Decrease in Mortality after the Implementation of a Hospital Model to Improve Performance in Sepsis Care: Princess Sepsis Code.

Sepsis is a time-dependent disease whose prognosis is influenced by early diagnosis and therapeutic measures. Mortality from sepsis remains high, and for this reason, the guidelines of the Surviving Sepsis Campaign recommend establishing specific care programs aimed at patients with sepsis. We present the results of the application of a hospital model to improve performance in sepsis care, called Princess Sepsis Code, with the aim of reducing mortality. A retrospective study was conducted using clinical, epidemiological, and outcome variables in patients diagnosed with sepsis from 2015 to 2022. A total of 2676 patients were included, 32% of whom required admission to the intensive care unit, with the most frequent focus of the sepsis being abdominal. Mortality in 2015, at the beginning of the sepsis code program, was 24%, with a declining rate noted over the study period, with mortality reaching 17% in 2022. In the multivariate analysis, age > 70 years, respiratory rate > 22 rpm, deterioration in the level of consciousness, serum lactate > 2 mmol/L, creatinine > 1.6 mg/dL, and the focus of the sepsis were identified as variables independently related to mortality. The implementation of the Princess Sepsis Code care model reduces the mortality of patients exhibiting sepsis and septic shock.

Código Sepsis: esquivando la mortalidad en un hospital terciario / Sepsis Code: dodging mortality in a tertiary hospital

Introducción. En el hospital de La Princesa comienza el “Código Sepsis” (CSP) en el año 2015, como un grupo multidisciplinar que dota al personal sanitario de herramientas clínicas, analíticas y organizativas, con el objetivo de la detección y el tratamiento precoz del paciente con sepsis. El objetivo de este estudio es evaluar el impacto de la implantación de CSP en la mortalidad y determinar las variables asociadas con un aumento de la misma.Material y métodos. Se realizó un estudio analítico retrospectivo de los pacientes con activación de la alerta CSP de 2015 a 2018. Se recogieron variables clínico-epidemiológicas, parámetros analíticos y factores de gravedad como el ingreso en Unidades de Cuidados Críticos (UCC) y la necesidad de aminas. La significación estadística se estableció en una p < 0,05. Resultados. Se incluyeron 1.121 pacientes. La estancia media fue de 16 días y un 32% requirieron ingreso en UCC. La mortalidad mostró una tendencia lineal descendente estadísticamente significativa del 24% en 2015 hasta el 15% en 2018. Las variables predictivas de mortalidad con asociación estadísticamente significativa fueron el lactato > 2 mmol/L, la creatinina > 1,6 mg/dL y la necesidad de aminas. Conclusiones. La implementación de Código Sepsis disminuye la mortalidad de los pacientes con sepsis y shock séptico. La presencia de una cifra de lactato > 2 mmol/L, los niveles de creatinina > 1,6 mg/dL y/o la necesidad de administrar aminas en las primeras 24 horas, se asocian con un aumento de la mortalidad en el paciente con sepsis. (AU)

Background. In the hospital of La Princesa, the “Sepsis Code” (CSP) began in 2015, as a multidisciplinary group that provides health personnel with clinical, analytical and organizational tools, with the aim of the detection and early treatment of patients with sepsis. The objective of this study is to evaluate the impact of CSP implantation on mortality and to determine the variables associated with an increase in it. Material and methods. A retrospective analytical study of patients with CSP alert activation from 2015 to 2018 was conducted. Clinical-epidemiological variables, analytical parameters, and severity factors such as admission to critical care units (UCC) and the need for amines were collected. Statistical significance was established at p < 0.05. Results. We included 1,121 patients. The length of stay was 16 days and 32% required admission to UCC. Mortality showed a statistically significant linear downward trend from 24% in 2015 to 15% in 2018. The predictive mortality variables with statistically significant association were lactate > 2 mmol/L, creatinine > 1.6 mg/dL and the need for amines. Conclusions. The implementation of Sepsis Code decreases the mortality of patients with sepsis and septic shock. The presence of a lactate > 2 mmol/L, creatinine > 1.6 mg/dL and/or the need to administer amines in the first 24 hours, are associated with an increase in mortality in the patient with sepsis. (AU)

Initial clinical outcomes and prognostic variables in the implementation of a Code Sepsis in a high complexity University Hospital / Resultados clínicos iniciales y variables pronósticas en la implementación de un Código Sepsis en un Hospital Universitario de alta complejidad

OBJECTIVES: To assess the impact of the first months of application of a Code Sepsis in a high complexity hospital, analyzing patient's epidemiological and clinical characteristics and prognostic factors. MATERIALS AND METHODS: A long-term observational study was carried out throughout a consecutive period of seven months (February 2015 - September 2015). The relationship with mortality of risk factors, and analytic values was analyzed using uni- and multivariate analyses. RESULTS: A total of 237 patients were included. The in-hospital mortality was 24% at 30 days and 27% at 60 days. The mortality of patients admitted to Critical Care Units was 30%. Significant differences were found between the patients who died and those who survived in mean levels of creatinine (2.30 vs 1.46 mg/dL, p <0.05), lactic acid (6.10 vs 2.62 mmol/L, p <0.05) and procalcitonin (23.27 vs 12.73 mg/dL, p < 0.05). A statistically significant linear trend was found between SOFA scale rating and mortality (p < 0.05). In the multivariate analysis additional independent risk factors associated with death were identified: age > 65 years (OR 5.33, p <0.05), lactic acid > 3 mmol/L (OR 5,85, p <0,05), creatinine > 1,2 mgr /dL (OR 4,54, p <0,05) and shock (OR 6,57, P <0,05). CONCLUSIONS: The epidemiological, clinical and mortality characteristics of the patients in our series are similar to the best published in the literature. The study has identified several markers that could be useful at a local level to estimate risk of death in septic patients. Studies like this one are necessary to make improvements in the Code Sepsis programs

OBJETIVO: Evaluar el impacto de un programa educativo y organizativo llamado Código Sepsis, en los primeros siete meses de su aplicación en un hospital de alta complejidad. MATERIAL Y MÉTODOS: Se realizó un estudio observacional durante un período consecutivo de siete meses (Febrero 2015-Septiembre 2015). Se analizó la relación con la mortalidad de los factores de riesgo y los valores analíticos usando análisis uni y multivariante. RESULTADOS: Se incluyeron un total de 237 pacientes. La mortalidad intrahospitalaria a los 30 días fue del 24 % y del 27% a los 60 días. La mortalidad de los pacientes ingresados en Unidades de Cuidados Críticos fue del 30%. Se encontraron diferencias significativas entre los pacientes que murieron y los que sobrevivieron en sus valores medios de creatinina (2,30 vs 1,46 mg/dL, p <0,05), ácido láctico (6,10 vs 2,62 mmol/L, p <0,05) y procalcitonina (23,27 vs 12,73 mg/dL, p <0,05). Se encontró una tendencia lineal estadísticamente significativa entre los valores de la escala SOFA y la mortalidad (p <0,05). En el análisis multivariante se identificaron otros factores de riesgo independientes asociados con la muerte: edad > 65 años (OR 5,33, p <0,05), ácido láctico > 3 mmol/L (OR 5,85, p <0,05), creatinina > 1,2 mgr/dL (OR 4,54, p <0,05) y el shock (OR 6,57, P <0,05). CONCLUSIONES: La mortalidad en este estudio se encuentra dentro de los límites de los ensayos clínicos más recientes de sepsis. El estudio ha identificado varios marcadores que podrían ser útiles a nivel local para estimar el riesgo en pacientes sépticos. Estudios como éste son necesarios para hacer mejoras en los programas de Código Sepsis

Probing the interaction between solid benzene and water using vacuum ultraviolet and infrared spectroscopy.

We present results of a combined vacuum ultraviolet (VUV) and infrared (IR) photoabsorption study of amorphous benzene : water mixtures and layers to investigate the benzene-water interaction in the solid phase. VUV spectra of 1 : 1, 1 : 10 and 1 : 100 benzene : water mixtures at 24 K reveal a concentration dependent shift in the energies of the 1B2u, 1B1u and 1E1u electronic states of benzene. All the electronic bands blueshift from pure amorphous benzene towards gas phase energies with increasing water concentration. IR results reveal a strong dOH-π benzene-water interaction via the dangling OH stretch of water with the delocalised π system of the benzene molecule. Although this interaction influences the electronic states of benzene with the benzene-water interaction causing a redshift in the electronic states from that of the free benzene molecule, the benzene-benzene interaction has a more significant effect on the electronic states of benzene. VUV spectra of benzene and water layers show evidence of non-wetting between benzene and water, characterised by Rayleigh scattering tails at wavelengths greater than 220 nm. Our results also show evidence of benzene-water interaction at the benzene-water interface affecting both the benzene and the water electronic states. Annealing the mixtures and layers of benzene and water show that benzene remains trapped in/under water ice until water desorption near 160 K. These first systematic studies of binary amorphous mixtures in the VUV, supported with complementary IR studies, provide a deeper insight into the influence of intermolecular interactions on intramolecular electronic states with significant implications for our understanding of photochemical processes in more realistic astrochemical environments.

Vacuum ultraviolet photoabsorption spectroscopy of crystalline and amorphous benzene.

We present the first high resolution vacuum ultraviolet photoabsorption study of amorphous benzene with comparisons to annealed crystalline benzene and the gas phase. Vapour deposited benzene layers were grown at 25 K and annealed to 90 K under conditions pertinent to interstellar icy dust grains and icy planetary bodies in our solar system. Three singlet-singlet electronic transitions in solid benzene correspond to the 1B2u, 1B1u and 1E1u states, redshifted by 0.05, 0.25 and 0.51 eV respectively with respect to the gas phase. The symmetry forbidden 1B2u ← 1A1g and 1B1u ← 1A1g transitions exhibit vibronic structure due to vibronic coupling and intensity borrowing from the allowed 1E1u ← 1A1g transition. Additionally the 1B2u ← 1A1g structure shows evidence of coupling between intramolecular vibrational and intermolecular lattice modes in crystalline benzene with Davydov crystal field splitting observed. The optically forbidden 0-0 electronic origin is clearly visible as a doublet at 4.69/4.70 eV in the crystalline solid and as a weak broadened feature at 4.67 eV in amorphous benzene. In the case of the 1B1u ← 1A1g transition the forbidden 0-0 electronic origin is only observed in crystalline benzene as an exciton peak at 5.77 eV. Thicker amorphous benzene samples show diffuse bands around 4.3, 5.0 and 5.4 eV that we tentatively assign to spin forbidden singlet-triplet 3B2u ← 1A1g, 3E1u ← 1A1g and 3B1u ← 1A1g transitions respectively, not previously reported in photoabsorption spectra of amorphous benzene. Furthermore, our results show clear evidence of non-wetting or 'islanding' of amorphous benzene, characterised by thickness-dependent Rayleigh scattering tails at wavelengths greater than 220 nm. These results have significant implications for our understanding of the physical and chemical properties and processes in astrochemical ices and highlight the importance of VUV spectroscopy.

[Sleep disorders in patients on a kidney transplant waiting list]. / Trastornos del sueño en pacientes en lista de espera de trasplante renal.

OBJECTIVE: To evaluate the prevalence of sleep disorders in patients awaiting kidney transplants compared to a control group. PATIENTS AND METHODS: We carried out an observational study of 23 patients on a kidney transplant waiting list in comparison with 20 healthy volunteers matched for age, sex, and body mass index (BMI). Overnight polysomnography was performed and a diagnosis of sleep apnea-hypopnea syndrome (SAHS) established when the apnea-hypopnea index (AHI) was 10 or higher. RESULTS: Eighty-two percent of the patients awaiting kidney transplants (16 men and 7 women with a mean [SD] age of 51 [15] years and a mean BMI of 25 [3.8] kg/m2) had some type of sleep disorder. The most frequent disorders were SAHS (48%) and insomnia and periodic limb movement disorder (30%). Patients showed poorer sleep efficiency compared to the control group (75.4% vs 87.8%; P=.01) and a lower percentage of slow-wave and rapid eye movement sleep (24.5% vs 40%; P=.001). Those with sleep-disordered breathing had a higher AHI (17.7 vs 3.6; P=.001) and oxygen desaturation index (31.5 compared to 8.2; P=.001). CONCLUSIONS: Sleep disorders are common in patients awaiting kidney transplants. Such patients show reduced quantity and quality of sleep compared to controls and a significantly elevated number of respiratory events that may affect morbidity and mortality.

Trastornos del sueño en pacientes en lista de espera de trasplante renal / Sleep disorders in patients on a kidney transplant waiting list

OBJETIVO: Valorar la prevalencia de los trastornos del sueño en pacientes en lista de espera de trasplante renal, comparados con un grupo control. PACIENTES Y MÉTODOS: Se ha realizado un estudio observacional en 23 pacientes en lista de espera para trasplante renal, cuyos resultados se compararon con los de 20 personas sanas que accedieron voluntariamente a participar en él. Se emparejaron por edad, sexo e índice de masa corporal. Se efectuó una polisomnografía de noche completa y el diagnóstico de síndrome de apneas-hipopneas durante el sueño se estableció cuando el índice de apneas-hipopneas era como mínimo de 10. RESULTADOS: Los pacientes en lista de espera para trasplante renal (16 varones y 7 mujeres; edad media ± desviación estándar: 51 ± 15 años; índice de masa corporal: 25 ± 3,8 kg/m2) presentaron en un 82% de los casos algún trastorno del sueño. Los más frecuentes fueron el síndrome de apneas-hipopneas durante el sueño (48%) e insomnio y síndrome de movimiento periódico de piernas (30%). Los pacientes presentaron, respecto al grupo control, una menor eficiencia del sueño (el 75,4 frente al 87,8%; p = 0,01) y un menor porcentaje de sueño de ondas lentas y REM (un 24,5 frente a un 40%; p = 0,001), mientras que los trastornos respiratorios del sueño mostraron un mayor índice de apneashipopneas (17,7 frente a 3,6; p = 0,001) e índice de desaturación (31,5 frente a 8,2; p = 0,001). CONCLUSIONES: Los trastornos del sueño son frecuentes en pacientes en lista de espera para trasplante renal, quienes, respecto al grupo control, tienen una menor cantidad y calidad del sueño, con un número significativamente elevado de eventos respiratorios, que pueden influir en la morbimortalidad (AU)

OBJECTIVE: To evaluate the prevalence of sleep disorders in patients awaiting kidney transplants compared to a control group. PATIENTS AND METHODS: We carried out an observational study of 23 patients on a kidney transplant waiting list in comparison with 20 healthy volunteers matched for age, sex, and body mass index (BMI). Overnight polysomnography was performed and a diagnosis of sleep apnea-hypopnea syndrome (SAHS) established when the apnea-hypopnea index (AHI) was 10 or higher. RESULTS: Eighty-two percent of the patients awaiting kidney transplants (16 men and 7 women with a mean [SD] age of 51 [15] years and a mean BMI of 25 [3.8] kg/m2) had some type of sleep disorder. The most frequent disorders were SAHS (48%) and insomnia and periodic limb movement disorder (30%). Patients showed poorer sleep efficiency compared to the control group (75.4% vs 87.8%; P=.01) and a lower percentage of slow-wave and rapid eye movement sleep (24.5% vs 40%; P=.001). Those with sleep-disordered breathing had a higher AHI (17.7 vs 3.6; P=.001) and oxygen desaturation index (31.5 compared to 8.2; P=.001). CONCLUSIONS: Sleep disorders are common in patients awaiting kidney transplants. Such patients show reduced quantity and quality of sleep compared to controls and a significantly elevated number of respiratory events that may affect morbidity and mortality (AU)