Ventilación no invasiva en la insuficiencia respiratoria aguda en urgencias PDF Download

Author: Juan Carlos Cano Ballesteros
Publisher:
ISBN:
Category :
Languages : es
Pages :

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La ventilación mecánica no invasiva (VMNI) es un método contrastado de soporte respiratorio. En este estudio se plantea que la VMNI aplicada de forma precoz por los médicos del Servicio de Urgencias de un hospital terciario, mejora el manejo terapéutico y con ello el pronóstico de los pacientes con insuficiencia respiratoria aguda (IRA).Objetivo. Estudiar la aplicabilidad de soporte respiratorio con ventilación mecánica no invasiva (VMNI) en los servicios de urgencias hospitalarios (SUH), mediante los análisis de una serie consecutiva de pacientes con insuficiencia respiratoria aguda (IRA) atendidos en el área de alta dependencia (ADA) del SUH del Hospital General Universitario Gregorio Marañón (HGUGM). Analizar los resultados asistenciales y estimar el pronóstico de estos pacientes, mediante el registro y el análisis de la supervivencia un año después de recibir asistencia en la unidad y la necesidad de reingresos hospitalarios en este período.Material y métodos. Estudio unicéntrico, observacional, prospectivo y de seguimiento durante 1 año, de una serie de 112 pacientes tratados con VMNI. Se recogieron y analizaron variables epidemiológicas, clínicas, analíticas, del método ventilatorio, estancia y destino al alta desde la unidad. Se realizó un seguimiento a los supervivientes de la hospitalización inicial con registro de los reingresos y los fallecimientos...

Author: Martí Pons Òdena
Publisher:
ISBN:
Category :
Languages : es
Pages : 282

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OBJETIVOS El objetivo principal de la tesis es determinar la efectividad de la ventilación no invasiva (VNI) e identificar factores pronósticos de fracaso en una cohorte general pediátrica. Los objetivos secundarios de la tesis son: 1.Estudiar si las cohortes establecidas según la clasificación cronológica presentan diferencias fisiológicas significativas anteriores al inicio de la VNI 2.Determinar la efectividad y los factores pronósticos de fracaso de la VNI de las tres cohortes (inicial, rescate y electiva) por separado 3.Evaluar la seguridad de la técnica, analizando su morbilidad y mortalidad asociadas MATERIAL Y MÉTODOS Diseño del estudio: Estudio de cohortes prospectivo realizado en UCIP del Hospital Sant Joan de Déu mediante muestreo consecutivo desde Enero 2005 - Diciembre 2009. Criterios de inclusión: ·Pacientes de ambos sexos entre los 0-18 años con criterios de insuficiencia respiratoria aguda grave (IRA). Criterios de exclusión: ·Pacientes con contraindicación para el uso de la VNI o con indicación paliativa. Variables a estudiar: Los datos de los pacientes fueron recogidas. Tipo de interfase, ventilador, modos (CPAP, BLPAP)y parámetros usados; variables fisiológicas (previo, 2a hora, 8, 12 y 24 horas); el cociente SpO2/FiO2 (SF), fue calculado retrospectivamente, eliminándose valores con SatHb superior a 97; Tiempo de uso de la VNI, duración de la estancia en UCIP y hospital. Las complicaciones y mortalidad atribuibles a la VNI. El fracaso de la VNI se define como la necesidad de intubación. RESULTADOS En el análisis descriptivo de los 491 episodios, las variables demográficas definen una población diana para el uso de la VNI: Edad media de 36 a 46 meses, con predominio sexo masculino, sin enfermedad de base, la causa más frecuente de IRA es la INFECCIÓN RESPIRATORIA. Las complicaciones han sido poco frecuentes (5,5%). No hubo mortalidad asociada al uso de la VNI. En la cohorte general según el grupo de edad, se diferencian significativamente, mayores y menores de seis meses. El análisis multivariable las variables independientes halladas son edad, modalidad (CPAP/BLPAP), el tipo de fallo respiratorio tipo II, el menor valor de SF y menor descenso de la FC a las dos horas. En el análisis de las cohortes generadas según la clasificación cronológica se observan diferencias significativas en las variables fisiológicas y las necesidades de oxígeno previas al inicio de la VNI. En el análisis multivariable de la cohorte inicial se observa : Modalidad CPAP, valores bajos de SF y altos de FC a las 2 horas, la edad mayor a 6 meses , así como los valores más bajos de IPAP a las 2 horas son factores independientes de fracaso CONCLUSIONES Conclusiones principales 1. La ventilación no invasiva es una técnica efectiva para prevenir la intubación en Pediatria 2. Los factores pronósticos de fracaso en la cohorte general son: ·Recibir tratamiento con CPAP en lugar de BLPAP ·Tener un fallo respiratorio tipo II, un valor de SF a las 2 horas y un descenso de la FC menor yun valor de FC a las 2 horas mayor Conclusiones secundarias 1.Las cohortes generadas por la clasificación cronológica presentan diferencias significativas en las variables fisiológicas previas 2. La efectividad en la cohorte general aumenta con la edad 3. La efectividad y factores pronósticos en las cohortes inicial, rescate y electiva fue superior en la cohorte-r (84%) respecto cohorte-i (71%) y cohorte-e (77%). En la VNI inicial, son factores pronósticos de fracaso: ·El valor más bajo de cociente SF, y el valor más alto de FC a las 2 horas ·Pertenecer al grupo CPAP 4. La técnica es segura, siendo su morbilidad baja y muy leve, y la mortalidad asociada nula.

Author: J.A. Kellum
Publisher: Karger Medical and Scientific Publishers
ISBN: 3318024074
Category : Medical
Languages : en
Pages : 218

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Associated with both acute kidney injury (AKI) and cardio-renal syndromes (CRS), new biomarkers represent both a popular area of investigation and a new opportunity for advancement of therapy. This book contains the resolutions of the most recent ADQI conferences on biomarkers in AKI (Dublin) and on cardio-renal syndromes (Venice). The first part answers specific questions about new biomarkers and their use and utility in AKI: What are the most suitable candidate molecules and physiologic measures, how solid and evidence based is the discovery phase? How can we incorporate the new biomarkers in the AKI conceptual model describing the evolution from susceptibility to insult, decreased GFR and organ death? Even if we have a positive biomarker pattern and we can identify patients at risk or patients with early or even subclinical AKI, how is this information affecting our clinical behavior and practice? The second part is dedicated to the appraisal of the current knowledge about the pathophysiological mechanisms involved in different forms of CRS: it contains contributions on the state-of-the-art knowledge and practice of CRS, particularly focusing on the pathophysiology of the five subtypes. Acute and chronic mechanisms of damage are explored in depth, with particular attention to the primacy of organ involvement and the subsequent pathways of organ crosstalk.Presenting the most recent research in the field of biomarkers, AKI and CRS, this publication is an important educational tool for advanced investigators and clinical experts, but also for students and fellows.

Author: Elisha Waldman
Publisher: Oxford University Press
ISBN: 0190066539
Category : Medical
Languages : en
Pages : 112

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As humanitarian aid organizations have evolved, there is a growing recognition that incorporating palliative care into aid efforts is an essential part of providing the best care possible. A Field Manual for Palliative Care in Humanitarian Crises represents the first-ever effort at educating and providing guidance for clinicians not formally trained in palliative care in how to incorporate its principles into their work in crisis situations. Written by a team of international experts, this pocket-sized manual identifies the needs of people affected by natural hazards, political or ethnic conflict, epidemics of life-threatening infections, and other humanitarian crises. Later chapters explore topics including pain management, skin conditions, non-communicable diseases, palliative care emergencies, the law and ethics of end of life care, and more. Concise and highly accessible, this manual is an ideal educational tool pre-deployment or during fieldwork for clinicians involved in planning and providing humanitarian aid, local care providers, and medical trainees.

Author: Romolo Joseph Gaspari
Publisher:
ISBN:
Category : Medical
Languages : en
Pages : 280

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Emergency Ultrasound: Principles and Practice provides the information you need to successfully perform ultrasound in the emergency department. The book is designed to serve as a quick reference tool, offering bulleted text, colour-coded anatomical drawings, and plenty of images to help you understand which images are important and how to get them. Templated protocol chapters cover initial approach, anatomy, techniques for capturing both still images and video images, and images that show landmarks, good positioning, and poor positioning. Anatomical color coding is consistent throughout the book, allowing readers to quickly understand correct probe placement. Protocols are specifically written to cover both still and video recording of ultrasound.

Author: Hunter B. Moore
Publisher: Springer Nature
ISBN: 3030536068
Category : Medical
Languages : en
Pages : 802

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The first edition of this publication was aimed at defining the current concepts of trauma induced coagulopathy by critically analyzing the most up-to-date studies from a clinical and basic science perspective. It served as a reference source for any clinician interested in reviewing the pathophysiology, diagnosis, and management of the coagulopathic trauma patient, and the data that supports it. By meticulously describing the methodology of most traditional as well as state of the art coagulation assays the reader is provided with a full understanding of the tests that are used to study trauma induced coagulopathy. With the growing interest in understanding and managing coagulation in trauma, this second edition has been expanded to 46 chapters from its original 35 to incorporate the massive global efforts in understanding, diagnosing, and treating trauma induced coagulopathy. The evolving use of blood products as well as recently introduced hemostatic medications is reviewed in detail. The text provides therapeutic strategies to treat specific coagulation abnormalities following severe injury, which goes beyond the first edition that largely was based on describing the mechanisms causing coagulation abnormalities. Trauma Induced Coagulopathy 2nd Edition is a valuable reference to clinicians that are faced with specific clinical challenges when managing coagulopathy.

Author: Peter C. Rimensberger
Publisher: Springer
ISBN: 3642012191
Category : Medical
Languages : en
Pages : 1584

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Written by outstanding authorities from all over the world, this comprehensive new textbook on pediatric and neonatal ventilation puts the focus on the effective delivery of respiratory support to children, infants and newborns. In the early chapters, developmental issues concerning the respiratory system are considered, physiological and mechanical principles are introduced and airway management and conventional and alternative ventilation techniques are discussed. Thereafter, the rational use of mechanical ventilation in various pediatric and neonatal pathologies is explained, with the emphasis on a practical step-by-step approach. Respiratory monitoring and safety issues in ventilated patients are considered in detail, and many other topics of interest to the bedside clinician are covered, including the ethics of withdrawal of respiratory support and educational issues. Throughout, the text is complemented by numerous illustrations and key information is clearly summarized in tables and lists.

Author: John P. Cloherty
Publisher: Lippincott Williams & Wilkins
ISBN: 1451154003
Category : Medical
Languages : en
Pages : 1098

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This edition of the Manual of Neonatal Care has been completely updated and extensively revised to reflect the changes in fetal, perinatal, and neonatal care that have occurred since the sixth edition. This portable text covers current and practical approaches to evaluation and management of conditions encountered in the fetus and the newborn, as practiced in high volume clinical services that include contemporary prenatal and postnatal care of infants with routine, as well as complex medical and surgical problems. Written by expert authors from the Harvard Program in Neonatology and other major neonatology programs across the United States, the manual’s outline format gives readers rapid access to large amounts of valuable information quickly. The Children’s Hospital Boston Neonatology Program at Harvard has grown to include 57 attending neonatologists and 18 fellows who care for more than 28,000 newborns delivered annually. The book also includes the popular appendices on topics such as common NICU medication guidelines, the effects of maternal drugs on the fetus, and the use of maternal medications during lactation. Plus, there are intubation/sedation guidelines and a guide to neonatal resuscitation on the inside covers that provide crucial information in a quick and easy format.

Author: Michael R. Pinsky
Publisher: Springer Science & Business Media
ISBN: 3642282709
Category : Medical
Languages : en
Pages : 430

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The two previous editions of Applied Physiology in Intensive Care Medicine proved extremely successful, and the book has now been revised and split into two volumes to enhance ease of use. This first volume comprises three elements -- "physiological notes," “technical notes,” and seminal studies. The physiological notes concisely and clearly capture the essence of the physiological perspectives underpinning our understanding of disease and response to therapy. The technical notes then succinctly explain some of the basics of “how to” in this technology-centered field of critical care medicine. Finally, a number of seminal studies are provided on diverse topics in intensive care. Applied Physiology in Intensive Care, written by some of the most renowned experts in the field, is an up-to-date compendium of practical bedside knowledge that will serve the clinician as an invaluable reference source on key issues regularly confronted in everyday practice.

Author:
Publisher:
ISBN:
Category : Accidents
Languages : en
Pages : 50

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