[Epidemiological surveillance for multidrug-resistant microorganisms in a general ICU]. / Vigilancia epidemiológica para microorganismos multirresistentes en una UCI polivalente.

OBJECTIVE: Multidrug resistant (MDR) microorganisms represent a threat for patients admitted in Intensive Care Units (ICUs). The objective of the present study is to analyse the results of epidemiological surveillance cultures for these microorganisms in one of these units. METHODS: General ICU. Retrospective analysis, descriptive statistics. Analysis of epidemiological surveillance cultures for MDR microorganisms in 2015. Studied microorganisms: Methicillin-resistant Staphylococcus aureus (MRSA), ESBL-and/or carbapenemase-producing Klebsiella pneumoniae (CESBL-KP) and MDR Acinetobacter baumannii (MDRAB). RESULTS: One thousand, two hundred and fifty nine patients admitted. A total of 2,234 specimens from 384 patients were analysed (690, 634, 62 and 286 were rectal, throat, nasal and skin swabs respectively). Global APACHE II was 18.3 ± 8 versus 21.7 ± 7.8 in patients colonized/infected on admission. Global mortality was 19.7% versus 22.3% in patients colonized/infected on admission. The higher sensitivities achieved with the different samples for the different microorganism detection were as follows. MRSA: 79% and 90% for nasal and nasal + throat swabs, respectively. MDRAB: 80% and 95% for throat and throat + rectal swabs, respectively. CESBL-KP: 95% and 98% for rectal and rectal + throat swabs, respectively. 94 out of the 384 patients (24.4%) were colonized/infected with MDR at admission. 134 patients (10.6% of the total patients admitted) were colonized/infected with a total of 169 MMR during the hospital stay. MRSA has the earliest colonization/infection (9.2 ± 6.4days) and ESBL-producing Enterobacteriaceae, the latest (18.7± 16.4 days). CONCLUSIONS: 24.4% of patients were colonized/infected by MDR at admission. Nasal, throat and rectal swabs were the most effective specimens for recovering MRSA, MDRAB and CESBL-KP, respectively. The combination of two specimens improves MDR detection except for CESBL-KP. Skin swabs are worthless. The most prevalent MDR at admission were ESBL-producing Enterobacteriaceae while the most frequent hospital acquired MDR was MDRAB..

Mechanical ventilation in acute respiratory distress syndrome: The open lung revisited.

Acute respiratory distress syndrome (ARDS) is still related to high mortality and morbidity rates. Most patients with ARDS will require ventilatory support. This treatment has a direct impact upon patient outcome and is associated to major side effects. In this regard, ventilator-associated lung injury (VALI) is the main concern when this technique is used. The ultimate mechanisms of VALI and its management are under constant evolution. The present review describes the classical mechanisms of VALI and how they have evolved with recent findings from physiopathological and clinical studies, with the aim of analyzing the clinical implications derived from them. Lastly, a series of knowledge-based recommendations are proposed that can be helpful for the ventilator assisted management of ARDS at the patient bedside.

[Sex differences in the integrated stroke management in a rural healthcare area in Asturias]. / Diferencias de sexo en el abordaje integral del ictus en un area sanitaria rural de Asturias.

INTRODUCTION: Sex differences and the (rural or urban) nature of populations largely determine the integrated management of time-dependent pathologies such as strokes, which is the main cause of female hospitalisation and mortality in our setting. AIM: To determine whether any differential characteristics can be observed between male and female stroke patients in a rural healthcare area in the Principality of Asturias. PATIENTS AND METHODS: A descriptive retrospective study was conducted at the Jarrio Hospital. Different variables were reviewed using the computerised medical records of patients who suffered a stroke in 2013. RESULTS: Altogether 126 patients were discharged, 53.2% among females, who suffered the disease with a five-year delay (p < 0.008) with respect to males. These latter smoked more and also drank harmful amounts of alcohol (p < 0.000). The pre-hospital delay did not yield any significant sex differences. Language disorder was the main symptom in the female group (p < 0.008), who scored higher on the National Institute of Health Stroke Scale (p < 0.046). Complementary studies, such as Holter monitoring (p < 0.04) and ultrasound scanning of the supra-aortic trunks (p < 0.02), are conducted less often in females, who mainly received conservative treatment with greater parenteral hydration (p < 0.017) and rest. The female group suffered more complications, disability at discharge (p < 0.001) and at three months (p < 0.004), and recorded higher percentages of subsequent institutionalisation (p < 0.005). CONCLUSIONS: There are demographic sex differences in the cerebrovascular risk profile, clinical presentation, hospital management and comorbidity of stroke in this rural population, which suggest that there are areas where there is room for improvement.

TITLE: Diferencias de sexo en el abordaje integral del ictus en un area sanitaria rural de Asturias.Introduccion. Las diferencias de sexo y el caracter (rural o urbano) de las poblaciones determinan en gran medida el abordaje integral de patologias dependientes del tiempo, como el ictus, principal causa de hospitalizacion y mortalidad femenina en nuestro medio. Objetivo. Determinar si en un area sanitaria rural del Principado de Asturias se ponen de manifiesto las caracteristicas diferenciales entre mujeres y hombres con ictus. Pacientes y metodos. Estudio descriptivo retrospectivo realizado en el Hospital de Jarrio. Se revisaron variables a traves de las historias clinicas informatizadas de los pacientes que sufrieron ictus en 2013. Resultados. Se produjeron 126 altas totales, el 53,2% en las mujeres, que sufrieron la enfermedad con un retraso de cinco años (p < 0,008) en relacion con los varones, los cuales fueron mas fumadores y consumidores perjudiciales de alcohol (p < 0,000). La demora prehospitalaria no arrojo diferencias de sexo significativas. El trastorno del lenguaje fue el sintoma principal en el grupo femenino (p < 0,008), que registro una puntuacion superior en la National Institute of Health Stroke Scale (p < 0,046). Los estudios complementarios, como el Holter (p < 0,04) y la ecografia de troncos supraaorticos (p < 0,02), se realizaron menos en las mujeres, que recibieron un tratamiento principalmente conservador con mayor hidratacion parenteral (p < 0,017) y reposo. El grupo femenino sufrio mas complicaciones, discapacidad al alta (p < 0,001) y a los tres meses (p < 0,004), y registro porcentajes mas elevados de institucionalizacion posterior (p < 0,005). Conclusiones. Existen diferencias de sexo demograficas, en el perfil de riesgo cerebrovascular, la presentacion clinica, el manejo hospitalario y la comorbilidad del ictus en esta poblacion rural, que sugieren areas de mejora.

[Monitorization of respiratory mechanics in the ventilated patient]. / Monitorización de la mecánica respiratoria en el paciente ventilado.

Monitoring during mechanical ventilation allows the measurement of different parameters of respiratory mechanics. Accurate interpretation of these data can be useful for characterizing the situation of the different components of the respiratory system, and for guiding ventilator settings. In this review, we describe the basic concepts of respiratory mechanics, their interpretation, and their potential use in fine-tuning mechanical ventilation.

[Inflammatory response and apoptosis in acute pulmonary injury]. / Respuesta inflamatoria y apoptosis en la lesión pulmonar aguda.

One of the principal mechanisms of pulmonary injury in acute respiratory distress is due to the effects of the precipitated inflammatory response. The damage produced to the alveolar epithelium and underlying endothelium depends on the sequestration and activation of inflammatory cells, which in turn exert their actions through mediators. On the other hand, apoptosis is a mechanism responsible for epithelial damage and regulation of inflammation. Response of the lung tissue subjected to mechanical ventilation stimulus is added to the previous mechanisms. All these processes flow into a series of common pathways of cellular activation. Knowledge of these mechanisms could serve to identify which patients would benefit from a specific treatment before applying therapies that act indiscriminately in the inflammatory response.