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Familial hyperchylomicronemia syndrome is a monogenic autosomal recessive disorder that causes severe and refractory hypertriglyceridemia. This uncommon condition is challenging to diagnose and treat and can lead to comorbidities such as acute pancreatitis. Although treatment options are limited in the pediatric population, strict diets and treatments approved for other dyslipidemias may be implemented in familial hyperchylomicronemia syndrome, given the lack of pharmacological interventions available. We report a 14-year-old female presented to the emergency room with abdominal pain suggestive of acute pancreatitis. Biochemical analysis revealed a triglyceride value of 4260 mg/dL. Treatment for triglyceride reduction with a strict CHILD-2 triglyceride-lowering diet, insulin infusion, fibrates, and multiple plasmapheresis were initially insufficient. Primary hypertriglyceridemia was suspected, and genetic testing identified a homozygous pathogenic variant in the lipoprotein lipase gene, diagnosing familial hyperchylomicronemia syndrome. She was discharged with a maximum dose of fibrate, statin, omega-3 fatty acids, and a restrictive diet. At her 1-month and 9-month follow-ups, her triglyceride values were 756 and 495 mg/dL, respectively, without incident complications. Familial hyperchylomicronemia syndrome is an uncommon condition with limited available literature and treatment options, especially in the pediatric population. Acute pancreatitis secondary to severe hypertriglyceridemia is a condition with a high risk of mortality which requires prompt clinical suspicion and treatment.

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OBJECTIVES: To explore variables associated with adverse maternal/fetal/neonatal outcomes among pregnant/postpartum patients admitted to ICU for hypertensive disorders of pregnancy (HDP). METHODS: Multicenter, prospective, national cohort study. RESULTS: Variables independently associated with maternal/fetal/neonatal mortality among 172 patients were as follows: Acute Physiology and Chronic Health Evaluation-II (APACHE-II)(OR1.20[1.06-1.35]), gestational age (OR0.698[0.59-0.82]) and aspartate aminotransferase (AST)(OR1.004[1.001-1.006]). Positive likelihood ratio for headache, epigastric pain, and visual disturbances to predict composite adverse outcomes were 1.23(1.16-1.30), 0.76(0.59-1.02), and 1.1(0.98-1.2), respectively. CONCLUSIONS: Maternal/fetal mortality due to HDP was independently associated with severity of illness on admission, gestational age, and elevated AST. Accuracy of clinical symptoms to predict composite adverse outcomes was low.

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RATIONALE: The purpose of the current study was to analyze the influence of coronavirus awareness, psychological stress responses, and sociodemographic variables on mental health indicators (somatization, depression, and anxiety) in residents of Honduras, Chile, Costa Rica, Mexico, and Spain. METHODS: The study used a quantitative, cross-sectional approach. Data was collected online using the Brief Symptom Inventory-18 (BSI-18); the Coronavirus Awareness Scale-6 (CAS-6) and a questionnaire that included psychological and sociodemographic questions. The total sample size consisted of 1559 respondents from Honduras (34%), Chile (29%), Costa Rica (17%), Mexico (11%), and Spain (9%). RESULTS: The most common stress domains correspond to family (22.97%), financial (22.53%), academic (16.47%), leisure time constraints (14.23%), health (12.48%), peer group (7.63%), and religious concerns (3.69%). These domains are significantly associated with the respondent's country, sex, employment status, and being or not a health worker. Respondents who reported confinement stress also reported higher scores in anxiety, depression, and somatization. The Global Severity Index was significantly predicted by confinement stress, health, academic, and leisure time-related stress, sex, age, being a health worker, COVID-19 Personal Concern, and Perceived Seriousness. Non-significant predictors were employment status, the number of people at home, presence of older adults and children at home, financial, peer group, family, and religious concerns; the regression model had an R2 of 0.26. Similar analyses were conducted for somatization, depression, and anxiety subscales. CONCLUSIONS: The COVID-19 pandemic has adverse effects on the mental health of the general population, particularly regarding anxiety, depression, and somatization. Specific populations, such as women and healthcare workers, are at particular risk of suffering a deterioration in mental wellbeing. The implications of the study for public policy are discussed.

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OBJECTIVES: To evaluate the effect of high-flow oxygen implementation on the respiratory rate as a first-line ventilation support in chronic obstructive pulmonary disease patients with acute hypercapnic respiratory failure. DESIGN: Multicenter, prospective, analytic observational case series study. SETTING: Five ICUs in Argentina, between August 2018 and September 2019. PATIENTS: Patients greater than or equal to 18 years old with moderate to very severe chronic obstructive pulmonary disease, who had been admitted to the ICU with a diagnosis of hypercapnic acute respiratory failure, were entered in the study. INTERVENTIONS: High-flow oxygen therapy through nasal cannula delivered using high-velocity nasal insufflation. MEASUREMENTS AND MAIN RESULTS: Forty patients were studied, 62.5% severe chronic obstructive pulmonary disease. After the first hour of high-flow nasal cannula implementation, there was a significant decrease of respiratory rate compared with baseline values, with a 27% decline (29 vs 21 breaths/min; p < 0.001). Furthermore, a significant reduction of Paco2 (57 vs 52 mm Hg [7.6 vs 6.9 kPa]; p < 0.001) was observed. The high-flow nasal cannula application failed in 18% patients. In this group, the respiratory rate, pH, and Paco2 showed no significant change during the first hour in these patients. CONCLUSIONS: High-flow oxygen therapy through nasal cannula delivered using high-velocity nasal insufflation was an effective tool for reducing respiratory rate in these chronic obstructive pulmonary disease patients with acute hypercapnic respiratory failure. Early determination and subsequent monitoring of clinical and blood gas parameters may help predict the outcome.

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RESUMEN La hipercetonemia o cetosis bovina es un desorden metabólico, que se caracteriza por el incremento patológico de cuerpos cetónicos (beta-hidroxibutirato (βHB), Acetoacetato (AcAc) y acetona) y ocurre en el periparto de vacas de leche. El origen primario de la enfermedad es el balance energético negativo (BEN), que puede ser desencadenado por el incremento excesivo de los requerimientos energéticos o la presentación de enfermedades posparto, resultando en la presentación de signos clínicos o disminución de la producción de leche. El objetivo de esta revisión consiste en describir, mediante un modelo, los procesos bioquímicos del rumen y los mecanismos fisiopatológicos, involucrados con incremento excesivo de los cuerpos cetónicos. En resumen, se realizó un modelo fisiológico uniendo literatura fragmentada, sobre la relación entre la función ruminal, hepática y la inducción de lipolisis e incremento de la actividad de Carnitil-Palmitoil transferasa-1 (CPT-1), cuyo resultado puede ser la producción excesiva de Acetil-CoA que, junto con la falta de propionato y oxalacetato (precursores de gluconeogénesis y ciclo de Krebs), dan lugar a la producción patológica de acetoacetato y beta-hidroxibutirato.

ABSTRACT Bovine hyperketonemia or ketosis is a metabolic disorder characterized by high levels of ketone bodies (beta-hydroxybutyrate (βHB), Acetoacetate (AcAc), and acetone) in periparturient dairy cows. A Negative Energy Balance (NEB) is identified as the primary cause of the disease, which is triggered by the excessive increase of energy requirements or the presence of postpartum diseases, resulting in the appearance of clinical signs or decreased milk production. The purpose of this review is to describe the rumen's biochemical Process and the physiopathological mechanisms involved in the excessive production of ketone bodies. After conducting a literature review, a physiological model was carried out in order to understand the relationship between the rumen and liver functions with lipolysis induction and increased CPT-1 activity. The above may result in the overproduction of Acetyl-CoA, which together, with the lack of propionate and oxaloacetate (gluconeogenesis and Krebs cycle precursors), leads to the pathological production of acetoacetate and beta-hydroxybutyrate.

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BACKGROUND: Resuscitation of septic patients regarding goals, monitoring aspects and therapy is highly variable. Our aim was to characterize cardiovascular and fluid management of sepsis in Argentina, a low and middle-income country (LMIC). Furthermore, we sought to test whether the utilization of dynamic tests of fluid responsiveness, as a guide for fluid therapy after initial resuscitation in patients with persistent or recurrent hypoperfusion, was associated with decreased mortality. METHODS: Secondary analysis of a national, multicenter prospective cohort study (n = 787) fulfilling Sepsis-3 definitions. Epidemiological characteristics, hemodynamic management data, type of fluids and vasopressors administered, physiological variables denoting hypoperfusion, use of tests of fluid responsiveness, and outcomes, were registered. Independent predictors of mortality were identified with logistic regression analysis. RESULTS: Initially, 584 of 787 patients (74%) had mean arterial pressure (MAP) < 65 mm Hg and/or signs of hypoperfusion and received 30 mL/kg of fluids, mostly normal saline (53%) and Ringer lactate (35%). Vasopressors and/or inotropes were administered in 514 (65%) patients, mainly norepinephrine (100%) and dobutamine (9%); in 22%, vasopressors were administered before ending the fluid load. After this, 413 patients (53%) presented persisting or recurrent hypotension and/or hypoperfusion, which prompted administration of additional fluid, based on: lactate levels (66%), urine output (62%), heart rate (54%), central venous O2 saturation (39%), central venous-arterial PCO2 difference (38%), MAP (31%), dynamic tests of fluid responsiveness (30%), capillary-refill time (28%), mottling (26%), central venous pressure (24%), cardiac index (13%) and/or pulmonary wedge pressure (3%). Independent predictors of mortality were SOFA and Charlson scores, lactate, requirement of mechanical ventilation, and utilization of dynamic tests of fluid responsiveness. CONCLUSIONS: In this prospective observational study assessing the characteristics of resuscitation of septic patients in Argentina, a LMIC, the prevalent use of initial fluid bolus with normal saline and Ringer lactate and the use of norepinephrine as the most frequent vasopressor, reflect current worldwide practices. After initial resuscitation with 30 mL/kg of fluids and vasopressors, 413 patients developed persistent or recurrent hypoperfusion, which required further volume expansion. In this setting, the assessment of fluid responsiveness with dynamic tests to guide fluid resuscitation was independently associated with decreased mortality.

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ABSTRACT Objective: to carry out an integrative review of the literature on autobiographical narratives as a discursive activity in the older adult with neurocognitive disorder. Methods: a descriptive study that covered the Scopus, SciELO, PubMed, and Science Direct databases, from 2009 to 2019, using the keywords autobiographical, narrative, dementia, reminiscence, the elderly, and the Boolean operator. A narrative synthesis was adopted considering the characteristics of the clinical, and methodological heterogeneity of the studies. Results: the results included 3 articles published between 2012 and 2018, in the English language, from the United Kingdom, Brazil, and Argentina, which highlighted the autobiographical narratives. Although in a strict sense they did not present the narrative as a specific objective of the autobiographical study, they did provide interesting and related data which justified their inclusion. Conclusion: it is observed that the literature researched presents a limited number of articles, adressing the autobiographical narrative as a discursive activity in the elderly with neurocognitive disorder.

RESUMEN Objetivo: realizar una revisión integrativa de la literatura sobre la narrativa autobiográfica como actividad discursiva del adulto mayor con trastorno neurocognitivo. Métodos: estudio descriptivo que cubrió las bases de datos Scopus, SciELO, PubMed y Science Direct, en el periodo de 2009 a 2019, con las palabras clave: narrativa autobiográfica, demencia, reminiscencia, adulto mayor y el operador booleano and. Se adoptó una síntesis narrativa considerando las características de la heterogeneidad clínica y metodológica de los estudios. Resultados: los resultados comprenden 3 artículos, publicados entre 2012 a 2018, en Reino Unido, Brasil y Argentina. Aunque en stricto sensu no presentan como objetivo específico el estudio de aspectos discursivos de la narrativa autobiográfica, entregan datos interesantes y relacionados a ella, lo que justifica su inclusión Conclusión: se observa que todavía hay un número limitado de artículos en la literatura con el enfoque de la narrativa autobiográfica como actividad discursiva de la persona mayor con trastorno neurocognitivo.

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Coffee husks represent about 12 wt % of coffee grains, generating a significant impact on the environment because of its inadequate disposal. In Colombia, this waste presents an energy resource opportunity equivalent to over 49,106 TJ per year. However, several challenges related to this type of biomass, such as the moisture content, the irregular shapes, and the low bulk density, make its use difficult in current burners. Thus, in this paper, the combustion of coffee husk pellets was studied in detail to design a high-efficiency burner to produce energy for coffee drying. The pellets were prepared in a pelletizer with 15% moisture and 20% yield and burned in a bench-scale lateral reactor to determine the energy density. It was found that the combustion properties of coffee husk depend on the specifics of the pelleting process. The energy density values were I v = 0.789 MW/m3 and I g = 0.007 MW/m2, which could be used to design the combustion chamber for coffee husk burning.

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BACKGROUND: Socioeconomic variables impact health outcomes but have rarely been evaluated in critical illness. Low- and middle-income countries bear the highest burden of sepsis and also have significant health inequities. In Argentina, public hospitals serve the poorest segment of the population, while private institutions serve patients with health coverage. Our objective was to analyze differences in mortality between public and private hospitals, using Sepsis-3 definitions. METHODS: This is a multicenter, prospective cohort study including patients with sepsis admitted to 49 Argentine ICUs lasting 3 months, beginning on July 1, 2016. Epidemiological, clinical, and socioeconomic status variables and hospital characteristics were compared between patients admitted to both types of institutions. RESULTS: Of the 809 patients included, 367 (45%) and 442 (55%) were admitted to public and private hospitals, respectively. Those in public institutions were younger (56 ± 18 vs. 64 ± 18; p < 0.01), with more comorbidities (Charlson score 2 [0-4] vs. 1 [0-3]; p < 0.01), fewer education years (7 [7-12] vs. 12 [10-16]; p < 0.01), more frequently unemployed/informally employed (30% vs. 7%; p < 0.01), had similar previous self-rated health status (70 [50-90] vs. 70 [50-90] points; p = 0.30), longer pre-admission symptoms (48 [24-96] vs. 24 [12-48] h; p < 0.01), had been previously evaluated more frequently in any healthcare venue (28 vs. 20%; p < 0.01), and had higher APACHE II, SOFA, lactate levels, and mechanical ventilation utilization. ICU admission as septic shock was more frequent in patients admitted to public hospitals (47 vs. 35%; p < 0.01), as were infections caused by multiresistant microorganisms. Sepsis management in the ICU showed no differences. Twenty-eight-day mortality was higher in public hospitals (42% vs. 24%; p < 0.01) as was hospital mortality (47% vs. 30%; p < 0.01). Admission to a public hospital was an independent predictor of mortality together with comorbidities, lactate, SOFA, and mechanical ventilation; in an alternative prediction model, it acted as a correlate of pre-hospital symptom duration and infections caused by multiresistant microorganisms. CONCLUSIONS: Patients in public hospitals belonged to a socially disadvantaged group and were sicker at admission, had septic shock more frequently, and had higher mortality. Unawareness of disease severity and delays in the health system might be associated with late admission. This marked difference in outcome between patients served by public and private institutions constitutes a state of health inequity.

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Congenital hernias, frequently misdiagnosed during pregnancy, are potentially fatal and require prompt repair. A pregnant woman with medical history of repaired congenital hernia was admitted with misdiagnosis of preeclampsia. Physical examination and chest x-ray revealed a Bochdalek hernia. Transitory stabilization prompted surgeons to postpone hernia repair, but an urgent thoracotomy was required to relieve a subsequent bowel obstruction that was complicated by an intrathoracic colonic perforation. Emergent cesarean delivery was required with a good maternal and fetal outcome. A multidisciplinary team was present in the operating room. All monitoring catheters were placed in advance in the intensive care unit. During recovery, the patient experienced ventricular fibrillation, presumed to be a manifestation of takotsubo syndrome, which responded favorably to cardiopulmonary resuscitation.

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RESUMEN Existe poca evidencia que avale el uso de ventilación mecánica no invasiva en falla respiratoria aguda hipoxémica. Sin embargo, considerando las complicaciones asociadas a la intubación endotraqueal, se intentó implementar ventilación mecánica no invasiva en una paciente de 24 años cursando 32 semanas de gestación, que ingresó a la unidad de cuidados intensivos con falla respiratoria aguda hipoxémica y sepsis a foco urinario. La falta de tolerancia a la ventilación mecánica no invasiva, nos indujo a utilizar un método alternativo con el fin de evitar la intubación endotraqueal. La implementación de terapia con oxígeno a alto flujo a través de cánula nasal permitió superar la situación, presentando a ésta técnica como una opción de tratamiento en pacientes obstétricas críticas, segura tanto para la madre como para el feto.

ABSTRACT Little evidence exists to support the use of noninvasive mechanical ventilation for acute hypoxemic respiratory failure. However, considering the complications associated with endotracheal intubation, we attempted to implement noninvasive mechanical ventilation in a 24-year-old patient who was 32 weeks pregnant and was admitted to the intensive care unit with acute hypoxemic respiratory failure and sepsis secondary to a urinary tract infection. Lack of tolerance to noninvasive mechanical ventilation led us to use an alternative method to avoid endotracheal intubation. The use of high-flow nasal cannula allowed to overcome this situation, wich supports this technique as a treatment option for critical obstetric patients that is safe for both the mother and fetus.

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BACKGROUND: High-flow nasal cannula (HFNC) enables delivery of humidified gas at high flow while controlling the FIO2 . Although its use is growing in patients with acute respiratory failure, little is known about the impact of HFNC on lung volume. Therefore, we aimed to assess lung volume changes in healthy subjects at different flows and positions. METHODS: This was a prospective physiological study performed in 16 healthy subjects. The changes in lung volumes were assessed by measuring end-expiratory lung impedance by using electrical impedance tomography. All the subjects successively breathed during 5 min in these following conditions: while in a supine position without HFNC (T0) and 3 measurements in a semi-seated position at 45° without HFNC (T1), and with HFNC at a flow of 30 L/min (T2), and 50 L/min (T3). RESULTS: Compared with the supine position, the values of end-expiratory lung impedance significantly increased with the subjects in a semi-seated position. End-expiratory lung impedance significantly increased after HFNC initiation in subjects in a semi-seated position and further increased by increasing flow at 50 L/min. When taking the end-expiratory lung impedance measurement in subjects in a semi-seated position (T1) as reference, the differences among the medians of global end-expiratory lung impedance were statistically significant (P < .001), which amounted to 1.05 units in T1; 1.12 units in T2; and 1.44 units in T3 (P < .05 for all comparisons, Wilcoxon test). The breathing frequency did not differ between the supine and semi-seated position (T0 and T1) but significantly decreased after initiation of HFNC and further decreased at high flow. T0 and T1 were not different (P = .13); whereas there was a statistically significant difference among T1, T2, and T3 (P < .05, post hoc test with Bonferroni correction). CONCLUSIONS: In healthy subjects, the semi-seated position and the use of HFNC increased end-expiratory lung impedance globally. These changes were accompanied by a significant decrease in the breathing frequency.

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Little evidence exists to support the use of noninvasive mechanical ventilation for acute hypoxemic respiratory failure. However, considering the complications associated with endotracheal intubation, we attempted to implement noninvasive mechanical ventilation in a 24-year-old patient who was 32 weeks pregnant and was admitted to the intensive care unit with acute hypoxemic respiratory failure and sepsis secondary to a urinary tract infection. Lack of tolerance to noninvasive mechanical ventilation led us to use an alternative method to avoid endotracheal intubation. The use of high-flow nasal cannula allowed to overcome this situation, wich supports this technique as a treatment option for critical obstetric patients that is safe for both the mother and fetus.

Existe poca evidencia que avale el uso de ventilación mecánica no invasiva en falla respiratoria aguda hipoxémica. Sin embargo, considerando las complicaciones asociadas a la intubación endotraqueal, se intentó implementar ventilación mecánica no invasiva en una paciente de 24 años cursando 32 semanas de gestación, que ingresó a la unidad de cuidados intensivos con falla respiratoria aguda hipoxémica y sepsis a foco urinario. La falta de tolerancia a la ventilación mecánica no invasiva, nos indujo a utilizar un método alternativo con el fin de evitar la intubación endotraqueal. La implementación de terapia con oxígeno a alto flujo a través de cánula nasal permitió superar la situación, presentando a ésta técnica como una opción de tratamiento en pacientes obstétricas críticas, segura tanto para la madre como para el feto.

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Pregnant and postpartum patients represent a challenge to critical care physicians, as two patients in one have to be cared for and because specific obstetric disorders, not universally covered in formal critical care training, need to be managed. Pregnancy also alters physiologic norms, so that the critical care physician may either fail to recognize a value as abnormal in pregnancy or mistakenly identify as abnormal a value within the normal range for a pregnant woman. In this article, we will review the most frequent obstetric causes of admission of pregnant/postpartum patients to the intensive care unit (hypertensive disease of pregnancy, obstetric hemorrhage, and obstetric sepsis) along with their diagnostic criteria, clinical presentation, and recommended treatment. We will also cover some specific, although less frequent, obstetric disorders, such as acute fatty liver of pregnancy, peripartum cardiomyopathy, and amniotic fluid embolism. Our primary aim is to improve quality of care for these types of patients.

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Objetivo: Describir las características clínicas de los pacientes internados en la UCI con requerimiento de VMi con FRAH-No SDRA. Evaluar la asociación de la mortalidad con diferentes variables. Diseño: Cohorte de comienzo. Ámbito: Estudio realizado en 2 UCIs argentinas del ámbito privado de la salud, entre el 01/07/2013 y 31/12/2014. Pacientes: De una muestra consecutiva de 2526 pacientes, se incluyeron a 229 mayores de 18 años, que ingresaron a la UCI con requirimiento de VMi por más de 24hs desarrollando FRAH-No SDRA. Variables de interés principales: Se registraron variables demográficas, estadía en VMi y en UCI, variables de programación inicial del respirador, variables de monitoreo y evolución al alta. También se registraron el número y tipo de complicaciones desarrolladas durante el periodo de VMi Resultados: El 70,7% de los ingresos fue por causa médica. El SAPS II fue de 42. El tiempo de VMi y de estadía en UCI fue mayor en los pacientes con delirio (p < 0,0001 en ambos). En el modelo de regresión logística ajustado por severidad de la hipoxemia, la edad (OR 1,02; IC95% 1,002-1,04: p = 0,033) y el shock (OR 2,37; IC95% 1,12-5: p = 0,023) resultaron predictores independientes de mortalidad. Conclusiones: En este grupo de pacientes que requirieron VMi por más de 24 hs y desarrollaron FRAH-No SDRA se encontró una distribución demográfica similar a la descripta por otros reportes. La mortalidad no se relacionó con la severidad de la hipoxemia, mientras que el shock y la edad fueron predictores independientes de mortalidad.

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Objective: To describe the clinical characteristics of patients with AHRF (without ARDS) hospitalized in the ICU who require IMV. To evaluate the association between mortality and different variables. Design: Inception cohort. Scope: This study was conducted in two Argentine ICUs from the private health sector between 07/01/2013 and 12/31/2014. Patients: From a consecutive sample of 2526 patients, 229 individuals aged 18 and upwards were included in the study; they were admitted to the ICU requiring IMV for over 24 hours and developed AHRF (without ARDS). Primary endpoints: Demographic variables and variables associated with the number of days with IMV and at the ICU were documented, as well as the initial setting of the respirator, monitoring variables and evolution at discharge. Likewise, the number and type of complications developed during the period of IMV were documented. Results: 70.7% of admissions were for medical reasons. SAPS II score was 42. The period of IMV and at the ICU was higher in patients with delirium (p<0.0001 in both). In the logistic regression model adjusted by the severity of hypoxemia, age (OR 1.02; 95% CI 1.002-1.04: p = 0.033) and shock (OR 2.37; 95% CI 1.12-5: p = 0.023) acted as independent predictors of mortality. Conclusions: In this group of patients who required IMV for over 24 hours and who developed AHRF (without ARDS) there was a demographic distribution similar to that described in other reports. Mortality was not associated with the severity of hypoxemia, whereas shock and age were independent predictors of mortality.

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OBJECTIVE: To evaluate pregnant/postpartum patients requiring ICUs admission in Argentina, describe characteristics of mothers and outcomes for mothers/babies, evaluate risk factors for maternal-fetal-neonatal mortality; and compare outcomes between patients admitted to public and private health sectors. DESIGN: Multicenter, prospective, national cohort study. SETTING: Twenty ICUs in Argentina (public, 8 and private, 12). PATIENTS: Pregnant/postpartum (< 42 d) patients admitted to ICU. INTERVENTIONS: None. MEASUREMENTS AND MAIN RESULTS: Three hundred sixty-two patients were recruited, 51% from the public health sector and 49% from the private. Acute Physiology and Chronic Health Evaluation II was 8 (4-12); predicted/observed mortality, 7.6%/3.6%; hospital length of stay, 7 days (5-13 d); and fetal-neonatal losses, 17%. Public versus private health sector patients: years of education, 9 ± 3 versus 15 ± 3; transferred from another hospital, 43% versus 12%; Acute Physiology and Chronic Health Evaluation II, 9 (5-13.75) versus 7 (4-9); hospital length of stay, 10 days (6-17 d) versus 6 days (4-9 d); prenatal care, 75% versus 99.4%; fetal-neonatal losses, 25% versus 9% (p = 0.000 for all); and mortality, 5.4% versus 1.7% (p = 0.09). Complications in ICU were multiple-organ dysfunction syndrome (34%), shock (28%), renal dysfunction (25%), and acute respiratory distress syndrome (20%); all predominated in the public sector. Sequential Organ Failure Assessment (during first 24 hr of admission) score of at least 6.5 presented the best discriminative power for maternal mortality. Independent predictors of maternal-fetal-neonatal mortality were Acute Physiology and Chronic Health Evaluation II, education level, prenatal care, and admission to tertiary hospitals. CONCLUSIONS: Patients spent a median of 7 days in hospital; 3.6% died. Maternal-fetal-neonatal mortality was determined not only by acuteness of illness but to social and healthcare aspects like education, prenatal control, and being cared in specialized hospitals. Sequential Organ Failure Assessment (during first 24 hr of admission), easier to calculate than Acute Physiology and Chronic Health Evaluation II, was a better predictor of maternal outcome. Evident health disparities existed between patients admitted to public versus private hospitals: the former received less prenatal care, were less educated, were more frequently transferred from other hospitals, were sicker at admission, and developed more complications; maternal and fetal-neonatal mortality were higher. These findings point to the need of redesigning healthcare services to account for these inequities.

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PURPOSE: Our goal was to describe the evolution of selected physical and psychologic symptoms and identify the determinants of health-related quality of life (HRQOL) after intensive care unit (ICU) discharge. METHODS: The study is a prospective cohort of consecutive adult patients admitted to a mixed ICU in a university-affiliated hospital, mechanically ventilated for more than 48 hours. During ICU stay, epidemiological data and events probably associated to worsening outcomes were recorded. After discharge, patients were interviewed at 1, 3, 6, and 12 months. Health-related quality of life was assessed with EuroQoL Questionnaire-5 Dimensions, which includes the EQ-index and EQ-Visual Analogue Scale. RESULTS: One hundred twelve patients were followed up, aged 33 [24-49] years, 68% male, 76% previously healthy, and cranial trauma was the main diagnosis. Physical and psychologic symptoms and moderate/severe problems according to the EQ index progressively decreased after discharge, yet were still highly prevalent after 1 year. EQ index improved from 0.22 [0.01-0.69] to 0.52 [0.08-0.81], 0.66 [0.17-0.79], and 0.68 [0.26-0.86] (P < .001, for all vs month 1). EQ-Visual Analogue Scale remained stable, within acceptable values. Independent determinants of EQ-index were time, duration of mechanical ventilation, shock, weakness, and return to study/work. CONCLUSIONS: Determinants of HRQOL after ICU discharge were both related to late sequelae of critical illness and to some events occurring in the ICU. Notwithstanding the high symptom burden, patients still perceived their HRQOL as good.

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OBJECTIVE: To describe characteristics, outcomes and clinical presentations for hypertensive disease of pregnancy (HDP) in patients admitted to three ICUs in Argentina. METHODS: Case-series multicenter study. RESULTS: There were 184 patients with HDP. Mean age 26 ± 8; 90% did not present comorbidity; APACHEII 9[6-14]; SOFA24 2[1-4]; ICU-LOS 3[2-6] days and hospital-LOS 8[5-12] days. Gestational age 34 ± 5 weeks; 46% (85) nulliparous and 71% received routine prenatal care. Maternal mortality 3.3% (6) - 50% attributed to intracranial hemorrhage (ICH). Neonatal mortality 13.6%. Diagnostic categories: eclampsia (64; 35%), severe preeclampsia (60; 32.6%), HELLP (33; 17.9%), eclampsia-HELLP (18; 9.8%) and other (chronic/gestational-hypertension) (9: 4.7%). Severe hypertension in 46%, multiple organ dysfunction in 23%, acute respiratory distress in 8.7% and acute renal failure in 8%. Variables independently associated with eclampsia: maternal age (OR 1.07 [1.02-1.13], gestational age (OR 1.14 [1.04-1.24]) and nulliparity (OR 2.40 [1.19-4.85]). CONCLUSIONS: Although patients were young and the majority received appropriate prenatal care, they spent considerable time in hospital and presented severe morbidity. Maternal mortality was 3.3% and in half of these cases it was attributed to ICH. Eclampsia and severe preeclampsia represented two thirds of the diagnostic categories. Variables independently associated with eclampsia were maternal and gestational ages and nulliparity.

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