Recenti progressi in medicina
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Clinical trials investigating traditional inotropic agents in patients with heart failure demonstrated an increased mortality rate (odds ratio 1.50; IC=0.51-3.92), high incidence of discontinuation of infusion therapy (odds ratio 0.46; IC=0.083-2.29) due to major side effects and, most of all, a limited clinical benefit (odds ratio 0.75; IC=1.42-0.08). On this background a new class of inotropic drugs, the calcium-sensitisers, have been developed. ⋯ Twenty-six patients with decompensated heart failure of different etiology have been treated with 24 hour infusion of levosimendan. In this experience the levosimendan improved the clinical status and the left ventricular ejection fraction.
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Mechanical ventilation is the essential treatment for acute respiratory failure. The methods used differ greatly depending on whether one chooses invasive or noninvasive. Noninvasive ventilation avoids orotracheal intubation, facilitates weaning and, if negative pressure ventilation is integrated with positive pressure ventilation, the majority of patients will not need intubated. The ideal setting for mechanical ventilation, where possible, is the Respiratory Intensive Care Unit.
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The Severe Acute Respiratory Syndrome (SARS) is a new life-threatening respiratory disease which has its origins in Guangdong province, China, where the earliest known cases were identified in November 2002. Since then, probable cases of SARS have been reported in 30 countries and the current cumulative number of cases is 8,240 with 745 deaths and a global fatality rate of 9%. The most frequently involved areas include China, Hong Kong, Singapore, Canada, Vietnam and Philippines. ⋯ This transmission pattern generally involves household members, health care workers and international travellers, while a large and sudden cluster of almost simultaneous cases in an housing estate of Hong Kong has raised the possibility of transmission from an environmental source. The most common presenting symptoms are fever, malaise, non-productive cough and dyspnea, associated with pulmonary interstitial infiltrates on chest radiography. A novel coronavirus is associated with this outbreak, and the laboratory evidences indicate that this virus has an etiologic role in SARS, but the role of other concurrent viral agents (such as metapneumovirus) identified in these patients requires further investigation.
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Recovery from nontraumatic cardiac arrest depends on the presence of all the elements in the chain of survival. "Early defibrillation" is critical because ventricular fibrillation is the most common initial dysrhythmia of sudden cardiac arrest. Defibrillation is the only treatment, and survival from ventricular fibrillation is determined by time. Out-of-hospital studies have demonstrated that defibrillation provided by first responders improves survival. ⋯ Improvement in in-hospital survival rates from cardiac arrest is not as evident as in the emergency medical service community. Medical centers need to assess response times to cardiac arrest and implement AED programs. All the nurses should learn to use an AED as part of basic life support training.