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Development of a prediction rule for diagnosing postoperative meningitis: a cross-sectional study / Fabián Humberto Muñoz Ramírez
Título : Development of a prediction rule for diagnosing postoperative meningitis: a cross-sectional study Tipo de documento : documento electrónico Autores : Fabián Humberto Muñoz Ramírez, Fecha de publicación : 2018 Títulos uniformes : Journal of Neurosurgery Idioma : Inglés (eng) Palabras clave : Postoperative meningitis nosocomial meningitis prediction rule lactate infection Resumen : Objective: Diagnosing nosocomial meningitis (NM) in neurosurgical patients is difficult. The standard CSF test is not optimal and when it is obtained, CSF cultures are negative in as many as 70% of cases. The goal of this study was to develop a diagnostic prediction rule for postoperative meningitis using a combination of clinical, laboratory, and CSF variables, as well as risk factors (RFs) for CNS infection. Methods: A cross-sectional study was performed in 4 intensive care units in Medellín, Colombia. Patients with a history of neurosurgical procedures were selected at the onset of febrile symptoms and/or after an increase in acute-phase reactants. Their CSF was studied for suspicion of infection and a bivariate analysis was performed between the dependent variable (confirmed/probable NM) and the identified independent variables. Those variables with a p value ≤ 0.2 were fitted in a multiple logistic regression analysis with the same dependent variable. After determining the best model according to its discrimination and calibration, the β coefficient for each selected dichotomized variable obtained from the logistic regression model was used to construct the score for the prediction rule. Results: Among 320 patients recruited for the study, 154 had confirmed or probable NM. Using bivariate analysis, 15 variables had statistical associations with the outcome: aneurysmal subarachnoid hemorrhage (aSAH), traumatic brain injury, CSF leak, positioning of external ventricular drains (EVDs), daily CSF draining via EVDs, intraventricular hemorrhage, neurological deterioration, age ≥ 50 years, surgical duration ≥ 220 minutes, blood loss during surgery ≥ 200 ml, C-reactive protein (CRP) ≥ 6 mg/dl, CSF/serum glucose ratio ≤ 0.4 mmol/L, CSF lactate ≥ 4 mmol/L, CSF leukocytes ≥ 250 cells, and CSF polymorphonuclear (PMN) neutrophils ≥ 50%. The multivariate analysis fitted a final model with 6 variables for the prediction rule (aSAH diagnosis: 1 point; CRP ≥ 6 mg/dl: 1 point; CSF/serum glucose ratio ≤ 0.4 mmol/L: 1 point; CSF leak: 1.5 points; CSF PMN neutrophils ≥ 50%: 1.5 points; and CSF lactate ≥ 4 mmol/L: 4 points) with good calibration (Hosmer-Lemeshow goodness of fit = 0.71) and discrimination (area under the receiver operating characteristic curve = 0.94). Conclusions: The prediction rule for diagnosing NM improves the diagnostic accuracy in neurosurgical patients with suspicion of infection. A score ≥ 6 points suggests a high probability of neuroinfection, for which antibiotic treatment should be considered. An independent validation of the rule in a different group of patients is warranted. Mención de responsabilidad : Olga Helena Hernández Ortiz, Héctor Iván García García, Fabián Muñoz Ramírez, Juan Sebastián Cardona Flórez, Bladimir Alejandro Gil Valencia, Salvador Ernesto Medina Mantilla, María Juliana Moreno Ochoa, Jorge Eliécer Sará Ochoa, Fabián Jaimes Referencia : J Neurosurg. 2018 Jan;128(1):262-271. DOI (Digital Object Identifier) : 10.3171/2016.10.JNS16379 PMID : 28298047 En línea : https://thejns.org/view/journals/j-neurosurg/128/1/article-p262.xml Enlace permanente : https://hospitalpablotobon.cloudbiteca.com/pmb/opac_css/index.php?lvl=notice_display&id=4103 Development of a prediction rule for diagnosing postoperative meningitis: a cross-sectional study [documento electrónico] / Fabián Humberto Muñoz Ramírez, . - 2018.
Obra : Journal of Neurosurgery
Idioma : Inglés (eng)
Palabras clave : Postoperative meningitis nosocomial meningitis prediction rule lactate infection Resumen : Objective: Diagnosing nosocomial meningitis (NM) in neurosurgical patients is difficult. The standard CSF test is not optimal and when it is obtained, CSF cultures are negative in as many as 70% of cases. The goal of this study was to develop a diagnostic prediction rule for postoperative meningitis using a combination of clinical, laboratory, and CSF variables, as well as risk factors (RFs) for CNS infection. Methods: A cross-sectional study was performed in 4 intensive care units in Medellín, Colombia. Patients with a history of neurosurgical procedures were selected at the onset of febrile symptoms and/or after an increase in acute-phase reactants. Their CSF was studied for suspicion of infection and a bivariate analysis was performed between the dependent variable (confirmed/probable NM) and the identified independent variables. Those variables with a p value ≤ 0.2 were fitted in a multiple logistic regression analysis with the same dependent variable. After determining the best model according to its discrimination and calibration, the β coefficient for each selected dichotomized variable obtained from the logistic regression model was used to construct the score for the prediction rule. Results: Among 320 patients recruited for the study, 154 had confirmed or probable NM. Using bivariate analysis, 15 variables had statistical associations with the outcome: aneurysmal subarachnoid hemorrhage (aSAH), traumatic brain injury, CSF leak, positioning of external ventricular drains (EVDs), daily CSF draining via EVDs, intraventricular hemorrhage, neurological deterioration, age ≥ 50 years, surgical duration ≥ 220 minutes, blood loss during surgery ≥ 200 ml, C-reactive protein (CRP) ≥ 6 mg/dl, CSF/serum glucose ratio ≤ 0.4 mmol/L, CSF lactate ≥ 4 mmol/L, CSF leukocytes ≥ 250 cells, and CSF polymorphonuclear (PMN) neutrophils ≥ 50%. The multivariate analysis fitted a final model with 6 variables for the prediction rule (aSAH diagnosis: 1 point; CRP ≥ 6 mg/dl: 1 point; CSF/serum glucose ratio ≤ 0.4 mmol/L: 1 point; CSF leak: 1.5 points; CSF PMN neutrophils ≥ 50%: 1.5 points; and CSF lactate ≥ 4 mmol/L: 4 points) with good calibration (Hosmer-Lemeshow goodness of fit = 0.71) and discrimination (area under the receiver operating characteristic curve = 0.94). Conclusions: The prediction rule for diagnosing NM improves the diagnostic accuracy in neurosurgical patients with suspicion of infection. A score ≥ 6 points suggests a high probability of neuroinfection, for which antibiotic treatment should be considered. An independent validation of the rule in a different group of patients is warranted. Mención de responsabilidad : Olga Helena Hernández Ortiz, Héctor Iván García García, Fabián Muñoz Ramírez, Juan Sebastián Cardona Flórez, Bladimir Alejandro Gil Valencia, Salvador Ernesto Medina Mantilla, María Juliana Moreno Ochoa, Jorge Eliécer Sará Ochoa, Fabián Jaimes Referencia : J Neurosurg. 2018 Jan;128(1):262-271. DOI (Digital Object Identifier) : 10.3171/2016.10.JNS16379 PMID : 28298047 En línea : https://thejns.org/view/journals/j-neurosurg/128/1/article-p262.xml Enlace permanente : https://hospitalpablotobon.cloudbiteca.com/pmb/opac_css/index.php?lvl=notice_display&id=4103 Reserva
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Código de barras Número de Ubicación Tipo de medio Ubicación Sección Estado DD000714 AC-2018-001 Archivo digital Producción Científica Artículos científicos Disponible Effects of hypertonic saline vs normal saline on lactate clearance after cardiovascular surgery / Fabián Alberto Jaimes Barragán
Título : Effects of hypertonic saline vs normal saline on lactate clearance after cardiovascular surgery Tipo de documento : documento electrónico Autores : Fabián Alberto Jaimes Barragán, Fecha de publicación : 2017 Títulos uniformes : Archivos de Cardiología de México Idioma : Inglés (eng) Palabras clave : Heart surgery Hypertonic saline solution Lactate Hemodynamic profile Safety Colombia Resumen : Background: The postoperative care of patients subjected to cardiac surgery frequently require a complete recovery with intravenous fluids, but crystalloid solutions like normal saline may increase the interstitial oedema, and itis also well known that fluid overload increases mortality. Objective: To compare the effect of 7.5% hypertonic saline (HS) with 0.9% normal saline (NS) on lactate clearance, as well as the haemodynamic response of patients during the first day after cardiovascular bypass surgery. Methods: The study included patients 18 years of age and older with coronary artery disease and/or heart valve disease, and who underwent bypass surgery and/or cardiac valve replacement and were randomly assigned to receive 4 mL/kg of HS or NS intravenously for 30 min once they were admitted to the ICU. Lactate, arterial blood gases, heart rate, central venous pressure, and pulmonary wedge pressure were measured at 0, 6, 12, and 24 h after being admitted to the ICU. The analyses were carried out with an intention-to-treat principle. Results: Out of a total of 494 patients evaluated, 102 were included and assigned to the HS groups (51 patients) or NS (51 patients). The mean age of the participants was 59 ± 14 years, and 59.8% were male. No statistically significant differences were observed between two groups in the lactate clearance, or in any of the secondary outcomes. Conclusions: Our study failed to show a better lactate clearance in the group on hypertonic saline, and with no evidence of a higher incidence of adverse effects in that group. Mención de responsabilidad : Luis Horacio Atehortúa-López, Ray Mendoza-Franco, José Fernando Escobar-Serna, Luis Alejandro Urrego, Fernando Alzate, Fabian Jaimes Referencia : Arch Cardiol Mex. 2018 Apr - Jun;88(2):100-106. DOI (Digital Object Identifier) : 10.1016/j.acmx.2017.02.004 PMID : 28292572 Derechos de uso : CC BY-NC-ND En línea : http://www.archivoscardiologia.com/previos/(2018)%20ACM%20Vol%2088.%202%20ABRIL- [...] Enlace permanente : https://hospitalpablotobon.cloudbiteca.com/pmb/opac_css/index.php?lvl=notice_display&id=4085 Effects of hypertonic saline vs normal saline on lactate clearance after cardiovascular surgery [documento electrónico] / Fabián Alberto Jaimes Barragán, . - 2017.
Obra : Archivos de Cardiología de México
Idioma : Inglés (eng)
Palabras clave : Heart surgery Hypertonic saline solution Lactate Hemodynamic profile Safety Colombia Resumen : Background: The postoperative care of patients subjected to cardiac surgery frequently require a complete recovery with intravenous fluids, but crystalloid solutions like normal saline may increase the interstitial oedema, and itis also well known that fluid overload increases mortality. Objective: To compare the effect of 7.5% hypertonic saline (HS) with 0.9% normal saline (NS) on lactate clearance, as well as the haemodynamic response of patients during the first day after cardiovascular bypass surgery. Methods: The study included patients 18 years of age and older with coronary artery disease and/or heart valve disease, and who underwent bypass surgery and/or cardiac valve replacement and were randomly assigned to receive 4 mL/kg of HS or NS intravenously for 30 min once they were admitted to the ICU. Lactate, arterial blood gases, heart rate, central venous pressure, and pulmonary wedge pressure were measured at 0, 6, 12, and 24 h after being admitted to the ICU. The analyses were carried out with an intention-to-treat principle. Results: Out of a total of 494 patients evaluated, 102 were included and assigned to the HS groups (51 patients) or NS (51 patients). The mean age of the participants was 59 ± 14 years, and 59.8% were male. No statistically significant differences were observed between two groups in the lactate clearance, or in any of the secondary outcomes. Conclusions: Our study failed to show a better lactate clearance in the group on hypertonic saline, and with no evidence of a higher incidence of adverse effects in that group. Mención de responsabilidad : Luis Horacio Atehortúa-López, Ray Mendoza-Franco, José Fernando Escobar-Serna, Luis Alejandro Urrego, Fernando Alzate, Fabian Jaimes Referencia : Arch Cardiol Mex. 2018 Apr - Jun;88(2):100-106. DOI (Digital Object Identifier) : 10.1016/j.acmx.2017.02.004 PMID : 28292572 Derechos de uso : CC BY-NC-ND En línea : http://www.archivoscardiologia.com/previos/(2018)%20ACM%20Vol%2088.%202%20ABRIL- [...] Enlace permanente : https://hospitalpablotobon.cloudbiteca.com/pmb/opac_css/index.php?lvl=notice_display&id=4085 Reserva
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Código de barras Número de Ubicación Tipo de medio Ubicación Sección Estado DD000694 AC-2017-083 Archivo digital Producción Científica Artículos científicos Disponible Documentos electrónicos
2017-083.pdfAdobe Acrobat PDF