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Abstract. Alpaca respiratory syndrome (ARS) was first recognized in California in October 2007. This syndrome is characterized by acute respiratory signs, high fever, and occasional sudden death, and has mostly been observed in pregnant alpacas (Vicugna pacos), although all signalments have been affected. A similarity in clinical signs to cases located on the East Coast of the United States was observed; however, a causative agent had not been identified. Preliminary diagnostic submissions to the California Animal Health and Food Safety Laboratory System (CAHFS) were negative for known bacterial, parasitic, fungal, and viral pathogens, as well as for toxins, making the etiology of this disease unknown. However, based on pathologic findings, a viral or toxic etiology was strongly considered. A novel coronavirus was recovered from lung tissue of a clinical case submitted to CAHFS. The coronavirus identity was confirmed in tissue culture by transmission electron microscopy and by sequence analysis of a conserved region within the viral genome. Statistical analysis calculating a serologic association between the serum virus neutralization antibody titer and coronavirus, the presence of exposure history on 40 animals with a history of ARS, and 167 controls provided an odds ratio of 121 (95% confidence interval: 36.54 and 402.84; P , 0.0001). The findings indicate that the ARS-associated coronavirus described is distinct from the previously reported gastrointestinal-associated coronavirus identified in alpaca herds.

a) Salbutamol administered through the endotracheal tube by a nebulizer device lessens respiratory system resistances and airway and alveolar pressures, and therefore could decrease the risk of barotrauma and alveolar damage; b) high respiratory system resistances in ARDS have an increased smooth muscle tone component that can be reversible with salbutamol.

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ORIGINALImpacto de las altas no programadas en la mortalidad hospitalaria tras la estancia en una unidad de cuidados intensivos ResumenObjetivos: Comprobar la frecuencia de altas no programadas y su relación con la mortalidad hospitalaria tras la estancia en UCI. Diseño: Registro prospectivo de los ingresos de 6 años consecutivos. Análisis retrospectivo de la primera admisión de la cohorte de los supervivientes a UCI. Ámbito: UCI polivalente de 10 camas en hospital general de segundo nivel con 540 camas. Pacientes: 1.521 pacientes con más de 12 horas de estancia, dados de alta vivos y con desenlace hospitalario conocido.Intervenciones: Ninguna. Principales variables de interés: Se registró el tipo de alta de la unidad, normal o no programada, y se exploró su relación con la mortalidad hospitalaria post-UCI, las tasas de readmisión y la estancia hospitalaria post-UCI. Resultados: Hubo 165 altas no programadas (10,8%). La tasa de mortalidad fue del 11,6% (176 pacientes). Los factores relacionados con la mortalidad fueron la limitación del esfuerzo terapéutico (OR = 14,02 [4,6]), las readmisiones (OR = 3,46 [1,78]), las altas no programadas (OR = 2,16 [1,41]), la puntuación de fallos orgánicos al alta de UCI (OR = 1,16 [1,01-1,32]) y la edad (OR = 1,03 [1,01-1,05]). Las readmisiones y las estancias post-UCI no diferían significativamente entre las altas no programadas y las normales (el 7,3 frente al 8,2%; p = 0,68 y 16, 7 ± 16,7 frente a 18,7 ± 21,3 días, respectivamente; p = 0,162). Conclusiones: Las altas no programadas son frecuentes en nuestro medio y contribuyen significativamente a la mortalidad post-UCI, sin que parezcan afectar a otros resultados de la asistencia a pacientes críticos. Impact of the premature discharge on hospital mortality after a stay in an intensive care unit Abstract Objective: To determine the frequency and to evaluate the relationship between premature discharge and post-ICU hospital mortality. Design: A prospective registry was made for patients admitted during six consecutive years, performing a retrospective analysis of the data on the first admission of ICU survivors. Setting: A 10-bed general ICU in a 540-bed tertiary-care community hospital. Patients: 1,521 patients with an ICU stay longer than 12 hours, discharged alive to wards with known hospital outcome. Interventions: None. Main variables:We recorded the patient data, including types of ICU discharge, normal or premature, and studying their relationship with post-ICU hospital mortality. The types of ICU discharge were also evaluated versus ICU readmission rate and post-ICU length of stay. Results: There were 165 patients (10.8%) with premature discharge. Mortality rate was 11.6% (176 patients). The factors related with mortality were withdrawal and limitation of life-sustaining treatments (OR=14. 02 [4.6-42.6 Conclusions: Premature discharges appear to be common in our setting and have a significant impact on mortality. Types of ICU discharge do not seem to be related with other outcome variables in the hospital care of cr...