[Survey on the management of acute renal failure and renal replacement techniques in Spanish intensive care units]. / Encuesta sobre el manejo del fracaso renal agudo y las técnicas de reemplazo renal en las unidades de cuidados intensivos españolas.

AIM: To analyze knowledge and experience in the diagnosis and management of acute renal failure (ARF) and the use of renal replacement therapy (RRT) in different Spanish Intensive Care Units (ICUs). DESIGN: A case series with a survey conducted by the Nephro-Intensive Care Working Group of the SEMICYUC was compiled between January and November 2011. SCOPE: Spanish national ICUs. INTERVENTIONS: A survey of 28 questions with multiple and open responses. PARTICIPANTS: The survey was sent to 99 ICUs. Volunteers consisting of the medical staff belonging to the 51 ICUs that responded. Main variables of interest General characteristics of hospitals and ICUs, definitions of ARF and RRT (indications and management). RESULTS: RIFLE/AKIN scales to define ARF (47%). ARF diagnosis: plasma creatinine (80.4%), creatinine clearance (52.9%). Protocols for RRT: 72.5%. RRT in non-renal indications: 70.6%. Indications for initiation of RRT: oliguria, increased creatinine and urea. End of RRT: increased diuresis. RRT dose: 21-35 ml/kg/h (41.2%), 36-45ml/kg/h (33.3%). CONCLUSIONS: There is great variability in the ARF detection methods, and adequate incorporation of the RIFLE/AKIN systems to daily clinical practice in the ICU is still lacking. Written protocols aimed at establishing an early diagnosis of ARF are needed, based on these systems. On the other hand, there is growing interest in RRT, despite the fact that there are no definitive indications or guidelines on the use and handling of such techniques.

[Loss of integrity of bipolar cardiac stimulation and its automatic correction. Report of 2 cases]. / Pérdida de la integridad de la estimulación cardíaca bipolar y su corrección automática. A propósito de dos casos.

We report two patients with DDD and VVI pacemakers respectively, in whom telemetry revealed a markedly high bipolar ventricular lead impedance, suggestive of a fracture or other defect in bipolar lead. Pulse generator was able to switch automatically to unipolar pacing, and a loss of ventricular capture was prevented.

[Ventricular fibrillation and myocarditis]. / Fibrilación ventricular y miocarditis.

We report a case of ventricular fibrillation with subacute myocarditis as the only underlying pathological abnormality in a 9-year-old child. The patient died suddenly after a follow-up of 13 years, despite the apparent control of the arrhythmia.