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1.
Medicina (B.Aires) ; 81(5): 865-868, oct. 2021. graf
Article in Spanish | LILACS | ID: biblio-1351064

ABSTRACT

Resumen La posición prona para el tratamiento de la insuficiencia respiratoria aguda hipoxémica en pacientes con neumonía grave por COVID-19, que están críticamente enfermos y mecánicamente ventilados, está bien documentada. Esta serie de casos brinda información sobre las ubicaciones de lesión más frecuentes, gravedad y prevalencia en los nervios periféricos afectados, que involucra en su mayoría a la extremidad superior, ya que estas lesiones no se tratan ampliamente en la literatura. Además, pretende ser un punto de partida para brindar a las unidades de cuidados intensivos, una revisión de sus protocolos de aplicación del prono.


Abstract The prone position for the treatment of hypoxemic acute respiratory failure in patients with severe COVID-19 pneumonia, who are critically ill and mechanically ventilated, is well documented. These cases provide information on the most frequent injury locations, severity, and prevalence in affected peripheral nerves, mostly involving the upper limb, as these injuries are not widely discussed in the literature. Furthermore, it is intended to be a starting point to provide intensive care units with a review of their prone application protocols.


Subject(s)
Humans , SARS-CoV-2 , COVID-19 , Prevalence , Critical Illness , Intensive Care Units
2.
Medicina (B.Aires) ; 81(4): 527-535, ago. 2021. graf
Article in English | LILACS | ID: biblio-1346503

ABSTRACT

Abstract Coronavirus disease 2019 (COVID-19) pandemic poses a major challenge for healthcare systems. In South America, local information about the incidence and clinical characteristics of critically ill patients diagnosed with COVID-19 is still limited. In this observational and retrospective study, we aimed to de scribe critically ill patients' clinical and respiratory characteristics with COVID-19. The study was performed over 6 months in an intensive care unit (ICU) of a high complexity hospital in Buenos Aires, Argentina. Patients older than 18 years with laboratory-confirmed COVID-19 by reverse tran scriptase-polymerase chain reaction (RT-PCR) for SARS-CoV-2 were included in the study. Demographic characteristics such as sex and age, comorbidities, laboratory results, imaging results, ventilatory mechanics data, complications, and mortality were recorded. A total of 168 critically ill patients with COVID-19 were included. Sixty-six percent were men with a median age of 65 years (58-75); 79.7% had at least one comorbidity. The most frequent comorbidity was arterial hypertension, affecting 52.4%. A 67.9% required invasive mechanical ventilation (MV), and no one was treated with non-invasive ventilation. Most of the patients in MV (73.7%) required neuromuscular blockade due to severe hypoxemia. A 36% was ventilated in the prone position. The length of stay in the ICU was 13 days (6-24) and ICU's mortality was 25%.


Resumen La pandemia de la enfermedad por coronavirus 2019 (COVID-19) plantea un gran desafío para los sistemas de salud. En América del Sur, la información local sobre la incidencia y las características clínicas de los pacientes crítica mente enfermos diagnosticados con COVID-19 aún es limitada. En este estudio observacional y retrospectivo, nuestro objetivo fue describir las características clínicas y respiratorias de los pacientes críticamente enfermos con COVID-19. El estudio se realizó durante 6 meses en una unidad de cuidados intensivos (UCI) de un hospital de alta complejidad en Buenos Aires, Argentina. Se incluyeron en el estudio pacientes mayores de 18 años con COVID-19 confirmado por laboratorio mediante la reacción en cadena de la polimerasa con transcriptasa inversa (RT-PCR) para SARS-CoV-2. Se registraron características demográficas como sexo y edad, comorbilidades, resultados de laboratorio, resultados de imagen, datos de mecánica ventilatoria, complicaciones y mortalidad. Se incluyeron un total de 168 pacientes críticamente enfermos con COVID-19. El 66% eran hombres con una mediana de edad de 65 años (58-75). El 79.7% presentaba al menos una comorbilidad. La comorbilidad más frecuente fue la hipertensión arterial, afectando al 52.4%. El 67.9% requirió ventilación mecánica invasiva (VM) y ninguno fue tratado con ventilación no invasiva. La mayoría de los pacientes en VM (73.7%) requirieron bloqueo neuromuscular por hipoxemia grave. Un 36% de ellos fueron ventilados en decúbito prono. La estancia en UCI fue de 13 días (6-24) y la mortalidad en UCI fue del 25%.


Subject(s)
Humans , Male , Middle Aged , Aged , Critical Illness , COVID-19 , Respiration, Artificial , Retrospective Studies , Pandemics , SARS-CoV-2 , Intensive Care Units
3.
Arch. argent. pediatr ; 119(4): 230-237, agosto 2021. tab, ilus
Article in English, Spanish | LILACS, BINACIS | ID: biblio-1280899

ABSTRACT

Introducción: El trasplante de células progenitoras hematopoyéticas (TPH) en niños es un procedimiento no exento de complicaciones graves. El ingreso de esta población a unidades de cuidados intensivos pediátricos (UCIP) se asocia con elevada mortalidad. Objetivos: Analizar la sobrevida y los factores predictivos de la mortalidad en niños que recibieron TPH e ingresaron a la UCIP y elaborar un modelo predictivo de mortalidad en esta población. Materiales y métodos: Revisión retrospectiva de niños y adolescentes que recibieron un TPH entre el 01/01/2005 y el 31/12/2019 e ingresaron a la UCIP de un hospital universitario de alta complejidad. Resultados: De un total de 264 niños que recibieron el trasplante, 114 ingresaron a la UCIP. La mortalidad general fue del 29 % (n = 34). El tipo de trasplante, enfermedad basal, evento de neutropenia febril, infección por citomegalovirus, insuficiencia respiratoria, enfermedad de injerto contra huésped (EICH), quimioterapia mieloablativa y desnutrición previa se asociaron con tasas de mortalidad más elevadas. En el análisis multivariado, la EICH (razón de posibilidades [OR, por su sigla en inglés]: 2,23; intervalo de confianza del 95 % [IC 95 %]: 1,92-2,98), la necesidad de ventilación mecánica invasiva (OR: 2,47; IC95 %: 1,39-5,73), el trasplante de donante alternativo (OR: 1,58; IC 95 %: 1,14-2,17) y la desnutrición previa (OR: 1,78; IC 95 %: 1,223-3,89) se asociaron con mayor mortalidad. Conclusión: En la población estudiada, dos de cada tres niños que recibieron TPH e ingresaron a la UCIP sobrevivieron. La EICH, ventilación mecánica, trasplante de donante alternativo y desnutrición previa fueron factores predictivos de mortalidad


Introduction: Hematopoietic stem cell transplantation (HSCT) in children is a procedure that is not exempt of severe complications. Admission to the pediatric intensive care unit (PICU) is associated with a high mortality rate. Objectives: To analyze survival and predictors of mortality among children who received a HSCT and were admitted to the PICU, and to develop a mortality prediction model in this population. Materials and methods: Retrospective review of children and adolescents who received a HSCT between January 1st, 2005 and December 31st, 2019 and were admitted to the PICU of a tertiary care teaching hospital. Results: Out of 264 children receiving the transplant 114 were admitted to the PICU. The overall mortality rate was 29 % (n = 34). The type of transplant, underlying disease, febrile neutropenia event, cytomegalovirus infection, respiratory failure, graft versus host disease (GVHD), myeloablative chemotherapy, and previous malnutrition were associated with higher mortality rates. In the multivariate analysis, GVHD (odds ratio [OR]: 2.23; 95 % confidence interval [CI]: 1.92-2.98), need for mechanical ventilation (OR: 2.47; 95 % CI: 1.39-5.73), alternative donor transplant (OR: 1.58; 95 % CI: 1.14-2.17), and previous malnutrition (OR: 1.78; 95 % CI: 1.22-3.89) were associated with a higher mortality rate. Conclusion: In the studied population, 2 out of 3 children who received a HSCT and were admitted to the PICU survived. GVHD, mechanical ventilation, alternative donor transplant, and previous malnutrition were predictors of mortality


Subject(s)
Humans , Male , Female , Infant , Child, Preschool , Child , Adolescent , Intensive Care Units, Pediatric/statistics & numerical data , Hematopoietic Stem Cell Transplantation/adverse effects , Hematopoietic Stem Cell Transplantation/mortality , Respiration, Artificial , Retrospective Studies , Critical Illness , Sepsis , Malnutrition , Graft vs Host Disease
4.
Medicina (B.Aires) ; 81(3): 401-407, jun. 2021. graf
Article in Spanish | LILACS | ID: biblio-1346476

ABSTRACT

Resumen La pandemia por COVID-19 significó una crisis mundial sin precedentes, que implicó la reorganización de los sistemas de salud y la racionalización de los recursos diagnósticos y terapéuticos disponibles. El objetivo de este estudio observacional y retrospectivo fue analizar características clínicas y evo lución de los pacientes internados en guardia, sala general y terapia intensiva en un hospital privado de alta complejidad de la Ciudad de Buenos Aires, durante los primeros siete meses de circulación viral. Se incluyeron 1005 pacientes con COVID-19 confirmado por laboratorio. La mediana de edad fue de 45 años; 73.7% eran varones. La mitad de los pacientes presentaba al menos una comorbilidad. La mediana de leucocitos totales fue 6300 células/mm3 y de linfocitos 818 células/mm3. El 82.3% presentó alteraciones en la tomografía de tórax; y el patrón radiológico observado con mayor frecuencia fue opacidad tipo vidrio esmerilado (33%). El 82.4% recibió antibioticoterapia empírica dirigida a foco respiratorio y, además, el 18.7% fu e tratado con dexametasona. Respecto de la gravedad, el 14.7% presentó enfermedad no complicada, el 55.2% neumonía leve, el 20.8% neumonía moderada y el 9.2% neumonía grave. Asimismo, el 8.7% fue transferido a terapia intensiva. Se registró una mortalidad hospitalaria del 2.3% y del 20.5% en terapia intensiva. Se encontró asociación estadísticamente significativa entre mortalidad y edad, con una diferencia de edad de 9.6 años, siendo mayor entre los fallecidos (p = 0.0004; IC 95% 4-14). Sin embargo, no hubo asociación entre presencia de comorbilidades y sexo vs. mortalidad y gravedad de la enfermedad.


Abstract Coronavirus disease 2019 (COVID-19) meant an unprecedented global crisis, which involved the reorganization of health systems and the rationalization of available diagnostic and therapeutic resources. The objective of this observational and retrospective study was to analyze the clinical characteristics and evolution of patients admitted to general ward, intensive care unit and emergency department of a high complexity hospital in Buenos Aires city, during the first seven months of viral circulation. A total of 1005 patients with laboratory-confirmed COVID-19 were included. The median age was 45 years, and 73.7% were men. Half of the patients had at least one comorbidity. Among the laboratory findings, the median of total leukocytes was 6300 cells/mm3 and that of lymphocytes 818 cells/mm3; 82.3% of the patients presented alterations in the chest tomography, and the most frequently observed radiological pattern was ground-glass opacity (33%); 82.4% of them received empirical antibiotic therapy directed to the respiratory focus and, in addition, 18.7% were treated with dexamethasone. Regarding severity, 14.7% of the patients presented uncomplicated disease, 55.2% mild pneumonia, 20.8% moderate pneumonia, and 9.2% severe pneumonia. Likewise, 8.7% of them were transferred to intensive care. In-hospital mortality was 2.3%, and 20.5% among critically ill patients. A statistically significant association was found between mortality and age, with an age difference of 9.6 years, being greater among the deceased (p = 0.0004; 95% CI 4-14). However, there was no association between the presence of comorbidities and sex vs. mortality and severity of the disease.


Subject(s)
Humans , Male , Female , Child , Middle Aged , SARS-CoV-2 , COVID-19 , Comorbidity , Retrospective Studies , Critical Illness , Intensive Care Units
5.
Rev. colomb. anestesiol ; 49(2): e300, Apr.-June 2021. tab, graf
Article in English | LILACS, COLNAL | ID: biblio-1251499

ABSTRACT

Abstract Introduction Although the use of matching techniques in observational studies has been increasing, it is not always adequate. Clinical trials are not always feasible in critically ill patients with renal outcomes, and observational studies are an important alternative. Objective Through a scoping review, determine the available evidence on the use of matching methods in studies involving critically ill patients and renal outcome assessments. Methods Medline, Embase, and Cochrane databases were used to identify articles published between 1992 and week 10 of 2020. Studies had to assess different exposures in critically ill patients with renal outcomes using propensity score matching. Results Most publications are cohort studies 94 (94.9%), with five (5.1%) reporting cross-sectional studies. The main pharmacological intervention was the use of antibiotics in seven studies (7.1%) and the main risk factor studied was renal injury prior to ICU admission in 10 studies (10.1%). The use of standardized means to assess balance of baseline characteristics was found in only 28 studies (28.2%). Most studies 95 (96%) used logistic regression to calculate the propensity score. Conclusion Major inconsistencies were observed regarding the use of methods and reporting of findings. Considerations related to the use of propensity score matching methods and reporting of findings are summarized.


Resumen Introducción El uso de técnicas de emparejamiento en estudios observacionales ha ido en aumento y no siempre se usa adecuadamente. Los experimentos clínicos no siempre son factibles en los pacientes críticos con desenlaces renales, por lo que los estudios observacionales son una alternativa importante. Objetivo Mediante una revisión de alcance, determinar la evidencia disponible sobre la utilización de los métodos de emparejamiento en los estudios que incluyen pacientes críticamente enfermos y que evalúan desenlaces renales. Métodos Se utilizaron las bases de datos de Medline, Embase, y Cochrane para identificar artículos publicados entre 1992 y 2020 hasta la semana 10, que estudiaran diferentes exposiciones en el paciente crítico con desenlaces renales y utilizaran métodos de emparejamiento por propensión. Resultados La mayoría de las publicaciones (94) son estudios de Cohorte (94,9 %), cinco estudios (5,1 %) correspondieron a cross-secctional. La principal intervención farmacológica fue el uso de antibióticos en siete estudios (7,1 %) y el principal factor de riesgo estudiado fue la lesión renal previa al ingreso a UCI en diez estudios (10,1 %). El balance entre las características de base evaluado mediante medias estandarizadas se encontró solo en 28 estudios (28,2 %). La mayoría de los estudios 95 (96 %) utilizaron regresión logística para calcular el índice de propensión. Conclusiones Se observaron grandes inconsistencias en la utilización de los métodos y en el informe de los hallazgos. Se hace un resumen de los aspectos por considerar en la utilización de los métodos y reporte de los hallazgos con el emparejamiento por índice de propensión.


Subject(s)
Humans , Critical Illness , Renal Replacement Therapy , Critical Care , Libraries, Digital , Propensity Score , Acute Kidney Injury , Kidney Diseases
6.
Medicina (B.Aires) ; 81(1): 69-75, mar. 2021. graf
Article in English | LILACS | ID: biblio-1287243

ABSTRACT

Abstract After a stressful event, adaptative mechanisms are carried out to support vital functions. Hypothalamic-pituitary-adrenal axis plays a key role in stress response regulating metabolism, cardiovascular function and immune system. This review addresses pathophysiological changes of the adrenal axis during critical illness, recognizing limitations of methods applied for its evaluation in this special context and defining indications for corticosteroid replacement in critically ill patients. The concept of relative adrenal insufficiency should be abandoned; cosyntropin stimulation test should not be performed for diagnosis of adrenal insufficiency in critical illness nor for establishing the need of treatment.


Resumen Diversos mecanismos adaptativos se ponen en marcha para sostener las funciones orgánicas vitales en el paciente crítico. El eje hipotálamo-hipófiso-adrenal tiene un papel clave en la respuesta al estrés al regular el metabolismo, la función cardiovascular y la respuesta inmune. Esta revisión tiene por objetivos analizar los cambios fisiopatológicos que se producen en el eje adrenal durante la enfermedad crítica, reconocer las limitaciones de los métodos diagnósticos y definir indicaciones de tratamiento de reemplazo corticoideo en este contexto. El concepto de insuficiencia adrenal relativa debe ser descartado y no se recomienda el test de estímulo con cosintropina para diagnóstico de insuficiencia adrenal durante enfermedad crítica ni para definir la necesidad de tratamiento.


Subject(s)
Humans , Critical Illness , Adrenal Insufficiency/diagnosis , Pituitary-Adrenal System , Hydrocortisone , Hypothalamo-Hypophyseal System
7.
Rev. urug. enferm ; 16(1): 1-13, mar. 2021.
Article in Portuguese | LILACS, BDENF | ID: biblio-1150996

ABSTRACT

Objetivo: descrever as barreiras vivenciadas e as estratégias ao seu enfrentamento utilizadas por profissionais de enfermagem para realizar o cuidado a pacientes em final de vida em um serviço de urgência e emergência. Materiais e Métodos: Trata-se de uma pesquisa descritiva, exploratória, de abordagem qualitativa, conduzida em um serviço de urgência e emergência no sul do Brasil, com um enfermeiro e dois técnicos por turno, totalizando 12 profissionais de enfermagem. Os dados foram produzidos entre maio e junho de 2018, por meio de entrevista semiestruturada e observação simples e, posteriormente, organizados por aproximação temática no programa Ethnograph v6, em sua versão de demonstração e submetidos à análise de conteúdos proposta por Laurence Bardin. Resultados: Foram elaboradas duas categorias: Barreiras aos cuidados às pessoas em final de vida e Estratégias para o enfrentamento das barreiras ao cuidado no final da vida. Os profissionais de enfermagem referiram que, embora o cenário do serviço de urgência e emergência seja adverso devido a fatores limitantes como rotina acelerada, por exemplo, buscam compreender e atender às necessidades dos pacientes dentro dos limites estruturais, de recursos humanos e institucionais. Assim, são realizados cuidados visando o alívio da dor e promoção de seu conforto. Conclusão: evidenciou-se conflito entre o idealizado e o realizado, pois os profissionais elencam aquilo que consideram prioridade para o cuidado no final da vida, mas nem sempre conseguem implementálo. Quando o fim da vida ocorre nos serviços de saúde é necessário movimentos de desconstrução das práticas atuais ofertadas, especialmente nos serviços de urgência e emergência.


Objetivo: describir las barreras experimentadas y las estrategias al su enfrentamiento utilizadas por los profesionales de enfermería para hacer el cuidado a los pacientes al final de la vida en un servicio de urgencia. Materiales y Métodos: investigación con enfoque cualitativo conducida en un servicio de urgencia y emergencia en el sur de Brasil con 12 profesionales de enfermería. Los datos fueron colectados entre mayo y junio de 2018 a través de entrevista semiestructurada y, luego, organizados en el programa Ethnograph, en su versión de demostración, y sometidos al análisis de contenido según Laurence Bardin. Resultados: fueron establecidas dos categorías: Barreras a los cuidados a las personas al final de la vida y Estrategias al enfrentamiento de las barreras al cuidado al final de la vida. Los profesionales de enfermería reportaron que, aunque el servicio de urgencia sea adverso debido a factores limitantes como rutina acelerada, por ejemplo, buscan comprender y atender a las necesidades de los pacientes dentro de los límites estructurales, de recursos humanos e institucionales. De esta forma realizan cuidados visando el alivio del dolor y la promoción de su confort. Conclusión: se concluye que existe confl icto entre lo idealizado y lo realizado puesto que los profesionales eligen aquello que consideran prioridad al cuidado en el final de la vida, si bien ni siempre logran implementarlo. Cuando el fin de la vida ocurre en los servicios de salud es necesario movimientos de desconstrucción de las prácticas actuales ofrecidas, especialmente en los servicios de urgencia.


Objective: to describe the barriers found and the strategies utilized by nursing professionals to face them to perform the care to end-of-life patients in an emergency medical service. Materials and Methods: we conducted a descriptive, exploratory, qualitative approach, in an emergency service in the south of Brazil, with 12 nursing professionals. We produced the data between May and June of 2018, through a semistructured interview and simple observation and, later, organized by the thematic approach in the program Ethnograph v6, in its version of demonstration and submitted to the content analysis proposed by Laurence Bardin. Results: we elaborated two categories: Barriers to care for people in the end-of-life and Strategies for coping with barriers to care at the end of life. Nursing professionals reported that, although the emergency service is adverse due to limiting factors such as an accelerated routine, for example, they seek to understand and meet patients' needs within the structural, human and institutional limits. Thus, care is taken to relieve pain and promote comfort. Conclusion: there was a conflict between the idealized and the realized, because the professionals list what they consider a priority for care at the end of life, but they are not always able to implement it. When the end of life occurs in health services, it is necessary to deconstruct the current practices offered, especially in emergency services.


Subject(s)
Humans , Male , Female , Adult , Middle Aged , Aged , Terminal Care , Critical Illness/nursing , Emergency Medical Services , Health Resources/supply & distribution , Nursing Care , Interviews as Topic , Qualitative Research
8.
Afr. J. Clin. Exp. Microbiol ; 22(4): 448-456, 2021.
Article in English | AIM | ID: biblio-1342108

ABSTRACT

Background: Risk assessment is the means of identifying and evaluating potential errors or problems that may occur in testing process. The aim of this study was to perform risk assessment of antimicrobial susceptibility testing (AST) process in clinical microbiology laboratories of Niamey, Niger Republic. Methodology: We conducted a descriptive cross-sectional study from October 1 to December 31, 2019, to evaluate AST performance in seven clinical microbiology laboratories at Niamey, the capital city of Niger republic. The evaluation focused on the determination of the criticality index (CI) of each critical point (frequency of occurrence of anomalies, severity of the process anomaly, and detectability of the anomaly during the process) in the AST process and the performance of the AST through an observation sheet using two reference strains; Escherichia coli ATCC 25922 and Staphylococcus aureus ATCC 29213. Results: The criticality index (CI) was greater than 6 for most of the critical points related to material, medium, equipment, method and labour for the AST process in all the laboratories. A range of 18-100% errors on the inhibition zone diameters of the reference strains were observed. Major and/or minor categorization (Sensitive S, Intermediate I and Resistance R) discrepancies were found at all the laboratories for either one or both reference strains. The antibiotics most affected by the S/I/R discrepancies were trimethoprim (100%), vancomycin (100%), amoxicillin (80%) and amoxicillin + clavulanic acid (70%). Conclusion: This study showed a deficiency in the control of critical control points that impacts the performance of the AST reported by the laboratories in Niger. Corrective actions are needed to improve the performance of AST in clinical microbiology laboratories in Niger


Subject(s)
Humans , Quality Control , Microbial Sensitivity Tests , Medical Laboratory Science , Microbiology , Critical Illness , Niger
9.
s.l; RedARETS; [2021]. 53 p. tab.
Non-conventional in Spanish | LILACS, BRISA, BIGG | ID: biblio-1254447

ABSTRACT

La enfermedad por el Coronavirus 2019 (COVID-19) es una patología respiratoria de humanos producida por SARS-CoV-2. El 11 de marzo de 2020 la Organización Mundial de la Salud (OMS) declaró al COVID-19 como una pandemia, y desde ese momento se han reportado en Argentina más de 3.000.000 casos confirmados y 68.000 muertes. Los síndromes de dificultad respiratoria aguda (SDRA) asociados a COVID-19 se observan después de la segunda semana, y no se relacionan sólo con la replicación viral no controlada, sino con la respuesta del huésped. Tocilizumab es un anticuerpo monoclonal recombinante humanizado aprobado por ANMAT para el manejo de diversas enfermedades entre las que se incluye la artritis reumatoide. En COVID-19, existen estados de hiperinflamación en personas severa o críticamente enfermas, donde la inmunosupresión y el bloqueo de este tipo de receptores de IL-6 podría ser beneficiosa. Esta guía está enfocada en emitir recomendaciones para uso de tocilizumab para pacientes con enfermedad severa y crítica por coronavirus. Metodología: la presente guía de práctica clínica fue confeccionada siguiendo los métodos de elaboración de guías de la oms 8. De forma general, se conformó un grupo desarrollador multidisciplinario compuesto por expertos temáticos clínicos y en políticas públicas, metodólogos y usuarios. Dado que no se identificaron guías susceptibles de ser adaptadas, la guía se desarrolló de novo. Se realizaron búsquedas de estudios aleatorizados hasta 17 de abril de 2021, en la base de datos l.ove de la fundación epistemonikos. Se elaboró la síntesis y los perfiles de evidencia utilizando el enfoque grade (grading of recommendations assessment, development and evaluation) y se desarrolló un modelo para valorar el impacto presupuestario de la incorporación de tociliuzmab desde la perspectiva del ministerio de salud de rio negro. Posteriormente, las recomendaciones fueron graduadas en un panel de expertos en la atención de pacientes con enfermedad severa y crítica por coronavirus. La guía fue evaluada por pares temáticos y metodológicos. Todos los participantes del panel y del grupo desarrollador firmaron una declaración de conflicto de intereses, los cuales fueron analizados por la coordinación de la guía. Pregunta: En pacientes con enfermedad severa y crítica por coronavirus ¿Debe utilizarse tocilizumab junto con el tratamiento estándar en comparación con el uso del tratamiento estándar sin tocilizumab? Se sugiere utilizar tocilizumab en pacientes hospitalizados con COVID-19 severa o crítica (recomendación Condicional sustentada en Moderada Certeza en la evidencia). La dirección de la recomendación se sustenta en los probables beneficios en reducción de la mortalidad e ingreso a ventilación mecánica invasiva. El carácter Condicional se sustenta en el impacto en el uso de los recursos: los costos de adquisicion de tocilizumab son elevados (entre $128.626 y $ 153.274); siendo incierto el impacto sobre el presupuesto en salud surgido de su incorporacion al esquema de tratamiento (fundamentalmente por el riesgo de sesgo en la estimacion de reduccion de los tiempos de internacion en UCI y la incertidumbre en los costos de internacion en dicha unidad). Las potenciales barreras surgidas de una posible incapacidad del productor de proveer la droga frente a un aumento sustancial en la demanda si se implementa el uso de tocilizumab en pacientes con enfermedad severa y critica por COVID-19. Ante esta situación con apoyo del grupo metodológico con experiencia en el metodo GRADE, expertos clínicos y en gestión en salud de la provincia de Rio Negro y el resto del país se ha desarrollado una guía de práctica clínica para orientar al personal de salud y a los generadores de políticas públicas del Ministerio de Salud de Rio Negro acerca del uso de tocilizumab para pacientes con enfermedad severa y crítica por coronavirus . El presente documento brinda información científica actualizada y confiable y se ha elaborado en base a la metodología GRADE (Grading of Recommendations Assessment, Development and Evaluation), con la finalidad de evitar la progresión a formas severas de la enfermedad y eventos fatales.


Subject(s)
Humans , SARS Virus/drug effects , COVID-19/drug therapy , Antibodies, Monoclonal/therapeutic use , Severity of Illness Index , Critical Illness , Hospitalization
10.
Clinics ; 76: e2610, 2021. tab, graf
Article in English | LILACS | ID: biblio-1278930

ABSTRACT

OBJECTIVES: To compare the early and late predictive values of several critical illness scores (CISs) and biomarkers in sepsis-3 patients with bloodstream infections (BSIs) and to identify the prognostic value of procalcitonin (PCT) for different gram-stain bacteria infections. METHODS: Patients with at least one positive blood culture within 24h of emergency department admission and with a final diagnosis of sepsis/septic shock were enrolled. CISs were calculated based on the first parameters on the day of admission. The receiver operating characteristics curve was used to analyze the predictive value of CISs and biomarkers for early and late mortality. RESULTS: Of 834 enrolled patients with sepsis-3, death occurred in 214 patients within 28 days and in 273 patients within 60 days. Compared with biomarkers, CISs showed a significantly higher area under the curve (AUC) in the prediction of early and late mortality (p<0.01), especially for patients with GNB infection. The Sequential Organ Failure Assessment score showed a higher AUC for predicting early mortality than the Mortality in Emergency Department Sepsis score (p=0.036). Compared with GNB infections, the AUC values of the PCT for gram-positive bacteria (GPB) infections were higher for predicting early or late mortality; PCT showed higher AUC than high-sensitivity C-reactive protein and white blood cells for predicting early mortality (p<0.05). CONCLUSIONS: CISs were more advantageous in the assessment of early and late prognosis, especially for patients with GNB infections; however, for sepsis with GPB infection, PCT can be used for the prediction of early mortality.


Subject(s)
Humans , Sepsis/diagnosis , Procalcitonin , Prognosis , Bacteria , Biomarkers , ROC Curve , Critical Illness
11.
Inmanencia (San Martín, Prov. B. Aires) ; 8(1): 144-149, 2021. tab.
Article in Spanish | LILACS, BINACIS | ID: biblio-1222723

ABSTRACT

Las secuencias integradas de cuidado para últimos días de vida proponen estándares de calidad para optimizar la atención de pacientes y familias. Se implementó el Programa Asistencial Multidisciplinario Pallium (PAMPA ©) basado en estándares del International Collaborative for Best Care for the Dying Person en cuatro fases: inducción, implementación, diseminación y sustentabilidad, en cinco centros de salud en Argentina, entre 2008 y 2018. Se incluyeron 1237 pacientes adultos en situación de últimos días de vida, en seguimiento por equipos de cuidados paliativos entrenados en el PAMPA ©. Se efectuó una auditoría antes y después de la ejecución del programa, aún en curso. El rango de medianas de permanencia en los cinco centros desde el inicio de la secuencia hasta el fallecimiento fue de 16 a 178 horas. Se compararon objetivos de cuidado: control de síntomas, comunicación, necesidades multidimensionales, hidratación y nutrición, documentación de intervenciones y cuidados post mortem. El análisis conjunto mostró una mejoría del número de registros (p = 0.001). La comunicación del plan de cuidados con el paciente no mostró diferencias (p = 0.173). Se realizó capacitación y supervisión permanente a los equipos profesionales de quienes se registraron percepciones de la implementación. Los principales emergentes de este análisis cualitativo fueron: actitudes ante el programa, aportes fundamentales, fortalezas, debilidades y definición subjetiva del programa, reconocimiento de las singularidades culturales institucionales y su influencia en el cuidado. El PAMPA © demostró la factibilidad de un modelo de atención para pacientes y familias en final de vida, basado en estándares de calidad internacionales


The integrated care pathways for the last days of life propose quality standards optimizing the care of patients and families. The Pallium Multidisciplinary Assistance Program (PAMPA ©) was implemented based on standards of the International Collaborative for Best Care for the Dying Person in 4 phases: induction, implementation, dissemination and sustainability, in five health centers in Argentina, between 2008 and 2018. A total of 1237 adult patients in the last days of life were included and cared for by palliative care teams trained in PAMPA ©. An audit was conducted before and after the implementation of the Program, which is still going on. The median range of follow up into five centers from the beginning of the pathway until death varied from 16 to 178 hours. Care goals were compared: symptom control, communication, multidimensional needs, hydration and nutrition, documentation of interventions and post-mortem care. The overall analysis showed an improvement in the number of records (p = 0.001). The goal of communication on care plan to the patient showed no difference (p = 0.173). Continuous training, support and permanent teams' supervision were carried out and perceptions and impact of the implementation were registered. The main emerging items of the qualitative analysis were attitudes towards the program, fundamental contributions, strengths, weaknesses and subjective definition of the program, recognition of institutional cultural singularities and its influence on care. PAMPA © demonstrated its feasibility as a model of end of life care for patients and families, based on international quality standards


Dez anos de experiência. Resumo: As sequências integradas de cuidado para últimos dias de vida propõem padrões de qualidade para otimizar a atenção de pacientes e famílias. Implementou-se o Programa Assistencial Multidisciplinar Pallium (PAMPA ©) baseado em parâmetros do International Collaborative for Best Care for the Dying Person em quatro fases: indução, implementação, disseminação e sustentabilidade, em cinco centros de saúde na Argentina, entre 2008 e 2018. Se incluíram 1237 pacientes adultos em situação terminal, assistidos por equipes de cuidados paliativos treinadas no PAMPA ©. Fez-se uma auditoria antes e despois da execução do programa, que ainda está sendo desenvolvido. A média de permanência nos cinco centros desde o início da sequência até a morte deu entre 16 a 178 horas. Conferiram-se objetivos de cuidado: controle de sintomas, comunicação, necessidades multidimensionais, hidratação e nutrição, documentação de intervenções e cuidados post mortem.A análise conjunta tem evidenciado uma melhora do número de registros (p = 0.001). A comunicação do regime de cuidados com o paciente não mostrou diferenças (p = 0.173). Realizou-se capacitação e supervisão permanente às equipes profissionais e se registraram as percepções da implementação.Desta análise qualitativa surgiram notadamente: atitudes em fase do programa, contribuições fundamentais, fortalezas, fraquezas e definição subjetiva do programa, reconhecimento das singularidades culturais institucionais e sua influência no cuidado. O PAMPA © demonstrou a factibilidade de um modelo de atendimento para pacientes e famílias em estado terminal, baseado em padrões de qualidade internacionais


Subject(s)
Humans , Male , Female , Palliative Care , Terminal Care , Hospice Care , Critical Illness
12.
Rev. Soc. Bras. Med. Trop ; 54: e00142021, 2021. tab
Article in English | LILACS | ID: biblio-1250823

ABSTRACT

Abstract INTRODUCTION: Severe acute respiratory syndrome coronavirus 2 has infected more than 9,834,513 Brazilians up to February 2021. Knowledge of risk factors of coronavirus disease among Brazilians remains scarce, especially in the adult population. This study verified the risk factors for intensive care unit admission and mortality for coronavirus disease among 20-59-year-old Brazilians. METHODS: A Brazilian database on respiratory illness was analyzed on October 9, 2020, to gather data on age, sex, ethnicity, education, housing area, and comorbidities (cardiovascular disease, diabetes, and obesity). Multivariate logistic regression analysis was performed to identify the risk factors for coronavirus disease. RESULTS: Overall, 1,048,575 persons were tested for coronavirus disease; among them, 43,662 were admitted to the intensive care unit, and 34,704 patients died. Male sex (odds ratio=1.235 and 1.193), obesity (odds ratio=1.941 and 1.889), living in rural areas (odds ratio=0.855 and 1.337), and peri-urban areas (odds ratio=1.253 and 1.577) were predictors of intensive care unit admission and mortality, respectively. Cardiovascular disease (odds ratio=1.552) was a risk factor for intensive care unit admission. Indigenous people had reduced chances (odds ratio=0.724) for intensive care unit admission, and black, mixed, East Asian, and indigenous ethnicity (odds ratio=1.756, 1.564, 1.679, and 1.613, respectively) were risk factors for mortality. CONCLUSIONS: Risk factors for intensive care unit admission and mortality among adult Brazilians were higher in men, obese individuals, and non-urban areas. Obesity was the strongest risk factor for intensive care unit admission and mortality.


Subject(s)
Humans , Male , Adult , Young Adult , Critical Illness , COVID-19 , Brazil/epidemiology , Risk Factors , SARS-CoV-2 , Hospitalization , Intensive Care Units , Middle Aged
13.
Rev. gaúch. enferm ; 42: e20200278, 2021. tab, graf
Article in English | LILACS, BDENF | ID: biblio-1347554

ABSTRACT

ABSTRACT Objectives To determine the efficacy of a multicomponent nursing program to prevent delirium in critically ill patients. Methods Parallel controlled randomized clinical trial to prevent delirium in 81 critically ill patients: 41 in the control group and 40 in the intervention group (intervention: spatial and temporal guidance, visual stimulus, auditive stimulus, and family support). Participants were recruited from September 2017 to March 2018 in the university hospital Los Comuneros, Bucaramanga, Colombia. Clinical Trials record NCT03215745. Results The incidence of delirium was 5% in the intervention group and 24% in the control group. The relative risk was 0.20 (95% CI 0.05 to 0.88). The absolute risk reduction was 19.39% (95% CI 4.61 to 34.17) and the number needed to treat was 5 (95 CI % 3 to 26%). Conclusion The multicomponent nursing program is efficient to prevent delirium in critically ill patients.


RESUMO Objetivos Determinar a eficácia de um programa de enfermagem com multicomponentes para a prevenção de delirium em pacientes críticos. Métodos Ensaio clínico controlado randomizado paralelo para prevenção de delirium em 81 pacientes críticos: 41 no grupo controle e 40 no grupo intervenção (Intervenção: orientação espacial e temporal, estimulação visual, estimulação auditiva e apoio familiar), recrutados de setembro de 2017 a março de 2018 no Hospital Universitário Los Comuneros, Bucaramanga, Colômbia. Número de registro de ensaios clínicos é NCT03215745. Resultados A incidência de delirium no grupo operado foi de 5% e no grupo controle de 24%. Risco relativo de 0,20 (IC 95% 0,05 a 0,88). A redução absoluta do risco foi de 19,39% (IC 95% 4,61 a 34,17) e o número necessário para o tratamento foi de 5 pacientes (IC 95% 3 a 26%). Conclusão O programa de enfermagem multicomponente é eficaz na prevenção do delirium em pacientes críticos.


RESUMEN Objetivos Determinar la eficacia de un programa de enfermería multicomponente para la prevención del delirium en pacientes críticamente enfermos. Métodos Ensayo clínico controlado aleatorizado en paralelo para la prevención de delirium en 81 pacientes críticamente enfermos: 41 en el grupo control y 40 en el grupo intervenido (Intervención: orientación espacial y temporal, estímulo visual, estimulo auditivo y apoyo familiar), reclutados desde septiembre de 2017 a marzo de 2018 en el Hospital Universitario Los Comuneros, Bucaramanga, Colombia. Registro en Clinical Trials número NCT03215745. Resultados La incidencia de delirium en el grupo intervenido fue de 5% y en el grupo control de 24%. Riesgo relativo de 0,20 (IC 95% 0.05 a 0.88). Reducción absoluta del riesgo 19,39% (IC95% 4,61 a 34,17) y el número necesario a tratar fue de 5 pacientes (IC95% 3 a 26%). Conclusión El programa de enfermería multicomponente es eficaz para prevenir el delirium en pacientes críticamente enfermos.


Subject(s)
Humans , Male , Female , Nursing/methods , Critical Illness , Critical Care , Delirium/prevention & control , Intensive Care Units , Control Groups
14.
Einstein (Säo Paulo) ; 19: eRW6186, 2021. tab, graf
Article in English | LILACS | ID: biblio-1286295

ABSTRACT

ABSTRACT The objective of this study was to highlight the global scientific effort to fight the SARS-CoV-2, addressing the preliminary results of passive immunization through convalescent plasma. We performed a search at the major databases of interventional clinical trial protocols about the transfusion of convalescent plasma in patients with COVID-19, as well as, published articles (n≥25), using the following search strategy: [(COVID-19 OR SARS-CoV-2 OR nCoV-2019) AND (Convalescent plasma OR Plasma exchange) AND (Treatment OR Therapy)]. A total of 24 interventional clinical trial protocols (advanced in phases II-III, III, and IV) were included in this review, as well as three studies that had enough outcomes to evaluate the efficacy of convalescent plasma therapy for patients with COVID-19. All interventional clinical trial protocols applied approximately 500mL of convalescent plasma (from single or more donations) in hospitalized patients, mainly in patients with severe disease associated with standard therapy for COVID-19, and compared to placebo or standard therapy plus specific drugs. Most of interventional clinical trial protocols are multicenter, and the phase IV studies are recruiting at intercontinental centers of North America, Oceania, Europe, but most are recruiting center inside their own county. The three studies published reported similar approach of convalescent plasma intervention with decrease in length of stay, mortality, with less than 4% of adverse events, mainly for treating critical cases with life-threatening disease. All advanced clinical trials focused on convalescent plasma therapy in patients with COVID-19 hospitalized in severe conditions, and the preliminary results provide strong evidence for therapy for the COVID-19 patients.


RESUMO O objetivo deste estudo foi destacar o esforço científico global para combater o SARS-CoV-2 abordando os resultados preliminares da imunização passiva por plasma convalescente. Foi realizada uma busca nas principais bases de dados dos protocolos de ensaios clínicos intervencionistas sobre transfusão de plasma convalescente em pacientes com COVID-19, bem como artigos publicados (n≥25), utilizando a seguinte estratégia de busca: [(COVID-19 OR SARS-CoV-2 OR nCoV-2019) AND (Convalescent plasma OR Plasma exchange) AND (Treatment OR Therapy)]. Um total de 24 protocolos de ensaios clínicos intervencionistas (avançados nas fases II-III, III e IV) foi incluído nesta revisão, assim como três estudos que tiveram resultados suficientes para avaliar a eficácia da terapia com plasma convalescente para pacientes com COVID-19. Todos os protocolos de ensaios clínicos intervencionistas aplicaram cerca de 500mL de plasma convalescente (de uma ou mais doações) em pacientes hospitalizados, principalmente naqueles com grau grave de doença associada à terapia-padrão para COVID-19 em comparação com placebo ou terapia-padrão mais medicamentos específicos. A maioria dos protocolos de ensaios clínicos intervencionistas é multicêntrica, e os estudos de fase IV estão recrutando em centros intercontinentais da América do Norte, Oceania e Europa, mas a maior parte dos centros de recrutamento está dentro de seu próprio país. Os três estudos publicados relataram abordagem semelhante de intervenção para plasma convalescente com redução do tempo de internação, mortalidade e menos de 4% de eventos adversos, principalmente para o tratamento de casos críticos com risco de vida. Todos os ensaios clínicos avançados focaram na terapia com plasma convalescente em pacientes com COVID-19 hospitalizados em condições graves, e os resultados preliminares fornecem fortes evidências para a terapia para esses pacientes com COVID-19.


Subject(s)
Humans , COVID-19/therapy , Plasma , Multicenter Studies as Topic , Immunization, Passive , Treatment Outcome , Critical Illness , SARS-CoV-2
15.
Clinics ; 76: e1924, 2021. tab, graf
Article in English | LILACS | ID: biblio-1153960

ABSTRACT

OBJECTIVES: Positive fluid balance is frequent in critically ill patients and has been considered a potential biomarker for acute kidney injury (AKI). This study aimed to evaluate positive fluid balance as a biomarker for the early detection of AKI in critically ill patients. METHODS: This was a prospective cohort study. The sample was composed of patients ≥18 years old who stayed ≥3 days in an intensive care unit. Fluid balance, urinary output and serum creatinine were assessed daily. AKI was diagnosed by the Kidney Disease Improving Global Outcome criteria. RESULTS: The final cohort was composed of 233 patients. AKI occurred in 92 patients (40%) after a median of 3 (2-6) days following ICU admission. When fluid balance was assessed as a continuous variable, a 100-ml increase in fluid balance was independently associated with a 4% increase in the odds of AKI (OR 1.04; 95% CI 1.01-1.08). Positive fluid balance categorized using different thresholds was always significantly associated with subsequent detection of AKI. The mixed effects model showed that increased fluid balance preceded AKI by 4 to 6 days. CONCLUSION: These results suggest that a positive fluid balance might be an early biomarker for AKI development in critically ill patients.


Subject(s)
Humans , Adult , Critical Illness , Acute Kidney Injury/diagnosis , Water-Electrolyte Balance , Biomarkers , Prospective Studies , Intensive Care Units
17.
Article in Chinese | WPRIM | ID: wpr-879872

ABSTRACT

Pediatric patients in the neonatal intensive care unit (NICU) and the pediatric intensive care unit (PICU) have a high incidence rate of genetic diseases, and early rapid etiological diagnosis and targeted interventions can help to reduce mortality or improve prognosis. Whole-genome sequencing covers more comprehensive information including point mutation, copy number, and structural and rearrangement variations in the intron region and has become one of the powerful diagnostic tools for genetic diseases. Sequencing data require highly professional judgment and interpretation and are returned for clinical application after several weeks, which cannot meet the need for the diagnosis and treatment of genetic diseases in children. This article introduces the clinical application of rapid whole-genome sequencing in the NICU/PICU and briefly describes related techniques of artificial intelligence-rapid whole-genome sequencing diagnostic system, a rapid high-throughput automated platform for the diagnosis of genetic diseases. The diagnostic system introduces artificial intelligence into the processing of data after whole-genome sequencing and can solve the problems of long time and professional interpretation required for routine genome sequencing and provide a rapid diagnostic regimen for critically ill children suspected of genetic diseases within 24 hours, and therefore, it holds promise for clinical application.


Subject(s)
Artificial Intelligence , Child , Critical Illness , Humans , Infant, Newborn , Intensive Care Units, Neonatal , Intensive Care Units, Pediatric , Whole Genome Sequencing
18.
Rev. cuba. med. mil ; 49(4): e926, tab, graf
Article in Spanish | LILACS, CUMED | ID: biblio-1156494

ABSTRACT

Introducción: El CIGB-258 es un péptido inmunomodulador con propiedades antiinflamatorias. Objetivos: Establecer la frecuencia de dosis y el tiempo de tratamiento con el péptido CIGB-258, para pacientes críticos con COVID-19. Además, definir los criterios de uso y el esquema terapéutico del péptido, para pacientes graves con COVID-19. Métodos: Se incluyeron 9 pacientes críticos y 3 pacientes graves. Las evaluaciones clínicas, radiológicas y de laboratorio se registraron de acuerdo al protocolo establecido. Se obtuvieron muestras de suero antes y después del tratamiento con la CIGB-258, para la determinación de los biomarcadores de la inflamación. Resultados: Se estableció el protocolo de actuación con el péptido CIGB-258, el cual consiste en la administración intravenosa de 1 mg del péptido cada 12 horas a los pacientes críticos. La dosis debe aumentarse a 2 mg cada 12 horas, para los pacientes que no muestren mejoría clínica y radiológica en 24 horas. Después de la extubación, los pacientes deben recibir 1 mg de CIGB-258 al día, durante otros tres días. Los pacientes graves deben recibir 1 mg de CIGB-258 cada 12 horas, hasta que resuelvan su condición clínica. Conclusiones: CIGB-258 mostró un buen perfil de seguridad. El protocolo de actuación establecido contribuyó a que todos los pacientes críticos se recuperaran de la dificultad respiratoria y fueran extubados. Los pacientes graves mejoraron considerablemente. Los niveles de los biomarcadores asociados con hiperinflamación y las citocinas disminuyeron significativamente durante el tratamiento(AU)


Introduction: CIGB-258 is an immunomodulatory peptide with anti-inflammatory properties. Objectives: To establish the therapeutic schedule with CIGB-258 peptide for COVID-19 critically ill patients. In addition, to define the criteria for use and schedule of this peptide for COVID-19 seriously ill patients. Methods: 9 critically ill patients and 3 seriously ill patients were included in this study. Clinical, radiological and laboratory evaluations were recorded according to the established protocol. Serum samples were obtained before and after treatment with CIGB-258, for the determination of the inflammation biomarkers. Results: The therapeutic protocol was established with the CIGB-258 peptide, which consists of intravenous administration of 1 mg of peptide every 12 hours for critically ill patients. The dose should be increased to 2 mg every 12 hours, for patients who do not show clinical and radiological improvement in 24 hours. After extubation, patients should receive 1 mg of CIGB-258 daily, for another three days. Seriously ill patients should receive 1 mg of CIGB-258 every 12 hours, until their clinical condition resolves. Conclusions: CIGB-258 showed an excellent safety profile. The established therapeutic protocol contributed to all critically ill patients recovering from respiratory distress and being extubated. Seriously ill patients improved considerably. The levels of the biomarkers associated with hyperinflammation and cytokines decreased significantly during treatment(AU)


Subject(s)
Humans , Critical Illness/therapy , Chaperonin 60 , Reference Drugs , Cytokine Release Syndrome/epidemiology , COVID-19/drug therapy
19.
Med. infant ; 27(2): 125-132, Diciembre 2020. Tab
Article in Spanish | LILACS, BINACIS, UNISALUD | ID: biblio-1148374

ABSTRACT

Introducción. Conocer las características epidemiológicas (CE) de una población resulta primordial para la definición de estrategias sanitarias. Nuestro objetivo es describir las características de pacientes críticos ingresados al sector reanimación (SR). Materiales y métodos. Estudio descriptivo y retrospectivo realizado en un servicio de urgencias de un hospital de tercer nivel entre 2/7/2018 y 1/7/2019. Se incluyeron todos los pacientes ingresados a SR. Se registró edad, sexo, motivo de ingreso, condición crónica, procedimientos diagnósticos y terapéuticos efectuados. Los datos fueron obtenidos del libro de registro y la historia clínica informatizada, y analizados con software Redcap Versión 8.9.2. Las variables categóricas se expresaron como frecuencias y porcentajes y las continuas con mediana y rango intercuartílico. Resultados. Ingresaron 2292 pacientes. El 94% fueron menores de 16 años. El 56,5% presentaba condiciones crónicas (CC), siendo más frecuentes las enfermedades neurológicas (29%), endocrino/metabólicas (15,5%) y cardiovasculares (11%). Los motivos de ingreso más habituales: enfermedad respiratoria aguda baja (31%), estado epiléptico (13%), sepsis (13%) y deshidratación grave (7%). Estudios complementarios más utilizados: laboratorio (54%), radiografía (28%), hemocultivos (23%). Los procedimientos realizados con más frecuencia fueron la colocación de acceso venoso periférico (67%), cánula nasal de alto flujo (6%) y ventilación mecánica (5%). Las drogas más indicadas: oxígeno (42%), fluidos (34%), antibióticos (22%). El 14% ingresó a cuidados intensivos. Hubo 11 paros cardiorrespiratorios y 6 óbitos. Conclusiones. En el SR se asisten pacientes críticos con patologías de alta prevalencia como también pacientes con enfermedades crónicas complejas. La evaluación periódica de CE resulta una herramienta fundamental para detectar dificultades y elaborar estrategias de mejora (AU)


Introduction. Knowledge on the epidemiological characteristics (EC) of a population is essential to define healthcare strategies. Our aim was to describe the characteristics of critical patients admitted to the resuscitation unit (RU). Materials and methods. A descriptive and retrospective study was conducted at an emergency department of a third-level hospital between 2/7/2018 and 1/7/2019. All patients admitted to the RU were included. Age, sex, reason for admission, underlying disease, and diagnostic and therapeutic procedures performed were recorded. The data were obtained from the logbook and electronic records, and analyzed using Redcap software Version 8.9.2. Categorical variables were expressed as frequencies and percentages and continuous variables as median and interquartile range. Results. 2292 patients were admitted; 94% were younger than 16 years of age. Overall, 56.5% had underlying diseases (UD), the most common of which were neurological (29%), endocrine/metabolic (15.5%), and cardiovascular (11%) disorders. The most common reasons for admission were acute lower respiratory tract disease (31%), status epilepticus (13%), sepsis (13%), and severe dehydration (7%). The most frequently used complementary studies were laboratory tests (54%), x-rays (28%), and hemocultures (23%). The most frequently performed procedures were peripheral venous line (67%), high-flow nasal cannula (6%), and mechanical ventilation (5%) placement. The most frequently indicated medications were oxygen (42%), fluids (34%), and antibiotics (22%). Overall, 14% required admission to the intensive care unit. There were 11 cardiorespiratory arrests and six deaths. Conclusions. Critical patients with highly prevalent diseases as well as patients with complex underlying diseases are seen at the RU. Periodic EC evaluation is a key tool for detecting difficulties and developing improvement strategies (AU)


Subject(s)
Humans , Infant , Child, Preschool , Child , Adolescent , Adult , Chronic Disease/epidemiology , Critical Illness/epidemiology , Emergency Service, Hospital/statistics & numerical data , Hospital Rapid Response Team/trends , Hospital Rapid Response Team/statistics & numerical data , Time Factors , Retrospective Studies , Treatment Outcome
20.
Med. infant ; 27(2): 107-112, Diciembre 2020. ilus, Tab
Article in Spanish | LILACS, BINACIS, UNISALUD | ID: biblio-1148102

ABSTRACT

La injuria renal aguda (IRA) se caracteriza por un abrupto deterioro de la función renal asociado a lteraciones hidroelectrolíticas y metabólicas. La misma es frecuente en la unidad de cuidados intensivos (UCI) pediátricos y tiene un impacto significativo en la morbilidad y mortalidad. Las principales indicaciones de terapia de reemplazo renal (TRR) incluyen la corrección de los trastornos metabólicos y el manejo de la sobrecarga de fluidos. Varios modos de TRR pueden ser utilizadas en la UCI: hemodiálisis intermitente, diálisis peritoneal y las terapias de reemplazo renal continuas (TRRC). Las terapias de reemplazo renal continuas han ganado un rol preponderante en Cuidados Críticos ya que posibilitan dializar a pacientes hemodinámicamente inestables. Del total de pacientes admitidos en la UCI (n:1506) desde enero 2012 hasta diciembre 2018, requirieron TRRC el 6,7% (n: 102). La mortalidad predicha por el Score PIM3 fue de 19,53%, la mediana de edad en meses fue de 60 (RIC 25-75: 12-144), no hubo diferencias en cuanto al sexo. Los diagnósticos más frecuentes fueron trasplantados de órganos sólidos 33%, seguidos de trasplante de células progenitoras hematopoyéticas (TCPH) el 26%. La mediana de los días de internación fue de 16 (RIC 25-75: 7-29) y de días de requerimiento de una TRRC 5 (RIC 25-75 3-9). La técnica dialítica más utilizada fue CVVHD, en el 87% de los pacientes. La mortalidad global fue del 75%, presentando los pacientes con TCPH mayor mortalidad con respecto a otros diagnósticos. Se debe reconocer y categorizar precozmente a los pacientes con mayor riesgo de desarrollar IRA y aplicar medidas de nefroprotección para mejorar su sobrevida (AU)


Acute renal injury (IRA) is characterized by sudden deterioration of kidney function associated with hydroelectrolytic and metabolic disturbances. IRA is common in the pediatric intensive care unit (ICU) and has a significant impact on morbidity and mortality. The main indications for renal replacement therapy (RRT) include correction of the metabolic disorders and management of fluid overload. Different types of RRT may be used in the ICU: intermittent hemodialysis, peritoneal dialysis, and continuous renal replacement therapies (CRRT). Continuous renal replacement therapies have gained a major role in critical care as they allow for dialysis in hemodynamically unstable patients. Of all patients admitted to the ICU (n:1506) between January 2012 and December 2018, 6.7% required CRRT (n: 102). Predicted mortality rate according to the PIM3 score was 19.53%. Median age was 60 months (IQR 25-75: 12-144). No differences in sex were observed. The most common diagnoses were solid organ transplantation in 33%, followed by hematopoietic stem cell transplantation (HSCT) in 26%. Median length of hospital stay was 16 days (IQR 25-75: 7-29) and median days on CTTT was 5 (IQR 25-75 3-9). The most common dialysis technique was CVVHD, used in 87% of the patients. Overall mortality rate was 75%, with a higher mortality in HSCT patients compared to others. Patients at a higher risk of developing IRA should be timely recognized and categorized and nephroprotective measures should be started early to improve survival (AU)


Subject(s)
Humans , Infant , Child, Preschool , Child , Water-Electrolyte Imbalance , Intensive Care Units, Pediatric , Immunocompromised Host , Critical Illness , Acute Kidney Injury/therapy , Continuous Renal Replacement Therapy , Survival Analysis , Retrospective Studies , Treatment Outcome
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