Evaluación de criterios clínicos perinatales y su importancia en la asistencia ventilatoria neonatal, Hospital Regional II IESS Dr. Teodoro Maldonado Carbo 2011-2013
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2014
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Universidad de Guayaquil. Facultad de Ciencias Médicas. Escuela de Graduados
Resumen
La asistencia ventilatoria es un recurso de extrema utilidad y efectividad en la atención de neonatos que requieren soporte vital, pero también no está exento de riesgos, por lo que su uso debe restringirse a los casos en los beneficios sean mayores que los daños al paciente. Las patologías neonatales en las que se utiliza la asistencia ventilatoria son: el síndrome de dificultad respiratoria, sepsis, neumonía, hernia diafragmática, aspiración de meconio, entre otros. La identificación de los criterios clínicos perinatales (maternos y neonatales) ayuda al reconocimiento de factores de riesgo que pueden influir en el pronóstico del paciente, en la elección del modo y tipo de ventilación, lo cual es el objetivo de la presente investigación. Metodología: La investigación fue de tipo descriptiva, retrospectiva y prospectiva, en el Hospital Teodoro Maldonado Carbo, Regional II del IESS, desde febrero del 2011 hasta enero del 2013. El universo estuvo conformado por todos los recién nacidos que ingresaron al área de terapia intensiva neonatal (n=716), y la muestra aquellos pacientes que necesitaron asistencia ventilatoria (n=144). Resultados: La ventilación invasiva fue la más utilizada (61%); las madres tuvieron en el 89% de los casos antecedentes infecciosos; el tipo de parto más frecuente fue la cesárea (69%); lo neonatos de sexo masculino, bajo peso, prematuros y reanimados con oxígeno, fueron los que más utilizaron asistencia ventilatoria; la mayor parte de los pacientes iniciaron la ventilación en menos de 24 horas (79%), las causas más frecuentes fueron la sepsis y la enfermedad de membrana hialina, con un promedio de duración de 1 a 5 días; la complicación más frecuente fue la neumonía (24%); la estancia hospitalaria promedio fue de 6 a 15 días y la mortalidad fue del 17%. Concluimos que es importante conocer los criterios clínicos perinatales, ya que ayudan al reconocimiento de factores de riesgo que pueden influir en la morbimortalidad neonatal asociada al uso de asistencia ventilatoria. El protocolo de ventilación mecánica neonatal que se elaboró, contribuirá para disminuir las complicaciones asociadas al uso inadecuado de la misma.
The Ventilatory support is a resource extremely useful and effective in infants who requiring life support , but it has risks, so it should be used in restricted cases where the benefits are greater than the patients harm. The Neonatal diseases in which ventilatory assistance is used are: respiratory distress syndrome , sepsis , pneumonia , diaphragmatic hernia, meconium aspiration, and others. The identification of the clinical perinatal criteria (maternal and neonatal) helps to the recognition of risk factors that may influence in the patient prognosis, the choice of the mode and ventilation type, which was the objective of the present investigation. Methodology: The research was descriptive, retrospective and prospective, in the Hospital Teodoro Maldonado Carbo Regional II IESS, from February 2011 to January 2013. The universe consisted of all newborns admitted to the neonatal intensive care area (n=716), and the sample were those patients requiring ventilatory support (n=144). Results: The invasive ventilation was the most used (61%); the mothers had an infectious history in the 89% of the cases; the most frequent type of delivery was cesarean (69%); the male infants, low birth weight, premature and resuscitated with oxygen, were those that used more ventilatory support; most patients began ventilation in less than 24 hours (79%), the most frequent causes were the sepsis and hyaline membrane disease, with an average duration of 1-5 days; the most common complication was pneumonia (24%); the average of the hospital stay was 6-15 days and mortality was 17%. We conclude that it is important to know the perinatal clinical criteria, helping the recognition of risk factors that may affect neonatal morbidity and mortality associated with the use of ventilatory support. The neonatal mechanical ventilation protocol that was developed to help reduce complications associated with inappropriate use of it.
The Ventilatory support is a resource extremely useful and effective in infants who requiring life support , but it has risks, so it should be used in restricted cases where the benefits are greater than the patients harm. The Neonatal diseases in which ventilatory assistance is used are: respiratory distress syndrome , sepsis , pneumonia , diaphragmatic hernia, meconium aspiration, and others. The identification of the clinical perinatal criteria (maternal and neonatal) helps to the recognition of risk factors that may influence in the patient prognosis, the choice of the mode and ventilation type, which was the objective of the present investigation. Methodology: The research was descriptive, retrospective and prospective, in the Hospital Teodoro Maldonado Carbo Regional II IESS, from February 2011 to January 2013. The universe consisted of all newborns admitted to the neonatal intensive care area (n=716), and the sample were those patients requiring ventilatory support (n=144). Results: The invasive ventilation was the most used (61%); the mothers had an infectious history in the 89% of the cases; the most frequent type of delivery was cesarean (69%); the male infants, low birth weight, premature and resuscitated with oxygen, were those that used more ventilatory support; most patients began ventilation in less than 24 hours (79%), the most frequent causes were the sepsis and hyaline membrane disease, with an average duration of 1-5 days; the most common complication was pneumonia (24%); the average of the hospital stay was 6-15 days and mortality was 17%. We conclude that it is important to know the perinatal clinical criteria, helping the recognition of risk factors that may affect neonatal morbidity and mortality associated with the use of ventilatory support. The neonatal mechanical ventilation protocol that was developed to help reduce complications associated with inappropriate use of it.
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Recién nacido, Evaluación clínica, Respiración artificial, Epidemiología descriptiva, Estudios retrospectivos, Hospital de Especialidades Dr. Teodoro Maldonado Carbo, Cantón Guayaquil, Ecuador