Medicina intensiva
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Since the advent of cardiopulmonary resuscitation more than 40 years ago, we have achieved a return to spontaneous circulation in a growing proportion of patients with cardiac arrest. Nevertheless, most of these patients die in the first few days after admission to the intensive care unit (ICU), and this situation has not improved over the years. Mortality in these patients is mainly associated to brain damage. ⋯ The therapeutic management of patients that recover spontaneous circulation after cardiopulmonary resuscitation maneuvers based on life support measures and a series of improvised actions based on "clinical judgment" might not be the best way to treat patients with post-cardiac arrest syndrome. Recent studies indicate that using goal-guided protocols to manage these patients including therapeutic measures of proven efficacy, such as inducing mild therapeutic hypothermia and early revascularization, when indicated, can improve the prognosis considerably in these patients. Given that there is no current protocol based on universally accepted evidence, the Steering Committee of the National Cardiopulmonary Resuscitation Plan of the Spanish Society of Intensive Medicine and Cardiac Units has elaborated this document after a thorough review of the literature and an online discussion involving all the members of the committee and a consensus meeting with the aim of providing a platform for the development of local protocols in different ICSs in our country to fit their own means and characteristics.
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Acute renal failure (ARF) is associated to multiple organ failure (MOF) in critically ill patients and its mortality is high. The main objective was to evaluate the outcome of critically ill patients with ARF and MOF treated with continuous venovenous hemodiafiltration (CVVHDF). ⋯ The mortality rate of critically ill patients with acute renal failure and multiple organ failure remains high. Traumatic and non-oliguric patients have a better survival. Age > or = 60 years and SOFA > or = 11 points were independent risk factors associated with mortality.
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Mechanical ventilation may cause and aggravate lung damage and contribute to the appearance of multiorgan failure. One of the mechanisms that has been described is alveolar hyperoxia. ⋯ Moreover, both the FiO(2) used as well as the PaO(2) achieved in the first 24h of admission are associated with mortality. Clinical trials are needed that assess the threshold of the safe oxygen level for FiO(2) and oxygen saturation.
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Comparative Study
[Seasonal influence in characteristics of patients admitted to an intensive care unit].
To investigate seasonal variability in the epidemiology and the outcome of critical illness. ⋯ The stability of our climate implies that this factor does not influence the prognosis of patients who are admitted with critical illness.
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Comparative Study
[Pandemic influenza A in the ICU: experience in Spain and Latin America. GETGAG/SEMICYUC/(Spanish Working Group on Severe Pandemic Influenza A/SEMICYUC)].
Pandemic Influenza A (H1N1)v infection is the first pandemic in which intensive care units (ICU) play a fundamental role. It has spread very rapidly since the first cases were diagnosed in Mexico with the subsequent spread of the virus throughout the Southern Cone and Europe during the summer season. ⋯ These data suggest that a more aggressive treatment strategy, with earlier and easier access to the antiviral treatment might reduce the number of ICU admissions and mortality.