The distinct clinical profile of chronically critically ill patients: a cohort study

INTRODUCTION: Our goal was to describe the epidemiology, clinical profiles, outcomes, and factors that might predict progression of critically ill patients to chronically critically ill (CCI) patients, a still poorly characterized subgroup. METHODS: We prospectively studied all patients admitted to a university-affiliated hospital intensive care unit (ICU) between 1 July 2002 and 30 June 2005. On admission, we recorded epidemiological data, the presence of organ failure (multiorgan dysfunction syndrome (MODS)), underlying diseases (McCabe score), acute respiratory distress syndrome (ARDS) and shock. Daily, we recorded MODS, ARDS, shock, mechanical ventilation use, lengths of ICU and hospital stay (LOS), and outcome. CCI patients were defined as those having a tracheotomy placed for continued ventilation. Clinical complications and time to tracheal decannulation were registered. Predictors of progression to CCI were identified by logistic regression. RESULTS: Ninety-five patients (12%) fulfilled the CCI definition and, compared with the remaining 690 patients, these CCI patients were sicker (APACHE II, 21 ± 7 versus 18 ± 9 for non-CCI patients, p = 0.005); had more organ dysfunctions (SOFA 7 ± 3 versus 6 ± 4, p < 0.003); received more interventions (TISS 32 ± 10 versus 26 ± 8, p < 0.0001); and had less underlying diseases and had undergone emergency surgery more frequently (43 versus 24%, p = 0.001). ARDS and shock were present in 84% and 83% of CCI patients, respectively, versus 44% and 48% in the other patients (p < 0.0001 for both). CCI patients had higher expected mortality (38% versus 32%, p = 0.003), but observed mortality was similar (32% versus 35%, p = 0.59). Independent predictors of progression to CCI were ARDS on admission, APACHE II and McCabe scores (odds ratio (OR) 2.26, p < 0.001; OR 1.03, p < 0.01; and OR 0.34, p < 0.0001, respectively). Lengths of mechanical ventilation, ICU and hospital stay were 33 (24 to 50), 39 (29 to 55) and 55 (37 to 84) days, respectively. Tracheal decannulation was achieved at 40 ± 19 days. CONCLUSION: CCI patients were a severely ill population, in which ARDS, shock, and MODS were frequent on admission, and who suffered recurrent complications during their stay. However, their prognosis was equivalent to that of the other ICU patients. ARDS, APACHE II and McCabe scores were independent predictors of evolution to chronicity

Endoscopy and diagnosis of swallowing disorders in cats. Retrospective study

Se presenta un informe retrospectivo sobre estudios endoscópicos realizados en gatos con trastornos de la deglución (disfagia y/o regurgitación) y una revisión sobre el tema. Materiales y Métodos. Se identificaron todos los felinos derivados al Servicio de Endoscopia por presentar trastornos de la deglución entre los años 2006 y 2010. Se analizaron los siguientes datos: edad, sexo, raza, signos clínicos asociados, evolución y hallazgos endoscópicos. Resultados. Sobre 78 endoscopias realizadas en felinos, se analizaron aquellas cuyo signo motivo de la derivación era disfagia y/o regurgitación. El 45 % (35/78) fueron digestivas altas y los problemas en la deglución se presentaban en el 34% (12/35). Los hallazgos endoscópicos fueron: estomatitis 8%, masa en orofaringe 17%, cuerpos extraños 17%, tonsilitis 8%, estenosis esofágica 17%, esofagitis 17 %, sin particularidades 17%. En el 34 % de los casos la endoscopia fue diagnóstica y terapéutica. Discusión y conclusiones. En 75% de los casos se encontraron alteraciones, lo que indicaría que el estudio endoscópico resulta indispensable para el reconocimiento de lesiones en pacientes con esos signos. Por otro lado, en 34% de los casos la endoscopía tuvo una función diagnóstica y al mismo tiempo terapéutica evitando al paciente sufrimientos y tratamientos prolongados.We present a retrospective study of endoscopies performed in cats with swallowing disorders and a review of the subject. Materials and Methods. All cats referred to the Department of Endoscopy for swallowing disorders between 2006 and 2010, were identified. The following data were analyzed: age, sex, race, associated clinical signs, course and endoscopic findings. Results. Out of 78 endoscopies performed in cats, we analyzed those in which dysphagia / regurgitation was the reason for referral. 45% of them (35/78) were upper gastrointestinal endoscopies and swallowing disorders was observed in 34% of them (12/35). Endoscopic findings were: stomatitis 8%, mass in oropharynx 17%, foreign bodies 17%, tonsillitis 8%, esophageal stricture 17%, esophagitis 17%, unremarkable 17%. In 34% of the cases, the endoscopy was diagnostic and therapeutic. Discussion and conclusions. In 75% of the cases, changes were found. This would indicate that the endoscopy is essential for the recognition of lesions in patients presenting these signs. Moreover, in 34% of the cases, endoscopy had a diagnostic function as well as a therapeutic one, thus preventing the patient from suffering and undergoing long-term treatments.Facultad de Ciencias Veterinaria

Endoscopy and diagnosis of swallowing disorders in cats. Retrospective study

Se presenta un informe retrospectivo sobre estudios endoscópicos realizados en gatos con trastornos de la deglución (disfagia y/o regurgitación) y una revisión sobre el tema. Materiales y Métodos. Se identificaron todos los felinos derivados al Servicio de Endoscopia por presentar trastornos de la deglución entre los años 2006 y 2010. Se analizaron los siguientes datos: edad, sexo, raza, signos clínicos asociados, evolución y hallazgos endoscópicos. Resultados. Sobre 78 endoscopias realizadas en felinos, se analizaron aquellas cuyo signo motivo de la derivación era disfagia y/o regurgitación. El 45 % (35/78) fueron digestivas altas y los problemas en la deglución se presentaban en el 34% (12/35). Los hallazgos endoscópicos fueron: estomatitis 8%, masa en orofaringe 17%, cuerpos extraños 17%, tonsilitis 8%, estenosis esofágica 17%, esofagitis 17 %, sin particularidades 17%. En el 34 % de los casos la endoscopia fue diagnóstica y terapéutica. Discusión y conclusiones. En 75% de los casos se encontraron alteraciones, lo que indicaría que el estudio endoscópico resulta indispensable para el reconocimiento de lesiones en pacientes con esos signos. Por otro lado, en 34% de los casos la endoscopía tuvo una función diagnóstica y al mismo tiempo terapéutica evitando al paciente sufrimientos y tratamientos prolongados.We present a retrospective study of endoscopies performed in cats with swallowing disorders and a review of the subject. Materials and Methods. All cats referred to the Department of Endoscopy for swallowing disorders between 2006 and 2010, were identified. The following data were analyzed: age, sex, race, associated clinical signs, course and endoscopic findings. Results. Out of 78 endoscopies performed in cats, we analyzed those in which dysphagia / regurgitation was the reason for referral. 45% of them (35/78) were upper gastrointestinal endoscopies and swallowing disorders was observed in 34% of them (12/35). Endoscopic findings were: stomatitis 8%, mass in oropharynx 17%, foreign bodies 17%, tonsillitis 8%, esophageal stricture 17%, esophagitis 17%, unremarkable 17%. In 34% of the cases, the endoscopy was diagnostic and therapeutic. Discussion and conclusions. In 75% of the cases, changes were found. This would indicate that the endoscopy is essential for the recognition of lesions in patients presenting these signs. Moreover, in 34% of the cases, endoscopy had a diagnostic function as well as a therapeutic one, thus preventing the patient from suffering and undergoing long-term treatments.Facultad de Ciencias Veterinaria

Endoscopy and diagnosis of swallowing disorders in cats. Retrospective study

Se presenta un informe retrospectivo sobre estudios endoscópicos realizados en gatos con trastornos de la deglución (disfagia y/o regurgitación) y una revisión sobre el tema. Materiales y Métodos. Se identificaron todos los felinos derivados al Servicio de Endoscopia por presentar trastornos de la deglución entre los años 2006 y 2010. Se analizaron los siguientes datos: edad, sexo, raza, signos clínicos asociados, evolución y hallazgos endoscópicos. Resultados. Sobre 78 endoscopias realizadas en felinos, se analizaron aquellas cuyo signo motivo de la derivación era disfagia y/o regurgitación. El 45 % (35/78) fueron digestivas altas y los problemas en la deglución se presentaban en el 34% (12/35). Los hallazgos endoscópicos fueron: estomatitis 8%, masa en orofaringe 17%, cuerpos extraños 17%, tonsilitis 8%, estenosis esofágica 17%, esofagitis 17 %, sin particularidades 17%. En el 34 % de los casos la endoscopia fue diagnóstica y terapéutica. Discusión y conclusiones. En 75% de los casos se encontraron alteraciones, lo que indicaría que el estudio endoscópico resulta indispensable para el reconocimiento de lesiones en pacientes con esos signos. Por otro lado, en 34% de los casos la endoscopía tuvo una función diagnóstica y al mismo tiempo terapéutica evitando al paciente sufrimientos y tratamientos prolongados.We present a retrospective study of endoscopies performed in cats with swallowing disorders and a review of the subject. Materials and Methods. All cats referred to the Department of Endoscopy for swallowing disorders between 2006 and 2010, were identified. The following data were analyzed: age, sex, race, associated clinical signs, course and endoscopic findings. Results. Out of 78 endoscopies performed in cats, we analyzed those in which dysphagia / regurgitation was the reason for referral. 45% of them (35/78) were upper gastrointestinal endoscopies and swallowing disorders was observed in 34% of them (12/35). Endoscopic findings were: stomatitis 8%, mass in oropharynx 17%, foreign bodies 17%, tonsillitis 8%, esophageal stricture 17%, esophagitis 17%, unremarkable 17%. In 34% of the cases, the endoscopy was diagnostic and therapeutic. Discussion and conclusions. In 75% of the cases, changes were found. This would indicate that the endoscopy is essential for the recognition of lesions in patients presenting these signs. Moreover, in 34% of the cases, endoscopy had a diagnostic function as well as a therapeutic one, thus preventing the patient from suffering and undergoing long-term treatments.Facultad de Ciencias Veterinaria

Rinitis linfoplasmocítica en gatos: diagnóstico endoscópico de dos casos clínicos

Las rinitis crónicas no infecciosas se distinguen en categorías de acuerdo al predominio de distintas células inflamatorias y a la presencia o ausencia de hiperplasia. Se clasifican en linfoplasmocíticas, eosinofílicas e hiperplásicas. La causa no está establecida. Se cree que la condición se debe a una respuesta crónica inflamatoria a agentes inhalados (irritantes o alérgicos). En humanos esto ya es bien reconocido, y está asociado a conjuntivitis, rinitis estacional recurrente, asma y pólipos nasales. Las evidencias que demuestran que podría tratarse de un proceso alérgico son experimentales. Ha sido demostrado que la exposición a largo tiempo de humo de cigarrillo causa rinitis crónica en perros; también perros con rinitis crónica han sido positivos a test intradérmicos contra alergenos inhalatorios. La rinitis linfoplasmocítica es una causa de enfermedad inflamatoria nasal relativamente común en perros y menos común en gatos (2,5). La inflamación de la mucosa nasal lleva a la vasodilatación e incremento de la permeabilidad vascular con congestión y edema asociados a los tejidos nasales. El exudado de líquido de las paredes de los vasos debilitados lleva tanto a edema de mucosa como a acumulación de líquido seroso en la luz nasal. La única prueba diagnóstica que puede facilitar un diagnóstico definitivo de la rinitis linfoplasmocítica es el examen histopatológico de muestras de mucosa nasal por vía endoscópica.Facultad de Ciencias Veterinaria

Reducing the environmental impact of surgery on a global scale: systematic review and co-prioritization with healthcare workers in 132 countries

Abstract Background Healthcare cannot achieve net-zero carbon without addressing operating theatres. The aim of this study was to prioritize feasible interventions to reduce the environmental impact of operating theatres. Methods This study adopted a four-phase Delphi consensus co-prioritization methodology. In phase 1, a systematic review of published interventions and global consultation of perioperative healthcare professionals were used to longlist interventions. In phase 2, iterative thematic analysis consolidated comparable interventions into a shortlist. In phase 3, the shortlist was co-prioritized based on patient and clinician views on acceptability, feasibility, and safety. In phase 4, ranked lists of interventions were presented by their relevance to high-income countries and low–middle-income countries. Results In phase 1, 43 interventions were identified, which had low uptake in practice according to 3042 professionals globally. In phase 2, a shortlist of 15 intervention domains was generated. In phase 3, interventions were deemed acceptable for more than 90 per cent of patients except for reducing general anaesthesia (84 per cent) and re-sterilization of ‘single-use’ consumables (86 per cent). In phase 4, the top three shortlisted interventions for high-income countries were: introducing recycling; reducing use of anaesthetic gases; and appropriate clinical waste processing. In phase 4, the top three shortlisted interventions for low–middle-income countries were: introducing reusable surgical devices; reducing use of consumables; and reducing the use of general anaesthesia. Conclusion This is a step toward environmentally sustainable operating environments with actionable interventions applicable to both high– and low–middle–income countries