Análisis del valor predictivo de los criterios de aislamiento preventivo en una unidad de cuidados intensivos.

Objetivo: evaluar la precisión diagnóstica de los criterios empleados para detectar el paciente realmente portador de microrganismos multi-resistentes (MMR) Diseño: Estudio prospectivo, observacional de mayo 2014 a mayo 2015 Ámbito: Unidad de Cuidados Intensivos polivalente. Pacientes cohorte de pacientes ingresados de forma consecutiva que cumplían los siguientes criterios de aislamiento preventivo: hospitalización de más de 4 días en los últimos 3 meses (“hospital”); antibioterapia durante una semana en el último mes (“antibiótico”), pacientes institucionalizados o en contacto con cuidados sanitarios (“institución o cuidado”); portador de MMR los últimos 6 meses (“MMR previo”). Variables: edad, sexo, Simplified Acute Physiology Score 3, tipo de paciente (médico vs quirúrgico), estancia en UCI, mortalidad en UCI, mortalidad hospitalaria y tiempo de aislamiento. Se realizó un análisis multivariable con regresión logística múltiple entre cada uno de los factores de riesgo y el que el paciente fuera realmente portador de MMR. Resultados: Durante el periodo de estudio ingresaron 575 pacientes y cumplieron los criterios un 28%. De los 162 pacientes con criterios 51 (31%) eran portadores de MMR y de los que no cumplían criterios 29 (7%) sí que tenían portadores. En el análisis multivariable la única variables asociada de forma independiente con el ser portador fue “MMR previo” con una OR 12.14 (IC 95% 4.24 - 34.77) Conclusiones El único criterio que se asoció de forma independiente con la capacidad de detectar los pacientes con MMR al ingreso en la UCI fue haber presentado un “MMR previo”pre-print229 K

Phenotypic plasticity of European larch radial growth and wood density along a‐1,000 m elevational gradient

Phenotypic plasticity is a key mechanism for sedentary long-living species to adjust to changing environment. Here, we use mature Larix decidua tree-ring variables collected along an elevational transect in the French Alps to characterize the range of individual plastic responses to temperature. Stem cores from 821 mature Larix decidua trees have been collected from four plots distributed along a 1,000-m elevational gradient in a natural forest to build up individual linear reaction norms of tree-ring microdensity traits to temperature. The sign, magnitude and spread of variations of the slopes of the individual reaction norms were used to characterize variation of phenotypic plasticity among plots and traits. Results showed a large range of phenotypic plasticity (with positive and negative slopes) at each elevational plot and for each tree-ring variable. Overall, phenotypic plasticity tends to be larger but positive at higher elevation, negative at the warmer lower sites, and more variable in the center of the elevation distribution. Individual inter-ring reaction norm is a valuable tool to retrospectively characterize phenotypic plasticity of mature forest trees. This approach applied to Larix decidua tree-ring micro-density traits along an elevation gradient showed the existence of large inter-individual variations that could support local adaptation to a fast-changing climate.Estación Experimental Agropecuaria BarilocheFil: Escobar Sandoval, Margarita. Institut National de la Recherche Agronomique (INRA); FranciaFil: Pâques, Luc. Institut National de la Recherche Agronomique (INRA); FranciaFil: Fonti, Patrick. Swiss Federal Institute for Forest Snow and Landscape Research; SuizaFil: Martinez Meier, Alejandro. Instituto Nacional de Tecnología Agropecuaria (INTA). Estación Experimental Agropecuaria Bariloche. Área de Recursos Forestales. Grupo de Ecología Forestal; ArgentinaFil: Rozenberg, Philippe. Institut National de la Recherche Agronomique (INRA); Franci

Evolution over Time of Ventilatory Management and Outcome of Patients with Neurologic Disease∗

OBJECTIVES: To describe the changes in ventilator management over time in patients with neurologic disease at ICU admission and to estimate factors associated with 28-day hospital mortality. DESIGN: Secondary analysis of three prospective, observational, multicenter studies. SETTING: Cohort studies conducted in 2004, 2010, and 2016. PATIENTS: Adult patients who received mechanical ventilation for more than 12 hours. INTERVENTIONS: None. MEASUREMENTS AND MAIN RESULTS: Among the 20,929 patients enrolled, we included 4,152 (20%) mechanically ventilated patients due to different neurologic diseases. Hemorrhagic stroke and brain trauma were the most common pathologies associated with the need for mechanical ventilation. Although volume-cycled ventilation remained the preferred ventilation mode, there was a significant (p < 0.001) increment in the use of pressure support ventilation. The proportion of patients receiving a protective lung ventilation strategy was increased over time: 47% in 2004, 63% in 2010, and 65% in 2016 (p < 0.001), as well as the duration of protective ventilation strategies: 406 days per 1,000 mechanical ventilation days in 2004, 523 days per 1,000 mechanical ventilation days in 2010, and 585 days per 1,000 mechanical ventilation days in 2016 (p < 0.001). There were no differences in the length of stay in the ICU, mortality in the ICU, and mortality in hospital from 2004 to 2016. Independent risk factors for 28-day mortality were age greater than 75 years, Simplified Acute Physiology Score II greater than 50, the occurrence of organ dysfunction within first 48 hours after brain injury, and specific neurologic diseases such as hemorrhagic stroke, ischemic stroke, and brain trauma. CONCLUSIONS: More lung-protective ventilatory strategies have been implemented over years in neurologic patients with no effect on pulmonary complications or on survival. We found several prognostic factors on mortality such as advanced age, the severity of the disease, organ dysfunctions, and the etiology of neurologic disease