Adherencia a los parámetros de ventilación mecánica protectora en los pacientes mayores de 18 años, con ventilación mecánica invasiva en el Hospital Militar Central

La ventilacion mecanica hace referencia al uso de dispositivos para asistir parcial o totalmente la respiracion del paciente, herramienta utilizada en los pacientes cuya dinamica ventilatoria no es adecuada.Llimitar el daño producido por las difernetes variables que componen el soporte, proporcionan...

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Autores:
Medina ahumada, Patricia
Delgado Lasso, Rene Arturo
Medina ahumada, Patricia
Tipo de recurso:
Fecha de publicación:
2019
Institución:
Universidad Militar Nueva Granada
Repositorio:
Repositorio UMNG
Idioma:
spa
OAI Identifier:
oai:repository.unimilitar.edu.co:10654/35118
Acceso en línea:
http://hdl.handle.net/10654/35118
Palabra clave:
Mechanical ventilation
Protective ventilation
Tidal volume
Driving pressure
Plateau pressure
RESPIRACION ARTIFICIAL
CUIDADOS INTENSIVOS (MEDICINA)
APARATO RESPIRATORIO
Ventilación mecánica
Ventilación protectora
Volumen corriente
Presión de conducción
Presión plateau
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License
Derechos Reservados - Universidad Militar Nueva Granada, 2020
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oai_identifier_str oai:repository.unimilitar.edu.co:10654/35118
network_acronym_str UNIMILTAR2
network_name_str Repositorio UMNG
repository_id_str
dc.title.spa.fl_str_mv Adherencia a los parámetros de ventilación mecánica protectora en los pacientes mayores de 18 años, con ventilación mecánica invasiva en el Hospital Militar Central
dc.title.translated.spa.fl_str_mv Adherence to protective mechanical ventilation parameters in patients over 18 years of age, with invasive mechanical ventilation at the Central Military Hospital
title Adherencia a los parámetros de ventilación mecánica protectora en los pacientes mayores de 18 años, con ventilación mecánica invasiva en el Hospital Militar Central
spellingShingle Adherencia a los parámetros de ventilación mecánica protectora en los pacientes mayores de 18 años, con ventilación mecánica invasiva en el Hospital Militar Central
Mechanical ventilation
Protective ventilation
Tidal volume
Driving pressure
Plateau pressure
RESPIRACION ARTIFICIAL
CUIDADOS INTENSIVOS (MEDICINA)
APARATO RESPIRATORIO
Ventilación mecánica
Ventilación protectora
Volumen corriente
Presión de conducción
Presión plateau
title_short Adherencia a los parámetros de ventilación mecánica protectora en los pacientes mayores de 18 años, con ventilación mecánica invasiva en el Hospital Militar Central
title_full Adherencia a los parámetros de ventilación mecánica protectora en los pacientes mayores de 18 años, con ventilación mecánica invasiva en el Hospital Militar Central
title_fullStr Adherencia a los parámetros de ventilación mecánica protectora en los pacientes mayores de 18 años, con ventilación mecánica invasiva en el Hospital Militar Central
title_full_unstemmed Adherencia a los parámetros de ventilación mecánica protectora en los pacientes mayores de 18 años, con ventilación mecánica invasiva en el Hospital Militar Central
title_sort Adherencia a los parámetros de ventilación mecánica protectora en los pacientes mayores de 18 años, con ventilación mecánica invasiva en el Hospital Militar Central
dc.creator.fl_str_mv Medina ahumada, Patricia
Delgado Lasso, Rene Arturo
Medina ahumada, Patricia
dc.contributor.advisor.spa.fl_str_mv Polanco, Lucas
dc.contributor.author.spa.fl_str_mv Medina ahumada, Patricia
Delgado Lasso, Rene Arturo
Medina ahumada, Patricia
dc.contributor.corporatename.spa.fl_str_mv Polanco Lucas
Velasquez Juan Pablo
dc.subject.keywords.spa.fl_str_mv Mechanical ventilation
Protective ventilation
Tidal volume
Driving pressure
Plateau pressure
topic Mechanical ventilation
Protective ventilation
Tidal volume
Driving pressure
Plateau pressure
RESPIRACION ARTIFICIAL
CUIDADOS INTENSIVOS (MEDICINA)
APARATO RESPIRATORIO
Ventilación mecánica
Ventilación protectora
Volumen corriente
Presión de conducción
Presión plateau
dc.subject.decs.none.fl_str_mv RESPIRACION ARTIFICIAL
CUIDADOS INTENSIVOS (MEDICINA)
APARATO RESPIRATORIO
dc.subject.proposal.spa.fl_str_mv Ventilación mecánica
Ventilación protectora
Volumen corriente
Presión de conducción
Presión plateau
description La ventilacion mecanica hace referencia al uso de dispositivos para asistir parcial o totalmente la respiracion del paciente, herramienta utilizada en los pacientes cuya dinamica ventilatoria no es adecuada.Llimitar el daño producido por las difernetes variables que componen el soporte, proporcionando una estrategia de ventilacion fisiologicamente segura, se conoce como estratgia de ventilacion protectora. El objetivo de esta estudio es determinar la adherencia al protocolo de ventilacion mecanica protectora en los pacientes mayores de 18 años que requieren ventilacion mecanica en el Hospital Militar Central.
publishDate 2019
dc.date.issued.none.fl_str_mv 2019-11-07
dc.date.accessioned.none.fl_str_mv 2020-03-17T16:49:59Z
dc.date.available.none.fl_str_mv 2020-03-17T16:49:59Z
dc.type.spa.fl_str_mv info:eu-repo/semantics/bachelorThesis
dc.type.coar.fl_str_mv http://purl.org/coar/resource_type/c_7a1f
dc.type.local.spa.fl_str_mv Trabajo de grado
dc.type.dcmi-type-vocabulary.spa.fl_str_mv Text
dc.identifier.uri.none.fl_str_mv http://hdl.handle.net/10654/35118
url http://hdl.handle.net/10654/35118
dc.language.iso.spa.fl_str_mv spa
spa
language spa
dc.relation.references.spa.fl_str_mv 1. Murray and Nadel’s (2016) Textbook of Respiratory Medicine, Sixth Edition. Elsevier, 101, 1761-1777.e4.
2. Parrillo, Joseph E., MD; Dellinger, R. Phillip, MD. (2014) Critical Care Medicine: Principles of Diagnosis and Management in the Adult. Fourth Edition. Elsevier. 9, 138-152.e4.
3. Dries David J. Mechanical Ventilation: History and Harm. Air Medical Journal 35:1
4. The Acute Respiratory Distress Syndrome Network. Ventilation with lower tidal volumes as compared with traditional tidal volumes for acute lung injury and the acute respiratory distress syndrome. N Engl J Med 2000;342:1301-8.
5. Determann, R. and Cols. RVeeseanrcthilation with lower tidal volumes as compared with conventional tidal volumes for patients without acute lung injury: a preventive randomized controlled trial. Critical Care 2010, 14:R1
6. Sutherasan Y. and Cols. Protective mechanical ventilation in the non-injured lung: review and meta-analysis. Critical Care 2014, 18:211
7. The National Heart, Lung, and Blood Institute ARDS Clinical Trials Network. Higher versus Lower Positive End-Expiratory Pressures in Patients with the Acute Respiratory Distress Syndrome. N Engl J Med 2004;351:327-36.
8. Gordo F and Cols. What PEEP level should I use in my patient? Med Intensiva. 2017;41(5):267-269
9. Haitsma J. Physiology of Mechanical Ventilation. Crit Care Clin 23 (2007) 117–134
10. Koh S. and Cols. Mode of Mechanical Ventilation: Volume Controlled Mode. Crit Care Clin 23 (2007) 161–167
11. Nichols D. and Cols, Pressure Control Ventilation. Pressure Control Ventilation
12. Seiberlich E. and Cols. Protective Mechanical Ventilation, Why Use It? Rev Bras Anestesiol 2011; 61: 5: 659-667
13. Haas. Carls and Cols. Mechanical Ventilation with Lung Protective Strategies: What Works? Crit Care Clin 27 (2011) 469–486
14. Daoud E. and Cols. Airway Pressure Release Ventilation: What Do We Know? respiratory care february 2012 Vol 57 No 2
15. Wright B. Lung-protective Ventilation Strategies and Adjunctive Treatments for the Emergency Medicine Patient with Acute Respiratory Failure. Emerg Med Clin N Am - (2014)
16. Determann et al. RVeeseanrcthilation with lower tidal volumes as compared with conventional tidal volumes for patients without acute lung injury: a preventive randomized controlled trial. Critical Care 2010, 14:R1
17. De Feo P ando Cols. Lung protective ventilation strategy for the acute respiratory distress syndrome. Cochrane Database of Systematic Reviews 2013, Issue 2. Art. No.: CD003844
18. Amato M. Driving Pressure and Survival in the Acute Respiratory Distress Syndrome. N Engl J Med 2015;372:747-55.
19. Budinger S. Balancing the Risks and Benefi ts of Oxygen Therapy in Critically Ill Adults. chest / 143 / 4 / april 2013
20. Rachmale S. Practice of Excessive FIO2 and Effect on Pulmonary Outcomes in Mechanically Ventilated Patients With Acute Lung Injury. respiratory care november 2012 vol 57 No 11
21. Ljland M. Bench-to-bedside review: Hypercapnic acidosis in lung injury - from ‘permissive’ to ‘therapeutic’. Ijland et al. Critical Care 2010, 14:237
22. Fan E, Del Sorbo L, Goligher EC, et al. An Official 29. American Thoracic Society/European Society of Intensive Care Medicine/Society of Critical Care Medicine Clinical Practice Guideline: Mechanical Ventilation in Adult Patients with Acute Respiratory Distress Syndrome. Am J Respir Crit Care Med 2017;195:1253-63
23. Hashimoto S, and Cols. The clinical practice guideline for the management of ARDS in Japan. Journal of Intensive Care (2017) 5:50
24. Serpa Neto A, Cardoso SO, Manetta JA, Pereira VG, Esposito DC, Pasqualucci Mde O, et al. Association between use of lung-protective ventilation with lower tidal volumes and clinical outcomes among patients without acute respiratory distress syndrome: a meta-analysis. JAMA 2012;308(16):1651-1659
25. David A Turner, and Cols. (2013) Lung protective ventilation: a summary of the current evidence from the 2012 American Association for Respiratory Care International Congress, Expert Review of Respiratory Medicine, 7:3, 209-212
26. Ochiai R. Mechanical ventilation of acute respiratory distress síndrome. Journal of Intensive Care (2015) 3:25
27. Passos M. and Cols. effect of a protective-ventilation strategy on mortality in the acute respiratory distress syndrome. N Engl J Med 1998;338:347-54
28. Lellouche F. Prophylactic protective ventilation: lower tidal volumes for all critically ill patients? Intensive Care Med (2013) 39:6–15
29. Pham T. And Cols. Mechanical Ventilation: State of the Art. Mayo Clin Proc. September 2017;92(9):1382-1400
30. Sutherasan Y, Vargas M, Pelosi P. Protective mechanical ventilation in the non-injured lung: review and meta-analysis. Crit Care 2014; 18(2):211
31. Petrucci N, De Feo C. Lung protective ventilation strategy for the acute respiratory distress syndrome. Cochrane Database Syst Rev 2013(2):CD003844
32. Writing Group for the PI, Simonis FD, Serpa Neto A, Binnekade JM, Braber A, Bruin KCM, et al. Effect of a low vs intermediate tidal volume strategy on ventilator-free days in intensive care unit patients without ARDS: a randomized clinical trial. JAMA 2018;320(18):1872- 1880
33. Koide M, Uchiyama A, Yamashita T, Yoshida T, Fujino Y. Attaining low tidal volume ventilation during patient-triggered ventilation in sedated subjects. Respir Care 2019;64(8):890-898
34. Bellani G, Laffey JG, Pham T, et al. Epidemiology Patterns of Care, and Mortality for Patients With Acute Respiratory Distress Syndrome in Intensive Care Units in 50 Countries. JAMA 2016;315:788-800
35. Nadeem RN, Elhoufi AM, Soliman MA, Bon I, Obaida ZA, Hussien MM, Salama L, Elsousi AN, Kamat S, Satti RM, Elahi N, Abuhijleh RH, ElZeiny MG, Fargaly H, Ibrahim MM. Clinical Predictors of Adherence to Low Tidal Volume Ventilation Practice: Is it Different on Weekend and Night Shifts?. Cureus. 2019 Jun 6;11(6):e4844
Kalb T, Raikhelkar J, Meyer S, Ntimba F, Thuli J, Gorman MJ, Kopec I, Scurlock C. A multicenter population based effectiveness study of teleintensive care unit directed ventilatorrounds demonstrating improved adherence to a protective lung strategy, decreased ventilatorduration, and decreased intensive care unit mortality. J Crit Care. 2014 Aug;29(4):691.e7-14
37. Laffey JG, Madotto F, Bellani G, Pham T, Fan E, Brochard L, et al; LUNG SAFE Investigators; ESICM Trials Group. Geo-economic variations in epidemiology, patterns of care, and outcomes in patients with acute respiratory distress syndrome: insights from the LUNG SAFE prospective cohort study. Lancet Respir Med. 2017; 5(8):627–638
38. Needham DM, Yang T, Dinglas VD, Mendez-Tellez PA, Shanholtz C, Sevransky JE, Brower RG, Pronovost PJ, Colantuoni E. Timing of Low Tidal Volume Ventilation and Intensive Care Unit Mortality in Acute Respiratory Distress Syndrome
A Prospective Cohort Study. Am J Respir Crit Care Med. 2015 Jan 15;191(2):177-85
dc.rights.spa.fl_str_mv Derechos Reservados - Universidad Militar Nueva Granada, 2020
dc.rights.coar.fl_str_mv http://purl.org/coar/access_right/c_abf2
dc.rights.uri.spa.fl_str_mv https://creativecommons.org/licenses/by-nc-nd/2.5/co/
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rights_invalid_str_mv Derechos Reservados - Universidad Militar Nueva Granada, 2020
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Atribución-NoComercial-SinDerivadas
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dc.publisher.department.spa.fl_str_mv Facultad de Medicina
dc.publisher.program.spa.fl_str_mv Medicina interna
dc.publisher.faculty.spa.fl_str_mv Medicina y Ciencias de la Salud - Medicina interna
institution Universidad Militar Nueva Granada
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spelling Polanco, LucasMedina ahumada, PatriciaDelgado Lasso, Rene ArturoMedina ahumada, PatriciaEspecialista en Medicina internaPolanco LucasVelasquez Juan PabloMedicina2020-03-17T16:49:59Z2020-03-17T16:49:59Z2019-11-07http://hdl.handle.net/10654/35118La ventilacion mecanica hace referencia al uso de dispositivos para asistir parcial o totalmente la respiracion del paciente, herramienta utilizada en los pacientes cuya dinamica ventilatoria no es adecuada.Llimitar el daño producido por las difernetes variables que componen el soporte, proporcionando una estrategia de ventilacion fisiologicamente segura, se conoce como estratgia de ventilacion protectora. El objetivo de esta estudio es determinar la adherencia al protocolo de ventilacion mecanica protectora en los pacientes mayores de 18 años que requieren ventilacion mecanica en el Hospital Militar Central.TABLA DE CONTENIDO 1. Resumen………………………………………………………………………………………4 1.1 Introducción………………………………………………………………………………….4 1.2 Metodos……………………………………………………………………………………...4 1.3 Resultados…………………………………………………………………………………..4 2. Identificación y formulación del problema…………………………………………………7 3. Objetivos e hipotesis……………………………………………………………………….10 3.1 Objetvo general……………………………………………………………………………10 3.2 Objetivos especificos……………………………………………………………………..10 3.3 Hipotesis……………………………………………………………………………………10 4. Metodología propuesta……...……………………………………………………………..11 4.1 Clasificación del estudio………………………………………………………………….11 4.2 Lugar………………………………………………………………………………………..11 4.3 Caracteristicas de la población…………………………………………………………..11 4.4 Variables……………………………………………………………………………………11 4.5 Aspectos del proceso de medición y seguimineto…………………………………….15 4.6 Muestra…………………………………………………………………………………….15 4.7 Mediciones e instrumentos.……………………………………………………………...16 5. Plan de análisis……………………………………………………………………………..17 6. Aspectos éticos……………………………………………………………………………..19 7. Resultados…………………………………………………………………………………..20 8. Discusión…………………………………………………………………………………….29 9. Conclusiones………………………………………………………………………………..33 10. Bibliografía…………………………………………………………………………………34Mechanical ventilation refers to the use of devices to partially or fully assist the patient's breathing, a tool used in patients whose ventilatory dynamics are not adequate. Limit the damage caused by the different deferred components that make up the support, providing a physiologically ventilated strategy Sure, it is known as protective ventilation strategy. The objective of this study is to determine the adherence to the protective mechanical ventilation protocol in patients older than 18 years who require mechanical ventilation in the Central Military HospitalEspecializaciónpdfapplication/pdfspaspaUniversidad Militar Nueva GranadaFacultad de MedicinaMedicina internaMedicina y Ciencias de la Salud - Medicina internaDerechos Reservados - Universidad Militar Nueva Granada, 2020https://creativecommons.org/licenses/by-nc-nd/2.5/co/Atribución-NoComercial-SinDerivadashttp://purl.org/coar/access_right/c_abf2Adherencia a los parámetros de ventilación mecánica protectora en los pacientes mayores de 18 años, con ventilación mecánica invasiva en el Hospital Militar CentralAdherence to protective mechanical ventilation parameters in patients over 18 years of age, with invasive mechanical ventilation at the Central Military Hospitalinfo:eu-repo/semantics/bachelorThesisTrabajo de gradoTexthttp://purl.org/coar/resource_type/c_7a1fMechanical ventilationProtective ventilationTidal volumeDriving pressurePlateau pressureRESPIRACION ARTIFICIALCUIDADOS INTENSIVOS (MEDICINA)APARATO RESPIRATORIOVentilación mecánicaVentilación protectoraVolumen corrientePresión de conducciónPresión plateau1. Murray and Nadel’s (2016) Textbook of Respiratory Medicine, Sixth Edition. Elsevier, 101, 1761-1777.e4.2. Parrillo, Joseph E., MD; Dellinger, R. Phillip, MD. (2014) Critical Care Medicine: Principles of Diagnosis and Management in the Adult. Fourth Edition. Elsevier. 9, 138-152.e4.3. Dries David J. Mechanical Ventilation: History and Harm. Air Medical Journal 35:14. The Acute Respiratory Distress Syndrome Network. Ventilation with lower tidal volumes as compared with traditional tidal volumes for acute lung injury and the acute respiratory distress syndrome. N Engl J Med 2000;342:1301-8.5. Determann, R. and Cols. RVeeseanrcthilation with lower tidal volumes as compared with conventional tidal volumes for patients without acute lung injury: a preventive randomized controlled trial. Critical Care 2010, 14:R16. Sutherasan Y. and Cols. Protective mechanical ventilation in the non-injured lung: review and meta-analysis. Critical Care 2014, 18:2117. The National Heart, Lung, and Blood Institute ARDS Clinical Trials Network. Higher versus Lower Positive End-Expiratory Pressures in Patients with the Acute Respiratory Distress Syndrome. N Engl J Med 2004;351:327-36.8. Gordo F and Cols. What PEEP level should I use in my patient? Med Intensiva. 2017;41(5):267-2699. Haitsma J. Physiology of Mechanical Ventilation. Crit Care Clin 23 (2007) 117–13410. Koh S. and Cols. Mode of Mechanical Ventilation: Volume Controlled Mode. Crit Care Clin 23 (2007) 161–16711. Nichols D. and Cols, Pressure Control Ventilation. Pressure Control Ventilation12. Seiberlich E. and Cols. Protective Mechanical Ventilation, Why Use It? Rev Bras Anestesiol 2011; 61: 5: 659-66713. Haas. Carls and Cols. Mechanical Ventilation with Lung Protective Strategies: What Works? Crit Care Clin 27 (2011) 469–48614. Daoud E. and Cols. Airway Pressure Release Ventilation: What Do We Know? respiratory care february 2012 Vol 57 No 215. Wright B. Lung-protective Ventilation Strategies and Adjunctive Treatments for the Emergency Medicine Patient with Acute Respiratory Failure. Emerg Med Clin N Am - (2014)16. Determann et al. RVeeseanrcthilation with lower tidal volumes as compared with conventional tidal volumes for patients without acute lung injury: a preventive randomized controlled trial. Critical Care 2010, 14:R117. De Feo P ando Cols. Lung protective ventilation strategy for the acute respiratory distress syndrome. Cochrane Database of Systematic Reviews 2013, Issue 2. Art. No.: CD00384418. Amato M. Driving Pressure and Survival in the Acute Respiratory Distress Syndrome. N Engl J Med 2015;372:747-55.19. Budinger S. Balancing the Risks and Benefi ts of Oxygen Therapy in Critically Ill Adults. chest / 143 / 4 / april 201320. Rachmale S. Practice of Excessive FIO2 and Effect on Pulmonary Outcomes in Mechanically Ventilated Patients With Acute Lung Injury. respiratory care november 2012 vol 57 No 1121. Ljland M. Bench-to-bedside review: Hypercapnic acidosis in lung injury - from ‘permissive’ to ‘therapeutic’. Ijland et al. Critical Care 2010, 14:23722. Fan E, Del Sorbo L, Goligher EC, et al. An Official 29. American Thoracic Society/European Society of Intensive Care Medicine/Society of Critical Care Medicine Clinical Practice Guideline: Mechanical Ventilation in Adult Patients with Acute Respiratory Distress Syndrome. Am J Respir Crit Care Med 2017;195:1253-6323. Hashimoto S, and Cols. The clinical practice guideline for the management of ARDS in Japan. Journal of Intensive Care (2017) 5:5024. Serpa Neto A, Cardoso SO, Manetta JA, Pereira VG, Esposito DC, Pasqualucci Mde O, et al. Association between use of lung-protective ventilation with lower tidal volumes and clinical outcomes among patients without acute respiratory distress syndrome: a meta-analysis. JAMA 2012;308(16):1651-165925. David A Turner, and Cols. (2013) Lung protective ventilation: a summary of the current evidence from the 2012 American Association for Respiratory Care International Congress, Expert Review of Respiratory Medicine, 7:3, 209-21226. Ochiai R. Mechanical ventilation of acute respiratory distress síndrome. Journal of Intensive Care (2015) 3:2527. Passos M. and Cols. effect of a protective-ventilation strategy on mortality in the acute respiratory distress syndrome. N Engl J Med 1998;338:347-5428. Lellouche F. Prophylactic protective ventilation: lower tidal volumes for all critically ill patients? Intensive Care Med (2013) 39:6–1529. Pham T. And Cols. Mechanical Ventilation: State of the Art. Mayo Clin Proc. September 2017;92(9):1382-140030. Sutherasan Y, Vargas M, Pelosi P. Protective mechanical ventilation in the non-injured lung: review and meta-analysis. Crit Care 2014; 18(2):21131. Petrucci N, De Feo C. Lung protective ventilation strategy for the acute respiratory distress syndrome. Cochrane Database Syst Rev 2013(2):CD00384432. Writing Group for the PI, Simonis FD, Serpa Neto A, Binnekade JM, Braber A, Bruin KCM, et al. Effect of a low vs intermediate tidal volume strategy on ventilator-free days in intensive care unit patients without ARDS: a randomized clinical trial. JAMA 2018;320(18):1872- 188033. Koide M, Uchiyama A, Yamashita T, Yoshida T, Fujino Y. Attaining low tidal volume ventilation during patient-triggered ventilation in sedated subjects. Respir Care 2019;64(8):890-89834. Bellani G, Laffey JG, Pham T, et al. Epidemiology Patterns of Care, and Mortality for Patients With Acute Respiratory Distress Syndrome in Intensive Care Units in 50 Countries. JAMA 2016;315:788-80035. Nadeem RN, Elhoufi AM, Soliman MA, Bon I, Obaida ZA, Hussien MM, Salama L, Elsousi AN, Kamat S, Satti RM, Elahi N, Abuhijleh RH, ElZeiny MG, Fargaly H, Ibrahim MM. Clinical Predictors of Adherence to Low Tidal Volume Ventilation Practice: Is it Different on Weekend and Night Shifts?. Cureus. 2019 Jun 6;11(6):e4844Kalb T, Raikhelkar J, Meyer S, Ntimba F, Thuli J, Gorman MJ, Kopec I, Scurlock C. A multicenter population based effectiveness study of teleintensive care unit directed ventilatorrounds demonstrating improved adherence to a protective lung strategy, decreased ventilatorduration, and decreased intensive care unit mortality. J Crit Care. 2014 Aug;29(4):691.e7-1437. Laffey JG, Madotto F, Bellani G, Pham T, Fan E, Brochard L, et al; LUNG SAFE Investigators; ESICM Trials Group. Geo-economic variations in epidemiology, patterns of care, and outcomes in patients with acute respiratory distress syndrome: insights from the LUNG SAFE prospective cohort study. Lancet Respir Med. 2017; 5(8):627–63838. Needham DM, Yang T, Dinglas VD, Mendez-Tellez PA, Shanholtz C, Sevransky JE, Brower RG, Pronovost PJ, Colantuoni E. Timing of Low Tidal Volume Ventilation and Intensive Care Unit Mortality in Acute Respiratory Distress Syndrome
A Prospective Cohort Study. Am J Respir Crit Care Med. 2015 Jan 15;191(2):177-85LICENSElicense.txtlicense.txttext/plain; charset=utf-83420http://repository.unimilitar.edu.co/bitstream/10654/35118/2/license.txta609d7e369577f685ce98c66b903b91bMD52ORIGINALmedinahumadapatricia2019_trabajo.pdfmedinahumadapatricia2019_trabajo.pdfapplication/pdf545708http://repository.unimilitar.edu.co/bitstream/10654/35118/1/medinahumadapatricia2019_trabajo.pdf98fb666fd34c45905ee5c9bcd85d517cMD51THUMBNAILmedinahumadapatricia2019_trabajo.pdf.jpgmedinahumadapatricia2019_trabajo.pdf.jpgIM Thumbnailimage/jpeg6160http://repository.unimilitar.edu.co/bitstream/10654/35118/3/medinahumadapatricia2019_trabajo.pdf.jpg24da107568adb660c15c2c5d7fac56ceMD5310654/35118oai:repository.unimilitar.edu.co:10654/351182020-09-19 01:04:32.057Repositorio Institucional 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