Medicina intensiva
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Multicenter Study Observational Study
Outcome of tracheotomized patients following reintubation.
To evaluate the outcome of tracheotomized patients after reintubation. ⋯ In our cohort of reintubated patients, tracheotomy is a common procedure in the ICU. Patients with tracheotomy had an outcome similar to those without tracheotomy.
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Critically ill patients are often affected by infections produced by Pseudomonas, which can be a cause of sepsis and renal failure. Early and adequate antibiotic treatment at correct dosage levels is crucial. ⋯ It must be taken into account that many antibiotics are largely cleared by continuous renal replacement therapies (CRRT). The aim of this review is to assess the clinical evidence on the pharmacokinetics and dosage recommendations of the main antibiotic groups used to treat Pseudomonas spp. infections in critically ill patients subjected to CRRT.
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Multicenter Study
[Antifungal prophylaxis in the postoperative period of lung transplant surgery in Spain].
To examine the type and duration of antifungal prophylaxis provided during the postoperative period of lung transplant recipients, together with the most frequent complications during admission to Intensive Care Units in Spain. ⋯ Antifungal prophylaxis during the postoperative period of lung transplantation is provided on a universal basis, though consensus is lacking as to the drug of choice, the administration route and the duration of such treatment.
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Practice Guideline
SEMICYUC 2012. Recommendations for intensive care management of acute pancreatitis.
Significant changes in the management of acute pancreatitis have taken place since the 2004 Pamplona Consensus Conference. The objective of this conference has been the revision and updating of the Conference recommendations, in order to unify the integral management of potentially severe acute pancreatitis in an ICU. ⋯ Eighty two recommendations for acute pancreatitis management in an ICU have been presented. Of these 84 recommendations, we would emphasize the new determinants-based classification of acute pancreatitis severity, new surgical techniques and nutritional recommendations. Note. This summary only lists the 84 recommendations of the 16 questions blocks except blocks greater relevance and impact of its novelty or because they modify the current management.
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Case Reports
Cranioplasty with bandaging. new forms of limitation of life support and organ donation.
Most of transplanted organs are obtained from brain death (BD) donors. In neurocritical patients with catastrophic injuries and decompressive craniectomy (DC), which show a dreadful development in spite of this treatment, DC could be a futile tool to avoid natural progress to BD. We propose if cranial compressive bandage (cranioplasty with bandage) could be an ethically correct practice, similar to other life-sustaining treatment limitation (LSTL) common methods. Based on a clinical case, we contacted with the Assistance Ethics Committee and some bioethics professionals asking them two questions: 1) Is ethically correct to perform a cranioplasty with bandage in those patients with LSTL indication? 2) Thinking in organ donation possibility, is this option preferable? Conclusions 1) Cranioplasty with bandage could be considered an ethically acceptable LSTL practice, similar to other procedures. 2) It facilitates organ donation for transplant, which provides value-added because of its own social good. 3) In these cases, it is necessary to know previous patient's will or, in absentia, to obtain family consent after a detailed procedure report.