Tos ineficaz y técnicas mecánicas de aclaramiento mucociliar / Ineffective cough and mechanical mucociliary clearance techniques

La tos es un mecanismo de defensa fundamental para mantener la vía respiratoria libre de elementos extraños. Cuando la tos es ineficaz, por debilidad muscular o por alteración del normal funcionamiento del sistema mucociliar, se puede dar lugar a situaciones que pongan en riesgo la vida. Cuando un paciente no es capaz de producir tos eficaz es cuando está indicada la aplicación de técnicas que, o bien potencien la tos del paciente, o bien la sustituyan. Actualmente el uso de sistemas mecánicos facilitadores o sustitutivos de la tos es creciente en las unidades de cuidados intensivos, donde con relativa frecuencia encontramos pacientes en esta situación por diversas causas clínicas. Esta revisión se centra en las recomendaciones de práctica clínica actuales con respecto a la indicación y aplicación de la tos asistida mecánica y de la ventilación percutora intrapulmonar (AU)

Cough is a fundamental defense mechanism for keeping the airway free of foreign elements. Life-threatening situations may arise when cough proves ineffective as a result of muscle weakness or altered mucociliary function. When a patient is unable to cough effectively, techniques are required to either reinforce or replace cough capacity. The use of mechanical systems that facilitate or substitute cough function is increasingly common in Intensive Care Units, where it is relatively frequent to find situations of ineffective cough due to different clinical causes. This review examines the current clinical practice recommendations referred to the indication and use of mechanical cough assist and intrapulmonary percussive ventilation systems (AU)

Ineffective cough and mechanical mucociliary clearance techniques. / Tos ineficaz y técnicas mecánicas de aclaramiento mucociliar.

Cough is a fundamental defense mechanism for keeping the airway free of foreign elements. Life-threatening situations may arise when cough proves ineffective as a result of muscle weakness or altered mucociliary function. When a patient is unable to cough effectively, techniques are required to either reinforce or replace cough capacity. The use of mechanical systems that facilitate or substitute cough function is increasingly common in Intensive Care Units, where it is relatively frequent to find situations of ineffective cough due to different clinical causes. This review examines the current clinical practice recommendations referred to the indication and use of mechanical cough assist and intrapulmonary percussive ventilation systems.

Soporte con oxigenación de membrana extracorpórea en un síndrome de Takotsubo y QT largo tras cirugía cardiaca / Extracorporeal membrane oxygenation support for Takotsubo syndrome and long QT after cardiac surgery

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Tratamiento de necrólisis epidérmica tóxica con ciclosporina A / Toxic epidermal necrolysis treated with cyclosporin A

El síndrome de Lyell o necrólisis epidérmica tóxica (NET) es una toxicodermia extremadamente grave e infrecuente; se caracteriza por la necrosis y el posterior desprendimiento de la epidermis en grandes áreas cutáneas tras una reacción idiosincrásica a un fármaco. Los pacientes que la padecen presentan idénticas complicaciones fisiopatológicas que los grandes quemados. Tradicionalmente se ha tratado con inmunomoduladores como los corticoides, inmunoglobulinas, ciclofosfamida, talidomida o plasmaférisis, obteniéndose una respuesta variable y enalgunos casos contradictoria.Desde finales de los años noventa, se ha ensayado en series limitadas la ciclosporina A comoinmunomodulador único en pacientes con NET, mejorando resultados en términos de supervivencia respecto a estudios con otros fármacos. En este artículo se presentan 3 casos consecutivos de NET tratados con ciclosporina A (AU)

Lyell’s syndrome or toxic epidermal necrolysis (TEN) is an extremely rare and dangerous severe skin disorder characterized by a high proportion of cutaneous lesions leading tonecrosis and subsequent shedding of the epidermis over large areas of skin after an idiosyncraticreaction triggered by a drug. The patients who suffer it pathophysiologically have similar complications to those seen in major burns.TEN traditionally has been treated with immunomodulators such as glucocorticoids, intravenousgammaglobulin, cyclophosphamide, thalidomide or plasmapheresis. A variable, and sometimes contradictory response, has been obtained in some series.Cyclosporin A has been tested as a single immunomodulator in patients with TEN since the end of the 90 s in a limited number series. The results have improved in regards to survival compared with studies with other drugs.We report three consecutive cases of toxic epidermal necrolysis treated with cyclosporin Ain this article (AU)

Rotura de aorta torácica descendente. Tratamiento endoprotésico / Descending thoracic aortic rupture, endoprosthetic treatment

Resumen La rotura de la aorta, independientemente de su localización y etiología, es unaafección extremadamente grave que conduce a la muerte rápidamente. En el momento actualno hay consenso sobre si el tratamiento endovascular de la rotura de la aorta torácica descendentees superior al tratamiento quirúrgico convencional a medio y largo plazo. En esta serie,de 13 casos, describimos nuestra experiencia y evaluamos los resultados en pacientes tratadosde forma endoprotésica desde enero de 2005 hasta enero de 2009 (AU)

Abstract Aortic rupture, independently of its location and etiology, is an extremely seriouscondition that leads to death rapidly. There is currently no consensus on whether endovasculartreatment of the descending thoracic aortic rupture is superior to conventional surgical repair interms of mid-or long-terms outcome. We describe our experience with 13 patients from January2005 to January 2009 to evaluate the results in patients with descending thoracic aortic ruptureundergoing endoprosthetic management (AU)

[Descending thoracic aortic rupture, endoprosthetic treatment]. / Rotura de aorta torácica descendente. Tratamiento endoprotésico.

Aortic rupture, independently of its location and etiology, is an extremely serious condition that leads to death rapidly. There is currently no consensus on whether endovascular treatment of the descending thoracic aortic rupture is superior to conventional surgical repair in terms of mid-or long-terms outcome. We describe our experience with 13 patients from January 2005 to January 2009 to evaluate the results in patients with descending thoracic aortic rupture undergoing endoprosthetic management.