Cir Cir
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The bispectral index (BIS) is a value derived from an electroencephalograph (EEG); it is correlated with depth of sedation and loss of consciousness. Therefore, it has been considered that its control on sedation depth could influence cost saving in drugs as well as decreased anesthesia costs. ⋯ Average drug costs for anesthesia were greater in BIS-controlled groups. Anesthesia cost/h was lower in prolonged procedures (>4 h). The bispectral Index as a sedation monitor during anesthesia is an excellent tool, although it did not show a real economic advantage, and we considered that it world only be feasible during long-term procedures.
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Case Reports
[Persistent left superior vena cava: infrequent localization of central venous catheter].
Our objective was to report a Persistent Left Superior Vena Cava in a critically ill patient. ⋯ A 52 years-old male without previous cardiovascular disease was admitted to the intensive care unit due to cranial trauma. A central left subclavian vein catheter was placed at his arrival at the center chest X-ray showed the catheter in the left of the cardiac silhohuete without hemo-pneumothorax. A angiographic evaluation through central venous catheter showed persistent left superior vena cava draining to the coronary sinus and right atrium with normal permeability of right superior vena cava. Other congenital alterations were excluded. Chest computed tomography confirmed the diagnosis. Persistent left superior vena cava is a congenital vascular abnormality. The intensive care unit staff must be aware of this vascular abnormality because it can complicate central venous catheterization.
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Knotting Swan-Ganz catheter is a rare complication of hemodynamic monitoring. This is the second case reported in Mexico in over 20 years. ⋯ Diagnostic confirmation is made by chest radiography, fluoroscopy, and echocardiography. Therapeutic approach depends on knot characteristics, either non-surgical or surgical.
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The innate immune response is the first line of defense against infection. Toll-like receptors (TLRs) recognize bacterial lipopolysaccharide and other pathogen-associated molecular patterns (PAMPs). Intracellular signals initiated by interaction between Toll receptors and specific PAMPs results in inflammatory response. Sepsis and septic shock are the result of an exaggerated inflammatory systemic response induced by innate immune dysregulation.
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Vasodilatory refractory shock is common in patients with severe burns. It is defined by resistance to high doses of volume and vasopressor therapy. ⋯ After administration of vasopressin, systemic vascular resistance index (SVRI) and pre-arrest morbidity (PAM) were significantly increased (p < 0.05). We observed a significant decrease in dopamine and norepinephrine requirements (p < 0.005). Norepinephrine was discontinued at 72 h and dopamine infusion was continued at low dose. Urine output, urinary sodium, and serum bicarbonate were significantly increased. deltaCO2 was increased and this finding was associated to decrease in norepinephrine and dopamine requirements; this effect translated in to better splachnic perfusion. Left ventricular function indexes were normal. Patients did not develop evidence of myocardial, splachnic, or limb ischemia during vasopressin infusion. In all patients vasopressin was weaned at 24 h and removed. In five patients, it was necessary to reinitiate vasopressin infusion for another 96 h without complications. Low-dose vasopressin infusions (0.04 IU/min), are a useful therapy to severely burned patients with vasodilatory refractary shock and who are devoid of adverse effects.