RESUMEN
The consensus paper for the implementation and development of the sepsis code, finished in April 2017 is presented here. It was adopted by the Regional Office of Health as a working document for the implementation of the sepsis code in the Community of Madrid, both in the hospital setting (acute, middle and long-stay hospitals) and in Primary Care and Out-of-Hospital Emergency Services. It is now published without changes with respect to the original version, having only added the most significant bibliographical references. The document is divided into four parts: introduction, initial detection and assessment, early therapy and organizational recommendations. In the second to fourth sections, 25 statements or proposals have been included, agreed upon by the authors after several face-to-face meetings and an extensive "online" discussion. The annex includes nine tables that are intended as a practical guide to the activation of the sepsis code. Both the content of the recommendations and their formal writing have been made taking into account their applicability in all areas to which they are directed, which may have very different structural and functional characteristics and features, so that we have deliberately avoided a greater degree of concretion: the objective is not that the sepsis code is organized and applied identically in all of them, but that the health resources work in a coordinated manner aligned in the same direction.
Asunto(s)
Consenso , Infección Hospitalaria/diagnóstico , Infección Hospitalaria/terapia , Tratamiento de Urgencia , Puntuaciones en la Disfunción de Órganos , Sepsis/diagnóstico , Sepsis/terapia , Antibacterianos/uso terapéutico , Biomarcadores/análisis , Lista de Verificación , Infecciones Comunitarias Adquiridas/diagnóstico , Infecciones Comunitarias Adquiridas/terapia , Toma de Decisiones en la Organización , Diagnóstico Precoz , Servicios Médicos de Urgencia/métodos , Medicina Basada en la Evidencia , Humanos , Norepinefrina/uso terapéutico , Grupo de Atención al Paciente/organización & administración , España , Vasoconstrictores/uso terapéuticoRESUMEN
OBJECTIVE: To assess the impact of the first months of application of a Code Sepsis in a high complexity hospital, analyzing patient´s epidemiological and clinical characteristics and prognostic factors. METHODS: A long-term observational study was carried out throughout a consecutive period of seven months (February 2015 - September 2015). The relationship with mortality of risk factors, and analytic values was analyzed using uni- and multivariate analyses. RESULTS: A total of 237 patients were included. The in-hospital mortality was 24% at 30 days and 27% at 60 days. The mortality of patients admitted to Critical Care Units was 30%. Significant differences were found between the patients who died and those who survived in mean levels of creatinine (2.30 vs 1.46 mg/dL, p <0.05), lactic acid (6.10 vs 2.62 mmol/L, p <0.05) and procalcitonin (23.27 vs 12.73 mg/dL, p<0.05). A statistically significant linear trend was found between SOFA scale rating and mortality (p<0.05). In the multivariate analysis additional independent risk factors associated with death were identified: age > 65 years (OR 5.33, p <0.05), lactic acid > 3 mmol/L (OR 5,85, p <0,05), creatinine > 1,2 mgr /dL (OR 4,54, p <0,05) and shock (OR 6,57, P <0,05). CONCLUSIONS: The epidemiological, clinical and mortality characteristics of the patients in our series are similar to the best published in the literature. The study has identified several markers that could be useful at a local level to estimate risk of death in septic patients. Studies like this one are necessary to make improvements in the Code Sepsis programs.
Asunto(s)
Protocolos Clínicos , Sepsis/terapia , APACHE , Adulto , Factores de Edad , Anciano , Anciano de 80 o más Años , Biomarcadores , Creatinina/sangre , Femenino , Mortalidad Hospitalaria/tendencias , Hospitales Universitarios , Humanos , Ácido Láctico/sangre , Masculino , Persona de Mediana Edad , Polipéptido alfa Relacionado con Calcitonina/sangre , Pronóstico , Factores de Riesgo , Sepsis/mortalidad , Resultado del TratamientoRESUMEN
Objective: To assess the correlation between left ventricular outflow tract velocity time integral (LVOT VTI) and stroke volume index (SVI) calculated by thermodilution methods in ventilated critically ill patients. Design: A prospective, descriptive, multicenter study was performed. Setting: Five intensive care units from university hospitals. Patients: Patients older than 17 years needing mechanical ventilation and invasive hemodynamic monitoring were included. Interventions: LVOT VTI was measured by pulsatile Doppler echocardiography. Calculations of SVI were performed through a floating pulmonary artery catheter (PAC) or a Pulse index Contour Cardiac Output (PiCCO(R)) thermodilution methods. Main variables: The relation between LVOT VTI and SVI was tested by linear regression analysis. Results: One hundred and fifty-six paired measurements were compared. Mean LVOT VTI was 20.83±4.86cm and mean SVI was 41.55±9.55mL/m2. Pearson correlation index for these variables was r=0.644, p<0.001; ICC was 0.52 (CI 95% 0.4-0.63). When maximum LVOT VTI was correlated with SVI, Pearson correlation index was r=0.62, p<0.001. Correlation worsened for extreme values, especially for those with higher LVOT VTI. Conclusions: LVOT VTI could be a complementary hemodynamic evaluation in selected patients, but does not eliminate the need for invasive monitoring at the present time. The weak correlation between LVOT VTI and invasive monitoring deserves additional assessment to identify the factors affecting this disagreement
Objetivo: Evaluar la correlación entre la integral velocidad tiempo del tracto de salida del ventrículo izquierdo (IVT TSVI) y el índice volumen sistólico (IVS) calculado por métodos de termodilución en pacientes ventilados críticamente enfermos. Diseño: Se realizó un estudio prospectivo, descriptivo y multicéntrico. Ámbito: Cinco unidades de cuidados intensivos de hospitales universitarios. Pacientes: Se incluyeron pacientes mayores de 17 años que necesitaron ventilación mecánica y monitorización hemodinámica invasiva. Intervenciones: La IVT TSVI se midió mediante Doppler pulsátil. Los cálculos de SVI se realizaron a través de un catéter de arteria pulmonar (CAP) o un método de Pulse index Contour Cardiac Output (PiCCO(R)), con métodos de termodilución. Variables principales: La relación entre IVT TSVI e IVS se evaluó mediante análisis de regresión lineal. Resultados: Se compararon 156 mediciones pareadas. La IVT TSVI media fue de 20,83±4,86cm y la media de IVS fue de 41,55±9,55ml/m2. El índice de correlación de Pearson para estas variables fue r=0,644, p<0,001; ICC fue 0,52 (IC 95%: 0,4-0,63). Cuando la IVT TSVI máxima se correlacionó con el IVS, el índice de correlación de Pearson fue r=0,62, p<0,001. La correlación empeoró para los valores extremos, especialmente para aquellos con mayor IVT TSVI. Conclusiones: La IVT TSVI podría ser una evaluación hemodinámica complementaria en pacientes seleccionados, pero no elimina la necesidad de un control invasivo en la actualidad. La débil correlación entre la IVT TSVI y la monitorización invasiva requiere estudios adicionales para identificar los factores que afectan a este desacuerdo
Asunto(s)
Humanos , Función Ventricular Izquierda/fisiología , Respiración Artificial/métodos , Termodilución/métodos , Correlación de Datos , Estudios Prospectivos , Unidades de Cuidados Intensivos/estadística & datos numéricos , Análisis de Regresión , Monitorización HemodinámicaRESUMEN
OBJECTIVE: To assess the correlation between left ventricular outflow tract velocity time integral (LVOT VTI) and stroke volume index (SVI) calculated by thermodilution methods in ventilated critically ill patients. DESIGN: A prospective, descriptive, multicenter study was performed. SETTING: Five intensive care units from university hospitals. PATIENTS: Patients older than 17 years needing mechanical ventilation and invasive hemodynamic monitoring were included. INTERVENTIONS: LVOT VTI was measured by pulsatile Doppler echocardiography. Calculations of SVI were performed through a floating pulmonary artery catheter (PAC) or a Pulse index Contour Cardiac Output (PiCCO®) thermodilution methods. MAIN VARIABLES: The relation between LVOT VTI and SVI was tested by linear regression analysis. RESULTS: One hundred and fifty-six paired measurements were compared. Mean LVOT VTI was 20.83±4.86cm and mean SVI was 41.55±9.55mL/m2. Pearson correlation index for these variables was r=0.644, p<0.001; ICC was 0.52 (CI 95% 0.4-0.63). When maximum LVOT VTI was correlated with SVI, Pearson correlation index was r=0.62, p<0.001. Correlation worsened for extreme values, especially for those with higher LVOT VTI. CONCLUSIONS: LVOT VTI could be a complementary hemodynamic evaluation in selected patients, but does not eliminate the need for invasive monitoring at the present time. The weak correlation between LVOT VTI and invasive monitoring deserves additional assessment to identify the factors affecting this disagreement.
Asunto(s)
Respiración Artificial , Volumen Sistólico , Función Ventricular Izquierda , Anciano , Velocidad del Flujo Sanguíneo , Correlación de Datos , Femenino , Humanos , Masculino , Estudios ProspectivosRESUMEN
No disponible
Asunto(s)
Humanos , Femenino , Anciano , Leiomiosarcoma/diagnóstico , Arteria Pulmonar/patología , Neoplasias Vasculares/diagnóstico , Angiografía , Disnea/etiologíaAsunto(s)
Líquido del Lavado Bronquioalveolar , Factor VIIa/uso terapéutico , Hemoptisis/tratamiento farmacológico , Hemorragia Posoperatoria/tratamiento farmacológico , Anticoagulantes/efectos adversos , Broncoscopía , Terapia Combinada , Comorbilidad , Embolización Terapéutica , Factor VIIa/administración & dosificación , Femenino , Hemoptisis/diagnóstico por imagen , Hemoptisis/etiología , Hemoptisis/terapia , Técnicas Hemostáticas , Humanos , Persona de Mediana Edad , Insuficiencia Multiorgánica/etiología , Neumonía Bacteriana/complicaciones , Hemorragia Posoperatoria/diagnóstico por imagen , Hemorragia Posoperatoria/etiología , Hemorragia Posoperatoria/terapia , Infecciones por Pseudomonas/complicaciones , Proteínas Recombinantes/administración & dosificación , Proteínas Recombinantes/uso terapéutico , Choque Séptico/etiología , Insuficiencia de la Válvula Tricúspide/cirugíaRESUMEN
No disponible
Asunto(s)
Humanos , Femenino , Persona de Mediana Edad , Síndrome de Brugada/complicaciones , Síndrome de Brugada , Fiebre/complicaciones , Fiebre/etiología , Fiebre , Imagen por Resonancia Magnética/instrumentación , Imagen por Resonancia Magnética/métodos , Imagen por Resonancia Magnética , Espectroscopía de Resonancia Magnética/métodos , Fiebre/terapia , Insuficiencia Respiratoria/complicaciones , Infecciones Comunitarias Adquiridas/complicaciones , Electrocardiografía/instrumentación , Electrocardiografía/métodos , ElectrocardiografíaAsunto(s)
Humanos , Masculino , Persona de Mediana Edad , Anafilaxia/complicaciones , Anafilaxia/diagnóstico , Angina de Pecho/complicaciones , Infarto del Miocardio/complicaciones , Factores de Riesgo , Antagonistas de los Receptores Histamínicos/uso terapéutico , Metilprednisolona/uso terapéutico , Disfunción Ventricular/complicaciones , Hipocinesia/complicaciones , Hipocinesia/diagnóstico , Síndrome de Abstinencia a Sustancias/complicaciones , Convulsiones por Abstinencia de Alcohol/complicaciones , Hipotensión/complicaciones , Angina de Pecho/diagnóstico , Disfunción Ventricular/diagnóstico , Hipotensión/diagnóstico , Electrocardiografía/métodos , Electrocardiografía/tendencias , Disfunción Ventricular/fisiopatología , Disfunción VentricularAsunto(s)
Enfermedades Pulmonares Intersticiales/etiología , Virus de la Parainfluenza 4 Humana/aislamiento & purificación , Neumonía Viral/etiología , Púrpura Trombocitopénica Trombótica/etiología , Infecciones por Rubulavirus/virología , Antiinfecciosos/uso terapéutico , Protocolos de Quimioterapia Combinada Antineoplásica/efectos adversos , Protocolos de Quimioterapia Combinada Antineoplásica/uso terapéutico , Neoplasias de la Mama/complicaciones , Neoplasias de la Mama/tratamiento farmacológico , Neoplasias de la Mama/cirugía , Carcinoma Ductal de Mama/complicaciones , Carcinoma Ductal de Mama/tratamiento farmacológico , Carcinoma Ductal de Mama/cirugía , Terapia Combinada , Resultado Fatal , Femenino , Humanos , Huésped Inmunocomprometido , Enfermedades Pulmonares Intersticiales/terapia , Enfermedades Pulmonares Intersticiales/virología , Persona de Mediana Edad , Insuficiencia Multiorgánica/etiología , Derrame Pericárdico/etiología , Plasmaféresis , Neumonía Viral/terapia , Neumonía Viral/virología , Complicaciones Posoperatorias/virología , Púrpura Trombocitopénica Trombótica/terapia , Infecciones por Rubulavirus/complicacionesRESUMEN
Acquired immune deficiency syndrome increases the risk of developing non-Hodgkin's B-cell lymphoma (NHL) (relative risk over 100). NHL tend to be high-grade and to affect the central nervous system and digestive tract. Biliary tract compression is usually due to external compression from enlarged lymph nodes, but is not usually the first manifestation.We describe 2 cases of bile duct obstruction secondary to NHL in patients diagnosed with HIV infection. Histological diagnosis of the lymphoma can be difficult but is necessary so that these patients do not undergo highly aggressive surgical treatment instead of chemotherapy, which currently produces the best results. Therefore, we emphasize the importance of including lymphomas in the differential diagnosis of bile duct obstruction in patients with HIV infection.