TEP / Pulmonary embolism

Marzo 18, 2016. No. 2269   Estimad@ Dr@ Víctor Valdés:

Avances recientes en el manejo del embolismo pulmonar. Enfoque en el paciente grave Recent advances in the management of pulmonary embolism: focus on the critically ill patients. Meyer G, Vieillard-Baron A, Planquette B. Ann Intensive Care. 2016 Dec;6(1):19. doi: 10.1186/s13613-016-0122-z. Epub 2016 Mar 3. Abstract The aim of this narrative review is to summarize for intensivists or any physicians managing "severe" pulmonary embolism (PE) the main recent advances or recommendations in the care of patients including risk stratification, diagnostic algorithm, hemodynamic management in the intensive care unit (ICU), recent data regarding the use of thrombolytic treatment and retrievable vena cava filters and finally results of direct oral anticoagulants. Thanks to the improvements achieved in the risk stratification of patients with PE, a better therapeutic approach is now recommended from diagnosis algorithm and indication to admission in ICU to indication of thrombolysis and general hemodynamic support in patients with shock. Given at current dosage, thrombolytic therapy is associated with a reduction in the combined end-point of mortality and hemodynamic decompensation in patients with intermediate-risk PE, but this is obtained without a decrease in overall mortality and with a significant increase in major extracranial and intracranial bleeding. In patients with high-intermediate-risk PE, thrombolytic therapy should be given in case of hemodynamic worsening. Vena cava filters are of little help when anticoagulant treatment is not contraindicated, even in patients with PE and features of clinical severity. Finally, direct oral anticoagulants have been shown to be as effective as and safer than the combination of low molecular weight heparin and vitamin K antagonist(s) in patients with venous thromboembolism and low- to intermediate-risk PE. KEYWORDS: Pulmonary embolism; Right ventricle; Risk stratification; Thrombolysis PDF Prevalencia de TVP en pacientes agudos ambulatorios admitidos en UCI no quirúrgica Prevalence of deep vein thrombosis in acutely admitted ambulatory non-surgical intensive care unit patients. Lawall H, Oberacker R, Zemmrich C, Bramlage P, Diehm C, Schellong SM. BMC Res Notes. 2014 Jul 5;7:431. doi: 10.1186/1756-0500-7-431. Abstract BACKGROUND: Data on prevalence rates of venous thromboembolism (VTE) in different patient populations are scarce. Most studies on this topic focus on older patients or patients with malignancies, immobilization or thrombophilia. Less is known about the VTE risk profile of non-surgical patients presenting with a variety of medical diseases of differing severity. Aim of the present study was to investigate VTE prevalence in a pospective cohort study of ambulatory medical intensive care unit patients within 24 h after acute admission. METHODS: Prospective cohort study of 102 consecutive patients after acute admission to medical intensive care unit. Ultrasound compression sonography, APACHE-II-Scoring and laboratory examination was performed within 24 hours after admission.Possible determinants of a high risk of VTE were examined. In all patients with a confirmed diagnosis of DVT or suspicion of PE thoracic computer tomography (CT) was performed. RESULTS: VTE was found in 7.8% out of 102 of patients, mean APACHE-II-Score was 14 (mortality risk of about 15%). Thrombus location was femoropopliteal in 5 patients, iliacal in 2 and peroneal in 1 patient. Five VTE patients had concomitant PE (62.5% of VTE, 4.9% of all patients). No predictors of prevalent VTE were identified from univariable regression analysis although relative risk was high in patients with a history of smoking (RR 3.40), immobility (RR 2.50), and elevated D-Dimer levels (RR 3.49). CONCLUSIONS: Prevalent VTE and concomitant PE were frequent in acutely admitted ICU patients. PDF

Anestesiología y Medicina del Dolor 52 664 6848905 vwhizar@anestesia-dolor.org anestesia-dolor.org Copyright © 2015

TVP y TEP en UCI / DVT and PE in ICU

Marzo 16, 2016. No. 2267

Avances recientes en el manejo del embolismo pulmonar. Enfoque en el paciente grave Recent advances in the management of pulmonary embolism: focus on the critically ill patients. Meyer G, Vieillard-Baron A, Planquette B. Ann Intensive Care. 2016 Dec;6(1):19. doi: 10.1186/s13613-016-0122-z. Epub 2016 Mar 3. Abstract The aim of this narrative review is to summarize for intensivists or any physicians managing "severe" pulmonary embolism (PE) the main recent advances or recommendations in the care of patients including risk stratification, diagnostic algorithm, hemodynamic management in the intensive care unit (ICU), recent data regarding the use of thrombolytic treatment and retrievable vena cava filters and finally results of direct oral anticoagulants. Thanks to the improvements achieved in the risk stratification of patients with PE, a better therapeutic approach is now recommended from diagnosis algorithm and indication to admission in ICU to indication of thrombolysis and general hemodynamic support in patients with shock. Given at current dosage, thrombolytic therapy is associated with a reduction in the combined end-point of mortality and hemodynamic decompensation in patients with intermediate-risk PE, but this is obtained without a decrease in overall mortality and with a significant increase in major extracranial and intracranial bleeding. In patients with high-intermediate-risk PE, thrombolytic therapy should be given in case of hemodynamic worsening. Vena cava filters are of little help when anticoagulant treatment is not contraindicated, even in patients with PE and features of clinical severity. Finally, direct oral anticoagulants have been shown to be as effective as and safer than the combination of low molecular weight heparin and vitamin K antagonist(s) in patients with venous thromboembolism and low- to intermediate-risk PE. KEYWORDS: Pulmonary embolism; Right ventricle; Risk stratification; Thrombolysis  PDF Prevalencia de TVP en pacientes agudos ambulatorios admitidos en UCI no quirúrgica Prevalence of deep vein thrombosis in acutely admitted ambulatory non-surgical intensive care unit patients. Lawall H, Oberacker R, Zemmrich C, Bramlage P, Diehm C, Schellong SM. BMC Res Notes. 2014 Jul 5;7:431. doi: 10.1186/1756-0500-7-431. Abstract BACKGROUND: Data on prevalence rates of venous thromboembolism (VTE) in different patient populations are scarce. Most studies on this topic focus on older patients or patients with malignancies, immobilization or thrombophilia. Less is known about the VTE risk profile of non-surgical patients presenting with a variety of medical diseases of differing severity. Aim of the present study was to investigate VTE prevalence in a pospective cohort study of ambulatory medical intensive care unit patients within 24 h after acute admission. METHODS: Prospective cohort study of 102 consecutive patients after acute admission to medical intensive care unit. Ultrasound compression sonography, APACHE-II-Scoring and laboratory examination was performed within 24 hours after admission.Possible determinants of a high risk of VTE were examined. In all patients with a confirmed diagnosis of DVT or suspicion of PE thoracic computer tomography (CT) was performed. RESULTS: VTE was found in 7.8% out of 102 of patients, mean APACHE-II-Score was 14 (mortality risk of about 15%). Thrombus location was femoropopliteal in 5 patients, iliacal in 2 and peroneal in 1 patient. Five VTE patients had concomitant PE (62.5% of VTE, 4.9% of all patients). No predictors of prevalent VTE were identified from univariable regression analysis although relative risk was high in patients with a history of smoking (RR 3.40), immobility (RR 2.50), and elevated D-Dimer levels (RR 3.49). CONCLUSIONS: Prevalent VTE and concomitant PE were frequent in acutely admitted ICU patients. PDF

Anestesiología y Medicina del Dolor 52 664 6848905 vwhizar@anestesia-dolor.org anestesia-dolor.org Copyright © 2015

Libro de cirugía / Book on surgery

Marzo 12, 2016. No. 2263

Cirugía esencial: Prioridades de Control de Enfermedades, tercera edición Essential Surgery: Disease Control Priorities, Third Edition Debas HT, Donkor P, Gawande A, et al., editors April 2015 Libro / Book

Anestesiología y Medicina del Dolor 52 664 6848905 vwhizar@anestesia-dolor.org anestesia-dolor.org Copyright © 2015

Bibliotecas. Noticias

bibliotecas
Notificaciones diarias ⋅ 13 de marzo de 2016
NOTICIAS


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ileon.com - Información de León
El Consejo de Cooperación Bibliotecaria se apoya en la Consejería de Cultura y Turismo para ...
ileon.com - Información de León
El Consejo de Cooperación Bibliotecaria se apoya en la Consejería de Cultura y Turismo para desarrollar la función social de las bibliotecas.
Cultura apoya al Consejo de Cooperación Bibliotecaria nacional en su función social -leonoticias.com
El Consejo de Cooperación se apoya en Cultura y Turismo para crear la función social de las ... - desdeSoria.es
Cobertura total de la noticia



Cultura apoya al Consejo de Cooperación Bibliotecaria para desarrollar su función social
leonoticias.com
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eLiburutegia, la opción de leer en formato digital de la Biblioteca
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eLiburutegia, la biblioteca digital de Euskadi, es el servicio de préstamo online de libros digitales creada y puesta en marcha por el Gobierno Vasco ...




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El Consejo de Cooperación Bibliotecaria se constituye en marzo de 2008 en las XII Jornadas de Cooperación Bibliotecaria donde se inicia la ...