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1.
Med. intensiva (Madr., Ed. impr.) ; 43(7): 395-401, oct. 2019. tab
Artigo em Espanhol | IBECS | ID: ibc-185866

RESUMO

Objetivo: Estimar la prevalencia de fragilidad en pacientes ingresados en cuidados intensivos (UCI) y su impacto sobre la mortalidad intra UCI, al mes y a los 6 meses. Diseño: Estudio de cohorte prospectiva. Ámbito: UCI polivalentes españolas. Intervención: Ninguna. Pacientes y métodos: Pacientes≥65 años ingresados en UCI>24horas. Se recogieron las variables al ingreso y la situación basal por teléfono al mes y a los 6 meses del alta de UCI. Variables de interés principal: Edad, sexo, fragilidad (escala FRAIL), situación basal (Barthel, Lawton, Clinical Dementia Rating y Nutric Score), días de ventilación mecánica (VM), escalas de gravedad (APACHE II y SOFA), mortalidad UCI, al mes y a los 6 meses del alta. Resultados: Ciento treinta y dos pacientes, 46 frágiles (34,9%). Pacientes frágiles vs. no frágiles: 78,8±7,2 vs. 78,6±6,4 años (p=0,43), varones 43,8% vs. 56,3% (p=0,10), SOFA 4,7±2,9 vs. 4,6±2,9 (p=0,75), VM 33.3% vs. 66,7% (p=0,75), días de VM 5,6±15 vs. 4,3±8,1 (p=0,57), mortalidad UCI 13% versus 6% (p = 0,14), mortalidad al mes 24% versus 8% (p = 0,01), mortalidad 6 meses 32% versus 15% (p = 0,03). La fragilidad se asocia con la mortalidad al mes (OR = 3,5; p <0,05, IC del 95% (1,22-10,03) y a los 6 meses del alta de UCI (OR = 2,62; p <0,05, IC del 95% (1,04-6,56). Conclusiones: La fragilidad está presente en el 35% de los pacientes ingresados en UCI, asociándose a la mortalidad


Objective: To estimate the prevalence of frailty in patients admitted to the Intensive Care Unit (ICU) and its impact upon ICU mortality at 1 and 6 months. Design: A prospective observational cohort study was carried out. Setting: Spanish ICU. Intervention: None. Patients and methods: Patients≥65 years of age admitted to the ICU for>24hours. Variables were registered upon admission, and functional status was assessed by telephone calls 1 and 6 months after discharge from the ICU. Main study variables: Age, gender, frailty (FRAIL scale), functional status (Barthel, Lawton, Clinical Dementia Rating and NUTRIC score), days of mechanical ventilation (MV), functional score (APACHE II and SOFA), ICU mortality, and mortality 1 and 6 months after ICU discharge. Results: A total of 132 patients were evaluated, of which 46 were frail (34.9%). Age of the frail versus non-frail patients: 78.8±7.2 and 78.6±6.4 years, respectively (P=.43); male gender: 43.8% versus 56.3% (P=.10); SOFA score: 4.7±2.9 versus 4.6±2.9 (P=.75); MV: 33.3% versus 66.7% (P=.75); days of MV: 5.6±15 versus 4.3±8.1 (P=.57); ICU mortality 13% versus 6% (P = .14), mortality at 1 month 24% versus 8% (P = .01), mortality 6 months 32% versus 15% (P = .03). Frailty is associated with mortality at one month (OR = 3.5, P <.05, 95% CI (1.22-10.03) and at 6 months after discharge from the ICU (OR = 2.62, P <.05, 95% CI (1.04-6.56). Conclusions: Frailty was present in 35% of the patients admitted to the ICU, and was associated with mortality


Assuntos
Humanos , Pessoa de Meia-Idade , Idoso Fragilizado , Fragilidade/epidemiologia , Unidades de Terapia Intensiva/tendências , Estudos de Coortes , Fragilidade/mortalidade , Repertório de Barthel , Atividades Cotidianas , Transtornos Cognitivos/complicações , Modelos Logísticos , Análise Multivariada
2.
Med Intensiva (Engl Ed) ; 43(7): 395-401, 2019 Oct.
Artigo em Inglês, Espanhol | MEDLINE | ID: mdl-30905473

RESUMO

OBJECTIVE: To estimate the prevalence of frailty in patients admitted to the Intensive Care Unit (ICU) and its impact upon ICU mortality at 1 and 6 months. DESIGN: A prospective observational cohort study was carried out. SETTING: Spanish ICU. INTERVENTION: None. PATIENTS AND METHODS: Patients≥65 years of age admitted to the ICU for>24hours. Variables were registered upon admission, and functional status was assessed by telephone calls 1 and 6 months after discharge from the ICU. MAIN STUDY VARIABLES: Age, gender, frailty (FRAIL scale), functional status (Barthel, Lawton, Clinical Dementia Rating and NUTRIC score), days of mechanical ventilation (MV), functional score (APACHE II and SOFA), ICU mortality, and mortality 1 and 6 months after ICU discharge. RESULTS: A total of 132 patients were evaluated, of which 46 were frail (34.9%). Age of the frail versus non-frail patients: 78.8±7.2 and 78.6±6.4 years, respectively (P=.43); male gender: 43.8% versus 56.3% (P=.10); SOFA score: 4.7±2.9 versus 4.6±2.9 (P=.75); MV: 33.3% versus 66.7% (P=.75); days of MV: 5.6±15 versus 4.3±8.1 (P=.57); ICU mortality 13% versus 6% (P = .14), mortality at 1 month 24% versus 8% (P = .01), mortality 6 months 32% versus 15% (P = .03). Frailty is associated with mortality at one month (OR = 3.5, P <.05, 95% CI (1.22-10.03) and at 6 months after discharge from the ICU (OR = 2.62, P <.05, 95% CI (1.04-6.56). CONCLUSIONS: Frailty was present in 35% of the patients admitted to the ICU, and was associated with mortality.


Assuntos
Fragilidade/mortalidade , Mortalidade Hospitalar , Unidades de Terapia Intensiva/estatística & dados numéricos , Fatores Etários , Idoso , Idoso de 80 Anos ou mais , Feminino , Idoso Fragilizado/estatística & dados numéricos , Fragilidade/epidemiologia , Humanos , Tempo de Internação , Modelos Logísticos , Masculino , Escores de Disfunção Orgânica , Prevalência , Estudos Prospectivos , Espanha/epidemiologia , Fatores de Tempo
3.
Med. intensiva (Madr., Ed. impr.) ; 34(2): 150-153, mar. 2010. ilus
Artigo em Espanhol | IBECS | ID: ibc-81259

RESUMO

La bronconeumonitis por virus herpes simple (VHS) es una entidad clínica descrita en pacientes críticos, asociada clásicamente a estados de inmunosupresión. Estudios recientes han demostrado una elevada frecuencia de detección del virus en muestras del tracto respiratorio inferior (obtenidas por lavado broncoalveolar [BAL]) de pacientes críticos inmunocompetentes ventilados mecánicamente, lo que indicaría su papel como sustrato patogénico independiente. Presentamos el caso de una paciente que ingresa tras intervención quirúrgica de neoplasia de recto, con sospecha de broncoaspiración durante la inducción anestésica. Presenta evolución clínica marcada por fiebre persistente pese a tratamiento antibiótico de amplio espectro, ausencia de crecimiento bacteriano en los cultivos obtenidos, sin claros infiltrados radiológicos y ventilación mecánica prolongada con reiterados fracasos en el destete, y que precisa traqueostomía percutánea. Se realiza broncoscopia con BAL y se detecta VHS (a nivel microbiológico e histológico), por lo que se inicia tratamiento con aciclovir con mejoría clínica y retirada del soporte ventilatorio (AU)


Herpes simplex virus bronchopneumonitis is a clinical entity described in critically ill patients and classically associated to immunosuppression. Recent reports have shown a higher frequency of virus detection from samples obtained by bronchoalveolar lavage of immunocompetent critically ill patients undergoing mechanical ventilation. This fact suggests its role as an independent pathogenic substrate. We report the case of a female patient who was admitted after an elective surgery of rectal tumor with suspected bronchoaspiration during anesthetic induction. The patient presented persistent fever despite broad spectrum antibiotic treatment. All cultures were negative for bacterial growth. The chest X-ray did not show opacifities. Prolonged mechanical ventilation with repeated failures to wean made it mandatory to perform percutaneous tracheostomy. A fibrobronchoscopy with bronchoalveolar lavage, performed previously, showed positive result for herpes simplex virus (PCR and specific nuclear inclusions in cells). Thus, treatment was initiated with acyclovir, with clinical improvement and weaning from mechanical ventilation (AU)


Assuntos
Humanos , Feminino , Idoso , Broncopneumonia/etiologia , Herpes Simples/etiologia , Pneumonia Viral/etiologia , Complicações Pós-Operatórias/etiologia , Insuficiência Respiratória/etiologia , Doença Aguda , Antivirais/uso terapêutico , Líquido da Lavagem Broncoalveolar/virologia , Broncopneumonia/diagnóstico , Broncopneumonia/tratamento farmacológico , Diagnóstico Diferencial , Herpes Simples/diagnóstico , Herpes Simples/tratamento farmacológico , Hospedeiro Imunocomprometido , Pneumonia Viral/diagnóstico , Pneumonia Viral/tratamento farmacológico , Complicações Pós-Operatórias/tratamento farmacológico , Complicações Pós-Operatórias/terapia , Complicações Pós-Operatórias/virologia , Insuficiência Respiratória/terapia
4.
Med Intensiva ; 34(2): 150-3, 2010 Mar.
Artigo em Espanhol | MEDLINE | ID: mdl-20156709

RESUMO

Herpes simplex virus bronchopneumonitis is a clinical entity described in critically ill patients and classically associated to immunosuppression. Recent reports have shown a higher frequency of virus detection from samples obtained by bronchoalveolar lavage of immunocompetent critically ill patients undergoing mechanical ventilation. This fact suggests its role as an independent pathogenic substrate. We report the case of a female patient who was admitted after an elective surgery of rectal tumor with suspected bronchoaspiration during anesthetic induction. The patient presented persistent fever despite broad spectrum antibiotic treatment. All cultures were negative for bacterial growth. The chest X-ray did not show opacifities. Prolonged mechanical ventilation with repeated failures to wean made it mandatory to perform percutaneous tracheostomy. A fibrobronchoscopy with bronchoalveolar lavage, performed previously, showed positive result for herpes simplex virus (PCR and specific nuclear inclusions in cells). Thus, treatment was initiated with acyclovir, with clinical improvement and weaning from mechanical ventilation.


Assuntos
Broncopneumonia/etiologia , Herpes Simples/etiologia , Pneumonia Viral/etiologia , Complicações Pós-Operatórias/etiologia , Insuficiência Respiratória/etiologia , Doença Aguda , Aciclovir/uso terapêutico , Adenocarcinoma/tratamento farmacológico , Adenocarcinoma/radioterapia , Adenocarcinoma/cirurgia , Idoso , Antimetabólitos Antineoplásicos/efeitos adversos , Antimetabólitos Antineoplásicos/uso terapêutico , Antivirais/uso terapêutico , Líquido da Lavagem Broncoalveolar/virologia , Broncopneumonia/diagnóstico , Broncopneumonia/tratamento farmacológico , Terapia Combinada , Diagnóstico Diferencial , Feminino , Fluoruracila/efeitos adversos , Fluoruracila/uso terapêutico , Herpes Simples/diagnóstico , Herpes Simples/tratamento farmacológico , Humanos , Hospedeiro Imunocomprometido , Pneumonia Aspirativa/diagnóstico , Pneumonia Viral/diagnóstico , Pneumonia Viral/tratamento farmacológico , Complicações Pós-Operatórias/tratamento farmacológico , Complicações Pós-Operatórias/terapia , Complicações Pós-Operatórias/virologia , Radioterapia Adjuvante , Neoplasias Retais/tratamento farmacológico , Neoplasias Retais/radioterapia , Neoplasias Retais/cirurgia , Respiração Artificial , Insuficiência Respiratória/terapia
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