Medicina intensiva
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Spain has a rate of 34.4 donors per million population, making it the country with the highest rate of organ donation all over the world. In spite of these values, need of lungs for transplantation is always greater than the number of organs obtained. ⋯ In all the potential lung donors, the Apnea Test with CPAP should be done and the criteria for the donation of the lung under ideal conditions and with expanded criteria lung donors are reviewed. The protocol of aggressive maintenance including a protective ventilation strategy, restricted fluid intake, use of prophylactic antibiotics, corticosteroids and the systematic use of measures aimed at avoiding alveolar collapse together with maneuvers aimed at achieving better lung recruitment can improve the management of the lung donor and obtain a greater number of organs for transplantation.
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Less than 10% of those individuals who suffer an episode of sudden cardiac arrest are successfully resuscitated and return home to live productive lives. New approaches to cardiac resuscitation could substantially improve such dismal outcome. Four current trends that have the greatest potential for improving outcome can be recognized in cardiopulmonary resuscitation (CPR): (1) systems to prevent cardiac arrests through recognition of early warning signs and timely intervention, (2) a shift towards a flow-based resuscitation emphasizing the delivery of high-quality uninterrupted CPR limiting the role of ventilation, (3) the growing role of technology in driving resuscitation interventions, incrementally enhancing the human decision-making process, and (4) the use of hypothermia.
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Traumatic brain injury (TBI) is an important reason of morbidity-mortality all over the world, affecting young males more and generating Public Health problem. Unfortunately, the advances in the pathophysiology knowledge have not followed a similar development in therapeutic options, there currently not being any contrasted neuroprotectants. In this article, we have reviewed the epidemiology, pathophysiology and therapeutic measures used in the management of patient with severe TBI. The general measures as well as those aimed at controlling intracranial hypertension, the role of the surgery and some more innovative therapeutic options currently under evaluation in these patients are analyzed.
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Review Case Reports
[Late amniotic fluid embolism among the diferential diagnosis of acute respiratory failure in the postpartum: case report and review].
The amniotic fluid embolism is an uncommon condition with a high mortality. The cardinal symptoms are hypoxia, hypotension, altered mental status and disseminated intravascular coagulation. ⋯ We describe a case of a primigravida who, after an uneventful delivery, suffers an acute respiratory failure in the late postpartum period. Exclusion of other causes of acute respiratory failure occurring during delivery or in the postpartum period led to establish the diagnosis.
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Neurally adjusted ventilatory assist (NAVA) is a new mode of assisted mechanical ventilation that uses the signal obtained from diaphragmatic electrical activity (Edi) to control the mechanical ventilator. Edi directly represents the central respiratory drive and reflects the length and intensity of the patient's neural effort. ⋯ During inspiration, the pressure delivered is proportional to the Edi and the inspiratory pressure assist ceases when the neural activation of the diaphragm starts to decline after reaching the inspiratory maximum value. NAVA is a new conceptual approach to mechanical ventilation that can significantly improve patient-ventilator interaction and optimize the level of effective respiratory muscle unloading during assisted mechanical ventilation.