Shock séptico. Actualización en tratamiento con suero salino hipertónico y hormona antidiurética-vasopresina / Septic shock. Update of treatment using hypertonic saline and antidiuretic hormone-vasopressin

La seguridad en el uso del suero salino hipertónico ha sido comprobada por estudios en el campo de la reanimación con pequeños volúmenes para el shock hipovolémico y en el tratamiento de la hipertensión intracraneal. En el ámbito del shock séptico, ha sido poco experimentado en seres humanos. Existen efectos inmunomodulatorios beneficiosos detectados en estudios preclínicos. Las interacciones con el eje hipofisario-adrenal y con la secreción de la hormona antidiurética son diversas y sugerentes, pero insuficientemente entendidas. Por otra parte, la vasopresina ejerce acciones cardiovasculares, osmorreguladoras, sobre la coagulación y también sobre el eje hipotálamo-hipofisario-adrenal. En el shock séptico hay un déficit relativo de vasopresina. Su uso en estos pacientes no parece presentar ventajas en cuanto a la mortalidad, pero puede ser beneficioso en pacientes en riesgo de insuficiencia renal aguda o en aquellos que reciben corticoides. La terlipresina es un análogo de la vasopresina que también se ha estudiado. La sinergia entre la vasopresina y el suero salino hipertónico es una hipótesis que se fundamenta, sobre todo, en estudios preclínicos. El uso del suero salino hipertónico en el shock séptico sigue siendo experimental, aunque prometedor, y debe quedar restringido al campo de los ensayos clínicos controlados(AU)

Safety in the use of small volumes of hypertonic saline solution for hypovolaemic shock and in the treatment of intracranial hypertension has been demonstrated in studies in the field of resuscitation. There is little experience of this for septic shock in humans. Beneficial immunomodulatory effects have been detected in pre-clinical studies. Interactions with the pituitary-adrenal axis and with the secretion of anti-diuretic hormone are varied and suggestive, but are not sufficiently understood. On the other hand, vasopressin has cardiovascular, osmoregulatory, and coagulation effects, and also acts on the hypothalamic-pituitary-adrenal axis. There is a relative deficit of vasopressin in septic shock. Its use in these patients does seem to have any advantages as regards mortality, but may be beneficial in patients at risk from acute renal failure, or those who receive corticosteroids. Terlipressin is a vasopressin analogue that has also been studied. The synergy between vasopressin and hypertonic saline is a hypothesis that is mainly supported in pre-clinical studies. The use of hypertonic saline solution in septic shock, although promising, is still experimental, and must be restricted to the field of controlled clinical trials(AU)

[Septic shock. Update of treatment using hypertonic saline and antidiuretic hormone-vasopressin]. / Shock séptico. Actualización en tratamiento con suero salino hipertónico y hormona antidiurética-vasopresina.

Safety in the use of small volumes of hypertonic saline solution for hypovolaemic shock and in the treatment of intracranial hypertension has been demonstrated in studies in the field of resuscitation. There is little experience of this for septic shock in humans. Beneficial immunomodulatory effects have been detected in pre-clinical studies. Interactions with the pituitary-adrenal axis and with the secretion of anti-diuretic hormone are varied and suggestive, but are not sufficiently understood. On the other hand, vasopressin has cardiovascular, osmoregulatory, and coagulation effects, and also acts on the hypothalamic-pituitary-adrenal axis. There is a relative deficit of vasopressin in septic shock. Its use in these patients does not seem to have any advantages as regards mortality, but may be beneficial in patients at risk from acute renal failure, or those who receive corticosteroids. Terlipressin is a vasopressin analogue that has also been studied. The synergy between vasopressin and hypertonic saline is a hypothesis that is mainly supported in pre-clinical studies. The use of hypertonic saline solution in septic shock, although promising, is still experimental, and must be restricted to the field of controlled clinical trials.

Síndrome coronario agudo sintomático en el seguimiento de una cohorte en el postoperatorio de cirugía no cardiaca / Symptomatic acute coronary syndrome in a cohort of patients followed after noncardiac surgery

Objetivo: Determinar la incidencia del síndrome coronario agudo (SCA) sintomático con y sin elevación del ST, los factores con los que se relacionó, la estancia media y la mortalidad atribuible en el periodo postoperatorio en pacientes de cirugía no cardiaca. Material y métodos: Se registraron prospectivamente los datos de una cohorte de pacientes intervenidos de cirugía no cardíaca que pasaron por la unidad de reanimación postoperatoria del Hospital General de Ciudad Real en el periodo comprendido entre abril de 2006 y diciembre de 2009. Se evaluó la incidencia de SCA sintomático. Resultados: Treinta y dos de 1.919 pacientes presentaron SCA (incidencia 1,7%). Los factores asociados fueron: sexo varón (p = 0,046), edad (p = 0,001), hipertensión arterial (68,8%; p = 0,012) y cardiopatía isquémica previa (34,4% p = 0,001). Los pacientes que sufrieron intervenciones quirúrgicas que presentaron SCA postoperatorio de forma significativa (p < 0,004) fueron cirugía general (37,5%), ortopedia-traumatología (28,1%) y cirugía vascular (15,6%). Fueron transfundidos el 20% de los pacientes en general, y el 50% de los que tuvieron SCA (p = 0,001). El tratamiento fue médico en el 87,5% de los pacientes. La estancia media de los pacientes en la unidad fue de 2,96 ± 6,3 días frente a 3,88 ± 5 días en los pacientes con SCA (p = 0,39) y la mortalidad del 5% frente al 6% respectivamente (p = 0,45). El análisis multivariante mostró como variables independientes para presentar SCA en el periodo postoperatorio: antecedentes de cardiopatía isquémica (OR = 4,59; IC 95% 1,98-10,62), y sangrado quirúrgico (OR =3,18; IC 95%, 1,51-6,71). La cirugía ginecológica (OR = 0,063; IC 95%, 0,004-1,09) mostró la menor probabilidad de presentar dicha alteración en el postoperatorio. Conclusión: La incidencia de SCA en nuestra cohorte en el postoperatorio de cirugía no cardiaca es del 1,7%. Son factores de riesgo la edad, el sexo masculino, los antecedentes de hipertensión arterial y cardiopatía isquémica, el tipo de cirugía y la hemorragia operatoria que precisó transfusión de concentrados de hematíes. Dada la gravedad de esta complicación es importante estratificar el riesgo de estos pacientes preoperatoriamente(AU)

Objetives: To determine the incidence of acute coronary syndrome (ACS) with and without ST-segment elevation, factors related to the development of ACS, mean hospital stay, and attributable mortality. Material and methods: In a noncardiac surgery cohort attended in the postoperative critical care unit of Hospital General de la Ciudad Real, Spain, data were recorded prospectively between April 2006 and December 2009. The incidence of symptomatic ACS was calculated. Results: Thirty-two of 1919 patients developed ACS (incidence, 1.7%). Patient factors related to developing the syndrome were male sex (P=.046), age (P=.001), arterial hypertension (68.8%, P=.012), and a history of ischemic heart disease (34.4%, P=.001). Types of surgery that were significantly related to developing ACS were general surgery (37.5%), orthopedic or trauma surgery (28.1%), and vascular surgery (15.6%) (P<.004). Twenty percent of the cohort received transfusions; 50% of those who developed ACS were transfused (P=.001). The condition was treated medically in 87.5% of the cases. The mean (SD) duration of hospital stay was 2.96 (6.3) days for the cohort and 3.88 (5) days for patients who developed ACS (P=.39); mortality rates were 5% and 6%, respectively (P=.45). Multivariate analysis confirmed that the following independent variables were associated with developing postoperative ACS: a history of ischemic heart disease (odds ratio [OR], 4.59; 95% confidence interval [CI], 1.98-10.62) and intraoperative bleeding (OR, 3.18; 95% CI, 1.51-6.71). Gynecologic surgery patients were the least likely to develop postoperative ACS (OR, 0.063; 95% CI, 0.004-1.09). Conclusions: The incidence of postoperative ACS in this noncardiac surgery cohort was 1.7%. Age, male sex, a history of arterial hypertension or ischemic heart disease, type of surgery, and intraoperative bleeding requiring transfusion of packed red blood cells are factors that are associated with developing this complication. Given the seriousness of ACS it is important to classify patients by risk before surgery(AU)

Aplicación de VMNI con "Helmet" en la insuficiencia respiratoria aguda secundaria a hemorragia alveolar (Granulomatosis de Wegener) / No disponible

No disponible

[Symptomatic acute coronary syndrome in a cohort of patients followed after noncardiac surgery]. / Síndrome coronario agudo sintomático en el seguimiento de una cohorte en el postoperatorio de cirugía no cardiaca.

OBJECTIVES: To determine the incidence of acute coronary syndrome (ACS) with and without ST-segment elevation, factors related to the development of ACS, mean hospital stay, and attributable mortality. MATERIAL AND METHODS: In a noncardiac surgery cohort attended in the postoperative critical care unit of Hospital General de la Ciudad Real, Spain, data were recorded prospectively between April 2006 and December 2009. The incidence of symptomatic ACS was calculated. RESULTS: Thirty-two of 1919 patients developed ACS (incidence, 1.7%). Patient factors related to developing the syndrome were male sex (P=.046), age (P=.001), arterial hypertension (68.8%, P=.012), and a history of ischemic heart disease (34.4%, P=.001). Types of surgery that were significantly related to developing ACS were general surgery (37.5%), orthopedic or trauma surgery (28.1%), and vascular surgery (15.6%) (P<.004). Twenty percent of the cohort received transfusions; 50% of those who developed ACS were transfused (P=.001). The condition was treated medically in 87.5% of the cases. The mean (SD) duration of hospital stay was 2.96 (6.3) days for the cohort and 3.88 (5) days for patients who developed ACS (P=.39); mortality rates were 5% and 6%, respectively (P=.45). Multivariate analysis confirmed that the following independent variables were associated with developing postoperative ACS: a history of ischemic heart disease (odds ratio [OR], 4.59; 95% confidence interval [CI], 1.98-10.62) and intraoperative bleeding (OR, 3.18; 95% CI, 1.51-6.71). Gynecologic surgery patients were the least likely to develop postoperative ACS (OR, 0.063; 95% CI, 0.004-1.09). CONCLUSIONS: The incidence of postoperative ACS in this noncardiac surgery cohort was 1.7%. Age, male sex, a history of arterial hypertension or ischemic heart disease, type of surgery, and intraoperative bleeding requiring transfusion of packed red blood cells are factors that are associated with developing this complication. Given the seriousness of ACS it is important to classify patients by risk before surgery.

Bloqueo auriculoventricular inducido por risperidona a altas dosis / No disponible

No disponible

Digestibility and effects of whole cottonseed fed to lactating cows.

Four lactating Holstein cows producing about 21 kg milk/day were fed complete rations containing 0, 5, 15, and 25% whole cottonseed in a 4 X 4 Latin square design. Diets were fed ad libitum. Periods were 21 days in length with total collections of feces and urine during the last 7 days of each period. Digestibilities o nitrogen, lipid, and energy increased with increasing cottonseed in the diet. There were no significant effects of cottonseed on digestibility or availability of fiber components, calcium, phosphorous, and magnesium. Cottonseed feeding did not affect dry matter intake or milk yield but did increase yields of milk fat and fat-corrected milk and decrease milk protein and solids-not-fat percentages. Synthesis of fatty acid in the mammary gland was depressed by about 50% on the 25% cottonseed diet, but transfer of dietary fat resulted in twofold increases in yields of stearic and oleic acids. Hydrogenation of cottonseed fatty acid in the rumen resulted in a fourfold increase in yield of trans oleic acid in milk fat. Samples from bulk milk tank and data collected from 55 commercial dairies showed similar changes in fatty acid composition of milk from cows fed whole cottonseed. There was no apparent effect of feeding up to 2.9 kg cottonseed dry matter per cow per day on calving interval or on incidence of displaced abomasum, ketosis, milk, fever, or retained placenta.