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There is little information of intensive care unit (ICU) performance when it's relocated to a totally new and equipped area.To analyze the clinical performance and use of resources of a new respiratory-ICU (nRICU) in a large third-level care hospital.Cross-sectional, comparative study using prospective data of patients admitted from July 17, 2017 to July 17, 2018. The Rapoport adjusted method was used to obtain the standardized clinical performance index (SCPI) and the standardized resource use index (SRUI).Out of 354 patients, those who were readmissions or remained hospitalized and those whose treatment was withheld or withdrawn where excluded from the analysis. In 301 patients, the observed survival at hospital discharge was 63% while the expected survival was 67.7%. Values of SCPI and SRUI were -1.03 and 0.05 respectively, placing results in coordinates within two standard deviations when plotted in the Rapoport chart. There was a statistically significant difference in survival when comparing the study period with outcomes obtained in the RICU before its relocation (63% vs. 55%, p = 0.01).In its 1st year of operation, the nRICU had better clinical performance compared to the former RICU, with no change in the use of resources.Existe poca información acerca del desempeño de una unidad de cuidados intensivos (UCI) cuando es reubicada en un área totalmente nueva y equipada.Analizar el rendimiento clínico y el uso de recursos de la nueva UCI respiratoria (UCIR) de un hospital grande de tercer nivel.Estudio transversal, comparativo, con datos prospectivos de pacientes ingresados del 17 de julio de 2017 al 17 de julio de 2018. Se usa el método ajustado de Rapoport para obtener el índice de rendimiento clínico estandarizado (IRCE) y el índice de uso de recursos estandarizado (IRURE).De 354 pacientes fueron excluidos los reingresos, los pacientes aún hospitalizados y aquellos a quienes se limitó o retiró el tratamiento. En 301 pacientes la sobrevida hospitalaria fue del 63%, mientras que la sobrevida esperada fue del 67.7%. El IRCE fue −1.03 y el IRURE fue 0.05, situando el resultado en coordenadas dentro de dos desviaciones estándar en el gráfico de Rapoport. Hubo una diferencia estadísticamente significativa en la sobrevida comparando el periodo de estudio con resultados de la UCIR obtenidos antes de su reubicación (63 vs. 55%, p = 0.01).En su primer año de funcionamiento, la nueva UCIR tuvo mejor rendimiento clínico que la antigua, sin modificación en el uso de recursos.

Background There is little information of intensive care unit (ICU) performance when it's relocated to a totally new and equipped area. Objective To analyze the clinical performance and use of resources of a new respiratory-ICU (nRICU) in a large third-level care hospital. Method Cross-sectional, comparative study using prospective data of patients admitted from July 17, 2017 to July 17, 2018. The Rapoport adjusted method was used to obtain the standardized clinical performance index (SCPI) and the standardized resource use index (SRUI). Results Out of 354 patients, those who were readmissions or remained hospitalized and those whose treatment was withheld or withdrawn where excluded from the analysis. In 301 patients, the observed survival at hospital discharge was 63% while the expected survival was 67.7%. Values of SCPI and SRUI were -1.03 and 0.05 respectively, placing results in coordinates within two standard deviations when plotted in the Rapoport chart. There was a statistically significant difference in survival when comparing the study period with outcomes obtained in the RICU before its relocation (63% vs. 55%, p = 0.01). Conclusions In its 1st year of operation, the nRICU had better clinical performance compared to the former RICU, with no change in the use of resources.

Resumen Antecedentes La mucormicosis pulmonar es una infeccion oportunista rara con alta mortalidad causada por hongos Mucorales. Los mas frecuentes son Rhizopus, Mucor, Lichtheimia y Rhizomucor. Caso clinico Se presenta el caso de una mujer de 56 anos con diabetes mellitus tipo 2 y enfermedad renal cronica, receptora de un trasplante de rinon cadaverico dos anos antes de su ingreso. Por este motivo recibio tratamiento inmunomodulador con timoglobulina, micofenolato de mofetilo, tacrolimus y prednisona. La paciente ingreso por un cuadro neumonico con tos, expectoracion y disnea; una tomografia computarizada mostro una lesion cavitada en el lobulo superior derecho. Con la sospecha de una aspergilosis pulmonar invasiva se comenzo un tratamiento antifungico con voriconazol, sin mejoria. Se realizo una biopsia por aspiracion con aguja fina, y en el cultivo de la misma crecio Rhizomucor pusillus. La identificacion se confirmo por PCR. A pesar del tratamiento con anfotericina B, la paciente presento hemoptisis masiva incoercible, que provoco su fallecimiento. Conclusiones La mucormicosis pulmonar es una infeccion rara que suele ser fatal en receptores de trasplante renal con terapia antirrechazo. Los mucorales producen fenomenos tromboticos, necrosis y destruccion tisular, que provocaron en nuestra paciente una hemoptisis incoercible. Es importante un diagnostico preciso que permita instaurar un tratamiento quirurgico adecuado y la administracion de anfotericina B.

Malignant tumors can compress or invade the trachea or bronchi leading to varying degrees of airway narrowing. Lung cancer is the most frequent cause of airway occlusion of neoplastic origin1 and also the leading cause of death among all the malignancies in the world.2 However, distant metastatic tu

Background: Improving intensive care unit (ICU) performance is a primary goal in quality of care management; for this purpose, measuring with tools that enable us to make comparisons with proposed standards is necessary. Objective: To describe the clinical performance and resource utilisation of a respiratory ICU (RICU) over a 5-year period. Material and methods: A cross-sectional, retrospective, comparative study was conducted in the RICU of a teaching hospital. Using the revised Rapoport–Teres method, the standardised clinical performance index (SCPI) and the standardised resource utilisation index (SRUI) were calculated annually and for the entire study period. The results were compared with those obtained by the ICUs participating in Project IMPACT (in standard deviations) in a four-quadrant coordinate graph designed for this purpose. SCPI and SRUI values greater than zero indicate better survival and a lower resource utilisation than expected. Values below zero indicate a mortality and resource utilisation higher than expected. Results: In the study period, 1177 patients were admitted to the RICU. Readmissions (n = 34) and patients

Tratar la obstruccion benigna de la via aerea (OBVA) continua siendo un reto. Describimos resultados del uso de coagulacion con argon plasma (CAP) en OBVA. Metodos: Analisis retrospectivo de una serie de casos. Resultados: Se incluyeron 20 pacientes con OBVA tratados en dos anos, con edad promedio 38.9 ± 12.8 anos, 12 fueron mujeres. La OBVA fue secundaria a: intubacion (n = 10), infeccion (n = 4), traqueoplastia (n = 2), lobectomia (n = 1), reaccion inflamatoria por cuerpo extrano (n = 1), granulomatosis de Wegener (n = 1) y trauma (n = 1). La localizacion de la obstruccion fue en subglotis (70%), en traquea en tercio superior (10%) y tercio medio (10%), en bronquio principal izquierdo (5%) y bronquio principal derecho (5%). Se utilizo CAP en un total de 38 sesiones (rango 1-7 sesiones/paciente); ademas, se realizo dilatacion laringea y/o traqueal en 11 casos. En 11 casos hubo mejoria significativa del grado de oclusion, en 8 la mejoria fue minima y en 1 no hubo cambios. El seguimiento promedio fue de 15.7 ± 6.4 meses (rango 7-30). No hubo complicaciones relacionadas a los procedimientos. Conclusiones: La OBVA puede ser tratada de manera efectiva y segura con CAP en casos seleccionados. El manejo combinado con dilatadores puede ser de ayuda para disminuir el grado de obstruccion

La proteinosis alveolar es una enfermedad rara con incidencia estimada de 0.36 casos por millon de habitantes, razon hombre-mujer es 2,1: 1, con una mediana de edad de 51 anos de edad. Dentro de los antecedentes de importancia se encuentran tabaquismo y exposicion a polvos inorganicos. Se considera como disfuncion metabolica del surfactante caracterizada por la acumulacion anormal de material proteinaceo en los espacios alveolares con deterioro del intercambio gaseoso. Puede ser congenita, primaria o secundaria. El diagnostico se sospecha por hallazgos clinicos y radiologicos caracterizado por areas dispersas de atenuacion alveolar en ground-glass o vidrio esmerilado. Las pruebas de funcion respiratoria sugieren patron restrictivo. La fibrobroncoscopia es diagnostica y terapeutica, con lavado broncoalveolar encontrando material lechoso, opaco y espumoso. La biopsia pulmonar puede ser util en algunos casos. El lavado bronquioalveolar puede mejorar el cuadro clinico. Se presentan dos casos de proteinosis alveolar y su evolucion clinica

Primary tracheobronchial amyloidosis (TBA) is a rare disease characterized by extracellular focal or diffuse submucosal deposits of amyloid proteins. Various types of endobronchial lesions have been described in TBA when bronchoscopy is performed using white light. Narrow-band imaging bronchoscopy has been mainly employed for detecting preneoplastic and neoplastic endobronchial lesions as it provides more detailed images of the microvasculature reflective of an altered angiogenesis process. Here, we describe bronchoscopic findings with white light and narrow-band imaging in 2 patients presenting with central airway obstructive disease later confirmed as having primary TBA.

Purpose. We describe characteristics, utility, and safety of fiberoptic bronchoscopy (FOB) in an intensive care unit (ICU). Methods. Prospective and descriptive cohort of patients admitted to a respiratory ICU from March 2010 to June 2012. Results. A total of 102 FOBs were performed in 84 patients among 580 patients that were admitted to the ICU. Mean age was years. FOB was useful in 65% of diagnostic procedures and 83% of therapeutic procedures, with an overall utility of 75%. Indications and utility according to indication were pneumonia in 31 cases, utility of 52%; percutaneous tracheostomy guidance in 26 cases, utility of 100%; atelectasis in 25 cases, utility of 76%; airway exploration in 16 cases, utility of 75%; hemoptysis in two cases, utility of 100%; and difficult airway intubation in two cases, utility of 100%. A decrease in oxygen saturation (SpO 2) of >5% during FOB was present in 65% of cases, and other minor complications were present in 3.9% of cases. Conclusions. Reasons for performing FOB in the ICU have remained relatively stable over time with the exception of the addition of percutaneous tracheostomy guidance. Our series documents current indications and also the utility and safety of this procedure.

Pulmonary mucormycosis is a rare opportunistic infection with high mortality that is caused by species of Mucorales. The most common species involved are Rhizopus, Mucor, Lichtheimia, and Rhizomucor.A 56 year-old woman presented with a clinical history of diabetes mellitus type 2 and chronic renal disease. She underwent a cadaveric kidney transplantation two years before her admission, for which immunomodulating therapy with thymoglobulin, tacrolimus, mofetil-microphenolate and prednisone was established. The patient suffered a pneumonic process with cough, expectoration, and dyspnoea. The computed tomography scan showed a cavitation in the right upper lobe. With all these findings an invasive broncopulmonary aspergillosis was suspected and the patient began an antifungal treatment with voriconazole without improvement. Rhizomucor pusillus was isolated from a clinical specimen obtained by fine needle aspiration, and its identification was confirmed by PCR. After this finding amphotericin B was administered, but the patient had an uncontrolled haemoptysis and died.Pulmonary mucormycosis is a rare infection, usually fatal in kidney transplant recipients with anti-rejection therapy. Mucorales species usually produce thrombotic phenomena, associated with necrosis and parenchymal destruction that caused a fatal uncontrolled haemoptysis in our patient. Early diagnosis is important in order to perform any surgical treatment and to administer amphotericin B.

We present the case of a 33-year-old woman who was being treated for bronchial asthma for 4 years. A tracheal tumor was evident on a computed tomography of the thorax and removed with argon plasma coagulation. It was diagnosed as pleomorphic adenoma of the trachea. It is a rare tracheal tumor without definite treatment guidelines. Our endoscopic approach to this rare lesion is discussed.

When compared with conventional surgery, bronchoscopy-guided percutaneous tracheostomy has demonstrated some advantages. We compare the results obtained with bronchoscopy-guided percutaneous tracheostomy performed by Intensive Care Unit personnel with those of conventional surgery.Prospective and descriptive cohort of patients admitted to a respiratory intensive care unit from March 2010 to March 2012.A total of 510 patients were admitted to the respiratory Intensive Care Unit. Tracheostomy was performed in 51 (10%); of which, 27 (53%) underwent bronchoscopy-guided percutaneous tracheostomy, and 24(47%) underwent tracheostomy by conventional surgery. There were no differences between bronchoscopy-guided percutaneous tracheostomy and conventional surgery groups in age (52 ± 16 vs 53 ± 18 years, p = 0.83). Simplified Acute Physiology Score-3 differed among groups (59.4 ± 11.2 vs 51.5 ± 14.3, p = 0.03). Indications for performing tracheostomy were prolonged intubation (74.1% vs 62.5%, p = 0.55), neurologic impairment (22.2% vs 16.6%, p = 0.88), and laryngeal disease (3.7% vs 20.8%, p 0.14). Mean time between intubation and tracheostomy was 13.3 days (range 4-45) vs 13.4 days (range 2-40). There were three minor complications in bronchoscopy-guided percutaneous tracheostomy patients, transient bigeminism in one, and moderate bleeding in two, and one minor complication of moderate bleeding in one patient in the conventional surgery group, p = 0.68.Bronchoscopy-guided percutaneous tracheostomy is a versatile and safe alternative for conventional tracheostomy when performed in Intensive Care Unit by personnel with expertise and appropriate training.

Bronchoscopy has been described as a safe procedure with a low rate of complications. We present a case of a 48-year-old woman who underwent flexible bronchoscopy for chronic cough. Immediately after the procedure, she developed proptosis of the left eye that required urgent attention. It resolved with medical treatment alone and the patient was discharged without any long-term complications.