RESUMEN
Aim: Compare two vancomycin dosing strategies in critical patients with methicillin-resistant Staphylococcus aureus (MRSA) infections, considering the heterogeneity of the dosing regimens administered and their implications for toxicity and efficacy. Materials & methods: Longitudinal retrospective observational study in two patient cohorts (standard dosing vs dosing via Bayesian algorithms). Results: The group of Bayesian algorithms received substantially higher and significantly heterogeneous doses, with an absence of nephrotoxicity. The speed of decrease observed in CRP and PCT was greater for the Bayesian strategy (p = 0.045 and 0.0009, respectively). Conclusion: Applying Bayesian algorithms to vancomycin dosage individualization allows for administering much higher doses than with standard regimens, facilitating a quicker clinical response in the absence of nephrotoxicity.
[Box: see text].
Asunto(s)
Algoritmos , Antibacterianos , Teorema de Bayes , Staphylococcus aureus Resistente a Meticilina , Infecciones Estafilocócicas , Vancomicina , Humanos , Vancomicina/administración & dosificación , Estudios Retrospectivos , Staphylococcus aureus Resistente a Meticilina/efectos de los fármacos , Antibacterianos/administración & dosificación , Antibacterianos/uso terapéutico , Infecciones Estafilocócicas/tratamiento farmacológico , Masculino , Femenino , Persona de Mediana Edad , Estudios Longitudinales , Anciano , Medicina de Precisión/métodos , Enfermedad Crítica , AdultoRESUMEN
Resumen: La mortalidad de los pacientes de COVID-19 en ventilación mecánica y las estrategias empleadas varían en la literatura. El objetivo de esta serie de casos es describir el curso clínico de pacientes en ventilación mecánica invasiva con COVID-19 y su desenlace a 28 días. Se incluyeron 21 pacientes con un promedio de edad de 49 ± 13 años, 81% de sexo masculino y 38% con al menos una comorbilidad. Las variables ventilatorias iniciales fueron PaO2/FiO2 de 135 ± 53, PEEP 12 cmH2O, presión meseta 26 ± 4.8 cmH2O, distensibilidad estática 32 ± 8.5 mL/cmH2O, driving pressure 15 ± 3.9 cmH2O y poder mecánico 19.2 ± 4 J/min. El 67% de los pacientes estuvieron en posición prono y en 76% se empleó bloqueante neuromuscular. Los desenlaces a 28 días fueron 21 días libres de ventilación mecánica y 14% de mortalidad.
Abstract: The mortality and ventilation strategies of COVID-19 ARDS vary in the literature. The objective of this case series is to describe the clinical course of patients on invasive mechanical ventilation with COVID-19 and its outcome at 28 days. Twenty-one patients were included with an average age of 49 ± 13 years, 81% male and 38% with at least one comorbidity. The initial ventilatory variables were PaO2/FiO2 of 135 ± 53, PEEP 12 cmH2O, plateau pressure 26 ± 4.8 cmH2O, static compliance 32 ± 8.5 mL/cmH2O, driving pressure 15 ± 3.9 cmH2O, and mechanical power 19.2 ± 4 J/min. 67% of the patients received prone position and in 76% a neuromuscular blocker was used. The 28-day outcomes were 21 days of mechanical ventilation-free days and 14% mortality.
Resumo: A mortalidade de pacientes com COVID-19 em ventilação mecânica e as estratégias utilizadas variam na literatura. O objetivo desta série de casos é descrever a evolução clínica de pacientes em ventilação mecânica invasiva com COVID-19 e sua evolução em 28 dias. Incluíram-se 21 pacientes com média de idade de 49 ± 13 anos, 81% do sexo masculino e 38% com pelo menos uma comorbidade. As variáveis ventilatórias iniciais foram PaO2/FiO2 135 ± 53, PEEP 12 cmH2O, pressão de platô 26 ± 4.8 cmH2O, complacência estática 32 ± 8.5 mL/cmH2O, pressão motriz 15 ± 3.9 cmH2O e potência mecânica 19.2 ± 4 J/min. 67% dos pacientes estavam em decúbito ventral e em 76% foi utilizado bloqueador neuromuscular. Os resultados aos 28 dias foram 21 dias sem ventilação mecânica e 14% de mortalidade.
RESUMEN
Introducción: Hoy el estudio del afrontamiento familiar a la atención del paciente grave es una exigencia social. Objetivo: Validar la viabilidad de un sistema de talleres de socialización familiar dirigido a mejorar el afrontamiento familiar en la atención al paciente ingresado en esta unidad en el Hospital General Docente "Dr. Agostinho Neto" de Guantánamo. Método: Se realizó un estudio experimental donde el universo fue el total de familiares de los pacientes egresados durante enero-febrero de 2019 (N=95), facilitadores de la interacción paciente-familia-profesional. Se seleccionó una muestra aleatoria (n=25), que se encuestó sobre el significado de su participación en la atención médica al paciente grave y su preparación para el afrontamiento de esta atención. Se validó mediante un pre-experimento la contribución de un sistema de talleres dirigido con esta finalidad. Resultados: El 100 % de las familias manifestó la necesidad de preparación para su participación en la atención al paciente grave. El 60 % mejoró su actitud para el afrontamiento familiar en la atención al paciente grave luego de aplicar el sistema de talleres. Conclusiones: El sistema de talleres de socialización familiar genera cambios favorables en la preparación de las familias para el afrontamiento en la atención al paciente grave.
Introduction: The study of family members coping with the healthcare process of critically ill patients is a social demand that needs to be addressed today. Objective: To validate the viability of a system of family interactive workshops in order to improve family coping of the healthcare process of the patients in the intensive care unit (ICU) at the Hospital General Docente "Dr. Agostinho Neto" in Guantanamo. Method: An experimental study was carried out, in which the population was made out of the family members (the facilitators of the patient-family-doctor interaction) of intensive-care-unit-discharged patients, in the period from January to February, 2019 (N=95). A random sample was selected (n=25) and interviewed to find out how effective the interactive workshops were in the learning process of how to cope with the situation of having a critically ill family member, and how important the participation on this process was for the family. The contribution of a workshop system was validated using a pre-experimental study. Results: 100% of the families expressed the need for preparation in workshops aimed to improve coping skills to face the treatment and healthcare of an ill family member. 60 % of families involved in the workshops system improved their coping abilities to carry on with the difficulties of the treatment of their ill family member. Conclusion: The family interactive workshops system creates favorable changes in the preparation of the families to cope with the treatment process of one of their members dealing with a critical illness.
Asunto(s)
Humanos , Adaptación Psicológica , Educación , Atención al Paciente , Unidades de Cuidados IntensivosRESUMEN
RESUMEN Introducción: Hoy el estudio del afrontamiento familiar a la atención del paciente grave es una exigencia social. Objetivo: Validar la viabilidad de un sistema de talleres de socialización familiar dirigido a mejorar el afrontamiento familiar en la atención al paciente ingresado en esta unidad en el Hospital General Docente "Dr. Agostinho Neto" de Guantánamo. Método: Se realizó un estudio experimental donde el universo fue el total de familiares de los pacientes egresados durante enero-febrero de 2019 (N=95), facilitadores de la interacción paciente-familia-profesional. Se seleccionó una muestra aleatoria (n=25), que se encuestó sobre el significado de su participación en la atención médica al paciente grave y su preparación para el afrontamiento de esta atención. Se validó mediante un pre-experimento la contribución de un sistema de talleres dirigido con esta finalidad. Resultados: El 100 por ciento de las familias manifestó la necesidad de preparación para su participación en la atención al paciente grave. El 60 por ciento mejoró su actitud para el afrontamiento familiar en la atención al paciente grave luego de aplicar el sistema de talleres. Conclusiones: El sistema de talleres de socialización familiar genera cambios favorables en la preparación de las familias para el afrontamiento en la atención al paciente grave.
ABSTRACT Introduction: The study of family members coping with the healthcare process of critically ill patients is a social demand that needs to be addressed today. Objective: To validate the viability of a system of family interactive workshops in order to improve family coping of the healthcare process of the patients in the intensive care unit (ICU) at the Hospital General Docente "Dr. Agostinho Neto" in Guantanamo. Method: An experimental study was carried out, in which the population was made out of the family members (the facilitators of the patient-family-doctor interaction) of intensive-care-unit-discharged patients, in the period from January to February, 2019 (N=95). A random sample was selected (n=25) and interviewed to find out how effective the interactive workshops were in the learning process of how to cope with the situation of having a critically ill family member, and how important the participation on this process was for the family. The contribution of a workshop system was validated using a pre-experimental study. Results: 100 per cent of the families expressed the need for preparation in workshops aimed to improve coping skills to face the treatment and healthcare of an ill family member. 60 per cent of families involved in the workshops system improved their coping abilities to carry on with the difficulties of the treatment of their ill family member. Conclusion: The family interactive workshops system creates favorable changes in the preparation of the families to cope with the treatment process of one of their members dealing with a critical illness.
Asunto(s)
Humanos , Adaptación Psicológica , Atención al Paciente , Unidades de Cuidados Intensivos , FamiliaRESUMEN
El manejo de la vía aérea (MVA) debe ser prioridad en el cuidado de pacientes críticos, las intervenciones en vía aérea tienen como finalidad asegurarla o controlar la ventilación ademas de evitar complicaciones.1,2,3 La evaluación de vía aérea (EVA) previa es un prerrequisito, con el fin de determinar la dificultad de la maniobra, los posibles riesgos y complicaciones a las que se ve enfrentado el médico y el paciente.4,5,6,7 Surgen interrogantes con respecto a la EVA como parte del MVA en las unidades de cuidado intensivo, como los siguientes: ¿Con qué frecuencia realizamos esta evaluación?, ¿es nuestra evaluación completa y adecuada?, si es así, ¿con qué certeza podemos afirmar que la evaluación nos puede dar información cierta? y ¿qué tan confiados podemos sentirnos a la hora de intubar nuestro paciente? El siguiente texto tiene como finalidad discutir la importancia de las actitudes adecuadas y los procesos a seguir previos al MVA en el paciente crítico.
Airway management (MVA) must be priority in the care of critical patients. Airway intervention is needed to assure or control the ventilation.1,2 The Airway evaluation (EVA) is a requirement, with the purpose of determining the difficulty of the orotraqueal intubation maneuver, the possible risks and complications for the physician and the patient.4,5,6,7 There is some questions with respect to EVA like part of the MVA in the intensive care units; ¿how frequently we made this evaluation?, ¿Is it a complete and suitable evaluation?, if it is thus, ¿how certain could we affirm that the evaluation can give true information to us? and ¿how trusted can we feel at the time of patient intubation? The following text has the purpose of discuss the importance of suitable attitudes and the processes to follow previously to the MVA in the critical patient.
Asunto(s)
HumanosRESUMEN
JUSTIFICATIVA E OBJETIVOS: Esta revisão tem como objetivo levantar os principais aspectos necessários para a realização de terapia nutricional segura e eficaz ao paciente crítico. CONTEÚDO: Foi feito um levantamento bibliográfico com livros didáticos e artigos científicos em Português, Inglês e Espanhol com resultados dos últimos 20 anos.A terapia nutricional é parte integrante dos cuidados do paciente em unidades de terapia intensiva. O seu sucesso envolve as etapas de avaliação nutricional, determinação das necessidades de calorias e nutrientes, decisão da via de infusão e o tipo de dieta empregada. CONCLUSÕES: O uso de nutrientes com a finalidade de melhorar a função imunológica (imunonutrientes), é cada vez mais freqüente, porém seu uso não está bem estabelecido para pacientes críticos. Mais estudos clínicos são necessários para estabelecer a melhor forma de nutrir o paciente crítico.
BACKGROUND AND OBJECTIVES: The purpose of this review is to approach the main necessary aspects for the accomplishment of safety and efficient nutritional therapy to the critically ill patient. CONTENTS: Bibliographical survey with didactic books and scientific articles was made in Portuguese, English and Spanish with results of the last 20 years. Nutritional support is an integrant part in the care of patients in intensive care units. The success of the nutritional therapy involves the stages of nutritional assessment, determines the route of diet infusion and the calories and nutrients needs. CONCLUSIONS: The use of nutrients with immune function (immunonutrients) is each more frequents, however, its use is not well established for critical illness. More clinical studies are necessary to establish the best form to nourish the critical ill patient.