Medicina intensiva
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To elaborate a working document to describe the professional competence (knowledge, skills, and attitudes) required of a physician for the care of critical patients, regardless of the physician's specialty and centered on the patients' needs. ⋯ This study can help to ensure that critical patients will be cared for by physicians capable of identifying their problems and managing them appropriately, regardless of the physicians' specialty background. In responding to this situation, the document recognizes the participation of physicians trained in diverse specialties in the care of the critical patient by scaling the knowledge required at different levels of care.
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Metformin is a biguanide used in the treatment of obese adults with type 2 diabetes mellitus; metformin decreases mortality by 36% in comparison to conventional treatment. Metformin administration has certain contraindications that, when ignored, especially in the case of acute renal insufficiency, leads to the accumulation of the drug and consequent lactic acidosis that can be fatal. ⋯ Two patients died after cardiac arrest that could have been avoided. In conclusion, lactic acidosis appearing during metformin treatment for diabetes requires rapid diagnosis and treatment to enable the drug to be withdrawn and prolonged continuous hemofiltration or hemodialysis with bicarbonate to be initiated.
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The interruption of a randomized clinical trial when the experimental treatment is clearly superior is an ethical obligation. However, performing multiple intermin statistical analyses and the early interruption of the trial increase the possibility of alpha error, favor the overestimation of the effect, and facilitate the introduction of ineffective therapies data monitoring. ⋯ This underlines the need for truly independent data monitoring committees and recommends the use of predefined restrictive rules for the interruption of a trial. Furthermore, clinicians should provide themselves with an adequate dose of skepticism and critical reading skills to enable them to explore some key aspects of these studies.
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Review Meta Analysis Comparative Study
[High PEEP vs. conventional PEEP in the acute respiratory distress syndrome: a systematic review and meta-analysis].
To perform a systematic review and meta-analysis of the literature to evaluate the effects of high PEEP versus conventional PEEP on mortality and on the risk of barotrauma in patients with the acute respiratory distress syndrome (ARDS). ⋯ The use of high or conventional PEEP in function of oxygenation does not affect mortality or the incidence of barotrauma in patients with ARDS. However, there might be a decrease in mortality associated to high PEEP individualized in function of the pulmonary mechanics of each patient.
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Review
[Applications of transcranial color-coded duplex sonography in monitoring neurocritical patients].
Transcranial sonography is a common tool for monitoring neurocritical patients. Transcranial color-coded duplex ultrasonography enables hemodynamic and structural study of the cerebral parenchyma in these patients. ⋯ The use of ultrasonographic contrast agents enables conclusive findings in practically 100% of cases and allows cerebral perfusion to be studied at the bedside using semiquantitative methods. This review aims to show the applications of transcranial color-coded duplex ultrasonography for monitoring neurocritical patients in intensive care units.