odrigo Cornejo R

Prevalencia de sepsis grave en las Unidades de Cuidado Intensivo: Primer estudio nacional multicéntrico

4. SS was the admission diagnosis of 94 of the 283 patients (33%)and 38 patients presented SS after admission. On the survey day, 112 patients fulfilled SS criteria(40%). APACHE II and SOFA scores were significantly higher in SS patients than in non SS patients.Global case-fatality ratio at 28 days was 15.9% (45/283). Case-fatality ratio in patients with orwithout SS at the moment of the survey was 26.7% (30/112) and 8.7% (17/171), respectively p<0.05. Thirteen percent of patients who developed SS after admission, died. Case-fatality ratios forpatients with SS from Santiago and the other cities were similar, but APACHE II score wassignificantly higher in patients from Santiago. In SS patients, the independent predictors of mortalitywere SS as cause of hospital admission, APACHE II and SOFA scores. Ninety nine percent of SSpatients had a known sepsis focus (48% respiratory and 30% abdominal). Eighty five patients thatpresented SS after admission, had a respiratory focus.

Neumonía adquirida en la comunidad: Comunicación de 8 casos de neumonía grave por Legionella pneumophila serogrupo 1 en Chile

Legionella pneumophila is the second cause of severe community acquired pneumonia. In Chile, however, there are few reports of pneumonia caused by Legionella. We report eight patients (6 men, aged 42 to 72 years old) with community-acquired pneumonia caused by Legionella pneumophila serogroup 1, confirmed by the measurement of urinary antigen. Clinical presentation was characterized by fever or hypothermia (in one case), cough, dyspnea and neurological abnormalities in four patients. Cigarette smoking was the most frequently identified risk factor. All patients had at least one American Thoracic Society severity criteria. Complications observed were acute hypoxemic respiratory failure in seven patients, shock in four, renal failure in four and need for mechanical ventilation in three. No patient died (Rev Med Chile 2002; 130: 309-13)

Necrosis intestinal como presentación de enfermedad de Takayasu: Report of one case

A 32 years old female was admitted to hospital due to acute abdominal pain, nausea, vomiting and liquid stools. Physical examination was normal except for pain on her left inferior abdominal quadrant without peritoneal irritation signs. An abdominal CAT-scan suggested thrombosis at celiac trunk, although the echo Doppler showed no alterations except for signs of ischemia in the distal branch of the superior mesenteric artery. An exploratory laparotomy was performed disclosing a necrosis of the distal ileum and cecum, diffuse peritonitis and thrombosis of the ileocecoapendiculocolic artery. No vasculitis lesions were found in the arteries of medium size examined. A history of intermittent claudication for the past 3 years as well as acrocyanosis, asymmetry of pulses and blood pressure in the superior extremities was ascertained after the surgery. A MRI angiogram showed multiple stenoses and irregularities at the celiac trunk, hepatic, superior mesenteric and fibular arteries. No abnormalities at the aortic arch and its main branches were documented. A sepsis due to Candida sp complicated her postoperatory period. After recovery, prednisone 1 mg/kg/day was started and the anticoagulation continued. The abdominal pain, intermittent claudication and superior limb acrocyanosis disappeared. This is an unusual case of type IV Takayasus arteritis with acute abdominal signs as the first manifestation (Rev Med Chile 2002; 130: 1159-64)

Traqueostomía percutánea con asistencia fibrobroncoscópica: Evaluación prospectiva de 100 casos consecutivos y revisión de la literatura

7 days of mechanical ventilation before PT. Eight patients (8%) had operativecomplications. One had an episode of transitory desaturation, one had a transitory hypotensionrelated to sedation and six had mild bleeding not requiring transfusion. No patient requiredconversion to surgical tracheostomy. Four patients (4%) presented post operative complications. Twohad a mild and transitory bleeding of the ostomy, and two had a displacement of the cannula. Noother complications were observed.

Morbilidad materna grave e ingreso a cuidado intensivo: Hospital Clínico Universidad de Chile (2006-2010)

Background: Maternal morbidity is a quality of care indicator. The frequency of severe maternal morbidity that requires an intensive care management has increased, due to an increase in maternal age. Aim: To describe the severe and acute maternal morbidity spectrum that requires an intensive care management in a University Hospital. Material and methods: Review of medical records of 89 pregnant women aged 29 years, admitted to an Intensive Care Unit (UCI) between 2006 and 2010. Results: Mean gestational age on admission was 32 weeks. The main comorbidities identified were chronic hypertension (13.5%), hypothyroidism (4.5%) and coagulopathies (6.7%). Severe preeclampsia, sepsis and obstetric hemorrhage were the main causes of admission. Length of stay ranged from 1 to 28 days. Seventy eight percent of patients were admitted in the immediate postnatal period. Mechanical ventilation was required in 24% of patients for a median of three days. The longer unit lengths of stay were observed in patients with preeclampsia and non-obstetric severe sepsis (pyelonephritis and pneumonia). Seven abortions and seven perinatal deaths were recorded. The latter were mainly secondary to severe preeclampsia/HELLP syndrome. Neonatal morbidity was related to prematurity (19% hyaline membrane, 18% persistent ductus and 4% cerebral hemorrhage). There were no maternal deaths. Conclusions: Preeclampsia and its complications were the main causes of maternal ICU admission. In this series, there were no maternal deaths and the perinatal survival rate was 92%.BACKGROUND Maternal morbidity is a quality of care indicator. The frequency of severe maternal morbidity that requires an intensive care management has increased, due to an increase in maternal age. AIM To describe the severe and acute maternal morbidity spectrum that requires an intensive care management in a University Hospital. MATERIAL AND METHODS Review of medical records of 89 pregnant women with a mean age of 29 years, admitted to an Intensive Care Unit (UCI) between 2006 and 2010. RESULTS Mean gestational age on admission was 32 weeks. The main comorbidities identified were chronic hypertension (13.5%), hypothyroidism (4.5%) and coagulopathies (6.7%). Severe preeclampsia, sepsis and obstetric hemorrhage were the main causes of admission. Length of stay ranged from 1 to 28 days. Seventy eight percent of patients were admitted in the immediate postnatal period. Mechanical ventilation was required in 24% of patients for a median of three days. The longer unit lengths of stay were observed in patients with preeclampsia and non-obstetric severe sepsis (pyelonephritis and pneumonia). Seven abortions and seven perinatal deaths were recorded. The latter were mainly secondary to severe preeclampsia/ HELLP syndrome. Neonatal morbidity was related to prematurity (19% hyaline membrane, 18% persistent ductus and 4% cerebral hemorrhage). There were no maternal deaths. CONCLUSIONS Preeclampsia and its complications were the main causes of maternal ICU admission. In this series, there were no maternal deaths and the perinatal survival rate was 92%.

Acidosis láctica severa asociada a infusión de propofol. Caso clínico

Propofol infusion syndrome (PRIS) is a rare but potentially lethal complications. This disorder is triggered under unknown circumstances by a propofol infusion of more than 5 mg/kg/h for more than 48 h. PRIS is characterized by a multiorgan failure and rhabdomyolysis and is induced by a disturbance in mitochondrial long chain fatty acid oxidation. We report a 43 year-old woman who underwent brain surgery due to a vascular malformation. In the immediate postoperative period, she had an unexplained and severe lactic acidosis. During anaesthesia, she received a propofol infusion of 7 mg/kg/h that continued in the UCI at a rate of 3.5 mg/kg/h, for 8 hours more. The suspicion of PRIS motivated immediate discontinuation of propofol with rapid correction of lactic acidosis and full recovery of the patient (Rev Med Chile 2008; 136: 88-92). (Key words: Acidosis, lactic; Propofol; Rhabdomyolysis)

Medicina intensiva en Chile: desafíos para su desarrollo. Documento de la Comisión Nacional de Medicina Intensiva del Ministerio de Salud

Intensive care medicine in Chile is still in its dawn. It has experienced a progressive growth in the last decade, but continues to be weak. Although investments in the discipline have increased fivefold, there is still a severe deficiency of intensive care specialists. This issue will represent a serious problem in the near future. The Ministry of Health gathered an expert committee to study the problem and propose solutions for the future development of the discipline.

Traumatismo materno grave y cirugía múltiple con resultado perinatal exitoso

RESUMEN El traumatismo mayor de la embarazada es frecuente, tiene riesgo de muerte y agrega a sus complicaciones propias, las generadas por el embarazo como prematurez, desprendimiento placentario y dano perinatal. Presentamos el caso de una embarazada de 27 semanas, con traumatismo grave por atropello, fracturas oseas y desforramiento extenso de extremidad inferior derecha, que fue sometida a tratamiento quirurgico con reduccion y correccion de luxofracturas, aseo e injertos cutaneos. Se complica con infeccion grave de foco cutaneo, persistente, permaneciendo 24 dias en Unidad de Cuidad Intensivo (UCI) en tratamiento antibiotico, 10 drenajes quirurgicos, nutricion enteral y manejo continuo del dolor, antes del parto. Inicia sindrome de respuesta inflamatoria sistemica y se efectua operacion cesarea. El recien nacido prematuro peso 1500 gramos y evoluciono favorablemente. En su puerperio permanece 60 dias hospitalizada en UCI con 14 cirugias de reparacion y mejoria completa. Se analiza las caracteristicas singulares de morbilidad materna del caso, discutiendo los aspectos obstetricos, quirurgicos y de cuidado intensivo, la evolucion materna, el manejo de la infeccion y el rol de la cirugia en la prolongacion del embarazo y su influencia en el resultado perinatal exitoso. Se concluye la importancia de la integracion multidisciplinaria en la toma de decisiones medicas y quirurgicas en el manejo del trauma materno grave.PALABRAS CLAVE: