Valor pronóstico de los biomarcadores procalcitonina, interleukina 6 y proteína C reactiva en la sepsis grave / Prognostic value of the biomarkers procalcitonin, interleukin-6 and C-reactive protein in severe sepsis

Objetivo: Comprobar el valor pronóstico de los biomarcadores procalcitonina, interleukina 6 y proteína C reactiva en pacientes sépticos graves Diseño: Cohorte de 81 pacientes críticos Ambito: Unidad de Críticos Hospital Dr. Peset. Valencia. Pacientes: Divididos según el grado de sepsis (sepsis, sepsis severa, shock séptico), foco de sepsis y grupo (pacientes médicos y posquirúrgicos de alto riesgo). Variables analizadas: Cuantitativas (procalcitonina, interleukina-6, proteína C reactiva, lactato, edad, Apache II y SOFA) al ingreso, 3.er y 7.o día de evolución. Cualitativas (mortalidad intra UCI, desarrollo Fallo Multiorgánico y sexo). Estadística: comparación variables cuantitativas con test U de Mann-Whitney; las cualitativas con test de χ2; análisis multivariante variables dependientes mortalidad y fallo multiorgánico e independientes las cuantitativas descritas; curvas ROC de las variables significativas en el multivariante Resultados: Pacientes con shock séptico fallecieron más y desarrollaron más fallo multiorgánico. Comparación entre vivos y fallecidos, mostró diferencias significativas Apache II, interleukina-6 y lactato (p <0,001) al ingreso, 3.er y 7.o día. Entre pacientes con fallo multiorgánico y sin él, también y los mismos días. La procalcitonina mostró diferencias solo en 3.er y 7.o día (p=0,001). Análisis multivariante con variable dependiente mortalidad la interleukina-6 mostró significación al 3.er día (O.R. 2,6). Con variable dependiente fallo multiorgánico solo SOFA tuvo significación (O.R. 2,3). Curva ROC Apache II e interleukina-6 3.er día mostró área 0,80 y 0,86 respectivamente. Conclusiones: 1) La interleukina-6 es un biomarcador inflamatorio con valor pronóstico de mortalidad; 2) Ningún biomarcador tuvo valor predictivo de fallo multiorgánico (AU)

Aim: To determine the prognostic value of the biomarkers procalcitonin, interlukin-6 and C-reactive protein in septic patients. Design: A cohort of 81 septic patients. Setting: Critical Care Unit. Dr. Peset Hospital. Valencia (Spain). Patients: Divided according to sepsis classification (sepsis, severe sepsis and septic shock), source and two different groups (medical and postsurgical). Variables analyzed: Quantitative (procalcitonin, interleukin-6, C-reactive protein, lactate, age, Apache II and SOFA scores upon admission and after 3 and 7 days). Qualitative (ICU mortality, multiorgan failure development and sex). Statistical analysis: Mann-Whitney U-test for the comparison of quantitative variables, X2 test for qualitative variables. Multivariate analysis with mortality and multiorgan failure as dependent variables and the described quantitative parameters as independent variables. ROC curves of the variables found to be significant in the multivariate analysis. Results: Septic shock patients showed greater mortality and more frequent multiorgan failure. Comparison of survivors versus deceased patients showed significant differences in Apache II score, interleukin-6 and lactate (p<0.001) upon admission and after 3 and 7 days. Similar findings applied to the comparison of patients with and without multiorgan failure, and on the same days. Procalcitonin only showed differences on days 3 and 7 (p=0.001). In the multivariate analysis with mortality as dependent variable, interleukin-6 proved significant on day 3 (OR 2.6). With multiorgan failure as dependent variable, only the SOFA score showed significance (OR 2.3). The Apache II and interleukin-6 ROC curves corresponding to day 3 showed areas of 0.80 and 0.86, respectively. Conclusions: 1) Interleukin-6 is an inflammatory biomarker with mortality prognostic value. 2) None of the biomarkers proved predictive of multiorgan failure (AU)

Prognostic value of the biomarkers procalcitonin, interleukin-6 and C-reactive protein in severe sepsis.

AIM: To determine the prognostic value of the biomarkers procalcitonin, interlukin-6 and C-reactive protein in septic patients. DESIGN: A cohort of 81 septic patients. SETTING: Critical Care Unit. Dr. Peset Hospital. Valencia (Spain). PATIENTS: Divided according to sepsis classification (sepsis, severe sepsis and septic shock), source and two different groups (medical and postsurgical). VARIABLES ANALYZED: Quantitative (procalcitonin, interleukin-6, C-reactive protein, lactate, age, Apache II and SOFA scores upon admission and after 3 and 7 days). Qualitative (ICU mortality, multiorgan failure development and sex). STATISTICAL ANALYSIS: Mann-Whitney U-test for the comparison of quantitative variables, χ² test for qualitative variables. Multivariate analysis with mortality and multiorgan failure as dependent variables and the described quantitative parameters as independent variables. ROC curves of the variables found to be significant in the multivariate analysis. RESULTS: Septic shock patients showed greater mortality and more frequent multiorgan failure. Comparison of survivors versus deceased patients showed significant differences in Apache II score, interleukin-6 and lactate (p<0.001) upon admission and after 3 and 7 days. Similar findings applied to the comparison of patients with and without multiorgan failure, and on the same days. Procalcitonin only showed differences on days 3 and 7 (p=0.001). In the multivariate analysis with mortality as dependent variable, interleukin-6 proved significant on day 3 (OR 2.6). With multiorgan failure as dependent variable, only the SOFA score showed significance (OR 2.3). The Apache II and interleukin-6 ROC curves corresponding to day 3 showed areas of 0.80 and 0.86, respectively. CONCLUSIONS: 1) Interleukin-6 is an inflammatory biomarker with mortality prognostic value. 2) None of the biomarkers proved predictive of multiorgan failure.

[New recommendations for uniform reporting of advanced life support]. / Nuevas recomendaciones para el registro uniforme de datos en la reanimación cardiopulmonar avanzada. Estilo Utstein pediátrico.

Pediatric patients requiring cardiopulmonary resuscitation show high morbidity and mortality. There are few studies on this topic and existing studies use distinct terminology and methodology in data collection, hampering comparisons, efficiency assessment, and meta-analyses, etc. Consequently, in clinical studies of cardiorespiratory arrest (CRA) and cardiopulmonary resuscitation (CPR) in the pediatric age group, data collection should be performed in a uniform manner. To define the criteria that allow uniform data collection, in 2004 a working group of the International Liaison Committee on Resuscitation published simplified recommendations for registering essential information, which could be applicable to adults and children both in clinical practice and research, as well as inside and outside the hospital setting. Following the Utstein style, the Spanish Group of Pediatric and Neonatal CPR has designed an algorithm and a data collection form for recording essential CPA data. The need for these documents to be designed with maximum accuracy is stressed, both because of their medico-legal and professional implications and because of the influence of some variables on post-CPA recovery. Likewise, while protecting patient confidentiality, provincial, regional and national CPA registries should be developed, which would improve the quality of care, research, and resource provision according to needs.

Nuevas recomendaciones para el registro uniforme de datos en la reanimación cardiopulmonar avanzada. Estilo Utstein pediátrico / New recommendations for uniform reporting of advanced life support. The pediatric Utstein style

Los pacientes pediátricos que requieren maniobras de reanimación cardiopulmonar presentan una elevada mortalidad y morbilidad. Existen pocos estudios y muchos de ellos utilizan distinta terminología y metodología en la recogida de datos, lo que dificulta la comparación, la valoración de la eficacia, la realización de metaanálisis, etc. Por ello, es necesario que en los estudios sobre la parada cardiorrespiratoria (PCR) y la reanimación cardiopulmonar (RCP) en los niños se realice la recogida de datos de forma uniforme. A fin de unificar criterios que permitan esta recogida de datos un grupo de trabajo del ILCOR ha publicado en 2004 unas recomendaciones simplificadas, con el propósito de registrar datos esenciales, que sean aplicables en adultos y niños tanto en la asistencia como en la investigación, dentro y fuera del hospital. Siguiendo el estilo Utstein, el Grupo Español de RCP Pediátrica y Neonatal ha diseñado un algoritmo y una plantilla para la recogida y registro de datos esenciales en la PCR. Se recalca la necesidad de que la confección de los documentos se realice con la máxima exactitud, tanto por las implicaciones médico-legales y profesionales que conlleva una RCP, como por la gran influencia en la recuperación tras una PCR que muestran algunas variables. Así mismo, y protegiendo la confidencialidad de cada paciente, se debería progresar en la confección de registros de PCR a nivel provincial, autonómico y nacional, lo que permitiría una mayor calidad en la asistencia, en la investigación y en la provisión de recursos acorde con las necesidades

Pediatric patients requiring cardiopulmonary resuscitation show high morbidity and mortality. There are few studies on this topic and existing studies use distinct terminology and methodology in data collection, hampering comparisons, efficiency assessment, and meta-analyses, etc. Consequently, in clinical studies of cardiorespiratory arrest (CRA) and cardiopulmonary resuscitation (CPR) in the pediatric age group, data collection should be performed in a uniform manner. To define the criteria that allow unform data collection, in 2004 a working group of the International Liaison Committee on Resuscitation published simplified recommendations for registering essential information, which could be applicable to adults and children both in clinical practice and research, as well as inside and outside the hospital setting. Following the Utstein style, the Spanish Group of Pediatric and Neonatal CPR has designed an algorithm and a data collection form for recording essential CPA data. The need for these documents to be designed with maximum accuracy is stressed, both because of their medico-legal and professional implications and because of the influence of some variables on post-CPA recovery. Likewise, while protecting patient confidentiality, provincial, regional and national CPA registries should be developed, which would improve the quality of care, research, and resource provision according to needs

Papel de la neuroprotección / Role of neuroprotection

Se lleva a cabo un análisis de los trastornos fisiopatológicos cerebrales secundarios a una parada cardiorrespiratoria. Se evalúan los marcadores pronósticos como pueden ser los marcadores clínicos, electrofisiológicos, ultrasonidos, neuroimagen, metabólicos y anatomopatológicos. Se detallan los procedimientos introducidos para mejorar el soporte vital avanzado, los fármacos estudiados con efecto neuroprotector y la neuroprotección física. Se concluye que dentro de la neuroprotección física, la reperfusión hipotérmica puede ser la de mayor utilidad frente al riesgo de secuelas neurológicas graves (AU)

La desfibrilación temprana: conclusiones y recomendaciones del I Foro de Expertos en Desfibrilación Semiautomática / Early defibrillation: conclusions and recommendations of the First Expert Forum in Semiautomatic Defibrillation

No disponible

[Guidelines for uniform reporting of data from out-of-hospital and in-hospital cardiac arrest and resuscitation in the pediatric population: the pediatria utstein-style]. / Recomendaciones para el registro uniforme de datos en la reanimación cardiopulmonar avanzada pediátrica: estilo Utstein pediátrico.

Children who require cardiopulmonary resuscitation present high mortality and morbidity. The few studies that have been published on this subject use different terminology and methodology in data collection, which makes comparisons, evaluation of efficacy, and the performance of meta-analyses, etc. difficult. Consequently, standardized data collection both in clinical studies on cardiorespiratory arrest and in cardiopulmonary resuscitation in the pediatric age group are required. The Spanish Group of Pediatric Cardiopulmonary Resuscitation emphasizes that recommendations must be simple and easy to understand. The first step in the elaboration of guidelines on data collection is to develop uniform definitions (glossary of terms). The second step comprises the so-called time intervals that include time periods between two events. To describe the intervals of cardiorespiratory arrest different clocks are used: the patient's watch, that of the ambulance, the interval between call and response, etc.Thirdly, a series of clinical results are gathered to determine whether the efforts of cardiopulmonary resuscitation have a positive effect on the patient, the patient's family and society. With the information gathered a registry of data that includes the patient's personal details, general data of the cardiopulmonary resuscitation, treatment, times of performance and definitive patient outcome is made.

Edema pulmonar no cardiogénico postextubación / Postextubation non-cardiogenic pulmonary edema

El edema pulmonar no cardiogénico por obstrucción de la vía aérea superior, aunque descrito inicialmente en niños, se presenta en adultos excepcionalmente y se han descrito casos esporádicos. Aunque el cuadro clínico generalmente es benigno y se resuelve normalmente en menos de 36 h desde su instauración, algunos casos desarrollan insuficiencia respiratoria grave de más larga evolución. Presentamos el caso de un paciente que desarrolló edema pulmonar no cardiogénico tras laringoespasmo postextubación, de características graves, y analizamos los posibles mecanismos patogénicos (AU)

Recomendaciones para el registro uniforme de datos en la reanimación cardiopulmonar avanzada pediátrica: estilo Utstein pediátrico / Guidelines for uniform reporting of data from out-of-hospital and in-hospital cardiac arrest and resuscitation in the pediatric population: the pediatria utstein-style

Los niños que requieren maniobras de resucitación presentan una elevada mortalidad y morbilidad. Existen pocos estudios sobre esta materia, y los que hay, utilizan distinta terminología y metodología en la recogida de datos, lo que dificulta la comparación, la valoración de la eficacia, la realización de metaanálisis, etc. Por ello, es necesario que en los estudios clínicos sobre la parada cardiorrespiratoria (PCR) y la reanimación cardiopulmonar (RCP) en la edad pediátrica, se realice la recogida de datos de forma uniforme. El Grupo Español de Reanimación Cardiopulmonar Pediátrica y Neonatal insiste en que las recomendaciones deben ser sencillas, fáciles de entender. El primer escalón para elaborar unas recomendaciones de recogida de datos es el desarrollo de unas definiciones uniformes (glosario de términos). El segundo escalón, engloba los denominados intervalos de tiempo, e incluye los períodos de tiempo entre dos sucesos. Para describir los intervalos de la PCR se emplean diferentes relojes: el reloj del paciente, de la ambulancia, intervalo de llamada-respuesta, etc. En tercer lugar se recogen una serie de resultados clínicos, necesarios para mostrar si los esfuerzos de la RCP tienen un beneficio positivo para el paciente, su familia y la sociedad. Con todo ello se realiza una hoja de registro de datos, que incluye filiación del paciente, datos generales de la PCR, tratamiento, tiempos de actuación y resultado definitivo del paciente (AU)

[Study of early response to cases of acute myocardial infarction in primary care]. / Estudio de la atención inicial a pacientes con infarto aguto de miocardio en atención primaria.

OBJECTIVE: To discover the present role of Primary Care (PC) in the early response to Acute Myocardial Infarction (AMI) in a health area, defining the diagnostic and therapeutic measures employed and whether these cause delay in thrombolytic treatment. DESIGN: Prospective, observational study of cohorts. SETTING: Casualty departments at the primary and hospital levels. PATIENTS: All AMI patients admitted to the only Intensive Therapy Unit (ITU) in a health area over a three-month period (No. = 28). MEASUREMENTS AND MAIN RESULTS: The patients were divided into two groups, defined by whether they had attended PC or hospital. The time elapsed before ITU admission, and the diagnostic methods and treatments in PC were investigated. Nine patients (32%) attended PC and 19 (67%), hospital. The average delay was 6.7 hours. The percentage of patients who were admitted to the ITU before four hours had elapsed was higher for those who had previously attended PC (p < 0.05; Chi squared, Yates correction). In PC neither ECG, nor anti-aggregants nor analgesics were used in any of the cases. Nitrites were used on 4 patients (44%). CONCLUSIONS: Patients with AMI preferred to go directly to hospital. Initial care in PC did not necessarily lead to any delay in the thrombolysis: indeed it led to a higher percentage of admissions during the first four hours. There was insufficient use of diagnostic procedures and drugs in the initial stage of AMI in PC.

[The role of glucose-1-phosphate in total parenteral nutrition protocols]. / Aporte de glucosa-1-fosfato en nutrición parenteral total protocolizada.

The results of a clinical study to evaluate the use of glucose-1-phosphate for phosphate supplementation to a group of 8 surgical patients receiving standardized total parenteral nutrition are presented. Average phosphate (p + 0.001), calcium (NS) and magnesium (NS) plasma concentrations increased during total parenteral nutrition. Positive average daily balances were obtained: 8.1 + 14.8, 4.5 + 4.3 and 1.8 + 3.3 mmol/day for phosphate, calcium and magnesium respectively. These findings support the hypothesis of higher bioavailability of glucose-1-phosphate with respect to inorganic phosphate. On the other hand, hyperphosphatemia was a frequent situation (45.8%); this fact suggests the need for reviewing phosphate daily requirements when supplied in the form of glucose-1-phosphate.