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An Educational Video Demonstration of How to Prone a Critically Ill Intubated Patient
Published on: November 30, 2022
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Prácticas de intubación y eventos adversos de periintubación en pacientes en estado crítico de 29 países
Vincenzo Russotto1,2, Sheila Nainan Myatra3, John G Laffey4,5
1School of Medicine and Surgery, University of Milano-Bicocca, Monza, Italy.
JAMA
|March 23, 2021
Resumen
La intubación traqueal en pacientes en estado crítico con frecuencia conduce a eventos adversos, particularmente inestabilidad cardiovascular. Este estudio pone de relieve la alta incidencia de estas complicaciones, haciendo hincapié en la necesidad de mejorar las prácticas de gestión de las vías respiratorias.
Área de la Ciencia:
- Medicina de cuidados intensivos
- Anestesiología
- Medicina de emergencia
Sus antecedentes:
- La intubación traqueal es un procedimiento común pero de alto riesgo en pacientes críticos.
- Hay datos limitados sobre eventos adversos que ocurren durante o inmediatamente después de la intubación.
Objetivo del estudio:
- Determinar la incidencia y los tipos de eventos adversos periintubacionales.
- Evaluar las prácticas actuales de intubación traqueal en pacientes en estado crítico.
Principales métodos:
- El estudio internacional de observación para comprender el impacto y las mejores prácticas del manejo de las vías respiratorias en pacientes críticamente enfermos (INTUBE) incluyó a 2964 pacientes de 197 sitios en 5 continentes.
- Este estudio prospectivo de cohorte analizó datos de octubre de 2018 a julio de 2019.
- Las reacciones adversas principales incluyeron inestabilidad cardiovascular, hipoxemia severa o paro cardíaco dentro de los 30 minutos posteriores a la intubación.
Principales resultados:
- Más del 45% de los pacientes experimentaron al menos un evento adverso periintubacional importante.
- La inestabilidad cardiovascular fue el evento más frecuente (42,6%), seguido de hipoxemia grave (9,3%) y paro cardíaco (3,1%).
- La mortalidad en la unidad de cuidados intensivos (UCI) fue del 32,8%.
Conclusiones:
- Los eventos adversos periintubacionales importantes son comunes en pacientes en estado crítico sometidos a intubación traqueal.
- La inestabilidad cardiovascular es la complicación predominante.
- Los hallazgos subrayan la necesidad de vigilancia y estrategias optimizadas de manejo de las vías respiratorias en entornos de cuidados intensivos.
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