ABSTRACT
OBJECTIVES: High flow nasal cannula (HFNC) is frequently used in patients with acute respiratory failure, but there is limited evidence regarding predictors of therapeutic failure. The objective of this study was to assess diaphragmatic ultrasound criteria as predictors of failure to HFNC, defined as the need for orotracheal intubation or death. METHODS: Prospective cohort study including adult patients consecutively admitted to the critical care unit, from July 24 to October 20, 2020, with respiratory failure secondary to SARS-CoV-2 pneumonia who required HFNC. After 12 hours of HFNC initiation we measured ROX index (ratio of SpO2 /FiO2 to respiratory rate), excursion and diaphragmatic contraction speed (diaphragmatic excursion/inspiratory time) by ultrasound, both in supine and prone position. RESULTS: In total, 41 patients were analyzed, 25 succeeded and 16 failed HFNC therapy. At 12 hours, patients who succeeded HFNC therapy presented higher ROX index in supine position (9.8 [9.1-15.6] versus 5.4 [3.9-6.8], P < .01), and higher PaO2 /FiO2 ratio (186 [135-236] versus 117 [103-162] mmHg, P = .03). To predict therapeutic failure, the supine diaphragmatic contraction speed presented sensitivity of 89% and a specificity of 57%, while the ROX index presented a sensitivity of 92.8% and a specificity of 75%. CONCLUSIONS: Diaphragmatic contraction speed by ultrasound emerges as a diagnostic complement to clinical tools to predict HFNC success. Future studies should confirm these results.
Subject(s)
COVID-19 , Pneumonia , Respiratory Insufficiency , Adult , Humans , Cannula , SARS-CoV-2 , Oxygen Inhalation Therapy/methods , Prospective Studies , Critical Illness/therapy , COVID-19/therapy , Respiratory Insufficiency/diagnostic imaging , Respiratory Insufficiency/therapySubject(s)
Humans , Male , Middle Aged , Intussusception/diagnostic imaging , Intussusception/surgery , PolypsSubject(s)
Encephalitis, Varicella Zoster/diagnosis , Herpes Zoster/complications , Acyclovir/administration & dosage , Administration, Intravenous , Aged, 80 and over , Antiviral Agents/administration & dosage , Cerebrospinal Fluid/virology , Encephalitis, Varicella Zoster/drug therapy , Encephalitis, Varicella Zoster/virology , Female , HumansABSTRACT
Con el objetivo de determinar la frecuencia y los factores asociados a las rehospitalizaciones en adultos mayores del servicio de medicina de un hospital general de Lima (Perú) se realizó un estudio longitudinal. Se realizó una entrevista a los pacientes o cuidadores durante la hospitalización, además de recoger datos de la historia clínica. Luego del alta médica se les siguió por 30 días mediante llamadas telefónicas, para conocer la condición del paciente y si estuvo hospitalizado en algún centro de atención durante este periodo. Se incluyeron 276 pacientes adultos mayores, el 14% de ellos fueron rehospitalizados. Se encontró que la rehospitalización estuvo asociada a dependencia funcional (p=0,003), el diagnostico de neumonía al ingreso (p=0,045) y a la falta de control ambulatorio (p<0,001); este último factor además tuvo un RRa de 2,22 (IC95%: 1,23-3,22). En conclusión, el factor asociado más importante para la rehospitalización de adultos mayores es la falta de una visita de control posterior al alta.
In order to determine the frequency and factors associated to rehospitalization among elderly patients in a general hospital in Lima (Peru), a longitudinal study was conducted. An interview was administered to patients or care providers during their hospitalization, and data were collected from their medical records. After they were discharged from the hospital, they were followed up for 30 days through phone calls to become aware of their condition and if they were hospitalized at some health center during this period of time. 276 elderly patients were included, 14% of which were rehospitalized. It was found that rehospitalization was associated to functional dependency (p=0,003), pneumonia diagnosis upon admission (p=0,045) and lack of outpatient control (p<0,001); the latter having had RRa 2.22 (95% CI: 1,23-3,22). In conclusion, the most important associated factor in the rehospitalization of the elderly is the lack of control visits after being discharged.
Subject(s)
Aged , Aged, 80 and over , Female , Humans , Male , Middle Aged , Patient Readmission/statistics & numerical data , Hospitals , Longitudinal Studies , PeruABSTRACT
In order to determine the frequency and factors associated to rehospitalization among elderly patients in a general hospital in Lima (Peru), a longitudinal study was conducted. An interview was administered to patients or care providers during their hospitalization, and data were collected from their medical records. After they were discharged from the hospital, they were followed up for 30 days through phone calls to become aware of their condition and if they were hospitalized at some health center during this period of time. 276 elderly patients were included, 14% of which were rehospitalized. It was found that rehospitalization was associated to functional dependency (p=0,003), pneumonia diagnosis upon admission (p=0,045) and lack of outpatient control (p<0,001); the latter having had RRa 2.22 (95% CI: 1,23-3,22). In conclusion, the most important associated factor in the rehospitalization of the elderly is the lack of control visits after being discharged.
Subject(s)
Patient Readmission/statistics & numerical data , Aged , Aged, 80 and over , Female , Hospitals , Humans , Longitudinal Studies , Male , Middle Aged , PeruABSTRACT
Objetivo: Determinar la morbimortalidad de los pacientes mayores de 60 años que ingresan a la unidad de cuidados intensivos (UCI) de un hospital general. Material y métodos: Estudio descriptivo transversal. Se incluyeron pacientes que ingresaron a la UCI del Hospital Nacional Cayetano Heredia entre julio 2006 a diciembre 2009. Se recopilaron datos del archivo existente conformado por las hojas de epicrisis y las hojas de monitoreo ventilatorio y hemodinámico de la unidad. Resultados: La ocupación de camas por mayores de 60 años en UCI fue 38% comparado con 62% en menores de 60 (p=0,0001). La principal causa de ingreso a la unidad fue la insuficiencia respiratoria en 30,5%, las diez principales causas de ingreso y la intensidad del manejo fueron similares en ambos grupos. Existió más comorbilidad en adultos mayores [78,6%] que en jóvenes [54,5%] (p=0,071). La mortalidad en > 60 años fue 29%, en < 60 años 23,6%, en los subgrupos de 60-69 años fue 22,4%, de 70-79 años 35,9% y en >80 años 31,4% (p=0,04). Conclusiones: El 38% de pacientes en UCI son mayores de 60 años y éste porcentaje disminuye a medida que aumenta la edad. Las principales causas de ingreso son similares a los del grupo menor de 60 años, pero existe mayor mortalidad en los pacientes mayores especialmente en el grupo que ingresó con enfermedad más severa.
Objective: To determine the morbidity and mortality of patients older than 60 years of age admitted into an intensive care unit (ICU) of a general hospital. Methods: Descriptive cross-sectional study. Patients admitted from July 2006 to December 2009 were included. Data were gathered from the clinical charts and from registers of mechanical ventilation and hemodynamic monitoring of the unit. Results: Bed utilization was 38% for patients above 60 years of age compared to 62% for younger patients (p=0.0001). The main cause of admission was respiratory insufficiency in 30.5%. No age difference was observed in the tenth main causes of admission. Elder patients had more co-morbid conditions: 78.6% vs. 54.5%, p=0.071. Mortality rate in patients <60 years of age was 29%; it was 23.6% in patients < 60 years of age; 22.4% in the 60-69 years of age group; 35.9% in the 70-79 age group and 31.4% in the >80 years age group (p=0.04). Conclusions: 38% of patients admitted to the ICU were older than 60 years of age. There is no age difference in the main reasons for admission, but there is more mortality in older patients.
Subject(s)
Humans , Aged , Middle Aged , Morbidity , Mortality , Intensive Care Units , Epidemiology, Descriptive , Cross-Sectional StudiesABSTRACT
Se reporta un caso de un varón de 41 años, que presentó el diagnóstico de Leptospirosis más Pancreatitis, con hiperamilasemia prolongada, lo cual constituye una rara presentación. Se realiza el diagnóstico clínico, de imágenes y de laboratorio, el nivel de amilasas fue mayor que tres o cuatro veces el valor normal. Una variedad de signos y síntomas aparecen durante el curso de la infección por Leptospira, habiéndose documentado la presencia de Leptospira patoc en títulos de 1/100.
