BACKGROUND: SARS-CoV-2 seems to affect the regulation of pulmonary perfusion. Hypoperfusion in areas of well-aerated lung parenchyma results in a ventilation-perfusion mismatch that can be characterized using subtraction computed tomography angiography (sCTA). This study aims to evaluate the efficacy of oral sildenafil in treating COVID-19 inpatients showing perfusion abnormalities in sCTA. METHODS: Triple-blinded, randomized, placebo-controlled trial was conducted in Chile in a tertiary-care hospital able to provide on-site sCTA scans and ventilatory support when needed between August 2020 and March 2021. In total, 82 eligible adults were admitted to the ED with RT-PCR-confirmed or highly probable SARS-COV-2 infection and sCTA performed within 24 h of admission showing perfusion abnormalities in areas of well-aerated lung parenchyma; 42 were excluded and 40 participants were enrolled and randomized (1:1 ratio) once hospitalized. The active intervention group received sildenafil (25 mg orally three times a day for seven days), and the control group received identical placebo capsules in the same way. Primary outcomes were differences in oxygenation parameters measured daily during follow-up (PaO2/FiO2 ratio and A-a gradient). Secondary outcomes included admission to the ICU, requirement of non-invasive ventilation, invasive mechanical ventilation (IMV), and mortality rates. Analysis was performed on an intention-to-treat basis. RESULTS: Totally, 40 participants were enrolled (20 in the placebo group and 20 in the sildenafil group); 33 [82.5%] were male; and median age was 57 [IQR 41-68] years. No significant differences in mean PaO2/FiO2 ratios and A-a gradients were found between groups (repeated-measures ANOVA p = 0.67 and p = 0.69). IMV was required in 4 patients who received placebo and none in the sildenafil arm (logrank p = 0.04). Patients in the sildenafil arm showed a significantly shorter median length of hospital stay than the placebo group (9 IQR 7-12 days vs. 12 IQR 9-21 days, p = 0.04). CONCLUSIONS: No statistically significant differences were found in the oxygenation parameters. Sildenafil treatment could have a potential therapeutic role regarding the need for IMV in COVID-19 patients with specific perfusion patterns in sCTA. A large-scale study is needed to confirm these results. TRIAL REGISTRATION: Sildenafil for treating patients with COVID-19 and perfusion mismatch: a pilot randomized trial, NCT04489446, Registered 28 July 2020, https://clinicaltrials.gov/ct2/show/NCT04489446 .
COVID-19 Drug Treatment , COVID-19 , Sildenafil Citrate , Vasodilator Agents , Administration, Oral , Adult , Aged , COVID-19/physiopathology , Female , Humans , Male , Middle Aged , Pilot Projects , Sildenafil Citrate/administration & dosage , Treatment Outcome , Vasodilator Agents/administration & dosage , Ventilation-Perfusion Ratio
Objetive: to evaluate survival and quality of life in a group of patients admitted into a general intensive care unit (ICU) two years before, identifying factors, prognosis and differences by age groups. Design: prospective observational study. Location: general intensive care unit at a university hospital. Patients: 45 patients admitted between june and july 1999 and evaluated until august 2001. Measurements: information referring to age, sex, initial diagnosis, assessment according to the acute physiology and chronic health evaluation (APACHE) II, life quality survey upon admittance and telephone survey after two years, intrahospital mortality and postdischarge. Results: average age: 60. Older than 65:19 (42 percent). Males: 22 (49 percent). Intrahospital mortality: 12 (26 percent), mortality at 2 years: 21 (47 percent). Total mortality under age 65 versus over 65:10 to 9 (p0,7). Total mortality over age 80:100 percent (p 0,04). APACHE II average upon admittance: 14. APACHE II average of deceased at the hospital versus non deceased: 18 and 12 (p 0.03). APACHE II average of deceased during the study versus non deceased: 17 and 11 (p 0.002). Quality of life score upon admittance between those over and under 65:5.6 and 1.9 (p 0.002), daily life activities list between deceased and non deceased: 3,7 and 1.6 (p 0,023), 62 percent of the survivors (15 out of 24) maintained of improved their quality of life after two years of follow-up. Conclusions: A high mortality rate appeared throughout the two year follow-up. This was non related to age except for those patients over age 80. Those patients over age 65 had a worse quality of life upon admittance, while an indicator of greater mortality was a deterioration of day to day activities. Most of those that survived the two-year period were able to improve or maintain the quality of life level presented before admittance independently of the age group. APACHE II confirmed itself as a predictor of mortality, both intra and extrahospital
Humans , Male , Female , Middle Aged , Quality of Life , Survivors , Follow-Up Studies , Intensive Care Units
La evaluación en la calidad de vida que presentan los pacientes posterior a su estadía en UCI, tiende a ser en la actualidad el parámetro que evalúa la utilidad de las Unidades de Cuidados Intensivos. La no existencia de datos claros al respecto nos motivó a ubicar y luego utilizar una encuesta de fácil aplicación e interpretación que fuera reproducible intra e interlocutor. Esta encuesta fue aplicada a 47 pacientes que voluntariamente aceptaron responderla y que habían permanecido hospitalizados en la UCI de nuestro Hospital por más de 48 hrs, y fueron dados de alta 18 meses antes que se aplicara la encuesta. Los resultados obtenidos en los tópicos evaluados son comparables con los publicados en la escasa literatura que existe al respecto, y nos permite establecer un patrón de comparación para futuros estudios sobre el tema
Humans , Female , Male , Adult , Middle Aged , Intensive Care Units , Quality of Life , Activities of Daily Living , Health Surveys , Mental Health , Sickness Impact Profile
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
Humans , Male , Female , Adolescent , Adult , Middle Aged , Sepsis/diagnosis , Systemic Inflammatory Response Syndrome/diagnosis , Peritonitis/complications , Sepsis/etiology , Gram-Negative Bacteria/pathogenicity , Intensive Care Units , Clinical Evolution , Pneumonia/complications , Prognosis , Systemic Inflammatory Response Syndrome/etiology
Humans , Multiple Organ Failure/metabolism , Respiratory Distress Syndrome, Newborn/etiology , Sepsis/metabolism , Systemic Inflammatory Response Syndrome/metabolism , Acute Kidney Injury/diagnosis , Acute Kidney Injury/drug therapy , Acute Kidney Injury/etiology , Brain Diseases, Metabolic/diagnosis , Disseminated Intravascular Coagulation , Kidney Tubular Necrosis, Acute/etiology , Meningococcal Infections , Pancreatitis/diagnosis , Pancreatitis/etiology , Lung/physiopathology , Respiratory Distress Syndrome, Newborn/drug therapy
Entre 1987 y 1993 tratamos a 17 pacientes con traumatismo grave de extremidades por proyectiles de alta velocidad, la mayoría de ellos producto de entrenamiento militar. Once de ellos presentaron compromiso de las extremidades inferiores. La lesión vascular se acompañó de lesión ósea y de partes blandas en todo los casos. La conducta terapéutica fue fijación de la extremidad por medio de tutores externos, la reparación arterial con resección y anastomosis término terminal, o bien injerto de vena. safena o PTFE, este último en cinco casos. Venorrafia se efectuó en seis casos. La cobertura de partes blandas se hizo con rotación de colgajo cutáneo (cinco casos), injerto de latissimus dorsi utilizando anastomosis vascular con técnica microquirúrgica en dos ocasiones, y en diez con injerto cutáneo fenestrado. Se obtuvo recuperación funcional completa de catorce pacientes y en sólo uno de la serie se debió recurrir a una amputación mayor por fracaso de la revascularización e infección
Humans , Male , Adult , Arm Injuries/surgery , Leg Injuries/surgery , Wounds, Gunshot/surgery , Vascular Surgical Procedures/methods , Blood Vessels/injuries , Wounds, Gunshot/complications
En la última década se ha logrado disminuir la morbimortalidad por sepsis abdominal grave, probablemente como resultado de innovaciones en el tratamiento quirúrgico, mejoría en las técnicas de drenaje percutáneo con ayuda de imágenes y disponibilidad de nuevas drogas antimicrobianas. Sin embargo, el problema, lejos de estar resuelto, aún persiste, y debemos continuar su estudio y esperar los resultados en la investigación de terapia inmunológica con anticuerpos monoclonales, antifactor necrótico tisular y otros, como parte del futuro terapéutico en estos pacientes y que quizás vengan a cambiar no sólo la morbimortalidad en sepsis abdominal, sino los conceptos actuales de tratamiento
Sepsis/diagnosis , Anti-Bacterial Agents/therapeutic use , Antibodies, Monoclonal/therapeutic use , Laparotomy , Sepsis/drug therapy , Sepsis/surgery
Acute respiratory distress syndrome (ARDS) secondary to systemic injury has a high mortality. Symptomatic treatment with mechanical ventilation, PEEP and high levels of inspired oxygen is effective for most of the patients. When ventilatory support fails in reversing hypoxemia, extracorporeal respiratory assistance has been advocated as a temporary treatment until lung repair occurs. We described our experience in eleven patients (9M, 2F, 41ñ16 yo) with severe ARDS refractory to conventional treatment and expected to die if not assisted with extracorporeal oxugenation. All patients required invasive monitoring; seven needed continuous renal therapy because of concurrent renal failure. Venous-venous percutaneous cannulation and systemic anticoagulation were performed and axtracorporeal oxygenation and CO2 removal started with blood pump flows of 20 to 30 percent of patient cardiac output. Improved oxygenation and decreased CO2 levels were immediately observed in 10/11 patients. One patient failed to have reversal of hypoxemia because recirculation and died shortly after initiation of extracorporeal therapy. Plasma leak syndrome and bleeding were observed in 3 and 2 patients respectively. Extracorporeal assistance was mantained for 52ñ34 h (19-134). Five (45 percent) patients were weaned off the pump and two (18 percent) survived and were discharged. Despite the high cos, extracorporeal respiratory assistance, when applied to selected patients, can reverse hypoxia and may save some previously unsalvagable patients allowing them to return to a normal life
Humans , Male , Female , Adult , Middle Aged , Respiration, Artificial/methods , Respiratory Distress Syndrome/therapy , Acute Disease , Multiple Trauma/complications , Ventilators, Mechanical
Entre 1985 y 1989 tratamos a doce pacientes con traumatismo grave de extremidades por proyectiles de alta velocidad, la mayoría de ellos, producto de entrenamiento militar. Nueve de ellos presentaron compromiso de las extremidades inferiores. La lesión vascular se acompañó de lesión ósea y de partes blandas en todos los casos. La conducta terapéutica fue fijación de la extremidad por medio de tutores externos, la reparación arterial con resección y anastomósis término terminal, o bien injerto de vena safena o PTFE, este último en cinco casos. Venorrafia se efectúa en cinco casos. La cobertura de partes blandas se hizo con rotación de colgajo cutáneo (cuatro casos), injerto de latissimus dorsi utilizando anastomosis vascular con técnica microquirúrgica en una ocasión y en siete con injerto cutáneo fenestrado. Se obtuvo recuperación funcional completa de diez pacientes y en sólo una de la serie se debió recurrir a una amputación mayor por fracaso de la revascularización e infección
Humans , Male , Adult , Arm Injuries , Wounds, Gunshot , Leg Injuries , Vascular Surgical Procedures
Se mencionan las condiciones clínicas, hemodinámicas y metabólicas que condicionan el Síndrome de Falla Orgánica Múltiple (FOM) y se analizan los factores de riesgo que influyen en su desarrollo, haciendo énfasis en su prevención orientado al buen manejo hemodinámico, nutricional, ventilatorio y de la sepsis que habitualmente acompaña este cuadro
Humans , Preoperative Care , Multiple Organ Failure/surgery , Multiple Organ Failure/diagnosis , Multiple Organ Failure/physiopathology
