Revisiones_bibliográficas TyO

Ann Transl Med. 2017 Jul;5(14):291. doi: 10.21037/atm.2017.07.19.

Abstract

Mechanical ventilation (MV) is the cornerstone of acute respiratory distress syndrome (ARDS) management. The use of protective ventilation is a priority in this acute phase of lung inflammation. Neuromuscular blocking agents (NMBAs) induce reversible muscle paralysis. Their use in patients with ARDS remains controversial but occurs frequently. NMBAs are used in 25-45% of ARDS patients for a mean period of 1±2 days. The main indications of NMBAs are hypoxemia and facilitation of MV. For ethical reasons, NMBA use is inseparable from sedation in the management of early ARDS. During paralysis, sedation monitoring seems to be necessary to avoid awareness with recall. Three randomized controlled trials (RCTs) have demonstrated that the systematic use of NMBAs in the early management of ARDS patients improves oxygenation. Furthermore, the most recent trial reported a reduction of mortality at 90 days when NMBAs were infused over 48 hours. Spontaneous ventilation (SV) during MV at the acute phase of ARDS could improve oxygenation and alveolar recruitment, but it may not allow protective ventilation. The major risk is an increase in ventilator-induced lung injury. However, the adverse effects of NMBAs are widely discussed, particularly the occurrence of intensive care unit (ICU)-acquired weakness. This review analyses the recent findings in the literature concerning sedation and paralysis in managing ARDS.

KEYWORDS: Acute respiratory distress syndrome (ARDS); muscle paralysis; neuromuscular blocking agent (NMBA); protective ventilation; sedation; spontaneous breathing; transpulmonary pressure

LI Congreso Mexicano de Anestesiología

Mérida Yucatán, Noviembre 21-25, 2017

International Anesthesia Research Society Annuals Meetings

USA

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17h World Congress of Anaesthesiologists, WFSA

Prague, Czech Republic, Sep 6-11, 2020

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http://www.lesionesdeportivas.com.mx/academia/actividad-fisica-y-deporte-lo-bueno-y-lo-malo-hospital-angeles-metropolitano/

Actividad Física y Deporte: Lo bueno y lo malo. Hospital Ángeles Metropolitano

El hospital Ángeles Metropolitano, la división de educación médica, invita a asistir a su sesión general el día 15 de noviembre a las 13:00 horas en el auditorio del hospital.
Ponentes:
Dr. Michell Ruiz Suarez
Dr. César Ernesto Millán Osuna
Dr. Roberto Porras González

Coordinador:
Dr. Antonio César Miguel Lara

Interacciones corazón-pulmón durante ventilación mecánica / Heart-lung interactions during mechanical ventilation.

Noviembre 13, 2017. No. 2901

Conceptos básicos de las interacciones corazón-pulmón durante la ventilación mecánica.

Los pacientes críticamente enfermos con la necesidad de ventilación mecánica muestran interacciones complejas entre la fisiología respiratoria y cardiovascular. Estas interacciones son importantes ya que pueden guiar las decisiones terapéuticas del médico y, posiblemente, afectar el resultado del paciente. El objetivo de la presente revisión es proporcionar al médico en ejercicio una visión general de los conceptos de las interacciones corazón-pulmón durante la ventilación mecánica. Resumimos la fisiología respiratoria y cardíaca básica durante la respiración espontánea y bajo ventilación mecánica. El foco principal está en la interacción entre la ventilación con presión positiva y sus efectos sobre la pre y poscarga del ventrículo derecho e izquierdo y la interdependencia ventricular. Además, discutimos diferentes modalidades para evaluar la capacidad de respuesta del volumen, como la variación de la presión del pulso. Nuestro objetivo es familiarizar al lector con los efectos secundarios cardiovasculares de la ventilación mecánica cuando experimenta problemas de destete o insuficiencia cardíaca derecha.

Basic concepts of heart-lung interactions during mechanical ventilation.

Grübler MR1, Wigger O1, Berger D2, Blöchlinger S3.

Swiss Med Wkly. 2017 Sep 25;147:w14491. doi: 10.4414/smw.2017.14491. eCollection 2017 Sep 25.

Abstract

Critically ill patients with the need for mechanical ventilation show complex interactions between respiratory and cardiovascular physiology. These interactions are important as they may guide the clinician's therapeutic decisions and, possibly, affect patient outcome. The aim of the present review is to provide the practicing physician with an overview of the concepts of heart-lung interactions during mechanical ventilation. We outline the basic cardiac and respiratory physiology during spontaneous breathing and under mechanical ventilation. The main focus is on the interaction between positive pressure ventilation and its effects on right and left ventricular pre- and afterload and ventricular interdependence. Further we discuss different modalities to assess volume responsiveness, such as pulse pressure variation. We aim to familiarise the reader with cardiovascular side effects of mechanical ventilation when experiencing weaning problems or right heart failure.

LI Congreso Mexicano de Anestesiología

Mérida Yucatán, Noviembre 21-25, 2017

International Anesthesia Research Society Annuals Meetings

USA

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17h World Congress of Anaesthesiologists, WFSA

Prague, Czech Republic, Sep 6-11, 2020

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Anestesiología y Medicina del Dolor

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http://www.mihombroycodo.com.mx/academia/anatomia-y-funcion-de-los-musculos-del-manguito-rotador/

jueves, 9 de noviembre de 2017

Anatomía y función de los músculos del manguito rotador

Anatomy and function of Rotator Cuff Muscles

Fuente

Este artículo y/o video es originalmente publicado en:

https://youtu.be/O3hZ5tscM00

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Courtesy: Prof Nabil Ebraheim, University of Toledo, Ohio, USA

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miércoles, 8 de noviembre de 2017

Paro cardiaco / Cardiac arrest

Noviembre 5, 2017. No. 2893

Epinefrina en el paro cardíaco fuera del hospital: ¿Útil o perjudicial?

Epinephrine in Out-of-hospital Cardiac Arrest: Helpful or Harmful?

Shao H1, Li CS1.

Chin Med J (Engl). 2017 Sep 5;130(17):2112-2116. doi: 10.4103/0366-6999.213429.

Abstract

OBJECTIVE: Epinephrine is the primary drug administered during cardiopulmonary resuscitation (CPR) to reverse cardiac arrest. The evidence for the use of adrenaline in out-of-hospital cardiac arrest (OHCA) and in-hospital resuscitation is inconclusive. We conducted a systematic review on the clinical efficacy of adrenaline in adult OHCA patients to evaluate whether epinephrine provides any overall benefit for patients. DATA SOURCES: The EMBASE and PubMed databases were searched with the key words "epinephrine," "cardiac arrest," and variations of these terms. STUDY SELECTION: Data from clinical randomized trials, meta-analyses, guidelines, and recent reviews were selected for review. RESULTS: Sudden cardiac arrest causes 544,000 deaths in China each year, with survival occurring in <1% of cases (compared with 12% in the United States). The American Heart Association recommends the use of epinephrine in patients with cardiac arrest, as part of advanced cardiac life support. There is a clear evidence of an association between epinephrine and increased return of spontaneous circulation (ROSC). However, there are conflicting results regarding long-term survival and functional recovery, particularly neurological outcome, after CPR. There is currently insufficient evidence to support or reject epinephrine administration during resuscitation. We believe that epinephrine may have a role in resuscitation, as administration of epinephrine during CPR increases the probability of restoring cardiac activity with pulses, which is an essential intermediate step toward long-term survival. CONCLUSIONS: The administration of adrenaline was associated with improved short-term survival (ROSC). However, it appears that the use of adrenaline is associated with no benefit on survival to hospital discharge or survival with favorable neurological outcome after OHCA, and it may have a harmful effect. Larger placebo-controlled, double-blind, randomized control trials are required to definitively establish the effect of epinephrine.

El papel del centro de despacho en la reanimación.

The role of dispatch in resuscitation.

Ng YY1, Leong SH2, Ong ME3,4.

Singapore Med J. 2017 Jul;58(7):449-452. doi: 10.11622/smedj.2017059.

Abstract

The role of the dispatch centre has increasingly become a focus of attention in cardiac arrest resuscitation. The dispatch centre is part of the first link in the chain of survival because without the initiation of early access, the rest of the chain is irrelevant. The influence of dispatch can also extend to the initiation of bystander cardiopulmonary resuscitation, early defibrillation and the rapid dispatch of emergency ambulances. The new International Liaison Committee on Resuscitation, the American Heart Association and, especially, the European ResuscitationCouncil 2015 guidelines have been increasing their emphasis on dispatch as the key to improving out-of-hospital cardiac arrest survival.

KEYWORDS: cardiopulmonary resuscitation; dispatcher-assisted CPR; primary safety access point; public access defibrillation; telephone CPR

LI Congreso Mexicano de Anestesiología

Mérida Yucatán, Noviembre 21-25, 2017

Anestesiología y Medicina del Dolor

52 664 6848905

Raquia continua en obstetricia / Continuous spinal anesthesia in obstetrics

Noviembre 8, 2017. No. 2896

Anestesia espinal continua para analgesia y anestesia obstétrica

Continuous Spinal Anesthesia for Obstetric Anesthesia and Analgesia.

Veličković I1, Pujic B2, Baysinger CW3, Baysinger CL4.

Front Med (Lausanne). 2017 Aug 15;4:133. doi: 10.3389/fmed.2017.00133. eCollection 2017.

Abstract

The widespread use of continuous spinal anesthesia (CSA) in obstetrics has been slow because of the high risk for post-dural puncture headache (PDPH) associated with epidural needles and catheters. New advances in equipment and technique have not significantly overcome this disadvantage. However, CSA offers an alternative to epidural anesthesia in morbidly obese women, women with severe cardiac disease, and patients with prior spinal surgery. It should be strongly considered in parturients who receive an accidental dural puncture with a large bore needle, on the basis of recent work suggesting significant reduction in PDPH when intrathecal catheters are used. Small doses of drug can be administered and extension of labor analgesia for emergency cesarean delivery may occur more rapidly compared to continuous epidural techniques.

KEYWORDS: intrathecal catheters; labor analgesia; neuraxial blockade; obstetric anesthesia; post-dural puncture headache; spinal catheters

LI Congreso Mexicano de Anestesiología

Mérida Yucatán, Noviembre 21-25, 2017

17h World Congress of Anaesthesiologists, WFSA

Prague, Czech Republic, Sep 6-11, 2020

Informes / Information

Anestesiología y Medicina del Dolor

52 664 6848905