[Role of plasma procalcitonin in the diagnosis of ventilator-associated pneumonia: systematic review and metaanalysis]. / Papel de la procalcitonina plasmática en el diagnóstico de la neumonía asociada a ventilación mecánica: revisión sistemática y metaanálisis.

OBJECTIVE: To determine the role of plasma procalcitonin (PCT) levels in diagnosing ventilator-associated pneumonia. DESIGN: A systematic review of publications prospectively assessing the diagnostic role of PCT in ventilator-associated pneumonia was carried out. The search was performed using Medline, Embase, the Cochrane Collaboration and MEDION, with reviewing of the references of retrieved articles. We extracted data that allowed the calculation of sensitivity, specificity, likelihood ratios and diagnostic odds ratio. Intervention Metaregression was performed to determine whether exposure to previous antibiotic treatment, the time to occurrence of ventilator-associated pneumonia and the type of patients had an impact upon the diagnostic performance of procalcitonin. RESULTS: Seven studies were considered (373 patients, 434 episodes). We found no publication bias or threshold effect. High plasma PCT levels were associated to an increased risk of suffering ventilator-associated pneumonia (OR: 8.39; 95% CI: 5.4-12.6). The pooled data on sensitivity, specificity, positive and negative likelihood ratio, and diagnostic odds ratio found were 76% (69-82), 79% (74-84), 4.35 (2.48-7.62), 0.26 (0.15-0.46) and 17.9 (10.1-31.7), respectively. Diagnostic yield was modified by prior exposure to antibiotics (rDOR 0.11, 0.02-0.069), but not by the type of critically ill patient or the time to occurrence of ventilator-associated pneumonia. CONCLUSIONS: Our results suggest that PCT provides additional information on the risk of VAP. Inclusion of PCT in diagnostic algorithms could improve their effectiveness.

Papel de la procalcitonina plasmática en el diagnóstico de la neumonía asociada a ventilación mecánica: revisión sistemática y meta análisis / Role of plasma procalcitonin in the diagnosis of ventilator-associated pneumonia: systematic review and meta-analysis

Objetivo. Determinar el papel de los niveles plasmáticos de procalcitonina (PCT) en el diagnóstico de neumonía asociada a ventilación mecánica. Diseño Revisión sistemática y metaanálisis de los trabajos originales que evalúan el papel de PCT en el diagnóstico de neumonía asociadaa ventilación mecánica. La búsqueda detrabajos se llevó a cabo en Medline, Embase, Colaboración Cochrane y MEDION y tras revisiónde las referencias de los artículos obtenidos. Se extrajeron datos que permitieron el cálculo dela sensibilidad, la especificidad, las razones deverosimilitud y la odds ratio diagnóstica...

11 March 2004: The terrorist bomb explosions in Madrid, Spain--an analysis of the logistics, injuries sustained and clinical management of casualties treated at the closest hospital.

At 07:39 on 11 March 2004, 10 terrorist bomb explosions occurred almost simultaneously in four commuter trains in Madrid, Spain, killing 177 people instantly and injuring more than 2000. There were 14 subsequent in-hospital deaths, bringing the ultimate death toll to 191. This report describes the organization of clinical management and patterns of injuries in casualties who were taken to the closest hospital, with an emphasis on the critically ill. A total of 312 patients were taken to the hospital and 91 patients were hospitalized, of whom 89 (28.5%) remained in hospital for longer than 24 hours. Sixty-two patients had only superficial bruises or emotional shock, but the remaining 250 patients had more severe injuries. Data on 243 of these 250 patients form the basis of this report. Tympanic perforation occurred in 41% of 243 victims with moderate-to-severe trauma, chest injuries in 40%, shrapnel wounds in 36%, fractures in 18%, first-degree or second-degree burns in 18%, eye lesions in 18%, head trauma in 12% and abdominal injuries in 5%. Between 08:00 and 17:00, 34 surgical interventions were performed in 32 patients. Twenty-nine casualties (12% of the total, or 32.5% of those hospitalized) were deemed to be in a critical condition, and two of these died within minutes of arrival. The other 27 survived to admission to intensive care units, and three of them died, bringing the critical mortality rate to 17.2% (5/29). The mean Injury Severity Score and Acute Physiology and Chronic Health Evaluation II scores for critically ill patients were 34 and 23, respectively. Among these critically ill patients, soft tissue and musculoskeletal injuries predominated in 85% of cases, ear blast injury was identified in 67% and blast lung injury was present in 63%. Fifty-two per cent suffered head trauma. Over-triage to the closest hospital probably occurred, and the time of the blasts proved to be crucial to the the adequacy of the medical and surgical response. The number of blast lung injuries seen is probably the largest reported by a single institution, and the critical mortality rate was reasonably low.

Casualties treated at the closest hospital in the Madrid, March 11, terrorist bombings.

BACKGROUND: At 07:39 am on March 11th, 2004, ten terrorist bomb explosions occurred almost simultaneously in four commuter trains in Madrid, Spain, killing instantly 177 people and injuring >2,000. There were 14 subsequent in-hospital deaths, bringing the definite death toll to 191 victims. This article describes the organization of the clinical management and patterns of injuries in casualties who were taken to the closest hospital, with emphasis on the critical patient population. RESULTS: There were 312 patients taken to that center, and 91 were hospitalized, 89 of them (28.5%) for >24 hrs. Sixty-two patients only had superficial bruises or emotional shock, but the remaining 250 patients had more severe lesions. The data on 243 of the latter form the basis of this report. Tympanic perforation occurred in 41% of 243 victims with moderate-to-severe trauma, chest injuries in 40%, shrapnel wounds in 36%, fractures in 18%, first- or second-degree burns in 18%, eye lesions in 18%, head trauma in 12%, and abdominal injuries in 5%. Between 8:00 am and 5:00 pm, 34 surgical interventions were performed on 32 victims. Twenty-nine casualties (12% of the total or 32.5% of those hospitalized) were deemed in critical condition, and two of them died within minutes of arrival. The other 27 survived to be admitted to intensive care units, and three of them died, bringing the critical mortality rate to 17.2% (5/29). The mean Injury Severity Score and Acute Physiology and Chronic Health Evaluation II scores of critical patients were 34 and 23, respectively. Among these critical patients, soft-tissue and musculoskeletal injuries predominated in 85% of cases, ear blast injury was identified in 67%, and blast lung injury was present in 63% (17 cases). Fifty-two percent suffered head trauma. CONCLUSIONS: There was probably an overtriage to the closest hospital, and the time of the blasts proved crucial for the adequacy of the medical and surgical response. The number of blast lung injuries seen is probably the largest reported by a single institution, and the critical mortality rate was reasonably low.

Supervivencia tras parada cardiorrespiratoria / Survival after cardiorespiratory arrest

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[Serum and pulmonary angiotensin converting enzyme as a marker of acute lung injury in an experimental model of adult respiratory distress syndrome]. / La enzima de conversión de la angiotensina (sérica y pulmonar) en un modelo experimental de distrés respiratorio del adulto, como marcador de lesión aguda pulmonar.

OBJECTIVE: To know if the determination of the angiotensin converting enzyme in serum (SACE) and lung (LACE) may be useful as a marker of acute lung injury (ALI) in the adult respiratory distress syndrome (ARDS). METHOD: By reproducing in a experimental model of ALI with oleic acid in dogs which simulate the early stage of ARDS, we have correlated the pathologic and analytical changes observed with the results of the determinations of SACE and LACE. RESULTS: We have found sequential pulmonary lesions (congestion, edema, hemorrhage polynuclear infiltration and thrombosis) and biological alteration (hypoxemia, pulmonary hypertension, early leukopenia and final leukocytosis, thrombopenia and hypofibrinogenemia) that reproduce the typical changes of ARDS, together with the decrease of SACE--slow and progressive--and LACE--abrupt in the onset and maintained during the experiment--. CONCLUSIONS: The LACE is a good marker of the beginning of the lesion because its decrease coincides with the first pathological changes (congestion) and with the hypoxemia, pulmonary hypertension and leukopenia, maintained without changes, during the whole experiment. On the other hand, the SACE corresponds as an inespecifical reactant, marker of acute inflammation and loss of pulmonary endothelium, because its progressive decrease evolutioned with the pathological lesions and the analytical changes. In conclusion, the sequential determination of SACE has a prognostic and evolutive value in comparison with the LACE, which has a diagnostic value from the beginning of the experiment of ALI and maintained throughout.