• By Soledad Andrade

Síndrome de insuficiencia respiratoria aguda: estudio identifica pacientes quirúrgicos con riesgo de presentar peligroso trastorno pulmonar

April 22, 2014

ROCHESTER, Minnesota — El síndrome de insuficiencia respiratoria aguda es la causa principal de insuficiencia respiratoria después de una cirugía. Los pacientes que desarrollan este trastorno pulmonar postoperatorio corren mayor riesgo de fallecer en el hospital, y quienes lo sobreviven pueden todavía presentar efectos físicos en años posteriores. Un estudio dirigido por Mayo Clinic ayuda a los médicos a identificar mejor a la mayoría de pacientes Hombre con una mascarilla para respiraren peligro, lo que constituye el primer paso hacia la prevención de esta peligrosa y cara complicación quirúrgica. Los científicos descubrieron nueve factores de riesgo independientes, entre ellos, sepsis, cirugía vascular aórtica de alto riesgo, cirugía cardiaca de alto riesgo, cirugía de emergencia, cirrosis hepática, y reingreso al hospital desde otro lugar diferente al domicilio, tal como un asilo médico o casa de reposo.

Los resultados se publican en la revista Anesthesiology (Anestesiología).

“Este síndrome es una de las razones frecuentes por las que se requiere apoyo respiratorio durante más tiempo después de una operación, y aproximadamente 20 a 25 por ciento de los pacientes que lo desarrollan mueren por su causa”, comenta el primer autor Dr. Daryl Kor, anestesiólogo de Mayo Clinic. “Ha quedado bien documentado que quienes desarrollan este síndrome permanecen más tiempo en cuidados intensivos y su internación en el hospital es igualmente mayor, además de que el síndrome puede continuar repercutiendo sobre la persona durante varios años”.

La prevención  del síndrome de insuficiencia respiratoria aguda se ha convertido en una prioridad para el Instituto Nacional del Corazón, Pulmón y Sangre, parte de los Institutos Nacionales de Salud, anotan los científicos.

Lo primero que los médicos deben hacer para prevenir la afección es identificar quiénes corren más riesgo, pero es difícil hacerlo con cada paciente, explican los científicos. El estudio analizó a 1562 pacientes quirúrgicos considerados con alto riesgo para desarrollar el síndrome y descubrió lo siguiente:

  • El síndrome de insuficiencia respiratoria aguda se desarrolló en 117 pacientes, equivalente al 7,5 por ciento.
  • Nueve factores independientes sirven para predecir el síndrome: sepsis; cirugía vascular aórtica de alto riesgo; cirugía cardiaca de alto riesgo; cirugía de emergencia; cirrosis; reingreso al hospital desde otro lugar diferente al domicilio, tal como un asilo médico o casa de reposo; mayor frecuencia respiratoria; y, dos medidas que indican hipoxemia o nivel de oxígeno en la sangre inferior a lo normal.
  • La identificación de esos nueve factores de riesgo en los pacientes quirúrgicos permitió a los científicos refinar los modelos anteriores para predicción del riesgo; el nuevo modelo puede servir para, antes de la cirugía, identificar a los pacientes con alto riesgo que podrían participar en estudios de prevención del síndrome de insuficiencia respiratoria aguda.

Los resultados podrían cambiar la forma en que se atiende en el quirófano a los pacientes con alto riesgo para el síndrome, acota el Dr. Kor.

“Por ejemplo, se puede ser un poco más conservador en la manera de transfundir productos sanguíneos, o realizar la ventilación pulmonar de forma un poco diferente a como se haría si la persona tuviese un puntaje más bajo”, dice el Dr. Kor. “Esperamos también que al identificar a los pacientes de alto riesgo, sea posible seleccionar mejor la población en estudios futuros para analizar métodos específicos de prevención. Anteriormente, dichos estudios no eran factibles de realizar porque no se podía identificar a los grupos de alto riesgo con ningún grado de exactitud.”

Las futuras investigaciones podrían incluir la función específica de la anestesia y determinar si es preciso modificar ciertos aspectos de los cuidados ofrecidos en el quirófano en los pacientes con alto riesgo de desarrollar el síndrome, añade el Dr. Kor.

Otros autores del estudio son médicos y científicos de Mayo Clinic en Rochester y Jacksonville, Florida, del Centro Médico Beth Israel Deaconess, de la Escuela de Medicina Albert Einstein, del Centro Médico Suroccidental de la Universidad de Texas, del Centro Médico de la Universidad de Duke, del Massachusetts General Hospital, de Ciencias de la Salud de la Universidad de Wake Forest, del Brigham and Women’s Hospital, de la Escuela de Medicina de la Universidad de Michigan y del St. Joseph Mercy Hospital. De igual manera, colaboró en el estudio el Grupo Estadounidense para Ensayos sobre Enfermedades y Lesiones Graves, financiado por los Institutos Nacionales de Salud.

El estudio se financió mediante un subsidio para desarrollo profesional de la Fundación para Educación e Investigación sobre Anestesia en Rochester, por los subsidios U01-HL108712-01, UL1 TR000135 y KL2 TR000136 de los Institutos Nacionales de Salud y por el Comité de Mayo Clinic para Investigación sobre Cuidados Intensivos.

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Información sobre Mayo Clinic
En el año 2014 se conmemoran 150 años de servicio a la humanidad de esta entidad sin fines de lucro y líder mundial en atención médica, investigación y educación. Si desea más información, visite: 150years.mayoclinic.org, MayoClinic.org/espanol o https://newsnetwork.mayoclinic.org/.

CONTACTO PARA LOS MEDIOS DE COMUNICACIÓN:
Soledad Andrade, Relaciones Públicas de Mayo Clinic, 507-284-5005, correo electrónico
: newsbureau@mayo.edu

Since the original discussion was removed from the homepage: http://newsletters.mayo.edu/newscenter/benefits_news/DOCMAN-0000101698

COMMENT

Still two questions left unanswered…..Why the short notice on when this will go into effect? I think that Mayo employees need an explanation for this as well as why not a major announcement instead of just posting it in the mayo news letter?

COMMENT

I am worried that employees who do not have enough PTO will come to work ill and more and more employees will become ill as they are exposed to it. In the long run I am concerned that we will be working with people who are contagious, and employees are going to end up with more "serious and complicated" illnesses who will end up hospitalized and who will be there to care for the patients who will also be exposed to unecessary illnesses?

COMMENT

I do not want to sign authorization for RCS having unlimited access to my medical record. Mayo's computer systems **do not limit** access to specific parts of medical records, date ranges, or any other criteria. Therefore, anyone with access to Mayo's electronic medical record system **has access to everything** in EVERYONE’S Mayo EMR. Also, by granting access to RCS, the employer essentially has carte blanche access to employees' complete medical records. RCS does not need direct access to employees' medical records to determine STD eligibility–This is apparently done to save physicians and employees some paperwork. I'd RATHER DO THE PAPERWORK! Non-Mayo insurance companies do not have unlimited access to all the patient's medical records! They receive service and diagnosis codes from healthcare providers and, when necessary, a letter and/or excerpt of specific medical documentation from the physician is provided. Saying that RCS will only view the records "pertinent to the case" is not enough protection of privacy for the employees in the patient role.

COMMENT

Still no explanation as to why RCS/OHS needs access to my entire medical record. If they want additional records regarding an injury/illness I would be happy to provide those particular records. I'm not sure why every employee asking for STD needs to sign away their privacy. At Mayo there is no such thing as partial access to medical records. They either have access to my entire medical file or nothing. If anyone has questions regarding Hipaa regs, I suggest you contact the regional hipaa rep: Region V – Chicago (Illinois, Indiana, Michigan, Minnesota, Ohio, Wisconsin) Valerie Morgan-Alston, Regional Manager Office for Civil Rights U.S. Department of Health and Human Services 233 N. Michigan Ave., Suite 240 Chicago, IL 60601 Voice Phone (312)886-2359 FAX (312)886-1807 TDD (312)353-5693

COMMENT

I think we should just be happy that we have Short Term in the first place. Many places do not offer short term as a benefit for their employees. They could take it away all together.

COMMENT

This is hilarious. This Q&A was supposed to answer questions that arose from comments on the STD article. However, its an almost word-for-word copy of the FAQ they posted in the original article. http://mayoweb.mayo.edu/humanresources/Documents/STD%20FAQ.pdf Way to go the extra mile guys.

COMMENT

For those of us that elected to sell PTO on open enrollment last November, I would like to see an extended period of time to use that at 100% pay. I wouldn't have sold 100 hrs if I would have known earlier.

COMMENT

Bottom line: 1-People will be coming to work sick. 2-Patients as well as co-workers will be exposed, and they will become sick. I agree that STD is a great benefit, most employers don't offer it. But we aren't most employers, we are Mayo Clinic. I was of the impression that we contribute to setting the standards when it comes to patient care. How is this new policy in the best interest of the patient? If your sick, your sick. I wouldn't encourage anyone who is sick to come to work. But employees are going to think twice about staying home when they are ill. This short notice of the new policy was simply unfair. Time should have been given for employees to build up their PTO should an illness occur.

COMMENT

The word "Recovery" in the name of RCS refers to the recovery of funds, not of the health of the patient!!Allowing RCH/OHS review medical records seems to violate the spirit of HIPAA. I have dealt with people in RCH and trust me, they are not qualified to make medical evaluations. Their mission statement is to limit/deny coverage and recover expences associated with workers compensation payments.

COMMENT

You complainers worry much to much. Get over it and get back to work.

COMMENT

The article doesn't say anywhere that you have to come to work sick. You can still be off from work, but you have to use PTO for all the days you are off and not use STD. I think for all of you that are worried about it, you could quit and go work somewhere else.

COMMENT

As a manager, I'm pleased to see the synch up between the policies and a loop hole closed that has allowed people to play the STD game in which 2 days of 314 are used. They then feel it is their due to take a "free" day of STD for illnesses such as earaches and headaches, which are not contagious nor are they generally serious medical conditions.

COMMENT

I'm with you, Robin. I am 100% in agreement with this policy change which is long overdue. The idea of having two time-off banks (STD and PTO)with employees choosing which they will use for minor illnesses and vacation is ridiculous, and the abuse of this system has gone on far too long.

COMMENT

I agree with Robin as well. There are employees who have taken advantage of the system. I've not been seriously sick with fever and ill for a week for 6 years so I understand how those that feel its unfair from those that don't abuse the system. But overall we work at one of the best places there are out there. We get benefits that many do not.

COMMENT
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