RESUMEN
BACKGROUND: Evaluation of changes in quality of life (QOL) in ICU patients several years after traumatic brain injury (TBI) is not well documented. METHODS: A prospective cohort study was conducted in all patients with TBI admitted between 2004 and 2008 to the ICU of Regional Hospital of Malaga (Spain). Functional status was evaluated by Glasgow Outcome Scale (GOS) and QOL by PAECC (Project for the Epidemiologic Analysis of Critical Care patients) questionnaire between 0 (normal QOL) to 29 points (worst QOL). RESULTS: A total of 531 patients. Median(Quartile1,Quartile 3) age: 35 (22, 56) years. After 3-4 years, 175 died (33%). Survivor QOL was deteriorated (median total PAECC score: 5 (0, 11) points) although 75.76% of patients who survived showed good functional situation (GOS normal or mild dysfunction). An improvement in QOL scores between 1 and 3-4 years was observed (median PAECC score differences between 3-4 years and 1 year: - 1(- 4, 0) points). QOL score improved during this interval of time: 62.6% of patients. Change in QOL was related by multivariate analysis to admission cranial-computed tomography scan (Marshall's classification), age, and Injury Severity Score (ISS), with the biggest improvement seen in younger patients and with more severe ISS. Basic physiological activities were maintained in the majority of patients. Subjective aspects and working activities improved between 1 and 3-4 years but with a high proportion still impaired in these items after 3-4 years. CONCLUSIONS: ICU patients with TBI after 1 year show improvement in QOL between 1 and 3-4 years, with the biggest improvement in QOL seen in younger patients and in those with more severe ISS.
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Lesiones Traumáticas del Encéfalo/terapia , Calidad de Vida , Adulto , Lesiones Traumáticas del Encéfalo/patología , Lesiones Traumáticas del Encéfalo/rehabilitación , Cuidados Críticos , Femenino , Escala de Consecuencias de Glasgow , Humanos , Masculino , Persona de Mediana Edad , Resultado del TratamientoRESUMEN
PURPOSE: This paper studies the relationship between computed tomography (CT) scan on admission, according to Marshall's tomographic classification, and quality-of-life (QoL) after 1 year in patients admitted to the Intensive Care Unit (ICU) with traumatic brain injury (TBI). METHODS: This study used validated scales including the Glasgow Outcome Scale and the PAECC (Project for the Epidemiologic Analysis of Critical Care Patients) QoL questionnaire. RESULTS: We enrolled 531 patients. After 1 year, 171 patients (32.2%) had died (missing data = 6.6%). Good recovery was seen in 22.7% of the patients, while 20% presented moderate disability. The PAECC score after 1 year was 9.43 ± 8.72 points (high deterioration). Patients with diffuse injury I had a mean of 5.08 points vs 7.82 in those with diffuse injury II, 11.76 in those with diffuse injury III and 19.29 in those with diffuse injury IV (p < 0.001). Multivariate analysis found that QoL after 1 year was associated with CT Marshall classification, depth of coma, age, length of stay, spinal injury and tracheostomy. CONCLUSIONS: Patients with TBI had a high mortality rate 1 year after admission, deterioration in QoL and significant impairment of functional status, although more than 40% were normal or self-sufficient. QoL after 1 year was strongly related to cranial CT findings on admission.
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Lesiones Traumáticas del Encéfalo/diagnóstico por imagen , Lesiones Traumáticas del Encéfalo/psicología , Calidad de Vida/psicología , Tomografía Computarizada por Rayos X , Adulto , Lesiones Traumáticas del Encéfalo/mortalidad , Estudios de Cohortes , Femenino , Escala de Consecuencias de Glasgow , Mortalidad Hospitalaria , Humanos , Modelos Logísticos , Masculino , Persona de Mediana Edad , Encuestas y Cuestionarios , Resultado del Tratamiento , Adulto JovenRESUMEN
The progressive introduction of non-invasive mechanical ventilation (NIMV) in the management of respiratory failure has increased the number of clinical indications and has reduced common complication of conventional mechanical ventilation. Results of the technique are variable depending on the disease that causes the respiratory failure. With the purpose of reviewing studies about the use of NIMV and to report levels of evidence, different scientific societies have elaborated consensus conferences to establish the utility of NIMV in different indications.
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Respiración Artificial , Humanos , Guías de Práctica Clínica como AsuntoRESUMEN
BACKGROUND: Mortality among the small percentage of cardiac surgery patients receiving prolonged mechanical ventilation is high, but this issue appears to be inadequately addressed in guidelines. METHODS: This study is a retrospective analysis of prospective, multi-center, and observational study in Spain including all adults undergoing cardiac surgery in 3 Andalusian hospitals between June 2008 and December 2012. RESULTS: The study included 3,588 adults with mean ± SD age of 63.5 ± 12.8 y and with median (interquartile range) EuroSCORE of 5 (3-7) points. Prolonged mechanical ventilation (> 24 h) was required by 415 subjects (11.6%), with ICU mortality of 44.3% (184 subjects), and was not required by 3,173 subjects (88.4%), with ICU mortality of 3.1% (99 subjects, P < .001). Prolonged mechanical ventilation was associated with more complications and was required by 4.5% of subjects with a EuroSCORE <5, 11.2% with a score of 5-7, 27.2% with a score of 8-10, and 32.2% with a score > 10. In the multivariable analysis, ICU mortality was associated with illness severity, duration of bypass surgery, surgery type, and prolonged mechanical ventilation (odds ratio 15.19, 95% CI 11.56-22.09). The main cause of death was multiple organ failure and sepsis in subjects who required prolonged mechanical ventilation (50.3%) and cardiogenic shock in those who did not (59.2%). CONCLUSION: Prolonged postoperative mechanical ventilation was required by 10-20% of cardiac surgery subjects, who constitute a specific group that represents most of the postoperative mortality, which is associated with multiple organ failure and sepsis.
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Procedimientos Quirúrgicos Cardíacos , Insuficiencia Multiorgánica , Complicaciones Posoperatorias/mortalidad , Respiración Artificial , Sepsis , Anciano , Procedimientos Quirúrgicos Cardíacos/métodos , Procedimientos Quirúrgicos Cardíacos/mortalidad , Causas de Muerte , Femenino , Humanos , Unidades de Cuidados Intensivos/estadística & datos numéricos , Masculino , Persona de Mediana Edad , Insuficiencia Multiorgánica/etiología , Insuficiencia Multiorgánica/mortalidad , Tempo Operativo , Estudios Prospectivos , Respiración Artificial/efectos adversos , Respiración Artificial/métodos , Factores de Riesgo , Sepsis/etiología , Sepsis/mortalidad , España/epidemiología , Factores de TiempoRESUMEN
INTRODUCTION AND OBJECTIVES: It is known that the outcome of percutaneous coronary intervention is worse in diabetics than in non-diabetics. The aim of our study was to determine whether abciximab therapy could improve clinical outcome in an unselected diabetic population that underwent percutaneous coronary interventions. MATERIAL AND METHODS: We analyzed retrospectively 198 diabetic patients who underwent PTCA from January 1997 to January 2000. Seventy-three patients (36.7%) were treated with abciximab and the remaining 125 patients (63.3%) did not receive abciximab. The mean follow-up was 12.6 months. The events considered were death, non-fatal myocardial infarction, any revascularization procedure (including the target vessel), and hospital admission for unstable angina. RESULTS: Patients who received abciximab had more frequent previous myocardial infarction (67.1 vs. 52.8%; p = 0.04), worse left ventricular function (0.53 vs. 0.59%; p = 0.02), more frequent angiographic thrombus (67.1 vs. 36.8%; p < 0.001), more complex lesions (B2/C) (76.4 vs. 55.8%; p = 0.004), and less frequent location in left anterior descending artery (34.2 vs. 60.8%; p = 0.002). The indication for PTCA in patients who received abciximab was most often related to myocardial infarction. There were no differences between the groups in sex, age and distribution of diabetes treatment. Events were more frequent in diabetics not treated with abciximab than in those who were treated with abciximab (38 vs. 22%; p < 0.037). The patients not treated with abciximab suffered more frequently target vessel revascularization (22.7 vs. 7.2%; p < 0.007). There were no significant differences in the frequency of death or non-fatal myocardial infarction, but hospital readmissions for unstable angina were significantly more frequent in diabetics not treated with abciximab (29.1 vs. 15.9%; p = 0.045). Multivariate analysis identified abciximab as a predictor of the absence of complications during follow-up (OR: 0.45; p = 0.03). CONCLUSION: Abciximab treatment seems to reduce events in unselected diabetic patients undergoing percutaneous coronary intervention, particularly target vessel revascularization.
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Angioplastia Coronaria con Balón , Anticuerpos Monoclonales/uso terapéutico , Complicaciones de la Diabetes , Fragmentos Fab de Inmunoglobulinas/uso terapéutico , Complejo GPIIb-IIIa de Glicoproteína Plaquetaria/antagonistas & inhibidores , Abciximab , Anciano , Angina Inestable/diagnóstico , Angioplastia Coronaria con Balón/mortalidad , Distribución de Chi-Cuadrado , Ensayos Clínicos como Asunto , Angiografía Coronaria , Interpretación Estadística de Datos , Diabetes Mellitus/tratamiento farmacológico , Femenino , Estudios de Seguimiento , Humanos , Masculino , Persona de Mediana Edad , Infarto del Miocardio/diagnóstico , Pronóstico , Estudios Retrospectivos , Factores de Riesgo , Factores de Tiempo , Función Ventricular IzquierdaAsunto(s)
Metanol/envenenamiento , Donantes de Tejidos , Adulto , Resultado Fatal , Humanos , MasculinoRESUMEN
BACKGROUND AND OBJETIVE: Obesity is a disease that affects a large part of the population and has been associated with worse outcomes after cardiac surgery. The aim of our study is to evaluate the consequences of obesity related to postoperative complications, hospital length of stay and mortality. METHODS: Observational, prospective, multicenter study of patients included in ARIAM registry of adult cardiac surgery between March 2008 to March 2011. We analyzed clinical variables, the surgical procedure, postoperative complications and mortality, comparing the group of patients with body mass index (BMI) greater or less than 30 kg/m(2). RESULTS: The study included 4,172 patients with a mean age of 64.03 (SD 12.08) years, BMI 28.53 (4.7) and EuroSCORE 5.58 (2.91). In 1,490 patients (35.7%) BMI was greater than 30. There were no differences in the development of overall postoperative complications (33% in obese and non-obese 35.8%, P=.07), although there were less appreciated reoperation rate or stroke (P<.05), as well as further development postoperative renal failure (P=.009). After adjusting for severity and length of cardio by pass time, obese patients had lower mortality without being statistically significant. OR 0.94 (0.79-1.04). There were no differences in ICU length of stay, but obese patients had greater Ward length of stay 9.04 (10.43) vs. 8.18 (9.2) days, P=.01. CONCLUSIONS: Obese patients undergoing cardiac surgery have a mortality, rate of complications and length of stay similar to non-obese. Obese patients required less reoperations but developed more frequently postoperative renal failure.
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Procedimientos Quirúrgicos Cardíacos , Obesidad/complicaciones , Lesión Renal Aguda/epidemiología , Lesión Renal Aguda/etiología , Anciano , Índice de Masa Corporal , Procedimientos Quirúrgicos Cardíacos/mortalidad , Enfermedades Cardiovasculares/epidemiología , Femenino , Humanos , Unidades de Cuidados Intensivos/estadística & datos numéricos , Tiempo de Internación/estadística & datos numéricos , Masculino , Persona de Mediana Edad , Complicaciones Posoperatorias/epidemiología , Pronóstico , Estudios Prospectivos , Sistema de Registros/estadística & datos numéricos , Reoperación/estadística & datos numéricos , Respiración Artificial/estadística & datos numéricos , Factores de Riesgo , Sepsis/epidemiología , España/epidemiología , Resultado del TratamientoRESUMEN
PURPOSE: The purpose of the study was to analyze postoperative complications, mortality, and related factors of elderly patients undergoing cardiac surgery. METHODS: An observational, retrospective, and multicenter study of cardiac surgery patients, obtained from the ARIAM registry, was performed between 2008 and 2011. Clinical-surgical data, postoperative complications, and mortality were analyzed in a group of patients older than 75 years and in a younger group. RESULTS: A total of 4548 patients were analyzed, with 882 (19.4%) patients at least 75 years old. Elderly patients had worse functional status (New York heart Association class) and comorbidities. The complication rate was higher in the elderly group (40.4% and 33.5%, respectively; P = .0001). Mortality in the elderly was 1.1%, 12%, and 15.1% (during surgery, intensive care unit [ICU], and 30-day mortality, respectively). Thirty-day mortality in elderly patients was higher when adjusted for EuroSCORE (European System for Cardiac Operative Risk Evaluation) and cardiopulmonary bypass time. The interaction between multiorgan dysfunction syndrome (MODS) and age more than 75 years was assessed by logistic regression, obtaining an odds ratio of 9.27 (5.88-14.60) for younger patients and 29.44 (12.22-70.94) for elderly patients who died during the ICU stay. CONCLUSIONS: Age more than 75 years is an independent risk factor for ICU mortality when adjusted for EuroSCORE and cardiopulmonary bypass time. Elderly patients also have a higher rate of complications during ICU stay. Elderly patients develop MODS more frequently and present a higher mortality rate than younger patients with MODS.
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Procedimientos Quirúrgicos Cardíacos/efectos adversos , Procedimientos Quirúrgicos Cardíacos/mortalidad , Complicaciones Posoperatorias/mortalidad , Anciano , Femenino , Mortalidad Hospitalaria , Humanos , Unidades de Cuidados Intensivos , Modelos Logísticos , Masculino , Sistema de Registros , Estudios Retrospectivos , Factores de RiesgoAsunto(s)
Antiarrítmicos/envenenamiento , Flecainida/envenenamiento , Intento de Suicidio , Femenino , HumanosAsunto(s)
Cuidados Críticos , Síndrome de Hiperestimulación Ovárica/epidemiología , Complicaciones del Embarazo/epidemiología , Aborto Terapéutico , Adulto , Ascitis/etiología , Ascitis/cirugía , Gonadotropina Coriónica/efectos adversos , Terapia Combinada , Cuidados Críticos/métodos , Transferencia de Embrión , Femenino , Humanos , Incidencia , Síndrome de Hiperestimulación Ovárica/diagnóstico , Síndrome de Hiperestimulación Ovárica/terapia , Terapia por Inhalación de Oxígeno , Paracentesis , Embarazo , Complicaciones del Embarazo/inducido químicamente , Complicaciones del Embarazo/diagnóstico , Complicaciones del Embarazo/terapia , Resultado del Embarazo , Estudios Retrospectivos , España/epidemiologíaRESUMEN
Renal dysfunction (RD) is a frequent complication after orthotopic liver transplantation (OLT), and it has an unfavorable effect on the prognosis of OLT patients. The purpose of our study was to identify possible risk factors for RD and its impact on survival. The possible relations of pre-, peri-, and postoperative variables to early-onset renal dysfunction (ED) (within the 1st 3 months), late-onset renal dysfunction (LD) (between 3 and 6 months), and chronic renal dysfunction (CRD) (beyond 6 months) was analyzed. We studied 245 liver transplants in 241 patients. RD was found in 64.1% of these patients, and 69% of the patients with RD recovered. LD was found in 16.7% of the transplant patients. In the multivariate analysis, baseline serum creatinine, perioperative volume of transfused bank-red blood cells, Acute Physiology and Chronic Health Evaluation (APACHE) II score at intensive care unit (ICU) admission, and infection were associated with the development of RD. Overall mortality was 27.8% and for the RD group, it was 33.5%. LD, but not ED, was related to lower survival (together with graft dysfunction and APACHE II score at ICU admission). In conclusion, ED is frequent alter OLT and is related to preexisting RD, the volume of transfused bank--red blood cells during surgery, higher APACHE II score at ICU admission, and infection. In general, the prognosis for ED is good, in contrast with that of LD, which is associated with diminished survival.
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Trasplante de Hígado/efectos adversos , Insuficiencia Renal/etiología , Adulto , Transfusión de Eritrocitos/efectos adversos , Femenino , Humanos , Incidencia , Masculino , Persona de Mediana Edad , Recuperación de la Función , Insuficiencia Renal/epidemiología , Estudios Retrospectivos , Factores de Riesgo , Índice de Severidad de la Enfermedad , Análisis de Supervivencia , Factores de TiempoRESUMEN
Fundamento y objetivo: La obesidad puede acompañarse de peores resultados tras cirugía cardiaca. Nuestro objetivo es evaluar las consecuencias de la obesidad en relación con la aparición de complicaciones postoperatorias, la estancia y la mortalidad. Método: Estudio observacional, prospectivo y multicéntrico de pacientes recogidos en el registro ARIAM de cirugía cardiaca de adultos entre marzo de 2008 y marzo de 2011. Se han analizado variables clínicas, del acto quirúrgico, complicaciones postoperatorias y mortalidad, comparando los grupos de pacientes con índice de masa corporal (IMC) mayor o menor de 30 kg/m2. Resultados: El estudio incluye 4.172 pacientes con una edad media (DE) de 64,03 (12,08) años, IMC de 28,53 (4,7) kg/m2 y EuroSCORE de 5,58 (2,91). En 1.490 pacientes (35,7%) el IMC fue mayor de 30 kg/m2. No se encontraron diferencias en el desarrollo de complicaciones posquirúrgicas globales (33% en obesos y 35,8% en no obesos, p = 0,07). Los pacientes obesos mostraron menor necesidad de reintervención quirúrgica y menor incidencia de accidente cerebrovascular en el postoperatorio (p < 0,05). Sin embargo, sí presentaron significativamente mayor deterioro de la función renal (p = 0,009). La estancia en la Unidad de Cuidados Intensivos (UCI) fue similar en ambos grupos, mientras que en planta fue mayor en los obesos, 9,04 (10,43) frente a 8,18 (9,2) días (p = 0,01). Tras ajustar por gravedad y tiempo de circulación extracorpórea, los obesos presentaron una mortalidad inferior, sin llegar a ser estadísticamente significativa (odds ratio 0,94, intervalo de confianza del 95% 0,79-1,04). Conclusiones: Los enfermos obesos sometidos a cirugía cardiaca presentan una mortalidad, complicaciones y estancia similares a las de los no obesos. Estos pacientes son reintervenidos con menos frecuencia, aunque es más habitual el desarrollo de fracaso renal agudo en el postoperatorio (AU)
Background and objective: Obesity is a disease that affects a large part of the population and has been associated with worse outcomes after cardiac surgery. The aim of our study is to evaluate the consequences of obesity related to postoperative complications, hospital length of stay and mortality. Methods: Observational, prospective, multicenter study of patients included in ARIAM registry of adult cardiac surgery between March 2008 to March 2011. We analyzed clinical variables, the surgical procedure, postoperative complications and mortality, comparing the group of patients with body mass index (BMI) greater or less than 30 kg/m2. Results: The study included 4,172 patients with a mean age of 64.03 (SD 12.08) years, BMI 28.53 (4.7) and EuroSCORE 5.58 (2.91). In 1,490 patients (35.7%) BMI was greater than 30. There were no differences in the development of overall postoperative complications (33% in obese and non-obese 35.8%,P = .07), although there were less appreciated reoperation rate or stroke (P < .05), as well as further development postoperative renal failure (P = .009). After adjusting for severity and length of cardio by pass time, obese patients had lower mortality without being statistically significant. OR 0.94 (0.79-1.04). There were no differences in ICU length of stay, but obese patients had greater Ward length of stay 9.04 (10.43) vs. 8.18 (9.2) days, P = .01. Conclusions: Obese patients undergoing cardiac surgery have a mortality, rate of complications and length of stay similar to non-obese. Obese patients required less reoperations but developed more frequently postoperative renal failure (AU)
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Humanos , Obesidad/complicaciones , Cardiopatías/cirugía , Procedimientos Quirúrgicos Cardíacos , Complicaciones Posoperatorias/epidemiología , Mortalidad , Factores de RiesgoRESUMEN
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