RESUMO
Acute renal failure (ARF) is an independent risk factor associated with increased mortality during sepsis. Recent consensus definitions have allowed the standardization of research on the subject. The understanding of the physiopathology of ARF during sepsis is limited by the scarcity of histological studies and the inability to measure renal microcirculatory flows. Historically, ARF during sepsis has been considered to be a consequence of diminished renal blood flow (RBF). Indeed, in early stages of sepsis or in sepsis associated to cardiogenic shock, RBF may decrease. However, recent studies have shown that in resuscitated sepsis, in which cardiac output is characteristically normal or even elevated and there is systemic vasodilatation, RBF is normal or even increased, with no associated histological evidence of significant tubular necrosis. Thus, other factors may participate in the genesis of ARF in sepsis. These include apoptosis, glomerular and medullary microcirculatory disorders, cell changes in response to the pro-inflammatory cascade characteristic of sepsis, oxidative stress, mitochondrial dysfunction and damage induced by mechanical ventilation, among others. Sepsis associated ARF treatment is supportive. In general, renal replacement therapies can be grouped as intermittent or continuous, and as those whose primary objective is the replacement of impaired renal function, versus those whose main objective is to secure hemodynamic stability through the clearing of pro-inflammatory mediators.
Assuntos
Injúria Renal Aguda/fisiopatologia , Sepse/complicações , Injúria Renal Aguda/sangue , Injúria Renal Aguda/etiologia , Injúria Renal Aguda/patologia , Injúria Renal Aguda/terapia , Apoptose , Débito Cardíaco , Creatinina/sangue , Taxa de Filtração Glomerular , Humanos , Mediadores da Inflamação/metabolismo , Isquemia/etiologia , Isquemia/fisiopatologia , Rim/irrigação sanguínea , Rim/patologia , Microcirculação , Mitocôndrias/fisiologia , Estresse Oxidativo , Circulação Renal , Terapia de Substituição Renal , Respiração Artificial/efeitos adversos , Trombofilia/etiologia , VasodilataçãoRESUMO
There is a direct correlation between the development of the multiple organ dysfunction syndrome (MODS) and the elevated mortality associated with sepsis. The mechanisms responsible for MODS development are being studied, however, the main efforts regarding MODS evaluation have focused on oxygen delivery optimization and on the modulation of the characteristic inflammatory cascade of sepsis, all with negative results. Recent studies have shown that there is development of tissue acidosis, even when there are normal oxygen conditions and limited presence of tissue cellular necrosis or apoptosis, which would indicate that cellular energetic dysfunction may be a central element in MODS pathogenesis. Mitochondrias are the main source of cellular energy, central regulators of cell death and the main source for reactive oxygen species. Several mechanisms contribute to mitochondrial dysfunction during sepsis, that is blockage of pyruvate entry into the Krebs cycle, oxidative phosphorylation substrate use in other enzymatic complexes, enzymatic complex inhibition and membrane damage mediated by oxidative stress, and reduction in mitochondrial content. Hypoxia-inducible factor-1alpha (HIF-1alpha) is a nuclear transcription factor with a central role in the regulation of cellular oxygen homeostasis. Its induction under hypoxic conditions is associated to the expression of hundreds of genes that coordinate the optimization of cellular oxygen delivery and the cellular energy metabolism. HIF-1alpha can also be stabilized under normoxic condition during inflammation and this activation seems to be associated with a prominent pro-inflammatory profile, with lymphocytes dysfunction, and to a reduction in cellular oxygen consumption. Further studies should establish a role for HIF-1alpha as a therapeutic target.
Assuntos
Subunidade alfa do Fator 1 Induzível por Hipóxia/fisiologia , Mitocôndrias/fisiologia , Insuficiência de Múltiplos Órgãos/etiologia , Insuficiência de Múltiplos Órgãos/metabolismo , Sepse/metabolismo , Sepse/fisiopatologia , HumanosRESUMO
AIM: To describe use of sedatives, analgesics, and neuromuscular blockers (NMB) in patients undergoing long-term mechanical ventilation and to assess factors associated with their use and their association with mortality at 28 days. DESIGN: Prospective observational multicenter cohort study. SETTING: Thirteen intensive care units (ICU) in Chile. PATIENTS: Patients undergoing mechanical ventilation for more than 48h. We excluded patients with neurological disorders, cirrhosis of the liver, chronic renal failure, suspected drug addiction, and early no resuscitation orders. INTERVENTION: None. MAIN MEASUREMENTS: Proportion of use and dosage of sedatives, analgesics, and NMB. Level of sedation observed (SAS). Variables associated with the Sedation Agitation Scale (SAS), use of sedatives, analgesics, and NMB. Multivariate logistic regression of variables associated to mortality at 28 days. RESULTS: A total of 155 patients participated (60+/-18 years, 57% male, SOFA 7 [6-10], APACHE II 18 [15-22], 63% with sepsis, and 47% with acute lung injury/adult respiratory distress syndrome. The drugs most frequently used were midazolam (85%, 4 [1.9-6.8]mg/hr) and fentanyl (81%, 76 [39-140]microg/hr). NMB were administered at least 1 day in 30% of patients. SAS score was 1 or 2 in 55% of patients. There was an association between NMB use and mortality at 28 days, but it was not consistent in all the models of NMB evaluated. CONCLUSIONS: Sedatives were frequently employed and deep sedation was common. Midazolam and fentanyl were the most frequently administered drugs. The use of NMB might be independently associated to greater mortality.
Assuntos
Analgesia , Sedação Consciente , Estado Terminal , Bloqueio Nervoso , Respiração Artificial , Idoso , Estudos de Coortes , Feminino , Humanos , Masculino , Pessoa de Meia-IdadeRESUMO
BACKGROUND: Septic shock is highly lethal. We recently implemented an algorithm (advanced resuscitation algorithm for septic shock, ARAS 1) with a global survival of 67%, but with a very high mortality (72%) in severe cases [norepinephrine (NE) requirements >0.3 microg/kg/min for mean arterial pressure > or =70 mmHg]. As new therapies with different levels of evidence were proposed [steroids, drotrecogin alpha, high-volume hemofiltration (HVHF)], we incorporated them according to severity (NE requirements; algorithm ARAS-2), and constructed a multidisciplinary team to manage these patients from the emergency room (ER) to the ICU. The aim of this study was to compare the outcome of severe septic shock patients under both protocols. METHODS: Adult patients with severe septic shock were enrolled consecutively and managed prospectively with ARAS-1 (1999-2001), and ARAS-2 (2002-05). ARAS-2 incorporates HVHF for intractable shock. RESULTS: Thirty-three patients were managed with each protocol, without statistical differences in baseline demographics, APACHE II (22.2 vs 23.8), SOFA (11.4 vs 12.7) and NE peak levels (0.62 vs 0.8 microg/kg/min). The 28-day mortality and epinephrine use were higher with ARAS-1 (72.7% vs 48.5%; 87.9% vs 18.2 %); and low-dose steroids (35.9% vs 72.7%), drotrecogin (0 vs 15 %) and HVHF use (3.0% vs 39.4%) were higher for ARAS-2 (P<0.05 for all). CONCLUSION: Management of severe septic shock with a multidisciplinary team and an updated protocol (according to the best current evidence), with precise entry criteria for every intervention at different stages of severity, may improve survival in these patients. Multidisciplinary management, rationalization of the use of vasoactives and rescue therapy based on HVHF instead of epinephrine may have contributed to these RESULTS: Management of severe septic shock with these kinds of algorithms is feasible and should be encouraged.
Assuntos
Algoritmos , Tratamento de Emergência , Unidades de Terapia Intensiva , Choque Séptico/mortalidade , Choque Séptico/terapia , Medicina Baseada em Evidências , Humanos , Pessoa de Meia-Idade , Estudos Prospectivos , Taxa de SobrevidaRESUMO
La sepsis y el shock séptico son patologías de gran mortalidad, cuyo evento final es la hipotensión refractaria, colapso cardiocirculatorio y falla multiorgánica. En los últimos años se han realizado importantes esfuerzos para entender la disfunción cardiaca asociada a este cuadro, que puede objetivarse hasta en el 50 por ciento de los pacientes con sepsis severa y shock séptico. A pesar de que hoy se acepta que la disfunción miocárdica juega un importante rol en la sepsis, aún no existe consenso respecto a la manera de evaluar la función cardiaca en este contexto, surgiendo nuevas propuestas como el uso de marcadores séricos. Por otra parte, el tratamiento más utilizado hasta hoy han sido los inótropos como la dobutamina, sin embargo con los nuevos estudios sobre la etiología de la disfunción miocárdica, se ha logrado el desarrollo de nuevas líneas experimentales de tratamiento.
The sepsis and the septic shock are pathologies of the great mortality, whose final event is the refractory hypotension, circulatory collapse and multiorganic failure. In the last years important efforts have been made to understand the associate cardiac dysfunction to this picture, which can appear until in 50 percent of the patients with severe sepsis and septic shock. Although today it is accepted that the myocardial dysfunction plays an important role in the sepsis. It does not yet exist consensus with respect to the way to evaluate the function cardiac. New proposals arising as the use from seric markers. On the other hand, the more used treatment until today has been the inotropic agent like the dobutamine. But with the new studies on the etiology of the myocardial dysfunction, has been obtained the development of experimental new line of treatment.
Assuntos
Humanos , Masculino , Adulto , Feminino , Cardiomiopatias/fisiopatologia , Sepse , Choque Séptico , Cardiomiopatias/tratamento farmacológico , Dobutamina/uso terapêutico , Biomarcadores/metabolismo , Peptídeo Natriurético Encefálico/metabolismo , Troponina/metabolismo , Agonistas Adrenérgicos beta/uso terapêuticoRESUMO
To assess the clinical impact of noninvasive mechanical ventilation (NIMV) on stable hypercapnic chronic obstructive pulmonary disease, changes in exercise capacity, dyspnoea and simple physiological parameters were evaluated. The time course of these effects during treatment and recovery was also assessed. Patients were randomly allocated to NIMV (n=27) or sham-NIMV (n=15), applied 3 h.day-1, 5 days a week, for 3 weeks. A 6-min walking distance (6MWD), arterial blood gases, spirometry, pattern of breathing, mouth occlusion pressure (P0.1), and respiratory system impedance (P0.1/tidal volume (VT)/inspiratory time (tI)) were measured weekly during treatment and 2 weekly during follow-up. Transition dyspnoea index (TDI) was also measured. During NIMV, carbon dioxide arterial tension decreased progressively, concomitantly with a slow deep pattern of breathing, a proportional increase in the forced expiratory volume in one second (FEV1), the forced vital capacity and significant reductions of P0.1 and P0.1/VT/tI. The 6MWD improved by a mean of 76 m after NIMV, and by 73 m and 61 m 1 and 2 weeks, respectively, after treatment. Dyspnoea improved with a mean TDI of three points. Changes in 6MWD were highly related to TDI and to a lesser extent to changes in FEV1 (r=0.60). The current authors conclude that noninvasive mechanical ventilation has significant and sustained clinical impact in stable hypercapnic chronic obstructive pulmonary disease.
Assuntos
Dispneia/terapia , Hipercapnia/terapia , Doença Pulmonar Obstrutiva Crônica/terapia , Respiração Artificial/métodos , Idoso , Análise de Variância , Gasometria , Dióxido de Carbono/sangue , Distribuição de Qui-Quadrado , Dispneia/diagnóstico , Tolerância ao Exercício/fisiologia , Feminino , Seguimentos , Humanos , Hipercapnia/diagnóstico , Masculino , Pessoa de Meia-Idade , Probabilidade , Doença Pulmonar Obstrutiva Crônica/diagnóstico , Testes de Função Respiratória , Mecânica Respiratória/fisiologia , Medição de Risco , Índice de Gravidade de Doença , Método Simples-Cego , Espirometria , Resultado do TratamentoRESUMO
Visceral afferents send information via cranial nerves to the nucleus tractus solitarius (NTS). The NTS is the initial step of information processing that culminates in homeostatic reflex responses. Recent evidence suggests that strong afferent synaptic responses in the NTS are most often modulated by depression and this forms a basic principle of central integration of these autonomic pathways. The visceral afferent synapse is uncommonly powerful at the NTS with large unitary response amplitudes and depression rather than facilitation at moderate to high frequencies of activation. Substantial signal depression occurs through multiple mechanisms at this very first brainstem synapse onto second order NTS neurons. This review highlights new approaches to the study of these basic processes featuring patch clamp recordings in NTS brain slices and optical techniques with fluorescent tracers. The vanilloid receptor agonist, capsaicin, distinguishes two classes of second order neurons (capsaicin sensitive or capsaicin resistant) that appear to reflect unmyelinated and myelinated afferent pathways. The differences in cellular properties of these two classes of NTS neurons indicate clear functional differentiation at both the pre- and postsynaptic portions of these first synapses. By virtue of their position at the earliest stage of these pathways, such mechanistic differences probably impart important differentiation in the performance over the entire reflex pathways.
Assuntos
Barorreflexo/fisiologia , Sistema Cardiovascular/inervação , Núcleo Solitário/fisiologia , Transmissão Sináptica/fisiologia , Fibras Aferentes Viscerais/fisiologia , HumanosRESUMO
Visceral afferents send information via cranial nerves to the nucleus tractus solitarius (NTS). The NTS is the initial step of information processing that culminates in homeostatic reflex responses. Recent evidence suggests that strong afferent synaptic responses in the NTS are most often modulated by depression and this forms a basic principle of central integration of these autonomic pathways. The visceral afferent synapse is uncommonly powerful at the NTS with large unitary response amplitudes and depression rather than facilitation at moderate to high frequencies of activation. Substantial signal depression occurs through multiple mechanisms at this very first brainstem synapse onto second order NTS neurons. This review highlights new approaches to the study of these basic processes featuring patch clamp recordings in NTS brain slices and optical techniques with fluorescent tracers. The vanilloid receptor agonist, capsaicin, distinguishes two classes of second order neurons (capsaicin sensitive or capsaicin resistant) that appear to reflect unmyelinated and myelinated afferent pathways. The differences in cellular properties of these two classes of NTS neurons indicate clear functional differentiation at both the pre- and postsynaptic portions of these first synapses. By virtue of their position at the earliest stage of these pathways, such mechanistic differences probably impart important differentiation in the performance over the entire reflex pathways.
Assuntos
Humanos , Barorreflexo , Sistema Cardiovascular , Núcleo Solitário , Transmissão Sináptica , Fibras Aferentes VisceraisRESUMO
We report a 68 years old man, farmer from the metropolitan region, admitted with a Hantavirus Cardiopulmonary Syndrome. The diagnosis was made using serologic test and was later confirmed by the Public Health Institute. He evolved to an early multiple organ failure, requiring high concentrations of oxygen and invasive ventilatory assistance, vasopressor drugs and renal replacement therapy. Swan Ganz and PiCCO were used simultaneously for hemodynamic monitoring. Treatment consisted in global support therapy, antimicrobial therapy and systemic corticosteroids. Intrathoracic blood volume was a more reliable parameter than pulmonary capillary wedge pressure for the assessment of preload. As expected in situations of increased vascular permeability, there was an increase in extravascular lung water. There was a good correlation between extravascular lung water and oxygenation parameters (PaO2/FiO2 and oxygenation index). PiCCO system may become a helpful tool in the management of patients with Hantavirus Cardiopulmonary Syndrome.
Assuntos
Humanos , Masculino , Idoso , Débito Cardíaco , Monitorização Fisiológica/métodos , Síndrome Pulmonar por Hantavirus/fisiopatologia , Insuficiência de Múltiplos Órgãos/tratamento farmacológico , Insuficiência de Múltiplos Órgãos/fisiopatologia , Insuficiência de Múltiplos Órgãos/virologia , Síndrome Pulmonar por Hantavirus/diagnóstico , Síndrome Pulmonar por Hantavirus/tratamento farmacológicoRESUMO
Bedside evaluation of pulmonary mechanics and thoracic computed axial tomography have changed the ventilatory management of patients suffering an acute respiratory failure caused by adult respiratory distress syndrome (ARDS). Mortality has been reduced limiting tidal volumes, which avoids alveolar overdistention and by the use of positive end expiratory pressure (PEEP), that reduces the damage caused by cyclical alveolar collapse-reopening. Nowadays, it is well known that inappropriate mechanical ventilation enhances lung damage caused by the underlying disease. However, the optimal adjustment of PEEP is not yet established. Usually, it is not easy to achieve an equilibrium between an optimal lung recruitment without producing alveolar overdistention and hemodynamic adverse effects such as hypotension and reduction of cardiac output. This paper reviews the interactions between heart and lung.
Assuntos
Humanos , Adulto , Insuficiência Respiratória/fisiopatologia , Respiração com Pressão Positiva , Insuficiência Respiratória/etiologia , Insuficiência Respiratória/terapia , Pressão Arterial/fisiologiaRESUMO
BACKGROUND: The Infectious Systemic Inflammatory Response syndrome and multiple organic dysfunction have common physiopathological mechanisms. Multiple organic dysfunction can be assessed using severity scores. AIM: To relate cytokine kinetics with a multiple organic dysfunction score during sepsis. MATERIAL AND METHODS: Tumor necrosis factor alpha (TNF alpha) and interleukin 6 (IL6) kinetics were studied in 25 patients with severe sepsis with less than 48 h of evolution and interleukin 1 beta (IL beta) kinetics was studied in 13 patients. Measurements were made at 0, 12, 24 and 48 hours after admission to the study, using an ELISA technique. These parameters were correlated with the Marshall multiple organic dysfunction score and survival. RESULTS: Mean age of study subjects was 70 years, the APACHE II score was 16.9 +/- 6 and the Marshall score was 6.8 +/- 3.6. Sepsis was of pulmonary origin in 56% of patients and intra abdominal in 32%. Mortality was 36%. TNF alpha increased during the study period (24.1 pg/ml initially and 37.8 pg/ml at 24 hours, with a slight posterior reduction, p < 0.02). These levels had no association with mortality or organic dysfunction. IL6 remained elevated during the first hours and had a tendency to decrease thereafter. Decreased patients had higher values than survivors (306 pg/ml and 55.4 pg/ml respectively, p = 0.011). Its values were tightly correlated with Marshall score, with the number of failing organs, with the presence of shock and with probability of dying during hospitalization. IL1 beta remained low and was not associated with clinical parameters. CONCLUSIONS: There is a tight correlation between the elevation of IL6 and the severity of the Systemic Inflammatory Response and mortality in these patients with sepsis.
Assuntos
Citocinas/metabolismo , Insuficiência de Múltiplos Órgãos/mortalidade , Sepse/mortalidade , APACHE , Idoso , Citocinas/sangue , Feminino , Mortalidade Hospitalar , Humanos , Interleucina-1/sangue , Interleucina-1/metabolismo , Interleucina-6/sangue , Interleucina-6/metabolismo , Masculino , Insuficiência de Múltiplos Órgãos/metabolismo , Estudos Prospectivos , Sepse/metabolismo , Índice de Gravidade de Doença , Choque Séptico/metabolismo , Choque Séptico/mortalidade , Síndrome de Resposta Inflamatória Sistêmica/metabolismo , Síndrome de Resposta Inflamatória Sistêmica/mortalidade , Fator de Necrose Tumoral alfa/metabolismoRESUMO
Multiauthorship shows an increasing trend in biomedical and other scientific journals. A main concern for editors, reviewers and readers is to find out whether all individuals enlisted as authors actually fulfill criteria for authorship as defined in the document "Uniform Requirements for Manuscripts Submitted to Biomedical Journals". Revista Médica de Chile is addressing this relevant topic with a combined strategy: (1) A retrospective analysis of the manuscripts published in the recent decades in the Revista will quantify and illustrate the local trend in multiauthorship; (2) A "Statement of accountability": signed by all authors in manuscripts submitted to the Revista, is in use since 1997; and (3) A new form of this "Statement of accountability" requests all authors to identify their personal involvement in the work represented by the manuscript. This information will be available to every person participating in the editorial assessment of the manuscript (editors and external reviewers) but during a trial period of six months authors will be allowed to object the publication of this data, stating the reasons for this objection. After six months the editors will evaluate the information collected and the self-declared role of every author enlisted. The terms "Author" and "Main author" will continue being used to designate participants because "contributor" (replacement alternative proposed by Rennie et al., currently in use by several leading general medical journals) has a different main meaning in Spanish than in English and it might have a negative effect.
Assuntos
Autoria , Publicações Periódicas como Assunto , RedaçãoRESUMO
Since 1973, Revista Médica de Chile has classified biomedical and clinical prospective research papers in a Section named "Research Articles", while purely clinical and retrospective studies were classified into another Section, named "Clinical Experiences". This distinction seems no longer necessary, because both types of manuscripts are subjected to a uniform external peer-review system and their intrinsic quality is not a distinctive feature. Furthermore, the name of Sections where similar papers are classified by the major general clinical medicine journals is clearly non-uniform. Therefore, "Research Articles" and "Clinical Experiences" will from now on be included into a single Section: "Research Articles".
Assuntos
Publicações Periódicas como Assunto/normas , Viés de Publicação , PesquisaRESUMO
We report a 27 years old homosexual male with AIDS that was admitted to the ICU dehydrated, with fever and severe malaise. He had irregular bullae, an extensive purpuric exanthema and a zone of epidermic detachment in the right arm. A toxic epidermal necrolysis was diagnosed and therapy with i.v. immunoglobulins was started. After four days of treatment, bullous lesions disappeared and the extension of exanthema decreased. Toxic epidermal necrolysis is a potentially fatal disease and the use of intravenous immunoglobulins for this condition has been reported as successful.
Assuntos
Imunoglobulinas Intravenosas/uso terapêutico , Unidades de Terapia Intensiva , Síndrome de Stevens-Johnson/tratamento farmacológico , Síndrome da Imunodeficiência Adquirida/complicações , Adulto , Humanos , MasculinoRESUMO
BACKGROUND: In 1992, a consensus conference defined the terms systemic inflammatory response syndrome (SIRS), sepsis, severe sepsis and septic shock. Since then, numerous reports have validated the prognostic usefulness of these operative definitions. AIM: To evaluate if sepsis severity criteria, as defined by the Consensus Conference, can be applied to noninfectious SIRS. PATIENTS AND METHODS: Five hundred eighteen patients admitted to 5 intensive care units (ICU) from 4 hospitals were prospectively evaluated during a 3 months period. Patients that met at least one severity criteria were included. SIRS etiology, organ dysfunction and evolution were recorded in each patient. RESULTS: One hundred two patients were included: 79 with sepsis (group I) and 23 with noninfectious SIRS (group II). ICU and hospital mortality were comparable (43 and 48% in sepsis compared to 43 and 51% in non infectious SIRS). The most common sources of sepsis were pneumonia and peritonitis. Group II patients had a wide variety of diseases. ICU stay, APACHE score and number of organs with dysfunction were not different among groups. Only the incidence of renal dysfunction was higher in the septic group. CONCLUSIONS: The Consensus sepsis severity criteria can be applied to noninfectious SIRS, defining a population subset with similar high mortality and organ dysfunction incidence, although with greatly heterogeneous etiologies.
Assuntos
Síndrome de Resposta Inflamatória Sistêmica/diagnóstico , APACHE , Adolescente , Adulto , Idoso , Idoso de 80 Anos ou mais , Diagnóstico Diferencial , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Prognóstico , Estudos Prospectivos , Sepse/diagnóstico , Sepse/microbiologia , Índice de Gravidade de Doença , Síndrome de Resposta Inflamatória Sistêmica/microbiologiaRESUMO
Randomised controlled trials reported in languages other than English are generally excluded from systematic reviews. This exclusion is often based in the biased opinion that the strictness of methodology and the quality of assessment of the results are essentially inferior to similar articles reported in English. A study published in 1996 in The Lancet compared completeness of reporting, design characteristics, and analytical approaches of 229 randomised controlled trials published in English, French, German, Italian or Spanish, between 1989 and 1994. Eight of those trials had been published in Revista Medica de Chile. No significant differences were found in any single item analysed, between trials published in English and in other languages. The peer review system applied by a journal and the editorial selection of original articles to be published are crucial determinants of the overall quality of its publications. The role of local journals that publish in languages other than English is most important for the communities they are intended to serve and their contribution to disseminating scientific and other important aspects of medicine should be acknowledged and considered by readers, authors and editors in English-speaking countries, especially when these local journals belong to the mainstream literature included in the major international indexing services.
Assuntos
Idioma , Publicações Periódicas como Assunto , Editoração/normas , Humanos , Ensaios Clínicos Controlados Aleatórios como Assunto , Projetos de PesquisaRESUMO
We report two patients, an 82 years old female and a 71 years old male, who had a severe sepsis with positive blood cultures for Staphylococcus aureus and a superficial phlebitis as the only probable focus. In both the diagnosis of septic phlebitis was reached and an emergency phlebotomy was performed under local anesthesia. The clinical response was satisfactory and the pathological examination of excised veins showed an acute exudative leukocytic thrombophlebitis.
Assuntos
Infecções Estafilocócicas/diagnóstico , Staphylococcus aureus/isolamento & purificação , Tromboflebite/microbiologia , Idoso , Idoso de 80 Anos ou mais , Cateteres de Demora/efeitos adversos , Feminino , Humanos , Infusões Intravenosas/efeitos adversos , Infusões Intravenosas/instrumentação , Masculino , Índice de Gravidade de Doença , Tromboflebite/diagnóstico , Tromboflebite/etiologia , Tromboflebite/cirurgiaRESUMO
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.
Assuntos
Asma/tratamento farmacológico , Broncodilatadores/uso terapêutico , Óxido Nítrico/uso terapêutico , Síndrome do Desconforto Respiratório do Recém-Nascido/tratamento farmacológico , Vasodilatadores/uso terapêutico , Doença Crônica , Humanos , Recém-NascidoRESUMO
Germán Schneider was born in 1820 in Magdeburg, Germany, and graduated as M.D. at the University of Bonn. In 1848, caught by the political and intellectual reformist movement in Europe, he was exiled in Paris. As part of a large group of German immigrants, he arrived in Valdivia, Chile, in 1851. Later on he moved to Santiago and in 1871 he was nominated Professor of Clinical Medicine at the University of Chile school of Medicine. An active participant in the academic activities organized by Sociedad Médica de Santiago (a scientific society that evolved into the chilean Society of Internal Medicine) he was the leader of a six-men team who founded Revista Médica de Chile, in 1872. As first Editor of this medical journal, he established the basis for its continuous success and devotion to medical progress and education. Dr. Schneider died in 1884, leaving several distinguished pupils who followed his path, and a medical journal that now stands as one of the oldest in the world.
Assuntos
Publicações Periódicas como Assunto/história , Editoração/história , Chile , História do Século XIXRESUMO
BACKGROUND: Lately, we have observed an increase in the admission to intensive care units of patients over 65 years old, probably due to the increase in life expectancy that is occurring in Chile. AIM: To compare the frequency of admissions to intensive care units in patients over 65 years old, their diagnoses, their severity and hospital course, with those of younger patients. PATIENTS AND METHODS: The charts of all patients admitted to an intensive care unit of a University Hospital, during one year, were reviewed. The diagnosis that caused the admission was considered the main disease. Severity at the moment of admission was assessed using the Apache score. RESULTS: A total of 777 patients were admitted during the study period. Twenty had to be excluded due to lack of reliable data. Four hundred thirty two (57%) were over 65 years old. Cardiovascular diseases were the main cause of admission in young and old patients. Mortality was 14.8% of patients over 65 years old and 18.7% in younger patients. Main causes of death were cardiac arrest, cardiogenic shock, sepsis and cerebrovascular disease. No differences in causes of death were observed between young and old patients. CONCLUSIONS: Patients older than 65 years old admitted to intensive care units are very similar to their younger counterparts in their prognosis and causes of admission.