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R Abizanda

Publications and source records attributed to R Abizanda.

10 recordsLinked to original sources
PubMed2006

[Prognostic estimation in critical patients. Validation of a new and very simple system of prognostic estimation of survival in an intensive care unit].

OBJECTIVE: To make the validation of a new system of prognostic estimation of survival in critical patients (EPEC) seen in a multidisciplinar Intensive care unit (ICU). DESIGN AND SCOPE: Prospective analysis of a patient cohort seen in the ICU of a multidisciplinar Intensive Medicine Service of a reference teaching hospital with 19 beds. PATIENTS AND METHOD: Four hundred eighty four patients admitted consecutively over 6 months in 2003. Data collection of a basic minimum data set that includes patient identification data (gender, age), reason for admission and their origin, prognostic estimation of survival by EPEC, MPM II 0 and SAPS II (the latter two considered as gold standard). Mortality was evaluated on hospital discharge. EPEC validation was done with analysis of its discriminating capacity (ROC curve), calibration of its prognostic capacity (Hosmer Lemeshow C test), resolution of the 2 x 2 Contingency tables around different probability values (20, 50, 70 and mean value of prognostic estimation). The standardized mortality rate (SMR) for each one of the methods was calculated. Linear regression of the EPEC regarding the MPM II 0 and SAPS II was established and concordance analyses were done (Bland-Altman test) of the prediction of mortality by the three systems. RESULTS: In spite of an apparently good linear correlation, similar accuracy of prediction and discrimination capacity, EPEC is not well-calibrated (no likelihood of death greater than 50%) and the concordance analyses show that more than 10% of the pairs were outside the 95% confidence interval. CONCLUSION: In spite of its ease of application and calculation and of incorporating delay of admission in ICU as a variable, EPEC does not offer any predictive advantage on MPM II 0 or SAPS II, and its predictions adapt to reality worse.

Adult↗
PubMed2001

Withdrawing and withholding life support in the intensive care unit: a Spanish prospective multi-centre observational study.

OBJECTIVE: To determine how frequently life support is withheld or withdrawn from adult critically ill patients, and how physicians and patients families agree on the decision regarding the limitation of life support. DESIGN: Prospective multi-centre cohort study. SETTING: Six adult medical-surgical Spanish intensive care units (ICUs). PATIENTS AND PARTICIPANTS: Three thousand four hundred ninety-eight consecutive patients admitted to six ICUs were enrolled. MEASUREMENTS AND RESULTS: Data collected included age, sex, SAPS II score on admission and within 24 h of the decision to limit treatment, length of ICU stay, outcome at ICU discharge, cause and mode of death, time to death after the decision to withhold or withdraw life support, consultation and agreement with patient's family regarding withholding or withdrawal, and the modalities of therapies withdrawn or withheld. Two hundred twenty-six (6.6%) of 3,498 patients had therapy withheld or withdrawn and 221 of them died in the ICU. Age, SAPS II and length of ICU stay were significantly higher in patients dying patients who had therapy withheld or withdrawn than in patients dying despite active treatment. The proposal to withhold or withdraw life support was initiated by physicians in 210 (92.9%) of 226 patients and by the family in the remaining cases. The patient's family was not involved in the decision to withhold or withdraw life support therapy in 64 (28.3%) of 226 cases. Only 21 (9%) patients had expressed their wish to decline life-prolonging therapy prior to ICU admission. CONCLUSIONS: The withholding and withdrawing of treatment was frequent in critically ill patients and was initiated primarily by physicians.

Adult↗
PubMed1994

[Ethical aspects of intensive medicine. Results of an opinion survey].

BACKGROUND: The aim of this study was to know the opinion of the professionals (physicians and nursing staff) of intensive medicine concerning aspects such as informed consent, family participation in health care decisions, the possibility of not undertaking resuscitation manoeuvers and limiting care in determined cases, the responsibility of decision in the case of differences in opinion, and the existence of bioethical committees. METHODS: A questionnaire with 19 questions was forwarded to which 381 professionals (183 physicians and 198 nurses) responded. Those who replied had a mean age of 36 +/- 7 years with at least one year of experience in an ICU (13 +/- 6 and 7 +/- 5 years, respectively). The male/female proportion was of 186/193 (152/30 physicians and 34/163 the nurses). The comparison of distribution study between physicians and nurses showed a level of significance of p < 0.05. RESULTS: Ninety-nine percent of the responses opted for the existence of orders of "no resuscitation" (p = NS) and 95% accepted the limitation of therapeutic effort in predetermined cases (p = 0.02); for 90% the quality of life was a factor to be considered (p = 0.02). It was agreed that informed consent should be obtained in 88% (p = 0.0008) but 54% were of the opinion that this wish was not always carried out (p = NS). Eighty-nine percent believed that critical patients should be informed as to their situation and possibilities (p < 0.00001). In the case of patient incompetence 98% were of the opinion that the information should be given to relatives (p = NS) while only 67% believed that the family opinion may substitute that of the patient (p < 0.01) and when in doubt the last word corresponded to the physician (54%, p = NS) who may impose "best clinical judgement" (74%, p = NS) and in the case of a vital emergency consent or information may be passed over (88%, p = NS). Finally, 77% considered that informed consent cannot be given in all cases given that the mean sociocultural level of the patient does not allow comprehension (p < 0.005) and that Bioethical Hospitalary Committee are convenient or necessary (92%, p = NS). CONCLUSIONS: The attitude towards the key ethical aspects of health care practice with respect to the critical patients is unanimous being most influenced by factors of age and religion rather than by aspects linked to professional status.

Adult↗
PubMed1994

[Failure of prediction of results with APACHE II. Analysis of prediction errors of mortality in critical patients].

BACKGROUND: The evaluation of the prognosis of critically ill patients by the APACHE II method is common in intensive care units (ICU). The aim of the present was to analyze the possible factors associated to errors in prediction. METHODS: A prospective study of 564 consecutive admissions in a department of intensive medical care was carried out. Prediction errors were studied by the calculation of the probability of death established after the first 24 hours of admission by means of APACHE II. The factors analyzed in relation to the prediction errors were: the diagnosis or cause of admission to the ICU, the length of the stay in the ICU, the time until possible death, the possible relation of the death with the cause of admission and the treatment given to the patients during the first 24 hours. Statistical analysis was performed with the SPSS software package with significance being determined at p < 0.05. RESULTS: Mortality was of 20.6% (116 cases) with three cut off points being chosen for probability of death (50, 70, and 90%). Accuracy of precision was 83.5%, 82.8% and 80.1%. There were 64 false survivors (mortality lower than 50%, 13.25%-64/483) and 29 false deaths (survival greater than 50%, 35.8%-29/81). Upon analysis of the cause of admission of these patients in whom there were prediction errors it was found that there were no differences among the false survivors and the false deaths. Significant differences were only detected upon comparison of the false survivors with the verified survivors, however these disappeared when the 136 cases admitted due to myocardial infarction were excluded. Neither did the length of stay in the ICU demonstrate any significant difference except among the verified and false deaths in that the stay was longer in the latter. CONCLUSIONS: The factors analyzed did not demonstrate that they may influence or be associated with errors in prediction of the prognosis of patients admitted to an intensive care unit, with these errors probably being due to errors in the system used.

Adolescent↗
PubMed1984

Wedge pulmonary angiography to determine the accuracy of pulmonary wedge pressure.

Wedge pulmonary angiography was done in 11 patients with acute respiratory failure, to assess the accuracy of pulmonary arterial wedge pressure (WP) as an estimation of left ventricular end-diastolic pressure (LVEDP). The pulmonary artery (PA) catheter tip was placed into a dependent position in the lungs. Although the pulmonary vein was not visualized in 7 of 11 patients, in no case was there a significant difference between WP and LVEDP. When WP is no greater than 15 mm Hg, wedge pulmonary angiography does not reflect the accuracy of WP; however, left ventricular filling pressure can be accurately estimated by WP in most of these patients.

Acute Disease↗
PubMed1981

The effect of lateral positions on gas exchange in patients with unilateral lung disease during mechanical ventilation.

Positional changes have long been known to have a gravitational effect on the distribution of pulmonary blood flow. The effect of body position, supine, right and left lateral decubitus, on gas exchange were evaluated in 10 patients with predominantly unilateral lung disease. All patients were treated with mechanical ventilation and PEEP. Arterial blood gases, measured after 15 min in each of the three positions, showed that lying on the side of the "normal" lung resulted in a higher arterial pO2 (mean: 144 mmHg) than lying on that of the "damaged" lung (mean: 86 mmHg). The delta AapO2 values were 334 to 391 mmHg. Both differences were statistically significant (p less than 0.005). No significant changes mean arterial carbon dioxide tensions were noted.

Adolescent↗
PubMed1981

The early detection of the effects of surgical shock on the viscera.

One hundred and one patients, in shock after operations were reviewed to examine the visceral effects on their prognoses. The shock was caused in 65 cases by hypovolaemia and in 36 cases by sepsis. The effects were studied on the heart and cardiovascular system, liver, kidneys, gastrointestinal system, central nervous system, lungs and blood clotting system. Surgical shock affected more frequently the lung and liver (P less than 0.05 and P less than 0.01). The lungs were most frequently involved in hypovolaemia (25 patients) and sepsis (25 cases). Pathology of the lung was associated with the highest mortality rate (P less than 0.005), followed by kidney (P less than 0.01) then heart and central nervous system (P less than 0.025). Involvement of the gastrointestinal tract or clotting system alone was not associated with higher mortality rates, except in the presence of other visceral derangements. Lung affection also had a greater mortality followed by kidney and the central nervous system. Involvement of one or several organs in failure to survive septic shock is dealt with in the discussion. It is concluded that visceral involvement secondary to shock could be of importance for prognosis.

Adolescent↗