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Introduction. COVID-19 has generated one of the highest disease burdens in the 21st century. To date, there are more than 280 million estimated cases globally. Many aspects of this condition are still unknown, which causes controversy in how to approach critically ill patients. Tracheostomy is an intervention that has been shown to be beneficial in the management of respiratory disease, however, there is an evidence gap on the effectiveness and safety of this intervention in critically ill COVID-19 patients. Consequently, the aim of this study was to relate the time elapsed from the onset of the clinical condition, during intubation and days of mechanical ventilation, to performing the tracheostomy, with the survival of patients with symptoms suggestive of COVID-19. Methodology. Retrospective cross-sectional study, conducted between March 2020 and February 2021 in two fourth-level hospitals in the city of Cartagena, Colombia. It included patients older than 18 years who were admitted to the intensive care unit due to the need for invasive mechanical ventilation for viral respiratory symptoms. Those with incomplete medical records and hospitalized for other respiratory causes were excluded. Results. A total of 122 patients were included in the study with a median age of 63 years (IQR 22; 20-89), with 66.4% (n = 81) being male. No significant correlation was found between the number of days from the onset of the clinical condition to the performance of tracheostomy (p = 0.12), nor between the time elapsed from endotracheal intubation to the performance of tracheostomy, with respect to survival (p = 0.53). However, there was a relationship between the number of days of invasive mechanical ventilation and the final outcome (p = 0.02). Discussion. Although it has been reported that tracheostomy is one of the riskiest procedures in the management of patients with severe respiratory symptoms, during the COVID-19 pandemic the literature describes that this intervention increases survival, decreases the time required for mechanical ventilation and reduces the length of stay in the intensive care unit. The number of complications is very low in comparison to the benefit it confers, and it was observed that the local behavior is very similar to that reported in the literature. Conclusions. Time from symptom onset or endotracheal intubation to the performance of tracheostomy does not correlate with survival in patients with respiratory symptomatology suggestive of COVID-19 who are mechanically ventilated and tracheostomized. [ABSTRACT FROM AUTHOR]

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Introduction: Early and appropriate care has been implemented since the scales to assess the risk of pressure ulcers have been required to identify patients with this condition. However, several of these scales have had to be designed according to the context of action. Objective: To propose a risk assessment scale for pressure ulcer in pediatric patients with mechanical ventilation. Methods: A quantitative and qualitative study was carried out at the José Luis Miranda Hospital in two stages: in the first stage, through the binary logistic regression method, the risk factors of pressure ulcers that most affected a population of 550 ventilated patients were determined. In the second stage, a nominal group formed by nine specialists selected the items that would make up the scale and their ranges of measurements from the information collected in a non-participatory observation guide that was applied to patients. Results: The risk factors related to the appearance of pressure ulcers in pediatric patients with artificial mechanical ventilation were immobility and the use of relaxants. Conclusions: A scale was designed to predict the risk of pressure ulcers in ventilated pediatric patients. It consists of eight items; they have three scoring alternatives ranging from one to three (the value 1 represents the greatest deterioration and the value 3 the least). The risk is determined by three categories: maximum for scores between 8 and 13, medium for values between 14 and 19 and minimum between 20 and 24 points. [ABSTRACT FROM AUTHOR]

Introduction: tracheostomy is a procedure indicated for patients with extended mechanical ventilation. Objective: The objective of the study was to learn about the technical characteristics, the appropriate timing for the procedure and its evolution. Material and method: Observational, retrospective study of ICU admitted patients during 2012, with elective tracheostomy. The demographic variables, the Apache II, the pathologies, the number of days in MV, length of stay and mortality were analyzed, both globally and by groups, depending on the early or late use of the technique. The study was approved by the Ethics Committee for Clinical Research of the institution, in accordance with the institutional bioethical principles. Results: The mean age in the sample with 42 patients was 61.36, and the mean Apache II was 18. The most frequent pathology was neurological. The approach was percutaneous in 71.5%, with minor complications in 20% of the cases. In the early tracheostomy group, the number of days in MV and the length of stay were both considerably shorter. Conclusions: Elective tracheostomy is a commonly used technique in the ICU and the procedure is performed according to the protocol. The percutaneous approach is the most frequently used, with few complications. In neurological critical patients with extended weaning, an early approach reduces the number of days with ventilation and the length of stay, with no positive impact on mortality. [ABSTRACT FROM AUTHOR]

Background: Mechanical ventilation (MV) is used in 60-70% of patients admitted to the intensive care unit (ICU). An f/Vt threshold value of 105 is a predictor of successful weaning from mechanical ventilation (WMV) in patients with asthma, cardiac surgery, pneumonia, sepsis, neurocritical, etc. However, there are no reports about the usefulness of the f/Vt value to predict successful WMV in patients with active smoking (AS). The purpose of this paper is to identify a threshold value for f/Vt to predict successful WMV in patients with AS. Methods: Prospectively, 85 patients with AS and MV >24 hours admitted to de ICU were included. Demographic and clinical data were registered. The f/Vt value was measured with a Wright's spirometer, and the sensibility, specificity, positive predictive value (PPV) and negative predictive value (NPV) were calculated to predict a successful WMV. A p value <0.05 was considered statistically significant. Results: The average of f/Vt was 68.69. Successful WMV was of 75.3%. An f/Vt threshold value of 79.5 had sensibility of 76%, specificity of 61%, PPV of 85%, and NPV of 46% to predict successful WMV in this group of patients. Conclusions: An f/Vt threshold value of 79.5 is useful to predict successful WMV in patients with AS. [ABSTRACT FROM AUTHOR]

Objective: To disclose our preliminary experience in inhalation sedation with sevoflorane in a standardized manner using the Anaesthetic Conserving Device in intubated, critically ill patients in our ICU. Patients: It has been used in 9 cases of adult patients (6 men and 3 women) over 24 months. Results: A proper implementation of the protocol by physicians and the nursing staff has been achieved, meeting the goals established for sedation (RASS 0, -2) free of hepatic or renal adverse outcomes or side effects. Conclusions: In our limited experience, adjuvant inhalation sedation with sevoflorane in the ICU is safe and complementary to the use of intravenous drugs such as propofol, remifentanil and midazolam, which are currently commonly used to achieve goal-directed sedation. [ABSTRACT FROM AUTHOR]

Objective: To describe the microbiological profile of ventilator-associated pneumonia (VAP) at the intensive care unit (ICU) of the Clínica Universitaria Bolivariana from 2009 to 2011. Methodology: A single-center retrospective study was conducted. Endotracheal aspirate was used for microbiological diagnosis. Quantitative variables were described using measures of central tendency, (mean or median) and dispersion, such as standard deviation or range. Categorical variables were analyzed as proportions. Results: Thirty-four patients were included, of which 19 were men (56%); the mean age was 60 (SD17.75); the median APACHE II score was 17 (8-36). The most common diagnoses upon admission were lung disease (24%), sepsis (18%), and trauma (18%). Klebsiella pneumoniae (23%) and Pseudomonas aeruginosa (21%) were the most common germs. We found a correlation of 59% between the isolates and germs associated with late VAP. Streptococcus viridans was the principal germ (20%) in throat cultures, followed by K. pneumoniae (16%) and E. Coli (16%). There was only a 38% correlation between the throat culture and endotracheal aspirates. Conclusions: K. pneumoniae and P. aeruginosa germs were the most frequent, with a poor correlation between the throat cultures and endotracheal aspirates. [ABSTRACT FROM AUTHOR]