Mortality study in patients at weaning from mechanical ventilation. / Estudio de mortalidad de pacientes en desconexión progresiva del ventilador.

OBJECTIVE: To explain mortality in the ICU and in hospital among patients subjected to invasive mechanical ventilation. DESIGN: A prospective, 9-month observational cohort study was carried out. SETTING: A Department of Intensive Care Medicine. PATIENTS: Consecutive patients requiring invasive mechanical ventilation were followed-up on until hospital discharge or death. INTERVENTIONS: None. INTEREST VARIABLES: Date of admission, day of first spontaneous breathing test, length of mechanical ventilation, final extubation date, days in ICU, days in hospital or discharge from ICU, SAPS-3 score, WIND study classification, day of death, hospital discharge. RESULTS: There were 266 patients: 40 in group 0 of the WIND classification (15%; 95% CI 11-20%); 166 in group 1 (62%; 95% CI 56-68%); 38 in group 2 (14%; 95% CI 11-19%); and 22 in group 3 (8%; 95% CI 6-12%. Logistic regression analysis showed group 3 to have the highest hospital mortality (group 3 vs. group 1; odds ratio 4.0; 95% CI 1.5-10.8; P=.007). However, Cox regression analysis showed no significant differences (hazard ratio group 3 vs. group 1, 1.6; 95% CI 0.7-3.4; P=ns). CONCLUSION: In our study, considering exposure time, the probability of mortality was the same among the 3 different groups of patients with at least one spontaneous breathing test.

[Primary care physicians behaviour on hypertensive patients with poor blood pressure control. The PRESCAP 2006 study]. / Conducta del médico de Atención Primaria ante el mal control de los pacientes hipertensos. Estudio PRESCAP 2006.

INTRODUCTION: There is little information available on Therapeutic Inertia in Primary Care (PC). This study aimed to know the therapeutic behavior of the physician for uncontrolled hypertensive patients. PATIENTS AND METHODS: Cross-sectional, multicenter study that included hypertensive patients of both genders, under pharmacological treatment who were recruited consecutively in the PC out-patient clinic in all of Spain. Social-demographic, clinical and treatment data were recorded, as well as the motives for eventual therapeutic modification. Adequate BP control was considered when BP values were below 140/90 mmHg in general, and below 130/80 mmHg in diabetes, renal insufficiency or cardiovascular disease. RESULTS: A total of 10,520 patients (53.7% women) were included with average age of 64.6 (11.3 years). Of these, 44.4% the patients were receiving monotherapy and 55.6% were treated with combined therapy (two drugs 41.2%, three drugs 11.7%, and more than three 2.8%). Uncontrolled hypertension was found in 58.6% (95% CI. 57.6-59.5) of the patients. Treatment was modified by physicians in 30.4% (95% CI. 29.2-31.6) of the uncontrolled patients, combination with another drug being the most frequent behavior (46.3%), followed by dose increase (26.1%), and antihypertensive drug switch (22.8%). The perception of the physician of good BP control was the factor most associated with not modifying the treatment in uncontrolled patients. CONCLUSIONS: Study results showed that the PC physician modified antihypertensive treatment in only 3 out of 10 uncontrolled patients. When treatment modification was made, association of drugs was the most frequent behavior.

Efecto del trandolapril sobre la presión arterial y la microalbuminuria en el paciente diabético: estudio galitran

Objetivo. Evaluar la respuesta de la albuminuria al tratamiento con trandolapril en los pacientes diabéticos, hipertensos o no, durante un año. Pacientes y métodos. Catorce centros de Asistencia Primaria incluyeron 131 pacientes diabéticos con microalbuminuria positiva, independientemente de sus cifras de presión arterial. Se cuantificaba la albuminuria en orina de 24 horas y se les administraba, en dosis crecientes de 2 a 4 mg, trandolapril, hasta lograr control de la presión arterial. Se evaluaba la respuesta de la proteinuria durante un período de seguimiento de doce meses. Aquellos pacientes con hipertensión arterial (HTA) no controlada recibían la asociación fija de trandolapril y verapamilo a dosis de 2/180 mg. Resultados. La presencia de albuminuria fue del 70 por ciento de los pacientes escrutados mediante tiras reactivas. Existía HTA en el 93 por ciento de los pacientes diabéticos. La albuminuria descendió significativamente desde 55,7 ñ 32 µg/min hasta 17,3 ñ 36 µg/min al cabo de un año de tratamiento (p < 0,001). Cuando se consideró la negativización de la proteinuria como un valor inferior a 20 µg/min, el porcentaje de pacientes pasó de un 23,3 por ciento inicial a un 83,7 por ciento al final del estudio. La presión arterial descendió significativamente, de 158,8 ñ 19/89,3 ñ 10 a 134,1 ñ 9/75,5 ñ 8 mmHg (p < 0,001). Considerando el objetivo de presión arterial por debajo de 130/85 mmHg, al cabo de un año se controló al 45,3 por ciento de los pacientes tratados. El control metabólico de la diabetes mejoró, pasando la glucemia de 177 ñ 51 mg/dl a 130 ñ 32 mg/dl (p < 0,001), y la hemoglobina glucosilada de 7,98 por ciento ñ 2,3 por ciento a 6,7 por ciento ñ 2,1 por ciento (p < 0,001). Conclusiones. La presencia de HTA es muy frecuente entre la población diabética con microalbuminuria. Las tiras reactivas pueden arrojar hasta un 30 por ciento de falsos positivos cuando se determina posteriormente la albuminuria en orina de 24 horas. El tratamiento con trandolapril controla la presión arterial en el diabético hipertenso, disminuye sustancialmente la microalbuminuria y ayuda a mejorar el control metabólico de la diabetes en estos pacientes al cabo de un año de tratamiento (AU)