Hemorragia digestiva secundaria a hemobilia por fístula arteriobiliar criptogenética / Digestive bleeding secondary to hemobilia due to cryptogenic arteriobiliary fistula

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Proyecto UCI sin paredes. Efecto de la detección precoz de los pacientes de riesgo / ICU without walls project. Effect of the early detection of patients at risk

Objetivos Describir y evaluar la repercusión de un sistema de detección e intervención precoz en pacientes de riesgo fuera de la UCI en la evolución de los pacientes ingresados en UCI y el número de paradas cardiorrespiratorias (PCR) hospitalarias. Ámbito Hospital de nivel 2 en la Comunidad de Madrid con historia clínica electrónica. Métodos Un intensivista revisa cada uno de los pacientes que cumplan los criterios de inclusión y decide la necesidad o no de intervención. Posteriormente, junto al médico a cargo del paciente, se determina cuál es el nivel de cuidados que necesita y se decide la pauta a seguir a continuación. Diseño Estudio descriptivo y cuasi-experimental «before-after». Resultados En el periodo de estudio se intervino en un total de 202 pacientes. Ciento cuarenta y siete fueron incluidos tras detectarse analíticas alteradas a través de nuestro programa informático. En el periodo de control la mortalidad en UCI fue 9 frente al 4,4% en el periodo de intervención (p=0,03). En el análisis multivariable, los 2 factores que guardaron relación significativa con la mortalidad fueron el haber ingresado durante el periodo de intervención OR 0,42 (IC95%; 0,18 a 0,98) (p=0,04) y el SAPS 3 OR 1,11 (IC95%; 1,07 a 1,14) (p<0,05). El número de avisos por PCR en el periodo control fue 10 frente 3 en el periodo de intervención (p=0,07).Conclusiones La actividad de detección precoz de pacientes en riesgo fuera de la UCI puede producir un efecto beneficioso sobre los pacientes ingresados en UCI así como una reducción de las PCR hospitalarias (AU)

Objectives To describe and evaluate the impact of a system for early detection and intervention in patients at risk outside the ICU upon the outcome of patients admitted to the ICU and the number of cases of hospital cardiopulmonary arrest. Setting A second-level hospital in the Community of Madrid (Spain) with electronic clinical histories Methods An intensivist reviewed each of the patients meeting the inclusion criteria, and decided the need or not for intervention. Posteriorly, in collaboration with the physician supervising the patient, the needed level of care was decided, along with the subsequent management protocol. Design A descriptive and quasi-experimental “before-after” study was made. Results A total of 202 patients were intervened during the study period, With the inclusion of 147 after detecting altered laboratory test results through our software application. During the control period, the mortality rate in the ICU was 9%, versus 4.4% during the intervention period (P=.03). In the multivariate analysis, the two factors significantly related to mortality were admission during the intervention period (OR=0.42; 95%CI: 0.18-0.98; P=.04) and SAPS 3 (OR=1.11; 95%CI: 1.07-1.14; P<0.05). There were 10 cardiopulmonary arrest alerts during the control period, versus three in the intervention period (P=.07).Conclusions Early detection activities in patients at risk outside the ICU can have beneficial effects upon the patients admitted to the ICU, and can contribute to reduce the number of hospital cardiopulmonary arrests (AU)

ICU without walls project. Effect of the early detection of patients at risk.

OBJECTIVES: To describe and evaluate the impact of a system for early detection and intervention in patients at risk outside the ICU upon the outcome of patients admitted to the ICU and the number of cases of hospital cardiopulmonary arrest. SETTING: A second-level hospital in the Community of Madrid (Spain) with electronic clinical histories. METHODS: An intensivist reviewed each of the patients meeting the inclusion criteria, and decided the need or not for intervention. Posteriorly, in collaboration with the physician supervising the patient, the needed level of care was decided, along with the subsequent management protocol. DESIGN: A descriptive and quasi-experimental "before-after" study was made. RESULTS: A total of 202 patients were intervened during the study period, With the inclusion of 147 after detecting altered laboratory test results through our software application. During the control period, the mortality rate in the ICU was 9%, versus 4.4% during the intervention period (P=.03). In the multivariate analysis, the two factors significantly related to mortality were admission during the intervention period (OR=0.42; 95%CI: 0.18-0.98; P=.04) and SAPS 3 (OR=1.11; 95%CI: 1.07-1.14; P<0.05). There were 10 cardiopulmonary arrest alerts during the control period, versus three in the intervention period (P=.07). CONCLUSIONS: Early detection activities in patients at risk outside the ICU can have beneficial effects upon the patients admitted to the ICU, and can contribute to reduce the number of hospital cardiopulmonary arrests.

Toxicidad pulmonar por hiperoxia / Hyperoxia induced pulmonary toxicity

La ventilación mecánica es capaz de producir y agravar el daño pulmonar y contribuir a la aparición de fracaso multiorgánico. Uno de los mecanismos descritos es la hiperoxia alveolar que, en modelos experimentales, conlleva una producción de radicales libres de oxígeno (O2) que exceden las posibilidades de defensa celular, y dan lugar a inflamación, a sobreexpresión genética y a daño celular directo con fenómenos de necrosis y apoptosis. Los hallazgos en humanos no son tan concluyentes, sí está claramente demostrada una alteración funcional debida a la exposición a la fracción inspiratoria de O2 (FiO2) elevada y a un mayor desreclutamiento pulmonar en los pacientes con lesión pulmonar, y que tanto la FiO2 empleada como la presión arterial de oxígeno conseguida en las primeras 24h de ingreso están relacionadas con la mortalidad. Sería necesario realizar ensayos clínicos que evalúen cuál es el umbral de la FiO2 y de la saturación de O2 seguro (AU)

Mechanical ventilation may cause and aggravate lung damage and contribute to the appearance of multiorgan failure. One of the mechanisms that has been described is alveolar hyperoxia. In experimental models, it has lead to the production of free oxygen radicals that exceed the cell defense capacity, giving rise to inflammation, cell damage and gene overexpression with necrosis and apoptosis phenomenon. However, these findings in humans are not as conclusive, although a functional alteration due to the exposure to high FiO2, and greater lung de-recruitment in patients with lung injury has been clearly demonstrated. Moreover, both the FiO2 used as well as the PaO2 achieved in the first 24h of admission are associated with mortality. Clinical trials are needed that assess the threshold of the safe oxygen level for FiO2 and oxygen saturation (AU)

[Hyperoxia-induced pulmonary toxicity]. / Toxicidad pulmonar por hiperoxia.

Mechanical ventilation may cause and aggravate lung damage and contribute to the appearance of multiorgan failure. One of the mechanisms that has been described is alveolar hyperoxia. In experimental models, it has lead to the production of free oxygen radicals that exceed the cell defense capacity, giving rise to inflammation, cell damage and gene overexpression with necrosis and apoptosis phenomenon. However, these findings in humans are not as conclusive, although a functional alteration due to the exposure to high FiO(2), and greater lung de-recruitment in patients with lung injury has been clearly demonstrated. Moreover, both the FiO(2) used as well as the PaO(2) achieved in the first 24h of admission are associated with mortality. Clinical trials are needed that assess the threshold of the safe oxygen level for FiO(2) and oxygen saturation.

[Secondary prevention of alcohol and/or drug abuse in trauma patients: results of a national survey in Spain]. / Prevención secundaria en traumatizados relacionados con alcohol y drogas. Resultados de una encuesta nacional.

OBJECTIVE: To determine the degree of activity in the field of secondary prevention of alcohol and/or drug abuse in trauma patients in Spain. MATERIAL AND METHODS: We surveyed 76 hospitals located in all the autonomous regions of Spain. We collected information about the number of severe trauma patients admitted to the ICU per year, the detection of alcohol and drugs in these patients, and the activity for secondary prevention through motivational intervention among other approaches. RESULTS: Of the 76 hospitals surveyed, 66 responded and only one carried out any secondary prevention activity through motivational intervention. Most of the hospitals surveyed (64.5%, 40/62) did not know of the possibility of secondary prevention through motivational intervention and (29%, 18/62) did not have the resources to carry it out. Asked whether they screened trauma patients for drugs and/or alcohol, 15.6% of centers responded "always" 37.5% (24/64) "usually", and 40.6% only "sometimes". CONCLUSION: Most centers surveyed are unaware of the usefulness of secondary prevention in trauma patients. This lack of awareness may be responsible for the lack of activity in this field in Spain. A plan to increase awareness, including educational interventions, is necessary to promote secondary prevention of alcohol and drug abuse among trauma patients.

Prevención secundaria en traumatizados relacionados con alcohol y drogas. Resultados de una encuesta nacional / Secondary prevention of alcohol and/or drug abuse in trauma patients: Results of a national survey in Spain

Objetivo: Averiguar cuál es el grado de actividad en el campo de la prevención secundaria en traumatizados relacionados con alcohol y drogas en el territorio español. Material y métodoEncuesta a 76 hospitales de todas las comunidades autónomas del país, solicitando información sobre número de pacientes traumatizados graves que requerían ingreso en UCI por año, la detección de alcohol y drogas en estos pacientes y la actividad en prevención secundaria mediante intervención motivacional, entre otras. Resultados: De los 76 hospitales encuestados, 66 respondieron y tan sólo uno realizaba alguna actividad de prevención secundaria mediante intervención motivacional. La mayoría de los encuestados (64,5% [40/62]) desconocían esta posibilidad y el 29% no la realizaba por falta de medios (18/62). El 15,6% de los centros realiza siempre análisis de alcohol y drogas en traumatizados. El 37,5% (24/64) admite realizar estas pruebas en la «mayoría» de los pacientes, y un 40,6% sólo lo realiza «a veces». Conclusión: La mayoría de los encuestados desconoce la utilidad de la prevención secundaria en traumatizados. Este desconocimiento puede ser causante de la nula actividad que se detecta en España en este campo. Es necesario un plan de difusión con acciones educacionales para promocionar este tipo de actividades (AU)

ObjectiveTo determine the degree of activity in the field of secondary prevention of alcohol and/or drug abuse in trauma patients in Spain. Material and methods: We surveyed 76 hospitals located in all the autonomous regions of Spain. We collected information about the number of severe trauma patients admitted to the ICU per year, the detection of alcohol and drugs in these patients, and the activity for secondary prevention through motivational intervention among other approaches. Results: Of the 76 hospitals surveyed, 66 responded and only one carried out any secondary prevention activity through motivational intervention. Most of the hospitals surveyed (64.5%, 40/62) did not know of the possibility of secondary prevention through motivational intervention and (29%, 18/62) did not have the resources to carry it out. Asked whether they screened trauma patients for drugs and/or alcohol, 15.6% of centers responded «always» 37.5% (24/64) «usually», and 40.6% only «sometimes». Conclusion: Most centers surveyed are unaware of the usefulness of secondary prevention in trauma patients. This lack of awareness may be responsible for the lack of activity in this field in Spain. A plan to increase awareness, including educational interventions, is necessary to promote secondary prevention of alcohol and drug abuse among trauma patients (AU)