Desplazamientos interhospitalarios de un equipo móvil para preservación de órganos con oxigenación por membrana extracorpórea en donantes en asistolia controlada / Interhospital transfers of a mobile team for organ preservation with extracorporeal membrane oxygenation in controlled donors after circulatory death

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Código alfa. Inicio de un nuevo programa de donación en asistolia / Alpha code. The start of a new non-heart beating donor program

Objetivo: Presentar resultados iniciales de un programa de donación en asistolia (DA) en unaciudad de menos de 500.000 habitantes. Diseño: Estudio observacional prospectivo durante 2010 y 2011.Ámbito: Hospital Virgen de las Nieves y Área Metropolitana de Granada. Población: DA y donantes en muerte encefálica (DME) de la provincia de Granada en 2010 y2011.Variables de interés: Características de los DA, tiempos extrahospitalarios e intrahospitalarios, negativas familiares y judiciales, métodos de preservación, procedimiento de información a familiares. Órganos: causas de no validez, extraídos y trasplantados. Receptores: sesiones de hemodiálisis y creatinina al alta. DME: número de donantes reales (DR) y de trasplantes renales. Resultados: En ME hubo 102 DR y se realizaron 104 trasplantes renales. Se han registrado en asistolia 22 donantes potenciales (DP), 21 donantes elegibles (DE), 20 DR y 13 donantes utilizados(DU). Edad media de los DR: 50 años (rango 33-62), 16 hombres y 4 mujeres. Se han realizado21 trasplantes renales y 2 hepáticos de DA. Las causas de no validez son múltiples. Número medio de sesiones de hemodiálisis postrasplante: 1,4 (rango 0-6). Estancia hospitalaria media:25 días (rango 14-41). Creatinina media al alta: 3,4 mg/dL (rango 1,5-6,4). Ninguna negativa judicial y una negativa familiar. Se describen los métodos de preservación y el procedimiento de información a familiares. Conclusiones: Los resultados iniciales apoyan el desarrollo de programas de DA en ciudades de menos de 500.000 habitantes. La DA ha supuesto en 2011 el 20,19% de los trasplantes renales y el 19,6% de los donantes de órganos de la provincia de Granada (AU)

Objective: To present the preliminary results of a non-heart beating donor (NHBD) program in a city of under 500,000 inhabitants. Design: A prospective observational study was conducted between 2010 and 2011.Setting: Virgin de las Nieves Hospital and metropolitan area of Granada (Spain).Population: NHBD and brain dead donors (BDD) in the province of Granada during 2010 and2011.Study variables: Characteristics of NHBD, out- and in-hospital times, family and legal refusals, preservation methods, and family information procedure. Organs: reasons for organnon-validness, and harvested and transplanted organs. Recipients: hemodialysis sessions and creatinine at discharge. BDD: number of real donors (RD) and of kidney transplants. Results: Among the BDD there were 102 RD and 104 kidney transplants were carried out. In systole, 22 potential donors, 21 eligible donors, 20 RD and 13 used donors were registered. The mean age among the RD was 50 years (range 33-62)(16 males and 4 females). Twenty-onekidney and two liver transplants from NHBD were performed. There were a number of reasons for organ non-validness. The mean number of post-transplantation hemodialysis sessions was1.4 (range 0-6). The mean hospital stay was 25 days (range 14-41), and the mean creatinine concentration at discharge was 3.4 mg/dl (range 1.5-6.4). There was one family rejection and no legal (court-ruled) rejections. The preservation methods and family information procedure are described. Conclusions: The preliminary results support the development of NHBD programs in cities with under 500,000 inhabitants. In 2011, NHBD accounted for 20.19% of the kidney transplants and19.60% of the global organ donations in the province of Granada (AU)

El consumo de alcohol y/o drogas favorece la reincidencia en el traumatismo y reduce el período sin traumatismos / Alcohol and/or drug abuse favors trauma recurrence and reduces the trauma-free period

Objetivo Nuestro objetivo ha sido determinar la influencia del consumo de alcohol y/o drogas en la reincidencia de pacientes traumatizados y, en pacientes no reincidentes, analizar el papel de estas sustancias en el tiempo de aparición del primer episodio de traumatismo. Diseño Estudio observacional prospectivo. Ámbito Unidad de cuidados intensivos (UCI) de un hospital terciario. Pacientes traumatizados ingresados en UCI. Intervención Ninguna. Variables principales La reincidencia en el traumatismo se definió por antecedentes de traumatismo previo que requiriera atención médica. Se ha determinado la presencia de alcohol y otras drogas de abuso al ingreso tras un traumatismo grave. Resultados De los 166 pacientes con traumatismo ingresados en la UCI durante el período de estudio, se incluyeron 102 (87 hombres). Se detectó alguna sustancia en 51 pacientes (50%), alcohol (39%), cannabis (12%) y cocaína (7%). De los 102 pacientes, 42 eran reincidentes, de los cuales 32 (76%) dieron positivo a alguna sustancia y solo en 10 se obtuvieron resultados negativos (p<0,001). De los 60 pacientes no reincidentes, 19 (32%) dieron resultados positivos a alguna sustancia, estos últimos eran significativamente más jóvenes (34,3±9 años) que los 41 con resultados negativos (48±23 años) (p<0,001).Conclusión El consumo de alcohol y/o drogas aumenta la probabilidad de reincidencia en el traumatismo y adelanta en casi 15 años la presentación del primer traumatismo (AU)

Aim A study is made of the influence of alcohol and/or drug abuse upon traumatism o recurrence, with an analysis of the influence of such abuse upon the time to appearance of first injury in patients without antecedents of trauma. Design A prospective observational study was made. Setting Trauma patients admitted to the Intensive care Unit (ICU) of a University Hospital. Patients Trauma patients admitted to the ICU. Intervention None. Main measurements Trauma recurrence was defined by a history of previous trauma requiring medical care. The presence of alcohol and other drugs of abuse were determined upon admission after severe trauma. Results Out of the 166 trauma patients admitted to the ICU during the study period, 102 (87 males) were included in the study. Some substance was detected in 51 patients (50%), most frequently in the males (48/87, p<0.02). The most frequently detected substance was alcohol (39%), followed by cannabis (12%) and cocaine (7%), while more than one substance was found in 10 patients (9.8%). Of the 102 patients, 42 were recurrent trauma cases, and 32 (76%) of them were substance-positive, while only 10 were substance-negative (p<0.001). Of the 60 patients without antecedents of trauma, 19 (32%) were substance-positive, and these were significantly younger (34.3±9 years) than the 41 subjects who were substance-negative (48±23 years) (p<0.001).Conclusion Alcohol and/or drug abuse increases the likelihood of recurrent trauma and may shorten the mean trauma-free period among patients without a history of trauma by almost 15 years (AU)

Alpha code. The start of a new non-heart beating donor program.

OBJECTIVE: To present the preliminary results of a non-heart beating donor (NHBD) program in a city of under 500,000 inhabitants. DESIGN: A prospective observational study was conducted between 2010 and 2011. SETTING: Virgen de las Nieves Hospital and metropolitan area of Granada (Spain). POPULATION: NHBD and brain dead donors (BDD) in the province of Granada during 2010 and 2011. STUDY VARIABLES: Characteristics of NHBD, out- and in-hospital times, family and legal refusals, preservation methods, and family information procedure. Organs: reasons for organ non-validness, and harvested and transplanted organs. Recipients: hemodialysis sessions and creatinine at discharge. BDD: number of real donors (RD) and of kidney transplants. RESULTS: Among the BDD there were 102 RD and 104 kidney transplants were carried out. In asystole, 22 potential donors, 21 eligible donors, 20 RD and 13 used donors were registered. The mean age among the RD was 50 years (range 33-62)(16 males and 4 females). Twenty-one kidney and two liver transplants from NHBD were performed. There were a number of reasons for organ non-validness. The mean number of post-transplantation hemodialysis sessions was 1.4 (range 0-6). The mean hospital stay was 25 days (range 14-41), and the mean creatinine concentration at discharge was 3.4mg/dl (range 1.5-6.4). There was one family rejection and no legal (court-ruled) rejections. The preservation methods and family information procedure are described. CONCLUSIONS: The preliminary results support the development of NHBD programs in cities with under 500,000 inhabitants. In 2011, NHBD accounted for 20.19% of the kidney transplants and 19.60% of the global organ donations in the province of Granada.

Alcohol and/or drug abuse favors trauma recurrence and reduces the trauma-free period.

AIM: A study is made of the influence of alcohol and/or drug abuse upon traumatismo recurrence, with an analysis of the influence of such abuse upon the time to appearance of first injury in patients without antecedents of trauma. DESIGN: A prospective observational study was made. SETTING: Trauma patients admitted to the Intensive care Unit (ICU) of a University Hospital. PATIENTS: Trauma patients admitted to the ICU. INTERVENTION: None. MAIN MEASUREMENTS: Trauma recurrence was defined by a history of previous trauma requiring medical care. The presence of alcohol and other drugs of abuse were determined upon admission after severe trauma. RESULTS: Out of the 166 trauma patients admitted to the ICU during the study period, 102 (87 males) were included in the study. Some substance was detected in 51 patients (50%), most frequently in the males (48/87, p<0.02). The most frequently detected substance was alcohol (39%), followed by cannabis (12%) and cocaine (7%), while more than one substance was found in 10 patients (9.8%). Of the 102 patients, 42 were recurrent trauma cases, and 32 (76%) of them were substance-positive, while only 10 were substance-negative (p<0.001). Of the 60 patients without antecedents of trauma, 19 (32%) were substance-positive, and these were significantly younger (34.3±9 years) than the 41 subjects who were substance-negative (48±23 years) (p<0.001). CONCLUSION: Alcohol and/or drug abuse increases the likelihood of recurrent trauma and may shorten the mean trauma-free period among patients without a history of trauma by almost 15 years.

[Incidence of the consumption of toxic substances in severe trauma patients]. / Incidencia del consumo de tóxicos en pacientes con traumatismos graves.

OBJECTIVE: To determine the incidence of the detection of abuse drugs in severe trauma patients DESIGN: Prospective observational study conducted from July 2004 to January 2006. SETTING: Neurotrauma intensive care unit of a reference tertiary university hospital. PATIENTS: Trauma patients who require admission to ICU during the study period. INTERVENTIONS: Determination of alcohol in blood and of toxics (cocaine, cannabis, amphetamines and other substances) in urine. RESULTS: Toxicological analysis was performed in 196 of the 288 severe trauma patients admitted during the study period. The most frequently detected cause of the trauma was traffic accident (69%). The most frequently detected substance was cannabis (22.4%), followed by alcohol (17.3%) and cocaine (12.8%). Cannabis was detected in 26.1% of under-45-yr-old patients versus 9.3% of older patients (p < 0.05), and cocaine in 16.3% vs. 0% in over-45-yr-olds (p < 0.001). Some substance of abuse was detected in 45% of under-45-yr-olds versus 23% of older patients (p < 0.05). CONCLUSION: The high proportion of positive results to toxic substances in severely traumatized patients suggests that the epidemiological environment for these patients is of great concern. These data may be of interest for the design of future prevention campaign.

Incidencia del consumo de tóxicos en pacientes con traumatismos graves / Incidence of the consumption of toxic substances in severe trauma patients

Objetivo. Determinar la incidencia de detecciónde drogas de abuso en pacientes con traumatismograve.Diseño. Estudio observacional prospectivo,rea lizado entre julio de 2004 y enero de 2006.Ámbito. Unidad de Cuidados Intensivos (UCI)neurotraumatológica de un hospital de tercer nivel.Pacientes. Pacientes con traumatismos queprecisaron el ingreso en la UCI durante el períodode estudio.Intervenciones. Análisis de alcoholemia y de tóxicos(cocaína, cannabis, anfetaminas y otras) enorina.Resultados. Se obtuvo una muestra para análisisde tóxicos en 196 pacientes de los 288 ingresadospor traumatismo grave. La causa más frecuentedel traumatismo fue el accidente detráfico, con un 69%. El tóxico más frecuentementeencontrado fue el cannabis (22,4%), seguidodel alcohol (17,3%) y la cocaína (12,8%). En menoresde 45 años, el cannabis fue detectado en el26,1% frente al 9,3% en mayores de 45 años (p < 0,05)y la cocaína en un 16,3% frente al 0% (p < 0,001).En menores de 45 años fue detectada la presenciade algún tóxico en el 45% frente al 23% en mayoresde 45 años (p < 0,05).Conclusión. La alta proporción de resultadospositivos a tóxicos en pacientes con traumatismosgraves sugiere que el ambiente epidemiológicoen que se mueven estos pacientes es muy preocupante. Estos datos deberían tener importancia para diseñar futuras campañas de prevención

Objective. To determine the incidence of thedetection of abuse drugs in severe trauma patientsDesign. Prospective observational study conductedfrom July 2004 to January 2006.Setting. Neurotrauma intensive care unit of areference tertiary university hospital.Patients. Trauma patients who require admissionto ICU during the study period.Interventions. Determination of alcohol in bloodand of toxics (cocaine, cannabis, amphetaminesand other substances) in urine.Results. Toxicological analysis was performedin 196 of the 288 severe trauma patients admittedduring the study period. The most frequently detectedcause of the trauma was traffic accident(69%). The most frequently detected substancewas cannabis (22.4%), followed by alcohol(17.3%) and cocaine (12.8%). Cannabis was detectedin 26.1% of under-45-yr-old patients versus9.3% of older patients (p < 0.05), and cocainein 16.3% vs. 0% in over-45-yr-olds (p < 0.001).Some substance of abuse was detected in 45% ofunder-45-yr-olds versus 23% of older patients (p< 0.05).Conclusion. The high proportion of positive resultsto toxic substances in severely traumatizedpatients suggests that the epidemiological environmentfor these patients is of great concern These data may be of interest for the design of future prevention campaign