[The prognosis for the immunocompromised host in an intensive care unit. A report of 80 cases]. / Pronóstico del huésped inmunocomprometido en la Unidad de Terapia Intensiva. Informe de 80 casos.

An analysis of 80 immunocompromised patients who were admitted to the intensive care unit (ICU) was made. It was 3 different groups: those treated chronically with more than 20 mg of prednisone or it's equivalent, patients with severe neutropenia (-500 PMN'S/mm3) and patients with AIDS. The reasons for admittance to the ICU were: pneumonia (51.2%), postoperative care (30%) extrapulmonary sepsis (8.7%) and other causes in 10%. Mortality was 62.5%. It was statistically higher in those that were admitted for pneumonia, developed respiratory failure, and required postoperative care after emergency surgery (80%, 89.5% and 70% respectively). Also in patients with multiple organic failure (3.2 +/- 1.6 vs 0.9 +/- 1.2 in survivors) and with higher APACHE II score (24 +/- 7 vs 15.4 +/- 6 in survivors). The mortality for acute respiratory failure, the principal organic failure observed, according to the primary diagnosis was: AIDS 100%, severe neutropenia 85.7% and chronic use of steroids in 85.7% of the patients.

[Surgical risk and complications after major surgery in patients with cirrhosis]. / Riesgo quirúrgico y complicaciones después de cirugía mayor en pacientes con cirrosis.

In this study we report the morbidity and the mortality observed in 55 patients with cirrhosis who had a major surgical procedure between October 1986 and June 1988, as well as its relation with different variables. The overall mortality was 34.5% and it was due to multiple organ failure or bleeding because of coagulopathy in 18 of 19 patients. The preoperative variables associated with major mortality were: emergency surgery, classification 3 or 4 of the American Society of Anesthesiology (ASA) and poor hepatic reserve evaluated with the Child Turcotte classification (the mortality for A group was 16%, B 62%, and C 100%). The transoperative hypotension increased the mortality 4.5 times. In the postoperative period an elevated APACHE (Acute Physiologic and Chronic Health Evaluation) II score (mortality of 100% in those with greater than 20 points), multiple organic failure (100% died with 2 or more organ failures) or surgical reintervention in the patients with Child A increased significatively the mortality. The 24 patients who survived without complications were discharged on the 19th day (+/- 9 S.D.), while those with complications stayed during 46 days (+/- 18 S.D.).

[Cardio-respiratory complications after major abdominal surgery in elderly patients. Risk factors and prognosis]. / Complicaciones cardio-respiratorias después de cirugía abdominal mayor en pacientes ancianos. Factores de riesgo y pronóstico.

One hundred and eleven patients over 65 years of age underwent a major abdominal surgery between March 1986 and February 1987. The cardiorespiratory (CR) complications found were: cardiovascular (CV) failure 36%, post-operative myocardial infarction 5%, respiratory (R) failure 24%, pneumonia 11%. The overall mortality rate was 36%. The factors related with CV failure were: age over 75 years, ischemic cardiopathy, Goldman 3 and over, ASA III and over, cardiac failure, transoperatory hypotension and over 4 hours duration surgery. The ones related with myocardial infarction were: age over 75 years, Goldman 3 and over, ASA III and over, over 4 hours duration surgery and vital capacity (VC) less than 60%. For pneumonia the only related factor was VC less than 60%. For mortality, the factors found were Goldman 3 and over, ASA III and over and VC less than 60%. The mortality rate in patients without CR failure was 9%, with CV failure 35% (p less than 0.01), with R failure 33% and CR failure 90% (p less than 0.001).