Prevalencia de contraindicaciones a succinilcolina en unidades de cuidados intensivos / Contraindications to succinylcholine in the intensive care unit. A prevalence study

Objetivo Conocer la prevalencia de contraindicaciones a succinilcolina en pacientes ingresados en unidades de cuidados intensivos (UCI). Diseño Estudio observacional, describiendo la frecuencia de contraindicaciones a succinilcolina por estancias. Análisis univariante de asociación de contraindicaciones con variables poblacionales. Ámbito UCI polivalente de hospital de tercer nivel. Pacientes Pacientes adultos críticos polivalentes. Se analizan en 30 días consecutivos todas las estancias. Intervenciones Ninguna. Variables descriptivas de la población: edad, sexo, APACHE, SOFA, patología, días de ingreso, ventilación mecánica, depuración extrarrenal. Contraindicaciones: hiperpotasemia, encamamiento, rabdomiólisis, traumatismo muscular, quemadura, perfusión de bloqueante neuromuscular, fracaso renal agudo, insuficiencia renal crónica, hipertensión intraocular, hipertensión endocraneal, estatinas crónicas, antecedente de hipertermia maligna, enfermedad neuromuscular, sección medular, bradicardia < 50 lpm, alergia al fármaco, déficit de pseudocolinesterasa. Resultados Ingresan 102 pacientes de 60±16 años, 56,9% varones, que generan 657 estancias. Patologías principales: cirugía cardiaca programada (33%), fallo respiratorio (22%) y sepsis (14%). Documentamos 466 estancias (70,9%) con alguna contraindicación, destacando encamamiento (140), bloqueante neuromuscular (101), fracaso renal agudo (126), estatinas (167), enfermedad neuromuscular (159) y bradicardia (76). Encontramos 74 estancias (11,3%) con alto riesgo de complicación (EARC) al asociarse factor de hiperkalemia con factor de disregulación de receptor. Se asocian a EARC: edad avanzada, hospitalización prolongada, estancia en UCI prolongada, APACHE-II superior, SOFA superior y estar en ventilación mecánica o depuración extrarrenal. Conclusiones Dada la elevada prevalencia de contraindicaciones a succinilcolina observada desaconsejamos su uso en pacientes ingresados en UCI (AU)

Objective To determine the prevalence of contraindications to succinylcholine in patients admitted to the ICU. Design An observational study was carried out, describing the frequency of succinylcholine contraindication by stays, and associating the contraindications to population variables. Setting The adult general ICU of a reference hospital. Patients Clinical-surgical critically ill patients. Thirty consecutive days were analyzed. Interventions None. Variables Population variables: age, sex, APACHE II and SOFA scores, illness, days of hospitalization, mechanical ventilation and renal replacement therapy. Contraindications: hyperkalemia, bedridden patients, rhabdomyolysis, muscle trauma, burns, infusion of neuromuscular blocking agents, acute renal failure, chronic renal failure, intraocular hypertension, intracranial hypertension, statin use, malignant hyperthermia, neuromuscular disease, spinal cord sectioning, bradycardia < 50 bpm, succinylcholine allergy, and pseudo-cholinesterase deficiency. Results A total of 102 patients were admitted, aged 60±16 years (56.9% males), with the generation of 657 stays. Main diseases: elective heart surgery (33%), respiratory failure (22%) and sepsis (14%). We documented 466 stays (70.9%) with contraindications, particularly bedridden patients (n=140), neuromuscular blocking agents (n=101), acute renal failure (n=126), statin use (n=167), neuromuscular disease (n=159) and bradycardia (n=76). We recorded 74 stays (11.3%) at high risk of complications, secondary to hyperkalemic risk associated to receptor dysregulation. A high risk of complications was associated to advanced age, prolonged hospitalization, prolonged length of stay in the ICU, higher APACHE II and SOFA scores, mechanical ventilation and renal replacement therapy. Conclusion Given the high prevalence of contraindications to succinylcholine observed, we discourage its use in patients admitted to the ICU (AU)

[Contraindications to succinylcholine in the intensive care unit. A prevalence study]. / Prevalencia de contraindicaciones a succinilcolina en unidades de cuidados intensivos.

OBJECTIVE: To determine the prevalence of contraindications to succinylcholine in patients admitted to the ICU. DESIGN: An observational study was carried out, describing the frequency of succinylcholine contraindication by stays, and associating the contraindications to population variables. SETTING: The adult general ICU of a reference hospital. PATIENTS: Clinical-surgical critically ill patients. Thirty consecutive days were analyzed. INTERVENTIONS: None. VARIABLES: Population variables: age, sex, APACHE II and SOFA scores, illness, days of hospitalization, mechanical ventilation and renal replacement therapy. CONTRAINDICATIONS: hyperkalemia, bedridden patients, rhabdomyolysis, muscle trauma, burns, infusion of neuromuscular blocking agents, acute renal failure, chronic renal failure, intraocular hypertension, intracranial hypertension, statin use, malignant hyperthermia, neuromuscular disease, spinal cord sectioning, bradycardia < 50 bpm, succinylcholine allergy, and pseudo-cholinesterase deficiency. RESULTS: A total of 102 patients were admitted, aged 60 ± 16 years (56.9% males), with the generation of 657 stays. Main diseases: elective heart surgery (33%), respiratory failure (22%) and sepsis (14%). We documented 466 stays (70.9%) with contraindications, particularly bedridden patients (n=140), neuromuscular blocking agents (n=101), acute renal failure (n=126), statin use (n=167), neuromuscular disease (n=159) and bradycardia (n=76). We recorded 74 stays (11.3%) at high risk of complications, secondary to hyperkalemic risk associated to receptor dysregulation. A high risk of complications was associated to advanced age, prolonged hospitalization, prolonged length of stay in the ICU, higher APACHE II and SOFA scores, mechanical ventilation and renal replacement therapy. CONCLUSION: Given the high prevalence of contraindications to succinylcholine observed, we discourage its use in patients admitted to the ICU.