Massive blood transfusion during hospitalization for delivery in New York State, 1998-2007.

OBJECTIVE: To define the frequency, risk factors, and outcomes of massive transfusion in obstetrics. METHODS: The State Inpatient Dataset for New York (1998-2007) was used to identify all delivery hospitalizations for hospitals that reported at least one delivery-related transfusion per year. Multivariable logistic regression analysis was performed to examine the relationship between maternal age, race, and relevant clinical variables and the risk of massive blood transfusion defined as 10 or more units of blood recorded. RESULTS: Massive blood transfusion complicated 6 of every 10,000 deliveries with cases observed even in the smallest facilities. Risk factors with the strongest independent associations with massive blood transfusion included abnormal placentation (1.6/10,000 deliveries, adjusted odds ratio [OR] 18.5, 95% confidence interval [CI] 14.7-23.3), placental abruption (1.0/10,000, adjusted OR 14.6, 95% CI 11.2-19.0), severe preeclampsia (0.8/10,000, adjusted OR 10.4, 95% CI 7.7-14.2), and intrauterine fetal demise (0.7/10,000, adjusted OR 5.5, 95% CI 3.9-7.8). The most common etiologies of massive blood transfusion were abnormal placentation (26.6% of cases), uterine atony (21.2%), placental abruption (16.7%), and postpartum hemorrhage associated with coagulopathy (15.0%). A disproportionate number of women who received a massive blood transfusion experienced severe morbidity including renal failure, acute respiratory distress syndrome, sepsis, and in-hospital death. CONCLUSION: Massive blood transfusion was infrequent, regardless of facility size. In the presence of known risk for receipt of massive blood transfusion, women should be informed of this possibility, should deliver in a well-resourced facility if possible, and should receive appropriate blood product preparation and venous access in advance of delivery. LEVEL OF EVIDENCE: : II.

Intervención fisioterápica preventiva del deterioro de la musculatura respiratoria en ancianas institucionalizadas con limitación funcional / Physiotherapy Intervention for Preventing the Respiratory Muscle Deterioration in Institutionalized Older Women with Functional Impairment

Introducción: En el anciano de edad avanzada (> 80 años) la función respiratoria puede verse afectada cuando a la presencia de comorbilidad y la pérdida de movilidad se suma el descenso de la fuerza de la musculatura respiratoria (MR). La literatura médica ha mostrado que el entrenamiento de la MR puede ser una intervención efectiva para mejorar la funcionalidad y prevenir el deterioro clínico, especialmente en la población con debilidad de la MR. El objetivo del estudio fue evaluar la efectividad del entrenamiento de la MR en la fuerza y resistencia de esta musculatura, en ancianas institucionalizadas con limitación funcional. Método: Se asignaron aleatoriamente 54 residentes con limitación para deambular (media 85 años, DE 6,7) a un grupo control (n = 27) y entrenado (n = 27). Se desarrolló un programa de entrenamiento supervisado, mediante Threshold ®IMT, 5 días por semana durante 6 semanas. Las variables principales fueron: la presión inspiratoria máxima (PImáx), la presión espiratoria máxima (PEmáx) y la ventilación voluntaria máxima (MVV), medidas en las semanas 0, 4, 7 y 10.ResultadosLos análisis estadísticos no revelaron cambio en la PImáx (F3,114 = 1,04, p = 0,368, R2 = 0,027), PEmáx (F3,114 = 1,86, p = 0,14, R2 = 0,047) y MVV (F3,114 = 1,74, p = 0,162, R2 = 0,044) entre ambos grupos tras la intervención. No obstante, la carga de trabajo mejoró significativamente con el entrenamiento (F5,100 = 72,031, p < 0,001, R2 = 0,791). Conclusión: El dispositivo de entrenamiento umbral en un programa interválico de 6 semanas no produce una mejora significativa de los parámetros relacionados con la fuerza y la resistencia de la MR, en la población estudiada(AU)

Introduction: In elderly seniors (>80 years), respiratory function may be compromised when, in addition to the presence of comorbidity and loss of mobility, there is also reduced respiratory muscle (RM) strength. The literature has shown that RM training could be an effective method to improve RM function and prevent clinical deterioration, particularly in population with RM weakness. The main purpose of this paper was to assess the effectiveness of RM training on the respiratory muscle strength and endurance of institutionalized elderly women with functional impairment. Method: Fifty-four residents (mean=85 years, SD=6.7) were randomly assigned to either a control (n=27) or training (n=27) group. A supervised training program was developed with Threshold®IMT, five times per week for 6-weeks. The main variables of the intervention were: maximum inspiratory pressure (PImax), maximum expiratory pressure (PEmax) and maximal voluntary ventilation (MVV), all of which were measured at weeks 0, 4, 7 and 10.ResultsStatistical analysis revealed no significant differences in PImax (F3,114=1.04, p=0.368, R2=0.027), PEmax (F3,114=1.86, p=0.14, R2=0.047) and MVV (F3,114=1.74, p=0.162, R2=0.044) between the two groups after the intervention. However, the workload significantly improved with the training sessions (F5,100=72.031, p<0.001, R2=0.791). Conclusion: In a 6-week interval-based training program, the threshold loading device does not significantly improve parameters related to RM strength and endurance of the study population(AU)