Practical document on the management of hyponatremia in critically ill patients. / Documento práctico del manejo de la hiponatremia en pacientes críticos.

Hyponatremia is the most prevalent electrolyte disorder in Intensive Care Units. It is associated with an increase in morbidity, mortality and hospital stay. The majority of the published studies are observational, retrospective and do not include critical patients; hence it is difficult to draw definitive conclusions. Moreover, the lack of clinical evidence has led to important dissimilarities in the recommendations coming from different scientific societies. Finally, etiopathogenic mechanisms leading to hyponatremia in the critical care patient are complex and often combined, and an intensive analysis is clearly needed. A study was therefore made to review all clinical aspects about hyponatremia management in the critical care setting. The aim was to develop a Spanish nationwide algorithm to standardize hyponatremia diagnosis and treatment in the critical care patient.

[Prognostic value of the sTREM-1 plasma values in patients with sepsis: a cohort study]. / Valor pronóstico de los niveles plasmáticos de sTREM-1 en pacientes con sepsis: un estudio de cohortes.

OBJECTIVE: To evaluate the association between plasma levels of soluble Triggering Receptor Expressed on Myeloid Cells-1 (sTREM-1) and mortality of patients with sepsis. DESIGN: Prospective cohort study. SETTING: Two general Intensive Care Units. PATIENTS: Patients with sepsis in whom sTREM-1 plasma levels were determined daily in the first 3 days of their presentation. VARIABLES OF INTEREST: Mortality at 28 days. RESULTS: We analyzed 121 patients (23% severe sepsis, 44% septic shock, 33% non-severe sepsis). Mortality at 28 days was 24.8%. The initial sTREM-1 levels were slightly higher in nonsurvivors than in survivors (median 366.9 versus 266.5 pg/ml, p=0.2668). An increase in sTREM-1 levels higher than 90 pg/ml within the first 3 days (delta-TREM) was associated with an excess of mortality (hazard ratio [HR] 2.68, p=0.0047), with a sensitivity of 47% and a specificity of 78%. This excess of mortality disappeared after adjusting for severity by Cox analysis (adjusted HR 1.07, p=0.8665). CONCLUSIONS: The increase in the levels of sTREM-1 during the first 3 days of evolution is associated with an excess of mortality in critically ill patients with sepsis. This is explained by the greater initial severity of these patients. The discriminative capacity of this finding is insufficient to be clinically useful.

[Gender bias in women with myocardial infarction: ten years after]. / Desigualdad de esfuerzo terapéutico en mujeres con infarto agudo de miocardio: 10 años después.

OBJECTIVE: Previous studies show that the women with acute myocardial infarction (AMI) receive less fibrinolitic treatment than the men. The objective of this study is to analyze if it exists any difference in fibrinolysis related to gender and to compare the results with those obtained 10 years ago. DESIGN: Retrospective descriptive study that compare patients with AMI of less than 24 hours of evolution of studies Analysis of Delay in Acute Infarct of Myocardium (ARIAM) in 2003-2004 and Project of Analysis Epidemiologist of Critical Patient (PAEEC) of 1992-1993. SETTING: ICUs from 86 hospitals in Spain that participated in the PAEEC study and 120 ICUs in the ARIAM. PATIENTS: We compared data of 9,981 patients including in study ARIAM in 2003-2004 with 1,668 of the PAEEC of 1992-1993. RESULTS: Women were less likely to receive thrombolytic therapy than men (odds ratio= 0.82, p < 0.01), after adjusting for age, origin, size of the hospital and antecedents. The probability of fibrynolisis is lower in elderly, patients referred from the general ward, in hospitals of more than 1,000 beds and patients with arterial hypertension, stroke, diabetes or peripheral vascular disease. The probability of fibrinólisis is higher when patient is transferred from another hospital (followed by those of Emergencies Room), in the hospitals by less than 300 beds (followed by those of 300-1,000) and when history of prior ischemic heart disease exists. Comparing the two periods, has increased the frequency of fibrynolisis in both genders, although the increment has been greater in the women. CONCLUSIONS: The women with AMI continue receiving less fibrynolisis, although exists an increase in the number of treatments superior to register in the men.

[Intracranial hemorrhage following second thrombolytic treatment of myocardial reinfarction]. / Hemorragia intracraneal tras un segundo tratamiento trombolítico por reinfarto de miocardio.

Intracranial hemorrhage was observed in a man, aged 66, after a second thrombolytic treatment due to myocardial reinfarction. The patient presented no potential risk factors which have often been associated to intracranial hemorrhage whereas no complications had occurred when thrombolytic therapy was given some months before because of the first infarction. This report emphasizes that a previous thrombolytic treatment with no secondary effects involves no lack of intracranial hemorrhage risk for a second thrombolysis. More research is needed in order to elucidate intracranial hemorrhage mechanisms associated to thrombolytic therapy.