Medicina intensiva
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To assess early pituitary function in a sequential cohort of critical care patients after severe traumatic brain injury (TBI). ⋯ Our data show that pituitary dysfunction occurs early and with high frequency after severe TBI, but the real significance of these findings still needs to be elucidated.
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Inmaculada Echevarría was a woman with Progressive Muscular Dystrophy who was totally dependent on mechanical ventilation. In October 2006, she publicly asked to be disconnected of the ventilator. The clinical and biographical data of the case are presented in the first part of the work. ⋯ It then presents four different settings of end-of-life decision making that have been clarified over these last years: euthanasia and assisted suicide, limitation of life-prolonging treatment, treatment refusal and palliative sedation. The article concludes that the latter three can be considered as sufficiently clarified after the case of Inmaculada Echevarría. However, the first one, that is euthanasia and assisted suicide, must be confronted by the Spanish society in forthcoming years.
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To evaluate the diagnostic role of bronchoalveolar lavage (BAL) in mechanically ventilated patients with suspected pneumonia and to describe the clinical outcome in the different kinds of pneumonia in critically ill patients. ⋯ The low incidence of positive BAL in the CAP group supports using BAL only for particularly severe, selected cases. Mortality was very high in the immunocompromised patients. In the light of our personal experience, BAL is most useful in the diagnosis of pneumonia in the group of patients with VAP.