Medicina
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Randomized Controlled Trial Comparative Study Clinical Trial
[Hydration in diabetic ketoacidosis. What is the effect of the infusion rate?].
Diabetic ketoacidosis (DKA) involves severe volume depletion; usually a large volume of saline solution is used, but fluid reposition rate remains controversial. With the aim of properly defining fluid administration in DKA without associated illness, we performed a prospective, randomized study in 27 patients under two therapeutic regimes which differed only with regard to the repletion rate. Group 1 (14 patients) received 0.9% saline solution at a rate of 1000 ml/h, and group 2 (13 patients) at 500 ml/h. ⋯ No changes were observed in anion gap, chloride, sodium or potassium among the therapeutic groups. We conclude that, regarding morbidity and mortality, in DKA patients without severe volume depletion it is equally effective to infuse 500 ml/h as 1000 ml/h as fluid repletion rate. Administration of modest amounts of fluids in these cases would result in reducing costs.
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The aim of the present study was to evaluate the hemodynamic and respiratory variations in patients with acute respiratory distress syndrome (ARDS) under two conditions: volume controlled ventilation (VCV) and pressure controlled inverse ratio ventilation (PCIRV). Seventeen patients with ARDS and the following criteria were included: lung injury score > 2.5 and peak inspiratory pressure > or = 40 cm H2O under VCV, constant flow and I/E ratio of 1/2. Measurements were obtained in VCV and after one hour in PCIRV with I/E ratio 2/1 using a similar PEEP value than VCV. ⋯ Our results show that PCIRV allow to ventilate patients with lower peak inspiratory and plateau pressures without significant changes in hemodynamic and oxygenation parameters. The conventional tidal volumes are excessive for lungs with SDRA, which is shown with the improvement in the static compliance and the airway pressures in PCIRV. PCIRV mode at the same PEEPt level as VCV, with normal I/E ratio does not improve the oxygenation, despite the higher level of the mean airway pressure.