Organ dysfunction as determined by the SOFA score is associated with prognosis in patients with acute traumatic spinal cord injury above T6

Observational study[Abstract] Study design: This is a retrospective, observational study. Objectives: To evaluate organ dysfunction in patients with an acute traumatic spinal cord injury (ATSCI) above T6 using the Sequential Organ Failure Assessment (SOFA) score to determine its association with mortality. Setting: The study was performed at the intensive care unit (ICU) of a tertiary hospital in the northwest of Spain. Methods: The study included 241 patients with an ATSCI above T6 who had been admitted to the ICU between 1998 and 2017. A descriptive analysis of all variables collected was performed to compare the survivors with the non-survivors. In addition, a logistic regression model was used in the multivariate analysis to identify variables that were independently associated with mortality. Results: The results revealed significant differences between the survivors and non-survivors in terms of their age, Charlson Comorbidity Index, Glasgow Coma Scale score on admission, APACHE II score, SOFA score on day 0 and day 4, and delta SOFA 4-0 (ΔSOFA 4-0). The results of this multivariate analysis identified the following variables as independent predictors of intra-ICU mortality: age (OR = 1.05; 95% CI: 1. 01-1.08), SOFA score on day 0 (OR = 1.42; 95% CI: 1.13-1.78), ΔSOFA 4-0 (OR = 1.53; 95% CI: 1.25-1.87), and fluid balance on day 4 (OR = 1.16; 95% CI: 1.00-1.35). Conclusions: The SOFA score is useful for evaluating organ dysfunction in patients with an ATSCI above T6. After adjusting the analysis for conventional variables, organ dysfunction on admission, changes in organ function between day 4 and day 0 (ΔSOFA 4-0), and fluid balance on day 4 were seen to be independently associated with mortality in our study

Characteristics and survival of patients with acute traumatic spinal cord injury above T6 with prolonged intensive care unit stays

[Abstract] Objective: To characterize patients with acute traumatic spinal cord injury (ATSCI) above T6 who were admitted to the intensive care unit (ICU) for ≥30 days and their 1-year mortality compared with patients admitted for <30 days. Methods: A retrospective observational study was performed on 211 patients with an acute traumatic spinal cord injury above T6 who were admitted to an ICU between 1998 and 2017. Multivariate logistic regression analysis was performed to determine the relationship between an ICU stay ≥30 days and mortality after ICU discharge. Results: Of patients, 29.4% were admitted to the ICU for ≥30 days, accounting for 53.4% of total days of ICU stays generated by all patients. An ICU stay ≥30 days was not identified as an independent risk factor for mortality (1-year survival: 88.5% vs. 88.1%; adjusted hazard ratio [HR] 0.80, P = 0.699). Variables identified as predictors of 1-year post-ICU discharge mortality were severity at admission according to the Acute Physiology and Chronic Health Evaluation II score (HR 1.18) and the American Spinal Injury Association Impairment Scale motor score (HR 0.97). Among patients who required invasive mechanical ventilation, a longer duration of the respiratory support was associated with increased mortality (HR 1.01). Conclusions: Three out of 10 patients with acute traumatic spinal cord injury above T6 require prolonged stays in the ICU. Variables found to be associated with 1-year post-ICU discharge mortality in these patients were American Spinal Injury Association Impairment Scale motor score, severity, and greater duration of invasive mechanical ventilation, but not an ICU stay ≥30 days

Trends in the presentation and management of traumatic spinal cord lesions above T6: 20-Year experience in a tertiary-level hospital in Spain

[Abstract] Objective: To analyze the changes in demographic and lesion characteristics of persons with acute traumatic spinal cord injury (ATSCI) above T6 over a period of 20 years, and to evaluate their impact on ICU resources use, length of stay and mortality.Design: Retrospective observational study.Setting: Intensive Care Unit (ICU) of the University Hospital Complex of A Coruña, Spain.Participants: The study included 241 persons between 1998 and 2017 with an ATSCI above T6. For the purposes of the analysis, the overall study period was divided into three subperiods.Results: Both the mean age of the people with ATSCI (49 vs. 51 vs. 57 years; P = 0.046) and the Charlson Comorbidity Index were higher during the last subperiod (mean: 1.9 ± 2.2; P < 0.01). The most frequent cause of the injury was falls, whose percentage increased over the years. The most common classification in the American Spinal Injury Association Impairment scale was grade A. An increase in the score of the Acute Physiology and Chronic Health Evaluation (APACHE II) score was observed (median: 9 vs. 10 vs. 15; P < 0.01). The length of stay in the ICU has decreased significantly over the years (30 ± 19 vs. 22 ± 14 vs. 19 ± 13 days). No significant differences were found between the rates of ICU or in-hospital mortality recorded over the three subperiods.Conclusions: Despite the progressive increase in the age, comorbidity, and APACHE II, the length of ICU stay decreased significantly, with no associated changes in the mortality rates

Procedural sedation analgesia for enzymatic debridement in patients with burns on face and neck

[Resumen] Introducción y Objetivo. La cantidad de procedimientos mínimamente invasivos realizados fuera del quirófano ha crecido en las últimas décadas. La sedación, la analgesia o ambas, pueden ser nece- sarias para muchos de estos procedimientos de intervención o diagnóstico. Sin embargo, y hasta donde hemos podido conocer, no hay experiencia en el uso de sedoanalgesia para procedimientos (SAP) en pacientes con quemaduras faciales que necesitan desbridamiento enzimático El objetivo de este trabajo es evaluar la eficacia y la seguridad de la SAP para el control del dolor en pacientes con quemaduras faciales sometidos a tratamiento con desbridamiento enzimático. Material y Método. Describimos 16 casos de pacientes adultos con quemaduras en cara y cuello que necesitaron desbridamiento enzimático. Cuatro pacientes sin ventilación mecánica fueron tratados con SAP. Resultados. La SAP generalmente requiere combinación de múltiples agentes para alcanzar los efectos deseados de analgesia más ansiolisis. El procedimiento fue bien tolerado y los pacientes no sufrieron complicaciones. Conclusiones. Presentamos la SAP como opción para el desbridamiento enzimático de quemaduras faciales en pacientes adultos sin ventilación mecánica.[Abstract] Background and Objective. The number of minimally invasive procedures performed outside of the operating room has grown exponentially over the last several decades. Sedation, analgesia, or both may be needed for many of these interventional or diagnostic procedures. However, to our knowledge, there is no experience on the use of procedural sedation analgesia (PSA) in patients with facial burns who need enzymatic debridement. The aim of this study is to assess the effectiveness and safety of PSA for pain relief in patients with facial burns undergoing enzymatic debridement. Methods. We describe 16 cases of adult patients with burns on the face and neck who needed enzymatic debridement. Four patients without mechanical ventilation were treated with PSA. The procedure was well tolerated and the patients did not suffer complications Results. PSA usually requires combinations of multiple agents to reach desired effects of analgesia plus anxiolysis. The procedure was well tolerated and the patients did not suffer complications. Conclusions. PSA can be an option for enzymatic debridement of facial burns in adults patients without mechanical ventilation

The evolution of the ventilatory ratio is a prognostic factor in mechanically ventilated COVID-19 ARDS patients

Background: Mortality due to COVID-19 is high, especially in patients requiring mechanical ventilation. The purpose of the study is to investigate associations between mortality and variables measured during the first three days of mechanical ventilation in patients with COVID-19 intubated at ICU admission. Methods: Multicenter, observational, cohort study includes consecutive patients with COVID-19 admitted to 44 Spanish ICUs between February 25 and July 31, 2020, who required intubation at ICU admission and mechanical ventilation for more than three days. We collected demographic and clinical data prior to admission; information about clinical evolution at days 1 and 3 of mechanical ventilation; and outcomes. Results: Of the 2,095 patients with COVID-19 admitted to the ICU, 1,118 (53.3%) were intubated at day 1 and remained under mechanical ventilation at day three. From days 1 to 3, PaO2/FiO2 increased from 115.6 [80.0-171.2] to 180.0 [135.4-227.9] mmHg and the ventilatory ratio from 1.73 [1.33-2.25] to 1.96 [1.61-2.40]. In-hospital mortality was 38.7%. A higher increase between ICU admission and day 3 in the ventilatory ratio (OR 1.04 [CI 1.01-1.07], p = 0.030) and creatinine levels (OR 1.05 [CI 1.01-1.09], p = 0.005) and a lower increase in platelet counts (OR 0.96 [CI 0.93-1.00], p = 0.037) were independently associated with a higher risk of death. No association between mortality and the PaO2/FiO2 variation was observed (OR 0.99 [CI 0.95 to 1.02], p = 0.47). Conclusions: Higher ventilatory ratio and its increase at day 3 is associated with mortality in patients with COVID-19 receiving mechanical ventilation at ICU admission. No association was found in the PaO2/FiO2 variation

Lesión medular aguda traumática por encima de T6: epidemioloxía e impacto da disfunción de órganos na mortalidade e estancia en UCI

Programa Oficial de Doutoramento en Ciencias da Saúde. 5007V01[Resumen] Objetivos: Caracterizar los pacientes que ingresan en la Unidad de Cuidados Intensivos (UCI) con lesión medular aguda traumática (LMAT) por encima de T6, su mortalidad y estancia, y el valor pronóstico de la escala SOFA. Métodos: Estudio observacional retrospectivo de pacientes con LMAT por encima de T6 ingresados en la UCI del Complexo Hospitalario Universitario de A Coruña en 1998 -2017 (n = 241). Resultados: La edad, el índice de Charlson y el APACHE II al ingreso aumentaron en el periodo estudiado, disminuyendo la estancia en UCI. No hubo cambios en la mortalidad intraUCI (12,4 %) ni hospitalaria (23,7 %). Las variables predictoras de mortalidad intra-UCI fueron edad (OR = 1,05), SOFA día 0 (OR = 1,42), ΔSOFA 4 - 0 (OR = 1,53) y el balance de líquidos al cuarto día (OR = 1,16). Un 29,4 % permanecieron ingresados ≥ 30 días en UCI, no asociándose la estancia prolongada a mayor mortalidad post-alta (HR = 0,80; p = 0,699). Mayor índice motor (sHR = 1,01), menor SOFA (sHR = 0,82), menor balance de fluidos al cuarto día (sHR = 0,95) y la ausencia de infección se asociaron con menor estancia en UCI. Conclusiones: Se constata un cambio epidemiológico, y el impacto de la disfunción de órganos y el balance de líquidos en la mortalidad y estancia de estos pacientes.[Resumo] Obxectivos: Caracterizar os doentes que ingresan na Unidade de Coidados Intensivos (UCI) con Lesión Medular Aguda Traumática (LMAT) por riba de T6, a súa mortalidade e estancia, e o valor pronóstico da escala SOFA de disfunción de órganos. Métodos: Estudio observacional retrospectivo de doentes con LMAT por riba de T6 ingresados na UCI do Complexo Hospitalario Universitario de A Coruña no período 1998 - 2017 (n = 241). Resultados: A idade, o índice de Charlson e o APACHE II ao ingreso aumentaron no período estudado, disminuíndo a estancia na UCI. Non houbo cambios na mortalidade intraUCI (12,4 %) nin hospitalaria (23,7 %). As variables predictoras de mortalidade intraUCI foron a idade (OR = 1,05), SOFA día 0 (OR = 1,42), ΔSOFA 4 - 0 (OR = 1,53) e balance de líquidos no cuarto día (OR = 1,16). Un 29,4 % permaneceron ingresados ≥ 30 días na UCI, sen que se asocie a estancia prolongada con maior mortalidade post-alta (HR = 0,80; p = 0,699). Maior índice mo¬tor (sHR = 1,01), menor SOFA (sHR = 0,82), menor balance de líquidos no cuarto día (sHR = 0,95) e a ausenza de infección asociaronse con menor estancia na UCI. Conclusións: Constátase un cambio epidemiolóxico, e o impacto da disfunción de órganos e o balance de líquidos na mortalidade e estancia destes doentes.[Abstract] Objectives: To characterise the patients admitted to the Intensive Care Unit (ICU) with acute traumatic spinal cord injury (TSCI) above the T6 level, including mortality, hospital admission length, and the prognostic value of the SOFA organ dysfunction scale. Methods: Retrospective observational study of patients with acute TSCI above T6 admitted to the ICU at the Complexo Hospitalario Universitario de A Coruña between 1998 - 2017 (n = 241). Results: Age, the Charlson index and APACHE II scores at admission increased during the study period in association with a reduction in patient admission lengths in the ICU. There were no changes in the intra-ICU (12.4 %) or hospital (23.7 %) mortality rates during this study period in our cohort. The intra-ICU mortality predictor variables were age (OR = 1.05), SOFA day 0 (OR = 1.42), ΔSOFA 4 – 0 (OR = 1.53), and fluid balance on day four (OR = 1.16); 29.4 % remai¬ned hospitalised in the ICU for ≥ 30 days, with a prolonged stay not being associated with higher post-discharge mortality (HR = 0.80; p = 0.699). A higher ASIA motor sco¬re (sub-distribution hazard ratio [sHR] = 1.01), lower SOFA score (sHR = 0.82), lower fluid balance on the fourth day (sHR = 0.95), and the absence of infection were asso¬ciated with shorter ICU stays. Conclusions: This work showed an epidemiological change in our hospital context and also demonstrated the effect of organ dysfunction and fluid balance on patient mortality and length of ICU stays

Predictors of intensive care unit stay in patients with acute traumatic spinal cord injury above T6

Observational study[Abstract] Objective: The objective of this study was to identify factors associated with the intensive care unit (ICU) length of stay (LOS) of patients with an acute traumatic spinal cord injury above T6. Methods: We performed a retrospective, observational study of patients admitted to an ICU between 1998 and 2017 (n = 241). The LOS was calculated using a cumulative incidence function, with events of death being considered a competing event. Factors associated with the LOS were analyzed using both a cause-specific Cox proportional hazards regression model and a competing risk model. A multistate approach was also used to analyze the impact of nosocomial infections on the LOS. Results: A total of 211 patients (87.5%) were discharged alive from the ICU (median LOS = 23 days), and 30 (12.4%) died (median LOS = 11 days). In the multivariate analysis after adjusting for variables collected 4 days after the ICU admission, a higher American Spinal Injury Association motor score (subdistribution hazards ratio [sHR] = 1.01), neurological level C5-C8 (HR = 0,64), and lower Sequential Organ Failure Assessment score (sHR = 0.82) and fluid balance (sHR = 0.95) on day 4 were linked to a lower LOS in this unit. In the multivariate analysis, the onset of an infection was significantly associated with a longer LOS when adjusting for variables collected both at ICU admission (adjusted sHR = 0.62; 95% confidence interval = 0.50-0.77) and on day 4 (adjusted hazards ratio = 0.65; 95% confidence interval = 0.52-0.80). Conclusions: After adjusting the data for conventional variables, we identified a lower American Spinal Injury Association motor score, injury level C5-C8, a higher Sequential Organ Failure Assessment score on day 4, a more positive fluid balance on day 4, and the onset of an infection as factors independently associated with a longer ICU LOS

Sedoanalgesia para procedimientos de desbridamiento enzimático en pacientes con quemaduras en cara y cuello

Resumen Introducción y Objetivo La cantidad de procedimientos mínimamente invasivos realizados fuera del quirófano ha crecido en las últimas décadas. La sedación, la analgesia o ambas, pueden ser nece- sarias para muchos de estos procedimientos de intervención o diagnóstico. Sin embargo, y hasta donde hemos podido conocer, no hay experiencia en el uso de sedoanalgesia para procedimientos (SAP) en pacientes con quemaduras faciales que necesitan desbridamiento enzimático El objetivo de este trabajo es evaluar la eficacia y la seguridad de la SAP para el control del dolor en pacientes con quemaduras faciales sometidos a tratamiento con desbridamiento enzimático. Material y Método Describimos 16 casos de pacientes adultos con quemaduras en cara y cuello que necesitaron desbridamiento enzimático. Cuatro pacientes sin ventilación mecánica fueron tratados con SAP. Resultados La SAP generalmente requiere combinación de múltiples agentes para alcanzar los efectos deseados de analgesia más ansiolisis. El procedimiento fue bien tolerado y los pacientes no sufrieron complicaciones. Conclusiones Presentamos la SAP como opción para el desbridamiento enzimático de quemaduras faciales en pacientes adultos sin ventilación mecánica