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Which percutaneous tracheostomy method is better? A systematic review / Álvaro Enrique Sanabria Quiroga  

Público ISBD Título : Which percutaneous tracheostomy method is better? A systematic review Tipo de documento : documento electrónico Autores : Álvaro Enrique Sanabria Quiroga, Fecha de publicación : 2014 Títulos uniformes : Respiratory Care Idioma : Inglés (eng) Palabras clave : Tracheostomy  meta-analysis  intensive care  surgery  minimally invasive surgical procedures Resumen : Background: The aim of this study was to assess the different methods of percutaneous tracheostomy in terms of successful performance of the tracheostomy as well as safety. Tracheostomy is the most common procedure performed on the airway for patients in ICUs. Lately, several methods of percutaneous tracheostomy (multiple dilator, progressive dilator, forceps dilation, screw-like dilation, balloon dilation, and translaryngeal) have been described, with theoretical advantages, but there is no consensus about which is better. Methods: A systematic review with critical appraisal of the literature was done. Literature in multiple databases was searched. Randomized controlled trials comparing different tracheostomy methods were selected. Clinical and methodological characteristics were assessed. A meta-analysis using fixed effect models was planned for statistically homogeneous outcomes. Results: Fourteen randomized controlled trials were included, most of them with small sample sizes and with comparisons of multiple methods. Blue Rhino methods were less difficult for surgeons (risk difference of 14.7% [95% CI 8–21.5]) and had more minor bleeding events (risk difference of −6.3% [95% CI −13.58 to 0.8]). There were no differences in major bleeding events. Statistically, heterogeneity and lack of data impede comparison with other outcomes. Conclusion: The Blue Rhino method is less difficult and has more minor bleeding events, but physicians also have more experience with this technique. However, trials are underpowered to define the best method. Mención de responsabilidad : Alvaro Sanabria Referencia : Respir Care. 2014 Nov;59(11):1660-70. DOI (Digital Object Identifier) : 10.4187/respcare.03050 PMID : 25185145 En línea : http://rc.rcjournal.com/content/59/11 Enlace permanente : https://hospitalpablotobon.cloudbiteca.com/pmb/opac_css/index.php?lvl=notice_display&id=3760 Which percutaneous tracheostomy method is better? A systematic review [documento electrónico] / Álvaro Enrique Sanabria Quiroga,  . - 2014. Obra : Respiratory Care Idioma : Inglés (eng) Palabras clave : Tracheostomy  meta-analysis  intensive care  surgery  minimally invasive surgical procedures Resumen : Background: The aim of this study was to assess the different methods of percutaneous tracheostomy in terms of successful performance of the tracheostomy as well as safety. Tracheostomy is the most common procedure performed on the airway for patients in ICUs. Lately, several methods of percutaneous tracheostomy (multiple dilator, progressive dilator, forceps dilation, screw-like dilation, balloon dilation, and translaryngeal) have been described, with theoretical advantages, but there is no consensus about which is better. Methods: A systematic review with critical appraisal of the literature was done. Literature in multiple databases was searched. Randomized controlled trials comparing different tracheostomy methods were selected. Clinical and methodological characteristics were assessed. A meta-analysis using fixed effect models was planned for statistically homogeneous outcomes. Results: Fourteen randomized controlled trials were included, most of them with small sample sizes and with comparisons of multiple methods. Blue Rhino methods were less difficult for surgeons (risk difference of 14.7% [95% CI 8–21.5]) and had more minor bleeding events (risk difference of −6.3% [95% CI −13.58 to 0.8]). There were no differences in major bleeding events. Statistically, heterogeneity and lack of data impede comparison with other outcomes. Conclusion: The Blue Rhino method is less difficult and has more minor bleeding events, but physicians also have more experience with this technique. However, trials are underpowered to define the best method. Mención de responsabilidad : Alvaro Sanabria Referencia : Respir Care. 2014 Nov;59(11):1660-70. DOI (Digital Object Identifier) : 10.4187/respcare.03050 PMID : 25185145 En línea : http://rc.rcjournal.com/content/59/11 Enlace permanente : https://hospitalpablotobon.cloudbiteca.com/pmb/opac_css/index.php?lvl=notice_display&id=3760

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Neuromonitoring of the laryngeal nerves in thyroid surgery: a critical appraisal of the literature / Álvaro Enrique Sanabria Quiroga  

Público ISBD Título : Neuromonitoring of the laryngeal nerves in thyroid surgery: a critical appraisal of the literature Tipo de documento : documento electrónico Autores : Álvaro Enrique Sanabria Quiroga, Fecha de publicación : 2013 Títulos uniformes : European Archives of Oto-rhino-laryngology Idioma : Inglés (eng) Palabras clave : Thyroid gland  laryngeal nerve injuries  neuromuscular monitoring  thyroidectomy  tracheostomy Resumen : One of the most significant complication of thyroid surgery is injury of the recurrent laryngeal nerve. Injury of the external branch of the superior laryngeal nerve is a less obvious but occasionally significant problem. Recently, neuromonitoring during thyroidectomy has received considerable attention because of literature encouraging its use, but there is no consensus about its advantages and utility. A critical assessment of the literature on neuromonitoring was conducted in order to define its effectiveness, safety, cost-effectiveness and medical-legal impact. Available data does not show results superior to those obtained by traditional anatomical methods of nerve identification during thyroid surgery. Data about cost-effectiveness is scarce. The literature shows inconsistencies in methodology, patient selection and randomization in various published studies which may confound the conclusions of individual investigations. The current recommendation for use in “high risk” patients should be assessed because definition heterogeneity makes identification of these patients difficult. As routine use of neuromonitoring varies according to geography, its use should not be considered to be the standard of care. Mención de responsabilidad : Alvaro Sanabria, Carl E Silver, Carlos Suárez, Ashok Shaha, Avi Khafif, Randall P Owen, Alessandra Rinaldo, Alfio Ferlito Referencia : Eur Arch Otorhinolaryngol. 2013 Sep;270(9):2383-95. DOI (Digital Object Identifier) : 10.1007/s00405-013-2558-1 PMID : 23685965 En línea : https://link.springer.com/article/10.1007%2Fs00405-013-2558-1 Enlace permanente : https://hospitalpablotobon.cloudbiteca.com/pmb/opac_css/index.php?lvl=notice_display&id=3713 Neuromonitoring of the laryngeal nerves in thyroid surgery: a critical appraisal of the literature [documento electrónico] / Álvaro Enrique Sanabria Quiroga,  . - 2013. Obra : European Archives of Oto-rhino-laryngology Idioma : Inglés (eng) Palabras clave : Thyroid gland  laryngeal nerve injuries  neuromuscular monitoring  thyroidectomy  tracheostomy Resumen : One of the most significant complication of thyroid surgery is injury of the recurrent laryngeal nerve. Injury of the external branch of the superior laryngeal nerve is a less obvious but occasionally significant problem. Recently, neuromonitoring during thyroidectomy has received considerable attention because of literature encouraging its use, but there is no consensus about its advantages and utility. A critical assessment of the literature on neuromonitoring was conducted in order to define its effectiveness, safety, cost-effectiveness and medical-legal impact. Available data does not show results superior to those obtained by traditional anatomical methods of nerve identification during thyroid surgery. Data about cost-effectiveness is scarce. The literature shows inconsistencies in methodology, patient selection and randomization in various published studies which may confound the conclusions of individual investigations. The current recommendation for use in “high risk” patients should be assessed because definition heterogeneity makes identification of these patients difficult. As routine use of neuromonitoring varies according to geography, its use should not be considered to be the standard of care. Mención de responsabilidad : Alvaro Sanabria, Carl E Silver, Carlos Suárez, Ashok Shaha, Avi Khafif, Randall P Owen, Alessandra Rinaldo, Alfio Ferlito Referencia : Eur Arch Otorhinolaryngol. 2013 Sep;270(9):2383-95. DOI (Digital Object Identifier) : 10.1007/s00405-013-2558-1 PMID : 23685965 En línea : https://link.springer.com/article/10.1007%2Fs00405-013-2558-1 Enlace permanente : https://hospitalpablotobon.cloudbiteca.com/pmb/opac_css/index.php?lvl=notice_display&id=3713

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Prediction of prolonged mechanical ventilation for intensive care unit patients: A cohort study / Álvaro Enrique Sanabria Quiroga    

Público ISBD Título : Prediction of prolonged mechanical ventilation for intensive care unit patients: A cohort study Otros títulos : Predicción de la ventilación mecánica prolongada en pacientes de la unidad de cuidado intensivo: Estudio de cohorte Tipo de documento : documento electrónico Autores : Álvaro Enrique Sanabria Quiroga, Fecha de publicación : 2013 Títulos uniformes : Colombia Médica Idioma : Inglés (eng) Palabras clave : tracheostomy  artificial respiration  intensive care units  ventilator weaning  intratracheal intubation  risk factors Resumen : Introduction: There are no established guidelines for selecting patients for early tracheostomy. The aim was to determine the factors that could predict the possibility of intubation longer than 7 days in critically ill adult patients. Methods: This is cohort study made at a general intensive care unit. Patients who required at least 48 hours of mechanical ventilation were included. Data on the clinical and physiologic features were collected for every intubated patient on the third day. Uni- and multivariate statistical analyses were conducted to determine the variables associated with extubation. Results: 163 (62%) were male, and the median age was 59±17 years. Almost one-third (36%) of patients required mechanical ventilation longer than 7 days. The variables strongly associated with prolonged mechanical ventilation were: age (HR 0.97 (95% CI 0.96-0.99); diagnosis of surgical emergency in a patient with a medical condition (HR 3.68 (95% CI 1.62-8.35), diagnosis of surgical condition-non emergency (HR 8.17 (95% CI 2.12-31.3); diagnosis of non-surgical-medical condition (HR 5.26 (95% CI 1.85-14.9); APACHE II (HR 0.91 (95% CI 0.85-0.97) and SAPS II score (HR 1.04 (95% CI 1.00-1.09) The area under ROC curve used for prediction was 0.52. 16% of patients were extubated after day 8 of intubation. Conclusions: It was not possible to predict early extubation in critically ill adult patients with invasive mechanical ventilation with common clinical scales used at the ICU. However, the probability of successfully weaning patients from mechanical ventilation without a tracheostomy is low after the eighth day of intubation. Mención de responsabilidad : Alvaro Sanabria, Ximena Gomez, Valentin Vega, Luis Carlos Dominguez, Camilo Osorio DOI (Digital Object Identifier) : 10.25100/cm.v44i3.1285 Derechos de uso : CC BY-NC-ND En línea : https://colombiamedica.univalle.edu.co/index.php/comedica/article/view/1285 Enlace permanente : https://hospitalpablotobon.cloudbiteca.com/pmb/opac_css/index.php?lvl=notice_display&id=4527 Prediction of prolonged mechanical ventilation for intensive care unit patients: A cohort study = Predicción de la ventilación mecánica prolongada en pacientes de la unidad de cuidado intensivo: Estudio de cohorte [documento electrónico] / Álvaro Enrique Sanabria Quiroga,  . - 2013. Obra : Colombia Médica Idioma : Inglés (eng) Palabras clave : tracheostomy  artificial respiration  intensive care units  ventilator weaning  intratracheal intubation  risk factors Resumen : Introduction: There are no established guidelines for selecting patients for early tracheostomy. The aim was to determine the factors that could predict the possibility of intubation longer than 7 days in critically ill adult patients. Methods: This is cohort study made at a general intensive care unit. Patients who required at least 48 hours of mechanical ventilation were included. Data on the clinical and physiologic features were collected for every intubated patient on the third day. Uni- and multivariate statistical analyses were conducted to determine the variables associated with extubation. Results: 163 (62%) were male, and the median age was 59±17 years. Almost one-third (36%) of patients required mechanical ventilation longer than 7 days. The variables strongly associated with prolonged mechanical ventilation were: age (HR 0.97 (95% CI 0.96-0.99); diagnosis of surgical emergency in a patient with a medical condition (HR 3.68 (95% CI 1.62-8.35), diagnosis of surgical condition-non emergency (HR 8.17 (95% CI 2.12-31.3); diagnosis of non-surgical-medical condition (HR 5.26 (95% CI 1.85-14.9); APACHE II (HR 0.91 (95% CI 0.85-0.97) and SAPS II score (HR 1.04 (95% CI 1.00-1.09) The area under ROC curve used for prediction was 0.52. 16% of patients were extubated after day 8 of intubation. Conclusions: It was not possible to predict early extubation in critically ill adult patients with invasive mechanical ventilation with common clinical scales used at the ICU. However, the probability of successfully weaning patients from mechanical ventilation without a tracheostomy is low after the eighth day of intubation. Mención de responsabilidad : Alvaro Sanabria, Ximena Gomez, Valentin Vega, Luis Carlos Dominguez, Camilo Osorio DOI (Digital Object Identifier) : 10.25100/cm.v44i3.1285 Derechos de uso : CC BY-NC-ND En línea : https://colombiamedica.univalle.edu.co/index.php/comedica/article/view/1285 Enlace permanente : https://hospitalpablotobon.cloudbiteca.com/pmb/opac_css/index.php?lvl=notice_display&id=4527

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