[Bacteremia in the elderly: associated and prognostic factors]. / Bacteriemia en el anciano: factores asociados y pronósticos.

BACKGROUND: Bacteremia is associated with high morbidity and mortality rates and its prevalence increases with age. The objective of the present investigation was to know the epidemiology, associated factors and prognosis in patients with bacteremia in our environment and in relation with age. METHODS: Two hundred and twenty-nine episodes of bacteremia were prospectively studied; 97 (42%) cases corresponded to patients aged > 70 years. The prognostic factors were evaluated by the univariate and multivariate analysis in the whole cohort and univariate study of associated factors for an age > 70 years. RESULTS: The etiology, infectious sources, nosocomial acquisition, and complications apart from shock (p = 0.02) were similar in the elderly patients. The associations of diabetes (p = 0.05), COPD and/or heart disease (p = 0.01), and exitus were higher for patients > 70 years. The main independent prognostic factor in the series was disseminated intravascular coagulation (p < 0.001, multivariate OR 14.2). CONCLUSIONS: Patients older than 70 years have a higher incidence of shock and mortality associated with infection. The higher overall mortality rate in the series was associated with disseminated intravascular coagulation and multisystemic failure irrespective of age.

[Pulse-oximetry monitoring during endoscopy of the upper digestive tract and chronic obstructive lung disease]. / Monitorización con pulsioximetría durante la endoscopia digestiva alta y enfermedad pulmonar obstructiva crónica.

BACKGROUND: During upper digestive endoscopy arterial desaturations occur which may favour cardiopulmonary complications; therefore, monitoring and oxygen administration to risk patients is recommended. The aim of this study was to evaluate desaturations occurring during endoscopy and whether there are differences between patients with or without prior obstructive respiratory pathology. METHODS: A total of 119 consecutive patients undergoing upper digestive endoscopy were studied. The clinical history and simple spirometry were obtained before endoscopy; during endoscopy, a continuous monitoring of oxygen saturation and heart rate with pulse oximetry. RESULTS: Forty-six patients (38.7%) had oxygen saturations lower than 90% (Group I). Patients were significantly older and FEV-1, FVC, FEF 25-75, and FEV-1/FVC significantly lower among patients in Group I than among the 73 patients (61.3%) with no oxygen desaturation (Group II). A Tiffenau index lower than 70% was not a good predictor for oxygen desaturation during endoscopy. CONCLUSIONS: Pulse-oximetry monitoring during upper digestive endoscopy is recommended and particularly in patients with obstructive respiratory conditions and/or advanced age.