Ventilación no invasiva en el paciente quirúrgico pediátrico PDF Download
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Author: Javier García Fernández
Publisher:
ISBN: 9788461224135
Category :
Languages : es
Pages : 152
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Author: Javier García Fernández
Publisher:
ISBN: 9788461224135
Category :
Languages : es
Pages : 152
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Book Description
Author: Javier García Fernández
Publisher:
ISBN: 9788485592425
Category :
Languages : es
Pages : 75
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Author: Martí Pons Òdena
Publisher:
ISBN:
Category :
Languages : es
Pages : 282
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OBJETIVOS El objetivo principal de la tesis es determinar la efectividad de la ventilación no invasiva (VNI) e identificar factores pronósticos de fracaso en una cohorte general pediátrica. Los objetivos secundarios de la tesis son: 1.Estudiar si las cohortes establecidas según la clasificación cronológica presentan diferencias fisiológicas significativas anteriores al inicio de la VNI 2.Determinar la efectividad y los factores pronósticos de fracaso de la VNI de las tres cohortes (inicial, rescate y electiva) por separado 3.Evaluar la seguridad de la técnica, analizando su morbilidad y mortalidad asociadas MATERIAL Y MÉTODOS Diseño del estudio: Estudio de cohortes prospectivo realizado en UCIP del Hospital Sant Joan de Déu mediante muestreo consecutivo desde Enero 2005 - Diciembre 2009. Criterios de inclusión: ·Pacientes de ambos sexos entre los 0-18 años con criterios de insuficiencia respiratoria aguda grave (IRA). Criterios de exclusión: ·Pacientes con contraindicación para el uso de la VNI o con indicación paliativa. Variables a estudiar: Los datos de los pacientes fueron recogidas. Tipo de interfase, ventilador, modos (CPAP, BLPAP)y parámetros usados; variables fisiológicas (previo, 2a hora, 8, 12 y 24 horas); el cociente SpO2/FiO2 (SF), fue calculado retrospectivamente, eliminándose valores con SatHb superior a 97; Tiempo de uso de la VNI, duración de la estancia en UCIP y hospital. Las complicaciones y mortalidad atribuibles a la VNI. El fracaso de la VNI se define como la necesidad de intubación. RESULTADOS En el análisis descriptivo de los 491 episodios, las variables demográficas definen una población diana para el uso de la VNI: Edad media de 36 a 46 meses, con predominio sexo masculino, sin enfermedad de base, la causa más frecuente de IRA es la INFECCIÓN RESPIRATORIA. Las complicaciones han sido poco frecuentes (5,5%). No hubo mortalidad asociada al uso de la VNI. En la cohorte general según el grupo de edad, se diferencian significativamente, mayores y menores de seis meses. El análisis multivariable las variables independientes halladas son edad, modalidad (CPAP/BLPAP), el tipo de fallo respiratorio tipo II, el menor valor de SF y menor descenso de la FC a las dos horas. En el análisis de las cohortes generadas según la clasificación cronológica se observan diferencias significativas en las variables fisiológicas y las necesidades de oxígeno previas al inicio de la VNI. En el análisis multivariable de la cohorte inicial se observa : Modalidad CPAP, valores bajos de SF y altos de FC a las 2 horas, la edad mayor a 6 meses , así como los valores más bajos de IPAP a las 2 horas son factores independientes de fracaso CONCLUSIONES Conclusiones principales 1. La ventilación no invasiva es una técnica efectiva para prevenir la intubación en Pediatria 2. Los factores pronósticos de fracaso en la cohorte general son: ·Recibir tratamiento con CPAP en lugar de BLPAP ·Tener un fallo respiratorio tipo II, un valor de SF a las 2 horas y un descenso de la FC menor yun valor de FC a las 2 horas mayor Conclusiones secundarias 1.Las cohortes generadas por la clasificación cronológica presentan diferencias significativas en las variables fisiológicas previas 2. La efectividad en la cohorte general aumenta con la edad 3. La efectividad y factores pronósticos en las cohortes inicial, rescate y electiva fue superior en la cohorte-r (84%) respecto cohorte-i (71%) y cohorte-e (77%). En la VNI inicial, son factores pronósticos de fracaso: ·El valor más bajo de cociente SF, y el valor más alto de FC a las 2 horas ·Pertenecer al grupo CPAP 4. La técnica es segura, siendo su morbilidad baja y muy leve, y la mortalidad asociada nula.
Author: Kathryn Fitch
Publisher: Rand Corporation
ISBN: 9780833029188
Category : History
Languages : en
Pages : 109
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Health systems should function in such a way that the amount of inappropriate care is minimized, while at the same time stinting as little as possible on appropriate and necessary care. The ability to determine and identify which care is overused and which is underused is essential to this functioning. To this end, the "RAND/UCLA Appropriateness Method" was developed in the 1980s. It has been further developed and refined in North America and, increasingly, in Europe. The rationale behind the method is that randomized clinical trials--the "gold standard" for evidence-based medicine--are generally either not available or cannot provide evidence at a level of detail sufficient to apply to the wide range of patients seen in everyday clinical practice. Although robust scientific evidence about the benefits of many procedures is lacking, physicians must nonetheless make decisions every day about when to use them. Consequently, a method was developed that combined the best available scientific evidence with the collective judgment of experts to yield a statement regarding the appropriateness of performing a procedure at the level of patient-specific symptoms, medical history, and test results. This manual presents step-by-step guidelines for conceptualising, designing, and carrying out a study of the appropriateness of medical or surgical procedures (for either diagnosis or treatment) using the RAND/UCLA Appropriateness Method. The manual distills the experience of many researchers in North America and Europe and presents current (as of the year 2000) thinking on the subject. Although the manual is self-contained and complete, the authors do not recommend that those unfamiliar with the RAND/UCLA Appropriateness Method independently conduct an appropriateness study; instead, they suggest "seeing one" before "doing one." To this end, contact information is provided to assist potential users of the method.
Author: Hunter B. Moore
Publisher: Springer Nature
ISBN: 3030536068
Category : Medical
Languages : en
Pages : 802
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Book Description
The first edition of this publication was aimed at defining the current concepts of trauma induced coagulopathy by critically analyzing the most up-to-date studies from a clinical and basic science perspective. It served as a reference source for any clinician interested in reviewing the pathophysiology, diagnosis, and management of the coagulopathic trauma patient, and the data that supports it. By meticulously describing the methodology of most traditional as well as state of the art coagulation assays the reader is provided with a full understanding of the tests that are used to study trauma induced coagulopathy. With the growing interest in understanding and managing coagulation in trauma, this second edition has been expanded to 46 chapters from its original 35 to incorporate the massive global efforts in understanding, diagnosing, and treating trauma induced coagulopathy. The evolving use of blood products as well as recently introduced hemostatic medications is reviewed in detail. The text provides therapeutic strategies to treat specific coagulation abnormalities following severe injury, which goes beyond the first edition that largely was based on describing the mechanisms causing coagulation abnormalities. Trauma Induced Coagulopathy 2nd Edition is a valuable reference to clinicians that are faced with specific clinical challenges when managing coagulopathy.
Author: Donald H. Shaffner
Publisher: Lippincott Williams & Wilkins
ISBN: 1469888378
Category : Medical
Languages : en
Pages : 5597
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Now in vibrant full color throughout, Rogers’ Textbook of Pediatric Intensive Care, 5th Edition, continues its tradition of excellence as the gold standard in the field. For more than 25 years, readers have turned to this comprehensive resource for clear explanations of both the principles underlying pediatric critical care disease and trauma as well as how these principles are applied in clinical practice. In the 5th Edition, more than 250 global contributors bring you completely up to date on today’s understanding, treatments, technologies, and outcomes regarding critical illness in children.
Author: Charles L. Sprung
Publisher:
ISBN:
Category : Medical
Languages : en
Pages : 230
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Author: Edward T. Bope
Publisher: Elsevier Health Sciences
ISBN: 1437709869
Category : Health & Fitness
Languages : en
Pages : 1350
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Book Description
Conn's Current Therapy 2011 is an easy-to-use, in-depth guide to the latest advances in therapeutics for common complaints and diagnoses. Drs. Edward T. Bope, Rick D. Kellerman, and Robert E. Rakel present the expertise and knowledge of hundreds of skilled international leaders on the full range of evidence-based management options. With coverage of recent developments in travel medicine, sleep apnea, and immunization practices, as well as standardized diagnostic points and clinical recommendation tables, you'll have access to the information you need, in print and online at www.expertconsult.com. Access the fully searchable contents online at www.expertconsult.com. Deliver effective treatment after making correct diagnoses through discussions of important diagnostic criteria in each chapter. Get the best, most practical and accurate advice from acknowledged expert contributors. Apply best practices from around the world from coverage of management methods used by international experts. Stay current with recent developments in travel medicine, sleep apnea, immunization practices, and much more. Know the full range of treatment options through coverage of the latest information on recently-approved and soon-to-be-approved drugs. Tap into the guidance of experts for practical and accurate advice on diagnosis and management. Find the answers you need more easily with standardized Current Diagnostic Points and Current Therapy clinical recommendation tables. Accurately code for reimbursement using an up-to-date ICD-9 list of common diseases and codes.
Author: Joseph B. Zwischenberger
Publisher: Extracorporeal Life Support
ISBN: 9780965675611
Category : Medical
Languages : en
Pages : 822
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Author:
Publisher:
ISBN:
Category : Accidents
Languages : en
Pages : 50
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