Continuous venovenous hemodiafiltration in patients with multiple organ dysfunction syndrome in an intensive care unit.

INTRODUCTION: Continuous venovenous hemodiafiltration, generally used in patients with acute renal failure, enables elimination of humoral mediators of systemic inflammatory response and sepsis from blood. This effect should improve treatment results in patients with multiple organ dysfunction, but evidence of improved survival is insufficient. OBJECTIVES: Describe the effect of continuous venovenous hemodiaflitration on patients with multiple organ dysfunction syndrome in terms of systemic and brain hemodynamics, oxygenation, metabolism and status on ICU separation. METHODS: An observational case series was done of 18 patients (11 men and 7 women) aged 24-78 years with multiple organ dysfunction syndrome treated with continuous venovenous hemodiafiltration in the Medical-Surgical Research Center's ICU in Havana. General, systemic and brain hemodynamic, oxygenation and metabolic variables were assessed immediately before and 12 hours after starting the procedure; vital status on separation from intensive care was recorded. For analysis, patients were grouped by whether cause of multiple organ dysfunction syndrome was septic or nonseptic. Variable means before and after treatment were compared using the Wilcoxon matched pairs test. Standardized mortality ratios were calculated for both groups, with survival efficacy defined by a ratio of <0.9. RESULTS: After 12 hours continuous venovenous hemodiafitration, the septic group showed clinical improvement, with statistically significant improvement in all variables except mean arterial pressure and brain hemodynamics. Survival to discharge from ICU was 64%, with a standardized mortality ratio of 0.66. In the nonseptic group, survival was 0% and ratio was 2.13; temperature was the only variable found to improve significantly. CONCLUSIONS: Continuous venovenous hemodiafltration improved clinical parameters and survival in patients with multiple organ dysfunction of septic origin. Further studies are needed with larger numbers of patients to corroborate these results.

Correlación entre el examen mínimo del estado mental y la escala de memoria de Wechsler en una muestra de pacientes con daño cerebral / Correlation between mini mental state examination and the Wechsler memory scale in a sample of patients with sequel

Introducción. La afectación de los procesos cognitivos es muy frecuente en pacientes con daño cerebral adquirido (DCA). Una adecuada evaluación neuropsicológica permite arribar a un diagnóstico certero de la magnitud del déficit y su repercusión funcional. Este estudio examina la correlación entre un test de cribado tradicional, el Examen Mínimo del Estado Mental (MMSE) y un test específico para la evaluación de la memoria, la Escala de Memoria de David Wechsler-I (WMS-I), en una muestra de 124 pacientes con DCA. Para ello se empleó el Método de Pearson. La correlación global obtenida entre ambos test fue significativa (p≤0.05) Conclusiones. Los test de cribado constituyen una manera breve y práctica para aproximarnos al diagnóstico neuropsicológico y este estudio de correlación constata la sensibilidad y el valor predictivo del MMSE como uno de los test de rastreo más empleados en la práctica clínica para orientar la exploración de las funciones comprometidas tras la lesión cerebral. No obstante, consideramos que en modo alguno deberían sustituirse las pruebas neuropsicológicas por los test de cribado para evaluar cognición en pacientes con daño cerebral adquirido.

Introduction. The cognitive impairments are frequently in patients with acquired brain injury (ABI). The neuropsychological assessment must provide a good diagnosis of the severity and functional repercussion of the cognitive impairments. This study examines the correlation between a traditional screening test, Mini–Mental State Examination (MMSE) and a specific test for the memory evaluation, the Wechsler Memory Scale I (WMS)I, in a sample of 124 patients with sequel of ABI. The global correlation (using coefficient of Pearson) between MMSE and WMS I was statistical significant (p≤0.05). Conclusions. The screening test constitutes an easy and brief way to obtain an adequate neuropsychological diagnosis. This correlation verifies the sensibility and the predictor value of the MMSE like one of the most employees test in the clinical practice to guide the exploration by damaged functions after the brain injury. Nevertheless, we consider that neuropsychological assessment in acquired brain injury patients should not be substituted by a scrutiny instrument.