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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Enfisema subcutáneo masivo tras traumatismo torácico en paciente con bullas pulmonares / Massive subcutaneous emphysema after thoracic trauma in a patient with pulmonary bullae

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Satisfacción en la Unidad de Cuidados Intensivos (UCI): la opinión del paciente como piedra angular / Satisfaction in the Intensive Care Unit (ICU). Patient opinion as a cornerstone

OBJETIVO: Estudiar la concordancia entre los grados de satisfacción de los pacientes y sus familiares (ambos pertenecientes a un mismo núcleo familiar) en cuanto a los cuidados y atenciones proporcionados durante su estancia en la UCI. DISEÑO: Estudio transversal, observacional, descriptivo y prospectivo durante 5 meses. Ámbito: UCI del Hospital Universitario Marqués de Valdecilla de Santander. Sujetos: Pacientes mayores de 18 años con estancia mayor de 24h que fueron dados de alta de la UCI durante el período de estudio y familiares de dichos pacientes. Intervención: Instrumento: cuestionario FS-ICU 34 para evaluar la satisfacción de los familiares de pacientes ingresados en la UCI y adaptación de dicho cuestionario para el paciente. Se determina el grado de concordancia mediante el índice de kappa ponderado para muestras pareadas. RESULTADOS: Se analizaron todos los cuestionarios procedentes de un mismo núcleo familiar, obteniéndose un total de 148 pares de cuestionarios (296 encuestas). Se obtuvieron índices kappa que oscilaron entre 0,278 y 0,558, lo que indica grados de concordancia entre débiles y moderados. CONCLUSIONES: Los familiares de los pacientes ingresados en la UCI no pueden ser considerados unos representantes adecuados, al menos para el subgrupo de pacientes competentes. En estos casos debemos acudir a esos pacientes para conocer de primera mano sus sentimientos, percepciones y vivencias durante su estancia en la UCI. Solo cuando los pacientes no están en condiciones de participar activamente en el proceso asistencial debemos acudir a sus familias

OBJECTIVE: To study the agreement between the level of satisfaction of patients and their families referred to the care and attention received during admission to the ICU. DESIGN: A prospective, 5-month observational and descriptive study was carried out. SETTING: ICU of Marqués de Valdecilla University Hospital, Santander (Spain). Subjects: Adult patients with an ICU stay longer than 24h, who were discharged to the ward during the period of the study, and their relatives. Intervention: Instrument: FS-ICU 34 for assessing family satisfaction, and an adaptation of the FS-ICU 34 for patients. The Cohen kappa index was calculated to assess agreement between answers. RESULTS: An analysis was made of the questionnaires from one same family unit, obtaining 148 pairs of surveys (296 questionnaires). The kappa index ranged between 0.278-0.558, which is indicative of mild to moderate agreement. CONCLUSIONS: The families of patients admitted to the ICU cannot be regarded as good proxies, at least for competent patients. In such cases, we must refer to these patients in order to obtain first hand information on their feelings, perceptions and experiences during admission to the ICU. Only when patients are unable to actively participate in the care process should their relatives be consulted

Matriz de densidad espectral de color en la herniación cerebral / Color density spectral array in brain herniation

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Utilidad de la matriz de densidad espectral del sistema de índice biespectral bilateral en la monitorización del status epilepticus no convulsivo / Usefulness of the bispectral index system density spectral array in monitoring non-convulsive status epilepticus

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Análisis de los empiemas subdurales intracraneales en un hospital de tercer nivel / Analysis of subdural intracranial empyemas in a third level hospital

El empiema subdural intracraneal (ESI) es un proceso infeccioso infrecuente, de etiología diversa yde difícil diagnóstico por presentar una clínica inespecífica. Pacientes y métodos. Estudio retrospectivo de los pacientes diagnosticados de ESI en un hospital universitario de tercer nivel durante un período de 15 años. Resultados. Se diagnosticaron cinco varones (media de edad: 39,3 años). El foco primario más frecuente fue ótico y sinusal (60%). Las manifestaciones clínicasiniciales fueron fiebre, cefalea, alteración del nivel de conciencia y síntomas neurológicos focales. El tiempo medio transcurrido desde el inicio de los síntomas hasta el diagnóstico fue de 3,6 días. El diagnóstico se realizó mediante tomografía computarizada en todos los pacientes. El ESI asentó sobre el hemisferio izquierdo en el 60% de los casos y afectó predominantementeal lóbulo parietal (80%). Los microorganismos aislados con mayor frecuencia fueron gérmenes anaerobios yestreptococos. El tratamiento se basó en terapia antibiótica y drenaje quirúrgico en el 100% de los casos. La técnica empleada para la evacuación del ESI fue la craneotomía en todos los pacientes. El tiempo medio transcurrido entre el diagnóstico yla intervención quirúrgica fue de 8,4 días. La estancia media en la Unidad de Cuidados Intensivos fue de 12,8 días, mientras que la hospitalaria global fue de 45,2 días. La mortalidad fue del 40%. Conclusión. El ESI, aunque infrecuente, presenta unaalta morbimortalidad, que puede disminuir con un abordaje terapéutico precoz, que debe incluir en todos los casos la evacuación quirúrgica de la colección

Intracranial subdural empyema (ISE) is an infrequent infectious disorder of diverse etiology anddifficult to diagnose because of its non-specific clinical features. Patients and methods. Retrospective study of patients diagnosed of ISE in a third-level university hospital in a 15-year period. Results. Five men were included (mean age: 39.3 years). Themost frequent primary source of infection was otic and sinusal (60%). The initial clinical manifestations were fever, headache, alteration of consciousness, and neurological focal symptoms. The mean time elapsed between onset of symptoms and diagnosis was 3.6 days. Diagnosis was performed by computed tomography in all patients. ISE was localized in the left hemisphere in 60% of cases mainly affecting the parietal lobe (80%). Anaerobic and streptococci germs were the most frequently isolated microorganisms. Therapy was based on antibiotics and surgical drainage in 100% of the cases. The surgical procedure used in the evacuation of empyema was craniotomy in all the patients. The mean time elapsed between diagnosis and surgery was 8.4 days. The mean Intensive Care Unit stay was 12.8 days, whereas the overall mean in-hospital stay was 45.2 days. Mortality was 40%. Conclusion. ISE, although infrequent, displays a high morbimortality that can be reduced with an early therapeutic approach which may include the surgical evacuation in all the cases

Importancia de la radiografía de tórax de control tras la canalización venosa central / Importance of checking central venous catheter tip location by X-ray

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Complicaciones de la canalización de una vía venosa central / Complications of the cannulation of a central venous line

Los catéteres venosos centrales son indispensables en la práctica médica actual, especialmente en Unidades de Cuidados Intensivos. Aunque estos catéteres proporcionan un acceso vascular necesario, su uso somete a los pacientes a un riesgo de complicaciones mecánicas e infecciosas. Desgraciadamente estas complicaciones se asocian con un aumento de la morbimortalidad, alargan la estancia hospitalaria y elevan los costes médicos. Para mejorar los resultados clínicos y disminuir los costes sanitarios se deben diseñar estrategias con el objetivo de reducir la incidencia de estas complicaciones

Central venous catheters are essential in modern-day medical practice, particularly in intensive care units. Although such catheters provide necessary vascular access, their use puts patients at risk of mechanical and infectious complications. Unfortunately, these complications are associated with an increase of the morbidity-mortality, lengthen hospitalization and raise medical costs. Strategies should be implemented to reduce the incidence of these complications to improve clinical outcome and reduce health-care costs

[Effect of sociocultural factors on maternal and perinatal morbidity with or without mortality among adolescents seen in 3 states of the Mexican Republic]. / Influencia de los factores socioculturales en la morbilidad y/o mortalidad materna y perinatal de adolescentes atendidas en tres estados de la República Mexicana.

This study was aimed on comparing the degree of association between social-cultural factors and maternal or perinatal morbidity and/or mortality of the adolescent. A paired case-control study was designed with adolescent in puerperal immediate stage affiliated to the Mexican Institute of Social Security from Tabasco, Tlaxcala and Northern Veracruz, that were adjusted to the selection criteria of the sample, between June of 1998 and February of 1999. Two groups were integrated, cases, with adolescent in puerperal immediate stage affected (with maternal or perinatal morbidity and/or mortality) and controls, with adolescent not affected in puerperal immediate stage. Information concerned to biological and social-cultural risk factors from each subject was obtained applying a validated survey (EFRASEMA 1) and checking their clinical file, whose information was poured in a database (EFRASEMA 2). Interviewers did not know the outcome of the study, which in turn assured the blindness of the information. Once data was obtained, subjects were assigned to each group of study. Matching factors were age, nutritional status, intergenesic interval and previous pregnancy systemic pathology. Proportion of subjects, cases and controls; with or without social-cultural risk factors was determined. The risk of maternal or perinatal morbidity and/or mortality in the exposed subjects was estimated by odds ratio (OR) and the differences inferred through Mantel and Haenszel chi 2 and Fisher's exact tests (confidence intervals alpha = 0.05 and beta = 0.2). There was a sample of 486 subject, 44 were eliminated due to insufficient data. Studied population was integrated finally with 221 cases and 221 paired controls 1: 1. 71.950% of participants were married, 22.62% in free union, 4.98% single and 0.45% separate, average global age was 17.98 +/- 1.39 years. The inferential analysis showed an OR 0.64 (Cornfield 95% confidence limits: 0.40 < OR < 1.03, p = 0.0510600) concerning desired pregnancy in favor to controls. Appropriate reproductive information had an OR = 0.34 (Cornfield 95% confidence limits: 0.21 < OR < 0.54 p = 0.0000014). Ideal cumulated fertility offered an OR 0.62 (Cornfield 95% confidence limits: 0.39 < OR < 0.98, p = 0.0298500). These results show an association between the social-cultural factors and the presence of maternal or perinatal morbidity and/or mortality in the studied adolescents. Desired pregnancy, appropriate reproductive information and ideal cumulated fertility are protection factors to maternal or perinatal morbidity and/or mortality.