RESUMEN
Traveling to high altitudes for entertainment or work is sometimes associated with acute high altitude pathologies. In the past, scientific literature from the lowlander point of view was primarily based on mountain climbing. Sea level scientists developed all guidelines, but they need modifications for medical care in high altitude cities. Acute Mountain Sickness, High Altitude Pulmonary Edema, and High Altitude Cerebral Edema are medical conditions that some travelers can face. We present how to diagnose and treat acute high altitude pathologies, based on 51 years of high altitude physiology research and medical practice in hypobaric hypoxic diseases in La Paz, Bolivia (3,600 m; 11,811 ft), at the High Altitude Pulmonary and Pathology Institute (HAPPI - IPPA). These can occasionally present after flights to high altitude cities, both in lowlanders or high-altitude residents during re-entry. Acute high altitude ascent diseases can be adequately diagnosed and treated in high altitude cities following the presented guidelines. Treating these high-altitude illnesses, we had no loss of life. Traveling to a high altitude with sound medical advice should not be feared as it has many benefits. Nowadays, altitude descent and evacuation are not mandatory in populated highland cities, with adequate medical resources.
Asunto(s)
Mal de Altura , Edema Encefálico , Edema Pulmonar , Humanos , Mal de Altura/diagnóstico , Mal de Altura/epidemiología , Mal de Altura/complicaciones , Altitud , Edema Encefálico/complicaciones , Edema Encefálico/terapia , Edema Pulmonar/complicaciones , Bolivia/epidemiología , Enfermedad AgudaRESUMEN
Vizcarra-Vizcarra, Cristhian A. and Angélica L. Alcos-Mamani. High-altitude pulmonary edema in a chronic kidney disease patient-Is peritoneal dialysis a risk factor? High Alt Med Biol. 23:96-99, 2022.-High-altitude pulmonary edema is a cause of acute respiratory failure secondary to hypobaric hypoxia, which occurs after ascent above 2,500 m (8,202 feet), in susceptible people or without prior acclimatization. We present the case of a 20-year-old man with chronic kidney disease (CKD) on peritoneal dialysis (PD), living at sea (Mollendo, Peru) who presented with dyspnea and pulmonary congestion, after ascending to a high-altitude city (Juliaca, Peru at 3,827 m or 12,555 feet). The patient required diuretics, nifedipine, PD, tracheal intubation, and mechanical ventilation, but recovered and was discharged without complications. We think that CKD and PD could be risk factors for the development of high-altitude pulmonary edema, secondary to pulmonary hypertension and fluid overload, so this diagnosis should be considered in this group of patients when they ascend to high altitude.
Asunto(s)
Mal de Altura , Hipertensión Pulmonar , Diálisis Peritoneal , Edema Pulmonar , Insuficiencia Renal Crónica , Adulto , Altitud , Mal de Altura/complicaciones , Mal de Altura/diagnóstico , Humanos , Masculino , Diálisis Peritoneal/efectos adversos , Edema Pulmonar/complicaciones , Insuficiencia Renal Crónica/complicaciones , Insuficiencia Renal Crónica/terapia , Factores de Riesgo , Adulto JovenAsunto(s)
Extubación Traqueal/efectos adversos , Extubación Traqueal/estadística & datos numéricos , Edema Pulmonar/complicaciones , Respiración , Desconexión del Ventilador/efectos adversos , Desconexión del Ventilador/estadística & datos numéricos , Adulto , Anciano , Anciano de 80 o más Años , Brasil , Estudios de Cohortes , Femenino , Humanos , Masculino , Persona de Mediana Edad , Estudios ProspectivosRESUMEN
Resumen Objetivo: La ventilación mecánica no invasiva se considera la primera elección de ventilación en pacientes con insuficiencia respiratoria secundaria a enfermedad pulmonar obstructiva crónica reagudizada, edema agudo de pulmón y en inmunocomprometidos. Un aspecto clave de la ventilación mecánica no invasiva es la posibilidad de evitar la entubación endotraqueal y la ventilación mecánica invasiva con sus potenciales complicaciones, y por ende, lograr menor morbimortalidad y estancia hospitalaria. El objetivo principal fue establecer si los pacientes con patología respiratoria sometidos a ventilación mecánica no invasiva presentaron un beneficio estadísticamente significativo en la mortalidad. Como objetivos específicos se determinaron las patologías respiratorias más frecuentes, el tipo de insuficiencia respiratoria asociado a la terapia, la interface más utilizada, las complicaciones más frecuentes, y las patologías respiratorias sometidas a terapia que obtuvieron mayor beneficio en la morbimortalidad. Métodos: Se realizó un estudio prospectivo, observacional y de reporte de casos, de una población adulta de 18 - 85 años hospitalizada en el período comprendido entre el 1 de agosto y el 31 de noviembre de 2014. Se estudió 40 pacientes con patología respiratoria que cumplieron criterios para recibir tratamiento con ventilación mecánica no invasiva. Resultados: El servicio más frecuente donde se utilizó ventilación mecánica no invasiva fue la Unidad de Cuidados Intensivos. Se brindó terapia a más pacientes masculinos con edad promedio de 55 años. El tiempo promedio de terapia fue de 8,4 horas. Los diagnósticos más frecuentes fueron: neumonía, edema agudo de pulmón y edema pulmonar lesional. Para dichos diagnósticos la insuficiencia respiratoria hipoxémica fue la principal indicación. La "full fase" fue la interface más usada. Las complicaciones de úlceras por presión y neumonía fueron infrecuentes. No se encontró cambios gasométricos, de índice respiratorio, ni de gradiente alveolo - arterial durante la terapia. Los puntajes de APACHE-II y SOFA fueron bajos para la mayoría de los pacientes, y el 57,5 % de los pacientes terminó por deshabituarse, con una mortalidad observada del 12 %. Conclusión: Las indicaciones más frecuentes para ventilación mecánica no invasiva en este estudio fueron edema agudo de pulmón y neumonía en el paciente inmunocomprometido. Algunos pacientes con índices respiratorios menores de 150, no se planteó la entubación, pero esto no se reflejó en una mayor tasa de fracaso en la deshabituación, o mayor mortalidad. Debido a la diversidad en la aplicación de la terapia, se debe tratar de protocolizar su uso en el Hospital México, para buscar obtener mejores resultados.
Abstract Aim: The non invasive mechanical ventilation is considered the first choice of ventilation in patients with respiratory insufficiency secondary to exacerbated chronic pulmonary obstructive disease, acute pulmonary edema and immunocompromised patients. The clue of the non invasive mechanical ventilation is the possibility to avoid intubation and invasive mechanical ventilation with its complications, less morbidity and mortality, and less hospital stay. Besides, it is more comfortable, the patient can communicate, eat and drink, cough, avoid the need of profound sedation, and maintain the defense mechanisms of superior airway. The main objective was to establish if the patients who received non invasive ventilation had a benefit in mortality statistically significant. It was also evaluated which were the most frequent pulmonary diseases, the type of respiratory insufficiency associated with the therapy, the type of interface used, the most frequent complications, and which of the pulmonary diseases benefited most in morbidity and mortality with the use of this type of ventilation. Methods: We did a prospective, observational and case report study. Of a total population of 18 - 85 years hospitalized in a period between 1 of August and 31 of November of 2014, we studied a total of 40 patients who developed a respiratory disease who met the criteria to receive treatment with non invasive ventilation. Results: The department who used more non invasive ventilation was the Intensive Care Unit. There were more male patients, with an average age of 55 years. The average time of therapy was 8,4 hours. The most frequent diagnostics where pneumoniae, acute pulmonary edema, and acute respiratory distress syndrome. For these diseases the hipoxemic respiratory insufficiency was the principal indication. The fullface was the main interface used. The complications of pressure ulcers and pneumoniae where infrequent during therapy. There were none shocked patients under therapy and tachycardia was the main risk factor of dying without being statistically significant. We didn't find gasometric changes neither changes in the respiratory index or alveolar-arterial gradient during therapy. The majority of patients with pneumonia and acute pulmonary edema started the therapy with a respiratory index less than 150, but this didn`t relate with more time in therapy neither more mortality. The scores of APACHE-II and SOFA where low at the beginning of the therapy, the observed mortality was of 12%. Conclusion: The most frequent indications for non invasive ventilation obsesrved were acute pulmonary edema and pneumoniae in inmunocompromised patients. The elaboration of protocols to guide the correct use of this ventilations method is needed.
Asunto(s)
Humanos , Masculino , Femenino , Adulto , Persona de Mediana Edad , Anciano , Anciano de 80 o más Años , Neumonía/complicaciones , Edema Pulmonar/complicaciones , Respiración Artificial/estadística & datos numéricos , Costa RicaRESUMEN
Paciente masculino de 23 años que presenta edema agudo del pulmón, no cardiogénico secundario a presión negativa, en el postoperatorio inmediato
This case is about a male patent, 23 years old, who presented negative pressure pulmonary edema during immediate post-operatve period.
Asunto(s)
Edema Pulmonar/complicaciones , Edema Pulmonar/diagnósticoRESUMEN
A congestão pulmonar aguda no paciente com doença cardíaca é uma manifestação clínica de extrema gravidade, ocorrendo em aproximadamente 25% dos casosde insuficiência cardíaca aguda. O diagnóstico é essencialmente clínico, baseado na anamnese e exame físico. Os exames complementares não devem retardar o início do tratamento na sala de emergência. Descontrole pressórico, progressão da doença valvar, infarto do miocárdio e arritmias são fatores desencadeantes frequentes paraedema agudo de pulmão. O tratamento inicial fundamenta-se na suplementação de oxigênio e suporte ventilatório, administração de opioides, diuréticos e vasodilatadores endovenosos. Inotrópicos estão indicados na presença de instabilidade hemodinâmicacom disfunção orgânica...
Acute pulmonary congestion in patients with cardiac disease is a clinical manifestation of extreme severity, occurring in approximately 25% of cases of acute heart failure. Diagnosis is essentially clinical, based on history and physical examination. Complementarytests should not delay the start of treatment in the emergency room. Uncontrolled blood pressure, progression of valvular disease, myocardial infarction, and arrhythmias are common triggers for acute pulmonary edema. Initial treatment is based on supplemental oxygen and ventilatory support, administration of opioids, intravenous diuretics, andvasodilators. Inotropic agents are indicated in the presence of hemodynamic instability with organ dysfunction...
Asunto(s)
Humanos , Edema Pulmonar/complicaciones , Edema Pulmonar/terapia , Insuficiencia Cardíaca/diagnóstico , Insuficiencia Cardíaca/terapia , Atrios Cardíacos , Cardiotónicos , Disnea/complicaciones , Diuréticos/administración & dosificación , Ecocardiografía Doppler/métodos , Electrocardiografía/métodos , Factores de Riesgo , Morfina/administración & dosificación , Ultrafiltración/métodos , Vasodilatadores/administración & dosificaciónRESUMEN
BACKGROUND: Noninvasive ventilation (NIV) is used in critically ill patients with acute respiratory failure (ARF) to avoid endotracheal intubation. However, the impact of NIV use on ARF patient's outcomes is still unclear. Our objectives were to evaluate the rate of NIV failure in hypoxemic patients with an arterial carbon dioxide partial pressure (PaCO2) < 45 mmHg or ≥ 45 mmHg at ICU admission, the predictors of NIV failure, ICU and hospital length of stay and 28-day mortality. METHODS: Prospective single center cohort study. All consecutive patients admitted to a mixed ICU during a three-month period who received NIV, except for palliative care purposes, were included in this study. Demographic data, APACHE II score, cause of ARF, number of patients that received NIV, incidence of NIV failure, length of ICU, hospital stay and mortality rate were compared between NIV failure and success groups. RESULTS: Eighty-five from 462 patients (18.4 %) received NIV and 26/85 (30.6 %) required invasive mechanical ventilation. NIV failure patients were comparatively younger (67 ± 21 vs. 77 ± 14 years; p = 0.031), had lower arterial bicarbonate (p = 0.005), lower PaCO2 levels (p = 0.032), higher arterial lactate levels (p = 0.046) and APACHE II score (p = 0.034) compared to NIV success patients. NIV failure occurred in 25.0 % of patients with PaCO2 ≥ 45 mmHg and in 33.3 % of patients with PaCO2 < 45 mmHg (p = 0.435). NIV failure was associated with an increased risk of in-hospital death (OR 4.64, 95 % CI 1.52 to 14.18; p = 0.007) and length [median (IQR)] of ICU [12 days (8-31) vs. 2 days (1-4); p < 0.001] and hospital [30 (19-42) vs. 15 (9-33) days; p = 0.010] stay. Predictors of NIV failure included age (OR 0.96, 95 % CI 0.93 to 0.99; p = 0.007) and APACHE II score (OR 1.13, 95 % CI 1.02 to 1.25; p = 0.018). CONCLUSION: NIV failure was associated with an increased risk of in-hospital death, ICU and hospital stay and was not affected by baseline PaCO2 levels. Patients that failed were comparatively younger and had higher APACHE II score, suggesting the need for a careful selection of patients that might benefit from NIV. A well-designed study on the impact of a short monitored NIV trial on outcomes is needed.
Asunto(s)
Enfermedad Crítica/terapia , Hipoxia/terapia , Intubación Intratraqueal/estadística & datos numéricos , Ventilación no Invasiva/métodos , Insuficiencia Respiratoria/terapia , APACHE , Enfermedad Aguda , Anciano , Anciano de 80 o más Años , Análisis de los Gases de la Sangre , Brasil , Dióxido de Carbono , Estudios de Cohortes , Infecciones Comunitarias Adquiridas/complicaciones , Infecciones Comunitarias Adquiridas/terapia , Enfermedad Crítica/mortalidad , Femenino , Mortalidad Hospitalaria , Humanos , Hipoxia/sangre , Hipoxia/etiología , Unidades de Cuidados Intensivos , Tiempo de Internación , Masculino , Persona de Mediana Edad , Mortalidad , Presión Parcial , Neumonía/complicaciones , Neumonía/terapia , Estudios Prospectivos , Enfermedad Pulmonar Obstructiva Crónica/complicaciones , Enfermedad Pulmonar Obstructiva Crónica/terapia , Edema Pulmonar/complicaciones , Edema Pulmonar/terapia , Respiración Artificial , Síndrome de Dificultad Respiratoria/complicaciones , Síndrome de Dificultad Respiratoria/terapia , Insuficiencia Respiratoria/sangre , Insuficiencia Respiratoria/etiología , Insuficiencia del Tratamiento , Resultado del TratamientoRESUMEN
OBJECTIVE: Bedside lung ultrasound (LUS) is a noninvasive, readily available imaging modality that can complement clinical evaluation. The Bedside Lung Ultrasound in Emergency (BLUE) protocol has demonstrated a high diagnostic accuracy in patients with acute respiratory failure (ARF). Recently, bedside LUS has been added to the medical training program of our ICU. The aim of this study was to investigate the accuracy of LUS based on the BLUE protocol, when performed by physicians who are not ultrasound experts, to guide the diagnosis of ARF. METHODS: Over a one-year period, all spontaneously breathing adult patients consecutively admitted to the ICU for ARF were prospectively included. After training, 4 non-ultrasound experts performed LUS within 20 minutes of patient admission. They were blinded to patient medical history. LUS diagnosis was compared with the final clinical diagnosis made by the ICU team before patients were discharged from the ICU (gold standard). RESULTS: Thirty-seven patients were included in the analysis (mean age, 73.2 ± 14.7 years; APACHE II, 19.2 ± 7.3). LUS diagnosis had a good agreement with the final diagnosis in 84% of patients (overall kappa, 0.81). The most common etiologies for ARF were pneumonia (n = 17) and hemodynamic lung edema (n = 15). The sensitivity and specificity of LUS as measured against the final diagnosis were, respectively, 88% and 90% for pneumonia and 86% and 87% for hemodynamic lung edema. CONCLUSIONS: LUS based on the BLUE protocol was reproducible by physicians who are not ultrasound experts and accurate for the diagnosis of pneumonia and hemodynamic lung edema.
OBJETIVO: O ultrassom pulmonar (USP) à beira do leito é uma técnica de imagem não invasiva e prontamente disponível que pode complementar a avaliação clínica. O protocolo Bedside Lung Ultrasound in Emergency (BLUE, ultrassom pulmonar à beira do leito em situações de emergência) demonstrou elevado rendimento diagnóstico em pacientes com insuficiência respiratória aguda (IRpA). Recentemente, um programa de treinamento em USP à beira do leito foi implementado na nossa UTI. O objetivo deste estudo foi avaliar a acurácia do USP baseado no protocolo BLUE, quando realizado por médicos com habilidades básicas em ultrassonografia, para orientar o diagnóstico de IRpA. MÉTODOS: Ao longo de um ano, todos os pacientes adultos consecutivos respirando espontaneamente admitidos na UTI por IRpA foram prospectivamente inclusos. Após treinamento, 4 operadores com habilidades básicas em ultrassonografia realizaram o USP em até 20 minutos após a admissão na UTI, cegados para a história do paciente. Os diagnósticos do USP foram comparados aos diagnósticos da equipe assistente ao final da internação na UTI (padrão-ouro). RESULTADOS: Foram inclusos na análise 37 pacientes (média etária: 73,2 ± 14,7 anos; APACHE II: 19,2 ± 7,3). O diagnóstico do USP demonstrou concordância com o diagnóstico final em 84% dos casos (kappa total: 0,81). As causas mais comuns de IRpA foram pneumonia (n = 17) e edema pulmonar cardiogênico (n = 15). A sensibilidade e a especificidade do USP comparado ao diagnóstico final foram de 88% e 90% para pneumonia e de 86% e 87% para edema pulmonar cardiogênico, respectivamente. CONCLUSÕES: O USP baseado no protocolo BLUE foi reproduzível por médicos com habilidades básicas em ultrassonografia e acurado para o diagnóstico de pneumonia e de edema pulmonar cardiogênico.
Asunto(s)
Sistemas de Atención de Punto , Insuficiencia Respiratoria/diagnóstico por imagen , Ultrasonografía/métodos , APACHE , Enfermedad Aguda , Anciano , Brasil , Femenino , Humanos , Unidades de Cuidados Intensivos , Masculino , Neumonía/complicaciones , Neumonía/diagnóstico por imagen , Estudios Prospectivos , Edema Pulmonar/complicaciones , Edema Pulmonar/diagnóstico por imagen , Insuficiencia Respiratoria/clasificación , Insuficiencia Respiratoria/etiología , Sensibilidad y EspecificidadRESUMEN
Objective: Bedside lung ultrasound (LUS) is a noninvasive, readily available imaging modality that can complement clinical evaluation. The Bedside Lung Ultrasound in Emergency (BLUE) protocol has demonstrated a high diagnostic accuracy in patients with acute respiratory failure (ARF). Recently, bedside LUS has been added to the medical training program of our ICU. The aim of this study was to investigate the accuracy of LUS based on the BLUE protocol, when performed by physicians who are not ultrasound experts, to guide the diagnosis of ARF. Methods: Over a one-year period, all spontaneously breathing adult patients consecutively admitted to the ICU for ARF were prospectively included. After training, 4 non-ultrasound experts performed LUS within 20 minutes of patient admission. They were blinded to patient medical history. LUS diagnosis was compared with the final clinical diagnosis made by the ICU team before patients were discharged from the ICU (gold standard). Results: Thirty-seven patients were included in the analysis (mean age, 73.2 ± 14.7 years; APACHE II, 19.2 ± 7.3). LUS diagnosis had a good agreement with the final diagnosis in 84% of patients (overall kappa, 0.81). The most common etiologies for ARF were pneumonia (n = 17) and hemodynamic lung edema (n = 15). The sensitivity and specificity of LUS as measured against the final diagnosis were, respectively, 88% and 90% for pneumonia and 86% and 87% for hemodynamic lung edema. Conclusions: LUS based on the BLUE protocol was reproducible by physicians who are not ultrasound experts and accurate for the diagnosis of pneumonia and hemodynamic lung edema. .
Objetivo: O ultrassom pulmonar (USP) à beira do leito é uma técnica de imagem não invasiva e prontamente disponível que pode complementar a avaliação clínica. O protocolo Bedside Lung Ultrasound in Emergency (BLUE, ultrassom pulmonar à beira do leito em situações de emergência) demonstrou elevado rendimento diagnóstico em pacientes com insuficiência respiratória aguda (IRpA). Recentemente, um programa de treinamento em USP à beira do leito foi implementado na nossa UTI. O objetivo deste estudo foi avaliar a acurácia do USP baseado no protocolo BLUE, quando realizado por médicos com habilidades básicas em ultrassonografia, para orientar o diagnóstico de IRpA. Métodos: Ao longo de um ano, todos os pacientes adultos consecutivos respirando espontaneamente admitidos na UTI por IRpA foram prospectivamente inclusos. Após treinamento, 4 operadores com habilidades básicas em ultrassonografia realizaram o USP em até 20 minutos após a admissão na UTI, cegados para a história do paciente. Os diagnósticos do USP foram comparados aos diagnósticos da equipe assistente ao final da internação na UTI (padrão-ouro). Resultados: Foram inclusos na análise 37 pacientes (média etária: 73,2 ± 14,7 anos; APACHE II: 19,2 ± 7,3). O diagnóstico do USP demonstrou concordância com o diagnóstico final em 84% dos casos (kappa total: 0,81). As causas mais comuns de IRpA foram pneumonia (n = 17) e edema pulmonar cardiogênico (n = 15). A sensibilidade e a especificidade do USP comparado ao diagnóstico final foram de 88% e 90% para pneumonia e de 86% e 87% para edema pulmonar cardiogênico, respectivamente. Conclusões: O USP baseado no protocolo BLUE foi reproduzível por médicos com habilidades básicas em ultrassonografia e acurado para o diagnóstico de pneumonia e de edema pulmonar cardiogênico. .
Asunto(s)
Anciano , Femenino , Humanos , Masculino , Sistemas de Atención de Punto , Insuficiencia Respiratoria , Ultrasonografía/métodos , Enfermedad Aguda , APACHE , Brasil , Unidades de Cuidados Intensivos , Estudios Prospectivos , Neumonía/complicaciones , Neumonía , Edema Pulmonar/complicaciones , Edema Pulmonar , Insuficiencia Respiratoria/clasificación , Insuficiencia Respiratoria/etiología , Sensibilidad y EspecificidadRESUMEN
PURPOSE: To estimate the mortality rate and trends of respiratory failure in the pregnant and postpartum population of Colombia. METHODS: A retrospective analysis of the national registry of mortality in Colombia was performed from 1998 to 2009. Maternal death was defined as death that occurred during pregnancy or up to 42 days postpartum. Two independent investigators reviewed maternal deaths to determine deaths caused by respiratory failure. Inter-rater agreement was assessed by kappa correlation coefficient. Causes of respiratory failure were identified according to the International Classification of Diseases (ICD-10). RESULTS: During the study period, 8,637,486 live births were reported with 6,676 maternal deaths for an overall maternal mortality rate (MMR) of 82.9 per 100,000 live births. Of these, a total of 835 cases were related to respiratory failure, with a specific MMR of 9.69 per 100,000 live births. The main causes of maternal deaths due to respiratory failure included pulmonary sepsis (284 cases, or 3.58 per 100,000 live births), pulmonary embolism (119 cases or 1.50 per 100,000 live births), and preeclampsia-related pulmonary edema (112 cases or 1.41 per 100,000 live births). All-cause maternal mortality ratio decreased yearly from 1998 to 2009 by -3.76% (95% CI -4.83 to -2.67), while the trend of mortality secondary to respiratory failure remained stable over time (P = 0.449). CONCLUSIONS: Respiratory failure is an important cause of mortality in the obstetric population in Colombia, with pulmonary sepsis as the lead cause of respiratory failure among maternal deaths. While overall maternal mortality rates have decreased in the last decade, respiratory failure-related deaths have remained stable over time.
Asunto(s)
Mortalidad Materna , Insuficiencia Respiratoria/mortalidad , Enfermedad Aguda , Adulto , Colombia/epidemiología , Femenino , Humanos , Nacimiento Vivo , Mortalidad Materna/tendencias , Periodo Posparto , Preeclampsia/mortalidad , Embarazo , Edema Pulmonar/complicaciones , Edema Pulmonar/mortalidad , Embolia Pulmonar/complicaciones , Embolia Pulmonar/mortalidad , Insuficiencia Respiratoria/etiología , Estudios Retrospectivos , Sepsis/complicaciones , Sepsis/mortalidad , Adulto JovenRESUMEN
OBJECTIVES: Proper assessment of dyspnea is important in patients with heart failure. Our aim was to evaluate the use of the 5-point Likert scale for dyspnea to assess the degree of pulmonary congestion and to determine the prognostic value of this scale for predicting adverse events in heart failure outpatients. METHODS: We undertook a prospective study of outpatients with moderate to severe heart failure. The 5-point Likert scale was applied during regular outpatient visits, along with clinical assessments. Lung ultrasound with ≥15 B-lines and an amino-terminal portion of pro-B-type natriuretic peptide (NT-proBNP) level >1000 pg/mL were used as a reference for pulmonary congestion. The patients were then assessed every 30 days during follow-up to identify adverse clinical outcomes. RESULTS: We included 58 patients (65.5% male, age 43.5 ± 11 years) with a mean left ventricular ejection fraction of 27 ± 6%. In total, 29.3% of these patients had heart failure with ischemic etiology. Additionally, pulmonary congestion, as diagnosed by lung ultrasound, was present in 58% of patients. A higher degree of dyspnea (3 or 4 points on the 5-point Likert scale) was significantly correlated with a higher number of B-lines (p = 0.016). Patients stratified into Likert = 3-4 were at increased risk of admission compared with those in class 1-2 after adjusting for age, left ventricular ejection fraction, New York Heart Association functional class and levels of NT-proBNP >1000 pg/mL (HR = 4.9, 95% CI 1.33-18.64, p = 0.017). CONCLUSION: In our series, higher baseline scores on the 5-point Likert scale were related to pulmonary congestion and were independently associated with adverse events during follow-up. This simple clinical tool can help to identify patients who are more likely to decompensate and whose treatment should be intensified.
Asunto(s)
Disnea/fisiopatología , Insuficiencia Cardíaca/fisiopatología , Psicometría/instrumentación , Edema Pulmonar/diagnóstico , Adulto , Brasil , Estudios de Cohortes , Disnea/etiología , Femenino , Estudios de Seguimiento , Insuficiencia Cardíaca/complicaciones , Humanos , Masculino , Persona de Mediana Edad , Péptido Natriurético Encefálico/análisis , Pacientes Ambulatorios , Fragmentos de Péptidos/análisis , Pronóstico , Estudios Prospectivos , Edema Pulmonar/complicaciones , Edema Pulmonar/diagnóstico por imagen , Ultrasonografía , Función Ventricular Izquierda/fisiologíaRESUMEN
OBJECTIVES: Proper assessment of dyspnea is important in patients with heart failure. Our aim was to evaluate the use of the 5-point Likert scale for dyspnea to assess the degree of pulmonary congestion and to determine the prognostic value of this scale for predicting adverse events in heart failure outpatients. METHODS: We undertook a prospective study of outpatients with moderate to severe heart failure. The 5-point Likert scale was applied during regular outpatient visits, along with clinical assessments. Lung ultrasound with ≥15 B-lines and an amino-terminal portion of pro-B-type natriuretic peptide (NT-proBNP) level >1000 pg/mL were used as a reference for pulmonary congestion. The patients were then assessed every 30 days during follow-up to identify adverse clinical outcomes. RESULTS: We included 58 patients (65.5% male, age 43.5±11 years) with a mean left ventricular ejection fraction of 27±6%. In total, 29.3% of these patients had heart failure with ischemic etiology. Additionally, pulmonary congestion, as diagnosed by lung ultrasound, was present in 58% of patients. A higher degree of dyspnea (3 or 4 points on the 5-point Likert scale) was significantly correlated with a higher number of B-lines (p = 0.016). Patients stratified into Likert = 3-4 were at increased risk of admission compared with those in class 1-2 after adjusting for age, left ventricular ejection fraction, New York Heart Association functional class and levels of NT-proBNP >1000 pg/mL (HR = 4.9, 95% CI 1.33-18.64, p = 0.017). CONCLUSION: In our series, higher baseline scores on the 5-point Likert scale were related to pulmonary congestion and were independently associated with adverse events during follow-up. This simple clinical tool can help to identify patients who are more likely to decompensate and whose treatment should be intensified. .
Asunto(s)
Adulto , Femenino , Humanos , Masculino , Persona de Mediana Edad , Disnea/fisiopatología , Insuficiencia Cardíaca/fisiopatología , Psicometría/instrumentación , Edema Pulmonar/diagnóstico , Brasil , Estudios de Cohortes , Disnea/etiología , Estudios de Seguimiento , Insuficiencia Cardíaca/complicaciones , Péptido Natriurético Encefálico/análisis , Pacientes Ambulatorios , Pronóstico , Estudios Prospectivos , Fragmentos de Péptidos/análisis , Edema Pulmonar/complicaciones , Edema Pulmonar , Función Ventricular Izquierda/fisiologíaRESUMEN
Fundamentos: Nas elevações agudas da hipertensão arterial sistêmica (HAS), a intervenção imediata e cuidadosa é essencial para a redução da morbidade e da mortalidade decorrentes dessa complicação.Objetivos: Identificar a frequência de urgência hipertensiva (UH), emergência hipertensiva (EH), pseudocrise hipertensiva (PCH) e elevação sintomática da pressão arterial (ESPA). Comparar o conhecimento prévio da HAS, o uso prévio de anti-hipertensivos (AH), os níveis pressóricos apresentados e os desfechos hospitalares nos grupos estudados. Métodos: Estudo analítico, casos e controles, seleção consecutiva e análise retrospectiva de pacientes com elevação aguda da pressão arterial, admitidos na emergência de hospital cardiológico de atendimento privado, entre 11/2009 e 10/2010. Casos representam os pacientes com crise hipertensiva (CH): UH+EH. Controles representam os pacientes sem CH: PCH+ESPA. Resultados: Foram estudados 216 atendimentos relacionados à HAS, 113 (52,0 %) mulheres, idade entre 25-95 anos, mediana de 58 anos. EH foi diagnosticada em 18 (8,0 %) pacientes, UH em 29 (13,0 %), PCH em 8 (4,0 %) e ESPA em 161 (75,0 %). Diagnóstico e tratamento prévio de HAS não diferiram nos grupos com e sem CH. Sintomas cardiovasculares, prescrição de AH e internação foram mais frequentes naqueles com CH (p<0,05); mas apenas 7,0 % dos pacientes não receberam AH. Não houve óbitos.Conclusões: Na população estudada, CH foi identificada em 21,0 % dos casos e o tratamento AH foi aplicado em 93,0 % dos casos. O diagnóstico de HAS e tratamento AH prévio não diferiram naqueles pacientes com e sem CH.
Background: For systemic high blood pressure (SHBP) surges, immediate and careful intervention is essential for reducing morbidity and mortality rates related to this complication.Objectives: To identify the frequency of hypertensive urgency (HU), hypertensive emergency (HE), pseudo-hypertensive crisis (PHC) and symptomatic blood pressure increase (SBPI). Compare prior knowledge of SHBP, previous use of anti-hypertensive (AH), pressure levels presented and hospital outcomes in both groups. Methods: Analytical, case and control study with consecutive selection and retrospective analysis of patients with acute increase in blood pressure, admitted to the emergency cardiac care unit at a private hospital, between November 2009 and October 2010. The cases were patients with hypertensive crisis (HC): HU + HE. The controls were patients without HC: PHC + SBPI. Results: A total of 216 cases related to SHBP were studied, consisting of 113 (52 %) women between 25 and 95 years old, with a median age of 58 years. HE was diagnosed in 18 (8 %) patients, HU in 29 (13 %), PHC in 8 (4 %) and SBPI in 161 (75 %). Prior diagnosis and treatment of SHBP did not differ between the groups with and without HC. Cardiovascular symptoms, hospitalization and AH prescriptions were more frequent among those with HC (p <0.05), but only 7 % of the patients did not receive AH. There were no deaths. Conclusions: In this population studied, HC was identified in 21 % of the cases and AH treatment was administered in 93 % of cases diagnosed with SHBP. Prior AH treatment did not differ among patients with and without HC.
Asunto(s)
Humanos , Masculino , Femenino , Adulto , Persona de Mediana Edad , Accidente Cerebrovascular/complicaciones , Accidente Cerebrovascular/diagnóstico , Edema Pulmonar/complicaciones , Hipertensión Maligna/complicaciones , Hipertensión Maligna/mortalidad , Factores de Riesgo , Insuficiencia CardíacaRESUMEN
Introducción: la cesárea es uno de los procedimientos más utilizados desde la antigüedad. A nivel internacional, nacional y local hay un incremento del índice de cesárea primitiva con elevada morbilidad y mortalidad materna y neonatal. Objetivo: identificar la morbilidad materna y neonatal relacionada con la cesárea primitiva.Métodos: se realizó un estudio analítico, caso-control, univariado en el servicio de Obstetricia del Hospital General Universitario Carlos Manuel de Céspedes de Bayamo, desde el 1ro de enero hasta el 30 de junio de 2011. Las variables, morbilidad materna, bajo peso al nacer, Apgar bajo a los 5 minutos de vida y morbilidad neonatal fueron analizadas utilizando frecuencias absolutas, relativas y la razón de productos cruzados (OR), con un nivel de significación del 5 por ciento para determinar el grado de asociación de cada una con la cesárea primitiva.Resultados: la endometritis resultó la complicación materna más importante, constituida factor de riesgo (OR=1,080) y de asociación estadística (p 0,001). Dentro de la morbilidad neonatal, se destacaron el edema pulmonar y la broncoaspiración de líquido amniótico meconial como las complicaciones más frecuentes (OR= 5,374) (OR=4,134) (p 0,001); los factores de riesgos presentes fueron el distrés transitorio y la hipoxia (OR=2,526) (OR=1,808). Conclusiones: el índice de cesáreas primitivas fue elevado en el período estudiado. La endometritis resultó ser factor de riesgo y de significación estadística. Dentro de la morbilidad neonatal, se destacaron el edema pulmonar y la broncoaspiración de líquido amniótico meconial como las complicaciones más frecuentes, constituyendo factor de riesgo el distrés transitorio y la hipoxia(AU)
Introduction: the cesarea is one of the most used procedures from the antiquity. In the international, national and local level, there is an increase of the index of primitive cesareas with a great maternal and neonatal morbility and mortality. Objective: to identify the maternal and neonatal morbility related to the primitive cesarea. Methods: it was made an analytical, case-control, univaried study in the Obstetrics service at Carlos Manuel de Cespedes General University Hospital in Bayamo, since January 1st until June 30, 2011. The variables, maternal morbility, low birth weights, low Apgar after the 5 minutes of life and neonatal morbility were analyzed using absolute, relative frequencies and the reason of crossed products (OR), with a level of significance of 5 percent to determine the degree of association of each one with the primitive cesarea. Results: the endometritis was the most important maternal complication, constituted like a risk factor (OR=1,080) and statistical association (p 0,001). Within the neonatal morbility, there were the pulmonary edema and the broncoaspiration of amniotic meconial liquid like the most frequent complications (OR= 5,374) (OR=4,134) (p 0,001); and the risk factors were the transitory distress and the hypoxia (OR=2,526) (OR=1,808).Conclusions: the index of primitive cesareas was high in the period studied. The endometritis was the a risk factor of statistical significance. Within the neonatal morbility, there were emphazised the pulmonary edema and the broncoaspiration of amniotic meconial liquid like the most frequent complications, and the transitory distress and the hypoxia were the risk factors(AU)
Asunto(s)
Humanos , Femenino , Embarazo , Recién Nacido , Cesárea , Mortalidad Infantil , Mortalidad Materna , Endometriosis/etiología , Edema Pulmonar/complicaciones , Estudios de Casos y Controles , Factores de RiesgoRESUMEN
A insuficiência cardíaca (IC) é a via comum da maioria das cardiopatias. A oxigenioterapia por ventilaçãomecânica não invasiva (VMNI) é baseada em evidências. Este relato de caso descreve um caso de IC e a aplicação da técnica de VMNI no seu tratamento. Paciente com dispneia intensa, taquipneia e alteração dos sinais vitais. Constatou-se quadro de edema agudo de pulmão (EAP)secundário à IC descompensada. Foi instituída terapia medicamentosa e VMNI. O paciente recebeu altahospitalar 36 horas após. Os trabalhos analisados concluíram que a VMNI é boa opção no tratamento da IC descompensada.
Heart failure (HF) is the common pathway of most heart diseases. Oxygen therapy for mechanical non-invasiveventilation (MNIV) is based on evidence. This case report describes a case of HF and application of the MNIV technique for its treatment. A patient with severedyspnea, tachypnea and alteration of vital signs presented acute edema of the lung secondary to decompensated HF. After drug therapy and MNIV, thepatient was discharged after 36 hours. The studies reviewed concluded that MNIV is good option for thetreatment of decompensated HF.
Asunto(s)
Humanos , Masculino , Anciano , Disnea/complicaciones , Edema Pulmonar/complicaciones , Edema Pulmonar/diagnóstico , Insuficiencia Cardíaca/complicaciones , Respiración Artificial/métodos , Electrocardiografía/métodos , Electrocardiografía , Radiografía Torácica/métodos , Radiografía TorácicaRESUMEN
Se presenta el caso clínico de una fémina con embarazo múltiple, obesa, hipertensa y con antecedente de riesgo obstétrico, quien estuvo durante más de una semana en el Hospital Materno de Palma Soriano hasta su traslado para el Ginecoobstétrico Mariana Grajales Coello de Santiago de Cuba, donde se detectaron una exagerada ganancia ponderal (17,5 kg) y grandes posibilidades de aparición de preeclampsia, que al producirse a las 31,3 semanas, obligó a interrumpir la gravidez. Por medio de una cesárea se extrajo a las 4 niñas, cuya madre evolucionó satisfactoriamente luego de haber permanecido ingresada en la Unidad de Cuidados Intensivos durante 72 horas(AU)
Tha case report of a hipertensive obese woman with multiple pregnancy and obstetric risk history is presented, who was for over a week in Palma Soriano Maternity Hospital until she moved to Mariana Grajales Coello Gynecoobstetric Hospital of Santiago de Cuba, where an exaggerated weight gain (17,5 kg) and a high potential for developing pre-eclampsia were detected, which occurred at 31,3 weeks and forced to interrupt the pregnancy. By means of caesarean section 4 girls were extracted, whose mother made good progress after her admission to the Intensive Care Unit for 72 hours(AU)
Asunto(s)
Humanos , Femenino , Persona de Mediana Edad , Embarazo Múltiple , Ultrasonografía , Preeclampsia/etiología , Edema Pulmonar/complicacionesRESUMEN
Introducción: La cetoacidosis diabética y el estado hiperosmolar hiperglucémico son las complicaciones agudas de la diabetes mellitus y constituyen causas frecuentes de ingreso en los hospitales. La patogenia de estas dos patologías difiere en cuanto a la disponibilidad de insulina, el estado de hidratación e incrementos de las hormonas contra reguladoras y por lo tanto la terapia es diferente. Fuentes: Artículos publicados a nivel internacional en relación al tratamiento de dichas patologías en los últimos 10 años. Desarrollo: El tratamiento de la cetoacidosis diabética requiere la administración de insulina, mientras que el estado hiperosmolar hiperglucémico requiere primordialmente de la adecuada terapia hídrica sustitutiva. Sin embargo en ambas situaciones es importante realizar al ingreso una minuciosa valoración clínicay laboratorial a los pacientes para establecer el manejo específico e individualizado en cada caso. Ya que la administración de insulina sin cuantificar previamente los niveles de potasio, selección inadecuada de soluciones isotónicas o hipotónicas para restitución hídrica, descenso acelerado de la osmolaridad plasmática entre otros, pueden poner en peligro la vida del paciente. Conclusión: El éxito de la terapia depende de la estrecha vigilancia clínico laboratorial periódica del paciente y de la capacidad del médico para identificar, tratar y prevenir las complicaciones tales como la hipoglucemia, hipocalemia, edema cerebral, síndrome de distres respiratorio agudo, tromboembolismo y coagulación intravascular diseminada entre otras con un alto grado de mortalidad; en los últimos años se han adoptado nuevas guías de manejo para estas condiciones, las cuales son recopiladas en esta revisión...