Fractura de cadera en el anciano e infección por COVID-19. Descripción de 3 casos / Hip fracture in elderly and COVID-19 infection. Report of 3 cases

La pandemia COVID-19 y su diseminación desde la descripción de los primeros casos en China en enero de 2020, ha condicionado la organización sanitaria y la asistencia convencional, tanto en sala de hospitalización como en unidades de cuidados intensivos (UCI), o consultas y actividad quirúrgica. Los pacientes con fractura de cadera, habitualmente ancianos y pluripatológicos, se benefician de una intervención precoz, sin embargo, la cirugía en presencia de infección SARS-CoV-2 activa, parece condicionar una morbimortalidad elevada. Presentamos 3 casos de pacientes ancianos con COVID-19 y fractura de cadera, intervenidos tras 3 semanas de evolución y con presencia de PCR positiva. A pesar de factores pronósticos de gravedad (edad, hipertensión arterial y marcadores de inflamación elevados) el postoperatorio fue el habitual y fueron dados de alta del hospital.(AU)

Since its first description in china in January 2020, COVID-19 pandemia outbreak has affected health organization and conventional care in all settings as wards, intensive care and surgery. Hip fracture patients usually are older and have a lot of comorbidities. This type of patientes benefit from early surgery. However, surgery in COVID-19 patients with active infection is associate with bad outcomes and mortality. We present three patients with COVID infection undergoing hip fracture surgery. Surgery was performed tree weeks after admission. Despite have risk factor (old age, arterial hypertension, elevated inflammatory parameters) the outcome was good and were discharged from hospital without events.(AU)

Hip fracture in elderly and COVID-19 infection. Report of 3 cases. / Fractura de cadera en el anciano e infección por COVID-19. Descripción de 3 casos.

Since its first description in china in January 2020, COVID-19 pandemia outbreak has affected health organization and conventional care in all settings as wards, intensive care and surgery. Hip fracture patients usually are older and have a lot of comorbidities. This type of patientes benefit from early surgery. However, surgery in COVID-19 patients with active infection is associate with bad outcomes and mortality. We present three patients with COVID infection undergoing hip fracture surgery. Surgery was performed tree weeks after admission. Despite have risk factor (old age, arterial hypertension, elevated inflammatory parameters) the outcome was good and were discharged from hospital without events.

[Hip fracture in elderly and COVID-19 infection. Report of 3 cases]. / Fractura de cadera en el anciano e infección por COVID-19. Descripción de 3 casos.

Since its first description in china in January 2020, COVID-19 pandemia outbreak has affected health organization and conventional care in all settings as wards, intensive care and surgery. Hip fracture patients usually are older and have a lot of comorbidities. This type of patientes benefit from early surgery. However, surgery in COVID-19 patients with active infection is associate with bad outcomes and mortality. We present three patients with COVID infection undergoing hip fracture surgery. Surgery was performed tree weeks after admission. Despite have risk factor (old age, arterial hypertension, elevated inflammatory parameters) the outcome was good and were discharged from hospital without events.

Single-lung ventilation with bronchofibroscopy during lung resection surgery. / Oxigenación unilobar con fibroscopio durante cirugía de resección pulmonar.

Lung isolation using one-lung ventilation is common during thoracic surgery procedures, as it allows proper visualisation and manipulation of the lung to be operated on. Selective lobar blockade has been described in patients that do not tolerate one-lung ventilation, and is usually achieved using endobronchial blockers. However, it depends on endobronchial blocker availability, its complexity regarding proper positioning, and the need for constant monitoring to ensure the correct placement of the bronchial seal. In the clinical case to be described, a new method was used to increase the available surface for oxygen exchange. This was accomplished by means of direct supply of oxygen through the bronchoscope's working channel to one of the not-to-be operated-on, non-ventilated lung lobes. With this technique, the surgeon had an optimal operating field, oxygenation from one-lung ventilation improved and no perioperative complications were found.

[Acute abdomen and hyperparathyroidism: a description of a case]. / Abdomen agudo e hiperparatiroidismo: descripción de un caso.

Hypercalcaemia secondary to primary hyperparathyroidism may present with an insidious clinical picture and involve multiple organs, which may lead to a delay in its diagnosis and erroneous therapeutic actions, due to its similarity to other different conditions. We describe the case of a patient who was admitted to our hospital with the diagnosis of acute abdomen. A laparotomy was performed which was negative. The slow post-operative progress and the clinical neurology of the patient was resolved after checking for the presence of a significant hypercalcaemia secondary to a parathyroid lymph node.

[Effect of nebulised iloprost combined with inhaled nitric oxide and oral sildenafil on lung transplant patients. Therapeutic efficacy in pulmonary hypertension during surgery]. / Efecto de iloprost nebulizado combinado con óxido nítrico inhalado y sildenafilo oral en las presiones pulmonares de pacientes sometidos a trasplante pulmonar. Eficacia terapéutica en la hipertensión pulmonar intraoperatoria.

OBJECTIVES: There is a high incidence of pulmonary hypertension during the lung transplant peri-operative period, and could lead to a haemodynamic deterioration that may require the need of extracorporeal circulation. Our aim was to study the haemodynamic effects on the pulmonary and systemic circulation of the combination of inhaled nitric oxide and iloprost and oral sildenafil in patients with severe pulmonary hypertension during lung transplant surgery. PATIENTS AND METHODS: Seventeen patients received 10µg of nebulised iloprost during the peri-operative period of the lung transplant when their mean pulmonary pressure exceeded 50mmHg. AU the patients received 50mg of oral sildenafil 30min before anaesthetic induction, 20ppm of inhaled nitric oxide after tracheal intubation. The haemodynamic and respiratory variables were recorded at baseline (after anaesthetic induction), prior to the administering of iloprost, and at 5 and 30min after it was given. RESULTS: The administering of iloprost significantly reduced the pulmonary arterial pressure and significantly increases the cardiac Índex and the right ventrícular ejection fractíon. There were no signíficant changes occurred in the systemic arterial pressure. CONCLUSIONS: The triple combination significantly reduces the pulmonary pressures in the lung transplant peri-operative and should be considered when there is severe pulmonary hypertension during the surgery or during the immediate post-operative period of lung transplantation.

[Training in the care of the critical and multiple-injured patient: role of clinical simulation]. / Formación en la asistencia al paciente crítico y politraumatizado: papel de la simulación clínica.

Clinical simulation is suggested as a new educational instrument to learn and train in different medical skills. It is conceived as a new method that integrates scientific knowledge and human factors. Experience with these systems has been limited up to now, but it is now being widely accepted since it seems to accelerate acquisition of skills and knowledge in a safe setting, that is, without risk for the patient. However, its effect on clinical performance has not been validated yet. They are two types of simulators for intensive cares: screen based and human patient simulator (HPS). These systems make it possible to simulate different situations that require the application of action protocols or the management of new drugs in the clinical practice, promoting the rational use of resources in urgent care of the critical and multiple-injured patients. The limiting factors that prevent the expansion of the simulation for clinical training are its high cost, human resources needed, and the difficulties to assess the effectiveness of the training in real situations.

[Independent pulmonary ventilation as a treatment in the re-expansion of atelectasis]. / Ventilación pulmonar independiente como tratamiento en la reexpansión de atelectasias.

Two patients with respiratory failure were treated with independent lung ventilation (ILV). During their clinical course they developed atelectasis without response to usual therapies. The use of ILV and selective positive end-expiratory pressure (S-PEEP) allowed lung expansion and oxymetric improvement. With the ILV plus S-PEEP we tried to correct the abnormal ventilation/perfusion ratio. ILV plus S-PEEP increases both the ventilation in the highly perfused areas, and the functional residual capacity selectively in the pathologic lung in unilateral affection cases.