Evolución de la fuerza muscular en paciente críticos con ventilación mecánica invasiva / Evolution in muscle strength in critical patients with invasive mechanical ventilation

OBJETIVO: Evaluar la evolución de la fuerza muscular en pacientes críticos con ventilación mecánica (VM) tras la retirada de la sedación y hasta el alta hospitalaria. MATERIAL Y MÉTODO: Estudio de cohortes desarrollado en 2 unidades de cuidados intensivos (UCI) del Hospital Universitari de Bellvitge, de noviembre del 2011 a marzo del 2012. Se incluyó a pacientes consecutivos con VM > 72h. Variable dependiente: fuerza muscular mediante la escala Medical Research Council (MRC), el primer día que el paciente fue capaz de responder a 3 de 5 órdenes (día 1), cada semana, al alta de la UCI y al alta hospitalaria o 60 días. Variables independientes: factores asociados a la pérdida de fuerza, días libres de VM, días de estancia en la UCI y estancia hospitalaria. Los pacientes se distribuyeron en 2 grupos (MRC < 48, MRC ≥ 48) tras la primera medición. RESULTADOS: Se evaluó a 34 pacientes. Variables independientes asociadas a pérdida de fuerza: días con SOFA cardiovascular > 2 (p < 0,001) y días con corticoides (p < 0,001). MRC inicial para el grupo MRC < 48: 38 (27-43) y 52 (50-54) para el grupo MRC ≥ 48. La mayor ganancia de fuerza se obtuvo la primera semana (31% versus 52%). Un MRC < 48 se asoció a más días de VM (p < 0,007) y mayor estancia en la UCI (p < 0,003). CONCLUSIONES: La mayor ganancia de fuerza tras retirar la sedación se consigue la primera semana. La pérdida de fuerza se asocia a un valor de SOFA cardiovascular > 2 y al uso de corticoides. Los pacientes con MRC < 48 presentan mayor duración de la VM y mayor estancia en UCI

OBJECTIVE: To assess the evolution of muscle strength in critically ill patients with mechanical ventilation (MV) from withdrawal of sedatives to hospital discharge. MATERIAL AND METHOD: A cohort study was conducted in two intensive care units in the Hospital Universitari de Bellvitge from November 2011 to March 2012. Inclusion criteria: Consecutive patients with MV > 72h. Dependent outcome: Muscle strength measured with the Medical Research Council (MRC) scale beginning on the first day the patient was able to answer 3 out of 5 simple orders (day 1), every week, at ICU discharge and at hospital discharge or at day 60 Independent outcomes: factors associated with muscle strength loss, ventilator-free days, ICU length of stay and hospital length of stay. The patients were distributed into two groups (MRC< 48, MRC ≥ 48) after the first measurement. RESULTS: Thirty-four patients were assessed. Independent outcomes associated with muscle strength weakness were: days with cardiovascular SOFA >2 (P<.001) and days with costicosteroids (P<.001). Initial MRC in MRC < 48 group was 38 (27-43), and 52 (50-54) in MRC ≥ 48. The largest muscle strength gain was obtained the first week (31% versus 52%). A MRC < 48 value was associated with more MV days (P < .007) and a longer ICU stay. (P < .003). CONCLUSION: The greatest muscle strength gain after withdrawing of the sedatives was achieved in the first week. Muscle strength loss was associated with a cardiovascular SOFA > 2 and costicosteroids. Patients with a MRC < 48 required more days with MV and a longer ICU stay

[Evolution in muscle strength in critical patients with invasive mechanical ventilation]. / Evolución de la fuerza muscular en paciente críticos con ventilación mecánica invasiva.

OBJECTIVE: To assess the evolution of muscle strength in critically ill patients with mechanical ventilation (MV) from withdrawal of sedatives to hospital discharge. MATERIAL AND METHOD: A cohort study was conducted in two intensive care units in the Hospital Universitari de Bellvitge from November 2011 to March 2012. INCLUSION CRITERIA: Consecutive patients with MV > 72h. Dependent outcome: Muscle strength measured with the Medical Research Council (MRC) scale beginning on the first day the patient was able to answer 3 out of 5 simple orders (day 1), every week, at ICU discharge and at hospital discharge or at day 60 Independent outcomes: factors associated with muscle strength loss, ventilator-free days, ICU length of stay and hospital length of stay. The patients were distributed into two groups (MRC< 48, MRC ≥ 48) after the first measurement. RESULTS: Thirty-four patients were assessed. Independent outcomes associated with muscle strength weakness were: days with cardiovascular SOFA >2 (P<.001) and days with costicosteroids (P<.001). Initial MRC in MRC<48 group was 38 (27-43), and 52 (50-54) in MRC ≥ 48. The largest muscle strength gain was obtained the first week (31% versus 52%). A MRC < 48 value was associated with more MV days (P<.007) and a longer ICU stay. (P<.003). CONCLUSION: The greatest muscle strength gain after withdrawing of the sedatives was achieved in the first week. Muscle strength loss was associated with a cardiovascular SOFA > 2 and costicosteroids. Patients with a MRC < 48 required more days with MV and a longer ICU stay.

Estatus epiléptico / Status epilepticus

El estatus epiléptico es una emergencia neurológica que requiere una atención inmediata. El diagnóstico y el tratamiento deben ser continuos a lo largo de los primeros minutos hasta su resolución. La causa más frecuente en pacientes epilépticos es el cambio o el incumplimiento de la medicación y en los no epilépticos son las lesiones vasculares, traumáticas, tóxicas y metabólicas. El estatus epiléptico puede ser convulsivo o no convulsivo y la monitorización electroencefalográfica continua es de gran ayuda para el diagnóstico y para valorar la respuesta al tratamiento. Las benzodiazepinas y la fenitoína o fosfenitoína son los fármacos de elección de primera y segunda línea. No existe consenso sobre los tratamientos de tercera y cuarta línea, entre los que se encuentran: fenobarbital, valproato, levetiracetam, propofol, midazolam, los barbitúricos y otros. El pronóstico dependerá de la causa, la edad, el tipo de estatus y la duración del mismo. Por ello, el tratamiento debe ser lo más precoz posible (AU)

Status epilepticus is a neurological emergency that requires prompt care. The diagnosis and treatment must be continuous from the first minutes to its resolution. The most frequent cause in epileptic patients is drug change or non-compliance and in the non-epileptic patients are cerebrovascular diseases, head trauma, drug toxicity and metabolic disturbances. Status epilepticus can be convulsive or non-convulsive and continuous electroencephalographic monitoring is useful for diagnosis and to evaluate response to treatment. Benzodiazepines and phenytoin or fosphenytoin are first-line and second-line therapy. There is no agreement on third and fourth line therapy: phenobarbital, valproate, levetiracetam, propofol, midazolam, barbiturates and others. The prognosis of status epilepticus is related to etiology, age, type and duration of the status. Thus, drug treatment for status epilepticus should be started without delay (AU)

[Status epilepticus]. / Estatus epiléptico.

Status epilepticus is a neurological emergency that requires prompt care. The diagnosis and treatment must be continuous from the first minutes to its resolution. The most frequent cause in epileptic patients is drug change or non-compliance and in the non-epileptic patients are cerebrovascular diseases, head trauma, drug toxicity and metabolic disturbances. Status epilepticus can be convulsive or non-convulsive and continuous electroencephalographic monitoring is useful for diagnosis and to evaluate response to treatment. Benzodiazepines and phenytoin or fosphenytoin are first-line and second-line therapy. There is no agreement on third and fourth line therapy: phenobarbital, valproate, levetiracetam, propofol, midazolam, barbiturates and others. The prognosis of status epilepticus is related to etiology, age, type and duration of the status. Thus, drug treatment for status epilepticus should be started without delay.