Medicina intensiva
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A compartment syndrome exists when increased pressure in a closed anatomic space threatens the viability of the tissue within the compartment. When this occurs in the abdominal cavity it threatens not only the function of the intra-abdominal organs, but it can have a devastating effect on distant organs as well. ⋯ It is only recently that this condition received a heightened awareness. This article reflects the current state of knowledge on intra-abdominal pressure regarding etiology, epidemiology, diagnosis, IAP measurement, organ dysfunction, prevention and treatment.
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Ventilator-induced lung injury (VILI) is associated to a high rate of mortality with an important social impact. Mechanical ventilation induces structural and ultrastructural alterations in all cell types of the lung and can derive in the transduction of intracellular signals, as well as in changes in the expression of genes, a process known as mechanotransduction. ⋯ VILI can be modulated by means of diverse interventions as the use of protective ventilatory modes, therapeutic approaches based on vasoactive and antioxidative drugs, and more recently treatments based on the use of repairing substances of the surfactant like poloxamers among others. Knowledge of the mechanisms involved in VILI is definitive for a better approach to this condition.
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Pseudomonas aeruginosa is a pathogen commonly encountered in clinical practice in critically ill patients. It is a serious cause of infection, associated with a high rate of morbidity and mortality. Inappropriate antimicrobial therapy and delay in starting effective antimicrobial therapy is associated with worse prognostic. ⋯ This combination therapy must be changed to monotherapy on the basis on the specific susceptibility pattern of the initial isolate. In cases without microbiological diagnosis and poor outcome, combination therapy will be maintained and other causes of infection will be studied. Multicentre prospective randomized trials in critically ill patients are needed to determine which antimicrobials combinations improve outcome in Pseudomonas infections.