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Objective To describe the incidence, risk factors, and impact on mortality of acute kidney injury (AKI) in patients with 2009 influenza A (H1N1) viral pneumonia requiring mechanical ventilation. Design Observational cohort study. Patients and methods AKI was defined as risk, injury or failure, according to the RIFLE classification. Early and late AKI were defined as AKI occurring on intensive care unit (ICU) day 2 or before, or after ICU day 2, respectively. Demographic data and information on organ dysfunction were collected daily. Results Of 84 patients, AKI developed in 43 patients (51%). Twenty (24%) needed renal replacement therapy. Early and late AKI were found in 28 (33%) and 15 (18%) patients, respectively. Patients with AKI, as compared with patients without AKI, had higher Acute Physiology and Chronic Health Evaluation (APACHE) II score and ICU mortality (72% versus 39%, p

Invasive aspergillosis is a common condition in patients with hematologic malignancies. Symptoms are extremely non-specific, and therefore it is necessary to be familiar with the diagnostic tests for early diagnosis. This review has attempted to clarify the current evidence regarding the following areas: clinical presentation, methods of study and treatment of this condition in hemato-oncological critical patients.

Community-acquired pneumonia (CAP) in adults is probably one of the infections affecting ambulatory patients for which the highest diversity of guidelines has been written worldwide. Most of them agree in that antimicrobial therapy should be initially tailored according to either the severity of the infection or the presence of comorbidities and the etiologic pathogen. Nevertheless, a great variability may be noted among the different countries in the selection of the primary choice in the antimicrobial agents, even for the cases considered as at a low-risk class. This fact may be due to the many microbial causes of CAP and specialties involved, as well as the different health-care systems effecting on the availability or cost of antibiotics. However, many countries or regions adopt some of the guidelines or design their own recommendations regardless of the local data, probably because of the scarcity of such data. This is the reason why we have developed a guideline for the initial treatment of CAP by 2002 upon the basis of several local evidences in South América (ConsenSur I). However, several issues deserve to be currently rediscussed as follows: certain clinical scores other than the Physiological Severity índex (PSI) have become more popular in clinical practice (i.e. CURB-65, CRB-65); some pathogens have emerged in the región, such as community-acquired methicillin resistant Staphylococcus aureus (CA-MRSA) and Legionella spp; new evidences on the performance of the rapid test for the etiologic diagnosis in CAP have been reported (eg. urinary Legionella andpneumococcus antigens); new therapeutic considerations needs to be approached (i.e. dosage reformulation, duration of treatment, emergence of novel antibiotics and clinical impact of combined therapy). Like in the first versión of the ConsenSur (ConsenSur I), the various current guidelines have helped to organize and stratify the present proposal, ConsenSur II.

ObjectiveTo determine the incidence rate and mortality of community-acquired pneumonia (CAP) in adults in three cities in Latin America during a 3-year period.DesignProspective population-based surveillance study.SettingHealthcare facilities (outpatient centres and hospitals) in the cities of General Roca (Argentina), Rivera (Uruguay) and Concepción (Paraguay).Participants2302 adults aged 18 years and older with CAP were prospectively enrolled between January 2012 and March 2015.Main outcome measuresIncidence rates of CAP in adults, predisposing conditions for disease, mortality at 14 days and at 1 year were estimated. Incidence rate of CAP, within each age group, was calculated by dividing the number of cases by the person-years of disease-free exposure time based on the last census; incidence rates were expressed per 1000 person-years.ResultsMedian age of participants was 66 years, 46.44% were men, 68% were hospitalised. Annual incidence rate was 7.03 (95% CI 6.64 to 7.44) per 1000 person-years in General Roca, 6.33 (95% CI 5.92 to 6.78) per 1000 person-years in Rivera and 1.76 (95% CI 1.55 to 2.00) per 1000 person-years in Concepción. Incidence rates were highest in participants aged over 65 years. 82.4% had at least one predisposing condition and 48% had two or more (multimorbidity). Chronic heart disease (43.6%) and smoking (37.3%) were the most common risk factors. 14-day mortality rate was 12.1% and 1-year mortality was 24.9%. Multimorbidity was associated with an increased risk of death at 14 days (OR 2.91; 95% CI 2.23 to 3.80) and at 1 year (OR 3.00; 95% CI 2.44 to 3.70).ConclusionsWe found a high incidence rate of CAP in adults, ranging from 1.76 to 7.03 per 1000 person-years, in three cities in South America, disclosing the high burden of disease in the region. Efforts to improve prevention strategies are needed.

Traumatic disease is a leading cause of death in younger patients. Substance abuse is a factor of risk for serious injuries and also influences the recurrence thereof. Detecting consumption is paramount to optimize the management of these patients in the care unit intensive as well as high once for prevention strategies secondary. Within these substances, the incidence of cocaine use in the South American cone is a growing health problem.

Prolonged shifts, workload, stress, and different conflicts are associated with burnout, loss of psychological wellbeing, and probably with an inadequate sleep quality (ISQ). This relevant disturbance leads to deterioration of the work performance, may impair quality of care provided to patients and increases the incidence of serious adverse events. The objective was to determine the prevalence of ISQ and sleepiness among Uruguayan ICU workers, and to evaluate risk factors associated with ISQ.

Objective To evaluate the diagnostic value of CSF lactate (LCSF) for the diagnosis of bacterial meningitis (BM) following neurosurgery, and compare it with other CSF markers. Methods Prospective study of consecutive neurosurgical postoperative patients admitted to the Intensive Care Unit (ICU) at Maciel Hospital. Patients with clinical suspicion of BM were categorised, according to preset criteria, into 3 groups: (1) proven BM; (2) probable BM, and (3) excluded BM. CSF markers were plotted in a receiver operating curve (ROC) to evaluate their diagnostic accuracy. Results The study included 158 patients. We obtained 46 CSF samples from patients with clinical suspicion of BM by lumbar puncture (LP): 10 corresponded to proven BM, 4 to probable BM and 32 to excluded BM. Mean lactate in CSF (LCSF) was: 10.72 ± 4.68 mM for proven BM, 6.07 ± 0.66 mM for probable BM and 3.06 ± 1.11 mM for excluded BM (P

La neumonía adquirida por adultos en la comunidad (NAC) es, probablemente, una de las infecciones que afecta a los pacientes ambulatorios para la cual se ha escrito la mayor diversidad de lineamientos en todo el mundo. La mayoría de ellos concuerdan en que el tratamiento antimicrobiano debe ser ajustado inicialmente de acuerdo con la gravedad de la infección o con la presencia de co-morbilidades y el patógeno etiológico. Aun así, se puede notar una gran variabilidad entre los diferentes países en la selección de la elección primaria de los agentes antimicrobianos, incluso en los casos considerados como de bajo riesgo. Este hecho puede deberse a las múltiples causas microbianas de la NAC y las especialidades médicas involucradas, como así también los diferentes sistemas de asistencia de salud que afectan la disponibilidad o el costo de los antimicrobianos. No obstante, muchos países o regiones adoptan alguno de los lineamientos o diseñan sus propias recomendaciones independientemente de los datos locales, probablemente debido a la escasez de dichos datos. Por esta razón desarrollamos lineamientos para el tratamiento inicial de la NAC hacia el año 2002, sobre la base de varias evidencias locales en Sudamérica (ConsenSur I). Sin embargo, varios temas merecen discutirse nuevamente como sigue: ciertos puntajes clínicos además del índice Fisiológico de Severidad (IFS) se hicieron más populares en la práctica clínica (por ej. CURB-65, CRB-65); emergieron algunos patógenos en la región, tal como Staphylococcus aureus resistente adquirido en la comunidad (SAMR-AC) y Legionella spp; se reportaron nuevas evidencias sobre el desempeño de la prueba rápida para el diagnóstico etiológico de NAC (por ejemplo, Legionella urinaria y antígenos de Streptococcus pneumoniae); deben abordarse nuevas consideraciones terapéuticas (por ej.: reformulación de la dosis, duración del tratamiento, emergencia de antimicrobianos nuevos e impacto clínico del tratamiento combinado). Como en la primera versión del ConsenSur (ConsenSur I), los diversos lineamientos actuales ayudaron a organizar y estratificar la presente propuesta, ConsenSur II.

Analyze the clinical usefulness of lactate clearance (CL6) immediately after admission to the intensive care unit (ICU) in the first 6 hours.Surgical-ICU. Centro de Asistencia del Síndicato Médico of Uruguay.Prospective, analytic and observational study performed between December 1, 2004 and March 31, 2006 in patients over 18 years whose arterial lactate level is higher than 2 mEq/l on admission to the ICU. Lactate clearance (CL6) was defined as the quotient between admissions (L0) minus the six hour lactate level (L6) divided by the admission lactate level. Sensitivity, specificity, positive and negative prognostic value for different CL6 cutoff were analyzed. The optimal CL6 was considered as the cutoff with the highest sum of sensitivity plus specificity.One hundred and eight patients were included; 64 patients died (mortality intra-ICU 59.3%). ICU mortality related variables, identified by Cox regression analysis, were CL6 (HR=0.458; CI 95%, 0.239-0.876), L0 (HR=1.16; CI 95%, 1.033-1.303) and SAPSII (HR=1.019; CI 95%, 1.006-1.034). A CL6 equal to or lower than 0.4 was considered as optimal cutoff with a positive prognostic value of 74% and negative prognostic value of 61%. It was also associated with lower survival adjusted by the SAPSII value and L0.In critically ill surgical patients, whose CL6 on admission was over 2 mEq/l, lactate clearance in the first six hours could be useful to predict the ICU outcome.

Objetivo Analizar la utilidad del aclaramiento de lactato a la sexta hora (CL6) del ingreso a la unidad de cuidados intensivos (UCI). Lugar UCI quirurgica. Centro Asistencial del Sindicato Medico del Uruguay. Diseno Prospectivo, observacional, analitico. Pacientes mayores de 18 anos ingresados entre el 1 de diciembre de 2004 y el 31 de marzo de 2006, cuya lactacidemia arterial inicial fue mayor de 2 mEq/l. Se calculo el CL6 como el cociente de la diferencia entre la lactacidemia inicial (L0) menos la lactacidemia a la sexta hora (L6) dividida por la lactacidemia inicial. Se calculo la sensibilidad, la especificidad, el valor predictivo positivo y el valor predictivo negativo para diferentes valores de CL6. Se considero el CL6 optimo el que sumo mayores sensibilidad y especificidad. Resultados Se incluyo a 108 pacientes, de los que fallecieron 64 en la unidad (mortalidad en UCI del 59,3%). Las variables relacionadas con la mortalidad en la UCI fueron el valor del CL6 (hazard ratio [HR] = 0,458; intervalo de confianza [IC] del 95%, 0,239-0,876), el valor de L0 (HR = 1,16; IC del 95%, 1,033-1,303) y el valor del SAPSII (HR = 1,019; IC del 95%, 1,006-1,034). El CL6 optimo fue ≤ 0,4, con un valor predictivo positivo del 74% y un valor predictivo negativo del 61% para la mortalidad en la UCI; tambien se relaciono con una menor supervivencia en la UCI ajustada por el valor de SAPSII y de L0. Conclusiones En pacientes criticos quirurgicos el CL6 puede ser una ayuda para discernir el pronostico en la UCI.

Community-acquired pneumonia (CAP) is probably one of the infections affecting ambulatory patients for which the most diverse guidelines have been written worldwide. Most guidelines agree that antimicrobial therapy should be initially tailored according to either the severity of the infection or the presence of co-morbidity and epidemiology. Nevertheless, a great variability may be noted among different countries in the selection of first choice antimicrobial agents, even for cases considered as low-risk. This may be due to the many microbial causes of CAP and specialties involved, as well as different health-care systems which affect the availability or cost of antibiotics. However, many countries or regions adopt some of the guidelines or design their own recommendations, regardless of the local data, probably because of the scarcity of such data. A committee composed of South American infectious diseases specialists and microbiologists, with strong interest and recognized experience in CAP, were convened to establish a working group (ConsenSur) for designing a local evidence-based practice guideline for the initial management of CAP. This supplement is intended to give a practice recommendation for the initial antimicrobial treatment of CAP upon the basis of local evidence, in the hope of procuring a suitable tool for use by the different health-care providers concerned with the management of this infection in South America or in other countries where the main considerations for CAP are comparable.

The ICU is a stressful place with several sources of conflicts. Among ICU workers, conflicts lead to burnout, loss of psychological well-being, and deterioration of the work performance. Intra-team conflicts (conflicts that occur among members of the intensive care team) are one of the most frequent types of conflicts in the ICU. The objectives of this study were to determine the prevalence, risk factors and consequences associated with intra-team conflicts in the ICU.

Burnout syndrome (BOS) is defined as a state of emotional fatigue that leads to a loss of motivation, usually progressing towards feelings of inadequacy and failure. Severe BOS is relevant as it leads to loss of psychological well-being, increased absenteeism and turnover, and deterioration in the quality of care provided to patients. The objective was to determine the prevalence of BOS among Uruguayan ICU clinicians. To evaluate personal or organization characteristics associated with the development of severe BOS.

Blood transfusions are associated with infectious complications. Despite this, only a few studies link the use of blood transfusions with the development of fungal infections. This study was performed to assess risk factors associated with Candida colonization and infection.

Outcome from intensive care has focused on reducing morbidity–mortality during hospitalization, but nowadays it incorporates the assessment of long-term survival and quality of life in survivors [1]. Our aim was to assess morbidity (physical and psychological) and health-related quality of life (HRQL) in patients discharged from the ICU.

Most investigators discuss the predictive value of respiratory surveillance cultures in mechanically ventilated patients and doubt on the appropriate selection of the antibiotic therapy based on these findings, when pneumonia develops. The aim of our study was to evaluate whether microorganisms cultured from semiquantitative tracheal aspirates (SQTA) in the 48 hours prior to the clinical suspicion of ventilator-associated pneumonia (VAP) were predictive of the etiology, compared with the bronchoalveolar lavage (BAL) results performed on the same day that the clinical diagnosis was considered