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Cuidados Críticos , Enfermedad Crítica , Enfermedad Crónica , Enfermedad Crítica/terapia , HumanosRESUMEN
BACKGROUND: Mycoplasma hyopneumoniae causes a chronic respiratory disease that produces important economic losses due to poor productive performance, increased mortality and costs for several control strategies. The prevalence of mycoplasma-like lesions (MLL) at abattoir has been widely studied in different countries, making use of different scoring systems. However, most of them are difficult to apply in abattoirs with high number of pigs sacrificed per hour. For that reason, it is necessary to adapt the scoring system to the reality of the modern abattoir, even if there is a loss of accuracy. Our purpose was to investigate the prevalence and severity of MLL at abattoirs in Spain and Portugal using a 0 to 5 scoring system adapted to abattoirs with high number of sacrificed pigs per hour and to highlight the histopathological diagnosis as confirmatory method to identify patterns of pneumonia correlated to gross lesions. RESULTS: Cranioventral pulmonary consolidation, a typical MLL, was the most frequent lung lesion (30.97 %) detected at the abattoir, followed by dorsocaudal infarcts with pleurisy (12.51 %) and pleurisy alone (6.26 %). The average score for all examined lungs at abattoir was 1.99 out of 5 points. The histopathological study revealed that the 78.17 % of the randomly selected lungs with MLL presented microscopic lesions compatible with M. hyopneumoniae infection. Most bronchointerstitial and interstitial pneumonia lesions had a chronic course while most suppurative and fibrinous bronchopneumonia lesions had an acute course and a higher degree of severity. The combination of microscopic lesions more frequently observed was bronchointerstitial pneumonia + interstitial pneumonia + suppurative bronchopneumonia. CONCLUSIONS: The prevalence of MLL at abattoir was 30.97 %, however, after microscopic examination the real prevalence of lungs with lesions compatible with M. hyopneumoniae infection was reduced up to 24.21 %. The six more prevalent combinations of lesions in the microscopic study involved the 66.13 % of examined lungs, and in all of them, microscopic lesions characteristic of M. hyopneumoniae infection were found, what supports the importance of M. hyopneumoniae as a primary pathogen in cases of PRDC.
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Candidemia , Infecciones por Coronavirus , Enfermedad Crítica , Pandemias , Neumonía Viral , Betacoronavirus , COVID-19 , Candidemia/epidemiología , Humanos , SARS-CoV-2RESUMEN
OBJECTIVE: The purpose of this study was to determine the late complications in critically ill patients requiring percutaneous tracheostomy (PT) using the balloon dilation technique. DESIGN: A prospective, observational cohort study was carried out. SCOPE: Two medical-surgical intensive care units (ICU). PATIENTS: All mechanically ventilated adult patients consecutively admitted to the ICU with an indication of tracheostomy. INTERVENTIONS: All patients underwent PT according to the Ciaglia Blue Dolphin® method, with endoscopic guidance. Survivors were interviewed and evaluated by fiberoptic laryngotracheoscopy and tracheal computed tomography at least 6 months after decannulation. VARIABLES: Intraoperative, postoperative and long-term complications and mortality (in-ICU, in-hospital) were recorded. RESULTS: A total of 114 patients were included. The most frequent perioperative complication was minor bleeding (n=20) and difficult cannula insertion (n=19). Two patients had severe perioperative complications (1.7%) (major bleeding and inability to complete de procedure in one case and false passage and desaturation in the other). All survivors (n=52) were evaluated 211±28 days after decannulation. None of the patients had symptoms. Fiberoptic laryngotracheoscopy and computed tomography showed severe tracheal stenosis (>50%) in 2patients (3.7%), both with a cannulation period of over 100 days. CONCLUSIONS: Percutaneous tracheostomy using the Ciaglia Blue Dolphin® technique with an endoscopic guide is a safe procedure. Severe tracheal stenosis is a late complication which although infrequent, must be taken into account due to its lack of clinical expressiveness. Evaluation should be considered in those tracheostomized critical patients who have been cannulated for a long time.
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Traqueostomía/efectos adversos , Anciano , Anciano de 80 o más Años , Cuidados Críticos/métodos , Dilatación/instrumentación , Dilatación/métodos , Endoscopía , Femenino , Hemorragia/etiología , Mortalidad Hospitalaria , Humanos , Complicaciones Intraoperatorias/diagnóstico por imagen , Complicaciones Intraoperatorias/etiología , Masculino , Persona de Mediana Edad , Complicaciones Posoperatorias/diagnóstico por imagen , Complicaciones Posoperatorias/etiología , Estudios Prospectivos , Factores de Tiempo , Tomografía Computarizada por Rayos X , Tráquea/diagnóstico por imagen , Tráquea/lesiones , Estenosis Traqueal/diagnóstico por imagen , Estenosis Traqueal/etiología , Traqueostomía/métodosAsunto(s)
Cuidados Posteriores/organización & administración , Cuidados Críticos/organización & administración , Servicio Ambulatorio en Hospital/organización & administración , Trastornos por Estrés Postraumático/prevención & control , Sobrevivientes , Actividades Cotidianas , Trastornos del Conocimiento/etiología , Trastornos del Conocimiento/prevención & control , Cuidados Críticos/psicología , Humanos , Trastornos Mentales/etiología , Trastornos Mentales/prevención & control , Debilidad Muscular/etiología , Debilidad Muscular/rehabilitación , Factores de Riesgo , Trastornos por Estrés Postraumático/etiología , Trastornos por Estrés Postraumático/rehabilitación , Sobrevivientes/psicologíaRESUMEN
The next generation of ionic liquids must be synthetized taking into account structures that guarantee the suitable properties for a defined application as well as ecological data. Thus, searching of the right methodologies to know, quickly and efficiently, the ecological effects of these compounds is a preliminary task. The effects of two imidazolium based ionic liquids with different anions, 1-butyl-3-methylimidazolium tetrafluoroborate, [C4C1Im][BF4], and 1-propyl-3-methylimidazolium bis(trifluoromethylsulfonyl)imide, [C3C1Im][NTf2], on seedling emergence of six tree species and on the microbial behaviour of two soils were determined in this work. Results showed that the highest doses of both ionic liquids caused the total inhibition of germination for almost all the species studied and that the seeds are more sensitive to the presence of these compounds than soil microbial activity. Nevertheless, signals of stress and death are observed from the results of heat released by microorganisms after the addition of the highest doses of both ionic liquids. The novelty of this work resides in the enlargement of knowledge of toxicity of ILs on complex organisms such as arboreal species and microbial activity of soils studied for the first time through a microcalorimetric technique.
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Germinación/efectos de los fármacos , Líquidos Iónicos/toxicidad , Microbiología del Suelo , Contaminantes del Suelo/toxicidad , Aniones/química , Imidazoles/toxicidad , Líquidos Iónicos/química , Medición de Riesgo , Plantones/efectos de los fármacos , Semillas , Suelo/química , Pruebas de ToxicidadRESUMEN
Objetivos: Proporcionar guías de traqueostomía para el paciente crítico, basadas en la evidencia científica disponible, y facilitar la identificación de áreas en las cuales se requieren mayores estudios. Métodos: Un grupo de trabajo formado con representantes de 10 países pertenecientes a la Federación Panamericana e Ibérica de Sociedades de Medicina Crítica y Terapia Intensiva y a la Latin American Critical Care Trial Investigators Network(LACCTIN) desarrollaron estas recomendaciones basadas en el sistema Grading of Recommendations Assessment, Development and Evaluation (GRADE). Resultados: El grupo identificó 23 preguntas relevantes entre las 87 preguntas planteadas inicialmente. En la búsqueda inicial de la literatura se identificaron 333 estudios, de los cuales se escogieron un total de 226. El equipo de trabajo generó un total de 19 recomendaciones: 10 positivas (1B = 3, 2C = 3, 2D = 4) y 9 negativas (1B = 8, 2C = 1). En 6 ocasiones no se pudieron establecer recomendaciones. Conclusión: La traqueostomía percutánea se asocia a menor riesgo de infecciones en comparación con la traqueostomía quirúrgica. La traqueostomía precoz solo parece reducir la duración de la ventilación mecánica pero no la incidencia de neumonía, la duración de la estancia hospitalaria o la mortalidad a largo plazo. La evidencia no apoya el uso de broncoscopia de forma rutinaria ni el uso de máscara laríngea durante el procedimiento. Finalmente, el entrenamiento adecuado previo es tanto o más importante que la técnica utilizada para disminuir las complicaciones.(AU)
OBJECTIVES: Provide evidence based guidelines for tracheostomy in critically ill adult patients and identify areas needing further research. METHODS: A task force composed of representatives of 10 member countries of the Pan-American and Iberic Federation of Societies of Critical and Intensive Therapy Medicine and of the Latin American Critical Care Trial Investigators Network developed recommendations based on the Grading of Recommendations Assessment, Development and Evaluation system. RESULTS: The group identified 23 relevant questions among 87 issues that were initially identified. In the initial search, 333 relevant publications were identified of which 226 publications were chosen. The task force generated a total of 19 recommendations: 10 positive (1B=3, 2C=3, 2D=4) and 9 negative (1B=8, 2C=1). A recommendation was not possible in six questions. CONCLUSION: Percutaneous techniques are associated with a lower risk of infections compared to surgical tracheostomy. Early tracheostomy only seems to reduce the duration of ventilator use but not the incidence of pneumonia, the length of stay, or the long-term mortality rate. The evidence does not support the use of routine bronchoscopy guidance or laryngeal masks during the procedure. Finally, proper prior training is as important or even a more significant factor in reducing complications than the technique used.(AU)
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Humanos , Traumatismos de la Médula Espinal/rehabilitación , Cuidados Críticos/métodos , Respiración Artificial , Factores de Tiempo , Broncoscopía , Traqueostomía , Máscaras Laríngeas , Tiempo de InternaciónRESUMEN
OBJECTIVES: Provide evidence based guidelines for tracheostomy in critically ill adult patients and identify areas needing further research. METHODS: A task force composed of representatives of 10 member countries of the Pan-American and Iberic Federation of Societies of Critical and Intensive Therapy Medicine and of the Latin American Critical Care Trial Investigators Network developed recommendations based on the Grading of Recommendations Assessment, Development and Evaluation system. RESULTS: The group identified 23 relevant questions among 87 issues that were initially identified. In the initial search, 333 relevant publications were identified of which 226 publications were chosen. The task force generated a total of 19 recommendations: 10 positive (1B=3, 2C=3, 2D=4) and 9 negative (1B=8, 2C=1). A recommendation was not possible in six questions. CONCLUSION: Percutaneous techniques are associated with a lower risk of infections compared to surgical tracheostomy. Early tracheostomy only seems to reduce the duration of ventilator use but not the incidence of pneumonia, the length of stay, or the long-term mortality rate. The evidence does not support the use of routine bronchoscopy guidance or laryngeal masks during the procedure. Finally, proper prior training is as important or even a more significant factor in reducing complications than the technique used.
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Traqueostomía , Broncoscopía , Quemaduras/terapia , Cuidados Críticos/normas , Medicina Basada en la Evidencia , Humanos , Máscaras Laríngeas , Tiempo de Internación , Respiración Artificial , Traumatismos de la Médula Espinal/terapia , Factores de Tiempo , Traqueostomía/efectos adversos , Traqueostomía/instrumentación , Traqueostomía/métodosRESUMEN
No disponible
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Humanos , Masculino , Adulto , Manejo de la Vía Aérea , Heridas Punzantes , Traumatismos del CuelloRESUMEN
BACKGROUND AND PURPOSE: Intravenous thrombolysis and mechanical thrombectomy predominantly using stent retrievers have been shown to effectively restore cerebral blood flow and improve functional outcome in patients with acute ischemic stroke. We sought to determine the safety and feasibility of mechanical thrombectomy using the new ERIC retrieval device. MATERIALS AND METHODS: We identified 36 consecutive patients from our Stroke Center registry with acute ischemic stroke who were treated with the new ERIC retriever from September 2013 to December 2014. Patients with ischemic stroke meeting the following criteria were eligible: onset-to-treatment time of ≤4.5 hours or wake-up stroke (n = 10) with relevant CT perfusion mismatch, NIHSS score of ≥4, and proof of large-vessel occlusion in the anterior circulation on CT angiography. We assessed the baseline characteristics including age, sex, comorbidities, stroke severity, site of vessel occlusion, presence of tissue at risk, and treatment-related parameters such as onset-to-treatment time, recanalization grade, and outcome. RESULTS: The mean age was 70 ± 13 years, and the median NIHSS score on admission was 18 (interquartile range, 10-20). Seventeen of 36 patients were on platelet inhibitors or anticoagulants before endovascular treatment (47.2%); 20 patients received intravenous thrombolysis (55.5%). The ERIC was used as the sole retriever in 28 patients (77.8%) and as a rescue device in 8. Excellent recanalization was achieved in 30/36 patients (83.3%) with TICI 3 in 19/36 and 2b in 11/36, respectively. Median procedural time in these patients was 90 minutes (interquartile range, 58-133 minutes). No intraprocedural complications occurred. CONCLUSIONS: In this observational study, the new ERIC retrieval device was technically feasible, safe, and effective in acute ischemic stroke with large-vessel occlusion.
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Infarto de la Arteria Cerebral Anterior/cirugía , Trombectomía/instrumentación , Enfermedad Aguda , Anciano , Anciano de 80 o más Años , Angiografía Cerebral , Terapia Combinada , Diseño de Equipo , Seguridad de Equipos , Estudios de Factibilidad , Femenino , Humanos , Infarto de la Arteria Cerebral Anterior/diagnóstico por imagen , Masculino , Persona de Mediana Edad , Suiza , Terapia Trombolítica , Tomografía Computarizada por Rayos XAsunto(s)
Respiración Artificial , Traqueotomía/métodos , Toma de Decisiones Clínicas , Humanos , Modelos Teóricos , Estudios Multicéntricos como Asunto , Neumonía Asociada al Ventilador/etiología , Neumonía Asociada al Ventilador/prevención & control , Estudios Prospectivos , Ensayos Clínicos Controlados Aleatorios como Asunto , Factores de TiempoRESUMEN
INTRODUCTION: In 2006, 528 tons of petroleum toxic waste have been released in Abidjan (Ivory Coast) during a major environmental accident. This study was aimed to describe the clinical manifestations provoked by these toxic waste. METHODS: We have analysed the records of patients admitted to the university hospital of Cocody (Abidjan) following exposure to toxic waste. All the information were recorded on specific files or on notification files created by the physicians of the National Institute of Public Health, the authority charged with the supervision of this exercise. The files were completed by the physician in the course of the examination of the patient. RESULTS: Over a period of 3-month-period, 10,598 patients were examined. The clinical manifestations affected all age groups. They were dominated by respiratory symptoms: pulmonary (74.5%) and upper respiratory (31.0%). Pulmonary symptoms included cough (48.8%), chest pain (37.9%), dyspnoea (9.5%) and a few cases of hemoptysis. Digestive symptoms mainly comprised abdominal pain (36.2%), diarrhea (23.0%), abdominal distension (19.9%) and vomiting (9.9%). The other symptoms were neurological, ophthalmic, cardiovascular and gynaecological. More than 96% of patients presented with at least two symptoms. The respiratory symptoms were significantly more frequent in patients over the age of 17 while diarrhea and vomiting were more often found in patients less than 17 years old. Chest pain was significantly more common in men while abdominal pain and vomiting predominated in women (P=0.001). CONCLUSION: The clinical consequences of toxic waste exposure were varied and sometimes serious. A medium- and long-term evaluation of the subjects is required.
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Accidentes de Trabajo , Enfermedades Gastrointestinales/inducido químicamente , Enfermedades del Sistema Nervioso/inducido químicamente , Contaminación por Petróleo/efectos adversos , Trastornos Respiratorios/inducido químicamente , Adolescente , Adulto , Enfermedades Cardiovasculares/inducido químicamente , Enfermedades Cardiovasculares/epidemiología , Côte d'Ivoire/epidemiología , Estudios Transversales , Exposición a Riesgos Ambientales , Oftalmopatías/inducido químicamente , Oftalmopatías/epidemiología , Femenino , Enfermedades Gastrointestinales/epidemiología , Enfermedades de los Genitales Femeninos/inducido químicamente , Enfermedades de los Genitales Femeninos/epidemiología , Humanos , Masculino , Persona de Mediana Edad , Enfermedades del Sistema Nervioso/epidemiología , Trastornos Respiratorios/epidemiología , Estudios Retrospectivos , Enfermedades de la Piel/inducido químicamente , Enfermedades de la Piel/epidemiología , Evaluación de Síntomas , Adulto JovenRESUMEN
OBJECTIVE: To describe the perioperative and postoperative complications in critically ill patients requiring percutaneous tracheostomy using the Ciaglia Blue Dolphin(®) technique. DESIGN: A prospective, observational, cohort study was carried out. SCOPE: Two medical-surgical Intensive Care Units. PATIENTS: Adult patients subjected to prolonged mechanical ventilation. INTERVENTION: Percutaneous tracheostomy using Ciaglia Blue Dolphin(®) with an endoscopic guide. VARIABLES: Demographic variables, intraoperative and postoperative complications, and Intensive Care Unit and ward mortality were recorded. RESULTS: Seventy patients were included. Age: 68.6 ± 12 years (68.6% males). APACHE II score: 23.5±8.7. Duration of mechanical ventilation prior to percutaneous tracheostomy: 14.3 ± 5.5 days. Perioperative complications were recorded in 25 patients. In 23 of them the complications were mild: difficulty inserting the tracheostomy cannula (n=10), mild bleeding (n=7), partial atelectasis (n=3), cuff leak (n=2), and technical inability to complete the procedure (switch to Ciaglia Blue Rhino(®)) (n=1). Severe complications were recorded in 2 patients: severe bleeding that forced completion of the procedure via surgical tracheostomy (n=1), and false passage with desaturation (n=1). None of the complications proved life-threatening. Eleven complications occurred in the learning curve. As postoperative complications, mild peri-cannula bleeding was seen in 2 patients. CONCLUSIONS: Percutaneous tracheostomy using the Ciaglia Blue Dolphin(®) technique with an endoscopic guide is a safe procedure. As with other procedures, the learning curve contributes to increase the incidence of complications. Potential benefits versus other percutaneous tracheostomy techniques should be explored by randomized trials.
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Complicaciones Intraoperatorias/etiología , Complicaciones Posoperatorias/etiología , Traqueostomía/efectos adversos , Traqueostomía/métodos , Anciano , Estudios de Cohortes , Enfermedad Crítica , Dilatación , Femenino , Humanos , Unidades de Cuidados Intensivos , Masculino , Estudios Prospectivos , Respiración Artificial , Índice de Severidad de la Enfermedad , ToracoscopíaRESUMEN
BACKGROUND: ''Zero-VAP'' is a proposal for the implementation of a simultaneous multimodal intervention in Spanish intensive care units (ICU) consisting of a bundle of ventilator-associated pneumonia (VAP) prevention measures. Methods/DESIGN: An initiative of the Spanish Societies of Intensive Care Medicine and of Intensive Care Nurses, the project is supported by the Spanish Ministry of Health, and participation is voluntary. In addition to guidelines for VAP prevention, the ''Zero-VAP'' Project incorporates an integral patient safety program and continuous online validation of the application of the bundle. For the latter, VAP episodes and participation indices are entered into the web-based Spanish ICU Infection Surveillance Program ''ENVIN-HELICS'' database, which provides continuous information about local, regional and national VAP incidence rates. Implementation of the guidelines aims at the reduction of VAP to less than 9 episodes per 1000 days of mechanical ventilation. A total of 35 preventive measures were initially selected. A task force of experts used the Grading of Recommendations, Assessment, Development and Evaluation Working Group methodology to generate a list of 7 basic "mandatory" recommendations (education and training in airway management, strict hand hygiene for airway management, cuff pressure control, oral hygiene with chlorhexidine, semi-recumbent positioning, promoting measures that safely avoid or reduce time on ventilator, and discouraging scheduled changes of ventilator circuits, humidifiers and endotracheal tubes) and 3 additional "highly recommended" measures (selective decontamination of the digestive tract, aspiration of subglottic secretions, and a short course of IV antibiotic). Discussion: We present the Spanish VAP prevention guidelines and describe the methodology used for the selection and implementation of the recommendations and the organizational structure of the project. Compared to conventional guideline documents, the associated safety assurance program, the online data recording and compliance control systems, as well as the existence of a pre-defined objective are the distinct features of "Zero VAP"
ANTECEDENTES: «Neumonía Zero» es una propuesta de aplicación de una intervención multimodal simultánea en las unidades de cuidados intensivos españolas que consiste en un paquete de medidas preventivas de la neumonía asociada a la ventilación mecánica (NAVM).Métodos/DISEÑO: Se trata de una iniciativa de las sociedades españolas de Medicina Intensiva y Enfermería Intensiva. El proyecto cuenta con el apoyo del Ministerio de Sanidad y la participación es voluntaria. Además de las directrices para la prevención de la NAVM, el proyecto« Neumonía Zero» incluye un programa integral de seguridad del paciente y una validación continua« online» de la aplicación de las medidas. Para ello se introducen los episodios de NAVM y los índices de participación en la base de datos en red del programa« ENVIN-HELICS» de vigilancia de las infecciones en las unidades de cuidados intensivos españolas, que ofrece información continua acerca de las tasas de incidencia de NAVM a nivel local, autonómico y nacional. La aplicación de «Neumonía Zero»preten de reducir las NAVM a menos de 9 episodios por cada 1.000 días de ventilación mecánica. Inicialmente, se seleccionaron 35 medidas de prevención. Un grupo de expertos utilizó la metodología del Grading of Recommendations, Assessment, Developmentand Evaluation Working Group para crear una lista de 7 recomendaciones básicas «obligatorias»(formación y entrenamiento en el manejo de la vía aérea, higiene estricta de manos en el manejo de la vía aérea, control de la presión del neumotaponamiento, higiene bucal con clorhexidina, posición semiincorporada, fomento de medidas que de forma segura eviten o reduzcan la duración de la ventilación mecánica, y desaconsejar los cambios programados de tubuladuras, humidificadores y tubos endotraqueales) y 3 medidas adicionales «muy recomendables» (descontaminación selectiva del tubo digestivo, aspiración de las secreciones subglóticas y un breve curso de antibióticos intravenosos). Debate: Presentamos las directrices españolas para la prevención de la NAVM y describimos la metodología utilizada para seleccionar y aplicar las recomendaciones y la estructura organizativa del proyecto. En comparación con recomendaciones convencionales, el programa de seguridad asociado, el registro de datos «online» y los sistemas de control del cumplimiento, además de la existencia de un objetivo predefinido, son características distintivas de «Neumonía Zero»