Monitorización de la glucemia en el paciente crítico adulto: tipo de muestra y método de análisis. Revisión sistemática y metanálisis / Blood glucose monitoring in critically ill adult patients: Type of sample and method of analysis. Systematic review and meta-analysis

IntroducciónLa guía clínica para el manejo de la sepsis recomienda usar muestras de sangre arterial para el control glucémico. Un estudio multicéntrico en 86 unidades de cuidados intensivos españolas reveló que el 85,4% de estas utilizaban punción capilar.ObjetivoAnalizar la fiabilidad de la glucemia comparando diferentes muestras sanguíneas (arterial, venosa, capilar) e instrumentos (glucómetros, gasómetros, laboratorio central). Secundariamente, estimar el efecto de variables confusoras y el rendimiento de los instrumentos de medición determinados por las diferentes normas de calidad.MetodologíaRevisión sistemática y metanálisis con búsqueda en las bases de datos PubMed, CINAHL y Embase en septiembre-2021 y septiembre-2022, sin límites temporales ni idiomáticos. Fuentes de literatura gris: DART-Europe, OpenGrey y Google Académico. Resultados resumidos mediante síntesis cualitativa (descripción de resultados, características de los estudios) y cuantitativa (metanálisis para evaluar la diferencia de medias estandarizadas). Calidad metodológica de artículos evaluada con Quality Assessment of Diagnostic Accuracy Studies-2. Protocolo: https://osf.io/ DOI 10.17605/OSF.IO/T8KYP.ResultadosSe incluyeron un total de 32 artículos y 5.451 pacientes. No se obtuvieron discrepancias entre muestras arteriales con glucómetro vs. laboratorio (sesgo [IC95%]: 0,01 [−0,12 a 0,14] mg/dL). En cambio, muestras arteriales con gasómetro sí sobreestimaron de forma significativa (sesgo [IC95%]: 0,12 [0,01 a 0,24] mg/dL). La misma tendencia presentan capilares con glucómetro, aunque no de forma significativa (sesgo [IC95%]: 0,07 [−0,02 a 0,15] mg/dL). Hay discrepancia entre los estudios sobre el efecto del hematocrito y el equilibrio ácido-base. El mayor consenso se da en la poca concordancia del glucómetro con muestras capilares vs. laboratorio en presencia de shock y soporte vasopresor, situación de fallo renal o durante el tratamiento con vitamina C.Conclusiones... (AU)

IntroductionThe clinical guideline for the management of sepsis recommends using arterial blood samples for glycaemic control. A multicentre study in 86 Spanish intensive care units revealed that 85.4% of these used capillary puncture.ObjectiveTo analyse the reliability of glycaemia by comparing different blood samples (arterial, venous, capillary) and instruments (glucometers, gasometers, central laboratory). Secondarily, to estimate the effect of confounding variables and the performance of measuring instruments as determined by different quality standards.MethodologySystematic review and meta-analysis with search in PubMed, CINAHL and Embase databases in September-2021 and September-2022, with no time or language limits. Grey literature sources: DART-Europe, OpenGrey and Google Scholar. Results summarised by qualitative (description of results, study characteristics) and quantitative (meta-analysis to assess standardised mean difference) synthesis. Methodological quality of articles assessed with Quality Assessment of Diagnostic Accuracy Studies-2. Protocol: https://osf.io/ DOI 10.17605/OSF.IO/T8KYP.ResultsA total of 32 articles and 5451 patients were included. No discrepancies were obtained between arterial glucometer vs. laboratory samples (bias [95%CI]: 0.01 [−0.12 to 0.14] mg/dL). In contrast, arterial samples with a gasometer did significantly overestimate (bias [95%CI]: 0.12 [0.01 to 0.24] mg/dL). The same trend is seen in capillaries with a glucometer, although not significantly (bias [95%CI]: 0.07 [−0.02 to 0.15] mg/dL). There is discrepancy between studies on the effect of haematocrit and acid-base balance. The greatest consensus is on the poor agreement of glucometer with capillary vs. laboratory samples in the presence of shock and vasopressor support, renal failure or during vitamin C treatment.Conclusions... (AU)

Monitorización de la glucemia en el paciente crítico adulto: tipo de muestra y método de análisis. Revisión sistemática y metanálisis / Blood glucose monitoring in critically ill adult patients: Type of sample and method of analysis. Systematic review and meta-analysis

IntroducciónLa guía clínica para el manejo de la sepsis recomienda usar muestras de sangre arterial para el control glucémico. Un estudio multicéntrico en 86 unidades de cuidados intensivos españolas reveló que el 85,4% de estas utilizaban punción capilar.ObjetivoAnalizar la fiabilidad de la glucemia comparando diferentes muestras sanguíneas (arterial, venosa, capilar) e instrumentos (glucómetros, gasómetros, laboratorio central). Secundariamente, estimar el efecto de variables confusoras y el rendimiento de los instrumentos de medición determinados por las diferentes normas de calidad.MetodologíaRevisión sistemática y metanálisis con búsqueda en las bases de datos PubMed, CINAHL y Embase en septiembre-2021 y septiembre-2022, sin límites temporales ni idiomáticos. Fuentes de literatura gris: DART-Europe, OpenGrey y Google Académico. Resultados resumidos mediante síntesis cualitativa (descripción de resultados, características de los estudios) y cuantitativa (metanálisis para evaluar la diferencia de medias estandarizadas). Calidad metodológica de artículos evaluada con Quality Assessment of Diagnostic Accuracy Studies-2. Protocolo: https://osf.io/ DOI 10.17605/OSF.IO/T8KYP.ResultadosSe incluyeron un total de 32 artículos y 5.451 pacientes. No se obtuvieron discrepancias entre muestras arteriales con glucómetro vs. laboratorio (sesgo [IC95%]: 0,01 [−0,12 a 0,14] mg/dL). En cambio, muestras arteriales con gasómetro sí sobreestimaron de forma significativa (sesgo [IC95%]: 0,12 [0,01 a 0,24] mg/dL). La misma tendencia presentan capilares con glucómetro, aunque no de forma significativa (sesgo [IC95%]: 0,07 [−0,02 a 0,15] mg/dL). Hay discrepancia entre los estudios sobre el efecto del hematocrito y el equilibrio ácido-base. El mayor consenso se da en la poca concordancia del glucómetro con muestras capilares vs. laboratorio en presencia de shock y soporte vasopresor, situación de fallo renal o durante el tratamiento con vitamina C.Conclusiones... (AU)

IntroductionThe clinical guideline for the management of sepsis recommends using arterial blood samples for glycaemic control. A multicentre study in 86 Spanish intensive care units revealed that 85.4% of these used capillary puncture.ObjectiveTo analyse the reliability of glycaemia by comparing different blood samples (arterial, venous, capillary) and instruments (glucometers, gasometers, central laboratory). Secondarily, to estimate the effect of confounding variables and the performance of measuring instruments as determined by different quality standards.MethodologySystematic review and meta-analysis with search in PubMed, CINAHL and Embase databases in September-2021 and September-2022, with no time or language limits. Grey literature sources: DART-Europe, OpenGrey and Google Scholar. Results summarised by qualitative (description of results, study characteristics) and quantitative (meta-analysis to assess standardised mean difference) synthesis. Methodological quality of articles assessed with Quality Assessment of Diagnostic Accuracy Studies-2. Protocol: https://osf.io/ DOI 10.17605/OSF.IO/T8KYP.ResultsA total of 32 articles and 5451 patients were included. No discrepancies were obtained between arterial glucometer vs. laboratory samples (bias [95%CI]: 0.01 [−0.12 to 0.14] mg/dL). In contrast, arterial samples with a gasometer did significantly overestimate (bias [95%CI]: 0.12 [0.01 to 0.24] mg/dL). The same trend is seen in capillaries with a glucometer, although not significantly (bias [95%CI]: 0.07 [−0.02 to 0.15] mg/dL). There is discrepancy between studies on the effect of haematocrit and acid-base balance. The greatest consensus is on the poor agreement of glucometer with capillary vs. laboratory samples in the presence of shock and vasopressor support, renal failure or during vitamin C treatment.Conclusions... (AU)

Comparación del riesgo nutricional alto por tres variantes del puntaje NUTrICen pacientes críticos ventilados / High nutritional risk by three variants of NUTRIC score in critically ventilated patients

Introducción: las variantes del puntaje NUTRIC con o sin biomarcadores inflamatorios, modificada sin interleucina-6 (IL-6) (NUTRICm), conproteína C reactiva (PCR) en lugar de IL-6, dicotómica (NUTRICpcr1) o en terciles (NUTRICpcr2), se propusieron para evaluar el riesgo nutricional(RN) en pacientes críticos. Sin embargo, la valoración del RN alto podría no ser uniforme entre dichos puntajes.Objetivos: comparar la valoración del RN alto por NUTRICm y las dos variantes del NUTRICpcr.Material y métodos: análisis de una cohorte prospectiva de pacientes ventilados previa al COVID-19. El acuerdo se analizó mediante la prueba deKappa y la discriminación de la mortalidad por regresión logística. La proporción de pacientes de RN alto se comparó con la prueba Chi-cuadrado.Resultados: se analizaron 550 pacientes. Mediana (RIQ) de edad y APACHE II: 44 (28-58) años y 17 (12-22) puntos, patología traumática predo-minante (38,2 %) y mortalidad en Unidad de Cuidados Intensivos (UCI) del 32,5 %. La concordancia fue alta entre NUTRICm y NUTRICpcr1 (Kappa= 0,81) y menor entre NUTRICm y NUTRICpcr2 (Kappa = 0,60). El AUCROC (IC 95 %) del NUTRICm, NUTRICpcr1 y NUTRICpcr2 para discriminarmortalidad fue de 0,695 (0,495-0,591), 0,693 (0,495-0,591) y 0,685 (0,495-0,591), respectivamente. El RN alto mostró diferencias significa-tivas entre NUTRICm y NUTRICpcr1 (19,8 % vs. 14,4 %, p 0,0243), y fue mayor entre NUTRICm y NUTRICpcr2 (19,8 vs. 9,8 %, p < 0,0001).Conclusión: las tres variantes del NUTRIC estudiadas discriminan la mortalidad en forma similar. Sin embargo, el NUTRICm, sin biomarcadorinflamatorio, clasifica más pacientes como de RN alto.(AU)

Introduction: variants of the NUTRIC score with or without inflammatory biomarkers, modified without interleukin 6 (IL-6) (NUTRICm), withC-reactive protein (CRP) instead of IL-6, dichotomous (NUTRICpcr1) or in tertiles (NUTRICpcr2), were proposed to assess nutritional risk (NR) incritical patients. However, the assessment of the high NR might not be uniform between these scores.Objectives: to compare the assessment of the high NR by NUTRICm and the two variants of the NUTRICpcr.Material and methods: analysis of a prospective cohort of patients ventilated prior to COVID-19. Agreement was analyzed using the Kappa testand mortality discrimination by logistic regression. The proportion of patients with high NR was compared with the Chi-square test.Results: five hundred and fifty patients were analyzed. Median (IQR) age and APACHE II: 44 (28-58) years and 17 (12-22) points, predominanttraumatic pathology (38.2 %) and Intensive Care Unit (ICU) mortality of 32.5 %. The concordance was high between NUTRICm and NUTRICpcr1(Kappa = 0.81) and lower between NUTRICm and NUTRICpcr2 (Kappa = 0.60). The AUCROC (95 % CI) of NUTRICm, NUTRICpcr1 and NUTRI-Cpcr2 to discriminate mortality was 0.695 (0.495-0.591), 0.693 (0.495-0.591) and 0.685 (0.495-0.591), respectively. The tall NB showedsignificant differences between NUTRICm and NUTRICpcr1 (19.8 % vs 14.4 %, p 0.0243), being greater between NUTRICm and NUTRICpcr2(19.8 vs 9.8 %, p < 0.0001).Conclusion: the three NUTRIC variants studied discriminate mortality in a similar way. However, the NUTRICm, without an inflammatory biomarker,classifies more patients as high nutritional risk.(AU)

Family burden after critical illness: the forgotten caregivers / La sobrecarga familiar tras una enfermedad crítica: los cuidadores olvidados

Objective To determine the incidence of primary caregiver burden in a cohort of family members of critically ill patients admitted to ICU and to identify risk factors related to its development in both the patient and the family member. Design Prospective observational cohort study was conducted for 24 months. Setting Hospital Universitario Clínico San Cecilio, Granada. Patients The sample was the primary caregivers of all patients with risk factors for development of PICS (Post-Intensive Care Syndrome). Interventions The follow-up protocol consisted of evaluation 3 months after discharge from the ICU in a specific consultation. Main variables of interest The scales used in patients were Barthel, SF-12, HADS, Pfeiffer, IES-6 and in relatives the Apgar and Zarit. Results A total of 93 patients and caregivers were included in the follow-up. 15 relatives did not complete the follow-up questionnaires and were excluded from the study. The incidence of PICS-F (Family Post Intensive Care Syndrome) defined by the presence of primary caregiver burden in our cohort of patients is 34.6% (n=27), 95% CI 25.0−45.7. The risk factors for the development of caregiver burden are the presence of physical impairment, anxiety or post-traumatic stress in the patient, with no relationship found with the characteristics studied in the family member. Conclusions One out of 3 relatives of patients with risk factors for the development of PICS presents at 3 months caregiver burden. This is related to factors dependent on the patient's state of health. (AU)

Objetivo Determinar la incidencia de la sobrecarga del cuidador principal en una cohorte de familiares de pacientes críticos ingresados en UCI e identificar los factores de riesgo relacionados con su desarrollo tanto en el paciente como en el familiar. Diseño Estudio de cohortes observacional prospectivo durante 24 meses. Ámbito Hospital Universitario Clínico San Cecilio de Granada. Pacientes La muestra estuvo compuesta por los cuidadores principales de todos los pacientes con factores de riesgo para el desarrollo de SPCI (Síndrome Post-Cuidados Intensivos). Intervenciones El protocolo de seguimiento consistió en la evaluación a los 3 meses del alta de la UCI en una consulta específica. Variables de interés principales Las escalas utilizadas fueron Barthel, SF-12, HADS, Pfeiffer, IES-6, Apgar y Zarit. Resultados Un total de 93 pacientes y cuidadores fueron incluidos en el seguimiento. 15 cuidadores no completaron los cuestionarios de seguimiento y fueron excluidos del estudio. La incidencia de PICS-F (Síndrome Post-Cuidados Intensivos Familiar) definido por la presencia de sobrecarga del cuidador en nuestra cohorte es del 34,6% (n=27), IC 95% 25,0–45,7. Los factores de riesgo para el desarrollo del mismo son la presencia de deterioro físico, ansiedad o estrés postraumático en el paciente, no encontrándose relación con las características estudiadas en el familiar. Conclusiones Uno de cada 3 familiares de pacientes con factores de riesgo para el desarrollo de SPCI presenta a los 3 meses sobrecarga del cuidador, relacionándose con factores dependientes del estado de salud del paciente. (AU)

[High nutritional risk by three variants of NUTRIC score in critically ventilated patients]. / Comparación del riesgo nutricional alto por tres variantes del puntaje NUTRIC en pacientes críticos ventilados.

Introduction: Introduction: variants of the NUTRIC score with or without inflammatory biomarkers, modified without interleukin 6 (IL-6) (NUTRICm), with C-reactive protein (CRP) instead of IL-6, dichotomous (NUTRICpcr1) or in tertiles (NUTRICpcr2), were proposed to assess nutritional risk (NR) in critical patients. However, the assessment of the high NR might not be uniform between these scores. Objectives: to compare the assessment of the high NR by NUTRICm and the two variants of the NUTRICpcr. Material and methods: analysis of a prospective cohort of patients ventilated prior to COVID-19. Agreement was analyzed using the Kappa test and mortality discrimination by logistic regression. The proportion of patients with high NR was compared with the Chi-square test. Results: five hundred and fifty patients were analyzed. Median (IQR) age and APACHE II: 44 (28-58) years and 17 (12-22) points, predominant traumatic pathology (38.2 %) and Intensive Care Unit (ICU) mortality of 32.5 %. The concordance was high between NUTRICm and NUTRICpcr1 (Kappa = 0.81) and lower between NUTRICm and NUTRICpcr2 (Kappa = 0.60). The AUCROC (95 % CI) of NUTRICm, NUTRICpcr1 and NUTRICpcr2 to discriminate mortality was 0.695 (0.495-0.591), 0.693 (0.495-0.591) and 0.685 (0.495-0.591), respectively. The tall NB showed significant differences between NUTRICm and NUTRICpcr1 (19.8 % vs 14.4 %, p 0.0243), being greater between NUTRICm and NUTRICpcr2 (19.8 vs 9.8 %, p < 0.0001). Conclusion: the three NUTRIC variants studied discriminate mortality in a similar way. However, the NUTRICm, without an inflammatory biomarker, classifies more patients as high nutritional risk.

Introducción: Introducción: las variantes del puntaje NUTRIC con o sin biomarcadores inflamatorios, modificada sin interleucina-6 (IL-6) (NUTRICm), con proteína C reactiva (PCR) en lugar de IL-6, dicotómica (NUTRICpcr1) o en terciles (NUTRICpcr2), se propusieron para evaluar el riesgo nutricional (RN) en pacientes críticos. Sin embargo, la valoración del RN alto podría no ser uniforme entre dichos puntajes.. Objetivos: comparar la valoración del RN alto por NUTRICm y las dos variantes del NUTRICpcr. Material y métodos: análisis de una cohorte prospectiva de pacientes ventilados previa al COVID-19. El acuerdo se analizó mediante la prueba de Kappa y la discriminación de la mortalidad por regresión logística. La proporción de pacientes de RN alto se comparó con la prueba Chi-cuadrado. Resultados: se analizaron 550 pacientes. Mediana (RIQ) de edad y APACHE II: 44 (28-58) años y 17 (12-22) puntos, patología traumática predominante (38,2 %) y mortalidad en Unidad de Cuidados Intensivos (UCI) del 32,5 %. La concordancia fue alta entre NUTRICm y NUTRICpcr1 (Kappa = 0,81) y menor entre NUTRICm y NUTRICpcr2 (Kappa = 0,60). El AUCROC (IC 95 %) del NUTRICm, NUTRICpcr1 y NUTRICpcr2 para discriminar mortalidad fue de 0,695 (0,495-0,591), 0,693 (0,495-0,591) y 0,685 (0,495-0,591), respectivamente. El RN alto mostró diferencias significativas entre NUTRICm y NUTRICpcr1 (19,8 % vs. 14,4 %, p 0,0243), y fue mayor entre NUTRICm y NUTRICpcr2 (19,8 vs. 9,8 %, p < 0,0001). Conclusión: las tres variantes del NUTRIC estudiadas discriminan la mortalidad en forma similar. Sin embargo, el NUTRICm, sin biomarcador inflamatorio, clasifica más pacientes como de RN alto.

Effectiveness of a specific follow up program for the management of the mental components of post-intensive care syndrome and chronic pain after COVID-19: results from the PAIN-COVID randomized clinical trial.

BACKGROUND: Critical COVID-19 survivors are at risk of developing Post-intensive Care Syndrome (PICS) and Chronic ICU-Related Pain (CIRP). We determined whether a specific care program improves the quality of life (QoL) of patients at risk of developing PICS and CIRP after COVID-19. METHODS: The PAIN-COVID trial was a parallel-group, single-centre, single-blinded, randomized controlled trial. The intervention consisted of a follow up program, patient education on PICS and pain, and a psychological intervention based on Rehm's self-control model in patients with abnormal depression scores (≥8) in the Hospital Anxiety and Depression Scale (HADS) at the baseline visit. QoL was evaluated with the 5-level EQ 5D (EQ 5D 5 L), mood disorders with the HADS, post-traumatic stress disorder (PTSD) with the PCL-5 checklist, and pain with the Brief Pain Inventory short form, the Douleur Neuropathique 4 questionnaire, and the Pain Catastrophizing Scale. The primary outcome was to determine if the program was superior to standard-of-care on the EQ visual analogue scale (VAS) at 6 months after the baseline visit. The secondary outcomes were EQ VAS at 3 months, and EQ index, CIRP incidence and characteristics, and anxiety, depression, and PTSD at 3 and 6 months after baseline visits. CONCLUSIONS: This program was not superior to standard care in improving QoL in critical COVID-19 survivors as measured by the EQ VAS. However, our data can help establish better strategies for the study and management of PICS and CIRP in this population. TRIAL REGISTRATION: # NCT04394169, registered on 5/19/2020.

Estratégias e dificuldades de comunicação do enfermeiro com o doente crítico e família: scoping review / Nurse communication strategies and difficulties with critically ill patients and their families: a scoping review

O presente trabalho, insere-se no plano de estudos do III Curso de Mestrado em Enfermagem Médico-cirúrgica, da Unidade Curricular Semestral, Estágio com relatório da Escola Superior de Saúde do Instituto Politécnico de Bragança. A unidade curricular contempla três campos de estágio, com um total de 540 horas de contacto dedicados a prática clinica, que decorreram no período de setembro de 2019 a fevereiro de 2020. Os ensinos clínicos foram realizados em três serviços: Centro de Hemodiálise, Serviço de Medicina Intensiva (SMI), Serviço de Urgência Polivalente (SUP). Todos estes campos envolvem o atendimento e tratamento da pessoa em situação crítica. O objetivo da elaboração deste trabalho, passa por analisar a evolução ao longo dos ensinos clínicos, fazendo uma reflexão crítica sobre as aprendizagem alcançadas e seus contributos para o desenvolvimento de saberes e competências profissionais. A metodologia utilizada foi essencialmente descritiva e reflexiva, de forma a descrever o pensamento e processo de tomada de decisão desenvolvidos durante este percurso de aquisição e desenvolvimento das competências nos contextos de prática clínica. Os contextos de estágio foram ricos em oportunidades de aprendizagem e permitiram-me desenvolver e adquirir novas competências. Relativamente à aquisição de competências de investigação, foi desenvolvida uma pesquisa científica sobre "Estratégias e dificuldades de comunicação do enfermeiro com o doente crítico e família: scoping review ", a qual se encontra em apêndice a este relatório.

The present work is part of the study plan of the III Master in Nursing-Specialization in Medical- Surgical, of the Semester Curricular Unit, Internship with report of the School of Health of the Polytechnic Institute of Bragança. The curricular unit includes three internship camps, with a total of 540 contact hours dedicated to clinical practice, which took place from September 2019 to February 2020. Clinical teaching was carried out in three services: Hemodialysis Center, Intensive Care Medicine Service (SMI), and Multipurpose Emergency Service (SUP). All these fields involve the care and treatment of the person in a critical situation. The objective of this work is to analyze the evolution throughout clinical teaching, making a critical reflection on the learning achieved and its contributions to the development of knowledge and professional skills. The methodology used was essentially descriptive and reflective, in order to describe the thinking and decision-making process developed during this path of acquisition and development of skills in the contexts of clinical practice. The internship contexts were rich in learning opportunities and allowed me to develop and acquire new skills. Regarding the acquisition of research skills, a scientific research was developed on "Strategies and difficulties of communication between nurses and critically ill patients and families: scoping review", which is attached to this report.

Blood glucose monitoring in critically ill adult patients: type of sample and method of analysis. Systematic review and meta-analysis.

INTRODUCTION: The clinical guideline for the management of sepsis, recommends using arterial blood samples for glycaemic control. A multicentre study in 86 Spanish intensive care units (ICU) revealed that 85.4% of ICUs used capillary puncture. OBJECTIVE: To analyse the reliability of glycaemia by comparing different blood samples (arterial, venous, capillary) and instruments (glucometers, gasometers, central laboratory). Secondarily, to estimate the effect of confounding variables and the performance of measuring instruments as determined by different quality standards. METHODOLOGY: Systematic review and meta-analysis with search in PubMed, CINAHL and Embase databases in September-2021 and September-2022, with no time or language limits. Grey literature sources: DART-Europe, OpenGrey and Google Scholar. Results summarised by qualitative (description of results, study characteristics) and quantitative (meta-analysis to assess standardised mean difference) synthesis. Methodological quality of articles assessed with Quality Assessment of Diagnostic Accuracy Studies-2 (QUADAS-2). PROTOCOL: https://osf.io/ DOI 10.17605/OSF.IO/T8KYP. RESULTS: A total of 32 articles and 5451 patients were included. No discrepancies were obtained between arterial glucometer vs laboratory samples [bias (95%CI): 0.01 (-0.12 to 0.14) mg/dL]. In contrast, arterial samples with a gasometer did significantly overestimate [bias (95%CI): 0.12 (0.01 to 0.24) mg/dL]. The same trend is seen in capillaries with a glucometer, although not significantly [bias (95%CI): 0.07 (--0.02 to 0.15) mg/dL]. There is discrepancy between studies on the effect of haematocrit and acid-base balance. The greatest consensus is on the poor agreement of glucometer with capillary vs laboratory samples in the presence of shock and vasopressor support, renal failure or during vitamin C treatment. CONCLUSIONS: The evidence to date recommends the use of arterial blood with a blood glucose meter for better reliability of glycaemic analysis and less effect of possible confounding variables, frequently present in the critically ill adult patient.

Family burden after critical illness: the forgotten caregivers.

OBJECTIVE: To determine the incidence of primary caregiver burden in a cohort of family members of critically ill patients admitted to ICU and to identify risk factors related to its development in both the patient and the family member. DESIGN: Prospective observational cohort study was conducted for 24 months. SETTING: Hospital Universitario Clínico San Cecilio, Granada. PATIENTS: The sample was the primary caregivers of all patients with risk factors for development of PICS (Post-Intensive Care Syndrome). INTERVENTIONS: The follow-up protocol consisted of evaluation 3 months after discharge from the ICU in a specific consultation. MAIN VARIABLES OF INTEREST: The scales used in patients were Barthel, SF-12, HADS, Pfeiffer, IES-6 and in relatives the Apgar and Zarit. RESULTS: A total of 93 patients and caregivers were included in the follow-up. 15 relatives did not complete the follow-up questionnaires and were excluded from the study. The incidence of PICS-F (Family Post Intensive Care Syndrome) defined by the presence of primary caregiver burden in our cohort of patients is 34.6% (n=27), 95% CI 25.0-45.7. The risk factors for the development of caregiver burden are the presence of physical impairment, anxiety or post-traumatic stress in the patient, with no relationship found with the characteristics studied in the family member. CONCLUSIONS: One out of 3 relatives of patients with risk factors for the development of PICS presents at 3 months caregiver burden. This is related to factors dependent on the patient's state of health.

Correlação entre o índice de resistência vascular e a arteriografia na avaliação do leito arterial distal na isquemia crítica dos membros inferiores / Correlation between the vascular resistance index and arteriography for assessment of the distal arterial bed in chronic limb threatening ischemia

Resumo Contexto Pacientes com isquemia crítica (IC) dos membros inferiores (MMII) precisam de arteriografia para o planejamento da cirurgia de revascularização. A ultrassonografia Doppler (UD) não é invasiva e, através da aferição do índice de resistência (IR), pode fornecer informações sobre as artérias distais. Objetivos Correlacionar a Classificação Angiográfica de Rutherford com o IR na avaliação do leito arterial distal dos MMII. Métodos Estudo transversal, realizado em hospital público terciário, com 120 pacientes portadores de IC dos MMII, entre setembro de 2019 a abril de 2022. Foi comparado o IR das artérias da perna passíveis de serem receptoras de revascularização com a imagem obtida através da arteriografia dessas artérias em acordo com a Classificação Angiográfica de leito distal de Rutherford. Resultados Foram avaliados 120 MMII em 120 pacientes com idade média de 68,6 anos. A amostra foi composta de 50,0% de pacientes do sexo masculino. Na amostra, 90,0% pacientes encontravam-se na classe cinco de Rutherford. Os valores do IR encontrados para as artérias de perna apresentaram uma correlação positiva, estatisticamente significativa, quando comparados com a Classificação de Rutherford (tibial anterior, p< 0,01; tibial posterior, p = 0,012 e fibular, p = 0,034 e artéria dorsal do pé, p < 0,001). Conclusões Neste estudo, os IRs das artérias da perna obtidos através da ultrassonografia Doppler apresentaram uma correlação positiva quando comparados à classificação de Rutherford. Em pacientes com isquemia crítica, esse índice pode ser útil na avaliação do leito arterial distal dos membros inferiores.

Abstract Background Patients with chronic limb threatening ischemia (CLTI) of the lower limbs (LL) undergo arteriography for revascularization surgery planning. Doppler ultrasound (DU) is non-invasive and can provide information about the distal arteries through measurement of the resistance index (RI). Objectives To correlate the Rutherford Angiographic Classification with the RI for assessment of the distal arterial bed of the LL. Methods A cross-sectional study, conducted at a public tertiary hospital with 120 patients with LL CLTI, from September 2019 to April 2022. The RI of arteries that were candidates for revascularization was compared with the images of the same arteries obtained using arteriography, using the Rutherford Angiographic Classification of the distal bed. Results A total of 120 LL were assessed in 120 patients with a mean age of 68.6 years. The sample was 50.0% male and 90.0% of the patients in the sample were classified as Rutherford category five. The RI values found for the arteries of the leg exhibited a statistically significant positive correlation with the Rutherford Classification (anterior tibial, p< 0.01; posterior tibial, p = 0.012 fibular, p = 0.034; and dorsalis pedis, p < 0.001). Conclusions In this study, RIs for the arteries of the leg measured using Doppler ultrasound exhibited a positive correlation with the Rutherford Classification. This index could be useful for assessment of the distal arterial bed of the lower limbs of patients with chronic limb threatening ischemia.

Arterialização venosa superficial com veia safena magna in situ: a experiência de um único centro / Superficial venous arterialization with the great saphenous vein in situ: a single-center experience

Resumo Contexto A arterialização do arco venoso dorsal do pé é uma técnica indicada em casos de isquemia crítica de membros inferiores sem leito distal adequado que possibilite tratamento convencional, como revascularização, angioplastia ou tratamento clínico. Objetivos O propósito do trabalho foi apresentar o resultado da arterialização do arco venoso do pé em 16 pacientes submetidos a essa técnica. Métodos Tratou-se de um estudo analítico descritivo retrospectivo transversal, baseado na revisão de prontuários de 16 pacientes submetidos à arterialização do arco venoso dorsal do pé para salvamento de membro, entre janeiro de 2016 a janeiro de 2021. Resultados Dos 16 pacientes submetidos à arterialização do arco venoso do pé, 25% (4) evoluíram para amputação maior durante a mesma internação, e 6,25% (1) pacientes evoluíram para amputação maior após 6 meses. Os demais pacientes (68,75%, 11) tiveram seus membros preservados, sendo que 10 foram submetidos a amputações menores (pododáctilos e antepé), e 1 paciente não necessitou de procedimento adicional. Conclusões A técnica de arterialização do arco venoso dorsal do pé deve ser considerada em casos selecionados. Trata-se de uma alternativa válida para a preservação do membro na impossibilidade de tratamento convencional.

Abstract Background Arterialization of the dorsal venous arch of the foot is a technique indicated in cases of critical lower limb ischemia that do not have a distal bed that is adequate to enable conventional treatment such as revascularization, angioplasty, or clinical treatment. Objectives The purpose of this study is to present the result of arterialization of the venous arch of the foot in 16 patients who underwent treatment with this technique. Methods This is a cross-sectional retrospective descriptive analytical study based on a review of the medical records of 16 patients who underwent arterialization of the dorsal venous arch of the foot for limb salvage from January 2016 to January 2021. Results Four (25%) of the 16 patients who underwent arterialization of the venous arch of the foot underwent a major amputation during the same hospital stay and one patient (6.25%) had a major amputation within 6 months. The other 11 patients (68.75%) had their limbs preserved, with 10 undergoing minor amputations (toes and forefoot) and one patient having no additional procedures. Conclusions We conclude that the technique of arterialization of the dorsal venous arch of the foot should be considered in selected cases. It is a valid alternative for limb salvage when conventional treatment is impossible.

Donald Trump e o fascismo: uma análise inspirada na teoria crítica / Donald Trump and fascism: an analysis inspired by critical theory / Donald Trump y el fascismo: un análisis inspirado en la teoría crítica / Donald Trump et le fascisme: une analyse inspirée de la théorie critique

Resumo A atuação de Donald Trump durante o período em que esteve na presidência dos Estados Unidos suscita a investigação de possíveis semelhanças entre ele e líderes fascistas do passado. A proposta deste ensaio é apresentar reflexões sobre a atuação política de Trump, inspiradas pelas discussões sobre a psicologia e a propaganda fascista na teoria crítica. Embora pareça impossível tomar Trump por um líder fascista clássico, principalmente em razão de contextos históricos muito diferentes, também é impossível desconsiderar o nexo entre suas estratégias políticas e o modus operandi de agitadores fascistas no século XX. Além disso, é inegável que sua política mobiliza elementos sociopsicológicos que remontam às análises da emergência do fascismo histórico, como a identificação com uma figura idealizada e transcendente, a submissão a uma autoridade ou causa superior e a agressividade direcionada às ameaças do out-group.

Abstract Donald Trump's actions during his presidency calls for an investigation regarding possible similarities between him and fascist leaders of the past. This essay is reflects on Trump's political actions inspired by discussions on fascist psychology and propaganda within Critical Theory. Although Trump may escape the category of a classic fascist leader, mainly due to the different historical contexts, the similarities between his political strategies and those of 20th-century fascist agitators is undeniable. Moreover, his politics mobilize socio-psychological elements that date back to the emergence of historical fascism, such as identification with an idealized and transcendent identity, submission to a superior authority or cause, and aggressiveness directed to out-group threats.

Resumen La actuación de Donald Trump durante el período en el que fue presidente de los Estados Unidos plantea la posibilidad de investigar posibles similitudes entre los líderes fascistas del pasado y él. El propósito de este ensayo es presentar reflexiones sobre la actuación política de Trump inspiradas en discusiones sobre psicología y propaganda fascista en teoría crítica. Si bien parece imposible ver a Trump como un líder fascista clásico, principalmente debido a contextos históricos muy diferentes, también es imposible ignorar el nexo entre sus estrategias políticas y el modus operandi de los agitadores fascistas en el siglo XX. Además, es innegable que su política moviliza elementos sociopsicológicos que se remontan al análisis del surgimiento del fascismo histórico, como la identificación con una identidad idealizada y trascendente, la sumisión a una autoridad o causa superior, y agresividad dirigida a amenazas del out-group.

Résumé Les actions de Donald Trump au cours de sa présidence appellent une enquête sur les similitudes possibles entre lui et les leaders fascistes du passé. Cet essai réfléchit aux actions politiques de Trump en s'inspirant des discussions sur la psychologie et la propagande fasciste au sein de la Théorie Critique. Bien que Trump puisse échapper à la catégorie de leader fasciste classique, principalement en raison de contextes historiques très différents, les similitudes entre ses stratégies politiques et celles des agitateurs fascistes du XXe siècle sont indéniable. En outre, sa politique mobilise des éléments socio-psychologiques qui remontent à l'émergence du fascisme historique, tels que l'identification à une identité idéalisée et transcendante, la soumission à une autorité ou à une cause supérieure, et l'agressivité dirigées vers les menaces du out-group.

Decúbito prono en el tercer trimestre del embarazo durante la era COVID-19: un abordaje transdisciplinar / Prone position in the third trimester of pregnancy during the COVID-19 era: A transdisciplinary approach

Existe evidencia muy limitada respecto del uso de la ventilación en decúbito prono como parte del tratamiento de un síndrome de distrés respiratorio agudo severo para pacientes en periodo de gestación. Actualmente las recomendaciones para el manejo ventilatorio invasivo en esta población son muy escasas y se basan en la extrapolación de las conclusiones obtenidas en estudios de pacientes no gestantes. La literatura disponible asevera que la anatomía y la fisiología de la gestante experimentan complejos cambios adaptativos que deben ser considerados durante el soporte ventilatorio invasivo y el prono. Con la ventilación en decúbito prono, los beneficios obtenidos para el binomio superan ampliamente a los eventuales riesgos. La programación adecuada del ventilador mecánico se correlaciona con un concepto claro y simple: la individualización del soporte. De todas maneras, la decisión del momento oportuno para la interrupción del embarazo debe fundamentarse con un adecuado juicio clínico multidisciplinario y además debe ser respaldado con una estricta monitorización fetal.(AU)

There is very limited evidence regarding the use of prone position as part of the treatment of severe acute respiratory distress syndrome in pregnant patients. Currently, recommendations for invasive ventilatory management in this population are very scarce and are based on the extrapolation of conclusions obtained in studies of non-pregnant patients. The available literature asserts that the anatomy and physiology of the pregnant woman undergoes complex adaptive changes that must be considered during invasive ventilatory support and prone position. With prone ventilation, the benefits obtained for the couple far outweigh the eventual risks. Adequate programming of the mechanical ventilator correlates with a clear and simple concept: individualization of support. In any case, the decision on the timing of termination of pregnancy should be based on adequate multidisciplinary clinical judgment and should be supported by strict monitoring of the product.(AU)

La percepción de la socialización paterna y materna sobre la resiliencia de adolescentes / Paternal and maternal socialization perception on adolescent resilience

La relación con los progenitores es un aspecto clave en el desa-rrollo adolescente, pues el sentimiento de aceptación o rechazo por parte de estos se ha visto relacionado con el ajuste psicológico de la descenden-cia. A su vez, la resiliencia, habitualmente conceptualizada como capacidad para gestionar o adaptarse a los retos y la adversidad, resultaría fundamental para el ajuste en dicho periodo, caracterizado por numerosos cambios y re-tos simultáneos en distintos aspectos vitales. Por ello, el objetivo de este trabajo es analizar la capacidad predictiva de las dimensiones de socializa-ción parental afecto-comunicacióny crítica-rechazosobre la resiliencia adolescen-te. Método:Participan 899 adolescentes (50.4% mujeres) de entre 12 y 19 años (M= 14.68; DT= 1.73). Mediante regresiones lineales se analiza la capacidad predictiva de las dimensiones de socialización parental sobre la resiliencia filial. Resultados:Se comprueba que las dimensiones paternas, es-pecialmente la crítica-rechazo, resultan más significativas a la hora de predecir las puntuaciones en resiliencia. Discusión: Los resultados apuntan a la rele-vancia de la crítica-rechazo sentida por los y las adolescentes, especialmente en el caso de proceder del padre. Se discute la posible interpretación dife-rencial de los y las adolescentes de las dimensiones en función del sexo de los progenitores.(AU)

Parent-child relations are a key aspect in adolescent develop-ment, since feelings of parental acceptance or rejection have been found to be associated with teenagers’ psychological adjustment. Resilience, usually conceptualised as the ability to manage or adapt to challenges and adversi-ty, is a fundamental factor in adjustment during adolescence, a period characterised by numerous simultaneous changes and challenges in differ-ent aspects of life. The aim of the present study is therefore to analyse the predictive capacity of different dimensions of parental socialisation (affec-tion-communication and criticism-rejection) on adolescent resilience. Meth-od:Participants were 899 adolescents (50.4% female), aged 12 to19 years (M= 14.68; SD= 1.73). Linear regressions were performed to analyse the predictive capacity of the different dimensions of parental socialisation on adolescent resilience. Results:Paternal dimensions, especially paternal criti-cism-rejection, were revealed as relevant factors for predicting resilience scores. Discussion:The results point to the important impact of the criti-cism-rejection felt by adolescents, especially if perceived from the father. Different possible interpretations of these dimensions are discussed, in ac-cordance with whether they are perceived from the mother or the fathe.(AU)

Disminución de la debilidad muscular adquirida en una unidad de cuidados intensivos con la implementación de un protocolo multicomponente: ensayo clínico cuasiexperimental

Introducción. La debilidad adquirida en las unidades de cuidados intensivos es una complicación frecuente de los pacientes con enfermedades críticas, que puede tener un impacto negativo en su pronóstico a corto y a largo plazo. Objetivos. Evaluar si la utilización de un protocolo multicomponente, que incluye movilidad activa temprana, manejo efectivo del dolor, reducción de la sedación, medidas no farmacológicas para prevenir el delirium, estimulación cognitiva y apoyo familiar, puede disminuir la incidencia de debilidad adquirida en las unidades de cuidados intensivos al momento del egreso del paciente. Materiales y métodos. Se trata de un ensayo clínico, no aleatorizado, en dos unidades de cuidados intensivos mixtas de un hospital de tercer nivel. Los participantes fueron pacientes mayores de 14 años con ventilación mecánica invasiva por más de 48 horas. Se aplicó como intervención un protocolo multicomponente y como control se utilizó el cuidado usual o estándar. Resultados. Ingresaron 188 pacientes al estudio, 82 al grupo de intervención y 106 al grupo control. La tasa de debilidad adquirida en las unidades de cuidados intensivos al egreso de la unidad fue significativamente menor en el grupo de intervención (41,3 % versus 78,9 %, p<0,00001). La mediana del puntaje de movilidad al momento del alta de la unidad de cuidados intensivos fue mayor en el grupo de intervención (3,5 versus 2, p<0,0138). No se encontraron diferencias estadísticamente significativas en las medianas de días libres de respiración mecánica asistida, ni de unidad de cuidados intensivos al día 28, tampoco en la tasa de mortalidad general al egreso del hospital (18 versus 15 días, p<0,49; 18,2 % versus 27,3 %, p<0,167). Conclusiones. Un protocolo multicomponente que incluía movilidad activa temprana tuvo un impacto significativo en la reducción de la debilidad adquirida en las unidades de cuidados intensivos al egreso en comparación con el cuidado estándar.

Introduction. Intensive care unit-acquired weakness is a frequent complication that affects the prognosis of critical illness during hospital stay and after hospital discharge. Objectives. To determine if a multicomponent protocol of early active mobility involving adequate pain control, non-sedation, non-pharmacologic delirium prevention, cognitive stimulation, and family support, reduces intensive care unit-acquired weakness at the moment of discharge. Materials and methods. We carried out a non-randomized clinical trial in two mixed intensive care units in a high-complexity hospital, including patients over 14 years old with invasive mechanical ventilation for more than 48 hours. We compared the intervention -the multicomponent protocol- during intensive care hospitalization versus the standard care. Results. We analyzed 82 patients in the intervention group and 106 in the control group. Muscle weakness acquired in the intensive care unit at the moment of discharge was less frequent in the intervention group (41.3% versus 78.9%, p<0.00001). The mobility score at intensive unit care discharge was better in the intervention group (median = 3.5 versus 2, p < 0.0138). There were no statistically significant differences in the invasive mechanical ventilation-free days at day 28 (18 versus 15 days, p<0.49), and neither in the mortality (18.2 versus 27.3%, p<0.167). Conclusion. A multi-component protocol of early active mobility significantly reduces intensive care unit-acquired muscle weakness at the moment of discharge.

Violencia urbana, "limpieza social" y conflicto armado en Caldas, 1980-2006

Se abordan las formas de violencia que afectan los contextos urbanos, conocidas como "limpieza social", en el departamento de Caldas entre 1980 y 2006. Estas se analizarán junto con el crecimiento de los grupos armados ilegales, con especial énfasis en el paramilitarismo. El objetivo es evidenciar las estrategias discursivas que se aplican por parte de sectores poderosos para estigmatizar ciertas prácticas y actores sociales, principalmente a través de los medios de comunicación. Se apeló al Análisis Crítico del Discurso, aplicado a los enunciados referentes al fenómeno en cuestión, y se siguieron las tesis de Foucault en lo referente a los dispositivos de normalización y la discriminación entre lo normal y lo anormal en la dinámica de las relaciones de poder También se asume la perspectiva moral que se halla en la base de la "limpieza social" y se postulan las razones de su persistencia. Los resultados muestran un proceso que va de la dispersión a la sistematicidad en relación con el exterminio social y sus manifestaciones discursivas. Las conclusiones dan cuenta de la persistencia del fenómeno en contextos contemporáneos.

The forms of violence that affect urban contexts, generally known as "social cleansing", are addressed in the department of Caldas between 1980 and 2006. These will be analyzed along with the growth of the illegal armed groups, with special emphasis on paramilitarism. The objective is to highlight the discursive strategies that are applied by powerful groups to stigmatize certain practices and social actors, mainly through the media. Critical discourse analysis was used, applied to the statements referring the mentioned phenomenon, and Foucault's thesis regarding normalization devices and discrimination between normal and abnormal in the dynamics of power relations were followed. The moral perspective that is at the base of "social cleansing" is also assumed and the reasons for its persistence are postulated. The results show a process that goes from dispersion to systematicity in relation to social extermination and its discursive manifestations. The conclusions show the persistence of the phenomenon in contemporary contexts.

São abordadas as formas de violência que afetam os contextos urbanos, conhecidas como "limpeza social", no departamento de Caldas entre 1980 e 2006. Elas serão analisadas juntamente com o crescimento de grupos armados ilegais, com ênfase especial no paramilitarismo. O objetivo é destacar as estratégias discursivas aplicadas por setores poderosos para estigmatizar determinadas práticas e atores sociais, principalmente por meio da mídia. A Análise Crítica do Discurso foi aplicada às declarações referentes ao fenômeno em questão, e a tese de Foucault foi seguida em relação aos dispositivos de normalização e à discriminação entre o normal e o anormal na dinâmica das relações de poder. Ela também assume a perspectiva moral que está na base da "limpeza social" e postula as razões de sua persistência. Os resultados mostram um proceso que vai da dispersão à sistematicidade em relação ao extermínio social e suas manifestações discursivas. As conclusões mostram a persistência do fenômeno em contextos contemporâneos.

Relationship between handgrip strength and inspiratory muscles with the success of the spontaneous breathing trial

Introduction: In critically ill patients on mechanical ventilation, the loss of inspiratory and peripheral muscle strength is associated with prolonged mechanical ventilation and failed weaning. Objective: To determine the relationship between handgrip strength and inspiratory muscle strength with the success of the Spontaneous Breathing Trial in adults with ventilatory support greater than 48 hours. Methodology: Prospective observational cross-sectional study performed at a tertiary hospital in Colombia. Handgrip strength and Maximal Inspiratory Pressure were measured once a day before Spontaneous Breathing Trial testing. Pearson's test and Cohen's D test were used to analyze correlations. Results: A total of 51 patients were included, 57% male, with a mean age of 51.9±20 years. A positive correlation was identified between Maximal Inspiratory Pressure and grip strength; and a negative correlation between grip strength and Maximal Inspiratory Pressure with the days of stay in the intensive care unit, (r -0.40; p<0.05) and (r -0.45; p<0.05). Conclusions: Handgrip strength and Maximal Inspiratory Pressure were positively correlated with Spontaneous Breathing Trial success. The importance of these measures to guide ventilator disconnection processes is highlighted.

Introducción: En el paciente críticamente enfermo con ventilación mecánica, la pérdida de la fuerza de los músculos inspiratorios y periféricos se asocia con ventilación mecánica prolongada y destete fallido. Objetivo: Determinar la relación entre la fuerza de prensión manual y la fuerza de músculos inspiratorios con el éxito de la prueba de respiración espontánea en adultos con soporte ventilatorio mayor a 48 horas. Metodología: Estudio prospectivo observacional de corte transversal realizado en un hospital de tercer nivel en Colombia. La fuerza de prensión manual y la presión inspiratoria máxima se midieron una vez al día antes de la prueba de prueba de respiración espontánea. Se utilizaron la prueba de Pearson y la prueba D de Cohen para analizar las correlaciones. Resultados: Se incluyeron 51 pacientes, 57 % de sexo masculino, con una edad promedio de 51,9 ± 20 años. Se identificó una correlación positiva entre Presión Inspiratoria Máxima y fuerza de la mano; y una correlación negativa entre la fuerza de la mano y la Presión Inspiratoria Máxima con los días de estancia en la Unidad de Cuidados Intensivos, (r -0,40; p < 0,05) y (r -0,45;p < 0,05). Conclusiones: La fuerza de prensión manual y la Presión Inspiratoria Máxima se correlacionaron positivamente con el éxito de la Prueba de Respiración Espontánea. Se destaca la importancia de estas mediciones para guiar procesos de desconexión del ventilador.

Estado ácido-base en obstetricia crítica y altitud / Acid-base status in critical care obstetrics at altitude

OBJETIVO: describir el estado ácido base en pacientes obstétricas críticamente enfermas a muy alta altitud, al momento de su ingreso a la Unidad de Cuidados Intensivos. MATERIAL Y MÉTODO: estudio descriptivo transversal. Se incluyen todas las pacientes obstétricas internadas en la Unidad de Cuidados Intensivos Adultos del Hospital del Norte de la ciudad de El Alto, La Paz a 4150 metros sobre el nivel del mar, ingresadas en el periodo enero 2019-enero 2022. RESULTADOS: se ingresaron 79 pacientes, con media de edad de 29 años (desviación estándar 8.06 años), 52 casos (66%) por preeclampsia severa, 14 casos (18%) por hemorragia obstétrica, 8 casos (10%) por sepsis obstétrica y 5 (6%) por diagnósticos diversos como taquicardia supraventricular e intoxicaciones, existieron 8 pacientes fallecidas (10% de mortalidad) destacando la sepsis obstétrica con mayor fallecimiento y mayor tiempo de internación. CONCLUSIÓN: los cambios fisiológicos propios del embarazo, la convierten en una paciente de riesgo, identificando la diferencia de iones fuertes aparente y abreviada como posibles factores pronóstico en la paciente obstétrica en estado crítico. PALABRAS CLAVE: estado acido-base, obstetricia crítica, gran altitud

OBJECTIVE: to describe the acid base status in critically ill obstetric patients at very high altitude, at the time of admission to the Intensive Care Unit. METHODOLOGY: retrospective descriptive study. All obstetric patients admitted to the Adult Intensive Care Unit of the Hospital del Norte in the city of El Alto, La Paz at 4150 meters above sea level, in the period January 2019-January 2022, are included. RESULTS: 79 patients were admitted, with a mean age of 29 years (standard deviation 8.06 years), 52 cases (66%) due to severe preeclampsia, 14 cases (18%) due to obstetric hemorrhage, 8 cases (10%) due to obstetric sepsis. and 5 (6%) due to various diagnoses such as supraventricular tachycardia and poisoning, there were 8 deceased patients (10% mortality), highlighting obstetric sepsis with the highest death rate and longest hospital stay. DISCUSSION: the physiological changes during pregnancy make her a risk patient, identifying the apparent and abbreviated strong ion difference as possible prognostic factors in the critically ill obstetric patient

Measuring ecosystem services and ecological sensitivity for comprehensive conservation in Giant Panda National Park.

China announced the development of its first 5 national parks in 2021, the primary objective of which is to conserve the natural state and integrity of natural ecosystems. As such, ecosystem services and biodiversity levels are crucial assessment factors for the parks. For Giant Panda National Park (GPNP), we evaluated ecological sensitivity based on water and soil erosion and rocky desertification; ecosystem services based on headwater conservation, soil and water conservation, and biodiversity conservation; and presence of giant panda (Ailuropoda melanoleuca) and sympatric species (e.g., takin [Budorcas taxicolor], Asiatic black bear [Ursus thibetanus]) habitat suitability derived from niche modeling to identify the ecosystem status and assess ecological problems within the park. From our results, we proposed ecologically critical areas to target to meet the park's goals. The suitable habitat for pandas and sympatric species encompassed 62.98% of the park and occurred mainly in the Minshan Mountains. One quarter of the total area (25.67%) contained areas important for ecosystem services. Ecologically sensitive and extremely sensitive areas covered 88.78% of the park and were distributed mainly in Qionglaishan and Minshan Mountains. This coverage indicated that there was much habitat for pandas and sympatric species but that the ecosystems in GPNP are vulnerable. Therefore, ecologically critical areas encompassed all suitable habitats for all the species examined and areas important and extremely important to ecosystem service provision,ecologically sensitive and extremely sensitive areas, encompassed 15.17% of panda habitat, accounted for 16.37% of the GPNP area, and were distributed mainly in the Minshan Mountains. Our results indicated where conservation efforts should be focused in the park and that by identifying ecologically critical areas managers can provide targeted protection for wildlife habitat and ecosystems and effectively and efficiently protect the composite ecosystem. Additionally, our methods can be used to inform development of new national parks.

Medición de los servicios ambientales y la sensibilidad ecológica para una conservación integral en el Parque Nacional del Panda Gigante Resumen China anunció el crecimiento de sus primeros cinco parques nacionales en 2021, con el objetivo principal de conservar el estado natural y la integridad de los ecosistemas naturales. Para ello, los servicios ambientales y los niveles de biodiversidad son factores cruciales de evaluación para los parques. Para poder identificar el estado del ecosistema y evaluar los problemas ecológicos dentro del Parque Nacional del Panda Gigante (PNPG), analizamos la sensibilidad ecológica con base en la erosión del agua y del suelo y la desertificación rocosa; los servicios ambientales con base en el suministro de conservación del agua, del agua y del suelo y de la biodiversidad; y la idoneidad de hábitat del panda gigante (Ailuropoda melanoleuca) y de especies simpátricas (takín [Budorcas taxicolor], oso negro asiático [Ursus thibetanus]) derivada del modelo de nichos. A partir de nuestros resultados proponemos enfocarnos en áreas ecológicamente críticas para lograr los objetivos del parque. El hábitat idóneo para los pandas y las especies simpátricas englobó el 62.98% del parque y se ubicó principalmente en las montañas Minshan. Un cuarto del área total (25.67%) albergó áreas importantes para los servicios ambientales. Las áreas ecológicamente sensibles y extremadamente sensibles cubrieron el 88.78% del parque y se distribuyeron en las montañas Minshan y Qionglaishan. Esta cobertura indica que hay bastante hábitat para los pandas y las especies simpátricas pero que los ecosistemas en el PNPG son vulnerables. Por lo tanto, las áreas ecológicamente críticas englobaron todos los hábitats para todas las especies analizadas y todas las áreas importantes y extremadamente importantes para el suministro de servicios ambientales. Las áreas ecológicamente sensibles y extremadamente sensibles englobaron el 15.17% del hábitat del panda, representaron el 16.37% del área del PNPG y se localizaron principalmente en las montañas Minshan. Nuestros resultados indican en dónde se deben enfocar los esfuerzos de conservación dentro del parque y que, si identificamos las áreas ecológicamente críticas, los gestores pueden proporcionar una protección focalizada para el hábitat y los ecosistemas y así proteger efectiva y eficientemente el ecosistema compuesto. Además, nuestro método puede usarse para guiar el desarrollo de nuevos parques nacionales.

大熊猫国家公园能实现物种和生态完整性的多重保护 中国在2021年宣布设立首批5个国家公园, 保护自然生态系统的真实性和完整性是其优先目标, 而生态系统服务和生物多样性水平是关键的评估要素。大熊猫国家公园作为首批唯一以单一物种命名的国家公园, 通过评估其生态系统服务、生态敏感性, 同时结合大熊猫及同域分布物种(羚牛、亚洲黑熊)的栖息地适宜性, 以揭示其国家公园内生态系统的状态及其面临的问题, 明确其生态关键区以实现多重保护的目标。我们发现大熊猫国家公园包含了超过62.98%的大熊猫和同域物种的适宜栖息地, 主要分布在岷山山系;其次, 大熊猫国家公园包含了25.67%的生态系统服务重要区域和高达88.78%的生态敏感区域, 主要分布在岷山山系和邛崃山山系。这表明尽管大熊猫国家公园内包含了大熊猫及同域物种所需的大面积适宜栖息地, 但是其生态系统具有较强的脆弱性。若将同时包含大熊猫及同域物种的适宜栖息地、生态系统服务重要和极重要区、生态敏感和极敏感的区域定义为生态关键区, 其面积占比为16.37%, 覆盖了15.17%的大熊猫栖息地, 主要分布在岷山山系。因此, 基于生态关键区制定新的科学的、针对性的保护措施, 不仅可以更好的来保护野生动物栖息地和应对生态系统的威胁, 而且也有效且高效地保护多重生态系统。.

[Prognostic utility of inflammatory indexes in critically ill newborns]. / Utilidad pronóstica de los índices inflamatorios en recién nacidos críticamente enfermos.

Background: Critically ill newborns (NB) are susceptible to serious complications due to their immature immune system. Objective: To know the prognostic utility of inflammatory indexes in critically ill NBs. Material and methods: Observational, analytical, longitudinal, prospective study. We included NBs hospitalized, critically ill and non-critically ill, who had a complete blood count at 12 hours of life (initial) and within 24 hours prior to discharge due to improvement or death (final). Systemic immune-inflammatory Index (SII), Neutrophil/Lymphocyte Ratio (NLR) and Platelets/Lymphocyte Ratio (PLR) were analyzed. There was follow-up from birth to discharge. Results: 211 patients of 33 (32-34) weeks of gestation, weight 1.569 (1.480-1.720) kg. 106 critical NB and 105 non-critical NB, with 50 deaths in the former group, were analyzed. The final NLR ≥ 1.38 (sensitivity [S] 58%, specificity [Sp] 58%, AUC 0.60 [p 0.006]) identified critically ill NBs compared to non-critical ill NBs; final NLR ≥ 1.84 (S 71%, Sp 71%, AUC 0.79 [p < 0.0001]) identified critically ill NBs who died compared to all those who survived; final SII ≥ 255.411 x 103 (S 55%, Sp 56%, AUC 0.60 [p 0.047]) and final NLR ≥ 1.75 (S 76%, Sp 76%, AUC 0.84 [p < 0.0001]) identified critical NBs who died from those who survived. Conclusion: The final NLR predicts which NBs may perish with respect to all who survive. The final NLR and SII predict among critically ill NBs who may die.

Introducción: los recién nacidos (RN) críticamente enfermos son susceptibles de mal pronóstico debido a su sistema inmunitario inmaduro. Objetivo: conocer la utilidad pronóstica de los índices inflamatorios en RN críticamente enfermos. Material y métodos: estudio observacional, analítico, longitudinal, prospectivo. Incluimos RN hospitalizados, críticamente enfermos y no críticos, que contaran con biometría hemática completa a las 12 horas de vida (inicial) y dentro de las 24 horas previas al egreso por mejoría o defunción (final). Se analizó el Índice inmunosistémico (IIS), neutrófilos linfocitos (INL) y plaquetas linfocitos (IPL). Hubo seguimiento desde el nacimiento hasta el egreso. Resultados: se analizaron 211 pacientes, de 33 (32-34) semanas de gestación, peso 1.569 (1.480-1.720) kg; 106 RN críticos y 105 no críticos, con 50 defunciones en los primeros. El INL final ≥ 1.38 (sensibilidad [S] 58%, especificidad [E] 58%, ABC 0.60 [p 0.006]) identificó RN críticamente enfermos con respecto a RN no críticos; INL final ≥1.84 (S 71%, E 71%, ABC 0.79 [p < 0.0001]) identificó RN críticamente enfermos que fallecieron con respecto a todos los que sobrevivieron; el IIS final ≥ 255.411 x 103 (S 55%, E 56%, ABC 0.60 [p 0.047]) e INL final ≥ 1.75 (S 76%, E 76%, ABC 0.84 [p < 0.0001]) identificaron a RN críticamente enfermos que fallecieron con respecto a los que sobrevivieron. Conclusiones: el INL final predice que RN pueden fallecer con respecto a todos los que sobreviven. El INL y el IIS finales predicen entre los RN críticamente enfermos quiénes pueden fallecer.