Medicina intensiva
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Review Comparative Study
[Result of extubation after spontaneous breathing test with automatic tube compensation versus continuous positive airway pressure].
The gold standard test to evaluate the readiness of a patient to be extubated is a spontaneous breathing trial. This trial is performed either using the T-piece disconnected from the ventilator, either using a low level of pressure support, with or without positive end-expiratory pressure. ⋯ A major goal to liberate the patient from the ventilator is to recognize the readiness for extubation as soon and as reliably as possible. The stop of sedation and the performance of a spontaneous breathing trial daily diminish the duration of mechanical ventilation due to the recognition of the patient's capability of breathing spontaneously.
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Glutamine is the most abundant amino acid in the human body and plays an important role in a number of metabolic pathways. Specifically, it is involved in amino acid and nucleotide synthesis, in the tricarboxylic acid cycle and in ureagenesis. Glutamine has been classified as a non-essential amino acid because the body can synthesize it, but under severe clinical conditions, the pool of glutamine is depleted and could be considered as conditionally essential. ⋯ Administration of supplemental glutamine by enteral or parenteral route has produced controversial results. Most of the studies published support the hypothesis that glutamine can change the morbidity-mortality of the critically ill patients. There are unresolved questions related to the dose of glutamine and the best way to administer it, and particularly the subgroups of patients who will really benefit from this treatment.
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Anemia is a common condition among medical and surgical patients admitted to the intensive care unit (ICU) and generally has a multifactorial origin. In order to avoid the deleterious effects of anemia, 40% of ICU patients receive allogenic blood transfusion (ABT). ⋯ In contrast, the administration of exogenous erythropoietin plus iron supplements, especially iv iron, improves anemia and reduces ABT requirements, although it does not reduce mortality. To ascertain whether treatment of anemia in the critically ill with exogenous erythropoietin and iron might improve outcomes and to optimize drug administration schedules and dosage, further studies with sufficient statistical power and adequate follow-up are warranted.