Prognosis of critical surgical patients depending on the duration of stay in the ICU.

OBJECTIVE: To analyze the epidemiological and prognostic differences between critical surgical patients admitted to intensive care unit (ICU) according to length of stay in the ICU. MATERIALS AND METHODS: Retrospective observational study on patients with surgical pathology admitted to ICU of a tertiary hospital, during 7 years, with a stay ≥ 5 days. The variables analyzed were age, sex, Acute Physiology and Chronic Health Evaluation II (APACHE II), duration of stay, hospital and ICU mortality, original service, reason for admission, geographical place of residence, and the use of invasive techniques such as mechanical ventilation (MV), tracheotomy, and techniques of continuous renal replacement (CRR). Two groups were defined; one with intermediate stay, the one that exceeds the average of our population (> 5 days) and another with long stay patients (> 14 days). Readmissions were excluded. Firstly, the analysis of differential characteristics of patients was performed, this was according to the duration of their stay using either a contrast equal averages when the variable contrast between the two groups was quantitative or the Chi-square test when the variable analyzed was qualitative. For both tests, the existence of significant differences between groups was considered when the significance level was less than 5%. And, secondly, a model forecast ICU survival of these patients, regardless of length of stay in ICU, using a binary logistic regression analysis was performed. RESULTS: Among the 540 patients analyzed, no significant differences were observed, depending on the length of stay in the ICU, except the need for invasive techniques such as MV or tracheotomy in those of longer stay (P = 0.000). However, ICU mortality was significantly higher for patients with intermediate stay (30 vs 17: 5%; P = 0.000), without observing differences in hospital mortality. ICU survival was influenced by age, APACHE II levels, admission to the ICU in a coma state, and the application of the three invasive techniques discussed. CONCLUSION: Surgical patients who survive in the ICU, regardless of the length of their stay in it, have the same odds of hospital survival. Found as predictors of mortality in ICU APACHE II, age, admission in a coma state, and application of invasive techniques.

Influencia de la duración de la estancia previa en planta en el pronóstico de los pacientes con permanencia prolongada en la Unidad de Cuidados Intensivos / Influence of the duration of a former ward stay on the prognosis of patients with long Intensive Care Unit stays

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Rotura de aorta torácica descendente afectada por un angiosarcoma / Rupture of descending thoracic aorta due to angiosarcoma

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Complications of post-injury decompressive craniectomy.

Decompressive craniectomy (DC) is a useful technique for the treatment of traumatic brain injuries (TBI) with intracranial hypertension (ICHT) resistant to medical treatment, increasing survival, although its role in the functional prognosis of patients is not defined. It is also a technique that is not without complications, and may increase the patient's morbidity and mortality. We report two cases of patients with TBI who required DC and suffered complications from the technique.

[Outcome of the critical patient according to the sex and the age]. / Pronóstico del paciente crítico según el sexo y la edad.

OBJECTIVE: To determine if gender and age are associated with differences in mortality in patients requiring critical care. DESIGN: Retrospective analysis of prospectively collected data over 6 consecutive years. SETTING: Polyvalent intensive care unit (ICU) of a tertiary hospital in the Canary Islands. PATIENTS: Adult patients who were hospitalized in the ICU, divided on the basis of gender and age (or=65 years). PRIMARY VARIABLES OF INTEREST: Demographic and clinical diagnosis data on ICU admission, APACHE II, days of mechanical ventilation, days of renal replacement therapy (RRT) and the mortality were collected. RESULTS: During the study period, 3786 patients were admitted to the ICU, 66.7% male and 2469 (65.2%)<65 years. Mortality in the ICU of the coronary group was greater in women (11.1% vs 6.7%; p=0.02), even though there were no significant differences between both genders in the APACHE II (p=0.56). No statistically significant differences were found according to gender in age (or=65 years), in the APACHE II, or in the need for mechanical ventilation or renal replacement therapy as well as in the ICU mortality. We also found no differences in the mortality between the diagnostic groups and gender even when the APACHE II was significantly greater on admission, as occurred for the women<65 years of the coronary and traumas group and for women with surgery>or=65 years. CONCLUSIONS: No significant differences were demonstrated in the outcome in relationship with gender except for in the coronary group in which mortality was greater in women. Age above or below 65 years had no influence on mortality in our patients.