Resultados de un protocolo de manejo sobre la vía aérea artificial en pacientes críticos sometidos a ventilación mecánica / Results of an artificial airway management protocol in critical patients subjected to mechanical ventilation

Objetivo: Conocer los resultados de la implantación de un protocolo de actuación en una unidad de cuidados intensivos (UCI), sobre pacientes críticos que precisan una vía aérea artificial prolongada. Diseño: Estudio de cohorte prospectivo y observacional. Intervención: Se establecieron estrategias de manejo sobre la vía aérea, mediante intubación endotraqueal (IET) o traqueotomía y se elaboraron pautas de actuación sobre el proceso de decanulación. Ámbito: Unidad de Cuidados Intensivos polivalente. Pacientes: Se estudiaron 169 pacientes sometidos a ventilación mecánica (VM); 67 con IET ≥ 10 días de VM y 102 con traqueotomía percutánea (TP) o quirúrgica (TQ). Variables de interés: Estancias UCI y hospitalaria, días de IET y VM, mortalidad, traqueotomía, factores de riesgo anatómicos, complicaciones quirúrgicas, postquirúrgicas y período de decanulación. Resultados: La IET presentó menos días de VM (17 vs. 30 días, p < 0,001), menor estancia en UCI (20 vs. 35 días, p < 0,001) y hospitalaria (34 vs. 51 días, p < 0,001) frente a traqueotomía. Se realizaron más TQ en pacientes con factores de riesgo (47 TP vs. 89% TQ, p < 0,001). La hemorragia leve intraoperatoria fue la complicación más frecuente asociándose a TQ (31 vs. 11%, p = 0,03). La TP se asoció a un menor período con cánula (25 días vs. 34 días, p < 0,04). Conclusiones: Las variantes de actuación del protocolo no presentaron diferencias en cuanto a complicaciones y mortalidad, orientando a su utilidad en el manejo de pacientes de características similares

Objective: To determine the results of the implementation of a protocol in an intensive care unit (ICU) referred to critically ill patients requiring a prolonged artificial airway. Design: A prospective, observational cohort study was carried out. Intervention: Management strategies were established on the airway by endotracheal intubation (ETI) or tracheostomy, and guidelines were developed for action in the decannulation process. Setting: A polyvalent ICU. Patients: We studied 169 patients subjected to mechanical ventilation (MV), 67 with ETI ≥ 10 days of MV and 102 with percutaneous (PT) or surgical tracheostomy (TQ). Variables of interest: ICU and hospital stays, days of ETI and MV, mortality, tracheostomy, anatomical risk factors, surgical complications, and postoperative decannulation period. Results: ETI versus tracheotomy involved fewer days of MV (17 vs. 30 days, p<0.001), a shorter ICU stay (20 vs. 35 days, p<0.001), and a shorter hospital stay (34 vs. 51 days, p<0.001).There were more TQ procedures in patients with risk factors (47% TP vs. 89% TQ, p<0.001). Intraoperative minor bleeding was the most common complication, being associated with TQ (31% vs. 11%, p = 0.03). TP was associated with a shorter cannulationperiod (25 days vs. 34 days, p<0.04). Conclusions: The protocol variants showed no differences in terms of complications and mortality, when orienting application to patients with similar characteristics

[Results of an artificial airway management protocol in critical patients subjected to mechanical ventilation]. / Resultados de un protocolo de manejo sobre la vía aérea artificial en pacientes críticos sometidos a ventilación mecánica.

OBJECTIVE: To determine the results of the implementation of a protocol in an intensive care unit (ICU) referred to critically ill patients requiring a prolonged artificial airway. DESIGN: A prospective, observational cohort study was carried out. INTERVENTION: Management strategies were established on the airway by endotracheal intubation (ETI) or tracheostomy, and guidelines were developed for action in the decannulation process. SETTING: A polyvalent ICU. PATIENTS: We studied 169 patients subjected to mechanical ventilation (MV), 67 with ETI ≥ 10 days of MV and 102 with percutaneous (PT) or surgical tracheostomy (TQ). VARIABLES OF INTEREST: ICU and hospital stays, days of ETI and MV, mortality, tracheostomy, anatomical risk factors, surgical complications, and postoperative decannulation period. RESULTS: ETI versus tracheotomy involved fewer days of MV (17 vs. 30 days, p<0.001), a shorter ICU stay (20 vs. 35 days, p<0.001), and a shorter hospital stay (34 vs. 51 days, p<0.001).There were more TQ procedures in patients with risk factors (47% TP vs. 89% TQ, p<0.001). Intraoperative minor bleeding was the most common complication, being associated with TQ (31% vs. 11%, p = 0.03). TP was associated with a shorter cannulationperiod (25 days vs. 34 days, p<0.04). CONCLUSIONS: The protocol variants showed no differences in terms of complications and mortality, when orienting application to patients with similar characteristics.

[Neck schwannomas]. / Schwannomas de cuello.

Given the rareness of cervical schwannomas, they are often mistaken for other kinds of lesions. We present 2 clinical cases, make comments on the clinical-pathological features involved and point out the essential elements that ensure the differential diagnosis of these tumours.

[Leiomyoblastoma of the tongue]. / Leiomioblastoma lingual.

Leiomyoma is a benign tumor of smooth muscle origin that is rarely found in oral cavity. We report a case of leiomyoblastoma of the tongue. The interest of this lesion is supported by its location and by the difficulty to determine its biological behavior. About 25% of the oral smooth muscle tumors are malignant, and have been reported "leiomyoma" locally invasive.

Leiomioblastomal lingual / Leiomioma smooth muscle

Presentamos un caso de leiomioblastoma lingual y, a partir de él, describimos los leiomiomas orales, tumores benignos que se originan en el músculo liso y cuya localización en la cavidad oral es muy rara. El interés de estos tumores no sólo estriba en la rareza de su lugar de asiento, sino también en la dificultad que existe para definir subenignidad y comportamiento biológico. El 25 por ciento de los tumores de músculo liso orales son malignos, y han sido descritos "leiomiomas" localmente invasivos (AU)

Leiomyoma is a benign tumor of smooth muscle origin that is rarely found in oral cavity. We report a case of leiomyoblastoma of the tongue. The interest of this lesion is supported by its location and by the difficulty to determine its biological behavior. About 25% of the oral smooth muscle tumors are malignant, and have been reported «leiomyoma» locally invasive (AU)