Percutaneous Dilatational Tracheostomy in a Cardiac Surgical Intensive Care Unit: A Single-Center Experience.

Background: A significant proportion of cardiac surgery intensive care unit (CSICU) patients require long-term ventilation, necessitating tracheostomy placement. The goal of this study was to evaluate the long-term postoperative outcomes and complications associated with percutaneous dilatational tracheostomy (PDT) in CSICU patients. Methods: All patients undergoing PDT after cardiac, thoracic, or vascular operations in the CSICU between January 1, 2013 and January 1, 2021 were identified. They were evaluated for mortality, decannulation time, and complications including bleeding, infection, and need for surgical intervention. Multivariable regression models were used to identify predictors of early decannulation and the complication rate. Results: Ninety-three patients were identified for this study (70 [75.3%] male and 23 [24.7%] female). Furthermore, 18.3% of patients had chronic obstructive pulmonary disease (COPD), 21.5% had history of stroke, 7.5% had end-stage renal disease, 33.3% had diabetes, and 59.1% were current smokers. The mean time from PDT to decannulation was 39 days. Roughly one-fifth (20.4%) of patients were on dual antiplatelet therapy and 81.7% had anticoagulation restarted 8 hours post-tracheostomy. Eight complications were noted, including 5 instances of bleeding requiring packing and 1 case of mediastinitis. There were no significant predictors of decannulation prior to discharge. Only COPD was identified as a negative predictor of decannulation at any point in time (hazard ratio, 0.28; 95% confidence interval, 0.08-0.95; p=0.04). Conclusion: Percutaneous tracheostomy is a safe and viable alternative to surgical tracheostomy in cardiac surgery ICU patients. Patients who undergo PDT have a relatively short duration of tracheostomy and do not have major post-procedural complications.

Determinación de cistatina C como marcador de función renal en pacientes normo albuminúricos con Diabetes Mellitus tipo 2 / Determination of cystatin C as a marker of renal function in normoalbuminuric patients with

Antecedentes: la identificación temprana del deterioro de la función renal es crucial en los pacientes diabéticos. Clínicamente la cistatina C sérica podría ser el indicador más sensible de tasa de filtrado glomerular. Objetivo: proponer el uso de cistatina C como prueba de rutina para evaluar la función renal en pacientes diabéticos tipo 2. Metodología: se realizó un estudio observacionalde corte transversal en 115 pacientes diabéticos tipo 2 normo albuminúricos, estableciendo la tasa de filtrado glomerular con valores de cistatina C y fórmula de Cockroft–Gault. A aquellos con un filtrado glomerular < 60 ml/min se realizó depuración de creatinina en orina de 24 horas; y se comparó los resultados con el programa estadístico SPSS 17, presentando los datos entablas de contingencia con análisis de riesgo y test de significancia de X2. Resultados: la tasa de filtrado glomerular obtenida con cistatina C, tuvo un valor promedio de 99ml/min±19.07, mientras que la de Cockroft-Gault un valor de 79.85ml/min±23.63 reflejando mejor correlación con aclaramiento de creatinina en orina de 24 horas que obtuvo un valor de 74.95ml/min±37.41.Al relacionar los valores con la depuración de creatinina en orina de 24 horas, no hubo una relación significativa entre ambos parámetros (p=0.14). Conclusión: la tasa de filtrado glomerular con cistatina C presenta una gran dispersión en la correlación conla depuración de creatinina en orina de 24 horas; este hecho, junto a diversos factores que influyen en su variabilidad, y el mayor coste de su determinación, hacen poco justificable su uso para valorar función renal.

Background: early identification of renal function impairment is crucial in diabetic patients. Clinically, serum cystatin C may be the most sensitive indicator of the glomerular filtration rate. Objective: to propose the use of cystatin C as a routine test to evaluate kidney function in type 2 diabetic patients. Methodology: an observational cross sectional study was done with 115 normoalbuminurictype 2 diabetic patients, establishing the glomerular filtration rate using cystatin C values and the Cockcroft-Gault formula. For those with a glomerular filtration rate <60 ml/min, a 24-hour creatinine clearance in urine test was performed, and the results were compared using SPSS 17, presenting the data in contingency tables with risk analysis and significance tests of X2. Results: the glomerular filtration rate obtained with cystatin C had a mean value of 99ml/min±19.07, while that obtained with the Cockroft-Gault formula was 79.85ml/min±23.63, which showed better correlation with the 24-hour creatinine clearance test with a value of 74.95ml/min±37.41. Neither parameter showed a significant relationship with the 24-hour creatinine clearance test values (p = 0.14). Conclusion: the glomerular filtration rate obtained using cystatin C has a large dispersion when correlated with the 24-hour creatinine clearance in urine test values. This fact, together with the different factors influencing its variability and the higher cost of its determination; result in little justification for its use in assessing renal function