ABSTRACT
INTRODUCTION: Patients admitted to the intensive care unit (ICU) because of acute or decompensated chronic abdominal disease and acute respiratory failure need to have the potential infection diagnosed as well as its site (pulmonary or abdominal). For this purpose, we measured soluble triggering receptor expression on myeloid cells-1 (sTREM-1) in alveolar and peritoneal fluid. METHODS: Consecutive patients (n = 21) with acute or decompensated chronic abdominal disease and acute respiratory failure were included. sTREM was measured in alveolar (A-sTREM) and peritoneal (P-sTREM) fluids. RESULTS: An infection was diagnosed in all patients. Nine patients had a lung infection (without abdominal infection), 5 had an abdominal infection (without lung infection) and seven had both infections. A-sTREM was higher in the patients with pneumonia compared to those without pneumonia (1963 ng/ml (1010-3129) vs. 862 ng/ml (333-1011); P 0.019). Patients with abdominal infection had an increase in the P-sTREM compared to patients without abdominal infection (1941 ng/ml (1088-3370) vs. 305 ng/ml (288-459); P < 0.001). A cut-off point of 900 pg/ml of A-sTREM-1 had a sensitivity of 81% and a specificity of 80% (NPV 57%; PPV 93%, AUC 0.775) for the diagnosis of pneumonia. In abdominal infections, a cut-off point for P-sTREM of 900 pg/ml had the best results (sensitivity 92%; specificity 100%; NPV 90%, PPV 100%, AUC = 0.903). CONCLUSIONS: sTREM-1 measured in alveolar and peritoneal fluids is useful in assessing pulmonary and peritoneal infection in critical-state patients-A-sTREM having the capacity to discriminate between a pulmonary and an extra-pulmonary infection in the context of acute respiratory failure.
Subject(s)
Ascitic Fluid/chemistry , Bronchoalveolar Lavage Fluid/chemistry , Critical Care/methods , Intraabdominal Infections/diagnosis , Membrane Glycoproteins/analysis , Receptors, Immunologic/analysis , Respiratory Tract Infections/diagnosis , Acute Disease , Adult , Biomarkers/analysis , Chronic Disease , Female , Humans , Intensive Care Units , Male , Middle Aged , Prospective Studies , Respiratory Distress Syndrome/metabolism , Sensitivity and Specificity , Triggering Receptor Expressed on Myeloid Cells-1ABSTRACT
El uso clínico de la Electromiografía laríngea es todavía escaso. Sin embargo en nuestra experiencia ha demostrado ser un test objetivo para el estudio de los trastornos neurológicos de la laringe y para el pronóstico de la recuperación tras una parálisis de las cuerdas vocales. Nosotros practicamos Electromiografía convencional del tiroaritenoideo y cricotiroideo donde las ondas positivas, potenciales de fibrilación y pérdida o en su caso ausencia de potenciales de unidad motora en el trazado de esfuerzo sugieren una denervación y por lo tanto un origen neurógeno de la denervación. Un incremento del porcentaje de los potenciales polifásicos y de la duración de los potenciales de unidad motora sugieren el establecimiento de reinervación con valor pronóstico de la neuropatía laríngea. La Electromiografía laríngea puede ser llevada a cabo como procedimiento habitual con un mínimo disconfort, proporcionándonos una evolución del estado neuromuscular y nos muestra una evidencia de la función de la cuerda vocal siendo útil para distinguir también si el problema es supranuclear o se trata de un trastorno mecánico. También ha demostrado ser eficaz para predecir la posibilidad de recuperación tras una parálisis de la cuerda vocal (AU)
