Change in triggered EMG thresholds for thoracic pedicle screws caused by pneumothorax during surgery for adolescent idiopathic scoliosis. Report of two cases. / Alteración en los umbrales de estimulación de tornillos pediculares torácicos secundaria a neumotórax en cirugía por escoliosis idiopática del adolescente. A propósito de dos casos.

Posterior spinal instrumentation and fusion with pedicle screws inserted by free-hand technique and controlled by multimodal intraoperative monitoring is the most common technique in adolescent idiopathic scoliosis surgery. Pneumothorax is a described complication of this kind of procedure. Triggered electromyography is used to identify pedicle wall breakthrough and prevent neurological injuries. We report 2 clinical cases in which unilateral decrease in triggered electromyography values associate with ipsilateral pneumothorax. Postoperative chest radiographs need to be done in order to diagnose a pneumothorax. However, routinely performing a chest radiograph has been questioned because of the low incidence of this surgical complication. As a result of the association described in this article, we consider that when a unilateral decrease in triggered electromyography values is detected, a hidden pneumothorax should be suspected and ruled out.

Resultados funcionales y supervivencia a ocho años de la artroscopia de cadera en pacientes con patología degenerativa de cadera / Functional outcomes and 8-year survival after hip arthroscopy in patients with degenerative hip disease

ANTECEDENTES Y OBJETIVOS: El objetivo de este estudio es evaluar qué factores pueden influir en la supervivencia de la artroscopia de cadera a medio plazo en el contexto de patología degenerativa. MATERIAL Y MÉTODOS: Llevamos a cabo un estudio retrospectivo de 40 casos de una serie de 102 pacientes intervenidos de artroscopia de cadera en nuestro centro, desde agosto de 2007 a octubre de 2011. Al final del seguimiento, todos los pacientes cumplimentaron tres escalas funcionales: Hip Outcome Score-Activites of Daily Life (HOS-ADL), Hip Outcome Score-Sport (HOS-S) y Harris Hip Score modificado (HHSm). RESULTADOS: Finalmente se incluyó un total de 39 pacientes (40 caderas), con una edad media de 43,1 años y un tiempo de seguimiento medio de 6 años (43-130 meses). Los pacientes intervenidos con una edad inferior a 50 años obtuvieron mejor puntuación en las escalas HOS-S (25,2 puntos) y HHS-m (84,1 puntos) en comparación con aquellos intervenidos a partir de dicha edad (HOS-S [25,2 puntos]; HHS-m [84,1 puntos]). El tiempo de evolución también influyó significativamente en el resultado de nuestros pacientes, siendo mejor en aquellos en los que éste era menor a 12 meses (26,6 meses), en comparación con aquellos en los que era mayor (21,3 meses). Por otro lado, aquellos que presentaban una intervención quirúrgica lumbar previa obtuvieron peores resultados de HOS-ADL (49,3 puntos), respecto a aquellos que no presentaban este antecedente (56,5 puntos). El Patient acceptable symptom state (PASS) fue superado por 23 pacientes (57,5%), 22 pacientes (55%) y 25 pacientes (62,5%) en las escalas HHSm, HOS-ADL y HOS-S respectivamente. Ningún paciente presentó ninguna complicación mayor. Cuatro pacientes presentaron complicaciones menores. La supervivencia media obtenida fue de 97,1 meses (IC 95%, 85,1-109,1 meses), asociado con un 81% de pacientes (IC 95%, 69%-93%) que no precisó rescate quirúrgico a los 10 años. CONCLUSIONES: Creemos que los datos obtenidos en nuestra serie sugieren que la artroscopia de cadera en el contexto de patología degenerativa es una intervención quirúrgica segura con un resultado funcional fiable a corto-medio plazo. Por otro lado, dicha indicación debería hacerse con mayor precaución en pacientes sometidos previamente a cirugía lumbar. NIVEL DE EVIDENCIA: Nivel IV. Serie de casos

BACKGROUND AND PURPOSE: The purpose of this study is to identify which variables may have a significant impact in mid-term survivorship following hip arthroscopy. METHODS: This a single-centre single-surgeon retrospective study including 102 patients who underwent a hip arthroscopy procedure between August 2007 and October 2011. Each subject completed three questionnaires at final follow- up: Hip Outcome Score-Activities of Daily Living (HOS-ADL), Hip Outcome Score-Sport (HOS-S) and Modified Harris Hip Score (m-HHS). RESULTS: Thirty-nine patients (40 hips) were finally included in our study. Mean age was 43.1 ± 9.9 years with a three-year minimum follow-up (75.43 ± 25.2 months). Younger patients and those with a shorter duration of symptoms obtained significantly higher HOS-S and m-HSS scores. Patients who had undergone previous lumbar spinal surgery obtained significantly worse HOS-ADL scores. Patient acceptable symptom state (PASS) was achieved in 23 patients (57.5%) for m-HHS, 22 patients (55%) for HOS-ADL and 25 patients for HOS-S scores. No major complication was observed. Only four patients had minor complications. Mean survival time was 97.1 months (95% CI, 85.1 to 109.1 months), with a survival at 8 years of 69% (95% CI, 53% to 85%). CONCLUSIONS: Our findings suggest that hip arthroscopy is a safe procedure with acceptable functional outcomes after a long follow-up. Care should be taken when treating patients with prior lumbar surgery. LEVEL OF EVIDENCE: Level IV. Case series

Functional outcomes and 8-year survival after hip arthroscopy in patients with degenerative hip disease. / Resultados funcionales y supervivencia a ocho años de la artroscopia de cadera en pacientes con patología degenerativa de cadera.

BACKGROUND AND PURPOSE: The purpose of this study is to identify which variables may have a significant impact in mid-term survivorship following hip arthroscopy. METHODS: This a single-centre single-surgeon retrospective study including 102 patients who underwent a hip arthroscopy procedure between August 2007 and October 2011. Each subject completed three questionnaires at final follow- up: Hip Outcome Score-Activities of Daily Living (HOS-ADL), Hip Outcome Score-Sport (HOS-S) and Modified Harris Hip Score (m-HHS). RESULTS: Thirty-nine patients (40 hips) were finally included in our study. Mean age was 43.1 ± 9.9 years with a three-year minimum follow-up (75.43 ± 25.2 months). Younger patients and those with a shorter duration of symptoms obtained significantly higher HOS-S and m-HSS scores. Patients who had undergone previous lumbar spinal surgery obtained significantly worse HOS-ADL scores. Patient acceptable symptom state (PASS) was achieved in 23 patients (57.5%) for m-HHS, 22 patients (55%) for HOS-ADL and 25 patients for HOS-S scores. No major complication was observed. Only four patients had minor complications. Mean survival time was 97.1 months (95% CI, 85.1 to 109.1 months), with a survival at 8 years of 69% (95% CI, 53% to 85%). CONCLUSIONS: Our findings suggest that hip arthroscopy is a safe procedure with acceptable functional outcomes after a long follow-up. Care should be taken when treating patients with prior lumbar surgery. LEVEL OF EVIDENCE: Level IV.

Infección quirúrgica profunda en cirugía instrumentada de raquis toracolumbar. Diez años de experiencia / Deep surgical site infection following thoracolumbar instrumented spinal surgery. Ten years of experience

Objetivo: Describir las características y la evolución de la infección profunda en cirugía instrumentada de raquis toracolumbar (IPCITL) en nuestro centro en un periodo de 10años. Material y método: Estudio descriptivo retrospectivo. Se analizan datos del paciente (epidemiológicos/salud), datos operatorios, presentación de la infección, gérmenes cultivados, limpiezas quirúrgicas requeridas, extracción de los implantes y complicaciones significativas derivadas de la infección. Resultados: Se revisan 110 pacientes (80mujeres). El seguimiento medio tras el diagnóstico de infección fue de 3,6años. Etiologías más frecuentes: escoliosis idiopática del adolescente, deformidad del adulto y estenosis lumbar degenerativa. El 62% de pacientes presentaban algún dato clínico que les hacía proclives a la infección. La aparición de la infección fue precoz (0-3meses de la cirugía primaria) en el 60,4% de los casos, retardada (3-24meses) en el 11,7% y tardía (más de 24meses) en el 27%. Todos los pacientes fueron tratados mediante limpieza quirúrgica. El 25% necesitaron más de una limpieza. Se extrajeron los implantes en el 46% de los pacientes (en el 71% de ellos en la primera limpieza). Los gérmenes aislados con mayor frecuencia fueron Staphylococcus coagulasa-negativo, Propionibacterium acnes y Enterococcus. Hubo complicaciones significativas derivadas de la IPCITL en el 15% de casos. El 88% de ellas precisaron cirugías complejas para su tratamiento. Conclusiones: Las IPCITL tardías son más frecuentes de lo esperado según la literatura. En IPCITL globalmente predominan gérmenes cutáneos. Las IPCITL provocan una alta tasa de complicaciones, que habitualmente requieren tratamiento mediante cirugías complejas

Objective: To describe thee characteristics and evolution of deep surgical site infection following thoracolumbar instrumented spinal surgery (DSITIS) in our centre over a period of ten years. Material and method: Descriptive retrospective study. Patient data (epidemiological/health status), surgical data, infection characteristics/presentation, isolated microorganisms, required surgical debridements, implant removal and major complications linked to infection were evaluated. Results: We included 110 patients (80 females). Median follow-up after infection diagnosis was 3.6years. Adolescent idiopathic scoliosis, adult deformity and degenerative lumbar stenosis were the most frequent aetiologies. Sixty-two percent of the patients had at least one clinical feature that made them prone to infection. Infection presentation was early (0-3months from first surgery) in 60.4% of the cases, delayed (3-24months) in 11.7%, and late (more than 24months) in 27%. All patients were treated by surgical debridement. Twenty-five percent needed more than one surgical debridement. Implants were removed in 46% of the patients (71% in the first surgical debridement). The most frequent isolated microorganisms were coagulasa-negative Staphylococcus, Propionibacterium acnes and Enterococcus. Major complications appeared in 15% of the patients, and 88% of them required major surgeries. Conclusions: Late DSITIS is more frequent than previously reported. Skin microorganisms predominate among the DSITIS culprits. DSIITS produce a high rate of major complications that usually require major surgery for treatment

Deep surgical site infection following thoracolumbar instrumented spinal surgery. Ten years of experience. / Infección quirúrgica profunda en cirugía instrumentada de raquis toracolumbar. Diez años de experiencia.

OBJECTIVE: To describe the characteristics and evolution of deep surgical site infection following thoracolumbar instrumented spinal surgery (DSITIS) in our centre over a period of ten years. MATERIAL AND METHOD: Descriptive retrospective study. Patient data (epidemiological/health status), surgical data, infection characteristics/presentation, isolated microorganisms, required surgical debridements, implant removal and major complications linked to infection were evaluated. RESULTS: We included 110 patients (80 females). Median follow-up after infection diagnosis was 3.6years. Adolescent idiopathic scoliosis, adult deformity and degenerative lumbar stenosis were the most frequent aetiologies. Sixty-two percent of the patients had at least one clinical feature that made them prone to infection. Infection presentation was early (0-3months from first surgery) in 60.4% of the cases, delayed (3-24months) in 11.7%, and late (more than 24months) in 27%. All patients were treated by surgical debridement. Twenty-five percent needed more than one surgical debridement. Implants were removed in 46% of the patients (71% in the first surgical debridement). The most frequent isolated microorganisms were coagulasa-negative Staphylococcus, Propionibacterium acnes and Enterococcus. Major complications appeared in 15% of the patients, and 88% of them required major surgeries. CONCLUSIONS: Late DSITIS is more frequent than previously reported. Skin microorganisms predominate among the DSITIS culprits. DSIITS produce a high rate of major complications that usually require major surgery for treatment.

Correlación de resultados clínicos y perfil sagital en escoliosis del adulto. Valor del ángulo espinosacro y del ángulo de inclinación del raquis / Relationship between clinical results and sagittal profile in adult scoliosis. Value of the spinal-sacral angle and the spinal inclination angle

Objetivos. Evaluar la validez clínica en EA de 2 nuevos parámetros (ASS y ST) descritos recientemente para la evaluación del perfil sagital espinopélvicos, y cuyo papel en EA no está aún definido. Material y método. Análisis prospectivo (no concurrente) radiográfico y clínico de 59 cirugías primarias de EA (Cobb > 40°), mínimo 2 años de seguimiento. Para este trabajo dispusimos de radiografías y cuestionarios de salud de 49 pacientes. Se evaluó el cambio de los parámetros radiográficos tras cirugía (test Wilcoxon) y la correlación resultados clínicos-radiográficos-edad (test de Spearman y regresión lineal múltiple). Resultados. Mediana de seguimiento postoperatorio 8,5 años. Mediana edad 49,5 años. Hubo cambio estadísticamente significativo con la cirugía en ASS y ST (en ambos inferior a 5°), cifosis torácica (CT), lordosis lumbar (LL), rotación pélvica (RP), balance sagital (BS) y Cobb frontal. No hubo correlación entre dolor y ASS-ST. Hubo correlación significativa entre actividad y ASS, ST, LL, BS) y edad. Tras análisis multivariante solo la edad (ni ASS ni ST) persistió como posible predictor de menor actividad. Discusión. Cuando predomina la deformidad frontal, los parámetros radiográficos sagitales, incluidos los más novedosos ángulos, si bien sí influyen en la actividad del paciente cuando se analizan de forma aislada, pierden esta influencia cuando se analizan en conjunto y junto a otros parámetros clínicos. Conclusiones. Los valores de SSA y ST varían escasamente con la cirugía. Solo se correlacionan con la actividad pero no pueden considerarse predictores de la misma. No parecen pues medidas de utilidad en EA (AU)

Objectives. To assess the clinical validity of two new recently described parameters (spinal-sacral angle (SSA) and spinal inclination angle (SIA) in adult scoliosis (AS) for evaluating the spinal-pelvic sagittal profile, as well as their still undefined role in AS. Material and method. A non-concurrent prospective radiographic and clinical study was conducted on 59 primary surgeries of AS (Cobb>40°), with a minimum of 2 years follow-up. The available X-rays and health questionnaires of 49 patients were used in the study. The changes in X-ray parameters after surgery were evaluated (Wilcoxon test), as well as the correlations as regards the clinical-radiography-age parameters (Spearman test and multiple linear regression). Results. The median post-surgical follow-up was 8.5 years, and the median age of the patients was 49.5 years. There was a statistically significant change with the surgery in the SSA and SIA (less than 5° in both), thoracic kyphosis, lumbar lordosis (LL), pelvic rotation, sagittal balance (SB) and frontal Cobb. There was no correlation between pain and SSA-ST. There was a significant relationship between activity and SSA, ST, LL, SB, and age. After the multivariate analysis only age (not SSA or SIA) remained as a possible predictor of lower activity. Discussion. When frontal deformity predominates, the sagittal radiographic parameters, including the newest angles, although they have an influence patient activity when analysed individually, they lose this influence when they are analysed together and with other clinical parameters. Conclusions. The SSA and SIA hardly change with surgery. They only correlate with activity, but cannot be considered predictors of this. Thus they do seem to be useful measurements in AS (AU)

Tumor de células gigantes en rótula: a propósito de un caso y revisión de la literatura / Patellar giant cell tumour: presentation of a case and a review of the literature

Los tumores en la rótula son poco frecuentes. Suelen afectar a pacientes jóvenes y se presentan como dolor inespecífico en la rodilla. El tumor de células gigantes (TCG) del hueso es un tumor benigno, pero localmente agresivo. Aunque la localización alrededor de la rodilla es muy frecuente, llegando a ser de hasta el 40-60%, la afectación de la rótula se ha descrito clásicamente en la literatura como casos aislados. Presentamos el caso de un varón de 19 años de edad, que acude a nuestra consulta presentando clínica meniscal. En el estudio radiológico se descubre de forma incidental una lesión lítica en la patela. Tras el estudio mediante resonancia magnética nuclear (RMN), se confirma el carácter benigno de la lesión, y en el mismo acto quirúrgico extraemos una biopsia incisional de la rótula. El estudio histológico confirma la sospecha de TCG, por lo que en un segundo tiempo quirúrgico se realiza el tratamiento definitivo. El paciente a los 56 meses de la intervención está asintomático y libre de enfermedad (AU)

Patellar tumours are rare. They typically appear in young patients, and present with a non-specific pain in the knee. Giant cell tumour (GCT) are benign, but locally aggressive. Although they are usually found around the knee (40-60%), those affecting the patella have been classically described in the literature as uncommon. We describe the case of a 19 year old male complaining of pain in his knee, whose clinical examination suggested a meniscal tear. Plain radiological examination, as well as MRI, revealed a well circumscribed lytic lesion within the patella. The patient underwent arthroscopic surgery, during which an incisional biopsy was performed. Following pathology reports, which confirmed the suspected GCT, definitive surgery was performed. At 56 months after the surgery the patient remains asymptomatic and free of disease (AU)

[Relationship between clinical results and sagittal profile in adult scoliosis. Value of the spinal-sacral angle and the spinal inclination angle]. / Correlación de resultados clínicos y perfil sagital en escoliosis del adulto. Valor del ángulo espinosacro y del ángulo de inclinación del raquis.

OBJECTIVES: To assess the clinical validity of two new recently described parameters (spinal-sacral angle (SSA) and spinal inclination angle (SIA) in adult scoliosis (AS) for evaluating the spinal-pelvic sagittal profile, as well as their still undefined role in AS. MATERIAL AND METHOD: A non-concurrent prospective radiographic and clinical study was conducted on 59 primary surgeries of AS (Cobb>40°), with a minimum of 2 years follow-up. The available X-rays and health questionnaires of 49 patients were used in the study. The changes in X-ray parameters after surgery were evaluated (Wilcoxon test), as well as the correlations as regards the clinical-radiography-age parameters (Spearman test and multiple linear regression). RESULTS: The median post-surgical follow-up was 8.5 years, and the median age of the patients was 49.5 years. There was a statistically significant change with the surgery in the SSA and SIA (less than 5° in both), thoracic kyphosis, lumbar lordosis (LL), pelvic rotation, sagittal balance (SB) and frontal Cobb. There was no correlation between pain and SSA-ST. There was a significant relationship between activity and SSA, ST, LL, SB, and age. After the multivariate analysis only age (not SSA or SIA) remained as a possible predictor of lower activity. DISCUSSION: When frontal deformity predominates, the sagittal radiographic parameters, including the newest angles, although they have an influence patient activity when analysed individually, they lose this influence when they are analysed together and with other clinical parameters. CONCLUSIONS: The SSA and SIA hardly change with surgery. They only correlate with activity, but cannot be considered predictors of this. Thus they do seem to be useful measurements in AS.

[Patellar giant cell tumour: presentation of a case and a review of the literature]. / Tumor de células gigantes en rótula: a propósito de un caso y revisión de la literatura.

Patellar tumours are rare. They typically appear in young patients, and present with a non-specific pain in the knee. Giant cell tumour (GCT) are benign, but locally aggressive. Although they are usually found around the knee (40-60%), those affecting the patella have been classically described in the literature as uncommon. We describe the case of a 19 year old male complaining of pain in his knee, whose clinical examination suggested a meniscal tear. Plain radiological examination, as well as MRI, revealed a well circumscribed lytic lesion within the patella. The patient underwent arthroscopic surgery, during which an incisional biopsy was performed. Following pathology reports, which confirmed the suspected GCT, definitive surgery was performed. At 56 months after the surgery the patient remains asymptomatic and free of disease.

[Double lumen tube insertion in awake patients through the AirTraq laryngoscope in 2 cases of expected difficult airway]. / Intubación con tubo de doble luz mediante laringoscopio Airtraq en dos pacientes despiertos con vía aérea díficil prevista.

The likelihood of difficult airway in thoracic surgery increases in the presence of associated cancer of the pharynx or larynx. The difficulty is greater when a double lumen tube must be inserted in these conditions, and various newly developed optical devices offer solutions for managing such cases. We report on 2 patients with expected difficult airway who were scheduled for lung resection. In both cases, intubation was accomplished through the AirTraq laryngoscope while the patient remained awake. Awake patient tolerance is facilitated by this laryngoscope, because the tube can be inserted without changing the position of the tongue or placing pressure on the vallecula.

Intubación con tubo de doble luz mediante laringoscopio Airtraq® en dos pacientes despiertos con vía aérea díficil prevista / Double lumen tube insertion in awake patients through the AirTraq laryngoscope in 2 cases of expected difficult airway

La posibilidad de hallar un paciente con vía aérea difícil (VAD) en cirugía torácica aumenta por la coexistencia de patología oncológica faringo-laríngea asociada. El uso de tubos de doble luz para el aislamiento pulmonar supone una dificultad añadida en estas situaciones. Diversos dispositivos ópticos diseñados en los últimos años, aportan nuevas soluciones disponibles para el manejo de estos casos. Presentamos dos pacientes con VAD conocida, programados para resección pulmonar, en los que se utilizó con éxito el laringoscopio Airtraq® para la inserción de tubo de doble luz con el paciente despierto. Este laringoscopio no requiere desplazamiento de la lengua, ni tracción de la vallécula, lo que facilita su tolerancia en pacientes despiertos(AU)

The likelihood of difficult airway in thoracic surgery increases in the presence of associated cancer of the pharynx or larynx. The difficulty is greater when a double lumen tube must be inserted in these conditions, and various newly developed optical devices offer solutions for managing such cases. We report on 2 patients with expected difficult airway who were scheduled for lung resection. In both cases, intubation was accomplished through the AirTraq laryngoscope while the patient remained awake. Awake patient tolerance is facilitated by this laryngoscope, because the tube can be inserted without changing the position of the tongue or placing pressure on the vallecula(AU)

[Septic shock due to community-acquired complicated intra-abdominal infection treated with ertapenem: outcome in 25 cases]. / Resultados en 25 pacientes con shock séptico por infección intraabdominal complicada adquirida en la comunidad tratados con ertapenem.

OBJECTIVES: To assess the effectiveness of ertapenem in patients admitted to a surgical intensive care unit with septic shock due to community-acquired complicated intra-abdominal infection. PATIENTS AND METHODS: Patients undergoing emergency surgery for community-acquired complicated intra-abdominal infection were enrolled prospectively. All patients were given intravenous ertapenem at a rate of 1 g/24 h and the guidelines of the Surviving Sepsis Campaign were applied. Outcome measures were duration of antibiotic therapy, mean length of stay in the surgical intensive care unit (ICU), antibiotic failure, and death while in the surgical ICU. RESULTS: Twenty-five patients with a mean (SD) age of 74 (14) years were enrolled. The origin of infection was the colon in 56% of the cases; most patients (76%) had generalized peritonitis. The mean stay in the surgical ICU was 10 (7) days. The mean duration of antibiotic therapy was 5.8 (1.26) days. Antibiotic failure occurred in 12%. Mortality in the surgical ICU was 28%. CONCLUSIONS: Our findings suggest that patients with community-acquired intra-abdominal infection and septic shock have a good chance of survival when treated according to the guidelines of the Surviving Sepsis Campaign. Ertapenem seems to give good results when used in this setting.

Resultados en 25 pacientes con shock séptico por infecciónintraabdominal complicada adquirida en la comunidad tratadoscon ertapenem / Septic shock due to community-acquired complicated intra-abdominal infection treated with ertapenem: outcome in 25 cases

OBJETIVOS: Evaluar la eficacia de un antibiótico comoertapenem en el grupo de pacientes con shock sépticodebido a infección intraabdominal complicada (IIAC)adquirida en la comunidad durante su ingreso en la unidadde cuidados críticos quirúrgicos (UCCQ).PACIENTES Y MÉTODO: Se incluyeron de forma prospectivapacientes intervenidos de forma urgente porIIAC adquirida en la comunidad y que desarrollaronshock séptico. En todos los pacientes fue administradoertapenem 1 g/24 h intravenoso y se aplicaron las recomendacionesde la campaña “sobrevivir a la sepsis”. Sevaloraron la duración del tratamiento antibiótico, laestancia media en UCCQ, el fracaso terapéutico del tratamientoantibiótico y, la mortalidad durante su estanciaen UCCQ.RESULTADOS: Se estudiaron 25 pacientes, edad media74 (DE 14) años. El origen anatómico más frecuente dela IIAC fue el colon (56%) y la mayoría de los pacientespresentaron una peritonitis generalizada (76%). Laestancia media de los pacientes durante su ingreso enUCCQ fue 10 (DE 7) días. La duración media del tratamientoantibiótico fue 5,83 (DE 1,26) días. El fracasoterapéutico del antibiótico se produjo en un 12% depacientes. La mortalidad durante su estancia en UCCQfue del 28%.CONCLUSIONES: Nuestros hallazgos sugieren que lospacientes con IIAC adquirida en la comunidad y shockséptico tratados siguiendo las recomendaciones de lacampaña “sobrevivir a la sepsis” suponen un grupo quepresentan una mortalidad muy favorable. Además, pareceque ertapenem es un antibiótico que puede ser utilizadocon buenos resultados en este grupo de pacientes (AU)

OBJECTIVES: To assess the effectiveness of ertapenemin patients admitted to a surgical intensive care unit withseptic shock due to community-acquired complicatedintra-abdominal infection.PATIENTS AND METHODS: Patients undergoingemergency surgery for community-acquired complicatedintra-abdominal infection were enrolled prospectively.All patients were given intravenous ertapenem at a rateof 1 g/24 h and the guidelines of the Surviving SepsisCampaign were applied. Outcome measures wereduration of antibiotic therapy, mean length of stay in thesurgical intensive care unit (ICU), antibiotic failure, anddeath while in the surgical ICU.RESULTS: Twenty-five patients with a mean (SD) ageof 74 (14) years were enrolled. The origin of infectionwas the colon in 56% of the cases; most patients (76%)had generalized peritonitis. The mean stay in thesurgical ICU was 10 (7) days. The mean duration ofantibiotic therapy was 5.8 (1.26) days. Antibiotic failureoccurred in 12%. Mortality in the surgical ICU was28%.CONCLUSIONS: Our findings suggest that patients withcommunity-acquired intra-abdominal infection andseptic shock have a good chance of survival when treatedaccording to the guidelines of the Surviving SepsisCampaign. Ertapenem seems to give good results whenused in this setting (AU)