[Analysis of maternal morbidity and mortality among patients admitted to Obstetric Intensive Care with severe preeclampsia, eclampsia or HELLP syndrome]. / Análisis de la morbimortalidad materna de las pacientes con preeclampsia grave, eclampsia y síndrome HELLP que ingresan en una Unidad de Cuidados Intensivos gineco-obstétrica.

OBJECTIVE: To describe the incidence and clinical and epidemiological profile of patients with severe preeclampsia admitted to Intensive Care. DESIGN: A prospective, observational case series. SETTING: A specific obstetric 8-bed ICU belonging to a university hospital with a total of 55 ICU beds. PATIENTS: A total of 262 patients admitted due to severe preeclampsia, eclampsia or HELLP syndrome. INTERVENTION: Descriptive analysis of the population and complications in the ICU and hospital mortality. RESULTS: The mean patient age was 30.47±5.7 years, with the following diagnóstico at admission: A total of 78% of the patients with severe preeclampsia, 16% with HELLP syndrome, and 6% with eclampsia, occurring in gestational week 31.85±4.45. In turn, 63% of the patients were nulliparous and had a low prevalence of previous diseases. The global complications rate was 14% (9% heart failure, 5% acute renal failure and 2% coagulopathy). Maternal mortality was 1.5% (4 patients), and was associated with non-nulliparous status, the presence of complications, and toast > 71mg/dl. CONCLUSIONS: Severe preeclampsia has a low mortality rate (1.5%), though the complications rate is considerable (14%). The condition develops more often in nulliparous women during the third trimester of pregnancy.

[Efficacy and safety of non-permanent transvenous pacemaker implantation in an intensive care unit]. / Eficacia y seguridad de la implantación de marcapasos transvenosos transitorios en una unidad de cuidados intensivos.

OBJECTIVE: To analyze the clinical indications for use, morbidity and mortality associated with a non-permanent transvenous pacemaker. DESIGN: Prospective and observational study. SETTING: Cardiac intensive care unit. METHOD: One hundred and eighty-two patients with non-permanent pacemakers implanted consecutively over a period of four years. DATA COLLECTED: Main variables of interest were demographic data, clinical indications, access route, length of stay and complications. RESULTS: A total of 63% were men, with a median age of 78 ± 9.5 years and with symptomatic third-degree atrioventricular block in 76.9% of the cases. Femoral vein access was preferred in 92.3% of the cases. Complications appeared in 40.11% of the patients, the most frequent being hematoma at the site of vascular access (13.19%). Restlessness was associated to the need for repositioning the pacemaker due to a shift in the electrode (p=0.059) and to hematoma (p=0.07). Subclavian or jugular vein lead insertion (p=0.012; OR=0.16; 95%CI, 0.04-0.66), restlessness during admission to ICU (p=0.006; OR=3.2; 95%CI, 1.4-7.3), and the presence of cardiovascular risk factors (p=0.042; OR=5; 95%CI, 1.06-14.2) were identified by multivariate analysis as being predictors of complications. Length of stay in ICU was significantly longer when lead insertion was carried out by specialized staff (p=0.0001), and in the presence of complications (p=0.05). CONCLUSIONS: Predictfurors of complications were restlessness, cardiovascular risk factors, and insertion through the jugular or subclavian vein. Complications prolonged ICU stay and were not related to the professionals involved.

[Clinical, epidemiological and taxonomic aspects of systemic candidiasis in an intensive care unit]. / Perfil clínico-epidemiológico y taxonómico de la candidiasis sistémica en una unidad de cuidados intensivos.

The clinical and epidemiological profile and survival of patients admitted into our intensive care unit (ICU) was analyzed. A retrospective-prospective case series from 2002 to 2004 and 2005 to 2006, respectively, of patients diagnosed with systemic candidiasis in an ICU in a tertiary hospital was studied. Twenty-six cases with systemic candidiasis were included (75% of the cases were male). These subjects underwent multiple vascular or drainage interventions and had a prolonged length of stay in ICU. The first motive to enter ICU was sepsis. Candida albicans (CA) was isolated in 53.8% of cases versus 46.2% for other Candidae (CNA). Over the last years, we have observed a progressively higher incidence for CNA (p = 0.02). We registered an especially high mortality rate (42%), that is higher in the CA group. <> defined the mortality in the progressive risk groups (p = 0.026).

[Decision on the time for post-operative extubation of maxillofacial surgery patient in the intensive care unit]. / Decisión del momento de extubación del postoperado de cirugía maxilofacial en la unidad de cuidados intensivos.

OBJECTIVE: Evaluate moment of extubation in maxillofacial post-operative patients admitted to an intensive care unit (ICU) and analyze early complications during their stay. DESIGN: An observational and prospective study. SETTING: Third level hospital ICU. PATIENTS AND METHODS: All patients we underwent maxillofacial surgery and admitted to the ICU for immediate post-operative care from February 2007 to March 2008 were studied. Demographic and clinical data variables of the patients, anesthesic variables prior to surgery and mechanical ventilation and postoperative complications during their stay in the ICU were recorded. RESULTS: A total of 102 patients were collected during the study. Of these, 58 (55.8%) patients were extubated early (within the first 4 hours of admission). Global rate of complications was 12.5%. Length of mechanical ventilation was longer in patients who required cervical lymph node extraction (p = 0.0031). We found an association between complications and late extubation (p = 0.034; OR = 3.78; 95% CI, 1.16-12.31). The multivariant study showed that late extubation and surgery that required lymph node extraction are predictors of complications. CONCLUSIONS: In our series, late extubation and the need for cervical lymph node extraction were independent risk factors for complications in ICU. Although early extubation may be hazardous in some cases in the first hours, we have no consistent data to maintain mechanical ventilation longer than needed to recover from the anesthesia.

[Epidemiology, initial management and analysis of morbidity-mortality of severe burn patient]. / Epidemiología, manejo inicial y análisisde morbimortalidad del gran quemado.

OBJECTIVE: Describe the epidemiological characteristics of severe burn patients and analyze the factors related with morbidity-mortality. DESIGN AND SCOPE: Observational, retrospective study of patients admitted to an intensive care unit of a level III hospital due to severe burns from January 1998 to December 2004. PATIENTS: 59 patients with criteria of "severe burn" and expected stay in ICU greater than three days. MAIN ENDPOINTS OF INTEREST: We studied epidemiological endpoints of this type of patients, diagnosis and initial treatment, early complications and morbidity-mortality. RESULTS: The burned body surface was 41% +/- 25% and age 49 +/- 21 years. Patients remained hospitalized in ICU for a median of 4 days (interquartile range: 2-19). A total of 78% of the patients needed mechanical ventilation, 47% had some infection during admission and 28% developed acute kidney failure during the first week. Mortality in the ICU was 42%. Endpoints associated independently with a significant increase of mortality were burned body surface greater than 35% (OR 1.08; 95% CI: 1.03-1.12) and development of kidney failure (OR 5.47; 95% CI: 2.02 -8.93). CONCLUSIONS: Mortality of these patients is very high and is conditioned largely by initial care. Percentage of burned body surface (BBS) and kidney failure entails greater mortality in our series.

[Use of methylene blue in the treatment of vasoplegic syndrome of post-operative heart surgery]. / Utilización de azul de metileno en el tratamiento del síndrome vasopléjico del postoperatorio de cirugía cardíaca.

Vasoplegia is a frequent complication in post-operative heart surgery and determines a significant increase in morbidity-mortality. When vasoplegia persists in spite of optimized fluid therapy with the use of Swan-Ganz catheter, we have a safe, effective and economical alternative, methylene blue. We present the case of a patient who developed vasoplegia refractory to treatment and shock in the scheduled post-operative period of myocardial revascularization. The use of a single dose of methylene blue resolved the hemodynamic instability and allowed for total discontinuation of vasoactive drugs. Thus, we present this new indication of methylene blue, still not approved by the corresponding bodies, for which no national publications have been found and its clinical management and the absence of adverse effects after its use.

[Dysautonomic seizures in patients admitted to an intensive care unit following severe traumatic brain injury]. / Crisis disautonómicas en pacientes ingresados en una unidad de cuidados intensivos tras un traumatismo craneoencefálico grave.

AIM: To describe clinical and radiologic features of dysautonomic crisis after severe traumatic brain injury and its influence in the clinical situation six months later. PATIENTS AND METHODS: Retrospective, observatory study of seven patients after severe head injury, with dysautonomic crisis, admitted in the Critical Care Unit (CCU) during six months. No interventions. Its clinical features, its association with intracranial pressure and the treatment for Dysautonomic crisis they have received were extracted from the computed clinical report. We have evaluated his neurologic prognosis with the Jennet-Bond scale and his radiologic characteristics with the Gennarelly scale. RESULTS: Dysautonomic crisis began in the first week if the patients didn't received neuromuscular blocks drugs and they continued when the patients were discharged from the CCU in a young population with an initial Glasgow scale coma of 5 points. We didn't wait a special radiologic pattern. After the next six months, crisis were disappeared in 86% of patients and all patients reached a good neurologic level in the Jennet-Bond scale. CONCLUSIONS: Dysautonomic crisis appeared early in young men after severe head injury. We didn't find a radiologic pattern that predisposes the dysautonomic crisis. They didn't interfere the recovering six months after head injury.

Impacto en salud infantil del invierno 2002: disociación entre factores ambientales y virus respiratorio sincicial, en Santiago / The influence of winter 2002 in pediatric health: dissociation between environmental factors and respiratory syncytial viruses, in Santiago

BACKGROUND: The increase in winter related health pediatric demand is associated with three factors: cold and rainy weather, air pollution and respiratory viral epidemics. During the winter of 2002 there was, successively, heavy rain, air pollution, cold weather and a respiratory syncytial virus (RSV) epidemic in Santiago. AIM: To study the influence of environmental factors and RSV epidemic on pediatric health care demand. PATIENTS AND METHODS: The number of hospital admissions and outpatient consultations for acute lower respiratory infections (ALRI) from April to October 2002 (Autumn to Spring in Chile), were registered in a public pediatric hospital of Santiago. A respiratory virus surveillance (RSV, adenovirus influenza and parainfluenza virus) was carried out among children admitted for ALRI. Climate conditions and air pollution (number of particles of more than 10 microns/mm3) values were provided by local environmental health services. RESULTS: As expected, a rise in winter hospital admissions and outpatient consultations was detected, that peaked in week 29. This rise coincided with the higher RSV detection week. There was heavy rain in weeks 22, 23 and 30, as well as cold weather in June-July (weeks 23, 24, 26, 27 and 30; mid Winter), that did not increase health care demand. Likewise, high air pollution, registered from weeks 24 to 26, did not increase health care demand. CONCLUSIONS: RSV epidemic is the principal factor associated to the increase in health burden during winter in Santiago.

Hospital-acquired adenovirus 7h infantile respiratory infection in Chile.

BACKGROUND: Adenoviruses are the second most common cause of viral acute lower respiratory tract infection (ALRI) requiring hospitalization in Chile. Little information is available with respect to nosocomial infection rate by adenovirus. This issue is important because of its potential severity and long term sequelae. METHODS: Infants hospitalized for ALRI were studied to determine the rate of nosocomial cross-infection with respiratory adenovirus and its corresponding genome type. The group studied included all cases younger than 2 years of age admitted to a seven crib ward in the Roberto del Rio Children's Hospital (Santiago, Chile) between May, 1995, and October, 1996. Nasopharyngeal aspirates for immunofluorescence assay and viral isolation were obtained on admission and the next day. On identification of a positive case for adenovirus, samples were obtained from contacts for 2 consecutive days and twice weekly thereafter for 2 weeks. RESULTS: Fifteen index positive cases for adenovirus and their 65 contacts were identified. Secondary attack rate for adenoviral cross-infection was 55%, most of which were diagnosed by viral isolation. Mortality occurred in 4 cases; 3 had underlying diseases. Four secondary cases presented mild respiratory infection after acquiring the cross-infection, and 16 patients developed a moderate and severe ALRI. Twelve patients required supplemental oxygen and 4 needed mechanical respiratory support. Genome types for the 10 index cases and 19 contacts were obtained. All of these corresponded to adenovirus 7h. CONCLUSIONS: The high secondary attack rate observed, stresses the importance of adequate isolation of patients and the need for rapid and sensitive viral diagnosis.

[Influence of respiratory viruses, cold weather and air pollution in the lower respiratory tract infections in infants children]. / Influencia de virus respiratorios, frío y contaminación aérea en la infección respiratoria aguda baja del lactante.

BACKGROUND: All winters, there is an increase in the number of pediatric consultations, associated to three factors: cold weather, air pollution and respiratory virus epidemics. AIM: To study the influence of these three factors in the demand for pediatric consultations between March and September, in an area of Metropolitan Santiago. PATIENTS AND METHODS: The number of consultations between March and September 1998 in the emergency room and the number of hospital discharges due to lower respiratory tract infections, were registered in a public pediatric hospital of Santiago. A respiratory virus surveillance (respiratory syncytial virus, adenovirus, influenza and parainfluenza virus) was done among children admitted for lower respiratory infections. Atmospheric temperature values and air pollution, measured as the number of particles of 10 microns or more per m3 (MP 10), were obtained from local health services. RESULTS: Two elevation waves of outpatient consultations were detected at weeks 19 and 26, that coincided with the periods of maximal detection of influenza and syncytial respiratory virus, respectively. The epidemics of respiratory syncytial virus coincided with the maximal number of hospital admissions for lower respiratory tract infections at week 27. There was no correlation between air pollution and the number of pediatric consultations. The lower ambient temperatures coincided with the higher detection of respiratory syncytial virus at week 28, moment in which the demand for consultations or hospital admissions was descending. CONCLUSIONS: There is a direct relationship between respiratory virus epidemics and the demand for pediatric consultations. There is also a minor influence of ambient temperature.

Community- and hospital-acquired respiratory syncytial virus infections in Chile.

Nasopharyngeal aspirates were obtained on admission from 614 patients younger than 2 years of age who were hospitalized in a ward for acute respiratory infections from June 1988 through October, 1989, in Santiago, Chile. Patients in two rooms were followed during the cold seasons by sampling aspirates every other day during the child's entire hospital stay. Clinical features were recorded daily. Indirect monoclonal immunofluorescent assay and isolation in HEp-2 were used for respiratory syncytial virus (RSV) diagnosis. The mean RSV detection rate was 39% at the time of admission, ranging from 8% in April, 1989, to 62% in July, 1988. During the cold months 43 of 288 (15%) nosocomial RSV cases were detected. Pneumonia and wheezing bronchitis were the principal diagnoses of both groups admitted, whether they were shedding RSV or not. It is concluded that RSV plays a major role in admissions for acute respiratory infections, as well as in nosocomial infections, in Santiago. Because clinical features do not allow one to differentiate viral from bacterial acute respiratory infections, the importance of rapid viral diagnosis is emphasized.

[Thrombolysis of thrombosed heart valve prostheses: presentation of 2 cases and review of the literature]. / Trombólisis de prótesis valvulares cardíacas trombosadas: presentación de 2 casos y revisión de la literatura.

Two women aged 38 and 51 years with thrombosed prosthetic heart valves (TPHV) in both tricuspid and mitral positions have been successfully treated with recombinant tissue plasminogen activator (rt-PA), 70 mg over 5 hours, and streptokinase (SK) 2,000,000 U over 10 hours without important complications. Cardiac surgery is the most commonly used therapy for combating this serious complication with a high mortality rate in general. There is controversy over the use of thrombolytics in TPHV. We reviewed the literature concerning treatment in 90 patients with this complication involving the different valve positions. We found an 80% therapeutical success rate, 8% partially successful, and 7% mortality rate. The main complications were of an embolic nature in 17% of cases, although the majority of these were transitory; haemorrhage occurred in 11% but there was only one case needing a transfusion. We conclude that thrombolytics are an efficient therapy in cases of TPHV in any position and should be started as soon as possible after the diagnosis has been confirmed.

Successful thrombolysis on a mechanical tricuspid prosthesis.

Recombinant tissue-type plasminogen activator (rt-PA) is presently used for the treatment of different clinical entities, mostly myocardial infarction. Its use for treatment of thrombotic dysfunction of prosthetic cardiac valves is more recent and has been only rarely reported. A 33-year-old woman with a St Jude Medical prosthesis in the tricuspid position, had suffered from thrombotic dysfunction of her prosthesis for more than 2 months. She was treated with rt-PA, and after infusion of 70 mg, the prosthesis functioned normally. She showed a moderate systemic fibrinolytic state associated with mild bleeding complications.

Efecto de inhibidores de la síntesis de prostaglandinas en el desarrollo embrionario del ratón / Effect of prostaglandins synthesis inhibitors on the embryonic development of mice

Se estudio el efecto de los inhibidores de la síntesis de prostaglandinas: naproxeno y sulindaco en un período crítico del desarrollo embrionario del ratón. Se analizaron las malformaciones obtenidas y se discutieron los mecanismos de acción de estos teratógenos