Pleural effusion is a common condition in critically ill patients (both clinical and surgical). Its diagnosis and classification are important for followup of patients with cardiorespiratory difficulty. Lung ultrasound is used for this purpose, but no reports have been published on its use in Cuba with critically ill patients in intensive care units. We performed lung ultrasound on 144 such patients with cardiorespiratory illnesses, average age 54 years, predominantly men (66%; 95/144), with average APACHE II score 13.6, and 22.1% mortality risk. Patients were divided into two groups: clinical (bronchopneumonia and cardiac insufficiency) and surgical (postoperative liver and kidney transplant or vascular and cardiovascular surgery) to diagnose and classify pleural effusion according to locus (right, left and bilateral) and structural pattern (I, II A, II B, III and IV). Pleural effusions were diagnosed in 81.2% (117/144) of patients (clinical 44.4%, 52/117; surgical 55.6%, 65/117). Bilateral location was the most common (68.4%, 80/117), followed by right (23.9%, 28/117) and then left (7.7%, 9/117). Structural pattern I (anechoic appearance) was observed in 61.5% of cases (72/117); 21.4% (25/117) were II A, 12.8% (15/117) II B, 3.4% (4/117) III, and 0.9% (1/117) were IV. We found no association between pleural effusion localization and ultrasound structural pattern in clinical patients (Fisher exact test 4.2 p = 0.9). In surgical patients, however, complex ultrasound patterns (II A, II B and III) were significantly more common in bilateral forms (Fisher exact test 14.1; p = 0.009). Further studies of this type in Cuba will help provide useful data for prompt treatment and followup of these patients.

KEYWORDS Pleural effusion, critical illness, intensive care unit, lung ultrasound, diagnostic ultrasound, Cuba

INTRODUCTION Knowledge of prognostic factors in end-stage renal disease patients has improved dialysis management and methods for reducing morbidity and mortality, underlining the importance of identification, prevention and control of these factors.

OBJECTIVE Identify factors affecting prognosis (survival or death) in hemodialysis patients at the Medical-Surgical Research Center in Havana over a ten-year period.

METHODS Descriptive, prospective study of 81 end-stage renal disease patients who received hemodialysis at the Medical-Surgical Research Center from 1995 to 2004. Prognostic factors were identified at initiation of and during dialysis treatment, using chi square, t test, McNemar test, Kaplan Meier analysis, log-rank test and Cox regression model, with significance threshold set at p <0.05.

RESULTS Hypertension and diabetes were the leading causes of end-stage renal disease. Six patients were referred late. Mean survival was 4.4 years; with survival of 86.6%, 54.7% and 26.6% at one, three and five years respectively. Factors predictive of decreased survival that were most frequent at initiation of hemodialysis were hypertension and chronic anemia (both present in 95.9% of cases); malnutrition, hypoalbuminemia, cardiovascular disease and chronic liver disease increased during treatment while hypertension decreased. In multivariate analysis, prognostic factors that significantly predicted decreased survival were hypertension, inadequate vascular access and diabetes. Patients aged ≥60 years and those with malnutrition, hypoalbuminemia, anemia, cardiovascular disease or liver disease had lower survival figures at the end of the study period. Leading causes of death were infections (45.2%) and cardiovascular disease (41.9%); the latter was present in 93.5% of deaths, independent of underlying cause of death.

CONCLUSIONS Survival of hemodialysis patients diminished at five years. Some negative predictive factors are present at initiation of hemodialysis, such as diabetes, hypertension and chronic anemia; others increased later, including malnutrition, hypoalbuminemia, cardiovascular disease and liver disease.

KEYWORDS Hemodialysis, prognostic factors, survival, chronic kidney disease, end-stage renal disease, Cuba

INTRODUCTION Continuous venovenous hemodiafiltration, generally used in patients with acute renal failure, enables elimination of humoral mediators of systemic inflammatory response and sepsis from blood. This effect should improve treatment results in patients with multiple organ dysfunction, but evidence of improved survival is insufficient.

OBJECTIVES Describe the effect of continuous venovenous hemodiaflitration on patients with multiple organ dysfunction syndrome in terms of systemic and brain hemodynamics, oxygenation, metabolism and status on ICU separation.

METHODS An observational case series was done of 18 patients (11 men and 7 women) aged 24–78 years with multiple organ dysfunction syndrome treated with continuous venovenous hemodiafiltration in the Medical-Surgical Research Center’s ICU in Havana. General, systemic and brain hemodynamic, oxygenation and metabolic variables were assessed immediately before and 12 hours after starting the procedure; vital status on separation from intensive care was recorded. For analysis, patients were grouped by whether cause of multiple organ dysfunction syndrome was septic or nonseptic. Variable means before and after treatment were compared using the Wilcoxon matched pairs test. Standardized mortality ratios were calculated for both groups, with survival efficacy defined by a ratio of <0.9.

RESULTS After 12 hours continuous venovenous hemodiafitration, the septic group showed clinical improvement, with statistically significant improvement in all variables except mean arterial pressure and brain hemodynamics. Survival to discharge from ICU was 64%, with a standardized mortality ratio of 0.66. In the nonseptic group, survival was 0% and ratio was 2.13; temperature was the only variable found to improve significantly.

CONCLUSIONS Continuous venovenous hemodiafltration improved clinical parameters and survival in patients with multiple organ dysfunction of septic origin. Further studies are needed with larger numbers of patients to corroborate these results.

KEYWORDS Continuous renal replacement therapy, hemodiafiltration, multiple organ failure, septic shock, acute liver failure, MODS, Cuba