[Mechanical ventilation. Influence of the age in the outcome]. / Asistencia respiratoria mecánica. Influencia de la edad en la evolución.

There is not consensus about the true influence of age on mortality associated to mechanical ventilation (MV). We performed a prospective study in order to determine if age is an independent factor to predict mortality in patients under MV. Two hundred patients requiring MV at the intensive care unit were included and clinical variables at admission, co-morbidities, complications and outcome at the hospital and after 6 months were registered. Patients were divided in 2 groups: Group 1 (n = 164) under 80 year old and Group 2 (n = 36) 80 year or older. There were no differences in intensive care unit or hospital mortality between the two groups (55.56% vs. 41.46% and 58.33% vs. 42.68%). Six-month survival were significantly lower in patients over 80 year-old (22.22% vs. 48.17%, p = 0.0051). Multivariate analysis showed that only an APACHE II score > 20 (p = 0.0077) or the absence of an autonomous life (p = 0.0028) were independent predictive factors of mortality. Elderly patients under mechanical ventilation do not show a higher mortality because of the advance age in itself. Restriction of mechanical ventilation and invasive care does not seem to be justified based on the advanced age.

[Spinal abscess in a patient with hereditary hemorrhagic telangiectasia]. / Absceso intramedular en paciente con enfermedad de Rendu-Osler-Weber.

Rendu-Osler-Weber syndrome is an autosomal dominant disorder characterized by multiple skin and mucosal telangiectasis and multiorgan arteriovenous malformations. Neurological manifestations may occur because of cerebral arteriovenous malformations, intracranial hemorrhage, and most commonly by ischemic stroke and brain abscess secondary to paradoxical embolization in patients with pulmonary arteriovenous malformations. Intramedullary abscess is a rare, unusual condition, in Rendu-Osler-Weber syndrome. We report the case of a 56 years old woman, with a familial history of Rendu-Osler-Weber syndrome, admitted to intensive care with acute quadriplegia and hypoxemia. Our diagnosis was pulmonary arteriovenous malformations and intramedullary abscess.

[Impending paradoxical embolism]. / Embolia paradojal inminente.

Impending paradoxical embolism. An intracardiac thrombus traversing a patent foramen ovale is a very infrequent but potentially catastrophic complication of the thromboembolic disease. It is named "impending paradoxical embolism". We report the case of a 71-year-old Caucasian male warded in ten days after a prostatectomy because of bilateral pulmonary embolism. Diagnosis was confirmed by HCT scan and the patient received anticoagulation with heparin. A transesophageal ecocardiogram disclosed a thrombus traversing foramen ovale into the left atrium. Surgical embolectomy was performed, but the patient died shortly after surgery.

[Paroxysmal sympathetic storm after diffuse axonal head injury]. / Tormenta simpática paroxística siguiendo a injuria axonal difusa.

The term paroxysmal sympathetic storms is used to define episodic alterations in body temperature, blood pressure, heart and respiratory rate, size of pupil, and level of consciousness coinciding with hyperhidrosis, excessive salivation and extensor posturing. All the cases were presented after severe diffuse axonal head injury. We present two young patients with diffuse axonal head injury that develop in their evolution hypertension, tachycardia and fever without evidence during the episodes of epileptiform activity and without any infectious cause with excellent answer to the treatment with beta-blockers and morphine. We consider that the correct diagnosis of this entity minimizes the application of unnecessary studies allowing an appropriate treatment.

Calidad de vida post terapia intensiva / Quality of life after intensive therapy

Los resultados del artículo publicado Calidad de vida y estatus funcional en pacientes que requirieron ventilación mecánica. Seguimiento al año del alta de terapia intensiva son coincidentes con lo reportado en la literatura. Un porcentaje importante de los pacientes que requirieron asistencia respiratoria mecánica (ARM) en terapia intensiva presentan dependencia para las actividades de la vida diaria, deterioro en la calidad de vida e incapacidad para regresar a la actividad laboral previa a la internación. El trabajo reviste especial importancia dada la escasa cantidad de publicaciones al respecto en nuestro medio

Asistencia respiratoria mecánica: Influencia de la edad en la evolución / Mechanical ventilation: Influence of the age in the outcome

No existe un concepto definido sobre la influencia de la edad en la mortalidad de la asistencia respiratoria mecánica. Realizamos un trabajo prospectivo-observacional para determinar si la edad es un factor independiente de mortalidad de la asistencia respiratoria mecánica. Se incluyeron 200 pacientes internados en la Unidad de Cuidados Intensivos del Hospital Británico de Buenos Aires. Se registraron características y comorbilidades al ingreso, al inicio de la asistencia respiratoria mecánica, complicaciones y evolución en el Hospital y a los 6 meses. Los 200 pacientes incluidos fueron divididos en dos grupos: Grupo 1 (n = 164) menores de 80 años y Grupo 2 (n = 36) de 80 años o más. No hubo diferencias en la mortalidad en la Unidad de Cuidados Intensivos y en el Hospital entre los pacientes menores de 80 años y los de 80 años o más. (55.56% vs. 41.46% y 58.33% vs. 42.68%). La supervivencia a los 6 meses de los = 80 años fue significativamente menor (22.22% vs. 48.17%, p = 0.0051). En el análisis multivariado solamente un APACHE II > 20 (p = 0.0007) o la ausencia de vida autónoma (p = 0.0028) conservaron poder predictivo independiente. Los pacientes añosos que reciben asistencia respiratoria mecánica no presentan una mayor mortalidad por el sólo hecho de ser ancianos. La restricción de los cuidados terapéuticos invasivos no parece justificada por la edad avanzada.

There is not consensus about the true influence of age on mortality associated to mechanical ventilation (MV). We performed a prospective study in order to determine if age is an independent factor to predict mortality in patients under MV. Two hundred patients requiring MV at the intensive care unit were included and clinical variables at admission, co-morbidities, complications and outcome at the hospital and after 6 months were registered. Patients were divided in 2 groups: Group 1 (n = 164) under 80 year old and Group 2 (n = 36) 80 year or older. There were no differences in intensive care unit or hospital mortality between the two groups (55.56% vs. 41.46% and 58.33% vs. 42.68%). Six-month survival were significantly lower in patients over 80 year-old (22.22% vs. 48.17%, p = 0.0051). Multivariate analysis showed that only an APACHE II score > 20 (p = 0.0077) or the absence of an autonomous life (p = 0.0028) were independent predictive factors of mortality. Elderly patients under mechanical ventilation do not show a higher mortality because of the advance age in itself. Restriction of mechanical ventilation and invasive care does not seem to be justified based on the advanced age.

Absceso intramedular en paciente con enfermedad de Rendu-Osler-Weber / Spinal abscess in a patient with hereditary hemorrhagic telangiectasia

La enfermedad de Rendu-Osler-Weber es una enfermedad autosómica dominante que se manifiesta por telangiectasias en piel y mucosas y malformaciones arteriovenosas en diversos órganos. El compromiso neurológico puede ocurrir por la presencia de malformaciones arterio-venosas cerebrales, hemorragia intracraneal, y más habitualmente por accidentes cerebrovasculares isquémicos y abscesos cerebrales secundarios a embolia paradojal, en pacientes con malformaciones arteriovenosas pulmonares. El absceso intramedular es una entidad rara, inusual como complicación de la enfermedad de Rendu-Osler-Weber. Presentamos el caso de una mujer de 56 años de edad, con antecedentes familiares de enfermedad de Rendu-Osler- Weber, que ingresó a Terapia Intensiva con cuadriplejia aguda e hipoxemia, en quien se diagnosticó fístulas arteriovenosas pulmonares y un absceso intramedular cervical.

Rendu-Osler-Weber syndrome is an autosomal dominant disorder characterized by multiple skin and mucosal telangiectasis and multiorgan arteriovenous malformations. Neurological manifestations may occur because of cerebral arteriovenous malformations, intracranial hemorrhage, and most commonly by ischemic stroke and brain abscess secondary to paradoxical embolization in patients with pulmonary arteriovenous malformations. Intramedullary abscess is a rare, unusual condition, in Rendu-Osler-Weber syndrome. We report the case of a 56 years old woman, with a familial history of Rendu-Osler-Weber syndrome, admitted to intensive care with acute quadriplegia and hypoxemia. Our diagnosis was pulmonary arteriovenous malformations and intramedullary abscess.

Embolia paradojal inminente / Impending paradoxical embolism

La presencia de un trombo venoso atrapado en un defecto interauricular e insinuándose en las cavidades izquierdas configura una forma extremadamente inusual de enfermedad tromboembólica denominada embolia paradojal inminente. Presentamos el caso de un varón de 71 años, sometido 10 días antes a adenomectomía prostática, que consultó por disnea y mareos. Se le diagnosticó tromboembolismo pulmonar bilateral por tomografía axial computada helicoidal. Se lo anticoaguló con heparina sódica y se le realizó un ecocardiograma transesofágico que mostró un trombo que atravesaba el foramen oval y se alojaba en la aurícula izquierda. No presentaba signos clínicos de embolización sistémica. Se realizó la embolectomía quirúrgica y cierre del defecto auricular. El paciente falleció

An intracardiac thrombus traversing a patent foramen ovale is a very infrequent but potentially catastrophic complication of the thromboembolic disease. It is named "impending paradoxical embolism". We report the case of a 71 year old Caucasian male warded in ten days after a prostatectomy because of bilateral pulmonary embolism. Diagnosis was confirmed by HCT scan and the patient received anticoagulation with heparin. A transesophageal ecocardiogram disclosed a thrombus traversing foramen ovale into the left atrium. Surgical embolectomy was performed, but the patient died shortly after surgery

Tormenta simpatica paroxistica siguiendo a injuria axonal difusa / Paroxysmal sympathetic storm after diffuse axonal head injury

El término tormenta simpática paroxística se utiliza como sinónimo de alteraciones episódicas de la temperatura corporal, la presión arterial, la frecuencia respiratoria y cardíaca, el tamaño pupilary el nivel de conciencia, que coinciden con hiperhidrosis, salivación excesiva y postura extensora. Esto siempreen el contexto de una injuria axonal difusa grave que sigue a un traumatismo encéfalo-craneano (TEC) grave.Presentamos dos pacientes jóvenes con injuria axonal difusa secundaria a TEC grave, que desarrollan en suevolución cuadros de hipertensión arterial, taquicardia y fiebre, sin evidencia durante los episodios de actividad epileptiforme y habiéndose descartado la causa infecciosa, que responden favorablemente al tratamiento con beta-bloqueantes y morfina. Consideramos que el correcto diagnóstico de esta entidad minimiza la solicitud de estudios innecesarios permitiendo iniciar un tratamiento adecuadoc

The term paroxysmal sympatheticstorms is used to define episodic alterations in body temperature, blood pressure, heart and respiratoryrate, size of pupil, and level of consciousness coinciding with hyperhidrosis, excessive salivation and extensor posturing. All the cases were presented after severe diffuse axonal head injury. We present two young patients with diffuse axonal head injury that develop in their evolution hypertension, tachycardia and fever without evidence during theepisodes of epileptiform activity and without any infectious cause with excellent answer to the treatment withbeta-blockers and morphine. We consider that the correct diagnosis of this entity minimizes the application ofunnecessary studies allowing an appropriate treatment

Hemoptisis masiva por fístula aorto bronquial / Massive hemoptysis from an aortobronchial fistula

This is a report of a 61 year old man who was admitted at the Intensive Care Unit because of massive hemoptysis and respiratory failure. Four years before he had had an aortic dissection type A, and at that time an aortic valve, ascending aorta and aortic arch replacement, had been carried out. A thorax CT scan showed an aneurysm of the ascending aorta. A bronchoscopy was normal. In the angiography, a collateral of the left mammary artery was identified as the cause of bleeding and was subsequently embolized. After the procedure, the patient had a new episode of massive hemoptysis, and surgery was recommended. During surgery, the diagnosis of aortobronchial fistula was confirmed but the patient died during the intervention.