SEMICYUC 2012. Recommendations for intensive care management of acute pancreatitis.

OBJECTIVE: Significant changes in the management of acute pancreatitis have taken place since the 2004 Pamplona Consensus Conference. The objective of this conference has been the revision and updating of the Conference recommendations, in order to unify the integral management of potentially severe acute pancreatitis in an ICU. PARTICIPANTS: Spanish and international intensive medicine physicians, radiologists, surgeons, gastroenterologists, emergency care physicians and other physicians involved in the treatment of acute pancreatitis. LEVELS OF EVIDENCE AND GRADES OF RECOMMENDATION: The GRADE method has been used for drawing them up. DRAWING UP THE RECOMMENDATIONS: The selection of the committee members was performed by means of a public announcement. The bibliography has been revised from 2004 to the present day and 16 blocks of questions on acute pancreatitis in a ICU have been drawn up. Firstly, all the questions according to groups have been drawn up in order to prepare one document. This document has been debated and agreed upon by computer at the SEMICYUC Congress and lastly at the Consensus Conference which was held with the sole objective of drawing up these recommendations. CONCLUSIONS: Eighty two recommendations for acute pancreatitis management in an ICU have been presented. Of these 84 recommendations, we would emphasize the new determinants-based classification of acute pancreatitis severity, new surgical techniques and nutritional recommendations. Note. This summary only lists the 84 recommendations of the 16 questions blocks except blocks greater relevance and impact of its novelty or because they modify the current management.

[Diagnostic value of quantitative cultures of endotracheal aspirate in ventilator-associated pneumonia: a multicenter study]. / Valor diagnóstico del cultivo cuantitativo del aspirado endotraqueal en la neumonía adquirida durante la ventilación mecánica. Estudio multicéntrico.

OBJECTIVE: To study the validity of quantitative cultures of tracheal aspirate (TA) in comparison with the plugged telescoping catheter (PTC) for the diagnosis of mechanical ventilator-associated pneumonia. METHOD: Prospective multicenter study enrolling patients undergoing mechanical ventilation for longer than 72 hours. TA samples were collected from patients with suspected ventilator-associated pneumonia, followed by PTC sampling. Quantitative cultures were performed on all samples. Patients were classified according to the presence or not of pneumonia, based on clinical and radiologic criteria, clinical course and autopsy findings. The cutoff points were > or = 103 colony-forming units (cfu)/mL for PTC cultures; the TA cutoffs analyzed were > or = 105 and > or = 106 cfu/mL. RESULTS: Of the 120 patients studied, 84 had diagnoses of pneumonia and 36 did not (controls). The sensitivity values for TA > or = 106, TA > or = 105, and PTC, respectively, were 54% (95% confidence interval [CI], 42%-64%), 71% (95% CI, 60%-81%), and 68% (95% CI, 57%-78%). The specificity values were 75% (95% CI, 58%-88%), 58% (95% CI, 41%-74%), and 75% (95% CI, 58%-88%), respectively. Staphylococcus aureus was the microorganism most frequently isolated in both TA and PTC samples, followed in frequency by Pseudomomonas aeruginosa in TA samples and Haemophilus influenzae in PTC samples. No significant differences were found between the sensitivity of TA > or = 105 and that of PTC, nor between the specificities of TA > or = 106 and PTC. CONCLUSIONS: No differences in the specificities of PTC and TA were found when a TA cutoff of > or = 106 cfu/ml was used. Moreover, at a cutoff of > or = 105 the sensitivity of TA was not statistically different from that of PTC. Quantitative cultures of TA can be considered acceptable for the diagnosis of ventilator-associated pneumonia.

Valor diagnóstico del cultivo cuantitativo del aspirado endotraqueal en la neumonía adquirida durantela ventilación mecánica. Estudio multicéntrico / Diagnostic value of quantitative cultures of endotracheal aspirate in ventilator-associated pneumonia: a multicenter study

OBJETIVO: Estudiar la validez del aspirado traqueal (AT) con cultivos cuantitativos y compararla con el catéter telescopado (CTP) en el diagnóstico de la neumonía relacionada con la ventilación mecánica (NVM). MÉTODO: Estudio prospectivo y multicéntrico en el que se incluyó a pacientes sometidos a ventilación mecánica durante más de 72 h. A los pacientes con sospecha clínica de NVM se les realizaron AT y posteriormente CTP. A todas estas muestras se les practicó un cultivo cuantitativo. De acuerdo con criterios clínicos, radiológicos, de seguimiento y autópsicos se dividieron los pacientes en casos con neumonía y sin neumonía (controles). Se escogió como punto de corte para el CTP 103 unidades formadoras de colonias (ufc)/ml y para el AT se evaluó con 105 y > 106 ufc/ml, respectivamente. RESULTADOS: Se estudió a 120 pacientes; se consideró que 84 presentaban neumonía y 36 no la presentaban (controles). La sensibilidad fue del 54 por ciento (intervalo de confianza [IC] del 95 por ciento, 42-64 por ciento), el 71 por ciento (IC del 95 por ciento, 60-81 por ciento) y el 68 por ciento (IC del 95 por ciento, 57-78 por ciento) para AT 106, AT 105 y CTP, respectivamente. Las especificidades encontradas fueron del 75 por ciento (IC del 95 por ciento, 58 - 88 por ciento), el 58 por ciento (IC del 95 por ciento, 41-74 por ciento) y el 75 por ciento (IC del 95 por ciento, 58 -88 por ciento), respectivamente. El organismo aislado más frecuentemente fue Staphylococcus aureus tanto por AT como por CTP, seguido por Pseudomomonas aeruginosa en AT y por Haemophilus influenzae en CTP. No se encontraron diferencias significativas entre la sensibilidad del AT 105 y del CTP, y tampoco con las especificidades del AT 106 y el CTP. CONCLUSIONES: Cuando se utiliza un punto de corte de 106 ufc/ml o mayor para el AT en el diagnostico de la NVM se obtienen porcentajes de especificidad similares a los obtenidos con el CTP, y con el punto de corte 105 o mayor, porcentajes de sensibilidad aceptables. Los cultivos cuantitativos del AT pueden considerarse aceptables en el diagnóstico de la NVM (AU)