RESUMEN
BACKGROUND: Up to 25% of patients with acute pancreatitis develop severe complications and are classified as severe pancreatitis with a high death rate. To improve outcomes, patients may require interventional measures including surgical procedures. Multidisciplinary approach and best practice guidelines are important to decrease mortality. METHODS: We have conducted a retrospective analysis from a prospectively maintained database in a low-volume hospital. A total of 1075 patients were attended for acute pancreatitis over a ten-year period. We have analysed 44 patients meeting the criteria for severe acute pancreatitis and for intensive care unit (ICU) admittance. Demographics and clinical data were analysed. Patients were treated according to international guidelines and a multidisciplinary flowchart for acute pancreatitis and a step-up approach for pancreatic necrosis. RESULTS: Forty-four patients were admitted to the ICU due to severe acute pancreatitis. Twenty-five patients needed percutaneous drainage of peri-pancreatic or abdominal fluid collections or cholecystitis. Eight patients underwent endoscopic retrograde cholangiopancreatography for choledocholithiasis and biliary sepsis or pancreatic leakage, and one patient received endoscopic trans-gastric endoscopic prosthesis for pancreatic necrosis. Sixteen patients underwent surgery: six patients for septic abdomen, four patients for pancreatic necrosis and two patients due to abdominal compartment syndrome. Four patients had a combination of surgical procedures for pancreatic necrosis and for abdominal compartment syndrome. Overall mortality was 9.1%. CONCLUSION: Severe acute pancreatitis represents a complex pathology that requires a multidisciplinary approach. Establishing best practice treatments and evidence-based guidelines for severe acute pancreatitis may improve outcomes in low-volume hospitals.
Asunto(s)
Pancreatitis/cirugía , Grupo de Atención al Paciente , Enfermedad Aguda , Adulto , Anciano , Colangiopancreatografia Retrógrada Endoscópica , Coledocolitiasis/cirugía , Drenaje/métodos , Femenino , Hospitales de Bajo Volumen , Humanos , Unidades de Cuidados Intensivos , Masculino , Persona de Mediana Edad , Pancreatitis/complicaciones , Pancreatitis Aguda Necrotizante/cirugía , Guías de Práctica Clínica como Asunto , Estudios Retrospectivos , EspañaRESUMEN
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Asunto(s)
Humanos , Oxigenación por Membrana Extracorpórea/métodos , Síndrome de Dificultad Respiratoria/terapia , Resultado del Tratamiento , Ensayos Clínicos como Asunto , Teorema de BayesRESUMEN
Entre el 10 y el 50% de los enfermos ventilados mecánicamente en las unidades de cuidados intensivos (UCI) presentan neumonía asociada a la ventilación mecánica (NAVM). Dentro de las medidas preventivas destaca el papel de la descontaminación digestiva selectiva (DDS). En 1998 se desarrolló el protocolo y se inició la aplicación de la DDS en la UCI del Hospital de Getafe. La DDS se aplica a los pacientes que van a requerir ventilación mecánica más de 72 h o con enfermedad en la que se ha demostrado la eficacia de la DDS. La DDS consiste en: 1) administrar un ciclo corto de antibióticos por vía intravenosa; 2) administración oral de antibióticos no absorbibles en forma de solución digestiva y pasta en orofaringe y nariz; 3) medidas de higiene y aislamiento. Con la implementación de esta técnica se ha reducido la tasa de NAVM en un 71% en pacientes medicoquirúrgicos y un 29% en pacientes quemados, sin aumento significativo de los microorganismos multirresistentes
The incidence of ventilator-associated pneumonia (VAP) among mechanically ventilated patients in intensive care units (ICUs) is 10-50%. Notable among preventive measures is selective digestive decontamination (SDD). In 1998, a protocol for SDD was developed and implemented in the ICU of the Hospital Universitario de Getafe. SDD is administered to patients admitted to the ICU who require mechanical ventilation for more than 72 hours and to those with diseases in which the efficacy of SDD has been demonstrated. SDD administration consists of: 1) a short course of systemic antibiotics; 2) oral administration of a solution of non-absorbable antibiotics and topical application in the oropharynx and nose of a non-absorbable antibiotic paste; 3) hygiene and isolation measures. Use of this protocol reduced the rate of VAP by 71% in medical-surgical patients and by 29% in burn patients, without producing a significant increase in multiresistant microorganisms