VAD y videolaringoscopios / Difficult airway and videolaringoscopes

Mayo 14, 2016. No. 2326

Comparación del video laringoscopio C-MAC con fibroscopio flexible para intubación con inmovilización de columna cervical Comparison of the C-MAC video laryngoscope to a flexible fiberoptic scope for intubation with cervical spine immobilization Roya Yumul MD, PhD (Professor)a , Ofelia L. Elvir-Lazo MD (Clinical Research Coordinator)a , Paul F. White PhD, MD, FANZCA (Professor)a,b, et al Journal of Clinical Anesthesia (2016) 31, 46-52 PDF Comparación del laringoscopio C-Mac con el vídeolaringoscopio McGrath serie 5 en vía aérea extremadamente difícil Comparison of the C-Mac video laryngoscope with the McGrath Series 5 video laryngoscope concerning an extremely difficult airway. Gaszyński T. Anaesthesiol Intensive Ther. 2016;48(1):55-7. doi: 10.5603/AIT.2016.0007. PDF  Comparación de los videolaringoscopios C-MAC y GlideScope en pacientes con enfermedades e inmovilización de la columna cervical Comparison of the C-MAC(®) and GlideScope(®) videolaryngoscopes in patients with cervical spine disorders and immobilisation. Brück S1, Trautner H, Wolff A, Hain J, Mols G, Pakos P, Roewer N, Lange M. Anaesthesia. 2015 Feb;70(2):160-5. doi: 10.1111/anae.12858. Epub 2014 Sep 29. PDF VIII Foro Internacional de Medicina del Dolor y Paliativa  Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán Junio 9-11, Ciudad de México Dra. Argelia Lara Solares Tel. 5513 3782  www.dolorypaliativos.org

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Trauma y coagulopatía / Coagulopathy following trauma

Mayo 19, 2016. No. 2331

Guías Europeas del manejo de sangrado mayor y coagulopatía después de trauma: Cuarta edición The European guideline on management of major bleeding and coagulopathy following trauma: fourth edition. Rossaint R1, Bouillon B2, Cerny V3,4,5,6, Coats TJ7, Duranteau J8, Fernández-Mondéjar E9, Filipescu D10, Hunt BJ11, Komadina R12, Nardi G13,Neugebauer EA14, Ozier Y15, Riddez L16, Schultz A17, Vincent JL18, Spahn DR19. Crit Care. 2016 Apr 12;20(1):100. doi: 10.1186/s13054-016-1265-x. Abstract BACKGROUND: Severe trauma continues to represent a global public health issue and mortality and morbidity in trauma patients remains substantial. A number of initiatives have aimed to provide guidance on the management of trauma patients. This document focuses on themanagement of major bleeding and coagulopathy following trauma and encourages adaptation of the guiding principles to each local situation and implementation within each institution. METHODS: The pan-European, multidisciplinary Task Force for Advanced Bleeding Care in Trauma was founded in 2004 and included representatives of six relevant European professional societies. The group used a structured, evidence-based consensus approach to address scientific queries that served as the basis for each recommendation and supporting rationale. Expert opinion and current clinical practice were also considered, particularly in areas in which randomised clinical trials have not or cannot be performed. Existing recommendations were reconsidered and revised based on new scientific evidence and observed shifts in clinical practice; new recommendations were formulated to reflect current clinical concerns and areas in which new research data have been generated. This guideline represents the fourth edition of a document first published in 2007 and updated in 2010 and 2013. RESULTS: The guideline now recommends that patients be transferred directly to an appropriate trauma treatment centre and encourages use of a restricted volume replacement strategy during initial resuscitation. Best-practice use of blood products during further resuscitation continues to evolve and should be guided by a goal-directed strategy. The identification and management of patients pre-treated with anticoagulant agents continues to pose a real challenge, despite accumulating experience and awareness. The present guideline should be viewed as an educational aid to improve and standardise the care of the bleeding trauma patients across Europe and beyond. This document may also serve as a basis for local implementation. Furthermore, local quality and safety management systems need to be established to specifically assess key measures of bleeding control and outcome. CONCLUSIONS: A multidisciplinary approach and adherence to evidence-based guidance are key to improving patient outcomes. The implementation of locally adapted treatment algorithms should strive to achieve measureable improvements in patient outcome. PDF Respuesta inflamatoria al trauma: Implicaciones para la coagulación y la resucitación Inflammatory response to trauma: implications for coagulation and resuscitation. Pierce A1, Pittet JF. Author information Curr Opin Anaesthesiol. 2014 Apr;27(2):246-52. doi: 10.1097/ACO.0000000000000047. Abstract PURPOSE OF REVIEW: Recent studies have changed our understanding of the timing and interactions of the inflammatory processes andcoagulation cascade following severe trauma. This review highlights this information and correlates its impact on the current clinical approach for fluid resuscitation and treatment of coagulopathy for trauma patients. RECENT FINDINGS: Severe trauma is associated with a failure of multiple biologic emergency response systems that includes imbalanced inflammatory response, acute coagulopathy of trauma, and endovascular glycocalyx degradation with microcirculatory compromise. These abnormalities are all interlinked and related. Recent observations show that after severe trauma: proinflammatory and anti-inflammatory responses are concomitant, not sequential and resolution of the inflammatory response is an active process, not a passive one. Understanding these interrelated processes is considered extremely important for the development of future therapies for severe trauma in humans. SUMMARY: Traumatic injuries continue to be a significant cause of mortality worldwide. Recent advances in understanding the mechanisms of end-organ failure, and modulation of the inflammatory response has important clinical implications regarding fluid resuscitation and treatment of coagulopathy. PDF  VIII Foro Internacional de Medicina del Dolor y Paliativa  Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán Junio 9-11, Ciudad de México Dra. Argelia Lara Solares Tel. 5513 3782  www.dolorypaliativos.org

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Sedación en daño cerebral agudo / Sedation in acute brain damage

Mayo 25, 2016. No. 2337

Optimizando sedación en los pacientes con daño cerebral agudo Optimizing sedation in patients with acute brain injury. Oddo M1,2, Crippa IA3,4,5, Mehta S6, Menon D7, Payen JF8, Taccone FS5, Citerio G3,4. Crit Care. 2016 May 5;20(1):128. doi: 10.1186/s13054-016-1294-5. Abstract Daily interruption of sedative therapy and limitation of deep sedation have been shown in several randomized trials to reduce the duration of mechanical ventilation and hospital length of stay, and to improve the outcome of critically ill patients. However, patients with severe acute brain injury (ABI; including subjects with coma after traumatic brain injury, ischaemic/haemorrhagic stroke, cardiac arrest, status epilepticus) were excluded from these studies. Therefore, whether the new paradigm of minimal sedation can be translated to the neuro-ICU (NICU) is unclear. In patients with ABI, sedation has 'general' indications (control of anxiety, pain, discomfort, agitation, facilitation of mechanical ventilation) and 'neuro-specific' indications (reduction of cerebral metabolic demand, improved brain tolerance to ischaemia). Sedation also is an essential therapeutic component of intracranial pressure therapy, targeted temperature management and seizure control. Given the lack of large trials which have evaluated clinically relevant endpoints, sedative selection depends on the effect of each agent on cerebral and systemic haemodynamics. Titration and withdrawal of sedation in the NICU setting has to be balanced between the risk that interrupting sedation might exacerbate brain injury (e.g. intracranial pressure elevation) and the potential benefits of enhanced neurological function and reduced complications. In this review, we provide a concise summary of cerebral physiologic effects of sedatives and analgesics, the advantages/disadvantages of each agent, the comparative effects of standard sedatives (propofol and midazolam) and the emerging role of alternative drugs (ketamine). We suggest a pragmatic approach for the use of sedation-analgesia in the NICU, focusing on some practical aspects, including optimal titration and management of sedation withdrawal according to ABI severity. PDF VIII Foro Internacional de Medicina del Dolor y Paliativa  Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán Junio 9-11, Ciudad de México Dra. Argelia Lara Solares Tel. 5513 3782  www.dolorypaliativos.org  Cursos de Anestesiología en Chile, 2016 Facultad de Medicina. Pontificia Universidad Católica de Chile Información

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