ABSTRACT
Severe infection and its evolution to sepsis are becoming more prevalent every day and are among the leading causes of critical illness and mortality. Proper management is crucial to improve prognosis. This document addresses three essential points that have a significant impact on this objective: a) early recognition of patients with sepsis criteria, b) identification of those patients who suffer from an infection and have a high risk of progressing to sepsis, and c) adequate selection and optimization of the initial antimicrobial treatment.
Subject(s)
Anti-Bacterial Agents , Cross Infection , Anti-Bacterial Agents/therapeutic use , Ceftazidime , Cephalosporins , Cross Infection/drug therapy , Humans , TazobactamABSTRACT
OBJECTIVE: To describe the pharmacokinetic (PK) profile of anidulafungin and to evaluate its concentration in the peritoneal fluid (PF) of patients suspected of suffering from peritoneal infection undergoing abdominal surgery, in order to ensure that therapeutic levels are achieved within the peritoneal cavity. METHODS: A descriptive, open, prospective, observational, multicentre and non-interventional study was performed. Anidulafungin was used at conventional doses. Blood and PF samples were obtained on day 2 of treatment or on any of the following days. RESULTS: A total of 31 patients in a serious clinical condition, as demonstrated by high mean clinical severity scale scores (APACHE II and SOFA scores), were included in the study. The mean area under the curve (AUC) in PF was 30% (31±19%) of that determined in the plasma and the maximum concentration (Cmax) reached in PF (mg/l) was close to 1 (0.9±0.5). No adverse effects were observed in any of the 31 patients. CONCLUSIONS: Anidulafungin at conventional doses reaches PF concentrations that exceed the minimum inhibitory concentration of the usual Candida spp, which explains the proven efficacy of this echinocandin in the treatment of Candida peritonitis in critically ill patients.
Subject(s)
Anidulafungin/pharmacokinetics , Antifungal Agents/pharmacokinetics , Candidiasis/drug therapy , Critical Illness , Peritonitis/drug therapy , APACHE , Aged , Aged, 80 and over , Anidulafungin/therapeutic use , Antifungal Agents/therapeutic use , Area Under Curve , Ascitic Fluid/metabolism , Candida/drug effects , Echinocandins/therapeutic use , Female , Humans , Male , Microbial Sensitivity Tests , Middle Aged , Peritonitis/microbiology , Prospective StudiesABSTRACT
INTRODUCTION: Adequate perfusion and oxygenation to a renal graft after transplantation are essential for its viability. Regional renal oximetry (RSrO2) through near-infrared spectroscopy shows real-time oxygen content of the graft. METHODS: A prospective study was conducted. We enrolled consecutive patients undergoing renal transplant from deceased donors from January 2015 to February 2016. RSrO2 was continuously measured for 24 hours, analyzed, and correlated with other clinical data such as hemoglobin, mixed central venous oxygen saturation (ScvO2), blood pressure, central venous pressure, diuresis, and blood lactate. Severity disease scales, cold and warm ischemia times were also measured, as well as the pulsatility index (PI) and resistive index (RI) by Doppler-dúplex ultrasound (DUS) at 24 hours. A statistical analysis with IBM SPSS version 22 (IBM, Armonk, NY) using a Pearson correlation was carried out. RESULTS: RSrO2 could anticipate serious arterial and bleeding events showing a maintained decrease >10% from basal data. A significant correlation was found between RSrO2 with lactate at 8 and 24 hours (P = .005 and P = .000 respectively), as well as with initial diuresis at hour 3 (P = .010), initial ScvO2 (P = .010), Sequential Organ Failure Assessment (P = .015), and warm ischemia (P = .035). A significant correlation was also detected between cold ischemia, RI, and diuresis (P = .037 and P = .049 respectively). No correlation was found between RSrO2 and DUS data. CONCLUSION: RSrO2 is a useful tool for initial kidney transplant grafts monitoring and could give early warnings regarding bleeding and arterial thrombosis. RSrO2 is found to have a correlation with initial diuresis, blood lactate, and ScvO2. No matching data with Doppler was found.
Subject(s)
Hemorrhage/diagnosis , Kidney Transplantation , Oximetry/methods , Postoperative Complications/diagnosis , Thrombosis/diagnosis , Adult , Aged , Female , Hemorrhage/etiology , Humans , Kidney/blood supply , Male , Middle Aged , Prospective Studies , Spectroscopy, Near-Infrared/methods , Thrombosis/etiologyABSTRACT
INTRODUCTION: Adequate perfusion and oxygenation to liver graft after transplantation is essential for its viability. Hepatic oximetry (hepatic tissue oxygenation [LSrO2]) through near infrared spectroscopy (NIRS) can help by showing real time oxygen content of the graft. METHODS: In this prospective study, we enrolled 50 consecutive patients undergoing liver transplant surgery from deceased donors. Liver NIRS (LSrO2) was continuously measured for 24 hours then analyzed and correlated with other clinical data such as hemoglobin (Hb), mixed venous oxygen saturation, cardiac index (CI), central venous pressure, arterial gases, diuresis, blood lactate, liver biochemistry, and normalized index ratio (INR). Severity disease scales and cold-warm ischemia time were also measured, as well as Doppler ultrasound (DUS) at hour 24. A statistical analysis with IBM SPSS 22 using Pearson correlation was carried out. RESULTS: LSrO2 could anticipate serious bleeding and hemodynamic events showing a decrease >10% from basal data. We found a significant correlation between LSrO2 with CI at 3 hours (P=.044), hemoglobin (Hb) at hour 3 and 24 (P = .004 and P = .002, respectively), and with Apache II (P=.041). A significant correlation was also detected between cold ischemia and INR at hour 24 (P=.016). No correlation of LSrO2 was found with lactate, liver biochemistry, and DUS data.
Subject(s)
Graft Survival/physiology , Liver Transplantation , Oximetry/methods , Postoperative Complications/diagnosis , Female , Humans , Liver/blood supply , Male , Middle Aged , Prospective Studies , Spectroscopy, Near-Infrared/methodsABSTRACT
Wernicke's encephalopathy is an acute neurological syndrome due to thiamine deficiency, which is characterized by a typical triad of mental status changes, oculomotor dysfunction and ataxia. Despite the fact that Wernicke's encephalopathy, in developed countries, is frequently associated with chronic alcoholism, there have been a number of published cases associating this encephalopathy with parenteral feeding without vitamin supplementation. Diagnosis is primarily a clinical one, and can be supported by laboratory tests and imaging studies; treatment should start as soon as possible, for the morbidity and mortality (almost 20%) associated with this syndrome is high. Thiamine supplementation, along with other vitamins, is recommended for patients in risk of developing this syndrome (AU)
La Encefalopatía de Wernicke es un síndrome neurológico de instauración aguda secundario a un déficit de tiamina y que se caracteriza por una típica tríada de alteración del nivel de conciencia, disfunción oculomotora y marcha atáxica. Aunque la causa más frecuente de Wernicke en nuestro medio sea el alcoholismo crónico, varios casos han sido descritos en enfermos con nutrición parenteral total sin aporte vitamínimo. El diagnóstico es principalmente clínico, apoyándose en pruebas analíticas y de neuroimagen, recomendándose empezar el tratamiento con tiamina lo más precozmente posible, dada la alta morbilidad y la alta mortalidad (de casi 20%), que se asocian a esta encefalopatía. La suplementación dietética con tiamina y otras vitaminas está indicada en todos los individuos en riesgo de desarrollar este síndrome (AU)
Subject(s)
Humans , Parenteral Nutrition, Total/adverse effects , Wernicke Encephalopathy/etiology , Thiamine Deficiency/complications , Thiamine/administration & dosage , Thiamine Deficiency/etiologyABSTRACT
Wernicke's encephalopathy is an acute neurological syndrome due to thiamine deficiency, which is characterized by a typical triad of mental status changes, oculomotor dysfunction and ataxia. Despite the fact that Wernicke's encephalopathy, in developed countries, is frequently associated with chronic alcoholism, there have been a number of published cases associating this encephalopathy with parenteral feeding without vitamin supplementation. Diagnosis is primarily a clinical one, and can be supported by laboratory tests and imaging studies; treatment should start as soon as possible, for the morbidity and mortality (almost 20%) associated with this syndrome is high. Thiamine supplementation, along with other vitamins, is recommended for patients in risk of developing this syndrome.
Subject(s)
Parenteral Nutrition, Total/adverse effects , Wernicke Encephalopathy/etiology , Adult , Critical Care , Humans , Infusions, Intravenous , Magnetic Resonance Imaging , Male , Peptic Ulcer Hemorrhage/complications , Peptic Ulcer Hemorrhage/therapy , Shock, Hemorrhagic/etiology , Shock, Hemorrhagic/therapy , Thalamus/pathology , Thiamine/administration & dosage , Thiamine/therapeutic use , Thiamine Deficiency/complications , Thiamine Deficiency/diagnosis , Tomography, X-Ray Computed , Vitamins/administration & dosage , Vitamins/therapeutic use , Wernicke Encephalopathy/drug therapy , Wernicke Encephalopathy/pathologyABSTRACT
Fundamento. La contracción de una deuda de oxígeno se ha asociado con peores resultados clínicos, y se ha hipotetizado que la optimización del transporte de oxígeno (DO2) mejoraría dichos resultados. En el presente estudio optimizamos el DO2 y valoramos su efecto sobre la morbimortalidad y estancia media en la unidad de medicina intensiva (UCI).Métodos. Estudio prospectivo, intervencional, aleatorizado y controlado con 390 enfermos sometidos a cirugía cardíaca con circulación extracorpórea (CEC), ingresados en nuestra UCI: el grupo optimizado (GO) incluía a 181 enfermos y el grupo control (GC) a 209. La optimización del GO se llevó a cabo en las primeras 8 h del postoperatorio inmediato, logrando una saturación venosa mixta de oxígeno (SvO2) 70 por ciento. Todos los enfermos ingresaron con un catéter en la arteria pulmonar y se registraron las mediciones de las variables cardiorrespiratorias a las 0, 4 y 8 h de su ingreso. Resultados. Los pacientes del GO revelaron una SvO2 y un DO2 significativamente mayores que los del GC, a pesar de lo cual no observamos ninguna diferencia significativa en las variables estudiadas, respecto al GC. Los enfermos que fallecieron presentaron -en relación con los que sobrevivieron- menores DO2 y SvO2, con cifras de DO2 cercanas a las del DO2 crítico, y precisaron con más frecuencia fármacos inotrópicos y balón de contrapulsación intraaórtica (BCIA). Conclusiones. La optimización del DO2 en el postoperatorio inmediato de cirugía cardíaca no logró disminuir la morbimortalidad ni la estancia media en la UCI; los pacientes que fallecieron contrajeron una deuda de oxígeno, fundamentalmente por fallo cardíaco de bomba, que les incapacitó para conseguir un DO2 superior al DO2 crítico (AU)
Subject(s)
Humans , Thoracic Surgery , Oxygen Transfer , Indicators of Morbidity and Mortality , Prospective StudiesABSTRACT
No disponible
Subject(s)
Aged , Male , Humans , Shock , Vascular Fistula , Iliac Aneurysm , Aortic Aneurysm , Aorta, Abdominal , Gastrointestinal Hemorrhage , Intestinal Fistula , Intestinal NeoplasmsABSTRACT
La oclusión aguda de la arteria renal es una entidad que requiere, para su diagnóstico, un alto grado de sospecha clínica, siendo muy difícil su diagnóstico en vida y bastante frecuente como hallazgo en la autopsia. Clásicamente las enfermedades cardiológicas, como la fibrilación auricular, la estenosis mitral y la endocarditis, entre otras, son factores de riesgo potencial para la embolización periférica, habiéndose descrito ésta a diferentes niveles cerebral, miembros inferiores, mesentérica, esplénica y renal. El infarto renal se produce cuando una arteria renal principal es ocluida por un émbolo o trombo, siendo la clínica muy inespecífica, dolor lumbar, fiebre, náuseas, etc., al igual que la alteración analítica que puede mostrar leucocitosis, proteinuria, hematuria. El tratamiento clásico propuesto es la revascularización quirúrgica, aunque es posible la disolución del coágulo mediante la perfusión de agentes trombolíticos (AU)
