Medicina intensiva
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To determine if gender and age are associated with differences in mortality in patients requiring critical care. ⋯ No significant differences were demonstrated in the outcome in relationship with gender except for in the coronary group in which mortality was greater in women. Age above or below 65 years had no influence on mortality in our patients.
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A systematic revision of medical publications between 2006 and 2008 regarding bacterial infections that affect the critical patients was performed. Four subjects were selected: Community-acquired pneumonia, ventilator-associated pneumonia, catheter-related bloodstream infection and new antimicrobial treatments. When dealing with community-acquired pneumonia and due to the absence of completely reliable standards, it is necessary to follow the locally adapted guidelines of clinical practice, to identify patients related to the health-care system and admit patients to the ICU in accordance with the criteria. ⋯ The empirical treatment of catheter-related bacteremia must be directed towards the most probable pathogens according to the puncture site. The most recently sold antibiotics are basically directed towards multidrug gram positive resistant bacteria. However, for the treatment of gram negative resistant bacilli, the use of the new antimicrobials must be combined with a new evaluation of the antibiotics that have been used for years and the possibility of choosing different administration forms.
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Acquired brain injury (ABI) is a major public health problem due to its high incidence and prevalence, long-term effects on patients and their families and enormous socioeconomical costs. In our country, this is treated unequally by the different institutions and specialties. Its etiology, by order of incidence, is due to stroke, traumatic brain injury and anoxic-ischemic encephalopathy and then, at a great distance, a miscellaneous group in which hypoxic encephalopathy stands out. ⋯ The International Classification of Impairments, Disabilities and Handicaps (ICIDH-2) describes disabilities and impairments. The efficacy of rehabilitation treatment depends on the how early they are done, their adaptation to each patient's needs, intensity and performance by qualified rehabilitation centers. It is difficult to quantify their results in order to compare them because of the serious methodological difficulties.
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Brain death has been recognized by the scientific community as the person's death, and accepted in the legislation of different countries. Brain death is defined as the irreversible ending of the functions of all the intracranial neurological structure in both the brain and brain stem. This clinical situation appears when intracranial pressure exceeds the patient's systolic blood pressure, leading to brain circulatory arrest. ⋯ More than 92% of the transplants performed in Spain are performed with brain death donor organs. Brain death confirmation is a high responsibility act, with medical, ethical and legal significance since it requires removal of all artificial support, or organs extraction for transplant. Extensive knowledge on its diagnostic and correct decision making avoid unnecessary use of resources and improves management of organs for transplant.