sábado, 4 de febrero de 2017

Pancreatitis y embarazo / Pancreatitis in pregnancy

Febrero 4, 2017. No. 2590






Pancreatitis y embarazo. Etiología, tratamiento y evolución
Pancreatitis in pregnancy: etiology, diagnosis, treatment, and outcomes.
Hepatobiliary Pancreat Dis Int. 2016 Aug;15(4):434-8.
Abstract
BACKGROUND: Acute pancreatitis in pregnancy is a rare and dangerous disease. This study aimed to examine the etiology, treatment, and outcomes of pancreatitis in pregnancy. METHOD: A total of 25 pregnant patients diagnosed with pancreatitis during the period of 1994 and 2014 was analyzed retrospectively. RESULTS: The pregnant patients were diagnosed with pancreatitis during a period of 21 years. Most (60%) of the patients were diagnosed with pancreatitis in the third trimester. The mean age of the patients at presentation was 25.7 years, with a mean gestational age of 24.4 weeks. Abdominal pain occurred in most patients and vomiting in one patient was associated hyperemesis gravidarum. The common cause of the disease was gallstone-related (56%), followed by alcohol-related (16%), post-ERCP (4%), hereditary (4%) and undetermined conditions (20%). The level of triglycerides was minimally high in three patients. ERCP and wire-guided sphincterotomy were performed in 6 (43%) of 14 patients with gallstone-related pancreatitis and elevated liver enzymes with no complications. Most (84%) of the patients underwent a full-term, vaginal delivery. There was no difference in either maternal or fetal outcomes after ERCP. CONCLUSIONS: Acute pancreatitis is rare in pregnancy, occurring most commonly in the third trimester, and gallstones are the most common cause. When laparoscopic cholecystectomy is not feasible and a common bile duct stone is highly suspected on imaging, endoscopic sphincterotomy or stenting may help to prevent recurrence and postpone cholecystectomy until after delivery.

Hipertrigliciridemia gestacional severa . Abordaje práctico para clínicos
Severe gestational hypertriglyceridemia: A practical approach for clinicians.
Obstet Med. 2015 Dec;8(4):158-67. doi: 10.1177/1753495X15594082. Epub 2015 Aug 21.
Abstract
Severe gestational hypertriglyceridemia is a potentially life threatening and complex condition to manage, requiring attention to a delicate balance between maternal and fetal needs. During pregnancy, significant alterations to lipid homeostasis occur to ensure transfer of nutrients to the fetus. In women with an underlying genetic predisposition or a secondary exacerbating factor, severe gestational hypertriglyceridemia can arise, leading to devastating complications, including acute pancreatitis. Multidisciplinary care, implementation of a low-fat diet with nutritional support, and institution of a hierarchical therapeutic approach are all crucial to reduce maternal and fetal morbidity. To avoid maternal pancreatitis, close surveillance of triglycerides throughout pregnancy with elective hospitalization for refractory cases is recommended. Careful dietary planning is required to prevent neural and retinal complications from fetal essential fatty acid deficiency. Questions remain about the safety of fibrates and plasmapheresis in pregnancy as well as the optimal timing for induction and delivery of these women.
KEYWORDS: High-risk pregnancy; complications; hypertriglyceridemia; maternal morbidity; maternal-fetal medicine; pancreatitis

Presentación y manejo de la pancreatitis por hipertricliciridemia en el embarazo. Informe de caso
Presentation and management of acute hypertriglyceridemic pancreatitis in pregnancy: A case report.
Obstet Med. 2015 Dec;8(4):200-3. doi: 10.1177/1753495X15605697. Epub 2015 Oct 7.
Abstract
Pancreatitis related to hypertriglyceridemia can occasionally occur during pregnancy, particularly if there are underlying genetic abnormalities in lipid metabolism. We report the case of a 27-year-old female with hypertriglyceridemic pancreatitis in pregnancy that was treated initially with lipid lowering medications, followed by plasma exchange for persistently elevated triglyceride levels. Despite multiple interventions, she developed recurrent pancreatitis and simultaneously had a preterm birth. In this case report, we highlight the various therapies and the use of plasmapharesis in secondary prevention of hypertriglyceridemic pancreatitis in pregnancy.
KEYWORDS: Pregnancy; hyperlipidemia; hypertriglyceridemia; pancreatitis; plasmapheresis
5to curso internacional Anestesiologia cardiotoracica_ vascular_ ecocardiografia y circulaci_n extracorporea.


Curso Internacional de Actualidades en Anestesiología
Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán
Cuidad de México, Febrero 9-11, 2017
Informes  ceddem_innsz@yahoo.com 
Curso sobre Anestesia en Trasplantes, Cirugía abdominal, Plástica, Oftalmología y Otorrinolaringología.
Committee for European Education in Anaesthesiology (CEEA) 
y el Colegio de Anestesiólogos de León A.C.
Abril 7-9, 2017, León Guanajuato, México

Informes  (477) 716 06 16, kikinhedz@gmail.com
Regional Anesthesiology and Acute Pain Medicine Meeting
April 6-8, 2017, San Francisco, California, USA
ASRA American Society of Regional Anesthesia and Pain Medicine
California Society of Anesthesiologists
Annual Meeting April 27-30, 2017
San Francisco California
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Anestesiología y Medicina del Dolor

52 664 6848905

Copyright © 2015

viernes, 3 de febrero de 2017

Muerte materna en UCI / ICU maternal death



Febrero 3, 2017. No. 2589






Rendimiento de la puntuación de la alerta temprana obstétrica en pacientes críticamente enfermos para la predicción de la muerte materna.
Performance of the Obstetric Early Warning Score in critically ill patients for the prediction of maternal death.
Am J Obstet Gynecol. 2017 Jan;216(1):58.e1-58.e8. doi: 10.1016/j.ajog.2016.09.103. Epub 2016 Oct 15.
Abstract
BACKGROUND: Every day, about 830 women die worldwide from preventable causes related to pregnancy and childbirth. Obstetric early warning scores have been proposed as a potential tool to reduce maternal morbidity and mortality, based on the identification of predetermined abnormal values in the vital signs or laboratory parameters, to generate a rapid and effective medical response. Several early warning scores have been developed for obstetrical patients, but the majority are the result of a clinical consensus rather than statistical analyses of clinical outcome measures (ie, maternal deaths). In 2013, the Intensive Care National Audit and Research Center Case Mix Program reported the first statistically validated early warning scoring system for pregnant women. OBJECTIVE: We sought to assess the performance of the Intensive Care National Audit and Research Center Obstetric Early Warning Score in predicting death among pregnant women who required admission to the intensive care unit. STUDY DESIGN: This retrospective cohort study included pregnant women admitted to the intensive care unit at a tertiary referral center from January 2006 through December 2011 in Colombia, a developing country, with direct and indirect obstetric-related conditions. The Obstetric Early Warning Score was calculated based on data collected during the first 24 hours of intensive care unit admission. The Obstetric Early Warning Score is calculated based on values of the following variables: systolic and diastolic blood pressure, respiratory rate, heart rate, fraction of inspired oxygen (FiO2) required to maintain an oxygen saturation ≥96%, temperature, and level of consciousness. The performance of the Obstetric Early Warning Score was evaluated using the area under the receiver operator characteristic curve. Outcomes selected were: maternal death, need for mechanical ventilation, and/or vasoactive support. Statistical methods included distribution appropriate univariate analyses and multivariate logistic regression. RESULTS: During the study period, 50,897 births were recorded. There were 724 obstetric admissions to critical care, for an intensive care unit admission rate of 14.22 per 1000 deliveries. A total of 702 women were included in the study, with 29 (4.1%) maternal deaths, and a mortality ratio of 56.98 deaths per 100,000 live births. The most frequent causes of admission were direct, obstetric-related conditions (n = 534; 76.1%). The Obstetric Early Warning Score value was significantly higher in nonsurvivors than in survivors [12 (interquartile range 10-13) vs 7 (interquartile range 4-9); P < .001]. Peripartum women with normal values of Obstetric Early Warning Score had 0% mortality rate, while those with high Obstetric Early Warning Score values (>6) had a mortality rate of 6.3%. The area under the receiver operator characteristic curve of the Obstetric Early Warning Score in discrimination of maternal death was 0.84 (95% confidence interval, 0.75-0.92). The overall predictive value of the Obstetric Early Warning Score was better when the main cause of admission was directly related to pregnancy or the postpartum state. The area under the receiver operator characteristic curve of the score in conditions directly related to pregnancy and postpartum was 0.87 (95% confidence interval, 0.79-0.95), while in indirectly related conditions the area under the receiver operator characteristic curve was 0.77 (95% confidence interval, 0.58-0.96). CONCLUSION: Although there are opportunities for improvement, Obstetric Early Warning Score obtained upon admission to the intensive care unit can predict survival in conditions directly related to pregnancy and postpartum. The use of early warning scores in obstetrics may be a highly useful approach in the early identification of women at an increased risk of dying.
KEYWORDS: intensive care unit; maternal death; maternal mortality; mortality prediction; pregnancy; severity scoring systems; validation

Factores asociados con muerte materna en UCI
Factors associated with maternal death in an intensive care unit.
Rev Bras Ter Intensiva. 2016 Oct-Dec;28(4):397-404. doi: 10.5935/0103-507X.20160073.
Abstract
OBJECTIVE:To identify factors associated with maternal death in patients admitted to an intensive care unit. METHODS:A cross-sectional study was conducted in a maternal intensive care unit. All medical records of patients admitted from January 2012 to December 2014 were reviewed. Pregnant and puerperal women were included; those with diagnoses of hydatidiform mole, ectopic pregnancy, or anembryonic pregnancy were excluded, as were patients admitted for non-obstetrical reasons. Death and hospital discharge were the outcomes subjected to comparative analysis. RESULTS:A total of 373 patients aged 13 to 45 years were included. The causes for admission to the intensive care unit were hypertensive disorders of pregnancy, followed by heart disease, respiratory failure, and sepsis; complications included acute kidney injury (24.1%), hypotension (15.5%), bleeding (10.2%), and sepsis (6.7%). A total of 28 patients died (7.5%). Causes of death were hemorrhagic shock, multiple organ failure, respiratory failure, and sepsis. The independent risk factors associated with death were acute kidney injury (odds ratio [OR] = 6.77), hypotension (OR = 15.08), and respiratory failure (OR = 3.65). CONCLUSION:The frequency of deaths was low. Acute kidney injury, hypotension, and respiratory insufficiency were independent risk factors for maternal death.

Diseño y validación interna de una puntuación de alerta temprana obstétrica: análisis secundario de la base de datos del Programa de Case Mix de la Intensive Care National Audit and Research Center.
Design and internal validation of an obstetric early warning score: secondary analysis of the Intensive Care National Audit and Research Centre Case Mix Programme database.
Anaesthesia. 2013 Apr;68(4):354-67. doi: 10.1111/anae.12180.
Abstract
We designed and internally validated an aggregate weighted early warning scoring system specific to the obstetric population that has the potential for use in the ward environment. Direct obstetric admissions from the Intensive Care National Audit and Research Centre's Case Mix Programme Database were randomly allocated to model development (n = 2240) or validation (n = 2200) sets. Physiological variables collected during the first 24 h of critical care admission were analysed. Logistic regression analysis for mortality in the model development set was initially used to create a statistically based early warning score. The statistical score was then modified to create a clinically acceptable early warning score. Important features of this clinical obstetric early warning score are that the variables are weighted according to their statistical importance, a surrogate for the FI O2 /Pa O2 relationship is included, conscious level is assessed using a simplified alert/not alert variable, and the score, trigger thresholds and response are consistent with the new non-obstetric National Early Warning Score system. The statistical and clinical early warning scores were internally validated using the validation set. The area under the receiver operating characteristic curve was 0.995 (95% CI 0.992-0.998) for the statistical score and 0.957 (95% CI 0.923-0.991) for the clinical score. Pre-existing empirically designed early warning scores were also validated in the same way for comparison. The area under the receiver operating characteristic curve was 0.955 (95% CI 0.922-0.988) for Swanton et al.'s Modified Early Obstetric Warning System, 0.937 (95% CI 0.884-0.991) for the obstetric early warning score suggested in the 2003-2005 Report on Confidential Enquiries into Maternal Deaths in the UK, and 0.973 (95% CI 0.957-0.989) for the non-obstetric National Early Warning Score. This highlights that the new clinical obstetric early warning score has an excellent ability to discriminate survivors from non-survivors in this critical care data set. Further work is needed to validate our new clinical early warning score externally in the obstetric ward environment.
5to curso internacional Anestesiologia cardiotoracica_ vascular_ ecocardiografia y circulaci_n extracorporea.


Curso Internacional de Actualidades en Anestesiología
Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán
Cuidad de México, Febrero 9-11, 2017
Informes  ceddem_innsz@yahoo.com 
Curso sobre Anestesia en Trasplantes, Cirugía abdominal, Plástica, Oftalmología y Otorrinolaringología.
Committee for European Education in Anaesthesiology (CEEA) 
y el Colegio de Anestesiólogos de León A.C.
Abril 7-9, 2017, León Guanajuato, México

Informes  (477) 716 06 16, kikinhedz@gmail.com
Regional Anesthesiology and Acute Pain Medicine Meeting
April 6-8, 2017, San Francisco, California, USA
ASRA American Society of Regional Anesthesia and Pain Medicine
Like us on Facebook   Follow us on Twitter   Find us on Google+   View our videos on YouTube 
Anestesiología y Medicina del Dolor

52 664 6848905

Copyright © 2015