[Severe acute intoxication treated in the intensive care unit in 1986-1997]. / Intoxicaciones agudas graves en un servicio de medicina intensiva (1986-1997).

BACKGROUND: To ascertain the epidemiology of the severe acute intoxications in an intensive care unit and to assess the PCR prognosis and death rate related to the different toxic substances. METHODS: Retrospective study conducted in the 10-bed polyvalent intensive care unit at a General Hospital for adult care. Study conducted over a 12-year period. Review of the clinical histories of the patients admitted as a result of severe acute intoxications. Data was gathered regarding demographic aspects. PCR at admission, need to VM, complications of the severe acute intoxications and death rate for the series. An overall as well as a year-by-year analysis was conducted. The data was processed statistically employing the SPSS package using the Student "t" or the Chi-square, taking values as being significant if p < 0.05. RESULTS: 233 subjects, 130 of whom were males, were included in this study. The average stay totaled 4 days. Sixty-three percent (63%) of the patients were under 40 years of age (p < 0.05). The most frequent type of intoxication was that caused by one single medication (72%). The survival rate following the PCR was 40% (4/10). The overall death rate totaled 5.6% (n = 13), 92% of the subjects who later died having been required VM at some point in time during their stay in the intensive care unit. CONCLUSIONS: In our environment, the most frequent type of intoxication is that which is caused by medication. The death rate has been revealed to depend upon the intentional aspect, however as being independent of the type of toxic substance (medication or non-medication). The PCR related to severe acute intoxication has a better prognosis for our series than that related to other diseases and disorders. The VM for severe acute intoxications has a low death rate (15.7%).

[Microbiological study via occluded telescopic catheter in patients under mechanical ventilation and suspected of pneumonia. Clinico-bacteriological follow up of the cases]. / Estudio microbiológico mediante catéter telescópico ocluido en pacientes bajo ventilación mecánica y sospecha de neumonía. Seguimiento clínico-bacteriológico de los casos.

Pneumonias related to mechanical ventilation pose a serious diagnostic challenge and are responsible for elevated mortality. Conventional diagnostic methods are of little help. The introduction of invasive techniques such as bronchial catling via an occluded telescopic catheter (OTC) has proven to be an important advance in diagnosis and therapy. We have compared the bacteriological results obtained using OTC with those using conventional diagnostic methods such as tracheobronchial pumps (TBP) and hemocultures, and we have undertaken a bacteriological, clinical follow-up of the cases. Seventy-four patients under mechanical ventilation and suspected of pneumonia were under study. The study consisted to two consecutive phases of collecting bacteriological samples throughout the patient's evolution. A total of 121 fibrobronchoscopies were performed. The sensitivity obtained with OTC was 76%, and the specificity was 100%. The two techniques, OTC and TBP, coincided in 38% of the cases. According to the bacteriological results obtained with OTC, the antibiotic treatment was modified in 44.5% of the patients. The sensitivity of the OTC was significantly less in those patients were the last doses of antibiotic was administered within two hours of performing the procedure. The procedure of gathering secretions from the inferior respiratory tract with OTC possesses greater sensitivity and diagnostic specificity in patients with mechanical ventilation and pulmonary infiltrates and improves the diagnosis performed by other conventional and routine techniques such as TBA and hemocultures.

[Tetanus in the Murcia region: the clinico-epidemiological characteristics of 150 cases]. / Tétanos en la Región de Murcia: características clínico-epidemiológicas de 150 casos.

150 tetanus cases registered on the region of Murcia have been retrospectively analyzed, they have been collected from the patients admitted at a Intensive Care Unit during a period of 18 years; the clinical together with the epidemiological features, as well as their variations, have been studied through out the years. The impact of a vaccination program in adults which was performed in our region during 1981 has been also evaluated in relationship with the incidence of disease and the economical cost of it. Incidence remained homogeneous until 1982, from that date on a sudden decrease on the number of cases was observed, related with the vaccination program [Period previous to the vaccination program: mean 10 cases/year, versus 5 cases/year since it was started (p < 0.001)]. Regarding the epidemiological characteristics, it is remarkable the shift of the disease toward a more advanced age of onset together with a predominance on females beginning in 1978, but without reaching statically significance. More frequent route of infection is nowadays the intramuscular suppurative injection. Besides this fact the severity of the cases have been increasing (from 59% to 71%, p < 0.005), which has determined that the global mortality of the disease remains almost the same (38%). Mortality has no relationship with age, but is related with being a female (p < 0.05), with intramuscular injection as route of infection (p < 0.025), with the clinical stage (p < 0.001) and with a short incubation period (p < 0.001).(ABSTRACT TRUNCATED AT 250 WORDS)

[The kidney in mechanical ventilation]. / El riñón en la ventilación mecánica.

The negative effect of artificial ventilation with positive pressure on renal function, expresses itself as a decrease of water and sodium excretion, being directly related with the raise of intrathoracic pressure. Factors participating in this process are: lowering in cardiac output, arousal of sympathic nervous system, increase in vasopressin action, activation of renin-angiotensin-aldosterone system and decrease of atrial natriuretic peptide release. This disorder of hydromineral metabolism produces: Impairment of hemodynamic equilibrium, favors the increase of hypoxia and renal failure. The effects of mechanical ventilation on renal function can be attenuated with the adoption of the following measures: a) techniques (use of low levels of PEEP and early disconnection of respirator); b) therapeutic (dopamine 2-3 mcg/kg/min, rational use of diuretics and fluids); y c) monitoring of renal function and hydro-mineral equilibrium.

[Analysis of the bacteriologic data obtained with a double-lumen distally-plugged telescopic catheter in the diagnosis of pulmonary infiltrates in patients on low mechanical ventilation]. / Análisis de la información bacteriológica aportada mediante catéter telescopado de doble luz y oclusión distal en el diagnóstico de infiltrados pulmonares en pacientes bajo ventilación mecánica.

In order to assess the bacteriology of bronchial secretion samples, 40 patients in the intensive care unit who had developed fever and pulmonary infiltrates during mechanical ventilation have been studied. In each patient bronchial secretion samples were obtained by a double lumen distally-plugged telescopic catheter (DTC) inserted under direct view through the fiber bronchoscope (FB) as well as from simple bronchial aspiration (SBA) done simultaneously. A week later DTC and SBA were repeated. A statistically significant difference was found between the positive cultures obtained by SBA and those obtained by DTC (p less than 0.005). However, in 9 samples (14.27%) other microorganisms were isolated with DTC which were not detected by SBA and a lower number of colonizing microorganisms were found by DTC (p less than 0.05). The isolation of microorganisms by DTC allowed more precise management and moreover, a better clinical course was observed in those patients in whom chemotherapy was based on the data given by DTC. The relationship between the cultures obtained by DTC and the previous antibiotic treatment was statistically significant, finding a greater number of positive cultures when they were taken 2 hours after the last doses of the antibiotic. This relationship was not found in the cultures obtained with SBA. The most frequently isolated microorganisms were diverse types of Pseudomonas and Acinetobacter. No complication caused by the techniques arose.