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1.
Med. intensiva (Madr., Ed. impr.) ; 37(3): 149-155, abr. 2013. ilus, tab
Article in Spanish | IBECS | ID: ibc-113794

ABSTRACT

Objetivo Analizar el pronóstico de los pacientes ancianos ventilados mecánicamente en la Unidad de Cuidados Intensivos (UCI).Diseño y ámbito Análisis secundario de un estudio observacional prospectivo y multicéntrico llevado a cabo durante un periodo de 2 años en 13 UCI españolas. Pacientes Pacientes adultos que precisaron ventilación mecánica (VM) invasiva durante más de 24 horas. Intervencione Ninguna. Variables de interés Datos demográficos, APACHE II, SOFA, motivo de VM, comorbilidad, situación funcional, reintubación, duración de la VM, traqueotomía, mortalidad en la UCI, mortalidad hospitalaria. Resultados Se incluyeron 1.661 pacientes. De ellos 1.127 (67,9%) eran hombres. Edad: 62,1±16,2 años. APACHE II: 20,3±7,5. SOFA total: 8,4±3,5. Cuatrocientos veintitrés pacientes (25,4%) tenían 75 años o más. Los índices de comorbilidad y capacidad funcional fueron peor en este grupo de pacientes (p<0,001 para ambas variables). La mortalidad en la UCI fue superior en este grupo (33,6%) que en los más jóvenes (25,9%) (p=0,002), al igual que la mortalidad hospitalaria (41,8 vs 31,8%; p<0,0001). No hubo diferencias en cuanto a tiempo de VM, incidencia de traqueotomías o índice de reintubaciones. Por causas de VM solo los pacientes ≥ 75 años ventilados por neumonía, sepsis o trauma presentaron una mortalidad en UCI más alta que los menores de esa edad (46,3 vs 33,1% p=0,006; 55 vs 25,8% p=0,002; 63,6 vs 4,5% p<0,001 respectivamente).Conclusiones Los ancianos (≥ 75 años) tienen una mayor mortalidad en UCI y hospitalaria que los más jóvenes sin diferencias en la duración de la VM. Las diferencias son a expensas de patologías como neumonía, sepsis y trauma (AU)


Objective To analyze the prognosis of mechanically ventilated elderly patients in the Intensive Care Unit (ICU).Design and scope Sub-analysis of a prospective multicenter observational cohort study conducted over a period of two years in 13 medical-surgical ICUs in Spain. Patients Adult patients who required mechanical ventilation (MV) for longer than 24hours.InterventionsNone.Study variables Demographic data, APACHE II, SOFA, reason for MV, comorbidity, functional condition, reintubation, duration of MV, tracheotomy, ICU mortality, in-hospital mortality. Results A total of 1661 patients were recruited. Males accounted for 67.9% (n=1127), with a mean age of 62.1±16.2 years. APACHE II: 20.3±7.5. Total SOFA: 8.4±3.5. Four hundred and twenty-three patients (25.4%) were ≥ 75 years of age. Comorbidity and functional condition rates were poorer in these patients (p<0.001 for both variables). Mortality in the ICU was higher in the elderly patients (33.6%) than in the younger subjects (25.9%) (p=0.002). Also, in-hospital mortality was higher in those ≥ 75 years of age. No differences in duration of MV, prevalence of tracheostomy or reintubation incidence were found. Regarding the indication for MV, only the patient ≥ 75 years of age with pneumonia, sepsis or trauma had a higher in-ICU mortality than the younger patients (46.3% vs 33.1%, p=0.006; 55% vs 25.8%, p=0.002; 63.6% vs 4.5%, p<0,001, respectively). No differences were found referred to other reasons for MV. Conclusion Older patients (≥ 75 years) have significantly higher in-ICU and in-hospital mortality than younger patients without differences in the duration of mechanical ventilation. Differences in mortality were at the expense of pneumonia, sepsis and trauma (AU)


Subject(s)
Humans , Male , Female , Aged , Respiration, Artificial/statistics & numerical data , Intensive Care Units/statistics & numerical data , Respiratory Insufficiency/mortality , Prognosis , Prospective Studies , Hospital Mortality , Critical Care/statistics & numerical data , Age Distribution
2.
Med Intensiva ; 37(3): 149-55, 2013 Apr.
Article in English, Spanish | MEDLINE | ID: mdl-22592112

ABSTRACT

OBJECTIVE: To analyze the prognosis of mechanically ventilated elderly patients in the Intensive Care Unit (ICU). DESIGN AND SCOPE: Sub-analysis of a prospective multicenter observational cohort study conducted over a period of two years in 13 medical-surgical ICUs in Spain. PATIENTS: Adult patients who required mechanical ventilation (MV) for longer than 24 hours. INTERVENTIONS: None. STUDY VARIABLES: Demographic data, APACHE II, SOFA, reason for MV, comorbidity, functional condition, reintubation, duration of MV, tracheotomy, ICU mortality, in-hospital mortality. RESULTS: A total of 1661 patients were recruited. Males accounted for 67.9% (n=1127), with a mean age of 62.1 ± 16.2 years. APACHE II: 20.3 ± 7.5. Total SOFA: 8.4 ± 3.5. Four hundred and twenty-three patients (25.4%) were ≥ 75 years of age. Comorbidity and functional condition rates were poorer in these patients (p<0.001 for both variables). Mortality in the ICU was higher in the elderly patients (33.6%) than in the younger subjects (25.9%) (p=0.002). Also, in-hospital mortality was higher in those ≥ 75 years of age. No differences in duration of MV, prevalence of tracheostomy or reintubation incidence were found. Regarding the indication for MV, only the patient ≥ 75 years of age with pneumonia, sepsis or trauma had a higher in-ICU mortality than the younger patients (46.3% vs 33.1%, p=0.006; 55% vs 25.8%, p=0.002; 63.6% vs 4.5%, p<0,001, respectively). No differences were found referred to other reasons for MV. CONCLUSION: Older patients (≥ 75 years) have significantly higher in-ICU and in-hospital mortality than younger patients without differences in the duration of mechanical ventilation. Differences in mortality were at the expense of pneumonia, sepsis and trauma.


Subject(s)
Intensive Care Units , Respiration, Artificial , Adult , Age Factors , Aged , Aged, 80 and over , Female , Humans , Male , Middle Aged , Prognosis , Prospective Studies , Young Adult
3.
Med. intensiva (Madr., Ed. impr.) ; 36(7): 488-495, oct. 2012. ilus, tab
Article in Spanish | IBECS | ID: ibc-109918

ABSTRACT

Objetivo: Diseñar un modelo de probabilidad de ventilación mecánica prolongada (VMP) con variables clínicas obtenidas durante las primeras 24 horas de su instauración. Diseño: Estudio de cohorte, observacional, prospectivo, multicéntrico. Ámbito: Trece UCI españolas polivalentes. Pacientes: Adultos ventilados durante más de 24 horas. Intervenciones: Ninguna. Variables de interés: APACHE II, SOFA, variables clínicas y demográficas, motivo de VM, comorbilidad y estado funcional. Se construyó un modelo de riesgo multivariante en el que la variable dependiente tenía tres posibles estados: 1.- Muerte precoz. 2.- Retirada precoz de la VM. 3.- VMP. Resultados: Se incluyeron 1.661 pacientes. El 67,9% (n=1.127) fueron hombres. Edad: 62,1±16,2 años. APACHE II: 20,3±7,5. SOFA: 8,4±3,5. Las puntuaciones APACHE II y SOFA fueron mayores en pacientes ventilados > 7 días (p=0,04 y p=0,0001 respectivamente). El fracaso de la ventilación no invasiva (VNI) se asoció a VMP (p=0,005). Se generó un modelo de riesgo multivariante con las siguientes variables: APACHE II, SOFA, fracaso de VNI, ubicación hospitalaria antes del ingreso en UCI y motivo de ventilación mecánica. La exactitud del modelo global (..) (AU)


Objective: To design a probability model for prolonged mechanical ventilation (PMV) using variables obtained during the first 24hours of the start of MV. Design: An observational, prospective, multicenter cohort study. Scope: Thirteen Spanish medical-surgical intensive care units. Patients: Adult patients requiring mechanical ventilation for more than 24hours. Interventions: None. Study variables: APACHE II, SOFA, demographic data, clinical data, reason for mechanical ventilation, comorbidity, and functional condition. A multivariate risk model was constructed. The model contemplated a dependent variable with three possible conditions: 1. Early mortality; 2. Early extubation; and 3. PMV. Results: Of the 1661 included patients, 67.9% (n=1127) were men. Age: 62.1±16.2 years. APACHE II: 20.3±7.5. Total SOFA: 8.4±3.5. The APACHE II and SOFA scores were higher in patients ventilated for 7 or more days (p=0.04 and p=0.0001, respectively). Noninvasive ventilation failure was related to PMV (p=0.005). A multivariate model for the three above exposed outcomes was generated. The overall accuracy of the model in the training and validation sample was 0.763 (95%IC: 0.729-0.804) and 0.751 (95%IC: 0.672-0.816), respectively. The likelihood ratios (LRs) for early extubation, involving a cutoff point of 0.65, in the training sample were LR (+): 2.37 (95%CI: 1.77-3.19) and LR (-): 0.47 (95%CI: 0.41-0.55). The LRs for the early mortality model, for a cutoff point of 0.73, in the training sample, were LR (+): 2.64 (95%CI: 2.01-3.4) and LR (-): 0.39 (95%CI: 0.30-0.51). Conclusions: The proposed model could be a helpful tool in decision making. However, because of its moderate accuracy, it should be considered as a first approach, and the results should be corroborated by further studies involving larger samples and the use of standardized criteria (AU)


Subject(s)
Humans , Respiration, Artificial , Intubation , Respiratory Insufficiency/epidemiology , Risk Factors , Risk Adjustment/methods , Prospective Studies , Multivariate Analysis , Intensive Care Units/statistics & numerical data
4.
Med Intensiva ; 36(7): 488-95, 2012 Oct.
Article in Spanish | MEDLINE | ID: mdl-22386270

ABSTRACT

OBJECTIVE: To design a probability model for prolonged mechanical ventilation (PMV) using variables obtained during the first 24 hours of the start of MV. DESIGN: An observational, prospective, multicenter cohort study. SCOPE: Thirteen Spanish medical-surgical intensive care units. PATIENTS: Adult patients requiring mechanical ventilation for more than 24 hours. INTERVENTIONS: None. STUDY VARIABLES: APACHE II, SOFA, demographic data, clinical data, reason for mechanical ventilation, comorbidity, and functional condition. A multivariate risk model was constructed. The model contemplated a dependent variable with three possible conditions: 1. Early mortality; 2. Early extubation; and 3. PMV. RESULTS: Of the 1661 included patients, 67.9% (n=1127) were men. Age: 62.1±16.2 years. APACHE II: 20.3±7.5. Total SOFA: 8.4±3.5. The APACHE II and SOFA scores were higher in patients ventilated for 7 or more days (p=0.04 and p=0.0001, respectively). Noninvasive ventilation failure was related to PMV (p=0.005). A multivariate model for the three above exposed outcomes was generated. The overall accuracy of the model in the training and validation sample was 0.763 (95%IC: 0.729-0.804) and 0.751 (95%IC: 0.672-0.816), respectively. The likelihood ratios (LRs) for early extubation, involving a cutoff point of 0.65, in the training sample were LR (+): 2.37 (95%CI: 1.77-3.19) and LR (-): 0.47 (95%CI: 0.41-0.55). The LRs for the early mortality model, for a cutoff point of 0.73, in the training sample, were LR (+): 2.64 (95%CI: 2.01-3.4) and LR (-): 0.39 (95%CI: 0.30-0.51). CONCLUSIONS: The proposed model could be a helpful tool in decision making. However, because of its moderate accuracy, it should be considered as a first approach, and the results should be corroborated by further studies involving larger samples and the use of standardized criteria.


Subject(s)
Models, Statistical , Respiration, Artificial , Cohort Studies , Female , Humans , Male , Middle Aged , Multivariate Analysis , Prospective Studies , Time Factors
7.
Med Intensiva ; 31(4): 165-71, 2007 May.
Article in Spanish | MEDLINE | ID: mdl-17562300

ABSTRACT

OBJECTIVE: To assess the efficacy and safety of a treatment with clopidogrel when associated or not to the treatment with tirofiban and aspirin for high-risk non-ST segment elevation myocardial infarction (non-STEMI), without early angioplasty. SETTING: Intensive Care and Coronary Unit (ICCU), in a center with no Hemodynamic Laboratory. DESIGN: Non randomized clinical trial. PARTICIPANTS: One hundred and twenty-three patients admitted with the diagnosis of high-risk non-STEMI, defined as patients with chest pain and one of the following: ST segment depression or transient elevation or an elevation in cardiac troponin I (TropIc). INTERVENTIONS: We included patients admitted in a 24-month period. During the first 12-month period, the patients received tirofiban and clopidogrel (group A). In the second one, clopidogrel was not administered (group B). Urgent cardiac catheterism was requested if recurrent ischemic chest pain with ST segment changes, left ventricular failure or hemodynamic instability were present. PRIMARY VARIABLES: A composite of recurrent ischemic chest pain with ST segment changes or death during ICCU admission was evaluated as an efficacy variable. A variable of safety was defined as the occurrence of intracranial or gastrointestinal bleeding, or any hemorrhagic event accompanied by a drop of at least 3 g/dl of hemoglobin. The rate of urgent cardiac catheterisms was recorded. RESULTS: Neither the rate of the efficacy variable (19.6 % in group A and 19.4% in group B; p = 0.97), nor the rate of the safety variable (3.5% and 2.9% of patients in groups A and B, p = 1) showed statistically significant difference. There was no statistically significant difference in the rate of urgent cardiac catheterism (19.6% in group A and 13.4% in group B; p = 0.35). CONCLUSIONS: In the early course of high-risk non-STEMI with a conservative management strategy, the addition of clopidogrel to tirofiban does not change the rate of ischemic events, death, need of urgent catheterism or hemorrhagic events.


Subject(s)
Aspirin/therapeutic use , Myocardial Infarction/drug therapy , Platelet Aggregation Inhibitors/therapeutic use , Ticlopidine/analogs & derivatives , Tyrosine/analogs & derivatives , Aged , Clopidogrel , Electrocardiography , Female , Humans , Male , Middle Aged , Myocardial Infarction/physiopathology , Ticlopidine/therapeutic use , Tirofiban , Tyrosine/therapeutic use
8.
Med. intensiva (Madr., Ed. impr.) ; 31(4): 165-171, mayo 2007. tab
Article in Es | IBECS | ID: ibc-64375

ABSTRACT

Objetivo. Valorar la eficacia y seguridad del tratamiento con clopidogrel cuando se asocia o no al tratamiento con tirofibán más ácido acetilsalicílico (AAS) en el síndrome coronario agudo sin elevación persistente del segmento ST (SCASEST) de alto riesgo, sin intervencionismo precoz. Ámbito. Unidad de Cuidados Intensivos (UCI), en centro sin laboratorio de hemodinámica. Diseño. Ensayo clínico sin asignación aleatoria. Pacientes. Ciento veintitrés pacientes con SCASEST de alto riesgo, definido como dolor torácico y uno de los siguientes: descenso del segmento ST o ascenso transitorio o aumento de troponina I cardíaca (TropIc). Intervenciones. Estudio desarrollado durante veinticuatro meses. Los primeros doce meses el tratamiento incluía tirofibán y clopidogrel (grupo A); en los siguientes doce meses, el clopidogrel no se administraba (grupo B). El cateterismo cardíaco urgente se solicitó si aparecía dolor torácico recurrente con cambios en el segmento ST, fallo ventricular izquierdo o inestabilidad hemodinámica. Variables principales. Se evaluó una variable de eficacia, formada por la combinación de la aparición de dolor torácico con cambios en el segmento ST o muerte durante la estancia en la UCI, y una variable de seguridad, definida por la existencia de hemorragias intracraneales, digestivas o aquellas asociadas a una disminución de hemoglobina de al menos 3 g/dl. Se registró la frecuencia de realización de cateterismo urgente. Resultados. No hubo diferencias estadísticas significativas en la frecuencia de la variable de eficacia (19,6% en el grupo A y 19,4% en el grupo B; p = 0,97), ni en la de seguridad (3,5 y 2,9% en los grupos A y B respectivamente; p = 1). Tampoco existió diferencia estadística significativa en la realización de cateterismo urgente (19,6% en el grupo A y 13,4% en el grupo B; p = 0,35). Conclusiones. En el curso inicial del SCASEST de alto riesgo con una estrategia de tratamiento conservadora, la adición de clopidogrel al tirofibán no modifica la aparición de eventos isquémicos, muerte o necesidad de cateterismo urgente, ni se asocia a un incremento de complicaciones hemorrágicas


Objective. To assess the efficacy and safety of a treatment with clopidogrel when associated or not to the treatment with tirofiban and aspirin for high-risk non-ST segment elevation myocardial infarction (non-STEMI), without early angioplasty. Setting. Intensive Care and Coronary Unit (ICCU), in a center with no Hemodynamic Laboratory. Design. Non randomized clinical trial. Participants. One hundred and twenty-three patients admitted with the diagnosis of high-risk non-STEMI, defined as patients with chest pain and one of the following: ST segment depression or transient elevation or an elevation in cardiac troponin I (TropIc). Interventions. We included patients admitted in a 24-month period. During the first 12-month period, the patients received tirofiban and clopidogrel (group A). In the second one, clopidogrel was not administered (group B). Urgent cardiac catheterism was requested if recurrent ischemic chest pain with ST segment changes, left ventricular failure or hemodynamic instability were present. Primary variables. A composite of recurrent ischemic chest pain with ST segment changes or death during ICCU admission was evaluated as an efficacy variable. A variable of safety was defined as the occurrence of intracranial or gastrointestinal bleeding, or any hemorrhagic event accompanied by a drop of at least 3 g/dl of hemoglobin. The rate of urgent cardiac catheterisms was recorded. Results. Neither the rate of the efficacy variable (19.6 % in group A and 19.4% in group B; p = 0.97), nor the rate of the safety variable (3.5% and 2.9% of patients in groups A and B, p = 1) showed statistically significant difference. There was no statistically significant difference in the rate of urgent cardiac catheterism (19.6% in group A and 13.4% in group B; p = 0.35). Conclusions. In the early course of high-risk non-STEMI with a conservative management strategy, the addition of clopidogrel to tirofiban does not change the rate of ischemic events, death, need of urgent catheterism or hemorrhagic events


Subject(s)
Humans , Coronary Disease/drug therapy , Platelet Aggregation Inhibitors/pharmacokinetics , Coronary Disease/physiopathology , Critical Care/methods , Myocardial Ischemia/physiopathology
9.
Med Intensiva ; 30(8): 370-3, 2006 Nov.
Article in Spanish | MEDLINE | ID: mdl-17129534

ABSTRACT

OBJECTIVE: Describe the use of remifentanil in definitive pacemaker implant. DESIGN: Prospective, observational study. SCOPE: Intensive Care Unit of two general hospitals. PATIENTS: Ninety-four patients subjected to DPM implant under sedation with remifentanil. INTERVENTIONS: The protocol for DPM implant was conducted: premedication with metoclopramide, remifentanil perfusion (20 micro g/ml), local infiltration with mepivacaine 2%, administration of magnesium metamizole at the end of the implant and posterior discontinuation of remifentanil. Remifentanil perfusion was initiated at 2 micro g/minute, increasing it until reaching a sedation grade 2-3 on the Ramsay scale, with a maximum of 6 micro g/minute. MAIN ENDPOINTS: Time needed to reach the desired sedation grade and duration of sedation, maximum dose of remifentanil necessary, frequency that another sedation was needed and of adverse events were recorded. Continuous quantitative endpoints were expressed as mean +/- SD. RESULTS: A sedation grade 2-3 was achieved with a perfusion rhythm of 3.6 +/- 1.4 micro g/min, in 20 +/- 22 minutes. In 89 patients (94.6%), the implant was performed only with remifentanil. Frequency of adverse events were nauseas/vomiting 21.3%, hypotension 5.3% and respiratory depression 1%. Remifentanil perfusion was discontinued in 3 patients (3.2%) due to appearance of adverse events. Another sedoanalgesic was used in 2 patients (2.1%). CONCLUSIONS: Remifentanil is useful in the implant of DPM as a sedoanalgesia method. Serious undesired effects are rare. Future studies are necessary to completely establish its effectiveness and safety in these types of procedures.


Subject(s)
Anesthetics, Intravenous/administration & dosage , Conscious Sedation/methods , Piperidines/administration & dosage , Adult , Aged , Aged, 80 and over , Anesthetics, Intravenous/adverse effects , Cardiac Pacing, Artificial , Cardiac Surgical Procedures/methods , Conscious Sedation/adverse effects , Female , Humans , Infusions, Intravenous , Male , Middle Aged , Pacemaker, Artificial , Piperidines/adverse effects , Prospective Studies , Remifentanil
10.
Med. intensiva (Madr., Ed. impr.) ; 30(8): 370-373, nov. 2006. tab
Article in Es | IBECS | ID: ibc-050081

ABSTRACT

Objetivo. Describir el empleo de remifentanilo en el implante de marcapasos definitivo. Diseño. Estudio prospectivo observacional. Ámbito. Unidad de Cuidados Intensivos de dos hospitales generales. Pacientes. Noventa y cuatro pacientes sometidos a implante de marcapasos definitivo (MPD) bajo sedación con remifentanilo. Intervenciones. Se llevó a cabo el protocolo para implantación de MPD: premedicación con metoclopramida, perfusión de remifentanilo (20 µg/ml), infiltración local con mepivacaína 2%, administración de metamizol magnésico al terminar el implante y suspensión posterior de remifentanilo. La perfusión de remifentanilo se inició con 2 µg/minuto, incrementándola hasta alcanzar un grado de sedación 2-3 en la escala de Ramsay, con un máximo de 6 µg/minuto. Variables principales. Se registraron los tiempos transcurridos en alcanzar el grado de sedación deseado y de permanencia de la sedación, la dosis máxima necesaria de remifentanilo, la frecuencia con la que se necesitó otra sedación y la de efectos adversos. Las variables cuantitativas continuas se expresaron como media ± desviación estándar (DE). Resultados. Un grado de sedación 2-3 se consiguió con un ritmo de perfusión de 3,6 ± 1,4 µg/minuto, en 20 ± 22 minutos. En 89 pacientes (94,6%) el implante se llevó a cabo con remifentanilo exclusivamente. La frecuencia de efectos adversos fueron náuseas/vómitos 21,3%, hipotensión 5,3% y depresión respiratoria 1%. La perfusión de remifentanilo fue suspendida en 3 pacientes (3,2%) por la aparición de efectos adversos. Se empleó otra sedoanalgesia en 2 pacientes (2,1%). Conclusiones. El remifentanilo es útil en el implante de MPD como método de sedoanalgesia. Los efectos indeseables graves son poco frecuentes. Son necesarios futuros estudios para establecer completamente su efectividad y seguridad en este tipo de procedimientos


Objective. Describe the use of remifentanil in definitive pacemaker implant. Design. Prospective, observational study. Scope. Intensive Care Unit of two general hospitals. Patients. Ninety-four patients subjected to DPM implant under sedation with remifentanil. Interventions. The protocol for DPM implant was conducted: premedication with metoclopramide, remifentanil perfusion (20 µg/ml), local infiltration with mepivacaine 2%, administration of magnesium metamizole at the end of the implant and posterior discontinuation of remifentanil. Remifentanil perfusion was initiated at 2 µg/minute, increasing it until reaching a sedation grade 2-3 on the Ramsay scale, with a maximum of 6 µg/minute. Main endpoints. Time needed to reach the desired sedation grade and duration of sedation, maximum dose of remifentanil necessary, frequency that another sedation was needed and of adverse events were recorded. Continuous quantitative endpoints were expressed as mean ± SD. Results. A sedation grade 2-3 was achieved with a perfusion rhythm of 3.6 ± 1.4 µg/min, in 20 ± 22 minutes. In 89 patients (94.6%), the implant was performed only with remifentanil. Frequency of adverse events were nauseas/vomiting 21.3%, hypotension 5.3% and respiratory depression 1%. Remifentanil perfusion was discontinued in 3 patients (3.2%) due to appearance of adverse events. Another sedoanalgesic was used in 2 patients (2.1%). Conclusions. Remifentanil is useful in the implant of DPM as a sedoanalgesia method. Serious undesired effects are rare. Future studies are necessary to completely establish its effectiveness and safety in these types of procedures


Subject(s)
Male , Female , Adult , Middle Aged , Aged , Humans , Narcotics/therapeutic use , Pacemaker, Artificial , Analgesia/methods , Prospective Studies , Clinical Protocols , Narcotics/adverse effects , Spain
11.
Med. intensiva (Madr., Ed. impr.) ; 29(7): 396-399, oct. 2005. ilus
Article in Es | IBECS | ID: ibc-040207

ABSTRACT

El alcoholismo crónico provoca toxicidad en el sistema nervioso central y periférico siendo la enfermedad de Marchiafava-Bignami una de sus complicaciones menos frecuentes. Esta entidad se caracteriza por desmielinización del cuerpo calloso. El cuadro clínico es variado, siendo los síntomas más frecuentes: la demencia, los trastornos de la atención, la dificultad para la marcha y el síndrome de desconexión interhemisférica. Para su diagnóstico se precisan técnicas de neuroimagen, fundamentalmente la resonancia magnética. Presentamos el caso de un paciente que ingresa en la Unidad de Cuidados Intensivos por deterioro neurológico y parada respiratoria, que es finalmente diagnosticado de enfermedad de Marchiafava-Bignami. Exponemos las dificultades diagnósticas y las alternativas terapéuticas de esta patología


Chronic alcoholism causes toxicity in the central and peripheral nervous system, Marchiafava-Bignami disease being one of its less frequent complications. This entity is characterized by demyelinization of the callous body. The clinical picture is varied, the most frequent symptoms being: dementia, attention disorders, gait difficulty and interhemispheric deconnection syndrome. Neuroimaging techniques, basically magnetic resonance imaging, are required for its diagnosis.We present the case of a patient who was admitted to the intensive care unit due to neurological deterioration and respiratory arrest. He was finally diagnosed as having Marchiafava-Bignami disease. We explain the diagnostic difficulties and therapeutic alternatives of this disease


Subject(s)
Male , Adult , Humans , Hemoglobinuria, Paroxysmal/epidemiology , Alcoholism/complications , Dementia/etiology , Corpus Callosum/physiopathology , Hypercapnia , Adrenal Cortex Hormones/therapeutic use , Myasthenia Gravis/diagnosis , Diagnosis, Differential
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