Factores desencadenantes de crisis asmáticas en niños: estudio en las áreas de emergencia y consulta externa del Hospital Vicente Corral Moscoso 2000-2001, Cuenca-Ecuador

Se dice que no existen estudios que establezcan la mayor o menor trascendencia de las diversas condiciones que podrían afectar para la presentación de crisis asmáticas. Conclusiones: Factores desencadenantes de crisis asmáticas en niños realizado en las áreas de emergencia y consulta del hospital Vicente Corral Moscoso de la ciudad de Cuenca: Los factores encontrados son: temperatura baja, infecciones del tracto respiratorio, ejercicio, temperatura baja y ejercicio. Se ha establecido que con respecto al tiempo transcurrido entre la exposición al factor desencadenante y la presentación de crisis asmática se presentaron más crisis asmáticas en un lapso de 20 a 24 horas. En cuanto a la edad en la qu más crisis asmáticas se presentaron es de 5 a 9 años siendo el factor más frecuente en los niños de esta edad la temperatura baja. Con respecto al sexo se presentaron más crisis en el sexo masculino siendo también el factor más frecuente en este sexo la temperatura bajaIt is said that there are no studies that establish the degree of importance of the various conditions that could affect to the presentation of asthma attacks. Conclusions: triggers of asthma in children conducted in the areas of emergency and consultation Vicente Corral Moscoso Hospital of Cuenca crisis factors found are: low temperature, respiratory tract infections, exercise, low temperature and exercise. It was established that with respect to the time between exposure to the trigger and presentation of flare longer asthmatic attacks occurred in a span of 20-24 hours. In terms of age in what appeared more asthma attacks it is 5-9 years being the most common in children of this age factor low temperature. About sex more crises occurred in males and is also the most common factor in this low temperature sexDoctor en Medicina y CirugíaCuenc

Evolution over Time of Ventilatory Management and Outcome of Patients with Neurologic Disease∗

OBJECTIVES: To describe the changes in ventilator management over time in patients with neurologic disease at ICU admission and to estimate factors associated with 28-day hospital mortality. DESIGN: Secondary analysis of three prospective, observational, multicenter studies. SETTING: Cohort studies conducted in 2004, 2010, and 2016. PATIENTS: Adult patients who received mechanical ventilation for more than 12 hours. INTERVENTIONS: None. MEASUREMENTS AND MAIN RESULTS: Among the 20,929 patients enrolled, we included 4,152 (20%) mechanically ventilated patients due to different neurologic diseases. Hemorrhagic stroke and brain trauma were the most common pathologies associated with the need for mechanical ventilation. Although volume-cycled ventilation remained the preferred ventilation mode, there was a significant (p < 0.001) increment in the use of pressure support ventilation. The proportion of patients receiving a protective lung ventilation strategy was increased over time: 47% in 2004, 63% in 2010, and 65% in 2016 (p < 0.001), as well as the duration of protective ventilation strategies: 406 days per 1,000 mechanical ventilation days in 2004, 523 days per 1,000 mechanical ventilation days in 2010, and 585 days per 1,000 mechanical ventilation days in 2016 (p < 0.001). There were no differences in the length of stay in the ICU, mortality in the ICU, and mortality in hospital from 2004 to 2016. Independent risk factors for 28-day mortality were age greater than 75 years, Simplified Acute Physiology Score II greater than 50, the occurrence of organ dysfunction within first 48 hours after brain injury, and specific neurologic diseases such as hemorrhagic stroke, ischemic stroke, and brain trauma. CONCLUSIONS: More lung-protective ventilatory strategies have been implemented over years in neurologic patients with no effect on pulmonary complications or on survival. We found several prognostic factors on mortality such as advanced age, the severity of the disease, organ dysfunctions, and the etiology of neurologic disease