[Severe lactic acidosis in a pregnant woman with partial HELLP syndrome and COVID-19]. / Acidosis láctica grave en una mujer embarazada con síndrome HELLP parcial y COVID-19.

The present report describes the case of a 23-year old pregnant woman who was in the 36.5th week of gestation of her second pregnancy. She was attended at the emergency room because of dry cough and progressive dyspnea, in association with headache and myalgia. The nasopharyngeal swab for SARS-CoV-2 polymerase chain reaction (PCR) was positive. Oxygen saturation and chest x-ray were normal. Laboratory tests showed elevated values of bilirubin, aminotransferases, alkaline phosphatase and lactic dehydrogenase, and mild thrombocytopenia. Shortly after being admitted she began with labor. Faced with the lack of progression, the termination of the pregnancy by cesarean section was decided. Arterial blood gases showed severe lactic acidosis. She never presented evidence of clinical signs of tissue hypoperfusion or sepsis that could explain it. The patient completed her postoperative period in the intensive care unit, undergoing supportive treatment. All laboratory parameters were normalized after 72 hours, evolving favorably from the clinical point of view. It was interpreted that she had a partial HELLP syndrome. Lactic acidosis is not a component of this syndrome. Nor can it be ascribed to a mild disease by SARS-Cov-2. It probably responded to a summation of causes, including hyperproduction of lactic acid during labor, as well as its reduced clearance because of liver dysfunction related to HELLP syndrome.

Se presenta el caso de una mujer embarazada secundigesta, cursando la semana 36.5 de gestación, que concurrió a guardia general por tos seca y disnea progresiva de 3 días de evolución, asociadas a cefalea y mialgias. Se realizó hisopado nasofaríngeo para reacción en cadena de la polimerasa (PCR) para SARS-CoV-2, resultando positivo. La saturación de oxígeno era normal, al igual que la radiografía de tórax. En el laboratorio presentó elevación de bilirrubina, transaminasas, fosfatasa alcalina y LDH, además de plaquetopenia leve. Poco después de su ingreso, comenzó con trabajo de parto. Frente a la falta de progresión del mismo se decidió la finalización del embarazo por cesárea. La gasometría arterial reveló la presencia de acidosis láctica grave. Nunca hubo evidencia clínica de hipoperfusión tisular o sepsis que pudieran explicarla. Cursó su postoperatorio en la unidad de terapia intensiva, realizándose tratamiento de sostén. Todos los parámetros de laboratorio se normalizaron al cabo de 72 horas, evolucionando favorablemente desde el punto de vista clínico. Se interpretó que cursó un síndrome HELLP parcial. La acidosis láctica no es un componente descripto en este síndrome. Tampoco puede adscribirse a la enfermedad leve por SARS-CoV-2. Podría deberse a una sumatoria de causas, incluidas la hiperproducción de ácido láctico en el marco del trabajo de parto, como la disminución de su aclaramiento por la disfunción hepática asociada al síndrome HELLP.

Acidosis láctica grave en una mujer embarazada con síndrome HELLP parcial y COVID-19 / Severe lactic acidosis in a pregnant woman with partial HELLP syndrome and COVID-19

Resumen Se presenta el caso de una mujer embarazada secundigesta, cursando la semana 36.5 de gestación, que concurrió a guardia general por tos seca y disnea progresiva de 3 días de evolución, asociadas a cefalea y mialgias. Se realizó hisopado nasofaríngeo para reacción en cadena de la polimerasa (PCR) para SARS-CoV-2, resultando positivo. La saturación de oxígeno era normal, al igual que la radiografía de tórax. En el laboratorio presentó elevación de bilirrubina, transaminasas, fosfatasa alcalina y LDH, además de plaqueto penia leve. Poco después de su ingreso, comenzó con trabajo de parto. Frente a la falta de progresión del mis mo se decidió la finalización del embarazo por cesárea. La gasometría arterial reveló la presencia de acidosis láctica grave. Nunca hubo evidencia clínica de hipoperfusión tisular o sepsis que pudieran explicarla. Cursó su postoperatorio en la unidad de terapia intensiva, realizándose tratamiento de sostén. Todos los parámetros de laboratorio se normalizaron al cabo de 72 horas, evolucionando favorablemente desde el punto de vista clínico. Se interpretó que cursó un síndrome HELLP parcial. La acidosis láctica no es un componente descripto en este síndrome. Tampoco puede adscribirse a la enfermedad leve por SARS-CoV-2. Podría deberse a una sumatoria de causas, incluidas la hiperproducción de ácido láctico en el marco del trabajo de parto, como la disminución de su aclaramiento por la disfunción hepática asociada al síndrome HELLP.

Abstract The present report describes the case of a 23-year old pregnant woman who was in the 36.5th week of gestation of her second pregnancy. She was attended at the emergency room because of dry cough and progressive dyspnea, in association with headache and myalgia. The nasopharyngeal swab for SARS-CoV-2 polymerase chain reaction (PCR) was positive. Oxygen saturation and chest x-ray were normal. Laboratory tests showed elevated values of bilirubin, aminotransferases, alkaline phosphatase and lactic dehydrogenase, and mild thrombocytopenia. Shortly after being admitted she began with labor. Faced with the lack of progression, the termination of the pregnancy by cesarean section was decided. Arterial blood gases showed severe lactic acidosis. She never presented evidence of clinical signs of tissue hypoperfusion or sepsis that could explain it. The patient completed her postoperative period in the intensive care unit, undergoing supportive treatment. All laboratory parameters were normalized after 72 hours, evolving favorably from the clinical point of view. It was interpreted that she had a partial HELLP syndrome. Lactic acidosis is not a component of this syndrome. Nor can it be ascribed to a mild disease by SARS-Cov-2. It probably responded to a summation of causes, including hyperproduction of lactic acid during labor, as well as its reduced clearance because of liver dysfunction related to HELLP syndrome.

Is a strategy based on routine endotracheal cultures the best way to prescribe antibiotics in ventilator-associated pneumonia?

OBJECTIVES: The objectives of this study were to evaluate if a strategy based on routine endotracheal aspirate (ETA) cultures is better than using the American Thoracic Society/Infectious Diseases Society of America (ATS/IDSA) guidelines to prescribe antimicrobials in ventilator-associated pneumonia (VAP). METHODS: This was a prospective, observational, cohort study conducted in a 15-bed ICU and comprising 283 patients who were mechanically ventilated for ≥48 h. Interventions included twice-weekly ETA; BAL culture was done if VAP was suspected. BAL (collected at the time of VAP) plus ETA cultures (collected≤7 days before VAP) (n=146 different pairs) were defined. We compared two models of 10 days of empirical antimicrobials (ETA-based vs ATS/IDSA guidelines-based strategies), analyzing their impact on appropriateness of therapy and total antimicrobial-days, using the BAL result as the standard for comparison. RESULTS: Complete ETA and BAL culture concordance (identical pathogens or negative result) occurred in 52 pairs; discordance (false positive or false negative) in 67, and partial concordance in two. ETA predicted the etiology in 62.4% of all pairs, in 74.0% of pairs if ETA was performed≤2 days before BAL, and in 46.2% of pairs if ETA was performed 3 to 7 days before BAL (P=.016). Strategies based on the ATS/IDSA guidelines and on ETA results led to appropriate therapy in 97.9% and 77.4% of pairs, respectively (P<.001). The numbers of antimicrobial-days were 1,942 and 1,557 for therapies based on ATS/IDSA guidelines and ETA results, respectively (P<.001). CONCLUSIONS: The ATS/IDSA guidelines-based approach was more accurate than the ETA-based strategy for prescribing appropriate, initial, empirical antibiotics in VAP, unless a sample was available≤2 days of the onset of VAP. The ETA-based strategy led to fewer days on prescribed antimicrobials.

Traqueobronquitis asociada al ventilador (TAV), implicancias del diagnostico clinico y microbiologico en una cohorte de pacientes en ventilacion mecanica / Ventilator associated tracheobronchitis (VAT), implications of clinical and microbiological diagnosis in a cohort of mechanical ventilated patients

Tratar con antibioticos una TAV, proceso intermedio entre colonizacion y neumonia asociada al ventilador (NAV), reduciria la incidencia de NAV y sus consecuencias. Metodos: seguimiento clinico diario y cultivos cuantitativos rutinarios de aspirado traqueal (CRAT) bisemanales hasta el destete en 323 pacientes en ventilacion mecanica. Cuando se sospecho clinicamente infeccion (2/3 criterios), si habia infiltrado radiografico nuevo, se diagnostico NAV y se practico lavado broncoalveolar (LBA) y sin infiltrado nuevo, se diagnostico TAV, se consideraron los aislamientos del LBA positivos (¡Ý 104 unidades formadoras de colonias (ufc)/ml) para la NAV) y del CRAT positivos (¡Ý 103 y < 106 ufc/ml (bajo recuento) y ¡Ý 106 ufc/ml (alto recuento)) para TAV. Resultados: 443 de 2.309 radiografias mostraban ausencia de infiltrado o infiltrado difuso estable; 92 cumplian criterios de TAV, 13 de estas, 12 con CRAT ¡Ý 106 ufc/ml, tuvieron una NAV en los siguientes 3 dias (12 con cultivo de LBA ¡Ý104 ufc/ml). En estas NAV, 11/15 (73.3%) de los pat¨®genos coincidian con los de la TAV precedente. Desde otro punto de vista, 10 TAVs ocurrieron durante la semana posterior a una NAV, solo 4/12(33.3%) patogenos de estas coincidian con los de la TAV, p=0.045 comparando con TAV precediendo a NAV. Setenta TAVs no tuvieron relacion temporal con NAVs. Discusion: este estudio sugiere que tratar con antibioticos las TAVs podria prevenir una NAV en 14% de los casos, exponiendo a un uso innecesario al 86%, lo cual limitaria fuertemente la conveniencia de tratar las TAVs para prevenir las NAVs.

The ventilator associated tracheobronchitis (VAT) is a process between airway colonization and ventilator-associated pneumonia (VAP). The antimicrobial therapy of VAT wouldreduce the incidence of VAP and its consequences. Methods: Daily follow up and twice a week routine quantitative culture of endotracheal aspirates (CETA) up to weaning were performed in 323 mechanically ventilated patients.When a lower respiratory tract infection was suspected (2/3 clinical criteria), if a new radiographic inf¨ªltrate was present, VAP was diagnosed and a bronchoalveolar lavage (BAL) culture was performed; if a radiographic infiltrate was absent, VAT was diagnosed. The bacteriological criteria for diagnosis were a BAL culture positive (¡Ý 104 colony forming units - cfu/ml) for VAP and a CETA positive culture (low count from ¡Ý 103 to < 106 cfu/ml and high count ¡Ý 106 ufc/ml) for VAT. Results: In 443 of 2,309 radiographs an infiltrate was absent or was diffuse and stable; 92 of them met diagnostic clinical criteria for VAT. In 13 (12 with CETA culture ¡Ý 106 cfu/ml), a VAP episode happened during the following 3 days (12 with BAL culture ¡Ý 104 cfu/ml). In 11/15 (73.3%) VAP cases, the isolated pathogens were the same that had been present in the preceding VAT episode. On the other side, ten episodes of VAT were diagnosed during the 7 days after the VAP. Only 4/12 (33.3%) isolated pathogens were the same than those isolated in the VAT preceding the VAP, p=0.045. Seventy VATs had not any temporal relationship with episodes of VAP. Discusion: This study suggests that antimicrobial therapy could prevent a VAP in 14% of the TAV cases. Therefore, exposure to antibiotics was unnecessary in 86% of cases. This finding could represent a severe limitation to the recommendation of treating TAVs with antibiotics to prevent VAPs.

Traqueobronquitis asociada al ventilador (TAV), implicancias del diagnostico clinico y microbiologico en una cohorte de pacientes en ventilacion mecanica / Ventilator associated tracheobronchitis (VAT), implications of clinical and microbiological diagnosis in a cohort of mechanical ventilated patients

Tratar con antibioticos una TAV, proceso intermedio entre colonizacion y neumonia asociada al ventilador (NAV), reduciria la incidencia de NAV y sus consecuencias. Metodos: seguimiento clinico diario y cultivos cuantitativos rutinarios de aspirado traqueal (CRAT) bisemanales hasta el destete en 323 pacientes en ventilacion mecanica. Cuando se sospecho clinicamente infeccion (2/3 criterios), si habia infiltrado radiografico nuevo, se diagnostico NAV y se practico lavado broncoalveolar (LBA) y sin infiltrado nuevo, se diagnostico TAV, se consideraron los aislamientos del LBA positivos (í¦ 104 unidades formadoras de colonias (ufc)/ml) para la NAV) y del CRAT positivos (í¦ 103 y < 106 ufc/ml (bajo recuento) y í¦ 106 ufc/ml (alto recuento)) para TAV. Resultados: 443 de 2.309 radiografias mostraban ausencia de infiltrado o infiltrado difuso estable; 92 cumplian criterios de TAV, 13 de estas, 12 con CRAT í¦ 106 ufc/ml, tuvieron una NAV en los siguientes 3 dias (12 con cultivo de LBA í¦104 ufc/ml). En estas NAV, 11/15 (73.3%) de los pat¿«genos coincidian con los de la TAV precedente. Desde otro punto de vista, 10 TAVs ocurrieron durante la semana posterior a una NAV, solo 4/12(33.3%) patogenos de estas coincidian con los de la TAV, p=0.045 comparando con TAV precediendo a NAV. Setenta TAVs no tuvieron relacion temporal con NAVs. Discusion: este estudio sugiere que tratar con antibioticos las TAVs podria prevenir una NAV en 14% de los casos, exponiendo a un uso innecesario al 86%, lo cual limitaria fuertemente la conveniencia de tratar las TAVs para prevenir las NAVs. (AU)

The ventilator associated tracheobronchitis (VAT) is a process between airway colonization and ventilator-associated pneumonia (VAP). The antimicrobial therapy of VAT wouldreduce the incidence of VAP and its consequences. Methods: Daily follow up and twice a week routine quantitative culture of endotracheal aspirates (CETA) up to weaning were performed in 323 mechanically ventilated patients.When a lower respiratory tract infection was suspected (2/3 clinical criteria), if a new radiographic inf¿¬ltrate was present, VAP was diagnosed and a bronchoalveolar lavage (BAL) culture was performed; if a radiographic infiltrate was absent, VAT was diagnosed. The bacteriological criteria for diagnosis were a BAL culture positive (í¦ 104 colony forming units - cfu/ml) for VAP and a CETA positive culture (low count from í¦ 103 to < 106 cfu/ml and high count í¦ 106 ufc/ml) for VAT. Results: In 443 of 2,309 radiographs an infiltrate was absent or was diffuse and stable; 92 of them met diagnostic clinical criteria for VAT. In 13 (12 with CETA culture í¦ 106 cfu/ml), a VAP episode happened during the following 3 days (12 with BAL culture í¦ 104 cfu/ml). In 11/15 (73.3%) VAP cases, the isolated pathogens were the same that had been present in the preceding VAT episode. On the other side, ten episodes of VAT were diagnosed during the 7 days after the VAP. Only 4/12 (33.3%) isolated pathogens were the same than those isolated in the VAT preceding the VAP, p=0.045. Seventy VATs had not any temporal relationship with episodes of VAP. Discusion: This study suggests that antimicrobial therapy could prevent a VAP in 14% of the TAV cases. Therefore, exposure to antibiotics was unnecessary in 86% of cases. This finding could represent a severe limitation to the recommendation of treating TAVs with antibiotics to prevent VAPs. (AU)

Interrelationship between oxygen-related variables in patients with acute myocardial infarction: an interpretative review.

The high mortality rate of cardiogenic shock in acute myocardial infarction (AMI) implies that debate over the correct haemodynamic management is still unresolved. The purpose of this review is to re-evaluate the reciprocal relationships between oxygen-related variables and response to treatment in a large number of patients with AMI. A MEDLINE search of reports published between 1970 and 2008 was performed. Twelve clinical reports including 453 patients with AMI and 989 sets of oxygen delivery and oxygen consumption expressed in ml min⁻¹ m⁻² and oxygen extraction ratio were selected. While processing this data, we found an early down-regulation in oxygen demand linked to a decrease in oxygen supply. This mechanism is also supported in some studies by a critically low oxygen uptake that was not associated with lactic acidosis.

[Death in an intensive care unit. Influence of life support withholding and withdrawal]. / La muerte en un servicio de terapia intensiva. Influencia de la abstención y retiro del soporte vital.

The influence of life support withholding and withdrawal on the deaths which occurred in an Intensive Care Unit (ICU) over a period of 32 months was analysed. Of 2640 patients admitted in ICU, one of the following five mutually exclusive categories was registered on the 548 patients who died: (i) complete treatment; (ii) complete treatment with non-resuscitation order (NRO); (iii) withholding of life-sustaining treatment; (iv) withdrawal of life-sustaining treatment; and (v) brain death. There was therapeutic limitation of life support in 45.6% of cases (n = 250), with an important majority of withholding (NRO and withholding) in 32.6% of cases, in comparison to withdrawal of life support (8.2% of cases). The comparative analysis with other statistic information suggests the existence of a similar global therapeutic limitation mean in communities with similar cultural background, even if there is a lower influence of life support withdrawal (8.2%) when compared to other countries regardless of their attitude towards the need to establish different degrees of control over technological resources applied to the critically ill. Further research should analyze the influence that moral perception of withdrawal as inconvenient in our society, has over our findings.

La muerte en un servicio de terapia intensiva: influencia de la abstencion y retiro del soporte vital / Death in an intensive care unit: influence of life support withholding and withdrawal

Se estudió la influencia de la abstención y retiro del soporte vital en la muerte ocurrida en un servicio de Terapia Intensiva durante un período de 32 meses. Sobre 2640 pacientes ingresados se registró la conducta terapéutica en 548 muertos, clasificando la misma en cinco categorías: (i) tratamiento completo, (ii) tratamiento completo con orden de no resucitación (ONR), (iii) abstención de soporte vital, (iv) retiro de soporte vital y (v) muerte cerebral. Hubo limitación terapéutica de soporte vital en el 45.6% (n= 250) con unpredominio importante de la abstención (ONR y abstención) en el 32.6% respecto del retiro de soporte vital (8.2%). Del estudio comparativo con otras estadísticas surge el hallazgo de un porcentaje global de limitación terapéutica media cercana a comunidades con una cultura similar, aunque con una incidencia de retiro (8.2%) manifiestamente inferior a la registrada en todos los países cualesquiera fuera su actitud frente a la necesidad de establecer diversos grados de control sobre el recurso tecnológico en el paciente crítico. Deberá indagarse la influencia que tiene la percepción moral del dejar de actuar, como un proceder inconveniente en nuestra sociedad, en los resultados observados.

The influence of life support withholding and withdrawal on the deaths which occurred in an Intensive Care Unit (ICU) over a period of 32 months was analysed. Of 2640 patients admitted in ICU, one of the following five mutually exclusive categories was registered on the 548 patients who died: (i) complete treatment; (ii) complete treatment with non-resuscitation order (NRO); (iii) withholding of life-sustaining treatment; (iv) withdrawal of life-sustaining treatment; and (v) brain death. There was therapeutic limitation of life support in 45.6% of cases (n=250), with an important majority of withholding (NRO and withholding) in 32.6% of cases, in comparison to withdrawal of life support (8.2% of cases). The comparative analysis with other statistic information suggests the existence of a similar global therapeutic limitation mean in communities with similar cultural background, even if there is a lower influence of life support withdrawal (8.2%) when compared to other countries regardless of their attitude towards the need to establish different degrees of control over technological resources applied to the critically ill. Further research should analyze the influence that moral perception of withdrawal as inconvenient in our society, has over our findings.

La muerte en un servicio de terapia intensiva: influencia de la abstencion y retiro del soporte vital / Death in an intensive care unit: influence of life support withholding and withdrawal

Se estudió la influencia de la abstención y retiro del soporte vital en la muerte ocurrida en un servicio de Terapia Intensiva durante un período de 32 meses. Sobre 2640 pacientes ingresados se registró la conducta terapéutica en 548 muertos, clasificando la misma en cinco categorías: (i) tratamiento completo, (ii) tratamiento completo con orden de no resucitación (ONR), (iii) abstención de soporte vital, (iv) retiro de soporte vital y (v) muerte cerebral. Hubo limitación terapéutica de soporte vital en el 45.6% (n= 250) con unpredominio importante de la abstención (ONR y abstención) en el 32.6% respecto del retiro de soporte vital (8.2%). Del estudio comparativo con otras estadísticas surge el hallazgo de un porcentaje global de limitación terapéutica media cercana a comunidades con una cultura similar, aunque con una incidencia de retiro (8.2%) manifiestamente inferior a la registrada en todos los países cualesquiera fuera su actitud frente a la necesidad de establecer diversos grados de control sobre el recurso tecnológico en el paciente crítico. Deberá indagarse la influencia que tiene la percepción moral del dejar de actuar, como un proceder inconveniente en nuestra sociedad, en los resultados observados.(AU)

The influence of life support withholding and withdrawal on the deaths which occurred in an Intensive Care Unit (ICU) over a period of 32 months was analysed. Of 2640 patients admitted in ICU, one of the following five mutually exclusive categories was registered on the 548 patients who died: (i) complete treatment; (ii) complete treatment with non-resuscitation order (NRO); (iii) withholding of life-sustaining treatment; (iv) withdrawal of life-sustaining treatment; and (v) brain death. There was therapeutic limitation of life support in 45.6% of cases (n=250), with an important majority of withholding (NRO and withholding) in 32.6% of cases, in comparison to withdrawal of life support (8.2% of cases). The comparative analysis with other statistic information suggests the existence of a similar global therapeutic limitation mean in communities with similar cultural background, even if there is a lower influence of life support withdrawal (8.2%) when compared to other countries regardless of their attitude towards the need to establish different degrees of control over technological resources applied to the critically ill. Further research should analyze the influence that moral perception of withdrawal as inconvenient in our society, has over our findings.(AU)

La muerte en un servicio de terapia intensiva: influencia de la abstencion y retiro del soporte vital / Death in an intensive care unit: influence of life support withholding and withdrawal

Se estudió la influencia de la abstención y retiro del soporte vital en la muerte ocurrida en un servicio de Terapia Intensiva durante un período de 32 meses. Sobre 2640 pacientes ingresados se registró la conducta terapéutica en 548 muertos, clasificando la misma en cinco categorías: (i) tratamiento completo, (ii) tratamiento completo con orden de no resucitación (ONR), (iii) abstención de soporte vital, (iv) retiro de soporte vital y (v) muerte cerebral. Hubo limitación terapéutica de soporte vital en el 45.6% (n= 250) con unpredominio importante de la abstención (ONR y abstención) en el 32.6% respecto del retiro de soporte vital (8.2%). Del estudio comparativo con otras estadísticas surge el hallazgo de un porcentaje global de limitación terapéutica media cercana a comunidades con una cultura similar, aunque con una incidencia de retiro (8.2%) manifiestamente inferior a la registrada en todos los países cualesquiera fuera su actitud frente a la necesidad de establecer diversos grados de control sobre el recurso tecnológico en el paciente crítico. Deberá indagarse la influencia que tiene la percepción moral del dejar de actuar, como un proceder inconveniente en nuestra sociedad, en los resultados observados.(AU)

The influence of life support withholding and withdrawal on the deaths which occurred in an Intensive Care Unit (ICU) over a period of 32 months was analysed. Of 2640 patients admitted in ICU, one of the following five mutually exclusive categories was registered on the 548 patients who died: (i) complete treatment; (ii) complete treatment with non-resuscitation order (NRO); (iii) withholding of life-sustaining treatment; (iv) withdrawal of life-sustaining treatment; and (v) brain death. There was therapeutic limitation of life support in 45.6% of cases (n=250), with an important majority of withholding (NRO and withholding) in 32.6% of cases, in comparison to withdrawal of life support (8.2% of cases). The comparative analysis with other statistic information suggests the existence of a similar global therapeutic limitation mean in communities with similar cultural background, even if there is a lower influence of life support withdrawal (8.2%) when compared to other countries regardless of their attitude towards the need to establish different degrees of control over technological resources applied to the critically ill. Further research should analyze the influence that moral perception of withdrawal as inconvenient in our society, has over our findings.(AU)

[Acute respiratory distress syndrome. Role of steroids]. / Síndrome de distrés respiratorio agudo. Utilidad de los corticoides.

The acute respiratory distress syndrome (ARDS) represents 7.7% of the intensive care population, and is associated with great morbidity and mortality (58%). Frequently, the mortality can be attributed to more than one cause. Refractory hypoxemia is uncommon (15%) and most of the patients also have multiple organic dysfunction, sepsis or septic shock. Although there are many publications concerning series of cases and clinical trials using steroids as a part of the treatment of ARDS, this issue remains controversial. In this article the role of steroids in the ARDS is evaluated by analysis of the available literature. We conclude that steroids are useful in a subgroup of patients with unresolving ARDS, after ruling out an active infection or after treatment with antibiotics.

Sindrome de distres respiratorio agudo utilidad de los costicoides / Acute respiratory distress syndrome: role of steroids

En Argentina, el síndrome de distrés respiratorio agudo (SDRA) representa el 7.7% de las admisiones en terapia intensiva y está asociado con una alta morbilidad y mortalidad (58%). Con frecuencia la muerte puede ser atribuida a más de una causa. La hipoxemia refractaria es una causa de muerte poco frecuente (15%) y en muchos casos puede coexistir con disfunción multiorgánica, sepsis o shock séptico. La utilidad de los esteroides como parte del tratamiento es aún motivo de debate a pesar de las múltiples series de casos y estudios clínicos publicados. En el artículo se evalúa la utilidad de los esteroides en el SDRA a través de la revisión de la bibliografía disponible. Se concluye que los esteroides estarían indicados en un pequeño subgrupo de pacientes con SDRA no resuelto o tardío, después de descartar o controlar una infección activa.

Sindrome de distres respiratorio agudo utilidad de los costicoides / Acute respiratory distress syndrome: role of steroids

En Argentina, el síndrome de distrés respiratorio agudo (SDRA) representa el 7.7% de las admisiones en terapia intensiva y está asociado con una alta morbilidad y mortalidad (58%). Con frecuencia la muerte puede ser atribuida a más de una causa. La hipoxemia refractaria es una causa de muerte poco frecuente (15%) y en muchos casos puede coexistir con disfunción multiorgánica, sepsis o shock séptico. La utilidad de los esteroides como parte del tratamiento es aún motivo de debate a pesar de las múltiples series de casos y estudios clínicos publicados. En el artículo se evalúa la utilidad de los esteroides en el SDRA a través de la revisión de la bibliografía disponible. Se concluye que los esteroides estarían indicados en un pequeño subgrupo de pacientes con SDRA no resuelto o tardío, después de descartar o controlar una infección activa.(AU)

Síndrome de distrés respiratorio agudo. Utilidad de los corticoides. / [Acute respiratory distress syndrome. Role of steroids]

The acute respiratory distress syndrome (ARDS) represents 7.7

of the intensive care population, and is associated with great morbidity and mortality (58

). Frequently, the mortality can be attributed to more than one cause. Refractory hypoxemia is uncommon (15

) and most of the patients also have multiple organic dysfunction, sepsis or septic shock. Although there are many publications concerning series of cases and clinical trials using steroids as a part of the treatment of ARDS, this issue remains controversial. In this article the role of steroids in the ARDS is evaluated by analysis of the available literature. We conclude that steroids are useful in a subgroup of patients with unresolving ARDS, after ruling out an active infection or after treatment with antibiotics.