Medicina intensiva
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Meta Analysis Comparative Study
Comparison of values in critically ill patients for global end-diastolic volume and extravascular lung water measured by transcardiopulmonary thermodilution: a meta-analysis of the literature.
Hemodynamic parameters such as the global end-diastolic volume index (GEDVI) and extravascular lung water index (EVLWI), derived by transpulmonary thermodilution, have gained increasing interest for guiding fluid therapy in critically ill patients. The proposed normal values (680-800ml/m(2) for GEDVI and 3-7ml/kg for EVLWI) are based on measurements in healthy individuals and on expert opinion, and are assumed to be suitable for all patients. We analyzed the published data for GEDVI and EVLWI, and investigated the differences between a cohort of septic patients (SEP) and patients undergoing major surgery (SURG), respectively. ⋯ The published data for GEDVI and EVLWI are heterogeneous, particularly in critically ill patients, and often exceed the proposed normal values derived from healthy individuals. In the group of septic patients, GEDVI and EVLWI were significantly higher than in the group of patients undergoing major surgery. This points to the need for defining different therapeutic targets for different patient populations.
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Multicenter Study
[Prolonged mechanical ventilation probability model].
To design a probability model for prolonged mechanical ventilation (PMV) using variables obtained during the first 24 hours of the start of MV. ⋯ The proposed model could be a helpful tool in decision making. However, because of its moderate accuracy, it should be considered as a first approach, and the results should be corroborated by further studies involving larger samples and the use of standardized criteria.
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There is little information about patients with severe aortic stenosis (SAS) who require admission to acute care units. We studied 27 patients with SAS admitted in a tertiary hospital coronary care unit. The most frequent reasons for admission were severe heart failure (42%), acute coronary syndrome (39%) and cardiac arrest (8%). ⋯ Cumulative survival was 74±8%, 70±9%, and 62±10% at 7, 30 and 60 days, respectively. Out of the 27 patients, 13 (48%) underwent surgical intervention, these patients having lower Euroscore (13±11 vs. 34±18%, p=0.002) and higher survival (92±7% at 7, 30 and 60 days vs. 50±13%, 40±14% and 30±14%; p=0.002). Thus, patients with SAS who require hospitalization in the intensive care units constitute a very high risk population, with very high mortality, especially during the first week after admission and in patients who have not undergone surgery.
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Massive hemorrhage is the main cause of mortality and morbidity in trauma patients, and is one of the most important causes in any patient following major surgery. Conventional treatment consists of volume replacement, including the transfusion of blood products, so that tissue perfusion and oxygenation may be maintained. Associated hypothermia, acidosis and coagulopathy is a lethal triad. ⋯ Where possible, this in turn should be guided by thromboelastography performed at point of care near the patient. Coagulopathy can occur early and late. With the exception of tranexamic acid, the cost-benefit relationships of the hemostatic agents, such as fibrinogen, prothrombin complex, and recombinant F VII, are subject to discussion.