Assuntos
Influenza Humana/epidemiologia , Transtornos Mentais/epidemiologia , Estresse Psicológico/epidemiologia , Comorbidade , Suscetibilidade a Doenças , Feminino , Humanos , Influenza Humana/psicologia , Masculino , Obesidade/epidemiologia , Gravidez , Complicações Infecciosas na Gravidez/epidemiologia , Fatores de Risco , Populações VulneráveisRESUMO
PURPOSE: To determine whether macrolide-based treatment is associated with mortality in critically ill H1N1 patients with primary viral pneumonia. METHODS: Secondary analysis of a prospective, observational, multicenter study conducted across 148 Intensive Care Units (ICU) in Spain. RESULTS: Primary viral pneumonia was present in 733 ICU patients with pandemic influenza A (H1N1) virus infection with severe respiratory failure. Macrolide-based treatment was administered to 190 (25.9 %) patients. Patients who received macrolides had chronic obstructive pulmonary disease more often, lower severity on admission (APACHE II score on ICU admission (13.1 ± 6.8 vs. 14.4 ± 7.4 points, p < 0.05), and multiple organ dysfunction syndrome less often (23.4 vs. 30.1 %, p < 0.05). Length of ICU stay in survivors was not significantly different in patients who received macrolides compared to patients who did not (10 (IQR 4-20) vs. 10 (IQR 5-20), p = 0.9). ICU mortality was 24.1 % (n = 177). Patients with macrolide-based treatment had lower ICU mortality in the univariate analysis (19.2 vs. 28.1 %, p = 0.02); however, a propensity score analysis showed no effect of macrolide-based treatment on ICU mortality (OR = 0.87; 95 % CI 0.55-1.37, p = 0.5). Moreover, the sensitivity analysis revealed very similar results (OR = 0.91; 95 % CI 0.58-1.44, p = 0.7). A separate analysis of patients under mechanical ventilation yielded similar results (OR = 0.77; 95 % CI 0.44-1.35, p = 0.4). CONCLUSION: Our results suggest that macrolide-based treatment was not associated with improved survival in critically ill H1N1 patients with primary viral pneumonia.
Assuntos
Mortalidade Hospitalar , Influenza Humana/tratamento farmacológico , Macrolídeos/uso terapêutico , Pneumonia Viral/tratamento farmacológico , APACHE , Adulto , Coinfecção , Comorbidade , Feminino , Humanos , Vírus da Influenza A Subtipo H1N1 , Influenza Humana/mortalidade , Influenza Humana/terapia , Unidades de Terapia Intensiva/estatística & dados numéricos , Tempo de Internação , Masculino , Pessoa de Meia-Idade , Estudos Multicêntricos como Assunto , Pneumonia Viral/mortalidade , Pneumonia Viral/terapia , Pontuação de Propensão , Estudos Prospectivos , Insuficiência Respiratória/tratamento farmacológico , Insuficiência Respiratória/etiologia , Insuficiência Respiratória/mortalidade , Espanha/epidemiologia , Resultado do TratamentoRESUMO
The number of patients who need coronary artery surgery growth every year. Most of these surgical operations are with extracorporeal circulation (ECC). Recently in our hospital this surgery is realized without ECC in selected patients. Some studies shows that this surgery is an alternative in the treatment of coronary artery disease, especially for aged patients with associated disease and in Jehovah's witness faith. A coronary artery diameter at the anastomotic site of 2 mm or greater and satisfactory hemodynamics with the cardiac manipulation are needed to realize this surgery. Given these limitations this technique has proved useful in selected patients requiring revascularization of the left anterior descending, circumflex or right coronary artery (not for grafting the posterior descending branch). The need of mechanical ventilation, days at ICU, blood required, morbidity and mortality, in our experience as in other studies, were fewer than surgery with CEC.
