ESPECIALIDAD EN MEDICINA CRÍTICA

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COMPLICACIONES DE LA HEMORRAGIA SUBARACNOIDEA ANEURISMÁTICA EN LOS PACIENTES INGRESADOS EN LA UNIDAD DE CUIDADOS INTENSIVOS DEL HOSPITAL ALCÍVAR EN EL PERIODO FEBRERO 2016 – OCTUBRE 2018
(2018-12-13) Zambrano Alcívar, José Ernesto; Quinteros Urgilés, Patricia Susana; Cevallos Espinar, Stenio
To analyze the complications of aneurysmal subarachnoid hemorrhage in patients admitted to the Intensive Care Unit of the Alcívar Hospital from February 2016 to October 2018. Methodology: An observational, quantitative, retrospective, analytical and transversal, which will analyze the medical records of 36 patients with subarachnoid hemorrhage in the> Intensive Care unit. The sample was non-probabilistic for convenience and Excel 2010 and SPSS 21 will be used for the statistical analysis of the information. For each patient, the demographic and clinical characteristics will be recorded in a data collection forms. Results: The age group most affected was> 60 years of age with 50% of cases, especially males (52.8%). 69.5% (25) developed clinical complications during their hospital stay, the most frequent being hyponatremia (36.1%), rebleeding (16.7%) and vasospasm (16.7%). The most common risk factors were the presence of hypertension (55.6%), cigarette smoking (44.4%), association of diabetes mellitus and hypertension (36.3%) and obesity (28.4%). Conclusions: A statistically significant association was found between the complications with the risk factors: hypertension, cigarette consumption, obesity and association of hypertension with diabetes mellitus, because the probability obtained from the p-value was
"FACTORES PRONÓSTICOS DEL PACIENTE CON HEMORRAGIA SUBARACNOIDEA ANEURISMÁTICA DEL SERVICIO DE TERAPIA INTENSIVA DEL HOSPITAL LUIS VERNAZA EN EL PERÍODO 2017 - 2018"
(2018-03-13) Vásconez Chérrez, Mónica Gabriela; Fernández Cadena, Telmo
To identify prognostic factors of the patient with aneurysmal subarachnoid hemorrhage, an analytical, descriptive, observational, retrospective and transversal study was designed, where 65 patients were evaluated between men and women from 18 to 79 years of age, who met the criteria for HSA aneurysmal hospitalized in the intensive care unit of the "Luis Vernaza" Hospital in Guayaquil, during January 2017 to August 2018. The epidemiological variables included were age, sex, personal and family history, habits, clinical condition to income according to Hunt and Hess scales, Fisher, World Federation of Neurological Surgeons, location and size of the aneurysm, type of treatment, complications and condition at discharge. Of 65 cases, the variables with the worst prognosis were ECG < 8 to the admission with mortality of 22% (OR: 3.5, 7 P: 0.02), according to the exclusion Aneurysmal, to 62% of patients was performed past the 72 hours with a mortality of 20% in relation to 22% that was not treated (or: 24.8 P: 0.002), data that is related to the most frequent complication, rebleeding with a mortality 17% (or 5.23 P: 0.01). The incidence was higher in women without generating an impact on mortality, in our opinion we must reconsider the time in which surgical treatment is performed due to the high risk of rebleeding, longer hospital stay and complications. Therefore, the creation of protocols for management, treatment and multidisciplinary work should be discussed.
EVALUACION DEL DELTA DE CO2 Y SATURACION VENOSA CENTRAL EN EL PACIENTE CRITICO ONCOLOGICO CON SHOCK SEPTICO DURANTE LA FASE INICIAL DE RESUCITACION EN EL HOSPITAL JUAN TANCA MARENGO SOLCA DE LA CIUDAD DE GUAYAQUIL EN EL PERIODO DE ENERO HASTA OCTUBRE DEL 2018.
(2018-01-13) Romero Carvajal, Stalin Norberto; Yánez Castro, Jorge Luis
Objective: To evaluate the levels of arterio-venous CO2 difference and central venous saturation in the initial resuscitation of oncological patients diagnosed with septic shock admitted to the Intensive Care Unit of the SOLCA Guayaquil Hospital. Methods: We conducted an observational, non-experimental, descriptive and analytical study in which 59 patients with diagnosis of septic shock were selected from the Intensive Care Service of the SOLCA Guayaquil Hospital, between January and October of 2018. The patients were assigned to two groups according to the value delta CO2 at entry; <6 mmHg or> 6 mmHg, and central venous saturation> 70% or <70%, determining its evolution at 6 and 24 hours after the start of hemodynamic resuscitation. Results: It was demonstrated that the CO2 delta> 6 mmHg in the first 24 hours correlated with a poor prognosis despite having a normal SvcO2. We also found a mortality of 41% in solid tumors and 39% in hematological tumors, with an OR: 1.1 (P: 0.0001), no statistically significant difference was found. Conclusions: Patients with elevated CO2 delta during the first hours of admission to the ICU have higher mortality. SvcO2> 70% within the first few hours of resuscitation are not associated with decreased mortality.
ASOCIACIÓN ENTRE TIEMPO DE CIRCULACIÓN EXTRACORPÓREA Y PINZAMIENTO AÓRTICO EN LA MORTALIDAD POSTOPERATORIA DE CIRUGÍA CARDÍACA EN LA UNIDAD DE CUIDADOS INTENSIVOS DEL HOSPITAL ALCÍVAR EN EL PERIODO ENERO 2017-JUNIO DEL 2018
(2019-01-13) Rodríguez Martínez, José Luis; San Martín Herrera, Carlos Julio; Cevallos Espinar, Stenio
Cardiac surgeries such as valvular replacements, coronary revascularization or mixed procedures usually require extracorporeal circulation (ECC). It is believed that prolonged CPB time and aortic clamping time are independently associated with an increase in postoperative mortality. Objective: To determine the association between the time of extracorporeal circulation and aortic clamping with the post-operative mortality of cardiac surgery in the intensive care unit of the Alcívar Hospital from January 2017 to June 2018. Methodology: Observational, quantitative research, retrospective, analytical and transversal. The sample was of a non-probabilistic type for convenience that evaluated 90 patients undergoing cardiac surgery with extracorporeal circulation, divided into 4 groups: with CPB time> 120 minutes, CPB <120 minutes, PA> 60 minutes, and BP <60 minutes. Excel 2010 and SPSS 21 were used for the statistical processing of the data. Results: 57.8% (52) were patients> 60 years. The average age was 59.43 years. The male sex predominated with 72.2% (65). Coronary surgery was the most performed with 47% (42). The mortality rate was 24.4% (22). The surgical risk using Euroscore II in 68.9% was low. The most frequent risk factors were hypertension (56.7%), diabetes mellitus (18.9%) and cigarette consumption (13.3%). Conclusions: The HTA triples the risk of mortality in relation to the group that is not hypertensive (HR: 3,877 IC95%: 0,331-9,326). The extracorporeal circulation time> 120 minutes is a risk factor 3 times higher for mortality (HR: 3.587 IC95%: 1,234- 10,430). The time of aortic clamping> 60 minutes is a risk factor 4 times higher for mortality (HR: 4.307 IC95: 1.425-13.017).
MEDICIÓN DEL DIÁMETRO DE VENA CAVA INFERIOR COMO PARTE DEL MANEJO DE LA VOLEMIA EN EL SHOCK SÉPTICO EN EL ÁREA DE TERAPIA INTENSIVA DEL HOSPITAL ALCÍVAR PERÍODO 2016 – 2017.
(2019-02-13) Puig Pérez, Andrés de Jesús; Cevallos Espinar, Stenio Eduardo
Intravascular volume monitoring has been performed by invasive procedures (Swan Ganz catheter, central venous pressure), lack of precision and potential complications progressively decreased its use by ecosonography, is non-invasive and quickly verifies the patient's liquid status. Objective: To demonstrate the use of vena cava diameter measurement as part of the management of volemia in the patient in septic shock. Method: The study was observational, descriptive, prospective. Forty-three patients with septic shock were studied, including those with other pathologies who developed septic shock during their admission. We monitor direct arterial pressure, central venous pressure (CVP) and transthoracic ultrasound. We measured the vena cava inferior to the admission and after the administration of intravenous crystalloids 30 ml / kg. Results: two groups were observed, the first one responded to the administration of volume in which the initial Distensibility index was measured greater than 18% and a Variability Index greater than 12% corresponding to 29 patients and the second in whom the index was measured. Initial distensibility lower than 18% and a Variability Index lower than 12% and despite achieving TAM ≥ 65 mm Hg, 14 patients required the use of amines during the following 3 hours for not maintaining TAM.
“DISNATREMIAS EN PACIENTES CON LESION CEREBRAL AGUDA SEVERA EN LA UNIDAD DE CUIDADOS INTENSIVOS DEL HOSPITAL LUIS VERNAZA DURANTE EL PERIODO MAYO 2017 – MAYO 2018”
(2019-01-13) Merino Mijas, Tatiana Maribel,; Fernández Cadena, Telmo Eduardo
Sodium disorders are the most common and least understood electrolyte disorders in patients with acute brain injury due to the central role played by the central nervous system in the regulation of sodium and water homeostasis which can lead to serious complications and adverse outcomes including death. Complications can be minimized by a systematic approach to the recognition, diagnosis and treatment of sodium alterations. Objective: To evaluate the disnatremias in adult patients with severe acute brain injury interned in the intensive care unit of the Luis Vernaza Hospital. Methodology: An observational, retrospective and descriptive study was conducted with all the patients who entered the critical medicine area of the "Luis Vernaza" Hospital during the period from May 2107 to May 2018. The sample consisted of 82 patients between the ages of 20 At 79 years between women and men, the statistical analysis was performed with odds ratio (OR) and Pearson's relationship coefficient to respond to the objectives of the study. Results: The risk of presenting any type of dysnatremia studied in the present series was not significantly higher by type of acute brain injury, CPS and HSA: OR 1.4, 95% CI 0.5- 3.9. CPS and TEC OR 0.6 IC 95% 0.2 - 1.5. Both the CPS and the insipid diabetes increase the risk of presenting a decrease in extracellular volume with OR 5.1 with an IC 1.9-14 in the case of the CPS and OR 4 with an IC 1.4-10 in the DI. CPS increases the risk of mortality with an OR 5.6 and CI 2 - 15, which is statistically significant, DI does not increase mortality, and however, it is a predictor of brain death. The average of Apache the average of those who survived was 14 and those who died 15, in the sofa the average both for living and dead is 6, therefore the severity measured by these predictors was the same between the two groups. When sodium was taken as limit of hypernatremia 150 meq/L the mortality happened to be of 33%, whereas when it was taken with range of sodium normality of 135 -145 meq/L, mortality decreases to zero. Conclusions: The greatest risk of finding hypernatremia is in a patient with cranial encephalic trauma and intraparenchymal hemorrhage was associated with an increased risk of hyponatremia. CPS is a risk factor for mortality in patients with severe acute brain injury, while in the DI and SIADH no statistically significant values were found.
“FACTORES DE RIESGO PARA EL DESARROLLO DEL SÍNDROME DE BAJO GASTO POST CIRUGÍA CARDIACA EN PACIENTES INGRESADOS A LA TERAPIA INTENSIVA DEL HOSPITAL ALCÍVAR EN EL PERIODO JULIO 2016 A JUNIO 2017”.
(2018-07-13) Lozano Samaniego, Fabian Agustin; Cevallos Espinar, Stenio Eduardo
The low cardiac output syndrome (LCOS) at the postoperative of a cardiac surgery is a potential complication for the intervened patients of cardiac surgery. It is associated to the rise of morbimortality, which is the extension of the stay in in the intensive care room, and as well it increments the use of the resources, for which we try to identify the risk factors that imply the LCOS as the patients are taken into the intensive therapy unit (ITU) at Alcivar Hospital. METHODS. A total of 88 consecutive patients were included who were submitted to some type of cardiac surgery between July 2016 and June 2017. For 18 and older patients we used the multivariable analysis to identify LCOS forecasters. RESULTS. By analyzing the data, we can tell which prediction of the low cardiac output syndrome is related to: IRC (OR: 3.61, IC 95%: 1.43 to 9.11, P: 0.0064), the valvular surgery (OR: 2.5, IC 95%:1.03 to 6.45, P: 0.04), maintaining the circulation pump above 120 minutes (OR: 9.42, IC95%: 1.86 to 47.5, P: 0.0066). The laboratory tests that were related at the entry to the intensive therapy unit: older leukocytes to 10500 (OR: 5.4, IC95%: 1.47 to 20.39, p: 0.01); the PH <7.35(OR: 3.6, IC95%: 1.43 to 9.11, p: 0.0064); the BNP> 385 (OR: 13.86, IC95%: 4.24 to 45.26, p: < 0.0001). Mortality relation was evidenced in patients that developed low cardiac output syndrome with: OR: 17, IC95%: 3.54 to 81.4, p: 0.0004
"CARACTERÍSTICAS CLÍNICAS Y TOMOGRÁFICAS DEL TRAUMATISMO CRÁNEO ENCEFÁLICO GRAVE. UNIDAD DE CUIDADOS INTENSIVOS. HOSPITAL LUIS VERNAZA. OCTUBRE 2017-OCTUBRE 2018
(2019-02-13) Lòpez Aguirre, Wilson Javier; Fernández Cadena, Telmo Eduardo
The traumatic brain injury (TBI) is the most frequent cause of death in young adults, in the polytrauma 45% of mortality is attributable to TBI, being the main cause of disability, generating a hospital cost, social and reintegration labor high. The traffic accident is the main mechanism of injury, followed by work accidents, falls and a number of events that generate dynamic changes in the cranial and brain structure. It highlights three stages of mortality, first in the accident site with catastrophic injuries, second generated in the transfer phase or hospital admission within the first hours, and a third stage that varies between 1 to 5 weeks due to complications such as sepsis. Its classification Glasgow Coma Scale (GCS) <8 and the classification of the Traumatic Coma Data Bank (TCDB) at the level of computed tomography of the brain. MARSHALL. Predictors of poor results hypothermia, hypotension, hypoxemia, pupils, delay in admission to the intensive care unit (ICU). At discharge we measure the Glasgow Outcome Scale (GOS) results, assessing five states 1 = death, 2 = vegetative state, 3 = severe disability, 4 = moderate disability, and 5 = good recovery. The main objective is to determine the clinical and tomographic characteristics in patients with severe head trauma admitted to the Intensive Care Unit of the Luis Vernaza Hospital, between October 2017 and October 2018, performed by collecting data obtained in a template designed in Excel , this study is of a descriptive, prospective, observational, longitudinal type; the results obtained showed us the clinical characteristics that are directly related to their mortality; Hypoxia, hypotension, pupillary change and glasgow of admission, and that the tomographic characteristics determined by Marshall's scale helped us to establish that the higher their score, the surgical management was, and in turn doubles the risk of serious disability upon discharge, it is recommended to take into account these characteristics since it will depend on decreasing mortality and disabilities, allowing early social and labor inclusion
MUERTE ENCEFÁLICA EN PACIENTES NEUROCRÍTICOS. UNIDAD DE CUIDADOS INTENSIVOS. HOSPITAL LUIS VERNAZA. 2016-2018.
(2019-03-13) Llumiquinga, Diego; Salvatierra, José
Brain death constitutes a medical entity accepted by the scientific community, state legislations and the main religions of the world. It is defined as the irreversible cessation of all neurological functions, including those of the brainstem. Although our country has a brain death guide, there are few data or studies on the characteristics of this population, its management, complications and the likelihood of being effective donors. Objective: The main objective is to establish the epidemiological profile of brain death in neurocritical patients of the intensive care service of the Hospital Luis Vernaza 2016-2018. Methodology: An observational, descriptive, retrospective, cross-sectional study was conducted with patients admitted to the critical area of the Hospital "Luis Vernaza" between April 1, 2016 and April 30, 2018. The population studied was 44 patients diagnosed with brain death. with established inclusion criteria. The variables to be studied were: age, gender, cause, time, effective donor, complications. Results: The most affected gender was male with an average age of 37 years, the main cause of brain death is head injury, the most usual diagnostic method was the clinical exploration, the time elapsed from admission to the brain death certification it was mostly 24 hours, with only 43.2% being effective donors. Recommendations: Knowledge about brain death within health personnel should be expanded in order to improve the management of these patients. Key words: Brain death, causes, intensive care unit, time, complications.
“PREDICTORES PRONÓSTICOS DE LOS PACIENTES CON SÍNDROME DE GUILLAIN BARRÉ EN LA UNIDAD DE CUIDADOS INTENSIVOS DEL HOSPITAL LUIS VERNAZA 2014-2018.”
(2019-01-13) García Coronel, Maritza; Lema Masalema, Jaime; Fernández Cadena, Telmo
The Guillain Barré Syndrome is characterized by an acute inflammatory polyneuropathy producing an immune response against peripheral nerve structures, destroying the myelin or axon resulting in the demyelinating and axonal variants of GBS. It appears after a previous infectious disease. GBS usually presents with progressive flaccid paralysis and areflexia, whose diagnosis is based on clinical findings, CSF findings and electromyography. Objective: To determine the predictive predictors of patients with GBS in the Intensive Care Unit of the Luis Vernaza Hospital in a given time of 5 years. Methodology: An observational, descriptive, retrospective and cross-sectional study was conducted in patients admitted with a diagnosis of GBS to the area of critical medicine of the Hospital "Luis Vernaza" during the period 2014 - 2018. The population was 25 patients diagnosed with SGB with the inclusion criteria established. Results: predominance of male sex with 64%, maximum age was 83 years and minimum age of 25 with an average of 45 years, 68% was the ascending form, the AMSAN variant with 48% followed by the AIDP variant with 32%, the condition of discharge was 96% alive and 4% deceased. The treatment received was immunoglobulins 52% and plasmapheresis 48%. Conclusions: In this study the clinical characteristics are similar to those reported by other authors, the AMSAN variant was the most frequent, the mortality and the demand for mechanical ventilation coincides with the international literature.
“NEUMONÍA ASOCIADA A VENTILACIÓN MECÁNICA (NAV) EN PACIENTES CON TRAUMATISMO CRANEOENCEFÁLICO (TCE) SEVERO, EN LA UNIDAD DE CUIDADOS INTENSIVOS DEL HOSPITAL TEODORO MALDONADO CARBO EN EL AÑO 2016”
(2018-08-13) Freire, Diego; Mawyin, Carlos
Background: Ventilator - associated pneumonia (VAP) due to mechanical ventilation (MV) has been reported as being more frequent among patients with Severe Trauma Brain Injury (TBI), due to factors that imply a physiopathological process with multifactorial effects that affect a "route". in between the brain and the lung, facilitating the development of this complication. However, certain factors increase the risk of developing it, although there are discrepancies about the role of some of them. Objective: To determine the risk factors of developing VAP among patients with severe TBI. Methodology: A relational, case – control study design was carried out in which patients with severe TBI treated in the Intensive Care Unit (ICU) of the Teodoro Maldonado Carbo Hospital (HTMC) in 2016 were included: 26 consecutive cases with severe TBI that developed VAP and 78 controls randomly chosen. Results: The prevalence of VAP among patients with severe TBI was 14.2%, mortality 26.9%: Associations were identified with factors such as severe Glasgow score (P 0.000032, OR 7.4, 95% CI 2.8-19 , 6), car accident (P 0.000137, OR 6.1, IC95% 2.2-16.3), Comorbidity (P 0.039, OR 3.8, IC95% 1.0-13.9), and multi-resistant germ infection (P 0.000044; OR 8.5, IC95% 2.9 - 24.0). The need for tracheostomy (P 0.016, OR 0.2, 95% CI 0.1-0.6), early tracheostomy (P 0.016, OR 0.1, IC95% 0.03-0.6) were identified as protection factors Conclusion: The presence of risk factors increases the possibility of developing VAP among patients with severe TBI in the HTMC.
COMPARACIÓN ENTRE TRAQUEOSTOMÍA TEMPRANA Y TARDÍA EN LOS PACIENTES CRÍTICOS HOSPITALIZADOS EN LA UNIDAD DE CUIDADOS INTENSIVOS DEL HOSPITAL LUIS VERNAZA. FEBRERO 2017 - FEBRERO 2018.
(2019-03-13) Coronel Cevallos, Jenny Magali; Salvatierra Murillo, José Ramón
Tracheostomy is a procedure that aims to establish a definitive airway in the critical patient (1). It is preferred to perform the tracheostomy in the first 7 days of intubation to reduce the complications related to intubation (2). Objectives: To determine if early tracheostomy improves the prognosis of critical patients in ICU. To compare the survival, mechanical ventilation time, hospital stay, and incidence of pneumonia in patients with an early tracheostomy. late tracheostomy. Design: Retrospective observational analytical study. Place: Intensive care unit of the Luis Vernaza Hospital, February 2017 to February 2018. Results: Of a total of 140 patients with tracheostomy, 37 belong to the early tracheostomy group and 103 to the late tracheostomy group. Statistically significant differences were found when comparing stay in ICU (27 vs. 34 days p = 0.013), total time of mechanical ventilation (17 vs. 22 days p = 0.002), pneumonia associated with mechanical ventilation 32% vs. 49% (n = 12 vs. 50). Survival of patients with early tracheostomy versus delayed tracheostomy visualized in the Kaplan-Meier curve does not find a significant difference at hospital discharge (p = 0.881). Conclusions: Early tracheostomy is associated with fewer days in the ICU and mechanical ventilation. It was not shown that early tracheostomy improves patient survival. Recommendations: Determine the predictive clinical factors to decide the performance of tracheostomy. Develop a management guide for the patient with a need for tracheostomy.
EFECTOS PULMONARES DE LA VENTILACIÓN NO INVASIVA INTERMITENTE COMPARADA CON TERAPIA RESPIRATORIA EN POSOPERATORIO DE CIRUGÍA CARDIACA. UNIDAD DE CUIDADOS INTENSIVOS DEL HOSPITAL LUIS VERNAZA. MARZO A OCTUBRE 2018.
(2018-12-13) Chango Criollo, Esteban Ismael; Córdoba López, Nelson Olmedo
An observational, analytical, prospective and longitudinal study was conducted in the Intensive Care Unit of the Luis Vernaza Hospital, from March to October 2018, with the objective of evaluating the pulmonary effects of non-invasive ventilation (NIV) versus respiratory physiotherapy in the postoperative period of cardiac surgery. We used a random sample, the 55 patients included in the study were divided into two groups: those who received intermittent NIV (31 patients) and those who received conventional respiratory therapy (24 patients). They were tested for lung function, oxygenation index and pulmonary complications were assessed. Both groups were compared using the SPSS version 21 program as a statistical method, performing the Kolmogorov Smirnov test to assess normality and the Student's T test to determine differences between the groups studied. The main results were: the NIV group decreased oxygenation levels at 6 hours versus the control group (p <0.05). The pulmonary complication 24 hours postoperatively of the NIV group was atelectasis, vs bronchial congestion presented by the control group. The pulmonary function of the NIV group was not superior to the control group at seven and thirty days postoperatively. It is concluded that NIV post-extubation did not show improvement in oxygenation compared to control group and did not decrease the percentage of atelectasis or improve pulmonary function tests compared to the control group, presenting significant difference with respect to extubation and stay in intensive care in comparison to the control group. NIV is not recommended after cardiac surgery to prevent postoperative atelectasis and hypoxemia.
“PREDICTORES DE MORBIMORTALIDAD RELACIONADOS A ESTATUS EPILEPTICO. UNIDAD DE CUIDADOS INTENSIVOS DEL HOSPITAL LUIS VERNAZA. OCTUBRE 2016 –OCTUBRE 2018”
(2019-02-13) Campozano Burgos, Cynthia Vanessa; Fernández Cadena, Telmo
The status epilepticus is a pathology recognized worldwide, by the impact as a predictor of morbidity and mortality, characterized by epileptogenic neuronal discharges. OBJECTIVE: To determine the predictors of morbidity and mortality related to epileptic status in the intensive care unit of the Luis Vernaza Hospital. METHODOLOGY: A total of 106 patients with a diagnosis of epileptic status were analyzed in the Critical Care Medicine Service. The patients were selected based on clinical and electroencephalographic criteria, with the subsequent analysis of factors associated with poor prognosis such as: age, sex, etiology, history of epilepsy, type of crisis, level of awareness upon admission, clinical complications inherent in the therapeutic, STESS (Severity score in epileptic status> of 3 unfavorable result). RESULTS: 106 patients were evaluated, consisting of 41 women and 65 men. The age ranges between 17 and 71 years, with a median of 38 years. The diagnoses found were cranioencephalic trauma, neuroinfection, cerebral vascular event, encephalopathies, cryptogenic, autoimmune, immunomodulatory drugs, brain tumors, cessation of antiepileptic drug. The most frequent factors associated with poor prognosis were age (patients> 65 years of age increased the risk of mortality); sex (male worse prognosis by correlation to etiology); the etiology most associated with mortality is trauma, neuroinfections and encephalopathies (sepsis / anoxic); cranioencephalic trauma expressed according to Marshall in relation to Rankin shows worse prognosis, without reaching statistical significance; the most frequent complication is pneumonia with a mortality of 45%; according to the type of crisis (non-convulsive) with a mortality of 53.8%; According to STESS, 57% of patients present an unfavorable prognosis. CONCLUSIONS: The Epileptic Status had a mortality of 50%, therefore the detection of risk predictors would allow an early intervention; considering that the progression of the neurological lesion increases in relation to the time of crisis, we recommend a management protocol according to our local reality, a comprehensive pharmacology analysis of the sedative and antiepileptic drugs most used in our service, accompanied by a bundle of indicators of systemic complications that allow us to avoid deleterious effects of the patient with epileptic status.
NUTRIC SCORE MODIFICADO PROMEDIO EN EL PACIENTE ONCOLÓGICO CRÍTICO EN EL HOSPITAL SOLCA GUAYAQUIL DURANTE EL PERÍODO SEPTIEMBRE 2017 HASTA AGOSTO 2018
(2019-03-13) Bajaña Huilcapi, Cynthia Katiuska; Martínez Rodríguez, Galo Leonardo; García Cruz, Carlos
To identify the average modified NUTRIC score in the critical oncological patient at the SOLCA Guayaquil hospital during the period September 2017 to August 2018. Methodology: A retrospective, observational analytical study that included critical patients older than 18 years of both sexes with oncological pathology and excluded those who were discharged or died within the first 24 hours of admission to the ICU. The analysis of the variables was done with descriptive and inferential statistics using MedCalc Statistical Software version 18.2.1. Results: 176 patients were studied, with a median age of 57.00 years. The 64.2% were women. The average of APACHE was 18 ± 7.30 DE and the median of SOFA was 4.00. The median of mNUTRIC score was 3. Mortality was 19.9%. The mNUTRIC score was significantly higher in patients died of the living at the end of their internship in UCI (p <0,0001). An analysis of ROC curves confirmed the analytical relationship. There is positive correlation between mNUTRIC score and the days of hospitalization in UCI (Rho de Spearman 0,401; p <0,0001). Statistically significant differences were found in the scores of mNUTRIC score and clinical and surgical admissions (Me 4.00 IR 2-6 vs Me 2 IR 1-3; p 0,0001) Conclusion: The mNUTRIC score is a good tool for assessing the nutritional risk in critically ill patients whose average was > 4 to benefit from early nutrition.
MORTALIDAD ASOCIADA AL BALANCE HÍDRICO POSITIVO DEBIDO A LA REANIMACIÓN EN PACIENTES CON SEPSIS Y/O CHOQUE SÉPTICO EN LA UNIDAD DE CUIDADOS INTENSIVOS DEL HOSPITAL LUIS VERNAZA DURANTE EL PERÍODO ABRIL 2017–OCTUBRE 2018
(2019-01-13) Abrigo Robles, José Luis; Paredes Chang, Carlos
Fluid therapy is one of the cornerstones in the management of patients with sepsis / septic shock; such intervention is not free of risks. Numerous studies demonstrated the association of positive fluid balance and increase in mortality, longer duration of days in mechanical ventilation and hospital stay in septic individuals. OBJECTIVE. To determine the mortality associated with the positive fluid balance in septic patients hospitalized in the intensive care unit of the Luis Vernaza Hospital. POPULATION. The universe consisted of 90 patients who met the inclusion and exclusion criteria hospitalized in the critical care unit of the Luis Vernaza Hospital during April 2017 - October 2018. METHOD. Analytical, retrospective and observational study. The information was obtained from electronic medical record. Fluid administration was calculated based on the amount of fluids administered and recorded. A univariate analysis, probability tests, statistical significance tests were obtained by Chi Square for qualitative variables, by Student's T for qualitative and quantitative variables and Pearson's correlation test for quantitative variables.
PREVENCIÓN NO FARMACOLÓGICA DE NEUMONÍA ASOCIADA A VENTILACIÓN MECÁNICA EN EL HOSPITAL TEODORO MALDONADO CARBO. PERÍODO JUNIO - NOVIEMBRE 2016
(2016-12) Vázquez Cárdenas, Andrés Leonardo; Torres, Cesar
Introduction: Pneumonias associated with mechanical ventilation (PAMV) are a significant public health problem, due to their tendency to accumulate complications, high fatality rates, as well as the high direct and indirect economic costs related to treatment and rehabilitation of these patients. Objective: To evaluate compliance with non-pharmacological prevention measures against ventilator-associated pneumonia in the Hospital "Teodoro Maldonado Carbo" in the period June-November 2016. Material and Methods: A quantitative, analytical, observational, prospective, non-experimental study was conducted in 103 patients of the Intensive Care Unit of the Hospital "Teodoro Maldonado Carbo" in the period June-November 2016. An instrument of Collection of data was applied. The qualitative variables were expressed as frequencies and the quantitative as means with standard deviation. The chi square test was used to determine associations and the Studen's T test to compare means between two groups. The results of the statistical tests were considered as significant when the p-value was less than 0.05. Results: The prevalence of PAMV was 61.2%. A significant association was found between days of prolonged endotracheal intubation (p<0.001), prolonged in-hospital stay (p=0.008), use of corticosteroids (p=0.006), and presence of radiographic changes. The SOFA scale was higher in PAMV (7.33 ± 2.57 points vs. 5.82 ± 1.90 points). There was a lower frequency of PAMV in the use of tracheostomy (37.0% vs 69.7%) and handwashing (45.2% vs. 72.1%) with a statistically significant association. Conclusions: There is a high prevalence of PAMV in our locality, where handwashing and early tracheostomy may offer a benefit to reduce the frequency of pneumonia. This is why it is necessary to reinforce important preventive measures against this entity, as well as the close monitoring of practices and protocols in the centers of assistance in critical medicine in our locality.
LA VARIACIÓN RESPIRATORIA EN EL DIÁMETRO DE LA VENA CAVA INFERIOR COMO UN INDICADOR EN LA REANIMACIÓN HÍDRICA DE LOS PACIENTES SÉPTICOS CON VENTILACIÓN MECÁNICA
(2017) Suárez Páez, Diego Armando; Torres Gutiérrez, César
Severe sepsis and septic shock are major health problems, affecting millions of individuals around the world each year. Similar to polytrauma, acute myocardial infarction, or stroke, the proper and rapid administration of therapy in the first few hours after developing severe sepsis is probably the main influence on clinical outcomes. As a general objective to determine the importance of the measurement of respiratory variation in the inferior vena cava diameter as an indicator in the water reanimation of septic patients with mechanical ventilation admitted to the Intensive Care Unit of the Hospital of the Ecuadorian Social Security Institute "Dr. Teodoro Maldonado Carbo "in the period January-June 2016. The hypothesis with which the research was carried out consisted of the following: "Respiratory variation in the diameter of the inferior vena cava is a determinant indicator during the water resuscitation of septic patients with mechanical ventilation admitted to the Intensive Care Unit of the Hospital Of the Ecuadorian Social Security Institute "Dr. Teodoro Maldonado Carbo "in the period January-June 2016. 25 A prospective review was carried out with a population of 247 septic patients admitted to the Intensive Care Service of the Hospital of Ecuadorian Social Security Institute "Dr. Teodoro Maldonado Carbo "in the Period January-June 2016; During that period, supported by descriptive cross-sectional research with the clinical epidemiological method. Information was obtained through observation, documentary analysis, bibliographical compilation and clinical records. The analysis of the results was done through statistical tables, graphical representations and percentage analyzes of the same. The most important result of the research process is that: "Respiratory variation in the diameter of the inferior vena cava is a determinant indicator during the water reanimation of the septic patients with mechanical ventilation admitted to the Intensive Care Unit of the Hospital of Instituto Ecuatoriano Of Social Security "Dr. Teodoro Maldonado Carbo "in the period January-June 2016. This research is structured of five chapters developed sequentially and annexes that complement it.
SEPTI FAST COMO HERRAMIENTA DE DIAGNÓSTICO MICROBIOLÓGICO TEMPRANO PARA SHOCK SÉPTICO
(2017-01) Salas Banchón, Julio César; Zurita Rosero, Bolívar
Septi Fast is a polymerase chain reaction test, known by its acronym in english PCR (polymerase chain reaction). It is a molecular biology technique developed by Roche laboratories, with the aim of detecting in real time and quickly the microorganism that frequently cause sepsis. Patients admitted to the Intensive Care Units, due to their characteristics of being found with hemodynamically lasers, with supports for some or some organ failures prevail in them the rapid stabilization and the diagnosis of their critical condition. New test in molecular biology laboratories are helping to decrease the time in diagnoses and to try to improve the treatments of these patients. That is why the speed of a diagnostic test is a great advantage and is decisive in the moment of leaning for an antimicrobial decision. It is widely known, that as for septic patients, to err with the antimicrobial treatment, it is deleterious. Recently, in areas where critically ill patients are managed, there is a need to optimize treatment, in terms of organ failure, even more so when referring to a patient in severe conditions. On the other hand, it is irreparable the mistake with regard to the indiscriminate use of antibiotics, since these errors are one of the pillars for the dissemination of multiresistant bacteria. Like trying to hit an arrow in the center, in the target game, you need scientific tools, with robust information, that are fast, accurate, infallible, which don not exist. However, high sensitivity and specificity are sought.
NT PRO PÉPTIDO NATRIURÉTICO CEREBRAL VERSUS APACHE II COMO PREDICTOR DE MORTALIDAD EN SHOCK SÉPTICO
(2017-02) Palaguachi Calle, Aida Lucia; Sánchez, Gonzalo
Brain natriuretic peptide (PNA) is a peptide hormone, and N-terminal pro-B-type natriuretic peptide (NT-proBNP) which is determined to be a stress marker of the ventricular wall and is released by the muscle cells of the cardiac atrium as a natural response to increased blood pressure. Septic shock is a consequence of a generalized infection of the organism, caused by a pathogen or microorganism to which the organism responds with an inflammation because of the generalized tissue damage in the organism. Elevated levels of PNA are associated with increased mortality in patients diagnosed with septic shock, and measurements of this hormone can be compared with the results obtained from the APACHE II score in order to analyze which method is more reliable. The study is a prospective and descriptive study applied to patients admitted to the Intensive Care Unit of the Luis Vernaza Hospital by analyzing the elevated values of NT-proBNP relative to the APACHE II score to determine which method is more reliable as a predictor of Mortality in patients diagnosed with septic shock, the total number of study subjects was 58 patients, mainly women with an incidence of 58.6% and a mortality rate of 52.9%. Of the total number of patients studied, the most frequent complication was hypertension for both living and Deceased It was determined that patients with higher ANP had a higher mortality in relation to APACHE II mainly in levels between 20-24. Determining that NT-proBNP along with APACHE II function as a reliable indicator of mortality.

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