RT info:eu-repo/semantics/doctoralThesis
T1 Estudio del coste efectividad del alto flujo frente a la ventilación no invasiva en pacientes con bronquiolitis
A1 Gutiérrez Moreno, Miriam
A2 Universidad de Valladolid. Escuela de Doctorado
K1 Pediatría
K1 Bronquios Enfermedades
K1 Oxygen therapy
K1 Oxigenoterapia
K1 Cost - effectiveness
K1 Coste - efectividad
K1 3201.10 Pediatría
AB Respiratory disease is the most frequent cause of hospital admission in children under 12 months old in developed countries, highlighting among them bronchiolitis. Between 2% and 5% of patients require hospital admission and, between them, 3 to 11% need assistance in a pediatric intensive care unit (PICU), due to associated complications or respiratory failure. Bronchiolitis is a disease that, even though has low mortality, requires many resources. However, there are still questions regarding the most appropriate management.Currently, medical treatment is based on general and respiratory support, since no pharmacological treatment has yet shown to be effective with a high degree of evidence. In the event that general treatments are not sufficient or the patient suffers clinical worsening, it might be necessary to start respiratory support that could include conventional oxygen therapy in low-flow nasal cannula (LFOT), high flow nasal cannula (HFNC) oxygen therapy, non-invasive ventilation (NIV); continuous or bi-level positive airway pressure) or even support with invasive mechanical ventilation (MV).	HFNC provides a flow of oxygen, alone or mixed with air, greater than the patient's demand for air (flows of 1-8 L/min in infants or from 5 to 40 L/min in the adult population) with specifically designed devices such as Fisher & Paykel®, Vapotherm® or Wilamed®, with a mixture of air and humidified oxygen (almost 100%) and heated (between 34-37ºC) through special nasal cannulas of different sizes, depending on the flows used. There is still insufficient evidence that has established its efficacy and efficiency, nor its specific indications, in acute bronchiolitis. However, their use is becoming widespread, both in emergency departments and in hospital wards.     The aim of our study was to describe the differences in the number of transfers to a PaediatrisIntensive Care Unit (PICU), days of oxygen therapy, number of readmissions and pharmacological treatments used in patients with acute bronchiolitis admitted to a second level hospital in two periods, differentiated according to the number of days of oxygen therapy, number of readmissions and pharmacological treatments used in patients with acute bronchiolitis admitted to a second level hospital in two periods, differentiated according to the number of days of oxygen therapy, number of readmissions and pharmacological treatments used periods, differentiated according to the availability or non-availability of HFNC.    This doctoral thesis is completed by carrying out a three-way study for a more complete assessment ofHFNC. To this end, a systematic review and calculation of network meta-analysis of the different studies published is carried out. A historical cohort of a second level hospital is used to review how HFNC is carried out, as well as the assessment of the risk of admission to intensive care, the greater need for MV compared to OC and NIV. In addition, a detailed cost-effectiveness analysis is carried out comparing HFNC support and other therapies.
YR 2021
FD 2021
LK https://uvadoc.uva.es/handle/10324/59945
UL https://uvadoc.uva.es/handle/10324/59945
LA spa
NO Escuela de Doctorado
DS UVaDOC
RD 07-ago-2024