RESUMO
We herein review the association between patients safety and simulation methods for medical education. This evidence should help to change the present paradigm in medical education, where there is still reticence towards this education method. A total of 20 papers on the subject were reviewed. Ninety percent of these articles conclude that simulation contributes to patient safety, 5% conclude that the evidence is uncertain and 5% conclude that the effects will be seen in the next decade. Thus, the majority of papers support the use of simulation in medical education as a method that improves patients safety.
Assuntos
Educação Médica/métodos , Segurança do Paciente , Simulação de Paciente , Educação Médica/normas , Humanos , Treinamento por Simulação/métodosRESUMO
OBJECTIVE: Extracorporeal membrane oxygenation (ECMO) affords mechanical circulatory assistance associated to high mortality. However, weaning from such mechanical support may not imply improved short- or long-term survival. This study describes the characteristics and evolution of patients with refractory cardiogenic shock (RCS) subjected to venoarterial ECMO (VA-ECMO) in a hospital with a heart transplant program. DESIGN: A single-center, retrospective cohort study was carried out. SETTING: The cardiovascular ICU of a tertiary hospital. PATIENTS: Forty-six patients consecutively subjected to VA-ECMO over 6 years. INTERVENTIONS: Hospital mortality after weaning from ECMO and overall survival (OS) were analyzed. RESULTS: Fifteen patients (33%) died with VA-ECMO and 31 (67%) were weaned after 8 days of support (IQR: 5-15). Fourteen patients under went transplantation. Hospital mortality in these patients was 32% (10/31), and was associated to age (P=.001), SAPS II score (P=.009), cannulation bleeding (P=.01) and post-acute myocardial infarction RCS (P=.001). After a median follow-up of 27 months (IQR: 11-49), 91% of the patients discharged from hospital were still alive. Overall survival after weaning from assistance was associated to the type of cardiac disease (P=.002). Patients with RCS after acute myocardial infarction had a poorer prognosis. CONCLUSIONS: In our experience, VA-ECMO can be used as mechanical assistance in the management of RCS. The technique is associated to high early mortality, though the long-term survival rate after hospital discharge is good.
Assuntos
Oxigenação por Membrana Extracorpórea/métodos , Choque Cardiogênico/terapia , Desmame do Respirador , Adulto , Idoso , Dano Encefálico Crônico/etiologia , Comorbidade , Feminino , Seguimentos , Transplante de Coração , Hemorragia/etiologia , Mortalidade Hospitalar , Humanos , Estimativa de Kaplan-Meier , Tempo de Internação/estatística & dados numéricos , Masculino , Pessoa de Meia-Idade , Infarto do Miocárdio/complicações , Infarto do Miocárdio/mortalidade , Prognóstico , Estudos Retrospectivos , Índice de Gravidade de Doença , Choque Cardiogênico/etiologia , Choque Cardiogênico/mortalidade , Choque Cardiogênico/cirurgiaRESUMO
Intravenous immunoglobulin (IVIg) therapy has multiple mechanisms of immunomodulatory action. We wished therefore to assess its efficacy in a spectrum of patients with refractory uveitis. Retrospective review of clinical charts was conducted to document response to IVIg treatment in consecutive patients with treatment-refractory uveitis. Main outcome measures were control of intraocular inflammation, visual acuity, progression of the disease, and complications. Four (two male) patients, with a mean age at the beginning of the treatment of 47 years (range: 39-64), were included in the study. Indication for treatment was patients with active non-infectious uveitis refractory to steroids and immunomodulatory therapy. All patients received a course of 0.5 g/kg per day of IVIg for three consecutive days, repeating this course at a mean of 11 week (range: 2-39 weeks) intervals when indicated clinically. The median duration of the IVIg therapy was 7 months (range: 3-14 months). In three patients treatment resulted in stabilisation and prevention of progression of the disease, and additionally in two patients it facilitated a decrease in prednisolone dose. Treatment failed to induce long-term remission in one patient with recurrence of macular oedema. IVIg was well tolerated with neither immediate nor longer-term adverse events observed. In three out of four cases IVIg was an effective adjunctive therapy and well tolerated for the management of treatment-refractory uveitis.
Assuntos
Imunoglobulinas Intravenosas/administração & dosagem , Fatores Imunológicos/administração & dosagem , Uveíte/tratamento farmacológico , Adulto , Progressão da Doença , Feminino , Humanos , Injeções Intravenosas , Masculino , Pessoa de Meia-Idade , Estudos Retrospectivos , Acuidade VisualRESUMO
PURPOSE: To describe a case of anterior scleritis related to SARS-CoV-2 vaccine. SARS-CoV-2 vaccines appear safe; however vaccination has triggered thromboembolic events in predisposed patients. METHODS: A retrospective case report of anterior scleritis in a woman following administration of both ChAdOx1nCoV-19 vaccine doses was studied by complete ophthalmologic examination and complementary tests. RESULTS: The patient has overcome SARS-CoV-2 infection a year prior. Ancillary tests including autoimmune and infectious diseases were negative. The chronology between ChAdOx1nCoV-19 vaccine and the sequential episodes of scleritis may have a cause-and-effect relationship. CONCLUSION: Ophthalmologists may be aware of scleritis as an ocular manifestation following ChAdOx1nCoV-19 vaccine, in otherwise healthy patients.
Assuntos
Vacinas contra COVID-19 , COVID-19 , Esclerite , Feminino , Humanos , ChAdOx1 nCoV-19 , Vacinas contra COVID-19/efeitos adversos , Estudos Retrospectivos , SARS-CoV-2 , Esclerite/induzido quimicamente , Esclerite/diagnóstico , Vacinação/efeitos adversosRESUMO
BACKGROUND AND OBJECTIVES: Stargardt disease produces lipofuscin accumulation predisposing to subretinal fibrosis (SRFib) after ocular trauma. Noninvasive imaging techniques allow in vivo assessment. The purpose of this study is to determine the prevalence of SRFib in a cohort of Stargardt patients, the presence of history of ocular trauma, the clinical features and possible genotype-phenotype associations in Stargardt patients with SRFib. METHODS: We evaluated retrospectively 106 Stargardt patients and analysed the multimodal imaging and the genotype of patients with SRFib. RESULTS: Six patients exhibited SRFib, three of them with history of ocular trauma. Multimodal imaging showed extensive SRFib principally in the temporal midperipheral retina with no fluid associated. SRFib was better defined by short wavelength autofluorescence and spectral domain optical coherence tomography and appeared clinically stable over time. There was no particular genotype associated to SRFib. CONCLUSION: SRFib occurs in a significant percentage of patients with Stargardt disease and can be diagnosed through multimodal imaging regardless the history of trauma, further sustaining the importance of an appropriate imaging in such patients. No genotype-phenotype association has been established, supporting the traumatic etiology in half of cases. The remaining cases may be classified as idiopathic or have a minimal trauma occurring early in life that may be not recalled by the patients.
Assuntos
Lipofuscina , Tomografia de Coerência Óptica , Fibrose , Angiofluoresceinografia/métodos , Humanos , Imagem Multimodal , Fenótipo , Prevalência , Estudos Retrospectivos , Doença de Stargardt , Tomografia de Coerência Óptica/métodosRESUMO
The rocky shores in Chile have a wide invertebrate species diversity, that include species with marked abundances in determined regions. The aim of the present study is to analyse the spatial distribution pattern in different marine invertebrate species in rocky shore of Araucania region, considering if these species have random, uniform or associated patterns, and extrapolate if these patterns have Poisson, binomial or negative binomial distribution respectively. The results revealed the presence mainly of gastropods molluscs that would graze on benthic algae, these species have mainly aggregated pattern that has a robust negative binomial distribution pattern. The obtained results agree with observations for marine benthic fauna that mentioned the presence of aggregated pattern, has negative binomial distribution. Other ecological topics about spatial distribution were discussed.
Assuntos
Gastrópodes , Invertebrados , Animais , Organismos Aquáticos , Chile , EcossistemaRESUMO
OBJECTIVE: To investigate the association between four polymorphisms of the 5-HT(2A) receptor and 5-HT transporter genes and heroin dependence. METHODS: 113 heroin- dependent patients (DSM-IV criteria) and 420 unrelated healthy controls from Asturias (Northern Spain) were genotyped using standard methods. RESULTS: There was an apparent difference in the distribution of genotypes for A-1438G polymorphisms (p = 0.024, not significant after Bonferroni correction). The 5-HT(2A) -1438A allele was significantly more common in patients than controls [0.55 and 0.45, respectively; corrected p = 0.042, OR = 1.51 (95% CI = 1.13-2.03)]. An interaction was observed between A-1438G of 5-HT(2A) and 5-HTT polymorphisms. The association between the -1438AA vs. AG/GG genotypes and heroin dependence was enhanced in the presence of 12-repeat 5-HTT VNTR and short 5-HTTLPR alleles [24.8% in heroin-dependent patients vs. 12.6% in controls; corrected p = 0.045, OR = 2.28 (95% CI = 1.36-3.82)]. CONCLUSIONS: Our findings support a contribution of the 5-HT(2A) gene to susceptibility to heroin dependence, as well as a possible synergistic effect of 5-HT(2A) and 5-HTT genes on susceptibility to heroin dependence.
Assuntos
Dependência de Heroína/genética , Polimorfismo Genético/genética , Receptor 5-HT2A de Serotonina/genética , Adulto , Alelos , Cromossomos Humanos Par 17/genética , Manual Diagnóstico e Estatístico de Transtornos Mentais , Feminino , Genótipo , Dependência de Heroína/diagnóstico , Dependência de Heroína/epidemiologia , Humanos , Masculino , Proteínas da Membrana Plasmática de Transporte de Serotonina/genéticaRESUMO
PurposeThe aim of this study was to determine a sequence of structural changes in acute posterior multifocal placoid pigment epitheliopathy (APMPPE) using optical coherence tomography-angiography (OCT-A) and comparing with other imaging modalities.Patients and methodsPatients with a new diagnosis of acute-onset APMPPE referred to a regional specialist centre from October 2015 to October 2016 were included. Multimodal imaging employed on all patients from diagnosis included the following: fundus fluorescein angiography, indocyanine green angiography, fundus autofluorescence, spectral domain-OCT (SD-OCT), and OCT-A. All non-invasive imaging processes were repeated during follow-up.ResultsTen eyes of five patients were included in the study, three males and two females, with a mean age of 26.2 years (range: 21-32) and a mean follow-up of 6.4 months (range: 2.6-13.3). All patients presented with bilateral disease and macular involving lesions. OCT-A imaging of the choriocapillaris was supportive of hypoperfusion at the site of APMPPE lesions during the acute phase of this condition with normalisation of choroidal vasculature during follow-up. Multimodal imaging consistently highlighted four sequential phases from presentation to resolution of active disease.ConclusionsMultimodal imaging in patients with APMPPE in acute and long-term follow-up demonstrates a reversible choroidal hypoperfusion supporting the primary inciting pathology as a choriocapillaritis. The evolution shows resolution of the ischaemia through a defined sequence that results in persistent changes at the level of the retinal pigment epithelium and outer retina. OCT-A was able to detect preclinical changes and chart resolution at the level of the choriocapillaris.
Assuntos
Corioidite/diagnóstico , Angiofluoresceinografia/métodos , Macula Lutea/patologia , Imagem Multimodal , Segmento Posterior do Olho/patologia , Tomografia de Coerência Óptica/métodos , Doença Aguda , Adulto , Corioidite/fisiopatologia , Progressão da Doença , Feminino , Seguimentos , Fundo de Olho , Humanos , Masculino , Coroidite Multifocal , Reprodutibilidade dos Testes , Epitélio Pigmentado da Retina/patologia , Estudos Retrospectivos , Acuidade Visual , Adulto JovemRESUMO
The rocky shores in Chile have a wide invertebrate species diversity, that include species with marked abundances in determined regions. The aim of the present study is to analyse the spatial distribution pattern in different marine invertebrate species in rocky shore of Araucania region, considering if these species have random, uniform or associated patterns, and extrapolate if these patterns have Poisson, binomial or negative binomial distribution respectively. The results revealed the presence mainly of gastropods molluscs that would graze on benthic algae, these species have mainly aggregated pattern that has a robust negative binomial distribution pattern. The obtained results agree with observations for marine benthic fauna that mentioned the presence of aggregated pattern, has negative binomial distribution. Other ecological topics about spatial distribution were discussed.(AU)
As costas rochosas no Chile têm uma ampla diversidade de espécies de invertebrados, que incluem espécies com abundância marcada em determinadas regiões. O objetivo do presente estudo é analisar o padrão de distribuição espacial em diferentes espécies de invertebrados marinhos na costa rochosa da região de Araucanía, considerando se essas espécies possuem padrões aleatórios, uniformes ou associados, e extrapolar se esses padrões possuem distribuição binomial de Poisson, binomial ou negativa. respectivamente. Os resultados revelaram a presença principalmente de moluscos gastrópodes que pastam em algas bentônicas, estas espécies têm principalmente agregado padrão que tem um padrão robusto de distribuição binomial negativa, padrão agregado de grupos, e a fauna de água doce que apresenta distribuição binomial negativa. Outros tópicos ecológicos sobre distribuição espacial foram discutidos.(AU)
Assuntos
Animais , Moluscos/classificação , Características de Residência , Distribuição BinomialRESUMO
Abstract The rocky shores in Chile have a wide invertebrate species diversity, that include species with marked abundances in determined regions. The aim of the present study is to analyse the spatial distribution pattern in different marine invertebrate species in rocky shore of Araucania region, considering if these species have random, uniform or associated patterns, and extrapolate if these patterns have Poisson, binomial or negative binomial distribution respectively. The results revealed the presence mainly of gastropods molluscs that would graze on benthic algae, these species have mainly aggregated pattern that has a robust negative binomial distribution pattern. The obtained results agree with observations for marine benthic fauna that mentioned the presence of aggregated pattern, has negative binomial distribution. Other ecological topics about spatial distribution were discussed.
Resumo As costas rochosas no Chile têm uma ampla diversidade de espécies de invertebrados, que incluem espécies com abundância marcada em determinadas regiões. O objetivo do presente estudo é analisar o padrão de distribuição espacial em diferentes espécies de invertebrados marinhos na costa rochosa da região de Araucanía, considerando se essas espécies possuem padrões aleatórios, uniformes ou associados, e extrapolar se esses padrões possuem distribuição binomial de Poisson, binomial ou negativa. respectivamente. Os resultados revelaram a presença principalmente de moluscos gastrópodes que pastam em algas bentônicas, estas espécies têm principalmente agregado padrão que tem um padrão robusto de distribuição binomial negativa, padrão agregado de grupos, e a fauna de água doce que apresenta distribuição binomial negativa. Outros tópicos ecológicos sobre distribuição espacial foram discutidos.
Assuntos
Animais , Gastrópodes , Invertebrados , Chile , Ecossistema , Organismos AquáticosRESUMO
Preoperative radiation therapy is one of the major indications for the use of ionizing radiation in the treatment of malignant disease. The preoperative application of radiation treatment is given with the intention of reducing the size of bulky cancers, thus converting unresectable tumors into resectable ones. Other benefits are reduction in the risk of locoregional recurrence and in the risk of blood-borne dissemination of malignant cells promoted during surgical resection.This paper presents and discusses three cases of unresectable intrapelvic tumors initially treated by radiation therapy with the primary goal of palliation. These three cases included rectal, cecal, and uterine carcinoma. In each case, a preoperative radiation dose of 4500 to 5000 cGy was delivered. Evaluations during and after the completion of the radiation treatments revealed that the tumor responded remarkably well to the treatment, which encouraged the surgical intervention; at surgery, minimal tumor was found. These three patients are alive to date without apparent evidence of disease.
Assuntos
Neoplasias/terapia , Idoso , Neoplasias do Ceco/terapia , Terapia Combinada , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Neoplasias/radioterapia , Neoplasias/cirurgia , Neoplasias Retais/terapia , Neoplasias Uterinas/terapiaRESUMO
RSP (Radioecological Software Package) is an interactive support system that simulates the behaviour of radionuclides in semi-natural environments and the consequences on the population in terms of the external exposure. RSP consists of three modules: the first one, soil mobility, simulates the vertical transport of radionuclide in soil using the mathematical model RABES. The second module, soil -to-plant transfer, simulates the radionuclide soil-to-plant transfer factor reported in the literature. Soil properties, vegetation types and environmental conditions are taken into consideration in the simulation process. In the third module, dose assessment, the dose-rate factor in air at a height of 1 m above ground can be calculated for sources distributed in a slab of finite thickness dn sources which are exponentially distributed with depth. The calculations are performed using DAGES Model, a Monte Carlo algorithm developed to simulated the photon transport for the soil/air configuration. A free copy of RSP can be downloaded from the website: http://imasl-apat.unsl.edu.ar.
Assuntos
Meio Ambiente , Modelos Teóricos , Radioisótopos/análise , Software , Poluentes Radioativos do Ar/análise , Algoritmos , Método de Monte Carlo , Radioisótopos/farmacocinética , Solo/análiseRESUMO
We analyzed the tissue oxygen extraction in 25 patients with acute respiratory failure. Fourteen met the clinical criteria for the adult respiratory distress syndrome (ARDS). The 11 remaining patients had acute respiratory failure with causes different from ARDS. In all cases the changes in the oxygen extraction ratio (O2ER) and in the oxygen consumption (VO2) were evaluated after changing oxygen availability (O2A) with positive end-expiratory pressure (PEEP) and dobutamine infusion. The patients with ARDS showed a change in VO2 parallel to O2A changes, with a significant correlation (r = 0.85); however, no changes were found in O2ER (r = 18). In the patients without ARDS, the changes in O2A did not modify the VO2 (r = 0.02) but there was a significant inverse relationship between DO2 and O2ER (r = -0.70). These findings suggest an abnormal regulation of tissue oxygen extraction and an abnormal dependence of VO2 on O2A in cases with ARDS. Dobutamine therapy, in addition to inotropic effects, could improve a situation of hidden hypoxia, as it is a vasodilator that might act on microvasculature.
Assuntos
Consumo de Oxigênio/fisiologia , Síndrome do Desconforto Respiratório/metabolismo , Insuficiência Respiratória/metabolismo , Doença Aguda , Adulto , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Respiração com Pressão Positiva , Síndrome do Desconforto Respiratório/fisiopatologia , Insuficiência Respiratória/fisiopatologiaRESUMO
Abstract The rocky shores in Chile have a wide invertebrate species diversity, that include species with marked abundances in determined regions. The aim of the present study is to analyse the spatial distribution pattern in different marine invertebrate species in rocky shore of Araucania region, considering if these species have random, uniform or associated patterns, and extrapolate if these patterns have Poisson, binomial or negative binomial distribution respectively. The results revealed the presence mainly of gastropods molluscs that would graze on benthic algae, these species have mainly aggregated pattern that has a robust negative binomial distribution pattern. The obtained results agree with observations for marine benthic fauna that mentioned the presence of aggregated pattern, has negative binomial distribution. Other ecological topics about spatial distribution were discussed.
Resumo As costas rochosas no Chile têm uma ampla diversidade de espécies de invertebrados, que incluem espécies com abundância marcada em determinadas regiões. O objetivo do presente estudo é analisar o padrão de distribuição espacial em diferentes espécies de invertebrados marinhos na costa rochosa da região de Araucanía, considerando se essas espécies possuem padrões aleatórios, uniformes ou associados, e extrapolar se esses padrões possuem distribuição binomial de Poisson, binomial ou negativa. respectivamente. Os resultados revelaram a presença principalmente de moluscos gastrópodes que pastam em algas bentônicas, estas espécies têm principalmente agregado padrão que tem um padrão robusto de distribuição binomial negativa, padrão agregado de grupos, e a fauna de água doce que apresenta distribuição binomial negativa. Outros tópicos ecológicos sobre distribuição espacial foram discutidos.
RESUMO
Abstract The rocky shores in Chile have a wide invertebrate species diversity, that include species with marked abundances in determined regions. The aim of the present study is to analyse the spatial distribution pattern in different marine invertebrate species in rocky shore of Araucania region, considering if these species have random, uniform or associated patterns, and extrapolate if these patterns have Poisson, binomial or negative binomial distribution respectively. The results revealed the presence mainly of gastropods molluscs that would graze on benthic algae, these species have mainly aggregated pattern that has a robust negative binomial distribution pattern. The obtained results agree with observations for marine benthic fauna that mentioned the presence of aggregated pattern, has negative binomial distribution. Other ecological topics about spatial distribution were discussed.
Resumo As costas rochosas no Chile têm uma ampla diversidade de espécies de invertebrados, que incluem espécies com abundância marcada em determinadas regiões. O objetivo do presente estudo é analisar o padrão de distribuição espacial em diferentes espécies de invertebrados marinhos na costa rochosa da região de Araucanía, considerando se essas espécies possuem padrões aleatórios, uniformes ou associados, e extrapolar se esses padrões possuem distribuição binomial de Poisson, binomial ou negativa. respectivamente. Os resultados revelaram a presença principalmente de moluscos gastrópodes que pastam em algas bentônicas, estas espécies têm principalmente agregado padrão que tem um padrão robusto de distribuição binomial negativa, padrão agregado de grupos, e a fauna de água doce que apresenta distribuição binomial negativa. Outros tópicos ecológicos sobre distribuição espacial foram discutidos.
RESUMO
AIMS: The aim of this study was to correlate the activity status disclosed in fluorescein angiography (FA) and fundus autofluorescence (FAF) imaging, and the variations of FAF images in the evolution of serpiginous choroidopathy (SC) and serpiginous-like choroidopathy (SLC). METHODS: Prospective consecutive case series. Patients with SC or SLC were included from July 2009 to December 2010. All patients underwent FAF imaging (Spaide Autofluorescence Filters, Topcon TRC 50IX) and FA (Topcon TRC 50IX). RESULTS: Twelve patients (eight males, mean age 51.2 years) were included. Bilateral involvement in nine cases. Three different patterns of FAF images were present: active inflammation, transitional, and inactive inflammation. CONCLUSION: FAF may be a useful tool for following patients with SC and SLC. It is possible to reserve other invasive techniques, such as FA, for cases with suspicious activity disclosed by FAF imaging.
Assuntos
Corioidite/diagnóstico , Angiofluoresceinografia , Epitélio Pigmentado da Retina/patologia , Adulto , Idoso , Feminino , Fundo de Olho , Humanos , Masculino , Pessoa de Meia-Idade , Projetos Piloto , Estudos ProspectivosRESUMO
PURPOSE: The aim of this study was to determine the prevalence of ocular and oculodermal melanocytosis (ODM) among patients with uveal melanoma (UM) in a Spanish population. METHODS: Retrospective review of the medical records of patients with ODM among patients with UM. RESULTS: Ten (11 eyes) of 400 patients (2.7%) with UM associated had ODM. The mean age at diagnosis of UM among patients with ODM was 62 years. One patient had bilateral tumours. UM was diagnosed during a routine-examination in two cases. All tumours were medium (7/11) or large (4/11) in size, with a mean maximum base of 13 mm and height of 7 mm. No patient had extraocular extension or metastatic disease at diagnosis. Enucleation was done in five cases and I-125-brachytherapy in six. The mean follow-up was 43 months. One patient died because of metastasis 2 years after enucleation; one patient is currently on treatment of systemic metastasis 11 years after. CONCLUSIONS: ODM is more frequent in spanish population with UM than in American population. Despite the risk of UM in ODM, it is often diagnosed late when a conservative treatment is not indicated.
Assuntos
Braquiterapia , Melanoma/epidemiologia , Melanose/epidemiologia , Neoplasias Cutâneas/epidemiologia , Neoplasias Uveais/epidemiologia , Adulto , Idoso , Idoso de 80 Anos ou mais , Detecção Precoce de Câncer , Enucleação Ocular/estatística & dados numéricos , Feminino , Humanos , Masculino , Melanoma/radioterapia , Melanoma/cirurgia , Melanose/radioterapia , Melanose/cirurgia , Pessoa de Meia-Idade , Prevalência , Prognóstico , Estudos Retrospectivos , Neoplasias Cutâneas/radioterapia , Neoplasias Cutâneas/cirurgia , Espanha/epidemiologia , Resultado do Tratamento , Neoplasias Uveais/radioterapia , Neoplasias Uveais/cirurgia , Acuidade VisualRESUMO
We herein review the association between patients safety and simulation methods for medical education. This evidence should help to change the present paradigm in medical education, where there is still reticence towards this education method. A total of 20 papers on the subject were reviewed. Ninety percent of these articles conclude that simulation contributes to patient safety, 5% conclude that the evidence is uncertain and 5% conclude that the effects will be seen in the next decade. Thus, the majority of papers support the use of simulation in medical education as a method that improves patients safety.
Assuntos
Humanos , Simulação de Paciente , Educação Médica/métodos , Segurança do Paciente , Educação Médica/normas , Treinamento por Simulação/métodosRESUMO
Objetivo: La membrana de oxigenación extracorpórea (ECMO) es un tipo de asistencia circulatoria que asocia elevada mortalidad. Sin embargo, superar la fase inicial de soporte mecánico no implica supervivencia ni a corto ni a largo plazo. Objetivo: describir las características y evolución de los pacientes con shock cardiogénico refractario (SCR) asistidos con ECMO veno-arterial (ECMO-VA) en un hospital con programa de trasplante cardíaco. Diseño: Estudio de cohortes y retrospectivo de centro único. Ámbito: UCI cardiológica de un hospital terciario. Pacientes: Un total de 46 pacientes asistidos consecutivamente con una ECMO-VA durante 6 años. Intervenciones: Análisis de la mortalidad hospitalaria tras la retirada del soporte mecánico, de la supervivencia global (SG) y de los factores asociados. Resultados: Quince pacientes (33%) fallecieron con la ECMO-VA y 31 (67%) sobrevivieron a su retirada tras un soporte de 8 días (RIC: 5-15); 14 pacientes fueron trasplantados. La mortalidad hospitalaria en estos pacientes fue del 32% (10/31) y se relacionó con: edad (p=0,001), SAPS-II (p=0,009), sangrado de cánulas (p=0,01), indicación de SCR post-IAM (p=0,001). Con una mediana de seguimiento de 27 meses (RIC: 11-49), seguían vivos el 91% de los pacientes que fueron dados de alta del hospital. La SG tras la retirada de la ECMO-VA se relacionó con el tipo de indicación (p=0,002), teniendo peor pronóstico los pacientes con SCR postinfarto. Conclusiones: En nuestra experiencia, la ECMO-VA es un tipo de asistencia mecánica que puede utilizarse en el manejo del SCR. Asocia una mortalidad precoz elevada, pero tras superar la fase hospitalaria la supervivencia de los pacientes es buena (AU)
Objective: Extracorporeal membrane oxygenation (ECMO) affords mechanical circulatory assistance associated to high mortality. However, weaning from such mechanical support may not imply improved short- or long-term survival. This study describes the characteristics and evolution of patients with refractory cardiogenic shock (RCS) subjected to venoarterial ECMO (VA-ECMO) in a hospital with a heart transplant program. Design: A single-center, retrospective cohort study was carried out. Setting: The cardiovascular ICU of a tertiary hospital. Patients: Forty-six patients consecutively subjected to VA-ECMO over 6 years. Interventions: Hospital mortality after weaning from ECMO and overall survival (OS) were analyzed. Results: Fifteen patients (33%) died with VA-ECMO and 31 (67%) were weaned after 8 days of support (IQR: 5-15). Fourteen patients under went transplantation. Hospital mortality in these patients was 32% (10/31), and was associated to age (P=.001), SAPS II score (P=.009), cannulation bleeding (P=.01) and post-acute myocardial infarction RCS (P=.001). After a median follow-up of 27 months (IQR: 11-49), 91% of the patients discharged from hospital were still alive. Overall survival after weaning from assistance was associated to the type of cardiac disease (P=.002). Patients with RCS after acute myocardial infarction had a poorer prognosis. Conclusions: In our experience, VA-ECMO can be used as mechanical assistance in the management of RCS. The technique is associated to high early mortality, though the long-term survival rate after hospital discharge is good (AU)