Medicina intensiva
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To describe the clinical characteristics and outcomes of patients with community-acquired pneumonia (CAP) admitted to the Intensive Care Unit (ICU). To evaluate new ATS/IDSA criteria to identify patients with CAP who required admission to ICU. ⋯ CAP mortality is still high despite early antibiotic therapy, especially in those patients with a non-S. pneumonia etiology or who require mechanical ventilation. Almost 90% of the ICU admissions were identified by the new criteria from ATS/IDSA.
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Statins are becoming one of the drugs used most for cardiovascular prevention. Given the age of the patients admitted to the intensive medicine units, many of them receive previous treatment with statins. ⋯ However, the existing studies support the hypothesis that withdrawing statins has a clear harmful effect. Thus, the withdrawal of statins after admission to an intensive medicine unit should be carefully evaluated.
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Nearly forty years ago, Swan and Ganz introduced pulmonary artery catheterization to monitor the hemodynamic status of critical patients. The need for pulmonary artery catheterization in clinical practice has been questioned because it may be related to increased mortality and because alternative techniques that will probably cause less morbidity and mortality have been developed. ⋯ This review aims to discuss the advantages and drawbacks of the Swan-Ganz catheter as the gold standard for monitoring hemodynamics in critical patients. We believe that combining the available techniques should help us evaluate the hemodynamics in critical patients and determine the cause of hemodynamic instability so we can select the most appropriate initial treatment and evaluate the subsequent response.
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[Prognostic factors of mortality in a cohort of patients with in-hospital cardiorespiratory arrest].
To define the prognostic factors related with mortality of patients who suffer cardiorespiratory arrest (CRA) in the hospital, according to Utstein style guidelines. ⋯ The type of witness was identified among the predictors of mortality on hospital discharge after an episode of cardiac arrest. This becomes important because the qualification of healthcare personnel can be improved through adequate training.
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The intensive care units must be prepared for a possible disaster, whether internal or external, in case it becomes necessary to evacuate the in-patients. They must have an Emergency and Self-protection Plan that includes the patient evacuation criteria and this must be known by all the personnel who work in the service. For that reason, the patients must be triaged, based on their attention priorities, according to their survival possibilities. Having an evacuation, known by all the personnel and updated by means of the performance of periodic drills, should be included as a quality indicator that must be met, since this would achieve better attention to the patient in case of a disaster situation requiring the evacuation of the ICU.