Cuidados generales en el manejo del traumatismo craneoencefálico grave: consenso latinoamericano / General care in the management of severe traumatic brain injury: Latin American consensus

El traumatismo craneoencefálico grave (TCEg) continúa siendo prevalente en la población adulta joven. Lejos de descender, su incidencia se mantiene elevada. Uno de los pilares en los que se asienta su tratamiento es evitar, detectar y corregir complicaciones secundarias de origen sistémico que agravan la lesión primaria. Gran parte de este objetivo se logra manteniendo un microambiente fisiológico adecuado que permita la recuperación del tejido cerebral lesionado. Las medidas de cuidados generales son acciones inespecíficas destinadas a cumplir dicho objetivo. Las guías disponibles de manejo del TCEg no han incluido la mayoría de los tópicos motivo de este consenso. Para ello, hemos reunido un grupo de profesionales miembros del Consorcio latinoamericano de Injuria Cerebral (LABIC), involucrados en los diferentes aspectos del manejo agudo del TCEg (neurocirujanos, intensivistas, anestesiólogos, neurólogos, enfermeros, fisioterapeutas). Se efectuó una búsqueda bibliográfica en las bases de datos LILACS, PubMed, Embasse, Scopus, Cochrane Controlled Register of Trials y Web of Science de los tópicos seleccionados. Para establecer recomendaciones o sugerencias con su respectiva fortaleza o debilidad, fue aplicada la metodología Grading of Recommendations, Assessment, Development and Evaluation (GRADE). Adicionalmente, ciertas recomendaciones (incluidas en material complementario) no fueron valoradas por GRADE, por ser las mismas un conjunto de acciones terapéuticas de cumplimento efectivo, en las que no fue posible aplicar dicha metodología. Fueron establecidas 32 recomendaciones; 16 fuertes y 16 débiles, con su respectivo nivel de evidencia. El presente consenso intenta homogeneizar y establecer medidas de cuidados generales básicas en esta población de individuos

Severe traumatic brain injury (sTBI) remains prevalent in the young adult population. Indeed, far from descending, the incidence of sTBI remains high. One of the key bases of treatment is to avoid, detect and correct secondary injuries of systemic origin, which aggravate the primary lesion. Much of this can be achieved by maintaining an adequate physiological microenvironment allowing recovery of the damaged brain tissue. General care measures are nonspecific actions designed to meet that objective. The available guidelines on the management of sTBI have not included the topics contemplated in this consensus. In this regard, a group of members of the Latin American Brain Injury Consortium (LABIC), involved in the different aspects of the acute management of sTBI (neurosurgeons, intensivists, anesthesiologists, neurologists, nurses and physiotherapists) were gathered. An exhaustive literature search was made of selected topics in the LILACS, PubMed, Embase, Scopus, Cochrane Controlled Register of Trials and Web of Science databases. To establish recommendations or suggestions with their respective strength or weakness, the GRADE methodology (Grading of Recommendations, Assessment, Development and Evaluation) was applied. Additionally, certain recommendations (included in complementary material) were not assessed by GRADE, because they constitute a set of therapeutic actions of effective compliance, in which it was not possible to apply the said methodology. Thirty-two recommendations were established, 16 strong and 16 weak, with their respective levels of evidence. This consensus attempts to standardize and establish basic general care measures in this particular patient population

General care in the management of severe traumatic brain injury: Latin American consensus. / Cuidados generales en el manejo del traumatismo craneoencefálico grave: consenso latinoamericano.

Severe traumatic brain injury (sTBI) remains prevalent in the young adult population. Indeed, far from descending, the incidence of sTBI remains high. One of the key bases of treatment is to avoid, detect and correct secondary injuries of systemic origin, which aggravate the primary lesion. Much of this can be achieved by maintaining an adequate physiological microenvironment allowing recovery of the damaged brain tissue. General care measures are nonspecific actions designed to meet that objective. The available guidelines on the management of sTBI have not included the topics contemplated in this consensus. In this regard, a group of members of the Latin American Brain Injury Consortium (LABIC), involved in the different aspects of the acute management of sTBI (neurosurgeons, intensivists, anesthesiologists, neurologists, nurses and physiotherapists) were gathered. An exhaustive literature search was made of selected topics in the LILACS, PubMed, Embase, Scopus, Cochrane Controlled Register of Trials and Web of Science databases. To establish recommendations or suggestions with their respective strength or weakness, the GRADE methodology (Grading of Recommendations, Assessment, Development and Evaluation) was applied. Additionally, certain recommendations (included in complementary material) were not assessed by GRADE, because they constitute a set of therapeutic actions of effective compliance, in which it was not possible to apply the said methodology. Thirty-two recommendations were established, 16 strong and 16 weak, with their respective levels of evidence. This consensus attempts to standardize and establish basic general care measures in this particular patient population.

Insuficiencia renal aguda según RIFLE y AKIN: estudio multicéntrico / Acute renal failure according to the RIFLE and AKIN criteria: A multicenter study

OBJETIVO: Determinar la incidencia de insuficiencia renal aguda (IRA) en pacientes críticos usando RIFLE y AKIN. DISEÑO: Estudio observacional prospectivo multicéntrico, realizado durante un año desde febrero de 2010. Se emplearon RIFLE y AKIN aplicando los criterios urinario (criterio U) y creatinina (criterio C) juntos y separados. Ámbito: Nueve Unidades de Cuidados Críticos (UCC) polivalentes de Argentina. PACIENTES: Un total de 627 pacientes críticos mayores de 18 años de edad internados en UCC durante más de 48 h; motivos de exclusión: imposibilidad de cuantificar diuresis, instrumentación quirúrgica de la vía urinaria y necesidad de terapias de soporte renal (TSR).Variables de interés: Se utilizó una diuresis horaria calculada (DHC) para aplicar el criterio U. RESULTADOS: La incidencia de IRA fue de 69,4 y 51,8% (RIFLE y AKIN, respectivamente). El criterio U detectó IRA en el 59,5% de los casos, mientras que el criterio C identificó IRA en el 34,7% (RIFLE) y 25,3% (AKIN). La mortalidad fue de 40,9 y 44,6% según RIFLE y AKIN, respectivamente, significativamente mayor a la de los pacientes sin IRA, y aumentó con la gravedad de la enfermedad. (Procesamiento de datos: Excel, SQL y SPSS. Test de Levenne, comparación de medias/promedios con t de Student y chi-cuadrado, con 95% de confianza).CONCLUSIONES: RIFLE identificó más casos de IRA que AKIN. El criterio U fue más eficaz que el criterio C. La presencia de IRA y sus niveles de gravedad tuvieron correlación con la mortalidad pero no con los días de estancia en UCC. La implementación de la DHC fue útil para unificar la aplicación del criterio C y lograr resultados comparables

OBJECTIVE: To determine the incidence of acute renal failure (ARF) in critically ill patients using the RIFLE and AKIN criteria. DESIGN: A prospective, multicenter observational study with a duration of one year from February 2010 was carried out. RIFLE and AKIN were employed using the urinary (UC) and creatinine criteria (CC) jointly and separately. Scope: Nine polyvalent Critical Care Units (CCUs) in Argentina. PATIENTS: A total of 627 critical patients over 18 years of age were admitted to the CCU for more than 48 h. Exclusion criteria: inability to quantify diuresis, surgical instrumentation of the urinary tract, and need for renal support therapy (RST).Variables of interest: Calculated hourly diuresis (CHD) was used to apply the UC. RESULTS: The incidence of ARF was 69.4% and 51.8% according to RIFLE and AKIN, respectively. UC detected ARF in 59.5% of cases, while CC identified ARF in 34.7% (RIFLE) and 25.3% (AKIN). The mortality rate was 40.9% and 44.6% according to RIFLE and AKIN respectively, was significantly higher than in patients without ARF, and increased with disease severity (Data processing: Excel, SQL and SPSS. Levene test, comparison of means with Student t and chi-squared, with 95% confidence interval). CONCLUSIONS: RIFLE identified more cases of ARF. UC proved more effective than CC. The presence of ARF and severity levels were correlated to mortality but not to days of stay in the CCU. Implementation of the unified CHD was useful for implementing UC and achieving comparable results

Acute renal failure according to the RIFLE and AKIN criteria: a multicenter study.

OBJECTIVE: To determine the incidence of acute renal failure (ARF) in critically ill patients using the RIFLE and AKIN criteria. DESIGN: A prospective, multicenter observational study with a duration of one year from February 2010 was carried out. RIFLE and AKIN were employed using the urinary (UC) and creatinine criteria (CC) jointly and separately. SCOPE: Nine polyvalent Critical Care Units (CCUs) in Argentina. PATIENTS: A total of 627 critical patients over 18 years of age were admitted to the CCU for more than 48h. EXCLUSION CRITERIA: inability to quantify diuresis, surgical instrumentation of the urinary tract, and need for renal support therapy (RST). VARIABLES OF INTEREST: Calculated hourly diuresis (CHD) was used to apply the UC. RESULTS: The incidence of ARF was 69.4% and 51.8% according to RIFLE and AKIN, respectively. UC detected ARF in 59.5% of cases, while CC identified ARF in 34.7% (RIFLE) and 25.3% (AKIN). The mortality rate was 40.9% and 44.6% according to RIFLE and AKIN respectively, was significantly higher than in patients without ARF, and increased with disease severity (Data processing: Excel, SQL and SPSS. Levene test, comparison of means with Student t and chi-squared, with 95% confidence interval). CONCLUSIONS: RIFLE identified more cases of ARF. UC proved more effective than CC. The presence of ARF and severity levels were correlated to mortality but not to days of stay in the CCU. Implementation of the unified CHD was useful for implementing UC and achieving comparable results.