[Survival of haematologic patients admitted to an Intensive Care Unit. A 16 years study]. / Supervivencia de los pacientes con hemopatías ingresados en una Unidad de Medicina Intensiva. Estudio de 16 años.

BACKGROUND AND OBJECTIVE: The survival of haematologic patients admitted to Intensive Care units (ICU) is so poor, that it is debatable whether they should be admitted or not to them. We aimed to find out the survival of these patients in an ICU to know if their admission is justified. PATIENTS AND METHOD: Retrospective study of 600 haematologic patients (49.4 ± 16.4 years, 58.3% male) representing a total of 660 different admissions to the ICU of a university hospital, with a 6 months follow-up. Haematologic diseases were: leukaemia (50.5%), lymphoma (18.7%), myeloma (10.0%), myelodysplasic syndromes (4.2%), aplastic anaemia or bone marrow aplasia (3.3%), thrombotic microangiopathies and HELLP syndrome (7.4%), and others. RESULTS: A total of 37.5% of patients survived. Survival of thrombotic microangiopathies and HELLP syndrome was higher (81.8% of patients) than that of leukaemias (26.6%) and lymphomas (49.1%). When the reason for ICU admission was respiratory failure with or without septic shock, the survival was lower (20 and 27% of admissions respectively) than when it was septic shock alone (58.7%). Survival of mechanically ventilated patients was 14.6%, that of those treated with any renal replacement therapy 32.4% and that of patients with both treatments 13.8%. From all mechanically ventilated leukaemia or lymphoma patients, 10.3% survived (93 days in the ICU per life saved) but only 7.7% were alive 6 months later. CONCLUSIONS: Considering that the ICU survival was higher than 10% for all the groups studied, we conclude that admission of haematologic patients to the ICU is appropriate.

[Lung transplanted patient climbing a mountain higher than 4,000 metres. Comparison with healthy climbers]. / Ascensión a gran altitud de un paciente con trasplante pulmonar. Comparación con montañeros sanos.

BACKGROUND AND OBJECTIVE: To ascertain if a bilaterally lung transplanted patient can climb a mountain higher than 4,000 metres and to compare the evolution of his physiological parameters during the ascent with those of healthy mountaineers. SUBJECTS AND METHOD: Heart rate, blood pressure, arterial oxygen saturation (SaO2), forced vital capacity, forced expiratory volume in one second, Tiffenau test, 25-75 mesoexpiratory flow, peak flow, severity of dyspnoea (analogic score) and symptoms and signs of acute mountain sickness (lake Louise and Serrano-Alcócer scores) were measured in a bilaterally lung transplanted patient and in 4 healthy mountaineers at sea level and at different altitudes during the ascent of Breithorn (4,164 m) from Zermatt in 3 days. RESULTS: All subjects attained the summit. The transplanted patient suffered from an acute mountain sickness at 2,700 m but recovered spontaneously. No other substantial differences were found during the climb between the patient's physiological parameters and those of the healthy controls. On the summit (third day) the patient's SaO2 (90%) was higher than the figure which should be theoretically expected for this altitude among non-acclimatised subjects (81%). CONCLUSIONS: Our study confirms that it is possible for a bilaterally lung transplanted patient to climb by his own effort a mountain higher than 4,000 m with no physiological changes other than those experienced by healthy mountaineers. Considering the spontaneous recovery from the acute mountain sickness and the high SaO2 on the summit of Breithorn, we conclude that lung transplantation does not necessarily prevent altitude acclimatisation.

[Arterial oxygen saturation at high altitude. A study on unacclimatised mountaineers and mountain dwellers]. / Saturación arterial de oxígeno a gran altitud. Estudio en montañeros no aclimatados y en habitantes de alta montaña.

BACKGROUND AND OBJECTIVE: We decided to determine how arterial oxygen saturation (SaO2) diminishes with altitude in unacclimatized mountaineers and in mountain dwellers. SUBJECTS AND METHOD: Pulseoximetric measurements in unacclimatized mountaineers (214 measurements in several Spanish mountains and in the Alps up to 4,164 m) and in mountain dwellers (209 measurements in several Spanish and Bolivian villages up to 4,230 m). We performed pulseoximetric measurements for three consecutive days in eight mountaineers on the summit of Aneto (3,404 m) to ascertain whether SaO2 increases or not during early acclimatization. RESULTS: Equations describing the SaO2 reduction with altitude are as follows: a) for unacclimatized mountaineers, SaO2 = 98.8183 - 0.0001.h - 0.000001.h2, b) for mountain dwellers, SaO2 = 98.2171 + 0.0012.h - 0.0000008.h2. (SaO2 in %; h: altitude in m. Lower limit of 95% confidence intervals given in the text). SaO2 of mountain dwellers is higher than that of unacclimatized mountaineers studied at the same altitude (p < 0.05 for any altitude over 1,692 m). SaO2 of mountaineers increased during early acclimatization (p < 0.05) to reach in few days the SaO2 of mountain dwellers. Unacclimatized mountaineers who spent the previous night over 2,000 m had higher SaO2 in altitude than those who slept under 2,000 m (p < 0.05). Mountaineers who performed any high-mountain activity (i.e. over 2,500 m) in the previous 12 months had higher SaO2 on the summit of Aneto than those who have never been over 2,500 m before (p < 0.05). CONCLUSION: SaO2 increases during the acclimatization process. Our equations serve to calculate the SaO2 which can be considered normal for healthy people for every altitude below 4,200 m, both before and after the acclimatization process.

[Respiratory changes during ascension to 8,000 meters mountain]. / Cambios respiratorios durante la ascensión a una montaña de más de 8.000 metros.

BACKGROUND: Our goal was to determine whether spirometric alterations occur during expeditions to 8,000-metre peaks, and whether these are modified by acclimatization or are related to acute mountain sickness, to arterial oxygen saturation (SaO2) or to muscular deterioration due to chronic hypoxic exposure. SUBJECTS AND METHOD: Forced vital capacity (FVC), forced expiratory volume in the first second (FEV1), inspiratory (MIP) and expiratory (MEP) maximal static pressures, grip strength in both hands, and SaO2 at rest and exercise were measured in eight subjects during an expedition to Gasherbrum II (8,035 m). RESULTS: Upon arrival at the base camp (5,200 m), both FVC and FEV1 decreased, with no changes in the FEV1/FVC ratio. FVC did not improve after a brief pressurisation in a portable hyperbaric chamber. A month later, FVC in the base camp returned to normal values. FVC fall correlated with both the severity of acute mountain sickness and weight loss. Resting SaO2 improved with acclimatisation and correlated with the previous hypoxic ventilatory response, both before and after acclimatisation. Acclimatisation led to a decrease in the exercise-induced SaO2 fall. Stay at a high altitude lowered body weight and grip strength, although MIP and MEP remained unchanged. CONCLUSIONS: We observed a restrictive alteration was corrected by with acclimatisation. This phenomenon seems to be related to a subclinical high-altitude pulmonary oedema rather than to an increase in the pulmonary vascular volume. Despite the high-altitude muscular deterioration, respiratory muscle weakness was not

Neuropathic pain and dysesthesia of the feet after Himalayan expeditions.

High altitude peripheral nerve disease secondary to frostbite or trauma is a well-recognized medical problem during mountaineering expeditions. However, in our experience as medical professionals on 19 expeditions to the Himalayas in the years 1977 to 2000, an unusual syndrome of neuropathic pain and/or dysesthesia in both feet apparently unrelated to frostbite or trench foot was observed in 8 (4.8%) of 165 European mountaineers. Mountaineers complained of persistent and continuous pain, which was consistently described as a "corky" sensation in their feet, associated with severe lancinating exacerbations. Pain improved with cold and worsened with heat and gentle pressure. Symptoms were incapacitating in a third of the cases. Treatment with carbamazepine was effective, and the disorder evolved to total resolution in 4 to 8 weeks. We present the case of a patient who had this syndrome and in whom complete work-up studies done on his arrival home, 14 days after its presentation, were unrevealing. The paucity of information regarding this particular variety of neuropathic pain of the feet may be due to lack of clinical suspicion in the field, favorable outcome, and difficulties for further study and evaluation.