Simplified acute physiology score II and Mannheim peritonitis index are associated with in-hospital mortality in patients with abdominal sepsis admitted to ICU.

OBJECTIVE: The objective of this study was to assess the association and interaction of laboratory parameters, Simplified Acute Physiology Score II (SAPSII), Modified Shock Index (MSI), and Mannheim Peritonitis Index (MPI) with in-hospital mortality. MATERIAL AND METHODS: We conducted a single-center case-control study. Adult patients with abdominal sepsis were included from May 2015 to May 2020. Baseline characteristics, laboratory parameters, SAPSII, MSI, and MPI scores at admission were collected. A principal component (PC) analysis was applied to evaluate variable interactions. In-hospital mortality risk was determined through logistic regression models. RESULTS: One hundred and twenty-seven patients were identified, 60 of which were included for analyses. Non-survivors (48.4%) had a higher frequency of hypertension, lactate and MPI, and lower BE and alactic BE levels. Eight PCs were obtained, PC1 being a linear combination of pH, AG, cAG, alactic BE, bicarbonate, and BE. MPI (OR = 9.87, 95% CI: 3.07-36.61, p = 0.0002), SAPSII (OR = 1.07, 95% CI: 1.01-1.14, p = 0.01), and PC1 (OR = 2.13, 95% CI: 1.12-4.76, p = 0.04) were significantly associated with mortality in univariate analysis, while MPI (OR = 10.1, 95% CI: 3.03-40.06, p = 0.0003) and SAPSII (OR = 1.07, CI95%: 1.01-1.14, p = 0.02) remained significant after adjusting for age and sex. CONCLUSION: MPI and SAPSII were associated with mortality, although the interaction of laboratory parameters was not.

OBJETIVO: Evaluar la asociación e interacción de los parámetros de laboratorio, SAPSII, MSI y MPI con la mortalidad intrahospitalaria. MATERIALES Y MÉTODOS: Nosotros realizamos un estudio de casos y controles de pacientes adultos con sepsis abdominal desde mayo 2015 a mayo 2020. Recolectamos las características basales, parámetros de laboratorio, SAPSII, MSI y MPI al ingreso. Se aplicó un Análisis de Componentes Principales. El riesgo de mortalidad intrahospitalaria se determinó mediante modelos de regresión logística. RESULTADOS: Identificamos 127 pacientes, 60 de los cuales se incluyeron. Los no supervivientes (48,4%) tuvieron mayor frecuencia de HAS, lactato y MPI, y menores niveles de EB y EB aláctico. Se obtuvieron ocho Componentes Principales (PC), siendo PC1 una combinación lineal de pH, AG, cAG, EB aláctico, bicarbonato y EB. MPI (OR = 9.87, IC95%: 3.07-36.61, p = 0.0002), SAPSII (OR = 1.07, IC95%: 1.01-1.14, p = 0.01) y PC1 (OR = 2.13, IC95%: 1.12-4.76, p = 0.04) se asociaron significativamente con la mortalidad en el análisis univariado, mientras que MPI (OR = 10.1, IC95%: 3.03-40.06, p = 0.0003) y SAPSII (OR = 1.07, IC 95%: 1.01-1.14, p = 0.02) permanecieron significativos después del ajuste por edad y sexo. CONCLUSIONES: MPI y SAPSII se asociaron con mortalidad, aunque la interacción de los parámetros de laboratorio no lo hizo.

Respiración de Biot. Fracaso de la extubación / Breathing Biot. Extubation failure / Respiração de Biot. Falha na extubação

Resumen: La ventilación mecánica (VM) prolongada incrementa el riesgo de complicaciones. Por otra parte, el retiro precoz de la misma expone al paciente a los riesgos que presentaba antes de iniciarla. El evento vascular cerebral (EVC)puede complicarse, requerir intubación y ventilación mecánica para soporte respiratorio. Presentamos el caso de un hombre de 76 años de edad con isquemia aguda a nivel de cerebelo que fracasó en la extubación a pesar de presentar parámetros objetivos correctos y adecuada tolerancia a la prueba de «pieza en T¼. Los parámetros que evalúan el éxito o fracaso de la extubación en el paciente neurológico son un problema no resuelto, hasta el día de hoy la escala de coma de Glasgow (ECG) es la variable asociada a buenos o malos resultados.

Abstract: Mechanical ventilation (MV) long increases the risk of complications, moreover early retirement of it exposes the patient to the risks presented before starting. Cerebral vascular event (CVE) can be complicated, requiring intubation and mechanical ventilation for respiratory support. We report the case of a male 76 years of age with acute ischemia cerebellar that failed extubation despite having objective parameters correct and proper tolerance test «T-piece¼. The parameters that evaluate the success or failure of extubation in neurological patient is an unresolved problem until today the Glasgow coma scale (GCS) is the variable associated with good or bad results.

Resumo: A ventilação mecânica (VM) prolongada incrementa o risco de complicações, por outra parte, o retiro precoce da mesma, expõe o paciente aos riscos apresentados antes de começar. O acidente vascular cerebral (AVC) pode complicarse, necessitando de intubação e ventilação mecânica para suporte respiratório. Relatamos o caso de um paciente masculino de 76 anos de idade, com isquemia aguda a nível cerebelar que falharam na extubação apesar de ter parâmetros objetivos corretos e adecuada tolerância ao teste de tolerância correto do tubo «T¼. Os parâmetros que avaliam o sucesso ou fracasso de extubação em paciente neurológico é um problema não resolvido, até hoje a Escala de Coma de Glasgow (ECG) é a variável associada a resultados positivos ou negativos.