Medicina intensiva
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Multicenter Study
[Impact of noninvasive ventilation failure upon patient prognosis. Subanalysis of a multicenter study].
Noninvasive ventilation (NIV) constitutes first-line treatment for the exacerbation of obstructive pulmonary disease and cardiogenic lung edema. Several studies suggest that NIV failure could increase the risk of mortality, mainly due to the delay in tracheal intubation. We aimed to evaluate the negative impact of NIV failure in routine practice among Spanish ICUs. ⋯ NIV failure and the need of intubation as routinely used do not seem to imply a poorer patient prognosis.
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Observational Study
[Hemodynamic and antipyretic effects of paracetamol, metamizol and dexketoprofen in critical patients].
The objective was to study the antipyretic and hemodynamic effects of three different drugs used to treat fever in critically ill patients. ⋯ Dexketoprofen was the most effective antipyretic agent at the doses tested. Although all three drugs reduced mean arterial pressure, the reduction with paracetamol was less pronounced.
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Flexible bronchoscopy (FB) has been of great help in the management of critically ill patients. Its safety and usefulness in the hands of experienced professionals, with the required measures of caution, has resulted in the increasingly widespread use of the technique even in unstable critical patients subjected to mechanical ventilation and with high oxygen demands. ⋯ The accreditation process seeks to stimulate good learning practice and quality in training. Both specialists in Intensive Care Medicine and other specialists, and the patients, will benefit from the commitment and control afforded by such accreditation, and from the learning and training which the mentioned process entails.
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To examine the predictive value of an early transcranial Doppler ultrasound (TCD) study performed in the emergency department in patients with spontaneous subarachoniod hemorrhage (SAH) in good neurological condition, in order to know which patients are at high risk of developing delayed cerebral ischemia (DCI). ⋯ During the first 3 days, an increase of 21cm/s/24h in MCA-MV was associated with the development of symptomatic vasospasm. TCD is a useful tool for the early detection of patients at risk of DCI after SAH.
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Hemodynamic monitoring is a tool of great value for the assessment of critically ill patients. It can not only detect and determine the source of hemodynamic instability, but also guide the choice of appropriate treatment and further evaluate its effectiveness. ⋯ Accordingly, the usefulness of monitoring systems should be evaluated not only on the basis of the accuracy and reliability of their measurements, but also on the ability to positively affect patient outcome. In this regard, many of the arguments against the use of hemodynamic monitoring are a consequence of non-protocolized use and of application not directed towards specific hemodynamic objectives of proven benefit for the patient.