Medicina intensiva
-
Less than 10% of those individuals who suffer an episode of sudden cardiac arrest are successfully resuscitated and return home to live productive lives. New approaches to cardiac resuscitation could substantially improve such dismal outcome. Four current trends that have the greatest potential for improving outcome can be recognized in cardiopulmonary resuscitation (CPR): (1) systems to prevent cardiac arrests through recognition of early warning signs and timely intervention, (2) a shift towards a flow-based resuscitation emphasizing the delivery of high-quality uninterrupted CPR limiting the role of ventilation, (3) the growing role of technology in driving resuscitation interventions, incrementally enhancing the human decision-making process, and (4) the use of hypothermia.
-
Traumatic brain injury (TBI) is an important reason of morbidity-mortality all over the world, affecting young males more and generating Public Health problem. Unfortunately, the advances in the pathophysiology knowledge have not followed a similar development in therapeutic options, there currently not being any contrasted neuroprotectants. In this article, we have reviewed the epidemiology, pathophysiology and therapeutic measures used in the management of patient with severe TBI. The general measures as well as those aimed at controlling intracranial hypertension, the role of the surgery and some more innovative therapeutic options currently under evaluation in these patients are analyzed.
-
Spain has a rate of 34.4 donors per million population, making it the country with the highest rate of organ donation all over the world. In spite of these values, need of lungs for transplantation is always greater than the number of organs obtained. ⋯ In all the potential lung donors, the Apnea Test with CPAP should be done and the criteria for the donation of the lung under ideal conditions and with expanded criteria lung donors are reviewed. The protocol of aggressive maintenance including a protective ventilation strategy, restricted fluid intake, use of prophylactic antibiotics, corticosteroids and the systematic use of measures aimed at avoiding alveolar collapse together with maneuvers aimed at achieving better lung recruitment can improve the management of the lung donor and obtain a greater number of organs for transplantation.
-
Controlled Clinical Trial
[Enoxaparin vs. non-fractionated heparin in primary angioplasty of acute myocardial infarction].
The objective of this study is to compare the effectiveness of intravenous enoxaparin (ENX) and Non-fractionated Heparin (NFH) in primary angioplasty (PA) of acute myocardial infarction (PA-AMI). ⋯ Primary angioplasty can be safely sued with the intravenous administration of ENX, no significant differences being found between both treatments in mortality and bleeding complications.
-
Blood derivatives are clinical products that are currently used, for which their lack of availability, clinical relevance and presence of associated side effect that make it necessary to known and evaluate their utility rigorously are characteristic. ⋯ Strong consideration must be made about transfusion and its over use should be avoided. For this purpose, educational guidelines and consensus meetings are necessary to establish recommendations on the use of blood products and their pharmacological alternatives.