Medicina intensiva
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Understanding the information provided to families and surrogates of the critically ill patients admitted to ICUs and its adequate communication without contradictions, is a fundamental aspect related with the possible participation of these persons in the treatment decision making and with the quality perceived regarding the care process. Our aim in this study is to assess these two aspects (information and communication of information). ⋯ The analysis of the questionnaire reveals the great heterogeneity of the contents and modes of information provided. This may cause difficulties in understanding and the integration of families and relatives in the care process. The agreement achieved among the different between physicians to facilitate the information and avoid subjective interpretations by the informed people is presented.
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Induced hypothermia in neurocritical patients is one of the most promising neuroprotective therapies in the last decade. Unfortunately, the promising results obtained in experimental studies have had an unequal reflection in the different diseases that affect the neurocritical patient. The use of therapeutic hypothermia is clearly established in patients with neurological deterioration after cardiac arrest. ⋯ Induced hypothermia has a role in the intensive care unit. Critical care physicians should be familiar with the physiologic effects, current indications, techniques, and complications of induced hypothermia. This review elaborates on the clinical implications of hypothermia research in traumatic brain injury, anoxic, brain injury, stroke and intracerebral hemorrhage.
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A 34-year old woman who developed persistent and severe acute respiratory distress syndrome with underlying myelomonocytic leukemia (M4FAB) is described. After ruling out the most common causes of pulmonary infiltration in this type of patient and one week of broad spectrum antibiotics and steroids therapy, we proposed leukemic pulmonary infiltration as etiological diagnosis. ⋯ The method, arterial blood gases, hemodynamic parameters and ventilatory mechanics before and after its use are described. The patient remained on P-ELA for nine days; one week later she was extubated and ten days after she was discharged from the Intensive Care Unit the patient left the hospital in good health condition.