To compare the characteristics of patients who died versus those who survived with systemic lupus erythematosus (SLE) in the emergency intensive care unit (UCIE).
Retrospective collection of clinical and laboratory findings of clinical histories of patients with SLE in the UCIE of the Hospital Clínico Quirúrgico de Holguín in the period from January 2016 to January 2021. A descriptive statistical study and univariate analysis were carried out for continuous and discrete variables. The APACHE II score was calculated.
There were 23 patients with SLE during the period worked. The frequency of SLE in the ICU of the Hospital Clínico Quirúrgico de Holguín is 1.5%, it is the most frequent rheumatic pathology in ICU. Mortality in the ICU was 39.13%. The most frequent reason for admission was respiratory failure (52.4%), mostly due to an infectious cause. The variables that were significantly associated with mortality in the UCIE were: high erythrocyte sedimentation rate (ESR), severe anemia, severe hypoalbuminemia, the relationship arterial oxygen pressure between the fraction of inspired oxygen (PaFi) < 200 on admission. The APACHE II score in the deceased group was significantly higher (19.9) (P<.01). Acute renal failure requiring hemodialysis and the need for invasive mechanical ventilation in different modalities for variable times were significantly associated with higher mortality in ICU.
SLE in the ICU of the Hospital Clínico Quirúrgico de Holguín has a high mortality rate, higher than that reported in previous studies. Poor prognostic factors were high ESR, severe anemia, severe hypoalbuminemia, PaFi < 200, high APACHE II score, need for hemodialysis and invasive mechanical ventilation.
COVID-19 infection mainly alters lung function, although extrapulmonary manifestations have also been recognized. Up to now, it is known that one of the most common cardiovascular complications associated with COVID-19 is pericarditis, which can present at its extreme severity with cardiac tamponade, which can have a fatal outcome if it is not recognized and treated in time. In the current case report, we describe the anecdotal case of a 39-year-old patient, with no significant pathological history, who has previously received 2 doses of mRNA-1273 for SARS-CoV-2 with the last dose applied at least 3 months after a clinical picture compatible with cardiac tamponade secondary to pericarditis due to SARS-CoV-2, its evolution was satisfactory after drainage by video-assisted thoracoscopy, as well as use of colchicine.
Pneumoperitoneum is a potentially serious entity that in most cases is secondary to abdominal injury. However, in 5-15% of cases it is not secondary to injury, giving rise to what has been called benign, idiopathic or non-surgical pneumoperitoneum. The causes of benign pneumoperitoneum are multiple, both of abdominal and thoracic origin or others. The management and diagnosis of these patients constitutes a challenge, generally performing an urgent laparotomy in the presence of pneumoperitoneum. However, in selected cases and taking into account the clinical history, analytical, radiological and examination data, conservative management can be opted for.
We present the case of a 61-year-old patient who, after orotracheal intubation, presented spontaneous pneumoperitoneum, which was managed conservatively with good evolution from the abdominal point of view.
Multiple manifestations and complications associated with COVID-19 have been described, including coagulation disorders. The infection is known to induce a prothrombotic state, however, bleeding events have also been reported in these patients. We present the case of a 52-year-old man hospitalized for SARS-CoV-2 pneumonia, with a history of diabetes mellitus, systemic arterial hypertension, obesity, smoking, and hyperuricemia, who presented to the emergency department due to severe symptoms of the disease. During his hospitalization, he developed hemodynamic instability with a significant decrease in hemoglobin concentration. Massive hemothorax and a large chest wall hematoma were documented. This case highlights the importance of considering both thrombotic events and bleeding, in order to detect early any suspected bleeding and thus reduce mortality.
Acute lymphoblastic leukaemia is a common malignant disorder in the paediatric population that occurs in just 20% of leukaemia cases in the adult population. The development of hyperleukocytosis is linked to greater mortality in patients with acute lymphoblastic leukaemia. Although the organs it most commonly affects are the brain and lungs, this case presented obstructive shock as an aggravating circumstance of the condition. The patient in this case is a 32-year-old woman suffering from asthenia and adynamia, which had been ongoing for 2 weeks on admission to hospital, and which was latterly accompanied by nausea and vomiting. The patient had no other underlying chronic degenerative disorders. On her admission to the emergency department, the patient had 652,000 leukocytes, with a monocyte differential of 480,000 and 88% immature cells. She had clinical symptoms of multiple organ failure. This case is submitted based on its detrimental outcome with the development of multiple organ dysfunction, with the aggravating circumstance of heart failure resulting from obstructive shock owing to hyperleukocytosis.
Prone position in spontaneous ventilation is not a recent strategy, and despite the many years it has been trying to consolidate, it has not been able to prove to be of real utility. During the recent pandemic, prone spontaneous ventilation re-emerged as a practical and simple alternative, although it was highly questioned due to its weak level of evidence. With time and experience, it was gradually relegated to become only an attractive hypothesis.
This study aims to analyze the potential benefits of prone position in spontaneous ventilation in patients with hypoxemia caused by SARS-CoV-2.
A panoramic review of the most relevant studies published in the MEDLINE, Embase and Scopus databases up to December 20, 2021 was performed.
After screening, 4 observational studies, 1 randomized clinical trial, and 3 systematic reviews were selected for analysis.
By statistical analysis we concluded that prone position in spontaneous ventilation, although it could delay intubation, did not improve survival in hypoxemic subjects with viral pneumonia caused by coronavirus type 2.
The invention of the stethoscope allowed the incorporation of lung auscultation into the physical examination and into medical education. Its performance in critically ill patients and its correlation with mechanical ventilatory parameters is uncertain.
To explore whether the retraining of clinical postgraduate students in pulmonary auscultation improves performance and correlation indices with parameters of ventilatory mechanics.
Diagnostic test evaluation study was performed in an Intensive Care Unit in Medellín, from March to August 2022. Intubated patients, on mechanical ventilation and with a RASS score ≥−3 were included.
Clinical postgraduate students underwent a pedagogical intervention on the semiology of lung auscultation. Patients were auscultated with a Littman® Classic II stethoscope before and after the intervention. Findings of abnormal respiratory sounds were noted according to the nomenclature of the international association. Simultaneously, an evaluation of ventilatory mechanics was performed. The kappa concordance index was used. A value of P<.05 (95% CI) was considered significant.
Fifty-three patients were analyzed. Abnormal lung auscultation was reported in 38% of the patients before the intervention and in 43% after it. A concordance of 94% and a kappa coefficient of 0.88 (P<.001) were found. When comparing the clinical findings with the parameters of ventilatory mechanics, a sensitivity of 55% and a specificity of 65% were found with an LR+ 1.54 and LR− 0.7.
Lung auscultation continues to be part of the physical examination despite its low sensitivity and diagnostic specificity, especially in critically ill patients. Lung auscultation retraining has little impact on physical examination in the intubated patient. The correlation of these findings with ventilatory mechanics is poor and requires its concomitant use with other diagnostic methods.
Medical professionals, health institutions, pharmacists and the civil community in general must be part of ethical discussions and not only scientific ones on the indiscriminate use of antibiotics, self-medication or self-prescription. Current bioethics emphasizes self-care and care for others and considers infectious and contagious diseases as a public health problem of the present and the future.
Bioethics invites critical reflection on the daily practice of antibiotic prescription in the hospital and community environment with or without a prescription. It helps to understand that an inappropriate and irrational prescription of an antibiotic contributes to bacterial resistance. Resistance is produced when bacteria mutate in response to the indiscriminate use of these drugs; it is bacteria and not humans that become resistant to antibiotics through overuse.
In order to know the relationship between bioethics, antibiotic prescription and bacterial resistance, a non-systematic bibliographic review of articles on basic bioethics, and normative ethics applied through ethical theories in Web Bioethics and in PubMed was carried out regarding bacterial resistance and prescription. of antibiotics. The objective of this article was to make a bioethical reflection on the medical prescription of antibiotics associated with bacterial resistance.
Hospital mortality of patients admitted to the intensive care unit (ICU) has decreased in the last two decades despite an increase in disease severity. Advances in intensive care and the incorporation of new technologies have enabled fewer patients to express the early trajectory of multiple organ dysfunction and death in the acute stage of critical illness. However, some patients who survive acute illness remain dependent on intensive treatment for prolonged periods and constitute the chronic critical illness (CCI) population. This patient population frequently develops complications that limit quality of life and pose long-term survival challenges. Knowing more about CCI will facilitate the planning and implementation of patient- and family-centered care protocols regarding short- and long-term prospects.
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