Medicina intensiva
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One of the main causes of secondary cerebral injury is cerebral hypoxia, basically of ischemic origin. However, cerebral tissue oxygenation depends on multiple physiological variables and cerebral hypoxia may be caused by an alteration of any one of them. ⋯ This present article presents a review of the most outstanding aspects of the PtiO2 monitoring and proposes a protocol for the interpretation of this monitoring technique. This algorithm attempts to facilitate the identification of the different types of different cerebral hypoxia and of the correct therapeutic choice in the complex decision making process in neurocritical patients at risk of cerebral hypoxia.
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To demonstrate that interdisciplinary consensus improves the quality of work in the daily Intensive Care Unit (ICU), thus avoiding unnecessary routine x-ray examinations. We propose to monitor the results to maintain this low percentage of requests for x-rays. ⋯ Unnecessary CPR can be easily reduced stressing our control in clinically stable patients. The requirement to justify a routine request (agreement between intensivists) makes it possible to decrease the number of CPRs. Periodic monitoring is the definitive tool for a successful improvement cycle.
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Acute peritoneal dialysis (APD) is still a useful tool in the critical pediatric patient. Acute kidney failure due to septic shock often requires invasive depuration procedures and although hemofiltration is very effective, not all pediatric Intensive Care Units have the equipment necessary to establish it. Pediatric APD is generally initiated with short dwell times, every hour exchanges and 10-20 ml/kg filling volumes. We present the evolution of two critical patients with kidney failure on APD who benefited from the measurement of dialysate-to-plasma (D/P) ratios for creatinine and urea, and dialysate-to-solution ratio for glucose (Dt/Do) to optimize APD prescription.
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The tracheostomy has turned into one of the procedures most performed in the intensive care units. To this fact they have contributed the introduction of the percutaneous technique and the theoretical advantages that tracheostomy has: increase of the comfort of the patient, decrease of the dead space, improvement of the bronchial toilet and decrease in the requirement of sedation. ⋯ The comparative studies show that the performance of a tracheostomy, versus translaryngeal intubation, could relate to a lower mortality in the unit of intensive care, but tracheostomy does not improve other outcomes as length of stay in the unit of intensive care, length of stay in the hospital and the mortality in the hospital. More studies are needed to be able to estimate what patients would benefit from a tracheostomy and which is the optimal timing for its performance.