Complications during repeated tracheal intubation in the Intensive Care Unit. A prospective, observational study comparing the first intubation and the reintubation.

BACKGROUND AND GOAL OF THE STUDY: The goal of the study was to compare the incidence of complications, technical difficulty of intubation and physiologic pre-intubation status between the first intubation and reintubation performed on the same patient in an ICU. MATERIALS AND METHODS: The study was approved by the ethics committee of Galicia (Santiago-Lugo, code No. 2015-012). Due to the observational, noninterventional, and noninvasive design of this study, the need for written consent was waived by the ethics committee of Galicia. Patients requiring tracheal intubation and reintubation in the ICU were included in this prospective observational study. Main endpoint was to compare the incidence of complications, physiologic pre-intubation status, and the rate of technical difficulty of intubation between the first intubation and reintubation performed on the same patient in an ICU. RESULTS AND DISCUSSION: 504 patients were intubated in our ICU during the study period, and 82 (16%) required reintubation. There was no difference between the first intubation and reintubation regarding number of total complication (35% vs 33%; P = ,86), hypotension (24% vs 24%; P = 1), hypoxia (26% vs 26%; P = 1), esophageal intubation (1% vs 1%; P = 1), and bronchoaspiration (2% vs 1%; P = ,86). Physiologic pre-intubation status and technical difficulty of intubation did not differ between the first intubation and reintubation. CONCLUSIONS: In our ICU patients requiring tracheal reintubation, incidence of complications, physiologic pre-intubation status, and technical difficulty of intubation did not differ between the first intubation and reintubation.

Ultrasonidos en anestesia locorregional. Fundamentos de la técnica e identificación de nervios periféricos / No disponible

El uso de ultrasonidos en anestesia locorregional se está convirtiendo en un estándar en la práctica clínica habitual. Aumentan la seguridad y en índice de éxitos de los bloqueos, sin embargo y como todas las técnicas, tiene limitaciones evidentes, derivadas fundamentalmente de las limitaciones técnicas y artefactos en la imagen que los ultrasonidos pueden provocar. En este artículo revisamos los principios físicos en los que se basan los ultrasonidos, y analizamos sus posibilidades y limitaciones, así como la forma de explorar nervios periféricos (AU)

The use of ultrasounds is becoming a standard in the clinical practice of locoregional anesthesia. They increase the rate of successful blocks and improve their security, but the ultrasound shave limitations due technical principles and the possibility of artefacts in the image. In this paper we review the basics of the physics of ultrasonography, their possibilities and limitations and the use of ultrasonography in the location of peripherals nerves (AU)

De la infección a la sepsis. Parte I. Mecanismos de inmunidad y daño tisular / From infection to sepsis. Part I. Immunologic mechanisms and tisular damage

La sepsis continúa siendo una de las causas fundamentales de muerte –posiblemente la más importante– en nuestro medio habitual de trabajo, puesto que frecuentemente los pacientes oncológicos, politraumatizados o con patología cardiovascular y neurológica fallecen debido a un fallo multiorgánico secundario a una infección. No están claras, sin embargo, las razones por las que una infección evoluciona o no a sepsis y a fallo multiorgánico. En esta revisión, que hemos dividido en dos partes, no pretendemos profundizar ni en la clínica ni el tratamiento de la sepsis, pretendemos revisar los conceptos fisiopatológicos implicados en la protección y daño celulares y tisulares. En la segunda parte prestaremos una especial dedicación a la información existente en la actualidad sobre la implicación de algunos genes en el pronóstico de estos enfermos (AU)

Sepsis is still one of the major causes of death, maybe the most important one in our work environment, where our oncologic, polytraumatized, neurologic, or cardiac patients often die due to a multiorganic failure secondary to an infection. However, the reasons for the evolution from infection to sepsis or even multiorganic failure remain unclear. In this two part review we don’t pretend to go into the clinical presentation and treatment of sepsis in depth, but to look through the physiopathologic features involved in cellular and tisular damage and protection. Moreover, in the second part we will pay special attention to the existing information about the role of certain genes in the outcome of these patients (AU)

[Respiratory morbidity after hospital discharge in premature infants born at < or = 32 weeks gestation with bronchopulmonary dysplasia]. / Morbilidad respiratoria tras el alta hositalaria en prematuros (< or = 32 semanas) con displasia broncopulmonar.

BACKGROUND: Bronchopulmonary dysplasia (BPD) is the most frequent cause of respiratory morbidity in the first 2 years of life among preterm infants who survive the first 28 days. OBJECTIVES: To evaluate respiratory morbidity in the first 2 years of life in a group of preterm infants born at (32 weeks' gestation with BPD (oxygen requirement at 36 weeks' postconceptional age) by comparing it with that in preterm infants born at (32 weeks without BPD and with a control group of full term infants without neonatal morbidity. To determine whether respiratory morbidity in children with BPD decreases after the age of 2 years. PATIENTS AND METHOD: Group I: preterm children with BPD (n = 29). Group II: preterm children without BPD (n = 29). Group III: children with appropriate gestational age and weight (n = 32). A cross-sectional, descriptive study of the three groups was performed over a 2-year period. In 17 children in group 1, the study was prolonged to the age of 4 years. We analyzed wheezing on at least two occasions, use of inhaled bronchodilators, use of inhaled glucocorticosteroids for more than 6 months, and hospitalization for respiratory illness. The chi-square test and Fischer's exact test were performed. RESULTS: At least one episode of wheezing occurred in 25 children (86.2%) in group I compared with 12 children (41.4%) in group II and 6 (18.8%) in group III. Nineteen children (65.5%) in group I and none in the remaining two groups received treatment with inhaled glucocorticosteroids for more than 6 months (p < 0.001). Inhaled bronchodilators were used by 25 children (86.2%) in group I compared with 12 (41.4%) in group II and 6 (18.8%) in the control group (p < 0.001). Twelve children (41.3%) in group I were hospitalized for respiratory illness compared with 8 (27.6%) in group II. There were no admissions among the control group. None of the children with BPD who received prophylaxis with palivizumab contracted respiratory syncytial virus infection. Seventeen children with BPD were evaluated until the age of 4 years. Episodes of wheezing decreased from 88.2% in the first year to 41 % between the third and fourth years (p < 0.001). Treatment with inhaled glucocorticosteroids for more than 6 months was given to 88.2% in the first year, 41.2 % between the first and second year and to 0 % after the second year (p < 0.001). Hospital admissions for respiratory illness decreased from 52.9% in the first year to 17.6% in the second year. None of the children were hospitalized after the age of 2 years (p < 0.001). CONCLUSIONS: During the first 2 years of life, children with BPD showed a greater number of admissions and episodes of wheezing and a greater need for medical treatment. Respiratory morbidity improved with age, 40% showed recurrent wheezing episodes at the age of 4 years.

Morbilidad respiratoria tras el alta hospitalaria en prematuros (32 semanas) con displasia broncopulmonar / Respiratory morbidity after hospital discharge in premature infants born at<= 32 weeks´ gestation with bronchopulmonary dysplasia

Antecedentes: La displasia broncopulmonar es la causa más frecuente de morbilidad respiratoria en los primeros 2 años en el niño pretérmino que sobrevive a los 28 días de vida. Objetivos: Valorar la morbilidad respiratoria durante los primeros 2 años de vida en un grupo de niños pretérmino (>=32 semanas) con displasia broncopulmonar (necesidad de oxígeno a las 36 semanas de edad posconcepcional), comparándola con la de niños pretérmino (<=32 semanas) sin displasia broncopulmonar y con un grupo control de nacidos a término sin enfermedad neonatal. Comprobar si la morbilidad respiratoria en los niños con displasia broncopulmonar disminuye a partir de los 2 años de edad. Pacientes y método: Grupo I: niños pretérmino con displasia broncopulmonar (n=29). Grupo II: niños pretérmino sin displasia broncopulmonar (n=29). Grupo III: niños de peso y edad gestacional adecuados (n=32). En los 3 grupos se realizó estudio longitudinal descriptivo durante 2 años, y en 17 niños del grupo I se realizó el mismo estudio hasta la edad de 4 años. Se analizaron las siguientes variables: sibilancias en al menos dos ocasiones, empleo de broncodilatadores inhalados, utilización de glucocorticoides inhalados durante más de 6 meses, ingresos hospitalarios por problemas respiratorios mediante test de chi cuadrado (X2) y test de Fischer. Resultados: Tuvieron algún episodio de sibilancias 25 niños del grupo I (86,2 por ciento) frente a 12 (41,4 por ciento) del grupo II y 6 (18,8 por ciento) del grupo III. Fueron tratados con glucocorticoides inhalados durante más de 6 meses, 19 niños del primer grupo (65,5 por ciento) y ninguno de los otros 2 grupos (p < 0,001). Utilizaron broncodilatadores inhalados 25 niños del grupo I (86,2 por ciento) frente a 12 (41,4 por ciento) del grupo II y 6 (18,8 por ciento) del grupo control (p < 0,001). Fueron hospitalizados por problemas respiratorios 12 niños del grupo I (41,3 por ciento) frente a 8 (27,6 por ciento) del grupo II, sin que ingresara ninguno del grupo control. De los niños con displasia broncopulmonar que recibieron profilaxis con palivizumab ninguno tuvo infección demostrada por virus respiratorio sincitial (VRS).Se evaluaron hasta los 4 años de edad 17 niños con displasia broncopulmonar. Los episodios de sibilancias disminuyeron del 88,2 por ciento en el primer año al 41 por ciento entre el tercer y cuarto años (p < 0,001). Recibieron tratamiento con glucocorticoides inhalados durante más de 6 meses el 88,2 por ciento en el primer año, el 41,2 por ciento entre el primer y segundo años y ninguno a partir del segundo año (p < 0,001).Los ingresos hospitalarios por problemas respiratorios descendieron del 52,9 por ciento en el primer año al 17,6 por ciento en el segundo, y ningún niño necesitó ingreso a partir de los 2 años (p < 0,001). Conclusiones: Durante los primeros 2 años, los niños con displasia broncopulmonar tienen mayor número de ingresos, más episodios de sibilancias y más necesidad de tratamiento médico; mejoran con la edad, aunque a los 4 años el 40 por ciento tienen episodios repetidos de sibilancias (AU)

Brown and white adipose tissue lipid composition in three successive progenies of rats: effects of ethanol exposure.

The effect of ethanol exposure on the fatty acid composition of brown and white adipose tissue in three successive rat progenies at the end of an experimental period (24 weeks) was studied. Ethanol-treated rats received a standard rat chow diet and 5, 10 and 15% ethanol in the ad libitum drinking fluid over 3 successive weeks. Then a concentration of 20% ethanol was maintained for 5 additional weeks up to the end of the experimental period. The males and females in the ethanol treated group were mated to obtain the 1st generation of offspring. Then female and male rats from the 1st generation were mated to obtain the 2nd generation. Finally, males and females from the 2nd generation were mated to obtain the 3rd generation of ethanol treated rats. Another group served as control and received only water and a standard rat chow diet. The control group was handled in the same way as the other experimental groups. In the 1st and 2nd generations the percentage of stearic acid (18:0) decreased and palmitoleic (16:1n7) and oleic acid (18:1n9) increased in both adipose tissues of ethanol-treated rats with respect to control. Additionally, n-3 and n-6 series were reduced both in brown and white adipose tissues. In the 3rd generation the fatty acid composition of the white adipose tissue was similar to that of control rats. Thus, no significant difference in essential fatty acids and oleic acid (18:1n9) were found. However, the fatty acid composition of the brown adipose tissue, in the 3rd generation, was similar to that observed in the 1st and 2nd generation. Thus, a decrease in essential fatty acids and an increase in oleic acid (18:1n9) was found. This suggests adaptation to ethanol consumption during successive progenies in white adipose tissue. However, in brown adipose tissue the values indicate a triglyceride storing during the thermogenesis, which is more important to newborns.

Effects of folic acid and amino acids supplementation on zinc intestinal absorption in the progeny of ethanol-treated rats.

This study was designed to examine the effects of supplementation with folic acid and amino acids in dams that consumed ethanol during gestation and lactation to see whether there is an improvement in the intestinal absorption of zinc in pup rats on the 21st day after birth. The rats were randomized into two groups: Ethanol-rats (EG) were administered ethanol during the pregnancy and lactation periods; the ethanol-folic acid group (EFG) received a folic acid and amino acid supplement concomitantly with ethanol administration during pregnancy and lactation. The dams were mated to obtain the first offspring. Two sets of experiments were performed on the offspring at 21 days after birth. In general, in the first set, jejunal zinc absorption in the offspring of EG and EFG groups showed a gradual increase along with increased perfusion time at all assayed concentrations. Jejunal zinc absorption expressed as nmol/intestinal surface was higher in the ethanol-folic acid group than in ethanol animals at all assayed concentrations except at 25 microM concentration. In the second set of experiments, distal ileum zinc absorption in the offspring of ethanolfolic acid dams showed a significant increase at all concentrations tested. These results indicate that supplementation of folic acid and amino acids to dams that consume ethanol during gestation and lactation increase serum and milk zinc levels, although the zinc ingestion is lower. In pups of the supplemented dams, the jejunal and ileal absorption of zinc increased; as a consequence, the serum zinc levels increased. The activity of alcohol dehydrogenase, a metaloenzyme dependent on zinc levels, also increased.

Folic acid intestinal absorption in newborn rats at 21 day postpartum: effects of maternal ethanol consumption.

This study was designed to examine the effects of prenatal and postnatal exposure of ethanol in the in vivo absorption of free folic acid in the small intestine in pups rats at the 21st day after birth. The rats were accustomed to increasing amounts of ethanol (5 to 20%, vol/vol) in tap water for 1 month. During pregnancy and suckling period, ethanol-fed dams were assigned again to ethanol 20% in drinking water. Two sets of experiments were performed. In the first set, jejunal free folic acid absorption in control group and litters nursed by dams receiving ethanol showed a gradual increase along with the increase of perfusion time at all the assayed concentrations. In general, in litters of ethanol-fed dams, jejunal free folic acid absorption expressed as nmol/intestinal surface, nmol/g tissue wet weight and nmol/g tissue dry weight were higher than in control animals. In the second set of experiments, in distal ileum loops, free folic acid absorption did not occur in control pups, but appeared in litters exposed to ethanol. Milk folic acid levels are significantly decreased in ethanol-treated dams. However, only a slight decrease in the serum folic acid levels occurs in litters of ethanol-fed dams. In conclusion, the results obtained in the present work suggested a different pattern of free folic acid absorption in distal ileum for the two groups. The exposure of rats to ethanol during the pregnancy and suckling period, can affect postnatal development of intestinal functions and could play a role in the genesis of malnutrition observed in the infant.

Effect of chronic ethanol consumption on fatty acid profile of heart tissue in rats.

The effect of chronic ethanol ingestion on fatty acid composition and lipid content of heart tissue in rats, and whether this effect depends on age, was studied. Rats were maintained on a 30% ethanol solution in drinking water for 3 and 5 months. Control animals were given water. Phospholipid concentration was unchanged in the ethanol-fed groups, compared with control groups, whereas total cholesterol content was increased at 5 months of treatment. An increase in stearic acid, palmitoleic acid, and 22:5n6 were observed at 3 months of ethanol ingestion. When ethanol was administered for 5 months, polyunsaturated fatty acids series n3 were decreased with respect to control. The effect of age on the profile of fatty acids of heart showed an increase of monounsaturated fatty acids and a decrease of long-chain polyunsaturated fatty acids in both control and ethanol-fed rats. The effect of ethanol ingestion on fatty acid composition of heart tissue is not very pronounced, but the small changes observed could contribute to the development of functional and electrophysiological features of alcoholic heart disease.

Zinc intestinal absorption in newborn rats at 21 day postpartum: effects of maternal ethanol consumption.

This study was designed to examine the effects of prenatal and postnatal exposure of ethanol in the in vivo absorption of zinc in the small intestine in newborn rats at the 21st day after birth. The rats were accustomed to increasing amounts of ethanol (5 to 20%, vol/vol) in tap water for 1 month. During pregnancy and suckling period, ethanol-fed dams were assigned again to ethanol 20% in drinking water. Two sets of experiments were performed. In the first set, jejunal zinc absorption in control group and litters nursed by dams receiving ethanol showed a gradual increase along with the increase of perfusion time at all the assayed concentrations. In general, in litters of ethanol-fed dams, jejunal zinc absorption expressed as nmol/intestinal surface was higher than in control animals. In the second set of experiments, distal ileum zinc absorption in offspring of ethanol-fed dams showed a significantly decrease at all concentrations tested. The results showed that intestinal parameters measured in jejunum and distal ileum of litters exposed to ethanol were always significantly less than in control newborn. These results indicate that exposure of rats to ethanol during the pregnancy and suckling period, may affect postnatal development of intestinal functions and decrease the distal ileum zinc absorption in pups at the end of the lactation period.

Changes in the fatty acid profile of plasma and adipose tissue in rats after long-term ethanol feeding.

The effect of chronic ethanol feeding on the fatty acid composition of plasma and abdominal adipose tissue in rats was studied. Animals were maintained on a 30% ethanol solution in drinking water for 3 and 5 months. Control rats were given water. Caloric intake was similar in control and ethanol-fed rats at the end of the experimental period. However, a decrease in body weight was observed in rats that had consumed ethanol. Palmitoleic (16:1n7) and oleic (18:1n9) acids increased markedly, and linoleic acid (18:2n6) decreased in the plasma and in the adipose tissue of ethanol-fed rats with respect to control rats. After 3 months of ethanol ingestion, long-chain polyunsaturated fatty acids were reduced both in plasma and adipose tissue. When ethanol was administered for 5 months, only plasma long-chain polyunsaturated fatty acids of the n-3 series were decreased. This suggest that changes induced by ethanol ingestion in essential fatty acid metabolism is less pronounced when ethanol feeding is maintained for a long period of time.