Pregnancy Hypertension: An International Journal of Women's Cardiovascular Health, 2012
Worldwide, hypertensive disease of pregnancy is one of the most frequent causes of admission of o... more Worldwide, hypertensive disease of pregnancy is one of the most frequent causes of admission of obstetric patients to the ICU. Maternal mortality risk related to Hypertension during pregnancy in Latin America is significantly higher than in developed countries. To describe the characteristics and outcomes of pregnant-postpartum patients with hypertensive disease of pregnancy admitted to ICU METHODS: Multicenter case series study. pregnant-postpartum (<42days) patients with hypertensive disease of pregnancy admitted to ICU. 3 ICUs in Argentina, 2 from the Public (P1) and 1 from the Private Health Sector (P2). Continuous data are presented as mean±SD or median [IQR], and categorical data as number (%). Comparisons among continuous data were performed with unpaired t test or Mann-Whitney U test. Categorical variables were analyzed by Chi-square test or Fisher exact test as appropriate. A two-sided α<0.05 was considered as significant. SPSS version 15 was used. One hundred and eighty four patients were included, 161(87.5%) from P1. General characteristics are shown in the Table. Gestational age was 34±5 weeks. Risk factors for preeclampsia not included in Charlson score were chronic hypertension (22;12%), Obesity (6;3%) and preeclampsia in previous pregnancy (5;3%). ICU admission was postpartum in 80%(145). Causes of admission were eclampsia (63;34%), severe preeclampsia (61;33%), HELLP (33;18%), Eclampsia-HELLP (18;10%), Chronic Hypertension (5;3%) and Gestational Hypertension (4;2%). Predictive mortality according with APACHEII was 14%. Antenatal care was present in 115/142(81%) patients; 97/124(78%) in P1 vs 18/18 (100%) in P2; p0.024. Antenatal care was appropriate in 77/108(71.3%) of patients; 59/90(65.5%) in P1 vs 18/18(100%) in P2; p0.001. Maternal deaths (6) occurred in the Public sector and none of the patients had received antenatal care. Causes of mortality were hemorrhagic stroke (3) and multiple organ dysfunction (3) Table 1. Most patients were from the public health sector and the majority did not have any comorbidity according with the Charlson score. Nevertheless, 18% presented risk factors for preeclampsia, not included in the mentioned score. Two-thirds of patients were admitted with eclampsia and severe preeclampsia. APACHEII overpredicted mortality. Half of deaths were related with hemorrhagic stroke, complication almost eradicated from developed countries. None of the patients who died had received antenatal care.
Coronavirus disease-19 has emerged as a devastating global public health crisis. An increased fre... more Coronavirus disease-19 has emerged as a devastating global public health crisis. An increased frequency of arterial and venous thrombosis was observed in COVID-19 infection. The objective of this study was to describe the thromboembolic complications of patients hospitalized for COVID-19 and their evolution. A prospective single-center study was conducted that compared the characteristics, risk factors, thromboembolic event rate, hospital stay and mortality among patients admitted to intensive care or general ward. The mean age of population was 46 ± 18 years, and 52% were female. The global rate of thromboembolic events was 4.4%, significantly higher in intensive unit patients (29% vs 1.4%; p < 0.001) despite the high use of prophylactic heparin (91.1% vs. 84.9%; p < 0.1). The independent predictive factors for the development of thromboembolic events were: age, D-dimer and creatinine. Of the patients admitted to intensive care, 45.1% required mechanical ventilation. Overall ...
PurposeTo identify determinants of oxygenation over time in patients with COVID-19 acute respirat... more PurposeTo identify determinants of oxygenation over time in patients with COVID-19 acute respiratory distress syndrome (ARDS); and to analyze their characteristics according to Berlin definition categories.Materials and methodsProspective cohort study including consecutive mechanically ventilated patients admitted between 3/20/2020–10/31/2020 with ARDS. Epidemiological and clinical data on admission; outcomes; ventilation, respiratory mechanics and oxygenation variables were registered on days 1, 3 and 7 for the entire population and for ARDS categories.Results1525 patients aged 61 ± 13, 69% male, met ARDS criteria; most frequent comorbidities were obesity, hypertension, diabetes and respiratory disease. On admission, 331(21%), 849(56%) and 345(23%) patients had mild, moderate and severe ARDS; all received lung-protective ventilation (mean tidal volumes between 6.3 and 6.7 mL/kg PBW) and intermediate PEEP levels (10–11 cmH2O). PaO2/FiO2, plateau pressure, static compliance, driving pressure, ventilation ratio, pH and D-dimer >2 mg/L remained significantly different among the ARDS categories over time. In-hospital mortality was, respectively, 55%, 58% and 70% (p < 0.000). Independent predictors of changes of PaO2/FiO2 over time were BMI; preexistent respiratory disease; D-dimer >2 mg/L; day 1-PEEP, and day 1-ventilatory ratio.ConclusionHypoxemia in patients with COVID-19-related ARDS is associated with comorbidities, deadspace and activated coagulation markers, and disease severity—reflected by the PEEP level required.
Coronavirus disease-19 has emerged as a devastating global public health crisis. An increased fre... more Coronavirus disease-19 has emerged as a devastating global public health crisis. An increased frequency of arterial and venous thrombosis was observed in COVID-19 infection. The objective of this study was to describe the thromboembolic complications of patients hospitalized for COVID-19 and their evolution. A prospective single-center study was conducted that compared the characteristics, risk factors, thromboembolic event rate, hospital stay and mortality among patients admitted to intensive care or general ward. The mean age of population was 46 ± 18 years, and 52% were female. The global rate of thromboembolic events was 4.4%, significantly higher in intensive unit patients (29% vs 1.4%; p < 0.001) despite the high use of prophylactic heparin (91.1% vs. 84.9%; p < 0.1). The independent predictive factors for the development of thromboembolic events were: age, D-dimer and creatinine. Of the patients admitted to intensive care, 45.1% required mechanical ventilation. Overall ...
D31. NON-PULMONARY CRITICAL CARE AND MONITORING, 2011
/ Thematic Poster Session / Wednesday, May 18/8:15 AM-4:30 PM D31 NON-PULMONARY CRITICAL CARE AND... more / Thematic Poster Session / Wednesday, May 18/8:15 AM-4:30 PM D31 NON-PULMONARY CRITICAL CARE AND MONITORING ... / Area K, Hall B (Upper Level), Colorado Convention Center ... Outcome And Level Of Intervention Of Critically Ill Obstetric Patients From The ...
During the SARS-CoV-2 pandemic, there was a marked requirement for critical care beds, supplies a... more During the SARS-CoV-2 pandemic, there was a marked requirement for critical care beds, supplies and trained professionals to assist patients with severe respiratory failure. The Argentine Society of Intensive Care (SATI) designed a study to characterize these aspects in intensive care units (ICUs). Multicenter, prospective cohort study; the participating ICUs completed a form at the end of the study (31/10/2020) on hospital characteristics, number of beds in pre- and intra-pandemic critical areas, incorporation of professionals, technological resources, and workload. Fifty-eight ICUs participated; 28(48%) were located in Buenos Aires Province, 22(38%) in Buenos Aires Autonomous City and 10 (17%) in other provinces; 31 (53%) of UCIs belonged to the public sector; 23 (47%) to the private-social security. In 35/58 (60%) of the hospitals critical care beds increased from 902 to 1575 (75%), 37% in ICU and 63% mainly in Coronary Care Unit and Emergency-shock room. In 41/55 (75%) UCIs, staff were incorporated: 27(49%) physicians (70% intensivists), 36 (65%) nurses, 28 (51%) respiratory therapists, 20(36%) cleaning staff, and 1(2%) others. A 96% of the ICUS reported having sufficient ventilators and 95% enough supplies and PPE. Of all patients on invasive mechanical ventilation, 55% [43-64] had COVID-19. Oxygen therapy was required as noninvasive support in 14% [8-24] of COVID-19 admissions. There was a significant expansion of critical operational areas, secondary to the increase in beds, staff, and adequate availability of ventilators and essential supplies. The burden of critical illness from COVID-19 was intense, with more than half of patients on mechanical ventilation.
Congenital hernias, frequently misdiagnosed during pregnancy, are potentially fatal and require p... more Congenital hernias, frequently misdiagnosed during pregnancy, are potentially fatal and require prompt repair. A pregnant woman with medical history of repaired congenital hernia was admitted with misdiagnosis of preeclampsia. Physical examination and chest x-ray revealed a Bochdalek hernia. Transitory stabilization prompted surgeons to postpone hernia repair, but an urgent thoracotomy was required to relieve a subsequent bowel obstruction that was complicated by an intrathoracic colonic perforation. Emergent cesarean delivery was required with a good maternal and fetal outcome. A multidisciplinary team was present in the operating room. All monitoring catheters were placed in advance in the intensive care unit. During recovery, the patient experienced ventricular fibrillation, presumed to be a manifestation of takotsubo syndrome, which responded favorably to cardiopulmonary resuscitation.
D31. NON-PULMONARY CRITICAL CARE AND MONITORING, 2011
/ Thematic Poster Session / Wednesday, May 18/8:15 AM-4:30 PM D31 NON-PULMONARY CRITICAL CARE AND... more / Thematic Poster Session / Wednesday, May 18/8:15 AM-4:30 PM D31 NON-PULMONARY CRITICAL CARE AND MONITORING ... / Area K, Hall B (Upper Level), Colorado Convention Center ... Characteristics And Severity Of Critically Ill Obstetric Patients From The Public ...
Journal of Maternal-Fetal and Neonatal Medicine, 2014
Abstract Objective: To describe characteristics, outcomes and clinical presentations for hyperten... more Abstract Objective: To describe characteristics, outcomes and clinical presentations for hypertensive disease of pregnancy (HDP) in patients admitted to three ICUs in Argentina. Methods: Case-series multicenter study. Results: There were 184 patients with HDP. Mean age 26 ± 8; 90% did not present comorbidity; APACHEII 9[6-14]; SOFA24 2[1-4]; ICU-LOS 3[2-6] days and hospital-LOS 8[5-12] days. Gestational age 34 ± 5 weeks; 46% (85) nulliparous and 71% received routine prenatal care. Maternal mortality 3.3% (6) - 50% attributed to intracranial hemorrhage (ICH). Neonatal mortality 13.6%. Diagnostic categories: eclampsia (64; 35%), severe preeclampsia (60; 32.6%), HELLP (33; 17.9%), eclampsia-HELLP (18; 9.8%) and other (chronic/gestational-hypertension) (9: 4.7%). Severe hypertension in 46%, multiple organ dysfunction in 23%, acute respiratory distress in 8.7% and acute renal failure in 8%. Variables independently associated with eclampsia: maternal age (OR 1.07 [1.02-1.13], gestational age (OR 1.14 [1.04-1.24]) and nulliparity (OR 2.40 [1.19-4.85]). Conclusions: Although patients were young and the majority received appropriate prenatal care, they spent considerable time in hospital and presented severe morbidity. Maternal mortality was 3.3% and in half of these cases it was attributed to ICH. Eclampsia and severe preeclampsia represented two thirds of the diagnostic categories. Variables independently associated with eclampsia were maternal and gestational ages and nulliparity.
D31. NON-PULMONARY CRITICAL CARE AND MONITORING, 2011
/ Thematic Poster Session / Wednesday, May 18/8:15 AM-4:30 PM D31 NON-PULMONARY CRITICAL CARE AND... more / Thematic Poster Session / Wednesday, May 18/8:15 AM-4:30 PM D31 NON-PULMONARY CRITICAL CARE AND MONITORING ... / Area K, Hall B (Upper Level), Colorado Convention Center ... Outcome And Level Of Intervention Of Critically Ill Obstetric Patients From The ...
D31. NON-PULMONARY CRITICAL CARE AND MONITORING, 2011
/ Thematic Poster Session / Wednesday, May 18/8:15 AM-4:30 PM D31 NON-PULMONARY CRITICAL CARE AND... more / Thematic Poster Session / Wednesday, May 18/8:15 AM-4:30 PM D31 NON-PULMONARY CRITICAL CARE AND MONITORING ... / Area K, Hall B (Upper Level), Colorado Convention Center ... Characteristics And Severity Of Critically Ill Obstetric Patients From The Public ...
Pregnancy Hypertension: An International Journal of Women's Cardiovascular Health, 2012
Worldwide, hypertensive disease of pregnancy is one of the most frequent causes of admission of o... more Worldwide, hypertensive disease of pregnancy is one of the most frequent causes of admission of obstetric patients to the ICU. Maternal mortality risk related to Hypertension during pregnancy in Latin America is significantly higher than in developed countries. To describe the characteristics and outcomes of pregnant-postpartum patients with hypertensive disease of pregnancy admitted to ICU METHODS: Multicenter case series study. pregnant-postpartum (&lt;42days) patients with hypertensive disease of pregnancy admitted to ICU. 3 ICUs in Argentina, 2 from the Public (P1) and 1 from the Private Health Sector (P2). Continuous data are presented as mean±SD or median [IQR], and categorical data as number (%). Comparisons among continuous data were performed with unpaired t test or Mann-Whitney U test. Categorical variables were analyzed by Chi-square test or Fisher exact test as appropriate. A two-sided α&lt;0.05 was considered as significant. SPSS version 15 was used. One hundred and eighty four patients were included, 161(87.5%) from P1. General characteristics are shown in the Table. Gestational age was 34±5 weeks. Risk factors for preeclampsia not included in Charlson score were chronic hypertension (22;12%), Obesity (6;3%) and preeclampsia in previous pregnancy (5;3%). ICU admission was postpartum in 80%(145). Causes of admission were eclampsia (63;34%), severe preeclampsia (61;33%), HELLP (33;18%), Eclampsia-HELLP (18;10%), Chronic Hypertension (5;3%) and Gestational Hypertension (4;2%). Predictive mortality according with APACHEII was 14%. Antenatal care was present in 115/142(81%) patients; 97/124(78%) in P1 vs 18/18 (100%) in P2; p0.024. Antenatal care was appropriate in 77/108(71.3%) of patients; 59/90(65.5%) in P1 vs 18/18(100%) in P2; p0.001. Maternal deaths (6) occurred in the Public sector and none of the patients had received antenatal care. Causes of mortality were hemorrhagic stroke (3) and multiple organ dysfunction (3) Table 1. Most patients were from the public health sector and the majority did not have any comorbidity according with the Charlson score. Nevertheless, 18% presented risk factors for preeclampsia, not included in the mentioned score. Two-thirds of patients were admitted with eclampsia and severe preeclampsia. APACHEII overpredicted mortality. Half of deaths were related with hemorrhagic stroke, complication almost eradicated from developed countries. None of the patients who died had received antenatal care.
Coronavirus disease-19 has emerged as a devastating global public health crisis. An increased fre... more Coronavirus disease-19 has emerged as a devastating global public health crisis. An increased frequency of arterial and venous thrombosis was observed in COVID-19 infection. The objective of this study was to describe the thromboembolic complications of patients hospitalized for COVID-19 and their evolution. A prospective single-center study was conducted that compared the characteristics, risk factors, thromboembolic event rate, hospital stay and mortality among patients admitted to intensive care or general ward. The mean age of population was 46 ± 18 years, and 52% were female. The global rate of thromboembolic events was 4.4%, significantly higher in intensive unit patients (29% vs 1.4%; p &amp;lt; 0.001) despite the high use of prophylactic heparin (91.1% vs. 84.9%; p &amp;lt; 0.1). The independent predictive factors for the development of thromboembolic events were: age, D-dimer and creatinine. Of the patients admitted to intensive care, 45.1% required mechanical ventilation. Overall ...
PurposeTo identify determinants of oxygenation over time in patients with COVID-19 acute respirat... more PurposeTo identify determinants of oxygenation over time in patients with COVID-19 acute respiratory distress syndrome (ARDS); and to analyze their characteristics according to Berlin definition categories.Materials and methodsProspective cohort study including consecutive mechanically ventilated patients admitted between 3/20/2020–10/31/2020 with ARDS. Epidemiological and clinical data on admission; outcomes; ventilation, respiratory mechanics and oxygenation variables were registered on days 1, 3 and 7 for the entire population and for ARDS categories.Results1525 patients aged 61 ± 13, 69% male, met ARDS criteria; most frequent comorbidities were obesity, hypertension, diabetes and respiratory disease. On admission, 331(21%), 849(56%) and 345(23%) patients had mild, moderate and severe ARDS; all received lung-protective ventilation (mean tidal volumes between 6.3 and 6.7 mL/kg PBW) and intermediate PEEP levels (10–11 cmH2O). PaO2/FiO2, plateau pressure, static compliance, driving pressure, ventilation ratio, pH and D-dimer >2 mg/L remained significantly different among the ARDS categories over time. In-hospital mortality was, respectively, 55%, 58% and 70% (p < 0.000). Independent predictors of changes of PaO2/FiO2 over time were BMI; preexistent respiratory disease; D-dimer >2 mg/L; day 1-PEEP, and day 1-ventilatory ratio.ConclusionHypoxemia in patients with COVID-19-related ARDS is associated with comorbidities, deadspace and activated coagulation markers, and disease severity—reflected by the PEEP level required.
Coronavirus disease-19 has emerged as a devastating global public health crisis. An increased fre... more Coronavirus disease-19 has emerged as a devastating global public health crisis. An increased frequency of arterial and venous thrombosis was observed in COVID-19 infection. The objective of this study was to describe the thromboembolic complications of patients hospitalized for COVID-19 and their evolution. A prospective single-center study was conducted that compared the characteristics, risk factors, thromboembolic event rate, hospital stay and mortality among patients admitted to intensive care or general ward. The mean age of population was 46 ± 18 years, and 52% were female. The global rate of thromboembolic events was 4.4%, significantly higher in intensive unit patients (29% vs 1.4%; p < 0.001) despite the high use of prophylactic heparin (91.1% vs. 84.9%; p < 0.1). The independent predictive factors for the development of thromboembolic events were: age, D-dimer and creatinine. Of the patients admitted to intensive care, 45.1% required mechanical ventilation. Overall ...
D31. NON-PULMONARY CRITICAL CARE AND MONITORING, 2011
/ Thematic Poster Session / Wednesday, May 18/8:15 AM-4:30 PM D31 NON-PULMONARY CRITICAL CARE AND... more / Thematic Poster Session / Wednesday, May 18/8:15 AM-4:30 PM D31 NON-PULMONARY CRITICAL CARE AND MONITORING ... / Area K, Hall B (Upper Level), Colorado Convention Center ... Outcome And Level Of Intervention Of Critically Ill Obstetric Patients From The ...
During the SARS-CoV-2 pandemic, there was a marked requirement for critical care beds, supplies a... more During the SARS-CoV-2 pandemic, there was a marked requirement for critical care beds, supplies and trained professionals to assist patients with severe respiratory failure. The Argentine Society of Intensive Care (SATI) designed a study to characterize these aspects in intensive care units (ICUs). Multicenter, prospective cohort study; the participating ICUs completed a form at the end of the study (31/10/2020) on hospital characteristics, number of beds in pre- and intra-pandemic critical areas, incorporation of professionals, technological resources, and workload. Fifty-eight ICUs participated; 28(48%) were located in Buenos Aires Province, 22(38%) in Buenos Aires Autonomous City and 10 (17%) in other provinces; 31 (53%) of UCIs belonged to the public sector; 23 (47%) to the private-social security. In 35/58 (60%) of the hospitals critical care beds increased from 902 to 1575 (75%), 37% in ICU and 63% mainly in Coronary Care Unit and Emergency-shock room. In 41/55 (75%) UCIs, staff were incorporated: 27(49%) physicians (70% intensivists), 36 (65%) nurses, 28 (51%) respiratory therapists, 20(36%) cleaning staff, and 1(2%) others. A 96% of the ICUS reported having sufficient ventilators and 95% enough supplies and PPE. Of all patients on invasive mechanical ventilation, 55% [43-64] had COVID-19. Oxygen therapy was required as noninvasive support in 14% [8-24] of COVID-19 admissions. There was a significant expansion of critical operational areas, secondary to the increase in beds, staff, and adequate availability of ventilators and essential supplies. The burden of critical illness from COVID-19 was intense, with more than half of patients on mechanical ventilation.
Congenital hernias, frequently misdiagnosed during pregnancy, are potentially fatal and require p... more Congenital hernias, frequently misdiagnosed during pregnancy, are potentially fatal and require prompt repair. A pregnant woman with medical history of repaired congenital hernia was admitted with misdiagnosis of preeclampsia. Physical examination and chest x-ray revealed a Bochdalek hernia. Transitory stabilization prompted surgeons to postpone hernia repair, but an urgent thoracotomy was required to relieve a subsequent bowel obstruction that was complicated by an intrathoracic colonic perforation. Emergent cesarean delivery was required with a good maternal and fetal outcome. A multidisciplinary team was present in the operating room. All monitoring catheters were placed in advance in the intensive care unit. During recovery, the patient experienced ventricular fibrillation, presumed to be a manifestation of takotsubo syndrome, which responded favorably to cardiopulmonary resuscitation.
D31. NON-PULMONARY CRITICAL CARE AND MONITORING, 2011
/ Thematic Poster Session / Wednesday, May 18/8:15 AM-4:30 PM D31 NON-PULMONARY CRITICAL CARE AND... more / Thematic Poster Session / Wednesday, May 18/8:15 AM-4:30 PM D31 NON-PULMONARY CRITICAL CARE AND MONITORING ... / Area K, Hall B (Upper Level), Colorado Convention Center ... Characteristics And Severity Of Critically Ill Obstetric Patients From The Public ...
Journal of Maternal-Fetal and Neonatal Medicine, 2014
Abstract Objective: To describe characteristics, outcomes and clinical presentations for hyperten... more Abstract Objective: To describe characteristics, outcomes and clinical presentations for hypertensive disease of pregnancy (HDP) in patients admitted to three ICUs in Argentina. Methods: Case-series multicenter study. Results: There were 184 patients with HDP. Mean age 26 ± 8; 90% did not present comorbidity; APACHEII 9[6-14]; SOFA24 2[1-4]; ICU-LOS 3[2-6] days and hospital-LOS 8[5-12] days. Gestational age 34 ± 5 weeks; 46% (85) nulliparous and 71% received routine prenatal care. Maternal mortality 3.3% (6) - 50% attributed to intracranial hemorrhage (ICH). Neonatal mortality 13.6%. Diagnostic categories: eclampsia (64; 35%), severe preeclampsia (60; 32.6%), HELLP (33; 17.9%), eclampsia-HELLP (18; 9.8%) and other (chronic/gestational-hypertension) (9: 4.7%). Severe hypertension in 46%, multiple organ dysfunction in 23%, acute respiratory distress in 8.7% and acute renal failure in 8%. Variables independently associated with eclampsia: maternal age (OR 1.07 [1.02-1.13], gestational age (OR 1.14 [1.04-1.24]) and nulliparity (OR 2.40 [1.19-4.85]). Conclusions: Although patients were young and the majority received appropriate prenatal care, they spent considerable time in hospital and presented severe morbidity. Maternal mortality was 3.3% and in half of these cases it was attributed to ICH. Eclampsia and severe preeclampsia represented two thirds of the diagnostic categories. Variables independently associated with eclampsia were maternal and gestational ages and nulliparity.
D31. NON-PULMONARY CRITICAL CARE AND MONITORING, 2011
/ Thematic Poster Session / Wednesday, May 18/8:15 AM-4:30 PM D31 NON-PULMONARY CRITICAL CARE AND... more / Thematic Poster Session / Wednesday, May 18/8:15 AM-4:30 PM D31 NON-PULMONARY CRITICAL CARE AND MONITORING ... / Area K, Hall B (Upper Level), Colorado Convention Center ... Outcome And Level Of Intervention Of Critically Ill Obstetric Patients From The ...
D31. NON-PULMONARY CRITICAL CARE AND MONITORING, 2011
/ Thematic Poster Session / Wednesday, May 18/8:15 AM-4:30 PM D31 NON-PULMONARY CRITICAL CARE AND... more / Thematic Poster Session / Wednesday, May 18/8:15 AM-4:30 PM D31 NON-PULMONARY CRITICAL CARE AND MONITORING ... / Area K, Hall B (Upper Level), Colorado Convention Center ... Characteristics And Severity Of Critically Ill Obstetric Patients From The Public ...
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