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viernes, 31 de marzo de 2017

Ancianos en UCI / Older ICU patients

Marzo 31, 2017. No. 2645

  



Daño renal agudo en el anciano en terapia intensiva de un país en desarrollo. Hallazgos clínicos y evolución
Acute kidney injury in elderly intensive care patients from a developing country: clinical features and outcome.
Int J Nephrol Renovasc Dis. 2017 Feb 3;10:27-33. doi: 10.2147/IJNRD.S126534. eCollection 2017.
Abstract
AIM: The elderly are at high risk of acute kidney injury (AKI) because of structural and functional degeneration over time and with the aging of the population, the demand for intensive care unit (ICU) admission for older patients has risen recently. However, data from developing countries are scarce. This study aimed to describe the incidence of AKI in elderly patients admitted to ICU from a developing country, to determine the most frequent etiologies for renal impairment and identify its risk factors and outcome. METHODS: All patients admitted to the ICU at a Brazilian teaching hospital for 12 consecutive months were followed prospectively from the time of admission until ICU discharge. Elderly was defined as aged >60 years and AKI was defined according to the Kidney Disease Improving Global Outcomes 2012 criteria. Multivariable logistic regression was used to adjust confounding and selection bias. RESULTS: Two hundred elderly patients were included in the study. AKI incidence was 27% and the main etiology was sepsis (48.1%). At logistic regression, baseline creatinine (odds ratio [OR]=5.17, p<0.0001), Acute Physiology and Chronic Health Evaluation (APACHE) II (OR=1.20, p<0.0001), sepsis (OR=2.96, p<0.0001), and longer ICU stay (OR=1.68, p<0.0001) were associated with AKI in elderly patients. Baseline creatinine (OR=1.97, p=0.018), APACHE II (OR=1.29, p<0.0001), sepsis (OR=1.87, p<0.0001), and AKI severity (OR=2.57, p=0.027) were identified as predictors of death. CONCLUSION: AKI was frequent in elderly patients admitted to ICU from a developing country, and it was identified as a risk factor for death. Sepsis was an important risk factor for both AKI and mortality, similar to developed countries and in younger populations.
KEYWORDS: acute kidney injury; elderly; intensive care; mortality

Estimulación de los nutrientes del flujo sanguíneo mesentérico. Implicaciones para los pacientes mayores críticamente enfermos.
Nutrient stimulation of mesenteric blood flow - implications for older critically ill patients.
World J Crit Care Med. 2017 Feb 4;6(1):28-36. doi: 10.5492/wjccm.v6.i1.28. eCollection 2017.
Abstract
Nutrient ingestion induces a substantial increase in mesenteric blood flow. In older persons (aged ≥ 65 years), particularly those with chronic medical conditions, the cardiovascular compensatory response may be inadequate to maintain systemic blood pressure during mesenteric blood pooling, leading to postprandial hypotension. In older ambulatory persons, postprandial hypotension is an important pathophysiological condition associated with an increased propensity for syncope, falls, coronary vascular events, stroke and death. In older critically ill patients, the administration of enteral nutrition acutely increases mesenteric blood flow, but whether this pathophysiological response is protective, or precipitates mesenteric ischaemia, is unknown. There are an increasing number of olderpatients surviving admission to intensive care units, who are likely to be at increased risk of postprandial hypotension, both during, and after, their stay in hospital. In this review, we describe the prevalence, impact and mechanisms of postprandial hypotension in older people and provide an overview of the impact of postprandial hypotension on feeding prescriptions in older critically ill patients. Finally, we provide evidence that postprandial hypotension is likely to be an unrecognised problem in older survivors of critical illness and discuss potential options for management.
KEYWORDS: Aged; Critical care; Enteral nutrition; Mesenteric ischaemia; Postprandial hypotension

Alteraciones del sueño en los ancianos en terapia intensiva
Sleep disturbance in older ICU patients.
Clin Interv Aging. 2014 Jun 23;9:969-77. doi: 10.2147/CIA.S59927. eCollection 2014.
Abstract
Maintaining a stable and adequate sleeping pattern is associated with good health and disease prevention. As a restorative process, sleep is important for supporting immune function and aiding the body in healing and recovery. Aging is associated with characteristic changes to sleep quantity and quality, which make it more difficult to adjust sleep-wake rhythms to changing environmental conditions. Sleep disturbance and abnormal sleep-wake cycles are commonly reported in seriously ill older patients in the intensive care unit (ICU). A combination of intrinsic and extrinsic factors appears to contribute to these disruptions. Little is known regarding the effect that sleep disturbance has on health status in the oldest of old (80+), a group, who with diminishing physiological reserve and increasing prevalence of frailty, is at a greater risk of adverse health outcomes, such as cognitive decline and mortality. Here we review how sleep is altered in the ICU, with particular attention to older patients, especially those aged ≥80 years. Further work is required to understand what impact sleep disturbance has on frailty levels and poor outcomes in older critically ill patients.
KEYWORDS: aging; frailty; intensive care unit; sleep; wake rhythm

Prescripción potencialmente inapropiada y el riesgo de reacciones adversas a medicamentos en adultos mayores en estado crítico.
Potentially inappropriate prescribing and the risk of adverse drug reactions in critically ill older adults.
Pharm Pract (Granada). 2016 Oct-Dec;14(4):818. doi: 10.18549/PharmPract.2016.04.818. Epub 2016 Dec 15.
Abstract
BACKGROUND: Potentially inappropriate medication (PIM) use in the elderly is associated with increased risk of adverse drug reactions (ADRs), but there is limited information regarding PIM use in the intensive care unit (ICU) setting. OBJECTIVE: The aim of the study is to describe the prevalence and factors associated with the use of PIM and the occurrence of PIM-related adverse reactions in the critically ill elderly. METHODS: This study enrolled all critically ill older adults (60 years or more) admitted to medical or cardiovascular ICUs between January and December 2013, in a large tertiary teaching hospital. For all patients, clinical pharmacists listed the medications given during the ICU stay and data on drugs were analyzed using 2012 Beers Criteria, to identify the prevalence of PIM. For each identified PIM the medical records were analyzed to evaluate factors associated with its use. The frequency of ADRs and, the causal relationship between PIM and the ADRs identified were also evaluated through review of medical records. RESULTS: According to 2012 Beers Criteria, 98.2% of elderly patients used at least one PIM (n=599), of which 24.8% were newly started in the ICUs. In 29.6% of PIMs, there was a clinical circumstance that justified their prescription. The number of PIMs was associated with ICU length of stay and total number of medications. There was at least one ADR identified in 17.8% of patients; more than 40% were attributed to PIM, but there was no statistical association. CONCLUSIONS: There is a high prevalence of PIM used in acutely ill older people, but they do not seem to be the major cause of adverse drug reactions in this population. Although many PIMs had a clinical circumstance that led to their prescription during the course of ICU hospitalization, many were still present upon hospital discharge. Therefore, prescription of PIMs should be minimized to improve the safety of elderly patients.
KEYWORDS: Aged; Brazil; Drug-Related Side Effects and Adverse Reactions; Inappropriate Prescribing; Inpatients; Intensive Care Units
Pronóstico y calidad de vida en los ancianos después de terapia intensiva
Prognosis and quality of life of elderly patients after intensive care.
Swiss Med Wkly. 2012 Sep 10;142:w13671. doi: 10.4414/smw.2012.13671.
Abstract
Ageing of the world's population raises important questions about the utilisation of the health care system. It is not clear how much should be invested in the last years of life whereas the costs are known to increase in parallel. Since intensive care units (ICU) are costly with highly specialised personnel, it seems of paramount importance that they would be used efficiently. Indeed, in the present context of predicted shortage of physicians in Switzerland, society and politics will need evidence that the care provided by ICUs is appropriate. There is no explicit limitation of care in any country according to age and nonagerians are admitted nowadays into ICUs with critical illness. This review article will address the question of elderly patients in ICU and their outcome. Outcome does not imply surviving ICU but only later during the hospital stay and after discharge. Furthermore, we emphasise the need of examining not solely the hospital survival but the quality of life of the patients when they return to their real life. The fundamental questions are actually "Do they go back to life?" "What is life for elderly people?" These questions lead to more basic questions such as "Are they able to go back home or are they institutionalised? How is their quality of life and functional status after ICU?". We tried to address these questions through the existing literature and our experience while caring for these particular patients. Some clues on the prognostic factors related to their outcome are reported.

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
Congreso Latinoamericano de Anestesia Regional
Asociación Latinoamericana de Anestesia Regional, Capítulo México
Ciudad de México, Mayo 24-27, 2017
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Anestesiología y Medicina del Dolor

52 664 6848905

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Publicado por Bibliomanazteca en 10:16 0 comentarios
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miércoles, 29 de marzo de 2017

Eficacia del polietileno antioxidante: Lo que las primeras recuperaciones nos pueden decir



Effectiveness of anti-oxidant polyethylene: What early retrievals can tell usFuente

Este artículo es originalmente publicado en:
De:
2017 Feb 2. doi: 10.1002/jbm.b.33840. [Epub ahead of print]Todos los derechos reservados para:© 2017 Wiley Periodicals, Inc.

.Abstract
The optimum UHMWPE orthopedic implant bearing surface must balance wear, oxidation, and fatigue resistance. Antioxidantpolyethylene addresses free radicals, resulting from irradiation used in cross-linking, that could oxidize and potentially lead to fatigue damage under cycles of in vivo use. This study evaluates what short-term antioxidant UHMWPE retrievals can reveal about: (1) oxidation-resistance and (2) fatigue-resistance of these new materials. Retrievals of three different antioxidant polyethylene materials (n = 25) were analyzed by FTIR and uniaxial tensile tests and compared to conventional (n = 20) and remelted highly cross-linked (n = 30) polyethylene retrievals of similar in vivo duration. Maximum oxidation values differed significantly across material types (p = 0.018). No antioxidant retrieval exhibited a subsurface oxidation peak, in contrast to conventional gamma-sterilized (55%) and highly cross-linked (37%) retrievals that exhibited subsurface oxidation peaks over the same in vivo time. Trans-vinylene index (TVI) correlated positively with nominal irradiation dose (p < 0.001). Tensile toughness correlated negatively with increasing TVI (p < 0.001). The antioxidant materials in this study prevented in vivo oxidation more effectively than remelted HXL polyethylene at least over the in vivo period represented. The comparison of antioxidant retrieval tensile properties can be used as a guide for clinicians in choosing appropriate materials for the applications represented by their patients. © 2017 Wiley Periodicals, Inc. J Biomed Mater Res Part B: Appl Biomater, 2017.
Resumen

La superficie óptima de apoyo del implante ortopédico UHMWPE debe equilibrar el desgaste, la oxidación y la resistencia a la fatiga. El polietileno antioxidante se dirige a los radicales libres, resultantes de la irradiación utilizada en la reticulación, que podría oxidarse y potencialmente conducir a daño por fatiga bajo ciclos de uso in vivo. Este estudio evalúa lo que las recuperaciones antioxidantes a corto plazo de UHMWPE pueden revelar acerca de: (1) resistencia a la oxidación y (2) resistencia a la fatiga de estos nuevos materiales. Se analizaron las recuperaciones de tres materiales de polietileno antioxidante diferentes (n = 25) mediante ensayos de FTIR y de tracción uniaxial y se compararon con recuperaciones de polietileno altamente reticuladas (n = 30) convencionales (n = 20) y refundidas de duración similar in vivo. Los valores máximos de oxidación difirieron significativamente entre los tipos de material (p = 0,018). Ninguna recuperación de antioxidantes exhibió un pico de oxidación subsuperficial, en contraste con las recuperaciones convencionales de gamma-esterilizada (55%) y altamente reticuladas (37%) que exhibieron picos de oxidación subsuperficiales durante el mismo tiempo in vivo. El índice de transvinileno (TVI) se correlacionó positivamente con la dosis de irradiación nominal (p <0,001). La tenacidad a la tracción se correlacionó negativamente con el aumento de TVI (p <0,001). Los materiales antioxidantes en este estudio evitaron la oxidación in vivo más eficazmente que el polietileno HXL refundido al menos durante el periodo in vivo representado. La comparación de las propiedades de tracción de recuperación de antioxidantes puede usarse como una guía para los médicos en la elección de materiales apropiados para las aplicaciones representadas por sus pacientes. © 2017 Wiley Periodicals, Inc. J. Biomed Mater Res Parte B: Appl Biomater, 2017.

© 2017 Wiley Periodicals, Inc.

PALABRAS CLAVE:
Polietileno antioxidante; Comparación de convencionales recuperados; Insertos tibiales altamente reticulados y antioxidantes; Oxidación in vivo; Análisis de recuperación; Resistencia a la tracción uniaxial
© 2017 Wiley Periodicals, Inc.
KEYWORDS:
antioxidant polyethylene; comparison of retrieved conventional; highly cross-linked and antioxidant tibial inserts; in vivo oxidation; retrieval analysis; uniaxial tensile toughness
PMID:   28152265   DOI:  
#Polietileno antioxidante#Insertos tibiales altamente reticulados y antioxidantes#Oxidación in vivo#Análisis de recuperación#Resistencia a la tracción uniaxial
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Polietilenos altamente reticulados estabilizados con vitamina E: El papel y la eficacia en la artroplastia total de cadera


                        Polietilenos altamente reticulados estabilizados con vitamina E: El papel y la eficacia en la artroplastia total de cadera – Reemplazos Articulares y Artroscopia                                                           Vitamin E-stabilized highly crosslinked polyethylenes: The role and effectiveness in total hip arthroplastyFuente
Este artículo es originalmente publicado en:
De:
2017 Feb 10. pii: S0949-2658(17)30018-0. doi: 10.1016/j.jos.2017.01.012. [Epub ahead of print]
Todos los derechos reservados para:
Copyright © 2017 The Japanese Orthopaedic Association. Published by Elsevier B.V. All rights reserved.Abstract
Morphology and design of ultra-high molecular weight polyethylene (UHMWPE or simply PE) acetabular components used in total hip arthroplasty (THA) have been evolving for more than half a century. Since the late-1990s, there were two major technological innovations in PE emerged from necessity to overcome the wear-induced periprosthetic osteolysis, i.e., the development of highly crosslinked PEs (HXLPEs). There are many literature reporting that radiation crosslinked and remelted/annealed (first-generation) HXLPEs markedly reduced the incidence of osteolysis and aseptic loosening. Regardless of such clinical success in the first-generation technologies, there were some recent shifts in Japan toward the use of new second-generation HXLPEs subjected to sequential irradiation/annealing or antioxidant vitamin E (α-tocopherol) incorporation. Although the selection rate of first-generation liners still account for more than half of all the PE THAs (∼58% in 2015), the use of vitamin E-stabilized liners has been steadily growing each year since their clinical introduction in 2010. In these contexts, it is of great importance to evaluate and understand the real clinical benefits of using the new second-generation liners as compared to the first generation. This article first summarizes structural evolution and characteristic features of first-generation HXLPEs, and then provides a detailed description of second-generation antioxidant HXLPEs in regard to the role of vitamin E incorporation on their chemical and mechanical performances in THA.
Resumen

La morfología y el diseño de componentes acetabulares de polietileno de peso molecular ultra alto (UHMWPE o simplemente PE) utilizados en la artroplastia total de cadera (THA) han estado evolucionando durante más de medio siglo. Desde finales de los noventa, hubo dos innovaciones tecnológicas importantes en PE surgidas de la necesidad de superar la osteólisis periprotésica inducida por el desgaste, es decir, el desarrollo de PE altamente reticuladas (HXLPE). Hay muchas publicaciones que informan de que la radiación reticulada y refundida / recocido (primera generación) HXLPEs redujo notablemente la incidencia de la osteólisis y aflojamiento aséptico.Independientemente de este éxito clínico en las tecnologías de primera generación, hubo algunos cambios recientes en Japón hacia el uso de nuevos HXLPE de segunda generación sometidos a incorporación secuencial de radiación / recocido o antioxidante de vitamina E (α-tocoferol). Aunque la tasa de selección de los revestimientos de primera generación sigue representando más de la mitad de todos los PE THA (~58% en 2015), el uso de revestimientos estabilizados con vitamina E ha ido creciendo cada año desde su introducción clínica en 2010. En estos contextos, es de gran importancia evaluar y comprender los beneficios clínicos reales del uso de los nuevos revestimientos de segunda generación en comparación con la primera generación. En este artículo se resumen primero la evolución estructural y características de la primera generación de HXLPEs, y luego proporciona una descripción detallada de la segunda generación de antioxidantes HXLPEs en relación con el papel de la vitamina E incorporación en sus funciones químicas y mecánicas en THA.
Copyright © 2017 The Japanese Orthopaedic Association. Published by Elsevier B.V. All rights reserved.
PMID:  28209339    DOI:  
#polietilenos#ultra alto peso molecular#artroplastia total de cadera#vitamina E
Publicado por Bibliomanazteca en 11:09 0 comentarios
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Manejo quirúrgico de las fracturas cerradas y aisladas de falange proximal en los dedos largos: Resultados funcionales y complicaciones de 87 fracturas


Surgical management of closed, isolated proximal phalanx fractures in the long fingers: Functional outcomes and complications of 87 fractures

Fuente
Este artículo es originalmente publicado en:
De:
Hand Surg Rehabil. 2017 Apr;36(2):127-135. doi: 10.1016/j.hansur.2016.08.009. Epub 2017 Feb 7.
Todos los derechos reservados para:
Corresponding author.© 2017 SFCM. Published by Elsevier Masson SAS. All rights reserved.Copyright © 2017 SFCM. Published by Elsevier Masson SAS. All rights reserved.Abstract
Finger fractures are the most common skeletal injuries of the upper limbs. The purpose of this study was to evaluate the functional outcomes and complications after surgical management of isolated, closed fractures of the proximal phalanx (PP) of the hand (thumb excluded). Surgical management was indicated in 87 PP fractures. Fractures were reduced and fixed with pins, screws or a plate. Functional outcomes were assessed through the range of motion (ROM) in flexion-extension, hand and finger strength, and the QuickDASH and PRWHE scores. Fixation was done with pins in 32 cases, screws in 41 cases, and a plate in 14 cases. Rehabilitation was started an average of 1.7 weeks after surgery. There was no significant difference in the functional outcomes based on either fracture type or surgical approach. Nevertheless, the following significant differences were observed: PRWHE score (P=0.017) by injured finger; proximal interphalangeal (PIP) ROM (P=0.037) by fixation type; and grip strength (P=0.019), Quick DASH (P=0.017), and PRWHE (P=0.045) by rehabilitation delay. The most common clinical complications were minor malrotation and cold intolerance. Radiological assessment showed complete union in all cases. Surgical management of PP fractures leads to good functional outcomes, including a satisfactory recovery of finger ROM. The functional recovery of a fractured digit is dependent on the right fixation choice, complete bone union, and early rehabilitation. We suggest using screw fixation to achieve patient satisfaction and optimal functional recovery of closed, isolated PP fractures of the long fingers.
Copyright © 2017 SFCM. Published by Elsevier Masson SAS. All rights reserved.
KEYWORDS:
Finger fractures; Fracture fixation; Fractures des doigts; Ostéosynthèse; Phalange proximale; Proximal phalanx; Surgical management; Traitement chirurgical
Resumen

Las fracturas de los dedos son las lesiones esqueléticas más comunes de los miembros superiores. El objetivo de este estudio fue evaluar los resultados funcionales y las complicaciones posteriores al manejo quirúrgico de fracturas aisladas y cerradas de la falange proximal (PP) de la mano (pulgar excluido). El manejo quirúrgico fue indicado en 87 fracturas de PP. Las fracturas se redujeron y se fijaron con clavijas, tornillos o una placa. Resultados funcionales se evaluaron a través de la amplitud de movimiento (ROM) en flexión-extensión, la mano y la fuerza del dedo, y el QuickDASH y PRWHE resultados. La fijación se realizó con clavos en 32 casos, tornillos en 41 casos y placa en 14 casos. La rehabilitación se inició un promedio de 1,7 semanas después de la cirugía. No hubo diferencias significativas en los resultados funcionales basados ​​en el tipo de fractura o el abordaje quirúrgico. Sin embargo, se observaron las siguientes diferencias significativas: puntaje PRWHE (P = 0,017) por dedo lesionado;Proximal interphalangeal (PIP) ROM (P = 0,037) por tipo de fijación; Y la fuerza de agarre (P = 0,019), Rápido DASH (P = 0,017), y PRWHE (P = 0,045) por retraso de rehabilitación. Las complicaciones clínicas más frecuentes fueron malrotación menor e intolerancia al frío. La evaluación radiológica mostró unión completa en todos los casos. El manejo quirúrgico de las fracturas de PP conduce a buenos resultados funcionales, incluyendo una recuperación satisfactoria de la ROM de los dedos. La recuperación funcional de un dígito fracturado depende de la elección de la fijación correcta, la unión completa del hueso y la rehabilitación temprana. Sugerimos el uso de la fijación del tornillo para lograr la satisfacción del paciente y la recuperación funcional óptima de fracturas cerradas y aisladas de PP de los dedos largos.

Copyright © 2017 SFCM. Publicado por Elsevier Masson SAS. Todos los derechos reservados.

PALABRAS CLAVE:
Fracturas de los dedos; Fijación de la fractura; Fractures des doigts; Ostéosynthèse;Falange proximal; Falange proximal; Manejo quirúrgico; Traitement chirurgical
PMID:   28325427   DOI:  
#Fracturas de los dedos#dedos#Fijación de la fractura#Falange proximal#manejo quirúrgico



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