Diferencias en el pronóstico entre trauma severo y pacientes con patologías médica que requieren ventilación mecánica
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Differences in the prognosis among severe trauma and medical patients requiring mechanical ventilation.
Santana-Cabrera L, Sánchez-Palacios M, Rodríguez AU.
Int J Burns Trauma. 2013 Nov 1;3(4):220-4.
Abstract
Objetive. To find the differences between the prognosis of the patients with severe traumatism injury and those who were admitted with medical pathology who also required mechanical ventilation in our ICU. Patients and Method. Retrospective descriptive study in a polyvalent ICU of a third level hospital for a period of 8 years. Epidemiological variables such as age, sex, average stay, mortality, APACHE II at admission and days of mechanical ventilation, were analyzed in patients with severe traumatism injury and patients with medical pathology that were admitted in ICU and received mechanical ventilation during this period. Results. During the study period were admitted 208 patients with severe traumatism injury and 732 medical patients, all of them required mechanical ventilation. Patients with severe traumatism injury are more younger (41.8 vs 55.3 years, p = 0.001) and entered ICU in a state of minor severity, according to the prognostic index APACHE II (14.8 vs 17.4, p < 0.001), despite which they required more days of mechanical ventilation (9.8 vs 7.8 days, p = 0.017) and had a higher average stay (11.4 vs 9.4 days, p = 0.027), although the mortality was significantly lower (38.2% vs 28.2%, p = 0.005). Multivariate analysis showed as independent variables associated with mortality, the APACHE II (p < 0.0001), the average stay in ICU (p < 0.0001), days of mechanical ventilation (p < 0.0001) and type patient (p = 0.016). Conclusions. Patients withsevere traumatic injury that require mechanical ventilation despite to be admitted in ICU in a state of greater severity, having an increased ICU stay and more days of mechanical ventilation, have a better prognosis than medical patients that required also mechanical ventilation at ICU stay, likely to be younger.
KEYWORDS: Respiration, artificial, multiple trauma, outcome assessment, patients
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Estrategias de ventilación en terapia intensiva para quemados: Estudio retrospectivo observacional
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Ventilation strategies in burn intensive care: A retrospective observational study.
Palazzo S, James-Veldsman E, Wall C, Hayes M, Vizcaychipi M.
Burn Trauma [serial online] 2014 [cited 2014 Jan 30];2:29-35.
Consensus regarding optimal burns intensive care (BICU) patient management is lacking. This study aimed to assess whether ventilation strategies, cardiovascular support and sedation in BICU patients have changed over time, and whether this affects outcome. A retrospective observational study comparing two 12-patient BICU cohorts (2005/06 and 2010/11) was undertaken. Demographic and admission characteristics, ventilation parameters, sedation, fluid resuscitation, cardiovascular support and outcome (length of stay, mortality) data were collected from patient notes. Data was analysed using T-tests, Fisher's exact and Mann-Whitney U tests. In our study cohort groups were equivalent in demographic and admission parameters. There were equal ventilator-free days in the two cohorts 10 ± 12.7 vs. 13.3 ± 12.2 ventilator free days; P = 0.447). The 2005/06 cohort were mechanically ventilated more often than in 2010/11 cohort (568 ventilator days/1000 patient BICU days vs. 206 ventilator days/1000 patient BICU days; P = 0.001). The 2005/06 cohort were ventilated less commonly in tracheostomy group/endotracheal tube spontaneous (17.8% vs. 26%; P = 0.001) and volume-controlled modes (34.4% vs. 40.8%; P = 0.001). Patients in 2010/11 cohort were more heavily sedated (P = 0.001) with more long-acting sedative drug use (P = 0.001) than the 2005/06 cohort, fluid administration was equivalent. Patient outcome did not vary. Inhalational injury patients were ventilated in volume-controlled (44.5% vs. 28.1%; P = 0.001) and pressure-controlled modes (18.2% vs. 9.5%; P = 0.001) more frequently than those without. Outcome did not vary. This study showed there has been shift away from mechanical ventilation, with increased use of tracheostomy/tracheal tube airway spontaneous ventilation. Inhalation injury patients require more ventilatory support though patient outcomes do not differ. Prospective trials are required to establish which strategies confer benefit.
Keywords: Burns, intensive care, ventilation, inhalation injury
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