Clinical Practice Guidelines for Vascular Catheter Infections Treatment.

Clinical Practice Guidelines for Vascular Catheter Infections Treatment. It has been defined as the presence of local or systemic signs without other obvious infection site, plus the microbiologic evidence involving the catheter. This document includes a review and update of concepts, main clinical aspects, and treatment and stresses the importance of prophylactic treatment. It includes assessment guidelines focused on the most important aspects to be accomplished

Late thrombolysis

Se realizó un estudio en los pacientes con Infarto Agudo del Miocardio (IMA) con un tiempo de evolución entre 12 y 14 h en la Unidad de Cuidados Intensivos, durante los meses de febrero a mayo de 1997, con el objetivo de ampliar la ventana de tiempo para la terapia lítica con estreptoquinasa recombinante (ER) cuando esta se administra entre 12 y 24 h de evolución del IMA. Para la medición del desenlace se tomó: el tamaño final del infarto, las complicaciones no fatales durante la hospitalización y el reingreso por causa cardiaca en los 3 meses siguientes al alta. El tamaño del IMA fue algo menor entre los pacientes trombolizados, la diferencia fue más evidente entre los hombres, los que aún referían dolor torácico, supradesnivel importante del segmento ST y para los de localización anterior. El uso de ER en pacientes con IMA que se presentan entre las 12 y 24 h de iniciados los síntomas puede ser beneficioso.A study of patients with Acute Myocardial Infarction (AMI) with a time of evolution between 12 and 14 hours at the Intensive Care Unit was conducted from February to May, 1997, in order to extend the time window for lithic therapy with recombinant streptokinase (RS) when this is administered between 12 and 24 hours of evolution of the AMI. To measure the outcome it was necessary to take into consideration the final size of the infarction, the nonfatal complications during hospitalization and the readmission due to cardiac cause during the 3 months following discharge. The AMI size was a little smaller among the thrombolized patients. The difference was more evident among men, who still complained of chest pain and had an important supradepression of the ST segment, and in those with infarction of anterior localization. The use of recombinant streptokinase in patients with AMI who arrive at the hospital between 12 and 14 hours after the onset of the symptoms may be benefitial

Trombosis tardía

A study of patients with Acute Myocardial Infarction (AMI) with a time of evolution between 12 and 14 hours at the Intensive Care Unit was conducted from February to May, 1997, in order to extend the time window for lithic therapy with recombinant streptokinase (RS) when this is administered between 12 and 24 hours of evolution of the AMI. To measure the outcome it was necessary to take into consideration the final size of the infarction, the nonfatal complications during hospitalization and the readmission due to cardiac cause during the 3 months following discharge. The AMI size was a little smaller among the thrombolized patients. The difference was more evident among men, who still complained of chest pain and had an important supradepression of the ST segment, and in those with infarction of anterior localization. The use of recombinant streptokinase in patients with AMI who arrive at the hospital between 12 and 14 hours after the onset of the symptoms may be benefitial.Se realizó un estudio en los pacientes con Infarto Agudo del Miocardio (IMA) con un tiempo de evolución entre 12 y 14 h en la Unidad de Cuidados Intensivos, durante los meses de febrero a mayo de 1997, con el objetivo de ampliar la ventana de tiempo para la terapia lítica con estreptoquinasa recombinante (ER) cuando esta se administra entre 12 y 24 h de evolución del IMA. Para la medición del desenlace se tomó: el tamaño final del infarto, las complicaciones no fatales durante la hospitalización y el reingreso por causa cardiaca en los 3 meses siguientes al alta. El tamaño del IMA fue algo menor entre los pacientes trombolizados, la diferencia fue más evidente entre los hombres, los que aún referían dolor torácico, supradesnivel importante del segmento ST y para los de localización anterior. El uso de ER en pacientes con IMA que se presentan entre las 12 y 24 h de iniciados los síntomas puede ser beneficioso

Clinical Practice Guidelines for Ventilation Associated Pneumonia.

Clinical Practice Guidelines for Ventilation Associated Pneumonia. Conceptualized as the bacterial pneumonia that develops in patients receiving mechanical ventilation for more than 48 hours, which is not present at the beginning of the ventilation. We review the concept, prevention and treatment. It includes assessment guidelines focused on the most important aspects to be accomplished

Valor del sistema de puntuación delQRS -Selvester en el infarto miocárdico agudo

74 patients with diagnosis of acute myocardial infarction (AMI) that were admitted during the first semester of 1991 at the Intensive Care Unit of the Provincial Hospital of Santa Clara were studied. Selvester's score was applied to these patients aimed at showing its usefulnes in the daily clinical practice. The average age of the series was 64 ± 12 and it was observed a predominance of males. None of the clinical conditions considered as risk markers to develop an AMI > 24% according to Selvester's score were associated with this finding. The above scoring system was significantly related to the appearance of some complications during the AMI evolution from the statistical point of view: heart insufficiency (RR = 4.77; CI = 2.94 - 7.73; p= ,0000002), cardiogenic shock (RR = 18.08; CI = 4.26 - 76.65; P = ,0000138), death at the ICU (RR = 9.04; CI = 3.13 -26.14; p = ,0001103). This scoring system may be used in the predicition of complications and fatal outcome during the hospitalization of patients with AMI.Se estudiaron 74 enfermos con diagnóstico de infarto miocárdico agudo (IMA) que ingresaron durante el primer semestre de 1991 en la Unidad de Cuidados Intensivos (UCI) del Hospital Provincial de Santa Clara. A estos pacientes se les aplicó el score de Selvester con el objetivo de esclarecer su utilidad en la práctica clínica diaria. La edad media de la serie fue de 64 ± 12; predominó el sexo masculino (62,2 %), ninguna de las condiciones clínicas consideradas como marcadores de riesgo para desarrollar un IMA > 24 % según el score de Selvester se asociaron con este hallazgo. El referido sistema de puntuación se asoció significativamente desde el punto de vista estadístico con la aparición de algunas complicaciones durante la evolución del IMA: insuficiencia cardiaca (RR = 4,77; IC = 2,94 - 7,73; p = ,0000002), choque cardiogénico (RR = 18,08; IC = 4,26 - 76,65; P = ,0000138), fallecimiento en la UCI (RR = 9,04; IC = 3,13 - 26,14; p = ,0001103). Este sistema de puntuación puede ser utilizado en la predicción de complicaciones y desenlace fatal durante la hospitalización de pacientes con IMA

Clinical Practice Guidelines for Severe Sepsis Treatment.

Clinical Practice Guidelines for Severe Sepsis Treatment. It is a syndrome of inflammatory systemic response caused by documented infection (clinical and/or microbiological), associated with organic dysfunction (respiratory, renal, hepatic, cardiovascular, haematological and neurological), hypotension or hypoperfusion. This document includes a review and update of the concept, risk factors, diagnosis and treatment. It includes assessment guidelines focused on the most important aspects to be accomplished