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BACKGROUND: Deciding the optimal timing for extubation in patients who are mechanically ventilated can be challenging, and traditional weaning predictor tools are not very accurate. The aim of this systematic review and meta-analysis was to assess the accuracy of lung and diaphragm ultrasound for predicting weaning outcomes in critically ill adults. METHODS: MEDLINE, the Cochrane Library, Web of Science, Scopus, LILACS, Teseo, Tesis Doctorales en Red, and OpenGrey were searched, and the bibliographies of relevant studies were reviewed. Two researchers independently selected studies that met the inclusion criteria and assessed study quality in accordance with the Quality Assessment of Diagnostic Accuracy Studies-2 tool. The summary receiver-operating characteristic curve and pooled diagnostic OR (DOR) were estimated by using a bivariate random effects analysis. Sources of heterogeneity were explored by using predefined subgroup analyses and bivariate meta-regression. RESULTS: Nineteen studies involving 1,071 people were included in the study. For diaphragm thickening fraction, the area under the summary receiver-operating characteristic curve was 0.87, and DOR was 21 (95% CI, 11-40). Regarding diaphragmatic excursion, pooled sensitivity was 75% (95% CI, 65-85); pooled specificity, 75% (95% CI, 60-85); and DOR, 10 (95% CI, 4-24). For lung ultrasound, the area under the summary receiver-operating characteristic curve was 0.77, and DOR was 38 (95% CI, 7-198). Based on bivariate meta-regression analysis, a significantly higher specificity for diaphragm thickening fraction and higher sensitivity for diaphragmatic excursion was detected in studies with applicability concerns. CONCLUSIONS: Lung and diaphragm ultrasound can help predict weaning outcome, but its accuracy may vary depending on the patient subpopulation.

Background: The GRACE (Global Registry of Acute Coronary Events) risk score is recommended for risk stratification in acute coronary syndrome (ACS). It does not include sex, a variable strongly associated with ACS prognosis. The aim of this study was to examine if sex adds prognostic information to the GRACE score in a contemporary population. Materials and Methods: Analysis of discrimination and calibration of GRACE score in the validation population, derived from the ARIAM-SEMICYUC registry (2012-2015). Outcome was hospital mortality. The uniformity of fit of the score was tested in predefined subpopulations: with and without ST-segment elevation myocardial infarction (STEMI and NSTEMI). Results: A total of 9781 patients were included: 4598 with NSTEMI (28% women) and 5183 with STEMI (23% women). Discriminative capacity of the GRACE score was significantly lower in women with STEMI compared to men (area under the receiver operating characteristic curve [AUC] 0.82, 95% CI 0.78-0.86 vs. AUC 0.90, 95% CI 0.88-0.92, p = 0.0006). In multivariate analysis, female sex predicted hospital mortality independently of GRACE in STEMI (p = 0.019) but not in NSTEMI (p = 0.356) (interaction p = 0.0308). However, neither the AUC nor the net reclassification index (NRI) improved by including female sex in the STEMI subpopulation (NRI 0.0011, 95% CI -0.023 to 0.025; p = 0.928). Conclusions: Although female sex was an independent predictor of hospital mortality in the STEMI subpopulation, it does not substantially improve the discriminative ability of GRACE score.

Some studies suggest that lung ultrasonography could be useful for diagnosing pneumonia; moreover, it has a more favorable safety profile and lower cost than chest radiography and CT. The aim of this study was to assess the accuracy of bedside lung ultrasonography for diagnosing pneumonia in adults through a systematic review and meta-analysis.

To evaluate the use and effectiveness of a routine invasive strategy (RIS) in patients with acute coronary syndrome without persistent ST-segment elevation with renal dysfunction in the real world scenario.

To measure accessibility to health care among diabetic patients and analyze whether differences in delay explain differences in hospital mortality.

Background: The available evidence about the effect of gender and/or sex on mortality differences is contradictory. Our aim is to assess the impact of gender on the access to reperfusion therapy in patients with acute coronary syndrome with ST-segment elevation (STEMI), and secondly, to analyze the effect of delay on the differences with regard to hospital mortality. Methods: A retrospective cohort study was conducted among consecutive patients with STEMI included in the ARIAM-SEMICYUC registry (2010-2013). Results: A total of 4816 patients were included (22.09% women). Women were older, presented with longer patient delay (90 vs. 75 minutes, p=0.0066), higher risk profile (GRACE>140: 75.1% vs. 56.05%, p

To identify determinants associated to an early invasive strategy in women with acute coronary syndromes without ST elevation (NSTE-ACS).

Several reports have suggested that nitrates limit acute ischaemic damage by a mechanism similar to preconditioning. This study aims to evaluate the effect of chronic oral nitrates on the clinical presentation and short-term outcomes of patients admitted with acute coronary syndrome (ACS).

Objetivo: Evaluar la efectividad de (UCE) en pacientes con (EPOC) agudizada frente a (HC) en términos de reingreso y mortalidad. Método: Estudio de cohortes retrospectivo no aleatorizado de pacientes hospitalizados por exacerbación de EPOC durante 2004 en un hospital general. El seguimiento se prolongó hasta el 31 de diciembre de 2006. La censura de datos se produce en la fecha final de seguimiento o aparición de muerte o reingreso. El análisis estadístico se basó en Kaplan-Meier, test del log-rank y regresión de Cox. Resultados: De los 543 pacientes incluidos, 252 ingresaron en UCE y 291 en HC. Los pacientes de UCE eran mayores (75,4 frente a 71,7 años; p < 0,001), y tendencia a un menor I. Charlson (0,46 frente a 0,58; p

Se presenta un mapa de 27 indicadores para medir la calidad de la asistencia prestada a los pacientes con síndrome coronario agudo (SCA) que son atendidos en el ámbito pre e intrahospitalario. Se incluyen indicadores de proceso técnicos (registro de los intervalos asistenciales, realización del ECG, monitorización y acceso venoso, evaluación de los riesgos pronóstico, hemorrágico y de mortalidad intrahospitalaria, empleo de técnicas de reperfusión y realización de ecocardiografía), indicadores de proceso farmacológicos (antiagregación plaquetaria, anticoagulación, trombolisis, administración de beta-bloqueantes, inhibidores de conversión de la angiotensina e hipolipemiantes) e indicadores de resultado (escalas de calidad de la atención prestada y mortalidad). We present a map of 27 indicators to measure the care quality given to patients with acute coronary syndrome attended in the pre- and hospital area. This includes technical process indicators (registration of care intervals, performance of electrocardiogram, monitoring and vein access, assessment of prognostic risk, hemorrhage and in-hospital mortality, use of reperfusion techniques and performance of echocardiograph), pharmacological process indicators (platelet receptors inhibition, anticoagulation, thrombolysis, beta-blockers, angiotensin converting inhibitors and lipid lowering drugs) and outcomes indicators (quality scales of the care given and mortality).

Objetivo: Evaluar la asociación entre los niveles plasmáticos de soluble triggering receptor expressed on myeloid cells-1 (sTREM-1) y la mortalidad de los pacientes con sepsis. Diseño: Estudio de cohortes prospectivo. Ámbito: Dos unidades de cuidados intensivos generales. Pacientes: Pacientes con sepsis en los que se determinaron los niveles plasmáticos de sTREM-1 durante los 3 primeros días de su presentación. Variables de interés principales: Mortalidad a los 28 días. Resultados: Se analizaron 121 pacientes (el 23% sepsis grave, el 44% shock séptico y el 33% sepsis no grave). La mortalidad a los 28 días fue del 24,8%. Los niveles de sTREM-1 iniciales fueron ligeramente más elevados en los fallecidos que en los supervivientes (mediana de 366,9 frente a 266,5pg/ml; p=0,2668). Una elevación de los niveles de sTREM-1 a lo largo de los 3 primeros días (delta-TREM) superior a 90pg/ml se asoció con un exceso de mortalidad (hazard ratio: 2,68; p=0,0047), con una sensibilidad del 47% y una especificidad del 78%. Este exceso de mortalidad de los pacientes desapareció al ajustar para gravedad mediante análisis de Cox (hazard ratio ajustado de 1,07; p=0,8665). Conclusiones: En pacientes críticos con sepsis, el aumento de los niveles de sTREM-1 a lo largo de los 3 primeros días de evolución se asocia con un exceso de mortalidad, que se explica por la mayor gravedad inicial de estos pacientes. La capacidad discriminativa de este hallazgo es insuficiente para ser útil en la clínica. Objective: To evaluate the association between plasma levels of soluble Triggering Receptor Expressed on Myeloid Cells-1 (sTREM-1) and mortality of patients with sepsis. Design: Prospective cohort study. Setting: Two general Intensive Care Units. Patients: Patients with sepsis in whom sTREM-1 plasma levels were determined daily in the first 3 days of their presentation. Variables of interest: Mortality at 28 days. Results: We analyzed 121 patients (23% severe sepsis, 44% septic shock, 33% non-severe sepsis). Mortality at 28 days was 24.8%. The initial sTREM-1 levels were slightly higher in nonsurvivors than in survivors (median 366.9 versus 266.5pg/ml, p=0.2668). An increase in sTREM-1 levels higher than 90pg/ml within the first 3 days (delta-TREM) was associated with an excess of mortality (hazard ratio [HR] 2.68, p=0.0047), with a sensitivity of 47% and a specificity of 78%. This excess of mortality disappeared after adjusting for severity by Cox analysis (adjusted HR 1.07, p=0.8665). Conclusions: The increase in the levels of sTREM-1 during the first 3 days of evolution is associated with an excess of mortality in critically ill patients with sepsis. This is explained by the greater initial severity of these patients. The discriminative capacity of this finding is insufficient to be clinically useful.