Medicina intensiva
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Review Meta Analysis
Role of plasma procalcitonin in the diagnosis of ventilator-associated pneumonia: Systematic review and metaanalysis.
To determine the role of plasma procalcitonin (PCT) levels in diagnosing ventilator-associated pneumonia. ⋯ Our results suggest that PCT provides additional information on the risk of VAP. Inclusion of PCT in diagnostic algorithms could improve their effectiveness.
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Multicenter Study Comparative Study
Prevention of venous thromboembolic disease in the critical patient: An assessment of clinical practice in the Community of Madrid.
To analyze measures referred to venous thromboembolic prophylaxis in critically ill patients. ⋯ Pharmacological prophylaxis with low molecular weight heparin was the most frequently used venous thromboembolic prophylactic measure. In patients with contraindications to pharmacological prophylaxis, mechanical measures were little used. The use of combined prophylaxis was anecdotal. Many of our ICUs lack specific prophylaxis protocols.
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The mortality of trauma patients has improved significantly in recent decades due to a combination of factors: medical care, educational campaigns and structural changes. Generalization of out-of hospital emergence medical services and the hospital care in specific centers for traumatized has undoubtedly contributed to this decline, but other factors such as periodic campaigns to prevent workplace and traffic accidents, as well as improvements in the road network have played a key role. The challenge now is to continue to decrease mortality, for which is essential an analysis of the situation to detect potential areas of improvement. ⋯ As medical practitioners, our role in prevention is mainly focused on the secondary prevention to avoid recidivism, for which it is necessary to identify risk factor (frequently alcohol, illegal drugs, psychotropic medication etc.) and implement a brief motivational intervention. This activity can reduce recidivism by nearly 50%. In Spain, the activity in this field is negligible therefore measures should be implemented for dissemination of secondary prevention in trauma.
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The Intensive Care Unit is a wonderful place where lives are saved, but it is also a very harsh and unpleasant place where critically ill patients face terrible diseases in very adverse environmental conditions. We must change the design of the ICU and its organization; we must improve privacy, welfare and comfort of patients and families, following their personal and emotional demands. ⋯ We need to redesign clinical practise so that ICU care becomes more agreeable and humane. We should put off this change no longer, since it is an imperative social and professional demand.
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The RIFLE and AKIN criteria have definitely help out to draw attention to the relationship between a deterioration of renal function that produces a small increase in serum creatinine and a worse outcome. However, the specific clinical utility of using these criteria remains to be well-defined. ⋯ The serum and urine biomarkers (creatinine, urea, and diuresis) currently in use are not sensitive or specific for detecting kidney damage, limiting treatment options and potentially compromising the outcome. New biomarkers are being studied in order to diagnose an earlier and more specific AKI, with the potential to change the definition criteria of AKI with different stages, currently based in diuresis and serum creatinine.