Printable Poly(3,4-ethylenedioxythiophene)-Based Conductive Patches for Cardiac Tissue Remodeling.

Myocardial cardiopathy is one of the highest disease burdens worldwide. The damaged myocardium has little intrinsic repair ability, and as a result, the distorted muscle loses strength for contraction, producing arrhythmias and fainting, and entails a high risk of sudden death. Permanent implantable conductive hydrogels that can restore contraction strength and conductivity appear to be promising candidates for myocardium functional recovery. In this work, we present a printable cardiac hydrogel that can exert functional effects on networks of cardiac myocytes. The hydrogel matrix was designed from poly(vinyl alcohol) (PVA) dynamically cross-linked with gallic acid (GA) and the conductive polymer poly(3,4-ethylenedioxythiophene) (PEDOT). The resulting patches exhibited excellent electrical conductivity, elasticity, and mechanical and contractile strengths, which are critical parameters for reinforcing weakened cardiac contraction and impulse propagation. Furthermore, the PVA-GA/PEDOT blend is suitable for direct ink writing via a melting extrusion. As a proof of concept, we have proven the efficiency of the patches in propagating the electrical signal in adult mouse cardiomyocytes through in vitro recordings of intracellular Ca2+ transients during cell stimulation. Finally, the patches were implanted in healthy mouse hearts to demonstrate their accommodation and biocompatibility. Magnetic resonance imaging revealed that the implants did not affect the essential functional parameters after 2 weeks, thus showing great potential for treating cardiomyopathies.

Design and implementation of a “crisis resource management” training program for the initial assessment of polytrauma patients / Diseño e implementación de un programa de aprendizaje crisis resource management para la evaluación inicial del paciente politraumatizado

Introduction: To describe the design and implementation of a Crisis Resource Management (CRM) training program for the initial assessment of polytrauma patients. Methods: Prospectively implemented CRM training program in acute-care tertiary hospital by hospital personnel involved in the care of polytraumatisms. The program has a blended format and 23-h duration, including 11 h of online theoretical training followed by 12-h simulation modules and practical cases devoted to the roles of members of the trauma team, functioning of the polytrauma room, and key aspects of teamwork. The Human Factors Attitude Survey (HFAS) was used to assess attitudes related to non-technical skills, and the End-of-Course Critique (ECC) survey to evaluate satisfaction with training. We evaluated changes in the pre- and post-training assessments. Results: Eighty staff personnel (26% specialists, 16% residents, 29% nurses, 14% nursing assistant, 15% stretcher bearer) participated in three editions of the program. Theoretical knowledge improved from a mean (SD) of 5.95 (1.7) to 8.27 (2.1) (P < .0001). In the HFAS, statistically significant differences in 18 of 23 attitudinal markers were observed, with improvements in all items of “leadership” and “roles”, in 4 of 5 items of “situational awareness”, and in 4 of 8 items of “communication”. Mean values obtained in the ECC questionnaire were also very high. Conclusions: A CRM training model developed for the initial care of polytrauma patients improved theoretical knowledge and participants perceptions and attitudes regarding leadership, communication, roles, and situational awareness of members of the trauma team. (AU)

Introducción: Describir el diseño y la implementación de un programa de formación basado en Crisis Resource Management para la evaluación inicial de los pacientes con politraumatismos. Métodos: Implementación prospectiva de un programa CRM de formación en Hospital terciario con el personal del hospital involucrado en la asistencia de politraumatismos. El programa tenía un formato semipresencial de 23 horas de duración, incluyendo 11 horas de formación online de contenido teórico seguidas de 12 horas de módulos de simulación y casos prácticos referidos a los papeles de los miembros del equipo de trauma, funcionamiento del box de trauma y aspectos claves del trabajo en equipo. El Human Factors Attitude Survey (HFAS) se utilizó para evaluar las actitudes relacionadas con las habilidades no técnicas y el End-of-Course Critique (ECC) cuestionario para valorar la satisfacción con la formación. Se evaluaron los cambios antes y después de la formación. Resultados: Ochenta miembros del hospital (26% especialistas, 16% residentes, 29% enfermeras, 14% auxiliares de enfermería, 15% camilleros) participaron en tres ediciones del programa. El conocimiento teórico aumentó de una media (DE) de 5.95 (1.7) a 8.27 (2.1) (P < ,0001). En el HFAS, se observaron diferencias estadísticamente significativas en 18 de los 23 marcadores de actitud, con mejorías en todos los ítems de “liderazgo” y “roles”, en 4 de los 5 items de “consciencia situacional” y en 4 de los 8 ítems de “comunicación”. Los valores medios obtenidos en el cuestionario ECC tambien fueron muy altos. Conclusiones: Un modelo CRM de formación desarrollado para la atención inicial de los pacientes con politraumatismos mejoró el conocimiento teórico y las percepciones y actitudes de los participantes relacionadas con el liderazgo, la comunicación, los roles y la consciencia situacional de los miembros del equipo de trauma. (AU)

Organic Functional Group on Carbon Nanotube Modulates the Maturation of SH-SY5Y Neuronal Models.

Carbon nanotubes (CNT) have proven to be excellent substrates for neuronal cultures, showing high affinity and greatly boosting their synaptic functionality. Therefore, growing cells on CNT offers an opportunity to perform a large variety of neuropathology studies in vitro. To date, the interactions between neurons and chemical functional groups have not been studied extensively. To this end, multiwalled CNT (f-CNT) is functionalized with various functional groups, including sulfonic (-SO3 H), nitro (-NO2 ), amino (-NH2 ), and oxidized moieties. f-CNTs are spray-coated onto untreated glass substrates and are used as substrates for the incubation of neuroblastoma cells (SH-SY5Y). After 7 d, its effect is evaluated in terms of cell attachment, survival, growth, and spontaneous differentiation. Cell viability assays show quite increased proliferation on various f-CNT substrates (CNTs-NO2 > ox-CNTs ≈ CNTs-SO3 H > CNTs ≈ CNTs-NH2 ). Additionally, SH-SY5Y cells show selectively better differentiation and maturation with -SO3 H substrates, where an increased expression of ß-III tubulin is seen. In all cases, intricate cell-CNT networks are observed and the morphology of the cells adopts longer and thinner cellular processes, suggesting that the type of functionalization may have an effect of the length and thickness. Finally, a possible correlation is determined between conductivity of f-CNTs and cell-processes lengths.

Mixed Conductive, Injectable, and Fluorescent Supramolecular Eutectogel Composites.

Eutectogels are an emerging family of soft ionic materials alternative to ionic liquid gels and organogels, offering fresh perspectives for designing functional dynamic platforms in water-free environments. Herein, the first example of mixed ionic and electronic conducting supramolecular eutectogel composites is reported. A fluorescent glutamic acid-derived low-molecular-weight gelator (LMWG) was found to self-assemble into nanofibrillar networks in deep eutectic solvents (DES)/poly(3,4-ethylenedioxythiophene) (PEDOT): chondroitin sulfate dispersions. These dynamic materials displayed excellent injectability and self-healing properties, high ionic conductivity (up to 10-2  S cm-1 ), good biocompatibility, and fluorescence imaging ability. This set of features turns the mixed conducting supramolecular eutectogels into promising adaptive materials for bioimaging and electrostimulation applications.

Design and implementation of a "crisis resource management" training program for the initial assessment of polytrauma patients.

INTRODUCTION: To describe the design and implementation of a Crisis Resource Management (CRM) training program for the initial assessment of polytrauma patients. METHODS: Prospectively implemented CRM training program in acute-care tertiary hospital by hospital personnel involved in the care of polytraumatisms. The program has a blended format and 23-h duration, including 11 h of online theoretical training followed by 12-h simulation modules and practical cases devoted to the roles of members of the trauma team, functioning of the polytrauma room, and key aspects of teamwork. The Human Factors Attitude Survey (HFAS) was used to assess attitudes related to non-technical skills, and the End-of-Course Critique (ECC) survey to evaluate satisfaction with training. We evaluated changes in the pre- and post-training assessments. RESULTS: Eighty staff personnel (26% specialists, 16% residents, 29% nurses, 14% nursing assistant, 15% stretcher bearer) participated in three editions of the program. Theoretical knowledge improved from a mean (SD) of 5.95 (1.7) to 8.27 (2.1) (P < .0001). In the HFAS, statistically significant differences in 18 of 23 attitudinal markers were observed, with improvements in all items of "leadership" and "roles", in 4 of 5 items of "situational awareness", and in 4 of 8 items of "communication". Mean values obtained in the ECC questionnaire were also very high. CONCLUSIONS: A CRM training model developed for the initial care of polytrauma patients improved theoretical knowledge and participants perceptions and attitudes regarding leadership, communication, roles, and situational awareness of members of the trauma team.

Improvement of Teamwork Nontechnical Skills Through Polytrauma Simulation Cases Using the Communication and Teamwork Skills (CATS) Assessment Tool.

OBJECTIVE: To assess acquisition of nontechnical skills (NTS) through clinical simulation cases by healthcare personnel who participated in a Crisis Resource Management (CRM) training program for the initial care of polytraumatisms. DESIGN: Pre-and postintervention study. SETTING: Acute-care teaching hospital in Sabadell, Barcelona (Spain). PARTICIPANTS: Healthcare personnel that composed teamworks providing initial care to polytraumatized patients attended 12-hour simulation training using a SimMan 3G manikin and performed exercises corresponding to 3 clinical scenarios. All simulations lasted 15 to 25 min and were video recorded. The CATS Assessment tool was used for analysis of teamwork NTS, which included 21 behaviors clustered into the categories of coordination, situational awareness, cooperation, communication, and crisis situation. RESULTS: Three editions of the CRM training course were carried out with 12 trauma team groups composed by team leader, anesthesiologist, general surgeon, traumatologist, registered nurses, nursing assistant, and stretcher bearer. There were statistically significant (p <0.001) improvements in the speed of key times of total duration of case resolution, transfusion of hemoderivatives, Focused Assessment Sonography for Trauma, and chest and pelvic X-rays. The percentage of cases correctly resolved improved from 75% to 91.7% but differences were not statistically significant (p = 0.625). Precourse and postcourse results of CATS scores showed a statistically significant increase in the weighted total score as well as in all behavioral categories of coordination, situational awareness, cooperation, communication, and crisis situation. CONCLUSIONS: Simulation-based training of NTS was associated with significant improvements in teamwork behaviors in the setting of the initial care of patients with polytraumatisms.

Neonatal rat ventricular myocytes interfacing conductive polymers and carbon nanotubes.

Carbon nanotubes (CNTs) have become promising advanced materials and a new tool to specifically interact with electroresponsive cells. Likewise, conductive polymers (CP) appear promising electroactive biomaterial for proliferation of cells. Herein, we have investigated CNT blends with two different conductive polymers, polypyrrole/CNT (PPy/CNT) and PEDOT/CNT to evaluate the growth, survival, and beating behavior of neonatal rat ventricular myocytes (NRVM). The combination of CP/CNT not only shows excellent biocompatibility on NRVM, after 2 weeks of culture, but also exerts functional effects on networks of cardiomyocytes. NRVMs cultured on CNT-based substrates exhibited improved cellular function, i.e., homogeneous, non-arrhythmogenic, and more frequent spontaneous beating; particularly PEDOT/CNT substrates, which yielded to higher beating amplitudes, thus suggesting a more mature cardiac phenotype. Furthermore, cells presented enhanced structure: aligned sarcomeres, organized and abundant Connexin 43 (Cx43). Finally, no signs of induced hypertrophy were observed. In conclusion, the combination of CNT with CP produces high viability and promotes cardiac functionality, suggesting great potential to generate scaffolding supports for cardiac tissue engineering.

Digital Light 3D Printing of PEDOT-Based Photopolymerizable Inks for Biosensing.

3D conductive materials such as polymers and hydrogels that interface between biology and electronics are actively being researched for the fabrication of bioelectronic devices. In this work, short-time (5 s) photopolymerizable conductive inks based on poly(3,4-ethylenedioxythiophene) (PEDOT):polystyrene sulfonate (PSS) dispersed in an aqueous matrix formed by a vinyl resin, poly(ethylene glycol) diacrylate (PEGDA) with different molecular weights (M n = 250, 575, and 700 Da), ethylene glycol (EG), and a photoinitiator have been optimized. These inks can be processed by Digital Light 3D Printing (DLP) leading to flexible and shape-defined conductive hydrogels and dry conductive PEDOTs, whose printability resolution increases with PEGDA molecular weight. Besides, the printed conductive PEDOT-based hydrogels are able to swell in water, exhibiting soft mechanical properties (Young's modulus of ∼3 MPa) similar to those of skin tissues and good conductivity values (10-2 S cm-1) for biosensing. Finally, the printed conductive hydrogels were tested as bioelectrodes for human electrocardiography (ECG) and electromyography (EMG) recordings, showing a long-term activity, up to 2 weeks, and enhanced detection signals compared to commercial Ag/AgCl medical electrodes for health monitoring.

Fast Visible-Light Photopolymerization in the Presence of Multiwalled Carbon Nanotubes: Toward 3D Printing Conducting Nanocomposites.

A new photoinitiator system (PIS) based on riboflavin (Rf), triethanolamine, and multiwalled carbon nanobutes (MWCNTs) is presented for visible-light-induced photopolymerization of acrylic monomers. Using this PIS, photopolymerization of acrylamide and other acrylic monomers was quantitative in seconds. The intervention mechanism of CNTs in the PIS was studied deeply, proposing a surface interaction of MWCNTs with Rf which favors the radical generation and the initiation step. As a result, polyacrylamide/MWCNT hydrogel nanocomposites could be obtained with varying amounts of CNTs showing excellent mechanical, thermal, and electrical properties. The presence of the MWCNTs negatively influences the swelling properties of the hydrogel but significantly improves its mechanical properties (Young modulus values) and electric conductivity. The new PIS was tested for 3D printing in a LCD 3D printer. Due to the fast polymerizations, 3D-printed objects based on the conductive polyacrylamide/CNT nanocomposites could be manufactured in minutes.

The era of nano-bionic: 2D materials for wearable and implantable body sensors.

Nano-bionics have the potential of revolutionizing modern medicine. Among nano-bionic devices, body sensors allow to monitor in real-time the health of patients, to achieve personalized medicine, and even to restore or enhance human functions. The advent of two-dimensional (2D) materials is facilitating the manufacturing of miniaturized and ultrathin bioelectronics, that can be easily integrated in the human body. Their unique electronic properties allow to efficiently transduce physical and chemical stimuli into electric current. Their flexibility and nanometric thickness facilitate the adaption and adhesion to human body. The low opacity permits to obtain transparent devices. The good cellular adhesion and reduced cytotoxicity are advantageous for the integration of the devices in vivo. Herein we review the latest and more significant examples of 2D material-based sensors for health monitoring, describing their architectures, sensing mechanisms, advantages and, as well, the challenges and drawbacks that hampers their translation into commercial clinical devices.

Thiophene-Based Trimers and Their Bioapplications: An Overview.

Certainly, the success of polythiophenes is due in the first place to their outstanding electronic properties and superior processability. Nevertheless, there are additional reasons that contribute to arouse the scientific interest around these materials. Among these, the large variety of chemical modifications that is possible to perform on the thiophene ring is a precious aspect. In particular, a turning point was marked by the diffusion of synthetic strategies for the preparation of terthiophenes: the vast richness of approaches today available for the easy customization of these structures allows the finetuning of their chemical, physical, and optical properties. Therefore, terthiophene derivatives have become an extremely versatile class of compounds both for direct application or for the preparation of electronic functional polymers. Moreover, their biocompatibility and ease of functionalization make them appealing for biology and medical research, as it testifies to the blossoming of studies in these fields in which they are involved. It is thus with the willingness to guide the reader through all the possibilities offered by these structures that this review elucidates the synthetic methods and describes the full chemical variety of terthiophenes and their derivatives. In the final part, an in-depth presentation of their numerous bioapplications intends to provide a complete picture of the state of the art.

3D Printable Conducting and Biocompatible PEDOT-graft-PLA Copolymers by Direct Ink Writing.

Tailor-made polymers are needed to fully exploit the possibilities of additive manufacturing, constructing complex, and functional devices in areas such as bioelectronics. In this paper, the synthesis of a conducting and biocompatible graft copolymer which can be 3D printed using direct melting extrusion methods is shown. For this purpose, graft copolymers composed by conducting polymer poly(3,4-ethylenedioxythiophene) (PEDOT) and a biocompatible polymer polylactide (PLA) are designed. The PEDOT-g-PLA copolymers are synthesized by chemical oxidative polymerization between 3,4-ethylenedioxythiophene and PLA macromonomers. PEDOT-g-PLA copolymers with different compositions are obtained and fully characterized. The rheological characterization indicates that copolymers containing below 20 wt% of PEDOT show the right complex viscosity values suitable for direct ink writing (DIW). The 3D printing tests using the DIW methodology allows printing different parts with different shapes with high resolution (200 µm). The conductive and biocompatible printed patterns of PEDOT-g-PLA show excellent cell growth and maturation of neonatal cardiac myocytes cocultured with fibroblasts.

Carbon Nanomaterials Embedded in Conductive Polymers: A State of the Art.

Carbon nanomaterials are at the forefront of the newest technologies of the third millennium, and together with conductive polymers, represent a vast area of indispensable knowledge for developing the devices of tomorrow. This review focusses on the most recent advances in the field of conductive nanotechnology, which combines the properties of carbon nanomaterials with conjugated polymers. Hybrid materials resulting from the embedding of carbon nanotubes, carbon dots and graphene derivatives are taken into consideration and fully explored, with discussion of the most recent literature. An introduction into the three most widely used conductive polymers and a final section about the most recent biological results obtained using carbon nanotube hybrids will complete this overview of these innovative and beyond belief materials.

2D and 3D Immobilization of Carbon Nanomaterials into PEDOT via Electropolymerization of a Functional Bis-EDOT Monomer.

Carbon nanomaterials (CNMs) and conjugated polymers (CPs) are actively investigated in applications such as optics, catalysis, solar cells, and tissue engineering. Generally, CNMs are implemented in devices where the relationship between the active elements and the micro and nanostructure has a crucial role. However, they present some limitations related to solubility, processibility and release or degradability that affect their manufacturing. CPs, such as poly(3,4-ethylenedioxythiophene) (PEDOT) or derivatives can hide this limitation by electrodeposition onto an electrode. In this work we have explored two different CNMs immobilization methods in 2D and 3D structures. First, CNM/CP hybrid 2D films with enhanced electrochemical properties have been developed using bis-malonyl PEDOT and fullerene C60. The resulting 2D films nanoparticulate present novel electrochromic properties. Secondly, 3D porous self-standing scaffolds were prepared, containing carbon nanotubes and PEDOT by using the same bis-EDOT co-monomer, which show porosity and topography dependence on the composition. This article shows the validity of electropolymerization to obtain 2D and 3D materials including different carbon nanomaterials and conductive polymers.

Additive Manufacturing of Conducting Polymers: Recent Advances, Challenges, and Opportunities.

Conducting polymers (CPs) have been attracting great attention in the development of (bio)electronic devices. Most of the current devices are rigid two-dimensional systems and possess uncontrollable geometries and architectures that lead to poor mechanical properties presenting ion/electronic diffusion limitations. The goal of the article is to provide an overview about the additive manufacturing (AM) of conducting polymers, which is of paramount importance for the design of future wearable three-dimensional (3D) (bio)electronic devices. Among different 3D printing AM techniques, inkjet, extrusion, electrohydrodynamic, and light-based printing have been mainly used. This review article collects examples of 3D printing of conducting polymers such as poly(3,4-ethylene-dioxythiophene), polypyrrole, and polyaniline. It also shows examples of AM of these polymers combined with other polymers and/or conducting fillers such as carbon nanotubes, graphene, and silver nanowires. Afterward, the foremost applications of CPs processed by 3D printing techniques in the biomedical and energy fields, that is, wearable electronics, sensors, soft robotics for human motion, or health monitoring devices, among others, will be discussed.

Toward Spontaneous Neuronal Differentiation of SH-SY5Y Cells Using Novel Three-Dimensional Electropolymerized Conductive Scaffolds.

Neuroblastoma-derived SH-SY5Y cells have become an excellent model for nervous system regeneration to treat neurodegenerative disorders. Many approaches achieved a mature population of derived neurons in in vitro plates. However, the importance of the third dimension in tissue regeneration has become indispensable to achieve a potential implant to replace the damaged tissue. Therefore, we have prepared porous 3D structures composed uniquely of carbon nanotubes (CNT) and poly(3,4-ethylenedioxythiophene) (PEDOT) that show great potential in the tridimensional differentiation of SH-SY5Y cells into mature neurons. The scaffolds have been manufactured through electropolymerization by applying 1.2 V in a three-electrode cell using a template of sucrose/CNT as a working electrode. By this method, PEDOT/CNT 3D scaffolds were obtained with homogeneous porosities and high conductivity. In vitro analyses showed that an excellent biocompatibility of the scaffold and the presence of high amount of ß-tubulin class III and MAP-II target proteins that mainly expresses in neurons, suggesting the differentiation into neuronal cells already after a week of incubation.

Tailored Methodology Based on Vapor Phase Polymerization to Manufacture PEDOT/CNT Scaffolds for Tissue Engineering.

Three-dimensional (3D) scaffolds with tailored stiffness, porosity, and conductive properties are particularly important in tissue engineering for electroactive cell attachment, proliferation, and vascularization. Carbon nanotubes (CNTs) and poly(3,4-ethylenedioxythiophene) (PEDOT) have been extensively used separately as neural interfaces showing excellent results. Herein, we combine both the materials and manufacture 3D structures composed exclusively of PEDOT and CNTs using a methodology based on vapor phase polymerization of PEDOT onto a CNT/sucrose template. Such a strategy presents versatility to produce porous scaffolds, after leaching out the sucrose grains, with different ratios of polymer/CNTs, and controllable and tunable electrical and mechanical properties. The resulting 3D structures show Young's modulus typical of soft materials (20-50 kPa), as well as high electrical conductivity, which may play an important role in electroactive cell growth. The conductive PEDOT/CNT porous scaffolds present high biocompatibility after 3 and 6 days of C8-D1A astrocyte incubation.

3D Scaffolds Based on Conductive Polymers for Biomedical Applications.

3D scaffolds appear to be a cost-effective ultimate answer for biomedical applications, facilitating rapid results while providing an environment similar to in vivo tissue. These biomaterials offer large surface areas for cell or biomaterial attachment, proliferation, biosensing and drug delivery applications. Among 3D scaffolds, the ones based on conjugated polymers (CPs) and natural nonconductive polymers arranged in a 3D architecture provide tridimensionality to cellular culture along with a high surface area for cell adherence and proliferation as well electrical conductivity for stimulation or sensing. However, the scaffolds must also obey other characteristics: homogeneous porosity, with pore sizes large enough to allow cell penetration and nutrient flow; elasticity and wettability similar to the tissue of implantation; and a suitable composition to enhance cell-matrix interactions. In this Review, we summarize the fabrication methods, characterization techniques and main applications of conductive 3D scaffolds based on conductive polymers. The main barrier in the development of these platforms has been the fabrication and subsequent maintenance of the third dimension due to challenges in the manipulation of conductive polymers. In the last decades, different approaches to overcome these barriers have been developed for the production of conductive 3D scaffolds, demonstrating a huge potential for biomedical purposes. Finally, we present an overview of the emerging strategies developed to manufacture 3D conductive scaffolds, the techniques used to fully characterize them, and the biomedical fields where they have been applied.

Three-Dimensional Conductive Scaffolds as Neural Prostheses Based on Carbon Nanotubes and Polypyrrole.

Three-dimensional scaffolds for cellular organization need to enjoy a series of specific properties. On the one hand, the morphology, shape and porosity are critical parameters and eventually related with the mechanical properties. On the other hand, electrical conductivity is an important asset when dealing with electroactive cells, so it is a desirable property even if the conductivity values are not particularly high. Here, we construct three-dimensional (3D) porous and conductive composites, where C8-D1A astrocytic cells were incubated to study their biocompatibility. The manufactured scaffolds are composed exclusively of carbon nanotubes (CNTs), a most promising material to interface with neuronal tissue, and polypyrrole (PPy), a conjugated polymer demonstrated to reduce gliosis, improve adaptability, and increase charge-transfer efficiency in brain-machine interfaces. We developed a new and easy strategy, based on the vapor phase polymerization (VPP) technique, where the monomer vapor is polymerized inside a sucrose sacrificial template containing CNT and an oxidizing agent. After removing the sucrose template, a 3D porous scaffold was obtained and its physical, chemical, and electrical properties were evaluated. The obtained scaffold showed very low density, high and homogeneous porosity, electrical conductivity, and Young's Modulus similar to the in vivo tissue. Its high biocompatibility was demonstrated even after 6 days of incubation, thus paving the way for the development of new conductive 3D scaffolds potentially useful in the field of electroactive tissues.

Paciente politraumático con fractura de pelvis: factores y lesiones asociados a la mortalidad / Pelvic fracture in the patient with multiple injuries: factors and lesions associated with mortality

Objetivo. El principal objetivo de este estudio es identificar aquellos factores demográficos, clínicos, analíticos o lesiones asociadas relacionados con la mortalidad a 30 días. Método. Estudio observacional con recogida prospectiva de datos de pacientes politraumáticos (PPT) con fractura de pelvis (FP) asociada entre enero de 2009 y enero de 2017. Se recogieron variables demográficas, clínicas y analíticas a la llegada al servicio de urgencias, tipo de fractura pélvica, procedimientos terapéuticos, lesiones asociadas y mortalidad a los 30 días. Se realizó un análisis de asociación uni y multivariable. Resultados. Se atendieron 2.061 PPT, de ellos 118 presentaban FP. La mortalidad a los 30 días fue del 12,7% (15 PPT). El 23,7% ingresaron con una presión arterial sistólica 90 mmHg, el 41,52% con frecuencia cardiaca > 100 lpm, 67,6% con lactacidemia 20 mg/dl y el 26,3% con un exceso de base (EB) -6. El Injury Severity Score medio fue de 20 puntos. Requirieron angiembolización el 80,6% y packing preperitoneal el 3,4%. Las principales lesiones asociadas fueron: fracturas costales (35,6%), hemo-neumotórax (31,3%), lesiones de raquis (35,6%) y traumatismo craneoencefálico (30%). Los factores independientes asociados a la mortalidad fueron: la edad, el sexo femenino, las fracturas complejas (Tile C), un lactato 20 mg/dL, un EB -6 y la asociación a perforación intestinal. Conclusiones. Se identifican 6 factores independientes relacionados con la mortalidad a 30 días de los PPT con FP (AU)

Background and objective. The main objective of this study was to identify demographic, clinical, analytical factors or injuries associated with 30-day mortality in patients with pelvic fractures. Methods. Prospective observational study of patients with multiple injuries including pelvic fractures between January 2009 and January 2017. We recorded demographic, clinical, and laboratory data on arrival at the emergency department; type of pelvic fracture; treatments; associated lesions; and 30-day mortality. Univariable and multivariable models were used to analyze the data. Results. A total of 2061 multiple-injury patients were attended; 118 had pelvic fractures. Fifteen of the patients with pelvic fractures (12.7%) died within 30 days. Arterial blood pressure on admission was less than 90 mm Hg in 23.7%, heart rate was over 100 beats per minute in 41.52%, lactic acid level was 20 mg/dL or higher in 67.6%, and base excess of -6 or less was recorded for 26.3%. The mean Injury Severity Score was 20 points. Angiographic embolization was required in 80.6% and preperitoneal packing in 3.4%. The main associated lesions were rib fractures (35.6%), hemo-pneumothorax (31.3%), spinal injuries (35.6%), and head injuries (30%). Conclusions. The 6 independent variables associated with risk of death in multiple-injury patients with pelvic fractures are age, female sex, complex fractures (Tile type C), lactic acid level of 20 mg/dL or more, base excess of -6 or less, and bowel perforation (AU)