Valoración del daño miocárdico mediante la medición de la heart-fatty acid-binding protein en cirugía de revascularización coronaria sin circulación extracorpórea. Estudio preliminar / Evaluation of postoperative myocardial injury by heart-type fatty acid-binding protein in off-pump coronary artery bypass grafting surgery

Introducción y objetivos del estudio. El infarto de miocardio posoperatorio es una complicación grave y frecuente de la cirugía cardiaca. El diagnóstico en este contexto es, en ocasiones, difícil. El objetivo de este estudio es evaluar la cinética y la precisión diagnóstica de un nuevo marcador, la heart-type fatty acid-binding protein (h-FABP), en la detección precoz de daño miocárdico en pacientes sometidos a cirugía de revascularización coronaria sin circulación extracorpórea en comparación con los biomarcadores clásicos. Materiales y métodos. Se estudiaron prospectivamente 17 pacientes consecutivos sometidos a cirugía cardiaca de revascularización sin circulación extracorpórea. Se analizaron biomarcadores de lesión de isquemia miocárdica (h-FABP, troponina, creatincinasa [CK] y CK-MB) al inicio de la cirugía (T1), inmediatamente después de la revascularización (T2), al ingreso en la UCC (T3) y después de 4 (T4), 8 (T5), 24 (T6) y 48 h (T7). Se registraron las complicaciones isquémicas perioperatorias, definidas de acuerdo con criterios electrocardiográficos, ecocardiográficos y hemodinámicos. Resultados. Los valores plasmáticos pico de la troponina se alcanzaron en T4 (2,9 ± 5,2 ng/ml) y en T5 con h-FABP (37,9 ± 55,5 ng/ml). Los valores máximos de CK y CK-MB fueron más tardíos, en T6 (741 ± 779 y 37 ± 51 U/L, respectivamente). El punto de corte obtenido para h-FABP para la detección de eventos isquémicos fue de 19 ng/ml, proporcionando una sensibilidad y especificidad del 77 y 75%, respectivamente, para el diagnóstico de la lesión isquémica perioperatoria, con un área bajo la curva ROC para h-FABP de 0,83 (IC 95% 0,6-1,0) vs. 0,63 (IC 95% 0,33-0,83) para troponina. Se alcanza este valor de corte para la h-FABP en promedio en T2 (18,9 ± 21,5 ng/ml). Conclusión. Este es el primer estudio que evalúa la cinética del biomarcador h-FABP en el perioperatorio de la cirugía de revascularización sin circulación extracorpórea, y el valor de corte establecido podría ayudar a la detección temprana de la isquemia miocárdica en este contexto (AU)

Background and goal of study. Postoperative myocardial infarction is a serious and frequent complication of cardiac surgery. Nonetheless, diagnosis in this context it is occasionally challenging. We sought to evaluate the kinetics and diagnostic accuracy of the new biomarker «heart-type fatty acid-binding protein» (h-FABP) in the early detection of myocardial injury in patients undergoing off-pump coronary artery bypass grafting, compared with classical biomarkers. Materials and methods. A prospective study was conducted on 17 consecutive patients who underwent off-pump coronary artery bypass grafting during a 2 month period. Blood samples were drawn for measurement of myocardial ischemic injury biomarkers (h-FABP, troponin, creatine kinase [CK] and CK-MB), at baseline (T1), immediate post-coronary artery bypass grafting (T2), on ICU admission (T3), and after 4 (T4), 8 (T5), 24 (T6) and 48 h (T7). Perioperative ischemic complications, defined according to electrocardiographic, echocardiographic and hemodynamic criteria, were recorded. Results. Earlier biomarkers peak plasma values occurred at T4 with troponin (2.9 ± 5.2 ng/mL), and at T5 with h-FABP (37.9 ± 55.5 ng/mL). Maximum values of CK and CK-MB occurred later, both in T6 (741 ± 779 and 37 ± 51 U/L, respectively). The optimized cut-off obtained for h-FABP was 19 ng/mL, providing a sensitivity and specificity of 77 and 75%, respectively, for diagnosis of perioperative ischemic injury, with an area under the ROC curve for h-FABP of 0.83 (95% CI 0.6-1.0) vs. 0.63 (95% CI 0.33-0.83) for troponin. This cut-off value for h-FABP is reached on average at T2 (mean value of h-FABP at T2: 18.9 ± 21.5 ng/mL). Conclusion. This is the first study evaluating the kinetics of h-FABP biomarker in perioperative off-pump coronary artery bypass grafting, and the cut-off value established could help to extend earlier detection of myocardial ischemia in this context (AU)

[Evaluation of postoperative myocardial injury by heart-type fatty acid-binding protein in off-pump coronary artery bypass grafting surgery]. / Valoración del daño miocárdico mediante la medición de la heart-fatty acid-binding protein en cirugía de revascularización coronaria sin circulación extracorpórea. Estudio preliminar.

BACKGROUND AND GOAL OF STUDY: Postoperative myocardial infarction is a serious and frequent complication of cardiac surgery. Nonetheless, diagnosis in this context it is occasionally challenging. We sought to evaluate the kinetics and diagnostic accuracy of the new biomarker « heart-type fatty acid-binding protein ¼ (h-FABP) in the early detection of myocardial injury in patients undergoing off-pump coronary artery bypass grafting, compared with classical biomarkers. MATERIALS AND METHODS: A prospective study was conducted on 17 consecutive patients who underwent off-pump coronary artery bypass grafting during a 2 month period. Blood samples were drawn for measurement of myocardial ischemic injury biomarkers (h-FABP, troponin, creatine kinase [CK] and CK-MB), at baseline (T1), immediate post-coronary artery bypass grafting (T2), on ICU admission (T3), and after 4 (T4), 8 (T5), 24 (T6) and 48 h (T7). Perioperative ischemic complications, defined according to electrocardiographic, echocardiographic and hemodynamic criteria, were recorded. RESULTS: Earlier biomarkers peak plasma values occurred at T4 with troponin (2.9 ± 5.2 ng/mL), and at T5 with h-FABP (37.9 ± 55.5 ng/mL). Maximum values of CK and CK-MB occurred later, both in T6 (741 ± 779 and 37 ± 51 U/L, respectively). The optimized cut-off obtained for h-FABP was 19 ng/mL, providing a sensitivity and specificity of 77 and 75%, respectively, for diagnosis of perioperative ischemic injury, with an area under the ROC curve for h-FABP of 0.83 (95% CI 0.6-1.0) vs. 0.63 (95% CI 0.33-0.83) for troponin. This cut-off value for h-FABP is reached on average at T2 (mean value of h-FABP at T2: 18.9 ± 21.5 ng/mL). CONCLUSION: This is the first study evaluating the kinetics of h-FABP biomarker in perioperative off-pump coronary artery bypass grafting, and the cut-off value established could help to extend earlier detection of myocardial ischemia in this context.

Hiperlactatemia en la ablación quirúrgica de la fibrilación auricular y cirugía cardiaca. ¿Es un factor predictivo de morbimortalidad posoperatoria? / Hyperlactatemia in surgical ablation of atrial fibrillation and cardiac surgery. Is it a predictive factor of postoperative morbidity?

Introducción: La elevación del lactato sérico en el posoperatorio de la cirugía cardiaca es frecuente y su etiopatogenia, multifactorial. Esta elevación se asocia a hipoxia tisular (hiperlactatemia tipo A) y a alteraciones metabólicas no hipóxicas (hiperlactatemia tipo B). El objetivo de este estudio fue evaluar la evolución del lactato en el posoperatorio de la ablación de la fibrilación auricular durante la cirugía valvular cardiaca y analizar si los niveles de lactato pudieran ser predictores de morbimortalidad. Material y métodos: Estudio de casos y controles. Se estudiaron 32 pacientes intervenidos entre 2011 y 2012 de ablación de la fibrilación auricular realizada junto a la cirugía de recambio valvular (grupo Maze), y 32 pacientes pareados (grupo Control). Se analizaron los niveles posoperatorios seriados de lactato, la morbimortalidad perioperatoria y la estancia hospitalaria. Se realizó un estudio univariante y multivariante para estancias prolongadas y un suceso compuesto de morbimortalidad con el fin de detectar predictores independientes. Resultados: El lactato estuvo más elevado a las 6, 12 y 24 h en el grupo Maze. En el análisis univariante resultaron significativos como predictores de complicaciones, mortalidad y estancias prolongadas el hecho de pertenecer al grupo Maze (OR 3,88; IC 95% 1,3-11,1; p = 0,01) y la elevación de lactato a las 12 h (OR 1,33; IC 95% 1,01-1,7; p = 0,04). En el análisis multivariante la pertenencia al grupo Maze fue predictor independiente de complicaciones mayores (OR 4,13; IC 95% 1,3-12,9; p = 0,015), para el suceso compuesto de morbimortalidad (OR 3,9; IC 95% 1,3-11,6; p = 0,01) y para estancia prolongada en la Unidad de Cuidados Críticos (OR 5,7; IC 95% 2,01-15,7; p = 0,01). Conclusiones: La cirugía de ablación de la fibrilación auricular podría ser una causa no descrita previamente de hiperlactatemia tipo B con picos entre las 4-24 h tras cirugía cardiaca. El valor predictivo de esta elevación, su correlación con la morbimortalidad, su sensibilidad y su especificidad para discriminar los umbrales significativos están aún por definir (AU)

Introduction: Increased serum lactate in postoperative cardiac surgery is very common and its pathogenesis is due to multiple factors. The elevation of serum lactate is associated with tissue hypoxia (hyperlactatemia type A) and non-hypoxic (hyperlactatemia type B) metabolic disorders. The aim of the study was to assess the evolution of postoperative lactate in surgical atrial fibrillation ablation during cardiac surgery, and to determine whether lactate levels could be predictors of morbimortality. Material and methods: A case-control study was conducted on 32 patients undergoing surgical atrial fibrillation ablation and cardiac surgery (Maze group) and 32 matched patients (Control group), operated on between 2011 and 2012. An analysis was made of the levels of postoperative lactate, perioperative morbimortality and hospital length of stay. A univariate and multivariate study was performed for a composite endpoint of morbimortality, and prolonged length of stay. Results: Lactate levels were significantly higher at 6, 12 and 24h in the Maze group. The univariate analysis showed that being in the Maze group (OR 3.88; 95% CI 1.3-11.1; P=.01) and an elevated lactate at 12h (OR 1.33; 95% CI 1.01-1.7; P=.04) were significant predictors of major complications, mortality, and longer hospital stays. In the multivariate analysis, surgical atrial fibrillation ablation (Maze group) was an independent predictor of major complications (OR 4.13; 95% CI 1.312.9; P=.015) for the morbimortality composite endpoint (OR 3.9; 95% CI 1.3-11.6; P=.01), and prolonged length of stay in the Intensive Care Unit (OR 5.7; 95% CI 2.01-15.7; P=.01). Conclusions: The atrial fibrillation surgical ablation may be a not-yet-described cause of type B hyperlactatemia, with serum peak values being reached between 4-24h after cardiac surgery. The predictive value of this elevation, its correlation with morbimortality, its sensitivity and specificity to discriminate the significant thresholds needs to be defined

Sepsis, miocardiopatía e infección por el virus de la inmunodeficiencia humana: a propósito de un caso / Sepsis, cardiomyopathy and human immunodeficiency virus infection: presentation of a case

La sepsis en los pacientes con el virus de la inmunodeficiencia humana (VIH) puede asociarse a la aparición de una disfunción cardiaca, que puede resultar difícil de manejar, tanto a la hora de realizar el diagnóstico diferencial, como deorientar un tratamiento correcto, ya que existen numerosos factores de riesgo asociados: la miocarditis por el propio VIH, la presencia o ausencia de tratamiento antirretroviral de gran actividad, el consumo de sustancias tóxicas y la miocardiopatía asociada a la sepsis. Describimos la estrategia diagnóstica y el enfoque terapéutico de un paciente portador de VIH con shock séptico y disfunción cardiaca, haciendo una breve revisión de las distintas causas de miocardiopatía que pueden afectar a este grupo de pacientes (AU)

Sepsis in patients with human immunodeficiency virus (HIV) may be associated with the appearance of cardiac dysfunction. This is a challenge, both when making the differential diagnosis and determining the proper treatment, as there are numerous risk factors: Myocarditis due to the HIV itself, the presence or absence of highly active antiretroviral therapy, toxic substances, and cardiomyopathy associated with sepsis. The diagnostic and therapeutic approach to an HIV positive patient with septic shock and cardiac dysfunction is described, as well as a brief review of the different causes of cardiomyopathy which may affect this group of patients is also presented (AU)

[Hyperlactatemia in surgical ablation of atrial fibrillation and cardiac surgery. Is it a predictive factor of postoperative morbidity?]. / Hiperlactatemia en la ablación quirúrgica de la fibrilación auricular y cirugía cardiaca. ¿Es un factor predictivo de morbimortalidad posoperatoria?

INTRODUCTION: Increased serum lactate in postoperative cardiac surgery is very common and its pathogenesis is due to multiple factors. The elevation of serum lactate is associated with tissue hypoxia (hyperlactatemia type A) and non-hypoxic (hyperlactatemia type B) metabolic disorders. The aim of the study was to assess the evolution of postoperative lactate in surgical atrial fibrillation ablation during cardiac surgery, and to determine whether lactate levels could be predictors of morbimortality. MATERIAL AND METHODS: A case-control study was conducted on 32 patients undergoing surgical atrial fibrillation ablation and cardiac surgery (Maze group) and 32 matched patients (Control group), operated on between 2011 and 2012. An analysis was made of the levels of postoperative lactate, perioperative morbimortality and hospital length of stay. A univariate and multivariate study was performed for a composite endpoint of morbimortality, and prolonged length of stay. RESULTS: Lactate levels were significantly higher at 6, 12 and 24h in the Maze group. The univariate analysis showed that being in the Maze group (OR 3.88; 95% CI 1.3-11.1; P=.01) and an elevated lactate at 12h (OR 1.33; 95% CI 1.01-1.7; P=.04) were significant predictors of major complications, mortality, and longer hospital stays. In the multivariate analysis, surgical atrial fibrillation ablation (Maze group) was an independent predictor of major complications (OR 4.13; 95% CI 1.312.9; P=.015) for the morbimortality composite endpoint (OR 3.9; 95% CI 1.3-11.6; P=.01), and prolonged length of stay in the Intensive Care Unit (OR 5.7; 95% CI 2.01-15.7; P=.01). CONCLUSIONS: The atrial fibrillation surgical ablation may be a not-yet-described cause of type B hyperlactatemia, with serum peak values being reached between 4-24h after cardiac surgery. The predictive value of this elevation, its correlation with morbimortality, its sensitivity and specificity to discriminate the significant thresholds needs to be defined.

[Sepsis, cardiomyopathy and human immunodeficiency virus infection: presentation of a case]. / Sepsis, miocardiopatía e infección por el virus de la inmunodeficiencia humana: a propósito de un caso.

Sepsis in patients with human immunodeficiency virus (HIV) may be associated with the appearance of cardiac dysfunction. This is a challenge, both when making the differential diagnosis and determining the proper treatment, as there are numerous risk factors: Myocarditis due to the HIV itself, the presence or absence of highly active antiretroviral therapy, toxic substances, and cardiomyopathy associated with sepsis. The diagnostic and therapeutic approach to an HIV positive patient with septic shock and cardiac dysfunction is described, as well as a brief review of the different causes of cardiomyopathy which may affect this group of patients is also presented.

Bloqueo paravertebral continuo para analgesia en cirugía cardiaca mínimamente invasiva. Respuesta de los autores / Continuous paravertebral block for analgesia in minimally invasive cardiac surgery. Reply of the authors

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Hemorragia y morbilidad asociada al uso de ácido tranexámico en cirugía cardiaca. Estudio multicéntrico de cohortes retrospectivo / Haemorrhage and morbidity associated with the use of tranexamic acid in cardiac surgery: A retrospective, multicentre cohort study

Introducción. Una complicación frecuente tras cirugía cardiaca con circulación extracorpórea es la hemorragia postoperatoria, llegando al 20% de los pacientes. La fibrinolisis es una de las causas de este sangrado excesivo y, por ello, se recomienda la utilización de ácido tranexámico. El problema de su utilización reside en las numerosas pautas y en las diferentes dosis de administración. Nuestro objetivo fue evaluar si existen diferencias en la hemorragia postoperatoria y la morbilidad tras cirugía cardiaca, con la administración de diferentes dosis de ácido tranexámico en 3 hospitales universitarios. Material y métodos. Estudio retrospectivo multicéntrico de cohortes. Se estudiaron 146 pacientes, intervenidos con CEC en cirugía programada según el protocolo anestésico-quirúrgico de cada centro. Se revisaron las historias clínicas y se dividieron en 2 grupos según las dosis de ácido tranexámico: Grupo A (dosis altas): dosis inicial de 20mg/kg y perfusión continua de 4mg/kg/h hasta el cierre de la esternotomía. Se añadieron 100mg al cebado de CEC. Grupo B (dosis bajas): dosis inicial de 10mg/kg seguido de una perfusión continua de 2mg/kg/h hasta el cierre de la esternotomía. Se añadieron 50mg al cebado de CEC. Se recogieron edad, sexo, peso, talla, tipo de procedimiento quirúrgico (valvular, coronario o mixto), hematocrito, INR y recuento de plaquetas preoperatorio, tiempo y temperatura de CEC y hematocrito al cierre esternal. Entre las variables postoperatorias: débito por drenajes a las 6, 12 y 24h postoperatorias, número y tipo de hemoderivados transfundidos en las primeras 24h, necesidad de reintervención por hemorragia, ACV, AIT o un nuevo infarto agudo de miocardio, convulsiones y mortalidad. Resultados. La incidencia de sangrado aumentado (pacientes en el percentil 90) fue superior en el grupo B en todas los momentos de evaluación del estudio (p<0,05). La incidencia de reintervención por sangrado y necesidad de transfusión de ≥3 concentrados de hematíes fue inferior en el grupo A (5,56%) respecto al grupo B (13,89%). No existieron diferencias significativas en los requerimientos de transfusión de hemoderivados entre ambos grupos. Respecto a morbilidad asociada, en el grupo A hubo un caso aislado de convulsiones y otro caso de IAM peroperatorio, y en el grupo B 3 casos de IAM peroperatorio. Conclusiones. La dosis elevada de ácido tranexámico en cirugía cardiaca con CEC parece reducir de forma significativa la hemorragia en las primeras horas del postoperatorio frente a dosis bajas. Sin embargo, esta disminución no se traduce en una reducción de las necesidades de hemoderivados(AU)

Introduction. Postoperative bleeding is common complication, affecting up to 20% of patients, after cardiac bypass surgery. Fibrinolysis is one of the causes of this excessive bleeding, and for this reason the use of tranexamic acid is recommended. The problem with using this is that there are numerous guidelines and differences in the dose to be administered. Our aim was to evaluate whether there were any differences in postoperative bleeding and morbidity after cardiac surgery with the administering of different tranexamic acid doses in three university hospitals. Material and methods. A retrospective, multicentre cohort study was conducted. A total of 146 patients who were subjected to elective cardiac bypass surgery according to the anaesthetic-surgical protocol of each hospital were included in the study. The clinical histories were reviewed, and they were divided into two groups according to the tranexamic acid dose: Group A (high doses), initial dose of 20mg/kg and continuous infusion of 4mg/kg/hour until closure of the sternotomy. A further 100mg was added to prime the bypass machine. Group B (low doses), initial dose of 10mg/kg followed by a continuous infusion of 2mg/kg/hour until closure of the sternotomy. A further 50mg was added to prime the bypass machine. Variables, such as age, sex, weight, height, type of surgical procedure (valvular, coronary or mixed), haematocrit, INR, and preoperative platelet count, time and temperature of the bypass machine, and haematocrit on sternum closure, were recorded. Among the post-operative variables collected were: debit due to drainage at 6, 12 and 24hours after surgery, number and type of blood products transfused in the first 24hours, need for further surgery due to haemorrhage, CVA, TIA, or a new acute myocardial infarction, convulsions, and mortality. Results. The incidence of increased bleeding (patients in the 90 percentile) was higher in Group B at all the study evaluation times (P<.05). The incidence of further surgery due to bleeding, and the need for transfusion of ≥3 units of packed red cells was lower in Group A (5.56%) than in Group B (13.89%). There were no significant differences in the requirements for blood products transfusions between the groups. As regards associated morbidity, there was one isolated case of convulsion and a perioperative AMI in another case in Group A, and three cases of perioperative AMI in Group B. Conclusions. Elevated doses of tranexamic acid in cardiac bypass surgery appear to significantly reduce bleeding in the first hours after surgery compared to low doses. However, this decrease did not lead to a reduction in the needs for blood products(AU)

[Haemorrhage and morbidity associated with the use of tranexamic acid in cardiac surgery: a retrospective, multicentre cohort study]. / Hemorragia y morbilidad asociada al uso de ácido tranexámico en cirugía cardiaca. Estudio multicéntrico de cohortes retrospectivo.

INTRODUCTION: Postoperative bleeding is common complication, affecting up to 20% of patients, after cardiac bypass surgery. Fibrinolysis is one of the causes of this excessive bleeding, and for this reason the use of tranexamic acid is recommended. The problem with using this is that there are numerous guidelines and differences in the dose to be administered. Our aim was to evaluate whether there were any differences in postoperative bleeding and morbidity after cardiac surgery with the administering of different tranexamic acid doses in three university hospitals. MATERIAL AND METHODS: A retrospective, multicentre cohort study was conducted. A total of 146 patients who were subjected to elective cardiac bypass surgery according to the anaesthetic-surgical protocol of each hospital were included in the study. The clinical histories were reviewed, and they were divided into two groups according to the tranexamic acid dose: Group A (high doses), initial dose of 20mg/kg and continuous infusion of 4 mg/kg/hour until closure of the sternotomy. A further 100mg was added to prime the bypass machine. Group B (low doses), initial dose of 10mg/kg followed by a continuous infusion of 2mg/kg/hour until closure of the sternotomy. A further 50mg was added to prime the bypass machine. Variables, such as age, sex, weight, height, type of surgical procedure (valvular, coronary or mixed), haematocrit, INR, and preoperative platelet count, time and temperature of the bypass machine, and haematocrit on sternum closure, were recorded. Among the post-operative variables collected were: debit due to drainage at 6, 12 and 24 hours after surgery, number and type of blood products transfused in the first 24 hours, need for further surgery due to haemorrhage, CVA, TIA, or a new acute myocardial infarction, convulsions, and mortality. RESULTS: The incidence of increased bleeding (patients in the 90 percentile) was higher in Group B at all the study evaluation times (P<.05). The incidence of further surgery due to bleeding, and the need for transfusion of ≥ 3 units of packed red cells was lower in Group A (5.56%) than in Group B (13.89%). There were no significant differences in the requirements for blood products transfusions between the groups. As regards associated morbidity, there was one isolated case of convulsion and a perioperative AMI in another case in Group A, and three cases of perioperative AMI in Group B. CONCLUSIONS: Elevated doses of tranexamic acid in cardiac bypass surgery appear to significantly reduce bleeding in the first hours after surgery compared to low doses. However, this decrease did not lead to a reduction in the needs for blood products.

Analgesia paravertebral continua frente a analgesia intravenosa en cirugía cardiaca mínimamente invasiva por minitoracotomía / Continuous paravertebral analgesia versus intravenous analgesia in minimally invasive cardiac surgery by mini-thoracotomy

Objetivos. La cirugía cardiaca de acceso mínimo mediante minitoracotomía tiene como objetivo principal una reincorporación precoz a la actividad diaria. Para ello, el control del dolor postoperatorio es fundamental. Realizamos un estudio para valorar la calidad de la analgesia postoperatoria tras cirugía cardiaca por minitoracotomía, según la técnica analgésica. Material y métodos. Estudio descriptivo observacional retrospectivo. Se incluyeron los pacientes intervenidos de cirugía cardiaca de acceso mínimo en nuestro centro, desde el año 2009 hasta 2011. Los pacientes se dividieron en 2 grupos dependiendo del tipo de analgesia recibida: analgesia por catéter paravertebral, mediante la infusión de anestésicos locales (grupo BPV), y analgesia intravenosa con opiáceos (grupo AIO). Los objetivos del estudio fueron la comparación de la calidad analgésica y las complicaciones asociadas a la técnica analgésica, tiempo de extubación, complicaciones posquirúrgicas y tiempos de estancia hospitalaria, entre ambas técnicas. Resultados. Treinta y siete pacientes fueron intervenidos mediante cirugía cardiaca de acceso mínimo tipo «Heart-Port» modificado. Quince pacientes recibieron analgesia mediante bloqueo paravertebral y 22 mediante analgesia con opiáceos. Los datos se muestran como media y desviación estándar (DE). Se apreció un tiempo de extubación traqueal inferior a 4h en el 60% de los pacientes en el grupo BPV, frente al 22% del grupo AIO (p<0,05). La estancia en la UCI para el grupo BPV fue de 1,2 (0,7) días frente a 2,2 (0,7) días del grupo AIO (p<0,05). La estancia hospitalaria fue de 4,8 (1,2) días para el grupo PVB y de 5,6 (2,8) días para el grupo AIO (p>0,05). No se observaron complicaciones asociadas al bloqueo paravertebral continuo. Discusión. La analgesia mediante bloqueo paravertebral es una técnica aceptablemente segura en cirugía cardiaca por toracotomía, que permite una extubación precoz con un control óptimo del dolor cuando se compara con analgesia iv con opiáceos(AU)

Objectives. Minimal access cardiac surgery via minithoracotomy aims faster recovery and shorter hospital length of stay. Pain control is essential in order to achieve this goal. A study was conducted to assess the quality of post-operative analgesia and complications related to the analgesia techniques after cardiac surgery by minithoracotomy. Material and methods. A descriptive, observational and retrospective study was conducted on the patients subjected to minimal access cardiac surgery in our centre between the years 2009 to 2011. The patients were divided into two groups according to the type of analgesia received: analgesia through a paravertebral catheter, with an infusion of local anaesthetics (PVB group), and intravenous analgesia with opioids (IOA group). The aim of the study was to compare the analgesic quality and the complications associated to the analgesic technique, extubation time, post-surgical complications, and length of hospital stay between both techniques. Results. A total of 37 patients underwent to a modified minimally invasive Heart-Port access cardiac surgery. Fifteen patients received analgesia through a paravertebral block and the other 22 IV analgesia with opioids. Data are shown as means and standard deviation (SD). Mean tracheal extubation time less than 4hours was observed in 60% of the patients in the PVB group, compared to 22% in the IOA group (P<.05). Length of stay in ICU for the PVB group was 1.2 (0.7) days compared to 2.2 (0.7) days in the IOA group (P<.05). Mean hospital stay was 4.8 (1.2) days for the PVB group, and 5.6 (2.8) for the IOA group (P>.05. No complications associated to the continuous paravertebral block were observed. Discussion. PVB analgesia is an acceptable safe technique in cardiac surgery via thoracotomy which enables early extubation with optimal pain control when compared with IV analgesia with opioids(AU)

[Continuous paravertebral analgesia versus intravenous analgesia in minimally invasive cardiac surgery by mini-thoracotomy]. / Analgesia paravertebral continua frente a analgesia intravenosa en cirugía cardiaca mínimamente invasiva por minitoracotomía.

OBJECTIVES: Minimal access cardiac surgery via minithoracotomy aims faster recovery and shorter hospital length of stay. Pain control is essential in order to achieve this goal. A study was conducted to assess the quality of post-operative analgesia and complications related to the analgesia techniques after cardiac surgery by minithoracotomy. MATERIAL AND METHODS: A descriptive, observational and retrospective study was conducted on the patients subjected to minimal access cardiac surgery in our centre between the years 2009 to 2011. The patients were divided into two groups according to the type of analgesia received: analgesia through a paravertebral catheter, with an infusion of local anaesthetics (PVB group), and intravenous analgesia with opioids (IOA group). The aim of the study was to compare the analgesic quality and the complications associated to the analgesic technique, extubation time, post-surgical complications, and length of hospital stay between both techniques. RESULTS: A total of 37 patients underwent to a modified minimally invasive Heart-Port access cardiac surgery. Fifteen patients received analgesia through a paravertebral block and the other 22 IV analgesia with opioids. Data are shown as means and standard deviation (SD). Mean tracheal extubation time less than 4 hours was observed in 60% of the patients in the PVB group, compared to 22% in the IOA group (P<.05). Length of stay in ICU for the PVB group was 1.2 (0.7) days compared to 2.2 (0.7) days in the IOA group (P<.05). Mean hospital stay was 4.8 (1.2) days for the PVB group, and 5.6 (2.8) for the IOA group (P>.05. No complications associated to the continuous paravertebral block were observed. DISCUSSION: PVB analgesia is an acceptable safe technique in cardiac surgery via thoracotomy which enables early extubation with optimal pain control when compared with IV analgesia with opioids.

Resistencia a los antibióticos y unidad de cuidados críticos / No disponible

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Sepsis puerperal tardía con shock séptico y disfunción cardiaca / Late-onset postpartum sepsis with septic shock and heart dysfunction

Presentamos el caso de una mujer de raza blanca de 37 años con diagnóstico de sepsis puerperal tardía por endometritis causada por estreptococo del grupo A (SGA) y shock séptico con insuficiencia mitral y disfunción cardiaca. La instauración precoz de antibioterapia de amplio espectro y soporte hemodinámico fue fundamental para la evolución favorable de la paciente. Debido al resurgir de cepas virulentas de SGA y las consecuencias fatales que pueden llegar a desencadenar, es importante incluir este microorganismo en el diagnóstico diferencial de las infecciones maternas relacionadas con el puerperio. La afectación cardiaca es poco frecuente en el contexto de infección por este microorganismo, sin embargo ante una sepsis con mala evolución el diagnóstico con ecocardiografía parece imprescindible para descartar disfunción cardiaca(AU)

We report a case of late-onset postpartum sepsis from endometritis due to group A streptococci (GAS) in a 37-year-old white woman. The patient developed septic shock, with mitral regurgitation and cardiac dysfunction. Early treatment with broad-spectrum antibiotics and hemodynamic support was essential for a favorable outcome. Because of the resurgence of virulent strains of GAS that can cause fatal infections, these pathogens should be included in the differential diagnosis of postpartum infections in the mother. Although cardiac dysfunction is rare in association with GAS infection, it should be ruled out by echocardiography when the condition of a patient with sepsis does not improve(AU)

[Late-onset postpartum sepsis with septic shock and heart dysfunction]. / Sepsis puerperal tardía con shock séptico y disfunción cardiaca.

We report a case of late-onset postpartum sepsis from endometritis due to group A streptococci (GAS) in a 37-year-old white woman. The patient developed septic shock, with mitral regurgitation and cardiac dysfunction. Early treatment with broad-spectrum antibiotics and hemodynamic support was essential for a favorable outcome. Because of the resurgence of virulent strains of GAS that can cause fatal infections, these pathogens should be included in the differential diagnosis of postpartum infections in the mother. Although cardiac dysfunction is rare in association with GAS infection, it should be ruled out by echocardiography when the condition of a patient with sepsis does not improve.

Sepsis puerperal tardía con shock séptico y disfunción cardiaca / Late-onset postpartum sepsis with septic shock and heart dysfunction

Presentamos el caso de una mujer de raza blanca de 37 años con diagnóstico de sepsis puerperal tardía por endometritis causada por estreptococo del grupo A (SGA) y shock séptico con insuficiencia mitral y disfunción cardiaca. La instauración precoz de antibioterapia de amplio espectro y soporte hemodinámico fue fundamental para la evolución favorable de la paciente. Debido al resurgir de cepas virulentas de SGA y las consecuencias fatales que pueden llegar a desencadenar, es importante incluir este microorganismo en el diagnóstico diferencial de las infecciones maternas relacionadas con el puerperio. La afectación cardiaca es poco frecuente en el contexto de infección por este microorganismo, sin embargo ante una sepsis con mala evolución el diagnóstico con ecocardiografía parece imprescindible para descartar disfunción cardiaca(AU)

We report a case of late-onset postpartum sepsis from endometritis due to group A streptococci (GAS) in a 37-year-old white woman. The patient developed septic shock, with mitral regurgitation and cardiac dysfunction. Early treatment with broad-spectrum antibiotics and hemodynamic support was essential for a favorable outcome. Because of the resurgence of virulent strains of GAS that can cause fatal infections, these pathogens should be included in the differential diagnosis of postpartum infections in the mother. Although cardiac dysfunction is rare in association with GAS infection, it should be ruled out by echocardiography when the condition of a patient with sepsis does not improve(AU)