Purpose: The purpose of this study was to describe factors associated with prolonged ventilatory support in subjects undergoing coronary artery bypass graft. Patients and Methods: This was an analytical retrospective case–control study. Cases were defined as subjects requiring prolonged mechanical ventilation (> 48 hours) following isolated coronary artery bypass graft. Subjects older than 18 years who had undergone surgery were included, while subjects with missing clinical record data, subjects in coma or subjects with prior cardiac surgery were excluded. Variables were measured at the three time points surrounding surgery. Results: A total of 204 cases and 408 controls were included. The final logistic model showed an association between prolonged mechanical ventilation and the following presurgical variables: chronic obstructive pulmonary disease (OR 1.85; 95% CI: 1.06– 3.23, p = 0.03) and chronic kidney disease (OR 1.90; 95% CI: − 3.31; p = 0.02). The associated transurgical variable was the use of intra-aortic balloon pump (OR 3.63; 95% CI: 1.73– 7.61, p = 0.00), and associated postsurgical variables were venous oxygen saturation < 60% (OR 2.00; 95% CI: 1.18– 3.40, p = 0.01), mediastinitis (OR 18.51; 95% CI: 4.06– 84.40, p = 0.00), inotrope use (OR 2.82; 95% CI: 1.77– 4.48, p = 0.00), pleural effusion requiring drainage (OR 3.57; 95% CI: 2.02– 6.32, p = 0.00) and delirium (OR 3.45; 95% CI: 1.91– 6.25, p = 0.00). Conclusion: This study identifies factors associated with prolonged mechanical ventilation in subjects subject to coronary artery bypass graft over the presurgical, transurgical and postsurgical periods, identifying a new factor, delirium, for this type of population.

Staphylococcus aureus infections are an important cause of morbidity and mortality among patients in intensive care units (ICUs), particularly those with multiple comorbidities and critical conditions. Methicillin-resistant S. aureus (MRSA) and methicillin-sensitive S. aureus (MSSA) strains differ in resistance, clinical behavior, and prognoses, making it important to understand their effects on clinical outcomes. Comparing clinical outcomes of MRSA and MSSA infections is important. This retrospective cohort study analyzed ICU patients with confirmed S. aureus infections at a quaternary care hospital. Demographic, clinical, and comorbidity data were collected. Poisson regression was used to analyze 7-day mortality and identify adjusted risk factors. Seven-day mortality was higher in patients with MSSA than MRSA infections, with an adjusted relative risk for MRSA of 0.380 (95% confidence interval: 0.15–0.95; p = 0.039). Independent risk factors for mortality included lack of an infectious disease consultation, vascular comorbidities, such as peripheral vascular disease and cerebrovascular events, chronic kidney disease, and inotropic support requirement. Patients with MRSA infections required significantly longer ventilatory support (mean 43.5 days vs. 13 days for MSSA; p = 0.019). Staphylococcus aureus infections in ICU patients were associated with poor outcomes, particularly in patients without infectious disease consultation and those with vascular comorbidities. Mortality differences between MRSA and MSSA highlight the importance of appropriate empiric therapy and standardized protocols incorporating infectious disease consultation to improve outcomes in critically ill patients.

Background: Hematooncology patients admitted to intensive care units (ICUs) are at high risk for mortality due to the severity of their critical illness. Such complications can develop into complex clinical management, thus signaling an urgent need to identify mortality-related factors to improve interventions and outcomes for these patients. Methods: A systematic review of studies published between 2012 and 2023 in databases such as PubMed, Scopus, and Web of Science was conducted, following the PRISMA guidelines. A meta-analysis was carried out to determine the significance of mortality-related factors. Results: In a review of twenty-four studies, it was found that invasive mechanical ventilation (IMV) was associated with an odds ratio (OR) between 2.70 and 8.26 in 75% of the studies. The use of vasopressor support had an OR of 6.28 in 50% of the studies, while pulmonary involvement by tumor had an OR of 6.73 in 30% of the studies. Sepsis showed an OR of 5.06 in 60% of the studies, and neutropenia upon admission increased mortality in 40% of the studies. Severe respiratory failure (PaO₂/FiO₂ < 150) had an OR of 7.69 in 55% of the studies. Additionally, ICU readmission and late admission were identified as risk factors for increased mortality. Conclusions: Mortality among hematooncology ICU patients is associated with IMV, vasopressor support, pulmonary involvement, sepsis, neutropenia, severe respiratory failure, ICU readmission, and late admission. Identifying and managing these factors in a timely manner can improve survival and the quality of care.

Varicella is a childhood disease characterized by its self-limiting and benign nature. However, it can also affect the adult population due to risk factors, leading to infection with numerous complications involving the central nervous system, kidneys, respiratory system, and skin. Varicella pneumonia, one of the most feared complications in adults, occurs in approximately 1 out of 400 patients with the disease. This complication primarily affects male patients with a history of heavy smoking and immunosuppression, either due to an underlying disease such as HIV and cancer, drug use, pregnancy or pulmonary disease. It is recommended that this complication should be treated with intravenous acyclovir at a dose of 10 mg/kg/8 hours. The prognosis depends on the development of respiratory failure; up to 50 % of patients with this complication require invasive mechanical ventilation. Here, we report the clinical case of an immunocompetent patient with a typical presentation of varicella that rapidly progressed to a respiratory infection requiring antiviral treatment and invasive mechanical ventilation.

Article: Risk factors for in-hospital mortality after coronary artery bypass grafting in Colombia - The Journal of Cardiovascular Surgery 2021 Aug 02 - Minerva Medica - Journals