Medicina intensiva
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In patients with acute respiratory distress syndrome, heterogeneity in filling of the lung parenchyma results in collapsed or distended lung areas. Protective ventilation strategies based on the use of low volumes have been shown to increase survival in this context. For opening the lung, and in addition to PEEP, recruitment maneuvers are used-this practice remaining the subject of debate. The present review offers an update on the alveolar recruitment techniques, considering the great variability that exists in the application of these maneuvers, and the different factors that influence the response to maneuvering.
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There exist profound differences in the training and professional duties of intensive care physicians and the way intensive care units are managed between the United States and Europe and particularly Spain. Some of the remarkable characteristics of intensive care medicine in the united states include the application process for residency, continuing evaluation during training, phased training with employability at every level, competency based training, scientific research as a core value during training and medical practice, and clinical activity reaching beyond the intensive care unit to include regular hospital wards and ambulatory clinics. The characteristics of intensive care units and the role of intensive care physicians are flexible and change according to the needs of the hospitals where they are located.
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Letter Case Reports
[Acute tolerance and opioid-induced hyperalgesia in a multi-operated patient].