A922 Sequential measurement of 1 hour creatinine clearance (1-CRCL) in critically ill patients at risk of acute kidney injury (AKI)

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Nurses' perceptions of aids and obstacles to the provision of optimal end of life care in ICU

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Complicaciones relacionadas con catéteres venosos centrales en niños críticamente enfermos

Objective Placing central venous catheters is essential when managing critically ill children. This paper was thus aimed at identifying the major complications involved in this and determining the incidence of mechanical and infection-related complications associated with central venous catheterization in critically ill children. Material and Methods A descriptive study was undertaken between October 2011 and March 2012 of all new central venous catheters inserted in critically ill children. The definition of central venous catheter infection was based on CDC criteria. Results During the study period 200 central venous catheters were placed, 51 % in male patients, mostly infants; 71 % required mechanical ventilation and 56.5 % medication for hemodynamic support. Respiratory tract infections were the leading diagnosis on admission in 33 % of the cases. Complications were reported in 8.5 % of the children (52 % of these being due to mechanical complication and 48 % to infection). Mechanical complication incidence was 4.5% and eight central venous catheters fulfilled CDC criteria for central line associated blood stream infection (4 % incidence, i.e. 5 per 1,000 catheter/day rate). Conclusions Despite some complications arising from its use, central venous catheter placement is a safe procedure. Mechanical and infection incidence associated with central venous catheter placement should be known, not only because it differs from that regarding adult patients but also because this can help to establish preventative measures for reducing such complications and improving the care of critically ill children

Complicaciones relacionadas con catéteres venosos centrales en niños críticamente enfermos

Objective Placing central venous catheters is essential when managing critically ill children. This paper was thus aimed at identifying the major complications involved in this and determining the incidence of mechanical and infection-related complications associated with central venous catheterization in critically ill children. Material and Methods A descriptive study was undertaken between October 2011 and March 2012 of all new central venous catheters inserted in critically ill children. The definition of central venous catheter infection was based on CDC criteria. Results During the study period 200 central venous catheters were placed, 51 % in male patients, mostly infants; 71 % required mechanical ventilation and 56.5 % medication for hemodynamic support. Respiratory tract infections were the leading diagnosis on admission in 33 % of the cases. Complications were reported in 8.5 % of the children (52 % of these being due to mechanical complication and 48 % to infection). Mechanical complication incidence was 4.5% and eight central venous catheters fulfilled CDC criteria for central line associated blood stream infection (4 % incidence, i.e. 5 per 1,000 catheter/day rate). Conclusions Despite some complications arising from its use, central venous catheter placement is a safe procedure. Mechanical and infection incidence associated with central venous catheter placement should be known, not only because it differs from that regarding adult patients but also because this can help to establish preventative measures for reducing such complications and improving the care of critically ill children

TP69 227. Arteritis de takayasu y síndrome cardiovocal (síndrome de ortner)

ObjetivosEl síndrome de Ortner se define como la aparición de disfonía debido a parálisis del nervio recurrente laríngeo izquierdo en el contexto de una enfermedad cardiovascular específica, destacando la patología aneurismática de aorta torácica y la valvulopatía mitral. Describimos el proceso diagnóstico-terapéutico utilizado en una paciente con arteritis de Takayasu, cuyo debut clínico fue la producción de un síndrome de Ortner.Material y métodosPaciente de 28 años con antecedentes de artritis reumatoide, que acude a urgencias en 2010 por presentar malestar general de 15 días de evolución, disfagia, disfonía y fiebre. Mediante examen otorrinolaringológico (ORL) se confirmó la parálisis de la cuerda vocal izquierda. Se realizó tomografía computarizada (TC) cervicotorácica y ecocardiografía transtorácica (ETT), identificándose derrame pericárdico, insuficiencia aórtica ligera e importante engrosamiento de la pared del cayado aórtico, aorta ascendente y origen de anastomosis secuencial de troncos supraaórticos (TSAo), en relación con la presencia de posible aortitis frente a colecciones periaórticas. El diagnóstico diferencial se estableció entre mediastinitis con derrame pericárdico purulento y aortitis de origen autoinmune.Resultados y conclusionesTras la realización de ventana pericárdica se confirma la presencia de pericarditis aguda serofibrinosa no infecciosa. La paciente fue diagnosticada de arteritis de Takayasu (cumpliendo 4 criterios mayores del American College of Rheumatology), con respuesta clínica y angiográfica favorable a corticoterapia y metotrexato. En 2011 se evidencia progresión de la insuficiencia aórtica hasta hacerse grave, realizándose cirugía de sustitución valvular. La variabilidad clínica en la forma de presentación de las vasculitis hace necesario un riguroso análisis, individualizado y sistemático, tanto en su diagnóstico como en su seguimiento

P44 202. Aneurisma gigante sobre injerto de safena: una complicación tardía de la cirugía coronaria

La degeneración aneurismática de los injertos de vena safena es una complicación infrecuente (<1%) que aparece en fases muy tardías. Normalmente son asintomáticos, aunque pueden presentar clínica de angina, infarto o disnea. El diagnóstico de sospecha debe realizarse ante la presencia de una masa mediastínica en la radiografía (Rx) de tórax en pacientes con antecedentes de revascularización miocárdica. La confirmación del diagnóstico se realiza mediante tomografía computarizada (TC) y coronariografía.El caso que presentamos trata de un varón de 74 años, con antecedentes de cuádruple bypass aortocoronario con injerto de safena hace 25 años. Asintomático hasta hace 1 año, cuando presenta un cuadro de disnea progresiva a moderados esfuerzos. En la Rx de tórax presentaba una masa en silueta paracardíaca derecha. La ecocardiografía confirmó la presencia de una masa adyacente a cavidades derechas, con flujo en su interior, de un tamaño de 65×86mm. Además, se informaba de una insuficiencia mitral (IM) moderada-grave. En la TC (Imagen) se confirmó imagen correspondiente a bypass coronario derecho aneurismático con trombosis parcial, que provocaba compresión extrínseca sobre aurícula derecha.Se intervino quirúrgicamente, realizándose resección del aneurisma, asociándose revascularización miocárdica e implantación de prótesis mitral.Debido a la importante morbimortalidad que conlleva por el riesgo de rotura, embolización o infarto, debe considerarse la cirugía de resección/exclusión del aneurisma como tratamiento de elección.El diagnóstico diferencial con los seudoaneurismas viene dado por su localización y la fase de aparición

Ten-year Retrospective Study of Treatment of Malignant Colonic Obstructions with Self-expandable Stents

Purpose: To describe the use of self-expandable metallic stents to manage malignant colorectal obstructions and to compare the radiation dose between fluoroscopic guidance of stent placement and combined endoscopic and fluoroscopic guidance. Materials and Methods: From January 1998 to December 2007, 467 oncology patients undergoing colorectal stent placement in a single center were included in the study. Informed consent was obtained in all cases. All procedures were performed with fluoroscopic or combined fluoroscopic and endoscopic guidance. Inclusion criteria were total or partial colorectal obstruction of neoplastic origin. Exclusion criteria were life expectancy shorter than I month, suspicion of perforation, and/or severe colonic neoplastic bleeding. Procedure time and radiation dose were recorded, and technical and clinical success were evaluated. Follow-up was performed by clinical examination and simple abdominal radiographs at 1 day and at I, 3, 6, and 12 months. Results: Of 467 procedures, technical success was achieved in 432 (92.5%). Thirty-five treatments (7.5%) were technical failures, and the patients were advised to undergo surgery. Significant differences in radiation dose and clinical success were found between the fluoroscopy and combined-technique groups (P < .001). Total decompression was achieved in 372 cases, 29 patients showed remarkable improvement, 11 showed slight improvement, and 20 showed clinical failure. Complications were recorded in 89 patients (19%), the most significant were perforation (2.3%) and stent migration (6.9%). Mean interventional time and radiation dose were 67 minutes and 3,378 dGy.cm(2), respectively. Conclusions: Treatment of colonic obstruction with stents requires a long time in the interventional room and considerable radiation dose. Nevertheless, the clinical benefits and improvement in quality of life justify the radiation risk