Fluid balance, biomarkers of renal function and mortality in critically ill patients with AKI diagnosed before, or within 24 h of intensive care unit admission: a prospective study.

BACKGROUND: To evaluate fluid balance, biomarkers of renal function and its relation to mortality in patients with acute kidney injury (AKI) diagnosed before, or within 24 h of intensive care unit admission. METHODS: A prospective cohort study considered 773 critically ill patients observed over six years. Pre-intensive care unit-onset AKI was defined as AKI diagnosed before, or within 24 h of intensive care unit admission. Body weight-adjusted fluid balance and fluid balance-adjusted biomarkers of renal function were measured daily for the first three days of intensive care unit admission. Primary outcome was mortality in the intensive care unit. RESULTS: Prevalence of pre-intensive care unit-onset AKI was 55.1%, of which 55.6% of cases were hospital-acquired and 44.4% were community-acquired. Fluid balance was higher in AKI patients than in non-AKI patients (p < 0.001) and had a negative correlation with urine output (p < 0.01). Positive fluid balance and biomarkers of renal function were independently related to mortality. Multivariate analysis identified the following AKI-related variables associated with increased mortality: (1) In AKI patients: type 1 cardiorenal syndrome (OR 2.00), intra-abdominal hypertension (OR 1.71), AKI stage 3 (OR 2.15) and increase in AKI stage (OR 4.99); 2) In patients with community-acquired AKI: type 1 cardiorenal syndrome (OR 5.16), AKI stage 2 (OR 2.72), AKI stage 3 (OR 4.95) and renal replacement therapy (OR 3.05); and 3) In patients with hospital-acquired AKI: intra-abdominal hypertension (OR 2.31) and increase in AKI stage (OR 4.51). CONCLUSIONS: In patients with pre-intensive care unit-onset AKI, positive fluid balance is associated with worse renal outcomes. Positive fluid balance and decline in biomarkers of renal function are related to increased mortality, thus in this subpopulation of critically ill patients, positive fluid balance is not recommended and renal function must be closely monitored.

Revisiting Pleiotropic Effects of Type I Interferons: Rationale for Its Prophylactic and Therapeutic Use Against SARS-CoV-2.

The pandemic distribution of SARS-CoV-2 together with its particular feature of inactivating the interferon-based endogenous response and accordingly, impairing the innate immunity, has become a challenge for the international scientific and medical community. Fortunately, recombinant interferons as therapeutic products have accumulated a long history of beneficial therapeutic results in the treatment of chronic and acute viral diseases and also in the therapy of some types of cancer. One of the first antiviral treatments during the onset of COVID-19 in China was based on the use of recombinant interferon alfa 2b, so many clinicians began to use it, not only as therapy but also as a prophylactic approach, mainly in medical personnel. At the same time, basic research on interferons provided new insights that have contributed to a much better understanding of how treatment with interferons, initially considered as antivirals, actually has a much broader pharmacological scope. In this review, we briefly describe interferons, how they are induced in the event of a viral infection, and how they elicit signaling after contact with their specific receptor on target cells. Additionally, some of the genes stimulated by type I interferons are described, as well as the way interferon-mediated signaling is torpedoed by coronaviruses and in particular by SARS-CoV-2. Angiotensin converting enzyme 2 (ACE2) gene is one of the interferon response genes. Although for many scientists this fact could result in an adverse effect of interferon treatment in COVID-19 patients, ACE2 expression contributes to the balance of the renin-angiotensin system, which is greatly affected by SARS-CoV-2 in its internalization into the cell. This manuscript also includes the relationship between type I interferons and neutrophils, NETosis, and interleukin 17. Finally, under the subtitle of "take-home messages", we discuss the rationale behind a timely treatment with interferons in the context of COVID-19 is emphasized.

Chronic comorbidities and clinical outcomes in patients with and without COVID-19: a large population-based study using national administrative healthcare open data of Mexico.

Coronavirus disease 2019 (COVID-19) was rapidly expanded worldwide within a short period. Its relationship with chronic comorbidities is still unclear. We aimed to determine the effects of chronic comorbidities on clinical outcomes of patients with and without COVID-19. This was an analysis of 65,535 patients with suspicion of viral respiratory disease (38,324 SARS-CoV-2 positive and 27,211 SARS-CoV-2 negative) from January 01 to May 12, 2020 using the national administrative healthcare open data of Mexico. SARS-CoV-2 infection was confirmed by reverse-transcriptase-polymerase-chain-reaction. General characteristics and chronic comorbidities were explored. Clinical outcomes of interest were hospital admission, pneumonia, intensive care unit admission, endotracheal intubation and mortality. Prevalence of chronic comorbidities was 49.4%. Multivariate logistic regression analysis showed that the effect of age, male sex, bronchial asthma, diabetes mellitus and chronic kidney disease on clinical outcomes was similar for both SARS-CoV-2 positive and negative patients. Adverse clinical outcomes were associated with the time from symptoms onset to medical contact, chronic obstructive pulmonary disease, hypertension and obesity in SARS-CoV-2 positive patients, but with cardiovascular disease in SARS-CoV-2 negative patients (p value < 0.01 for all comparisons). Chronic comorbidities are commonly found in patients with suspicion of viral respiratory disease. The knowledge of the impact of comorbidities on adverse clinical outcomes can better define those COVID-19 patients at higher risk. The different impact of the specific type of chronic comorbidity on clinical outcomes in patients with and without SARS-CoV-2 infection requires further researches. These findings need confirmation using other data sources.

Critically ill patients with cancer: A clinical perspective.

Cancer patients account for 15% of all admissions to intensive care unit (ICU) and 5% will experience a critical illness resulting in ICU admission. Mortality rates have decreased during the last decades because of new anticancer therapies and advanced organ support methods. Since early critical care and organ support is associated with improved survival, timely identification of the onset of clinical signs indicating critical illness is crucial to avoid delaying. This article focused on relevant and current information on epidemiology, diagnosis, and treatment of the main clinical disorders experienced by critically ill cancer patients.

Outcomes of ventilatory asynchrony in patients with inspiratory effort. / Resultados de la asincronía ventilatoria en pacientes con esfuerzo inspiratório.

OBJECTIVE: To identify the relationship of patient-ventilator asynchrony with the level of sedation and hemogasometric and clinical results. METHODS: This was a prospective study of 122 patients admitted to the intensive care unit who underwent > 24 hours of invasive mechanical ventilation with inspiratory effort. In the first 7 days of ventilation, patient-ventilator asynchrony was evaluated daily for 30 minutes. Severe patient-ventilator asynchrony was defined as an asynchrony index > 10%. RESULTS: A total of 339,652 respiratory cycles were evaluated in 504 observations. The mean asynchrony index was 37.8% (standard deviation 14.1 - 61.5%). The prevalence of severe patient-ventilator asynchrony was 46.6%. The most frequent patient-ventilator asynchronies were ineffective trigger (13.3%), autotrigger (15.3%), insufficient flow (13.5%), and delayed cycling (13.7%). Severe patient-ventilator asynchrony was related to the level of sedation (ineffective trigger: p = 0.020; insufficient flow: p = 0.016; premature cycling: p = 0.023) and the use of midazolam (p = 0.020). Severe patient-ventilator asynchrony was also associated with hemogasometric changes. The persistence of severe patient-ventilator asynchrony was an independent risk factor for failure of the spontaneous breathing test, ventilation time, ventilator-associated pneumonia, organ dysfunction, mortality in the intensive care unit, and length of stay in the intensive care unit. CONCLUSION: Patient-ventilator asynchrony is a frequent disorder in critically ill patients with inspiratory effort. The patient's interaction with the ventilator should be optimized to improve hemogasometric parameters and clinical results. Further studies are required to confirm these results.

Resultados de la asincronía ventilatoria en pacientes con esfuerzo inspiratório / Outcomes of ventilatory asynchrony in patients with inspiratory effort

RESUMO Objetivo: Identificar la relación de la asincronía paciente-ventilador con el nivel de sedación y evaluar la asociación con los resultados hemogasométricos y clínicos. Métodos: Estudio prospectivo de 122 pacientes admitidos en la unidad de cuidados intensivos con > 24 horas de ventilación mecánica invasiva y esfuerzo inspiratorio. En los primeros 7 días de ventilación, diariamente se evaluó la asincronía paciente-ventilador durante 30 minutos. La asincronía paciente-ventilador severa se definió con un índice de asincronía > 10%. Resultados: Se evaluaron 339.652 ciclos respiratorios en 504 observaciones. La media del índice de asincronía fue 37,8% (desviación estándar 14,1% - 61,5%). La prevalencia de asincronía paciente-ventilador severa fue 46,6%. Las asincronías paciente-ventilador más frecuentes fueron: trigger ineficaz (13,3%), auto-trigger (15,3%), flujo insuficiente (13,5%) y ciclado demorado (13,7%). La asincronía paciente-ventilador severa se relacionó con el nivel de sedación (trigger ineficaz: p = 0,020; flujo insuficiente: p = 0,016; ciclado precoz: p = 0,023) y el uso de midazolam (p = 0,020). La asincronía paciente-ventilador severa se asoció con las alteraciones hemogasométricas. La persistencia de la asincronía paciente-ventilador severa fue un factor de riesgo independiente para fracaso en la prueba de ventilación espontánea, tiempo de ventilación, neumonía asociada al ventilador, disfunción de órganos, mortalidad en la unidad de cuidados intensivos y estadía en la unidad de cuidados intensivos. Conclusión: La asincronía paciente-ventilador es un trastorno frecuente en los pacientes críticos con esfuerzo inspiratorio. La interacción del paciente con el ventilador debe optimizarse para mejorar los parámetros hemogasométricos y los resultados clínicos. Se requieren otros estudios que confirmen estos resultados.

Abstract Objective: To identify the relationship of patient-ventilator asynchrony with the level of sedation and hemogasometric and clinical results. Methods: This was a prospective study of 122 patients admitted to the intensive care unit who underwent > 24 hours of invasive mechanical ventilation with inspiratory effort. In the first 7 days of ventilation, patient-ventilator asynchrony was evaluated daily for 30 minutes. Severe patient-ventilator asynchrony was defined as an asynchrony index > 10%. Results: A total of 339,652 respiratory cycles were evaluated in 504 observations. The mean asynchrony index was 37.8% (standard deviation 14.1 - 61.5%). The prevalence of severe patient-ventilator asynchrony was 46.6%. The most frequent patient-ventilator asynchronies were ineffective trigger (13.3%), autotrigger (15.3%), insufficient flow (13.5%), and delayed cycling (13.7%). Severe patient-ventilator asynchrony was related to the level of sedation (ineffective trigger: p = 0.020; insufficient flow: p = 0.016; premature cycling: p = 0.023) and the use of midazolam (p = 0.020). Severe patient-ventilator asynchrony was also associated with hemogasometric changes. The persistence of severe patient-ventilator asynchrony was an independent risk factor for failure of the spontaneous breathing test, ventilation time, ventilator-associated pneumonia, organ dysfunction, mortality in the intensive care unit, and length of stay in the intensive care unit. Conclusion: Patient-ventilator asynchrony is a frequent disorder in critically ill patients with inspiratory effort. The patient's interaction with the ventilator should be optimized to improve hemogasometric parameters and clinical results. Further studies are required to confirm these results.

PROGRAM OF INTESTINAL REHABILITATION AND EARLY POSTOPERATIVE ENTERAL NUTRITION: A PROSPECTIVE COHORT STUDY.

BACKGROUND: Some factors can act on nutritional status of patients operated for a gastrointestinal cancer. A timely and appropriate nutritional intervention could have a positive effect on postoperative outcomes. AIM: To determine the effect of a program of intestinal rehabilitation and early postoperative enteral nutrition on complications and clinical outcomes of patients underwent gastrointestinal surgery for cancer. METHODS: This is a prospective study of 465 patients underwent gastrointestinal surgery for cancer consecutively admitted in an oncological intensive care unit. The program of intestinal rehabilitation and early postoperative enteral nutrition consisted in: 1) general rules, and 2) gastrointestinal rules. RESULTS: The mean age of analysed patients was 63.7±9.1 years. The most frequent operation sites were colon-rectum (44.9%), gynaecological with intestinal suture (15.7%) and oesophagus-gastric (11.0%). Emergency intervention was performed in 12.7% of patients. The program of intestinal rehabilitation and early postoperative enteral nutrition reduced major complication (19.2% vs. 10.2%; p=0.030), respiratory complications (p=0.040), delirium (p=0.032), infectious complications (p=0.047) and gastrointestinal complications (p<0.001), mainly anastomotic leakage (p=0.033). The oncological intensive care unit mortality (p=0.018), length of oncological intensive care unit (p<0.001) and hospital (p<0.001) stay were reduced as well. CONCLUSIONS: Implementing a program of intestinal rehabilitation and early postoperative enteral nutrition is associated with reduction in postoperative complications and improvement of clinical outcomes in patients undergoing gastrointestinal surgery for cancer.

Volume expansion and variation in hemodynamic parameters. / Expansión del volumen y variación en los parámetros hemodinámicos.

OBJECTIVES: To assess correlations among variations in hemodynamic parameters during fluid volume loading. MATERIAL AND METHODS: Prospective observational study in 2 intensive care units. Sixty patients requiring intravenous fluids underwent challenge tests with 300 mL of crystalloids over a 48-hour period. Percent change in hemodynamic parameters after infusion was measured. We used hierarchical cluster and principal component analyses to explore correlations among changes in hemodynamic responses. RESULTS: The parameters that underwent the greatest median (interquartile range) percent changes were central venous pressure (24% [0.0%-41.7%]), pulse pressure (12.9% [0.0%-22.4%]), shock index (5.8% [2.7%-13.7%]), rate-pressure product (5.8% [3.8%-18.8%]), and systemic pressure difference (5.8% [-3.8%-18.8%]). There were strong correlations between percent changes in the following parameters: systolic blood pressure, pulse pressure, rate-pressure product, shock index, and systemic pressure difference. Central venous pressure was not correlated with any of the other hemodynamic parameters. CONCLUSION: The relationships between changes in hemodynamic parameters after fluid loading are complex and must be taken into account if fluids are infused during resuscitation.

OBJETIVO: Determinar la relación entre los parámetros hemodinámicos durante la expansión del volumen. METODO: Estudio observacional y prospectivo en dos unidades de cuidados intensivos. En las primeras 48 horas se realizó una prueba de volumen con 300 ml de cristaloides en 60 pacientes con indicación de fluidos endovenosos. Se evaluaron los cambios en los parámetros hemodinámicos después de la infusión de volumen, y las relaciones entre las variaciones se exploraron con los análisis de clústeres jerárquicos y de componentes principales. RESULTADOS: Los mayores porcentajes de variación se observaron en la presión venosa central [mediana 24% (rango intercuartil (RIC) 0,0-41,7%)], presión del pulso [mediana 12,9% (RIC 0,0-22,4%)], índice de shock [mediana 5,8% (RIC 2,7-13,7%)], producto presión del pulso-frecuencia cardiaca [mediana 5,8% (RIC ­3,8-18,8%)] y diferencia de presiones sistémicas [mediana 5,8% (RIC ­3,8-18,8%)]. Hubo una fuerte correlación entre las variaciones de la presión arterial sistólica, presión del pulso, producto presión del pulso-frecuencia cardiaca, índice de shock y diferencia de presiones sistémicas. La presión venosa central no se correlacionó con ningún parámetro hemodinámico. CONCLUSIONES: Las relaciones entre las variaciones que se producen en los parámetros hemodinámicas después del aporte de volumen son complejas, lo que se debe tener en cuenta durante la reanimación con volumen.

Program of gastrointestinal rehabilitation and early postoperative enteral nutrition: a prospective study.

Nutritional depletion is commonly observed in patients undergoing surgical treatment for a gastrointestinal malignancy. An appropriate nutritional intervention could be associated with improved postoperative outcomes. The study was aimed to determine the effect of a program of gastrointestinal rehabilitation and early postoperative enteral nutrition upon complications and clinical outcomes in patients who experienced gastrointestinal surgery for cancer. This is a prospective study (2013 January-2015 December) of 465 consecutive patients submitted to gastrointestinal surgery for cancer and admitted to an Oncological Intensive Care Unit. The program of gastrointestinal rehabilitation and early postoperative enteral nutrition consisted on: (1) general rules: pain relive, early mobilization, antibiotic prophylaxis, deep vein thrombosis prophylaxis and respiratory physiotherapy; and (2) gastrointestinal rules: gastric protection, control of postoperative nausea and vomiting, early nasogastric tube remove and early enteral nutrition. The most frequent surgical sites were colorectal (44.9%), gynecological with intestinal suturing (15.7%) and esophagus/stomach (11.0%). Emergency surgery was performed in 12.7% of patients. The program of intestinal rehabilitation and early postoperative enteral nutrition reduced major complications (19.2 vs. 10.2%; p = 0.030), respiratory complications (p = 0.040), delirium (p = 0.032), infectious complications (p = 0.047) and gastrointestinal complications (p < 0.001). Intensive care unit mortality (p = 0.018), length of intensive care unit stay (p < 0.001) and length of hospitalization (p < 0.001) were reduced as well. A program of gastrointestinal rehabilitation and early postoperative enteral nutrition is associated with reduced postoperative complications and improved clinical outcomes in patients undergoing gastrointestinal surgery for cancer.

Valor pronóstico de la función renal a corto plazo en pacientes con infarto agudo de miocardio / Short-term prognostic value of renal function in patients with acute myocardial infarction

Resumen Introducción: El infarto agudo de miocardio es una de las primeras causas de muerte en Cuba y el mundo. En la actualidad cerca de un 20 a 30% de los pacientes con enfermedad coronaria, tienen insuficiencia renal. Objetivo: Determinar la asociación entre insuficiencia renal en el momento del ingreso y la mortalidad a corto plazo en los pacientes con infarto agudo de miocardio. Método: Se analizaron 284 pacientes consecutivos con diagnóstico de infarto agudo de miocardio ingresados en la Unidad de Cuidados Intensivos (UCI) del Hospital Universitario "Dr. Miguel Enríquez", entre el 1(. de enero 2015 y el 1(. de diciembre de 2016. Se determinó la creatinina, la tasa de filtrado glomerular estimado y las escalas de pronóstico cardiovascular en el momento del ingreso. Mediante regresión logística se evaluó la capacidad predictiva de muerte a corto plazo de la función renal. Resultados: 26 pacientes fallecieron en la UCI (9,2%). El valor de la creatinina sérica fue superior, en tanto que las tasas de filtrado glomerular fueron inferiores (p < 0,0001) en el grupo de pacientes que falleció respecto a los supervivientes. Todas las variables de función renal y las de pronóstico cardiovascular se asociaron con la mortalidad; al comparar ambas, se obtuvo una mejor discriminación con las primeras en relación a las segundas. Conclusiones: La valoración de la función renal mediante la determinación de la creatinina y la estimación del filtrado glomerular, proporciona información útil y muy valiosa para la evaluación inicial de los pacientes con infarto agudo de miocardio.

Abstract Introduction: Acute myocardial infarction is one of the primary causes of death in Cuba, and the world. Currently, around 20% to 30% of patients with coronary disease have renal failure. Objective: To determine the relationship between renal failure at the time of admission and the short-term mortality in patients with acute myocardial infarction. Material and methods: An analysis was made on a total of 284 consecutive patients with a diagnosis of acute myocardial infarction admitted into the Intensive Care Unit (ICU) of the "Dr. Miguel Enríquez" University Hospital between 1 January 2015 and 1 December 2016. The creatinine and the calculated glomerular filtration rate were determined, as well as the scores on the cardiovascular prognostic scales, at the time of admission. The predictive value of the renal function for short-term death was evaluated using logistic regression. Results: A total of 26 (9.2%) patients died in the ICU. The serum creatinine was higher and the glomerular filtration rates were lower (P < .001) in the patient group that died compared to the survivors. All the renal function variables and the cardiac prognostic scores were associated with mortality. A better discrimination was obtained with the renal function variables compared to the cardiovascular ones. Conclusions: The assessment of renal function using the serum creatinine level and the calculated glomerular filtration rate provide very useful and valuable information for the initial evaluation of patients with acute myocardial infarction.

Clinical characteristics and outcomes of cancer patients requiring intensive care unit admission: a prospective study.

PURPOSE: The study was aimed to describe the characteristics of cancer patients admitted to the oncological ICU and to identify clinical features associated with outcomes. METHODS: This is a prospective study (January 2014 to December 2015) of 522 cancer patients consecutively admitted to the oncological ICU. Patients with a length of oncological ICU stay ≤ 1 day were excluded. Demographic and clinical variables were obtained at oncological ICU admission. The primary outcome of interest was hospital mortality. Logistic regression analysis was performed to identify independent risk factors for hospital mortality. RESULTS: The study cohort consisted of 492 (94.3%) patients with solid tumours and 30 patients (5.7%) with haematological malignancies. Advanced cancer was observed in 53.3%. Unplanned admission accounted for 25.3%. Hospital mortality rate was 13.0% (n = 68), and it was higher for patients with unplanned admission than those for electively admitted patients (35.6% vs. 5.4; p < 0.0001). Stage IV of cancer (OR 5.28; 95% CI 2.71-10.28; p < 0.0001), patients from the emergency department (OR 3.33; 95% CI 1.68-6.61; p = 0.001), unplanned admission (OR 7.99; 95% CI 4.45-14.33; p < 0.0001), non-malignancy-related admission (OR 5.80; 95% CI 3.26-10.32; p < 0.0001), sepsis (OR 4.81; 95% CI 2.28-10.16; p < 0.0001), chemotherapy-induced adverse event (OR 5.64; 95% CI 2.33-13.66; p < 0.0001), and invasive mechanical ventilation (OR 18.70; 95% CI 9.93-35.21; p < 0.0001) were independently associated with increased hospital mortality in multivariate logistic regression analysis. CONCLUSIONS: ICU admission of cancer patients should be based on potential chance of recovering from the acute problem. Clinical predictor for mortality could support this purpose (UIN: researchregistry3484).

Program of intestinal rehabilitation and early postoperative enteral nutrition: a prospective cohort study / Programa de reabilitação intestinal e introdução de nutrição enteral pós-operatória precoce: estudo de cohort prospectivo

ABSTRACT Background: Some factors can act on nutritional status of patients operated for a gastrointestinal cancer. A timely and appropriate nutritional intervention could have a positive effect on postoperative outcomes. Aim: To determine the effect of a program of intestinal rehabilitation and early postoperative enteral nutrition on complications and clinical outcomes of patients underwent gastrointestinal surgery for cancer. Methods: This is a prospective study of 465 patients underwent gastrointestinal surgery for cancer consecutively admitted in an oncological intensive care unit. The program of intestinal rehabilitation and early postoperative enteral nutrition consisted in: 1) general rules, and 2) gastrointestinal rules. Results: The mean age of analysed patients was 63.7±9.1 years. The most frequent operation sites were colon-rectum (44.9%), gynaecological with intestinal suture (15.7%) and oesophagus-gastric (11.0%). Emergency intervention was performed in 12.7% of patients. The program of intestinal rehabilitation and early postoperative enteral nutrition reduced major complication (19.2% vs. 10.2%; p=0.030), respiratory complications (p=0.040), delirium (p=0.032), infectious complications (p=0.047) and gastrointestinal complications (p<0.001), mainly anastomotic leakage (p=0.033). The oncological intensive care unit mortality (p=0.018), length of oncological intensive care unit (p<0.001) and hospital (p<0.001) stay were reduced as well. Conclusions: Implementing a program of intestinal rehabilitation and early postoperative enteral nutrition is associated with reduction in postoperative complications and improvement of clinical outcomes in patients undergoing gastrointestinal surgery for cancer.

RESUMO Racional: Alguns fatores podem atuar sobre o estado nutricional de pacientes operados por câncer gastrointestinal. Intervenção nutricional oportuna e adequada poderia ter efeito positivo nos resultados pós-operatórios. Objetivo: Determinar o efeito de um programa de reabilitação intestinal e nutrição enteral pós-operatória precoce em complicações e resultados clínicos de pacientes submetidos à cirurgia gastrointestinal para câncer. Métodos: É estudo prospectivo de 465 pacientes submetidos à cirurgia gastrointestinal para câncer consecutivamente admitido em uma unidade de terapia intensiva oncológica. O programa de reabilitação intestinal e nutrição enteral pós-operatória precoce consistiu em: 1) regras gerais e 2) regras gastrointestinais. Resultados: A idade média dos pacientes analisados ​​foi de 63,7±9,1 anos. Os locais de operação mais frequentes foram colorretais (44,9%), ginecológicos com sutura intestinal (15,7%) e esofagogástrico (11,0%). Intervenção de emergência foi realizada em 12,7% dos pacientes. O programa de reabilitação intestinal e nutrição enteral pós-operatória precoce reduziu complicações maiores (19,2% vs. 10,2%; p=0,030), complicações respiratórias (p=0,040), delírio (p=0,032), complicações infecciosas (p=0,047) e gastrointestinais complicações (p<0,001), principalmente vazamento anastomótico (p=0,033). A mortalidade da unidade oncológica de terapia intensiva (p=0,018), duração da unidade oncológica de terapia intensiva (p<0,001) e hospital (p<0,001) permaneceu também reduzida. Conclusões: A implantação de um programa de reabilitação intestinal e nutrição enteral pós-operatória precoce está associada à redução das complicações pós-operatórias e à melhora dos resultados clínicos em pacientes submetidos a operações gastrointestinais para câncer.

El sobrepeso y la obesidad como factores de riesgo para la preeclampsia / Overweight and obesity as risk factors in preeclampsia

Introducción: la preeclampsia es un trastorno multisistémico que se caracteriza por una invasión anormal del trofoblasto y que tiene entre sus factores de riesgo la obesidad. Objetivo: determinar la relación entre la obesidad y la preeclampsia como desencadenantes de complicaciones maternas y perinatales. Métodos: se realizó un estudio descriptivo de corte transversal de casos y controles en el Hospital Docente Ginecobstétrico de Guanabacoa desde 2014 hasta 2015. El universo quedó constituido por las 101 pacientes con diagnóstico de preeclampsia que concluyeron el embarazo. El grupo control lo integraron 96 pacientes que no desarrollaron la enfermedad en una muestra tomada de forma aleatoria. Se utilizó la prueba de chi cuadrado con corrección de Yate o la prueba exacta de Fisher para hacer comparaciones entre grupos. Resultados: se estudiaron 197 pacientes, 101 con preeclampsia (51,3 por ciento) y 96 controles sin preeclampsia (48,7 por ciento). Del total de pacientes, 86,1 por ciento presentó preeclampsia con elementos de agravamiento. El índice de masa corporal fue significativamente mayor entre las pacientes con preeclampsia que en el grupo control (p= 0,002). Hubo proporción de obesidad entre las pacientes con preeclampsia (48,5 por ciento de ellas con ganancia exagerada de peso. La preeclampsia se relacionó significativamente con las complicaciones maternas o perinatales combinadas (64,8 por ciento vs. 46,2 por ciento; p= 0,029). Conclusión: el incremento del índice de masa corporal influye en el riesgo de preeclampsia y esta a su vez en los adversos resultados maternos y perinatales(AU)

Introduction: preeclampsia is a multisystem disorder that is characterized by an abnormal invasion of the trophoblast and obesity is among its risk factors. Objective: determine the relationship between overweight and hypertensive disease that develops during pregnancy. Methods: across-sectional descriptive study of cases and controls was performed at the G-O teaching Hospital in Guanabacoa from 2014 to 2015. The universe consisted of the 101 patients diagnosed with preeclampsia who completed their pregnancy. The control group was composed of 96 patients who did not develop the disease in a sample taken at random. The chi square test with Yate correction or the Fisher exact test was used to make comparisons between groups. Results: 197 patients were studied, 101 with preeclampsia (51.3 percent) and 96 controls without preeclampsia (48.7 percent). Out of the total number of patients, 86.1percent presented preeclampsia with aggravating factors. Body mass index was significantly higher among patients with preeclampsia than in the control group (p= 0.002). There was a proportion of obesity among patients with preeclampsia (48.5 percent of them with an exaggerated weight gain. Preeclampsia was significantly associated with combined maternal or perinatal complications (64.8 percent vs. 46.2 percent, p= 0.029). Conclusion: the increase in body mass index influences the risk of preeclampsia and this, in turn, in adverse maternal and perinatal outcomes(AU)

Caracterización de las pacientes con síndrome HELLP / Characterization of patients with HELLP syndrome

Introducción: el síndrome HELLP es una complicación de los trastornos hipertensivos del embarazo. Objetivo: identificar las características de las pacientes que padecen este trastorno. Métodos: se realizó un estudio descriptivo de corte transversal y retrospectivo en el Hospital Osio de Cua, Municipio Urdaneta, estado Miranda en la República Bolivariana de Venezuela desde la creación de la Unidad de Cuidados Intensivos (UCI), periodo comprendido desde Septiembre del 2010 hasta Junio del 2012. La muestra la integraron 35 pacientes que ingresaron en la unidad con diagnóstico de Síndrome HELLP o que durante su estadía fueron diagnosticadas con esta patología. La fuente primaria de obtención de datos fue la historia clínica y registro de la Unidad de Cuidados Intensivos. Resultados: encontramos como factores predominantes la edad materna entre 20 y 29 años (57,14 por ciento); la edad gestacional al momento de la interrupción del embarazo entre 28 y 34 semanas (42,87 por ciento). Los motivos del ingreso que más se hallaron fueron la epigastralgia y cifras tensionales elevadas. Por el conteo de plaquetas (48, 58 por ciento) el HELLP tipo II fue el más frecuente, en 80 por ciento de las pacientes, las cifras de hemoglobina fueron inferiores a 100g/l y 88,58 por ciento tuvo los niveles de transaminasas elevadas, también 82,85 por ciento de los valores del perfil renal se comportó por encima de lo normal. Durante el embarazo la enfermedad se presentó en 75 por ciento de las mujeres. Conclusión: el Síndrome HELLP es un proceso patológico que puede presentarse en el embarazo o en el puerperio(AU)

Introduction: HELLP syndrome is a complication of hypertensive disorders in pregnancy. Objective: To identify the characteristics of patients who suffer it. Methods: A retrospective, cross-sectional and descriptive study was carried out in Hospital Osio de Cua, Urdaneta municipality, state of Miranda in the Bolivarian Republic of Venezuela since the creation of the intensive care unit in the period of September 2010 through June 2012. The sample was made up of 35 patients who were admitted to the unit with diagnosis of HELLP syndrome or were so diagnosed during their stay at hospital. The primary data source was the medical history and the intensive care unit records. Results: The predominant factors were found to be maternal age of 20 to 29 years (57.14 percent) and gestational age of 28 to 34 weeks (42.87percent) at the time of pregnancy cessation. The most frequent causes of admission were epigastralgia and high blood pressure figures. According to the platelet count (48.58 percent), the most common type was HELLP II; 80 percent of patients showed hemoglobin values lower than 100g/l and 88.58 percent had high transaminase levels whereas 82.85 percent of the renal profile values were over the normal figures. During pregnancy, the disease affected 75 percent of studied females. Conclusions: HELLP syndrome is a pathological process that may occur in pregnancy or in puerperium(AU)

Postoperative complications and clinical outcomes among patients undergoing thoracic and gastrointestinal cancer surgery: A prospective cohort study.

OBJECTIVE: This study sought to determine the influence of postoperative complications on the clinical outcomes of patients who underwent thoracic and gastrointestinal cancer surgery. METHODS: A prospective cohort study was conducted regarding 179 consecutive patients who received thorax or digestive tract surgery due to cancer and were admitted to an oncological intensive care unit. The Postoperative Morbidity Survey was used to evaluate the incidence of postoperative complications. The influence of postoperative complications on both mortality and length of hospital stay were also assessed. RESULTS: Postoperative complications were found for 54 patients (30.2%); the most common complications were respiratory problems (14.5%), pain (12.9%), cardiovascular problems (11.7%), infectious disease (11.2%), and surgical wounds (10.1%). A multivariate logistic regression found that respiratory complications (OR = 18.68; 95%CI = 5.59 - 62.39; p < 0.0001), cardiovascular problems (OR = 5.06, 95%CI = 1.49 - 17.13; p = 0.009), gastrointestinal problems (OR = 26.09; 95%CI = 6.80 - 100.16; p < 0.0001), infectious diseases (OR = 20.55; 95%CI = 5.99 - 70.56; p < 0.0001) and renal complications (OR = 18.27; 95%CI = 3.88 - 83.35; p < 0.0001) were independently associated with hospital mortality. The occurrence of at least one complication increased the likelihood of remaining hospitalized (log-rank test, p = 0.002). CONCLUSIONS: Postoperative complications are frequent disorders that are associated with poor clinical outcomes; thus, structural and procedural changes should be implemented to reduce postoperative morbidity and mortality.

Complicaciones posoperatorias en cirugía mayor torácica y abdominal: definiciones, epidemiología y gravedad / Postoperative complications in thoracic and abdominal surgery: definitions, epidemiology and severity

Las complicaciones posoperatorias en pacientes sometidos a cirugía mayor torácica o abdominal son eventos frecuentes, asociados a una mala evolución. El objetivo de este trabajo es precisar las definiciones, características epidemiológicas y clasificaciones de severidad de las complicaciones posoperatorias en la cirugía mayor torácica y abdominal. Se realizó una revisión bibliográfica sobre las complicaciones posoperatorias en la cirugía mayor torácica y abdominal. Se presentan las definiciones atendiendo a las complicaciones posoperatorias. Se discuten los reportes referentes a la incidencia y mortalidad de las complicaciones más importantes. Por último, se abordan las principales herramientas de clasificación de severidad de las complicaciones posoperatorias. Las complicaciones posoperatorias son eventos frecuentes que incrementan las complicaciones y mortalidad. Deben aplicarse instrumentos de estratificación de riesgo, monitorizar estrechamente su aparición y gravedad, así como actuar rápida y oportunamente para su solución((AU)

Postoperative complications in patients undergoing thoracic or abdominal major surgery are frequent events associated with a poor evolution. The aim of this paper is to clarify the definitions, epidemiological characteristics and classifications postoperative complications severity in most thoracic and abdominal surgery. A literature review on postoperative complications in most thoracic and abdominal surgery was carried out. Definitions are stated regarding postoperative complications. Reports are discussed concerning the incidence and mortality of the most important complications. Finally, the main tools for postoperative complications severity classification are discussed. Postoperative complications are frequent events that increase complications and mortality. Risk stratification tools should be applied, their appearance and severity should be closely monitored, as well as to act quickly and timely for a solution(AU)

Complicaciones postoperatorias y resultados clínicos en pacientes operados por cáncer torácico y gastrointestinal: Estudio de cohorte prospectivo / Postoperative complications and clinical outcomes among patients undergoing thoracic and gastrointestinal cancer surgery: A prospective cohort study

RESUMEN Objetivo: Determinar la influencia de las complicaciones postoperatorias sobre los resultados clínicos en pacientes operados por cáncer torácico y gastrointestinal. Métodos: Se realizó un estudio de cohorte prospectivo de 179 pacientes consecutivos que fueron operados de tórax o vías digestivas por cáncer y admitidos en una unidad de cuidados intensivos oncológicos. Se evaluó la incidencia de las complicaciones postoperatorias mediante el Postoperative Morbidity Survey y su influencia sobre la mortalidad y estadía hospitalaria. Resultados: Se presentaron complicaciones postoperatorias en 54 sujetos (30,2%); las más frecuentes fueron las pulmonares (14,5%), el dolor (12,9%), las cardiovasculares (11,7%), las infecciosas (11,2%) y las de la herida quirúrgica (10,1%). En el análisis multivariado de regresión logística las complicaciones pulmonares (OR 18,68; IC95% 5,59 - 62,39; p < 0,0001), cardiovasculares (OR 5,06; IC95% 1,49 - 17,13; p = 0,009), gastrointestinales (OR 26,09; IC95% 6,80 - 100,16; p < 0,0001), infecciosas (OR 20,55; IC95% 5,99 - 70,56; p < 0,0001) y renales (OR 18,27; IC95% 3,88 - 83,35; p < 0,0001) se relacionaron de forma independiente con la mortalidad hospitalaria. La ocurrencia de al menos una complicación incrementó la probabilidad de permanecer hospitalizado (Log Rank test; p = 0,002). Conclusiones: Las complicaciones postoperatorias son trastornos frecuentes y asociados con malos resultados clínicos, por lo que se deben realizar cambios estructurales y de proceso para reducir la morbilidad y mortalidad postoperatorias.

ABSTRACT Objective: This study sought to determine the influence of postoperative complications on the clinical outcomes of patients who underwent thoracic and gastrointestinal cancer surgery. Methods: A prospective cohort study was conducted regarding 179 consecutive patients who received thorax or digestive tract surgery due to cancer and were admitted to an oncological intensive care unit. The Postoperative Morbidity Survey was used to evaluate the incidence of postoperative complications. The influence of postoperative complications on both mortality and length of hospital stay were also assessed. Results: Postoperative complications were found for 54 patients (30.2%); the most common complications were respiratory problems (14.5%), pain (12.9%), cardiovascular problems (11.7%), infectious disease (11.2%), and surgical wounds (10.1%). A multivariate logistic regression found that respiratory complications (OR = 18.68; 95%CI = 5.59 - 62.39; p < 0.0001), cardiovascular problems (OR = 5.06, 95%CI = 1.49 - 17.13; p = 0.009), gastrointestinal problems (OR = 26.09; 95%CI = 6.80 - 100.16; p < 0.0001), infectious diseases (OR = 20.55; 95%CI = 5.99 - 70.56; p < 0.0001) and renal complications (OR = 18.27; 95%CI = 3.88 - 83.35; p < 0.0001) were independently associated with hospital mortality. The occurrence of at least one complication increased the likelihood of remaining hospitalized (log-rank test, p = 0.002). Conclusions: Postoperative complications are frequent disorders that are associated with poor clinical outcomes; thus, structural and procedural changes should be implemented to reduce postoperative morbidity and mortality.

Repercusión de las complicaciones mayores posoperatorias en pacientes operados de tórax / Repercussion of major postoperative complications in patients undergoing thoracic surgery

Introducción: las complicaciones en la cirugía de tórax (pulmón, mediastino, esófago) se han asociado con un incremento en la morbilidad y la mortalidad. No se conoce cuál es la influencia de estas en la evolución de estos pacientes. Objetivo: determinar la influencia de las complicaciones mayores posoperatorias en la evolución a corto plazo de los pacientes sometidos a cirugía tóraco-mediastinal-esofágica. Métodos: se realizó un estudio de cohorte retrospectivo. De las bases de datos de la Unidad de Cuidados Intensivos y hospitalaria, entre marzo y octubre del 2013, se estudiaron a los enfermos sometidos a cirugía tóraco-mediastinal-esofágica, se identificó la ocurrencia de complicaciones mayores posoperatorias durante la estadía hospitalaria. Se precisó el tipo de complicación y su influencia en la evolución de los enfermos. Resultados: de 50 pacientes analizados, con una mediana de edad de 58,50 años (RIQ 48-65 años), a 30 (60 por ciento) se les realizó resección pulmonar, a 11 (22 por ciento) cirugía torácica sin resección pulmonar (mediastino y otras) y la cirugía esofágica se le practicó a 9 sujetos (18 por ciento). En 10 pacientes (20 por ciento) se presentó alguna complicación mayor posoperatoria, con 13 complicaciones en total, 7 de carácter médico (53,85 por ciento) y 6 quirúrgicas (46,15 por ciento). Las complicaciones más frecuentes fueron la hemorragia posoperatoria (40 por ciento), la neumonía nosocomial (20 por ciento) y las arritmias cardiacas (20 por ciento). Murieron 4 pacientes, fundamentalmente por complicaciones médicas. Las complicaciones mayores posoperatorias disminuyeron las probabilidades de alta hospitalaria (HR de 0,376 [95 por ciento IC: 0,173-0,815]; p= 0,013). Conclusiones: la frecuencia de las complicaciones mayores posoperatorias en la cirugía tóraco-mediastinal-esofágica fue relativamente alta en esta serie. La mortalidad fue más frecuente en los pacientes con complicaciones médicas. Las complicaciones mayores incrementaron significativamente la estadía en cuidados críticos y hospitalarios(AU)