Medicina intensiva
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Meta Analysis
[Thrombolysis in acute ischemic stroke in centers lacking a stroke unit: referral to reference center or on-site treatment?].
To assess the clinical impact of on-site thrombolysis versus referral to another hospital in patients with ischemic stroke attended in a hospital lacking a stroke unit. ⋯ The available evidence does not support the recommendations of the national stroke strategy or some regional plans that discourage the administration of thrombolysis in hospitals without stroke units.
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Multicenter Study
[ECAIS study: inadvertent cardiovascular adverse events in sepsis].
To describe the incidence of cardiovascular adverse events in patients with sepsis in its various stages. ⋯ In this study patients with sepsis showed a low incidence of cardiovascular ischemic events. In contrast, arrhythmic events showed a high incidence. Conventional monitoring failed to detect any of the ischemic events and most arrhythmic events. In this study, cardiovascular events generated by adrenergic discharge had no impact upon mortality.
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Cardiovascular failure is a common disorder in critical care medicine. When admitted to the ICU, patients with hemodynamic deterioration should be examined rapidly to correctly assess the main determinants of cardiovascular function (preload, afterload and contractility). This review examines the assessment of contractility and afterload involving the combined use of several hemodynamic monitors, which allows different approaches to the same problem, with a view to improving the efficiency of management and treatment in critically ill patients.
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To determine whether the alveolar-arterial oxygen gradient (Grad[A-a]O₂) helps confirm the influence of PEEP on PaFi (PaO₂/FiO₂). ⋯ By adding PEEP to the PaFi model (PaFip), we clearly improve the latter, as reflected by a better goodness of fit.
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To describe the incidence and main clinical characteristics of barotrauma during open lung ventilation (OLV). ⋯ Barotrauma was an exclusive complication of patients with primary lung injury, and the incidence in this group was high. In most cases, there were only radiological findings without clinical significance that did not require the suspension of OLV. Barotrauma was neither related to high pressures and volumes nor associated with increased mortality.