Description of Intensive Care and Intermediate Care resources managed by Anaesthesiology Departments in Spain and their adaptation capacity during the COVID-19 pandemic.

INTRODUCTION: It is essential to understand the strategic importance of intensive care resources in the sustainable organisation of healthcare systems. Our objective has been to identify the intensive and intermediate care beds managed by Anaesthesiology and Resuscitation Services (A-ICU and A-IMCU) in Spain, their human and technical resources, and the changes made to these resources during the COVID-19 pandemic. MATERIAL AND METHODS: Prospective observational study performed between December 2020 and July 2021 to register the number and characteristics of A-ICU and A-IMCU beds in hospitals listed in the catalogue published by the Spanish Ministry of Health. RESULTS: Data were obtained from 313 hospitals (98% of all hospitals with more than 500 beds, 70% of all hospitals with more than 100 beds). One hundred and forty seven of these hospitals had an A-ICU with a total of 1702 beds. This capacity increased to 2107 (124%) during the COVID-19 pandemic. Three hundred and eight hospitals had an A-IMCU with a total of 3470 beds, 52.9% (2089) of which provided long-term care. The hospitals had 1900 ventilators, at a ratio of 1.07 respirators per A-ICU; 1559 anaesthesiologists dedicated more than 40% of their working time to intensive care. The nurse-to-bed ratio in A-ICUs was 2.8. DISCUSSION: A large proportion of fully-equipped ICU and IMCU beds in Spanish hospitals are managed by the anaesthesiology service. A-ICU and A-IMCUs have shown an extraordinary capacity to adapt their resources to meet the increased demand for intensive care during the COVID-19 pandemic.

Los equivalentes metabólicos estimados no se relacionan con el consumo máximo de oxígeno calculado en pacientes candidatos a cirugía de resección pulmonar / Estimated metabolic equivalents of task do not correlate with the maximal oxygen consumption of patients undergoing lung resection surgery

Antecedentes y objetivo: Los equivalentes metabólicos (MET) son una medida fisiológica que representa el coste metabólico de una actividad de la vida cotidiana. Un MET equivale al consumo metabólico en reposo. Los MET se pueden estimar mediante cuestionarios o calcular a partir de la medida del máximo consumo de oxígeno (VO2máx). El objetivo de este estudio es determinar si existe concordancia entre los MET estimados en la consulta de preanestesia (METSe) con los MET calculados a partir de VO2máx (METVO2). Pacientes y métodos: Estudio observacional retrospectivo en pacientes candidatos a cirugía de resección pulmonar. La estimación de los METSe se obtuvo en la consulta de preanestesia de acuerdo a las guías europeas y americanas de valoración cardiovascular preoperatoria en cirugía no cardiaca de 2014. El VO2máx se calculó en el laboratorio de ergometría. Resultados: Se incluyeron un total de 104 pacientes en el estudio, de los que 25 (24%) eran mujeres. La edad media fue de 65,1 años (±9,8). Veintiséis pacientes (25%) presentaron una clasificación concordante de METSe con METVO2 (κ=−0,107; p=0,02). En el resto de los pacientes, los METSe sobreestimaron la capacidad funcional medida por ergometría (METSe>METVO2). Conclusiones: La valoración subjetiva sobreestima la capacidad funcional y no debe reemplazar la realización de pruebas objetivas en pacientes propuestos para cirugía de resección pulmonar.(AU)

Background and objective: Metabolic equivalent of task (MET) is a physiological measure that represents the metabolic cost of an activity of daily living. One MET is equivalent to the resting metabolic rate. METs can be estimated by questionnaires or calculated by measuring maximal oxygen uptake (VO2max). The aim of this study is to determine whether METs estimated in the pre- consultation (METse) correlates with METs calculated from VO2max (METsVO2). Patients and methods: Retrospective observational study in patients scheduled for lung resection surgery. The estimation of METs was obtained in the pre- consultation according to the 2014 European and American guidelines for preoperative cardiovascular assessment in non-cardiac surgery. VO2max was calculated in the ergometry laboratory. Results: A total of 104 patients were included in the study, of whom 25 (24%) were female. The mean age was 65.1 years (±9.8). In 26 patients (25%), the METse classification correlated with METsVO2 (κ=−0.107; P=0.02). In the remaining patients, METse overestimated functional capacity measured by ergometry (METse>METsVO2). Conclusions: Subjective assessment overestimates functional capacity and should not replace objective testing in patients scheduled for lung resection surgery.(AU)

Estimated metabolic equivalents of task do not correlate with the maximal oxygen consumption of patients undergoing lung resection surgery.

BACKGROUND AND OBJECTIVE: Metabolic equivalent of task (MET) is a physiological measure that represents the metabolic cost of an activity of daily living. One MET is equivalent to the resting metabolic rate. METs can be estimated by questionnaires or calculated by measuring maximal oxygen uptake (VO2max). The aim of this study is to determine whether METs estimated in the pre-consultation (METse) correlates with METs calculated from VO2max (METsVO2). PATIENTS AND METHODS: Retrospective observational study in patients scheduled for lung resection surgery. The estimation of METs was obtained in the pre-consultation according to the 2014 European and American guidelines for preoperative cardiovascular assessment in non-cardiac surgery. VO2max was calculated in the ergometry laboratory. RESULTS: A total of 104 patients were included in the study, of whom 25 (24%) were female. The mean age was 65.1 years (±9.8). In 26 patients (25%), the METse classification correlated with METsVO2 (κ = -0.107 P = .02). In the remaining patients, METse overestimated functional capacity measured by ergometry (METse > METsVO2). CONCLUSIONS: Subjective assessment overestimates functional capacity and should not replace objective testing in patients scheduled for lung resection surgery.

Preoperative nutritional status assessed using the CONUT tool and its relationship with the appearance of major postoperative complications.

INTRODUCTION: Malnutrition is a risk factor for the appearance of major postoperative complications; therefore, early identification and perioperative optimization of surgical patients may improve postoperative outcomes. The objective of our study was to determine the prevalence of moderate or high under nutrition alerts in patients undergoing major non-cardiac surgery, and their relationship with the appearance of major postoperative complications. Nutritional status was calculated using the CONUT tool. MATERIAL AND METHODS: A retrospective observational study in 190 patients who underwent major non-cardiac surgery over two consecutive years. Preoperative nutritional status was calculated using CONUT, and the patients' medical records were reviewed to determine their epidemiological characteristics and major complications. RESULTS: The under nutrition alert was moderate in 17% of patients, and high in 10%. A high under nutrition alert was an independent risk factor for treatment with vasoactive drugs (OR 3.58; 95% CI 1.18-10.89; p = 0.025), respiratory support (OR 7.63; 95% CI 1.25-46.43; p = 0.027), renal support (OR 23.29; 95% CI 2.0-271.08; p = 0.012), prolonged hospital stay (Coef 20.16; 95% CI 2.10-38.22; p = 0.029) and higher in-hospital mortality (OR 7.15; 95% CI 1.31-39.02; p = 0.023). CONCLUSIONS: In total, 10% of patients who underwent major non-cardiac surgery presented serious preoperative deterioration in their nutritional status. A high under nutrition alert was an independent risk factor for the appearance of major postoperative complications.

Estado nutricional preoperatorio valorado mediante la herramienta CONUT y su relación con la aparición de complicaciones mayores postoperatorias / Preoperative nutritional status assessed using the CONUT tool and its relationship with the appearance of major postoperative complications

Introducción: La desnutrición es un factor de riesgo para la aparición de complicaciones mayores postoperatorias, por lo que una identificación precoz de los pacientes, acompañada de una optimización perioperatoria, puede relacionarse con una mejoría de los resultados. El objetivo de nuestro estudio fue conocer la prevalencia de alerta nutricional moderada o alta, calculada por el sistema CONUT, en los pacientes intervenidos de cirugía mayor no cardiaca y su relación con la aparición de complicaciones mayores postoperatorias. Material y métodos: Estudio retrospectivo observacional que incluyó 190 pacientes intervenidos de cirugía mayor no cardiaca en el periodo de dos años consecutivos, con alerta nutricional CONUT calculada previa a la intervención. Se revisaron las historias clínicas para conocer las características epidemiológicas de los pacientes así como las complicaciones mayores asociadas. Resultados: La prevalencia de alerta nutricional moderada fue del 17% y alta del 10%. Tener una alerta nutricional alta fue factor de riesgo independiente de necesidad de tratamiento con drogas vasoactivas (OR 3,58; IC 95% 1,18-10,89; p=0,025), terapia de soporte respiratorio (OR 7,63; IC 95% 1,25-46,43; p=0,027), soporte renal (OR 23,29; IC 95% 2,0-271,08; p=0,012), aumento de estancia hospitalaria (coef. 20,16; IC 95% 2,10-38,22; p=0,029) y mayor mortalidad durante el ingreso (OR 7,15; IC 95% 1,31-39,02; p=0,023). Conclusiones: El 10% de los pacientes que se intervinieron de cirugía mayor no cardiaca presentaron un deterioro preoperatorio grave del estado nutricional. Una alerta nutricional alta fue factor de riesgo independiente para la aparición de complicaciones mayores postoperatorias.(AU)

Introduction: Malnutrition is a risk factor for the appearance of major postoperative complications; therefore, early identification and perioperative optimization of surgical patients may improve postoperative outcomes. The objective of our study was to determine the prevalence of moderate or high under nutrition alerts in patients undergoing major non-cardiac surgery, and their relationship with the appearance of major postoperative complications. Nutritional status was calculated using the CONUT tool. Material and methods: A retrospective observational study in 190 patients who underwent major non-cardiac surgery over two consecutive years. Preoperative nutritional status was calculated using CONUT, and the patients’ medical records were reviewed to determine their epidemiological characteristics and major complications.ResultsThe under nutrition alert was moderate in 17% of patients, and high in 10%. A high under nutrition alert was an independent risk factor for treatment with vasoactive drugs (OR 3.58; 95% CI 1.18-10.89; p=.025), respiratory support (OR 7.63; 95% CI 1.25-46.43; p=.027), renal support (OR 23.29; 95% CI 2.0-271.08; p=.012), prolonged hospital stay (coef. 20.16; 95% CI 2.10-38.22; p=.029) and higher in-hospital mortality (OR 7.15; 95% CI 1.31-39.02; p=.023). Conclusions: In total, 10% of patients who underwent major non-cardiac surgery presented serious preoperative deterioration in their nutritional status. A high under nutrition alert was an independent risk factor for the appearance of major postoperative complications.(AU)

Preoperative nutritional status assessed using the CONUT tool and its relationship with the appearance of major postoperative complications. / Estado nutricional preoperatorio valorado mediante la herramienta CONUT y su relación con la aparición de complicaciones mayores postoperatorias.

INTRODUCTION: Malnutrition is a risk factor for the appearance of major postoperative complications; therefore, early identification and perioperative optimization of surgical patients may improve postoperative outcomes. The objective of our study was to determine the prevalence of moderate or high under nutrition alerts in patients undergoing major non-cardiac surgery, and their relationship with the appearance of major postoperative complications. Nutritional status was calculated using the CONUT tool. MATERIAL AND METHODS: A retrospective observational study in 190 patients who underwent major non-cardiac surgery over two consecutive years. Preoperative nutritional status was calculated using CONUT, and the patients' medical records were reviewed to determine their epidemiological characteristics and major complications. RESULTS: The under nutrition alert was moderate in 17% of patients, and high in 10%. A high under nutrition alert was an independent risk factor for treatment with vasoactive drugs (OR 3.58; 95% CI 1.18-10.89; p=.025), respiratory support (OR 7.63; 95% CI 1.25-46.43; p=.027), renal support (OR 23.29; 95% CI 2.0-271.08; p=.012), prolonged hospital stay (coef. 20.16; 95% CI 2.10-38.22; p=.029) and higher in-hospital mortality (OR 7.15; 95% CI 1.31-39.02; p=.023). CONCLUSIONS: In total, 10% of patients who underwent major non-cardiac surgery presented serious preoperative deterioration in their nutritional status. A high under nutrition alert was an independent risk factor for the appearance of major postoperative complications.

Incidence of electrocardiographic alterations in the preoperative period of non-cardiac surgery.

BACKGROUND: The electrocardiogram is the most widely used test to assess cardiovascular risk during the preoperative period. The objective of the present study is to evaluate the incidence of electrocardiographic alterations in the general population scheduled for non-cardiac surgery and to determine if the age greater than or equal to 65 years or the revised cardiac risk index ≥1 represent a risk factor for presenting these alterations. MATERIAL AND METHODS: Over a period of one month, all preoperative electrocardiograms (ECG) from the anesthesia clinic were analyzed. Various epidemiological data were collected and the revised cardiac risk index was calculated. Major alterations were defined as those requiring Cardiology follow-up. RESULTS: 476 patients were recruited, of whom 40.8% were ≥65 years, 32.6% had HTN, 14.4% DM and 27.9% dyslipidemia. 16.16% of the patients had a Lee Index ≥1. Of the entire sample, 80.5% had a normal ECG, 6.5% minor alterations and 13.0% major alterations. In the multivariate analysis, age ≥65 years and the presence of HTN were shown as independent risk factors for presenting alterations in the total and major ECG. The Lee index ≥1 was not associated with an increased risk of electrocardiographic abnormalities. CONCLUSIONS: Patients ≥65 years old and those with HTN are at greater risk of presenting major electrocardiographic abnormalities, so we recommend including the ECG as a routine diagnostic test in the preoperative period of non-cardiac surgery.

Incidencia de alteraciones electrocardiográficas en el preoperatorio de cirugía no cardiaca / Incidence of electrocardiographic alterations in the preoperative period of non-cardiac surgery

Antecedentes: El electrocardiograma es la prueba más utilizada para evaluar el riesgo cardiovascular durante el periodo preoperatorio. El objetivo del presente estudio es evaluar la incidencia de alteraciones electrocardiográficas en la población general programada para cirugía no cardiaca y determinar si la edad ≥ 65 años o el índice de riesgo cardiaco revisado ≥ 1 suponen un factor de riesgo para presentar dichas alteraciones. Material y métodos: Durante un periodo de un mes se analizaron todos los electrocardiogramas (ECG) preoperatorios de la consulta de anestesia. Se recogieron datos epidemiológicos y se calculó el índice de riesgo cardiaco revisado. Se definieron como alteraciones electrocardiográficas mayores aquellas que precisaban seguimiento por Cardiología. Resultados: Se reclutaron 476 pacientes, de los cuales 40,8% eran ≥ 65 años, 32,6% tenían HTA, 14,4% DM y 27,9% dislipemia. Un 16,16% de los pacientes tuvieron un índice de Lee ≥ 1.El 80,5% de los pacientes presentaban un ECG normal, el 6,5% alteraciones menores y el 13%, alteraciones mayores. En el análisis multivariante, la edad ≥ 65 años y la presencia de HTA se mostraron como factores de riesgo independiente para presentar alteraciones en el ECG totales y mayores.El índice de Lee ≥ 1 no se asoció con un mayor riesgo de alteraciones electrocardiográficas.ConclusiónLos pacientes ≥ 65 años o aquellos con HTA tienen mayor riesgo de presentar alteraciones electrocardiográficas mayores, por lo que recomendamos incluir en estos el ECG como prueba diagnóstica preoperatoria de rutina en cirugía no cardiaca.(AU)

BackgroundThe electrocardiogram is the most widely used test to assess cardiovascular risk during the preoperative period.The objective of the present study is to evaluate the incidence of electrocardiographic alterations in the general population scheduled for non-cardiac surgery and to determine if the age greater than or equal to 65 years or the revised cardiac risk index ≥ 1 represent a risk factor for presenting these alterations.Material and methods: Over a period of one month, all preoperative electrocardiograms (ECG) from the anesthesia clinic were analyzed. Various epidemiological data were collected and the revised cardiac risk index was calculated. Major alterations were defined as those requiring Cardiology follow-up.Results: 476 patients were recruited, of whom 40.8% were ≥ 65 years, 32.6% had HTN, 14.4% DM and 27.9% dyslipidemia. 16.16% of the patients had a Lee Index ≥ 1.Of the entire sample, 80.5% had a normal ECG, 6.5% minor alterations and 13.0% major alterations. In the multivariate analysis, age ≥ 65 years and the presence of HTN were shown as independent risk factors for presenting alterations in the total and major ECG.The Lee index ≥ 1 was not associated with an increased risk of electrocardiographic abnormalities.Conclusions: Patients ≥ 65 years old and those with HTN are at greater risk of presenting major electrocardiographic abnormalities, so we recommend including the ECG as a routine diagnostic test in the preoperative period of non-cardiac surgery.(AU)

Incidence of electrocardiographic alterations in the preoperative period of non-cardiac surgery. / Incidencia de alteraciones electrocardiográficas en el preoperatorio de cirugía no cardiaca.

BACKGROUND: The electrocardiogram is the most widely used test to assess cardiovascular risk during the preoperative period. The objective of the present study is to evaluate the incidence of electrocardiographic alterations in the general population scheduled for non-cardiac surgery and to determine if the age greater than or equal to 65 years or the revised cardiac risk index ≥ 1 represent a risk factor for presenting these alterations. MATERIAL AND METHODS: Over a period of one month, all preoperative electrocardiograms (ECG) from the anesthesia clinic were analyzed. Various epidemiological data were collected and the revised cardiac risk index was calculated. Major alterations were defined as those requiring Cardiology follow-up. RESULTS: 476 patients were recruited, of whom 40.8% were ≥ 65 years, 32.6% had HTN, 14.4% DM and 27.9% dyslipidemia. 16.16% of the patients had a Lee Index ≥ 1. Of the entire sample, 80.5% had a normal ECG, 6.5% minor alterations and 13.0% major alterations. In the multivariate analysis, age ≥ 65 years and the presence of HTN were shown as independent risk factors for presenting alterations in the total and major ECG. The Lee index ≥ 1 was not associated with an increased risk of electrocardiographic abnormalities. CONCLUSIONS: Patients ≥ 65 years old and those with HTN are at greater risk of presenting major electrocardiographic abnormalities, so we recommend including the ECG as a routine diagnostic test in the preoperative period of non-cardiac surgery.

Lung pulse visualized through pleural effusion as a diagnostic sign of complete obstructive atelectasis of the left lung in a critical patient with respiratory failure. / Pulso pulmonar visualizado a través de derrame pleural como signo diagnóstico de atelectasia obstructiva completa del pulmón izquierdo en paciente crítico con insuficiencia respiratoria.

Complete obstructive atelectasis occurs when mucous or a foreign body obstruct one of the main bronchi. Several lung ultrasound signs have been associated with this entity. We describe the case of a patient admitted to the surgical critical care unit in whom lung ultrasound led to a diagnosis of complete obstructive atelectasis, and the presence of pleural effusion provided direct visualization of lung pulse, a sign that has only previously been described by interpreting ultrasound artifacts.

Efectividad de un paquete de medidas para reducir las bacteriemias asociadas a catéter venoso central / Effectiveness of a bundle of measures for reducing central line-associated bloodstream infections

INTRODUCCIÓN: Las infecciones asociadas a catéter son la principal causa de bacteriemia nosocomial. El objetivo principal fue demostrar una posible disminución en las tasas de bacteriemia asociada a catéter venoso central (BACVC) del entorno perioperatorio tras implementar un paquete de medidas. El objetivo secundario fue determinar qué factores se asociaban a mayor riesgo de BACVC tras la implementación del paquete de medidas. MÉTODOS: El paquete de medidas consistió en: subclavia como acceso de elección, desinfección con clorhexidina alcohólica 2%, paño estéril de cuerpo entero, funda estéril para ecógrafo y check-list de inserción. La incidencia acumulada (IA) y densidad de incidencia (DI) de BACVC se compararon antes y después de la intervención. La asociación entre las características de pacientes o CVC y BACVC se resumieron mediante odds ratio e intervalos de confianza al 95%, obtenidos mediante regresión logística múltiple, ajustado por edad, sexo, comorbilidades y días con CVC. RESULTADOS: Antes de la implementación del paquete de medidas entre enero-noviembre de 2016 la IA de BACVC fue 5,05% y de DI 5,17‰. En el mismo periodo de 2018 la IA de BACVC fue 2,28% y de DI 2,27‰, suponiendo una reducción del 54% en IA (p = 0,072) y del 56% en DI (p = 0,068). En el análisis multivariable se asociaron a mayor riesgo de BACVC: reemplazo del CVC (OR: 11,01; IC 95%: 2,03-59,60, p = 0,005), 2 o más cateterizaciones (OR: 10,05; IC 95%: 1,77-57,16; p = 0,009) y nutrición parenteral (OR: 23,37; IC 95%: 4,37-124,91; p < 0,001). CONCLUSIONES: Las tasas de BACVC disminuyeron tras implementar el paquete de medidas de inserción. El reemplazo del CVC, 2 o más cateterizaciones y la nutrición parenteral se asociaron a BACVC tras implementar el paquete de medidas

INTRODUCTION: Catheter-associated infections are the main cause of nosocomial bacteremia. The main objective of this study was to demonstrate a possible decrease in CLABSI rates in perioperative environment after the implementation of a bundle of measures. Secondary objective was to determine which factors were associated with an increased risk of CLABSI, after the implementation of the bundle. METHODS: Insertion bundle consisted of: subclavian vein as access of choice, disinfection with alcoholic 2% chlorhexidine, central-line full body drapes, sterile ultrasound probe-cable covers and insertion check-list. Cumulative Incidence (CI) and Incidence Density Rate (IR) of CLABSIs were compared before and after the intervention. Associations between patient or CVC characteristic and CLABSI were summarized with odds ratios and 95% confidence interval, obtained from multiple logistic regression, adjusting for age, sex, comorbidities and days with CVC. RESULTS: Before implementing the bundle, from January to November 2016, CI of CLABSI was 5.05% and IR was 5.17 ‰. In the same period of 2018, CI of CLABSI was 2.28% and IR was 2.27 ‰, which means a reduction of 54.8% in CI (P=.072) and of 56% in IR (P=.068) In multivariable analyses, replacement of CVC was associated with a higher risk of CLABSI (OR 11.01, 95%CI 2.03-59.60, P=.005), as well as 2 or more catheterizations (OR 10.05, 95%CI 1.77-57.16, P=.009), and parenteral nutrition (OR 23.37, 95%CI 4.37-124.91, P<.001). CONCLUSIONS: CLABSI rates decreased after the implementation of the insertion bundle. CVC replacement, 2 or more catheterizations and parenteral nutrition were associated with CLABSI after bundle implementation

Effectiveness of a bundle of measures for reducing central line-associated bloodstream infections. / Efectividad de un paquete de medidas para reducir las bacteriemias asociadas a catéter venoso central.

INTRODUCTION: Catheter-associated infections are the main cause of nosocomial bacteremia. The main objective of this study was to demonstrate a possible decrease in CLABSI rates in perioperative environment after the implementation of a bundle of measures. Secondary objective was to determine which factors were associated with an increased risk of CLABSI, after the implementation of the bundle. METHODS: Insertion bundle consisted of: subclavian vein as access of choice, disinfection with alcoholic 2% chlorhexidine, central-line full body drapes, sterile ultrasound probe-cable covers and insertion check-list. Cumulative Incidence (CI) and Incidence Density Rate (IR) of CLABSIs were compared before and after the intervention. Associations between patient or CVC characteristic and CLABSI were summarized with odds ratios and 95% confidence interval, obtained from multiple logistic regression, adjusting for age, sex, comorbidities and days with CVC. RESULTS: Before implementing the bundle, from January to November 2016, CI of CLABSI was 5.05% and IR was 5.17 ‰. In the same period of 2018, CI of CLABSI was 2.28% and IR was 2.27 ‰, which means a reduction of 54.8% in CI (P=.072) and of 56% in IR (P=.068) In multivariable analyses, replacement of CVC was associated with a higher risk of CLABSI (OR 11.01, 95%CI 2.03-59.60, P=.005), as well as 2 or more catheterizations (OR 10.05, 95%CI 1.77-57.16, P=.009), and parenteral nutrition (OR 23.37, 95%CI 4.37-124.91, P<.001). CONCLUSIONS: CLABSI rates decreased after the implementation of the insertion bundle. CVC replacement, 2 or more catheterizations and parenteral nutrition were associated with CLABSI after bundle implementation.

Pro-adrenomedulina preoperatoria como predictor de la necesidad de soporte orgánico postoperatorio en pacientes programados para cirugía abdominal mayor / Pre-Operative pro-adrenomedullin as a predictor of postoperative requirement of organ support in patients scheduled for major abdominal surgery. A prospective observational pilot study

INTRODUCCIÓN: La región medial de la pro-adrenomedulina (MR-Pro-ADM) es un marcador de gravedad en un amplio espectro de enfermedades como la sepsis y la disfunción cardiovascular. Su utilidad como predictor de morbimortalidad en pacientes quirúrgicos aún no se ha dilucidado. Examinamos en este estudio la capacidad del valor preoperatorio de la MR-Pro-ADM para predecir la necesidad de soporte orgánico postoperatorio (SOP). MÉTODO: Estudio observacional prospectivo piloto, en un solo centro, que incluyó a pacientes adultos programados para cirugía abdominal mayor. La capacidad de la MR-Pro-ADM para predecir la necesidad de SOP se determinó por el análisis del área bajo la curva receiver operating characteristic (AUROC). Se realizó un análisis multivariante de regresión logística para determinar si el nivel de MR-pro-ADM identificado se asocia de forma independiente para la necesidad de SOP. RESULTADOS: Se reclutaron un total de 59 pacientes programados para cirugía abdominal mayor. La incidencia de SOP fue del 13,6%. Para la asociación entre los niveles de la MR-Pro-ADM y la incidencia de SOP se obtuvo un área bajo la curva ROC de 0,85 (IC 95%: 0,74-0,96; p = 0,002). El valor preoperatorio de la MR-Pro-ADM con la mejor combinación de sensibilidad y especificidad para predecir el SOP fue de 0,87nmol/l. Los pacientes con niveles séricos preoperatorios de la MR-Pro-ADM≥0,87nmol/l tuvieron una incidencia significativamente mayor de SOP (33,3 vs. 4,9%; p = 0,007). Niveles séricos preoperatorios de MR-Pro-ADM≥0,87nmol/l mostraron ser un factor independiente de riesgo en la necesidad de SOP (p = 0,001; OR: 9,758; IC 95%: 1,73-54,78) en el análisis multivariante. CONCLUSIÓN: El valor sérico preoperatorio de la MR-Pro-ADM puede ser un biomarcador útil del riesgo perioperatorio y de la necesidad de SOP en pacientes adultos programados para cirugía abdominal mayor

BACKGROUND: Mid-Regional-Pro-Adrenomedullin (MR-Pro-ADM) is a marker of severity in a wide spectrum of pathological conditions such as sepsis, and cardiovascular dysfunction. Its usefulness as a predictor of morbidity and mortality in surgical patients has yet to be elucidated. We examined the ability of preoperative MR-Pro-ADM in predicting Postoperative Requirement of Organ Support (PROS). METHODS: One centre, pilot, prospective observational cohort study, enrolling adult patients scheduled for major abdominal surgery. The accuracy of the MR-Pro-ADM to predict PROS was determined by area under the receiver operating characteristic curve (AUROC) analysis. An univariate analysis was performed to identify the association of PROS and the MR-Pro-ADM value with the best combination of sensitivity and specificity. A multivariate analysis was performed to identify preoperative MR-Pro-ADM as independent risk factor for PROS. RESULTS: A total of 59 patients scheduled for major abdominal surgery were enrolled. The incidence of PROS was 13.6%. The association of MR-Pro-ADM levels with the incidence of PROS, was determined by an area under the ROC curve of 0.85 (95% CI: 0.74-0.96, p = 0.002). The preoperative value of MR-Pro-ADM with the best combination of sensitivity and specificity to predict PROS was 0.87 nmol/l. Patients with preoperative serum levels of MR-Pro-ADM≥0.87 nmol/l had a significantly higher incidence of PROS (33.3% vs 4.9%, p = 0.007). MR-Pro-ADM≥0.87 nmol/l was shown to be an independent risk factor for PROS (p = 0.001; OR 9.758; IC 1.73-54.78) in the multivariate analysis. CONCLUSION: The preoperative serum level of MR-Pro-ADM may be a useful biomarker of perioperative risk and to predict postoperative requirement of organic support (PROS) in adult patients scheduled for major abdominal surgery

Eliminación extracorpórea de CO2 en un caso de síndrome de distrés respiratorio por sepsis / Extracorporeal CO2 removal in a case of respiratory distress syndrome by sepsis

El síndrome de disfunción multiorgánica es la causa más frecuente de mortalidad en las unidades de cuidados intensivos. Los pulmones y los riñones son 2 órganos frecuentemente afectados, por lo que hasta el 60% de los pacientes precisan simultáneamente soporte respiratorio y terapia de sustitución renal. En la actualidad se han desarrollado sistemas de eliminación extracorpórea de CO2 con el objetivo de reducir la incidencia de lesión pulmonar aguda, que pueden ser combinados con terapias de soporte renal en pacientes con disfunción de ambos órganos. Presentamos un caso de shock séptico de origen respiratorio con fracaso renal y síndrome de distrés respiratorio, en el que se llevó a cabo terapia de eliminación extracorpórea de CO2 que permitió facilitar pautas de ventilación de protección con una disminución del volumen corriente hasta 4ml/kg y una reducción de la presión meseta por debajo de 30cmH20, con valores de PaCO2 inferiores a 60mmHg

Multiorgan dysfunction syndrome is the most common cause of mortality in intensive care units. The lungs and kidneys are frequently affected, so up to 60% of patients require simultaneous respiratory support and renal replacement therapy. Extracorporeal CO2 elimination systems have now been developed with the aim of reducing the incidence of acute lung injury. These systems can be combined with renal support therapies in patients with dysfunction of both organs. We present a case of respiratory septic shock with renal failure and respiratory distress syndrome, in which extracorporeal elimination of CO2 therapy facilitated the use of protective ventilation, with a low tidal volume of 4ml/kg, plateau pressure below 30cmH2O, and PaCO2 values of less than 60mmHg

Pre-Operative pro-adrenomedullin as a predictor of postoperative requirement of organ support in patients scheduled for major abdominal surgery. A prospective observational pilot study. / Pro-adrenomedulina preoperatoria como predictor de la necesidad de soporte orgánico postoperatorio en pacientes programados para cirugía abdominal mayor.

BACKGROUND: Mid-Regional-Pro-Adrenomedullin (MR-Pro-ADM) is a marker of severity in a wide spectrum of pathological conditions such as sepsis, and cardiovascular dysfunction. Its usefulness as a predictor of morbidity and mortality in surgical patients has yet to be elucidated. We examined the ability of preoperative MR-Pro-ADM in predicting Postoperative Requirement of Organ Support (PROS). METHODS: One centre, pilot, prospective observational cohort study, enrolling adult patients scheduled for major abdominal surgery. The accuracy of the MR-Pro-ADM to predict PROS was determined by area under the receiver operating characteristic curve (AUROC) analysis. An univariate analysis was performed to identify the association of PROS and the MR-Pro-ADM value with the best combination of sensitivity and specificity. A multivariate analysis was performed to identify preoperative MR-Pro-ADM as independent risk factor for PROS. RESULTS: A total of 59 patients scheduled for major abdominal surgery were enrolled. The incidence of PROS was 13.6%. The association of MR-Pro-ADM levels with the incidence of PROS, was determined by an area under the ROC curve of 0.85 (95% CI: 0.74-0.96, p=0.002). The preoperative value of MR-Pro-ADM with the best combination of sensitivity and specificity to predict PROS was 0.87 nmol/l. Patients with preoperative serum levels of MR-Pro-ADM≥0.87 nmol/l had a significantly higher incidence of PROS (33.3% vs 4.9%, p=0.007). MR-Pro-ADM≥0.87 nmol/l was shown to be an independent risk factor for PROS (p=0.001; OR 9.758; IC 1.73-54.78) in the multivariate analysis. CONCLUSION: The preoperative serum level of MR-Pro-ADM may be a useful biomarker of perioperative risk and to predict postoperative requirement of organic support (PROS) in adult patients scheduled for major abdominal surgery.

Extracorporeal CO2 removal in a case of respiratory distress syndrome by sepsis. / Eliminación extracorpórea de CO2 en un caso de síndrome de distrés respiratorio por sepsis.

Multiorgan dysfunction syndrome is the most common cause of mortality in intensive care units. The lungs and kidneys are frequently affected, so up to 60% of patients require simultaneous respiratory support and renal replacement therapy. Extracorporeal CO2 elimination systems have now been developed with the aim of reducing the incidence of acute lung injury. These systems can be combined with renal support therapies in patients with dysfunction of both organs. We present a case of respiratory septic shock with renal failure and respiratory distress syndrome, in which extracorporeal elimination of CO2 therapy facilitated the use of protective ventilation, with a low tidal volume of 4ml/kg, plateau pressure below 30cmH2O, and PaCO2 values of less than 60mmHg.