Ventilación mecánica no invasiva en la enfermedad pulmonar obstructiva crónica y en el edema agudo de pulmón cardiogénico / Noninvasive mechanical ventilation in chronic obstructive pulmonary disease and in acute cardiogenic pulmonary edema

La ventilación no invasiva (VNI) junto con el tratamiento convencional mejora la evolución de los pacientes con insuficiencia respiratoria aguda por descompensación hipercápnica de la enfermedad pulmonar obstructiva crónica (EPOC) o por edema agudo de pulmón cardiogénico (EAPC). Esta revisión resume los principales efectos de la VNI en dichas enfermedades. En la EPOC la VNI mejora el intercambio de gases y la clínica, reduce la necesidad de intubación endotraqueal, la mortalidad hospitalaria y la estancia hospitalaria en comparación con la oxigenoterapia convencional. Además, puede evitar la reintubación y disminuir el tiempo de ventilación mecánica invasiva. En el EAPC el tratamiento con VNI acelera la remisión de los síntomas y la normalización gasométrica, reduce la necesidad de intubación endotraqueal y se asocia a una tendencia a menor mortalidad sin aumentar la incidencia de infarto de miocardio. La modalidad ventilatoria utilizada en el EAPC no afecta el pronóstico de los pacientes

Noninvasive ventilation (NIV) with conventional therapy improves the outcome of patients with acute respiratory failure due to hypercapnic decompensation of chronic obstructive pulmonary disease (COPD) or acute cardiogenic pulmonary edema (ACPE). This review summarizes the main effects of NIV in these pathologies. In COPD, NIV improves gas exchange and symptoms, reducing the need for endotracheal intubation, hospital mortality and hospital stay compared with conventional oxygen therapy. NIV may also avoid reintubation and may decrease the length of invasive mechanical ventilation. In ACPE, NIV accelerates the remission of symptoms and the normalization of blood gas parameters, reduces the need for endotracheal intubation, and is associated with a trend towards lesser mortality, without increasing the incidence of myocardial infarction. The ventilation modality used in ACPE does not affect the patient prognosis

Noninvasive mechanical ventilation in chronic obstructive pulmonary disease and in acute cardiogenic pulmonary edema.

Noninvasive ventilation (NIV) with conventional therapy improves the outcome of patients with acute respiratory failure due to hypercapnic decompensation of chronic obstructive pulmonary disease (COPD) or acute cardiogenic pulmonary edema (ACPE). This review summarizes the main effects of NIV in these pathologies. In COPD, NIV improves gas exchange and symptoms, reducing the need for endotracheal intubation, hospital mortality and hospital stay compared with conventional oxygen therapy. NIV may also avoid reintubation and may decrease the length of invasive mechanical ventilation. In ACPE, NIV accelerates the remission of symptoms and the normalization of blood gas parameters, reduces the need for endotracheal intubation, and is associated with a trend towards lesser mortality, without increasing the incidence of myocardial infarction. The ventilation modality used in ACPE does not affect the patient prognosis.

[Analysis of early tracheostomy and its impact on development of pneumonia, use of resources and mortality in neurocritically ill patients]. / Análisis de la traqueotomía precoz y su impacto sobre la incidencia de neumonía, consumo de recursos y mortalidad en pacientes neurocríticos.

OBJECTIVE: We analyze the most suitable time to perform tracheostomy in neurocritically ill patients. We compare morbimortality and use of resources between those patients in which tracheostomy was done early (9 days), in a selected group of patients. MATERIAL AND METHODS: We made an observational prospective study involving a group of patients diagnosed as traumatic brain injury (TBI) or stroke, whose tracheostomy was performed during their stay at the Intensive Care Unit. We compared two groups: a) early tracheostomy (during first 9 days of ICU stay); b) late tracheostomy (made on 10th day or later). As variables, we studied: demographic data, severity of illness at admission, admittance department, diagnosis, length of intubation, length of mechanical ventilation (LMV), sedation and antibiotic treatment needs, ventilator-associated pneumonia (VAP) events, ICU length of stay and mortality. We calculated relative risk of suffering from pneumonia and made a multivariate logistic regression to establish which factors were associated with an increased risk of developing pneumonia. Statistical signification p

Análisis de la traqueotomía precoz y su impacto sobre la incidencia de neumonía, consumo de recursos y mortalidad en pacientes neurocríticos / Analysis of early tracheostomy and its impact on development of pneumonia, use of resources and mortality in neurocritically ill patients

Objetivos. Analizar el momento más adecuado parala realización de la traqueotomía en enfermos neurocríticos,comparando en una población seleccionadade pacientes las diferencias de morbimortalidad yconsumo de recursos entre el grupo en que se realizó latraqueotomía precozmente (≤9 días) y aquéllos en losque fue más tardía (>9 días).Material y métodos. Estudio prospectivo y observacionalen una población de pacientes con diagnósticode traumatismo craneoencefálico (TCE) o accidentecerebrovascular (ACVA) que precisaron traqueotomíadurante su ingreso en UCI. Se compararon los datosen dos grupos de pacientes: a) traqueotomía precoz(TP) en los primeros 9 días; b) traqueotomía tardía(TT) a partir del 10º día. Variables estudiadas: datosdemográficos, gravedad al ingreso, procedencia, diagnóstico,duración de la intubación orotraqueal (IOT)y de la ventilación mecánica (VM), necesidades desedación y de antibioterapia, frecuencia de neumoníaasociada a ventilación mecánica (NAV), duración de laestancia y mortalidad. Se calculó el riesgo relativo depadecer neumonía y un modelo de regresión logísticamultivariante para determinar los factores asociadosal desarrollo de neumonía. Significación estadísticapara una p≤0.05.Resultados. Se estudiaron 118 pacientes, 60% conTCE. La media de IOT previa a la traqueotomía (TRQ)fue de 12 días y la duración de la VM de 20 días. Sediagnosticaron 94 episodios de NAV en 81 pacientes(68.6%). El grupo de TP muestra menor duración de laVM, de la sedación, de la antibioterapia y de la estanciaen UCI, con menor incidencia de neumonía (p<0.001).La precocidad de la TRQ no influyó en la duración de laestancia hospitalaria (p=0.844), ni en la mortalidad enUCI (p=0.924), ni en la hospitalaria (p=0.754). La mediade edad fue menor en el grupo con TCE (p<0.001),además la TRQ se realiza más tarde (p=0.026) y requieren (..) (AU)

Objective. We analyze the most suitable time to performtracheostomy in neurocritically ill patients. Wecompare morbimortality and use of resources betweenthose patients in which tracheostomy was done early(≤ 9 days) and those in which it was perform later (>9days), in a selected group of patients.Material and methods. We made an observationalprospective study involving a group of patients diagnosedas traumatic brain injury (TBI) or stroke, whosetracheostomy was performed during their stay at theIntensive Care Unit. We compared two groups: a) earlytracheostomy (during first 9 days of ICU stay); b) latetracheostomy (made on 10th day or later). As variables,we studied: demographic data, severity of illness atadmission, admittance department, diagnosis, lengthof intubation, length of mechanical ventilation (LMV),sedation and antibiotic treatment needs, ventilatorassociatedpneumonia (VAP) events, ICU length of stayand mortality. We calculated relative risk of sufferingfrom pneumonia and made a multivariate logisticregression to establish which factors were associatedwith an increased risk of developing pneumonia. Statisticalsignification p < 0.05.Results. We analyzed 118 patients, 60% with TBI.Mean length of intubation before tracheostomy was 12days and mean LMV was 20 days. 94 VAP events werediagnosed in 81 patients (68.6%). Early tracheostomygroup showed lower length of mechanical ventilationand ICU stay, lower length of sedation and antibiotictreatment, and less pneumonia events (p<0,001). Theprecocity of tracheostomy didn’t have any influenceeither on hospital length of stay (p=0.844), ICU mortality(p=0.924) or in-hospital mortality (p=0.754). At theTBI group mean age was lower (p<0.001), tracheostomywas made later (p=0.026), and patients needed a longersedation (p=0.001) and a longer antibiotic treatment(..) (AU)