Estudio sobre diarrea en una unidad de cuidados intensivos quirúrgica

Pedro Grille; Estela Olano; Hugo Bertullo; Homero Bagnulo

Authors

Pedro Grille Universidad de la República, Facultad de Medicina, Medicina Intensiva, Asistente. CASMU, Departamento de Medicina, Médico Grado II suplente
Estela Olano CASMU, Departamento de Medicina, Médica Grado II titular
Hugo Bertullo CASMU, Departamento de Medicina Intensiva, Médicos Coordinadores, Grado IV
Homero Bagnulo CASMU, Departamento de Medicina Intensiva, Médicos Coordinadores, Grado IV

Keywords:

DIARRHEA, CRITICAL CARE, RISK FACTORS, CLOSTRIDIUM DIFFICILE

Abstract

Background. Diarrhea often causes difficulties in patients under critical conditions. The incidence of the most common diarrhea, the non-hemorrhagic gastrointestinal complication, is relatively high and its adverse effects are particularly important for the course of the disease.
Objective. To analyze the impact and determining factors of diarrhea in a intensive care unit (UCI) surgically-framed.
Methods. Seventy-eight patients admitted in the UCI for at least 48 hours were analyzed in a prospective study. Diarrhea is defined as watery stools occurring at least three times in one day.
Bacterial tests in samples of blood, stool and urine were done. ELISA and agglutination tests were used to determine Clostridium difficile (CD) A toxin in stool.
Results. Thirty-two patients out of the analyzed 78 patients (41%) developed diarrhea of a mean duration of 6 + 4 days. Diarrhea was associated with severity on admission (SAPS II = 30) and stay-in at UCI longer than 15 days (p=0,02 y p=0,04 respectively), as well as sepsis (p=0,01). An association with positive uroculture was also found (p=0,01). CD C citotoxin was found in 26% of the studied patients.
Conclusions. Diarrhea is a common event in the UCI, its incidence is 41%. Severity on admission and lasting of stay-in were associated with diarrhea. Sepsis was also associated with it, that might indicate the intestine as a target of multiple organic failure. CD is relatively frequent in the UCI, it sometimes appears as a microepidemic.

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