[Effect of the availability of a medicalized mobile ICU (MMICU) on the hospital admissions after an out-of-hospital cardiorespiratory arrest (OH-CRA)]. / Efecto de la disponibilidad de una UVI móvil medicalizada en los ingresos hospitalarios tras una parada cardiorrespiratoria extrahospitalaria.

Patients admitted in an ICU after OH-CRA before and after the implementation of a MMICU were evaluated. During a period of 11 years, divided into a pre-MMICU period (1988-1993) and a post-MMICU period (1994-1998), 39 patients were admitted in the pre period and 64 patients in the post period. The basal characteristics, the etiologies of OH-CRA and of death in ICU they were similar. The incidence of severe anoxic encephalopathy (SAE) it doubled in the post period. There were not significant differences both to the discharge from ICU and to the hospital discharge. We conclude that after implementing a MMICU more patients are admitted in ICU resuscitated after OH-CRA. The survival does not vary, but the incidence of SAE increases.

Efecto de la disponibilidad de una UVI móvil medicalizada en los ingresos hospitalarios tras una parada cardiorrespiratoria extrahospitalaria / Effect of the availability of a medicalized mobile ICU

Se analizaron pacientes (px) ingresados en UCI tras una parada cardiorrespiratoria extrahospitalaria (PCR-E) antes y después de implantar una UVI móvil medicalizada (UVIMM). Durante 11 años, divididos en período pre-UVIMM (1988-1993) y post-UVIMM (1994-1998), ingresaron 39 px en el período pre y 64 px en el post-UVIMM. Las características basales, las etiologías de PCR-E y de fallecimiento en UCI fueron similares. La incidencia de encefalopatía anóxica severa (EAS) se duplicó en el período post. No hubo diferencias significativas tanto al alta de UCI como al alta hospitalaria. Concluimos que tras implantar una UVIMM ingresan en UCI más px reanimados tras una PCR-E. La supervivencia no varía, pero aumenta la incidencia de EAS (AU)

Effectiveness and cost of selective decontamination of the digestive tract in critically ill intubated patients. A randomized, double-blind, placebo-controlled, multicenter trial.

We evaluated the effect of selective decontamination of the digestive tract (SDD) on the incidence of ventilator-associated pneumonia (VAP) and its associated morbidity and cost in a mixed population of intubated patients. Two hundred seventy-one consecutive patients admitted to the intensive care units (ICUs) of five teaching hospitals and who had an expected need for intubation exceeding 48 h were enrolled and received topical antibiotics or placebo. Uninfected patients additionally received ceftriaxone or placebo for 3 d. VAP occurred in 11.4% of SDD-treated and 29.3% of control-group patients (p < 0.001; 95% confidence interval [CI]: 7.8 to 27.9). The incidence of nonrespiratory infections in the two groups was 19.1% and 30.7%, respectively (p = 0.04; 95% CI: 0.7 to 22.7). Among survivors, the median length of ICU stay was 11 d (interquartile range: 7 to 21.5 d) for the SDD-treated group and 16. 5 d (10 to 30 d) for the control group (p = 0.006). Mean cost per survivor was $11,926 for treated and $16,296 for control-group patients. Mortality was 38.9% and 47.1%, respectively (p = 0.57). In decontaminated patients, the prevalence of gram-negative bacilli fell within 7 d from 47.4% to 13.0% (p < 0.001), whereas colonization with resistant gram-positive strains was higher (p < 0. 05) than in the placebo group. In a mixed population of intubated patients, SDD was associated with a significant reduction of morbidity at a reduced cost. Our findings support the use of SDD in this high-risk group.