Subject(s)
Drug Resistance, Viral/genetics , Influenza A Virus, H1N1 Subtype/genetics , Influenza, Human/virology , Mutation, Missense , Neuraminidase/genetics , Point Mutation , Antiviral Agents/pharmacology , Antiviral Agents/therapeutic use , Fatal Outcome , Female , Humans , Immunocompromised Host , Influenza A Virus, H1N1 Subtype/drug effects , Influenza A Virus, H1N1 Subtype/isolation & purification , Influenza, Human/complications , Influenza, Human/drug therapy , Oseltamivir/pharmacology , Oseltamivir/therapeutic use , Respiratory Insufficiency/etiology , Zanamivir/therapeutic useSubject(s)
Abscess/etiology , Periodontal Abscess/complications , Vulvar Diseases/etiology , Abdominal Abscess/etiology , Abdominal Abscess/surgery , Abscess/surgery , Drainage , Female , Humans , Periodontal Abscess/surgery , Pleural Effusion/etiology , Postoperative Complications/etiology , Postoperative Complications/surgery , Vulvar Diseases/surgery , Young AdultSubject(s)
Coronary Restenosis/diagnosis , Drug-Eluting Stents/adverse effects , Heart Arrest/complications , Aged , Angioplasty, Balloon, Coronary , Aspirin/therapeutic use , Clopidogrel , Coronary Angiography , Electroencephalography , Female , Humans , Myocardial Ischemia/therapy , Platelet Aggregation Inhibitors/therapeutic use , Ticlopidine/analogs & derivatives , Ticlopidine/therapeutic useABSTRACT
OBJECTIVE: Evaluate moment of extubation in maxillofacial post-operative patients admitted to an intensive care unit (ICU) and analyze early complications during their stay. DESIGN: An observational and prospective study. SETTING: Third level hospital ICU. PATIENTS AND METHODS: All patients we underwent maxillofacial surgery and admitted to the ICU for immediate post-operative care from February 2007 to March 2008 were studied. Demographic and clinical data variables of the patients, anesthesic variables prior to surgery and mechanical ventilation and postoperative complications during their stay in the ICU were recorded. RESULTS: A total of 102 patients were collected during the study. Of these, 58 (55.8%) patients were extubated early (within the first 4 hours of admission). Global rate of complications was 12.5%. Length of mechanical ventilation was longer in patients who required cervical lymph node extraction (p = 0.0031). We found an association between complications and late extubation (p = 0.034; OR = 3.78; 95% CI, 1.16-12.31). The multivariant study showed that late extubation and surgery that required lymph node extraction are predictors of complications. CONCLUSIONS: In our series, late extubation and the need for cervical lymph node extraction were independent risk factors for complications in ICU. Although early extubation may be hazardous in some cases in the first hours, we have no consistent data to maintain mechanical ventilation longer than needed to recover from the anesthesia.
Subject(s)
Critical Care , Intubation, Intratracheal , Oral Surgical Procedures , Postoperative Care , Female , Humans , Intensive Care Units , Intubation, Intratracheal/methods , Male , Middle Aged , Prospective Studies , Time FactorsABSTRACT
Objetivo. Evaluar el momento de extubación de los pacientes postoperados de cirugía maxilofacial (CMF) que requieren ingreso en la unidad de cuidados intensivos (UCI) y relacionarlo con las complicaciones acaecidas durante su estancia. Diseño. Estudio observacional prospectivo. Ámbito. UCI de un hospital de tercer nivel. Pacientes y métodos. Se estudió a todos los pacientes sometidos a CMF ingresados en UCI para manejo postoperatorio inmediato, desde febrero de 2007 hasta marzo de 2008. Se registraron variables clínicas y demográficas de los pacientes, variables anestésicas previas al acto quirúrgico y tiempos de ventilación mecánica y complicaciones inmediatas durante su estancia en UCI. Resultados. Se registraron 102 pacientes durante el periodo del estudio. Se extubó precozmente (dentro de las primeras 4 h) a 58 (55,8%) pacientes. La tasa general de complicaciones fue del 12,5%. La duración de la ventilación mecánica fue mayor en la cirugía que requirió vaciamiento ganglionar cervical (p = 0,003). Encontramos relación (p = 0,03) entre la presencia de alguna complicación y la extubación tardía (odds ratio: 3,78; intervalo de confianza del 95%, 1,16-12,31). El análisis multivariable reveló que son predictores de complicaciones la cirugía que incluye vaciamiento ganglionar y la extubación tardía. Conclusiones. En nuestra serie, el destete tardío y la cirugía que conlleva vaciamiento ganglionar cervical fueron factores relacionados con morbilidad. A pesar de que la extubación del postoperado de CMF pueda parecer arriesgada en determinados casos y en las primeras horas, no disponemos de datos consistentes para mantener la ventilacion mecánica más allá de lo preciso para la recuperación anestésica (AU)
Objective. Evaluate moment of extubation in maxillofacial post-operative patients admitted to an intensive care unit (ICU) and analyze early complications during their stay. Design. An observational and prospective study. Setting. Third level hospital ICU. Patients and methods. All patients we underwent maxillofacial surgery and admitted to the ICU for immediate post-operative care from February 2007 to March 2008 were studied. Demographic and clinical data variables of the patients, anesthesic variables prior to surgery and mechanical ventilation and postoperative complications during their stay in the ICU were recorded. Results. A total of 102 patients were collected during the study. Of these, 58 (55.8%) patients were extubated early (within the first 4 hours of admission). Global rate of complications was 12.5%. Length of mechanical ventilation was longer in patients who required cervical lymph node extraction (p = 0.0031). We found an association between complications and late extubation (p = 0.034; OR = 3.78; 95% CI, 1.16-12.31). The multivariant study showed that late extubation and surgery that required lymph node extraction are predictors of complications. Conclusions. In our series, late extubation and the need for cervical lymph node extraction were independent risk factors for complications in ICU. Although early extubation may be hazardous in some cases in the first hours, we have no consistent data to maintain mechanical ventilation longer than needed to recover from the anesthesia (AU)
Subject(s)
Humans , Ventilator Weaning/methods , Oral Surgical Procedures/methods , Postoperative Care/methods , Postoperative Complications , Risk Factors , Lymph Node Excision/adverse effectsSubject(s)
Consciousness Disorders/etiology , Malaria, Cerebral/diagnosis , Pregnancy Complications, Infectious/diagnosis , Anemia, Hemolytic, Autoimmune/diagnosis , Antimalarials/therapeutic use , Brain Infarction/diagnostic imaging , Brain Infarction/etiology , Cesarean Section , Chorioamnionitis/diagnosis , Chorioamnionitis/parasitology , Doxycycline/therapeutic use , Drug Therapy, Combination , Emergencies , Female , Humans , Infant, Newborn , Malaria, Cerebral/drug therapy , Mefloquine/therapeutic use , Parasitemia/diagnosis , Parasitemia/drug therapy , Pregnancy , Pregnancy Complications/diagnostic imaging , Pregnancy Complications/etiology , Pregnancy Complications, Infectious/drug therapy , Puerperal Disorders/diagnosis , Radiography , Young AdultABSTRACT
No disponible
Subject(s)
Humans , Female , Pregnancy , Adult , Malaria, Cerebral/complications , Plasmodium falciparum/pathogenicity , Pregnancy ComplicationsABSTRACT
No disponible
Subject(s)
Humans , Methylene Blue/therapeutic use , Hypotension/drug therapy , Extracorporeal Circulation/adverse effects , Postoperative Complications/drug therapy , Etomidate/therapeutic use , Cardiac Surgical Procedures/methodsABSTRACT
We present the case of a patient who was previously diagnosed of hypertrophic cardiomyopathy. The patient was admitted to our coronary unit due to a sustained ventricular tachycardia picture. A coronariography was performed as part of the ventricular tachycardia study protocol. It showed angiographically normal epicardic arteries. In the ventriculography, there was a pattern of dilated cardiomyopathy with prominent left ventricular trabeculation, which suggested the diagnosis of non-compacted cardiomyopathy (NCC). The findings of the transthoracic echocardiography, that showed a dilated and hypertrophic left ventricle, with very depressed systolic function, and ventricular myocardium with a thick internal non-compacted endocardium, with a meshwork of multiple trabeculations and intracardic recesses in communication with the ventricular cavity, confirmed this diagnosis. There continues to be little knowledge on NCC and thus it is probably underdiagnosed. It must be considered in the differential diagnosis of patients diagnosed of hypertrophic or dilated cardiomyopathy.
Subject(s)
Cardiomyopathy, Hypertrophic/complications , Heart Ventricles/pathology , Tachycardia, Ventricular/etiology , Cardiomyopathy, Hypertrophic/diagnosis , Humans , Male , Middle AgedABSTRACT
Presentamos el caso de un paciente, diagnosticado previamente de miocardiopatía hipertrófica, que ingresó en nuestra Unidad Coronaria por un cuadro de taquicardia ventricular sostenida. Como parte del protocolo de estudio de la taquicardia ventricular se le realizó una coronariografía que mostró arterias epicárdicas angiográficamente normales. En la ventriculografía se apreció un patrón de micardiopatía dilatada con llamativa trabeculación del ventrículo izquierdo, sugiriendo el diagnóstico de miocardiopatía no compactada (MNC). Los hallazgos de la ecocardiografía transtorácica, en la que se apreció un ventrículo izquierdo dilatado e hipertrófico con una función sistólica muy deprimida, y un miocardio ventricular con una gruesa capa interna endocárdica no compactada, con una malla de múltiples trabeculaciones y recesos intramiocárdicos en comunicación con la cavidad ventricular, confirmaron este diagnóstico. La MNC sigue siendo una patología poco conocida, y probablemente por ello infradiagnosticada. Hay que considerarla en el diagnóstico diferencial de pacientes afectos de miocardiopatía hipertrófica o dilatada
We present the case of a patient who was previously diagnosed of hypertrophic cardiomyopathy. The patient was admitted to our coronary unit due to a sustained ventricular tachycardia picture. A coronariography was performed as part of the ventricular tachycardia study protocol. It showed angiographically normal epicardic arteries. In the ventriculography, there was a pattern of dilated cardiomyopathy with prominent left ventricular trabeculation, which suggested the diagnosis of non-compacted cardiomyopathy (NCC). The findings of the transthoracic echocardiography, that showed a dilated and hypertrophic left ventricle, with very depressed systolic function, and ventricular myocardium with a thick internal non-compacted endocardium, with a meshwork of multiple trabeculations and intracardic recesses in communication with the ventricular cavity, confirmed this diagnosis. There continues to be little knowledge on NCC and thus it is probably underdiagnosed. It must be considered in the differential diagnosis of patients diagnosed of hypertrophic or dilated cardiomyopathy
Subject(s)
Humans , Male , Middle Aged , Tachycardia, Ventricular/etiology , Cardiomyopathies/complications , Cardiomyopathy, Hypertrophic/diagnosis , Cardiomyopathy, Dilated/diagnosis , Diagnosis, DifferentialSubject(s)
Boutonneuse Fever/complications , Brain Edema/etiology , Cerebral Hemorrhage/etiology , Encephalitis/etiology , Anti-Bacterial Agents/therapeutic use , Boutonneuse Fever/diagnosis , Boutonneuse Fever/drug therapy , Brain Damage, Chronic/etiology , Female , Humans , Middle Aged , Paraplegia/etiology , Vasculitis/etiologyABSTRACT
OBJECTIVE: Describe the epidemiological characteristics of severe burn patients and analyze the factors related with morbidity-mortality. DESIGN AND SCOPE: Observational, retrospective study of patients admitted to an intensive care unit of a level III hospital due to severe burns from January 1998 to December 2004. PATIENTS: 59 patients with criteria of "severe burn" and expected stay in ICU greater than three days. MAIN ENDPOINTS OF INTEREST: We studied epidemiological endpoints of this type of patients, diagnosis and initial treatment, early complications and morbidity-mortality. RESULTS: The burned body surface was 41% +/- 25% and age 49 +/- 21 years. Patients remained hospitalized in ICU for a median of 4 days (interquartile range: 2-19). A total of 78% of the patients needed mechanical ventilation, 47% had some infection during admission and 28% developed acute kidney failure during the first week. Mortality in the ICU was 42%. Endpoints associated independently with a significant increase of mortality were burned body surface greater than 35% (OR 1.08; 95% CI: 1.03-1.12) and development of kidney failure (OR 5.47; 95% CI: 2.02 -8.93). CONCLUSIONS: Mortality of these patients is very high and is conditioned largely by initial care. Percentage of burned body surface (BBS) and kidney failure entails greater mortality in our series.
Subject(s)
Burns/mortality , APACHE , Adult , Burns/therapy , Female , Hospital Mortality , Humans , Intensive Care Units/statistics & numerical data , Male , Middle Aged , Morbidity , Retrospective Studies , Risk FactorsABSTRACT
Objetivo. Describir las características epidemiológicas de los pacientes quemados graves y analizar los factores relacionados con la morbimortalidad. Diseño y ámbito. Estudio observacional retrospectivo de los pacientes ingresados en una Unidad de Cuidados Intensivos (UCI) de un hospital de nivel III por quemaduras graves, entre enero de 1998 y diciembre de 2004. Pacientes. Cincuenta y nueve pacientes con criterios de «gran quemado» y estancia esperada en UCI superior a tres días. Principales variables de interés. Estudiamos variables epidemiológicas de este tipo de pacientes, diagnóstico y manejo inicial, complicaciones precoces y morbimortalidad. Resultados. La superficie corporal quemada fue del 41 ± 25% y la edad 49 ± 21 años. Los pacientes permanecieron ingresados en la UCI durante una mediana de 4 días (rango intercuartil: 2-19). Un 78% de los pacientes necesitaron ventilación mecánica, un 47% presentó alguna infección durante el ingreso, y un 28% desarrolló insuficiencia renal aguda durante la primera semana. La mortalidad en UCI fue del 42%. Las variables asociadas de manera independiente con un aumento significativo de la mortalidad fueron la superficie corporal quemada superior al 35% (OR 1,08; IC 95%: 1,03-1,12) y el desarrollo de insuficiencia renal (OR 5,47; IC 95%: 2,02-8,93). Conclusiones. La mortalidad de estos pacientes es muy alta, y viene condicionada, en gran parte, por la asistencia inicial. El porcentaje de superficie corporal quemada y el fallo renal conllevan mayor mortalidad en nuestra serie
Objective. Describe the epidemiological characteristics of severe burn patients and analyze the factors related with morbidity-mortality. Design and scope. Observational, retrospective study of patients admitted to an intensive care unit of a level III hospital due to severe burns from January 1998 to December 2004. Patients. 59 patients with criteria of «severe burn» and expected stay in ICU greater than three days. Main endpoints of interest. We studied epidemiological endpoints of this type of patients, diagnosis and initial treatment, early complications and morbidity-mortality. Results. The burned body surface was 41% ± 25% and age 49 ± 21 years. Patients remained hospitalized in ICU for a median of 4 days (interquartile range: 2-19). A total of 78% of the patients needed mechanical ventilation, 47% had some infection during admission and 28% developed acute kidney failure during the first week. Mortality in the ICU was 42%. Endpoints associated independently with a significant increase of mortality were burned body surface greater than 35% (OR 1.08; 95% CI: 1.03-1.12) and development of kidney failure (OR 5.47; 95% CI: 2.02 -8.93). Conclusions. Mortality of these patients is very high and is conditioned largely by initial care. Percentage of burned body surface (BBS) and kidney failure entails greater mortality in our series
Subject(s)
Humans , Burns/mortality , Retrospective Studies , Burn Units , Analysis of Variance , Severity of Illness IndexABSTRACT
Vasoplegia is a frequent complication in post-operative heart surgery and determines a significant increase in morbidity-mortality. When vasoplegia persists in spite of optimized fluid therapy with the use of Swan-Ganz catheter, we have a safe, effective and economical alternative, methylene blue. We present the case of a patient who developed vasoplegia refractory to treatment and shock in the scheduled post-operative period of myocardial revascularization. The use of a single dose of methylene blue resolved the hemodynamic instability and allowed for total discontinuation of vasoactive drugs. Thus, we present this new indication of methylene blue, still not approved by the corresponding bodies, for which no national publications have been found and its clinical management and the absence of adverse effects after its use.
Subject(s)
Cardiopulmonary Bypass/adverse effects , Hypotension/drug therapy , Hypotension/etiology , Methylene Blue/therapeutic use , Aged , Dilatation, Pathologic , Humans , Male , Vascular ResistanceABSTRACT
Objetivo. Conocer el perfil y las complicaciones que desarrollan los donantes reales de órganos y los recursos que se invierten en su manejo. Diseño. Estudio de cohortes retrospectivo de todos los pacientes donantes reales de órganos ingresados desde enero de 1997 a enero de 2002 en nuestra Unidad. Ámbito. Unidad de Cuidados Intensivos del Complejo Hospitalario Hospital Carlos Haya. Se trata de una Unidad polivalente de 42 camas, que atiende todo tipo de patología crítica. El Hospital es Centro de Referencia provincial para patología neuroquirúrgica. Pacientes y métodos. Se incluyeron un total de 114 pacientes en el período de estudio en el que se recogieron variables epidemiológicas y demográficas, así como métodos diagnósticos, monitorización, complicaciones y tratamiento aplicado. Resultados. El perfil del donante real de órganos en nuestro medio es un hombre joven con traumatismo craneoencefálico, que desarrolla como complicaciones más frecuentes hipotermia, hipotensión y diabetes insípida con hipernatremia y que precisa soporte vasoactivo. El porcentaje de monitorización arterial invasiva en pacientes en Glasgow Coma Scale de 3 fue del 50 por ciento. El número de órganos extraídos fue mayor en pacientes más jóvenes y la media por paciente fue de tres órganos, siendo los más frecuentemente extraídos los riñones y el hígado. Conclusiones. Las frecuentes complicaciones asociadas a la situación de muerte encefálica suponen un tratamiento hemodinámico agresivo que precisa una monitorización adecuada que debe ser prestada en las Unidades de Cuidados Intensivos (AU)
