Medicina intensiva
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COPD and asthmatic patients use a substantial proportion of mechanical ventilation in the ICU, and their overall mortality with ventilatory support can be significant. From the pathophysiological standpoint, they have increased airway resistance, pulmonary hyperinflation, and high pulmonary dead space, leading to increased work of breathing. If ventilatory demand exceeds work output of the respiratory muscles, acute respiratory failure follows. ⋯ The physician must be cautious to avoid complications related to mechanical ventilation during ventilatory support. One major cause of the morbidity and mortality arising during mechanical ventilation in these patients is excessive dynamic pulmonary hyperinflation (DH) with intrinsic positive end-expiratory pressure (intrinsic PEEP or auto-PEEP). The purpose of this article is to provide a concise update of the most relevant aspects for the optimal ventilatory management in these patients.
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Comparative Study
[Differential characteristics of patients with acute coronary syndrome without ST-segment elevation compared to those with transient ST-segment elevation].
To evaluate different characteristics of patients with acute coronary syndrome (ACS) without ST-segment elevation compared with transient St-segment elevation. ⋯ Patients with ACS with transient ST-segment elevation differ in the type of population, myocardial damage and coronary angiographic results with respect to patients with ACS without ST-segment elevation. More research is needed to clarify whether these differences imply a different therapeutic approach.
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The CRASH 2, a randomized, double-blind, controlled trial, that enrolled 20,211 adult trauma patients, has shown that the administration of tranexamic acid significantly reduces all-cause mortality and that specifically associated with severe blood loss as well. We consider it a significant therapeutic advance, because, for the first time, a drug has been demonstrated to safely diminish mortality due to traumatic bleeding shock. On the basis of these results, and the high rate of death due to traumatic bleeding, we suggest that tranexamic acid should be considered for compassionate use in bleeding trauma patients prior to its definitive approval for this medical condition.
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To study the correlation between intraabdominal and intrathoracic pressure in patients with suspected intraabdominal hypertension. ⋯ A stiffer chest wall was observed in patients with IAH. In patients with risk factors for IAH, pressures in these compartments were highly variable.
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During resuscitation, basic life support (BLS) and automated external defibrillation refer to maneuvers designed to maintain airway patency and support breathing and circulation without equipment other than a barrier device and the use of an automated external defibrillator (AED). We present some of the most important developments incorporated to the new international recommendations for resuscitation 2010. Aspects related to prevention and early detection of cardiac arrest are highlighted, along with the important role of dispatchers of emergency medical services, the importance of high quality CPR and programs of public access defibrillation. We likewise describe sequences of action and basic life support algorithms, and semi-automated external defibrillation.