Metaanálisis de los efectos del suero salino en la mortalidad en cuidados intensivos / Meta-analysis of the effects of normal saline on mortality in intensive care

Introducción y objetivo: Evaluar, mediante un metaanálisis, el efecto del suero salino sobre la mortalidad en los pacientes de cuidados intensivos, cuando se compara su uso con el de cristaloides balanceados. Material y método: Se ha realizado un metaanálisis de ensayos clínicos controlados, aleatorizados y estudios prospectivos secuenciales en el tiempo, publicados, que evaluaron la mortalidad del suero salino en enfermos ingresados en unidades de cuidados intensivos. Se llevó a cabo una búsqueda electrónica en Medline, Embase, biblioteca Cochrane, ISI Proceedings y Web of Science y una búsqueda manual sobre las referencias seleccionadas. La extracción de datos fue realizada de forma independiente por 2 investigadores. Las discrepancias se resolvieron por consenso en el grupo de trabajo. El cálculo de la OR y su intervalo de confianza se realizó ponderando por el inverso de la varianza. La heterogeneidad se evaluó mediante I2. El sesgo de publicación se valoró mediante funnel plot y test de Egger. Resultados: Se seleccionaron 8 artículos para el metaanálisis de mortalidad, que incluían un total de 20.684 pacientes. Se objetivó una asociación entre el uso de suero salino y la mortalidad en los enfermos de cuidados intensivos (OR 1,0972; IC 95%:1,0049-1,1979) cuando se comparaba con el uso de cristaloides balanceados. No se encontró evidencia de sesgo de publicación (prueba de Egger p=0,5349). En el análisis de sensibilidad ninguno de los estudios modificó sustancialmente el resultado global si se eliminaba del metaanálisis. Conclusiones: Es posible que exista un aumento de la mortalidad asociada al empleo de suero salino en los pacientes ingresados en cuidados intensivos cuando se compara con el empleo de cristaloides balanceados

Introduction and objective: To evaluate, by means of a meta-analysis, the effect of normal saline on mortality in intensive care patients, when compared with the use of balanced crystalloids. Material and method: Published controlled clinical trials, randomised and sequential prospective studies in time, evaluating the mortality when physiological saline was used in patients admitted to intensive care units. Electronic search was performed in Medline, Embase, Cochrane Library, ISI Proceedings, and Web of Science, as well as a manual search of selected references. An independent evaluation was performed by 2 investigators. Discrepancies were resolved by consensus in the working group. Contingency tables were performed, and the OR with confidence intervals of each study were obtained. Heterogeneity was assessed by I2. Publication bias was assessed using funnel plot and Egger test. Results: A total of 8 articles were selected for the meta-analysis of mortality, which included a total of 20,684 patients. A significant association was observed between the use of saline and mortality in intensive care patients (OR 1.0972; 95% CI 1.0049-1.1979), when compared to the use of balanced crystalloids. No statistical evidence of publication bias (Egger, P=.5349) was found. In the sensitivity analysis, none of the studies substantially modified the overall outcome if it was eliminated from the meta-analysis. Conclusions: There may be an increase in mortality associated with the use of saline in patients admitted to intensive care when comparing with the use of balanced crystalloids

Meta-analysis of the effects of normal saline on mortality in intensive care. / Metaanálisis de los efectos del suero salino en la mortalidad en cuidados intensivos.

INTRODUCTION AND OBJECTIVE: To evaluate, by means of a meta-analysis, the effect of normal saline on mortality in intensive care patients, when compared with the use of balanced crystalloids. MATERIAL AND METHOD: Published controlled clinical trials, randomised and sequential prospective studies in time, evaluating the mortality when physiological saline was used in patients admitted to intensive care units. Electronic search was performed in Medline, Embase, Cochrane Library, ISI Proceedings, and Web of Science, as well as a manual search of selected references. An independent evaluation was performed by 2 investigators. Discrepancies were resolved by consensus in the working group. Contingency tables were performed, and the OR with confidence intervals of each study were obtained. Heterogeneity was assessed by I2. Publication bias was assessed using funnel plot and Egger test. RESULTS: A total of 8 articles were selected for the meta-analysis of mortality, which included a total of 20,684 patients. A significant association was observed between the use of saline and mortality in intensive care patients (OR 1.0972; 95% CI 1.0049-1.1979), when compared to the use of balanced crystalloids. No statistical evidence of publication bias (Egger, P=.5349) was found. In the sensitivity analysis, none of the studies substantially modified the overall outcome if it was eliminated from the meta-analysis. CONCLUSIONS: There may be an increase in mortality associated with the use of saline in patients admitted to intensive care when comparing with the use of balanced crystalloids.

Tratamientos de soporte vital al final de la vida: costos y aspectos éticos. Punto de vista en una unidad de cuidados intensivos basado en la metodología Q / Life-support treatments at end of life: Costs and ethical aspects. Point of view in an intensive care unit based on Q methodology

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Epidemiología del traumatismo craneoencefálico en la población mayor de 65 años a lo largo de 25 años / Epidemiology of traumatic brain injury in the elderly over a 25 year period

Objetivo: Conocer los cambios en la epidemiología del traumatismo craneoencefálico (TCE) en una cohorte de enfermos mayores de 65 años ingresados en UCI de un hospital de tercer nivel a lo largo de 25 años. Material y métodos: Estudio de cohortes retrospectivo realizado en una unidad de cuidados intensivos de un hospital universitario de tercer nivel español. Se recogieron variables demográficas, clínicas en el momento del ingreso, comorbilidades, mecanismos de lesión y lesiones presentadas, días de estancia en UCI y hospitalaria de los pacientes mayores de 65 años que ingresaron con el diagnóstico de TCE. Se realizó un análisis estadístico por lustros. Resultados: Se analizaron un total de 446 TCE en mayores de 65 años. En el análisis por lustros, se observó un aumento de la proporción de enfermos que presentan hematoma epidural (1,39% en el periodo 1990-1995 vs. 9,46% en 2010-2015), con tendencia lineal significativa (p=0,018). En la actualidad las caídas desde la propia altura han pasado de representar un 8,33% (1991-1995) a más de un 70% (2011-2015), p<0,001. El porcentaje de accidentes de tráfico ha descendido desde un 26,39% hasta un 3,95% en el último periodo, p<0,001. Conclusiones: En los últimos 25 años parece evidenciarse un cambio en la etiología del TCE en la población mayor de 65 años en nuestro ámbito

Objective: To identify the changes in the epidemiology of traumatic brain injury (TBI) in a cohort of patients older than 65 years old admitted in the Intensive care unit of a third-level hospital over a 25 year period. Material and methods: A retrospective cohort study conducted on patients over 65 years-old admitted with the diagnosis of TBI into an intensive care unit of a Spanish university hospital. The demographic, clinical variables were collected at the time of admission, including comorbidities, injury mechanisms, and injuries presented, and days of stay in ICU. A statistical analysis was carried out by five-year periods. Results: A total of 446 TBI in patients over 65 years were included. In the analysis, an increase was observed in the proportion of patients presenting with epidural haematoma (1.39% in the period 1990-1995 vs. 9.46% in 2010-2015), with a significant linear tendency (P=.018). Falls from own height have increased from 8.33% (1991-1995) to currently more than 70% (2011-2015), P<.001. The percentage of traffic accidents declined from 26.39% to 3.95% in the last period, P<.001. Conclusions: In the last 25 years there seems to be evidence of a change in the origins of TBI in the elderly in our field

Epidemiology of traumatic brain injury in the elderly over a 25 year period. / Epidemiología del traumatismo craneoencefálico en la población mayor de 65 años a lo largo de 25 años.

OBJECTIVE: To identify the changes in the epidemiology of traumatic brain injury (TBI) in a cohort of patients older than 65 years old admitted in the Intensive care unit of a third-level hospital over a 25 year period. MATERIAL AND METHODS: A retrospective cohort study conducted on patients over 65 years-old admitted with the diagnosis of TBI into an intensive care unit of a Spanish university hospital. The demographic, clinical variables were collected at the time of admission, including comorbidities, injury mechanisms, and injuries presented, and days of stay in ICU. A statistical analysis was carried out by five-year periods. RESULTS: A total of 446 TBI in patients over 65 years were included. In the analysis, an increase was observed in the proportion of patients presenting with epidural haematoma (1.39% in the period 1990-1995 vs. 9.46% in 2010-2015), with a significant linear tendency (P=.018). Falls from own height have increased from 8.33% (1991-1995) to currently more than 70% (2011-2015), P<.001. The percentage of traffic accidents declined from 26.39% to 3.95% in the last period, P<.001. CONCLUSIONS: In the last 25 years there seems to be evidence of a change in the origins of TBI in the elderly in our field.