RESUMEN
We investigated the incidence of post-intubation hypotension (PIH) in hemodynamically stable patients with STEMI requiring rapid sequences intubation (RSI) and medicated with ketamine or midazolam as induction agent. STEMI patients admitted between 1st January 2009 and 1st January 2017 who did not receive any type of inotropic support before the endotracheal intubation (ETI) was reviewed. PIH was defined as a reduction greater than 20% or a drop of systolic blood pressure (SBP) below 90 mmHg within 10 min from the administration of the induction agent [ketamine (1 mg/kg) or midazolam (0.3 mg/kg)]. Over the study period, 136 patients (66 male and 70 females, mean age 72.25 ± 7.33 years) met the inclusion criteria. Patients treated with midazolam and ketamine were 63 and 73, respectively. PIH was observed in 38 (27.9%) patients after 10 min from ETI. Midazolam patients had a significant lower SBP at both 5 and 10 min after induction (97.75 ± 8.06 vs 100.81 ± 8.08, p = 0.029 and 92.83 ± 7.53 vs 101.58 ± 7.29, p < 0.0001, respectively) (ANOVA p < 0.0001). Age (OR 1.91, 95% CI 1.87-1.97, p = 0.001), history of arterial hypertension (OR 2.27, 95% CI 2.21-2.35, p = 0.0001), multivessel coronary artery disease (OR 2.66, 95% CI 2.58-2.71, p = 0.001), SI ≥0.9 (OR 2.41, 95% CI 2.36-2.48, p < 0.0001) and anterior STEMI (OR 2.51, 95% CI 2.48-2.57, p = 0.0001) resulted independent predictors of PIH in STEMI patients treated with midazolam, as induction agent, before ETI. Midazolam was more likely than ketamine to cause significant PIH when used as an induction agent for RSI in hemodynamically stable patients with STEMI.
Asunto(s)
Manejo de la Vía Aérea/métodos , Urgencias Médicas , Hemodinámica/efectos de los fármacos , Intubación Intratraqueal , Ketamina/uso terapéutico , Midazolam/uso terapéutico , Infarto del Miocardio con Elevación del ST/terapia , Adyuvantes Anestésicos/uso terapéutico , Anciano , Analgésicos/uso terapéutico , Femenino , Estudios de Seguimiento , Humanos , Masculino , Estudios Retrospectivos , Infarto del Miocardio con Elevación del ST/fisiopatologíaRESUMEN
A 76-year-old hypertensive man with previous bilateral iliac stenting was admitted in our center for acute stroke with an NIH score of 20 at 6 h from symptoms onset. The common carotid occlusion with a huge thrombus and a very calcified plaque has been successfully recanalyzed with a combination of coronary total occlusion technique, filter-aided coronary manual thrombectomy and Penumbra vacuum thrombectomy systems.
Asunto(s)
Arteria Carótida Común , Estenosis Carotídea/terapia , Trombectomía/instrumentación , Trombosis/terapia , Dispositivos de Acceso Vascular , Calcificación Vascular/terapia , Anciano , Angiografía , Arteria Carótida Común/diagnóstico por imagen , Estenosis Carotídea/complicaciones , Estenosis Carotídea/diagnóstico por imagen , Imagen de Difusión por Resonancia Magnética , Diseño de Equipo , Humanos , Masculino , Accidente Cerebrovascular/diagnóstico por imagen , Accidente Cerebrovascular/etiología , Trombosis/complicaciones , Trombosis/diagnóstico por imagen , Resultado del Tratamiento , Calcificación Vascular/complicaciones , Calcificación Vascular/diagnóstico por imagenRESUMEN
OBJECTIVE: To describe the efficacy and safety of protein C (PC) concentrate to restore physiological values in adult septic patients having clinical contraindications to activated PC. DESIGN: Case series (pilot study). SETTING: Three adult ICUs of a University Hospital. PATIENTS AND PARTICIPANTS: Twenty adult patients affected by severe sepsis or septic shock with plasma values of PC < 50%. INTERVENTIONS: Patients were treated with PC concentrate (Ceprotin ((R))--Baxter) with a starting bolus followed by a continuous infusion for 72 h [3 IU/(kg h)]. MEASUREMENTS AND RESULTS: PC activity, WBC, platelets, D: -Dimer, fibrinogen, PT, aPTT, AT III, lactate, Sepsis-related Organ Failure Assessment (SOFA), Disseminated Intravascular Coagulation (DIC) score, adverse events, and mortality were measured. Baseline plasma PC activity was 34.5 +/- 9.1%. PC concentrate normalized the PC activity in all patients within 48 h, and then remained stable for the following days. At baseline, several patients showed abnormal PT, aPTT, platelets values, and lactate levels. During the study period, there was a significant increase of platelets, fibrinogen, PT, AT III, and a significant decrease of D: -Dimer, aPTT, DIC score, and lactate. No adverse reactions (hemorrhage or thrombosis) were observed. Mortality at 28 days was 35%. CONCLUSIONS: Our pilot study shows that the administration of PC concentrate to patients having contraindications to the treatment with activated PC was safe and possibly useful to control the coagulopathy triggered and sustained by sepsis. A randomized, double blind study in patients with severe sepsis and contraindications to activated PC administration would be advisable to state the safety and the possible role of this product in the treatment of severe sepsis.
Asunto(s)
Anticoagulantes/uso terapéutico , Mortalidad Hospitalaria , Proteína C/uso terapéutico , Sepsis/tratamiento farmacológico , Choque Séptico/tratamiento farmacológico , Adulto , Anciano , Anciano de 80 o más Años , Anticoagulantes/metabolismo , Femenino , Humanos , Unidades de Cuidados Intensivos , Masculino , Persona de Mediana Edad , Proyectos Piloto , Proteína C/metabolismo , Sepsis/clasificación , Sepsis/metabolismo , Índice de Severidad de la Enfermedad , Choque Séptico/clasificación , Choque Séptico/metabolismoRESUMEN
A 79-year-old woman presented with hypoxemic acute respiratory failure secondary to pneumonia and was started on continuous noninvasive positive pressure ventilation (NPPV) by helmet. Patient improved over first two days of NPPV, but worsened suddenly on the third day because of development of a pneumothorax. Pneumothorax may have been caused by barotrauma from desynchronization between patient and ventilator.