ABSTRACT
Intra-abdominal infections (IAIs) are common in the clinical practice, which include a variety of patholo-gical conditions. Severe IAIs can lead to sepsis, secondary organ dysfunction, and threaten the lives of patients. Patients with IAIs are under a high metabolic reaction, and often have gastrointestinal dysfunction, manifesting as impaired intestinal mucosal barrier function, out of control in intestinal flora regulation, and continuous loss of nutrients. The body is in a malnutrition condition, and body resistance severely declines, which further aggravates disease progression. Intestinal micro-ecology is the largest and most complex ecosystem in the human body. In the case of coexistence of many bacteria, the synergy and antagonism between different strains maintain the balance of digestive tract microecology. Intestinal flora and nutritional status under IAIs have their particularity. Understanding the mechanism of intestinal flora abnormalities under IAIs, reasonable and effective nutritional support treatment and management is essential for improving the prognosis of patients with IAIs.
ABSTRACT
Intra-abdominal infections (IAIs) are common in the clinical practice,which include a variety of pathological conditions.Severe IAIs can lead to sepsis,secondary organ dysfunction,and threaten the lives of patients.Patients with IAIs are under a high metabolic reaction,and often have gastrointestinal dysfunction,manifesting as impaired intestinal mucosal barrier function,out of control in intestinal flora regulation,and continuous loss of nutrients.The body is in a malnutrition condition,and body resistance severely declines,which further aggravates disease progression.Intestinal micro-ecology is the largest and most complex ecosystem in the human body.In the case of coexistence of many bacteria,the synergy and antagonism between different strains maintain the balance of digestive tract microecology.Intestinal flora and nutritional status under IAIs have their particularity.Understanding the mechanism of intestinal flora abnormalities under IAIs,reasonable and effective nutritional support treatment and management is essential for improving the prognosis of patients with IAIs.
ABSTRACT
Resumen: Introducción: La población de pacientes que requiere de cuidados intensivos por tiempo prolongado se ha incrementado en las últimas décadas, lo que ha dado lugar a una nueva población de individuos con enfermedad crítica crónica (ECC). El objetivo de este trabajo fue describir las características epidemiológicas de los sujetos con enfermedad crítica crónica en la Unidad de Cuidados Intensivos (UCI) del Hospital Regional de Alta Especialidad de Oaxaca. Material y métodos: Se realizó un estudio ambispectivo, observacional y descriptivo que incluyó a las personas ingresadas entre el 01 de enero de 2012 y el 31 de diciembre de 2015. Se definió a los pacientes con ECC como aquéllos con ventilación mecánica prolongada (más de 21 días de ventilación mecánica por más de seis horas al día). Los individuos fueron seguidos hasta su egreso hospitalario o defunción. Se excluyeron los sujetos con expedientes clínicos incompletos, edad menor de 16 años, enfermedades neuromusculares (síndrome de Guillain-Barre y miastenia gravis) y aquéllos sin ventilación mecánica o requerimiento menor a 48 horas. Resultados: Se incluyeron 284 pacientes; la incidencia de ECC fue de 9.8%. En los individuos con ECC, la escala de APACHE II fue 19.4 ± 9.7, y en aquéllos sin ECC, fue 15.94 ± 8.6 (p = 0.044). La escala SOFA en los sujetos con ECC fue de 8.7 ± 2.6, y aquéllos sin ECC, de 7.01 ± 4.4 (p = 0.007). Los días de estancia en la UCI fueron 17.1 ± 9.2 en las personas con ECC y 8 ± 4.8 días en aquéllas sin ECC (p = 0.0000). Los días de estancia hospitalaria fueron 45.9 ± 19.7 en los pacientes con ECC y 18.3 ± 12.4 en los individuos sin ECC (p = 0.0000). La mortalidad en la UCI fue de 17.8% en los sujetos con ECC y de 27.7% en las personas sin ECC (p = 0.0000). La mortalidad hospitalaria fue de 50% en los pacientes con ECC y de 16% en aquéllos sin ECC (p = 0.0000). Fueron egresados del hospital 32.2% de los individuos con ECC y 56.3% de los sujetos sin ECC (p = 0.0000). Conclusiones: La incidencia de ECC en nuestro estudio fue similar a la reportada en la literatura. La severidad de la enfermedad aguda al ingreso (de acuerdo con las escalas de SOFA y APACHE) estuvo relacionada con el desarrollo de ECC. Las personas con enfermedad crítica crónica tuvieron mayor estancia en la UCI, más días de sedación, así como una estancia hospitalaria más prolongada y una mortalidad hospitalaria aumentada.
Abstract: Introduction: The population of patients requiring intensive care for a prolonged time has increased in recent decades, resulting in a new population of individuals with chronic critical illness (CCI). The aim of this study was to describe the epidemiological characteristics of subjects with CCI in the ICU of the High Specialty Regional Hospital of Oaxaca. Material and methods: It was a retrospective and prospective, observational and descriptive study that included people admitted between January 1, 2012 and December 31, 2015. Patients with CCI were defined as those with prolonged mechanical ventilation (more than 21 days of ventilation for more than six hours/day). The individuals were followed until their hospital discharge or death. Subjects with incomplete medical records, under 16 years of age, neuromuscular diseases (Guillain-Barre syndrome and Myasthenia gravis) and those without mechanical ventilation or who required it for less than 48 hours were excluded. Results: Two-hundred eighty-four people were included; the incidence of CCI was 9.8%. In patients with CCI, the APACHE II score was 19.4 ± 9.7, and in those without CCI, it was 15.94 ± 8.6 (p = 0.044). The SOFA scale in individuals with CCI was 8.7 ± 2.6, and in those without CCI, 7.01 ± 4.4 (p = 0.007). The days of ICU stay were 17.1 ± 9.2 for subjects with CCI and 8 ± 4.8 for those without CCI (p = 0.0000). The days of hospital stay were 45.9 ± 19.7 in people with CCI and 18.3 ± 12.4 in patients without CCI (p = 0.0000). ICU mortality was 17.8% in individuals with CCI and 27.7% in subjects without CCI (p = 0.0000). The hospital mortality was 50% in people with CCI and 16% in those without CCI (p = 0.0000). Of those patients with CCI, 32.2% were discharged from hospital, compared to 56.3% of individuals without CCI (p = 0.0000). Conclusions: The incidence of CCI in our study was similar to that reported in the literature. The severity of acute disease upon admission, according to the APACHE and SOFA scales, was related to the development of CCI. Subjects with chronic critical illness had a longer ICU stay, more days on sedation and of hospital stay, and increased hospital mortality.
Resumo: Introdução: A população de pacientes que necessitam de cuidados intensivos por tempo prolongado tem aumentado nas últimas décadas, resultando em uma nova população de pacientes com doença crítica crônica (DCC). O objetivo deste estudo foi descrever as características epidemiológicas dos pacientes com a doença crônica crítica na UTI do Hospital Regional de Alta Especialidade de Oaxaca. Material e métodos: Estudo ambispectivo, observacional e descritivo que incluiu pacientes admitidos entre 1 de janeiro de 2012 a 31 de dezembro de 2015. Definiu-se os pacientes com DCC como aqueles com ventilação mecânica prolongada > 21 dias ventilação mecânica por > 6 horas por dia. Os pacientes foram acompanhados até a alta hospitalar ou morte. Foram excluídos pacientes com prontuários incompletos, idade inferior a 16 anos, as doenças neuromusculares (síndrome de Guillain Barré e Miastenia Gravis) e pacientes sem ventilação mecânica ou exigência ventilatória menor à 48 horas. Resultados: 284 pacientes foram incluídos no estudo, a incidência de DCC foi de 9.8%. Em pacientes com DCC a pontuação APACHE II foi de 19.4 + 9.7 e sem DCC foi 15.94 + 8.6 (p = 0.044), a escala SOFA em paciente com DCC foi de 8.7 + 2.6, e sem DCC 7.01 + 4.4 (p = 0.007). Os dias de permanência na UTI foram de 17.1 + 9.2 dias para os pacientes com DCC e 8 + 4.8 dias para os pacientes sem DCC (p = 0.0000). Os dias de permanência hospitalar foram de 45.9 + 19.7 dias para os pacientes com DCC e para os pacientes sem DCC 18.3 + 12.4 dias (p = 0.0000). A mortalidade na UTI foi de 17.8% nos pacientes com DCC e 27.7% nos pacientes sem DCC (p = 0.0000). A mortalidade hospitalar foi de 50% nos pacientes com DCC e 16% (p = 0.0000) nos pacientes sem DCC. 32.3% dos pacientes com DCC tiveram alta e 56.3% dos pacientes sem DCC (p = 0.0000). Conclusões: A incidência de DCC em nosso estudo foi semelhante ao relatado na literatura. A gravidade da doença aguda ao ingresso do paciente, de acordo com a pontuação APACHE e SOFA está relacionada com o desenvolvimento da DCC. Os pacientes com doença crítica crônica tiveram um maior tempo de permanência na UTI, mais dias de sedação, maior tempo de internação e maior mortalidade hospitalar.