Postoperative Respiratory Failure and Advanced Ventilator Settings.

Postoperative respiratory failure has a multifactorial etiology, of which atelectasis is the most common mechanism. Its injurious effects are magnified by surgical inflammation, high driving pressures, and postoperative pain. Chest physiotherapy and noninvasive ventilation are good options to prevent progression of respiratory failure. Acute respiratory disease syndrome is a late and severe finding, which is associated with high morbidity and mortality. If present, proning is a safe, effective, and underutilized therapy. Extracorporeal membrane oxygenation is an option only when traditional supportive measures have failed.

Impact of Fluid Balance on Intensive Care Unit Length of Stay in Critically Ill Trauma Patients.

BACKGROUND: There is significant data in the medical and surgical literature supporting the correlations between positive volume balance and negative outcomes such as AKI, prolonged mechanical ventilation, intensive care unit and hospital length of stay and increased mortality. METHODS: This single-center, retrospective chart review included adult patients identified from a Trauma Registry database. The primary outcome was the total ICU LOS. Secondary outcomes include hospital LOS, ventilator-free days, incidence of compartment syndrome, acute respiratory distress syndrome (ARDS), renal replacement therapy (RRT), and days of vasopressor therapy. RESULTS: In general, baseline characteristics were similar between groups with the exception of mechanism of injury, FAST exam, and disposition from the ED. The ICU LOS was shortest in the negative fluid balance and longest in the positive fluid balance group (4 days vs 6 days, P = .001). Hospital LOS was also shorter in the negative balance group than that of the positive balance group (7 days vs 12 days, P < .001). More patients in the positive balance group experienced acute respiratory distress syndrome compared to the negative balance group (6.3% vs 0%, P = .004). There was no significant difference in the incidence of renal replacement therapy, days of vasopressor therapy, or ventilator-free days. DISCUSSION: A negative fluid balance at seventy-two hours was associated with a shorter ICU and hospital LOS in critically ill trauma patients. Our observed correlation between positive volume balance and total ICU days merits further exploration with prospective, comparative studies of lower volume resuscitation to key physiologic endpoints compared with routine standard of care.

Assessment of Acute Kidney Injury in Neurologically Injured Patients Receiving Hypertonic Sodium Chloride: Does Chloride Load Matter?

Background: Increasing evidence suggests that large-volume infusions of 0.9% sodium chloride (NaCl) for resuscitation are associated with hyperchloremic metabolic acidosis, renal vasoconstriction, and increased risk of acute kidney injury (AKI). Patients with neurological injury may require hypertonic NaCl for therapeutic hypernatremia, treatment of cerebral salt wasting, hyponatremia, or elevated intracranial pressure. Consequently, this increased exposure to chloride may result in an increased risk for development of AKI. Objective: The primary aim of this study was to describe the risk for development of AKI in neurologically injured patients receiving large volumes of intravenous hypertonic NaCl. Methods: This single-center, retrospective study looked at neurologically injured patients who received hypertonic NaCl and sodium acetate. Data were collected to assess renal function, hyperchloremia, and acidemia. Receiver operating characteristic (ROC) curve analysis was used to determine the predictive association between the amount of daily and overall chloride exposure and development of AKI. Results: A total of 301 patients were screened, and of those, 142 were included. Of the 142 patients included, 13% developed AKI, and 38% developed hyperchloremia. Additionally, 32% of patients were switched from NaCl to sodium acetate after an average of 3.4 ± 1.5 days of NaCl therapy. The ROC curve demonstrated that if patients received greater than 2055 mEq of chloride over 7 days, they were more likely to develop AKI (sensitivity 72%, specificity 70%; P = 0.002; area under the curve = 0.7). Conclusion and Relevance: Neurologically injured patients receiving hypertonic sodium therapy with a high chloride load are at risk of developing hyperchloremia and AKI.

Prevalencia de anticuerpos antimaláricos en donantes del banco de sangre del Hospital Universitario San Vicente de Paúl de Medellín, Colombia / Antimalaric antibodies prevalence in blood donors at the University Hospital San Vicent de Paul in Medellin, Colombia

Se determinó la prevalencia de anticuerpos antimaláricos, tipo IgG, mediante la técnica de inmunofluorescencia indirecta (IFI), en 392 sueros de donantes voluntarios de sangre del Hospital Universitario San Vicente de Paúl, recolectados durante los meses de septiembre y octubre del año 1995 y mantenidos en cogelación a -70ºC durante 36 meses. La prevalencia de seropositividad fue de 1,8 por ciento (7 donantes), de los cuales, tres tenían antecedentes de haber vivido en zona endémica para malaria; de éstos, dos habían sufrido malaria, por lo menos, una vez en la vida; los cuatro donantes restantes no habían vivido en zona endémica para la malaria ni tenían antecedentes de haberla padecido. Todos los donantes tuvieron gotas gruesas negativas para Plasmodium. Para tratar de reducir el riesgo de malaria transfusional, se recomienda informar en forma clara a los donantes sobre las áreas endémicas para malaria en el departamento, completar la encuesta que realizan los bancos de sangre con gota gruesa en todas la unidades de sangre que se vayan a transfundir y determinar anticuerpos antimaláricos en todos los donantes de riesgo con encuestas sospechosas y que puedan ser transmisores potenciales de Plasmodium