[Modification of immediate survival after in-hospital cardiac arrest during evenings and weekends]. / Modificación de la supervivencia inmediata tras parada cardiorrespiratoria intrahospitalaria en horario de tarde-noche y fin de semana.

OBJECTIVE: To determine whether cardiac arrests occurring at night or during the weekend, carry lower immediate survival. METHOD: An analysis of logistic regression was performed, adjusted for age, sex, time to care of the cardiac arrest and first monitored rhythm, to determine whether there are differences in immediate survival. RESULTS: The immediate survival of the cohort studied (n=121) was 32 patients (26%). A difference of 13% in immediate survival between both periods studied was found. The logistic regression analysis taking immediate survival as an effect, showed that suffering an in-hospital cardiac arrest during evenings or weekends was a variable that is not associated with a successful outcome. The OR: .48 (95% CI: .20-1.12; P=.08). CONCLUSIONS: Patients who suffer a cardiac arrest in our centre during evenings or weekends are more vulnerable.

Bloqueo del ganglio estrellado como terapia de rescate en el vasoespasmo refractario tras hemorragia subaracnoidea / Stellate ganglion block as rescue therapy in refractory vasospasm after subarachnoid hemorrhage

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Valor de la fracción de espacio muerto (Vd/Vt) como predictor de éxito en la extubación / Utility of the dead space fraction (Vd/Vt) as a predictor of extubation success

Objetivo: Comprobar qué valor tiene la fracción de espacio muerto (Vd/Vt) como predictor del fracaso en la extubación de los enfermos que necesitaron ventilación mecánica (VM) ingresados en las unidades de cuidados intensivos. Diseño: Estudio de cohortes, prospectivo, observacional. Desde el 1 de septiembre de 2010hasta 1 de marzo de 2011.Ámbito: Unidad de cuidados intensivos generales (UCIG), del complejo hospitalario de tercer nivel Hospital Universitario Marqués de Valdecilla. Pacientes o participantes: Se han incluido en el estudio aquellos enfermos que recibían VM por un espacio de tiempo superior a las 12 horas; y quienes en el proceso de destete seguían un protocolo de presión soporte de bajo nivel. Han sido criterios de exclusión la edad inferior a 18anos, enfermos ventilados a través de traqueotomía y enfermos considerados no colaboradores ˜por diversas causas. Durante el periodo de estudio, ingresaron en UCIG 392 enfermos. De ellos 214 precisaron ventilación mecánica. En 154 se inició proceso de destete. Fueron excluidos del estudio 54 enfermos y no fueron extubados de VM 24. Finalmente 76 enfermos fueron extubados y analizados. Variables de interés principales: Se calculó Vd/Vt como el cociente (PaCO2-PC CO2)/PaCO2;con los parámetros registrados. Resultados: El análisis de regresión logística mostró una asociación significativa entre la variable Vd/Vt y el fracaso en la extubación con una OR de 1,52 (IC 95%: 1,11-2,09; p = 0,008). El área bajo la curva ROC, con respecto a predecir el fracaso en la extubación mediante el valor deVd/Vt fue de 0,94 (IC 95%: 0,86-0,98; p < 0,0001) (AU)

Purpose: To determine the value of Vd/Vt as a predictor of extubation failure in patients with mechanical ventilation admitted to the intensive care units. Design: A prospective, observational cohort study conducted from 1 September 2010 to 1 March2011.Setting: General intensive care unit (G-ICU) of a third level university hospital. Patients or participants: The study included patients on mechanical ventilation (MV) for over12 hours, and who in the process of weaning were subjected to low-level pressure support. Exclusion criteria were age under 18 years, ventilation via tracheotomy and patients failing to cooperate for different reasons. During the study, 392 patients were admitted to the G-ICU; of these, 214 required MV. The weaning process was started in 154 cases. Fifty-four patients were excluded from the study, and 24 were not extubated from MV. A total of 76 patients were finally extubated and analyzed. Variables of interest: Vd/Vt was calculated as the ratio (PaCO2-PC CO2)/PaCO2, with the recorded parameters. Results: Logistic regression analysis showed a significant association between the Vd/Vt and extubation failure, with OR = 1.52 (95%CI 1.11 to 2.09, p = 0.008).The area under the ROC curve with respect to the prediction of extubation failure according to the Vd/Vt value was 0.94 (95%CI 0.86 to 0.98, p < 0.0001) (AU)

[Utility of the dead space fraction (Vd/Vt) as a predictor of extubation success]. / Valor de la fracción de espacio muerto (Vd/Vt) como predictor de éxito en la extubación.

PURPOSE: To determine the value of Vd/Vt as a predictor of extubation failure in patients with mechanical ventilation admitted to the intensive care units. DESIGN: A prospective, observational cohort study conducted from 1 September 2010 to 1 March 2011. SETTING: General intensive care unit (G-ICU) of a third level university hospital. PATIENTS OR PARTICIPANTS: The study included patients on mechanical ventilation (MV) for over 12 hours, and who in the process of weaning were subjected to low-level pressure support. Exclusion criteria were age under 18 years, ventilation via tracheotomy and patients failing to cooperate for different reasons. During the study, 392 patients were admitted to the G-ICU; of these, 214 required MV. The weaning process was started in 154 cases. Fifty-four patients were excluded from the study, and 24 were not extubated from MV. A total of 76 patients were finally extubated and analyzed. VARIABLES OF INTEREST: Vd/Vt was calculated as the ratio (PaCO(2)-Pє CO(2))/PaCO(2), with the recorded parameters. RESULTS: Logistic regression analysis showed a significant association between the Vd/Vt and extubation failure, with OR=1.52 (95%CI 1.11 to 2.09, p=0.008). The area under the ROC curve with respect to the prediction of extubation failure according to the Vd/Vt value was 0.94 (95%CI 0.86 to 0.98, p<0.0001). CONCLUSIONS: Vd/Vt is a powerful predictor of extubation failure in patients on MV.

Intoxicación grave con verapamilo / Severe intoxication with verapamil

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