Medicina intensiva
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Despite low mortality in patients undergoing major abdominal surgery, the number of high-risk patients is increasing and has become a health problem. At present, surgery is understood as a continuous process, in which numerous guidelines added to less invasive techniques offering a lesser physiological impact upon patients with serious comorbidities are responsible for the final outcome. The prevention, identification and early treatment of complications prove as important as the preoperative or surgical technique.?The introduction of ERAS (enhanced recovery after surgery) protocols is the cornerstone for the management of these patients, and is advocated by most surgical societies for reducing mortality, length of hospital stay and hospital costs. The postoperative management of these patients in postsurgery Intensive Care Units guarantees effectiveness and efficiency in maintaining optimum patient care.
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A narrative review is presented on the diagnosis, treatment and management of accidental hypothermia. Although all these processes form a continuum, for descriptive purposes in this manuscript the recommendations are organized into the prehospital and in-hospital settings. ⋯ Extracorporeal life support has revolutionized rewarming of the hemodynamically unstable victim or patients suffering cardiac arrest, with survival rates of up to 100%. The new evidences indicate that the management of accidental hypothermia has evolved favorably, with substantial improvement of the final outcomes.
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Immunotherapy seeks to harness the power of the immune system to eradicate malignant tissues. Despite impressive therapeutic success, however, it can be accompanied by severe adverse effects such as cytokine release syndrome (CRS). These therapies cause the release of a great amount of cytokines, with IL-6 playing a central role, that can potentially lead to multiple organ dysfunction. ⋯ Despite possible concerns about the admission of such patients (mainly with advanced oncological disease), we consider that the Intensive Care Unit should remain an option, since these individuals present a potentially reversible drug-related adverse event and are being treated with a new drug that could change the prognosis of the disorder. Intensive care medicine will become a key component in the management of the complications of modern cancer therapies, dealing with patients presenting an overactive immune system producing organ dysfunction while also trying to maintain treatment efficacy. This is the new paradigm.
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Intensive care is an ideal environment for the use of Big Data Analysis (BDA) and Machine Learning (ML), due to the huge amount of information processed and stored in electronic format in relation to such care. These tools can improve our clinical research capabilities and clinical decision making in the future. The present study reviews the foundations of BDA and ML, and explores possible applications in our field from a clinical viewpoint. We also suggest potential strategies to optimize these new technologies and describe a new kind of hybrid healthcare-data science professional with a linking role between clinicians and data.
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Surgery represents one of the main therapeutic references in the world, affording greater survival and life expectancy for many patients. In general, the estimated postoperative mortality is low (around 1-4%). Thirteen percent of the surgical procedures have a high risk of complications, accounting for 80% of all postoperative deaths. ⋯ Institutional policies are required to ensure the detection of patients at risk in hospitalization wards, with early admission to the ICU of those patients in whom admission is indicated, adapting the treatment in the ICU and optimizing the criteria for discharge. The detection and prevention of post-ICU syndrome in patients and relatives, and the follow-up of ICU discharge and hospitalization in a multidisciplinary manner can reduce the sequelae among critical surgical patients, improving the outcomes and quality of life, and restoring the patient to society. In future publications of this series directed to the surgical patient, updates will be provided on the perioperative management of some of the most complex surgeries.