Proyecto UCI sin paredes. Efecto de la detección precoz de los pacientes de riesgo / ICU without walls project. Effect of the early detection of patients at risk

Objetivos Describir y evaluar la repercusión de un sistema de detección e intervención precoz en pacientes de riesgo fuera de la UCI en la evolución de los pacientes ingresados en UCI y el número de paradas cardiorrespiratorias (PCR) hospitalarias. Ámbito Hospital de nivel 2 en la Comunidad de Madrid con historia clínica electrónica. Métodos Un intensivista revisa cada uno de los pacientes que cumplan los criterios de inclusión y decide la necesidad o no de intervención. Posteriormente, junto al médico a cargo del paciente, se determina cuál es el nivel de cuidados que necesita y se decide la pauta a seguir a continuación. Diseño Estudio descriptivo y cuasi-experimental «before-after». Resultados En el periodo de estudio se intervino en un total de 202 pacientes. Ciento cuarenta y siete fueron incluidos tras detectarse analíticas alteradas a través de nuestro programa informático. En el periodo de control la mortalidad en UCI fue 9 frente al 4,4% en el periodo de intervención (p=0,03). En el análisis multivariable, los 2 factores que guardaron relación significativa con la mortalidad fueron el haber ingresado durante el periodo de intervención OR 0,42 (IC95%; 0,18 a 0,98) (p=0,04) y el SAPS 3 OR 1,11 (IC95%; 1,07 a 1,14) (p<0,05). El número de avisos por PCR en el periodo control fue 10 frente 3 en el periodo de intervención (p=0,07).Conclusiones La actividad de detección precoz de pacientes en riesgo fuera de la UCI puede producir un efecto beneficioso sobre los pacientes ingresados en UCI así como una reducción de las PCR hospitalarias (AU)

Objectives To describe and evaluate the impact of a system for early detection and intervention in patients at risk outside the ICU upon the outcome of patients admitted to the ICU and the number of cases of hospital cardiopulmonary arrest. Setting A second-level hospital in the Community of Madrid (Spain) with electronic clinical histories Methods An intensivist reviewed each of the patients meeting the inclusion criteria, and decided the need or not for intervention. Posteriorly, in collaboration with the physician supervising the patient, the needed level of care was decided, along with the subsequent management protocol. Design A descriptive and quasi-experimental “before-after” study was made. Results A total of 202 patients were intervened during the study period, With the inclusion of 147 after detecting altered laboratory test results through our software application. During the control period, the mortality rate in the ICU was 9%, versus 4.4% during the intervention period (P=.03). In the multivariate analysis, the two factors significantly related to mortality were admission during the intervention period (OR=0.42; 95%CI: 0.18-0.98; P=.04) and SAPS 3 (OR=1.11; 95%CI: 1.07-1.14; P<0.05). There were 10 cardiopulmonary arrest alerts during the control period, versus three in the intervention period (P=.07).Conclusions Early detection activities in patients at risk outside the ICU can have beneficial effects upon the patients admitted to the ICU, and can contribute to reduce the number of hospital cardiopulmonary arrests (AU)

ICU without walls project. Effect of the early detection of patients at risk.

OBJECTIVES: To describe and evaluate the impact of a system for early detection and intervention in patients at risk outside the ICU upon the outcome of patients admitted to the ICU and the number of cases of hospital cardiopulmonary arrest. SETTING: A second-level hospital in the Community of Madrid (Spain) with electronic clinical histories. METHODS: An intensivist reviewed each of the patients meeting the inclusion criteria, and decided the need or not for intervention. Posteriorly, in collaboration with the physician supervising the patient, the needed level of care was decided, along with the subsequent management protocol. DESIGN: A descriptive and quasi-experimental "before-after" study was made. RESULTS: A total of 202 patients were intervened during the study period, With the inclusion of 147 after detecting altered laboratory test results through our software application. During the control period, the mortality rate in the ICU was 9%, versus 4.4% during the intervention period (P=.03). In the multivariate analysis, the two factors significantly related to mortality were admission during the intervention period (OR=0.42; 95%CI: 0.18-0.98; P=.04) and SAPS 3 (OR=1.11; 95%CI: 1.07-1.14; P<0.05). There were 10 cardiopulmonary arrest alerts during the control period, versus three in the intervention period (P=.07). CONCLUSIONS: Early detection activities in patients at risk outside the ICU can have beneficial effects upon the patients admitted to the ICU, and can contribute to reduce the number of hospital cardiopulmonary arrests.

Pressure versus volume controlled modes in invasive mechanical ventilation.

The first generation of mechanical ventilators were controlled and cycled by pressure. Unfortunately, they did not allow control of the delivered tidal volume under changes in the dynamics of the respiratory system. This led to a second generation of ventilators that allowed volume control, hence favoring the ventilatory strategy based on normalization of the arterial gases. Studies conducted in the 1980s which related lung injury to the high ventilator pressures utilized while treating acute respiratory distress syndrome patients renewed interest in pressure-controlled mechanical ventilation. In addition, new evidence became available, leading to the development of pulmonary protective strategies aiming at preventing the progression of ventilator-induced lung injury. This review provides a detailed description of the control of pressure or volume using certain ventilatory modes, and offers a general view of their advantages and disadvantages, based on the latest available evidence.

Coma en el postoperatorio de cirugía cardíaca: masa en la silla turca / Coma following cardiac surgery. Mass in the sella turcica

Las causas de bajo nivel de conciencia tras el postoperatorio de cirugía cardíaca son numerosas. Una de ellas muy poco frecuente es el infarto o hemorragia de un adenoma hipofisario que, en general, no había sido diagnosticado previamente. Describimos el caso de una paciente que, durante el postoperatorio de cirugía cardíaca, presentó una evolución tórpida con múltiples complicaciones, entre ellas bajo nivel de conciencia, siendo diagnosticada de macroadenoma hipofisario e hipopituitarismo, y con un curso evolutivo favorable mediante tratamiento hormonal sustitutivo (AU)