Medicina intensiva
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Life-sustaining treatment limitation (LSTL) is an increasingly common practice. However, its application is sometimes not clearly reflected in the clinical record-this giving rise to the adoption of measures that could have been avoided, including admission to the intensive care unit (ICU), with the suffering and economical costs this implies. One way to trace patients subjected to LSTL is through an electronic registry allowing identification at all times of these individuals, and of the therapies that have been restricted in each case. The Ethics Committee of our center has developed a tool allowing the identification of patients subjected to LSTL and of the level of intervention required, and offering the association of a patient comfort management protocol.
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Volume expansion is used in patients with hemodynamic insufficiency in an attempt to improve cardiac output. Finding criteria to predict fluid responsiveness would be helpful to guide resuscitation and to avoid excessive volume effects. ⋯ In this review we define preload and preload-responsiveness concepts. A description is made of the characteristics of each indicator in patients subjected to mechanical ventilation or with spontaneous breathing.
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An evaluation is made of lung function and quality of life 6 months after discharge from the Intensive Care Unit (ICU) among survivors of acute respiratory distress syndrome (ARDS) due to pandemic 2009 influenza A H1N1, based on studies of lung function and the EQ-5D health questionnaire. ⋯ Although the sample is small, our results suggest that patients with ARDS due to influenza A H1N1 evaluated 6 months after discharge from the ICU show no deterioration of lung function, and the impact on quality of life is moderate-in contrast to the situation found in patients with ARDS of other etiologies.
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To describe the lung pathological changes in influenza A (H1N1) viral pneumonia. We studied morphological changes, nitro-oxidative stress and the presence of viral proteins in lung tissue. ⋯ Lung tissue from patients with pandemic influenza A (H1N1) viral pneumonia shows histological findings consistent with DAD. Prolonged nitro-oxidative stress is present despite antiviral treatment. Viral proteins may remain in lung tissue for prolonged periods of time, lodged in macrophages and type I pneumocytes.
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Traumatic brain injury (TBI) is a worldwide health problem that is especially prevalent in young adults. It is characterized by one or more primary injury foci, with secondary spread to initially not compromised areas via cascades of inflammatory response, excitotoxicity, energy failure conditions, and amplification of the original tissue injury by glia. In theory, such progression of injury should be amenable to management. ⋯ We highlight the role of glia in each cellular mechanism discussed. Therapeutic approaches related to the described mechanisms have been included. The discussion is completed with a working model showing the convergence of the main topics.