RESUMEN
OBJECTIVES: To determine the association between preadmission oral corticosteroid receipt and the development of acute respiratory distress syndrome in critically ill patients with sepsis. DESIGN: Retrospective observational study. SETTING: Medical, surgical, trauma, and cardiovascular ICUs of an academic medical center. PATIENTS: A total of 1,080 critically ill patients with sepsis. INTERVENTIONS: None. MEASUREMENTS AND MAIN RESULTS: The unadjusted occurrence rate of acute respiratory distress syndrome within 96 hours of ICU admission was 35% among patients who had received oral corticosteroids compared with 42% among those who had not (p = 0.107). In a multivariable analysis controlling for prespecified confounders, preadmission oral corticosteroids were associated with a lower incidence of acute respiratory distress syndrome in the 96 hours after ICU admission (odds ratio, 0.53; 95% CI, 0.33-0.84; p = 0.008), a finding that persisted in multiple sensitivity analyses. The median daily dose of oral corticosteroids among the 165 patients receiving oral corticosteroids, in prednisone equivalents, was 10 mg (interquartile range, 5-30 mg). Higher doses of preadmission oral corticosteroids were associated with a lower incidence of acute respiratory distress syndrome (odds ratio for 30 mg of prednisone compared with 5 mg 0.53; 95% CI, 0.32-0.86). In multivariable analyses, preadmission oral corticosteroids were not associated with in-hospital mortality (odds ratio, 1.41; 95% CI, 0.87-2.28; p = 0.164), ICU length of stay (odds ratio, 0.90; 95% CI, 0.63-1.30; p = 0.585), or ventilator-free days (odds ratio, 1.06; 95% CI, 0.71-1.57; p = 0.783). CONCLUSIONS: Among ICU patients with sepsis, preadmission oral corticosteroids were independently associated with a lower incidence of early acute respiratory distress syndrome.
Asunto(s)
Corticoesteroides/administración & dosificación , Enfermedad Crítica , Servicios Médicos de Urgencia/estadística & datos numéricos , Síndrome de Dificultad Respiratoria/prevención & control , Sepsis/tratamiento farmacológico , APACHE , Corticoesteroides/uso terapéutico , Adulto , Factores de Edad , Anciano , Comorbilidad , Relación Dosis-Respuesta a Droga , Femenino , Mortalidad Hospitalaria , Humanos , Incidencia , Unidades de Cuidados Intensivos , Tiempo de Internación/estadística & datos numéricos , Masculino , Persona de Mediana Edad , Respiración Artificial/estadística & datos numéricos , Síndrome de Dificultad Respiratoria/etiología , Síndrome de Dificultad Respiratoria/mortalidad , Estudios Retrospectivos , Factores de Riesgo , Sepsis/complicaciones , Sepsis/mortalidadRESUMEN
We describe a rare case of severe low-flow, low-gradient aortic stenosis due to a calcified aortic valve chordae tendineae. The chordae was captured on cardiac computed tomography (CT) using advanced 3-dimensional image reconstruction to reveal the fibrous strand tethering the non-coronary cusp to the left ventricular outflow tract, rendering it functionally immobile. This is one of the first reported cases of severe aortic stenosis from an aortic valve chordae tendineae which highlights the utility of advanced image processing techniques in cardiac CT.