RESUMEN
BACKGROUND: The present sub-analysis aimed to examine the relationship between obesity index and cardiovascular risk among primary care attendees. STUDY DESIGN: Stratified random sampling was previously used to recruit general practitioners, practicing on Crete island, Greece, whose patients were then enrolled. METHODS: Initial sample included 815 primary care attendees (55.7% women; mean age 65.2 years; range 40-98 years). Due to missing values regarding 13 participants, data from 802 patients were included for the current analysis. Body measurements (weight, height), among other bio-clinical parameters, were recorded upon practice visit. The 10-year cardiovascular disease risk was estimated using the European Society of Cardiology (and other societies), 10-year Systematic Coronary Risk Estimation and multivariate linear regression was used to assess relationships between Obesity Index and cardiovascular disease risk. RESULTS: Higher risk is shown to be significantly related with male gender, older age, unemployed/retired status, urban area of living or smoking (p<0.05), as well as with higher levels of obesity index (stand. beta=0.048, p=0.028). CONCLUSIONS: Obesity Index may be useful for cardiovascular disease risk prediction and correction at the primary care settings, since obesity is easily addressed during the first medical contact.
Asunto(s)
Enfermedades Cardiovasculares , Adulto , Anciano , Anciano de 80 o más Años , Índice de Masa Corporal , Enfermedades Cardiovasculares/epidemiología , Enfermedades Cardiovasculares/etiología , Femenino , Grecia/epidemiología , Factores de Riesgo de Enfermedad Cardiaca , Humanos , Masculino , Persona de Mediana Edad , Obesidad/complicaciones , Obesidad/epidemiología , Atención Primaria de Salud , Factores de RiesgoRESUMEN
Traumatic brain injury (TBI) victims are considered to be at high risk for infection. The purpose of this cohort study was to delineate the rates, types and risk factors for infection in TBI patients. Retrospective surveillance of infections was conducted for all TBI patients, aged ≥18 years, cared for at the Department of Neurosurgery of the University Hospital of Heraklion, Greece, between 1999 and 2005. A total of 760 patients (75% men) with a median age of 41 years were included. Most (59%) were injured in a motor vehicle accident. One third of them underwent a surgical procedure. Two hundred and fourteen infections were observed. The majority were infections of the lower respiratory tract (47%), followed by surgical site infections (SSI) (17%). Multivariate analysis showed that SSI development was independently associated with the performance of ≥2 surgical procedures (OR 16.7), presence of concomitant infections, namely VAP (OR 5.7) and UTI (OR 8.8), insertion of lumbar (OR 34.5) and ventricular drains (OR 4.0), and cerebrospinal fluid (CSF) leak (OR 3.8). Development of meningitis was associated with prolonged hospitalization (OR 1.02), especially >7 days ICU stay (OR 25.5), and insertion of lumbar (OR 297) and ventricular drains (OR 9.1). There was a notable predominance of Acinetobacter spp. as a VAP pathogen; gram-positive organisms remained the most prevalent in SSI cases. Respiratory tract infections were the most common among TBI patients. Device-related communication of the CSF with the environment and prolonged hospitalization, especially in the ICU setting, were independent risk factors for SSIs and meningitis cases.
Asunto(s)
Acinetobacter/patogenicidad , Lesiones Encefálicas/microbiología , Infección de la Herida Quirúrgica/microbiología , Adulto , Anciano , Lesiones Encefálicas/complicaciones , Femenino , Grecia/epidemiología , Hospitalización , Humanos , Masculino , Persona de Mediana Edad , Análisis Multivariante , Complicaciones Posoperatorias/microbiología , Prevalencia , Enfermedades Respiratorias/complicaciones , Enfermedades Respiratorias/epidemiología , Enfermedades Respiratorias/microbiología , Estudios Retrospectivos , Factores de Riesgo , Infección de la Herida Quirúrgica/complicaciones , Infección de la Herida Quirúrgica/epidemiología , Factores de Tiempo , Resultado del Tratamiento , Adulto JovenRESUMEN
BACKGROUND: Noninvasive bilevel positive pressure ventilation (N-BiPAP) has an established role in providing respiratory support in patients with acute respiratory failure. The significant advantage of N-BiPAP is to avoid endotracheal intubation and its complications. Currently there are no data that support N-BiPAP as first-line treatment in patients with blunt thoracic trauma. OBJECTIVE: To evaluate the safety and efficacy of N-BiPAP in patients with acute respiratory failure due to blunt thoracic trauma. METHODS: Prospective observational study. Twenty-two patients with blunt chest trauma (mean injury severity score 26 +/- 9) were studied. N-BiPAP was applied via a tight-fitting full or total-face mask, combined with regional anesthesia in all patients. RESULTS: N-BiPAP resulted in significant changes in blood gasses, heart rate and breathing frequency at 1 h. Eighteen out of 22 patients avoided intubation and were discharged from the ICU (success group). Four patients met predefined criteria and required intubation (failure group) within 24 h after N-BiPAP. Three of the patients in the failure group survived while 1 developed septic shock and died. The acute response of oxygenation to N-BiPAP differed significantly between groups, being higher in the success group. Complications related to N-BiPAP were minor, consisting of nose bridge injury (1 patient) and gastric distention (1 patient). CONCLUSIONS: N-BiPAP administration could be a safe and effective method to improve the gas exchange in patients with acute respiratory failure due to blunt thoracic trauma.
Asunto(s)
Respiración con Presión Positiva , Insuficiencia Respiratoria/etiología , Insuficiencia Respiratoria/terapia , Traumatismos Torácicos/complicaciones , Heridas no Penetrantes/complicaciones , Enfermedad Aguda , Adolescente , Adulto , Anciano , Anciano de 80 o más Años , Femenino , Humanos , Masculino , Persona de Mediana Edad , Estudios Prospectivos , Pruebas de Función Respiratoria , Resultado del TratamientoRESUMEN
OBJECTIVE: During assisted mechanical ventilation, changes in ventilator settings may acutely affect the respiratory motor output via the mechanoreceptor reflex feedback system, thus interfering with patient management. This feedback system in mechanically ventilated patients with parenchymal lung injury remains largely unexplored. To investigate this, the early response of respiratory motor output to varying ventilator settings was determined in 13 sedated patients with acute lung injury. DESIGN: During assist/control and pressure support (PS) ventilation changes in (1) tidal volume (V(T)) at fixed inspiratory flow (V'(I)), (2) V'(I) at fixed V(T) and (3) PS level were employed and the response of respiratory motor output was followed for two breaths after the change. Respiratory motor output was assessed by total pressure generated by the respiratory muscles (Pmus), computed from esophageal pressure (Pes). RESULTS: Neural expiratory time increased with increasing V(T) and PS, while it remained constant with V'I changes. Neural inspiratory time (T(I)n) increased with decreasing V'(I) and PS, but was not affected by V(T) changes. None of the changes in ventilator settings influenced significantly the rate of rise of Pmus, used as an index of respiratory drive. The changes in respiratory timing resulted in significant changes in breathing frequency, which increased with decreasing V(T) and PS and increasing V'(I). The time integral of Pmus, an index of respiratory effort, increased with increasing T(I)n. These acute responses were not related to the severity of deterioration of respiratory system mechanics. CONCLUSIONS: We conclude that alterations in commonly used ventilator settings induce acute changes in respiratory timing, without affecting the respiratory drive. These changes, probably mediated via mechanoreceptor reflex feedback, are dependent on the type of the alteration in the ventilator settings.
Asunto(s)
Respiración con Presión Positiva/métodos , Síndrome de Dificultad Respiratoria/terapia , Mecánica Respiratoria , Músculos Respiratorios , Adulto , Anciano , Anciano de 80 o más Años , Análisis de Varianza , Femenino , Humanos , Masculino , Mecanorreceptores , Persona de Mediana Edad , Modelos Biológicos , Reflejo , Análisis de Regresión , Volumen de Ventilación Pulmonar , Factores de TiempoRESUMEN
OBJECTIVE: The delivery of bronchodilator drugs with metered-dose inhaler (MDI) and a spacer in mechanically ventilated patients has become a widespread practice. However, the various ventilator settings that influence the efficacy of MDI are not well established. The tidal volume (VT) during drug delivery has been suggested as one of the factors that might increase the effectiveness of this therapy. To test this, the effect of two different VT on the bronchodilation induced by beta 2-agonists administered with MDI and a spacer in a group of mechanically ventilated patients with chronic obstructive pulmonary disease (COPD) was examined. METHODS: Nine patients with COPD, mechanically ventilated on volume-controlled mode, were prospectively randomised to receive six puffs of salbutamol (S, 100 micrograms/puff) either with a VT of 8 ml/kg (normal VT, 582 +/- 85) or with a VT of 12 ml/kg (high VT, 912 +/- 137). With both modes inspiratory flow was identical. S was administered with an MDI adapted to the inspiratory limb of the ventilator circuit using an aerosol cloud enhancer spacer. After a 6-h washout, patients were crossed-over to receive S by the alternative mode of administration. Static and dynamic airway pressures, minimum (Rint) and maximum (Rrs) inspiratory resistance, the difference between Rrs and Rint (delta R), static end-inspiratory respiratory system compliance (Cst,rs), intrinsic positive end-expiratory pressure (PEEPi) and heart rate (HR) were measured before and at 15, 30 and 60 min after S. RESULTS: S caused a significant decrease in dynamic and static airway pressures, PEEPi, Rint and Rrs. These changes were not influenced by VT and were evident at 15, 30 and 60 min after S. With normal and high VT, Cst,rs, delta R and HR did not change after S. CONCLUSIONS: We conclude that S delivered with an MDI and a spacer device induces significant bronchodilation in mechanically ventilated patients with COPD, the magnitude of which is not affected by at least a 50% increase in VT. These results do not support the VT manipulations when bronchodilators are administered in adequate doses during controlled mechanical ventilation.
Asunto(s)
Agonistas Adrenérgicos beta/administración & dosificación , Albuterol/administración & dosificación , Broncodilatadores/administración & dosificación , Enfermedades Pulmonares Obstructivas/terapia , Respiración con Presión Positiva , Administración por Inhalación , Anciano , Resistencia de las Vías Respiratorias/fisiología , Análisis de Varianza , Estudios Cruzados , Femenino , Frecuencia Cardíaca/efectos de los fármacos , Humanos , Enfermedades Pulmonares Obstructivas/tratamiento farmacológico , Masculino , Nebulizadores y Vaporizadores , Estudios Prospectivos , Mecánica Respiratoria/efectos de los fármacos , Volumen de Ventilación Pulmonar/fisiologíaRESUMEN
This study paper reports on two cases of poisoning with the organophosphorus insecticides, fenthion and omethoate. The two victims were admitted in the Intensive Care Unit (ICU) a few hours after ingestion of the two insecticides. They received appropriate treatment for organophosphorous poisoning (gastric lavage, activated charcoal, atropine and pralidoxime) and supportive care. Both patients survived. Organophosphate blood levels were determined on admission (fenthion 2.9 micrograms/ml, omethoate 1.6 micrograms/ml) and during the hospitalisation and proved to be considerably high. Slow elimination rate of the poison already distributed in the body was indicated for both pesticides. The patient with omethoate poisoning remained clinically well (Glasgow Coma Scale: 15) and was discharged three days later. The patient with fenthion poisoning, who had also ingested 30 mg of bromazepam and 720 mg of oxetoron, developed cholinergic crisis six hours after admission and was intubated for 24 days, with concomitant complications.
Asunto(s)
Inhibidores de la Colinesterasa/envenenamiento , Dimetoato/análogos & derivados , Fentión/envenenamiento , Insecticidas/envenenamiento , Adulto , Antídotos/administración & dosificación , Antídotos/uso terapéutico , Atropina/administración & dosificación , Atropina/uso terapéutico , Carbón Orgánico/administración & dosificación , Carbón Orgánico/uso terapéutico , Inhibidores de la Colinesterasa/sangre , Reactivadores de la Colinesterasa/administración & dosificación , Reactivadores de la Colinesterasa/uso terapéutico , Cuidados Críticos , Dimetoato/sangre , Dimetoato/envenenamiento , Femenino , Fentión/sangre , Lavado Gástrico , Grecia , Humanos , Insecticidas/sangre , Masculino , Persona de Mediana Edad , Intoxicación/sangre , Intoxicación/terapia , Compuestos de Pralidoxima/administración & dosificación , Compuestos de Pralidoxima/uso terapéutico , Resultado del TratamientoRESUMEN
The delivery of bronchodilators with a metered-dose inhaler (MDI) and a spacer in mechanically ventilated patients has become widespread practice. However, the various ventilator settings that influence the efficacy of MDI are not well established. Application of an end-inspiratory pause (EIP) during drug delivery has been suggested as one of the factors that might increase the effectiveness of this therapy. To test this, the effect of EIP on the bronchodilation induced by beta2-agonists administered with MDI and a spacer in a group of mechanically ventilated patients with chronic obstructive pulmonary disease (COPD) was examined. Twelve patients with COPD, mechanically ventilated on volume-controlled mode, were prospectively randomized to receive six puffs of salbutamol (100 microg x puff(-1)) either with or without EIP of 5 s duration. Salbutamol was administered with an MDI adapted to the inspiratory limb of the ventilator circuit using an aerosol cloud-enhancer spacer. After a 6 h wash-out, patients were crossed over to receive salbutamol by the alternative mode of administration. Static and dynamic airway pressures, minimum (Rmin) and maximum (Rmax) airflow resistance, the difference between Rmax and Rmin (deltaR), static end-inspiratory respiratory system compliance (Cst,rs) and cardiac frequency (fc) were measured before and at 15, 30 and 60 min after salbutamol administration. Salbutamol caused a significant decrease in dynamic and static airway pressures, Rmin and Rmax. These changes were not influenced by application of EIP and were evident at 15, 30 and 60 min after salbutamol. With and without EIP, Cst,rs,deltaR and fc did not change after salbutamol. In conclusion, salbutamol delivered with a metered-dose inhaler and a spacer device induced significant bronchodilation in mechanically ventilated patients with chronic obstructive pulmonary disease, the magnitude of which was not affected by an end-expiratory pause of 5 s. These results do not support the use of end-inspiratory pause when bronchodilators are administered in adequate doses during controlled mechanical ventilation.
Asunto(s)
Albuterol/administración & dosificación , Broncodilatadores/administración & dosificación , Enfermedades Pulmonares Obstructivas/tratamiento farmacológico , Nebulizadores y Vaporizadores , Respiración Artificial , Anciano , Resistencia de las Vías Respiratorias/efectos de los fármacos , Albuterol/efectos adversos , Relación Dosis-Respuesta a Droga , Femenino , Humanos , Enfermedades Pulmonares Obstructivas/diagnóstico , Masculino , Persona de Mediana Edad , Ventilación Pulmonar/efectos de los fármacosRESUMEN
During spontaneous breathing, respiratory muscle pressure (Pmus) waveform is determined by a complex system consisting of a motor arm, a control centre and various feedback mechanisms that convey information to the control centre. In mechanically ventilated patients, the pressure delivered by the ventilator (Paw) is incorporated into the system that controls breathing and may alter Pmus, which in turn modifies the Paw waveform. Thus, the response of the patient's respiratory effort to Paw and the response of Paw to patient effort constitute the two components of the control of breathing during mechanical ventilation. The response of Paw to patient effort depends on: 1) the mode of ventilatory support; 2) the mechanics of the respiratory system; and 3) the characteristics of the patient's respiratory effort. On the other hand, the response of patient effort to Paw is mediated through four feedback systems: 1) mechanical; 2) chemical; 3) reflex; and 4) behavioural. It follows that in mechanically ventilated patients the ventilatory output is determined by the interaction between the function of the ventilator and the patient's breathing control system. This interaction should be taken into account in the management of mechanically ventilated patients.