Revisiones_bibliográficas TyO

Scand J Trauma Resusc Emerg Med. 2018 Jun 26;26(1):51. doi: 10.1186/s13049-018-0518-x.

Abstract

BACKGROUND: In 2011, the role of Point of Care Ultrasound (POCUS) was defined as one of the top five research priorities in physician-provided prehospital critical care and future research topics were proposed; the feasibility of prehospital POCUS, changes in patient management induced by POCUS and education of providers. This systematic review aimed to assess these three topics by including studies examining all kinds of prehospital patients undergoing all kinds of prehospital POCUS examinations and studies examining any kind of POCUS education in prehospital critical care providers. METHODS AND RESULTS: By a systematic literature search in MEDLINE, EMBASE, and Cochrane databases, we identified and screened titles and abstracts of 3264 studies published from 2012 to 2017. Of these, 65 studies were read in full-text for assessment of eligibility and 27 studies were ultimately included and assessed for quality by SIGN-50 checklists. No studies compared patient outcome with and without prehospital POCUS. Four studies of acceptable quality demonstrated feasibility and changes in patient management in trauma. Two studies of acceptable quality demonstrated feasibility and changes in patient management in breathing difficulties. Four studies of acceptable quality demonstrated feasibility, outcome prediction and changes in patient management in cardiac arrest, but also that POCUS may prolong pauses in compressions. Two studies of acceptable quality demonstrated that short (few hours) teaching sessions are sufficient for obtaining simple interpretation skills, but not image acquisition skills. Three studies of acceptable quality demonstrated that longer one- or two-day courses including hands-on training are sufficient for learning simple, but not advanced, image acquisition skills. Three studies of acceptable quality demonstrated that systematic educational programs including supervised examinations are sufficient for learning advanced image acquisition skills in healthy volunteers, but that more than 50 clinical examinations are required for expertise in a clinical setting. CONCLUSION: Prehospital POCUS is feasible and changes patient management in trauma, breathing difficulties and cardiac arrest, but it is unknown if this improves outcome. Expertise in POCUS requires extensive training by a combination of theory, hands-on training and a substantial amount of clinical examinations - a large part of these needs to be supervised.

KEYWORDS: Cardiac arrest; Critical care; Dyspnea; Education; Point of care; Prehospital; Systematic review; Trauma; Ultrasound

Antiepiléticos en el paciente grave

Antiepileptic drugs in critically ill patients.

Farrokh S1, Tahsili-Fahadan P2,3, Ritzl EK2,4, Lewin JJ 3rd5, Mirski MA5.

Crit Care. 2018 Jun 7;22(1):153. doi: 10.1186/s13054-018-2066-1.

Abstract

BACKGROUND: The incidence of seizures in intensive care units ranges from 3.3% to 34%. It is therefore often necessary to initiate or continue anticonvulsant drugs in this setting. When a new anticonvulsant is initiated, drug factors, such as onset of action and side effects, and patient factors, such as age, renal, and hepatic function, should be taken into account. It is important to note that the altered physiology of critically ill patients as well as pharmacological and nonpharmacological interventions such as renal replacement therapy, extracorporeal membrane oxygenation, and target temperature management may lead to therapeutic failure or toxicity. This may be even more challenging with the availability of newer antiepileptics where the evidence for their use in critically ill patients is limited. MAIN BODY: This article reviews the pharmacokinetics and pharmacodynamics of antiepileptics as well as application of these principles when dosing antiepileptics and monitoring serum levels in critically ill patients. The selection of the most appropriate anticonvulsant to treat seizure and status epileptics as well as the prophylactic use of these agents in this setting are also discussed. Drug-drug interactions and the effect of nonpharmacological interventions such as renal replacement therapy, plasma exchange, and extracorporeal membrane oxygenation on anticonvulsant removal are also included. CONCLUSION: Optimal management of antiepileptic drugs in the intensive care unit is challenging given altered physiology, polypharmacy, and nonpharmacological interventions, and requires a multidisciplinary approach where appropriate and timely assessment, diagnosis, treatment, and monitoring plans are in place.

KEYWORDS: Antiepileptic drugs; Critical care; Drug-drug Interaction; Pharmacodynamics; Pharmacokinetics; Seizure

Biomarcadores en falla renal inducida por sepsis

Biomarkers of Sepsis-Induced Acute Kidney Injury.

Wang K1, Xie S1, Xiao K1, Yan P1, He W2, Xie L1.

Biomed Res Int. 2018 Apr 24;2018:6937947. doi: 10.1155/2018/6937947. eCollection 2018.

Abstract

Sepsis, an infection-induced systemic disease, leads to pathological, physiological, and biochemical abnormalities in the body. Organ dysfunction is caused by a dysregulated host response to infection during sepsis which is a major contributing factor to acute kidney injury (AKI) and the mortality rate for sepsis doubles due to coincidence of AKI. Sepsis-induced AKI is strongly associated with increased mortality and other adverse outcomes. More timely diagnosis would allow for earlier intervention and could improve patient outcomes. Sepsis-induced AKI is characterized by a distinct pathophysiology compared with other diseases and may also have unique patterns of plasma and urinary biomarkers. This concise review summarizes properties and perspectives of the biomarkers for their individual clinical utilization.

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Congresos Médicos por Especialidades en todo Mundo

Medical Congresses by Specialties around the World

vwhizar@anestesia-dolor.org

Events of the California Society of Anesthesiologists

Información / Information

Safe Anaesthesia Worldwide

Delivering safe anaesthesia to the world's poorest people

Informes / Information

Anestesiología y Medicina del Dolor

52 664 6848905

anestesia-dolor.org

martes, 19 de junio de 2018

Dolor en UCI / Pain in ICU

Junio 18, 2018. No. 3115

Prevalencia de dolor en pacientes hospitalizados en Unidad de Cuidados Intensivos Metabólicos con intubación orotraqueal y bajo sedación, medido con escala COMFORT

P. E. García Ramírez, L. C. Valenzuela Molina, E. Zazueta Araujo, C. M. López Morales, R. Cabello Molina y P. Martínez Hernández Magro

Rev Soc Esp Dolor 2018; 25(1): 7-12

RESUMEN

Introducción: El dolor es un padecimiento frecuente en pacientes hospitalizados en unidades de cuidados intensivos, sin embargo es subdiagnosticado en aquellos pacientes que no tienen la capacidad para expresarlo. Diversas escalas se han validado a nivel mundial para determinar el nivel de dolor en dichos pacientes, pero existe poco personal entrenado para aplicarlas y escasos estudios sobre prevalencia de dolor en UCI. Objetivos: Se determina la prevalencia de dolor en pacientes hospitalizados en la Unidad de Cuidados Intensivos Metabólicos (UCIM) orointubados y bajo sedación. Material y métodos: Estudio de cohorte, descriptivo, observacional y prospectivo. Fueron incluidos todos los pacientes hospitalizados en UCIM que cumplen con los criterios de inclusión (pacientes orointubados bajo sedación). Resultados: Se incluyeron 36 pacientes, siendo el 77,7 % del sexo masculino. La edad osciló entre 18 y 71 años con media de 51 y desviación estándar de 14,05. El 86 % de los pacientes ingresó por patología quirúrgica y el 75 % se encontraba con politerapia analgésica. La prevalencia de dolor medido con escala COMFORT fue del 69,4 %. Conclusión: La prevalencia de dolor en pacientes intubados y bajo sedación endovenosa en la UCIM es similar a la reportada en la literatura, siendo el nivel de sedación el factor que más se correlaciona de manera significativa con una mayor intensidad de dolor. Palabras clave: Dolor, terapia intensiva, intubación, sedación.

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Congresos Médicos por Especialidades en todo Mundo

Medical Congresses by Specialties around the World

XV Congreso Virtual Mexicano de Anestesiología

Octubre-Diciembre 2018

vwhizar@anestesia-dolor.org

Events of the California Society of Anesthesiologists

Información / Information

Safe Anaesthesia Worldwide

Delivering safe anaesthesia to the world's poorest people

Informes / Information

Anestesiología y Medicina del Dolor

52 664 6848905

anestesia-dolor.org

sábado, 26 de mayo de 2018

Ideas no confirmadas en UCI / ICU unconfirmed ideas.

Mayo 24, 2018. No. 3090

Siete ideas no confirmadas para mejorar la práctica futura de la UCI.

Seven unconfirmed ideas to improve future ICU practice.

Marini JJ1, De Backer D2, Ince C3,4, Singer M5, Van Haren F6,7,8, Westphal M9, Wischmeyer P10.

Crit Care. 2017 Dec 28;21(Suppl 3):315. doi: 10.1186/s13054-017-1904-x.

Abstract

With imprecise definitions, inexact measurement tools, and flawed study execution, our clinical science often lags behind bedside experience and simply documents what appear to be the apparent faults or validity of ongoing practices. These impressions are later confirmed, modified, or overturned by the results of the next trial. On the other hand, insights that stem from the intuitions of experienced clinicians, scientists and educators-while often neglected-help place current thinking into proper perspective and occasionally point the way toward formulating novel hypotheses that direct future research. Both streams of information and opinion contribute to progress. In this paper we present a wide-ranging set of unproven 'out of the mainstream' ideas of our FCCM faculty, each with a defensible rationale and holding clear implications for altering bedside management. Each proposition was designed deliberately to be provocative so as to raise awareness, stimulate new thinking and initiate lively dialog.

KEYWORDS: Adaptive clinical trials; Melatonin; Metabolic monitoring; Microcirculation; Personalized medicine; Resuscitation; Sepsis; Shock; Ventilator-induced lung injury

Algunas de nuestras ideas favoritas sin confirmar.

A few of our favorite unconfirmed ideas.

Marini JJ, Gattinoni L, Ince C, Kozek-Langenecker S, Mehta RL, Pichard C, Westphal M, Wischmeyer P, Vincent JL.

Crit Care. 2015;19 Suppl 3:S1. doi: 10.1186/cc14719. Epub 2015 Dec 18.Abstract

Medical practice is rooted in our dependence on the best available evidence from incremental scientific experimentation and rigorous clinical trials. Progress toward determining the true worth of ongoing practice or suggested innovations can be glacially slow when we insist on following the stepwise scientific pathway, and a prevailing but imperfect paradigm often proves difficult to challenge. Yet most experienced clinicians and clinical scientists harbor strong thoughts about how care could or should be improved, even if the existing evidence base is thin or lacking. One of our Future of Critical Care Medicine conference sessions encouraged sharing of novel ideas, each presented with what the speaker considers a defensible rationale. Our intent was to stimulate insightful thinking and free interchange, and perhaps to point in new directions toward lines of innovative theory and improved care of the critically ill. In what follows, a brief background outlines the rationale for each novel and deliberately provocative unconfirmed idea endorsed by the presenter.

Congresos Médicos por Especialidades en todo Mundo

Medical Congresses by Specialties around the World