The UCRI, efficiency and quality of care, also against the coronavirus
In fact, this good health data, always maintaining the utmost respect for the deceased and their families, and assessing the strengths and mutations of the microorganism, which is so devastating, has been achieved during the sixth wave of the COVID-19 pandemic.
“As of February 11, 570 patients had been admitted to La Princesa, of which 143 were treated at the UCRI. Twenty-six died, ”says Dr. Enrique Zamora García, head of the Intermediate Respiratory Care Unit of the Pneumology Service.
If the almost 5,000 patients who were admitted to this level 3 hospital center during the entire pandemic period, from March 2020, were counted, the sum of resulting deaths, both in the ICU and IRCU and on the hospital ward, would reach 14.5% of cases treated to date.
“The first wave caught us off guard, since no one expected the huge number of infections that we suffered. This collapse of the health system forced us to organize and coordinate as quickly as possible, but, once the first major impact was overcome, we managed to anticipate the virus day after day », he highlights.
According to a study published in the Journal of Respiratory Pathology of the NeumoMadrid Foundation at the end of 2021, severe pneumonia caused by SARS-CoV-2 infection led to more than 15% of the cases registered in fourteen hospitals being admitted to critical care. Madrilenians (85% of the referenced population).
25% of these people with severe respiratory failure required invasive or non-invasive ventilatory support, with a recognized mortality rate between 8% and 36% depending on the series.
On the occasion of the SEPAR 2022 year dedicated to the UCRI, and in an interview granted to EFEsalud, the specialized website of the EFE Agency, Dr. Zamora García underlines the keys to achieving a high level of success for the ucri in the face of the merciless coronavirus and other pathologies with lung involvement, such as COPD: «Training, clinical experience and scientific evidence«.
The respiratory reasons of the UCRI
The Intermediate Respiratory Care Units offer medical assistance to patients with pulmonary insufficiency caused by any disease that decreases oxygen levels in the blood or increases carbon dioxide levels dangerously.
“We are talking about respiratory patients whose prognosis is not so serious as to require invasive mechanical ventilation (IMV), and remain in the ICU, but who do need much more attention, monitoring and surveillance than any other patient hospitalized on the ward,” says the pulmonologist .
“Therefore, they are patients who require high-concentration oxygen with non-invasive mechanical ventilation (NIMV) and monitoring of vital signs, such as blood pressure, blood oxygen saturation level or heart rate,” he adds.
In the IRCU, patients with acute respiratory failure caused by a primary disease, such as a viral or bacterial pneumoniaamyotrophic lateral sclerosis (neuromuscular), rib cage pathologies, hypoventilation-obesity syndrome, COPD or a tuberculosis.
“Also, we care for post-thoracic surgical patients, with tracheotomy or with difficulty in weaning from Invasive Mechanical Ventilation (IMV), always a relief for the overload of critical patients in the ICU”, reports Dr. Zamora.
Invasive and Non-Invasive Ventilation
“With IMV, the airway is entered through sedation and endotracheal intubation, that is, inserting a tube through the nose or mouth in most cases. This tube is connected to a mechanical ventilator (respirator) », he describes.
If the patient requires a tracheotomy to be able to breathe, a hole will be made in the front outer area of the neck through which a tube will be inserted to where the trachea branches into the lungs.
“With NIMV, air is delivered through a mask that can cover the patient’s nose and mouth. The tubing of the automatic respirator sends a positive pressure to the patient without the need to intubate him, that is, without the need to insert a tube through his airways.
Dr. Enrique Zamora Garcia
In covid times, in addition, the ucris have kept the back of the ucis.
Pulmonology was forced to offer NIMV as a therapy in cases of pneumonia with severe hypoxemia, where the ICUs were overwhelmed to offer invasive support.
“At the same time, there are patients who need to leave intensive care to receive treatment in intermediate care; a protocol based on clinical experience that has substantially improved its prognosis », she indicates.
There are more and more publications that support the usefulness and safety of non-invasive therapy as support for patients with severe pneumonia without ICU criteria or as a way to try to reduce the number of orotracheal intubations.
«In summary -he adds-, in the ICUs we provide all kinds of respiratory support and specialized hospital care, except for Invasive Mechanical Ventilation -intubation-. Nor do we take care of patients with involvement of any other organ that puts their lives in danger.
In this clinical sense, the ucris already existed, although not in all hospitals.
“Before the coronavirus pandemic, there were fewer ucris, but the ones that worked were not equipped with enough beds with their corresponding applied technologies,” he mentions.
“What the covid has come to highlight is the relevance of these units, which were perhaps not so well known to the vast majority of the population. The ucris free ICU beds and manage many patients with high quality and efficiency“, he emphasizes.
In the case of the Autonomous Community of Madrid, most hospital centers have expanded or implemented these resources during the pandemic, a clear opportunity that has improved and improves the respiratory situation of thousands of covid patients.
For the Spanish Society of Pulmonology and Thoracic Surgery (SEPAR), the Intermediate Respiratory Care Units enhance the role of pulmonology, nursing and respiratory physiotherapy.
“The National Health System must promote the training of professionals, scientific research and the publication of knowledge around the ucris”, SEPAR emphasized in a press release.
In turn, Dr. Enrique Zamora García demands, with the calm that characterizes him, a significant increase in personnel contracts for these “essential” respiratory units: more well-trained doctors, nurses and auxiliaries.
“It is the open secret that conditions health quality of any hospital unit, such as the UCRI of La Princesa”, concludes one of the most experienced specialists of the Pneumology Service that directs the Dr. Julio Ancochea Bermudezprofessor of Medicine at the UAM and president of Asomega.
0 Comments:
Publicar un comentario