Publications (7)5.68 Total impact
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Article: Utility of diffusion-weighted magnetic resonance imaging in severe focal traumatic brain injuries.
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ABSTRACT: OBJECTIVE: To describe the apparent diffusion coefficient (ADC) in a series of severe traumatic brain injuries, their clinical and outcome features, and possible implications. DESIGN: A descriptive, observational case-series study was carried out. PATIENTS AND INTERVENTIONS: Patients with severe traumatic brain injuries (TBIs) admitted to the ICU were subjected to MRI study using a 1.5 T scanner. Diffusion-weighted images (DWMR) were obtained using the following echo-planar pulse sequence: TR 10000 ms, TE 126.9 ms, with b values 1000 s/mm2 in the three spatial dimensions. Combining the three sets of images, an isotropic image conforming a map of the mean ADCs was obtained. RESULTS: DWMR was performed in 23 patients with severe TBI admitted to the ICU between 2001 and 2004. In the MR images we selected 26 regions of interest (ROIs) where ADC was recorded. We observed a clear increase in diffusion in non-treated space-occupying lesions versus other types of injuries and the normal values. A poorer outcome was recorded in patients with lower ADC values. CONCLUSIONS: Mean ADC in the lesions was greater than the normal values and greater in contusions than in other types of injuries, as an expression of extracellular edema. ADCs were decreased in patients with a poor outcome, suggesting an association between ischemia and the patient prognosis.Medicina Intensiva 09/2012; · 1.07 Impact Factor -
Article: [Temporary endocavitary pacemaker implantation].
Medicina Intensiva 03/2012; 36(2):159-60; author reply 160-1. · 1.07 Impact Factor -
Article: [Pulmonary thromboembolism and congenital absence of the inferior vena cava].
Medicina Intensiva 05/2011; 36(2):152-3. · 1.07 Impact Factor -
Article: [Is the permanent pacemaker implant more efficient in level 1 hospital?].
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ABSTRACT: To determine if permanent pacemaker implants (PPM) interventions and change of generator are more efficient in small hospitals. A cost-effective analysis and retrospective, cross-sectional and observational study of diagnostic related groups (DRG). The data was obtained from the national Minimum Basic Data Set (MBDS) for the year 2007 provided by the Health Ministry. This includes the total number of patients who required treatment in all national hospitals for 5 DRG: 115 - bradyarrhythmic complication during the acute coronary syndrome, heart failure or shock; 116 -symptomatic isolated conduction defects; 117 -revisions, but without changing the battery, 118- application of a new one, 549 - implementation or revision but with serious complications. PRINCIPAL VARIABLES OF INTEREST: demographic, clinical (number of secondary diagnoses (NSD) and procedures (NP), mortality) and management (total and preoperative length of stay (LOS), access, discharge, hospital size), defining inefficient stays as those exceeding 2 days on the average. 23,154 episodes, 5.3% small hospitals. The comparative bivariate study between small hospitals and the rest, not discriminated by DRG, showed a mean LOS of 7.87±8.78 days vs 11.01±12.95 (p=0.005, 95% CI for mean difference [0.17, 1.65]) and also lower than preoperatively (3.62±6.14 vs. 4.22±6.68 days (p=0.015)) without greater comorbidity, as measured by proxy through the NSD (5.23±2.88 vs 5.42±3.28 (p=0.055)) and NP as proxy of diagnostic and therapeutic effort (3.79±2.50 vs 3.55±2.69 (p=0.002)). A total of 24.1% were inefficient, there being an association with preoperative stay, NDS, NP and emergency access. Pacemaker implantation and generator change in small hospitals is more efficient, with internal consistency by subgroups.Medicina Intensiva 03/2011; 35(2):68-74. · 1.07 Impact Factor -
Article: [Economics and equity in urgency and emergency care].
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ABSTRACT: The financial sustainability of public health systems (PHS) is currently threatened by population growth, increased prevalence of chronic conditions and disabilities, inequality in access and use of resources, zero cost delivery and global economic crisis. The emergency department (ED) is one for which demand is highest--without relation to the health model--because disease becomes established in disadvantaged socio-demographic areas and inequalities, hyperconsumption and decision making more closely linked to the user are maintained. The medical device of ED is a multiple one and its diverse product lines make it difficult to measure. This review discusses the need to deploy measurement tools in ED, where there are high direct costs--primarily structural--and other variables related to the activity, where the marginal cost is higher than the average and there is no economy of scale in such interventions. The possible mechanisms of private copayment in financing the supply of EDs are also studied, showing their advantages and disadvantages, with the conclusion that they are not recommendable--due to their scarce fund raising and deterrent capacity, which is why fundamental strategic changes in the management of these resources are needed.Anales del sistema sanitario de Navarra 01/2010; 33 Suppl 1:19-27. · 0.32 Impact Factor -
Article: [Adverse effects, intercommunication, management of knowledge and care strategies in intensive nursing].
Medicina Intensiva 35(1):3-5. · 1.07 Impact Factor -
Article: Traqueostomía percutánea de emergencia en un paciente politraumatizado
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ABSTRACT: El abordaje de la vía aérea difícil en situación de urgencia supone un reto continuo para los médicos que trabajan con pacientes críticos. La técnica de la traqueostomía percutánea mediante múltiples dilatadores de calibre progresivo fue descrita por Ciaglia en 1985. Desde entonces se han desarrollado nuevas variantes de las técnicas percutáneas por dilatación. Actualmente disponemos de procedimientos más sencillos, rápidos y con baja tasa de complicaciones, cuando son realizados por personal experimentado. Este hecho hace que las técnicas percutáneas actuales puedan plantearse, en determinadas situaciones, como alternativa a la cricotiroidotomía en el manejo de la vía aérea difícil en situación de urgencia, ofreciendo algunas ventajas sobre ésta. Presentamos un caso clínico que ilustra el abordaje de la vía aérea difícil en un paciente politraumatizado mediante la técnica de traqueostomía percutánea por dilatación en un solo paso con dilatador de calibre progresivo con cubierta hidrofílica (Ciaglia Blue Rhino. Cook Critical Care®, Bloomington, EEUU).Emergencias: Revista de la Sociedad Española de Medicina de Urgencias y Emergencias, ISSN 1137-6821, Vol. 17, Nº. 6, 2005, pags. 274-276.
