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1.
Med Intensiva (Engl Ed) ; 43(1): 26-34, 2019.
Artigo em Inglês, Espanhol | MEDLINE | ID: mdl-29398167

RESUMO

INTRODUCTION: The goals of this project were to compare both the anatomic and physiologic severity scores in trauma patients admitted to intensive care unit (ICU), and to elaborate mixed statistical models to improve the precision of the scores. METHODS: A prospective study of cohorts. The combined medical/surgical ICU in a secondary university hospital. Seven hundred and eighty trauma patients admitted to ICU older than 16 years of age. Anatomic models (ISS and NISS) were compared and combined with physiological models (T-RTS, APACHE II [APII], and MPM II). The probability of death was calculated following the TRISS method. The discrimination was assessed using ROC curves (ABC [CI 95%]), and the calibration using the Hosmer-Lemeshows H test. The mixed models were elaborated with the tree classification method type Chi Square Automatic Interaction Detection. RESULTS: A 14% global mortality was recorded. The physiological models presented the best discrimination values (APII of 0.87 [0.84-0.90]). All models were affected by bad calibration (P<.01). The best mixed model resulted from the combination of APII and ISS (0.88 [0.83-0.90]). This model was able to differentiate between a 7.5% mortality for elderly patients with pathological antecedents and a 25% mortality in patients presenting traumatic brain injury, from a pool of patients with APII values ranging from 10 to 17 and an ISS threshold of 22. CONCLUSIONS: The physiological models perform better than the anatomical models in traumatic patients admitted to the ICU. Patients with low scores in the physiological models require an anatomic analysis of the injuries to determine their severity.


Assuntos
Escala de Gravidade do Ferimento , Unidades de Terapia Intensiva , Modelos Anatômicos , Modelos Biológicos , Modelos Estatísticos , Ferimentos e Lesões/mortalidade , APACHE , Adulto , Fatores Etários , Idoso , Calibragem , Distribuição de Qui-Quadrado , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Estudos Prospectivos , Curva ROC , Escore Fisiológico Agudo Simplificado
2.
Med Intensiva ; 39(5): 290-7, 2015.
Artigo em Espanhol | MEDLINE | ID: mdl-25444058

RESUMO

PURPOSE: The aims of this study were to determine the clinical characteristics of patients with urinary sepsis associated to ureteral calculi admitted to the Intensive Care Unit (ICU), and to identify predictors of mortality in the first 24 hours of admission. DESIGN: A retrospective observational study covering a 16-year period (2006-2011) was carried out. SETTING: The combined clinical/surgical ICU of a secondary-level University hospital. PATIENTS: All patients admitted to the ICU due to obstructive urinary sepsis. INTERVENTIONS: None. MAIN VARIABLES: We analyzed general clinical and laboratory test and urological data. The diagnostic technique, affected side, decompression technique, isolated microorganism and antibiotic therapy used were also considered. The assessment of risk factors was performed by multiple logistic regression analysis. RESULTS: A total of 107 patients admitted to the ICU were included in the study, with a mortality rate of 19.6%. The diagnosis was mainly established by ultrasound, and the most commonly used decompression technique was retrograde JJ stenting. Microorganisms were isolated in 48.6% of the patients. In total, 20.6% of the patients had bacteremia. Multivariate analysis found age, acute renal failure and the use of vasoactive drugs administered continuously for the first 24 hours of admission to be independently associated to mortality. CONCLUSIONS: Advanced age, acute renal failure and the need for vasoactive drugs were associated to an increased risk of mortality in patients with urinary sepsis associated to upper urinary tract calculi.


Assuntos
Pielonefrite/mortalidade , Cálculos Ureterais/complicações , Obstrução Ureteral/complicações , Doença Aguda , Injúria Renal Aguda/etiologia , Fatores Etários , Idoso , Comorbidade , Dopamina/uso terapêutico , Feminino , Infecções por Bactérias Gram-Negativas/etiologia , Infecções por Bactérias Gram-Negativas/mortalidade , Mortalidade Hospitalar , Humanos , Hidronefrose/etiologia , Unidades de Terapia Intensiva/estatística & dados numéricos , Masculino , Pessoa de Meia-Idade , Norepinefrina/uso terapêutico , Pielonefrite/etiologia , Pielonefrite/microbiologia , Estudos Retrospectivos , Fatores de Risco , Choque Séptico/etiologia , Choque Séptico/mortalidade , Espanha/epidemiologia
3.
Med Intensiva ; 39(1): 26-33, 2015.
Artigo em Espanhol | MEDLINE | ID: mdl-24612759

RESUMO

OBJECTIVE: A study is made to determine the characteristics of endotracheal intubation (ETI) procedures performed in an Intensive Care Unit, and to describe the associated severe complications and related risk factors. DESIGN: A prospective cohort study involving a 2-year period was carried out. SETTING: The combined clinical/surgical Intensive Care Unit in a secondary university hospital. PATIENTS: All ETIs carried out by intensivists were included. INTERVENTIONS: None. MAIN VARIABLES: We analyzed the data associated with the patient, the procedure and the postoperative complications after intubation. The study of risk factors was performed using multiple logistic regression analysis. RESULTS: Seventy-six percent of the ETIs were performed immediately. Most of them were carried out by Intensive Care Units residents (60%). A total of 34% of the procedures had severe complications, including respiratory (16%) or hemodynamic (5%) disorders, or both (10%). Three patients died (1%), and 2% of the subjects experienced cardiac arrest. Logistic regression analysis identified the following independent risk factors for complications: age (OR 1.1; 95% CI: 1.1-1.2), systolic blood pressure≤90mmHg (OR 3.0; 95% CI: 1.4-6.4) and SpO2≤90% (OR 4.4; 95% CI: 2.3-8.1) prior to intubation, the presence of secretions (OR 2.2; 95% CI: 1.1-4.6), and the need for more than one ETI attempt (OR 3.5; 95% CI: 1.4-8.7). CONCLUSIONS: ETI in Intensive Care Unit patients is associated with respiratory and hemodynamic complications. The independent risk factors associated with the development of complications were advanced age, hypotension and previous hypoxemia, the presence of secretions, and the need for more than one ETI attempt.


Assuntos
Unidades de Terapia Intensiva , Intubação Intratraqueal/efeitos adversos , Adulto , Fatores Etários , Idoso , Idoso de 80 Anos ou mais , Grupos Diagnósticos Relacionados , Feminino , Parada Cardíaca/etiologia , Parada Cardíaca/mortalidade , Hospitais Universitários , Humanos , Hipotensão/epidemiologia , Hipóxia/epidemiologia , Intubação Intratraqueal/estatística & dados numéricos , Masculino , Pessoa de Meia-Idade , Estudos Prospectivos , Curva ROC , Transtornos Respiratórios/etiologia , Transtornos Respiratórios/mortalidade , Fatores de Risco
4.
Med Intensiva ; 37(2): 83-90, 2013 Mar.
Artigo em Espanhol | MEDLINE | ID: mdl-22551489

RESUMO

OBJECTIVES: An analysis is made of the characteristics of patients younger than 14 years treated in an adult ICU (AICU), to determine the procedures and techniques required by such patients, and to evaluate the use of the Pediatric Index of Mortality (PIM) in stratifying severity. DESIGN: A retrospective observational study was carried out. SETTING: An AICU of a second level hospital. PATIENTS: We studied 130 patients aged from 1 month to 14 years (average age 6.1±4 years) treated in the AICU from January 1997 to December 2010. VARIABLES OF INTEREST: Clinical-demographic parameters, diagnosis, clinical procedures, PIM score, length of stay, transfer to pediatric ICU (PICU), and mortality. Classification by destination (AICU, PICU) and outcome (alive, dead). PIM and assessment of the diagnostic performance curve (ROC) for mortality. RESULTS: The average age of the patients was 6.1±4 years. Most common diagnoses: trauma (26.9%) and sepsis (22.3%). Main procedures: mechanical ventilation (58.5%), central venous line (74.6%) and vasoactive drugs (20%). A total of 64.6% were transferred to PICU, and the overall mortality was 13%. Patients who stayed in the AICU were older (8.2±4 vs 5.5±4 years, p<0.001), had low morbidity, and their stay was short (44.5±38 hours). The PIM score was significantly higher in the patients who died (60±20 AICU, 38±30 PICU) than in those who survived (4±1 AICU, 9±1 PICU) (p<0.001). ROC curve with AUC=0.91 (95%CI: 0.85 to 0.98). CONCLUSIONS: The PIM score can stratify severity and identify patients at an increased risk of death. Critical child care in the AICU requires the presence of adequate materials and the continuous learning of procedures adapted to pediatric patients in order to ensure adequate care.


Assuntos
Cuidados Críticos , Unidades de Terapia Intensiva , Índice de Gravidade de Doença , Adolescente , Fatores Etários , Criança , Pré-Escolar , Feminino , Humanos , Lactente , Masculino , Estudos Retrospectivos
5.
Med Intensiva ; 35(9): 539-45, 2011 Dec.
Artigo em Espanhol | MEDLINE | ID: mdl-21784561

RESUMO

PURPOSE: To determine the incidence and characteristics of mental disorders (MD) in the Intensive Care Unit (ICU), and to define a classification system adapted to the ICU environment. DESIGN: A retrospective, descriptive analysis. SETTING: Intensive Care Unit, Arnau de Vilanova Hospital in Lérida (Spain). PATIENTS: All patients with MD admitted during 5-year period (January, 1 2004 to December 31, 2008). MAIN VARIABLES: General variables included clinical-demographic data, diagnostic variables, procedures, severity score, length of stay and mortality. Specific variables included psychiatric history, screening for substance abuse, psychiatric assessment, monitoring and transfer to a psychiatric center. Classification of the MD was as follows: 1) acute substance intoxication (SI); 2) suicide attempts (SA); and 3) MD associated with the main diagnosis (AMD). RESULTS: A total of 146 patients had MD (7.8%); they were predominantly male (74%) and were younger than the general ICU population (43.9 vs. 55.3 years, p<0.001). The ICU stays of the patients with MDs were shorter (4 days vs. 7 days, p<0.001), and there was less hospital mortality (17.1 vs. 25%, p<0.05). They also showed a higher incidence of pneumonia (19.9 vs. 13.8%, p<0.05), but no differences in the level of severity were observed. The SI group (24.7%) contained the highest number of young people; the SA group (36.3%) showed a predominance of women; and the AMD (39%) group had the longest stays and the highest mortality. Psychiatric consultation was carried out mainly in the SA group (62.3%). CONCLUSIONS: MD is a relatively common problem in the ICU. Collaboration with the Psychiatry Department seldom occurs, but must be encouraged to develop fully integrated management of critical patients with MD.


Assuntos
Unidades de Terapia Intensiva , Transtornos Mentais/classificação , Adulto , Idoso , Transtornos de Ansiedade/epidemiologia , Grupos Diagnósticos Relacionados , Manual Diagnóstico e Estatístico de Transtornos Mentais , Feminino , Hospitais Universitários/estatística & dados numéricos , Humanos , Tempo de Internação , Masculino , Transtornos Mentais/epidemiologia , Pessoa de Meia-Idade , Transtornos do Humor/epidemiologia , Transtornos Psicóticos/epidemiologia , Estudos Retrospectivos , Espanha/epidemiologia , Transtornos Relacionados ao Uso de Substâncias/epidemiologia , Tentativa de Suicídio/estatística & dados numéricos
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