Medicina intensiva
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The pulmonary artery catheter has been a key tool for monitoring hemodynamic status in the intensive care unit for nearly 40 years. During this period of time, it has been the hemodynamic monitoring technique most commonly used for the diagnosis of many clinical situations, allowing clinicians to understand the underlying cardiovascular physiopathology, and helping to guide treatment interventions. ⋯ Technological advances have introduced new and less invasive hemodynamic monitoring techniques. This review provides a systematic update on the hemodynamic variables offered by cardiac output monitoring devices, taking into consideration their clinical usefulness and their inherent limitations, with a view to using the supplied information in an efficient way.
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Airway isolation by endotracheal intubation or tracheostomy impedes or even interrupts speech and swallowing. Pharyngeal and laryngeal impairment frequently occurs after extubation or de-cannulation, common consequences being dysphonia, dysphagia and the aspiration of oral secretions, food, or fluids. ⋯ Although the literature reports a high frequency of dysphagia following intubation and tracheostomy, the data vary considerably, and the true incidence of oropharyngeal dysphagia following artificial airway isolation remains to be established. We conducted a systematic review of the available evidence, in order to assess oropharyngeal dysphagia physiology, diagnosis and treatment.
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To describe the indications, diagnostic performance and safety of fiberoptic bronchoscopy (FOB) performed in a respiratory intensive care unit (RICU). ⋯ These results show that FOB is used commonly in the RICU. It is a safe and fast procedure that contributes significantly to clinical management. Patients requiring additional FOB during admission to the RICU show high mortality.
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To describe sedation with continuous perfusion of propofol in critically ill children. ⋯ Propofol at a dose of 1 to 4 mg/kg/h is a safe alternative for sustained sedation in critically ill children. However, further studies are needed to assess its effects and safety profile.
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Emotional factors may lead to cognitive impairment that can adversely affect the capacity of patients to reason, and thereby, limit their participation in decision taking. ⋯ The patients are of the firm opinion that they should have the last word in the taking of decisions; they prefer bad news to be given by the physician; and feel that the presence of a psychologist would make the process easier. Failure on the part of the professional to answer their questions is perceived as the greatest stress factor. Increased depression results in lesser cognitive capacity, and for patients with impaired cognitive capacity, participation in the decision taking process constitutes a burden. The variables anxiety and depression are significantly related to decision taking capacity.