Revista médica de Chile
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Revista médica de Chile · Jun 1999
Review[Effect of catecholamines on splanchnic perfusion in sepsis].
Splanchnic ischemia is frequent in sepsis and septic shock and is related to impairment in intestinal permeability, derangement in mucosal barrier functions and translocation of proinflammatory mediators. These changes can contribute to the pathogenesis of multiple organ failure. ⋯ On the other hand, epinephrine further impairs splanchnic perfusion. In view of the contradictory effects of different vasoactive drugs, gastric tonometry must be measured during their use, to find the optimal drug combination that optimizes splanchnic blood flow.
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Revista médica de Chile · Feb 1999
Review[Ventilatory support in patients with acute disease of the central nervous system].
Patients with severe head injury are prone to pulmonary complications that result in hypoxemia or hypercarbia, which could worsen their neurological condition. A rational ventilatory approach requires a good knowledge of respiratory and neurological pathophysiology. ⋯ The use of low or moderate positive and expiratory pressure levels apparently improves oxygenation without worsening intracranial pressure. Ventilatory management should be closely monitored and adjusted to hemodynamic, respiratory and neurological status to achieve a good outcome.
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Recent reports have described a pathogenic role of nitric oxide in several respiratory disease. It is specially useful in the adult respiratory distress syndrome, where it acts as a selective vasodilator and improves gas exchange, decreasing pulmonary shunting. Although it has a proven bronchodilator effect, its therapeutic role in diseases such as asthma and chronic limitation of airway flow is not well defined. This article review the metabolism, mechanisms of action, potential uses and adverse effects of nitric oxide in respiratory disease.
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Revista médica de Chile · Nov 1996
Review Case Reports[Intracardiac thrombosis in a patient with primary antiphospholipid syndrome. Report of a case].
Antiphospholipid antibody syndrome is characterized by arterial or venous thrombosis associated to the presence of antiphospholipid antibodies. We report a 32 atrial thrombus. ⋯ The laboratory work-up confirmed an antiphospholipid syndrome. Five months later the patient has not presented new thrombotic episodes and is receiving oral anticoagulants and antiplatelet therapy.
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Revista médica de Chile · Oct 1995
Review Case Reports[Extracorporeal membrane oxygenation in adult respiratory distress syndrome. Experience in 2 patients].
We report two female patients with adult respiratory distress syndrome and severe respiratory failure in whom extracorporeal membrane oxygenation was used. Its indication was due to a bad response to conventional treatment with mechanical ventilation and high levels of positive end expiratory pressure. A 2.0 or 2.2 m2 membrane oxygenator in a veno-venous circuit with systemic anticoagulation was used, maintaining mechanical ventilation. ⋯ The second patient was connected to the procedure after three weeks of respiratory distress syndrome and no increase in arterial oxygenation was achieved. The patient died due to an intracranial hemorrhage, probably hastened by systemic anticoagulation. The real benefits of extracorporeal membrane oxygenation are not defined yet.