[Blood transfusion during heart surgery. A retrospective nested case-control study]. / Transfusión intraoperatoria en cirugía cardiaca. Estudio retrospectivo anidado de casos y controles.

OBJECTIVE: To assess the correlation between intraoperative packed red blood cells transfusion and adverse outcome in a Spanish cohort of cardiac surgery patients. METHODS: Retrospective observational multicentre study. An analysis was performed on the data from 927 cardiac surgery patients treated in 24 Spanish hospitals in 2007. Patients who received intraoperative transfusions were compared with non-transfused patients. Multivariate analyses were performed (including, among others, several items from the Euroscore, surgery type, basal renal status and haemoglobin levels, and Thakar score). RESULTS: Every transfusion of packed red cells was associated with increased postoperative risk of acute kidney damage at 72 hours after surgery, prolonged mechanical ventilation, and need for haemodynamic support. Moreover, transfused patients showed an increased in-hospital mortality rates (Adjusted OR: 1.30; 95% CI: 1.19-1.42), as well as longer hospital stays (almost 4 days). CONCLUSIONS: In this cohort of patients, intraoperative transfusion might independently predict higher risk of early acute kidney damage, prolonged postoperative mechanical ventilation, and a need for haemodynamic support, and reduced short term survival (adjusted OR for mortality: 1.30; 95% CI: 1.19-1.42), and longer hospital stays (4 days longer).

[Acute kidney injury]. / Insuficiencia renal aguda.

Acute kidney injury (AKI) is defined as an abrupt decline in the glomerular filtration rate with accumulation of nitrogenous waste products and the inability to maintain fluid and electrolyte homeostasis. Occurring in 7% of all hospitalized patients and 28% to 35% of those in intensive care units, AKI increases hospital mortality. Early evaluation should include differentiating prerenal and postrenal components from intrinsic renal disease. Biological markers can give early warning of AKI and assist with differential diagnosis and assessment of prognosis. The most effective preventive measure is to maintain adequate circulation and cardiac output, avoiding ischemia- or nephrotoxin-induced injury. To that end, patients and situations of risk must be identified, hemodynamics and diuresis monitored, hypovolemia reversed, and nephrotoxins avoided. Protective agents such as sodium bicarbonate, mannitol, prostagiandins, calcium channel blockers, N-acetyl-L-cysteine, sodium deoxycholate, allopurinol, and pentoxifylline should be used. Treatment includes the elimination of prerenal and postrenal causes of AKI; adjustment of doses according to renal function; avoidance of both overhydration and low arterial pressure; maintenance of electrolytic balance, avoiding hyperkalemia and correcting hyperglycemia; and nutritional support, assuring adequate protein intake. For severe AKI, several modalities of renal replacement therapy, differentiated by mechanism and duration, are available. Timing--neither the best moment to start dialysis nor the optimal duration--has been not established. Early detection of AKI is necessary for preventing progression and starting renal replacement therapy at adjusted doses that reflect metabolic requirements.

[An awake fiberoptic intubation protocol: descriptive retrospective assessment of safety and efficacy]. / Evaluación de la eficacia y seguridad de un protocolo de intubación mediante fibroscopio en paciente despierto. Estudio descriptivo retrospectivo.

BACKGROUND AND OBJECTIVE: Flexible fiberoptic intubation of the trachea is emphasized in guidelines on the management of difficult airway. The aim of this study was to analyze the efficacy and safety of our tertiary hospital's awake fiberoptic intubation protocol. MATERIAL AND METHODS: For retrospective descriptive study we collected information on all fiberoptic intubations performed on awake patients in the 3 years after a specific protocol was implemented. The protocol's key points focus on operating room arrangement, required staff, and sedation before the procedure. Data gathered included demographic variables, patients' diseases, preanesthetic assessment of potential difficult airway, adherence to the protocol, medication administered, and complications recorded. RESULTS: In the course of the study, 634 fiberoptic intubations were performed; 473 patients (74.6%) had at least 1 risk factor for aspiration and 232 patients (36.5%) had at least 1 type of cardiovascular comorbidity. Difficult intubation was expected in 67%. In 99%, remifentanil was administered via target controlled infusion with a mean effect concentration of 2.9 ng/mL. The operating room arrangement and staffing protocol was followed in all cases. No pulmonary or hemodynamic complications occurred during fiberoptic intubation or immediately after surgery. CONCLUSION: Our hospital's protocol was followed in all cases and no post-implementation complications were detected.

[Evaluation of a formula for optimal positioning of a central venous catheter through the right internal jugular vein]. / Evaluación de una fórmula para la posición óptima de un catéter venoso central a través de vena yugular interna derecha.

OBJECTIVE: To evaluate the efficiency of a formula for predicting the optimal length of catheter inserted through the right internal jugular vein. PATIENTS AND METHOD: A prospective study in which the length of catheter to insert was calculated by the following formula: (height in cm/10)-1 cm. Punctures were approximately at the cricoid cartilage and length was measured from the point of insertion. Catheter tip placement was confirmed by anteroposterior chest film, read by a radiologist blinded as to the objective of the study. The position was considered optimal if the catheter tip was in the distal portion of the superior vena cava. Patients enrolled required insertion of a central venous line for therapy or monitoring and were excluded if they had risk factors that could predispose them to poor placement. RESULTS: Fifty-eight catheterizations were performed. Three of them were excluded due to poor positioning in the contralateral subclavian vein. Among the 55 remaining patients, we observed the catheter tip in the superior vena cava in 52 cases and in the right atrium in 3. CONCLUSIONS: The aforementioned formula predicted appropriate placement of the catheter tip in 94.54% of the patients.