{"id":117888,"date":"2018-03-11T10:47:38","date_gmt":"2018-03-11T10:47:38","guid":{"rendered":"https:\/\/www.deberes.net\/tesis\/sin-categoria\/alteracion-neurologica-grave-en-el-paciente-con-insuficiencia-respiratoria-aguda-tratamiento-mediante-ventilacion-mecanica-no-invasiva\/"},"modified":"2018-03-11T10:47:38","modified_gmt":"2018-03-11T10:47:38","slug":"alteracion-neurologica-grave-en-el-paciente-con-insuficiencia-respiratoria-aguda-tratamiento-mediante-ventilacion-mecanica-no-invasiva","status":"publish","type":"post","link":"https:\/\/www.deberes.net\/tesis\/murcia\/alteracion-neurologica-grave-en-el-paciente-con-insuficiencia-respiratoria-aguda-tratamiento-mediante-ventilacion-mecanica-no-invasiva\/","title":{"rendered":"Alteraci\u00f3n neurol\u00f3gica grave en el paciente  con insuficiencia respiratoria aguda. tratamiento mediante ventilaci\u00f3n mec\u00e1nica no invasiva."},"content":{"rendered":"<h2>Tesis doctoral de <strong> Andres Carrillo Alcaraz <\/strong><\/h2>\n<p>Resumen  objetivos: el objetivo principal es establecer la preValencia del coma hiperc\u00e1pnico en los pacientes que ingresan en uci por insuficiencia respiratoria aguda (ira) y reciben ventilaci\u00f3n no invasiva (vni) y conocer la efectividad de esta en estos pacientes. Como objetivos secundarios se plantea el an\u00e1lisis de las complicaciones relacionadas con vni,, y establecer los factores predictivos para \u00e9xito o fracaso de la vni, y los relacionados con la mortalidad hospitalaria.   material y m\u00e9todos: estudio prospectivo de todos los pacientes que de forma consecutiva ingresaban en uci con diagnostico de ira y precisaban vni, durante  13 a\u00f1os. Se diferenciaban dos grupos de pacientes: grupo de pacientes en coma hiperc\u00e1pnico cuando presentaban una puntuaci\u00f3n en la escala de coma de glasgow (ecg) de ? 8 puntos junto a un ph arterial &lt; 7,20 y paco2 &gt; 80 mmhg, y los que presentaban una puntuaci\u00f3n en la ecg &gt; 8. Se recog\u00edan variables sociodemogr\u00e1ficas, cl\u00ednicas, anal\u00edticas y evolutivas. Se define \u00e9xito de la vni cuando en el paciente se evitaba la intubaci\u00f3n endotraqueal y era dado de alta vivo de la uci, permaneciendo vivo en planta y sin necesidad de vni al menos 24 horas. Los datos se expresan como medias \u00c2\u00b1 desviaci\u00f3n est\u00e1ndar, frecuencias absolutas y relativas. Las comparaciones entre variables mediante prueba de chi2 de pearson y t de student. An\u00e1lisis multivariante mediante regresi\u00f3n log\u00edstica. Se ha utilizado el programa spss versi\u00f3n 22.0 para windows.  resultados. Se han analizado 3.062 episodios de ira tratados con vni, que corresponden a  3.902 ingresos en uci en 3.842 pacientes. La patolog\u00eda mas frecuente ha sido el edema agudo de pulmon cardiog\u00e9nico (1.088 pacientes, 27,5%), seguido de 666 pacientes afectos de epoc (16,8%) y 525 (13,3%) neumon\u00edas. La edad media era de 69,6 \u00c2\u00b1 14,5 a\u00f1os y 59,1% eran hombres. El ventilador mas utilizado fue el bipap vision (3.493 pacientes, 88,2%). Al inicio de la vni, 256 presentaban coma hiperc\u00e1pnico (preValencia del 6,5%), de los cuales la patolog\u00eda mas frecuente era  epoc (113 pacientes) seguida de obesidad m\u00f3rbida e hipoventilacion alveolar (30 pacientes).  El ph arterial en este grupo era de 7,10 \u00c2\u00b1 0,08 mientras que en el grupo con &gt; 8 puntos en la ecg era de 7,31 \u00c2\u00b1 0,10 (p&lt;0,001) y el nivel de paco2 de 105 \u00c2\u00b1 22 y 55 \u00c2\u00b1 22 respectivamente (p&lt;0,001). Ni el numero de pacientes con complicaciones, 90 (35,2%) y 1.219 (32,9%) [p=0,456], ni ninguna de las complicaciones por separado difiri\u00f3 entre los dos grupos. El \u00e9xito de vni fue de 78,1% en grupo en coma y 70,2% en grupo con ecg &gt; 8 (p=0,007). La mortalidad hospitalaria no difiri\u00f3 en ambos grupos, 25,5% y 28,6%,  respectivamente (p=0,296). en el grupo de pacientes en coma los factores predictivos independientes para \u00e9xito de la vni fueron el nivel de ecg a la hora de la vni (or 1,593; ic-95%: 1,323-1,918), nivel sofa m\u00e1ximo (or:0,683; ic-95%: 0,592-0,789), frecuencia respiratoria a la hora de la vni (or:0,895, ic-95%: 0,821-0,975) y paco2 1 hora de vni (or: 0,979, ic-95%: 0,960-0,998). Los factores de riesgo independiente para mortalidad hospitalaria fueron p presencia de orden de no intubaci\u00f3n (or:5,368; ic-95%: 2,068-13,930), n\u00edvel sofa m\u00e1ximo (or: 1,532; ic-95%: 1,306-1,797), frecuencia respirat\u00f3ria a la hora de vni (or:1,118; ic-95%: 1,018-1,227) y  \u00ed\u00aaxito de vni (or: 0,217; ic-95%: 0,076-0,619).  conclusiones. La alteraci\u00f3n neurol\u00f3gica en la ira es frecuente en los pacientes ingresados en uci, pudiendo se tratado de forma exitosa con vni y con complicaciones poco graves. El conocimiento de los factores de riesgo para \u00e9xito de la vni seria \u00fatil para una mejor selecci\u00f3n de los pacientes candidatos a esta t\u00e9cnica ventilatoria.    summary  objectives: the main objective is to establish the prevalence of hypercapnic coma patients admitted to the icu with acute respiratory failure (arf) and receive noninvasive ventilation (niv) and determine the effectiveness of niv in these patients. Secondary objectives was niv related complications, and determinate the predictive factors for success or failure of niv, and factors related hospital mortality.  material and methods: prospective study of all patients who were admitted consecutively to the icu with a diagnosis of arf and required niv, for 13 years. Two groups of patients were distinguished: group of hypercapnic coma when patients had a score on the glasgow coma scale (gcs) of ? 8 points with  arterial ph &lt;7.20 and paco2&gt; 80 mmhg, and those with a score on the ecg &gt; 8. Sociodemographic, clinical, laboratory and evolutionary variables are collected. Success of niv is defined when the patient avoided endotracheal intubation and was discharged alive from the icu, remaining live on ward without vni at least 24 hours. Data are expressed as mean \u00c2\u00b1 standard deviation, absolute and relative frequencies. Comparisons between variables by pearson chi2 test and student t.Test multivariate logistic regression analysis. We used spss version 22.0 for windows.  results. We analyzed 3,062 episodes of arf treated with niv, corresponding to 3,902 icu admissions in 3,842 patients. The most common condition was acute cardiogenic pulmonary edema (1,088 patients, 27.5%), followed 666 patients with copd (16.8%) and 525 (13.3%) pneumonia. The mean age was 69.6 \u00c2\u00b1 14.5 years and 59.1% were men. Ventilator was more used bipap vision (3,493 patients, 88.2%). At the start of niv, 256 had hypercapnic comma (prevalence 6.5%), of which the most frequent disease was copd (113 patients) followed by morbid obesity and alveolar hypoventilation (30 patients). Arterial ph in this group was of 7.10 \u00c2\u00b1 0.08 while in the group with &gt; 8 points in the gcs was 7.31 \u00c2\u00b1 0.10 (p &lt;0.001) and paco2 level of 105 \u00c2\u00b1 22 and 55 \u00c2\u00b1 22, respectively (p &lt;0.001). Neither the number of patients with complications, 90 (35.2%) and 1,219 (32.9%) [p = 0.456], or any of the separately complications differed between the two groups. The success of niv was 78.1% in group coma and 70.2% in group ecg &gt; 8 (p = 0.007). Hospital mortality did not differ in both groups, 25.5% and 28.6%, respectively (p = 0.296).In the group of patients in coma independent predictors for success of niv:  gcs level 1 hour  niv (or 1.593; 95% ci: 1.323 to 1.918), sofa maximum level (or: 0.683; ci -95%: .592-.789), respiratory rate 1 hour  niv (or: 0.895, 95% ci: 0.821 to .975) and paco2 1 hour niv (or: 0.979, 95% ci: 0.960 to 0.998). The independent risk factors for hospital mortality were: p do not intubated order (or: 5.368; 95% ci: 2.068 to 13.930) maximum level sofa (or: 1.532; 95% ci: 1.306 to 1.797), respiratory rate when vni (or: 1,118 ; 95% ci: 1.018 to 1.227) and success of niv (or: 0.217; 95% ci: 0.076 to 0.619).  conclusions. The neurological disorder in the ira is common in patients admitted to the icu, it can be successfully treated with niv and some serious complications. Knowing the risk factors for success of niv would be useful for a better selection of patients for this ventilatory technique.<\/p>\n<p>&nbsp;<\/p>\n<h3>Datos acad\u00e9micos de la tesis doctoral \u00ab<strong>Alteraci\u00f3n neurol\u00f3gica grave en el paciente  con insuficiencia respiratoria aguda. tratamiento mediante ventilaci\u00f3n mec\u00e1nica no invasiva.<\/strong>\u00ab<\/h3>\n<ul>\n<li><strong>T\u00edtulo de la tesis:<\/strong>\u00a0 Alteraci\u00f3n neurol\u00f3gica grave en el paciente  con insuficiencia respiratoria aguda. tratamiento mediante ventilaci\u00f3n mec\u00e1nica no invasiva. <\/li>\n<li><strong>Autor:<\/strong>\u00a0 Andres Carrillo Alcaraz <\/li>\n<li><strong>Universidad:<\/strong>\u00a0 Murcia<\/li>\n<li><strong>Fecha de lectura de la tesis:<\/strong>\u00a0 15\/07\/2015<\/li>\n<\/ul>\n<p>&nbsp;<\/p>\n<h3>Direcci\u00f3n y tribunal<\/h3>\n<ul>\n<li><strong>Director de la tesis<\/strong>\n<ul>\n<li>Vicente Vicente Garcia<\/li>\n<\/ul>\n<\/li>\n<li><strong>Tribunal<\/strong>\n<ul>\n<li>Presidente del tribunal: Mar\u00eda  inmaculada Heras fernando <\/li>\n<li>Manuel Jos\u00e9 Parraga ramirez (vocal)<\/li>\n<li>miquel Ferrer monreal (vocal)<\/li>\n<li>bernardo Gil rueda (vocal)<\/li>\n<\/ul>\n<\/li>\n<\/ul>\n<p>&nbsp;<\/p>\n","protected":false},"excerpt":{"rendered":"<p>Tesis doctoral de Andres Carrillo Alcaraz Resumen objetivos: el objetivo principal es establecer la preValencia del coma hiperc\u00e1pnico en los 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