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1.
Acta otorrinolaringol. esp ; 71(6): 386-392, nov.-dic. 2020. tab
Artigo em Espanhol | IBECS | ID: ibc-188375

RESUMO

La alta incidencia de insuficiencia respiratoria aguda en el contexto de la pandemia por COVID-19 ha conllevado el uso de ventilación mecánica hasta en un 15%. Dado que la traqueotomía es un procedimiento quirúrgico frecuente, este documento de consenso, elaborado por tres Sociedades Científicas, la SEMICYUC, la SEDAR y la SEORL-CCC, tiene como objetivo ofrecer una revisión de las indicaciones y contraindicaciones de traqueotomía, ya sea por punción o abierta, esclarecer las posibles ventajas y exponer las condiciones ideales en que deben realizarse y los pasos que considerar en su ejecución. Se abordan situaciones regladas y urgentes, así como los cuidados posoperatorios


The current COVID-19 pandemic has rendered up to 15% of patients under mechanical ventilation. Because the subsequent tracheotomy is a frequent procedure,the three societies mostly involved (SEMICYUC, SEDAR and SEORL-CCC) have setup a consensus paper that offers an overview about indications and contraindications of tracheotomy, be it by puncture or open, clarifying its respective advantages and enumerating the ideal conditions under which they should be performed, as well as the necessary steps. Regular and emergency situations are displayed together with the postoperative measures


Assuntos
Humanos , Sociedades Médicas , Traqueotomia/métodos , Traqueotomia/normas , Infecções por Coronavirus/cirurgia , Pneumonia Viral/cirurgia , Betacoronavirus , Pandemias , Insuficiência Respiratória/cirurgia , Insuficiência Respiratória/virologia , Respiração Artificial/métodos
2.
Med. intensiva (Madr., Ed. impr.) ; 44(8): 493-499, nov. 2020. tab
Artigo em Espanhol | IBECS | ID: ibc-188212

RESUMO

La alta incidencia de insuficiencia respiratoria aguda en el contexto de la pandemia por COVID-19 ha conllevado el uso de ventilación mecánica hasta en un 15%. Dado que la traqueotomía es un procedimiento quirúrgico frecuente, este documento de consenso, elaborado por tres Sociedades Científicas, la SEMICYUC, la SEDAR y la SEORL-CCC, tiene como objetivo ofrecer una revisión de las indicaciones y contraindicaciones de traqueotomía, ya sea por punción o abierta, esclarecer las posibles ventajas y exponer las condiciones ideales en que deben realizarse y los pasos que considerar en su ejecución. Se abordan situaciones regladas y urgentes, así como los cuidados posoperatorios


The current COVID-19 pandemic has rendered up to 15% of patients under mechanical ventilation. Because the subsequent tracheotomy is a frequent procedure,the three societies mostly involved (SEMICYUC, SEDAR and SEORL-CCC) have setup a consensus paper that offers an overview about indications and contraindications of tracheotomy, be it by puncture or open, clarifying its respective advantages and enumerating the ideal conditions under which they should be performed, as well as the necessary steps. Regularand emergency situations are displayed together with the postoperative measures


Assuntos
Humanos , Consenso , Sociedades Médicas/normas , Traqueotomia/normas , Infecções por Coronavirus/complicações , Insuficiência Respiratória/epidemiologia , Traqueotomia/métodos , Traqueotomia/efeitos adversos , Cuidados Pós-Operatórios , Respiração Artificial/métodos , Contraindicações de Procedimentos , Espanha/epidemiologia
3.
Med. intensiva (Madr., Ed. impr.) ; 44(6): 371-388, ago.-sept. 2020.
Artigo em Espanhol | IBECS | ID: ibc-187189

RESUMO

El 11 de marzo de 2020 el director general de la Organización Mundial de la Salud (OMS) declaró la enfermedad causada por el SARS-CoV-2 (COVID-19) como una pandemia. La propagación y evolución de la pandemia está poniendo a prueba los sistemas sanitarios de decenas de países y ha dado lugar a una miríada de artículos de opinión, planes de contingencia, series de casos e incipientes ensayos. Abarcar toda esta literatura es complejo. De forma breve y sintética, en la línea de las anteriores recomendaciones de los Grupos de Trabajo, la Sociedad Española de Medicina Intensiva, Crítica y Unidades Coronarias (SEMICYUC) ha elaborado esta serie de recomendaciones básicas para la asistencia a pacientes en el contexto de la pandemia


On March 11, 2020, the Director-General of the World Health Organization (WHO) declared the disease caused by SARS-CoV-2 (COVID-19) as a pandemic. The spread and evolution of the pandemic is overwhelming the healthcare systems of dozens of countries and has led to a myriad of opinion papers, contingency plans, case series and emerging trials. Covering all this literature is complex. Briefly and synthetically, in line with the previous recommendations of the Working Groups, the Spanish Society of Intensive, Critical Medicine and Coronary Units (SEMICYUC) has prepared this series of basic recommendations for patient care in the context of the pandemic


Assuntos
Humanos , Infecções por Coronavirus/epidemiologia , Betacoronavirus , Pneumonia Viral , Pessoal de Saúde/normas , Transferência de Pacientes/normas , Cuidados Críticos/normas , Espanha/epidemiologia , Guias de Prática Clínica como Assunto , Sociedades Médicas/normas , Segurança do Paciente , Pandemias , Cuidados Críticos/organização & administração
6.
Acta Otorrinolaringol Esp ; 71(6): 386-392, 2020.
Artigo em Espanhol | MEDLINE | ID: mdl-32513456

RESUMO

The current COVID-19 pandemic has rendered up to 15% of patients under mechanical ventilation. Because the subsequent tracheotomy is a frequent procedure, the three societies mostly involved (SEMICYUC, SEDAR and SEORL-CCC) have setup a consensus paper that offers an overview about indications and contraindications of tracheotomy, be it by puncture or open, clarifying its respective advantages and enumerating the ideal conditions under which they should be performed, as well as the necessary steps. Regular and emergency situations are displayed together with the postoperative measures.


Assuntos
Betacoronavirus , Consenso , Infecções por Coronavirus/epidemiologia , Pneumonia Viral/epidemiologia , Sociedades Médicas , Traqueostomia/normas , Anestesiologia , Broncoscopia/efeitos adversos , Broncoscopia/normas , Contraindicações de Procedimentos , Unidades de Cuidados Coronarianos , Procedimentos Cirúrgicos Eletivos/normas , Emergências , Humanos , Unidades de Terapia Intensiva , Otolaringologia , Procedimentos Cirúrgicos Otorrinolaringológicos , Pandemias , Cuidados Pós-Operatórios/métodos , Cuidados Pós-Operatórios/normas , Respiração Artificial/normas , Ressuscitação , Espanha , Fatores de Tempo , Traqueostomia/efeitos adversos , Traqueostomia/métodos
7.
Crit Care ; 24(1): 60, 2020 Feb 22.
Artigo em Inglês | MEDLINE | ID: mdl-32087761

RESUMO

BACKGROUND: The knowledge of new prognostic factors in out-of-hospital cardiac arrest (OHCA) that can be evaluated since the beginning of cardiopulmonary resuscitation (CPR) manoeuvres could be helpful in the decision-making process of prehospital care. We aim to identify metabolic variables at the start of advanced CPR at the scene that may be associated with two main outcomes of CPR (recovery of spontaneous circulation (ROSC) and neurological outcome). METHODS: Prospective observational study of all non-traumatic OHCA in patients older than 17 years assisted by emergency medical services (EMS), with doctor and nurse on board, between January 2012 and December 2017. Venous blood gases were sampled upon initially obtaining venous access to determine the initial values of pH, pCO2, HCO3-, base excess (BE), Na+, K+, Ca2+ and lactate. ROSC upon arrival at the hospital and neurological status 30 days later (Cerebral Performance Categories (CPC) scale) were recorded. RESULTS: We included 1552 patients with OHCA with blood test data in a 6-year period. ROSC was achieved in 906 cases (58.4%), and good neurological recovery at 30 days (CPC I-II) occurred in 383 cases (24.68%). In multivariate analysis, we found a significant relationship between non-recovery of spontaneous circulation (no-ROSC) and low pH levels (adjusted odds ratio (OR) 0.03 (0.002-0.59), p = 0.020), high pCO2 levels (adjusted OR 1.03 [1.01-1.05], p = 0.008) and high potassium levels (adjusted OR 2.28 [1.43-3.61], p = 0.008). Poor neurological outcomes were associated with low pH levels (adjusted OR 0.06 [0.02-0.18], p < 0.001), high pCO2 (adjusted OR 1.05 [1.03-1.08], p < 0.001), low HCO3- (adjusted OR 0.97 [0.94-0.999], p = 0.044), low BE (adjusted OR 0.96 [0.93-0.98], p < 0.001) and high potassium levels (adjusted OR 1.37 [1.16-1.60], p < 0.001). CONCLUSION: There is a significant relationship between severe alterations of venous blood-gas variables and potassium at the start of CPR of non-traumatic OHCA and low-ROSC rate and neurological prognosis.


Assuntos
Gasometria , Reanimação Cardiopulmonar , Serviços Médicos de Emergência , Parada Cardíaca Extra-Hospitalar , Idoso , Idoso de 80 Anos ou mais , Testes Hematológicos , Humanos , Pessoa de Meia-Idade , Razão de Chances , Parada Cardíaca Extra-Hospitalar/diagnóstico , Parada Cardíaca Extra-Hospitalar/terapia , Prognóstico , Estudos Prospectivos
9.
Infection ; 45(1): 115-117, 2017 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-27670678

RESUMO

INTRODUCTION: Ceftolozane/tazobactam is a novel antibiotic approved for the treatment of complicated intra-abdominal and complicated urinary tract infections. CASE DESCRIPTION: We describe the use of off-label ceftolozane/tazobactam in the management of a multidrug-resistant Pseudomonas aeruginosa bacteremia that was already being treated with colistin and amikacin, the only active antibiotics according to the antibiogram.


Assuntos
Antibacterianos/uso terapêutico , Bacteriemia , Cefalosporinas/uso terapêutico , Ácido Penicilânico/análogos & derivados , Infecções por Pseudomonas , Pseudomonas aeruginosa/efeitos dos fármacos , Antibacterianos/farmacologia , Bacteriemia/tratamento farmacológico , Bacteriemia/epidemiologia , Bacteriemia/microbiologia , Cefalosporinas/farmacologia , Farmacorresistência Bacteriana Múltipla , Humanos , Masculino , Testes de Sensibilidade Microbiana , Pessoa de Meia-Idade , Uso Off-Label , Ácido Penicilânico/farmacologia , Ácido Penicilânico/uso terapêutico , Infecções por Pseudomonas/tratamento farmacológico , Infecções por Pseudomonas/epidemiologia , Infecções por Pseudomonas/microbiologia , Tazobactam
10.
J Crit Care ; 30(3): 654.e1-7, 2015 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-25656920

RESUMO

PURPOSE: The prognosis of a patient who deteriorates during a prolonged intensive care unit (ICU) stay is difficult to predict. We analyze the prognostic value of the serialized Sequential Organ Failure Assessment (SOFA) score and other variables in the early days after a complication and to build a new predictive score. MATERIALS AND METHODS: EPIPUSE (Evolución y pronóstico de los pacientes con ingreso prolongado en UCI que sufren un empeoramiento, Evolution and prognosis of long intensive care unit stay patients suffering a deterioration) study is a prospective, observational study during a 3-month recruitment period in 75 Spanish ICUs. We focused on patients admitted in the ICU for 7 days or more with complications of adverse events that involve organ dysfunction impairment. Demographics, clinical variables, and serialized SOFA after a supervening clinical deterioration were recorded. Univariate and multivariate analyses were performed, and a predictive model was created with the most discriminating variables. RESULTS: We included 589 patients who experienced 777 cases of severe complication or adverse event. The entire sample was randomly divided into 2 subsamples, one for development purposes (528 cases) and the other for validation (249 cases). The predictive model maximizing specificity is calculated by minimum SOFA + 2 * cardiovascular risk factors + 2 * history of any oncologic disease or immunosuppressive treatment + 3 * dependence for basic activities of daily living. The area under the receiver operating characteristic curve is 0.82. A 14-point cutoff has a positive predictive value of 100% (92.7%-100%) and negative predictive value of 51% (46.4%-55.5%) for death. CONCLUSIONS: EPIPUSE model can predict mortality with a specificity and positive predictive value of 99% in some groups of patients.


Assuntos
Estado Terminal/mortalidade , Unidades de Terapia Intensiva , Insuficiência de Múltiplos Órgãos/mortalidade , Escores de Disfunção Orgânica , Atividades Cotidianas , Idoso , Doenças Cardiovasculares/epidemiologia , Técnicas de Apoio para a Decisão , Progressão da Doença , Feminino , Humanos , Imunossupressores/uso terapêutico , Tempo de Internação , Masculino , Pessoa de Meia-Idade , Neoplasias/epidemiologia , Prognóstico , Estudos Prospectivos , Curva ROC , Reprodutibilidade dos Testes , Medição de Risco , Fatores de Risco , Espanha , Suspensão de Tratamento
11.
Crit Care ; 18(1): 114, 2014 Feb 27.
Artigo em Inglês | MEDLINE | ID: mdl-24602204

RESUMO

In recent decades, numerous studies have compared survival according to gender of patients admitted to general hospitals and particularly to intensive care units. In a previous issue of Critical Care, Schoeneberg and colleagues presented the results of a German observational study on a sample from a 10 year registry in a Level 1 trauma center. The conclusion is that there is a trend towards a higher mortality in women than in men.


Assuntos
Ferimentos e Lesões/mortalidade , Feminino , Humanos , Masculino
12.
Cir Esp ; 83(6): 320-4, 2008 Jun.
Artigo em Espanhol | MEDLINE | ID: mdl-18570848

RESUMO

OBJECTIVE: To define the epidemiological and injury profile of patients severely injured due to all-terrain vehicle accidents admitted to the Trauma ICU of a tertiary hospital. METHODS: Descriptive observational study including all patients admitted to our ICU who suffered an all-terrain vehicle accident in the last three years, included prospectively in our data base. We recorded demographic variables, clinical condition at admission, outcome, injury pattern, severity scores and survival probability by TRISS. RESULTS: Between 2004 and 2006 twelve patients who suffered an all-terrain vehicle accident were admitted. All of them were male and had a median age of 28.5 years (18-37.75). The median ISS was 25 points (17-27). Cranium and brain (AIS region 1) were present in 75% of the patients, face (AIS 2) in 41.6%, upper limbs (AIS 7) in 33%, thorax (AIS 4) in 25%, spine (AIS 6) and lower limbs (AIS 8) in 16.7% and there were no injures in AIS region 3 (neck) and 5 (abdomen-pelvis). Mortality at ICU and at day 28 was 16.7% and hospital mortality was 25%. Median ICU stay was 8 days (1.75-17) and median hospital stay was 21.5 days (8.25-27). ICU stay was shorter in patients without traumatic brain injury (1 [1-1.5] vs 12 [5-23]; p < 0.05). CONCLUSIONS: All-terrain vehicle use is a growing source of high morbidity and mortality accidents. Injury patterns associated to these accidents are described. Traumatic brain injuries are common and have a poorer prognosis. New epidemiological and clinical studies are needed for a better knowledge of the problem.


Assuntos
Acidentes/estatística & dados numéricos , Veículos Off-Road , Ferimentos e Lesões/epidemiologia , Adolescente , Adulto , Humanos , Escala de Gravidade do Ferimento , Masculino
13.
Cir. Esp. (Ed. impr.) ; 83(6): 320-324, jun. 2008. tab
Artigo em Espanhol | IBECS | ID: ibc-66223

RESUMO

Objetivos. Definir el perfil epidemiológico y lesional de los pacientes graves atendidos por accidente de quad en la UCI de traumatología de un hospital terciario de referencia. Métodos. Estudio observacional descriptivo que incluye a todos los pacientes ingresados por accidente de quad en los últimos 3 años, recogidos prospectivamente en la base de datos de nuestra UCI de traumatología. Se registraron variables relativas a datos demográficos, situación al ingreso, evolución, lesiones por regiones corporales, índices de gravedad y probabilidad de supervivencia por TRISS. Resultados. Entre 2004 y 2006 se recibió a 12 pacientes accidentados por quad, todos varones, con una mediana de edad de 28,5 (18-37,75) años. La mediana del ISS fue de 25 (17-27) puntos. En cuanto a las lesiones, el 75% de los pacientes presentaron lesiones craneales y encefálicas (región AIS 1); el 41,6%, faciales (AIS 2); el 33%, en las extremidades superiores (AIS 7); el 25%, torácicas (AIS 4); el 16,7%, raquimedulares (AIS 6) y en extremidades inferiores (AIS 8), y ninguno cervicales y abdominales (AIS 3 y 5). La mortalidad en UCI y a los 28 días alcanzó el 16,7%, y la mortalidad hospitalaria fue del 25%. La mediana de la estancia en UCI fue 8 (1,75-17) días y la estancia hospitalaria fue de 21,5 (8,25-27) días. La estancia en UCI fue menor en los pacientes sin traumatismo craneoencefálico (TCE) que en los pacientes con TCE (1 [1-1,5] frente a 12 [5-23]; p < 0,05). Conclusiones. El uso de quad es una fuente de accidentes con alta morbimortalidad y está en aumento. Se describen los patrones lesionales relaciona-dos con estos accidentes. El TCE es frecuente y empeora el pronóstico. Se necesitan nuevos estudios epidemiológicos y clínicos para definir mejor el problema The increased use of biomaterials for the repair of abdominal wall hernias has achieved a significant reduction in recurrences and consequently improved the quality of life of patients. However, the appearance of complications such as infection may require the implanted prosthetic material to be removed in a considerable number of patients. A possible treatment option in areas compromised by infection is the implant a biocompatible prosthetic material to generate, or induce the formation of a support tissue so that, in a second stage, the definitive repair of the parietal defect may be undertaken. This is the main goal of bioprostheses. These implants are composed of collagen of animal (usually porcine) or human origin. They should be acellular and fully biocompatible so that they induce a minimal foreign body reaction and immune response (AU)


Objective. To define the epidemiological and injury profile of patients severely injured due to all-terrain vehicle accidents admitted to the Trauma ICU of a tertiary hospital. Methods. Descriptive observational study including all patients admitted to our ICU who suffered an all-terrain vehicle accident in the last three years, included prospectively in our data base. We recorded demographic variables, clinical condition at admission, outcome, injury pattern, severity scores and survival probability by TRISS. Results. Between 2004 and 2006 twelve patients who suffered an all-terrain vehicle accident were admitted. All of them were male and had a median age of 28.5 years (18-37.75). The median ISS was 25 points (17-27). Cranium and brain (AIS region 1) were present in 75% of the patients, face (AIS 2) in 41.6%, upper limbs (AIS 7) in 33%, thorax (AIS 4) in 25%, spine (AIS 6) and lower limbs (AIS 8) in 16.7% and there were no injures in AIS region 3 (neck) and 5 (abdomen-pelvis). Mortality at ICU and at day 28 was 16.7% and hospital mortality was 25%. Median ICU stay was 8 days (1.75-17) and median hospital stay was 21.5 days (8.25-27). ICU stay was shorter in patients without traumatic brain injury (1 [1-1.5] vs 12 [5-23]; p < 0.05). Conclusions. All-terrain vehicle use is a growing source of high morbidity and mortality accidents. Injury patterns associated to these accidents are described. Traumatic brain injuries are common and have a poorer prognosis. New epidemiological and clinical studies are needed for a better knowledge of the problem The increased use of biomaterials for the repair of abdominal wall hernias has achieved a significant reduction in recurrences and consequently improved the quality of life of patients. However, the appearance of complications such as infection may require the implanted prosthetic material to be removed in a considerable number of patients. A possible treatment option in areas compromised by infection is the implant a biocompatible prosthetic material to generate, or induce the formation of a support tissue so that, in a second stage, the definitive repair of the parietal defect may be undertaken. This is the main goal of bioprostheses. These implants are composed of collagen of animal (usually porcine) or human origin. They should be acellular and fully biocompatible so that they induce a minimal foreign body reaction and immune response (AU)


Assuntos
Humanos , Masculino , Adulto , Idoso , Veículos Off-Road , Ferimentos e Lesões/epidemiologia , Perfil de Saúde , Escala de Gravidade do Ferimento , Sobrevivência , Escala de Coma de Glasgow , Hospitais Universitários , Espanha
14.
Rev Esp Cardiol ; 61(5): 534-9, 2008 May.
Artigo em Espanhol | MEDLINE | ID: mdl-18462658

RESUMO

The development of postoperative ventricular dysfunction immediately after heart transplantation is a serious complication that leads to low-output syndrome and which necessitates circulatory support. It is one of the most common causes of early morbidity and mortality. We present our experience with 6 heart transplant patients who were treated with intravenous levosimendan, a calcium sensitizer with inodilator properties, after regular hemodynamic therapy with sympathomimetic amines failed to result in a satisfactory hemodynamic status. Use of this drug was well tolerated and brought about hemodynamic improvements that were sufficient to enable patients to be weaned from inotropic support with amines and which led to clinical recovery, with 5 of the 6 patients being discharged from the intensive care unit.


Assuntos
Transplante de Coração/efeitos adversos , Hidrazonas/uso terapêutico , Piridazinas/uso terapêutico , Vasodilatadores/uso terapêutico , Disfunção Ventricular/tratamento farmacológico , Adulto , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Estudos Prospectivos , Simendana , Disfunção Ventricular/etiologia
15.
Rev. esp. cardiol. (Ed. impr.) ; 61(5): 534-539, mayo 2008. mapas
Artigo em Espanhol | IBECS | ID: ibc-123741

RESUMO

La disfunción ventricular del injerto en el postoperatorio inmediato del paciente trasplantado cardiaco es una complicación grave, que cursa con un síndrome de bajo gasto cardiaco y necesidad de soporte circulatorio, y es una de las causas más frecuentes de morbimortalidad inicial. Presentamos la experiencia clínica con 6 pacientes trasplantados en los que, tras un manejo hemodinámico habitual con aminas simpaticomiméticas, no se consiguió una adecuada situación hemodinámica y se utilizó levosimendán intravenoso, un fármaco sensibilizador al calcio con propiedades inodilatadoras. El uso de este fármaco fue bien tolerado y favoreció una mejoría hemodinámica que facilitó la retirada del soporte inotrópico con aminas y la recuperación clínica (con alta de UCI de 5 de los 6 pacientes) (AU)


The development of postoperative ventricular dysfunction immediately after heart transplantation is a serious complication that leads to low-output syndrome and which necessitates circulatory support. It is one of the most common causes of early morbidity and mortality. We present our experience with 6 heart transplant patients who were treated with intravenous levosimendan, a calcium sensitizer with inodilator properties, after regular hemodynamic therapy with sympathomimetic amines failed to result in a satisfactory hemodynamic status. Use of this drug was well tolerated and brought about hemodynamic improvements that were sufficient to enable patients to be weaned from inotropic support with amines and which led to clinical recovery, with 5 of the 6 patients being discharged from the intensive care unit (AU)


Assuntos
Humanos , Transplante de Coração , Baixo Débito Cardíaco/tratamento farmacológico , Cardiotônicos/farmacocinética , Disfunção Ventricular/tratamento farmacológico , Complicações Pós-Operatórias/prevenção & controle , Hemodinâmica
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