Ignacio Martingano

Se presenta el caso de un paciente de 86 años con antecedente de vía urinaria instrumentada que consultó por fiebre y debilidad generalizada. Se documentó bacteriemia, inicialmente interpretada como foco urinario por evidencia de litiasis y urocultivo positivo con enterobacterias multirresistentes, y se inició tratamiento antibiótico dirigido. Durante la evolución presentó persistencia de fiebre y marcadores inflamatorios elevados pese a tratamiento terapéutico adecuado. Por tomografía computarizada se evidenció un aneurisma sacular de la aorta abdominal, confirmado como aneurisma micótico mediante tomografía con emisión de positrones. Dada la edad avanzada y la fragilidad del paciente, se optó por un manejo conservador con antibioticoterapia prolongada. El paciente presentó una evolución clínica favorable.

Introduction: Unplanned transfers from the General Ward to Critical Care Units occur due to a deterioration in the patient's clinical status. They are of great interest because of their negative impact, associated with longer hospital stays and higher mortality. Objectives: To report the frequency at which these transfers occur, characteristics of these patients and causes of the transfer. Identify shortcomings in the care process that may allow improvement strategies. Methodology: cross-sectional study. Cases were considered those who, during the first 24 hours of hospitalization in the General Ward, required transfer to the ICU between January - December 2022 in a high-complexity hospital in Buenos Aires. Results: Of 8317 admissions, 124 were transferred to the ICU, with a rate of 14 per 1000 and an average of 70 years. The most frequent comorbidities were high blood pressure, heart failure, cancer and overweight-obesity. The main causes of hospitalization were respiratory and gastrointestinal symptoms. 67% had non-alarming results in the NEWS score prior to transfer to the ICU. The most frequent causes were respiratory failure, hemodynamic instability and requirement for monitoring. Average hospital stay was 10 days and in-hospital mortality was 26%. Conclusions: Respiratory decompensation in elderly male patients was the most common cause of transfer to a Closed Unit. One of the shortcomings of the care process seems to be the NEWS score, where in 67% of cases it did not warn about the high requirement of patient monitoring.