Preoperative use of statins does not improve outcomes and development of acute renal failure after cardiac surgery. A propensity score analysis of ARIAM-Andalucía database.

BACKGROUND: Statin use prior to cardiac surgery has been reported to improve outcomes in the postoperative period because of other effects apart from decreasing lipid levels. Objective of the study was to analyse mortality and acute renal failure (ARF) during the cardiac surgery postoperative period in patients treated with or without statins. METHODS: This prospective cohort study comprised adult patients who underwent cardiac surgery at 11 institutions in the Andalusian community from March 2008 to July 2012 included in the ARIAM adult cardiac surgery project. We performed a first analysis in the whole cohort and in a second analysis statin users prior to surgery were pair matched with non-users according to their propensity score based on demographics, comorbidities, medication and surgical data. We analysed differences in outcomes, ARF, need for renal replacement therapy (RRT) and a composite end point with mortality or major morbidity in both groups. RESULTS: The study included 7276 patients, of whom 3749 were treated with statins. Overall, hospital mortality was 10.1%, 10.5% developed ARF and 2.5% required RRT. In the whole non-matched cohort, statins were associated with lower hospital mortality (OR 0.79; 95% CI, 0.67-0.93) and less ARF (OR 0.79; 95% CI, 0.68-0.93). However, after propensity score analysis in the matched cohort of 3056 patients (1528 in each group), statin use was not consistently associated with less ARF (OR 0.94; 95% CI, 0.74-1.19), hospital mortality (OR 0.83; 95% CI, 0.68-1.1) or composite outcome (OR 0.857; 95% CI, 0.723-1.015). CONCLUSION: Despite better outcomes for the statin users in the whole cohort, the matched analysis showed that statin use before cardiac surgery was not associated with a lower risk of ARF. Nor was presurgery statin use associated with lower hospital mortality.

Evaluación diaria del protocolo FASTHUG y resultados a corto plazo / Daily evaluation of the FASTHUG protocol and short-term outcomes

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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 / Analysis of maternal morbidity and mortality among patients admitted to Obstetric Intensive Care with severe preeclampsia, eclampsia or HELLP syndrome

Objetivo: Describir la incidencia y el perfil clínico y epidemiológico de las pacientes con preeclampsia grave que requieren ingreso en Cuidados Intensivos. Diseño: Estudio observacional prospectivo de una serie de casos. Ámbito: UCI específica de enfermedad gineco-obstétrica de 8 camas, perteneciente a un hospital universitario de nivel 3, con una dotación de 55 camas de UCI en total. Pacientes: Un total de 262 pacientes ingresadas por preeclampsia grave, eclampsia o síndrome HELLP Intervención: Análisis descriptivo de la población y de las complicaciones en UCI así como de la mortalidad intrahospitalaria. Resultados: La edad media fue de 30,47±5,7 años, con una distribución diagnóstica al ingreso de 78% de pacientes con preeclampsia grave, 16% por síndrome HELLP y 6% por eclampsia, que sucedió en la semana gestacional 31,85±4,45. El 63% de las pacientes fueron primigestas y presentaron escasa prevalencia de enfermedades previas. La tasa de complicaciones fue del14% (fracaso cardiaco en 9%, insuficiencia renal aguda en 5% y coagulopatía en 2%).La mortalidad materna fue 1,5% (4 pacientes) y se relacionó con la no-primigestación, la presencia de complicaciones y un nivel superior de la transaminasa GOT a 71 mg/dl. Conclusiones: La preeclampsia grave tiene una baja tasa de mortalidad (1,5%), no así de complicaciones(14%) y se presenta con mayor frecuencia en nulíparas durante el tercer trimestre de gestación (AU)

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 was14% (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 > 71 mg/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 (AU)

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

Objetivo: Analizar las características clínicas, indicaciones y morbimortalidad asociada a la implantación de marcapasos transvenosos transitorios. Diseño: Estudio observacional y prospectivo. Ámbito: Unidad de cuidados intensivos cardiológicos. Pacientes: Se implantó marcapasos transvenoso transitorio a 182 pacientes, en un periodo de 4 años. Variables recogidas: Se registraron variables demográficas, clínicas, indicaciones, vía de acceso, días de estancia en la unidad y complicaciones. Resultados: El 63% eran hombres, con una media de edad de 78±9,5 años con bloqueo auriculoventricular sintomático en un 76,9% de los casos. La vía venosa de abordaje habitual fue la femoral (92,3%). El 40,11% sufrió complicaciones, siendo la más frecuente el hematoma enla zona de punción (13,19%). No hubo diferencias entre el profesional que implantó el marcapasos y la aparición de complicaciones. La agitación psicomotriz se asoció a la existencia de hematoma en la zona de punción (p = 0,07) y a la necesidad de movilización del catéter (p = 0,059). Se identificó la vía de inserción no femoral (p = 0,012, OR = 0,16; IC del 95%, 0,04-0,66), la agitación (p = 0,006; OR = 3,2; IC del 95%, 1,4-7,3) y la presencia de factores de riesgo cardiovascular (p = 0,042; OR = 5; IC del 95%, 1,06-14,2) como predictores de complicaciones. La realización del procedimiento por parte del personal especializado (p = 0,0001) y la presencia de complicaciones (p = 0,05) incrementaron la estancia en la unidad.Conclusiones: La presencia de agitación, los factores de riesgo cardiovascular y la inserción a través de la vena subclavia o yugular fueron predictores de complicaciones. Estas no se relacionaron con el tipo de profesional implicado en la implantación, pero incrementaron la estancia en la unidad (A)

Objective: To analyze the clinical indications for use, morbidity and mortality associated witha 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, accessroute, 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 ofcardiovascular 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 (AU)

Experiencia con tigeciclina en el tratamiento de gérmenes multirresistentes en UCI / Cerebellar hemorrhage secondary to cerebrospinal pinal fluid leak after lumbar canal surgery

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[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.

[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.

Esofaguectomía. Dilatación gástrica / Esophagectomy. Gastric dilatation

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[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.

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

Se define el perfil clínico de los pacientes con candidiasis sistémica ingresados en nuestra UCI y se realiza un análisis de mortalidad. Se analizaron retrospectivamente los casos de candidiasis sistémica durante 2002-2004 y, prospectivamente, durante 2005-2006, en una unidad de cuidados intensivos de un hospital de tercer nivel. Se registraron 26 casos (el 75% varones), cuyo principal motivo de ingreso fue la sepsis, con multiinstrumentación y una estancia prolongada. Se aisló Candida albicans en el 53,8% y otras cándidas en el 46,2%. La incidencia de otras cándidas fue superior a la de C. albicans desde el año 2004 (p = 0,02). La mortalidad fue del 42%, más elevada en infecciones por C. albicans, en especial (p = 0,026) en los grupos progresivos de riesgo determinados en el ®Score Sevilla» (AU)

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. ®Sevilla Score» defined the mortality in the progressive risk groups (p = 0.026) (AU)

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

Objetivo. Evaluar el momento de extubación de los pacientes postoperados de cirugía maxilofacial (CMF) que requieren ingreso en la unidad de cuidados intensivos (UCI) y relacionarlo con las complicaciones acaecidas durante su estancia. Diseño. Estudio observacional prospectivo. Ámbito. UCI de un hospital de tercer nivel. Pacientes y métodos. Se estudió a todos los pacientes sometidos a CMF ingresados en UCI para manejo postoperatorio inmediato, desde febrero de 2007 hasta marzo de 2008. Se registraron variables clínicas y demográficas de los pacientes, variables anestésicas previas al acto quirúrgico y tiempos de ventilación mecánica y complicaciones inmediatas durante su estancia en UCI. Resultados. Se registraron 102 pacientes durante el periodo del estudio. Se extubó precozmente (dentro de las primeras 4 h) a 58 (55,8%) pacientes. La tasa general de complicaciones fue del 12,5%. La duración de la ventilación mecánica fue mayor en la cirugía que requirió vaciamiento ganglionar cervical (p = 0,003). Encontramos relación (p = 0,03) entre la presencia de alguna complicación y la extubación tardía (odds ratio: 3,78; intervalo de confianza del 95%, 1,16-12,31). El análisis multivariable reveló que son predictores de complicaciones la cirugía que incluye vaciamiento ganglionar y la extubación tardía. Conclusiones. En nuestra serie, el destete tardío y la cirugía que conlleva vaciamiento ganglionar cervical fueron factores relacionados con morbilidad. A pesar de que la extubación del postoperado de CMF pueda parecer arriesgada en determinados casos y en las primeras horas, no disponemos de datos consistentes para mantener la ventilacion mecánica más allá de lo preciso para la recuperación anestésica (AU)

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 (AU)

Paludismo cerebral en una gestante / No disponible

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