Los síndromes pericárdicos agudos en la unidad de cuidados intensivos / Acute pericardial syndromes in the intensive care unit

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Cardiogenic shock: management of right ventricular infarction shock.

Right ventricular infarction is a not uncommon cause of cardiogenic shock, whose frecuency is variable and could be underestimated. Although left ventricular myocardial management is well defined in the right ventricular infarction are few studies with low level of evidence, to establish definitive guidelines. It is assumed that the treatment is similar to that of the left ventricle, although there are some differences. The axis of the therapeutic management, as well as the left ventricle infarction, is based on early myocardial reperfusion, particularly through percutaneous coronary interventionism. Throm-bolysis is an option, especially after an increase in systemic blood pressure using vasoactive drugs such as norepinephrine. The preload optimization by volume administration during resuscitation of shock is useful, but it must be with caution. The use of levosimendan could be potentially beneficial option. On the neurohormonal modulation of systemic inflammatory response produced after the cardiogenic shock (CS), the use of ACE inhibitors and beta-blockers is controversial.

Presión intraabdominal y torácica en pacientes críticos con sospecha de hipertensión intraabdominal / Intraabdominal and thoracic pressure in critically ill patients with suspected

ObjetivoAnalizar la correlación entre la presión intraabdominal e intratorácica en pacientes con sospecha de hipertensión intraabdominal (HIA).DiseñoEstudio prospectivo observacional de una cohorte.ÁmbitoUnidad de medicina intensiva polivalente de un hospital universitario.PacientesSe incluyó a 27 pacientes medicoquirúrgicos dependientes de ventilación mecánica controlada por fallo respiratorio agudo y con factores de riesgo de hipertensión intraabdominal.Principales variablesMedimos las presiones intraabdominal (PIA), esofágica (Peso) y de la vía aérea en condiciones estáticas (est) y dinámicas (din). Calculamos la distensibilidad del sistema respiratorio (Csr), pulmón (Cp) y pared torácica (Cpt).ResultadosEn 10 pacientes la PIAest fue mayor de 12mmHg (HIA, PIAest, 14±2 [12-21] mmHg) y en el resto fue normal (n=17; PIAest, 8±2 [3-11] mmHg). La Pesoest fue 11±5 (2-27) y Pesodin, 7±4 (2-24) cmH2O. Considerando la presencia o no de HIA, Pesoest fue 9±4 vs. 7±3cmH2O (p=0,2) y Pesodin, 6±2 vs. 4±3cmH2O (p=0,3), respectivamente. La correlación de Pesoest y din con PIAest fue 0,5 (p=0,003) y 0,4 (p=0,03), respectivamente. Los componentes de la distensibilidad del sistema respiratorio estaban disminuidos (Csr, 31±8; Cp, 52±22; Cpt, 105±50ml/cmH2O), Cpt fue significativamente más baja en los pacientes con HIA (81±31 vs. 118±55ml/cmH2O; p=0,02). El coeficiente de correlación entre la PIAest y Cpt fue –0,7 (p<0,001) y de –0,5 (p=0,002) con Csr.ConclusionesLa pared torácica es más rígida en pacientes con hipertensión abdominal. En presencia de factores de riesgo de HIA las presiones en estos compartimentos son muy variables (AU)

Objective: To study the correlation between intraabdominal and intrathoracic pressure inpatients with suspected intraabdominal hypertension.Design: A prospective, observational cohort study.Setting: Polyvalent intensive care unit of a University hospital.Patients: Twenty-seven medical-surgical patient dependent upon controlled mechanical ventilationdue to acute respiratory failure and with several risk factors for intraabdominalhypertension (IAH).Main variables: Intraabdominal (IAP), esophageal (Peso) and airways pressure were measuredunder static (st) and dynamic (dyn) conditions. Respiratory system (Crs), lung (Cl) and chestwall compliance (Ccw)were calculated.Results: In 10 patients IAP > 12mmHg (IAH, IAPst, 14±2 [12-21] mmHg), while in the rest thepressure proved normal (n = 17; IAPst, 8±2 [3-11] mmHg). Peso st was 11±5 (2-27) and Pesodyn 7±4 (2-24) cmH2O. Depending on the presence or absence of IAH, Peso st was 9±4 vs7±3 cmH2O (p = 0.2) and Peso dyn 6±2 vs 4±3 cmH2O (p = 0.3), respectively. The correlationbetween Peso st and dyn with IAPst was 0.5 (p = 0.003) and 0.4 (p = 0.03), respectively. Thecompliance components were decreased (Crs, 31±8; Cl, 52±22 and Ccw, 105±50 ml/cmH2O);Ccw was significantly lower in patients with IAH (81±31 vs 118±55 ml/cmH2O; p = 0.02). Thecorrelation coefficient between IAPst and Ccw was —0.7 (p < 0.001), and —0.5 (p = 0.002) withrespect to Crs.Conclusions: A stiffer chest wall was observed in patients with IAH. In patients with risk factorsfor IAH, pressures in these compartments were highly variable (AU)

[Intraabdominal and thoracic pressure in critically ill patients with suspected intraabdominal hypertension]. / Presión intraabdominal y torácica en pacientes críticos con sospecha de hipertensión intraabdominal.

OBJECTIVE: To study the correlation between intraabdominal and intrathoracic pressure in patients with suspected intraabdominal hypertension. DESIGN: A prospective, observational cohort study. SETTING: Polyvalent intensive care unit of a University hospital. PATIENTS: Twenty-seven medical-surgical patient dependent upon controlled mechanical ventilation due to acute respiratory failure and with several risk factors for intraabdominal hypertension (IAH). MAIN VARIABLES: Intraabdominal (IAP), esophageal (Peso) and airways pressure were measured under static (st) and dynamic (dyn) conditions. Respiratory system (Crs), lung (Cl) and chest wall compliance (Ccw)were calculated. RESULTS: In 10 patients IAP > 12 mmHg (IAH, IAPst, 14 ± 2 [12-21] mmHg), while in the rest the pressure proved normal (n = 17; IAPst, 8 ± 2 [3-11] mmHg). Peso st was 11 ± 5 (2-27) and Peso dyn 7 ± 4 (2-24) cmH2O. Depending on the presence or absence of IAH, Peso st was 9 ± 4 vs 7 ± 3 cmH2O (p = 0.2) and Peso dyn 6 ± 2 vs 4 ± 3 cmH2O (p = 0.3), respectively. The correlation between Peso st and dyn with IAPst was 0.5 (p= 0.003) and 0.4 (p = 0.03), respectively. The compliance components were decreased (Crs, 31 ± 8; Cl, 52 ± 22 and Ccw, 105 ± 50 ml/cmH2O); Ccw was significantly lower in patients with IAH (81 ± 31 vs 118 ± 55 ml/cmH2O; p = 0.02). The correlation coefficient between IAPst and Ccw was -0.7 (p < 0.001), and -0.5 (p = 0.002) with respect to Crs. CONCLUSIONS: A stiffer chest wall was observed in patients with IAH. In patients with risk factors for IAH, pressures in these compartments were highly variable.

Efecto de la administración de las estatinas en la patología crítica no cardiológica / Resumen La administración de estatinas se ha mostrado eficaz en reducir la mortalidad cardiovascular. Su beneficio podría expandirse hacia otras áreas de la medicina intensiva, pudiendo disminuir la mortalidad del paciente críticamente enfermo. Existen diversos estudios, aunque sin un alto nivel de evidencia, en el que parece detectarse un posible beneficio en su administración, y un empeoramiento clínico con la discontinuación de estos fármacos, sobre los pacientes que previamente las tomaban. A pesar de que la mayoría de los pacientes que tomaban previamente estatinas, lo hacían como prevención primaria o secundaria, teniendo por tanto una mayor comorbilidad, en global se detecta una disminución de la mortalidad en dichos subgrupos. Este beneficio podría ser generalizado ante toda la patología crítica, aunque se requieren estudios con un mayor nivel de evidencia, para su adecuada contrastación

La administración de estatinas se ha mostrado eficaz en reducir la mortalidad cardiovascular. Su beneficio podría expandirse hacia otras áreas de la medicina intensiva, pudiendo disminuir la mortalidad del paciente críticamente enfermo. Existen diversos estudios, aunque sin un alto nivel de evidencia, en el que parece detectarse un posible beneficio en su administración, y un empeoramiento clínico con la discontinuación de estos fármacos, sobre los pacientes que previamente las tomaban.A pesar de que la mayoría de los pacientes que tomaban previamente estatinas, lo hacían como prevención primaria o secundaria, teniendo por tanto una mayor comorbilidad, en global se detecta una disminución de la mortalidad en dichos subgrupos. Este beneficio podría ser generalizado ante toda la patología crítica, aunque se requieren estudios con un mayor nivel de evidencia, para su adecuada contrastación (AU)

Administration of statins has been shown to be effective in reducing cardiovascularmortality. Their benefit could expand towards other areas of intensive medicine, it beingpossible to decrease mortality of the critically ill patient. There are several studies, althoughwithout a high level of evidence, that have detected a possible benefit when they are administeredas well as clinical deterioration when they are discontinued, compared to those patientswho had previously taken them.Even though most of the patients who had previously taken statins did so as primary orsecondary prevention, thus having greater comorbidity, overall, a decrease is detected in themortality of these subgroups. This benefit could be generalized to all the critical conditions,although studies with a higher level of evidence are needed for their adequate comparison.© 2009 Elsevier Espa˜na, S.L. y SEMICYUC. All rights reserved (AU)

[Effect of the administration of statins in non-cardiac critical disease]. / Efecto de la administración de las estatinas en la patología crítica no cardiológica.

Administration of statins has been shown to be effective in reducing cardiovascular mortality. Their benefit could expand towards other areas of intensive medicine, it being possible to decrease mortality of the critically ill patient. There are several studies, although without a high level of evidence, that have detected a possible benefit when they are administered as well as clinical deterioration when they are discontinued, compared to those patients who had previously taken them. Even though most of the patients who had previously taken statins did so as primary or secondary prevention, thus having greater comorbidity, overall, a decrease is detected in the mortality of these subgroups. This benefit could be generalized to all the critical conditions, although studies with a higher level of evidence are needed for their adequate comparison.