Should fresh blood be recommended for intensive care patients?

Fresh blood has many potential advantages over older blood, but there is no evidence that these properties translate into clinical benefit for intensive care patients. The observational multicenter study by Karam and colleagues provides some evidence suggesting that blood stored for less than 14 days is better than older blood in terms of new organ failure and reduction in length of stay in pediatric intensive care units. Though in favor of using young blood, this study suffers from several limitations. As a consequence, it is ethical and certainly pertinent to conduct a randomized clinical trial in order to test the hypothesis that fresh blood might reduce mortality. The rationale is strong and the potential benefit of fresh blood is substantial

Measurement of intracellular generation of hydrogen peroxide by rat glomeruli in vitro

Sequential reduction of oxygen along the univalent pathway leads to the generation of superoxide anion, hydrogen peroxide, hydroxyl radical, and water [1, 2]. These partially reduced oxygen intermediates have been implicated as important mediators in various models of ischemic, toxic and immune-mediated tissue injury including glomerular injury [3]. Reactive oxygen metabolites have been shown to affect several biological processes potentially important in glomerular diseases, and their role in both inflammatory as well as non-inflammatory glomerular diseases has recently been demonstrated [3]. Evidence for the importance of reactive oxygen metabolites in experimental models of glomerular disease is based largely on the protective effects of scavengers of reactive oxygen metabolites

Elderly Patients in the Intensive Care Unit

Very old intensive care unit (ICU) patients, aged ≥ 80 years, are by no mean newcomers, but during the last decades their impact on ICU admissions has grown in parallel with the increase in the number of elderly persons in the community. Hence, from being a “rarity,” they have now become common and constitute one of the largest subgroups within intensive care, and may easily be the largest group in 20 years and make up 30 to 40% of all ICU admissions. Obviously, they are not admitted because they are old but because they are with various diseases and problems like any other ICU patient. However, their age and the presence of common geriatric syndromes such as frailty, cognitive decline, reduced activity of daily life, and several comorbid conditions makes this group particularly challenging, with a high mortality rate. In this review, we will highlight aspects of current and future epidemiology and current knowledge on outcomes, and describe the effects of the aforementioned geriatric syndromes. The major challenge for the coming decades will be the question of whom to treat and the quest for better triage criteria not based on age alone. Challenges with the level of care during the ICU stay will also be discussed. A stronger relationship with geriatricians should be promoted to create a better and more holistic care and aftercare for survivors.acceptedVersio

Lo que no sabemos de la vida en la cárcel

Esta crónica de inmersión recibe el nombre de "Lo que no sabemos de la vida en la cárcel" y tiene su fundamento en el deseo de la autora de acercar al público aquella información que los ciudadanos de a pie no conocen sobre cómo viven los internos en las cárceles españolas. En ella se refleja cómo es el trato humano entre los trabajadores e internos de la prisión de El Acebuche, el funcionamiento de la prisión, los servicios de los que disponen los reclusos y el desarrollo de los días dentro de la misma. De esta manera, la crónica pretende poner en conocimiento a los lectores de cuáles son los principios, las obligaciones y las claves de una correcta puesta en marcha de la labor de reinserción social de las personas que lo necesitan para la armónica vida en sociedad.Universidad de Sevilla. Grado en Periodism

Finger-vein individuals identification on massive databases

In massive biometric identification, response times highlydepend on the searching algorithms. Traditional systems operate with databases of up to 10,000 records. In large databases, with an increasing number of simultaneous queries, the system response time is a critical factor. This work proposes a GPU-based implementation for the matching process of finger-vein massive identification. Experimental resultss how that our approach solves up to 256 simultaneous queries on large databases achieving up to 136x.Instituto de Investigación en InformáticaInstituto de Investigación en Informátic

HeatMap3D: 3D Heat maps for protection of critical control areas

Desde el siglo XVIII, han tenido lugar tres generaciones industriales. En cada una de estas etapas, las técnicas de producción y gestión de la energía han ido progresando para dar servicio y respuesta a las problemáticas de cada época. Expertos de diferentes sectores coinciden en que actualmente estamos entrando en la cuarta revolución industrial. Este fenómeno se caracterizará por transformar el concepto de “producción”, digitalizando y automatizando de cada una de las tareas implicadas en los procesos de producción, así como el control de estos procesos [1,2] y la gestión eficiente de la propia energía, propios de los actuales sistemas de “Smart Grids” o redes eléctricas inteligentes. En este ámbito, se hará uso de tecnologías innovadoras como el Internet de las cosas (IoT), inteligencia artificial, Cloud/Fog/Mobile Edge computing, Big Data, nanotecnología, virtualización y sistemas de realidad virtual. El proyecto que se ha desarrollado surge para dar respuesta al último campo, la realidad virtual, modelando un entorno en tres dimensiones en el cual se ha modelado un escenario de Smart Grid en un entorno simulado. La abstracción que se ha elaborado permite la visualización de anomalías y la monitorización en tiempo real de un sistema de control de energía de una forma intuitiva y realista, mejorando, pero no sustituyendo, los tradicionales sistemas de computación y visualización basados en HMI (Human-Machine-Interfaces), utilizados hoy en día para el control local o remoto de subestaciones de energía

An integrated approach for prescribing fewer chest x-rays in the ICU

Chest x-rays (CXRs) are the main imaging tool in intensive care units (ICUs). CXRs also are associated with concerns inherent to their use, considering both healthcare organization and patient perspectives. In recent years, several studies have focussed on the feasibility of lowering the number of bedside CXRs performed in the ICU. Such a decrease may result from two independent and complementary processes: a raw reduction of CXRs due to the elimination of unnecessary investigations, and replacement of the CXR by an alternative technique. The goal of this review is to outline emblematic examples corresponding to these two processes. The first part of the review concerns the accumulation of evidence-based data for abandoning daily routine CXRs in mechanically ventilated patients and adopting an on-demand prescription strategy. The second part of the review addresses the use of alternative techniques to CXRs. This part begins with the presentation of ultrasonography or capnography combined with epigastric auscultation for ensuring the correct position of enteral feeding tubes. Ultrasonography is then also presented as an alternative to CXR for diagnosing and monitoring pneumothoraces, as well as a valuable post-procedural technique after central venous catheter insertion. The combination of the emblematic examples presented in this review supports an integrated global approach for decreasing the number of CXRs ordered in the ICU

The good, the bad and the ugly: pandemic priority decisions and triage.

In this analysis we discuss the change in criteria for triage of patients during three different phases of a pandemic like COVID-19, seen from the critical care point of view. Availability of critical care beds has become a hot topic, and in many countries, we have seen a huge increase in the provision of temporary intensive care bed capacity. However, there is a limit where the hospitals may run out of resources to provide critical care, which is heavily dependent on trained staff, just-in-time supply chains for clinical consumables and drugs and advanced equipment. In the first (good) phase, we can still do clinical prioritisation and decision-making as usual, based on the need for intensive care and prognostication: what are the odds for a good result with regard to survival and quality of life. In the next (bad phase), the resources are mostly available, but the system is stressed by many patients arriving over a short time period and auxiliary beds in different places in the hospital being used. We may have to abandon admittance of patients with doubtful prognosis. In the last (ugly) phase, usual medical triage and priority setting may not be sufficient to decrease inflow and there may not be enough intensive care unit beds available. In this phase different criteria must be applied using a utilitarian approach for triage. We argue that this is an important transition where society, and not physicians, must provide guidance to support triage that is no longer based on medical priorities alone

Errors in administration of parenteral drugs in intensive care units: multinational prospective study

Objective To assess on a multinational level the frequency, characteristics, contributing factors, and preventive measures of administration errors in parenteral medication in intensive care units