Medicina intensiva
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Among the most severe complications caused by the influenza A virus H1N1 pandemic is the Acute Respiratory Distress Syndrome (ARDS). The main objective of this study was to assess mortality after applying a strict protocol of ventilatory management and to describe the clinical characteristics of the patients. ⋯ After applying a strict management protocol for ventilatory management, mortality in this patient group was 16.6. We also stress that obesity and early renal failure were independent risk factors for mortality.
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Statins are becoming one of the drugs used most for cardiovascular prevention. Given the age of the patients admitted to the intensive medicine units, many of them receive previous treatment with statins. ⋯ However, the existing studies support the hypothesis that withdrawing statins has a clear harmful effect. Thus, the withdrawal of statins after admission to an intensive medicine unit should be carefully evaluated.
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Review
[Stress hyperglycemia and its control with insulin in critically ill patients: current evidence].
To analyze the current evidence on glycemic control with insulin therapy in the critically ill. ⋯ Stress hyperglycemia in critically ill patients has been associated with increased morbidity and mortality. Furthermore, current evidence suggests that glucose variability has a predictive value for hospital mortality. Initially, the Leuven studies showed that intensive insulin therapy was capable of reducing the mortality among surgical and medical ICU patients. Nevertheless, this strategy significantly increases the incidence of severe hypoglycemia. Three important trials on glucose control have been published recently: the VISEP, the Glucontrol study and the NICE-SUGAR. They have shown that strict control of glycemia is associated with a higher incidence of mortality and severe hypoglycemia. Furthermore, according to a recent meta-analysis, intensive insulin therapy may be beneficial for patients admitted to a surgical ICU. Further studies should be able to address some queries about these results on glycemic control in the critically ill.