3 research outputs found
Ecais study: inadvertent cardiovascular adverse events in sepsis
Objetivo
Describir la incidencia de eventos cardiovasculares adversos en pacientes con diagnóstico de sepsis en sus diferentes estadios.
Diseño
Estudio observacional, descriptivo, longitudinal.
Ámbito
Unidades de cuidados intensivos de tipo mixto de dos hospitales universitarios en la ciudad de Bogotá.
Participantes
Se incluyeron una serie de pacientes mayores de edad, que ingresan a UCI con diagnostico de sepsis, sin evidencia de lesión miocárdica isquémica previa.
Intervenciones
Registros electrocardiográficos continuos de 12 derivaciones durante 48 horas con monitoría Holter
Variables de interés
Isquemia, arritmia cardiaca, variabilidad de la frecuencia cardiaca.
Resultados
Se analizaron 100 pacientes, 62% de los cuales se estadificó como choque séptico. El 3% presentó evento cardiovascular adverso de tipo isquémico detectado por Holter y desapercibido por monitoreo convencional. El 46% presentaron un evento de tipo arrítmico por Holter, comparado con solo un 6% detectado por monitoreo convencional. La mortalidad cruda fue de 40%. El 100% presentó pérdida de la variabilidad de la frecuencia cardiaca.
Conclusión
La sepsis en esta experiencia mostró una baja incidencia de eventos cardiovasculares isquémicos. Los eventos arrítmicos, sin embargo, mostraron una incidencia alta. El monitoreo convencional falló en detectar la totalidad de los eventos isquémicos y en mayor proporción los eventos arrítmicos. En esta serie, los eventos cardiovasculares generados por descarga adrenérgica no impactan en la mortalidad.Objective
To describe the incidence of cardiovascular adverse events in patients with sepsis in its various stages.
Design
A longitudinal, descriptive, observational study was carried out.
Setting
Intensive care units of two university hospitals in Bogotá (Colombia).
Patients
A number of patients consecutively admitted to the adult ICU with a diagnosis of sepsis, and no evidence of previous ischemic myocardial injury.
Interventions
Forty-eight hours of electrocardiographic record using Holter technology.
Main variables
Ischemia, cardiac arrhythmia, heart rate variability.
Results
A total of 100 patients were analyzed, 62% being staged as presenting septic shock. Three percent suffered ischemic events detected by Holter and unnoticed through conventional monitoring. Forty-six percent suffered an arrhythmic event detected by Holter, compared with only 6% as detected by conventional monitoring. Mortality was 40%. All patients showed loss of heart rate variability.
Conclusion
In this study patients with sepsis showed a low incidence of cardiovascular ischemic events. In contrast, arrhythmic events showed a high incidence. Conventional monitoring failed to detect any of the ischemic events and most arrhythmic events. In this study, cardiovascular events generated by adrenergic discharge had no impact upon mortality
Body mass index and complications following major gastrointestinal surgery: A prospective, international cohort study and meta-analysis
Aim Previous studies reported conflicting evidence on the effects of obesity on outcomes after gastrointestinal surgery. The aims of this study were to explore the relationship of obesity with major postoperative complications in an international cohort and to present a metaanalysis of all available prospective data. Methods This prospective, multicentre study included adults undergoing both elective and emergency gastrointestinal resection, reversal of stoma or formation of stoma. The primary end-point was 30-day major complications (Clavien–Dindo Grades III–V). A systematic search was undertaken for studies assessing the relationship between obesity and major complications after gastrointestinal surgery. Individual patient meta-analysis was used to analyse pooled results. Results This study included 2519 patients across 127 centres, of whom 560 (22.2%) were obese. Unadjusted major complication rates were lower in obese vs normal weight patients (13.0% vs 16.2%, respectively), but this did not reach statistical significance (P = 0.863) on multivariate analysis for patients having surgery for either malignant or benign conditions. Individual patient meta-analysis demonstrated that obese patients undergoing surgery formalignancy were at increased risk of major complications (OR 2.10, 95% CI 1.49–2.96, P < 0.001), whereas obese patients undergoing surgery for benign indications were at decreased risk (OR 0.59, 95% CI 0.46–0.75, P < 0.001) compared to normal weight patients. Conclusions In our international data, obesity was not found to be associated with major complications following gastrointestinal surgery. Meta-analysis of available prospective data made a novel finding of obesity being associated with different outcomes depending on whether patients were undergoing surgery for benign or malignant disease