RESUMEN
Systems for extracorporeal lung support have recently undergone significant technological improvements leading to more effective and safe treatment. Despite limited scientific evidence these systems are increasingly used in the intensive care unit for treatment of different types of acute respiratory failure. In general two types of systems can be differentiated: devices for extracorporeal carbon dioxide removal (ECCO2R) for ventilatory insufficiency and devices for extracorporeal membrane oxygenation (ECMO) for severe hypoxemic failure. Despite of all technological developments extracorporeal lung support remains an invasive and a potentially dangerous form of treatment with bleeding and vascular injury being the two main complications. For this reason indications and contraindications should always be critically considered and extracorporeal lung support should only be carried out in centers with appropriate experience and expertise.
Asunto(s)
Oxigenación por Membrana Extracorpórea , Síndrome de Dificultad Respiratoria , Insuficiencia Respiratoria , Humanos , Unidades de Cuidados Intensivos , Respiración ArtificialRESUMEN
BACKGROUND: Percutaneous dilatational tracheostomy (PDT) in critically ill patients is often led by optical guidance with a bronchoscope. This is not without its disadvantages. Therefore, we aimed to study the feasibility of a recently introduced endotracheal tube-mounted camera (VivaSight™-SL, ET View, Misgav, Israel) in the guidance of PDT. METHODS: We studied 10 critically ill patients who received PDT with a VivaSight-SL tube that was inserted prior to tracheostomy for optical guidance. Visualization of the tracheal structures (i.e., identification and monitoring of the thyroid, cricoid, and tracheal cartilage and the posterior wall) and the quality of ventilation (before puncture and during the tracheostomy) were rated on four-point Likert scales. Respiratory variables were recorded, and blood gases were sampled before the interventions, before the puncture and before the insertion of the tracheal cannula. RESULTS: Visualization of the tracheal landmarks was rated as 'very good' or 'good' in all but one case. Monitoring during the puncture and dilatation was also rated as 'very good' or 'good' in all but one. In the cases that were rated 'difficult', the visualization and monitoring of the posterior wall of the trachea were the main concerns. No changes in the respiratory variables or blood gases occurred between the puncture and the insertion of the tracheal cannula. CONCLUSION: Percutaneous dilatational tracheostomy with optical guidance from a tube-mounted camera is feasible. Further studies comparing the camera tube with bronchoscopy as the standard approach should be performed.
Asunto(s)
Traqueostomía/instrumentación , Adulto , Anciano , Puntos Anatómicos de Referencia , Análisis de los Gases de la Sangre , Broncoscopía , Enfermedad Crítica , Dilatación , Estudios de Factibilidad , Femenino , Humanos , Intubación Intratraqueal/instrumentación , Masculino , Persona de Mediana Edad , Estudios Prospectivos , Respiración Artificial , Mecánica Respiratoria , Tráquea/anatomía & histología , Traqueostomía/métodos , Grabación en VideoRESUMEN
Acute and acute-on-chronic liver failure have different underlying causes and are associated with hepatic or extrahepatic organ failure. Depending on etiology, up to 20% of critically ill patients suffer from hepatic dysfunction, which contributes to increased morbidity and mortality. A variety of extracorporeal procedures including renal replacement therapies, artificial and bioartificial liver support, and plasma exchange are used in the management of patients with liver diseases. Several randomized controlled studies of artificial liver support and plasma exchange proved the safety of these procedures and demonstrated improvement of hepatic encephalopathy and hemodynamics. A survival benefit could be observed in some of the randomized, controlled trials. In contrast, renal replacement therapy in critically ill patients with liver diseases has been assessed in retrospective case series and was associated with high mortality rates in liver cirrhosis. In summary, extracorporeal therapies are a cornerstone of therapeutic options in critically ill patients with hepatic failure. In addition to the comparison of different procedures, future studies should assess the timing of initiation as well as duration, and identify criteria of therapeutic futility of extracorporeal therapies in this population.
Asunto(s)
Encefalopatía Hepática , Fallo Hepático , Hígado Artificial , Terapia de Reemplazo Renal , Encefalopatía Hepática/terapia , Humanos , Fallo Hepático/terapia , Ensayos Clínicos Controlados Aleatorios como Asunto , Estudios RetrospectivosRESUMEN
Hepatitis C virus (HCV) is a main cause of chronic liver disease, which may lead to the development of liver cirrhosis and hepatocellular carcinoma. Therapeutic options are still limited in a significant proportion of patients. Small interfering RNAs (siRNAs) are an efficient tool to inhibit gene expression by RNA interference. As HCV RNA replicates in the cytoplasm of liver cells without integration into the genome, RNA-directed antiviral strategies are likely to successfully block its replication cycle. In this study, a panel of siRNAs was used to target various important regions of the HCV genome [5' untranslated region (UTR), NS3, NS4A, NS4B, NS5B, 3' UTR]. Convergent opposing human H1 and U6 polymerase III promoters were used to generate siRNAs. Target genes in sense and antisense orientation were attached to a luciferase reporter system to test the inhibitory efficiency of both siRNA strands. Our data revealed effective RNA interference against the HCV(+)-strand, the HCV(-)-strand or both strands simultaneously up to 65%. Subsequently, active siRNAs were tested in HCV subgenomic replicon cells and suppression of HCV RNA and NS5B protein levels up to 75% was confirmed. Interestingly, siRNAs that were effective against the sense as well as the antisense strand revealed the greatest inhibitory effects on HCV subgenomic replicons. Additionally, combinations of siRNAs induced a greater inhibition of HCV subgenomic replication of up to 90% proving the potential of this combined antiviral approach.
Asunto(s)
Hepacivirus/genética , Plásmidos/genética , ARN Polimerasa III/genética , ARN Interferente Pequeño/genética , Replicón/genética , Línea Celular Tumoral , Secuencia Conservada , Silenciador del Gen , Proteínas Fluorescentes Verdes/genética , Humanos , Luciferasas/genética , Regiones Promotoras Genéticas , Transfección , Regiones no Traducidas , Replicación Viral/genéticaRESUMEN
On the basis of standardized protocols of the therapeutic results of acute non-lymphoblastic leukaemias in adults sent to the Institute of Haematology in Warsaw from 8 haematological centres in Poland it was demonstrated that complete remission occurred in 34.4% of patients (129 out of 375 cases). The mean survival time of the patients treated intensively according to programmes I, II, III and IV 8.6 months, those of patients with complete remission - 13.5 months, patients without complete remission - 3.7 months. The most frequent cause of death (82.5%) were infections and/or haemarrhagic diathesis.