Relación entre la procedencia de los enfermos sépticos ingresados en la unidad de cuidados intensivos y su pronóstico / Patients with sepsis admitted to the intensive care unit from different hospital departments: influence on prognosis

Objetivo: Comparar el pronóstico de pacientes sépticos en función de su procedencia previa al ingreso en la unidad de cuidados intensivos (UCI).Método: Se registraron de manera consecutiva los pacientes con sepsis ingresados en la UCI durante un periodo de 5 años. Se analizaron edad, sexo, estancia en UCI, foco de infección, ácido láctico, puntuación APACHE II y mortalidad. Los pacientes fueron clasificados según la procedencia al ingreso en UCI: urgencias o planta de hospitalización. Resultados: Se analizaron 511 pacientes, 330 procedentes de urgencias y el resto de planta de hospitalización. No hubo diferencias en la edad y puntuación APACHE II al ingreso en la UCI. Se objetivó una mortalidad significativamente menor en los pacientes procedentes del servicio de urgencias (29,4%), con respecto a la de los pacientes hospitalizados (50%).Conclusión: La mortalidad de los pacientes ingresados en la UCI fue menor en el grupo procedente de urgencias que en el grupo procedente de la planta de hospitalización (AU)

Objective: To compare prognosis in patients admitted to the intensive care unit (ICU) with sepsis according to source (a hospital ward or the emergency department).Methods: Patients admitted to the ICU for sepsis were enrolled consecutively for 5 years. Variables recorded included age, sex, length of ICU stay, focus of infection, lactic acid levels, APACHE II score, and mortality. The patients were classified according to whether they were admitted from the emergency department or a hospital ward. Results: A total of 511 patients were studied; 330 patients were admitted from the emergency department and the others came from a ward. No differences in age or APACHE II score on ICU arrival were found between ward-admitted and emergency-admitted patients. Mortality was significantly lower in patients from the emergency department (29.4%)than in patients from wards (50%).Conclusions: Mortality is higher in ICU patients with sepsis admitted from hospital wards is higher than in patients from the emergency department (AU)

[Bronchoalveolar lavage for diagnosing pneumonia in mechanically ventilated patients]. / Lavado broncoalveolar para el diagnóstico de neumonía en enfermos en ventilación mecánica.

OBJECTIVE: To evaluate the diagnostic role of bronchoalveolar lavage (BAL) in mechanically ventilated patients with suspected pneumonia and to describe the clinical outcome in the different kinds of pneumonia in critically ill patients. DESIGN: Descriptive study. SETTING: A 17-bed medical and surgical intensive care unit. PATIENTS: Mechanically ventilated patients admitted to the ICU from November 2003 to March 2006 with suspected pneumonia who underwent bronchoscopy with BAL. INTERVENTIONS: BAL was performed by fiberoptic bronchoscopy with three aliquots of 50 ml sterile normal saline. Recovered BAL fluid was pro-cessed for microbiologic analysis. MAIN VARIABLES OF INTEREST: Age, APACHE II score within the first 24 hours of admission, time on mechanical ventilation, ICU length of stay, mortality, and isolated bacteria were analyzed. RESULTS: A total of 96 cases of suspected pneumonia with BAL were recruited, including 4 groups: community associated pneumonia (CAP), 12 cases, early-onset ventilator-associated pneumonia (VAP), 26 cases, late-onset ventilator-associated pneumonia, 43 cases, and immunocompromised patients, 15 cases. BAL was positive (> 10000 ufc/ml) in 40 (41.7%) patients (2, 16, 17 and 5 patients with CAP, early-onset VAP, late-onset VAP and immunocompromised, respectively). Mortality was 33.3%, 26.9%, 25.6% and 73.3% in CAP, early-onset VAP, late-onset VAP and immunocompromised patients respectively. CONCLUSIONS: The low incidence of positive BAL in the CAP group supports using BAL only for particularly severe, selected cases. Mortality was very high in the immunocompromised patients. In the light of our personal experience, BAL is most useful in the diagnosis of pneumonia in the group of patients with VAP.

Lavado broncoalveolar para el diagnóstico de neumonía en enfermos en ventilación mecánica / C-reactive protein as a marker of mortality in intensive care unit

Objetivo. Evaluar la utilidad diagnóstica del lavado broncoalveolar (LBA) en enfermos en ventilación mecánica con sospecha de neumonía y describir los resultados clínicos de los diferentes tipos de neumonía en enfermos críticos. Diseño. Estudio descriptivo. Ámbito. Unidad de cuidados intensivos (UCI) médico-quirúrgica de 17 camas. Pacientes. Enfermos ingresados en UCI desde noviembre de 2003 a marzo de 2006 con ventilación mecánica y sospecha clínica de neumonía a quienes se realizó LBA. Intervenciones. Se realizó LBA a través de tubo orotraqueal con 150 ml de suero salino fisiológico, repartidos en tres alícuotas de 50 ml; la muestra se procesó para estudio microbiológico. Principales variables de interés. Edad, APACHE II al ingreso, días en ventilación mecánica, estancia en UCI, mortalidad y agentes etiológicos aislados en el LBA. Resultados. Se incluyó a 96 pacientes a quienes se realizó LBA; se distinguieron 4 grupos: neumonía adquirida en la comunidad (NAC), 12 casos; neumonía asociada a ventilación mecánica (NAVM) precoz, 26 casos. NAVM tardía, 43 casos, y neumonía en enfermos inmunodeficientes, 15 casos. El LBA fue positivo (> 10.000 ufc/ml) en 40 (41,7%) pacientes (2 con NAC, 16 con NAVM precoz, 17 con NAVM tardía, 5 con neumonía e inmunodeficiencia). La mortalidad fue del 33,3, el 26,9, el 25,6 y el 73,3% en NAC, NAVM precoz, NAVM tardía e inmunodeficientes, respectivamente. Conclusiones. La escasa sensibilidad del LBA en la NAC corrobora la actitud de limitar su indicación sólo a casos seleccionados. En el grupo de enfermos inmunodeficientes la mortalidad fue muy elevada. El LBA, según nuestra limitada experiencia, tiene su mayor utilidad en el diagnóstico de NAVM

Objective. To evaluate the diagnostic role ofbronchoalveolar lavage (BAL) in mechanicallyventilated patients with suspected pneumoniaand to describe the clinical outcome in the differentkinds of pneumonia in critically ill patients.Design. Descriptive study.Setting. A 17-bed medical and surgical intensivecare unit.Patients. Mechanically ventilated patients admittedto the ICU from November 2003 to March2006 with suspected pneumonia who underwentbronchoscopy with BAL.Interventions. BAL was performed by fiberopticbronchoscopy with three aliquots of 50 ml sterilenormal saline. Recovered BAL fluid was processedfor microbiologic analysis.Main variables of interest. Age, APACHE IIscore within the first 24 hours of admission, timeon mechanical ventilation, ICU length of stay,mortality, and isolated bacteria were analyzed.Results. A total of 96 cases of suspected pneumoniawith BAL were recruited, including 4 groups: community associated pneumonia (CAP), 12 cases, early-onset ventilator-associated pneumonia (VAP), 26 cases, late-onset ventilator-associated pneumonia, 43 cases, and immunocompromised patients, 15 cases. BAL was positive (>10000 ufc/ml) in 40 (41.7%) patients (2, 16, 17 and5 patients with CAP, early-onset VAP, late-onset VAP and immunocompromised, respectively).Mortality was 33.3%, 26.9%, 25.6% and 73.3% inCAP, early-onset VAP, late-onset VAP and immunocompromised patients respectively.Conclusions. The low incidence of positive BALin the CAP group supports using BAL only for particularlysevere, selected cases. Mortality wasvery high in the immunocompromised patients. Inthe light of our personal experience, BAL is mostuseful in the diagnosis of pneumonia in the groupof patients with VAP