Impact of mobilization in patients with short-term mechanical circulatory support such as Levitronix® CentriMag as a bridge to heart transplantation.

INTRODUCTION: Despite the benefits of mobilisation in the critical patient, the evidence in patients with Levitronix® CentriMag as a bridge to heart transplantation (HT) is scarce. The objective of this study is to analyze the impact of mobility on these patients. METHODS: Retrospective observational study of patients who received a HT with Levitronix® CentriMag admitted between 2010 and 2019 to a tertiary hospital. Degree of mobility and nutritional status were assessed at the time of HT. Outcomes including infections, length of hospital admission and mortality were evaluated. RESULTS: 27 patients were included and divided in two groups according to degree of mobility (22 with low mobility and 5 with high mobility). 90-day survival after HT was 63.6% in patients with low mobility and 80% in high mobility group; no statistically significant differences were observed. No differences were observed regarding ICU discharge after HT at 30 days. Nevertheless, lower albumin levels were observed in low mobility group (24,5 g/L (IQR: 23-30) vs 33 g/L (IQR: 26-36); p = .029). Invasive mechanical ventilation (IMV) post HT was longer in patients with low mobility (p = .014). There were no significant differences in appearance of pressure ulcers, or post HT infections among mobility groups. CONCLUSIONS: Patients with high mobility had a shorter time of IMV and a better nutritional status. No complications were observed associated to mobility. No differences were observed between the degree of mobility and 90-day mortality, ICU stay or post HT adverse events.

Impacto de la movilización en pacientes portadores de soporte circulatorio mecánico de corta duración tipo Levitronix® CentriMag como puente a trasplante cardíaco / Impact of mobilization in patients with short-term mechanical circulatory support such as Levitronix® CentriMag as a bridge to heart transplantation

Introducción: Pese a los beneficios de la movilización en el paciente crítico, la evidencia de su aplicación en pacientes portadores de Levitronix® CentriMag como puente a trasplante cardíaco (TC) es prácticamente nula. El objetivo del estudio fue analizar el impacto de la movilidad en estos pacientes. Métodos: Estudio observacional retrospectivo. Se incluyeron los pacientes sometidos a un TC previamente portadores de Levitronix® CentriMag ingresados entre el 2010 y el 2019 en el Hospital Universitario de Bellvitge. Se relacionaron las variables grado de movilidad y estado nutricional con la evolución clínica posterior al TC (infecciones, tiempo de estancia en UCI y mortalidad). Resultados: Los 27 pacientes seleccionados se dividieron en dos grupos según el grado de movilidad (22 baja y 5 alta). Se observó una supervivencia a 90 días post-TC del 63,6% en el grupo de pacientes con movilidad baja, mientras que en el grupo con movilidad alta fue del 80%; no se observaron diferencias estadísticamente significativas. Tampoco las hubo en la distribución de las altas de UCI desde el TC a 30 días. Por otro lado, se observaron unos menores niveles de albúmina en el grupo de movilidad baja, con una diferencia estadísticamente significativa (24,5 g/L [RIC: 23-30] vs. 33 g/L [RIC: 26-36]; p = 0,029). También se observaron diferencias en la mediana de días de ventilación mecánica invasiva (VMI) post-TC (p = 0,014), siendo mayor en el grupo de movilidad baja. No se observaron diferencias en la aparición de infecciones ni UPP. Conclusiones: Los pacientes con un grado de movilidad alto presentaron un menor tiempo de VMI y un mejor estado nutricional. No se observaron complicaciones asociadas a la movilidad. No se encontraron diferencias significativas entre el grado de movilidad y la mortalidad a 90 días, el tiempo de ingreso en UCI, la aparición de infecciones o UPP post-TC.(AU)

Introduction: Despite the benefits of mobilization in the critical patient, the evidence in patients with Levitronix® CentriMag as a bridge to heart transplantation (HT) is almost absent. The objective of this study is to analyze the impact of mobility on these patients. Methods: Retrospective observational study of patients who received a HT with Levitronix® CentriMag admitted between 2010 and 2019 to “Hospital Universitario de Bellvitge” (Barcelona). Degree of mobility and nutritional status were assessed at the time of HT. Outcomes including infections, length of hospital admission and mortality were evaluated. Results: 27 patients were included and divided in two groups according to degree of mobility (22 with low mobility and 5 with high mobility). 90-day survival after HT was 63.6% in patients with low mobility and 80% in high mobility group; no statistically significant differences were observed. No differences were observed regarding ICU discharge after HT at 30 days. Nevertheless, lower albumin levels were observed in low mobility group (24.5 g/L (IQR: 23-30) vs. 33 g/L (IQR: 26-36); p = 0.029). Invasive mechanical ventilation (IMV) post HT was longer in patients with low mobility (p = 0.014). There were no significant differences in appearance of pressure ulcers, or post-HT infections among mobility groups. Conclusions: Patients with high mobility had a shorter time of IMV and a better nutritional status. No complications were observed associated to mobility. No differences were observed between the degree of mobility and 90-day mortality, ICU stay or post-HT adverse events.(AU)

Discharge survival of patients undergoing ECMO therapy after ECPR in a third level hospital.

GOAL: The goal of this study was to assess the survival to hospital discharge in patients after the implementation of venoarterial-extracorporeal membrane oxygenation (VA-ECMO) during cardiopulmonary arrest (simultaneously or during the first six hours after the event) in a Spanish tertiary hospital. METHOD: This is a descriptive and retrospective study conducted with patients subjected to VA-ECMO therapy during or after cardiopulmonary resuscitation (CPR) in the last 10 years. The variables were extracted from the electronic medical record of each patient. RESULTS: 175 ECMO therapies were implemented, 84% (147) were VA-ECMO, and the indication for 17% (25) was CPR. In 40% (10), ECMO therapy was initiated simultaneously during CPR, and the rest (15) during the first six hours after the event. Survival rates reached 44%. CONCLUSIONS: The use of CPR in well-selected patients can improve their survival.

Supervivencia al alta hospitalaria de los pacientes sometidos a terapia ECMO tras PCR en un hospital de tercer nivel / Discharge survival of patients undergoing ECMO therapy after ECPR in a third level hospital

Objetivo El objetivo del estudio fue analizar la supervivencia al alta hospitalaria de los pacientes tras la instauración de una membrana de oxigenación extracorpórea veno-arterial (ECMO-VA) durante paro cardiorrespiratorio (simultáneamente o durante las 6 horas posteriores a este) en un hospital de tercer nivel español. Metodología Estudio descriptivo y retrospectivo de los pacientes sometidos a una terapia ECMO-VA durante o tras maniobras de reanimación cardiopulmonar (ERCP) en los últimos 10 años. Las variables fueron extraídas de la historia clínica electrónica de cada paciente. Resultados Se implantaron 175 ECMO, el 84% (147) fueron ECMO-VA y el 17% (25) su indicación fue de ECPR. El 40% (10) la terapia ECMO se inició simultáneamente durante las maniobras de RCP y el resto (15) en las 6 horas posteriores. Se obtuvieron tasas de supervivencia del 44%. Conclusiones El uso de la ERCP a pacientes bien seleccionados puede mejorar su supervivencia. (AU)

Goal The goal of this study was to assess the survival to hospital discharge in patients after the implementation of venoarterial-extracorporeal membrane oxygenation (VA-ECMO) during cardiopulmonary arrest (simultaneously or during the first six hours after the event) in a Spanish tertiary hospital. Method This is a descriptive and retrospective study conducted with patients subjected to VA-ECMO therapy during or after cardiopulmonary resuscitation (ECPR) in the last 10 years. The variables were extracted from the electronic medical record of each patient. Results 175 ECMO therapies were implemented, 84% (147) were VA-ECMO, and the indication for 17% (25) was ECPR. In 40% (10), ECMO therapy was initiated simultaneously during CPR, and the rest (15) during the first six hours after the event. Survival rates reached 44%. Conclusions The use of CPR in well-selected patients can improve their survival. (AU)

Discharge survival of patients undergoing ECMO therapy after ECPR in a third level hospital. / Supervivencia al alta hospitalaria de los pacientes sometidos a terapia ECMO tras PCR en un hospital de tercer nivel.

GOAL: The goal of this study was to assess the survival to hospital discharge in patients after the implementation of venoarterial-extracorporeal membrane oxygenation (VA-ECMO) during cardiopulmonary arrest (simultaneously or during the first six hours after the event) in a Spanish tertiary hospital. METHOD: This is a descriptive and retrospective study conducted with patients subjected to VA-ECMO therapy during or after cardiopulmonary resuscitation (ECPR) in the last 10 years. The variables were extracted from the electronic medical record of each patient. RESULTS: 175 ECMO therapies were implemented, 84% (147) were VA-ECMO, and the indication for 17% (25) was ECPR. In 40% (10), ECMO therapy was initiated simultaneously during CPR, and the rest (15) during the first six hours after the event. Survival rates reached 44%. CONCLUSIONS: The use of CPR in well-selected patients can improve their survival.

Atención de Enfermería durante el postoperatorio a paciente sometido a clipaje de aneurisma por ruptura / Postsurgical Nursing Attention on a patient who underwent aneurysm clipping / Assistência de enfermagem no pós-operatório ao paciente submetido a ruptura de aneurisma

Introducción Es reconocido que el personal de enfermería es quien tiene mayor interacción con el paciente, por lo que se ve obligado a contar con conocimientos y experiencia suficiente que permita identificar y atender las necesidades de individuos que sufren de enfermedad cerebrovascular. Esta condición de salud puede ser secundaria a la ruptura de un aneurisma, lo que conduce al paciente a un estado crítico; además, puede traducirse en riesgo para el equilibrio financiero de la familia y el Sistema Sanitario. Métodos: Se desarrollaron las etapas del proceso de cuidado de enfermería centradas en una situación real de la práctica clínica durante el periodo postoperatorio de una paciente sometida a clipaje de aneurisma. Se utilizó el modelo de patrones funcionales de Marjory Gordon para la recolección de los datos; además de la taxonomía NANDA-NIC-NOC. Resultados: Se presentan los planes de cuidado en los que se centró la intervención de enfermería en la paciente valorada. Así como la evaluación del proceso en las dimensiones de estructura, proceso y resultado. Discusión/conclusiones: El EVC secundario a ruptura de aneurisma cerebral es una situación grave y devastadora para la familia y el sistema sanitario. Por tanto, una adecuada atención de enfermería a este problema es de la mayor importancia.

Introduction: It is well acknowledged that nursing staff have the greatest interaction with patients and thus, nurses need to have sufficient knowledge and experience to identify the diverse needs, for example of those patients suffering from cerebrovascular disease. This condition can be a consequence of a ruptured aneurysm, which can in turn lead the patient to a critical status jeopardizing the financial equilibrium of his/her family and the health system. Methods: The nursing process stages were developed during the postsurgical period of a patient who underwent an aneurysm clipping. The Gordon's functional health patterns model was used to collect data, in addition to the NANDA/NIC/NOC taxonomy. Results: Care plans derived from the nursing intervention were presented, as well as the related assessment in terms of the structure, process, and results dimensions. Discussion/Conclusion: The CVE secondary to the rupture of an aneurysm is a serious and devastating situation for the patient, his/her family, and the health system, therefore, an adequate related nursing attention becomes of the most importance.

Introdução: Reconhece-se que os enfermeiros têm maior interação com o paciente, sendo obrigados a ter conhecimento e experiência suficientes para identificar e atender às necessidades dos indivíduos portadores de doença cerebrovascular. Essa condição de saúde pode ser secundária à ruptura de um aneurisma, que leva o paciente a um estado crítico; além disso, pode ser traduzido em risco para o equilíbrio financeiro da família e do Sistema de Saúde. Métodos: Desenvolveram-se as etapas do processo de cuidar em enfermagem, enfocando uma situação real da prática clínica no pós-operatório de um paciente submetido a clipagem de aneurisma. O modelo de padrões funcionais de Marjory Gordon foi utilizado para coleta de dados; além da taxonomia NANDA-NIC-NOC. Resultados: São apresentados planos de cuidados em que a intervenção de enfermagem foi focada no paciente valorizado. Assim como a avaliação do processo nas dimensões de estrutura, processo e resultado. Discussão / conclusões: A EVC secundária a um aneurisma cerebral roto é uma situação grave e devastadora para a família e o sistema de saúde. Portanto, cuidados de enfermagem adequados para este problema são de extrema importância.

[Whipple's disease: a case report and review of the literature]. / Enfermedad de Whipple. Presentación de un caso y revisión de la literatura.

Whipple's disease is a systemic infectious condition caused by a gram-positive bacteria belonging to the family of actinomycetes called Tropherima whipplei. It presents most often in males and 13% of patients present with severe diarrhea, fever, adenopathy, weight loss and pigmentation of the skin. Diagnosis is made through duodenal biopsy by which shows foamy macrophages PAS positive. In cases where the histology is negative, we can make the identification of the infectious agent by polymerase-chain reaction (PCR). We describe a 47 years old woman with Whipple's disease whose diagnosis was made through the duodenum and colon biopsies showing infiltration by PAS-positive macrophages.

[Salmonellosis in infancy and childhood: epidemiologic aspects]. / Salmonelosis en la infancia: aspectos epidemiológicos.

Diarrheic processes from an infectious origin constitute a frequent pathology during childhood. We have analyzed, from a epidemiological point of view, a series of 117 children diagnosed as having diarrhea and having stool cultures bacteriologically positive for Salmonella. Special reference has been made to the epidemiological chain of this infection. Of the patients studied, 68 (58.2%) were boys and 49 (41.8%) were girls. Their ages ranged between 1 month and 14 years. An epidemiological environment was recognized in 34.1% of the cases. The most frequent serotype was Salmonella Enteritidis (72.6%).

[Bacterial diarrhea in infancy: epidemiologic study of 256 cases]. / Diarrea bacteriana en la infancia: estudio epidemiológico de 256 casos.

Infectious diarrhoea are common causes of morbility in children. Although viral agents are responsible for the majority of cases of acute diarrhoea during infancy, bacterial infections are also well recognized as causes of them. 256 patients with diarrhoea due to a bacterial pathogen were studied to determine the importance of different epidemiologic factors. The study group comprised 151 boys (59%) and 105 girls (41%) aged between first month and 14 years. Family history of acute diarrhoea was found in 15% of children. 63,7% of them were hospitalized by the severity of clinical features. 32% of cases were detected in summer. Salmonella entérica was isolated in 45% of stool samples and Campylobacter spp in 33,2%. Clinical evolution of diarrhoea differentiated the patients into three groups: acute diarrhoea (95,7%), prolonged diarrhoea (3,1%) and chronic diarrhoea (1,1%).