OBJECTIVE Diagnosing nosocomial meningitis (NM) in neurosurgical patients is difficult. The standard CSF test is not optimal and when it is obtained, CSF cultures are negative in as many as 70% of ...cases. The goal of this study was to develop a diagnostic prediction rule for postoperative meningitis using a combination of clinical, laboratory, and CSF variables, as well as risk factors (RFs) for CNS infection. METHODS A cross-sectional study was performed in 4 intensive care units in Medellín, Colombia. Patients with a history of neurosurgical procedures were selected at the onset of febrile symptoms and/or after an increase in acute-phase reactants. Their CSF was studied for suspicion of infection and a bivariate analysis was performed between the dependent variable (confirmed/probable NM) and the identified independent variables. Those variables with a p value ≤ 0.2 were fitted in a multiple logistic regression analysis with the same dependent variable. After determining the best model according to its discrimination and calibration, the β coefficient for each selected dichotomized variable obtained from the logistic regression model was used to construct the score for the prediction rule. RESULTS Among 320 patients recruited for the study, 154 had confirmed or probable NM. Using bivariate analysis, 15 variables had statistical associations with the outcome: aneurysmal subarachnoid hemorrhage (aSAH), traumatic brain injury, CSF leak, positioning of external ventricular drains (EVDs), daily CSF draining via EVDs, intraventricular hemorrhage, neurological deterioration, age ≥ 50 years, surgical duration ≥ 220 minutes, blood loss during surgery ≥ 200 ml, C-reactive protein (CRP) ≥ 6 mg/dl, CSF/serum glucose ratio ≤ 0.4 mmol/L, CSF lactate ≥ 4 mmol/L, CSF leukocytes ≥ 250 cells, and CSF polymorphonuclear (PMN) neutrophils ≥ 50%. The multivariate analysis fitted a final model with 6 variables for the prediction rule (aSAH diagnosis: 1 point; CRP ≥ 6 mg/dl: 1 point; CSF/serum glucose ratio ≤ 0.4 mmol/L: 1 point; CSF leak: 1.5 points; CSF PMN neutrophils ≥ 50%: 1.5 points; and CSF lactate ≥ 4 mmol/L: 4 points) with good calibration (Hosmer-Lemeshow goodness of fit = 0.71) and discrimination (area under the receiver operating characteristic curve = 0.94). CONCLUSIONS The prediction rule for diagnosing NM improves the diagnostic accuracy in neurosurgical patients with suspicion of infection. A score ≥ 6 points suggests a high probability of neuroinfection, for which antibiotic treatment should be considered. An independent validation of the rule in a different group of patients is warranted.
Extubation failure (EF) occurs in 2–25% of ICU patients. Our objective was to develop an EF predictive model.
We performed a retrospective cohort study in a medical-surgical ICU with 40 beds at a ...University Hospital. Were analyzed 1017 patients, from January 2010 to December 2014, all over 16 years old, undergoing invasive ventilation for more than 24 h, and successful spontaneous breathing test (SBT). Seventeen variables were evaluated; we utilized logistic regression analysis with an evaluation of discrimination and calibration based on the area under the ROC curve (AUC-ROC) and the Hosmer-Lemeshow's goodness-of-fit test (Chi2 H-L), respectively.
Extubation failure was present in 157 patients (15.4%); we developed a predictive model that included PaO2/FIO2 ratio ≤ 237.5, hemoglobin ≤9.5 g, accumulated fluid balance > 6022 ml, APACHE II > 16, blood urea nitrogen > 22.5 mg/dl and the presence of cardiopulmonary diagnostics. This model exhibited an AUC-ROC = 0.689 and a Chi2 H-L, p = 0.579.
This study presents a risk score with an estimated probability of EF based on a multivariate predictive model. Due to the strong limitation of our retrospective study, however, it is necessary for an independent prospective cohort to improve discrimination and to prove the model applicability.
•One hundred fifty seven patients presented Extubation Failure of 1017 (15.4%), 43 (4.2%) were re-intubated and 114 (11.2%) had rescue Noninvasive Ventilation in the last 48 h after extubation.•In both the stepwise algorithm and the backward exclusion procedure, the six best Extubation Failure predictors were PaO2/FIO2 ratio, hemoglobin, APACHE II, accumulated fluid balance, cardiopulmonary diagnostic and BUN.•The study identified a cut-off point through an ROC curve for this predictors: BUN: 22.5 mg/dl, PaO2/FIO2 ratio: 237.5, APACHE II: 16.5, accumulated fluid balance: 6022 ml and hemoglobin: 9.55 gm/dl.•The predictors were become in a respective scores, the final score shows Extubation Failure risk groups according to their probability.•The analysis with a high probability of Extubation Failure (>15%) found a sensitivity of 61%, specificity of 64%, positive predictive value of 23%, negative predictive value of 90% and a positive Likelihood Ratio of 1.71.
La pancreatitis aguda es un proceso inflamatorio del páncreas, manifestado por dolor abdominal, y causado en un gran porcentaje de casos por cálculos en las vías biliares.
Se evaluaron 43 historias ...clínicas de pacientes con pancreatitis aguda, diagnosticados por medio de los hallazgos clínicos, enzimas pancreáticas y tomografía.
Veintiún pacientes eran mujeres y 22 hombres, la edad media fue de 67,7 años, 21 pacientes tenían evidencia de patología biliar concomitante (48,8%). La incidencia de ingresos en la Unidad de Cuidados Intensivos de pacientes con pancreatitis aguda fue del 0,79%, la mortalidad de 18,6%. Existe una asociación del uso de inotrópicos (87,5 vs. 37,1%, p=0,016), altos niveles de BUN y creatinina al egreso con la mortalidad (48 vs. 15 y 2,75 vs. 0,7, p=0,000 y 0,000). Todos los fallecidos tuvieron ventilación mecánica y solo el 37,1% de los sobrevivientes (p=0,001). También se encontró una estricta asociación de los niveles de bilirrubinas y transaminasas hepáticas con la presencia de patología biliar demostrada con ecografía y tomografía abdominal.
Acute pancreatitis is an inflammatory event in the pancreas; abdominal pain is the main symptom. Pancreatitis is started by gallstone in most cases.
Forty-three charts of patients with acute pancreatitis were analyzed; clinic evaluation, pancreatic enzymes and tomography established the diagnosis.
The analysis showed 21 female patients and 22 male, the average age was 67.6 years and 21 patients had biliary diseases; the incidence of patients admitted to intensive care unit was 0.79% and a mortality of 18.6%. There is an association between inotrope agent use (87.5 vs. 37.1%, p=.016), high level of blood urea nitrogen and creatinine at discharge of intensive care unit (48 vs. 15 y 2.75 vs. 0.7, p=.000 y .000) with mortality. Similarly, the use of mechanical ventilation was associated to mortality (100 vs. 37.1%, p=.001). The high level of hepatic enzymes (bilirubin and transaminases) was associated with biliary diseases diagnosed by ultrasound or tomography (concomitant with pancreatitis).
En pacientes con hemorragia intracerebral (HIC) aguda, evaluar el resultado en mortalidad, discapacidad y cambio en el volumen del hematoma cuando se hace manejo intensivo vs. conservador de la ...presión arterial.
Revisión sistemática y metaanálisis donde se revisaron las bases de datos Cochrane central, MEDLINE y EMBASE hasta el 20 de julio del 2016.
Pacientes con HIC en cuidados intensivos.
Ensayos clínicos aleatorizados en pacientes con HIC.
Control intensivo de la presión arterial (PAS < 140mmHg), comparado con manejo conservador de la presión (PAS < 180mmHg).
Discapacidad, mortalidad y aumento de tamaño del volumen del hematoma.
Identificamos 5 estudios aleatorizados (n = 4.360) con una adecuada calidad metodológica para combinar en el metaanálisis. La mortalidad a 90 días para tratamiento intensivo vs. conservador presentó un RR de 0,98; IC95%: 0,82-1,16; p = 0.94, I2 = 0% por el modelo de efectos fijos y aleatorio. La discapacidad para tratamiento intensivo vs. conservador a los 90 días presentó un RR de 1,0; IC95%: 0,93-1,08; p = 0,90, I2 = 0% por el modelo de efectos fijos y aleatorio. El aumento del volumen del hematoma mayor del 30% en manejo intensivo vs. conservador reveló un RR de 0,87; IC95%: 0,69-1,10; p = 0,15, I2 = 41% por el modelo de efectos aleatorios.
En los pacientes con HIC el manejo dirigido hacia el control estricto de la presión arterial no impacta en forma favorable la mortalidad, la discapacidad o el cambio en el volumen del hematoma.
The aim of this study was to compare intensive (systolic BP < 140 mmHg) versus conventional blood pressure management (systolic BP < 180 mmHg), in patients with acute intracerebral haemorrhage; our clinical outcomes were: mortality, disability, and haematoma expansion more than 30% at 24hours.
We performed a systematic review and meta-analysis. A search was made in Cochrane central, MEDLINE, and EMBASE databases up 20 July 2016. High-quality randomised controlled trials with intensive blood pressure monitoring versus conventional therapy were chosen.
Five high-quality randomised controlled trials with 4360 patients were included in the Meta-Analyses. The mortality at 90 days showed a RR: 0.98; 95% CI: 0.82-1.16; P=.94, I2= 0%. The disability showed a RR: 1.0; 95% CI: 0.93-1.08; P=.90, I2= 0%. The hematoma expansion more than 30% at 24hours showed a RR: 0.87; 95% CI0.69-1.10; P=.15, I2= 41%.
In patients with acute intracerebral haemorrhage, intensive blood pressure management or conventional therapy could be similar when the outcomes measured are: mortality at 90 days, disability (Rankin scale), and haematoma expansion.
Las enfermedades cardiovasculares son la primera causa de muerte, ameritando numerosos procedimientos quirúrgicos para su manejo. En Colombia existen datos insuficientes sobre la epidemiología y los ...factores de riesgo de este grupo poblacional.
Explorar factores asociados a mortalidad en pacientes sometidos a cirugía cardiaca.
Estudio observacional de cohorte, pacientes mayores de 18años, con cirugía cardiovascular entre abril de 2009 y febrero de 2016, en la clínica CardioVid de Medellín. Se realizó: análisis descriptivo de variables independientes, análisis bivariado con el desenlace mortalidad en UCI, y finalmente un análisis multivariado logístico para identificar asociación independiente entre esas variables y la mortalidad.
Analizamos 709 pacientes. La mortalidad fue del 4,2% (30/709). En el análisis bivariado, la edad, la EPOC, la falla cardíaca, la hipertensión arterial, la falla renal previa, las transfusiones, el uso de catéter de la arteria pulmonar y el tiempo de intubación tuvieron asociación estadística con el desenlace. Al realizar el análisis multivariado, la edad (OR: 1.045; p=0,021), la falla cardíaca preoperatoria (OR: 4,64; p=0,000), el uso de transfusiones durante la cirugía (OR: 7,11; p=0,003), el uso de coloides durante la cirugía (OR: 1,0; p=0,007) y la falla renal preoperatoria (OR: 3,567; p=0,007) tuvieron asociación significativa con la mortalidad.
En los pacientes analizados, la edad, la falla cardíaca previa, el uso de derivados sanguíneos durante la cirugía, el uso de coloides durante la cirugía y la falla renal preoperatoria son factores de riesgo asociados a mortalidad.
Cardiac diseases are the first cause of death in the world. Cardiac surgery is increasing every year. Few studies have been conducted on morbidity and mortality after cardiac surgery in Colombia.
To determine the risk factors related to mortality in cardiac surgery.
A study was conducted on a cohort of patients older than 18years with cardiac surgery in a university hospital from 2009 to 2016. Bivariate and logistic regression analysis was used to determine risk factors associated with mortality.
The incidence of mortality was 4.2% in 709 patients. The bivariate and multivariate analysis showed 5 risk factors associated with mortality: age (OR: 1.045; P=.021), cardiac failure before the surgery (OR: 4.64; P=.000), need of transfusions (OR: 7.11; P=.003), use of colloids during the surgery (OR: 1.0; P=.007), and renal failure before the surgery (OR: 3.567; P=.007).
The age, cardiac failure before the surgery, the need of transfusions during the surgery, colloid use during the surgery, and renal failure before the surgery, are risk factors associated with intensive care unit mortality after cardiac surgery.
Neumonía organizada criptogénica: un caso clínico Sará Ochoa, Jorge Eliécer; Flórez Posada, Harvey Andrés; Hernández Ortiz, Olga ...
Acta Colombiana de Cuidado Intensivo,
April-June 2017, 2017-04-00, Volume:
17, Issue:
2
Journal Article
Peer reviewed
La neumonía organizada criptogénica hace parte de las neumonías intersticiales idiopáticas.
Reportamos el caso de un paciente de 49 años de edad con diagnóstico confirmado de neumonía organizada ...criptogénica; cuadro clínico consistente en tos, dificultad respiratoria, fiebre y pérdida de peso de un mes de evolución; hallazgos tomográficos con presencia de consolidaciones subpleurales bilaterales y vidrio esmerilado, en especial en los lóbulos inferiores; reporte histológico con inflamación crónica y patrón de neumonía organizada. Soporte ventilatorio mecánico por 61 días; manejado con antibióticos empíricos, antimicóticos y esteroides; complicado por fístula pleural, neumonía e infección de vías urinarias nosocomiales; finalmente fue dado de alta con resolución de su patología.
The cryptogenic organizing pneumonia was included in the idiopathic interstitial pneumonias group.
We reported a case of a 49 years old male patient with diagnosis of cryptogenic organizing pneumonia. The clinical features were cough, respiratory difficulty, fever, and weight loss during the last month. Peripheral consolidation and ground glass in the lower lung lobes on the computed tomography. The histologic performance was a chronic inflammation and organizing pneumonia. The patient had mechanical ventilation for 61 days. He was treated with antibiotics, antifungal and steroids. He had pleural fistula, nosocomial pneumonia and urinary infection. Finally, he was discharged at home.
El virus H1N1 es mutante de la influenza humana, porcina y aviar; ha generado 4 pandemias en los últimos 100 años, la gravedad e incertidumbre para diagnosticarlos hace especial a estos pacientes, ...muchos de ellos deben manejarse en cuidados intensivos, principalmente por fallo respiratorio.
Presentamos 58 pacientes con sospecha de neumonía por H1N1, manejados en cuidados intensivos, pero solo en 11 pacientes se confirmó el diagnóstico.
Se evidenció una diferencia significativa en la mediana de la estancia en cuidados intensivos (10 días vs. 3,5 días; p=0,00), cociente de presión arterial de oxígeno/fracción inspirada de oxígeno (114,1 vs. 79; p=0,013), APACHE II (17 vs. 25; p=0,001) y tiempo de síntomas previos a la consulta (8 días vs. 5 días; p=0,007), al comparar el grupo sobrevivientes con fallecidos, respectivamente. El grupo con diagnóstico de H1N1 presentó una mediana significativamente más baja del cociente presión arterial de oxígeno/fracción inspirada de oxígeno, al ingresar a cuidados intensivos (74,3 vs. 112,1; p=0,009).
El grupo de pacientes con fallo respiratorio que mueren, presentan un mayor puntaje APACHE II; menor tiempo desde el inicio de los síntomas y la consulta, menor relación PaO2/FiO2, menor tiempo de estancia en la UCI y su procedencia es del área rural. Los pacientes admitidos en la UCI con fallo respiratorio y diagnóstico de H1N1, presentan un cociente de presión arterial de oxígeno/fracción inspirada de oxígeno al ingreso, significativamente menor que en los que no se confirma el diagnóstico.
H1N1 virus is a mutant of human, swine, and avian influenza. It has generated 4 pandemics in the last century. The seriousness and uncertainty of the diagnosis makes these patients special, many of whom have to be admitted to the ICU, mainly due to respiratory failure.
The cases are presented on 58 pneumonia patients suspected of H1N1 admitted to the ICU. H1N1 diagnosis was confirmed in only 11 of the patients.
There was a significant difference in the median stay in the ICU (10 days vs. 3.5 days, P=.00), partial pressure arterial oxygen (PaO2)/fraction inspired oxygen (FiO2) ratio (114.1 vs. 79 P=.013), APACHE II (17 vs. 25, P=.001), and time without symptoms prior to consultation (8 days vs. 5 days, P=.007) when comparing the number of deceased with the number of survivors. The groups with H1N1 diagnosis showed a significantly lower median of PaO2/FiO2 (74.3 vs. 112.1, P=.009) in the ICU.
The group of patients with respiratory failure who died showed a higher APACHE II score, less time lapse between the onset of symptoms and consultation, a lower PaO2/FiO2 ratio, a lower stay in the ICU, and they came from rural areas. The patients admitted to the ICU for respiratory failure and a confirmed H1N1 diagnosis show a much lower PaO2/FiO2 ratio than the patients without a confirmed H1N1 diagnosis.
El mecanismo deglutorio es dirigido por 6 nervios craneales y más de 30 pares de músculos. Los trastornos deglutorios se presentan en el 40-85% de los pacientes ventilados mecánicamente y con ...traqueostomía. La dificultad deglutoria termina en deshidratación, malnutrición y neumonía. El fortalecimiento de la musculatura deglutoria es la vía apropiada para restablecer la eficiencia de este mecanismo.
Presentamos 17 pacientes con terapia de fortalecimiento de la musculatura deglutoria, después del diagnóstico de disfagia; antecedentes de soporte ventilatorio, intubación orotraqueal y traqueostomía; la edad media era de 63,4 años, 9 mujeres, un promedio de 15 días con soporte ventilatorio mecánico invasivo; una media de traqueostomía de 5,6 días hasta el inicio de la terapia; tiempo medio de terapia fonoaudiológica de 25,4 días, y Glasgow de 15 al momento de iniciar la terapia. Finalmente, un paciente falleció durante la hospitalización (5,8%), sin tolerar decanulación, ni vía oral; 16 pacientes toleraron alimentación oral y 12 toleraron decanulación después del manejo (70,6%); la media de estancia en unidad de cuidados intensivos fue de 39,4 días y en hospitalización general de 4,9 días.
Se obtuvo resultado satisfactorio en el restablecimiento del mecanismo de deglución en el 94,2% de los pacientes y decanulación exitosa en el 70,6%; la terapia de fortalecimiento de la musculatura deglutoria es el primer paso en el manejo de los pacientes con trastornos de la deglución en la unidad de cuidados intensivos; el manejo interdisciplinario entre el personal médico, de enfermería y fonoaudiología, para restablecer la deglución fisiológica, devuelve la buena calidad de vida al paciente.
The swallowing mechanism is controlled by 6 cranial nerves and more than 30 pairs of muscles. Swallowing problems are seen in 40% to 85% of patients both with tracheostomy and mechanical ventilation. These problems lead to dehydration, malnutrition and pneumonia. Strengthening the muscles involved in swallowing is necessary in order to restore the efficiency of the deglutition mechanism.
The cases are presented of 17 patients, who received swallowing muscles strengthening therapy. The patients were diagnosed with dysphagia and had a history of ventilatory support and tracheal intubation. The median age was 63.4 years, and 9 of the patients were women. The patients had invasive mechanical ventilation for a mean of 15 days, a median of 5.6 days of tracheostomy, a median of 25.4 days of speech and language therapy, and a Glasgow score of 15 by the time therapy started. One of the patients finally died during hospitalisation, rejecting both decannulation and oral feeding. Oral feeding was tolerated by 16 patients, and 12 tolerated decannulation (70.6%). The median stay in the intensive care unit was 39.4 days, and 4.9 days on a ward.
The swallowing mechanism was successfully re-established in 94.2% of the patients, and successful decannulation was achieved in 70.6%. Therapy to strengthen the swallowing muscles is the first step in treating patients with these problems in the intensive care unit. Teamwork between the physicians, nursing staff, and speech-language pathologists is essential in giving the patients a good quality of life
EL uso de la ventilación mecánica no invasiva durante la extubación se ha incrementado, pero no es totalmente clara la evidencia que soporta su uso y condición clínica.
Evaluar la eficacia de la ...ventilación mecánica no invasiva profiláctica, comparada con la oxigenoterapia estándar, en pacientes en liberación de la ventilación invasiva y prueba de respiración espontánea superada.
Búsqueda sistemática en PubMed, EMBASE y LILACS, sin restricción de idiomas.
Ensayos clínicos aleatorios que comparen el uso de ventilación mecánica no invasiva, con oxigenoterapia estándar, para disminuir la falla ventilatoria postextubación, reintubación, estancia en UCI, estancia en hospitalización, mortalidad en UCI, mortalidad en hospitalización o mortalidad a los 90 días.
Tres evaluadores independientemente extrajeron los datos y evaluaron la calidad de acuerdo a los criterios previstos; se realizó el análisis estadístico con el programa RevMan 5.3.
Se identificaron 7 ensayos clínicos de moderada a buena calidad metodológica, con 969 pacientes en total. Comparada con oxigenoterapia estándar, la ventilación mecánica no invasiva reduce la reintubación (OR: 0,43; IC 95%: 0,25-0,76; I2: 0%); disminuye la mortalidad en UCI (OR: 0,29; IC 95%: 0,13-0,67; I2: 0%); y en hospitalización (OR: 0,54; IC 95%: 0,29-1; I2: 0%), en especial en pacientes con factores de riesgo para falla ventilatoria postextubación.
El uso profiláctico de ventilación mecánica no invasiva reduce la reintubación, mortalidad en UCI y en hospitalización, en especial en pacientes con factores de riesgo identificados para falla respiratoria postextubación.
The use of prophylactic non-invasive mechanical ventilation after extubation has been increasing, but the evidence for its use is not yet clear.
To evaluate the efficacy of prophylactic non-invasive mechanical ventilation after extubation compared with standard oxygen therapy in patients with invasive mechanical ventilation and who overcome a spontaneous breathing trial.
Databases including PubMed, Embase, and LILACS (August 2014) were searched for pertinent studies without language restrictions.
Randomized trials of prophylactic non-invasive mechanical ventilation after extubation compared with standard oxygen therapy in patients with invasive mechanical were included. Effects on primary outcomes: reduce post-extubation respiratory failure, reintubation rate, ICU and/or hospital mortality, and hospital length of stay were accessed in this meta-analysis.
Three review authors independently assessed trial quality and abstracted data according to pre-specified criteria. The program RevMan 5.3 was used for analysis.
Seven trials with moderate to good quality involving 969 patients were included.
The use of NIV following extubation for patients decrease the reintubation rate (odds risk OR 0.43, 95% confidence interval CI 0.25-0.76, I2 0%); reduces ICU mortality (OR 0.29, 95% CI 0.13-0.67, I2 0%), and reduces hospital mortality (OR 0.54, 95% CI 0.29-1.0, I2 0%) compared to standard oxygen therapy, particularly in patients with risk factors associated with failed extubation.
The results of this review suggested prophylactic non-invasive mechanical ventilation after extubation seems to be effective in reducing reintubation rate, and ICU and/or hospital mortality. This is most important in patients with risk factors associated with failed extubation.
El tromboembolismo pulmonar (TEP) es el enclavamiento de un trombo en las arterias pulmonares, relacionado con la tríada: estasis, lesión endotelial e hipercoagulabilidad; la estabilización ...hemodinámica-ventilatoria requiere manejo en la unidad de cuidados intensivos (UCI).
Treinta y ocho pacientes con TEP, diagnosticados tomográficamente, ingresaron en la UCI para estabilización hemodinámica y/o ventilatoria durante los años 2010-2014; la edad media fue de 54,8 años; 55,2% eran mujeres; 34,2% tenían antecedentes de cirugía reciente; 15,7% de traumatismo y 13,1% de tumores.
Los síntomas de ingreso hospitalario fueron: 30 pacientes con disnea (79%), 15 con dolor precordial (39%), 5 con síncope (13%), 4 con tos (10%), uno con fiebre (2%) y uno con hemoptisis (2%); 8 pacientes presentaron hipotensión arterial al ingreso (21%); 20 pacientes (52,6%) con TVP, 3 tenían trombo intracavitario cardiaco y 3 foramen oval permeable; 16 pacientes recibieron manejo con trombólisis, de ellos uno presentó evento cerebral hemorrágico; finalmente, 5 pacientes murieron (13%).
El análisis exploratorio sobre mortalidad halló una diferencia significativa en los valores de ingreso en la UCI de la presión arterial de oxígeno (96,8 mmHg vs 57,6mmHg; p=0,018) y de los niveles de bicarbonato (21,5mEq/l vs 17mEq/l; p=0,010); valores bajos en el grupo mortalidad.
Una incidencia de TEP de 0,7% al ingreso en la UCI, características clínicas parecidas a las reportadas en otros estudios, y un resultado exploratorio que identifica la PO2 y HCO3 como factores de mortalidad crean la necesidad de estudios con mayor complejidad para corroborar nuestros hallazgos.
Pulmonary embolism (PE) is a blockage due to thrombi in the pulmonary arteries. Venous thrombi are caused by a combination of stasis, endothelial damage, and hypercoagulability. Haemodynamic and ventilatory stabilisation is the objective in the Intensive Care Unit (ICU).
A cases series is presented of 38 patients admitted to ICU for haemodynamic and ventilatory stabilisation between 2010 and 2014. PE was diagnosed using computed tomography scanning. The mean age was 54.8 years old, with 55.2% females, and 34.2% had recent surgery. A history of trauma was recorded in 15.7%, and 13.1% had a tumour.
The most common clinical presentations on admission to ICU were: dyspnoea in 30 patients (79%), chest pain in 15 (39%), syncope in five patients (13%), cough in four (10%), and fever and haemoptysis in one patient (2% for each). Of patients admitted to the ICU, eight had hypotension (21%). The study confirmed deep venous thrombosis in 20 patients (52.6%), intracavitary thrombus in three, and patent foramen ovale in three. Thrombolytic agents were used in 16 patients, one of them had cerebral haemorrhage, and five patients died later (13%).
Factors associated with mortality in the ICU in the exploratory analysis were: arterial oxygen pressure (96.8mmHg vs 57.6mmHg; P=.018), and serum bicarbonate (21.5mEq/l vs 17mEq/l; P=.010). The mortality was highest in the group with low values, with significant difference.
PE incidence of 0.7% was found. The study showed clinical features similar to those reported in other studies. The exploration analysis found that levels of PO2 and HCO3 are predictive factors of mortality. Larger studies will need to be conducted to confirm this finding.
