Estimación de potenciales donantes en muerte cardiocirculatoria en el Hospital General Universitario de Elche / Estimation of potential donors after cardiocirculatory death in Elche University General Hospital (Alicante, Spain)

OBJETIVO: Estimar el número y las características de potenciales donantes de órganos de personas fallecidas por muerte cardiocirculatoria. Diseño y ámbito: Estudio retrospectivo observacional de los fallecidos entre 15-65 años entre el 2006 y 2014 en el Hospital General Universitario de Elche. Intervención: Realización de análisis univariante y modelo predictivo de regresión logística binaria para discriminar los factores relacionados con la contraindicación para la donación. Variables de interés: Identificar los pacientes con contraindicaciones para la donación. RESULTADOS: De los 1.510 pacientes fallecidos se excluyeron 1.048 por criterios crónicos de exclusión, 86 por evolucionar a muerte encefálica y 20 por pérdidas. Se analizaron 356 pacientes en 2 grupos: 288 en donación en asistolia II y 68 en donación en asistolia III. Resultaron potenciales donantes en asistolia II 70 pacientes y 10 donantes en asistolia III, lo que podría incrementar la actividad de donación en 8-9 donantes/año. Los pacientes fallecieron en: UCI, reanimación, urgencias, medicina interna, digestivo y neurología. Resultaron variables protectoras frente a contraindicación para la donación: fallecer en urgencias, parada cardiorrespiratoria previa o durante el ingreso, la enfermedad cardiológica, respiratoria y neurológica como causa de ingreso. Fallecer en el servicio de medicina interna se asoció a un mayor riesgo de contraindicaciones para la donación. CONCLUSIONES: Poner en marcha un protocolo de donación en asistolia en nuestro hospital podría incrementar el potencial de donación en unos 8-9 donantes/año

OBJECTIVE: To evaluate the number and characteristics of potential organ donors among cardiocirculatory death cases. Design and setting: A retrospective observational study was made of individuals between 15-65 years of age who died in the period 2006-2014 in Elche University General Hospital (Alicante, Spain). Intervention: A univariate analysis and binary logistic regression predictive model were performed to discriminate factors related to donation contraindication. Variables of interest: Identification of patients with donation contraindication. RESULTS: Of the 1510 patients who died in the mentioned period, 1048 were excluded due to the application of exclusion criteria; 86 due to evolution towards brain death; and 20 due to losses. A total of 356 patients were analyzed, divided into two groups: 288 in non-heart beating donation II and 68 in non-heart beating donation III. Seventy patients were found to be potential non-heart beating donation II and 10 were found to be potential non-heart beating donation III, which could increase donation activity by 8-9 donors a year. The patients died in the ICU, Resuscitation, Emergency Care, Internal Medicine, Digestive Diseases and Neurology. The following protective factors against organ donation contraindication were identified: death in Emergency Care, cardiorespiratory arrest before or during admission, and heart, respiratory and neurological disease as the cause of admission. Death in Internal Medicine was associated to an increased risk of donation contraindication. CONCLUSIONS: Implementing a non-heart beating donation protocol in our hospital could increase the donation potential by 8-9 donors a year

Estimation of potential donors after cardiocirculatory death in Elche University General Hospital (Alicante, Spain). / Estimación de potenciales donantes en muerte cardiocirculatoria en el Hospital General Universitario de Elche.

OBJECTIVE: To evaluate the number and characteristics of potential organ donors among cardiocirculatory death cases. DESIGN AND SETTING: A retrospective observational study was made of individuals between 15-65 years of age who died in the period 2006-2014 in Elche University General Hospital (Alicante, Spain). INTERVENTION: A univariate analysis and binary logistic regression predictive model were performed to discriminate factors related to donation contraindication. VARIABLES OF INTEREST: Identification of patients with donation contraindication. RESULTS: Of the 1510 patients who died in the mentioned period, 1048 were excluded due to the application of exclusion criteria; 86 due to evolution towards brain death; and 20 due to losses. A total of 356 patients were analyzed, divided into two groups: 288 in non-heart beating donation II and 68 in non-heart beating donation III. Seventy patients were found to be potential non-heart beating donation II and 10 were found to be potential non-heart beating donation III, which could increase donation activity by 8-9 donors a year. The patients died in the ICU, Resuscitation, Emergency Care, Internal Medicine, Digestive Diseases and Neurology. The following protective factors against organ donation contraindication were identified: death in Emergency Care, cardiorespiratory arrest before or during admission, and heart, respiratory and neurological disease as the cause of admission. Death in Internal Medicine was associated to an increased risk of donation contraindication. CONCLUSIONS: Implementing a non-heart beating donation protocol in our hospital could increase the donation potential by 8-9 donors a year.

Liver transplantation complications in the intensive care unit and at 6 months.

OBJECTIVE: This study sought to determine the factors that influence the 6-month outcomes of liver transplants. PATIENTS AND METHODS: One hundred ninety-six variables (donor, recipient, operation, intensive care unit [ICU], evolution at 3 and 6 months) were collected from the first 74 consecutive liver transplantation performed from 2002 to 2004. The primary endpoint was patient survival at 6 months. The statistical analysis included a screening univariate analysis followed by a stepwise logistic regression with forward inclusion to test independent associations and finally generation of receiver-operator characteristic (ROC) curves to evaluate predictive factors. RESULTS: Patient survival at 6 months was 86%, namely 10 deaths, including 4 intraoperatively and 6 postoperatively due to sepsis. Complications in the ICU were classified as reoperations due to biliary problems, vascular complications, and peritonitis. Late complications included 51% rejection episodes, 24% infections, 11% pleural effusions, and 16% diabetes mellitus. Logistic regression analysis showed independent negative predictors of survival were the number of packed red cells during transplantation, the number of fresh frozen plasma units administered in the ICU, blood urea nitrogen (BUN) concentration in the ICU, and graft complications. The odds ratios of these variables were 10.2, 5.2, 42.1, and 36.9, respectively. The area under the curve (AUC) of the ROC was 0.99; the sensitivity was 94%; and the specificity was 100%. The independent predictors of surgical complications were the length of the operation, the need for pressor support, and the number of fresh frozen plasma units administered in the operating room, with odds ratios of 1.0, 7.7, and 1.1, respectively. CONCLUSION: This study revealed specific operative and ICU variables that correlated with the evolution of our patients.

Multidrug-resistant Acinetobacter meningitis in neurosurgical patients with intraventricular catheters: assessment of different treatments.

BACKGROUND: The treatment of multidrug-resistant Acinetobacter baumannii meningitis is a serious therapeutic problem due to the limited penetration of antibiotics into the CSF. We describe the clinical features and the outcome of a group of patients with nosocomial neurosurgical meningitis treated with different therapeutic options. METHODS: All patients with nosocomial post-surgical meningitis due to A. baumannii diagnosed between 1990 and 2004 were retrospectively reviewed. RESULTS: During the period of study, 51 cases of this nosocomial infection were identified. Twenty-seven patients were treated with intravenous (iv) monotherapy: carbapenems (21 cases), ampicillin/sulbactam (4 cases) and other antibiotics (2 cases). Four patients were treated with iv combination therapy. Nineteen patients were treated with iv and intrathecal regimens: colistin by both routes (8 cases), carbapenems plus iv and intrathecal (4 cases) or only intrathecal (5 cases) aminoglycosides, and others (2 cases). Seventeen patients died due to the infection. One patient died without treatment. The mean (SD) duration of therapy was 17.4 (8.3) days (range 3-44). Although no patients treated with colistin died, we did not observe statistically significant differences in the mortality among the groups with different treatments. CONCLUSIONS: Nosocomial Acinetobacter meningitis has a high mortality. Combined therapy with iv and intrathecal colistin is a useful and safe option in the treatment of nosocomial Acinetobacter meningitis.