Evaluación hemodinámica no invasiva a largo plazo de la terapia de resincronización cardíaca endocárdica izquierda / Long-term Non-invasive Hemodynamic Evaluation of Left Endocardial Cardiac Resynchronization Therapy

RESUMEN Introducción: La terapia de resincronización cardíaca presenta una tasa de un 25%-30% de pacientes "no respondedores". La resincronización endocárdica, en la que el catéter del ventrículo izquierdo se implanta en el endocardio, sería una alternativa para estos pacientes, aunque su evolución a largo plazo no ha sido investigada. Objetivos: Evaluación hemodinámica no invasiva a largo plazo de la resincronización endocárdica en respondedores clínicos. Métodos: Se incluyeron pacientes implantados según los criterios para resincronización, usando la técnica Jurdham, con más de 6 meses desde el implante. Todos eran respondedores clínicos. La respuesta hemodinámica se evaluó con un analizador de la función cardíaca, que mide los intervalos sistólicos (períodos preeyectivo y eyectivo) del ventrículo izquierdo y calcula automáticamente un índice de función sistólica y estimar la fracción de eyección (Systocor mod ÍS100). Para determinar la eficacia mecánica de la TRCe se comparó la función cardíaca durante el modo biventricular con el bloqueo completo de la rama izquierda, espontáneo o por estimulación única del ventrículo derecho; los pacientes fueron sus propios controles. Se promediaron al menos 20 latidos en cada modo de estimulación y se consideraron solo los cambios >1% con valor p < 0,01 como clínicamente relevantes y estadísticamente significativos. Resultados: Se incluyeron 17 pacientes, con mediana de seguimiento de 43 meses, rango 9 a 78 meses. La resincronización endocárdica, en comparación con la activación ventricular con BCRI, demostró que todos los pacientes acortaron el período preeyectivo en un promedio de 31 ms (15%), indicativo de disminución de la disincronía interventricular causada por el BCRI. En todos aumentó el índice de función sistólica en 0,3 (23%) y la FE en el 8,3%. En 12/17 (71%) aumentó el período eyectivo en promedio 8,7 mseg (2,9%), lo que sugiere un aumento del volumen sistólico. En todos los cambios el valor de p fue menor de 0,01. Conclusiones: La TRCe ofrece mejoría hemodinámica significativa a largo plazo, detectada por intervalos sistólicos.

ABSTRACT Background: Cardiac resynchronization therapy has 25% to 30% rate of "non-responder" patients. Endocardial cardiac resynchronization therapy (eCRT), in which the left ventricular catheter is implanted in the endocardium, would be an alternative for these patients; however, its long-term outcome has not been investigated. Objectives: The aim of this study was the long-term non-invasive hemodynamic evaluation of eCRT in clinical responders. Methods: Patients implanted according to the criteria for resynchronization, using the Jurdham technique, with more than 6 months after the implant, were included in the study. All were clinical responders. The hemodynamic response was evaluated with a cardiac function analyzer, which measures the left ventricular systolic intervals (preejection and ejection periods) and automatically calculates an index of systolic function and estimates the ejection fraction (Systocor mod ÍS100). To assess the mechanical efficacy of eCRT, the cardiac function during biventricular mode was compared with left bundle branch block (LBBB), either spontaneous or by single stimulation of the right ventricle, with patients as their own controls. At least 20 beats were averaged in each stimulation mode and only changes >1% with p <0.01 were considered as clinically relevant and statistically significant. Results: Seventeen patients were included, with a median follow-up of 43 months, (9 to 78 months). Endocardial resynchronization, compared with LBBB ventricular activation, showed that all patients shortened the preejection period by an average of 31 ms (15%), indicative of decreased interventricular dyssynchrony caused by LBBB. In all patients, systolic function index increased by 0.3 (23%) and the EF by 8.3%. In 12/17 of cases (71%) the ejective period increased on average 8.7 ms (2.9%), suggesting an increase in systolic volume. In all changes p was <0.01. Conclusions: Endocardial resynchronization therapy offers significant long-term hemodynamic improvement, detected by systolic intervals.

Hospitalizaciones evitables por reacciones adversas a medicamentos en una unidad geriátrica de agudos. Análisis de 3.292 pacientes / Avoidable hospitalizations due to adverse drug reactions in an acute geriatric unit. Analysis of 3, 292 patients

Objetivo: Determinar la prevalencia de ingresos por reacciones adversas a medicamentos (RAM) y si el ingreso era evitable o no, y qué fármacos y factores de riesgo estaban implicados. Diseño: Estudio observacional transversal. Muestra de estudio Todos los pacientes hospitalizados en una unidad geriátrica de agudos durante el período de enero de 2001 a diciembre de 2010 fueron estudiados. Mediciones: Para determinar si los ingresos se debieron a RAM se utilizaron los criterios de la World Health Organization-Uppsala Monitoring Centre y la escala de Naranjo. Para detectar los medicamentos potencialmente inadecuados se utilizaron los criterios de Beers. Resultados: Se estudió un total de 3.292 pacientes (edad media 84,7 años, 60,1% mujeres). De estos, 197 (6%) fueron ingresos por RAM, de los cuales 152 (76,4%) se consideraron ingresos evitables. Los 5 grupos de fármacos más frecuentemente asociados a los ingresos por RAM fueron digoxina, antiinflamatorios no esteroideos, benzodiacepinas, diuréticos y antibióticos. Los factores de riesgo independientes de ingreso por RAM fueron el sexo femenino (OR 1,84; IC 95% 1,3-2,61), la medicación inadecuada según los criterios de Beers (OR 4,2; IC 95% 2,9-6,03), la polifarmacia (>5 fármacos) (OR 1,5; IC 95% 1,04-2,13), el filtrado glomerular<30ml/min (OR 3; IC 95% 2,12-4,23) y el uso de sedantes (OR 1,4; IC 95% 1-1,91). Conclusión: Las RAM fueron responsables del 6% de los ingresos en una unidad geriátrica de agudos, considerándose evitables tres cuartas partes de estos ingresos. El sexo femenino, la medicación inadecuada, la polifarmacia, la insuficiencia renal y el uso de sedantes fueron factores de riesgo independientes de ingreso por RAM (AU)

Objective: To determine prevalence of admissions due to an adverse drug reaction (ADR) and determine whether or not admission was avoidable, and what drugs and risk factors were implicated. Design: Cross-sectional observational study. Study sample: All patients hospitalized in an acute geriatric unit during the period January 2001 to December 2010 were studied. Measurement: To determine whether admissions were due toADR, we used the World Health Organization-Uppsala Monitoring Centre criteria and the Naranjo scale. Beers criteria were used to detect potentially inappropriate medication. Results: A total of 3,292 patients (mean age 84.7 years, 60.1% women) were studied. Of these, 197 (6%) were admissions for ADR and nearly three quarters (76.4%, 152 cases) were considered avoidable admissions. The 5 most frequent drugs associated with admissions for ADR were digoxin, nonsteroidal anti-inflammatory drugs, benzodiazepines, diuretics and antibiotics. Independent risk factors for admissions for ADR were being female (OR 1.84; 95% CI 1.30-2.61), inappropriate medication according to Beers criteria (OR 4.20; 95% CI 2.90-6.03), polypharmacy (>5 drugs) (OR 1.50; 95% CI 1.04-2.13), glomerular filtration rate<30mL/min (OR 3; 95% CI 2.12-4.23) and sedative use (OR 1.40; 95% CI 1-1.91). Conclusion: ADR were responsible for 6% of admissions to an acute geriatric unit, and over 75% of these admissions were considered avoidable. Associated risk factors were being female, inappropriate medication, polypharmacy, renal insufficiency and sedative use (AU)

Avoidable hospitalizations due to adverse drug reactions in an acute geriatric unit. Analysis of 3,292 patients. / Hospitalizaciones evitables por reacciones adversas a medicamentos en una unidad geriátrica de agudos. Análisis de 3.292 pacientes.

OBJECTIVE: To determine prevalence of admissions due to an adverse drug reaction (ADR) and determine whether or not admission was avoidable, and what drugs and risk factors were implicated. DESIGN: Cross-sectional observational study. STUDY SAMPLE: All patients hospitalized in an acute geriatric unit during the period January 2001 to December 2010 were studied. MEASUREMENT: To determine whether admissions were due toADR, we used the World Health Organization-Uppsala Monitoring Centre criteria and the Naranjo scale. Beers criteria were used to detect potentially inappropriate medication. RESULTS: A total of 3,292 patients (mean age 84.7 years, 60.1% women) were studied. Of these, 197 (6%) were admissions for ADR and nearly three quarters (76.4%, 152 cases) were considered avoidable admissions. The 5 most frequent drugs associated with admissions for ADR were digoxin, nonsteroidal anti-inflammatory drugs, benzodiazepines, diuretics and antibiotics. Independent risk factors for admissions for ADR were being female (OR 1.84; 95% CI 1.30-2.61), inappropriate medication according to Beers criteria (OR 4.20; 95% CI 2.90-6.03), polypharmacy (>5 drugs) (OR 1.50; 95% CI 1.04-2.13), glomerular filtration rate<30mL/min (OR 3; 95% CI 2.12-4.23) and sedative use (OR 1.40; 95% CI 1-1.91). CONCLUSION: ADR were responsible for 6% of admissions to an acute geriatric unit, and over 75% of these admissions were considered avoidable. Associated risk factors were being female, inappropriate medication, polypharmacy, renal insufficiency and sedative use.

Pneumonia as comorbidity in chronic obstructive pulmonary disease (COPD). Differences between acute exacerbation of COPD and pneumonia in patients with COPD.

INTRODUCTION: Pneumonia is considered an independent entity in chronic obstructive pulmonary disease (COPD), to be distinguished from an infectious exacerbation of COPD. The aim of this study was to analyze the clinical characteristics and progress of the exacerbation of COPD (ECOPD) compared to pneumonia in COPD (PCOPD) patients requiring hospitalization. PATIENTS AND METHODS: Prospective, longitudinal, observational cohort study including 124 COPD patients requiring hospital admission for lower respiratory tract infection. Patients were categorized according to presence of ECOPD (n=104) or PCOPD (n=20), depending on presence of consolidation on X-ray. Demographic, clinical, laboratory, microbiological and progress variables were collected. RESULTS: Patients with ECOPD showed more severe respiratory disease according to the degree of obstruction (P<.01) and need for oxygen therapy (P<.05). PCOPD patients showed increased presence of fever (P<.05), lower blood pressure (P<.001), more laboratory abnormalities (P<.05; leukocytosis, elevated CRP, low serum albumin) and increased presence of crepitus (P<.01). Microbiological diagnosis was achieved in 30.8% of cases of ECOPD and 35% of PCOPD; sputum culture yielded the highest percentage of positive results, predominantly Pseudomonas aeruginosa. Regarding the progress of the episode, no differences were found in hospital stay, need for ICU or mechanical ventilation. CONCLUSIONS: Our data confirm clinical and analytical differences between ECOPD and PCOPD in patients who require hospital admission, while there were no differences in subsequent progress.

La neumonía como comorbilidad en la enfermedad pulmonar obstructiva crónica (EPOC). Diferencias entre la exacerbación aguda de la EPOC y la neumonía en los pacientes con EPOC / Pneumonia as comorbidity in chronic obstructive pulmonary disease (COPD). Differences between acute exacerbation of COPD and pneumonia in patients with COPD

Introducción: La neumonía se considera una entidad propia, diferente a la exacerbación de la enfermedad pulmonar obstructiva crónica (EPOC) de causa infecciosa. El objetivo de nuestro estudio fue analizar las características clínicas y la evolución según se presentara una agudización de la EPOC (AEPOC) o una neumonía (NEPOC) en los pacientes con EPOC que precisaban un ingreso hospitalario. Pacientes y métodos: Estudio de cohortes, prospectivo, longitudinal y observacional que incluyó 124 pacientes con EPOC que precisaron ingreso hospitalario por una infección respiratoria baja. Se categorizaron según presentaran una AEPOC (n = 104) o una NEPOC (n = 20), en función de la aparición de condensación radiológica. Recogida de variables demográficas, clínicas, de laboratorio, microbiológicas y evolutivas. Resultados: Los pacientes con AEPOC mostraban mayor gravedad de la enfermedad respiratoria según el grado de obstrucción (p < 0,01) y necesidad de oxigenoterapia crónica (p < 0,05). Los pacientes con NEPOC mostraban mayor presencia de fiebre (p < 0,05), mayor hipotensión arterial (p < 0,001), mayor alteración analítica (p < 0,05; leucocitosis, elevación de la PCR, hipoalbuminemia), así como mayor presencia de crepitantes (p < 0,01). El diagnóstico microbiológico se obtuvo en el 30,8% de los casos de AEPOC y en el 35% de las NEPOC, siendo el cultivo de esputo la técnica con mayor porcentaje de resultados positivos, mostrando una preponderancia de Pseudomonas aeruginosa. La evolución del episodio no mostró diferencias en la estancia hospitalaria, ni la necesidad de UCI o ventilación mecánica. Conclusiones: Nuestros datos confirman diferencias clínicas y analíticas entre una AEPOC y una NEPOC en los pacientes que precisan ingreso hospitalario, aunque sin diferencias en la evolución posterior

Introduction: Pneumonia is considered an independent entity in chronic obstructive pulmonary disease (COPD), to be distinguished from an infectious exacerbation of COPD. The aim of this study was to analyze the clinical characteristics and progress of the exacerbation of COPD (ECOPD) compared to pneumonia in COPD (PCOPD) patients requiring hospitalization. Patients and methods: Prospective, longitudinal, observational cohort study including 124 COPD patients requiring hospital admission for lower respiratory tract infection. Patients were categorized according to presence of ECOPD (n = 104) or PCOPD (n = 20), depending on presence of consolidation on X-ray. Demographic, clinical, laboratory, microbiological and progress variables were collected. Results: Patients with ECOPD showed more severe respiratory disease according to the degree of obstruction (P < .01) and need for oxygen therapy (P < .05). PCOPD patients showed increased presence of fever (P < .05), lower blood pressure (P < .001), more laboratory abnormalities (P < .05; leukocytosis, elevated CRP, low serum albumin) and increased presence of crepitus (P < .01). Microbiological diagnosis was achieved in 30.8% of cases of ECOPD and 35% of PCOPD; sputum culture yielded the highest percentage of positive results, predominantly Pseudomonas aeruginosa. Regarding the progress of the episode, no differences were found in hospital stay, need for ICU or mechanical ventilation. Conclusions: Our data confirm clinical and analytical differences between ECOPD and PCOPD in patients who require hospital admission, while there were no differences in subsequent progress

[Peripheral venous catheter-related bacteremia in a general hospital]. / Características de la bacteriemia relacionada con catéter venoso periférico en un hospital general.

INTRODUCTION: Catheter sepsis is a constant and serious problem in our hospitals for the cost it generates, both in terms of morbidity and economics. It's becoming more frequent also in peripherally inserted catheters. Our study aims to know the importance and characteristics of peripheral venous catheter bacteremia in a general hospital. MATERIAL AND METHODS: Prospective and comparative analysis of all episodes of central and peripheral venous catheter-related bacteraemia, in 2009. RESULTS: Twenty-eight episodes of catheter-related bacteraemia in a total of 25 patients. Sixteen episodes originated in central catheter (57.2%), 11 in peripheral (39.3%) and 1 in peripherally inserted central catheter (3.5%). Two cases of exitus directly related to the peripheral catheter infection. ETIOLOGY: 13 episodes of S. aureus (3 MRSA), including 8 in peripheral catheter (8/13, 61.5%), 12 episodes of plasma coagulase negative staphylococcus, including 2 in peripheral catheter (2/12, 16.6%). CONCLUSIONS: Peripheral catheter-related bacteraemia is an emerging health problem with important clinical and prognostic connotations for patients. It is necessary continuous training on correct handling measures to prevent intravascular catheters infections including peripheral catheters in every hospital ward.

Características de la bacteriemia relacionada con catéter venoso periférico en un hospital general / Peripheral venous catheter-related bacteremia in a general hospital

Introducción. La bacteriemia por catéter es un problema constante y grave en nuestros hospitales, por el coste que genera, tanto en términos de morbilidad como económico. Cada vez es más frecuente la bacteriemia originada en catéteres de inserción periférica. Nuestro trabajo pretende conocer la importancia y características de la bacteriemia de catéter venoso periférico en un hospital general. Material y métodos. Análisis prospectivo y comparativo de todos los episodios de infección de catéter venoso central y periférico, durante el año 2009. Resultados. 28 episodios de bacteriemia por catéter en 25 pacientes. Dieciséis episodios se originaron en catéter central (57,2%), 11 en periférico (39,3%) y 1 en catéter central de inserción periférica (3,5%). Hubo dos casos de fallecimiento relacionados directamente con la infección del catéter periférico. Etiología. 13 episodios por Staphylococcus aureus (3 S. aureus resistente a meticilina, SARM), de ellos 8 en catéter periférico (8/13; 61,5%), 12 episodios por estafilococo coagulasa negativo (ECN), de ellos 2 en periférico (2/12; 16,6%). Conclusiones. La bacteriemia relacionada con catéter periférico es un problema sanitario emergente con importantes connotaciones clínicas y pronósticas para los pacientes. Es necesaria una formación continuada sobre normas de actuación consensuadas para prevenir las infecciones de catéteres intravasculares incluidos los periféricos, en todos los dispositivos asistenciales hospitalarios(AU)

Introduction. Catheter sepsis is a constant and serious problem in our hospitals for the cost it generates, both in terms of morbidity and economics. It’s becoming more frequent also in peripherally inserted catheters. Our study aims to know the importance and characteristics of peripheral venous catheter bacteremia in a general hospital. Material and methods. Prospective and comparative analysis of all episodes of central and peripheral venous catheter- related bacteraemia, in 2009. Results. Twenty-eight episodes of catheter-related bacteraemia in a total of 25 patients. Sixteen episodes originated in central catheter (57.2%), 11 in peripheral (39.3%) and 1 in peripherally inserted central catheter (3.5%). Two cases of exitus directly related to the peripheral catheter infection. Etiology: 13 episodes of S. aureus (3 MRSA), including 8 in peripheral catheter (8/13, 61.5%), 12 episodes of plasma coagulase negative staphylococcus, including 2 in peripheral catheter (2/12, 16.6%). Conclusions. Peripheral catheter-related bacteraemia is an emerging health problem with important clinical and prognostic connotations for patients. It is necessary continuous training on correct handling measures to prevent intravascular catheters infections including peripheral catheters in every hospital ward(AU)