Antoni Costes i Rodríguez

New definition of sepsis and septic shock: What does it give us?

A few days ago, new definitions of sepsis and septic shock were launched as a result of a consensus of 19 experts SCCM (Society of Critical Care Medicine) and ESICM (European Society of Intensive Care Medicine). Perhaps the greatest contribution of this expert opinion consensus has been to recognize sepsis as a difficult to characterize syndromic condition, with a cellular metabolic disorder as a lead condition along with the development of organ failure. However, as the most important feature, the new definition excludes the concept of SIRS (Systemic Inflammatory Response Syndrome) since this term is being considered of not useful anymore. The authors supported this decision mainly based on a retrospective study conducted in Australia and New Zealand in which it was observed (glass half-empty approach) that 1 out of 8 patients (12.5%) with sepsis and multiorgan failure (MOF) did not have at least 2 SIRS criteria. However, these results (glass halffull approach) could be reinterpreted as 7 out of 8 patients (87.5%) did present positive SIRS criteria. Furthermore, the authors, in the paper on new sepsis definitions, affirmed that SIRS does not represent a dysregu-

Pacientes con gripe por el virus influenza A (H1N1)pdm09 ingresados en la UCI. Impacto de las recomendaciones de la SEMICYUC

OBJECTIVES To evaluate the impact of the recommendations of the SEMICYUC (2012) on severe influenza A. DESIGN A prospective multicenter observational study was carried out. SETTING ICU. PATIENTS Patients infected with severe influenza A (H1N1) from the GETGAG/SEMICYUC registry. INTERVENTIONS Analysis of 2 groups according to the epidemic period of the diagnosis (2009-2011; 2013-2015). VARIABLES Demographic, temporal, comorbidities, severity, treatments, mortality, late diagnosis and place of acquisition. RESULTS A total of 2,205 patients were included, 1,337 (60.6%) in the first period and 868 (39.4%) in the second one. Age and severity on admission were significantly greater in the second period, as well as co-infection. With regard to the impact of the recommendations, in the second period the diagnosis was established earlier (70.8 vs. 61.1%, P<.001), without changes in the start of treatment. Patients received less corticosteroid treatment (39.7 vs. 44.9%, P<.05), more NIMV was used (47.4 vs. 33.2%, P<.001) and more vaccination was made (11.1 vs. 1.7%, P<.001), without changes in mortality (24.2 vs. 20.7%). A decrease in nosocomial infection was also noted (9.8 vs. 16%, P<.001). Patients needed less MV with more days of ventilation, more vasopressor drug use and more ventral decubitus. CONCLUSIONS The management of patients with severe influenza A (H1N1) has changed over the years, though without changes in mortality. The recommendations of the SEMICYUC (2012) have allowed earlier diagnosis and improved corticosteroid use. Pending challenges are the delay in treatment, the vaccination rate and the use of NIMV.

Coeducación y experiencias positivas. aportaciones a la convivencia desde la expresión motriz cooperativa

Creating positive experiences in Physical Education is one of the key aspects to promote education for interpersonal relations. This study examined the effects of cooperative expression motor situations (SMEC) on the moods of college students participating in segregated and mixed groups. It included 81 students (22 girls and 59 boys) of the Science of Physical Activity and Sport degree (INEFC Barcelona). At the beginning and end of each session, participants completed the POMS questionnaire. Statistical analysis using generalized estimating equations was conducted and showed that participants’ moods were improved in both groups. Tension-anxiety, depression-dejection values were more favorable in mixed groups while overall score, vigor-activity, fatigue-immobility values were higher in segregated groups. The findings confirm the contribution of SMEC for creating positive environments and improving coexistence in and between both genders.

Pneumococcal pneumonia coinfection in critically ill patients with influenza a (h1n1) primary viral pneumonia

It has been generally believed that influenza virus infection increase susceptibility to invasive pneumococcal pneumonia. However, information regarding the impact of S. pneumoniae respiratory coinfection (SpCoI) in patients affected with A(H1N1) primary viral pneumonia is scarce.