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Resumen Objetivo Pocos estudios han evaluado el impacto en el diagnostico y tratamiento de la ecocardiografia transtoracica basica en los pacientes postoperados de cirugia cardiaca. El objetivo de nuestro estudio fue valorar el impacto de la ecocardiografia transtoracica basica en el manejo diagnostico y terapeutico de estos pacientes. Diseno Durante 18 meses se estudiaron prospectivamente todos los pacientes postoperados de cirugia cardiaca que ingresaron en el Servicio de Medicina Intensiva de un hospital universitario. Se realizo una valoracion clinica a todos ellos para establecer un diagnostico y un tratamiento inicial. Se realizo una ecocardiografia transtoracica basica para valoracion diagnostica, que se comparo con la valoracion clinica. En caso de discrepancia, se valoro cambiar el tratamiento en funcion a la ecocardiografia y se evaluo la respuesta terapeutica. Se realizo un analisis descriptivo de los hallazgos. Resultados Se incluyeron 136 pacientes y se realizaron 203 ecocardiografias. La ecocardiografia transtoracica diferia del diagnostico inicial en 101 (49,8%) ecocardiografias. En 56 de estas (55,44%) se obtuvo un diagnostico alternativo, lo que comporto un cambio en el tratamiento en 30 pacientes (53,6%). Encontramos mejoria clinica significativa en 26 de estos pacientes (86,76%) en los siguientes 30-60 min. Conclusiones La ecocardiografia transtoracica basica es util en el manejo diagnostico y terapeutico de los pacientes postoperados de cirugia cardiaca. En la mitad de las ecocardiografias realizadas no se pudo confirmar el diagnostico clinico. En la mayoria de los pacientes en que observamos cambio en el diagnostico debido a la ecocardiografia, se observo mejoria clinica tras el cambio de tratamiento.

Background Transthoracic echocardiography can significantly change the management of many critical patients, and is being incorporated into many Intensive Care Units (ICU). Very few studies have examined the feasibility and impact of intensivists performing basic transthoracic echocardiography upon the management of critical patients after cardiac surgery. The present study therefore evaluates the quality of acquisition and accuracy of intensivist interpretation of basic transthoracic echocardiograms in the postoperative period of heart surgery. Methods Over an 8-month period we prospectively studied 148 patients within 24 h after admission to a university hospital ICU following heart surgery. We performed basic transthoracic echocardiography to evaluate ventricular function, pericardial effusion, hypovolemia and mitral regurgitation. Cohen's Kappa was used to compare transthoracic echocardiograms obtained by intensivists with basic versus advanced training. Concordance on image acquisition and interpretation was evaluated. Results We analyzed data of adequate transthoracic echocardiograms in 148 patients (92.5%). Apical four-chamber view and advanced trainees obtained better quality images. Concordance was good for right and left ventricular function (kappa = 0.7 ± 0.14 and 0.87 ± 0.05, respectively), and moderate for the remaining parameters. Interpretation concordance between basic and advanced training intensivists was good (kappa = 0.73 ± 0.05). Conclusions Intensivists with basic training in echocardiography are capable of performing and interpreting echocardiograms in most patients during the postoperative period of heart surgery.

Objective To determine factors related to limitations on life support within 48 h of intensive care unit (ICU) admission. Study design Prospective multicenter study. Setting Eleven ICUs. Patients All patients who died and/or had limitations on life support after ICU admission during a four-month period. Variables Patient characteristics, hospital characteristics, characteristics of limitations on life support. Time-to-first-limitation was classified as early ( Results 3335 patients were admitted; 326 (9.8%) had limitations on life support. A total of 344 patients died; 247 (71.8%) had limitations on life support (range among centers, 58.6%–84.2%). The median (p25–p75) time from admission to initial limitation was 2 (0–7) days. CHAID analysis found that the modified Rankin score was the variable most closely related with early limitations. Among patients with Rankin >2, early limitations were implemented in 71.7% (OR = 2.5; 95% CI: 1.5–4.4) and lung disease was the variable most strongly associated with early limitations (OR = 12.29; 95% CI: 1.63–255.91). Among patients with Rankin ≤2, 48.8% had early limitations; patients admitted after emergency surgery had the highest rate of early limitations (66.7%; OR = 2.4; 95% CI: 1.1–5.5). Conclusion Limitations on life support are common, but the practice varies. Quality of life has the greatest impact on decisions to limit life support within 48 h of admission.