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1.
Rev. méd. Chile ; 135(5): 620-630, mayo 2007. graf, tab
Artigo em Espanhol | LILACS | ID: lil-456679

RESUMO

Background: Severe sepsis (SS) is the leading cause of death in the Intensive Care Units (ICU). Aim: To study the prevalence of SS in Chilean ICUs. Material and methods: An observational, cross-sectional study using a predesigned written survey was done in all ICUs of Chile on April 21st, 2004. General hospital and ICU data and the number of hospitalized patients in the hospital and in the ICU at the survey day, were recorded. Patients were followed for 28 days. Results: Ninety four percent of ICUs participated in the survey. The ICU occupation index was 66 percent. Mean age of patients was 57.7+18 years and 59 percent were male, APACHE II score was 15+7.5 and SOFA score was 6+4. SS was the admission diagnosis of 94 of the 283 patients (33 percent) and 38 patients presented SS after admission. On the survey day, 112 patients fulfilled SS criteria (40 percent). APACHE II and SOFA scores were significantly higher in SS patients than in non SS patients. Global case-fatality ratio at 28 days was 15.9 percent (45/283). Case-fatality ratio in patients with or without SS at the moment of the survey was 26.7 percent (30/112) and 8.7 percent (17/171), respectively p <0.05. Thirteen percent of patients who developed SS after admission, died. Case-fatality ratios for patients with SS from Santiago and the other cities were similar, but APACHE II score was significantly higher in patients from Santiago. In SS patients, the independent predictors of mortality were SS as cause of hospital admission, APACHE II and SOFA scores. Ninety nine percent of SS patients had a known sepsis focus (48 percent respiratory and 30 percent abdominal). Eighty five patients that presented SS after admission, had a respiratory focus. Conclusions: SS is highly prevalent in Chilean ICUs and represents the leading diagnosis at admission. SS as cause of hospitalization, APA CHE II and SOFA scores were independent predictors of mortality.


Assuntos
Adolescente , Adulto , Idoso , Idoso de 80 Anos ou mais , Criança , Pré-Escolar , Feminino , Humanos , Lactente , Recém-Nascido , Masculino , Pessoa de Meia-Idade , Unidades de Terapia Intensiva , Sepse/epidemiologia , Chile/epidemiologia , Métodos Epidemiológicos , Insuficiência de Múltiplos Órgãos/epidemiologia , Sepse/microbiologia , Sepse/mortalidade
2.
Rev. méd. Chile ; 133(7): 761-766, jul. 2005. ilus, tab
Artigo em Espanhol | LILACS | ID: lil-429134

RESUMO

Background: Cardiac output can be measured non invasively by transesophageal Doppler. This is an alternative to measure it by thermodilution with a catheter in the pulmonary artery. Aim: To compare both methods of cardiac output measurement. Material and methods: Simultaneous measurement of cardiac output by transesophageal Doppler and thermodilution with a catheter in the pulmonary artery in four male critical patients, aged 60±12 years, hospitalized in a University Hospital. The Bland and Altman method to compare the concordance between two measurements, was used. Results: Forty measurements were performed. The results of both methods had a correlation coefficient of 0.98. According to the Bland and Altman method, the difference between both methods was -0.5 L with a precision of 0.52 L/min (95% confidence interval -1.51 to 0.52 L/min). Considering that a change between two sequential measurements is considered significant when the difference is more than 15%, both measurements agreed in 83% of cases, that there was a change in cardiac output. Conclusions:Transesophageal Doppler is a promising non invasive technique to measure cardiac output in critical care patients. It becomes a valid alternative to the thermodilution technique. This preliminary experience must be confirmed in a larger series.


Assuntos
Humanos , Masculino , Pessoa de Meia-Idade , Débito Cardíaco/fisiologia , Cateterismo de Swan-Ganz , Ecocardiografia Doppler/métodos , Ecocardiografia Transesofagiana/métodos , Termodiluição/métodos , Cuidados Críticos , Ecocardiografia Doppler/normas , Ecocardiografia Transesofagiana/normas , Estudos Prospectivos , Termodiluição/normas
3.
Rev Med Chil ; 133(4): 447-52, 2005 Apr.
Artigo em Espanhol | MEDLINE | ID: mdl-15953952

RESUMO

Malignant middle cerebral territory infarction represents 5 to 10% of all brain infarctions. Its mortality is 80%, due to brain herniation and it is not reduced by medical treatment. Decompressive hemicraniectomy reduces mortality to 12%, and the subsequent quality of life of patients is acceptable. We report two male patients aged 61 and 54 years, with a malignant middle cerebral territory infarction who were treated with decompressive hemicraniectomy. After two years of follow up, both patients are self-sufficient and live at home with their families.


Assuntos
Craniotomia/métodos , Descompressão Cirúrgica , Infarto da Artéria Cerebral Média/cirurgia , Hipertensão Intracraniana/cirurgia , Humanos , Infarto da Artéria Cerebral Média/diagnóstico , Masculino , Pessoa de Meia-Idade , Qualidade de Vida , Tomografia Computadorizada por Raios X
4.
Rev. méd. Chile ; 133(4): 447-452, abr. 2005. ilus, tab
Artigo em Espanhol | LILACS | ID: lil-417383

RESUMO

Malignant middle cerebral territory infarction represents 5 to 10 percent of all brain infarctions. Its mortality is 80 percent, due to brain herniation and it is not reduced by medical treatment. Decompressive hemicraniectomy reduces mortality to 12 percent, and the subsequent quality of life of patients is acceptable. We report two male patients aged 61 and 54 years, with a malignant middle cerebral territory infarction who were treated with decompressive hemicraniectomy. After two years of follow up, both patients are self-sufficient and live at home with their families.


Assuntos
Humanos , Feminino , Pessoa de Meia-Idade , Craniotomia/métodos , Descompressão Cirúrgica , Infarto da Artéria Cerebral Média/cirurgia , Infarto da Artéria Cerebral Média/diagnóstico , Hipertensão Intracraniana/cirurgia
5.
Rev. méd. Chile ; 130(7): 787-791, jul. 2002. ilus, tab
Artigo em Espanhol | LILACS | ID: lil-323254

RESUMO

Vibrio vulnificus is a lactose positive Gram negative rod that lives in warm seas and can infect wounds and produce sepsis. Its infection is acquired after eating oysters or other filtering marine organisms. We report a 53 years old diabetic male who started with fever after a voyage to Central America. He was admitted febrile, hipotense, dehydrated and polypneic. Painful erythematous lesions and lumps were observed in his upper and lower limbs. After 72 hours of evolution, the lesions became violaceous, with crepitating vesicles full of hemorrhagic exudate. He developed a renal failure and a disseminated intravascular coagulation. Blood cultures demonstrated the presence of Vibrio vulnificus and the patient died 68 hours after admission


Assuntos
Humanos , Masculino , Pessoa de Meia-Idade , Vibrioses , Choque Séptico/microbiologia , Coagulação Intravascular Disseminada/microbiologia , Hepatite Alcoólica/complicações
6.
Rev. méd. Chile ; 128(12): 1343-8, dic. 2000. ilus, tab
Artigo em Espanhol | LILACS | ID: lil-281993

RESUMO

We report a 27 years old homosexual male with AIDS that was admitted to the ICU dehydrated, with fever and severe malaise. He had irregular bullae, an extensive purpuric exanthema and a zone of epidermic detachment in the right arm. A toxic epidermal necrolysis was diagnosed and therapy with i.v. immunoglobulins was started. After four days of treatment, bullous lesions disappeared and the extension of exanthema decreased. Toxic epidermal necrolysis is a potentially fatal disease and the use of intravenous immunoglobulins for this condition has been reported as successful


Assuntos
Humanos , Masculino , Adulto , Síndrome de Stevens-Johnson/tratamento farmacológico , Imunoglobulinas Intravenosas/farmacologia , Síndrome de Stevens-Johnson/diagnóstico , Síndrome de Stevens-Johnson/etiologia , Adjuvantes Imunológicos/farmacologia , Epidermólise Bolhosa/diagnóstico , Síndrome da Imunodeficiência Adquirida/complicações
8.
Rev. méd. Chile ; 127(11): 1339-44, nov. 1999. tab
Artigo em Espanhol | LILACS | ID: lil-257992

RESUMO

Background: in 1992, a consensus conference defined the terms systemic inflammatory response syndrome (SIRS), sepsis, severe sepsis and septic shock. Since then, numerous reports have validated the prognostic usefulness of these operative definitions. Aim: to evaluate if sepsis severity criteria, as defined by the Consensus Conference, can be applied to noninfectious SIRS. Patients and methods: five hundred eighteen patients admitted to 5 intensive care units (ICU) from 4 hospitals were prospectively evaluated during a 3 months period. Patients that met at least one severity criteria were included. SIRS etiology, organ dysfunction and evolution were recorded in each patient. Results: One hundred two patients were included: 79 with sepsis (group I) and 23 with noninfectious SIRS (group II). ICU and hospital mortality were comparable (43 and 48 percent in sepsis compared to 43 and 51 percent in non infectious SIRS). The most common sources of sepsis were pneumonia and peritonitis. Group II patients had a wide variety of diseases. ICU stay, APACHE score and number of organs with dysfunction were not different among groups. Only the incidence of renal dysfunction was higher in the septic group. Conclusions: The Consensus sepsis severity criteria can be applied to noninfectious SIRS, defining a population subset with similar high mortality and organ dysfunction incidence, although with greatly heterogeneous etiologies


Assuntos
Humanos , Masculino , Feminino , Adolescente , Adulto , Pessoa de Meia-Idade , Sepse/diagnóstico , Síndrome de Resposta Inflamatória Sistêmica/diagnóstico , Peritonite/complicações , Sepse/etiologia , Bactérias Gram-Negativas/patogenicidade , Unidades de Terapia Intensiva , Evolução Clínica , Pneumonia/complicações , Prognóstico , Síndrome de Resposta Inflamatória Sistêmica/etiologia
12.
Rev. méd. Chile ; 125(9): 1019-25, sept. 1997. tab, graf
Artigo em Espanhol | LILACS | ID: lil-208917

RESUMO

We retrospectively analyzed the mortality of 443 patients older than 65 years old, admitted to an intensive care unit between 1993 and 1994. The mortality was compared with that of 334 younger patients admitted in the same period. Severity of disease was determined using admission APACHE II score. Older patients had a higher admission APACHE score than younger subjects (18.4+- and 14.5+-8.7 respectively, p 0.01). Mortality during the intensive care unit stay was similar in older and younger patients (18.5 and 14.4 per cent, respectively). Hospital mortality was also similar (22.4 and 25.9 per cent respectively). Older patients had a higher frequency of chronic diseases and degree of functional impairment. Mortality rates for different diseases were also similar in older and younger patients. Older age was not associated with a higher mortality during intensive care unit stay. Prognosis is determined by the admission severity score and the number of concomitant chronic diseases


Assuntos
Humanos , Masculino , Feminino , Idoso , /estatística & dados numéricos , Taxa de Sobrevida/tendências , Unidades de Terapia Intensiva/estatística & dados numéricos , Saúde do Idoso , Admissão do Paciente/tendências
13.
Rev. méd. Chile ; 125(8): 931-3, ago. 1997.
Artigo em Espanhol | LILACS | ID: lil-207133

RESUMO

Critical care medicine was practiced informally during several years, specially during was periods. Nowadays it is, however, a fundamental part of health systems in which patients attain care facilities of increasing complexity in a cost effective manner, according to their needs. The importance of this discipline in Chile, durign its 30 years of developments, has progressively increased and at the present time, intensive care units represent up to 30 percent of the total number of beds in some hospitals. Even though these units requiere great budgets and many resources, teheir place and the role of physicians who work in them has not been recognized adquately by the national medical community. The present document presents the official position of the Chilean Society of Intensive Medicine on the general objectives of this discipline. It indicates the scope of action of the specialty and the role of intensive care physicians, their relationship with other specialties, their duties and responsibilities with their patients


Assuntos
Humanos , Responsabilidade Legal , Unidades de Terapia Intensiva/legislação & jurisprudência , Assistência ao Paciente , Ética Médica , Relações Médico-Paciente
14.
Rev. méd. Chile ; 125(3): 305-10, mar. 1997. tab
Artigo em Espanhol | LILACS | ID: lil-194832

RESUMO

The charts of all patients admitted to an intensive care unit of a University Hospital, during 1 year, were reviewed. The diagnosis that caused the admission was considered the main disease. Severity at the moment of admission was assesses using the Apache asore. A total of 777 patients were admitted during the study period. Twenty had to be excluded due to lack of reliable data. Four hundred thirty two (57 percent) were over 65 years old. Cardiovascular diseases were the main cause of admission in young and old patients. Mortality was 14,8 percent of patients over 65 years old and 18.7 percent in younger patients. Main causes of death were cardiac arrest, cardiogenic shock, sepsis and cerebrovascular disease. No differences in causes of death were observed between young and old patients. Patients older than 65 years old admitted to intensive care units are very similar to the younger counterparts in their prognosis and causes of admission


Assuntos
Humanos , Masculino , Feminino , Idoso , Unidades de Terapia Intensiva/estatística & dados numéricos , Admissão do Paciente/estatística & dados numéricos , Índice de Gravidade de Doença , Doenças Respiratórias/epidemiologia , Doenças Cardiovasculares/epidemiologia , Causas de Morte/tendências , Gastroenteropatias/epidemiologia , Idoso Fragilizado/estatística & dados numéricos
15.
Rev. méd. Chile ; 125(2): 195-9, feb. 1997. graf
Artigo em Espanhol | LILACS | ID: lil-194818

RESUMO

We report the case of a 42 years old male, with a bipolar disorder and receiving lithium therapy, valproic acid and clonazepam. Due to an exacerbation of his underlying disease, he was admitted to a psychiatric clinic and received 50 mg of intramuscular chlorpromazine in 2 ocasions. Afterwards, the patient had an alteration of conciousness, fever reaching 39ºC and generalized muscular rigidity. Laboratory work-up showed a normal brain CT scan, a diffuse slowness in the EEG and a creatinphosphokinase that reached values of 3.040 U/l. He was transferred to an intensive care unit and treated with sodium dantrolene and bromocriptine, obtaining a good clinical response


Assuntos
Humanos , Masculino , Adulto , Clorpromazina/efeitos adversos , Síndrome Maligna Neuroléptica/diagnóstico , Transtorno Bipolar/complicações , Antipsicóticos/efeitos adversos , Síndrome Maligna Neuroléptica/tratamento farmacológico
18.
Rev. méd. Chile ; 124(7): 813-9, jul. 1996. ilus, tab, graf
Artigo em Espanhol | LILACS | ID: lil-174908

RESUMO

Adult respiratory distress syndrome is highly prevalent in intensive care units and has a high mortality. Lately, nitric oxide has been used as adjuvant therapy. To study the effects of nitric oxide inhalation in patients with adult respiratory distress syndrome, 12 patients were subjected to nitric oxide inhalation at a concentration of 10 parts per million, during 30 minutes. At the end of the nitric oxide inhalation period, there was an improvement of PaO2/FIOa ratio from 89ñ32 to 111ñ43 mm Hg and 16 percent reduction of lung shunting (Qs/Qt). Nitric oxide inhalation at a concentration of 10 parts per million improved arterial oxygenation and reduced pulmonary shunting in patients with adult respiratory distress syndrome


Assuntos
Humanos , Masculino , Feminino , Adulto , Pessoa de Meia-Idade , Óxido Nítrico/farmacocinética , Síndrome do Desconforto Respiratório/terapia , Terapia Respiratória , Troca Gasosa Pulmonar/fisiologia , Hemodinâmica , Síndrome do Desconforto Respiratório/fisiopatologia
19.
Rev. méd. Chile ; 124(4): 442-7, abr. 1996. tab, graf
Artigo em Espanhol | LILACS | ID: lil-173354

RESUMO

To assess the acute effects of methylene blue infusion, an inhibitor of nitric oxyde synthesis, on hemodynamic parameters in patients with refractory septic shock. Fourteen patients admitted to intensive care units with septic shock of diverse etiologies and unable to maintain median arterial pressures over 60 mm Hg with the use of at least 2 vasoactive drugs, were studied. All received a 1 mg/kg bolus of methylene blue. Hemodinamic parameters were measured before and 30, 60, 120 and 180 min after the bolus. Systolic and diastolic blood pressure and systemic vascular resistance increased in all patients. There were no significant changes in cardiac output, oxygen consumption or extraction. Methylene blue has an acute pressor effect in patients with septic shock


Assuntos
Humanos , Masculino , Feminino , Adulto , Pessoa de Meia-Idade , Guanilato Ciclase/antagonistas & inibidores , Azul de Metileno/farmacologia , Óxido Nítrico/antagonistas & inibidores , Síndrome de Resposta Inflamatória Sistêmica/tratamento farmacológico , Resistência Vascular/efeitos dos fármacos , Vasoconstritores/farmacologia , Hemodinâmica , Pressão Sanguínea , Pressão Venosa Central , Protocolos Clínicos
20.
Rev. méd. Chile ; 124(1): 94-102, ene. 1996. tab, graf
Artigo em Espanhol | LILACS | ID: lil-173310

RESUMO

Inhalation therapy with nitric oxide has been suggested as beneficial in the adult respiratory distress syndrome, however there are few reports of its prolonged use. We report a patient with a chronic lymphocytic leukemia that developed an adult respiratory distress syndrome with severe hypoxemia, refractory to conventional therapeutic measures, during the course of a septic shock. The patient received nitric oxide (19 ppm) improving arterial oxygen saturation and allowing the reduction of FiO2 to 40 percent. The patient died 5 days later due to a multiple organ failure


Assuntos
Humanos , Masculino , Idoso , Óxido Nítrico/administração & dosagem , Síndrome do Desconforto Respiratório/terapia , Hemodinâmica , Leucemia Linfoide/complicações , Pressão Sanguínea , Choque Séptico/complicações
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