Medicina intensiva
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Recently, dobutamine stress echocardiography [DSE] has been used to study the cardiovascular response in patients with septic shock. The increase in stroke volume index after DSE was seen to be strongly correlated to survival. However, its effect on the tissue Doppler imaging [TDI] values in patients with septic shock was not well established. In this study we investigated the effect of DSE on TDI values as a predictor of norepinephrine weaning and mortality in patients with septic shock. ⋯ Variations in TDI after DSE were able to predict survival in septic shock patients, with an s' wave stress-rest change of >4cm/s being associated to lower ICU mortality, while a cutoff value >2cm/s was associated to better norepinephrine weaning.
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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.