Follow-up program after intensive care unit discharge. / Programa de seguimiento al alta de la unidad de cuidados intensivos.

INTRODUCTION: Patient follow-up after intensive care unit (ICU) discharge allows the early recognition of complications associated to post-intensive care syndrome (PICS). The aim of this project is to standardize outcome variables in a follow-up program for patients at risk of suffering PICS. METHODS: The Rehabilitation and Patient Follow-up Committee of the Argentine Society of Intensive Care Medicine (Sociedad Argentina de Terapia Intensiva, SATI) requested the collaboration of different committees to design the present document. A thorough search of the literature on the issue, together with pre-scheduled meetings and web-based discussion encounters were carried out. After comprehensive evaluation, the recommendations according to the GRADE system included in the follow-up program were: frequency of controlled visits, appointed healthcare professionals, basic domains of assessment and recommended tools of evaluation, validated in Spanish, and entire duration of the program. CONCLUSION: The measures herein suggested for patient follow-up after ICU discharge will facilitate a basic approach to diagnosis and management of the long-term complications associated to PICS.

The incidence and causes of death in a follow-up study of individuals with haemoglobin AS and AA.

A cohort of 574 black Adults (mean age 47 years with a range of 28-73 years) with sickle cell trait (haemoglobin AS) which had been age and sex matched with 1148 controls (haemoglobin AA) was monitored for 7 years. We found no evidence of excess mortality or differential causes of mortality between cases and controls. There were no case deaths related to kidney disease, splenic infarcts, or pregnancy. Reports in the literature have been inconsistent with regard to the health effects of sickle cell trait. These findings suggest that discrimination against trait carriers in terms of life insurance premiums and some job opportunities are unjustified.

An example of record linkage methods to monitor mortality and cancer incidence.

Linkage of New York State record systems was the key strategy in a restrospective cohort study with a 24-34 year followup interval. Parents of children with anencephaly or spina bifida and matched control parents were traced to determine the parents' cancer and death experience. Birth certificates for Upstate New York for 1945-55 were the source of the study groups. This report describes the methodology employed. The New York State Health Department's Cancer Registry and vital records, the State motor vehicle license files, and city and phone directories were searched for the most recent record indicating residence in Upstate New York, cancer incidence, or death.Among the parents of the 1,152 index children were 18,571 person-years of followup for mothers and 21,675 person-years for fathers. Among the 1,152 controls, there were 19,682 person-years of followup for mothers and 22,596 person-years for fathers. Although losses were larger than the optimal, a large proportion of the maximum possible person-years were obtained, regardless of the birth year of the index child. Patterns of loss to followup were similar for cases and controls.Record linkage techniques are especially applicable in followup studies if the risk factor is identifiiable from routinely collected information (for example, congenital neural tube defects listed on birth certificates) and the outcome is also identifiable from such records (for example, cancer registry certificate or death certificate). If the outcome is definitive, reported routinely and comprehensively, and stored on a machine-readable medium, use of a computerized record linkage design is very efficient. A major advantage of the design is that cases and controls are treated equally with respect to outcome ascertainment and followup, so that some potential biases are eliminated. Finally, the method is non-intrusive; the subjects are never contacted or interviewed. Strictly maintained confidentiality is, of course, required.

Hiperglucemia en el paciente neurocrítico / Hyperglycemia in neurocritical patients

Introducción. El enfermo neurocrítico desarrolla una respuesta a la lesión hipermetabólica e hipercatabólica. En tal circunstancia, aumentan las glucemias producto de la insulino resistencia propia del estrés metabólico. La hiperglucemia en estos pacientes, se asocia con un aumento de la morbilidad y mortalidad. Marco teórico. La actividad cerebral requiere un alto consumo energético, utilizando principalmente el 30% de la glucosa plasmática. El aporte de glucosa debe ser continuo, debido a que el cerebro no dispone de reservas.El gradiente entre los valores plasmáticos y cerebrales de glucosa es de 110-126 mg/dl, lo que sugiere puntos de corte más amplios en el control glucémico de estos pacientes. Se ha visto que una reducción drástica en los valores de glucemia por controles estrictos (<110 mg/dl) favorece un incremento en la relación lactatopiruvato y glutamato del cerebro, aumentando el daño cerebral. Argumentación. Se presentan distintos argumentos para el control de glucemias estricto (<110 mg/dl) versus el manejo convencional (<180 mg/dl). Se observó mayor incidencia de mortalidad asociada a hipoglucemias por controles estrictos con tratamiento intensivo de insulina. La Asociación Dietética Americana (ADA) recomienda para pacientes críticos que el nivel de glucosa debe mantenerse entre 140 y 180 mg/dl, en este punto coinciden guías americanas y europeas.Conclusión. Dado que los hallazgos de los estudios sugieren que el objetivo de normoglucemia no necesariamente beneficiaría al paciente y podría ser perjudicial, las publicaciones actuales no recomiendan el uso de objetivos glucémicos bajos en pacientes neurocríticos.

The epidemiology of sudden infant death in upstate New York: II: birth characteristics.

This study describes the epidemiology of sudden infant death syndrome (SIDS) among infants born during 1974 to upstate New York residents. Birth certificate characteristics for 184 SIDS cases are compared with those of 417 infants dying from other causes in the same age range, 7-365 days. The results confirm the following as infant risk factors: fall or winter birth, low birthweight for gestational age, twin birth, and live birth order three or more. Maternal risk factors include: age under 20, abnormal uterine bleeding during pregnancy, late initiation of prenatal care, less than 12 years of education and single marital status. The increased risk for mothers who first gave birth in their teens and for second-born twins has not been previously reported. The evidence that SIDS babies are small for gestational age, that twins, especially the second born, and babies whose mothers experienced abnormal uterine bleeding during pregnancy are all at increased risk of SIDS suggests that perinatal stress leading to hypoxia is one of the components that determine the risk of SIDS.

The epidemiology of sudden infant death in upstate New York.

The epidemiology of sudden infant death among infants born during 1974 to mothers residing in upstate New York was studied. Death-certificate characteristics for 190 infants with sudden infant death syndrome (SIDS) are compared with those for 434 infants dying of other causes in the same age range. The overall incidence of SIDS was 1.43 per 1,000 live births. No relationship was found between SIDS rate and population density. The SIDS deaths peaked in January, with an overall seasonal pattern compatible with that of viral respiratory infections. The SIDS infants were more likely to die during sleeping hours than infants dying suddenly of other causes. Their age at death distribution is significantly different from that of other infant deaths. Progress in understanding sudden death in infancy is still hampered by the lack of positive diagnostic criteria.