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4.
Clin Nutr ; 2019 Jun 08.
Artigo em Inglês | MEDLINE | ID: mdl-31255348

RESUMO

Myo-neuropathy of the critically ill patient is a difficult nosological entity to understand and manage. It appears soon after injury, and it is estimated that 20-30% of patients admitted to Intensive Care Units will develop it in some degree. Although muscular and nervous involvement are related, the former has a better prognosis. Myo-neuropathy associates to more morbidity, longer stay in Intensive Care Unit and in hospital, and also to higher costs and mortality. It is considered part of the main determinants of the new entities: the Chronic Critical Patient and the Post Intensive Care Syndrome. This update focuses on aetiology, pathophysiology, diagnosis and strategies that can prevent, alleviate and/or improve muscle (or muscle-nerve) weakness.

5.
Nutr Hosp ; 36(Spec No2): 12-17, 2019 Jul 01.
Artigo em Espanhol | MEDLINE | ID: mdl-31189318

RESUMO

Introduction: Polyneuropathy in the critically ill patient was defined as a generalized weakness, acquired during Intensive Care Unit (ICU) admittance and attributed to lesion of the peripheral nerve. Research in this field progressed over time, revealing the crucial role of muscle injury in this disease, to the point of re-naming the disorder as ICU adquired weakness (ICUAW). Muscle damage is common in severe illness, and may be classified in qualitative (weakness) or quantitative (decrease in mass) muscle loss. The most frequent scenario in these patients, is simultaneous change in quality and quantity of muscle; resulting in a challenging and delayed recovery during hospital admittance and after discharge. Multiple causes have been identified in the pathogenesis of this disorder, such as: prolonged bed rest, inadequate intake of nutrients and exposure to drugs that affect muscle structure and contraction. The assessment of muscle mass using images provided by ultrasound or computerized tomography may guide follow up. The prevention and treatment of ICUAW requires a multimodal approach: early mobilization and exercise, appropriate nutritional prescription and, occasionally, muscle protein synthesis stimulants. Further studies will clarify more aspects regarding critically ill patients suffering from muscle injury, in order to better address prevention and treatment of ICUAW.


Assuntos
Estado Terminal , Debilidade Muscular/patologia , Músculo Esquelético/patologia , Cuidados Críticos , Força Muscular , Debilidade Muscular/metabolismo , Músculo Esquelético/metabolismo , Polineuropatias/complicações , Polineuropatias/metabolismo , Polineuropatias/patologia
6.
Med. clín (Ed. impr.) ; 152(1): 13-16, ene. 2019. graf, tab
Artigo em Espanhol | IBECS | ID: ibc-181667

RESUMO

Antecedentes y objetivo: Tras la publicación de la nueva definición de sepsis y shock séptico, nuestro objetivo es analizar la evolución de los pacientes que ingresan en UCI por enfermedad infecciosa utilizando la definición clásica y los nuevos criterios. Material y métodos: Subanálisis de un estudio observacional y prospectivo. Incluye a 98 pacientes ingresados en UCI por enfermedad infecciosa desde Urgencias durante 18 meses. Se estudió la evolución clínica en UCI y la mortalidad hospitalaria. Resultados: El 78% de los pacientes tuvieron shock séptico con la definición Sepsis-2 y el 52% con los criterios Sepsis-3. La mortalidad hospitalaria fue del 29 y del 41%, respectivamente. El RR de mortalidad hospitalaria de los pacientes con shock séptico fue 10,3 (IC 95%: 2,8-37,5) respecto a los pacientes sin shock. La probabilidad de supervivencia a los 30 días de los pacientes con sepsis y shock séptico fue del 78 y 68%, respectivamente (long Rank < 0,001). Conclusiones: En nuestra experiencia, la incorporación de la puntuación SOFA y el lactato a la nueva definición puede mejorar la valoración del riesgo de muerte hospitalaria


Background and objectives: After the publication of the new definition for sepsis and septic shock, our objective is to analyse the evolution of patients admitted to ICU with an infection process using the previous and new recommendations. Materials and methods: This is a sub-analysis of a previous observational prospective study. We included 98 patients admitted to ICU from the emergency department due to infection during an 18-month period. We studied the clinical evolution during ICU admission and hospital mortality. Results: According to Sepsis-2 definition, 78% percent had septic shock and using Sepsis-3 criteria, 52%; hospital mortality was 29 and 41%, respectively. The RR of hospital mortality of septic shock was 10.3 (95% CI: 2.8-37.5) compared to patients without shock. The 30-day probability survival of patients with sepsis and septic shock were 78% and 68%, respectively (long rank < 0.001). Conclusions: In our experience, the incorporation of the SOFA score and lactate levels to the new definition could help improve the evaluation of risk of hospital death


Assuntos
Humanos , Masculino , Adulto , Pessoa de Meia-Idade , Idoso , Feminino , Terminologia como Assunto , Sepse/classificação , Choque Séptico , Doenças Transmissíveis/epidemiologia , Unidades de Terapia Intensiva , Estudos Prospectivos , Mortalidade Hospitalar
7.
Med Clin (Barc) ; 152(1): 13-16, 2019 01 04.
Artigo em Inglês, Espanhol | MEDLINE | ID: mdl-29680459

RESUMO

BACKGROUND AND OBJECTIVES: After the publication of the new definition for sepsis and septic shock, our objective is to analyse the evolution of patients admitted to ICU with an infection process using the previous and new recommendations. MATERIALS AND METHODS: This is a sub-analysis of a previous observational prospective study. We included 98 patients admitted to ICU from the emergency department due to infection during an 18-month period. We studied the clinical evolution during ICU admission and hospital mortality. RESULTS: According to Sepsis-2 definition, 78% percent had septic shock and using Sepsis-3 criteria, 52%; hospital mortality was 29 and 41%, respectively. The RR of hospital mortality of septic shock was 10.3 (95% CI: 2.8-37.5) compared to patients without shock. The 30-day probability survival of patients with sepsis and septic shock were 78% and 68%, respectively (long rank < 0.001). CONCLUSIONS: In our experience, the incorporation of the SOFA score and lactate levels to the new definition could help improve the evaluation of risk of hospital death.

8.
Nutr. hosp ; 36(extr.2): 12-17, 2019. tab
Artigo em Espanhol | IBECS | ID: ibc-183911

RESUMO

La "polineuropatía del paciente crítico", un cuadro que cursa con debilidad generalizada durante la estancia de los pacientes en la UCI, fue inicialmente atribuida a una afectación de los nervios periféricos. No obstante, a medida que ha progresado la investigación en este campo ha podido describirse el papel fundamental de la alteración muscular en este cuadro de "debilidad muscular adquirida en la UCI" (DMA-UCI). La afectación muscular es frecuente en pacientes críticos. Puede ser cualitativa (debilidad muscular), cuantitativa (disminución de la masa muscular) o, con frecuencia, de ambos tipos. Los efectos de la afectación muscular comprometen la recuperación de los pacientes tanto en la UCI como en el hospital y se extienden hasta después del alta hospitalaria durante un periodo que puede ser prolongado. El origen de la alteración muscular suele ser multifactorial, estando implicados factores como el reposo prolongado, la inadecuada ingesta de nutrientes o la exposición a fármacos que pueden afectar a la estructura muscular y a la función contráctil. La valoración de la masa muscular mediante técnicas de imagen como la ecografía o la tomografía computarizada puede servir de ayuda para el seguimiento de los pacientes. La prevención y el tratamiento de la DMA-UCI requiere un abordaje multimodal recurriendo al empleo de movilización y ejercicio precoces, tratamiento nutricional adecuado y, ocasionalmente, fármacos con efecto estimulante sobre la síntesis proteica muscular. Estudios en marcha permitirán una mejor definición de las alteraciones musculares durante la enfermedad crítica y la mejor forma de abordar su prevención y tratamiento


Polyneuropathy in the critically ill patient was defined as a generalized weakness, acquired during Intensive Care Unit (ICU) admittance and attributed to lesion of the peripheral nerve. Research in this field progressed over time, revealing the crucial role of muscle injury in this disease, to the point of re-naming the disorder as ICU adquired weakness (ICUAW). Muscle damage is common in severe illness, and may be classified in qualitative (weakness) or quantitative (decrease in mass) muscle loss. The most frequent scenario in these patients, is simultaneous change in quality and quantity of muscle; resulting in a challenging and delayed recovery during hospital admittance and after discharge. Multiple causes have been identified in the pathogenesis of this disorder, such as: prolonged bed rest, inadequate intake of nutrients and exposure to drugs that affect muscle structure and contraction. The assessment of muscle mass using images provided by ultrasound or computerized tomography may guide follow up. The prevention and treatment of ICUAW requires a multimodal approach: early mobilization and exercise, appropriate nutritional prescription and, occasionally, muscle protein synthesis stimulants. Further studies will clarify more aspects regarding critically ill patients suffering from muscle injury, in order to better address prevention and treatment of ICUAW


Assuntos
Humanos , Estado Terminal , Músculo Esquelético/metabolismo , Músculo Esquelético/fisiopatologia , Polineuropatias/fisiopatologia , Apoio Nutricional , Debilidade Muscular/etiologia , Debilidade Muscular/reabilitação , Nutrição Enteral , Nutrição Parenteral , Fatores de Risco
9.
Nutr Hosp ; 35(6): 1257-1262, 2018 Oct 17.
Artigo em Espanhol | MEDLINE | ID: mdl-30525837

RESUMO

BACKGROUND: the effective contribution of enteral nutrition (EN) in intensive care units (ICU) is due to multiple factors. OBJECTIVES: to determine the efficacy of caloric intake in critically ill patients with traumatic pathology receiving enteral nutrition, and to analyze cause and time of interruption of EN. METHOD: prospective observational study (November 2015 - August 2016). INCLUSION CRITERIA: patient with EN ≥ 48 hours and age ≥ 18 years. EXCLUSION CRITERIA: patient with oral and/or parenteral nutrition. VARIABLES: demographic, day of EN, prescribed and administered kilocalories (kcal), caloric difference, caloric objective and variables related to the interruptions of the EN. The handling of EN and interruptions are made according to the unit's internal protocol. Kcal/patient are calculated according to the Harris-Benedict equation and multiplied by a stress factor depending on the type of trauma of the patient. RESULTS: sixty-nine patients were included, 79.71% were men, with a median age of 46 (34-58) years. A total of 1,112 days of EN were monitored. As of the third day of admission to the ICU (979 days monitored), the nutritional efficacy was optimal (caloric intake > 80%): 92.43% (72.8-97.5). The optimal caloric goal was maintained in 67.9% of these days. The most frequent causes of interruption of NE were procedures unrelated to airway, with holding time of three (1-7.25) hours. CONCLUSIONS at the third day, the patients with traumatic pathology received at least 80% of the prescribed caloric intake. Among the most frequent causes of interruption of EN were the procedures unrelated to airway.


Assuntos
Estado Terminal , Ingestão de Energia , Nutrição Enteral/métodos , Ferimentos e Lesões/metabolismo , Adulto , Idoso , Cuidados Críticos , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Estado Nutricional , Estudos Prospectivos
10.
Nutr. hosp ; 35(6): 1257-1262, nov.-dic. 2018. tab, graf
Artigo em Espanhol | IBECS | ID: ibc-181464

RESUMO

Introducción: el aporte efectivo de la nutrición enteral (NE) en las unidades de cuidados intensivos (UCI) se ve afectado por múltiples factores. Objetivos: determinar la eficacia en el aporte calórico a los pacientes críticos con patología traumática que reciben nutrición enteral. Analizar causa y tiempo de interrupción de NE. Método: estudio observacional prospectivo (de noviembre de 2015 a agosto de 2016). Criterios de inclusión: paciente con NE ≥ 48 horas y edad ≥ 18 años. Criterios de exclusión: paciente con dieta oral y/o parenteral. Variables: demográficas, día de NE, kilocalorías (kcal) prescritas, administradas, diferencia calórica, objetivo calórico y relacionadas con las interrupciones de la NE. El manejo de NE e interrupciones se realiza según protocolo interno de la unidad. Las kcal/paciente se calculan según la ecuación de Harris-Benedict y multiplicando por un factor de estrés en función del tipo de trauma del paciente. Resultados: se incluyeron 69 pacientes (el 79,71% eran hombres) con una mediana de edad de 46 (34-58) años. Se monitorizaron un total de 1.112 días de NE. A partir del tercer día de ingreso en UCI (979 días monitorizados) la eficacia nutricional fue óptima (aporte calórico > 80%): 92,43% (72,8-97,5). Mantenemos el objetivo calórico óptimo en el 67,9% de estos días. Observamos como causa más frecuente de interrupción de la NE los procedimientos no relacionados con la vía aérea, con un tiempo de parada de tres (1-7,25) horas. Conclusión: el aporte calórico del paciente crítico con patología traumática se logra de forma óptima a partir del día 3. Entre las causas de interrupción de la NE más frecuentes se encuentran los procedimientos no relacionados con la vía aérea


Background: the effective contribution of enteral nutrition (EN) in intensive care units (ICU) is due to multiple factors. Objectives: to determine the efficacy of caloric intake in critically ill patients with traumatic pathology receiving enteral nutrition, and to analyze cause and time of interruption of EN. Method: prospective observational study (November 2015 - August 2016). Inclusion criteria: patient with EN ≥ 48 hours and age ≥ 18 years. Exclusion criteria: patient with oral and/or parenteral nutrition. Variables: demographic, day of EN, prescribed and administered kilocalories (kcal), caloric difference, caloric objective and variables related to the interruptions of the EN. The handling of EN and interruptions are made according to the unit’s internal protocol. Kcal/patient are calculated according to the Harris-Benedict equation and multiplied by a stress factor depending on the type of trauma of the patient. Results: sixty-nine patients were included, 79.71% were men, with a median age of 46 (34-58) years. A total of 1,112 days of EN were monitored. As of the third day of admission to the ICU (979 days monitored), the nutritional efficacy was optimal (caloric intake > 80%): 92.43% (72.8-97.5). The optimal caloric goal was maintained in 67.9% of these days. The most frequent causes of interruption of NE were procedures unrelated to airway, with holding time of three (1-7.25) hours. Conclusions: at the third day, the patients with traumatic pathology received at least 80% of the prescribed caloric intake. Among the most frequent causes of interruption of EN were the procedures unrelated to airway


Assuntos
Humanos , Masculino , Feminino , Adulto , Pessoa de Meia-Idade , Idoso , Estado Terminal , Ingestão de Energia , Nutrição Enteral/métodos , Ferimentos e Lesões/metabolismo , Cuidados Críticos , Estado Nutricional , Estudos Prospectivos
13.
Transplantation ; 102(11): 1901-1908, 2018 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-29979343

RESUMO

BACKGROUND: Little is known about the incidence of acute kidney injury (AKI), as defined using the Kidney Disease Improving Global Outcome classification, after heart transplantation (HT). Our objective was to evaluate the impact of AKI in a cohort of HT recipients. (Setting: University Hospital.) METHODS: We studied 310 consecutive HT recipients from 1999 to 2017, with AKI being defined according to the Kidney Disease Improving Global Outcome criteria. Risk factors were analyzed by multivariable analyses, and survival by Kaplan-Meier curves and a risk-adjusted Cox proportional hazards regression model. RESULTS: One hundred twenty-five (40.3%) patients developed AKI, with 73 (23.5%), 18 (5.8%), and 34 (11%) patients having AKI stages 1, 2, and 3, respectively. Cardiac tamponade (odds ratio [OR], 16.82; 95% confidence interval [CI], 1.06-138), acute right ventricular failure (OR, 3.54; 95% CI, 1.82-6.88), and major bleeding (OR, 2.46; 95% CI, 1.18-5.1) were the principal risk factors for AKI. Patients with AKI had a greater hospital mortality (3.8% vs 16%, P < 0.05), especially those requiring renal replacement therapy (46.9% vs 5.4%, P = 0.006). Acute kidney injury requiring renal replacement therapy was independently associated with hospital mortality (OR, 11.03; 95% CI, 4.08-29.8). With a median follow-up after hospital discharge of 6.7 years (interquartile range, 2.4-11.6), overall survival at 1, 5, and 10 years was 95.4%, 85.1%, and 75.4% versus 85.2%, 69.8% and 63.5% among patients without AKI and with AKI stages 2 to 3, respectively (P = 0.08). CONCLUSIONS: The onset of AKI after HT is mainly associated with postoperative complications. Only severe AKI stage predicts worse short-term outcome, with this impact appearing to be lost at long-term follow-up.


Assuntos
Lesão Renal Aguda/epidemiologia , Transplante de Coração/efeitos adversos , Lesão Renal Aguda/diagnóstico , Lesão Renal Aguda/mortalidade , Lesão Renal Aguda/terapia , Adulto , Feminino , Transplante de Coração/mortalidade , Mortalidade Hospitalar , Humanos , Incidência , Masculino , Pessoa de Meia-Idade , Terapia de Substituição Renal , Estudos Retrospectivos , Medição de Risco , Fatores de Risco , Índice de Gravidade de Doença , Espanha/epidemiologia , Fatores de Tempo , Resultado do Tratamento
14.
Emergencias ; 29(2): 87-92, 2017.
Artigo em Espanhol | MEDLINE | ID: mdl-28825249

RESUMO

OBJECTIVES: To identify prehospital and on-arrival factors associated with hospital outcome in patients with traumatic cardiac arrest (TCA) discharged with recovered spontaneous circulation from the emergency department. MATERIAL AND METHODS: Multipurpose prospective cohort study of patients with TCA who recovered after treatment at a tertiary care hospital emergency department between 2003 and 2016. We gathered data on epidemiologic variables, type and cause of injuries, and prehospital and hospital emergency care. The outcome was overall hospital mortality. RESULTS: A total of 130 TCA cases were included; 123 patients (94.6%) had received blunt trauma injuries and 65 (50%) had been in traffic accidents. The mean (SD) age was 39 (16) years, and 96 (73.8%) were male. Fifty patients (65%) were in asystole and 42 (32.3%) had pulseless electrical activity. Sixteen (12.3%) survived to be discharged; 13 of the survivors (81.3%) had recovered neurological activity. Factors that were independently associated with hospital mortality were asystole on arrival of first responders (odds ratio [OR], 25; 95% CI, 2.5-247; P=.006), nonreactive pupils on arrival at the hospital (OR, 13; 95% CI, 2.0-79; P=.006), and an Injury Severity Score over 25 (OR, 13; 95% CI, 1.8-94; P=.011). CONCLUSION: Twelve percent of patients in this cohort survived to discharge after TCA and 8 out of 10 of the surviving patients recovered neurologically. Asystole at start of prehospital care, nonreactive pupils on hospital arrival, and a severity score over 25 may indicate poor prognosis after TCA.


Assuntos
Emergências , Parada Cardíaca/terapia , Acidentes de Trânsito , Adulto , Suporte Vital Cardíaco Avançado , Dano Encefálico Crônico/etiologia , Dano Encefálico Crônico/prevenção & controle , Serviços Médicos de Emergência , Feminino , Parada Cardíaca/etiologia , Parada Cardíaca/mortalidade , Mortalidade Hospitalar , Humanos , Escala de Gravidade do Ferimento , Masculino , Pessoa de Meia-Idade , Prognóstico , Estudos Prospectivos , Reflexo Anormal , Reflexo Pupilar , Resultado do Tratamento , Ferimentos não Penetrantes/complicações , Adulto Jovem
15.
Emergencias (St. Vicenç dels Horts) ; 29(2): 87-92, abr. 2017. graf, tab
Artigo em Espanhol | IBECS | ID: ibc-161659

RESUMO

Objetivo. Identificar los factores pronóstico a la llegada a urgencias y los resultados al alta hospitalaria de los pacientes en parada cardiaca traumática (PCT), documentada por un servicio de emergencias médicas (SEM), con posterior recuperación de la circulación espontánea (RCE). Métodos. Estudio de cohorte multipropósito de pacientes con PCT recuperada atendidos en un servicio de urgencias (SU) de un hospital universitario de tercer nivel de 2003 a 2016. Se recogieron variables epidemiológicas, tipo y mecanismo del traumatismo, datos de la atención extrahospitalaria y del SU. La variable de resultado fue la mortalidad global intrahospitalaria. Resultados. Se incluyeron 130 PCT, de los cuales 123 (94,6%) sufrieron un traumatismo cerrado y 65 (50%) tuvieron un accidente de tráfico. La edad media fue de 39 (DE 16) años y 96 (73,8%) fueron varones. Cincuenta pacientes (65%) presentaron asistolia y 42 (32,3%) actividad eléctrica sin pulso (AESP). Dieciséis (12,3%) sobrevivieron al alta, de los cuales 13 (81,3%) tuvieron recuperación neurológica favorable. Un ritmo de asistolia en la primera atención de extrahospitalaria (OR = 25; IC 95% 2,5-247; p = 0,006), las pupilas arreactivas a la llegada al hospital (OR = 13; IC 95% 2,0-79; p = 0,006), y una puntuación > 25 de la Injury Severity Score (ISS) (OR = 13; IC 95% 1,8-94; p = 0,011) se asociaron de forma independiente con la mortalidad intrahospitalaria. Conclusión. En nuestra serie, la supervivencia intrahospitalaria de la PCT fue un 12% siendo la recuperación neurológica favorable en ocho de cada diez vivos. El ritmo inicial en asistolia en la atención extrahospitalaria, la pupilas arreactivas a la llegada al hospital y una puntuación > 25 de ISS podrían implicar un mal pronóstico (AU)


Objective. To identify prehospital and on-arrival factors associated with hospital outcome in patients with traumatic cardiac arrest (TCA) discharged with recovered spontaneous circulation from the emergency department. Material and methods. Multipurpose prospective cohort study of patients with TCA who recovered after treatment at a tertiary care hospital emergency department between 2003 and 2016. We gathered data on epidemiologic variables, type and cause of injuries, and prehospital and hospital emergency care. The outcome was overall hospital mortality. Results. A total of 130 TCA cases were included; 123 patients (94.6%) had received blunt trauma injuries and 65 (50%) had been in traffic accidents. The mean (SD) age was 39 (16) years, and 96 (73.8%) were male. Fifty patients (65%) were in asystole and 42 (32.3%) had pulseless electrical activity. Sixteen (12.3%) survived to be discharged; 13 of the survivors (81.3%) had recovered neurological activity. Factors that were independently associated with hospital mortality were asystole on arrival of first responders (odds ratio [OR], 25; 95% CI, 2.5–247; P=.006), nonreactive pupils on arrival at the hospital (OR, 13; 95% CI, 2.0–79; P=.006), and an Injury Severity Score over 25 (OR, 13; 95% CI, 1.8–94; P=.011). Conclusions. Twelve percent of patients in this cohort survived to discharge after TCA and 8 out of 10 of the surviving patients recovered neurologically. Asystole at start of prehospital care, nonreactive pupils on hospital arrival, and a severity score over 25 may indicate poor prognosis after TCA (AU)


Assuntos
Humanos , Parada Cardíaca/epidemiologia , Traumatismo Múltiplo/complicações , Tratamento de Emergência/métodos , Suporte Vital Cardíaco Avançado , Reanimação Cardiopulmonar , Prognóstico , Avaliação de Resultados da Assistência ao Paciente , Serviço Hospitalar de Emergência/estatística & dados numéricos
16.
Med. clín (Ed. impr.) ; 148(5): 197-203, mar. 2017. tab, ilus, graf
Artigo em Espanhol | IBECS | ID: ibc-160681

RESUMO

Antecedentes y objetivo. Un origen frecuente de los pacientes que ingresan en la UCI es el Servicio de Urgencias. Es necesario analizar el pronóstico a corto plazo de estos pacientes, pero también su evolución tras el alta hospitalaria, puesto que es una preocupación importante de los enfermos. Nuestro objetivo es describir las características epidemiológicas de los pacientes que ingresan en la UCI desde Urgencias y analizar su evolución. Pacientes y método. Estudio de cohortes observacional y prospectivo. Incluye 269 pacientes ingresados consecutivamente en la UCI desde Urgencias durante 18 meses. Los factores asociados a la mortalidad hospitalaria se presentan en odds ratio (OR) y a la mortalidad a largo plazo como hazard ratio (HR). El nivel de significación aceptado fue del 5%. La supervivencia global se analizó mediante curvas de Kaplan-Meier. Resultados. La mortalidad hospitalaria fue del 15%, las complicaciones desarrolladas en la UCI fueron las variables con mayor impacto en la misma: insuficiencia renal aguda (OR 22,7) y distrés respiratorio (OR 51,2). Tras el alta hospitalaria, la mortalidad acumulada a los 12, 24 y 36 meses fue del 6, 11 y 15%, respectivamente. El grado de dependencia funcional (HR 3,7), el cáncer (HR 3,4) y las arritmias (HR 2,4) fueron los factores relacionados con la mortalidad a largo plazo. Conclusiones. El pronóstico a corto plazo de los pacientes que ingresan en la UCI se relaciona con su edad y comorbilidad, pero sobre todo con las características de la enfermedad aguda. Sin embargo, la evolución a largo plazo está más asociada a las características del paciente (AU)


Background and objective. A frequent source of critically-ill patients admitted to the ICU is the Emergency Department. It is essential to analyse the short-term prognosis of these patients, but also their evolution after their discharge from the hospital, since this is one of the major concerns of these patients. The aim of this study is to describe the epidemiological characteristics of patients admitted to the ICU from the Emergency Department and to analyse their outcome. Patients and method. This consisted of an observational prospective cohorts study which included 269 Emergency Department patients consecutively admitted to the ICU over an 18-month period. Factors associated with hospital mortality were presented as an odds ratio (OR) and factors associated with long-term mortality were presented as a hazard ratio (HR). A P-value lower than .05 was accepted as significant. The overall survival was analysed on the basis of the Kaplan-Meier curves. Results. Hospital mortality was 15%, ICU complications where the variables with the greatest impact on short-term mortality: acute renal failure (OR 22.7) and respiratory distress syndrome (OR 51.2). After hospital discharge, the cumulative mortality at 12, 24 and 36 months was 6, 11 and 15%, respectively. The degree of functional dependence (HR 3.7), cancer (HR 3.4) and arrhythmias (HR 2.4) were factors related to long-term mortality. Conclusions. The short-term outcome of ICU patients is related to age and comorbidity, but more significantly to the characteristics of the acute illness. However, the long-term outcome is more closely associated with the patients’ characteristics (AU)


Assuntos
Humanos , Masculino , Feminino , Estado Terminal/epidemiologia , Cuidados Críticos/métodos , Cuidados Críticos/normas , Mortalidade Hospitalar/tendências , Insuficiência Renal/complicações , Emergências/epidemiologia , Serviços Médicos de Emergência/métodos , Razão de Chances , Estimativa de Kaplan-Meier , Prognóstico , Estudos de Coortes , Estudos Prospectivos
17.
Med Clin (Barc) ; 148(5): 197-203, 2017 Mar 03.
Artigo em Inglês, Espanhol | MEDLINE | ID: mdl-27993409

RESUMO

BACKGROUND AND OBJECTIVE: A frequent source of critically-ill patients admitted to the ICU is the Emergency Department. It is essential to analyse the short-term prognosis of these patients, but also their evolution after their discharge from the hospital, since this is one of the major concerns of these patients. The aim of this study is to describe the epidemiological characteristics of patients admitted to the ICU from the Emergency Department and to analyse their outcome. PATIENTS AND METHOD: This consisted of an observational prospective cohorts study which included 269 Emergency Department patients consecutively admitted to the ICU over an 18-month period. Factors associated with hospital mortality were presented as an odds ratio (OR) and factors associated with long-term mortality were presented as a hazard ratio (HR). A P-value lower than .05 was accepted as significant. The overall survival was analysed on the basis of the Kaplan-Meier curves. RESULTS: Hospital mortality was 15%, ICU complications where the variables with the greatest impact on short-term mortality: acute renal failure (OR 22.7) and respiratory distress syndrome (OR 51.2). After hospital discharge, the cumulative mortality at 12, 24 and 36 months was 6, 11 and 15%, respectively. The degree of functional dependence (HR 3.7), cancer (HR 3.4) and arrhythmias (HR 2.4) were factors related to long-term mortality. CONCLUSIONS: The short-term outcome of ICU patients is related to age and comorbidity, but more significantly to the characteristics of the acute illness. However, the long-term outcome is more closely associated with the patients' characteristics.


Assuntos
Estado Terminal/mortalidade , Serviço Hospitalar de Emergência , Unidades de Terapia Intensiva , Encaminhamento e Consulta , Centros de Atenção Terciária , Adolescente , Adulto , Idoso , Idoso de 80 Anos ou mais , Estado Terminal/terapia , Feminino , Seguimentos , Mortalidade Hospitalar , Humanos , Estimativa de Kaplan-Meier , Masculino , Pessoa de Meia-Idade , Prognóstico , Estudos Prospectivos , Fatores de Risco , Espanha , Taxa de Sobrevida , Adulto Jovem
18.
Anesth Analg ; 123(6): 1522-1524, 2016 12.
Artigo em Inglês | MEDLINE | ID: mdl-27749340

RESUMO

Fluid resuscitation is one of the most prevalent treatment in critical care. There is not definitive evidence about the best fluid for resuscitation. The aim of this review will be to asses the efficacy and safety of buffered solution versus saline. We will perform an electronic search in Medline, Embase, and Central. Studies will be eligible if they are clinical trials who including critical ill patients. Primary outcomes are mortality and renal failure. All findings will be tabulated and synthesized. We will perform a meta-analysis according to Cochrane Review standards. We will design a summary of findings table.


Assuntos
Cuidados Críticos/métodos , Estado Terminal/terapia , Hidratação/métodos , Ressuscitação/métodos , Cloreto de Sódio/administração & dosagem , Tampões (Química) , Hidratação/efeitos adversos , Humanos , Infusões Intravenosas , Soluções Isotônicas , Projetos de Pesquisa , Ressuscitação/efeitos adversos , Cloreto de Sódio/efeitos adversos , Resultado do Tratamento
19.
J Thorac Cardiovasc Surg ; 152(2): 613-20, 2016 08.
Artigo em Inglês | MEDLINE | ID: mdl-27174515

RESUMO

OBJECTIVE: The evaluation of right ventricular systolic function is essential to the hemodynamic management of critically ill cardiac patients. Nevertheless, assessment of right ventricular function remains problematic. We sought to analyze the correlation between tricuspid annular plane systolic excursion (TAPSE) and right ventricular ejection fraction (RVEF) in the assessment of global and regional right ventricular function, respectively. METHODS: This was a prospective study of 61 cardiac surgical patients. TAPSE was measured with transthoracic echocardiography and RVEF was obtained by a thermodilution pulmonary artery catheter. Both measurements were estimated simultaneously during the early postoperative period. Patients with previously identified severe tricuspid insufficiency were excluded from the study to avoid confounding results. RESULTS: The etiologies for cardiac surgery were surgical pulmonary thromboendarterectomy in 19 patients, valve replacement in 17 patients, heart transplant in 13 patients, and coronary artery bypass graft in 9 patients. Mean RVEF and TAPSE were 26.2% ± 9.7% and 11.4 ± 4 mm, respectively. RVEF and TAPSE showed a significant correlation (r = 0.73, P < .001). Weak reverse relationships between TAPSE or RVEF with afterload hemodynamic parameters, mean pulmonary artery pressure, or pulmonary vascular resistance were elucidated. CONCLUSIONS: TAPSE is a robust measure of right ventricular function that correlates with RVEF assessed by pulmonary artery catheter. A noninvasive method such as echocardiography can guide and support invasive monitoring of right ventricular function in cardiac surgical patients.


Assuntos
Procedimentos Cirúrgicos Cardíacos , Cateterismo de Swan-Ganz , Ecocardiografia , Ventrículos do Coração/diagnóstico por imagem , Volume Sistólico , Valva Tricúspide/diagnóstico por imagem , Função Ventricular Direita , Adulto , Idoso , Procedimentos Cirúrgicos Cardíacos/efeitos adversos , Feminino , Ventrículos do Coração/fisiopatologia , Humanos , Masculino , Pessoa de Meia-Idade , Valor Preditivo dos Testes , Estudos Prospectivos , Sístole , Termodiluição , Fatores de Tempo , Resultado do Tratamento , Valva Tricúspide/fisiopatologia
20.
JPEN J Parenter Enteral Nutr ; 40(2): 250-5, 2016 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-25274497

RESUMO

BACKGROUND: Patients treated with mechanical ventilation in the prone position (PP) could have an increased risk for feeding intolerance. However, the available evidence supporting this hypothesis is limited and contradictory. OBJECTIVE: To examine the feasibility and efficacy of enteral nutrition (EN) support and its associated complications in patients receiving mechanical ventilation in PP. METHODS: Prospective observational study including 34 mechanically ventilated intensive care patients who were turned to the prone position over a 3-year period. End points related to efficacy and safety of EN support were studied. RESULTS: In total, more than 1200 patients were admitted to the intensive care unit over a period of 3 years. Of these, 34 received mechanical ventilation in PP. The mean days under EN were 24.7 ± 12.3. Mean days under EN in the supine position were significantly higher than in PP (21.1 vs 3.6; P < .001), but there were no significant differences in gastric residual volume adjusted per day of EN (126.6 vs 189.2; P = .054) as well as diet volume ratio (94.1% vs 92.8%; P = .21). No significant differences in high gastric residual events per day of EN (0.06 vs 0.09; P = .39), vomiting per day of EN (0.016 vs 0.03; P = .53), or diet regurgitation per day of EN (0 vs 0.04; P = .051) were found. CONCLUSIONS: EN in critically ill patients with severe hypoxemia receiving mechanical ventilation in PP is feasible, safe, and not associated with an increased risk of gastrointestinal complications. Larger studies are needed to confirm these findings.


Assuntos
Nutrição Enteral , Decúbito Ventral , Respiração Artificial , Adulto , Idoso , Estado Terminal/terapia , Determinação de Ponto Final , Estudos de Viabilidade , Feminino , Mucosa Gástrica/metabolismo , Humanos , Hipóxia/terapia , Unidades de Terapia Intensiva , Tempo de Internação , Masculino , Pessoa de Meia-Idade , Estudos Prospectivos , Vômito
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