The aim of this study was to evaluate the clinical efficacy, mechanical stability, and safety of the Simon nitinol inferior vena cava filter (SNF). The SNF was inserted in 114 consecutive patients at two institutions for prophylaxis of pulmonary embolism (PE). Clinical follow-up data were obtained retrospectively on all patients, and 38 patients underwent a dedicated radiologic follow-up protocol consisting of abdominal radiography, Doppler sonography, and CT. There was no immediate complication following filter insertion. Fifty patients died, on average, 5.6 (1-23) months after filter insertion, and 64 patients were alive, on average, 27 (3-62) months after filter insertion. Recurrent pulmonary embolism was documented in 5 patients (4.4 %) but originated distal to the filter in 1 patient. Deep venous thrombosis (DVT) was documented in 5.3 %, thrombosis at the access site in 3.5 %, and thrombosis of the inferior vena cava in 3.5 %. The rate of thromboembolic complications was similar in patients who did receive long-term anticoagulation and in those who did not. Radiologic follow-up showed no filter migration after, on average, 32 (5-62) months. A CT examination showed that struts of the SNF had penetrated the vena cava in 95 %, and were in contact with adjacent organs in 76 %; however, there were no clinical symptoms attributable to the filter. Filters were in an eccentric position in 63 % and partial filter disruption was found in 16 %; however, this did not affect filter function. The rate of recurrent pulmonary embolism after insertion of the SNF is 2.4 % per patient per year. Regardless of long-term anticoagulation, the rate of caval thrombosis is acceptably low. Except for occasional access-site thrombosis, no other filter-related morbidity was observed.
This study was conducted to evaluate usefulness of the physiologic stability index (PSI) in a pediatric intensive care Unit (PICU) of a University based hospital at Santiago, Chile. Subjects include all patients (n=152) consecutively admited to our PICU between april 1987 and august 1988. The PSI system was applied during the first four days from admission. The age of the patients ranged from 10 days to 15 years. Scores obtained from survivors and non survivors were compared using an analysis of variance. For maximum PSI, survivors had significantly lower scores (9.39 points) that non survivors (21.71 points). Multiple logistic regression was used to display associations between mean obtained scores and probability of death and a curve was plotted which is similar to that obtained in previous experiences from other countries. (Key words: physiologic stability index, PSI, mortality, pediatric intensive care.)El paciente critico necesita y recibe una cantidad enorme de jecursos para mantener sus posibilidades de sobrevivencia y para ayudar su progreso hacia una recuperation satisfactoria.Se han llevado a cabo variados esfuerzos para evaluar el funcionamiento de las unidades de cuidados intensivos (UCI) pediatricas y se han desarrollado diferentes sistemas para clasificar los pacientes que ingresan a ellas, determinar sus necesidades y su pronostico. Los sistemas desarrollados para clasificar a los pacientes estan destinados a calificar la severidad de la enfermedad, los requerimientos terapeuticos, la eficacia del tratamiento y el pronostico'~3. Debido a la gran variedad de causas de hospitalizacion en las CCI pediatricas el sistema para calificar a los pacientes debe ser lo suficientemente versatil para ser aplicado a diferentes problemas y edades. Existen varios indices de calificacion de gravedad de los pacientes, como por ejemplo el Sistema de Clasificacion Ch'nica (CCS) o la puntuacion basada en Intervention Terapeutlca (TISS), que miden en forma indirecta la severidad de la enfermedad en base a una evaluation de las necesidades terapeuticas. Knaus desarrollo, ademas, un sistema de clasificacion basado en alteraciones fisiologicas (APACHE) aplicable a los adultos. Sin embargo, estos procedimientos de evaluation no existian para pediatri'a hasta el ano 1984 en que se publico la validation de un indice de estabilidad fisiologica para ser aplicado en nifios (PSI) 4 ' 5 . Este indice clasifica la severidad de la enfermedad a partir del grado de alteration de 7 grandes sistemas fisiologicos e incluye 34 variables adaptadas a pacientes menores de un ano y mayores de un afto. Los objetivos de este trabajo fueron ensayar la factibilidad de aplicar el PSI a los pacientes que ingresen a nuestra unidad de cuidados intensivos pediatricos, evaluar los criterios de ingreso a dicha unidad en base a las calificaciones promedio de los pacientes ingresados y el funcionamiento de la misma correlacionando la mortalidad con las calificaciones asignadas. MATERIAL Y METODOSe aplico el PSI a todos los pacientes (n=152) que ingresaro...
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