Background: Near infrared spectroscopy can be used to monitor cerebral oxygen saturation in out-of-hospital cardiac arrest (OHCA). Brain oxygen saturation increase has been associated to cardiopulmonary resuscitation therapy (CPR), and higher saturation values are observed during return of spontaneous circulation (ROSC) and in survivors. In this study we evaluate cerebral oxygen saturation to identify ROSC, and compare its value for patients treated with manual or mechanical CPR. Materials and Methods: A total of 87 OHCA patients treated by the Emergency medical system (EMS) of the Basque Country were included, 32 treated with manual CPR and 55 with the LUCAS-3 device (Stryker). Brain oxygen saturation was measured in the left and right lobes using the NIRO NX-200 (Hamamatsu) in the manual group, and the SenSmart X-100 (NONIN) in the LUCAS-3 group. For each patient the mean value of the left and right lobe saturation in the first minute after the end of chest compressions was computed. Saturation values for the ROSC/no-ROSC groups were compared using the Wilcoxon rank sum test, p<0.01 was considered significant. The area under the curve (AUC) was computed for each CPR group to measure how well brain saturation discriminates ROSC from no-ROSC. Results: In the manual CPR group median (IQR) saturation values were 39.2% (33.6-49.7) for the no-ROSC (n=23) and 64.3% (55.2-67.0) for ROSC (n=9) (p<0.01), and the AUC was 0.92. In the LUCAS-3 CPR group saturation values were 41.5% (29.8-50.5) for the no-ROSC (n=37) and 67.0% (61.8-75.0) for ROSC (n=18) (p<0.01), and the AUC was 0.91. No significant differences in saturation were observed between manual and mechanical CPR for both ROSC (p=0.46) and no-ROSC patients (p=0.28). Conclusions: Differences in cerebral oximetry were significant between ROSC and no-ROSC patients. No differences were observed in saturation between the manual and mechanical CPR groups, despite using different oximeter models. Cerebral oximetry could be used to predict outcome regardless of the type of CPR.
LaburpenaPankreatitis akutua pankrearen gaixotasun onbera eta akutua da. Kasurik gehienetan arina izan ohi da, baina formarik larrienetan hilkortasun-eta konplikazio-tasa handiak izan ditzake. Kasu larri horietarako, oso garrantzitsua da espezialitate anitzeko protokolo bat izatea, maila ezberdinetan eman beharreko arreta hitzartua duena. Berrikuspen-lan honetan maila ezberdin bakoitzean eman beharreko arreta egokia deskribatzen da. Larrialdi Zerbitzuetan: Diagnostikoa egin, Analgesia egokia, Larritasun-mailaren balorazioa, Hidratazio egokia hasi. Ospitaleratze Unitateetan: Ezinbestekoa da pazientearen larritasuna modu kliniko eta analitikoan egiaztatzea, 12 orduan behin, lehen 48 orduetan. Edozein momentutan organo-gutxiegitasun datuak atzematen badira, pazientea Zainketa Intentsiboen Unitatean artatu behar da. Horretaz gain, honako neurri hauek hartuko dira: analgesia mantendu, hidratazio egokia eman, elikadura hasi, sabelalde barneko presioa neurtu, erradiologiaprobak egin. Antibiotiko enpirikoaren erabilera ez da gomendatzen. Kirurgiarako indikazioak: Tratamendu medikoarekin konpontzen ez den sabelalde barneko presioaren igoera larria, nekrosi infektatua (neurri minimoki inbaditzaileez saia liteke lehen urrats moduan, edo step-up estrategia), hesteen zulaketa, hemorragia akutua (erradiologia interbentzionista erabiltzen da normalean). Ondorioak: Pankreatitis akutua gaixotasun arina da gehienetan, baina kasurik larrienetan hilkortasuneta konplikazio-tasa altua ditu. Horiek artatzeko protokolo bat izatea eta parte hartzen duten espezialista ezberdinen elkarlana ezinbestekoa da.Gako-hitzak: pankreatitis akutua, protokolo klinikoa, kirurgia. Abstract Acute pancreatitis is an acute but benign disease of the pancreas. It is usually a mild illness, but in its
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