Serum selenium and glutathione peroxidase-3 activity: biomarkers of systemic inflammation in the critically ill?

OBJECTIVES: To confirm the influence of systemic inflammatory response syndrome (SIRS) on selenium (Se) levels and prospectively evaluate the relationship between serum Se concentration [Se], glutathione peroxidase activity [GPx-3] and injury severity in patients at the time of intensive care unit (ICU) admission. DESIGN: Prospective, observational study. SETTING: Multidisciplinary University Hospital ICU. PATIENTS AND PARTICIPANTS: A total of 36 ICU patients and 23 healthy volunteer subjects (HVS). MEASUREMENTS AND RESULTS: Healthy volunteer subjects were designated as controls (Group 1). ICU patients were divided into three groups: without SIRS (Group 2); with SIRS (Group 3); with SIRS and multiple organ dysfunction syndrome (MODS) (Group 4). The latter groups had APACHE II scores >15. [GPx-3] and [Se] were determined by standard methods within the first 48 h of admission to ICU. Kruskal-Wallis and Mann-Whitney U test were used for analysis of non-parametric continuous variables. The predictive value of [Se] and [GPx-3] for SIRS was calculated using a receiver operating characteristics (ROC) analysis. In SIRS and MODS patients [GPx-3] and [Se] decreased significantly (P = 0.0001 and P = 0.002, respectively). After ICU admission [GPx-3] and [Se] had a predictive value for SIRS ([GPx-3] sensitivity: 90%, specificity: 86.2% (cut-off value: 0.5 U/mL); [Se]: sensitivity 90%, specificity 72.4% (cut-off value: 60 microg/L). [Se] had predictive value for ICU mortality (P = 0.034). CONCLUSIONS: Systemic inflammatory response syndrome and MODS were associated with early decreases in [Se] and [GPx-3]. Low [Se] and [GPx-3] after ICU admission had a predictive value for SIRS, which may aid future selection of patients who could benefit from Se supplementation.

Desnutrición asociada a enfermedad en los pacientes quirúrgicos del Hospital de Clínicas. Montevidéo - Uruguay / Disease-associated malnutrition in surgical patients at the Hospital de Clinicas. Montevideo - Uruguay / Doença associada à desnutrição em pacientes cirúrgicos no Hospital de Clínicas. Montevideo - Uruguai

Introdución: La desnutrición asociada a enfermedad (DAE) es frecuente en los pacientes hospitalizados. Casuística y métodos: Se determinó mediante Evaluación Global Subjetiva (EGS) la prevalencia de la DAE en los pacientes quirúrgicos del Hospital de Clínicas (Montevideo - uruguay); e se evaluó la relación entre DAE, tiempo de hospitalizacion y patología. Resultados: Fueron incluidos 104 pacientes: Neoplasia Digestiva (ND) y patología nefrourológica no neoplásica 9,6%; Neoplasia No Digestiva (NND) 20%; Patologia vascular 17%; Postoperatorio 11,5%; infecciones y miscelánea: 32,3%. por EGS, se agrupan en las categorías: A:42,3%, B, C y D:19,2% cada una. Existe 38,4% de DAE (B+D) y 19,2% de pacientes con riesgo de desnutrición (C). En el grupo ND la DAE es 88% y en el grupo NND: 65%. Estadía promedio en días: categoria A: 19; D: 39 (kruskall-Wallis= 8,6684; P= 0,03) . Conclusion: estos resultados indican la necesidad de implementar políticas de soporte nutricional especial en el hospital universitário del Uruguay.

Introduction: Malnutrition-associated disease (DAE) is common in hospitalized patients. Casuistry and Methods: We determined by Subjective Global Assessment (EGS) the prevalence of AEDs in patients Surgical Hospital (Montevideo - Uruguay), and evaluated the relationship between DAE, length of hospital and pathology. Results: 104 patients were included: Gastrointestinal Neoplasia (ND) and non-neoplastic disease nephrourologic 9.6% Digestive neoplasm (NNH) 20% 17% vascular Pathology; Postoperative 11.5% and miscellaneous infections: 32.3% . by EGS, are grouped into categories: A: 42.3%, B, C and D: 19.2% each. There is 38.4% of DAE (B + D) and 19.2% of patients at risk of malnutrition (C). In group ND DAE is 88% and in group NNH: 65%. Average stay in days: category A: 19, D: 39 (Kruskal-Wallis = 8.6684, P = 0.03). Conclusion: These results indicate the need to implement special policies for nutritional support in the university hospital in Uruguay.

Nuevas estrategias ventilatorias en el síndrome de distrés respiratorio agudo: maniobra de reclutamiento alveolar / New ventilatory strategies in acute respiratory distress syndrome: alveolar recruitment strategies

Con el objetivo de evaluar los efectos inmediatos de la maniobra de reclutamiento, se estudiaron ocho pacientes con síndrome de distrés respiratorio agudo (SDRA) (PaO2/FIO2 de 88,7ñ34,6) temprano (menos de 72 horas) y de etiología diversa (cinco intrapulmonar y tres extrapulmonar) pre y post reclutamiento. La maniobra de reclutamiento se realizó con ventilación controlada por presión (PCV) + PEEP. Se midieron variables gasométricas, hemodinámicas y de la mecánica respiratoria: sin PEEP (TO), con PEEP (71), postreclutamiento inmediato (T2), y a los 30 minutos (T3). Se observó un incremento significativo de la PaO2: 88,6ñ35; 256ñ105; 374+107; y 305ñ137* mmHg (TO, Tl, T2 y T3 respectivamente, p<0,05). Postreclutamiento inmediato se observó, además, un aumento del volumen corriente (VC) de 0,42ñ0,09 a 0,55ñ010* L (Tl y T2 respectivamente, p<0,05). Concluimos que la maniobra de reclutamiento alveolar resulta útil para mejorar el intercambio pulmonar de gases en el SDRA temprano. A partir de estos datos se realiza un análisis de los fundamentos, indicaciones y técnicas de realización de la maniobra