Subject(s)
Analgesics, Opioid/therapeutic use , Oral Surgical Procedures , Pain, Postoperative/prevention & control , Piperidines/therapeutic use , Postoperative Care , Analgesics, Opioid/adverse effects , Female , Humans , Male , Middle Aged , Piperidines/adverse effects , Remifentanil , Time FactorsABSTRACT
Objetivo: Analizar las características clínicas, indicaciones y morbimortalidad asociada a la implantación de marcapasos transvenosos transitorios. Diseño: Estudio observacional y prospectivo. Ámbito: Unidad de cuidados intensivos cardiológicos. Pacientes: Se implantó marcapasos transvenoso transitorio a 182 pacientes, en un periodo de 4 años. Variables recogidas: Se registraron variables demográficas, clínicas, indicaciones, vía de acceso, días de estancia en la unidad y complicaciones. Resultados: El 63% eran hombres, con una media de edad de 78±9,5 años con bloqueo auriculoventricular sintomático en un 76,9% de los casos. La vía venosa de abordaje habitual fue la femoral (92,3%). El 40,11% sufrió complicaciones, siendo la más frecuente el hematoma enla zona de punción (13,19%). No hubo diferencias entre el profesional que implantó el marcapasos y la aparición de complicaciones. La agitación psicomotriz se asoció a la existencia de hematoma en la zona de punción (p = 0,07) y a la necesidad de movilización del catéter (p = 0,059). Se identificó la vía de inserción no femoral (p = 0,012, OR = 0,16; IC del 95%, 0,04-0,66), la agitación (p = 0,006; OR = 3,2; IC del 95%, 1,4-7,3) y la presencia de factores de riesgo cardiovascular (p = 0,042; OR = 5; IC del 95%, 1,06-14,2) como predictores de complicaciones. La realización del procedimiento por parte del personal especializado (p = 0,0001) y la presencia de complicaciones (p = 0,05) incrementaron la estancia en la unidad.Conclusiones: La presencia de agitación, los factores de riesgo cardiovascular y la inserción a través de la vena subclavia o yugular fueron predictores de complicaciones. Estas no se relacionaron con el tipo de profesional implicado en la implantación, pero incrementaron la estancia en la unidad (A)
Objective: To analyze the clinical indications for use, morbidity and mortality associated witha non-permanent transvenous pacemaker.Design: Prospective and observational study.Setting: Cardiac intensive care unit.Method: One hundred and eighty-two patients with non-permanent pacemakers implanted consecutively over a period of four years.Data collected: Main variables of interest were demographic data, clinical indications, accessroute, length of stay and complications.Results: A total of 63% were men, with a median age of 78±9.5 years and with symptomatic third-degree atrioventricular block in 76.9% of the cases. Femoral vein access was preferred in 92.3% of the cases. Complications appeared in 40.11% of the patients, the most frequent being hematoma at the site of vascular access (13.19%). Restlessness was associated to the need for repositioning the pacemaker due to a shift in the electrode (p = 0.059) and to hematoma(p = 0.07). Subclavian or jugular vein lead insertion (p = 0.012; OR = 0.16; 95%CI, 0.04-0.66),restlessness during admission to ICU (p = 0.006; OR = 3.2; 95%CI, 1.4-7.3), and the presence ofcardiovascular risk factors (p = 0.042; OR = 5; 95%CI, 1.06-14.2) were identified by multivariate analysis as being predictors of complications. Length of stay in ICU was significantly longer when lead insertion was carried out by specialized staff (p = 0.0001), and in the presence of complications (p = 0.05).Conclusions: Predictfurors of complications were restlessness, cardiovascular risk factors, and insertion through the jugular or subclavian vein. Complications prolonged ICU stay and were not related to the professionals involved (AU)
Subject(s)
Humans , Critical Care/methods , Pacemaker, Artificial , Atrioventricular Block/therapy , Intensive Care Units/statistics & numerical data , Atrioventricular Block/epidemiology , Risk FactorsABSTRACT
OBJECTIVE: To analyze the clinical indications for use, morbidity and mortality associated with a non-permanent transvenous pacemaker. DESIGN: Prospective and observational study. SETTING: Cardiac intensive care unit. METHOD: One hundred and eighty-two patients with non-permanent pacemakers implanted consecutively over a period of four years. DATA COLLECTED: Main variables of interest were demographic data, clinical indications, access route, length of stay and complications. RESULTS: A total of 63% were men, with a median age of 78 ± 9.5 years and with symptomatic third-degree atrioventricular block in 76.9% of the cases. Femoral vein access was preferred in 92.3% of the cases. Complications appeared in 40.11% of the patients, the most frequent being hematoma at the site of vascular access (13.19%). Restlessness was associated to the need for repositioning the pacemaker due to a shift in the electrode (p=0.059) and to hematoma (p=0.07). Subclavian or jugular vein lead insertion (p=0.012; OR=0.16; 95%CI, 0.04-0.66), restlessness during admission to ICU (p=0.006; OR=3.2; 95%CI, 1.4-7.3), and the presence of cardiovascular risk factors (p=0.042; OR=5; 95%CI, 1.06-14.2) were identified by multivariate analysis as being predictors of complications. Length of stay in ICU was significantly longer when lead insertion was carried out by specialized staff (p=0.0001), and in the presence of complications (p=0.05). CONCLUSIONS: Predictfurors of complications were restlessness, cardiovascular risk factors, and insertion through the jugular or subclavian vein. Complications prolonged ICU stay and were not related to the professionals involved.
