Epidemiología y pronóstico de los pacientes con antecedentes de neoplasia ingresados en las Unidades de Cuidados Intensivos. Estudio multicéntrico observacional / Epidemiology and prognosis of patients with a history of cancer admitted to intensive care. A multicenter observational study

Objetivo Conocer la epidemiología y evolución al alta de los pacientes oncológicos que precisan ingreso en UCI. Diseño Estudio descriptivo observacional de datos del registro ENVIN-HELICS combinado con variables registradas específicamente. Se comparan pacientes con y sin neoplasia. Se identifican grupos de pacientes neoplásicos con peor evolución. Ámbito UCI participantes en ENVIN-HELICS del año 2018 con participación voluntaria en el registro oncológico. Pacientes Ingresados más de 24horas. Entre estos aquellos diagnosticados de neoplasia en los últimos 5 años. Variables principales Las generales epidemiológicas del registro ENVIN-HELICS y variables relacionadas con la neoplasia. Resultados En las 92 UCI con datos completos se seleccionaron 11.796 pacientes, de los que 1.786 (15,1%) son pacientes con neoplasia. La proporción de pacientes con cáncer por unidad fue muy variable (rango: 1-48%). La mortalidad en UCI de los pacientes oncológicos fue superior a los no oncológicos (12,3% versus 8,9%; p<0,001). En pacientes oncológicos predominaron los ingresados en el postoperatorio programado (46,7%) o urgente (15,3%). Los pacientes con proceso patológico médico fueron más graves, con mayor estancia y mortalidad (27, 5%). Aquellos ingresados en UCI por enfermedad no quirúrgica relacionada con el cáncer tuvieron la mortalidad más alta (31,4%). Conclusión Existe una gran variabilidad en el porcentaje de pacientes oncológicos en las diferentes UCI. El 46,7% de los pacientes ingresa tras someterse a cirugía programada. La mayor mortalidad corresponde a pacientes con enfermedad médica (27,5%) y a los ingresados por complicaciones relacionadas con el cáncer (31,4%). (AU)

Objective To assess the epidemiology and outcome at discharge of cancer patients requiring admission to the Intensive Care Unit (ICU). Design A descriptive observational study was made of data from the ENVIN-HELICS registry, combined with specifically compiled variables. Comparisons were made between patients with and without neoplastic disease, and groups of cancer patients with a poorer outcome were identified. Setting Intensive Care Units participating in ENVIN-HELICS 2018, with voluntary participation in the oncological registry. Patients Subjects admitted during over 24hours and diagnosed with cancer in the last 5 years. Primary endpoints The general epidemiological endpoints of the ENVIN-HELICS registry and cancer-related variables. Results Of the 92 ICUs with full data, a total of 11,796 patients were selected, of which 1786 (15.1%) were cancer patients. The proportion of cancer patients per Unit proved highly variable (1-48%). In-ICU mortality was higher among the cancer patients than in the non-oncological subjects (12.3% versus 8.9%; P<.001). Elective postoperative (46.7%) or emergency admission (15.3%) predominated in the cancer patients. Patients with medical disease were in more serious condition, with longer stay and greater mortality (27.5%). The patients admitted in ICU due to nonsurgical disease related to cancer exhibited the highest mortality rate (31.4%). Conclusions Great variability was recorded in the percentage of cancer patients in the different ICUs. A total of 46.7% of the patients were admitted after undergoing scheduled surgery. The highest mortality rate corresponded to patients with medical disease (27.5%), and to those admitted due to cancer-related complications (31.4%). (AU)

Epidemiology and prognosis of patients with a history of cancer admitted to intensive care. A multicenter observational study.

OBJECTIVE: To assess the epidemiology and outcome at discharge of cancer patients requiring admission to the Intensive Care Unit (ICU). DESIGN: A descriptive observational study was made of data from the ENVIN-HELICS registry, combined with specifically compiled variables. Comparisons were made between patients with and without neoplastic disease, and groups of cancer patients with a poorer outcome were identified. SETTING: Intensive Care Units participating in ENVIN-HELICS 2018, with voluntary participation in the oncological registry. PATIENTS: Subjects admitted during over 24 h and diagnosed with cancer in the last 5 years. PRIMARY ENDPOINTS: The general epidemiological endpoints of the ENVIN-HELICS registry and cancer-related variables. RESULTS: Of the 92 ICUs with full data, a total of 11,796 patients were selected, of which 1786 (15.1%) were cancer patients. The proportion of cancer patients per Unit proved highly variable (1%-48%). In-ICU mortality was higher among the cancer patients than in the non-oncological subjects (12.3% versus 8.9%; p < .001). Elective postoperative (46.7%) or emergency admission (15.3%) predominated in the cancer patients. Patients with medical disease were in more serious condition, with longer stay and greater mortality (27.5%). The patients admitted to the ICU due to nonsurgical disease related to cancer exhibited the highest mortality rate (31.4%). CONCLUSIONS: Great variability was recorded in the percentage of cancer patients in the different ICUs. A total of 46.7% of the patients were admitted after undergoing scheduled surgery. The highest mortality rate corresponded to patients with medical disease (27.5%), and to those admitted due to cancer-related complications (31.4%).

[A review of clinical evidence supporting techniques to prevent chronic postoperative pain syndromes]. / Bibliografía de evidencias clínicas sobre la prevención de los síndromes de dolor crónico postquirúrgicos.

OBJECTIVE: To conduct a systematic review to evaluate the level of evidence for using acute postoperative pain management techniques with a view to pre-empting the later development of chronic pain syndromes. MATERIAL AND METHODS: Systematic review of the literature on the treatment of acute postoperative pain and its usefulness in preventing postoperative chronic pain syndromes. RESULTS: Fifteen studies focusing on 3 conditions were examined: chronic postmastectomy pain syndrome, chronic postthoracotomy pain syndrome, and chronic phantom limb pain. Four clinical trials provided no clear evidence of benefit from preoperative injections of local anesthetic in decreasing the incidence of chronic postmastectomy pain. Continuous thoracic epidural analgesia started before surgery has been shown to have a clearly beneficial effect in preventing chronic pain 3, 6, and 12 months after thoracotomy. Chronic phantom limb pain syndromes have not been found to be prevented by the use of continuous epidural analgesia started before or after surgery in comparison with the injection of local anesthetics through a perineural catheter or the oral or intramuscular administration of morphine-like drugs. CONCLUSIONS: Only chronic pain following thoracotomy has been found to be preempted by acute pain management and only by continuous thoracic epidural analgesia started before surgery. There is no solid evidence demonstrating that other techniques used to relieve acute postoperative pain have a beneficial effect in preempting chronic postoperative pain syndromes.

[Effectiveness of preventive activities at 8 years of their introduction in a general medicine practice in a health center]. / Efectividad de las actividades preventivas a los 8 años de su introducción en una consulta de medicina general de un centro de salud.

OBJECTIVES: Main: to assess the change in coronary risk (CR) in adults after 8 years of their involvement in the Programme of Preventive Activities and Health Promotion (PAPPS). Secondary: to determine the level of anti-tetanus vaccination reached and patients' compliance with activities. DESIGN: "Before and after" intervention study without random allocation. SETTING: A general medical clinic at a health centre. PATIENTS: 429 patients (204 men, 225 women) between 30 and 65 monitored for 8 years, recruited by active search for cases at daily consultations. INTERVENTIONS: Blood pressure, cholesterol, weight, tobacco habit, alcohol intake, anti-tetanus vaccination state, CR calculation at 10 years on the Framingham scale, and degree of compliance with activities were all determined at the start, at 4 years and at 8 years. Data was obtained from the clinical notes. RESULTS: Total population: a 0.8 drop in CR (CI difference: 0.4-1.2), equivalent to 8.5% of the initial figure. 64.4% increase in correct anti-tetanus vaccination (CI difference: 59.9-69). Compliance with activities at the start and after eight years: pressure 100%, 71%; tobacco consumption 99.5%, 71%; cholesterol determination 89%, 64%. Initially high CR sub-group: 6.7 drop of CR at 8 years (CI difference: 4.9-8.5), equivalent to 24.8% of the initial figure. CONCLUSIONS: In the total population, the CR drop found was not clinically significant, whereas in the initially high CR sub-group the drop was. There should probably be an active search made for patients with high CR and action taken on them.

Efectividad de las actividades preventivas a los 8 años de su introducción en una consulta de medicina general de un centro de salud / Effectiveness of preventive activities eight years after their introduction at a general medical clinic in a health centre

Objetivo. Principal: valorar la modificación del riesgo coronario (RC) en pacientes adultos tras 8 años de su incorporación al Programa Actividades Preventivas y Promoción Salud (PAPPS).Secundario: determinar nivel de vacunación antitetánica alcanzado y cumplimiento de actividades. Diseño. Estudio de intervención sin asignación aleatoria 'antes-después'. Emplazamiento. Una consulta de medicina general de un centro de salud. Pacientes. Un total de 429 pacientes (204 varones, 225 mujeres) de 30-65 años seguidos durante 8 años, captados por búsqueda activa de casos en la consulta diaria. Intervenciones. Determinación de tensión arterial, colesterol, peso, tabaquismo, ingesta etílica, estado vacunal antitetánico, cálculo del RC a los 10 años según Framinghan y grado de cumplimiento de actividades. Estas variables se determinaron al inicio, a los 4 y a los 8 años. Datos obtenidos de la historia clínica. Resultados. Población total: a los 8 años descenso del RC, 0,8 (IC diferencia, 0,4-1,2), equivalente al 8,5 por ciento del inicial. Incremento obtenido de la vacunación antitetánica correcta del 64,4 por ciento (IC diferencia, 59,9-69 por ciento). Cumplimiento actividades al inicio y al octavo año: tensión, 100 por ciento, 71 por ciento; consumo tabaco, 99,5 por ciento, 71 por ciento; determinación colesterol, 89 por ciento, 64 por ciento. Subgrupo RC inicial alto: a los 8 años descenso del RC, 6,7 (IC diferencia, 4,9-8,5), equivalente al 24,8 por ciento del inicial. Conclusiones. En la población total el descenso del RC obtenido no es clínicamente significativo, mientras que en el subgrupo con RC inicial alto el descenso sí lo ha sido. Probablemente debería hacerse búsqueda activa de los pacientes con RC alto y actuar sobre ellos (AU)