Síndrome benigno de hiperlaxitud articular como un factor causal del retraso de la motricidad fina en niños de 3-5 años: I.E.I.P. Amiguito-Rímac-Lima, noviembre 2007

Objetivos: Determinar si el síndrome benigno de hiperlaxitud articular es un factor causal del retraso de la motricidad fina en niños de 3-5 años. Material y Métodos: El presente trabajo analítico-explicativo, de corte transversal, de casos y control, se realizó en la Institución Educativa Inicial Particular Amiguito del distrito del Rímac totalizando 72 niños de 3 a 5 años. Para el grupo de casos se evaluó la motricidad fina a niños de ambos sexos que presenten grados de retraso y riesgo en ésta área de desarrollo; los cuales fueron 24. Luego, se eligió el grupo control en función de edad y sexo. Posteriormente se evaluó a todos los niños para detectar el Síndrome Benigno de Hiperlaxitud Articular (SBHA). El retraso de la motricidad fina se evaluó a través del Test de TEPSI utilizando el sub Test. de coordinación. El SBHA se determinó por el puntaje de Beighton, considerándose positivo un puntaje de 4 o más sobre 9. Resultados: De los 72 niños evaluados del colegio Amiguito del distrito del Rímac, un 33.33 % presenta retraso de la motricidad fina que son los casos, de los cuales el 79.17% presentan SBHA, mientras que en el grupo control fueron 58.33% con este síndrome. El sexo femenino presenta mayor porcentaje (87.5%) del SBHA en el grupo de casos. Los niños con retraso de la motricidad fina a menor edad presentan un mayor porcentaje de SBHA. Las actividades que presentaron mayor cantidad de fracasos en el grupo de casos con SBHA fueron las de enhebrar un hilo con una aguja y dibujar más de 9 partes de una figura humana. Conclusiones: Se concluye que existe asociación causal entre la presencia del SBHA y la alteración de la motricidad fina aplicando la prueba de OR=2.71. La prevalencia del retraso motor fino en niños con SBHA es 2.71 veces más probable que en niños sin SBHA. Las actividades que presentan un mayor porcentaje de fracasos en los niños con retraso de la motricidad fina con SBHA son: enhebrar el hilo con una aguja y dibujar más de 9 partes de una figura humana (100%) para ambos casos.Tesi

Weaning from mechanical ventilation in intensive care units across 50 countries (WEAN SAFE): a multicentre, prospective, observational cohort study

Background Current management practices and outcomes in weaning from invasive mechanical ventilation are poorly understood. We aimed to describe the epidemiology, management, timings, risk for failure, and outcomes of weaning in patients requiring at least 2 days of invasive mechanical ventilation. Methods WEAN SAFE was an international, multicentre, prospective, observational cohort study done in 481 intensive care units in 50 countries. Eligible participants were older than 16 years, admitted to a participating intensive care unit, and receiving mechanical ventilation for 2 calendar days or longer. We defined weaning initiation as the first attempt to separate a patient from the ventilator, successful weaning as no reintubation or death within 7 days of extubation, and weaning eligibility criteria based on positive end-expiratory pressure, fractional concentration of oxygen in inspired air, and vasopressors. The primary outcome was the proportion of patients successfully weaned at 90 days. Key secondary outcomes included weaning duration, timing of weaning events, factors associated with weaning delay and weaning failure, and hospital outcomes. This study is registered with ClinicalTrials.gov, NCT03255109. Findings Between Oct 4, 2017, and June 25, 2018, 10 232 patients were screened for eligibility, of whom 5869 were enrolled. 4523 (77·1%) patients underwent at least one separation attempt and 3817 (65·0%) patients were successfully weaned from ventilation at day 90. 237 (4·0%) patients were transferred before any separation attempt, 153 (2·6%) were transferred after at least one separation attempt and not successfully weaned, and 1662 (28·3%) died while invasively ventilated. The median time from fulfilling weaning eligibility criteria to first separation attempt was 1 day (IQR 0–4), and 1013 (22·4%) patients had a delay in initiating first separation of 5 or more days. Of the 4523 (77·1%) patients with separation attempts, 2927 (64·7%) had a short wean (≤1 day), 457 (10·1%) had intermediate weaning (2–6 days), 433 (9·6%) required prolonged weaning (≥7 days), and 706 (15·6%) had weaning failure. Higher sedation scores were independently associated with delayed initiation of weaning. Delayed initiation of weaning and higher sedation scores were independently associated with weaning failure. 1742 (31·8%) of 5479 patients died in the intensive care unit and 2095 (38·3%) of 5465 patients died in hospital. Interpretation In critically ill patients receiving at least 2 days of invasive mechanical ventilation, only 65% were weaned at 90 days. A better understanding of factors that delay the weaning process, such as delays in weaning initiation or excessive sedation levels, might improve weaning success rates

Weaning from mechanical ventilation in intensive care units across 50 countries (WEAN SAFE): a multicentre, prospective, observational cohort study

Background: Current management practices and outcomes in weaning from invasive mechanical ventilation are poorly understood. We aimed to describe the epidemiology, management, timings, risk for failure, and outcomes of weaning in patients requiring at least 2 days of invasive mechanical ventilation. Methods: WEAN SAFE was an international, multicentre, prospective, observational cohort study done in 481 intensive care units in 50 countries. Eligible participants were older than 16 years, admitted to a participating intensive care unit, and receiving mechanical ventilation for 2 calendar days or longer. We defined weaning initiation as the first attempt to separate a patient from the ventilator, successful weaning as no reintubation or death within 7 days of extubation, and weaning eligibility criteria based on positive end-expiratory pressure, fractional concentration of oxygen in inspired air, and vasopressors. The primary outcome was the proportion of patients successfully weaned at 90 days. Key secondary outcomes included weaning duration, timing of weaning events, factors associated with weaning delay and weaning failure, and hospital outcomes. This study is registered with ClinicalTrials.gov, NCT03255109. Findings: Between Oct 4, 2017, and June 25, 2018, 10 232 patients were screened for eligibility, of whom 5869 were enrolled. 4523 (77·1%) patients underwent at least one separation attempt and 3817 (65·0%) patients were successfully weaned from ventilation at day 90. 237 (4·0%) patients were transferred before any separation attempt, 153 (2·6%) were transferred after at least one separation attempt and not successfully weaned, and 1662 (28·3%) died while invasively ventilated. The median time from fulfilling weaning eligibility criteria to first separation attempt was 1 day (IQR 0-4), and 1013 (22·4%) patients had a delay in initiating first separation of 5 or more days. Of the 4523 (77·1%) patients with separation attempts, 2927 (64·7%) had a short wean (≤1 day), 457 (10·1%) had intermediate weaning (2-6 days), 433 (9·6%) required prolonged weaning (≥7 days), and 706 (15·6%) had weaning failure. Higher sedation scores were independently associated with delayed initiation of weaning. Delayed initiation of weaning and higher sedation scores were independently associated with weaning failure. 1742 (31·8%) of 5479 patients died in the intensive care unit and 2095 (38·3%) of 5465 patients died in hospital. Interpretation: In critically ill patients receiving at least 2 days of invasive mechanical ventilation, only 65% were weaned at 90 days. A better understanding of factors that delay the weaning process, such as delays in weaning initiation or excessive sedation levels, might improve weaning success rates. Funding: European Society of Intensive Care Medicine, European Respiratory Society