Reanimación cardiopulmonar en prono a propósito de un caso / Case report cardiopulmonary resuscitation in prone position

Prone position is necessary for some neurosurgical and othopedic procedures. Cardiopulmonary resuscitation (CPR) in prone position was first described by McNeil in 1989, since then several successful cases have been published. We report the case of a 72-year-old patient with history of stage IV breast cancer who presented acute spinal cord compression due to a vertebral fracture at T10 level. Surgical spinal cord decompression and posterior arthrodesis was performed. After three hours of surgery, cardiorespiratory arrest occur while patient was in prone position. Unestable spine and fixed head made turning the patient into supine position very difficult, consequently prone CPR manoeuvres were started with recovery of spontaneous circulation. In case of cardiorespiratory arrest in prone position, the intense fixation and the extent of the surgical incision make the change to supine a time-consuming and technically complex procedure. If cardiorespiratory arrest occurs in the prone position, CPR in the prone position might be reasonable.

La posición de decúbito prono es necesaria para la realización de algunos procedimientos neuroquirúrgicos y traumatológicos. La reanimación cardiopulmonar (RCP) en prono fue descrita por primera vez por McNeil en 1989, desde entonces se han publicado varios casos de RCP en prono con buen resultado. Presentamos el caso de una paciente de 72 años con antecedentes de carcinoma de mama estadio IV que presenta síndrome de compresión medular por fractura patológica a nivel de T10. Se decide realizar descompresión medular y artrodesis por vía posterior. A las 3 horas de la cirugía se produjo parada cardiorrespiratoria en prono. Dada la inestabilidad espinal y la fijación de la paciente, el cambio a supino era complejo por lo que se iniciaron maniobras de RCP en prono con posterior recuperación de circulación espontánea. En caso de parda cardiorrespiratoria en prono, la intensa fijación y la extensión de la incisión quirúrgica hace que el cambio a supino consuma tiempo y sea técnicamente complejo. Si la PCR ocurre en prono, está justificado iniciar las maniobras de RCP en esta posición.

Role of de-escalation strategies in the treatment and prevention of chronic critical illness / 中华胃肠外科杂志

De-escalation strategy is the gradual transition of various complex, expensive, high-risk but effective treatments for critically ill patients to simple, safe, physiological but still effective ones. Chronic critical illness refers to patients suffering severe disease or surgical hit who later shift into a chronic state of relapse or even aggravation and stay in the intensive care unit for extended period. Risk factors for surgical related chronic critical illness include advanced age, malnutrition, multiple organ dysfunction and multiple hits. During the treatment of critically ill patients, the strategy of de-escalation therapy should always be implemented, including rational use of antibiotics, de-escalation of liquid therapy (i.e. de-resuscitation), timely removal of ventilator, rapid introduction and with drawal of continuous renal replacement measures, parenteral + enteral nutrition support therapy and timely cessation of sedation.

The clinical significance of B-type natriuretic peptide in the process of fluid resuscitation in the patients with severe acute pancreatitis / 重庆医学

Objective To investigate the clinical significance of B-type natriuretic peptide(BNP) in the process of fluid resuscita-tion with different crystalloid-colloid ratio in the patients with severe acute pancreatitis (SAP) .Methods Clinical data of 85 SAP patients were analyzed retrospectively in the Emergency Center of Chongqing during January of 2010 to December of 2012 .Early goal-directed therapy(EGDT) was confirmed the end criterion of the end point of resuscitation .Low crystalloid-colloid ratio group (n=45) and high crystalloid-colloid ratio group(n=40) were divided according to crystalloid-colloid ratio (3∶1) as the borderline , BNP were observed at the time point of before fluid resuscitation ,and 1 ,2 ,3 days after resuscitation and the day before discharge . Results Different fluid resuscitation of crystalloid-colloid ratio could improve hemodynamics in patients ,BNP increased with the to-tal amount of resuscitation liquid ,were positively correlated with liquid volume .The total amount of fluid of the high crystalloid-colloid ratio group was significantly higher than that of the low crystalloid-colloid ratio group .Conclusion BNP could guide early fluid resuscitation and low crystalloid-colloid ratio should be adopted for SAP patients .