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La fistula del muñón bronquial es una seria complicación de la neumonectomía, por su complejidad tanto en los cambios anatomofisiológicos que el paciente experimenta, como en la diversidad de recursos para su resolución. El objetivo de este estudio es la presentación de este primer caso en la historia quirúrgica del país de abordaje transesternal, transpericárdico para el cierre de la fístula del muñón bronquial post neumonectomía en el Hospital San Vicente en Guatemala. Método: Se presenta el caso de una paciente de sexo femenino a quien se le realizó neumonectomía derecha por tuberculosis pulmonar y que presentó dehiscencia del muñón bronquial por lo que se procedió a realizar abordaje transesternal transpericárdico para el cierre del muñón bronquial a nivel de la Carina. Resultados: Se da seguimiento a la paciente por 8 años tras los cuales el problema se considera resuelto. Conclusión: la utilización del abordaje transesternal, transpericárdico para el cierre de la fístula del muñón bronquial postneumonectomía permite alcanzar el bronquio en un ambiente no contaminado debiendo considerarse como un procedimiento adecuado para resolver este tipo de complicación.

Background: Bronchial stump fstula is a serious complicaton of pneumonectomy. The aim of this case report is to document the frst surgical patenttreated with trans-sternal, trans-pericardial approach for bronchial stump fstula closing afer pneumonectomy at San Vicente Hospital in Guatemala.Methods: A female patent who underwent right pneumonectomy for pulmonary tuberculosis with postoperatve bronchial stump dehiscence.Trans-sternal trans-pericardial approach was performed for closing the bronchial stump fstula at the carina.Results: Afer 8 years of follow up, the problem in the patent had completely resolved.Conclusion: Trans-pericardial trans-sternal approach for bronchial stump fstula closing allows bronchium access in a non-contaminated space andshould be considered to resolve this kind of complicaton.

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IntroducciónLas Unidades de Cuidados Intensivos no se adaptan a la realidad social y sanitaria con respecto al fenómeno de la muerte, lo que produce un alto grado de insatisfacción entre profesionales, familiares y pacientes. Las características especiales de estas unidades adjudican a la enfermera el puesto protagonista como cuidadora del paciente crítico moribundo. El objetivo principal de este estudio es conocer las vivencias y actitudes del profesional de enfermería ante el fenómeno de la muerte en la Unidad de Cuidados Intensivos.Participantes y métodosEstudio cualitativo descriptivo de carácter fenomenológico. Comparación constante e incorporación progresiva de participantes mediante muestreo intencional hasta llegar a la saturación de datos (n=16). La técnica de recogida de datos empleada fue la entrevista en profundidad semiestructurada, las entrevistas fueron grabadas y transcritas literalmente. Los datos recogidos fueron verificados por los informantes y analizados siguiendo los pasos propuestos por Taylor-Bogdan.ResultadosEl análisis reveló cinco categorías temáticas: la muerte y las creencias, trabajo emocional, factores ambientales, toma de decisiones frente a la limitación del soporte vital y relación con la familia.ConclusionesEl modelo de gestión de la muerte en la Unidad de Cuidados Intensivos se centra en la intervención médica y deja de lado la opinión de enfermeras, familiares y pacientes. Este estudio refleja las contribuciones que el profesional de enfermería puede realizar en la toma de decisiones y atención al paciente moribundo ingresado en estas áreas (AU)

IntroductionIntensive Care Units do not adapt to the social and health reality regarding the phenomenon of death and this results in a high degree of dissatisfaction among professional, relatives and patients. The special characteristics of these units give the nursing staff a main roll as carers of critical dying patients. The principal aim of this study is to know the nursing staffs’ experiences and attitudes towards the phenomenon of death in the intensive care units.Participants and methodA descriptive qualitative study of phenomenological character was performed. Constant comparison and progressive incorporation of participants was made, using intentional sampling up to data saturation (n=16). The data collection technique used was a semi-structured in-depth interview, which were recorded and literally transcribed. The data collected was verified by the informants and analyzed according to the steps proposed by Taylor-Bogdan.ResultsThe analysis shows 5 thematic categories: death and beliefs, emotional work, environmental factors, decision-making management of death in intensive care units and relationships with relatives.ConclusionsThe management model of death in intensive care units focuses on medical intervention and overlooks the opinions of the nurses, relatives and patients. This study shows the contributions that can be provided by the nursing staff in decision making and in the care of the dying patients in these wards (AU)

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INTRODUCTION: Intensive Care Units do not adapt to the social and health reality regarding the phenomenon of death and this results in a high degree of dissatisfaction among professional, relatives and patients. The special characteristics of these units give the nursing staff a main roll as carers of critical dying patients. The principal aim of this study is to know the nursing staffs' experiences and attitudes towards the phenomenon of death in the intensive care units. PARTICIPANTS AND METHOD: A descriptive qualitative study of phenomenological character was performed. Constant comparison and progressive incorporation of participants was made, using intentional sampling up to data saturation (n=16). The data collection technique used was a semi-structured in-depth interview, which were recorded and literally transcribed. The data collected was verified by the informants and analyzed according to the steps proposed by Taylor-Bogdan. RESULTS: The analysis shows 5 thematic categories: death and beliefs, emotional work, environmental factors, decision-making management of death in intensive care units and relationships with relatives. CONCLUSIONS: The management model of death in intensive care units focuses on medical intervention and overlooks the opinions of the nurses, relatives and patients. This study shows the contributions that can be provided by the nursing staff in decision making and in the care of the dying patients in these wards.

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A significant number of patients in the Intensive Care Units require ventilator support over long periods of time. A tracheostomy is necessary in these cases so that the patients can breathe properly and to allow access to the airway. Percutaneous tracheostomy (PT) is an increasingly used and minimally invasive procedure in which the Seldinger method is used for access the trachea. In recent years, it has become the alternative to surgical tracheostomy. In fact, it is becoming the technique of first choice in critical patients since it has many advantages regarding the conventional tracheostomy. It is an easy-to-use and safe technique, but one that is not exempt from risks. The nursing staff that helps to perform this operation must know its procedures, advantages, disadvantages, indications, contraindications and complications in order to act correctly and in coordination with the rest of the team and to be able to satisfy the patient's needs at each moment. In this article, the characteristic interventions of the nursing staff before, during and after performing this technique are explained.

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En las unidades de cuidados intensivos un importante número de pacientes requiere soporteventilatorio durante largos períodos de tiempo. En estos casos se hace necesaria larealización de una traqueostomía que permita el correcto manejo de la vía aérea.La traqueostomía percutánea (TP) es un procedimiento mínimamente invasivo, de crecienteinstauración, en el que el abordaje traqueal se efectúa usando el método Seldinger.En los últimos años se ha convertido en la alternativa a la traqueostomía quirúrgica yse está imponiendo como técnica de primera elección en los pacientes en estado crítico,ya que aporta numerosas ventajas respecto a la traqueostomía convencional. Se trata deuna técnica segura y sencilla, pero no está exenta de riesgos.El personal de enfermería que colabora en su realización debe conocer el procedimiento,sus ventajas, inconvenientes, indicaciones, contraindicaciones y complicaciones, parapoder actuar de forma adecuada y coordinada con el resto del equipo y dar respuesta alas necesidades del paciente en cada momento.En el desarrollo de este artículo se exponen las intervenciones propias de enfermeríaantes, durante y después de la realización de dicha técnica(AU)

A significant number of patients in the Intensive Care Units require ventilator supportover long periods of time. A tracheostomy is necessary in these cases so that the patientscan breathe properly and to allow access to the airway.Percutaneous tracheostomy (PT) is an increasingly used and minimally invasive procedurein which the Seldinger method is used for access the trachea. In recent years, it has become the alternative to surgical tracheostomy. In fact, it is becoming the technique offirst choice in critical patients since it has many advantages regarding the conventionaltracheostomy. It is an easy-to-use and safe technique, but one that is not exempt fromrisks.The nursing staff that helps to perform this operation must know its procedures,advantages, disadvantages, indications, contraindications and complications in order toact correctly and in coordination with the rest of the team and to be able to satisfy thepatient’s needs at each moment.In this article, the characteristic interventions of the nursing staff before, during andafter performing this technique are explained(AU)

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