Systemic acidemia impairs cardiac function in critically Ill patients.

BACKGROUND: Acidemia, is associated with reduced cardiac function in animals, but no studies showing an effect of acidemia on cardiac function in humans are reported. In the present study, we examined the effect of acidemia on cardiac function assessed with transpulmonary thermodilution technique with integrated pulse contour analysis (Pulse Contour Cardiac Output, PiCCO™) in a large cohort of critically ill patients. METHODS: This was a prospective multicenter observational cross-sectional study of 297 patients from 6 intensive care units in London, England selected from all patients admitted consecutively between May 2018 and March 2019. Measurements of lowest plasma pH and concurrent assessment of cardiac function were obtained. FINDINGS: There was a significant difference between two pH categories (pH ≤ 7.28 vs. pH > 7.28) for the following variables of cardiac function: SVI (difference in means 32.7; 95% CI: 21 to 45 mL/m2; p < 0.001); GEF (18; 95% CI: 11 to 26%; p < 0.001), dPmax (-331; 95% CI: -510 to -153 mmHg/s; p = 0.001), CFI (0.7; 95% CI: 0.2 to 1.3 1/min; p = 0.01) and CPI (0.09; 95% CI: 0.03 to 0.15 W/m2; p < 0.001). However, there was no significant difference in CI (0.13; 95% CI: -0.20 to 0.47 L/min/m2; p = 0.12) between the pH categories. Also, a significant relationship was found between the quantitative pH and the following variables: SVI (132; 95% CI: 77 to 188 mL/m2; p < 0.001), GEF (74.7; 95% CI: 37.1 to 112.4%; p < 0.001), dPmax (-1587; 95% CI: -2361 to -815 mmHg/s; p < 0.001), CFI (3.5; 95% CI: 0.9 to 6.1 /min; p = 0.009), CPI (0.62; 95% CI: 0.36 to 0.88 W/m2; p < 0.001) and CI (regression coefficient 1.96; 95% CI:0.45 to 3.47 L/min/m2; p = 0.01). INTERPRETATION: Acidemia is associated with impaired cardiac function in seriously ill patients hospitalized in the intensive care unit supporting the potential value of early diagnosis and improvement of arterial pH in these patients. FUNDING: The study was partially supported by unrestricted funds from the UCLA School of Medicine.

El algoritmo de la gasometría arterial: propuesta de un enfoque sistemático para el análisis de los trastornos del equilibrio ácido-base / The arterial blood gas algorithm: proposal of a systematic approach to analysis of acid-base disorders

Las anomalías en el equilibrio ácido-base son problemas clínicos comunes, y pueden tener efectos perjudiciales en la función celular y ser el indicio de varios trastornos. Por lo tanto, es importante para el clínico, el hacer un diagnóstico preciso de los trastornos ácido-base presentes para un tratamiento adecuado. Se han propuesto 3 enfoques para evaluar los trastornos ácido-base: un enfoque centrado en el bicarbonato, el enfoque de Stewart y el enfoque de exceso de base. Aunque los 2 últimos tienen muchos adeptos, solo discutiremos el enfoque centrado en el bicarbonato. Este enfoque es más fácil de utilizar desde el punto de vista clínico, tiene una evaluación fisiológica del trastorno ácido-base, presenta una lógica fácilmente comprensible para evaluar la gravedad y proporciona, además, una base más sólida para el desarrollo de terapias efectivas. Por lo tanto, nuestro trabajo se limitará a un examen en profundidad de esta teoría. En esta revisión, primero se introducirán nuevos conceptos importantes; sus beneficios y discusión de sus limitaciones; y luego se mostrará su utilización para analizar casos reales. Se ha generado un algoritmo para abordar de forma sistemática el análisis que incorpora estos nuevos conceptos

Abnormalities in the acid-base balance are common clinical problems and can have deleterious effects on cellular function and be a clue to various disorders. Therefore, it is important for the clinician to make a precise diagnosis of the acid-base disorder(s) present for a proper treatment. Three approaches have been proposed to evaluate acid-base disorders: a bicarbonate-centric approach; the Stewart approach, and the base excess approach. Although the latter two have many adherents, we will only discuss the bicarbonate-centric approach. This approach is simpler to utilize at the bedside, has a physiological evaluation of the acid-base disorder, presents an easily understandable approach to assess severity, and provides a more solid foundation for the development of effective therapies. Therefore, the following discussion will be limited to an examination of this approach. In this case-centric review, important new concepts will be introduced first; their benefits and limitations discussed; and then their utilization to analyze actual cases will be shown. A systematic approach algorithm that incorporates these new concepts has been generated and will be highlighted

The arterial blood gas algorithm: Proposal of a systematic approach to analysis of acid-base disorders. / El algoritmo de la gasometría arterial: propuesta de un enfoque sistemático para el análisis de los trastornos del equilibrio ácido-base.

Abnormalities in the acid-base balance are common clinical problems and can have deleterious effects on cellular function and be a clue to various disorders. Therefore, it is important for the clinician to make a precise diagnosis of the acid-base disorder(s) present for a proper treatment. Three approaches have been proposed to evaluate acid-base disorders: a bicarbonate-centric approach; the Stewart approach, and the base excess approach. Although the latter two have many adherents, we will only discuss the bicarbonate-centric approach. This approach is simpler to utilize at the bedside, has a physiological evaluation of the acid-base disorder, presents an easily understandable approach to assess severity, and provides a more solid foundation for the development of effective therapies. Therefore, the following discussion will be limited to an examination of this approach. In this case-centric review, important new concepts will be introduced first; their benefits and limitations discussed; and then their utilization to analyze actual cases will be shown. A systematic approach algorithm that incorporates these new concepts has been generated and will be highlighted.

Antibiotic-resistant hypervirulent Klebsiella pneumoniae causing community- acquired liver abscess: an emerging disease.

We report a case of a patient with fatal community-acquired pyogenic liver abscess (CA-PLA) caused by multi drug-resistant, hypervirulent, Klebsiella pneumoniae (mdrhvKP). HvKP causing PLA has been described in East and South East Asia and it is recognized as an emerging infection worldwide. The syndrome is characterized by cryptogenic liver abscess formation without a previous history of hepatobiliary or colonic disease and metastatic spread of infection via the bloodstream to distant sites, including lungs, central nervous system and other organ systems. Diabetes mellitus is a recognized risk factor. Most previously reported cases have involved antibiotic susceptible strains of hvKP although reports of bloodstream infections caused by resistant strains, including carbapenemase producers, are increasing. Our report highlights the need for awareness of this devastating infection in patients presenting with sepsis and liver abscess without underlying hepatobiliary or colonic disease.

Cetoacidosis no diabética en una mujer embarazada, debido a inanición aguda con gripe A (H1N1) concomitante e insuficiencia respiratoria / Nondiabetic ketoacidosis in a pregnant woman due to acute starvation with concomitant influenza A (H1N1) and respiratory failure

Raramente se reporta la acidosis metabólica resistente de riesgo debido a cetoacidosis no diabética por inanición a corto plazo. La cetoacidosis grave debida a inanición es una situación infrecuente y lo es más aún durante el embarazo con situación clínica estresante concomitante. Este informe de un caso presenta a una mujer no diabética ingresada en cuidados intensivos debido a insuficiencia respiratoria tipo 1 durante el tercer trimestre de embarazo, con acidosis metabólica grave resistente a tratamiento médico. Diagnosticamos a la paciente de cetoacidosis por inanición, basándonos en su historia y la ausencia de otras causas de acidosis metabólica con anión gap elevado, tras la realización de un análisis riguroso de su trastorno ácido-base

Threatening refractory metabolic acidosis due to short-term starvation nondiabetic ketoacidosis is rarely reported. Severe ketoacidosis due to starvation itself is a rare occurrence, and more so in pregnancy with a concomitant stressful clinical situation. This case report presents a nondiabetic woman admitted in intensive care for respiratory failure type 1 during the third trimester of pregnancy with a severe metabolic acidosis refractory to medical treatment. We diagnosed the patient with acute starvation ketoacidosis based on her history and the absence of other causes of high anion gap metabolic acidosis after doing a rigorous analysis of her acid-base disorder

Nondiabetic ketoacidosis in a pregnant woman due to acute starvation with concomitant influenza A (H1N1) and respiratory failure. / Cetoacidosis no diabética en una mujer embarazada, debido a inanición aguda con gripe A (H1N1) concomitante e insuficiencia respiratoria.

Threatening refractory metabolic acidosis due to short-term starvation nondiabetic ketoacidosis is rarely reported. Severe ketoacidosis due to starvation itself is a rare occurrence, and more so in pregnancy with a concomitant stressful clinical situation. This case report presents a nondiabetic woman admitted in intensive care for respiratory failure type 1 during the third trimester of pregnancy with a severe metabolic acidosis refractory to medical treatment. We diagnosed the patient with acute starvation ketoacidosis based on her history and the absence of other causes of high anion gap metabolic acidosis after doing a rigorous analysis of her acid-base disorder.

Sintomatología clínica residual y factores asociados en supervivientes de un fracaso multiorgánico: una hipoteca a largo plazo / Clinical residual symptomatology and associated factors in multiple organ failure survivors: a long-term mortgage

Objetivo. Evaluar la sintomatología clínica residual que puedan presentar los supervivientes de un fracaso multiorgánico (FMO) tras su alta de la Unidad de Cuidados Intensivos (UCI) e identificar aquellos factores que puedan estar asociados. Material y métodos. Fueron seleccionados de forma consecutiva en el estudio un total de 545 pacientes adultos con FMO a su ingreso. Se realizó una encuesta a los 6 y 12 meses tras el alta de una UCI médico-quirúrgica en España. Se realizó una encuesta telefónica sobre los síntomas clínicos presentes al alta de UCI. Resultados. Se realizó seguimiento a un total de 266 pacientes supervivientes al FMO; un 62,2% eran varones, la edad media fue de 60±18 años y un 67,8% eran pacientes médicos. Los síntomas más comunes presentados tras el alta hospitalaria fueron astenia (173; 76%), alteraciones en el sueño (112; 50%) y depresión (109; 48%). Conclusiones. El seguimiento reveló la presencia frecuente de síntomas clínicos «residuales» que persistieron al menos un año; de forma más notable, la artromialgia y la astenia. La presencia de síntomas depresivos tras los primeros 6 meses del alta poshospitalaria también fue común entre los pacientes supervivientes de FMO. La duración de la sintomatología se relacionó principalmente con una situación basal pobre a los 6 y 12 meses, un ingreso hospitalario largo y una puntuación de gravedad alta al ingreso en la UCI (AU)

Purpose. To evaluate which residual clinical symptoms multi-organ failure (MOF) patients may exhibit post discharge from Intensive Care Units (ICU) and to identify the associated factors that cause such symptoms. Material and methods. A total of 545 adult patients admitted to a medical & surgical ICU in Spain diagnosed with MOF on admission were included in the study. Follow up in the form of a telephone survey regarding the patients clinical symptoms were conducted at 6 and 12 months after discharge from ICU. Results. A total of 266 patients were followed up at both 6 and 12 months post ICU discharge; 62.2% were male; age 60±18 years; 67.8% medical patients. The most common symptoms to appear following hospital discharge included: asthenia (173; 76%), sleep disturbances (112; 50%) and depression (109; 48%). Conclusions. The study revealed frequent residual clinical symptoms persisting for almost a year post ICU discharge, most notably arthromyalgia and asthenia. Depression symptoms during the first 6 months post-hospital discharge were also common among multiple organ failure survivors. The presence of symptomatology over time was found to be related to a poor functional situation at 6 and12 months post ICU discharge, length of hospital stay and severity of illness score on ICU admission (AU)

Clinical residual symptomatology and associated factors in multiple organ failure survivors: A long-term mortgage. / Sintomatología clínica residual y factores asociados en supervivientes de un fracaso multiorgánico: una hipoteca a largo plazo.

PURPOSE: To evaluate which residual clinical symptoms multi-organ failure (MOF) patients may exhibit post discharge from Intensive Care Units (ICU) and to identify the associated factors that cause such symptoms. MATERIAL AND METHODS: A total of 545 adult patients admitted to a medical & surgical ICU in Spain diagnosed with MOF on admission were included in the study. Follow up in the form of a telephone survey regarding the patients clinical symptoms were conducted at 6 and 12 months after discharge from ICU. RESULTS: A total of 266 patients were followed up at both 6 and 12 months post ICU discharge; 62.2% were male; age 60±18 years; 67.8% medical patients. The most common symptoms to appear following hospital discharge included: asthenia (173; 76%), sleep disturbances (112; 50%) and depression (109; 48%). CONCLUSIONS: The study revealed frequent residual clinical symptoms persisting for almost a year post ICU discharge, most notably arthromyalgia and asthenia. Depression symptoms during the first 6 months post-hospital discharge were also common among multiple organ failure survivors. The presence of symptomatology over time was found to be related to a poor functional situation at 6 and12 months post ICU discharge, length of hospital stay and severity of illness score on ICU admission.

Long-term admission to the intensive care unit: a cost-benefit analysis / Ingresos de larga duración en la unidad de cuidados intensivos: análisis de costo-beneficio

Objective. To assess outcomes in long-term ICU patients, with follow-ups carried out at one year post discharge, in order to calculate the costs incurred by the hospital in relation to the benefits gained. Material. Of 3639 patients consecutively admitted over the course of three years to ICU, 235 (6.5%) were assessed for the purposes of the study, having spent a period exceeding 20 days in intensive care. Method. The survey tool used was the Spanish Minimum Data Set (MDS). The length of ICU stay and hospital stay following discharge from ICU were calculated, and one year post discharge the patient/next of kin was contacted in order to carry out a follow-up survey on survival and functional status (according to GOS-E scale). Results. The 235 study patients had a mean stay of 37 days, occupied 34% of ICU beds available and consumed 29% of the ICU's economic resources ($14,400,175). Their stay on hospital wards was (mean) 33 days. Mortality in ICU and on hospital wards was 40% higher amongst older patients, and those with a higher APACHE II and Charlson index score. Mortality rates were three times higher among neurosurgical patients: mortality at follow-up was 25%, and only 21% recovered an acceptable functional status. Conclusions. Mortality rates in long-term ICU patients are high, both during their hospital stay and in the first year post discharge. Surviving patients (AU)

Objetivo. Evaluar los resultados de los pacientes de larga duración en la UCI por medio de un seguimiento al año del alta a fin de calcular los gastos soportados por el hospital en relación con los beneficios obtenidos. Materiales. de los 3.639 pacientes consecutivos ingresados en la UCI durante tres años, se evaluó a 235 (un 6,5%) para el presente estudio, todos ellos con una estancia superior a 20 días. Métodos. el instrumento de evaluación fue la base de datos española CMBD (conjunto mínimo de base de datos). Se calcularon la duración de la estancia en la UCI y en la planta después del alta de la UCI y, un año después del alta hospitalaria, se contactó con el paciente o su pariente más próximo para realizar una encuesta de seguimiento sobre su estado funcional (según la escala GOSE). Resultados. los 235 pacientes estudiados estuvieron ingresados un promedio de 37 días, ocuparon un 34% de las camas disponibles en la UCI y emplearon un 29% de los recursos económicos de dicha unidad (14.400.175$). Su estancia media en planta fue de 33 días. La mortalidad en la UCI y en planta fue un 40% más alta en los pacientes de mayor edad, puntuación del APACHE II e índice de Charlson. Las tasas de mortalidad se triplicaron en los pacientes neuroquirúrgicos. En el seguimiento después de un año, la tasa de mortalidad fue del 25%, y únicamente el 21% recuperó un estado funcional aceptable. Conclusiones. las tasas de mortalidad en pacientes de larga duración en la UCI son altas, tanto durante la estancia hospitalaria como durante el año posterior al alta. Los pacientes de larga duración no presentan una recuperación correcta y consumen una gran proporción de recursos económicos (AU)

An interesting case of an aortopulmonary artery fistula.

Aortopulmonary artery fistulae are exceeding rare and may be associated with aortic arch aneurysms or thoracic aortic surgery. Here, we present a case of an aortopulmonary artery fistula in an 87-year-old woman with no history of aneursymal disease or thoracic surgery and discuss the likely aetiology and management of this condition.

Long-term admission to the intensive care unit: a cost-benefit analysis.

OBJECTIVE: To assess outcomes in long-term ICU patients, with follow-ups carried out at one year post discharge, in order to calculate the costs incurred by the hospital in relation to the benefits gained. MATERIAL: Of 3639 patients consecutively admitted over the course of three years to ICU, 235 (6.5%) were assessed for the purposes of the study, having spent a period exceeding 20 days in intensive care. METHOD: The survey tool used was the Spanish Minimum Data Set (MDS). The length of ICU stay and hospital stay following discharge from ICU were calculated, and one year post discharge the patient/next of kin was contacted in order to carry out a follow-up survey on survival and functional status (according to GOS-E scale). RESULTS: The 235 study patients had a mean stay of 37 days, occupied 34% of ICU beds available and consumed 29% of the ICU's economic resources ($14,400,175). Their stay on hospital wards was (mean) 33 days. Mortality in ICU and on hospital wards was 40% higher amongst older patients, and those with a higher APACHE II and Charlson index score. Mortality rates were three times higher among neurosurgical patients: mortality at follow-up was 25%, and only 21% recovered an acceptable functional status. CONCLUSIONS: Mortality rates in long-term ICU patients are high, both during their hospital stay and in the first year post discharge. Surviving patients do not exhibit a good level of recovery, and consume a large proportion of economic resources.

Incidencia del trastorno por duelo prolongado en los allegados de pacientes fallecidos durante o tras ingreso en la Unidad de Cuidados Intensivos / Incidence of prolonged grief disorder in relatives of patients who die during or after admission in Intensive Care Unit

Objetivos. Estudiar la incidencia del «trastorno por duelo prolongado» desde un año después del fallecimiento de un familiar ingresado en la Unidad de Cuidados Intensivos (UCI). Material y métodos. Estudio de seguimiento longitudinal con corte transversal en una UCI polivalente de un hospital de referencia. Se evaluó a los allegados alrededor de un año después del fallecimiento, usando como herramientas los «criterios de consenso para el diagnóstico del trastorno por duelo prolongado» (CCTDP). Se determinó la prevalencia entre el primero y segundo años. Resultados. Se incluyeron 151 familiares de fallecidos en la UCI. El seguimiento se realizó 22,1±5,3 meses tras el fallecimiento. Once familiares (10,3%) cumplieron los CCTDP. De todos los allegados en duelo, aquellos identificados con trastorno por duelo prolongado son los que con más frecuencia precisaron apoyo psicológico/psiquiátrico. Conclusiones. En una muestra de allegados de pacientes fallecidos tras un ingreso en la UCI, una minoría significativa cumplió los CCTDP al cabo de 1-2 años tras el fallecimiento. Hay que tener en consideración este hecho que es frecuentemente pasado por alto, y que podría precisar algún tipo de intervención psicológica(AU)

Objectives. To determine the incidence of «Prolonged Grief Disorder» from one year after the death of a relative admitted to the Intensive Care Unit. Material and methods. A cross-sectional, longitudinal follow-up study was conducted in a general ICU of a reference hospital. The relatives were evaluated approximately one year after the death using the «Consensus Criteria for Prolonged Grief Disorder» as a tool. The prevalence between the first and second years was determined. Results. A total of 151 relatives of patients who died in ICU were included. The follow-up was carried out 22.1±5.3 months after the death. Eleven relatives (10.3%) fulfilled the «Consensus Criteria for Prolonged Grief Disorder». Of all the grieving relatives, those identified with prolonged grief disorder are the ones who most often require psychological/psychiatric support. Conclusions. In a sample of close relatives of patients who died in ICU, a significant minority fulfilled the criteria for «Prolonged Grief Disorder» 1-2 years after the death. This condition, which is often overlooked, and could require some kind of psychological treatment, should be taken into consideration(AU)

[Incidence of prolonged grief disorder in relatives of patients who die during or after admission in Intensive Care Unit]. / Incidencia del trastorno por duelo prolongado en los allegados de pacientes fallecidos durante o tras ingreso en la Unidad de Cuidados Intensivos.

OBJECTIVES: To determine the incidence of «Prolonged Grief Disorder¼ from one year after the death of a relative admitted to the Intensive Care Unit. MATERIAL AND METHODS: A cross-sectional, longitudinal follow-up study was conducted in a general ICU of a reference hospital. The relatives were evaluated approximately one year after the death using the «Consensus Criteria for Prolonged Grief Disorder¼ as a tool. The prevalence between the first and second years was determined. RESULTS: A total of 151 relatives of patients who died in ICU were included. The follow-up was carried out 22.1±5.3 months after the death. Eleven relatives (10.3%) fulfilled the «Consensus Criteria for Prolonged Grief Disorder¼. Of all the grieving relatives, those identified with prolonged grief disorder are the ones who most often require psychological/psychiatric support. CONCLUSIONS: In a sample of close relatives of patients who died in ICU, a significant minority fulfilled the criteria for «Prolonged Grief Disorder¼ 1-2 years after the death. This condition, which is often overlooked, and could require some kind of psychological treatment, should be taken into consideration.

Trombocitopenia grave al ingreso en una unidad de cuidados intensivos en pacientes con disfunción multiorgánica / Severe thrombocytopenia on admission to the intensive care unit in patients with multiple organ failure

Objetivo: Evaluar la frecuencia de la trombocitopenia grave (TCPG) (<50.000/µl) en las primeras 24 horas en pacientes con síndrome de disfunción multiorgánica (SDMO) y los factores asociados a su aparición. Diseño: Estudio retrospectivo, con diseño observacional. Ámbito: Unidad de cuidados intensivos (UCI) médico-quirúrgica de un hospital de nivel III. Pacientes: Aquellos con disfunción de al menos dos órganos, según criterios SOFA; se excluyen neurocríticos y politraumatizados. Variables de interés: Antecedentes personales, medicación habitual, situación funcional basal, datos de filiación, puntuaciones de gravedad en UCI, datos de la disfunción multiorgánica, evolución UCI y datos hospitalarios. Resultados: Se incluyeron 587 pacientes. El 6,3% (37 pacientes) presentaban TCPG durante el primer día de ingreso. El 64,6% eran hombres; la mediana de edad fue 69 (56-77) años; al ingreso, SOFA 8 (5-10); APACHE II 18 (13-24); APACHE IV 59 (46-73); 32,5% son quirúrgicos. Durante su evolución 79,9% necesitaron ventilación mecánica y el 71,4% requirió fármacos vasoactivos. Estancia en UCI 4 (2-10) días; estancia hospitalaria 18 (9-35) días. El 29,2% fallecieron en UCI. El 11,7% desarrollaron durante su ingreso en UCI TCPG. En el análisis multivariable los principales determinantes de la aparición de la trombocitopenia al ingreso fueron los antecedentes de ingreso hospitalario en el último año, el peor valor de bilirrubina y albúmina sanguínea y la sepsis. Conclusión: La prevalencia de TCPG en pacientes críticos con SDMO durante el primer día de estancia en UCI es del 6,3%. Los factores asociados son: la presencia o no de ingresos hospitalarios en el último año, los niveles de albúmina y bilirrubina y la sepsis (AU)

Objective: To evaluate the frequency of severe thrombocytopenia (STCP) (< 50.000/µl) in the first 24hours in patients with multiple organ dysfunction syndrome, and the factors that influence its occurrence. Design: A retrospective, observational study. Area: Medical-surgical intensive care unit (ICU). Tertiary hospital. Patients: Those with failure of at least two organs, according to SOFA criteria, with the exclusion of neurological and traumatologic critical cases. Variables: Medical history, regular medication, baseline functional status, demographic variables, severity scores in ICU, multiple-organ failure data, course in ICU and main hospital data. Results: A total of 587 patients were included; 6.3% (37 patients) presented with STCP during the first day of admission; 64.6% were men; SOFA 8 (5-10); APACHE II 18 (13-24); APACHE IV 59 (46-73); 32.5% were surgical patients. A total of 79.9% subsequently needed mechanical ventilation, and 71.4% required vasoactive drugs. Overall stay in ICU: 4 (2-10) days, main hospital stay 18 (9-35) days. A total of 29.2% died in the ICU; 11.7% developed STCP during admission to the ICU. Multivariate analysis found the main determining factors in the occurrence of thrombocytopenia on admission to be: history of hospitalization in the last year, albumin and bilirubin levels, and sepsis. Conclusion: The prevalence of STCP among critical patients was 6.3%. Its occurrence was associated with albumin and bilirubin levels, sepsis, and with patient admittance in the last year (AU)

[Severe thrombocytopenia on admission to the intensive care unit in patients with multiple organ failure]. / Trombocitopenia grave al ingreso en una unidad de cuidados intensivos en pacientes con disfunción multiorgánica.

OBJECTIVE: To evaluate the frequency of severe thrombocytopenia (STCP) (≤ 50,000/µl) in the first 24 hours in patients with multiple organ dysfunction syndrome, and the factors that influence its occurrence. DESIGN: A retrospective, observational study. AREA: Medical-surgical intensive care unit (ICU). Tertiary hospital. PATIENTS: Those with failure of at least two organs, according to SOFA criteria, with the exclusion of neurological and traumatologic critical cases. VARIABLES: Medical history, regular medication, baseline functional status, demographic variables, severity scores in ICU, multiple-organ failure data, course in ICU and main hospital data. RESULTS: A total of 587 patients were included; 6.3% (37 patients) presented with STCP during the first day of admission; 64.6% were men; SOFA 8 (5-10); APACHE II 18 (13-24); APACHE IV 59 (46-73); 32.5% were surgical patients. A total of 79.9% subsequently needed mechanical ventilation, and 71.4% required vasoactive drugs. Overall stay in ICU: 4 (2-10) days, main hospital stay 18 (9-35) days. A total of 29.2% died in the ICU; 11.7% developed STCP during admission to the ICU. Multivariate analysis found the main determining factors in the occurrence of thrombocytopenia on admission to be: history of hospitalization in the last year, albumin and bilirubin levels, and sepsis. CONCLUSION: The prevalence of STCP among critical patients was 6.3%. Its occurrence was associated with albumin and bilirubin levels, sepsis, and with patient admittance in the last year.

Utilización de la colistina nebulizada en la colonización e infección respiratoria por Acinetobacter baumannii en pacientes críticos / Nebulized colistin treatment of multi-resistant Acinetobacter baumannii pulmonary infection in critical ill patients

ResumenObjetivo: Evaluar la eficacia de la colistina nebulizada en la erradicación microbiológica y lamejoría clínica de pacientes con Acinetobacter baumannii en vías respiratorias.Dise˜no: Estudio retrospectivo.Ámbito: Servicio de medicina intensiva en hospital terciario.Pacientes: Pacientes ingresados en ventilación mecánica invasiva con cultivos positivos en víaaérea para A. baumannii multirresistente.Intervenciones: Todos recibieron tratamiento con colistina (CL). Se determinó neumonía nosocomial(NN) o traqueobronquitis (TB) según criterios habituales y colonización (CO) si habíacultivo positivo en ausencia de criterios de infección. Se definieron 3 grupos de pacientes:tratados con CL nebulizada, con CL i.v. y con CL i.v. más nebulizada.Variables de interés: Características basales. Se consideró erradicación microbiológica y curaciónclínica según criterios habituales.Resultados: Se estudió a 83 pacientes; 54 fueron tratados, con los diagnósticos: 15 (27,8%)con NN, 16 (29,6%) con TB y 23 pacientes (42,6%) con CO. La CL nebulizada fue utilizada en36 pacientes (66,7%): en el 66,7% en CO, el 33,3% en tratamiento de TB y en ningún caso de NN.En el 61,1% de los pacientes se utilizó CL i.v: en la CO en el 22,2%, en la TB en el 38,9% y en lasNN en el 38,9%. La combinación de CL i.v. más nebulizada fue utilizada en 15 pacientes (27,8%),que se empleó: 5 (33,3%) CO, 2 (13,3%) TB y 8 (53,3%) NN. La erradicación microbiológica seconsiguió en 32 pacientes (59,3%), con la distribución: 8 (47,1%) con CL i.v., 15 (83,3%) conCL nebulizadas y 9 pacientes (69,2%) con la combinación CL i.v. más nebulizada. La curaciónclínica se consigue en 42 pacientes (77,8%): 12 (80%) con CL i.v., 18 (94,7%) con CL nebulizaday 12 (85,7%) con la combinación de CL nebulizada e intravenosa. Estas diferencias no fueronsignificativas. En el grupo de pacientes (..) (AU)

AbstractObjective: To analyze the efficacy of nebulized colistin in the microbiological eradication andclinical improvement of patients with pulmonary infection by multi-resistant Acinetobacterbaumannii (MAB).Design: A retrospective study.Setting: Intensive Care Unit of a Tertiary hospital.Patients: Hospitalized patients on invasive mechanical ventilation with positive MAB culturesof the airway.Interventions: All received treatment with colistin (CL). Nosocomial pneumonia (NP) or Tracheobronchitis(TB) was determined according to routine criteria and colonization (CO) wasdetermined in the case of a positive culture in the absence of infection criteria. Three groupsof patients were defined: those treated with nebulized CL, those treated with IV CL and thosetreated with IV CL plus nebulized CL.Main measurements: Baseline characteristics. Microbiological eradication and clinical recoverywere evaluated according to routine criteria.Results: 83 patients were studied, 54 of whom were treated, with the following diagnoses: 15(27.8%) with NP, 16 (29.6%) with TB and 23 patients (42.6%) with CO. Nebulized CL was usedin 36 patients (66.7%): 66.7% of which for CO, 33.3% in treatment for TB and in no case of NP.In 61.1% of the patients, IV CL was used: 22.2% of which for CO, 38.9% for TB and 38.9% in NP.The combination of IV CL and nebulized CL was used in 15 patients (27.8%): 5 patients (33.3%) (..) (AU)

[Nebulized colistin treatment of multi-resistant Acinetobacter baumannii pulmonary infection in critical ill patients]. / Utilización de la colistina nebulizada en la colonización e infección respiratoria por Acinetobacter baumannii en pacientes críticos.

OBJECTIVE: To analyze the efficacy of nebulized colistin in the microbiological eradication and clinical improvement of patients with pulmonary infection by multi-resistant Acinetobacter baumannii (MAB). DESIGN: A retrospective study. SETTING: Intensive Care Unit of a Tertiary hospital. PATIENTS: Hospitalized patients on invasive mechanical ventilation with positive MAB cultures of the airway. INTERVENTIONS: All received treatment with colistin (CL). Nosocomial pneumonia (NP) or Tracheobronchitis (TB) was determined according to routine criteria and colonization (CO) was determined in the case of a positive culture in the absence of infection criteria. Three groups of patients were defined: those treated with nebulized CL, those treated with IV CL and those treated with IV CL plus nebulized CL. MAIN MEASUREMENTS: Baseline characteristics. Microbiological eradication and clinical recovery were evaluated according to routine criteria. RESULTS: 83 patients were studied, 54 of whom were treated, with the following diagnoses: 15 (27.8%) with NP, 16 (29.6%) with TB and 23 patients (42.6%) with CO. Nebulized CL was used in 36 patients (66.7%): 66.7% of which for CO, 33.3% in treatment for TB and in no case of NP. In 61.1% of the patients, IV CL was used: 22.2% of which for CO, 38.9% for TB and 38.9% in NP. The combination of IV CL and nebulized CL was used in 15 patients (27.8%): 5 patients (33.3%) CO, 2 patients (13.3%) TB and 8 patients (53.3%) NP. Microbiological eradication was achieved in 32 patients (59.3%), with the following distribution: 8 (47.1%) with IV CL, 15 (83.3%) with nebulized CL and 9 patients (69.2%) with a combination of IV CL and nebulized CL. Clinical recovery was achieved in 42 patients (77.8%): 12 (80%) with IV CL, 18 (94.7%) with nebulized CL and 12 (85.7%) with a combination of nebulized and IV CL. These differences were not significant. In the group of patients with infection due to TB and NP (31 patients, 57.4%), microbiological eradication was achieved in 5 patients (100%) treated with nebulized CL and in 6 of the 9 patients (42.9%) treated with IV CL, the difference being significant (P<.05). Clinical recovery in this group was 100% (6 patients) treated with nebulized CL and 75% (9 of the 12 patients) in the IV CL group. This difference was not significant. CONCLUSIONS: Our study suggests that treatment with colistin in patients with pulmonary infection with multi-resistant Acinetobacter baumannii could be more efficient if it were to be administrated solely nebulized or in combination with IV colistin rather than administered solely intravenously.