Medicina intensiva
-
From the time when a disease whose treatment is going to require hospitalization for a surgical intervention is diagnosed, both the patient and his/her family members or primary caretakers are involved in a process that may involve the experience of several emotional alterations. This work focuses on the description of the different psychological problems and needs manifested by the patients who require, as part of the treatment process and recovery control, admission to an Intensive Care Unit (ICU). During the patient's stay in the ICU, the emotional alterations mentioned most frequently by them are anxiety, stress, depression or the so-called intensive care syndrome, during which factors such as excessive noise that may make sleeping and rest difficult, pain, the methods used for ventilation that prevent the patients from communicating adequately, etc. ⋯ The experiences lived may continue to produce emotional alterations even months after hospital discharge, with the development of a Posttraumatic Stress Disorder. This justifies a follow-up in order to detect them and treat them adequately. It seems to be appropriate for the treatment of these patients to be multidisciplinary, attending to both the physical needs related with the disease as well as the psychological ones.
-
Recombinant activated factor VII is a drug that should be considered when there is massive bleeding. Its activation after it is bond to the tissue factor expressed triggers the coagulation cascade by action sequence of the different factors. ⋯ Although the adverse effects are well characterized, it is still a newly used drug. Thus, the potential risks of its use in each patient must be weighed.
-
Paraquat is the most important member of the bipyridyl compound. It is directly caustic in nature and it exerts its herbicidal activity by inhibiting the reduction of NADP to NADPH during photosynthesis, a process in which superoxide, singlet oxygen, hydroxyl, and peroxide radicals are formed. Human tissue toxicity likely results from a similar oxidative mechanism. ⋯ Low-inspired oxygen therapy should be given until it becomes impractical in the face of hypoxemia. Administration of immunodepressive therapy, steroids and cyclophosphamide, should be considered. In addition, there should be intermittent assessment of pulmonary function and of plasma and urinary concentrations of paraquat.
-
The incidence of neurological complications after cardiac surgery continues to be elevated, although this is variable in the different studies published, fundamentally because of the different populations studied and the different definitions of neurological dysfunction. The etiology of these alterations is attributed to a multifactorial origin, aortic artherosclerosis, cerebral hypoperfusion and inflammatory phenomenon secondary to the technique. ⋯ Having knowledge of the risk markers and understanding the pathogenesis is important to try to plan strategies that may minimize the appearance and development of these complications and contribute to the decrease of their serious consequences. The data and the experience obtained by our group are shown at the end of the review.