Medicina intensiva
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Traumatic brain Injury (TBI) is a major public healthcare concern, affecting people of all ages. Despite advances in the diagnosis, monitoring and clinical management of TBI, many unresolved questions remain regarding its physiopathology. ⋯ In turn, each model represents a specific type of trauma and evaluates a specific physiopathological aspect of the cascade triggered as a result of TBI. This review describes the main experimental models currently available referred to TBI and their possible application to the clinical setting.
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The humanization of care emerges as a response to something that seems indisputable: the scientific and technological developments in Intensive Care Units. Such development has improved the care of the critically ill patient in quantitative terms, but has perhaps caused the emotional needs of patients, families and professionals to be regarded as secondary concerns. The humanization of healthcare should be discussed without confusing or discussing the humanity displayed by professionals. In this paper we review and describe the different strategic lines proposed in order to secure humanized care, and adopt a critical approach to their adaptation and current status in the field of pediatric critical care.
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Hyponatremia is the most prevalent electrolyte disorder in Intensive Care Units. It is associated with an increase in morbidity, mortality and hospital stay. The majority of the published studies are observational, retrospective and do not include critical patients; hence it is difficult to draw definitive conclusions. ⋯ Finally, etiopathogenic mechanisms leading to hyponatremia in the critical care patient are complex and often combined, and an intensive analysis is clearly needed. A study was therefore made to review all clinical aspects about hyponatremia management in the critical care setting. The aim was to develop a Spanish nationwide algorithm to standardize hyponatremia diagnosis and treatment in the critical care patient.
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Important recent insights have emerged regarding the cellular and molecular role of carbon dioxide (CO2) and the effects of hypercapnia. The latter may have beneficial effects in patients with acute lung injury, affording reductions in pulmonary inflammation, lessened oxidative alveolar damage, and the regulation of innate immunity and host defenses by inhibiting the expression of inflammatory cytokines. ⋯ Clearly, hypercapnia has both beneficial and harmful consequences, and it is important to determine the net effect under specific conditions. The purpose of this review is to describe the immunological and physiological effects of carbon dioxide, considering their potential consequences in patients with acute respiratory failure.
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Extracorporeal membrane oxygenation (ECMO) support is indicated in patients who are refractory to treatment, those with cardiogenic shock or respiratory failure and those with exacerbations eligible for heart and lung transplantation. Physician experience and quantity of necessary resources are reasons why regionalization could benefit patients of this kind, establishing ECMO reference centers and integrating a transportation network specialized in ECMO. This type of transportation is a challenge for healthcare systems and physicians, given its greater complexity, requiring a multidisciplinary and inter-territorial approach. ⋯ Air transfer with ECMO is an increasingly frequent option. Although there are data on its safety, there are none on the physiology of patients undergoing ECMO at high altitudes. Such information could be of help in the indication and management of this type of transportation.