Presión venosa central, tiempo de recalentamiento y líquidos totales son factores postoperatorios de morbi-mortalidad en cirugía cardiaca

Producción CientíficaOBJETIVOS: Analizar la influencia de factores del postoperatorio inmediato (primer día), como posibles marcadores de la evolución postoperatoria en los enfermos operados de cirugía cardiaca. PACIENTES Y MÉTODOS: Se diseñó un estudio transversal en el que se incluyeron consecutivamente pacientes intervenidos de cirugía cardiaca. Se analizó el efecto de la presión venosa central, el tiempo de recalentamiento hasta alcanzar los 35,5ºC de temperatura central y los líquidos totales administrados en 24 horas, sobre la mortalidad y las complicaciones cardiacas, pulmonares y renales. RESULTADOS: Se incluyeron 236 pacientes. Se observó que la presión venosa central mayor de 18 mmHg, el tiempo de recalentamiento mayor de 6 horas y la administración de líquidos mayores a 5 litros durante las primeras 24 horas, se asoció a un incremento de la mortalidad y a la aparición de complicaciones cardiovasculares, pulmonares y renales. CONCLUSIONES: La presión venosa central, el tiempo de recalentamiento y los líquidos administrados durante el primer día son determinantes de la evolución postoperatoria

Comparative study of single-dose and 24-hour multiple-dose antibiotic prophylaxis for cardiac surgery

Producción CientíficaUse of single-dose antibiotic prophylaxis is associated with reduced antibiotic resistance, lower costs, and fewer problems with drug toxicity and superinfections. We tested the hypothesis that single doses of cefazolin are as effective as a 24-hour regimen of cefazolin in preventing surgical site infections in adults undergoing cardiac procedures. This random, prospective, clinical study included 838 adult patients undergoing elective coronary artery bypass grafting, valve operations, or both. These patients were randomly given a single dose of cefazolin (2 g) or a 24-hour treatment (2-g initial dose, followed by 1 g every 8 hours). Investigators blinded to the drug regimen diagnosed wound infections according to Centers for Disease Control and Prevention criteria. Patient clinical and demographic characteristics were noted, with follow-up for 12 postoperative months. The primary objective was to compare the incidence of surgical infections between groups up to 12 months postoperatively. Results: A total of 419 patients received single-dose cefazolin, and another 419 received the 24-hour treatment. Surgical site infection occurred in 35 (8.3%) patients receiving single doses and 15 (3.6%) patients administered the 24-hour treatment (P ¼ .004). We identified no differences between groups for mortality or duration of hospitalization (preoperative hospitalization, intensive care unit stay, and hospitalization after surgical intervention). The microorganisms isolated showed a similar distribution in both groups. The germs isolated were gram-positive cocci in 86% of the surgical site infections. Single-dose cefazolin used as antibiotic prophylaxis in cardiac surgery is associated with a higher surgical site infection rate than the 24-hour, multiple-dose cefazolin regimen

Prevalence of positive prick test to anaesthetic drugs in the surgical population

Producción CientíficaPrevalence of patients with positive prick tests to anaesthetics occurred in 4.7% of the surgical populatio

The inflammatory response to colloids and crystalloids used for pump priming during cardiopulmonary bypass

Producción CientíficaBackground: Systemic inflammatory response frequently occurs after coronary artery bypass surgery and is strongly correlated with the risk of postoperative morbidity and mortality. This study tests the hypothesis that the priming of the extracorporeal circuit with colloid solutions results in less inflammation in patients undergoing cardiac surgery than priming with crystalloid solutions. Methods: A prospective, randomized studywas designed. Forty-four patients undergoing elective coronary artery bypass grafting were randomly allocated to one of two groups: 22 patients primed with Ringer’s lactate (RL) solution and 22 patients primed with gelatin-containing solution during the surgery. Plasma levels of interleukin (IL)-6, IL-8, tumor necrosis factor (TNF)-a, C-reactive protein (CRP) and, complement 4 were measured during the surgical intervention and over the following 48 postoperative hours. Cytokine levels were measured by enzyme-linked assays from plasma samples obtained at specific time points pre- and post-operatively. Results: In both groups the serum levels of the pro-inflammatory cytokines (IL-6, IL-8, TNF-a), CRP, complement 4, and leukocytes increased significantly over the baseline, although no significant differences were observed between the two groups. The operation time, blood loss, need for inotropic support, extubation time, and length of intensive care unit stay did not differ significantly between the two groups. Conclusion: Priming with gelatin vs. RL produces no significant differences in the inflammatory response in patients undergoing coronary artery bypass grafting with cardiopulmonary bypass

Desarrollo, seguimiento y evaluación de la formación especializada en el modelo troncal.

La implantación de la troncalidad en la formación sanitaria especializada en España es el cambio más profundo y complejo que se introduce en la regulación del sistema de formación especializada desde el año 1978. Este hecho hace imprescindible la puesta en marcha de un conjunto de elementos estructurales, organizativos y de acción dirigidos específicamente a garantizar que el proceso se implante siguiendo las premisas y calendarios previstos en las disposiciones legales que le dan soporte y de acuerdo con conceptos y evidencias científicamente fundados y que traduzcan también la experiencia acumulada en España y otros países en relación con estos temas

Antivíricos y gripe pandémica

Producción CientíficaHemos leído con agrado el editorial de Diògene Fadini etal1, y al hilo de sus afirmaciones quisiéramos establecer unaaportación sencilla para documentar el empleo clínico delos antivirales en el contexto pandémico al que aluden losautores.Estos se ̃nalan con acierto que la aparición de resistenciaa oseltamivir parece ser independiente de la prevalencia deluso del fármaco, y refieren la contribución de Dharan et al2relativa a su empleo en los Estados Unidos de América, sibien cabe matizar que esta serie hace referencia a aisladosanteriores a la aparición de la cepa pandémic