Suchergebnisse

Introduction: The standard in
intensive care units is to compute the water balance. In
the Central Military Hospital, we have bioimpedance, a
technological resource that has proven reproducibility and
validity in ambulatory patients; however, no literature has
been published regarding critically ill patients. We aim to
verify the concordance between extracellular water reported
by bioimpedance and water balance; if there is such, it
will be used as a guide to manage the hydration status
without the inconvenience of waiting hours to compute a
water balance. Objectives: To determine the concordance
between the water balance report measured by bioimpedance
and the calculated water balance. Material and methods:
Serial bioimpedance measurements were performed on the
patients admitted in the ICU of the Central Military
Hospital during the study; we compared the calculated water
balance report and the bioimpedance report, applied the
kappa index and Bland-Altman proof to determine the
concordance between the two measurements. Results: There is
a coincidence between water balance and bioimpedance. The
kappa index was 0.3366 (Z = 5.1235 and p < 0.05);
therefore, statistically and qualitatively, bioimpedance
has a moderate coincidence with water balance. The positive
predictive index is 83.21. The negative predictive value is
88.89. The Bland-Altman method shows that in 100
measurements, 97 will have some coincidence between
bioimpedance and calculated water balance: in 66%, it will
be high; in 21%, medium; in 10%, poor. Conclusion:
Bioimpedance is a non-invasive, validated method that is
easy to perform and allows to obtain important and accurate
information regarding body composition, nutritional state
and the hydric state in healthy people, sick ones and
critically-ill patients; it is low-cost and easy to
use.

BACKGROUND: Percutaneous
tracheostomy is one of the most frequently used procedures
in the Intensive Care Unit, its indication is
posteriormenin patients requiring a prolonged airway has
multiple benefits for the patient as for the institution,
due to its invasive and physiologically critical nature,
the Tracheostomy may be associated with significant
morbidity and even mortality. The Military Central Hospital
has been operating for 16 years. OBJECTIVE: To evaluate the
morbidity and mortality of percutaneous tracheostomy at the
Military Central Hospital. METHODS: An observational,
analytical, prospective and transverse study was carried
out over a period of 10 months in patients who were
candidates for elective percutaneous tracheostomy with
APACHE < 25 in the adult intensive care unit. RESULTS:
We included 36 procedures, which fulfilled the criteria and
inclusion, the ages of the patients were 54.14 + 19.39
years, 77.8% (28) was performed with bronchoscope support,
in our hospital the doctor who performed the procedure was
the Resident physician with 55.6% (20) of the procedures,
and the specialist physician in 44.4% (16). The duration of
the procedure was recorded without statistical difference
between the type of doctor or the specialty. Complications
accounted for 13.9% (5); the minimal bleeding occurring
more frequently 40% (2). Mortality during the procedure was
null and mortality before decanulation was present in 13
cases representing 38.2%, factors associated with mortality
were the patient's diagnosis p=0.001 and the patient's age
p=0.004. CONCLUSIONS: Morbidity of the percutaneous
tracheostomy in the adult intensive care unit of the
Military Central Hospital is 13.9%, with bleeding being the
most frequent, mortality during the procedure was
nil.