Show simple item record

dc.contributor.advisorCarrizosa Gonzalez, Jorge Armando 
dc.contributor.advisorRodríguez Lima, David 
dc.contributor.advisorCelis Rodríguez, Edgar 
dc.contributor.advisorFerrer, Leopoldo 
dc.creatorGarzón Posada, Natalia 
dc.date.accessioned2016-08-01T15:41:52Z
dc.date.available2016-08-01T15:41:52Z
dc.date.created2016-07-07
dc.date.issued2016
dc.identifier.urihttp://repository.urosario.edu.co/handle/10336/12273
dc.descriptionIntroducción La ventilación mecánica es fundamental en el manejo de la falla respiratoria aguda, actualmente no existe consenso sobre el momento exacto de extubación. Este estudio describe el comportamiento de la escala OMAHA+ en nuestra institución. Objetivo Principal Describir los desenlaces clínicos relacionados con la escala OMAHA+ durante la extubación de los pacientes de las unidades de cuidado intensivo del hospital universitario. Métodos Estudio descriptivo, retrospectivo, basado en el registro de la escala OMAHA+ de 68 pacientes durante el proceso de extubación en las Unidades de cuidado intensivo adulto de la Fundación Santa Fe de Bogotá durante Agosto de 2014 a Mayo de 2015. Resultados Se encontraron valores gasométricos cercanos a la normalidad, con una PaO2/FiO2 media de 261 (DS 60,6), SaO2 media de 96% (DS 2%), media de lactato sérico de 1.5 mmol/L (DS 1,2 mmol/L), con signos vitales normales. La causa más común de ingreso a UCI fue Neumonía, seguida por cirugía cardiaca y abdominal. Las medias de parámetros ventilatorios al momento de extubación fueron; PEEP de 6 (DS 0,8), volumen corriente de 8ml/Kg (DS 1,4 ml/Kg), índice de Tobín de 34 (DS 11,9), test de fuga positivo 94%, y sólo una extubación fallida. Conclusiones La escala OMAHA+ puede ser una herramienta útil, aplicable y fácilmente reproducible en los pacientes con soporte ventilatorio mecánico invasivo previo al proceso de extubación, con baja proporción de fallo. Estos resultados deben ser evaluados en estudios prospectivos.
dc.description.abstractPURPOSE Mechanical ventilation is a life-saving supportive therapy but it can also cause lung injury or infection, and its prolongation is related to increased mortality. Weaning from mechanical ventilation is a challenge. Although research suggests that the use of protocols to guide the ventilator discontinuation process may improve outcomes there is currently no consensus on when to perform the extubation of the patient and which protocol to use. The aim of this study was to describe the extubation process using the OMAHA+ scale. METHODS We conducted a descriptive, prospective study, based on the record of the instrument OMAHA+ and follow up of 68 patients during and after extubation between August 2014 and May 2015. RESULTS We found ABG values close to normal, with mean PaO2/FiO2 ratio 261 (SD 60, 6), mean SaO2 96% (SD 2%), mean serum lactate 1, 5 mmol/L (SD 1, 2 mmol/L), with normal vital signs, the most common cause of ICU admission was pneumonia, followed by cardiac and abdominal surgery, ventilator settings at the time of extubation where mean PEEP 6 (SD 0, 8), mean tidal volume 8ml/kg (SD 1, 4 ml/kg), mean Tobin index of 34 (SD 11, 9), positive cuff-leak test 94%, there was only one failed extubation (1, 5%). CONCLUSIONS OMAHA+ scale could be a useful, simple and comprehensive tool to guide extubation patients in the ICU with a low failure rate, and that it includes the predictors of weaning that clinicians use, include demographic characteristics, subjective signs, vital signs and hemodynamic variables, lung mechanics, gas exchange and mechanical ventilator parametres.
dc.format.mimetypeapplication/pdf
dc.language.isospa
dc.rights.urihttp://creativecommons.org/licenses/by-nc-nd/2.5/co/
dc.sourceinstname:Universidad del Rosario
dc.sourcereponame:Repositorio Institucional EdocUR
dc.subjectVentilación Mecánica
dc.subjectExtubación
dc.subjectWeaning
dc.subjectCuidados intensivos
dc.subject.ddcProblemas & servicios de bienestar social 
dc.subject.lembCuidados intensivos (Medicina)
dc.titleDesenlaces de la escala Omaha+ en los pacientes en cuidado intensivo en la fundación santa fe de Bogotá
dc.typemasterThesis
dc.publisherUniversidad del Rosario
dc.creator.degreeEspecialista en Medicina Crítica y Cuidado Intensivo
dc.publisher.programEspecialización en Medicina Crítica y Cuidado Intensivo
dc.publisher.departmentFacultad de Medicina
dc.subject.keywordMechanical ventilation
dc.subject.keywordExtubation
dc.subject.keywordWeaning
dc.subject.keywordCritical Care
dc.rights.accesRightsinfo:eu-repo/semantics/openAccess
dc.subject.decsCuidados críticos
dc.subject.decsRespiración artificial
dc.subject.decsEnfermedades respiratorias
dc.subject.decsEnfermedades pulmonares
dc.type.spaTrabajo de grado
dc.rights.accesoAbierto (Texto completo)
dc.type.hasVersioninfo:eu-repo/semantics/acceptedVersion
dc.source.bibliographicCitation1. Haas CF, Loik PS. Ventilator discontinuation protocols. Respir Care. 2012;57(10):1649-62.
dc.source.bibliographicCitation2. Happ, M. B., Tuite, P., Dobbin, K., DiVirgilio-Thomas, D., & Kitutu, J. (2004). Communication ability, method, and content among nonspeaking nonsurviving patients treated with mechanical ventilation in the intensive care unit. American Journal of Critical Care, 13(3), 210Y220.
dc.source.bibliographicCitation3. MacIntyre NR, Cook DJ, Ely EW Jr, et al. Evidence-based guidelines for weaning and discontinuing ventilatory support: a collective task force facilitated by the American College of Chest Physicians; the American Association for Respiratory Care; and the American College of Critical Care Medicine. Chest 2001; 120:375S.
dc.source.bibliographicCitation4. Epstein SK, Ciubotaru RL, Wong JB. Effect of failed extubation on the outcome of mechanical ventilation. Chest 1997;
112:186 –192
dc.source.bibliographicCitation5. Prasad M, Christie JD, Bellamy SL, Reubenfeld GD, Kahn JM. The availability of clinical protocols in United States teaching intensive care units. J Crit Care 2010;25(4):610-619. Protocolos de extubación.
dc.source.bibliographicCitation6. Walsh, T. S., Dodds, S., & McArdle, F. Evaluation of simple criteria to predict successful weaning from mechanical ventilation in intensive care patients. British Journal of Anaesthesia, 2004; 92(6), 793Y799.
dc.source.bibliographicCitation7. Tobin MJ. Remembrance of weaning past: the seminal papers. Intensive Care Med 2006;32(10):1485-1493.
dc.source.bibliographicCitation8. Esteban A, Ferguson ND, Meade MO, Frutos-Vivar F, Apezteguia C, Brochard L, Raymondos K, Nin N, Hurtado J, Tomicic V, et al. Evolution of mechanical ventilation in response to clinical research. Am J Respir Crit Care Med 2008;177:170–177.
dc.source.bibliographicCitation9. Esteban A, Anzueto A, Frutos F, et al. Mechanical Ventilation International Study Group. Characteristics and outcomes in adult patients receiving mechanical ventilation: a 28-day international study. JAMA 2002; 287: 345–355.
dc.source.bibliographicCitation10. Ferrer M, Esqinas A, Arancibia F, et al. Noninvasive ventilation during persistent weaning failure. Am J Respir Crit Care Med 2003; 168: 70–76.
dc.source.bibliographicCitation11. Boles JM, Bion J, Connors A, Herridge M, Marsh B, Melot C, et al. Weaning from mechanical ventilation. Eur Respir J 2007;29(5):1033- 1056.
dc.source.bibliographicCitation12. Cohen IL, Chalfin DB. Economics of mechanical ventilation: surviving the '90s. Clin Pulm Med 1994;1:100-7.
dc.source.bibliographicCitationmedical intensive care unit patients. Crit Care Med 2011;39:2612– 2618.
dc.source.bibliographicCitation14. Brochard L. Pressure support is the preferred weaning method. As presented at the 5th International Consensus Conference in Intensive Care Medicine: Weaning from Mechanical Ventilation. Hosted by ERS, ATS, ESICM, SCCM and SRLF; Budapest, April 28–29, 2005.
dc.source.bibliographicCitation15. Thille AW, Cortés-Puch I, Esteban A. Weaning from the ventilator and extubation in ICU. Curr Opin Crit Care. 2013 Feb;19(1):57-64.
dc.source.bibliographicCitation16. Meade M, Guyatt G, Cook D, et al. Predicting success in weaning from mechanical ventilation. Chest 2001; 120:400S.
dc.source.bibliographicCitation17. Epstein SK. Decision to extubate. Intensive Care Med 2002;28(5): 535–546.
dc.source.bibliographicCitation18. Esteban A, Cortés I. Proceso del retiro del soporte ventilatorio. Libro de soporte respiratorio básico y avanzado (SORBA) editorial Distribuna. 2013: 229-337.
dc.source.bibliographicCitation19. Coplin WM, Pierson DJ, Cooley KD, Newell DW, Rubenfeld GD. Implications of extubation delay in brain-injured patients meeting standard weaning criteria. Am J Respir Crit Care Med 2000; 161: 1530–1536.
dc.source.bibliographicCitation20. Patiño J.F, Celis E, Díaz J.C. (2014) Bogotá: Editorial Médica Panamericana. Gases sanguíneos, fisiología de la respiración e insuficiencia respiratoria aguda.
dc.source.bibliographicCitation21. Yang KL, Tobin MJ. A prospective study of indexes predicting the outcome of trials of weaning from mechanical ventilation. N Engl J Med 1991; 324:1445-50.
dc.source.bibliographicCitation22. Peñuelas O, Frutos-Vivar F, Fernández C, et al; Ventila Group: Characteristics and outcomes of ventilated patients according to time to liberation from mechanical ventilation. Am J Respir Crit Care Med 2011; 184:430–437
dc.source.bibliographicCitation23. Funk GC, Anders S, Breyer MK, et al: Incidence and outcome of weaning from mechanical ventilation according to new categories. Eur Respir J 2010; 35:88–94
dc.source.bibliographicCitation24. Sellares J, Ferrer M, Cano E, et al: Predictors of prolonged weaning and survival during ventilator weaning in a respiratory ICU. Intensive Care Med 2011; 37:775–784
dc.source.bibliographicCitation25. Cheng KC, Hou CC, Huang HC, Lin SC, Zhang H. Intravenous injection of methylprednisolone reduces the incidence of postextubation stridor in intensive care unit patients. Crit Care Med. 2006;34(5):1345-50.
dc.source.bibliographicCitation26. Salam A, Tilluckdharry L, Amoateng-Adjepong Y, Manthous CA. Neurologic status, cough, secretions and extubation outcomes. Intensive Care Med 2004; 30:1334.
dc.source.bibliographicCitation27. Smina M, Salam A, Khamiees M, et al. Cough peak flows and extubation outcomes. Chest 2003; 124:262.
dc.source.bibliographicCitation28. Miller RL, Cole RP. Association between reduced cuff leak volume and postextubation stridor. Chest 1996; 110:1035– 1040
dc.source.bibliographicCitation29. Sandhu RS, Pasquale MD, Miller K, Wasser TE. Measurement of endotracheal tube cuff leak to predict postextubation stridor and need for reintubation. J Am Coll Surg 2000;190(6):682-687
dc.source.bibliographicCitation30. Jaber S, Chanques G, Matecki S, Ramonatxo M, Vergne C, Souche B, et al. Post-extubation stridor in intensive care unit patients. Risk factors evaluation and importance of the cuff-leak test. Intensive Care Med 2003;29(1):69-74. 5.
dc.source.bibliographicCitation31. Kriner EJ, Shafazand S, Colice GL. The endotracheal tube cuff-leak test as a predictor for postextubation stridor. Respir Care 2005;50(12): 1632-1638.
dc.source.bibliographicCitation32. De Bast Y, De Backer D, Moraine JJ, Lemaire M, Vandenborght C, Vincent JL. The cuff leak test to predict failure of tracheal extubation for laryngeal edema. Intensive Care Med 2002;28(9): 1267-1272.
dc.source.bibliographicCitation33. Lee CH, Peng MJ, Wu CL. Dexamethasone to prevent postextubation airway obstruction in adults: a prospective, randomized, double-blind, placebo-controlled study. Crit Care 2007; 11:R72.
dc.source.bibliographicCitation34. Soo Hoo GW, Park L. Variations in the measurement of weaning parameters: a survey of respiratory therapists. Chest. 2002; 121(6):1947-55.
dc.source.bibliographicCitation35. Esteban A, Frutos F, Tobin MJ, Alia I, Sotsoma JF, Vallverdú I, et al. A comparison of four methods of weaning patients from mechanical ventilation. N Engl J Med. 1995; 332: 345-50
dc.source.bibliographicCitation36. Esteban A, Alia I, Gordo F. Weaning: what the recent studies have shown us. Clin Pulm Med 1996; 3:91-100
dc.source.bibliographicCitation37. Krieger BP, Isber J, Breitenbucheer A, et al. Serial measurements of the rapid-shallow-breathing index as a predictor of weaning outcome in elderly medical patients. Chest 1997; 112:1029–1034
dc.source.bibliographicCitation38. Lee K, Hui K, Chan T. Rapid shallow breathing frequency-tidal volume ratio did not predict extubation outcome. Chest. 1994; 105: 540-3.
dc.source.bibliographicCitation39. Mohamad F, El K, Salah M, Ghassan W. Effect of pressure support ventilation and positive end expiratory pressure on the rapid shallow breathing index in intensive care unit patients. Intensive Care Med. 2008; 34: 505-10.
dc.rights.ccAtribución-NoComercial-SinDerivadas 2.5 Colombia
dc.rights.licenciaEL AUTOR, manifiesta que la obra objeto de la presente autorización es original y la realizó sin violar o usurpar derechos de autor de terceros, por lo tanto la obra es de exclusiva autoría y tiene la titularidad sobre la misma. PARGRAFO: En caso de presentarse cualquier reclamación o acción por parte de un tercero en cuanto a los derechos de autor sobre la obra en cuestión, EL AUTOR, asumirá toda la responsabilidad, y saldrá en defensa de los derechos aquí autorizados; para todos los efectos la universidad actúa como un tercero de buena fe. EL AUTOR, autoriza a LA UNIVERSIDAD DEL ROSARIO, para que en los términos establecidos en la Ley 23 de 1982, Ley 44 de 1993, Decisión andina 351 de 1993, Decreto 460 de 1995 y demás normas generales sobre la materia, utilice y use la obra objeto de la presente autorización. -------------------------------------- POLITICA DE TRATAMIENTO DE DATOS PERSONALES. Declaro que autorizo previa y de forma informada el tratamiento de mis datos personales por parte de LA UNIVERSIDAD DEL ROSARIO para fines académicos y en aplicación de convenios con terceros o servicios conexos con actividades propias de la academia, con estricto cumplimiento de los principios de ley. Para el correcto ejercicio de mi derecho de habeas data cuento con la cuenta de correo habeasdata@urosario.edu.co, donde previa identificación podré solicitar la consulta, corrección y supresión de mis datos.


Files in this item

Thumbnail

This item appears in the following Collection(s)

Show simple item record

http://creativecommons.org/licenses/by-nc-nd/2.5/co/
Except where otherwise noted, this item's license is described as http://creativecommons.org/licenses/by-nc-nd/2.5/co/