Browsing by Author "Aguirre Bermeo, Hernán Marcelo"

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Características del delirium en los pacientes críticamente enfermos del Hospital Vicente Corral Moscoso, en el periodo octubre 2018 - enero 2019
(Universidad de Cuenca, 2021-02-17) Ochoa Durán, Christian Fernando; Pacheco Sanmartín, Martín Ismael; Aguirre Bermeo, Hernán Marcelo
Background: delirium in critically ill patients is an alteration of the state of consciousness characterized by disorganization of thought and perception and causes a longer hospital stay, cognitive dysfunction and higher mortality. Objective: to establish the characteristics of delirium in critically ill patients at the “Hospital Vicente Corral Moscoso”. Methodology: a descriptive cross-sectional study was carried out on 101 patients admitted in the period October 2018 - January 2019 from the trauma and intensive care center of the “Hospital Vicente Corral Moscoso”. The information was obtained through medical records and was collected using an individual form created by the authors, and it was analyzed in the IBM SPSS version 22 program. Results: from a sample of 186 patients, 101 were eligible. 26.7% presented delirium, highlighting the hyperactive subtype (63%). Both mechanical ventilation and hospitalization longer than 72 hours occurred in 63% of the patients who presented delirium. In these patients, the SAPS III score greater than 50 points was also in 55.6%, and the sedation administered in 59.3% of them. Mortality in the ICU and mortality at 90 days after discharge from the ICU were similar in 11.1% of delusional patients. Conclusions: delirium was present in 26.7% of patients. The male sex, use of mechanical ventilation, longer hospitalization time, and use of sedatives were the most frequent variables in these patients.
Características y evolución clínica de los pacientes con diagnóstico de COVID- 19 ingresados en la Unidad de Cuidados Intensivos del Hospital Vicente Corral Moscoso, marzo 2020 - octubre 2021, Cuenca, Ecuador
(Universidad de Cuenca, 2025-08-28) Cambizaca Loja, Belén Estefanía; Chiriapo Pulgarín, Luz Marianela; Aguirre Bermeo, Hernán Marcelo
Introduction: The pandemic provoked by the SARS-COV2 virus resulted in a great challenge to health-care systems around the world. Additionally, information about the clinical features and evolution of the resultant disease were lacking in different countries including our own. Objective: To establish the features and clinical outcome in COVID-19 patients admitted to the ICU at the “Hospital Vicente Corral Moscoso” during March 2020 to October 2021 in Cuenca, Ecuador. Methodology and Resources/Tools: Descriptive, Cross-Sectional, and Retrospective Research. Demographic variables, clinical outcomes, and patients’ evolution were registered during their admission to ICU from march 2020 to october 2021. Results: 61,4% of the patients were men. Symptoms started to appear within 8±4 days. The most frequent comorbidity was hypertension. The most common symptoms and signs were dyspnea and tachypnea. During their admission, all patients presented hypoxemia. Therefore, they required breathing support. The most common technique used for this purpose was oxygen therapy. Hospitalization overall time was 13 days. Mortality was 36,2% average.Conclusions: The results gathered about clinical features were similar to those described regionally and globally. The mortality rate in our study is underneath the rates described in similar research within our region, but slightly superior to developed countries. This fact illustrates the differences in the health-care system, response capacity, and socio-economic resources.
Características y mortalidad de los pacientes con trauma craneoencefálico grave del Hospital Vicente Corral Moscoso-Cuenca. Periodo Enero - Diciembre 2019
(Universidad de Cuenca, 2021-04-09) Tene Fernández, Richard David; Uchupaille Torres, Paola Yessenia; Aguirre Bermeo, Hernán Marcelo
Background: Traumatic brain injury (TBI), considered as any structural o functional damage to the skull or its’ content due to a sudden mechanical energy exchange, is an entity with an approximate worldwide incidence of 939 cases per 100,000 habitants, with a total of 69 millions cases per year. About 7.95% of affected people belong to severe classification, having a mortality of 50%. TBI has a considerable potential of mortality and physical, cognitive and psychosocial sequelae. These aspects can be influenced by demographic, clinic and therapeutic factors. Objective: To describe the characteristics and mortality of patients with severe traumatic brain injury at “Hospital Vicente Corral Moscoso-Cuenca”, JanuaryDecember 2019. Methodology: Retrospective observational study, based on the harvesting of demographic, clinical, laboratory and imaging features, additionally to outcome status at hospital discharge of all patients diagnosed with severe traumatic brain injury, admitted on the intensive care unit or trauma center at “Hospital Vicente Corral Moscoso”. All the obtained information was registered in the authors’ forms and afterwards a data base was created in SPSS v.25. Results are exposed in simple boards of frequency and percentage. Results: There were 35 patients with severe TBI, about 62% of them were young adults and the majority belonged to male gender. Low grades (3-5points) in Glasgow coma scale, anemia and Marshall Classification type IV were representative at hospital admission. Antiepileptic drugs were used in more than 50%. A 60% of patients had neurosurgical intervention. The overall mortality was 42,9%, with only 55% of alive patients with 14-15 points in Glasgow coma score at hospital discharge. Conclusions: Young male adults are the most affected. The most frequent characteristics on admission are scores less than 5 on the Glasgow coma scale and anemia. Marshall’s classification was the factor with the greatest variability from admission to 48h. Surgical therapeutics and the use of anticonvulsants are the most applied. Mortality from severe TBI in HVCM is high, exceeding the 40% of patients
Criterios QSOFA y nivel de lactato como predictores de necesidad de cuidados críticos en pacientes con sospecha de sepsis en el área de emergencia del Hospital Vicente Corral Moscoso, Cuenca-2020
(Universidad de Cuenca, 2022-02-09) Vanegas Bravo, Diego Mateo; Aguirre Bermeo, Hernán Marcelo
Background: Sepsis and septic shock are considered a medical emergency, which brings seriousdeleterious effects on the health of those who suffer from it. There are criteria to predict severity in an emergency room such as qSOFA and lactate levels; however, there are still controversies regarding its role as a predictor for admission to the Intensive Care Unit. Objective: to determine if the qSOFA criteria and lactate levels are good predictors of the need for Critical Care in patients with suspected Sepsis in the Emergency Department of the Vicente Corral Moscoso Hospital, Cuenca-2020. Methodology: validation of diagnostic tests, 175 participants were included, determining the capacity of the qSOFA score and lactate levels as predictors of the need for Critical Care in patients with suspected sepsis. Sensitivity, specificity, PPV, NPV and ROC curve were assessed.All bioethical procedures were applied. Results: A positive qSOFA (≥ 2) had a sensitivity of 72.8%, specificity of 34.0%, PPV of 48.8%,NPV of 59.3%. The lactate level, with a cut-off point of ≥ 2 mmol / L, obtained a sensitivity of 60.5%, specificity of 50.3%, PPV of 53.3%, NPV of 61.4%. The lactate level with a higher Youden Index (IY = 0.28) was ≥ 1.69 mg / dl with a sensitivity of 82.7%, specificity of 45.7%, PPV of 56.8%, NPV of 75.4% and AUC of 0.648. Conclusions: qSOFA and lactate levels in patients with suspected sepsis have limited value in predicting the probability of needing critical care.
Estudio observacional de la terapia nutricional en pacientes críticos de Unidad de Cuidados Intensivos (UCI) del Hospital Vicente Corral Moscoso de la ciudad de Cuenca, 2021
(Universidad de Cuenca, 2022-07-06) Castillo Romero, Laura Raquel; López Becerra, Andrea Ximena; Aguirre Bermeo, Hernán Marcelo
Background: The critical patient has been a challenge in the ICU due to the high rate of morbidity, mortality and complications. Nutritional therapy is important because its adequate administration has been associated with good clinical results. General objective: To observe the nutritional therapy administered to critical patients in the Intensive Care Unit of the Vicente Corral Moscoso Hospital, Cuenca, 2021. Methodology: A retrospective, observational-descriptive study was carried out using the Excel database created from the digital medical records of 13 patients from the HVCM ICU, collected using forms. The results were worked in Excel, through distribution of frequencies and percentages, measures of central tendency (mean) and dispersion (standard deviation); presented in tables and graphs. Results: Resting energy expenditure (REE) measured by indirect calorimetry (CI) (1728 ± 231 kcal/day) and estimated by the thumb formula (1718 ± 323 kcal/day) were apparently similar. Calories actually administered were 999 ± 305 kcal/day, representing 84% of the mean caloric goal (1118 ± 263 kcal/day) and 57.81% of the REE measured by CI. Conclusion: Nutritional therapy in critical patients of ICU from HVCM does not seem to vary if IC or thumb formula is used. Since the IC is considered the international gold standard in these patients, it should be used whenever it is available. However, more related studies are required in Ecuador.
Frecuencia de complicaciones durante fibrobroncoscopia con soporte con ventilación de alto flujo. Hospital Vicente Corral Moscoso, 2019
(Universidad de Cuenca, 2020-06-07) Maldonado Yépez, Bryam Remigio; Martínez Muñoz, Juan Andrés; Aguirre Bermeo, Hernán Marcelo
Background: Bronchoscopy is a procedure that allows to observe bronchial tracheo tree for diagnostic and therapeutic purposes. The bronchoscope added to the use of sedation can produce respiratory and hemodynamic complications. These complications can cause an interruption of the procedure. High-flow oxygen therapy decreases breathing work and dead space, better tolerance to high oxygen flow administration. Objective: Determine the frequency of complications during fiber bronchoscopy with high flow oxygen therapy support. Methodology: Observational and prospective study that investigates high flow oxygen therapy benefits during bronchoscopy and complications reduction. Variables measured: heart rate, respiratory rate, MAP, Sat O2, FiO2, PaO2, PaCO2, PaO2/FiO2 index, desaturation time, patient and operator comfort, success rate of bronchoscopy. Probabilistic analyzes were performed with SPSS biostatistical program 23th version. Results: Bronchoscopy was performed on 20 patients from intensive care unit, it was observed that 30% of patients desaturated in the procedure and saturation variations were 2.7% ± 1.94; 25% had blood pressure alterations and 20% had tachycardia. Average duration of bronchoscopy was 7:44 min ± 2:06 with very good patient tolerance and operator comfort. Conclusion: High flow fibrobroncoscopy has very good comfort for operator and patient due to low frequency of complications and saturation variation compared to studies without high flow.
Frecuencia de diagnóstico de tuberculosis en los pacientes atendidos en el HVCM durante el periodo pre pandemia, pandemia y post pandemia de COVID- 19. Enero 2018 - octubre 2023. Cuenca, Ecuador
(Universidad de Cuenca, 2025-08-29) Ortiz Verdugo, María Emilia; Ortega Sinchi, Mauro Sebastián; Aguirre Bermeo, Hernán Marcelo
Background: Tuberculosis (TB) corresponds to a highly prevalent infectious disease in Latin America, caused by the bacterium Mycobacterium tuberculosis. COVID-19 corresponds to an infection caused by the SARS-CoV-2 virus. Both pathologies share pulmonary affinity in their clinical presentation, airborne transmission, and risk factors for development such as overcrowding. Objectives: To describe the frequency of tuberculosis diagnosis in the pre pandemic, pandemic, and post pandemic periods in patients treated at the Hospital Vicente Corral Moscoso from January 2018 to October 2023. Methods: An anonymized database of patients diagnosed with tuberculosis during the periods January 2018 to October 2023 was analyzed. Chi-square was calculated to determine the association of variables, with a significance level of 0.05. Results: Two divisions of the periods were made according to the definition of pandemic by the WHO and the definition of pandemic by HVCM. According to the pandemic period defined by the Vicente Corral Moscoso Hospital, there is an increase in TB cases after the pandemic; this increase shows a statistically significant relationship with male sex compared to female (66.9% vs. 33.1%, respectively), p=0.03. These results were not evidenced in the division according to the WHO definition. Conclusions: in the local definition of pandemic by HVCM, the results are similar to those reported globally and regionally,showing a decrease in the diagnosis of tuberculosis cases during the pandemic and subsequently an increase in TB detection post-pandemic.
Frecuencia de tromboembolia pulmonar y aplicación de exámenes complementarios. Hospital Vicente Corral Moscoso. Cuenca, 2019
(Universidad de Cuenca, 2021-05-17) Chazi Inga, Oswaldo Felipe; Ortiz Freire, Edison Bolívar; Aguirre Bermeo, Hernán Marcelo
Background: pulmonary embolism (PE) is considered like a cardiovascular urgency, with high mortality in hospitalized patients. Patients who survive, develop disabilities from the chronic pulmonary hypertension that lead to dead. General objective: determinate the frequency of Pulmonary embolism and the application of complementary tests in the “Vicente Corral Moscoso Hospital” in the year 2019. Methodology: this is a cross-sectional descriptive observational study carried out in 2019 at the Vicente Corral Moscoso Hospital. All medical records of patients in whom Angiotomography (CT angiography) was request due to suspected PE were included. On the other hand, medical records whose requests were made for other pathologies were excluded. For data collection, we used a form, which included clinical probability scales, as well as the complementary tests. The information was analyzed and interpreted with the SPSS 15.0 version, using frequency distribution, central tendency measures (mean) and dispersion (standard deviation). Results: it was found that, from 75 patients who underwent CT Angiography for suspected PE, 12% had a positive diagnosis, with an age average of 61.88 years, the most being women. While 55.55% of patients with PE had a high probability according to the Wells scale. Ultimately, all patients showed a high D-dimer. Conclusions: most patients had a negative diagnosis after the CT Angiography realization, demonstrating that the PE prevalence is low in our environment.
Mortalidad y su relación con el estado nutricional en pacientes críticos en la Unidad de Cuidados Intensivos del Hospital Vicente Corral Moscoso de octubre 2021 a enero del 2022, Cuenca Ecuador
(Universidad de Cuenca, 2024-01-02) Hurtado Matute, Johanna Alexandra; Aguirre Bermeo, Hernán Marcelo
Background: Malnutrition in critically ill patients has gained importance; studies have shown that obesity and malnutrition are independent risk factors for mortality, leading to a longer stay in intensive care and time on mechanical ventilation. In our country there is no data on malnutrition in critically ill patients or any relationship with mortality. Objective: Determine mortality and its relationship with nutritional status in patients in the Intensive Care Unit of the Vicente Corral Moscoso Hospital from October 2021 to January 2022. Methodology: Analytical, prospective observational study, clinical records were reviewed collecting sociodemographic data, biochemical and anthropometric parameters, arm and calf circumference. Measures of central tendency and dispersion were calculated, Chi2 to measure association, relative risk, 95% confidence interval and p value (< 0.05) for statistical significance. Results: 81 patients, 46% aged between 20 and 44 years, 67% male, 85.2% with enteral nutrition,21% died. 43% of adults were overweight, 52% of older adults had a normal BMI, 46.9% had a moderate risk of malnutrition according to CONUT. Albumin values were lower at discharge, in deceased patients (2.39 mg/dl) and in living patients (2.83 mg/dl) (P= 0.019). Those malnourished according to calf circumference had higher mortality (P=0.030) with a RR 3.68 95% CI (1.08-12.5). Conclusions: There is a high percentage of overweight with a higher risk of death, there was no relationship between anthropometric or biochemical variables at admission, at discharge there was a relationship between mortality with albumin levels and malnutrition according to calf circumference.
Nueva técnica de colocación de catéter venoso central, guiada por electrocardiograma intracavitario, Unidad de Cuidados Intensivos del Hospital Vicente Corral Moscoso. Periodo febrero-octubre, Cuenca 2019.
(Universidad de Cuenca, 2020-04-28) Moscoso Romo, Freddy Andrés; Ochoa Villamagua, Eduardo Paúl; Aguirre Bermeo, Hernán Marcelo
Background: Central venous catheters (CVC) are procedures implemented in critical patients in the intensive care units (ICU). The proper position of these assures an optimum functioning, due to it is necessary to check the positioning through a standard chest x-ray. Nowadays, the setting of the CVC guided by electrocardiography is an alternative and safe technique that allows a reduction of the patient's exposure to radiation and reduces hospital expenses. Objective: To analyze the new setting technique of central venous catheter guided by intracavitary electrocardiogram in patients hospitalized in the intensive care unit of the Vicente Corral Moscoso Hospital, February-October period, Cuenca 2019. Methodolgy: A descriptive, observational, retrospective study was done in order to evaluate the efficacy and safety of a CVC setting guided by intracavitary electrocardiogram. The medical records of patients hospitalized in the intensive care unit that they accomplished the inclusion criteria were included. The information was collected using a form prepared by the authors, and subsequently, for the analysis a digital database of free statistical software compatible with Windows X was processed. Results: The analyzed universe was 25 patients, to whom were placed on CVC guided by intracavitary electrocardiogram, where we have determined a technical efficacy of 72%, on the other hand, a prevalence of total complications of 4%, as well as bacteremia related to catheterization with a rate of 5.52 x 1000 patient days. Conclusions: Based on the results, the efficacy of the new setting technique of the central venous catheter is close to international studies, and complications are also relatively infrequent.
Oxigenoterapia de alto flujo en pacientes críticos con insuficiencia respiratoria aguda, Hospital Vicente Corral Moscoso, 2019
(Universidad de Cuenca, 2021-02-24) Berrezueta Rodríguez, Diana Marisol; Regalado Cevallos, Erika Anabel; Aguirre Bermeo, Hernán Marcelo
Background: approximately 40% of critically ill patients are admitted for acute respiratory failure (ARF) and require high concentrations of oxygen to maintain stable vital functions. Currently, high-flow nasal cannula (HFNC) has shown to decrease the need for mechanical ventilation. General objective: to describe the use of HFNC in critically ill patients with ARF, admitted to the intensive care unit (ICU) and intermediate care units of the “Vicente Corral Moscoso” Hospital, in a period of six months, 2019. Methodology: a descriptive, cross-sectional study was carried out, which includes reports of 45 critically ill patients with ARF, admitted to the ICU and intermediate patients, who used HFNC for a time greater than 24 hours. The data was tabulated and analyzed in SPSS version 25, using frequency distribution, measures of central tendency (mean) and dispersion (standard deviation). Results: a male predominance was found with 55,6%, with a middle age of 49,04 years, chronic lung disease (COPD) as a pathological antecedent with 22,2%, the main cause of admission was ARF with 84,4%, 91,1% presented a degree of severe ARF, a 6,7% of the patients were intubated prior to the use HFNC and after the use of high flow, the 4,4% required mechanical ventilation. Conclusion: most of the patients presented a lower need for mechanical ventilation compared to the high percentage that presented severe ARF and with adequate tolerance levels to highflow oxygenation.
Prevalencia y caracterización clínico - epidemiológica y médico legal de los intentos autolíticos en el Hospital Vicente Corral Moscoso. Cuenca, 2018-2020
(Universidad de Cuenca, 2022-12-06) Pesántez Bravo, María Augusta; Aguirre Bermeo, Hernán Marcelo
Background: Suicide attempts are part of suicidal behavior and people who manifest it can end up consummating this act. In Ecuador, there are few studies on this rate, which is why it becomes a social and public health problem that must be prioritized in our country. General objective: to determine the prevalence and clinical-epidemiological and medico-legal characterization of suicide attempts at the Vicente Corral Moscoso Hospital. Basin, 2018-2020 Materials and methods: Quantitative, cross-sectional, retrospective and descriptive study. The medical records that correspond to suicide attempts at the Vicente Corral Moscoso Hospital, year 2018-2020, are included. The variables that were studied were: sociodemographic, clinical-epidemiological and medico-legal characteristics. The information was collected from the hospital statistics service to be later analyzed and expressed in frequency tables and percentages for qualitative and quantitative variables, means and standard deviation. Results: The prevalence of suicide attempts produced in 3 years at the Vicente Corral Moscoso Hospital was 0.69% more common in women and in the range of 20 to 39 years, the majority due to dru0067 intoxication with consumption of 1.1% of the cases. A comparison was made with the prevalence during the pandemic, showing an increase of 0.99%. Conclusions: The prevalence of attempted suicide in the sample studied is below the general average, with similar clinical characteristics in Latin America. However, it was shown that, in the COVID 19 pandemic, its prevalence increased, with a low frequency of consummation.