Preeclampsia grave. Propuesta de actuación basada en la evidencia / Severe pre-eclampsia. An evidence-based practice proposal

Objetivos. Aunque hay numerosas pautas de tratamiento de la preeclampsia en la paciente obstétrica, hay escasa evidencia acerca de lo adecuado del tratamiento estándar. Por otra parte, organismos sanitarios internacionales recomiendan que haya disponibles recomendaciones, protocolos o guías escritas para la atención de situaciones frecuentes o graves por parte de hospitales o servicios de anestesia. Nuestro objetivo fue elaborar recomendaciones basadas en la evidencia sobre el abordaje terapéutico de la paciente con preeclampsia grave. Material y métodos. Se realizó una revisión de la bibliografía obtenida de diversas fuentes, bases de datos, recomendaciones de sociedades y revisiones. Se llevó a cabo por 4 anestesiólogos expertos que plantearon preguntas clínicas (extraídas de la lectura de revisiones recientes sobre preeclampsia). Para la selección final se requirió consenso de al menos 3 de los 4 expertos. Se siguieron los criterios de asignación de evidencia de Oxford y se aplicó la escala de Jadad a los estudios seleccionados. Resultados. Se eligieron 50 preguntas clínicas que fueron respondidas. Se clasificaron en: medidas generales, influencia de la forma de parto, evaluación preanestésica, tratamiento periparto (incluyendo la analgesia y anestesia), eclampsia, posparto y tratamiento intensivo y traslado. La mayoría de las respuestas presentan una evidencia científica baja que las avale. Conclusiones. Se proponen unas recomendaciones basadas en la evidencia para el tratamiento de la preeclampsia grave, especialmente enfocadas a los anestesiólogos(AU)

Objectives. There are several treatment proposals for the obstetric patient with pre-eclampsia, but there is limited evidence on the adequacy of standard treatment. International healthcare organisations recommend that hospitals or anaesthesia departments have written guidelines, protocols or recommendations for dealing with common or severe situations. We propose evidence-based recommendations for the treatment of pre-eclampsia. Material and methods. A literature review was performed using several sources, bibliography databases, recommendations made by specialist societies, and reviews. Four anaesthesiologists reviewed the references selected, in order to design clinical questions (these were obtained from recent pre-eclampsia review articles). Consensus of at least 3 out of 4 experts was required. The Oxford criteria for evidence were chosen to classify the scientific articles, and the Jadad score was applied to the final articles selected. Results. A total of 50 clinical questions were designed and answered. These were classified into: general questions, influence of the type of delivery, pre-anaesthesia evaluation, peripartum treatment (including analgesia and anaesthesia), eclampsia, post-delivery period, and intensive care and transport. Most of the responses showed low scientific evidence. Conclusions. Evidence-based recommendations for severe pre-eclampsia treatment were provided with special emphasis on the anaesthesiologist point of view(AU)

[Severe pre-eclampsia. An evidence-based practice proposal]. / Preeclampsia grave. Propuesta de actuación basada en la evidencia.

OBJECTIVES: There are several treatment proposals for the obstetric patient with pre-eclampsia, but there is limited evidence on the adequacy of standard treatment. International healthcare organisations recommend that hospitals or anaesthesia departments have written guidelines, protocols or recommendations for dealing with common or severe situations. We propose evidence-based recommendations for the treatment of pre-eclampsia. MATERIAL AND METHODS: A literature review was performed using several sources, bibliography databases, recommendations made by specialist societies, and reviews. Four anaesthesiologists reviewed the references selected, in order to design clinical questions (these were obtained from recent pre-eclampsia review articles). Consensus of at least 3 out of 4 experts was required. The Oxford criteria for evidence were chosen to classify the scientific articles, and the Jadad score was applied to the final articles selected. RESULTS: A total of 50 clinical questions were designed and answered. These were classified into: general questions, influence of the type of delivery, pre-anaesthesia evaluation, peripartum treatment (including analgesia and anaesthesia), eclampsia, post-delivery period, and intensive care and transport. Most of the responses showed low scientific evidence. CONCLUSIONS: Evidence-based recommendations for severe pre-eclampsia treatment were provided with special emphasis on the anaesthesiologist point of view.

[The clinical history and physical examination in patients with chronic lumbar pain. Patient classification by a decision tree]. / Historia clínica y exploración física en pacientes con dolor lumbar crónico. Clasificación de pacientes con un árbol de decisión.

AIM: To analyze the correlation between clinical symptoms and physical examination signs in diagnostic groups of low back pain patients; making a spanning tree. MATERIAL AND METHOD: A prospective longitudinal study of 485 low back pain patients was carried. We assess the type of pain and its irradiation, evolution in time, duration of the episodes, timetable, intensity and morning stiffness. A complete physical examination with specific tests for sacroiliac joints and neurologic examination was carried. We carried out a study of absolute and relative frequencies; calculating the rates with the chi 2 Pearson test and having a confidence of 95%. RESULTS: We found a significant relation (p < 0.0001) between the type of pain and the diagnosis groups. Proximal irradiation with functional disorders (p < 0.01) and metabolic bone diseases (p < 0.0001); the radicular irradiation and the disorders by physical agents (p < 0.001). The flare-up back pain with disorders by physical agents and metabolic bone diseases (p < 0.001). The morning stiffness was exclusive in the inflammatory diseases. In the physical examination, was found a significant relation (p < 0.0001) between the different tests with the diagnostic groups. CONCLUSION: The history and the physical examination provide us symptoms and signs which let us direct towards the above diagnostic. The type of pain with its characteristics and the referred pain as a main symptoms, give us some information, which complemented with the physical examination tests, providing the base on which we support our diagnostic hypothesis, allow us the first classification of the patients; at the same time we understand as a low back pain patients suffer its problem.