Medicina Crítica最新文献

{"title":"Asociación entre el nivel de cortisol sérico y la mortalidad en pacientes postquirúrgicos con choque hipovolémico hemorrágico","authors":"Susana Patricia Díaz Gutiérrez, J. S. Sánchez Díaz, Enrique Antonio Martínez Rodríguez, Rosalba Carolina García Méndez, Karla Gabriela Peniche Moguel, M.V. Calyeca Sánchez","doi":"10.35366/78358","DOIUrl":"https://doi.org/10.35366/78358","url":null,"abstract":"Las glándulas suprarrenales son órganos endocrinos multifuncionales que secretan diversos esteroides. El cortisol es el principal corticosteroide; se produce en la zona reticular de la corteza suprarrenal, regulando su secreción a través del eje hipotálamo-hipófi sis-suprarrenales y liberándose en respuesta al estrés.1,2 El uso de corticosteroides para el tratamiento de pacientes con choque séptico ha llevado a considerar su empleo en otros procesos patológicos, entre ellos, el choque hipovolémico hemorrágico, aunque con resultados controversiales.3 A pesar de los avances en el reconocimiento y manejo oportuno de pacientes con choque hipovolémico hemorrágico en los últimos años (cirugía de control de daños, uso de soluciones balanceadas, protocolos de transfusión masiva, etcétera), esta entidad continúa produciendo gran impacto socioeconómico. El choque hipovolémico hemorrágico alcanza una mortalidad hasta de 40% en las primeras 24 horas posteriores a la lesión.4 Dentro de la fi siopatología se destaca que con pérdidas mayores al 10% del volumen sanguíneo circulante (VSC) existe repercusión hemodinámica evidente, con descenso del volumen minuto cardiaco (VMC) y vasoconstricción periférica mediada por incremento de la actividad simpática; esto ocasionará alteraciones en la macrocirculación (hipotensión arterial sistémica, taquicardia) y alteraciones en la microcirculación (hipoperfusión tisular); incluso con pérdidas superiores al 35% del VSC, el estado de choque puede ser irreversible.5,6 Los pacientes con eje hipotálamo-hipófi sis-suprarrenales íntegro desarrollarán incremento en las concentraciones de hormona adrenocorticótropa (ACTH) ante enfermedad grave o estrés; esto, a su vez, aumenta los niveles de cortisol sérico circulante y favorece la liberación de catecolaminas con la fi nalidad de mantener la homeostasis.7,8 Está documentado que hasta 60% de los pacientes con choque séptico presentan niveles de cortisol disminuidos, lo que condiciona insufi ciencia corticoadrenal relativa, lo que contribuye a los malos resultados en estos pacientes.9-11 Desde los años 70 se agregaron los corticosteroides al tratamiento del choque séptico y se ha demostrado reducción de la mortalidad.12 Por otro lado, la asociación entre choque hipovolémico hemorrágico e insufi ciencia corticoadrenal relativa es controversial, lo que hace necesario realizar estudios RESUMEN Introducción: El uso de corticosteroides para el tratamiento de pacientes con choque séptico ha llevado a considerar su empleo en otros procesos patológicos, entre ellos, el choque hipovolémico hemorrágico, aunque con resultados controversiales. Material y métodos: Se realizó un estudio de cohorte, prospectivo, longitudinal, observacional y analítico. Se incluyeron pacientes ingresados a la Unidad de Cuidados Intensivos (UCI) con diagnóstico de choque hipovolémico hemorrágico secundario a evento quirúrgico en el periodo comprendido entre el 1 de enero y el 31 de julio de 2017. Resultados: Por medi","PeriodicalId":344697,"journal":{"name":"Medicina Crítica","volume":"2 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"1900-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"131458440","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Coccidioidomicosis en paciente con COVID-19. Reporte de caso en la Unidad de Terapia Intensiva","authors":"Kenia Armenta Sánchez, Daniel Pacheco Ambriz","doi":"10.35366/105797","DOIUrl":"https://doi.org/10.35366/105797","url":null,"abstract":"","PeriodicalId":344697,"journal":{"name":"Medicina Crítica","volume":"50 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"1900-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"132430434","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Índice de choque como marcador inicial de choque hipovolémico en hemorragia obstétrica de primer trimestre 73","authors":"Mtchel Eréndira Contreras Martínez, Aurea Carmona Domínguez, Felipe de Jesús Montelongo","doi":"10.35366/87292","DOIUrl":"https://doi.org/10.35366/87292","url":null,"abstract":"estudado em pacientes com e sem trauma e é usado na prática clínica para avaliar o choque hipovolêmico ou a gravidade do choque não-hipovolêmico e para auxiliar no tratamento agudo nesse contexto. Na população normal não gestante, o intervalo do IC normal é de 0.5-0.7 e um IC > 0.9 foi associado a uma mortalidade mais elevada. No presente trabalho foi realizada a correlação do índice de choque como um marcador inicial de choque hipovolêmico em pacientes com hemorragia obstétrica no primeiro trimestre. Foi realizado um estudo observacional, prospectivo, transversal e analítico em pacientes de todas as idades com hemorragia obstétrica no primeiro trimestre. Observou-se que a IC em pacientes com diagnóstico de hemorragia obstétrica no primeiro trimestre está signifi cativamente associada à instabilidade hemodinâmica e maior probabilidade de necessidade de hemoderivados. Palavras-chave: Índice de choque, hemorragia obstétrica, choque hipovolêmico.","PeriodicalId":344697,"journal":{"name":"Medicina Crítica","volume":"6 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"1900-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"133113412","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Tubo endotraqueal con aspiración subglótica y riesgo de neumonía asociada a ventilador","authors":"Eduardo Fernández García, Juan Carlos Corona Meléndez","doi":"10.35366/78368","DOIUrl":"https://doi.org/10.35366/78368","url":null,"abstract":"e doze (40%) sem TEAS desenvolveram PAV (OR 0.33, IC 95% de 0.12-0.89). NNT = 4.6. Uma correlação signifi cativa foi encontrada entre PAV e a adesão ao protocolo de redução de risco (r = 0.223, p = 0.036), dias de ventilação mecânica (r = -0.51, p < 0.0001) e permanência na UTI (r = 0.42, p < 0.0001). Conclusão: El TEAS e a adesão ao protocolo de redução de riscos diminue o risco de PAV em pacientes com AMVI na UTI, além de reduzir os dias de ventilação mecânica e a estadia hospitalária. Palavras-chave: Pneumonía associada ao ventilador, tubo endotraqueal de aspiração subglótica.","PeriodicalId":344697,"journal":{"name":"Medicina Crítica","volume":"24 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"1900-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"122555792","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Origen de la acidosis metabólica según los determinantes del déficit de base en pacientes con choque séptico como factor de riesgo para mortalidad","authors":"Eduardo Márquez Rosales,  Jesús Salvador  Sánchez Díaz, Karla Gabriela Peniche Moguel,  Enrique Antonio  Martínez Rodríguez, Josué Eli  Villegas Domínguez, María Verónica  Calyeca Sánchez","doi":"10.35366/89126","DOIUrl":"https://doi.org/10.35366/89126","url":null,"abstract":"Introduction: In patients with septic shock, metabolic acidosis is the most frequent acid-base disorder and the main causative ion will determine the prognosis in this group of patients. Studies have focused on the estimation of lactate to determine the prognosis, although today we know that metabolic acidosis in these patients may be caused by the effect not only of lactate but also by the effect of water, effect of chlorine, effect of albumin and effect of unmeasured anions. Material and methods: A cohort study was performed, ambispective, longitudinal, descriptive and analytical. In patients diagnosed with septic shock and metabolic acidosis, admitted to the Intensive Care Unit (ICU) in the period from June 15, 2015 to July 30, 2018. The risk for mortality of the variables was evaluated: lactate, the effect of water, the effect of chlorine, the effect of albumin and the effect of unmeasured anions. All statistical analyzes were performed with the SPSSTM 22.0 program. Results: In the period considered, 87 patients met the inclusion criteria, of which 46% were male and 54% were female. 44.8% of patients died during their stay. In the multivariate analysis, the variables with statistical significance, measures at admission as a risk factor for mortality were: the effect of water with cut-off point > -0.75 mEq/L, presents an OR 7.227 (CI95%: 1.831-28.5; p = 0.005), the effect of albumin with cut-off point of > -4.75 mEq/L, presents an OR 6.163 (CI95%: 1.786-21.2, p = 0.004). Conclusion: Metabolic acidosis goes beyond the addition or removal of solutes, the dissociation of water having great importance.","PeriodicalId":344697,"journal":{"name":"Medicina Crítica","volume":"28 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"1900-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"122981101","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Importancia de los estudios de anatomía patológica en COVID-19","authors":"Alfredo Ávila Toscano, Á. Bassols, J. E. González","doi":"10.35366/94901","DOIUrl":"https://doi.org/10.35366/94901","url":null,"abstract":"de los más sobresalientes reportados en la literatura, que no se limitan al daño alveolar difuso, sino que abarcan algunas otras entidades complejas, las cuales deben analizarse con cuidado por tener importantes implicaciones tanto en la estrategia de mecánica ventilatoria como farmacológica. coronavirus, ABSTRACT Histopathological analysis constitutes the king study of all diagnostic tests in medicine, however, the particular characteristics of the COVID-19 pandemic have imposed serious limitations on them, so that specific information in this regard is limited. A reflection is made on these aspects and some of the most outstanding findings reported in the literature are presented, that are not limited to the diffuse alveolar damage, but include some other complex entities that must be carefully analyzed, as they could have important therapeutic implications both in ventilatory and pharmacological strategies.","PeriodicalId":344697,"journal":{"name":"Medicina Crítica","volume":"69 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"1900-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"128924227","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Asociación de la presión de impulso y el poder mecánico ventilatorio con la mortalidad en pacientes con COVID-19 grave-crítico","authors":"José Carlos Hernández Pedroza, María del Rosario Muñoz Ramírez","doi":"10.35366/106511","DOIUrl":"https://doi.org/10.35366/106511","url":null,"abstract":"","PeriodicalId":344697,"journal":{"name":"Medicina Crítica","volume":"169 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"1900-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"116413175","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Púrpura fulminans relacionada con deficiencia de antitrombina III en paciente agudo críticamente enfermo con aislamiento de Enterococcus faecalis","authors":"Javier Mauricio Giraldo Sánchez","doi":"10.35366/107462","DOIUrl":"https://doi.org/10.35366/107462","url":null,"abstract":"","PeriodicalId":344697,"journal":{"name":"Medicina Crítica","volume":"24 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"1900-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"114089407","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Manejo avanzado de la vía aérea en pacientes con sospecha o diagnóstico de COVID-19","authors":"Pamela Mercado Velázquez, Víctor Acosta Nava, José Angel Baltazar Torres, J. L. Oropeza, E. R. Sigarroa, Guillermo Domínguez Cherit","doi":"10.35366/99153","DOIUrl":"https://doi.org/10.35366/99153","url":null,"abstract":"In March 2020, the World Health Organization (WHO) issued a pandemic alert for infection with coronavirus 2 of severe acute respiratory syndrome (SARS-CoV-2). This virus produces clinical symptoms that range from mild respiratory symptoms to pneumonia with severity criteria. The disease caused by the SARS-CoV-2 has been called coronavirus disease 19 (COVID-19). The SARS-CoV-2 has a high rate of contagion among humans, which means that the management of patients with COVID-19 implies a high risk of contagion for health personnel in the hospital setting. Therefore, it is important to have standardized management protocols that minimize the risk of contagion, especially during the performance of procedures that generate aerosols, which are considered the highest risk. Advanced airway management is included in this category of procedures. This document is not intended to replace current guidelines on the standardized control and management of infectious diseases. Its objective is to provide recommendations for the advanced management of the airway in this group of patients, which allow performing a procedure safely for the patient, promoting self-care of health personnel and preventing the spread of the virus in the hospital environment.","PeriodicalId":344697,"journal":{"name":"Medicina Crítica","volume":"16 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"1900-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"127427696","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Atención del paciente quemado en ''tiempos de COVID-19''","authors":"Raúl Carrillo Esper, R. E. Melgar Bieberach, Sarahi Anilú Jacinto Flores, Ángela Nallely Campa Mendoza, Mauricio Tapia Salazar","doi":"10.35366/104873","DOIUrl":"https://doi.org/10.35366/104873","url":null,"abstract":"In December 2019, an outbreak of a new coronavirus begins in the city of Wuhan, capital of the province of Hubei, China, called by the World Health Organization (WHO) as SARS-CoV-2, causing a new disease, COVID-19 and declaring a pandemic on March 11, 2020. This entails a challenge for all health systems, including Burn Units (BU) around the world, which are forced to modify their work and operating structure and logistics, in order to guarantee the care of burned patients, and participate in the containment of the pandemic. The most important elements to take into account are hospital reconversion, which does not exclude BUs, primary care and hospital care for burned patients, and the use of telemedicine as a tool to optimize the care of these patients. It is important to generate new knowledge from lived experiences and prepare for future similar situations.","PeriodicalId":344697,"journal":{"name":"Medicina Crítica","volume":"27 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"1900-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"121663441","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}