La criticidad de las Unidades de Intensivo. Ampliando las Unidades en tiempos de pandemia / Expanding ICU facilities in a pandemic scenario

Our country is suffering the effects of the ongoing pandemic of coronavirus disease (COVID-19). Because the vulnerability of healthcare systems, especially the intensive care areas they can rapidly be overloaded. That challenge the ICUs simultaneously on multiple fronts making urgent to increase the number of beds, without lowering the standards of care. The purpose of this article is to discuss some aspects of the national situation and to provide recommendations on the organizational management of intensive care units such as isolation protocols, surge in ICU bed capacity, ensure adequate supplies, protect and train healthcare workers maintaining quality clinical management.

Factores asociados a bajo gradiente en estenosis aórtica severa con fracción de eyección preservada / Factors associated with low gradient in severe aortic valve stenosis with preserved ejection fraction

Introducción: La estenosis aórtica es frecuente en países desarrollados, cuando es severa (EAS) y sintomática se recomienda reemplazo valvular. Su diagnóstico ecocardiográfico se realiza con cualquiera de; área valvular aórtica (AVA) <1.0 cm², gradiente medio (GM) >40 mmHg, velocidad máxima >4 m/s. Habitualmente existe concordancia entre estos criterios, pero diversas razones generan discordancia hasta en un 40%, principalmente entre área y gradiente (DAG), causando incertidumbre diagnóstica en presencia de fracción de eyección preservada del ventrículo izquierdo (FEp) (FEVI >50%). Objetivos: Caracterizar pacientes con EAS en la red UC. Establecer prevalencia y factores asociados a DAG en pacientes con EAS y FEp. Métodos: Estudio de corte transversal, incluyó todos los pacientes con AVA<1.0 cm2 durante 17.5 años en la red UC. Se registraron variables biodemográficas y eco-cardiográficas. Los pacientes con EAS y FEp se subdivi-dieron en 2 grupos según GM, bajo (<40 mmHg) y alto (>40mmHg), se utilizó t-student y Chi cuadrado. Resultados: 1281 pacientes cumplieron criterio de AVA<1.0 cm2. Edad 71.8±13 años, mujeres 51.4%, hombres el 48.6%. FEVI 68.71 ± 14.62%, FEp 89,2%, Características grupo GM Bajo: Edad 81.66 ± 6.56 años, Mujeres 56.3%, fibrilación auricular (FA) 14.1%. Grupo GM Alto. 68.08 ± 13.21 años, mujeres 47.6%, FA 8%. Presencia de DAG 42.5%. Factores asociados a bajo gradiente con FEp fueron: edad avanzada (>70 años), mujer y fibrilación auricular. Conclusiones: La EAS en nuestro medio se observa en personas mayores con FEp. La presencia de DAG es frecuente y el principal factor asociado en presencia de FEp es la FA.

Introduction: Aortic stenosis (AS) is the most prevalent valvular heart disease in developed countries. Symptomatic severe AS requires surgical intervention, and its echocardiographic criteria encompass: Aortic valve area (AVA) < 1.0 cm2, aortic mean gradient (MG) > 40 mmHg, peak aortic jet velocity > 4 m/s. Usually there is agreement among these criteria, but several reasons can cause up to 40% discordant results, mainly between AVA an MG, casting doubt about severity in the setting of preserved left ventricular ejection fraction (pLVEF). Objectives: Characterize patients with severe AS. Assess prevalence and factors related to AG discordance (AGD) in patients with pLVEF. Methods: Cross-sectional study, that included all patients with an AVA <1.0 cm2 during the last 17.5 years in UC health network. Bio-demographic and echocardiographic variables were registered. Patients with severe AS and pLVEF where allocated in 2 subgroups according to the MG as low (<40 mmHg) and high (>40 mmHg), 2 sides t-student and chi-squared test were performed. Results: 1281 patients fulfill criteria of AVA<1.0 cm2. Age 71.8±13 years, women 51.4%, male 48.6%, LVEF 68.71 ± 14.62%. pLVEF 89.2%. Low MG group: Age 81.66 ± 6.56 y, women 56.3%, atrial fibrillation (AF) 14.1%. High MG group: Age 68.08 ± 13.21 y, women 47.6%, AF 8%. AGD prevalence was 42.5%. Factors related to low MG with pLVEF were; advance age (>70 y), women and AF. Conclusions: Severe AS occurs mainly in advance age patients with pLVEF. AGD is frequent and the foremost related factor is AF.