was complicated by tactile hyperalgesia at the site of the surgical wound. Pain management with the usual dose of nonsteroidal anti-inflammatory drugs associated with a high dose of morphine (50 mg administered in less than 2 hours) produced no analgesic or adverse effects. The pain was finally brought under control by epidural perfusion of ropivacaine and fentanyl and subsequently maintained with multimodal analgesia.
