Medicina intensiva
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Transient apical dysfunction syndrome, ballooning or Takotsubo cardiomyopathy is a recently described syndrome. It is a disease with a partially known mechanism, characterized by the morphology adopted by the left ventricle secondary to hypokinesis and dyskinesis of the apical segments and hypercontractibility of the basal segments. ⋯ Furthermore, the alterations described have a reversible character. Some diagnostic clinical criteria have been proposed and there is presently some controversy on them and on the complementary examination needed to diagnose it.
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[Inflammatory state in patients with atrial fibrillation before and after electrical cardioversion].
To assess the inflammatory state in patients with persistent atrial fibrillation and to determine the predictive value in the success of cardioversion and recurrence at 30 days. ⋯ There is an increased inflammatory state in patients with atrial fibrillation. FNT-alpha and Interleukin-6 levels were increased in non-cardiovertors, but no biomarker was associated with success of cardioversion or rhythm state at 30-days. However, higher levels of hs-CRP showed a trend to be related to recurrence of atrial fibrillation.
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Review
[Selective digestive decontamination. Why don't we apply the evidence in the clinical practice?].
Selective digestive decontamination (SDD) is a prophylactic strategy whose objective is to reduce the incidence of infections, mainly mechanical ventilation associated pneumonia in patients who require intensive cares, preventing or eradicating the oropharyngeal and gastrointestinal carrier state of potentially pathogenic microorganisms. Fifty-four randomized clinical trials (RCTs) and 9 meta-analysis have evaluated SDD. Thirty eight RCTs show a significant reduction of the infections and 4 of mortality. ⋯ Thus, 5 patients from the ICU with SDD must be treated to prevent pneumonia and 12 patients from the ICU should be treated to prevent one death. The data that show benefit of the SDD on mortality have an evidence grade 1 or recommendation grade A (supported by at least two level 1 investigations). The aim of this review is to explain the pathogeny of infections in critical patients, describe selective digestive decontamination, analyze the evidence available on it efficacy and the potential adverse effects and discuss the reasons published by the experts who advise against the use of SDD, even though it is recognized as the best intervention evaluated in intensive cares to reduce morbidity and mortality of the infections.
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Percutaneous tracheostomy is an alternative to conventional surgical tracheostomy. It is associated to a more feasible procedure, that is less invasive and linked to a lower degree of complications. Herein, we review our experience since the implementation of this technique in our Department. ⋯ In our experience, percutaneous tracheostomy performed at bedside in the ICU is an adequate solution with a low complication rate and its makes it possible to reduce the level of ventilatory support.
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Traumatic injury of the abdominal aorta with total interruption of blood flow is uncommon. When there is total obstruction of the artery, the clinical picture is dramatic. ⋯ The patients have absent femoral and distal pulses, associated to neuropathy in the lower limbs. We present a case of abdominal aorta injury secondary to closed trauma and review the causes, presentation forms and management of the injury.