RESUMO
Background: Tracheostomy procedures are performed in the intensive care unit (ICU) for prolonged intubation, unsuccessful weaning and infection prevention through either percutaneous or surgical techniques. This study aimed to outline the impact of tracheostomy timing in the ICU on mortality, need for mechanical ventilation, and complications. Methods: Patients were included in the study on the day of tracheostomy. Demographic information, tracheostomy timing, technique, complications, sedation requirement and need for mechanical ventilation at discharge were recorded by an anesthesiologist, including the pre-tracheostomy period. Results: Tracheostomy was performed on 33 patients during the first 14 days of intubation and on 54 patients on the 15th day and beyond. There was no significant difference between the tracheostomy timing and mortality, sedation requirement, or weaning from the ventilator. We observed that patients who underwent tracheostomy with the surgical technique experienced more complications, but there was no significant difference. Tracheostomy performed after the 14th day was shown to be associated with prolonged hospital stay. Conclusions: Early tracheostomy does not have any influence on the need for mechanical ventilation, sedation and mortality. The optimal timing for tracheostomy is still controversial. We are of the opinion that randomized controlled trials involving patient groups with similar survival expectations are needed.
RESUMO
The new coronavirus disease, in which 100,000 of people are infected in the world, appears in tables ranging from asymptomatic course to severe acute respiratory distress syndrome. Extracorporeal membrane oxygenation (ECMO) is one of the salvage treatments applied in intubated patients due to high mortality. However, since ECMO treatment is a complicated treatment, the gain loss rate should be determined well. We aimed to share two cases that we applied ECMO treatment in our clinic. Although we could not achieve a successful result, we believe that new experiences should be shared in order to better understand the place of ECMO in coronavirus disease 2019 treatment.
RESUMO
Migration implies differences in lifestyle, dietary and health behavior practice, and adherence, all of which are relevant factors in terms of disease outcome. However, renal transplantation in immigrant groups has been rarely studied in Europe. We have investigated the effect of immigration on outcomes in all children who underwent renal transplantation (RTx) at the Medical University of Vienna. From 1978 to 2007, 196 children underwent 236 RTx. In comparison to native recipients, immigrant recipients (31 boys, 17 girls) tended to be younger and male, with a higher rate of congenital renal diseases. The percentage of adolescent immigrant recipients tended to be lower, and living donation tended to be higher. In both the immigrant and native groups, RTx outcomes at 1, 5, and 10 years, including acute rejection rate (34 vs. 44, 55 vs. 62, 74 vs. 78%, respectively) and patient (98 vs. 92, 88 vs. 91, 80 vs. 82%, respectively) and graft survival (83 vs. 82, 79 vs. 65, 66 vs. 51%, respectively) were similar. All outcomes improved over time. In conclusion, this study demonstrates that outcomes in RTx are equivalent in immigrants and native recipients. Potential barriers to success among the Austrian immigrant recipient population may have been overcome by protective factors. These results should serve as a catalyst to retrieve data from larger databases to verify these single-center results.
