RESUMEN
Early volume resuscitation of a patient with sepsis has been shown to reduce morbidity, mortality, and healthcare resource consumption. Hypertonic saline offers a theoretically viable option for volume resuscitation. This article reviews the current information available regarding fluid resuscitation in patients with sepsis, with emphasis on the use of hypertonic saline.
Asunto(s)
Fluidoterapia/métodos , Resucitación/métodos , Solución Salina Hipertónica/uso terapéutico , Sepsis/terapia , Animales , Coloides/uso terapéutico , Cuidados Críticos/métodos , Soluciones Cristaloides , Modelos Animales de Enfermedad , Evaluación Preclínica de Medicamentos , Humanos , Derivados de Hidroxietil Almidón/uso terapéutico , Soluciones Isotónicas/uso terapéutico , Selección de Paciente , Sustitutos del Plasma/uso terapéutico , Volumen Plasmático , Lactato de Ringer , Solución Salina Hipertónica/farmacología , Cloruro de Sodio/uso terapéutico , Resultado del TratamientoRESUMEN
Sleep is essential to human life. Sleep patterns are significantly disrupted in patients who are hospitalized, particularly those in the intensive care unit. Sleep deprivation is pervasive in this patient population and impacts health and recovery from illness. Immune system dysfunction, impaired wound healing, and changes in behavior are all observed in patients who are sleep deprived. Various factors including anxiety, fear, and pain are responsible for the sleep deprivation. Noise, light exposure, and frequent awakenings from caregivers also add to these effects. Underlying medical illnesses and medications can also dramatically affect a patient's ability to sleep efficiently. Therapy with attempts to minimize sleep disruption should be integrated among all of the caregivers. Minimization of analgesics and other medications known to adversely affect sleep should also be ensured. Although further research in the area of sleep deprivation in the intensive care unit setting needs to be conducted, effective protocols can be developed to minimize sleep deprivation in these settings.
Asunto(s)
Cuidados Críticos/métodos , Privación de Sueño/prevención & control , Trastornos del Conocimiento/etiología , Enfermedad Crítica/enfermería , Efectos Colaterales y Reacciones Adversas Relacionados con Medicamentos , Ambiente de Instituciones de Salud/organización & administración , Humanos , Unidades de Cuidados Intensivos/organización & administración , Ruido/efectos adversos , Ruido/prevención & control , Dolor/etiología , Polisomnografía , Respiración Artificial/efectos adversos , Privación de Sueño/etiología , Fases del Sueño/fisiologíaRESUMEN
A 61-year-old man with a history of testicular carcinoma and more recently diagnosed metastatic renal cell carcinoma was admitted because of recurrent submassive hemoptysis as evidenced by bright red blood in his bedside basin. Despite an exhaustive workup, including multiple invasive procedures, no cause of the bleeding was found. The diagnosis was Münchausen syndrome manifested as factitious hemoptysis via unusual and modern means. The case is a reminder to all members of the critical care team, from nurses to physicians: When dealing with the frustration of a recurrent problem with no clear answer, remain vigilant and remember the age-old advice to look at the patient and trust your gut.