Transarterial Embolization for Adhesive Capsulitis of the Shoulder: Midterm Outcomes on Function and Pain Relief.

PURPOSE: To determine the safety and potential effectiveness of transarterial embolization for adhesive capsulitis of the shoulder. MATERIALS AND METHODS: This prospective study analyzed consecutive adult patients with adhesive capsulitis referred for embolization between January 2018 and May 2023 after a poor response to treatment (symptoms and limitation of motion in ≥2 axes; ≤120° flexion, ≤50° external rotation and/or internal rotation with the shoulder abducted 90°) persisting for >3 months after having completed ≥6 weeks of analgesics and physical therapy. Different types of pain and mobility were measured before embolization and 1, 3, and 6 months after embolization. Overall upper limb function (Quick Disabilities of Arm, Shoulder, and Hand) and patient satisfaction were measured before and 6 months after embolization. Long-term follow-up comprised telephone interviews and clinical history reviews. RESULTS: A total of 20 patients (12 [60%] women; median age, 50.7; interquartile ranges [IQR], 45‒55 years) were included; 6 (30%) had diabetes and 15 (75%) were off work. Median duration of symptoms before embolization was 39.4 weeks (IQR, 28‒49 weeks), and median duration of rehabilitation therapy was 12.8 weeks (IQR, 8‒16 weeks). Six months after embolization, significant improvements were observed in nocturnal pain (P = .003), pain on moving (P = .001), external rotation (P < .001), internal rotation (P < .001), active flexion (P < .001), passive flexion (P = .03), active abduction (P < .001), passive abduction (P < .001), and overall function (P < .001). Despite objective improvements, patient satisfaction was nearly unchanged. Only 1 patient experienced a mild adverse event. CONCLUSION: Transarterial embolization is safe and potentially effective in treating adhesive capsulitis of the shoulder refractory to conventional treatment. Clinical improvements were maintained in the mid to long term.

Evaluation of the last 2 decades in the characteristics of presentation, management and prognosis of serious spontaneous intracerebral hemorrhage in a third level hospital.

OBJECTIVE: To analyze the change in the characteristics of presentation, evolution and treatment in the ICU, as well as the functional evolution at 12 months of spontaneous intracranial hemorrhages (ICHs) treated in an ICU reference center. PATIENT AND METHODS: Descriptive, retrospective study in a Neurocritical Reference Hospital. All admissions of patients with HICE during three periods are studied: 1999-2001 (I), 2015-2016 (II) and 2020-2021 (III). Evolution in the three periods of demographic variables, baseline characteristics of the patients, clinical variables and characteristics of bleeding, evolutionary data in the ICU are studied. At one year we assessed the GOS scale (Glasgow Outcome Score) according to whether they had a poor (GOS 1-3) or good (GOS 4-5) prognosis. RESULTS: 300 admitted patients, distributed in periods: I: 28.7%, II: 36.3% and III: 35%. 56.7% were males aged 66 (55.5-74) years; ICH score 2 (1-3). The ICU stay was 5 (2-14) days with a mortality of 36.8%. GOS 1-3 a year in 67.3% and GOS 4-5 in 32.7%. Comparing the three periods, we observed a higher prevalence in women, and the presence of cardiovascular factors; no changes in etiology; in relation to the location, it increases cerebellar hemorrhage and in the brainstem. Although the severity was greater, the stay in the ICU, the use of invasive mechanical ventilation and tracheostomy were lower. Open surgery has decreased its use by 50%. Mortality continues to be high, stagnating in the ICU at 35% and entails a high degree of disability one year after assessment. CONCLUSIONS: Severe ICH is a complex pathology that has changed some characteristics in the last two decades, with more severe patients, with more cardiovascular history and a greater predominance of brainstem and cerebellar hemorrhage. Despite the increase in severity, better parameters during the ICU stay, with open surgery used 50% less. Mortality remains stagnant at 35% with high disability per year.

Herpes simplex virus type 1 (HSV-1) over-infection in patients with acute respiratory distress syndrome secondary to COVID-19 pneumonia: Impact on mortality.

Objective: Herpes simplex virus type 1 (HSV-1) reactivation have been described in patients with invasive mechanical ventilation and recently in patients with acute respiratory distress syndrome (ARDS) secondary to COVID-19 with higher rates of reactivation than were detected previously in critical care, and although the diagnosis of HSV-1 pneumonia is not easy, its presence is associate with an increase in morbidity and mortality. The objective of this study is to determinate if the identification of HSV-1 in lower airway of patients with ARDS secondary to COVID-19 have influence in clinical outcome and mortality. Method: Two hundred twenty-four admitted patients in intensive care unit (ICU) of Complejo Hospitalario Universitario de Toledo diagnosed of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) were reviewed and were selected those with mechanical ventilation who had undergone (BAL). It was registered all results of HSV-1 PCR (negative and positive). Results: During the study period (November 28, 2020 to April 13, 2021) was admitted 224 patients in ICU diagnosed of SARS-CoV-2 pneumonia. Eighty-three patients of them had undergone BAL, with HSV-1 PCR positive result in 47 (56%), and negative result in 36 (43.4%). We performed pathological anatomy study in BAL samples on 26 of the total BAL realized. Typical cytopathic characteristics of HSV-1 were found in 13 samples (50%) and 11 of them (84.6%) have had HSV-1 PCR positive result. Thirty days mortality was significantly higher in the group of patients with HSV-1 PCR positive result (33.5% vs. 57.4%, p = 0.015). This difference was stronger in the group of patients with HSV-1 findings in the pathological anatomy study (30.8% vs. 69.2%, p = 0.047). Conclusion: Our results suggest that ARDS secondary to SARS-CoV-2 pneumonia is highly associated to HSV-1 reactivation and that the finding of HSV-1 in lower airway is associated with a worst prognostic and with significantly mortality increase. It is necessary to carry out more extensive studies to determinate if treatment with acyclovir can improve the prognosis of these patients.

Objetivo: Las reactivaciones del virus herpes simple (VHS) están descritas en los pacientes en ventilación mecánica invasiva y recientemente en el síndrome de distrés respiratorio agudo (SDRA) por COVID-19, con tasas más altas que las descritas previamente en pacientes críticos, y aunque el diagnóstico de neumonía por VHS es difícil, su presencia se asocia con aumento de la morbimortalidad. El objetivo de este estudio es determinar si la identificación de VHS en el tracto respiratorio inferior en pacientes en ventilación mecánica con SDRA por COVID-19 influye sobre la evolución clínica y la mortalidad. Método: Se revisaron 224 pacientes ingresados en el servicio de medicina intensiva del Complejo Hospitalario de Toledo con el diagnóstico de neumonía por SARS-CoV-2 y se seleccionaron los pacientes en ventilación mecánica a los que se les había realizado lavado broncoalveolar (LBA). Se registraron todos los resultados de la PCR, tanto si fue positiva como si fue negativa para VHS. Resultados: Durante el periodo de estudio (del 28 de noviembre de 2020 hasta el 13 de abril de 2021) ingresaron 224 pacientes en la UCI con el diagnóstico de neumonía por SARS-CoV-2. De ellos, en 83 se realizó lavado broncoalveolar (LBA), siendo la PCR para VHS-1 positiva en 47 y negativa en 36 (56,6%). Realizamos estudio anatomopatológico en muestras de LBA a 26 pacientes del total de la muestra. Se encontraron características citopáticas típicas de infección por herpes en 13 (50%), de los cuales 11 (84,6%) tenían PCR positiva. La mortalidad a los 30 días fue significativamente mayor en el grupo de pacientes con PCR positiva (33,5% vs 57,4%, p = 0,015). Esta diferencia fue aún más marcada en el grupo con hallazgos anatomopatológicos compatibles con neumonía por VHS (30,8% versus 69,2%, p = 0,047). Conclusión: Nuestros resultados sugieren que el SDRA secundario a neumonía por SARS-CoV-2 se asocia a una alta reactivación del VHS y que su hallazgo en el tracto respiratorio inferior se asocia con un peor pronóstico y un aumento significativo de la mortalidad. Son necesarios estudios más amplios para determinar si el tratamiento con aciclovir puede mejorar el pronóstico de estos pacientes.

Sobreinfección respiratoria por virus herpes simple tipo1 en pacientes con SDRA secundario a neumonía grave por COVID-19. Impacto sobre la mortalidad / Herpes simplex virus type 1 (HSV-1) over-infection in patients with acute respiratory distress syndrome secondary to COVID-19 pneumonia: Impact on mortality

Objetivo: Las reactivaciones del virus herpes simple (VHS) están descritas en los pacientes en ventilación mecánica invasiva y recientemente en el síndrome de distrés respiratorio agudo (SDRA) por COVID-19, con tasas más altas que las descritas previamente en pacientes críticos, y aunque el diagnóstico de neumonía por VHS es difícil, su presencia se asocia con aumento de la morbimortalidad. El objetivo de este estudio es determinar si la identificación de VHS en el tracto respiratorio inferior en pacientes en ventilación mecánica con SDRA por COVID-19 influye sobre la evolución clínica y la mortalidad.MétodoSe revisaron 224 pacientes ingresados en el servicio de medicina intensiva del Complejo Hospitalario de Toledo con el diagnóstico de neumonía por SARS-CoV-2 y se seleccionaron los pacientes en ventilación mecánica a los que se les había realizado lavado broncoalveolar (LBA). Se registraron todos los resultados de la PCR, tanto si fue positiva como si fue negativa para VHS.ResultadosDurante el periodo de estudio (del 28 de noviembre de 2020 hasta el 13 de abril de 2021) ingresaron 224 pacientes en la UCI con el diagnóstico de neumonía por SARS-CoV-2. De ellos, en 83 se realizó lavado broncoalveolar (LBA), siendo la PCR para VHS-1 positiva en 47 y negativa en 36 (56,6%). Realizamos estudio anatomopatológico en muestras de LBA a 26 pacientes del total de la muestra. Se encontraron características citopáticas típicas de infección por herpes en 13 (50%), de los cuales 11 (84,6%) tenían PCR positiva. La mortalidad a los 30días fue significativamente mayor en el grupo de pacientes con PCR positiva (33,5% vs 57,4%, p=0,015). Esta diferencia fue aún más marcada en el grupo con hallazgos anatomopatológicos compatibles con neumonía por VHS (30,8% versus 69,2%, p=0,047). (AU)

Objective: Herpes simplex virus type1 (HSV-1) reactivation have been described in patients with invasive mechanical ventilation and recently in patients with acute respiratory distress syndrome (ARDS) secondary to COVID-19 with higher rates of reactivation than were detected previously in critical care, and although the diagnosis of HSV-1 pneumonia is not easy, its presence is associate with an increase in morbidity and mortality. The objective of this study is to determinate if the identification of HSV-1 in lower airway of patients with ARDS secondary to COVID-19 have influence in clinical outcome and mortality.MethodTwo hundred twenty-four admitted patients in intensive care unit (ICU) of Complejo Hospitalario Universitario de Toledo diagnosed of severe acute respiratory syndrome coronavirus2 (SARS-CoV-2) were reviewed and were selected those with mechanical ventilation who had undergone (BAL). It was registered all results of HSV-1 PCR (negative and positive).ResultsDuring the study period (November 28, 2020 to April 13, 2021) was admitted 224 patients in ICU diagnosed of SARS-CoV-2 pneumonia. Eighty-three patients of them had undergone BAL, with HSV-1 PCR positive result in 47 (56%), and negative result in 36 (43.4%). We performed pathological anatomy study in BAL samples on 26 of the total BAL realized. Typical cytopathic characteristics of HSV-1 were found in 13 samples (50%) and 11 of them (84.6%) have had HSV-1 PCR positive result. Thirty days mortality was significantly higher in the group of patients with HSV-1 PCR positive result (33.5% vs. 57.4%, P=.015). This difference was stronger in the group of patients with HSV-1 findings in the pathological anatomy study (30.8% vs. 69.2%, P=.047). (AU)

[Herpes simplex virus type 1 (HSV-1) over-infection in patients with acute respiratory distress syndrome secondary to COVID-19 pneumonia: Impact on mortality]. / Sobreinfección respiratoria por virus herpes simple tipo1 en pacientes con SDRA secundario a neumonía grave por COVID-19. Impacto sobre la mortalidad.

OBJECTIVE: Herpes simplex virus type1 (HSV-1) reactivation have been described in patients with invasive mechanical ventilation and recently in patients with acute respiratory distress syndrome (ARDS) secondary to COVID-19 with higher rates of reactivation than were detected previously in critical care, and although the diagnosis of HSV-1 pneumonia is not easy, its presence is associate with an increase in morbidity and mortality. The objective of this study is to determinate if the identification of HSV-1 in lower airway of patients with ARDS secondary to COVID-19 have influence in clinical outcome and mortality. METHOD: Two hundred twenty-four admitted patients in intensive care unit (ICU) of Complejo Hospitalario Universitario de Toledo diagnosed of severe acute respiratory syndrome coronavirus2 (SARS-CoV-2) were reviewed and were selected those with mechanical ventilation who had undergone (BAL). It was registered all results of HSV-1 PCR (negative and positive). RESULTS: During the study period (November 28, 2020 to April 13, 2021) was admitted 224 patients in ICU diagnosed of SARS-CoV-2 pneumonia. Eighty-three patients of them had undergone BAL, with HSV-1 PCR positive result in 47 (56%), and negative result in 36 (43.4%). We performed pathological anatomy study in BAL samples on 26 of the total BAL realized. Typical cytopathic characteristics of HSV-1 were found in 13 samples (50%) and 11 of them (84.6%) have had HSV-1 PCR positive result. Thirty days mortality was significantly higher in the group of patients with HSV-1 PCR positive result (33.5% vs. 57.4%, P=.015). This difference was stronger in the group of patients with HSV-1 findings in the pathological anatomy study (30.8% vs. 69.2%, P=.047). CONCLUSION: Our results suggest that ARDS secondary to SARS-CoV-2 pneumonia is highly associated to HSV-1 reactivation and that the finding of HSV-1 in lower airway is associated with a worst prognostic and with significantly mortality increase. It is necessary to carry out more extensive studies to determinate if treatment with acyclovir can improve the prognosis of these patients.

Evolución de pacientes con ELA bajo seguimiento neumológico y comparación de dos áreas asistenciales en una provincia española / Evolution under respiratory follow-up of patients with ALS and comparison of two healthcare areas in a Spanish province

Introducción: Describir las características de pacientes con Esclerosis Lateral Amiotrófica (ELA) remitidos para valoración respiratoria, determinando si existen factores diferenciales en el manejo clínico y su evolución en dos áreas asistenciales. Métodos: Análisis retrospectivo (seguimiento de 16 años) de pacientes con ELA atendidos en dos Servicios de Neumología en la misma provincia. Se analizan características demográficas, tipo de ELA, clase de adaptación a la ventilación domiciliaria (VMD), modalidad ventilatoria, uso de asistencia mecánica para la tos e indicación de gastrostomía, comparando supervivencia. El Área Sanitaria de Talavera de la Reina cuenta con acreditación de Unidad de Ventilación Domiciliaria Especializada, siendo de Unidad Básica en el Área de Toledo. Resultados: Se analizaron 97 pacientes (60 en Toledo). La edad media fue de 63,3 años y el 60,8% varones. Inicio espinal en el 55,7% y bulbar 35,1%. Se inició VMD en el 88% de los pacientes, siendo programada en el 80%. Indicación de tos asistida mecánica en un 35,1% y en el 51,5% de los pacientes se realizó gastrostomía. La supervivencia media global fue de 32,3 meses, desde el inicio de la VMD de 26,2 meses y 17,1 meses desde la realización de gastrostomía. Los datos de supervivencia fueron similares comparando ambas áreas asistenciales. Conclusiones: Los pacientes con ELA atendidos en dos áreas asistenciales, con criterios clínicos similares, pero con estrategias diferenciadas según los recursos disponibles, presentaron una supervivencia global similar, así como tras el inicio de la VMD y la realización de gastrostomía y con un resultado equiparable al de centros de referencia.(AU)

Background: We aim to describe the characteristics of patients with Amyotrophic Lateral Sclerosis (ALS) referred for respiratory assessment, and whether there are differential factors in the evolution of patients according to two different healthcare areas. Methods: Retrospective analysis of patients with ALS in two Pulmonology services at the same province in Spain (16-year follow-up). We analysed demographic variables, ALS subtype, Home Mechanical Ventilation (HMV) modality and way of adaptation, use of mechanical assisted cough and gastrostomy indication, comparing survival. In the Health Area of Talavera there is a Specialized Unit of HMV according to accreditation by Spanish Respiratory Society, with a Basic Unit in the Toledo Area. Results: A total of 97 patients were analysed (60 in Toledo). The mean age was 63,3 years and 60,8% were male. The form of onset was spinal: 55,7% and bulbar: 35,1%. HMV was started in 88% of the patients, programmed in 80% of them. The use of mechanical assisted cough reached 35,1% of the patients and up to 51,5% of them underwent gastrostomy. Median survival was 32,3 months, being 26,2 months from the start of HMV and 17,1 months after gastrostomy. When comparing the two areas survival data were similar. Conclusions: Patients with ALS assisted in two healthcare areas at the same province, with similar clinical criteria, but with differentiated strategies according to the available resources, present a similar overall survival, as well as after the start of HMV and the performance of gastrostomy and with a similar outcome compared with reference units.(AU)

Trombectomía mecánica en la tromboembolia pulmonar aguda de riesgo intermedio-alto / Aspiration thrombectomy for acute pulmonary embolism with an intermediate-high risk

Introducción y objetivo:El tratamiento de la tromboembolia pulmonar (TEP) aguda con riesgo de mortalidad intermedio-alto a los 30 días, sigue sin estar bien definido, recomendándose por las últimas guías clínicas de la European Society of Cardiology2019 el tratamiento anticoagulante exclusivamente, reduciendo la indicación de trombectomía mecánica a pacientes de riesgo alto o pacientes con riesgo intermedio-alto con mala evolución hemodinámica. Nuestro objetivo fue comprobar la mejoría ecocardiográfica, respiratoria y hemodinámica en las primeras horas de los pacientes sometidos a trombectomía mecánica con tromboembolia pulmonar de riesgo intermedio-alto.Material y métodos:Se analizó la evolución cardíaca por ecocardiografía (diámetro de ventrículo derecho, TAPSE, Onda S e hipertensión pulmonar), hemodinámica, respiratoria y clínica de los pacientes en las primeras 24 horas tras trombectomía mecánica por aspiración, así como las complicaciones hemorrágicas y mortalidad del procedimiento.Resultados:Se llevaron a cabo 42 trombectomías mecánicas, 16 con inestabilidad hemodinámica (TEP masivo) y 26 estables hemodinámicamente (TEP submasivo). Se obtuvo mejoría (p<0,05) en el diámetro de ventrículo derecho, TAPSE, Onda S y presión arterial oxígeno/fracción inspiratoria de oxígeno (PaFi). Ocho pacientes recibieron tratamiento fibrinolítico, presentando 4 de ellos (50%) complicaciones hemorrágicas. Solo un paciente presentó complicación directa por el procedimiento (rotura arteria pulmonar). Ocho pacientes fallecieron en la fase aguda de la enfermedad.Conclusiones:La trombectomía mecánica por aspiración es una técnica segura y efectiva, observando una mejoría de la situación respiratoria, hemodinámica y ecocardiográfica de los pacientes en las primeras 24 horas postprocedimiento con baja tasa de complicaciones frente al tratamiento fibrinolítico. (AU)

Introduction and purpose:The treatment of acute pulmonary embolism (PE) with an intermediate-high risk of mortality at 30 days is still not well defined, recommending the latest clinical guidelines of the European Society of Cardiology 2019 exclusively anticoagulant treatment, reducing the indication for mechanical thrombectomy to high-risk patients or intermediate-high risk patients with poor hemodynamic evolution. Our purpose is to determine the safety and efficacy of aspiration thrombectomy in intermediate-high risk patients with PE and to analyze possible differences in these results between hemodynamically unstable patients (massive PE) and hemodynamically stable patients (submassive PE).Methods:We analyzed all patients who underwent aspiration thrombectomy for PE at our tertiary university hospital during a 34-month period. We compared echocardiographic parameters (right ventricular diameter, tricuspid plane annular plane systolic excursion (TAPSE), S′ wave, and pulmonary hypertension), respiratory parameters (PaO2/FiO2 ratio), and clinical parameters recorded before and 24h after the procedure. We also analyzed bleeding complications and mortality.Results:In the 42 patients included (16 with massive PE and 26 with submassive PE), aspiration thrombectomy resulted in significant improvements in right ventricular diameter, TAPSE, S′ wave, andPaO2/FiO2 ratio. Of the 8 patients administered fibrinolysis, 4 developed bleeding complications. Only one direct complication of the procedure was observed (pulmonary artery rupture). Eight patients died in the acute phase.Conclusions:Aspiration thrombectomy for PE is safe and effective, significantly improving respiratory and hemodynamic parameters in the first 24h after the procedure with a low rate of complications compared to fibrinolysis. (AU)

Chronic critical illness in polytrauma. Results of the Spanish trauma in ICU registry.

PURPOSE: Chronic critical illness after trauma injury has not been fully evaluated, and there is little evidence in this regard. We aim to describe the prevalence and risk factors of chronic critical illness (CCI) in trauma patients admitted to the intensive care unit. MATERIAL AND METHODS: Retrospective observational multicenter study (Spanish Registry of Trauma in ICU (RETRAUCI)). Period March 2015 to December 2019. Trauma patients admitted to the ICU, who survived the first 48 h, were included. Chronic critical illness (CCI) was considered as the need for mechanical ventilation for a period greater than 14 days and/or placement of a tracheostomy. The main outcomes measures were prevalence and risk factors of CCI after trauma. RESULTS: 1290/9213 (14%) patients developed CCI. These patients were older (51.2 ± 19.4 vs 49 ± 18.9); p < .01) and predominantly male (79.9%). They presented a higher proportion of infectious complications (81.3% vs 12.7%; p < .01) and multiple organ dysfunction syndrome (MODS) (27.02% vs 5.19%; p < .01). CCI patients required longer stays in the ICU and had higher ICU and overall in-hospital mortality. Age, injury severity score, head injury, infectious complications, and development of MODS were independent predictors of CCI. CONCLUSION: CCI in trauma is a prevalent entity in our series. Early identification could facilitate specific interventions to change the trajectory of this process.

[Post-covid syndrome after icu admission. Parameters related to a better physical recovery after 4 months.] / Síndrome pos-COVID tras ingreso en UCI. Parámetros relacionados con una mejor recuperación física a los 4 meses.

OBJECTIVE: Post-COVID syndrome can impact against every sphere of daily live. The objective of this work was to detect the factors correlated with a better or worse physical recovery four months after hospital discharge from a hospitalization in ICU due to COVID-19. METHODS: Prospective descriptive study of 125 patients valued by the Rehabilitation Service during hospitalization in ICU, from March 12th to December 31st, 2020. Data from 76 patients was analysed with clinical follow up after 1, 2 and 4 months of hospital discharge. Variables on personal, hospitalary, functional symptoms/signals and physical recovery were analysed with mean ± standard deviation, counting (percentage), T-student test and Fisher test. RESULTS: After one month, fatigue was observed in 60 (80%) patients and dyspnoea in 47 (62%). After two months, fatigue in 37 (55%), dyspnoea in 25 (33%), shoulder pain in 33 (43%), average QuickDASH was 22.7 (11.3-50), Sit-to-Stand Test in 30 seconds 11.5 (10-13) and 6-minute walk test 390 meters (326-445). In the fourth month, 25 (53%) had returned to work and had an average of the physical recovery of 79.1%±18.3%. There was no correlation between physical recovery ≥75% and the first month data, but there certainly was a correlation between some second month variables, such as fatigue (p=0.001), dyspnoea (p=0.035), QuickDASH (p=0.001) and 6-minute walk test (p=0.021). CONCLUSIONS: Symptoms (fatigue and dyspnoea) and functional scales (QuickDASH and 6-minute walk test) after 2 months predict a better/worsen physical recovery after 4 months of hospital discharge.

OBJETIVO: El síndrome pos-COVID puede impactar en todas las esferas de la vida diaria. El objetivo de este trabajo fue detectar qué factores se relacionan con una mejor/peor recuperación física a los 4 meses del alta hospitalaria tras ingreso en UCI por la COVID-19. METODOS: Estudio prospectivo de una cohorte de 125 pacientes valorados por Rehabilitación durante su ingreso en UCI, del 12 marzo al 31 diciembre del 2020. Las variables personales, hospitalarias, síntomas/signos funcionales y de recuperación física de los 76 pacientes que continuaron seguimiento al mes, 2 y 4 meses del alta hospitalaria fueron analizadas mediante media ± desviación estándar, contaje (porcentaje), test t-student y test de Fisher. RESULTADOS: En el primer mes, aquejaban fatiga 60 (80%) pacientes y disnea 47 (62%). En el segundo mes referían fatiga 37 (55%), disnea 25 (33%), dolor de hombro 33 (43%), la media de QuickDASH fue 22,7 (11,3-50), de sit to stand test en 30 segundos 11,5 (10-13) y de test 6 minutos marcha 390 metros (326-445). En el cuarto mes, se habían reincorporado laboralmente 25 (53%) y la media de recuperación física fue 79,1%±18,3%. No hay relación entre una recuperación física ≥75% y variables del primer mes, pero sí con variables del segundo mes, como la fatiga (p=0,001), disnea (p=0,035), QuickDASH (p=0,001) y Test 6 minutos marcha (p=0,021). CONCLUSIONES: Los síntomas (fatiga y disnea) y el QuickDASH y test 6 minutos marcha a los 2 meses predicen una mejor/peor recuperación física a los 4 meses tras el alta hospitalaria.

Síndrome pos-COVID tras ingreso en UCI. Parámetros relacionados con una mejor recuperación física a los 4 meses / Post-COVID syndrome after ICU admission. Parameters related to a better physical recovery after 4 months

Fundamentos: El síndrome pos-COVID puede impactar en todas las esferas de la vida diaria. El objetivo de este trabajo fue detectar qué factores se relacionan con una mejor/peor recuperación física a los 4 meses del alta hospitalaria tras ingreso en UCI por la COVID-19. Métodos: Estudio prospectivo de una cohorte de 125 pacientes valorados por Rehabilitación durante su ingreso en UCI, del 12 marzo al 31 diciembre del 2020. Las variables personales, hospitalarias, síntomas/signos funcionales y de recuperación física de los 76 pacientes que continuaron seguimiento al mes, 2 y 4 meses del alta hospitalaria fueron analizadas mediante media ± desviación estándar, contaje (porcentaje), test t-student y test de Fisher. Resultados: En el primer mes, aquejaban fatiga 60 (80%) pacientes y disnea 47 (62%). En el segundo mes referían fatiga 37 (55%), disnea 25 (33%), dolor de hombro 33 (43%), la media de QuickDASH fue 22,7 (11,3-50), de sit to stand test en 30 segundos 11,5 (10-13) y de test 6 minutos marcha 390 metros (326-445). En el cuarto mes, se habían reincorporado laboralmente 25 (53%) y la media de recuperación física fue 79,1%±18,3%. No hay relación entre una recuperación física ≥75% y variables del primer mes, pero sí con variables del segundo mes, como la fatiga (p=0,001), disnea (p=0,035), QuickDASH (p=0,001) y Test 6 minutos marcha (p=0,021). Conclusiones: Los síntomas (fatiga y disnea) y el QuickDASH y test 6 minutos marcha a los 2 meses predicen una mejor/peor recuperación física a los 4 meses tras el alta hospitalaria.(AU)

Background: Post-COVID syndrome can impact against every sphere of daily live. The objective of this work was to detect the factors correlated with a better or worse physical recovery four months after hospital discharge from a hospitalization in ICU due to COVID-19. Methods: Prospective descriptive study of 125 patients valued by the Rehabilitation Service during hospitalization in ICU, from March 12th to December 31st, 2020. Data from 76 patients was analysed with clinical follow up after 1, 2 and 4 months of hospital discharge. Variables on personal, hospitalary, functional symptoms/signals and physical recovery were analysed with mean ± standard deviation, counting (percentage), T-student test and Fisher test. Results: After one month, fatigue was observed in 60 (80%) patients and dyspnoea in 47 (62%). After two months, fatigue in 37 (55%), dyspnoea in 25 (33%), shoulder pain in 33 (43%), average QuickDASH was 22.7 (11.3-50), Sit-to-Stand Test in 30 seconds 11.5 (10-13) and 6-minute walk test 390 meters (326-445). In the fourth month, 25 (53%) had returned to work and had an average of the physical recovery of 79.1%±18.3%. There was no correlation between physical recovery ≥75% and the first month data, but there certainly was a correlation between some second month variables, such as fatigue (p=0.001), dyspnoea (p=0.035), QuickDASH (p=0.001) and 6-minute walk test (p=0.021). Conclusions: Symptoms (fatigue and dyspnoea) and functional scales (QuickDASH and 6-minute walk test) after 2 months predict a better/worsen physical recovery after 4 months of hospital discharge.(AU)

[Aspiration thrombectomy for acute pulmonary embolism with an intermediate-high risk]. / Trombectomía mecánica en la tromboembolia pulmonar aguda de riesgo intermedio-alto.

INTRODUCTION AND PURPOSE: The treatment of acute pulmonary embolism (PE) with an intermediate-high risk of mortality at 30 days is still not well defined, recommending the latest clinical guidelines of the European Society of Cardiology 2019 exclusively anticoagulant treatment, reducing the indication for mechanical thrombectomy to high-risk patients or intermediate-high risk patients with poor hemodynamic evolution. Our purpose is to determine the safety and efficacy of aspiration thrombectomy in intermediate-high risk patients with PE and to analyze possible differences in these results between hemodynamically unstable patients (massive PE) and hemodynamically stable patients (submassive PE). METHODS: We analyzed all patients who underwent aspiration thrombectomy for PE at our tertiary university hospital during a 34-month period. We compared echocardiographic parameters (right ventricular diameter, tricuspid plane annular plane systolic excursion (TAPSE), S' wave, and pulmonary hypertension), respiratory parameters (PaO2/FiO2 ratio), and clinical parameters recorded before and 24h after the procedure. We also analyzed bleeding complications and mortality. RESULTS: In the 42 patients included (16 with massive PE and 26 with submassive PE), aspiration thrombectomy resulted in significant improvements in right ventricular diameter, TAPSE, S' wave, andPaO2/FiO2 ratio. Of the 8 patients administered fibrinolysis, 4 developed bleeding complications. Only one direct complication of the procedure was observed (pulmonary artery rupture). Eight patients died in the acute phase. CONCLUSIONS: Aspiration thrombectomy for PE is safe and effective, significantly improving respiratory and hemodynamic parameters in the first 24h after the procedure with a low rate of complications compared to fibrinolysis.

Machine learning techniques for mortality prediction in critical traumatic patients: anatomic and physiologic variables from the RETRAUCI study.

BACKGROUND: Interest in models for calculating the risk of death in traumatic patients admitted to ICUs remains high. These models use variables derived from the deviation of physiological parameters and/or the severity of anatomical lesions with respect to the affected body areas. Our objective is to create different predictive models of the mortality of critically traumatic patients using machine learning techniques. METHODS: We used 9625 records from the RETRAUCI database (National Trauma Registry of 52 Spanish ICUs in the period of 2015-2019). Hospital mortality was 12.6%. Data on demographic variables, affected anatomical areas and physiological repercussions were used. The Weka Platform was used, along with a ten-fold cross-validation for the construction of nine supervised algorithms: logistic regression binary (LR), neural network (NN), sequential minimal optimization (SMO), classification rules (JRip), classification trees (CT), Bayesian networks (BN), adaptive boosting (ADABOOST), bootstrap aggregating (BAGGING) and random forest (RFOREST). The performance of the models was evaluated by accuracy, specificity, precision, recall, F-measure, and AUC. RESULTS: In all algorithms, the most important factors are those associated with traumatic brain injury (TBI) and organic failures. The LR finds thorax and limb injuries as independent protective factors of mortality. The CT generates 24 decision rules and uses those related to TBI as the first variables (range 2.0-81.6%). The JRip detects the eight rules with the highest risk of mortality (65.0-94.1%). The NN model uses a hidden layer of ten nodes, which requires 200 weights for its interpretation. The BN find the relationships between the different factors that identify different patient profiles. Models with the ensemble methodology (ADABOOST, BAGGING and RandomForest) do not have greater performance. All models obtain high values ​​in accuracy, specificity, and AUC, but obtain lower values ​​in recall. The greatest precision is achieved by the SMO model, and the BN obtains the best recall, F-measure, and AUC. CONCLUSION: Machine learning techniques are useful for creating mortality classification models in critically traumatic patients. With clinical interpretation, the algorithms establish different patient profiles according to the relationship between the variables used, determine groups of patients with different evolutions, and alert clinicians to the presence of rules that indicate the greatest severity.

Respuesta: Transmisión nosocomial comparada de los virus gripales / Reply: Comparative nosocomial transmission of influenza viruses

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Gripe A nosocomial. Prevalencia y factores clínicos asociados en un hospital de tercer nivel / Influenza A virus infections. Prevalence and associated clinical factors in a tertiary hospital

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Neuromonitorización en el traumatismo craneoencefálico grave. Datos del Registro español de Trauma en UCI (RETRAUCI) / Neuromonitoring in the severe traumatic brain injury. Spanish Trauma ICU Registry (RETRAUCI)

OBJETIVOS: Analizar el empleo de la monitorización de la presión intracraneal (PIC) y la oxigenación cerebral en los pacientes con traumatismo craneoencefálico (TCE) grave de acuerdo con los datos del Registro español de Trauma en las Unidades de Cuidados Intensivos (RETRAUCI). MÉTODOS: Se incluyó a los pacientes con TCE y una puntuación en la escala de coma de Glasgow ≤ 8 puntos. El contraste de hipótesis se realizó con el test de la t de Student o de Wilcoxon (variables cuantitativas) y el test de la chi al cuadrado (variables categóricas). Se realizó un análisis multivariante mediante regresión logística para analizar las variables asociadas al empleo de monitorización de la PIC. RESULTADOS: Se analizó a 1.463 pacientes. Edad 49,1 años, hombres 1.130 (77,3%). Mecanismo lesional: caídas accidentales 350 casos (23,9%). Injury Severity Score 27,9. Un 39,3% presentó midriasis uni o bilateral en la recogida. Cirugía craneal < 24 h 331 pacientes (22,7%). La PIC se monitorizó en 635 pacientes (45,1%), la presión tisular de oxígeno en 122 pacientes (8,6%), la saturación yugular de oxígeno en 19 pacientes (1,34%) y se empleó el espectroscopia del infrarrojo cercano en 25 casos (1,77%). Tras el análisis multivariante, la edad, la midriasis bilateral al ingreso y la toma previa antiagregantes o anticoagulantes se asociaron negativamente a la probabilidad de monitorización de la PIC. La gravedad lesional y la necesidad de neurocirugía urgente aumentaron la probabilidad de monitorización. CONCLUSIONES: Nuestro trabajo muestra una foto fija de la monitorización de la PIC en el TCE grave en nuestro medio. El empleo de técnicas de oximetría cerebral en nuestro país es muy limitado

OBJECTIVES: To analyze the use of intracranial pressure (ICP) and cerebral oximetry monitoring in patients with severe traumatic brain injury (TBI) according to the Spanish Trauma ICU Registry (RETRAUCI). METHODS: We included TBI patients with Glasgow Coma Scale score ≤ 8. Hypotheses were tested using the Student-T or Wilcoxon tests (quantitative variables) and the Chi-square test (categorical variables). Multivariate analysis using logistic regression was performed to analyze the variables associated with the use of ICP monitoring. RESULTS: We analyzed 1463 patients. Age 49.1 years. Males 1130 (77.3%). Mechanism of injury: falls in 350 cases (23.9%). Injury Severity Score 27.9. Uni- or bilateral mydriasis was present in 39.3% of the patients. Neurosurgical intervention within 24 hours was performed in 331 patients (22.7%). ICP was monitored in 635 patients (45.1%), pbtO2 in 122 patients (8.6%), SjVO2 in 19 patients (1.34%) and NIRS was used in 25 cases (1.77%). In the multivariate analysis, age, bilateral mydriasis at admission and previous use of antiplatelets or anticoagulants was inversely related with ICP monitoring. Severity of injury and the need of neurosurgical intervention increased the probability of ICP monitoring. CONCLUSIONS: Our study shows a picture of ICP monitoring in severe TBI patients in our environment. Use of cerebral oximetry techniques is very limited