RESUMO
Eighty-year old woman with a medical history of arterial hypertension, rheumatic valvular heart disease with mitral and aortic valve replacement, chronic atrial fibrillation and congestive heart failure dependent on domiciliary chronic oxygen for 17 daily hours. The reason for arrival to the hospital was a stroke of cardioembolic etiology.
Mujer de 80 años con antecedentes de hipertensión arterial, valvulopatía reumática con recambio valvular mitral y aórtica, fibrilación auricular crónica e insuficiencia cardiaca congestiva dependiente de oxígeno crónico domiciliario durante 17 horas diarias. El motivo de llegada al hospital fue ictus cerebral de etiología cardioembólica.
Assuntos
Cardiomegalia/diagnóstico por imagem , Embolia/complicações , Cardiopatias/complicações , Acidente Vascular Cerebral/etiologia , Idoso de 80 Anos ou mais , Feminino , Cardiopatias/fisiopatologia , HumanosRESUMO
BACKGROUND AND OBJECTIVE: Augmented renal clearance or glomerular hyperfiltration (GHF) can significantly affect the clinical outcomes of renally eliminated drugs by promoting subtherapeutic drug exposure. The aggression suffered in patients who suffer severe trauma is a predisposition to manifest GHF and the identification of these patients remains a clinical challenge. The main objective of this study was to describe the prevalence of GHF in a cohort of critically ill trauma patients. MATERIALS AND METHODS: Prospective observational study of a cohort of adult patients admitted after suffering severe trauma or polytrauma in the Anesthesiology ICU of the University Hospital of Albacete (Spain). Creatinine clearance (ClCr) was calculated in a 4-h urine collection sample at 24, 72 and 168â¯h after admission applying the formula; CrCl: [Diuresis in ml (urine/4â¯h) × Creatinine in urine (mg/dl)] ÷ [240 (minutes) × Creatinine in plasma (mg/dl)]. A CrCl above 130â¯mL/min was considered GHF. The analyses were performed with the statistical software R version 4.0.4. RESULTS: 85 patients were included. The median age of the patients was 51 years (IQR 26), 78.82% male. 68 patients were male (78.82%). 75.29% of the patients were polytraumatized. 61 patients (71.76%) presented GHF at some point in the CrCl determination. At 24â¯h of admission, 56.34% of the patients presented GHF with a mean CrCl of 195.8â¯ml/min, 61.11% of the patients presented it at 72â¯h with a mean CrCl of /min and 56.52% presented GHF at 168â¯h of admission with a mean CrCl of 207â¯ml/min. A significant positive relationship (pâ¯=â¯0.07) was found between GHF manifested at 72â¯h and at 168â¯h. We observed a statistically significant relationship between this phenomenon with younger ages, lower ISS scores and lower plasma creatinines. CONCLUSIONS: GHF are a common condition in critically ill patients admitted for severe trauma. We recommend the use of CrCl to assess renal function and make dosage adjustments. Studies are required to understand the clinical impact of these phenomena on drug elimination and to be able to establish the ideal dosage in those cases.
Assuntos
Estado Terminal , Insuficiência Renal , Adulto , Feminino , Humanos , Masculino , Creatinina , Testes de Função Renal , Glomérulos Renais , Pessoa de Meia-IdadeRESUMO
Ultrasound evaluation of diaphragm function allows the detection of diaphragm dysfunction and the adaptation of ventilatory support in patients admitted to intensive care units. The studied patient had a C3 spinal cord injury. Ultrasound evaluation of diaphragm mobility showed that the patient suffered diaphragm dysfunction. A tracheotomy was indicated, and early ventilatory support was initiated. Ultrasound evaluation of diaphragm function in patients with cervical spinal cord injury is a useful and simple technique. It provides fast and reliable data for the diagnosis of respiratory insufficiency of neuromuscular origin.
RESUMO
Abstract Ultrasound evaluation of diaphragm function allows the detection of diaphragm dysfunction and the adaptation of ventilatory support in patients admitted to intensive care units. The studied patient had a C3 spinal cord injury. Ultrasound evaluation of diaphragm mobility showed that the patient suffered diaphragm dysfunction. A tracheotomy was indicated, and early ventilatory support was initiated. Ultrasound evaluation of diaphragm function in patients with cervical spinal cord injury is a useful and simple technique. It provides fast and reliable data for the diagnosis of respiratory insufficiency of neuromuscular origin.