Medicina intensiva
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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appearing during metformin treatment for diabetes requires rapid diagnosis and treatment to enable the drug to be withdrawn and prolonged continuous hemofiltration or hemodialysis with bicarbonate to be initiated.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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The two pillars of the appropriate management of patients with ST-elevation myocardial infarction (STEMI) are immediate access to defibrillation and early reperfusion. The Public Enterprise for Health Emergencies (EPES) and the Andalusian ARIAM (Analysis of the Delay in the Treatment of Acute Myocardial Infarction) Project aim to implement a common basic strategy that can be adapted to local situations in order to facilitate decision making about the treatment of these patients. ⋯ The consensus document establishes the following priorities: 1. To apply the set of general measures recommended for the care of STEMI patients strictly and appropriately 2. To foster the use of early reperfusion in as many patients as possible, promoting the extension of fibrinolysis outside of hospitals and referral to a center with facilities for primary percutaneous coronary intervention. 3. To monitor and evaluate the management of these patients, with special attention placed on outcome and safety.
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[Implementation and evaluation of a protocol for continuous insulin perfusion in critical patients].
To analyze the efficacy and safety of a protocol for the continuous infusion of insulin to maintain blood glucose levels between 100 and 140 mg/dl, evaluating the results by a method that takes all of the hours of treatment into consideration. ⋯ The protocol was safe and enabled adequate control of blood glucose levels. The analysis of all of the hours of treatment might provide more data than a simple study of the percentages of blood glucose measurements within the normal range and the mean blood glucose level.