martes, 2 de junio de 2015

Insuficiencia respiratoria aguda/Acute respiratory distress syndrome

Síndrome de dificultad respiratoria aguda. Implicaciones de estudios recientes 
Acute respiratory distress syndrome: Implications of recent studies
Cleve Clin J Med 2014; 81:683-690 doi:10.3949/ccjm.81a.140 

Síndrome de dificultad respìratoria aguda y neumotórax
Acute respiratory distress syndrome and pneumothorax.
Terzi E, Zarogoulidis K, Kougioumtzi I, Dryllis G, Kioumis I, Pitsiou G, Machairiotis N, Katsikogiannis N, Lampaki S, Papaiwannou A, Tsiouda T, Madesis A,Karaiskos T, Zaric B, Branislav P, Zarogoulidis P.
J Thorac Dis. 2014 Oct;6(Suppl 4):S435-42. doi: 10.3978/j.issn.2072-1439.2014.08.34.
Acute respiratory distress syndrome (ARDS) can occur during the treatment of several diseases and in several interventional procedures as a complication. It is a difficult situation to handle and special care should be applied to the patients. Mechanical ventilation is used for these patients and several parameters are changed constantly until compliance is achieved. However, a complication that is observed during the application of positive airway pressure is pneumothorax. In our current work we will present definition and causes of pneumothorax in the setting of intensive care unit (ICU). We will identify differences and similarities of this situation and present treatment options.
KEYWORDS: Acute respiratory distress syndrome (ARDS); extracorporeal membrane oxygenation (ECMO); intensive care unit (ICU); mechanical ventilation; pneumothorax; recruitment


Las percepciones de diagnóstico y manejo de pacientes con síndrome de distrés respiratorio agudo: un estudio del Reino Unido con médicos de cuidados intensivos

Perceptions of diagnosis and management of patients with acute respiratory distress syndrome: a survey of United Kingdom intensive care physicians.
Dushianthan A, Cusack R, Chee N, Dunn JO, Grocott MP.
BMC Anesthesiol. 2014 Oct 2;14:87. doi: 10.1186/1471-2253-14-87. eCollection 2014.
BACKGROUND: Acute respiratory distress syndrome (ARDS) is a potentially devastating refractory hypoxemic illness with multi-organ involvement. Although several randomised controlled trials into ventilator and fluid management strategies have provided level 1 evidence to guide supportive therapy, there are few, established guidelines on how to manage patients with ARDS. In addition, and despite their continued use, pharmacotherapies for ARDS disease modulation have no proven benefit in improving mortality. Little is known however about the variability in diagnostic and treatment practices across the United Kingdom (UK). The aim of this survey, therefore, was to assess the use of diagnostic criteria and treatment strategies for ARDS in critical care units across the UK. METHODS: The survey questionnaire was developed and internally piloted at University Hospital Southampton NHS Foundation Trust. Following ethical approval from University of Southampton Ethics and Research Committee, a link to an online survey engine (Survey Monkey) was then placed on the Intensive Care Society (UK) website. Fellows of The Intensive Care Society were subsequently personally approached via e-mail to encourage participation. The survey was conducted over a period of 3 months. RESULTS:The survey received 191 responses from 125 critical care units, accounting for 11% of all registered intensive care physicians at The Intensive Care Society. The majority of the responses were from physicians managing general intensive care units (82%) and 34% of respondents preferred the American European Consensus Criteria for ARDS. There was a perceived decline in both incidence and mortality in ARDS. Primary ventilation strategies were based on ARDSnet protocols, though frequent deviations from ARDSnet positive end expiratory pressure (PEEP) recommendations (51%) were described. The majority of respondents set permissive blood gas targets (hypoxia (92%), hypercapnia (58%) and pH (90%)). The routine use of pharmacological agents is rare. Neuromuscular blockers and corticosteroids are considered occasionally and on a case-by-case basis. Routine (58%) or late (64%) tracheostomy was preferred to early tracheostomy insertion. Few centres offered routine follow-up or dedicated rehabilitation programmes following hospital discharge. CONCLUSIONS: There is substantial variation in the diagnostic and management strategies employed for patients with ARDS across the UK. National and/or international guidelines may help to improve standardisation in the management of ARDS.
KEYWORDS: Acute respiratory distress syndrome; Guidelines; Hypoxia; Survey

Anestesiología y Medicina del Dolor
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