Implantación de un equipo de asistencia al trauma grave. Análisis de la activación y tiempos de asistencia en pacientes ingresados en UCI / Implementation of a severe trauma assistance team: Analysis of activation and attendance times in patients admitted to the ICU

Objetivo Analizar los factores asociados a la activación del equipo de asistencia al trauma grave (EATG) en pacientes que ingresan en la Unidad de Cuidados Intensivos (UCI), medir su repercusión en los tiempos de asistencia, y analizar los grupos de pacientes según activación y nivel de afectación anatómica. Diseño Estudio de cohortes prospectivo del trauma grave que ingresan en UCI. Desde junio 2017 a mayo 2019. Factores de riesgo de la activación analizados con regresión logística y árbol de clasificación tipo CART. Ámbito UCI hospital de segundo nivel. Pacientes Pacientes ingresados de forma consecutiva. Intervenciones Ninguna. Variables de intereses principales Activación del EATG. Variables demográficas. Puntuación de la gravedad de la lesión (ISS), intencionalidad, mecanismo, tiempos de asistencia, complicaciones evolutivas y mortalidad. Resultados Ingresaron un total de 188 pacientes (46,8% de activación EATG), edad mediana de 52 (37-64) años (activados 47 (27-62) vs. no activados 55 (42-67) p = 0,023), varones 84,0%. No diferencias en la mortalidad según activación. El modelo logístico encuentra como factores: la atención (16,6 [2,1-13,2]) e intubación prehospitalaria (4,2 [1,8-9,8]) y, la lesión grave de extremidades inferiores (4,4 [1,6-12,3]). Padecer una caída accidental (0,2 [0,1-0,6]) hace menos probable la activación. El modelo CART selecciona el tipo de mecanismo del traumatismo y es capaz de separar los traumatismos de alta y baja energía. Conclusiones Los factores asociados con activación del ETAG fueron la atención prehospitalaria, requerir intubación previa, mecanismos de alta energía y lesiones graves de extremidades inferiores. Menores tiempos de asistencia si activación sin influir en la mortalidad. Debemos mejorar la activación en pacientes mayores con traumatismos de baja energía y sin atención prehospitalaria (AU)

Objective To analyse the factors associated with the activation of the severe trauma care team (STAT) in patients admitted to the ICU, to measure its impact on care times, and to analyse the groups of patients according to activation and level of anatomical involvement. Design Prospective cohort study of severe trauma admitted to the ICU. From June 2017 to May 2019. Risk factors for the activation of the STAT analysed with logistic regression and CART type classification tree. Setting Second level hospital ICU. Patients Patients admitted consecutively. Interventions No. Main variables of interest STAT activation, demographic variables, injury severity (ISS), intentionality, mechanism, assistance times, evolutionary complications, and mortality. Results A total of 188 patients were admitted (46.8% of STAT activation), median age of 52 (37–64) years (activated 47 (27–62) vs. not activated 55 (42–67), p = 0.023), males 84.0%. No difference in mortality according to activation. The logistic model finds as factors: care (16.6 (2.1–13.2)) and prehospital intubation (4.2 (1.8–9.8)) and severe lower extremity injury (4.4 (1.6–12.3)). Accidental fall (0.2 (0.1–0.6)) makes activation less likely. The CART model selects the type of trauma mechanism and can separate high and low energy trauma. Conclusions Factors associated with STAT activation were prehospital care, requiring prior intubation, high-energy mechanisms, and severe lower extremity injuries. Shorter care times if activated without influencing mortality. We must improve activation in older patients with low-energy trauma and without prehospital care (AU)

Occult donor metastatic adenocarcinoma. Contribution of the forensic autopsy. A case report.

BACKGROUND: The transmission of malignancies from the organ donor to the recipients is an uncommon complication, but it can be fatal. Older donors may increase the risk of tumor transmission. A forensic autopsy will help identify diseases that might be transmitted to the recipient. CASE REPORT: Donor was a 75-year-old man with traumatic brain injury caused by an accidental fall, which led to brain death. He had no previous cancer history. The forensic autopsy conducted on the following day revealed a suspicious spot in the lung, on which a biopsy was done. Histological examination confirmed the presence of a metastatic adenocarcinoma in the lung 7 days after both kidneys had been transplanted. After notifying the transplant team, both recipients underwent an early transplant nephrectomy. 15 months later, no signs of malignancy have been detected in the recipients and so they have received a new transplant. CONCLUSIONS: Conducting a forensic autopsy on donors deceased as a result of a fatality offers an additional opportunity to detect previously undiagnosed malignancies. Any suspicious lesion found that could compromise transplant viability should be notified to the transplant team notwithstanding the pathologist's legal requirements. This case shows the need for an exhaustive donor evaluation, including, in selected cases, the performance of an autopsy.

[Recall and memory after intensive care unit stay. Development of posttraumatic stress disorder]. / Recuerdos y memoria del paciente crítico a largo plazo. Desarrollo de estrés postraumático.

BACKGROUND AND OBJECTIVE: The intensive care unit (ICU) confers a stress on patients and may affect the memory. The aim of the study was to examine the memory after critical care and the relationship with therapy and the development of posttraumatic stress disorder. PATIENTS AND METHOD: Prospectively study conducted between December 2001 and June 2003. Patients were excluded if language difficulties or had a neurologic or psychiatric disease. We collected data on gender and age, length of stay in the ICU, severity of acute illness, diagnoses and medical treatment with mechanical ventilation, propofol, midazolam and dopamine during the ICU stay. 12 months after ICU eligible patients were contacted to assess memory. The ICUM (Intensive Care Memory) tool and IES (Impact Event Scale) were used to assess memory and posttraumatic stress disorder. RESULTS: A total of 169 patients were included. The incidence of memory was 77.6%. 41 patients recalled delusional memories and these patients had higher IES after discharge. The logistic regression suggested a relationship with propofol, dopamine and length of stay. CONCLUSIONS: ICU treatment may be related more to recall of delusions. The delusional memory is associated with posttraumatic stress disorder symptoms after ICU.

Recuerdos y memoria del paciente crítico a largo plazo. Desarrollo de estrés postraumático / Recall and memory after intensive care unit stay. Development of posttraumatic stress disorder

Fundamento y objetivo: Ingresar en una unidad de cuidados intensivos (UCI) provoca estrés que afecta a la memoria del paciente. El objetivo del presente estudio ha sido evaluar la memoria de los pacientes tras su estancia en la UCI y la influencia del tratamiento, además de examinar la relación entre memoria y síntomas de estrés postraumático. Pacientes y método: Se ha realizado un estudio prospectivo, que incluyó consecutivamente a los pacientes ingresados en la UCI del Hospital Universitario Arnau de Vilanova de Lleida entre diciembre de 2001 y junio de 2003. Se excluyó a los pacientes de nacionalidades distintas de la española y a los que presentaban alteraciones neurológicas o psiquiátricas. Se recogieron datos de filiación, estancia en UCI y hospitalaria, gravedad, diagnóstico principal y variables clínicas como ventilación mecánica, uso de dopamina y sedantes. A los 12 meses se realizó una entrevista programada en la que se recogieron las vivencias experimentadas en UCI según la herramienta ICUM (Intensive Care Unit Memory) y la escala de impacto del estresor (EIE) para evaluación de estrés postraumático. Resultados: Se incluyó a 169 pacientes. El 77,6% tenía algún recuerdo. Un total de 41 pacientes refirieron memoria ilusoria con EIE significativamente más alto que el resto de pacientes. El modelo de regresión logística múltiple demostró como factores predictores independientes de memoria ilusoria el tratamiento con propofol o con dopamina y la estancia hospitalaria. Conclusiones: El tratamiento recibido en la UCI puede favorecer la memoria ilusoria. La alteración de los recuerdos con aumento de la memoria ilusoria puede tener consecuencias psicológicas a largo plazo

Background and objective: The intensive care unit (ICU) confers a stress on patients and may affect the memory. The aim of the study was to examine the memory after critical care and the relationship with therapy and the development of posttraumatic stress disorder. Patients and method: Prospectively study conducted between December 2001 and June 2003. Patients were excluded if language difficulties or had a neurologic or psychiatric disease. We collected data on gender and age, length of stay in the ICU, severity of acute illness, diagnoses and medical treatment with mechanical ventilation, propofol, midazolam and dopamine during the ICU stay. 12 months after ICU eligible patients were contacted to assess memory. The ICUM (Intensive Care Memory) tool and IES (Impact Event Scale) were used to assess memory and posttraumatic stress disorder. Results: A total of 169 patients were included. The incidence of memory was 77.6%. 41 patients recalled delusional memories and these patients had higher IES after discharge. The logistic regression suggested a relationship with propofol, dopamine and length of stay. Conclusions: ICU treatment may be related more to recall of delusions. The delusional memory is associated with posttraumatic stress disorder symptoms after ICU