Clinical characteristics of kidney transplant recipients admitted in the intensive care unit of the Hospital de Clínicas, Paraguay.

Introducción: En diciembre de 1985 se realizó el primer trasplante renal del Hospital de Clínicas. El equipo multidisciplinario trabajó coordinadamente para dar respuesta a pacientes que requerían de esta terapéutica. El objetivo de este trabajo fue caracterizar a los pacientes trasplantados renales ingresados al Departamento de Cuidados Intensivos Adultos del Hospital de Clínicas de la Facultad de Ciencias Médicas de la Universidad Nacional de Asunción. Metodología: Se realizó un estudio observacional, descriptivo, retrospectivo de corte transversal, con muestreo no probabilístico de casos consecutivos. Se utilizaron fichas médicas de pacientes trasplantados que ingresaron a terapia intensiva en post operatorio inmediato de enero 2017 a diciembre 2023. Resultados: Fueron sometidos a trasplante renal 74 pacientes. El riñón trasplantado provenía de donante cadavérico en 63,6 %. Fueron del sexo masculino 64,8 % (n:48). La mediana de edad fue de 33 años. La principal comorbilidad del receptor fue hipertensión arterial 79,7 %. El score pronóstico utilizado fue APACHE II, con mediana de 12. La mediana de días de internación fue 3. Necesitaron asistencia respiratoria mecánica 5,4% y el promedio de días de ventilación fue 9 (rango: 2-19). Requirieron infusión continúa de furosemida 48,6%, vasodilatadores 39,1 % y vasopresores en un 10,8 %. De los pacientes estudiados, 95,9 % se encontraban en hemodiálisis (n:71). Requirieron sesiones dialíticas posterior al trasplante 9 pacientes. La ecografía Doppler del riñón trasplantado mostró estenosis de la arteria renal en 12, 9%, con repercusión clínica en 2 pacientes, llegando a trasplantectomía en uno de ellos. La supervivencia al alta de la terapia intensiva fue 100 %. Reingresaron en postoperatorio mediato por infecciones asociadas a cuidados de la salud 2 pacientes, que finalmente fallecieron. Conclusión: En el Paraguay el trasplante renal, es una válida opción terapéutica con buenos resultados y bajas complicaciones para pacientes en etapa terminal de la enfermedad renal.Introduction: In December 1985, the first kidney transplant was performed at the Hospital de Clínicas. The multidisciplinary team worked in coordination to respond to the increasing needs of patients who required this therapy. The aim of this work was to characterize kidney transplant patients admitted to the Adult Intensive Care Department of the Hospital de Clínicas of the Faculty of Medical Sciences of the National University of Asunción. Methods: An observational, descriptive, retrospective cross-sectional study was made, with non-probabilistic sampling of consecutive cases. The records of all patients admitted to intensive care unit in the immediate postoperative period from January 2017 to December 2023 were used. Results: 74 kidney transplant patients were during the study period. The transplanted kidney proceeds from a cadaveric donor in 63.6%. Forty-eight were male (64,8%). The median age was 33 years. The main comorbidity of the recipient was arterial hypertension 79.7%. The prognostic score used was APACHE II, with a median of 12. The median number of days of hospitalization was 3. The 5.4% required mechanical respiratory assistance and the average number of days of ventilation was 9 (range: 2-19). Furosemide infusion was required in 48.6% of patients, vasodilators in 39,1% and 10.8% of vasopressors. Of the patients studied, 95.9% were on hemodialysis (n:71). Nine patients required dialysis sessions after transplantation. Doppler ultrasound of the transplanted kidney showed renal artery stenosis in 12.9%, with clinical repercussions in 2 patients, leading to transplantectomy in one of them. Discharge survival from intensive care was 100%. Two patients were readmitted in the mid-postoperative period with healthcare associated infections, who finally died. Conclusion: In Paraguay, kidney transplantation is a valid therapeutic option with good results and low complications for patients in the terminal stage of kidney disease

Resultados da participação do Paraguai no estudo nutritionDay 2021

Each year, nutritionDay (nDay) provides de opportunity to analyze the intention to optimize nutritional and metabolic support and compare results with those obtained in the region and in the world. The aim of this study is to present the most relevant results of nDay in inpatient hospital wards and Intensive Care Units in 2021.El nutritionDay (nDay) ayuda a analizar cada año la intención de optimizar el soporte nutricional y metabólico, y comparar los resultados con los obtenidos en la región y en el mundo. El objetivo de este estudio es presentar los resultados más relevantes del nDay en las salas de internación de hospitales y unidades de cuidados intensivos (UCI) en 2021.O nutritionDay (nDay) ajuda a analisar a cada ano a intenção de otimizar o suporte nutricional e metabólico e comparar os resultados com os obtidos na região e no mundo. O objetivo deste estudo é apresentar os resultados mais relevantes do nDay nas unidades de internação hospitalar e unidades de terapia intensiva (UTI) em 2021

Prevalence, associated factors and outcomes of pressure injuries in adult intensive care unit patients: the DecubICUs study

Funder: European Society of Intensive Care Medicine; doi: http://dx.doi.org/10.13039/501100013347Funder: Flemish Society for Critical Care NursesAbstract: Purpose: Intensive care unit (ICU) patients are particularly susceptible to developing pressure injuries. Epidemiologic data is however unavailable. We aimed to provide an international picture of the extent of pressure injuries and factors associated with ICU-acquired pressure injuries in adult ICU patients. Methods: International 1-day point-prevalence study; follow-up for outcome assessment until hospital discharge (maximum 12 weeks). Factors associated with ICU-acquired pressure injury and hospital mortality were assessed by generalised linear mixed-effects regression analysis. Results: Data from 13,254 patients in 1117 ICUs (90 countries) revealed 6747 pressure injuries; 3997 (59.2%) were ICU-acquired. Overall prevalence was 26.6% (95% confidence interval [CI] 25.9–27.3). ICU-acquired prevalence was 16.2% (95% CI 15.6–16.8). Sacrum (37%) and heels (19.5%) were most affected. Factors independently associated with ICU-acquired pressure injuries were older age, male sex, being underweight, emergency surgery, higher Simplified Acute Physiology Score II, Braden score 3 days, comorbidities (chronic obstructive pulmonary disease, immunodeficiency), organ support (renal replacement, mechanical ventilation on ICU admission), and being in a low or lower-middle income-economy. Gradually increasing associations with mortality were identified for increasing severity of pressure injury: stage I (odds ratio [OR] 1.5; 95% CI 1.2–1.8), stage II (OR 1.6; 95% CI 1.4–1.9), and stage III or worse (OR 2.8; 95% CI 2.3–3.3). Conclusion: Pressure injuries are common in adult ICU patients. ICU-acquired pressure injuries are associated with mainly intrinsic factors and mortality. Optimal care standards, increased awareness, appropriate resource allocation, and further research into optimal prevention are pivotal to tackle this important patient safety threat

Correction to: Prevalence, associated factors and outcomes of pressure injuries in adult intensive care unit patients: the DecubICUs study

The original version of this article unfortunately contained a mistake

Prevalence, associated factors and outcomes of pressure injuries in adult intensive care unit patients: the DecubICUs study

Funder: European Society of Intensive Care Medicine; doi: http://dx.doi.org/10.13039/501100013347Funder: Flemish Society for Critical Care NursesAbstract: Purpose: Intensive care unit (ICU) patients are particularly susceptible to developing pressure injuries. Epidemiologic data is however unavailable. We aimed to provide an international picture of the extent of pressure injuries and factors associated with ICU-acquired pressure injuries in adult ICU patients. Methods: International 1-day point-prevalence study; follow-up for outcome assessment until hospital discharge (maximum 12 weeks). Factors associated with ICU-acquired pressure injury and hospital mortality were assessed by generalised linear mixed-effects regression analysis. Results: Data from 13,254 patients in 1117 ICUs (90 countries) revealed 6747 pressure injuries; 3997 (59.2%) were ICU-acquired. Overall prevalence was 26.6% (95% confidence interval [CI] 25.9–27.3). ICU-acquired prevalence was 16.2% (95% CI 15.6–16.8). Sacrum (37%) and heels (19.5%) were most affected. Factors independently associated with ICU-acquired pressure injuries were older age, male sex, being underweight, emergency surgery, higher Simplified Acute Physiology Score II, Braden score 3 days, comorbidities (chronic obstructive pulmonary disease, immunodeficiency), organ support (renal replacement, mechanical ventilation on ICU admission), and being in a low or lower-middle income-economy. Gradually increasing associations with mortality were identified for increasing severity of pressure injury: stage I (odds ratio [OR] 1.5; 95% CI 1.2–1.8), stage II (OR 1.6; 95% CI 1.4–1.9), and stage III or worse (OR 2.8; 95% CI 2.3–3.3). Conclusion: Pressure injuries are common in adult ICU patients. ICU-acquired pressure injuries are associated with mainly intrinsic factors and mortality. Optimal care standards, increased awareness, appropriate resource allocation, and further research into optimal prevention are pivotal to tackle this important patient safety threat

Hidatidosis en salas de Clínica Médica y Cirugía del Hospital de Clínicas entre los años 2006 al 2013

La hidatidosis es una zoonosis parasitaria que afecta al ser humano de manera accidental produciendo quistes en cualquier localización anatómica, durante su lento crecimiento se mantiene asintomático, con los meses se manifestará  como tumor local, dolor o reacción de hipersensibilidad. Se presenta descripción de 12 casos cuyo perfil es: mujer de 49 años, dedicada a los quehaceres domésticos, procedente del área urbana, quien presenta quiste hepático y recibe tratamiento combinado quirúrgico y farmacológico,  con resolución de la patología. En el Hospital de Clínicas consultan en promedio 1,7 pacientes con hidatidosis por año.

Caracterización y mortalidad de pacientes con enfermedades Reumatológica ingresados en una unidad de cuidados intensivos adultos del Paraguay

Introducción: Las enfermedades reumatológicas no son infrecuentes en la población ge- neral. Este grupo de pacientes suele requerir hospitalización por diversas causas y hasta un tercio puede ingresar a la Unidad de Cuidados Intensivos (UCI). El pronóstico puede ser desfavorable, sobretodo en presencia de compromiso renal. Objetivo: Caracterizar a los pacientes reumatológicos ingresados a Cuidados Intensivos y determinar la mortalidad. Métodos: Se realizó un estudio descriptivo, retrospectivo de corte transversal. Los datos fueron obtenidos de las historias clínicas de los pacientes con enfermedades reumatológi- cas ingresados al Departamento de Cuidados Intensivos Adultos del Hospital de Clínicas desde enero de 2021 hasta diciembre de 2022. Resultados: Veintinueve pacientes con enfermedades reumatológicas ingresaron en los dos años de estudio. Con una mediana de edad de 37 años (RIC 22,5), veintitrés fueron mujeres (79,31%). Tenían lupus eritematoso sistémico veinte pacientes (68,9%); cinco con artritis reumatoide (17,2%) y los cuatros pacientes restantes tenían enfermedad mixta del tejido conectivo, Síndrome de Sjogren, Síndrome de Superposición y Vasculitis de Churg Strauss (3,44%). Las comorbilidades más frecuentes fueron: hipertensión arterial (55%) y nefropatía (41,3%). Las causas de ingreso a la UCI fueron médicas (62%) y quirúrgicas (38%). Entre las médicas, la insuficiencia respiratoria aguda fue el principal motivo (44%), seguido por shock (27%) e infecciones sobre agregadas (11,1%). La puntuación media de APACHE II (Age and Chronic Health Evaluation) fue 17 ± 10; SOFA al ingreso (Sequential Organ Failure Assessment): 6 ± 8,5 y en los pacientes lúpicos la Escala de SLEDAI (Sys- temic Lupus Erythematosus Disease Activity Measure): 10,6 ± 8,3. Recibieron asistencia respiratoria mecánica (ARM) 19 pacientes (65,5%) con una mediana de días de ARM de 6 (RIC 9). Utilizaron drogas vasoactivas 65,5% y hemodiálisis 17,2%. Se administró metil- prednisolona a 10 de los pacientes (37,9%), además 4 de ellos requirieron ciclofosfamida y 3 inmunoglobulinas. Durante su hospitalización desarrollaron falla renal aguda 13 (44,8%) y sobreinfecciones12 pacientes (41,3%), de los cuales en 6 se aislaron Gram positivos en sangre. La mediana de estancia fue de 6 días (RIC:10) y la mortalidad en UCI fue del 37,9% (11 pacientes). Conclusiones: En nuestro estudio la población fue principalmente de mujeres jóvenes con comorbilidades, que ingresaron graves a terapia intensiva, la mayoría por causas médicas. Dos tercios requirieron ARM y drogas vasoactivas. Presentaron complicaciones como la falla renal aguda y sobreinfecciones bacterianas. La mortalidad fue del 38%, solo un poco mayor que la correspondiente al escore de gravedad del ingreso

Prevalence, associated factors and outcomes of pressure injuries in adult intensive care unit patients: the DecubICUs study

Funder: European Society of Intensive Care Medicine; doi: http://dx.doi.org/10.13039/501100013347Funder: Flemish Society for Critical Care NursesAbstract: Purpose: Intensive care unit (ICU) patients are particularly susceptible to developing pressure injuries. Epidemiologic data is however unavailable. We aimed to provide an international picture of the extent of pressure injuries and factors associated with ICU-acquired pressure injuries in adult ICU patients. Methods: International 1-day point-prevalence study; follow-up for outcome assessment until hospital discharge (maximum 12 weeks). Factors associated with ICU-acquired pressure injury and hospital mortality were assessed by generalised linear mixed-effects regression analysis. Results: Data from 13,254 patients in 1117 ICUs (90 countries) revealed 6747 pressure injuries; 3997 (59.2%) were ICU-acquired. Overall prevalence was 26.6% (95% confidence interval [CI] 25.9–27.3). ICU-acquired prevalence was 16.2% (95% CI 15.6–16.8). Sacrum (37%) and heels (19.5%) were most affected. Factors independently associated with ICU-acquired pressure injuries were older age, male sex, being underweight, emergency surgery, higher Simplified Acute Physiology Score II, Braden score 3 days, comorbidities (chronic obstructive pulmonary disease, immunodeficiency), organ support (renal replacement, mechanical ventilation on ICU admission), and being in a low or lower-middle income-economy. Gradually increasing associations with mortality were identified for increasing severity of pressure injury: stage I (odds ratio [OR] 1.5; 95% CI 1.2–1.8), stage II (OR 1.6; 95% CI 1.4–1.9), and stage III or worse (OR 2.8; 95% CI 2.3–3.3). Conclusion: Pressure injuries are common in adult ICU patients. ICU-acquired pressure injuries are associated with mainly intrinsic factors and mortality. Optimal care standards, increased awareness, appropriate resource allocation, and further research into optimal prevention are pivotal to tackle this important patient safety threat

Prevalence, associated factors and outcomes of pressure injuries in adult intensive care unit patients: the DecubICUs study

Funder: European Society of Intensive Care Medicine; doi: http://dx.doi.org/10.13039/501100013347Funder: Flemish Society for Critical Care NursesAbstract: Purpose: Intensive care unit (ICU) patients are particularly susceptible to developing pressure injuries. Epidemiologic data is however unavailable. We aimed to provide an international picture of the extent of pressure injuries and factors associated with ICU-acquired pressure injuries in adult ICU patients. Methods: International 1-day point-prevalence study; follow-up for outcome assessment until hospital discharge (maximum 12 weeks). Factors associated with ICU-acquired pressure injury and hospital mortality were assessed by generalised linear mixed-effects regression analysis. Results: Data from 13,254 patients in 1117 ICUs (90 countries) revealed 6747 pressure injuries; 3997 (59.2%) were ICU-acquired. Overall prevalence was 26.6% (95% confidence interval [CI] 25.9–27.3). ICU-acquired prevalence was 16.2% (95% CI 15.6–16.8). Sacrum (37%) and heels (19.5%) were most affected. Factors independently associated with ICU-acquired pressure injuries were older age, male sex, being underweight, emergency surgery, higher Simplified Acute Physiology Score II, Braden score 3 days, comorbidities (chronic obstructive pulmonary disease, immunodeficiency), organ support (renal replacement, mechanical ventilation on ICU admission), and being in a low or lower-middle income-economy. Gradually increasing associations with mortality were identified for increasing severity of pressure injury: stage I (odds ratio [OR] 1.5; 95% CI 1.2–1.8), stage II (OR 1.6; 95% CI 1.4–1.9), and stage III or worse (OR 2.8; 95% CI 2.3–3.3). Conclusion: Pressure injuries are common in adult ICU patients. ICU-acquired pressure injuries are associated with mainly intrinsic factors and mortality. Optimal care standards, increased awareness, appropriate resource allocation, and further research into optimal prevention are pivotal to tackle this important patient safety threat

Correction to: Prevalence, associated factors and outcomes of pressure injuries in adult intensive care unit patients: the DecubICUs study (Intensive Care Medicine, (2021), 47, 2, (160-169), 10.1007/s00134-020-06234-9)

The original version of this article unfortunately contained a mistake. The members of the ESICM Trials Group Collaborators were not shown in the article but only in the ESM. The full list of collaborators is shown below. The original article has been corrected