Medicina intensiva
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Practice Guideline
[GEIPC-SEIMC and GTEI-SEMICYUC recommendations for antibiotic treatment of gram positive coccal infections in the critical patient].
In recent years, an increment of infections caused by gram-positive cocci has been documented in nosocomial and hospital-acquired infections. In diverse countries, a rapid development of resistance to common antibiotics against gram-positive cocci has been observed. This situation is exceptional in Spain but our country might be affected in the near future. ⋯ It is essential to improve our current knowledge about pharmacokinetic properties of traditional and new antimicrobials to maximize its effectiveness and to minimize toxicity. These issues are even more important in critically ill patients because inadequate empirical therapy is associated with therapeutic failure and a poor outcome. Experts representing two scientific societies (Grupo de estudio de Infecciones en el Paciente Critico de la SEIMC and Grupo de trabajo de Enfermedades Infecciosas de la SEMICYUC) have elaborated a consensus document based on the current scientific evidence to summarize recommendations for the treatment of serious infections caused by gram-positive cocci in critically ill patients.
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To determine whether the usual mortality prediction systems (APACHE and SAPS) can be complemented by cranial computed tomography (CT) brain herniation findings in patients with structural neurological involvement. ⋯ In critical care patients with structural neurological involvement, cranial CT signs of subfalcial herniation complement the prognostic information given by the usual severity indexes.
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The incidence of neurological complications after cardiac surgery continues to be elevated, although this is variable in the different studies published, fundamentally because of the different populations studied and the different definitions of neurological dysfunction. The etiology of these alterations is attributed to a multifactorial origin, aortic artherosclerosis, cerebral hypoperfusion and inflammatory phenomenon secondary to the technique. ⋯ Having knowledge of the risk markers and understanding the pathogenesis is important to try to plan strategies that may minimize the appearance and development of these complications and contribute to the decrease of their serious consequences. The data and the experience obtained by our group are shown at the end of the review.
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Review
[Effectiveness and safety of triple antiaggregation in patients undergoing coronary intervention].
To evaluate glycoprotein IIb/IIIa inhibitors (GPIIb/IIIa inhibitors) effectiveness and safety in patients with non-ST segment elevation acute coronary syndrome (NSTEACS) or stable coronary disease referred for percutaneous coronary revascularization pre-treated with aspirin and thienopyridines by means of a systematic review. ⋯ Use of GPIIb/IIIa inhibitors reduces the risk of adverse cardiac events in NSTEACS patients pre-treated with aspirin and thienopyridines but increases the risk of severe bleeding and thrombocytopenia. Its utilization in stable coronary patients does not seem justified.
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The concept of continuity of care by intensivists as an element of quality control in the medical care of Intensive Care Unit (ICU) patients surviving multiple organ dysfunction syndrome has led to a rethinking of the ICU model in recent years. We discuss the rationale to design and implement a hospital-based, prospective, randomized, multicenter Intervention/Control study in order to estimate the impact of an interdisciplinary intervention during the post-ICU recovery phase on medium-term medical outcomes in ICU patients with multiple organ dysfunction.