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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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.
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There is a growing body of evidence that early management of patients with acute pancreatitis may alter the natural course of disease and improve outcomes of patients. The aim of this paper is to optimize the management of patients with acute pancreatitis during the first 72 h after hospital admission by proposing several clinical care pathways. ⋯ Further studies will need to assess whether the adoption of these pathway reduces mortality and morbidity in patients with acute pancreatitis. The previous SEMICYUC guidelines on management of patients with acute pancreatitis in Intensive Care will need to be revised to reflect the recent developments in the field.