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Introduction: Septic shock still entails significant morbidity and mortality, with the heart being affected due to catecholamine overexpression and direct injury from sepsis. Therefore, the effect of ß-blocking the receptors to improve performance is promising when attempting to reverse tachycardia and reduce mortality. Methods: We conducted a comprehensive search across five databases for studies published up to 28 January 2024, using a PICO strategy. Ten studies were identified for quantitative analysis and included in our meta-analysis. Results: Our meta-analysis evaluated 28-day in-hospital mortality risk across nine randomized controlled trials (RCTs) involving a total of 1,121 adults with septic shock. We found an association between ß-blocker use and reduced overall mortality (OR 0.57; 95% CI 0.34-0.98; I 2: 56%). This effect was significant in the esmolol subgroup (OR 0.47; 95% CI 0.26-0.82; I 2: 32%), but not in the landiolol subgroup (OR 0.98; 95% CI 0.0-1,284.5; I 2: 72%). Additionally, the intervention group shows a significant reduction in HR and lactate levels, as well as an increase in stroke volume index (SVI). Conclusion: In adults with septic shock, ß-blockers are associated with a reduction in 28-day in-hospital mortality, a benefit primarily observed with esmolol rather than landiolol. Furthermore, improvements in heart rate (HR) control, lactate levels, and SVI were noted. However, these findings should be interpreted with caution, and further high-quality RCTs comparing different ß-blockers are necessary to better elucidate these effects. Systematic review registration: https://www.crd.york.ac.uk/prospero/, identifier CRD42024513610.

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La ventilación mecánica invasiva como estrategia terapéutica no está exenta de complicaciones. Es imperativo tener parámetros de ventilación protectiva en aquellos pacientes que están sometidos a ello. Se pretende demostrar si la potencia mecánica como parámetro ventilatorio tiene validez pronóstica de mortalidad en pacientes críticos con ventilación mecánica invasiva prolongada. Material y Métodos: Se realizó un estudio transversal analítico de pacientes críticos en ventilación mecánica invasiva prolongada debido a Síndrome de Distrés Respiratorio Agudo por COVID-19 que ingresaron a la Unidad de Cuidados Intensivos del Hospital Regional Docente de Trujillo durante el periodo de marzo 2020 a marzo del 2021. Resultados: La potencia mecánica, como parámetro ventilatorio, se asocia a mortalidad (RPa 1.061; IC 95% 1.037-1.085; p=0.00) al igual que la presión plateau y siendo la driving pressure y compliance estática factores protectores para mortalidad. La potencia mecánica como parámetro ventilatorio tiene validez pronóstica para mortalidad severa por COVID-19(AU)

Invasive mechanical ventilation as a therapeutic strategy is not without complications. It is imperative to have protective ventilation parameters in those patients who are subjected to it. We aim to demonstrate whether mechanical power as a ventilatory parameter has prognostic validity for mortality in critically ill patients with prolonged invasive mechanical ventilation. Material and Methods: An analytical cross-sectional study was carried out of critically ill patients on prolonged invasive mechanical ventilation due to Acute Respiratory Distress Syndrome due to COVID-19 who were admitted to the Intensive Care Unit of the Hospital Regional de Trujillo during the March 2020 to March 2021 period. Results: Mechanical power, as a ventilatory parameter, is associated with mortality (RPa 1.061; 95% CI 1.037-1.085; p = 0.00) as well as plateau pressure, and driving pressure and static compliance are protective factors for mortality. Mechanical power as a ventilatory parameter has prognostic validity for mortality in critically ill patients with invasive mechanical ventilation due to severe acute respiratory distress syndrome due to COVID-19(AU)

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La COVID-19 es una enfermedad infecciosa que causa importantes disfunciones respiratorias con repercusión a largo plazo, perdurando después del alta médico. En este estudio, se determinó la asociación entre los factores sociodemográficos, clínicos y asistenciales con el impacto de la COVID-19 en la capacidad funcional respiratoria post alta hospitalaria. Material y métodos: estudio observacional, analítico, transversal. La muestra conformada por 385 pacientes con diagnóstico de COVID-19. Se aplicó una ficha de recolección de datos, se estimó la capacidad funcional respiratoria. Se realizó un análisis bivariado mediante la prueba de chi cuadrado y razón de prevalencias considerando una significancia del 95% (p<0,05). Resultados: De los 385 pacientes, 228 (59,2%) se les percibió capacidad respiratoria normal y, disminuida en 157 (40,8%). Los adultos contemporáneos (55,84%) y masculinos (67,80%) fueron mayormente afectados. La comorbilidad (p= 0,292) y Co-Rads (p= 0,797) no mostraron estar directamente asociadas a la afectación respiratoria; contrario a RALE ≥ 3 en Radiografía de tórax (p=0,000). El tiempo en hospitalización, UCI y ventilación mecánica sugiere estar relacionado con la disminución respiratoria. Sin embargo, por RPc no hubo evidencia estadísticamente significativa. Pero, clínica severa 3.029 [1.611 ­ 5.696] p= 0.001 y RALE ≥3 4.079 [2.248 ­ 7.401] p= 0,000, arrojaron asociación. Conclusión: se identificaron como factores asociados el grado de severidad y RALE≥ 3 en radiografía de tórax. Se sugiere realizar estudios que confirme los hallazgos de esta investigación y se proponga un protocolo de rehabilitación integral dirigido a pacientes post covid-19 que les permita recuperar la normalidad en la capacidad funcional respiratoria(AU)

COVID-19 is an infectious disease that causes significant respiratory dysfunctions with long-term repercussions, lasting after medical discharge. In this study, association between socio-demographic, clinical and healthcare factors with the impact of COVID-19 on post-discharge respiratory functional capacity was determinated. Material and methods: observational study, analytical, cross-sectional study. The sample made up of 385 patients diagnosed with COVID-19. A data collection form was applied; the respiratory functional capacity was estimated. A bivariate analysis was performed using the fe chi square test and prevalence ratio, considering a significance of 95% (p<0.05). Results: of the 385 patients, 228 (59.2%) had normal respiratory capacity, and decreased in 157 (40.8%). Contemporary adults (55.84%) and males (67.80%) were mostly affected. Comorbidity (p= 0,292) and Co-Rads (p= 0,797) were not shown to be directly associated with respiratory involvement; contrary to RALE ≥ 3 in chest X-ray (p=0,000). The time in hospitalization, ICU and mechanical ventilation suggests to be related to the respiratory decrease. However, by PCR there was no statically significant evidence. But, clinical severe 3,029 [1,611 ­ 5,696] p= 0.001 and RALE ≥3 4,079 [2,248 ­ 7,401] p= 0,000, showed association. Conclusion: the degree of severity and RALE ≥ 3 in chest X-ray were identified as associated factors. It is suggest to carry out studies that confirm the findings of this research and propose a comprehensive rehabilitation protocol aimed at post-covid-19 patients that allows them to recover normal respiratory functional capacity(AU)

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La alta morbi-mortalidad asociada con COVID-19, se ha desarrollado herramientas de estratificación de riesgo clínico para estos pacientes, con el fin de predecir la progresión a enfermedad grave y/o mortalidad. En este estudio se comparó la Escala Quick COVID19 Severity Index con News2 como predictor de mortalidad en adultos con infección por SARS ­ CoV-2, precisando su validez diagnóstica. Materiales y métodos: Estudio observacional, retrospectivo, analítico, de pruebas diagnósticas. Se incluyeron a 255 pacientes, mayores de 18 años, hospitalizados en el Hospital II ­ I Moyobamba con diagnóstico de COVID-19, con requerimiento de oxígeno ≤6 Lt/min, en el periodo de enero a diciembre del 2020. Resultados: 13% (32/255) de los pacientes fallecieron, con predominio del sexo masculino 62,5% (20/32), con edad promedio de 50 años, los parámetros bioclínico valorados no demostraron asociación estadísticamente significativa, a excepción de la glucemia p: 0.01. En cuanto a las escalas, considerándose como puntaje alto ≥ 7 puntos; Quick Covid-19 Severity Index no tiene asociación significativa como predictor de mortalidad, con una sensibilidad y especificidad de 43,75% y 63,23% respectivamente; mientras que NEWS-2 arrojo sensibilidad de 87,50%; especificidad de 50,67%; AUC 0,768 (IC: 0,684-0,853; p 0,00); es decir existe más del 75% de probabilidad de pronóstico. Conclusión: la escala NEWS-2estadisticamente mostró ser una buena herramienta para el pronóstico de mortalidad en pacientes con infección con SARS ­ CoV ­ 2, se sugiere realizar estudios que confirme los hallazgos de esta investigación y valorar su aplicabilidad y reproducibilidad en otras poblaciones(AU)

Due to the high morbidity and mortality associated with COVID-19, clinical risk stratification tools have been developed for these patients, in order to predict progression to severe disease and/or mortality. In this study, the Quick COVID19 Severity Index Scale was compared with News2 as a predictor of mortality in adults with SARS-CoV-2 infection, specifying its diagnostic validity. Materials and methods: Observational, retrospective, analytical study of diagnostic tests. 255 patients were included, over 18 years of age, hospitalized in Hospital II - I Moyobamba with a diagnosis of COVID-19, with an oxygen requirement of ≤6 Lt/min, from January to December 2020. Results: 13% (32/255) of the patients died, with a predominance of males 62.5% (20/32), with an average age of 50 years, the bioclinical parameters evaluated did not show a statistically significant association, except for the blood glucose p: 0.01. Regarding the scales, considering a high score ≥ 7 points; Quick Covid-19 Severity Index has no significant association as a predictor of mortality, with a sensitivity and specificity of 43.75% and 63.23%, respectively; while NEWS-2 showed sensitivity of 87.50%; specificity of 50.67%; AUC 0.768 (CI: 0.684-0.853, p 0.00); that is, there is more than 75% probability of prognosis. Conclusion: the NEWS-2 scale statistically showed to be a good tool for the prognosis of mortality in patients infected with SARS - CoV - 2, it is suggested to carry out studies that confirm the findings of this research and assess its applicability and reproducibility in other populations(AU)

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El COVID-19 es la causa más frecuente de SDRA generando cuadros clínicos leves, moderados y graves, en esta última, los pacientes podrían evolucionar a la necesidad de intubación orotraqueal y soporte ventilatorio avanzado; reportándose mortalidad de 26-90%, en estos casos. Es por ello, la necesidad de identificar factores de riesgos y herramientas predictores de mortalidad. En este estudio se determinó la validez diagnóstica de los índices de saturación de oxígeno y oxigenación como predictores de pronóstico de mortalidad en pacientes con SDRA severo por COVID-19 que requirieron de ventilación mecánica invasiva. Material y métodos: estudio transversal, analítico y retrospectivo. La muestra estuvo constituida por 176 historias clínicas de pacientes críticos. Se realizó análisis bivariado, y multivariado, además de determinar especificidad, sensibilidad, VPP, VPN y AUC. Resultados: 57,37% (101/176) de los pacientes fallecieron, con predominio del sexo masculino 79% (80/101); con edad promedio de 56 años. El lactato (p=0,115), no mostró asociación estadísticamente significativa. Contrariamente, en el análisis multivariado, el sexo masculino (p=0.04), glicemia (p=0,02) y, OI (p=0.00), arrojaron asociación. En cuanto a los índices, OSI registró sensibilidad y especificidad de 33% y 96% respectivamente; mientras que, IO tuvo 33,6% de sensibilidad y, 97,33% de especificidad; AUC 0,773 (IC: 0,677-0,868); es decir más del 77,3% de probabilidad de pronóstico a mortalidad. Conclusión: OSI y OI son adecuados predictores de mortalidad, teniendo OI mejor validez diagnóstico. Además, se ratifica, al sexo masculino y, aumento de valores glicémicos, como factores asociados a riesgo de desarrollar cuadros graves por COVID-19(AU)

COVID-19 is the most frequent cause of ARDS, generating mild, moderate and severe clinical symptoms, in the latter, patients could evolve to the need for orotracheal intubation and advanced ventilatory support; reporting mortality of 26-90% in these cases. This is why there is a need to identify risk factors and predictive tools for mortality. In this study, the diagnostic validity of the oxygen saturation and oxygenation indices as predictors of mortality prognosis in patients with severe ARDS due to COVID-19 who required invasive mechanical ventilation was determined. Material and methods: cross-sectional, analytical and retrospective study. The sample consisted of 176 medical records of critically ill patients. Bivariate and multivariate analyzes were performed, in addition to determining specificity, sensitivity, PPV, NPV, and AUC. Results: 57.37% (101/176) of the patients died, with a predominance of males 79% (80/101); with an average age of 56 years. Lactate (p=0.115) did not show a statistically significant association. Results: 57.37% (101/176) of the patients died, with a predominance of males 79% (80/101); with an average age of 56 years. Lactate (p=0.115) did not show a statistically significant association. Regarding the indices, OSI registered sensitivity and specificity of 33% and 96%, respectively; while IO had 33.6% sensitivity and 97.33% specificity; AUC 0.773 (CI: 0.677-0.868); that is, more than 77.3% probability of prognosis for mortality. Conclusion: OSI and OI are adequate predictors of mortality, with OI having better diagnostic validity. In addition, the male sex and increased glycemic values are confirmed as factors associated with the risk of developing serious conditions due to COVID-19(AU)

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La enfermedad COVID-19 tiene como complicación el de Síndrome Agudo Respiratorio Severo (SDRA), que es considerada la principal causa de mortalidad dentro de las unidades de cuidados intensivos, a pesar de brindar soporte ventilatorio precoz y óptimo. Sin embargo, es necesario identificar los factores que se asocian a mortalidad en estos pacientes. Objetivo: Determinar cuáles son los factores asociados a mortalidad en pacientes críticos con Síndrome de distrés respiratorio agudo severo por COVID-19 en unidad de cuidados intensivos. Material y métodos: Estudio transversal analítico. Se usó una base de datos obtenida de 176 historias clínicas de los pacientes con distrés respiratorio agudo severo por COVID-19 en un hospital público de Trujillo desde marzo 2020 a junio 2021. Se dividieron un grupo de pacientes que sobreviven y otro grupo de los que fallecen, subdividiéndose según presentaron o no factores de mortalidad asociados. Se realizó un análisis bivariado y con los factores que resultaron estadísticamente significativos se realizó un análisis multivariado para determinar variables asociadas a mortalidad. Resultados: Se halló una mortalidad de 57% del total de pacientes, al realizar el análisis multivariado se encontró asociación estadística significativa en la presencia de comorbilidades medidas con el Índice de Charlson (RPa=1,348; IC 95%: 1,01-1,79; p=0,040) y dentro de los parámetros ventilatorios a la presión pico (RPa=1,261 IC; 95%: 1,13-1,40; p<=0,000). Es necesario identificar aquellas variables de riesgo de mortalidad para estratificar a pacientes y optimizar la terapéutica(AU)

The COVID-19 disease is complicated by severe acute respiratory syndrome (ARDS), which is considered the main cause of mortality within intensive care units, despite providing early and optimal ventilatory support. However, it is necessary to identify the factors associated with mortality in these patients. Objective: To determine the factors associated with mortality in critically ill patients with severe acute respiratory distress syndrome due to COVID-19 in the intensive care unit. Material and methods: Analytical cross-sectional study. A database obtained from 176 medical records of patients with severe acute respiratory distress due to COVID-19 was used in a public hospital in Trujillo from March 2020 to June 2021. A group of patients who survived and another group of those who died were divided, being subdivided according to whether or not they present associated mortality factors. A bivariate analysis was performed and with the factors that were statistically significant, a multivariate analysis was performed to determine variables associated with mortality. Results: A mortality of 57% of the total number of patients was found, when performing the multivariate analysis, a significant statistical association was found in the presence of comorbidities measured with the Charlson Index (RPa = 1.348; 95% CI: 1.01-1.79; p = 0.040) and within the ventilatory parameters at peak pressure (RPa = 1.261 CI; 95%: 1.13-1.40; p <= 0.000). It is necessary to identify those mortality risk variables to stratify patients and optimize therapy(AU)

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Establecer la validez diagnóstica de la escala CALL como predictor de mortalidad en pacientes con COVID-19 severo en Unidad de Cuidados Intensivos del Hospital Regional Docente de Trujillo desde abril del 2020 hasta julio del 2021. Material y métodos: Se llevó a cabo un estudio analítico, retrospectivo, en el cual se incluyeron a 177 pacientes con COVID-19 severo internados en Unidad de Cuidados Intensivos del Hospital Regional Docente de Trujillo, según criterios de selección, se calculó la escala CALL para cada uno y se asoció con la mortalidad encontrada; aplicándose la prueba estadística chi cuadrado; posteriormente se realizó un análisis de regresión multivariante para identificar los factores de riesgo asociados a la mortalidad. A su vez se utilizó el AUROC (área bajo la curva ROC) para establecer el rendimiento predictivo de la escala CALL. Resultados: De una muestra de 177 pacientes, al analizar la información mediante la curva ROC, se obtuvo un valor de corte 6 puntos para la escala CALL, con un área bajo la curva (AUC) de 0.612 (p=0,014); sensibilidad, especificidad, valor predictivo positivo y negativo de 86%, 29%, 60% y 62% respectivamente. No se encontraron diferencias significativas estadísticamente en cuanto a sexo, edad, shock séptico, SOFA, índice de comorbilidad de Charlson, necesidad de TRR ni compliance estática. En cambio, se evidenció asociación con la PaO2/FiO2(AU)

To establish the diagnostic validity of the CALL score as a predictor of mortality in patients with severe COVID-19 in the Intensive Care Unit of the Trujillo Regional Teaching Hospital from April 2020 to July 2021.Material and methods: An analytical, retrospective study was carried out, in which 177 patients with severe COVID-19 admitted to the Intensive Care Unit of the Regional Teaching Hospital of Trujillo were included, according to selection criteria, the CALL score was calculated for each one and was associated with the mortality found; applying the statistical chi 2 test; Subsequently, a multivariate regression analysis was performed to identify risk factors associated with mortality. In turn, the AUROC (area under the ROC curve) was used to establish the predictive performance of the CALL score. Results: From a sample of 177 patients, when analyzing the information using the ROC curve, a cut-off value of 6 points was obtained for the CALL score, with an area under the curve (AUC) of 0.612 (p=0.014); sensitivity, specificity, positive and negative predictive value of 86%, 29%, 60% and 62% respectively. No statistically significant differences were found in terms of sex, age, septic shock, SOFA, Charlson comorbidity index, need for renal replacement therapy (RRT) or static compliance. On the other hand, an association with PaO2 / FiO2 was evidenced(AU)

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Cardiopulmonary resuscitation (CPR) refers to the set of procedures aimed at restoring spontaneous circulation in reversible cardiac arrest (CA) patients. There is a big difference between assisting a cardiac arrest in an end-stage disease patient where the cardiac arrest is an expected outcome resulting from the irrevocable evolution of a distressing disease, and assisting an unexpected sudden cardiac arrest in a patient admitted with a recoverable condition.

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PURPOSE: To determine the prognosis significance of the TNM clinic stage and the five-year survival rate of patients with primary carcinoma of the gallbladder. MATERIAL AND METHODS: A descriptive, longitudinal, observational study with a single-box empirical design that evaluated 71 patients with gallbladder cancer who had surgical resection of the neoplasia in the Belén Hospital in Trujillo, Peru between 1966 and 2000. RESULTS: The mean age of the total series was 61.6+/-12.04 years (ranging from 33 to 88 years). Most of the patients belonged to the age group of 60 years or older (56.3%). Ten patients were males (14.1%) and 61 were females (85.9%), with a M:F ratio of 1:6.1. In the univariate analysis using the log-rank test, the following variables were significantly related to a five-year survival time: primary tumor (p=0.0001), regional ganglionic condition (p=0.0038), clinic stage (p=0.00001). The actuarial survival rate of all the series at 12, 36, and 60 months was 30%, 14.1%, and 11.3%, respectively. CONCLUSIONS: The prognosis factors significantly related to five-year survival were: primary tumor (p=0.0001), regional ganglionic condition (p=0.0038) and clinic stage (p=0.00001). The actuarial survival rate of all the series at 12, 36, and 60 months was 30%, 14.1%, and 11.3%, respectively.

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Objetivos: Determinar la significancia pronóstica del estadío clínico TNM y la tasa de sobrevida quinquenal de pacientes con carcinoma primario de vesícula biliar. Material y Métodos: Estudio descriptivo, longitudinal, observacional y con diseño empírico de una sola casilla evaluó 71 pacientes con cáncer de vesícula biliar sometidos a resección de la neoplasia en el Hospital Belén, Trujillo, Perú, entre los años 1966 y 2000. Resultados: La edad media de la serie total fue de 61,6 + 12,04 años (límites de 33 a 88 años). La mayoría de pacientes perteneció al grupo etáreo de mayor o igual a 60 años (56.3 por ciento). Diez pacientes pertenecieron al sexo masculino (14.1 por ciento) y 61 al sexo femenino (85.9 por ciento), proporción (H:M = 1:6,1). En el análisis univariado, usando el test de log -rank, las siguientes variables estuvieron asociadas significativamente con la sobrevida quinquenal: tumor primario (p= 0.0001), estado ganglionar regional (p=0.0038), estadío clínico (p=0.00001). Las tasas de sobrevida actuarial de toda la serie a los 12, 36 y 60 meses fueron de 30 por ciento, 14.1 por ciento y 11.3 por ciento respectivamente. Conclusiones: Los factores pronósticos que estuvieron asociados significativamente con la sobrevida quinquenal fueron: el tumor primario (p=0.0001), estado ganglionar regional (p=0.0038) y estadío clínico (p=0.00001). Las tasas de sobrevida actuarial de toda la serie a los 12, 36 y 60 meses fueron de 30 por ciento, 14.1 por ciento y 11,3 por ciento respectivamente.

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