Subject(s)
COVID-19/complications , Cytokine Release Syndrome/therapy , Immunomodulation , Membranes, Artificial , SARS-CoV-2 , Adsorption , COVID-19/immunology , Cytokine Release Syndrome/etiology , Hemofiltration/instrumentation , Hemofiltration/methods , Humans , Isoelectric Point , Systemic Inflammatory Response Syndrome/etiology , Systemic Inflammatory Response Syndrome/therapyABSTRACT
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Subject(s)
Humans , Immunomodulation , Lymphohistiocytosis, Hemophagocytic/virology , Coronavirus Infections/drug therapy , Pneumonia, Viral/complications , Coronavirus Infections/complications , Pneumonia, Viral/drug therapy , Pandemics , Cytokines/immunology , Evidence-Based Medicine , Severity of Illness Index , Risk FactorsABSTRACT
Introducción: Los paradigmas de la hemofiltración para manejar pacientes críticos con una respuesta inflamatoria desregulada (RID) evalúan la función renal para su inicio, adaptación y finalización. Presentamos la Hiperfiltración Venosa Continua (Protocolo CONVEHY), en el cual una membrana de adsorción inespecífica (AN69-ST-heparina anclada) se utiliza con citrato como líquido anticoagulante y de sustitución. El protocolo CONVEHY utiliza herramientas fácilmente disponibles para lograr objetivos renales y no renales, guiándose por las respuestas fisiopatológicas. Objetivos: Comparar la respuesta a la membrana AN69-ST-HA cuando se utilizó heparina (He, n = 5: protocolo estándar) o citrato (Ci, n = 6: protocolo CONVEHY) para evaluar si fuera factible un estudio mayor sobre los beneficios de este protocolo. Materiales y métodos: En un estudio retrospectivo, se evaluaron los beneficios del protocolo CONVEHY en pacientes con RID en una unidad de cuidados críticos quirúrgicos (UCCq), evaluando las puntuaciones SOFA (He 11 +/- 2,35; Ci 11 +/- 3,63; p = 0,54) y APACHE II (He 28,60 +/- 9,40; Ci 24 +/- 8,46; p = 0,93). Resultados: Hospitalización (He 35,2 +/- 16,3 noches; Ci 9 +/- 2,53; p = 0,004), hospitalización tras el alta de UCCq (He 40,25 +/- 21,82; Ci 13,2 +/- 4,09; p = 0,063), pacientes hospitalizados > 20 días (He 80%; Ci 0%; p = 0,048), días con ventilación mecánica (He 16 +/- 5,66; Ci 4 +/- 1,72; p = 0,004) y la mortalidad predicha (55,39 +/- 26,13%) frente a la real en ambos grupos (9,1%; p = 0,004). Conclusiones: El protocolo CONVEHY mejora las respuestas clínicas de los pacientes con una RID, destacando el valor potencial de realizar estudios más grandes y confirmatorios
Introduction: Haemofiltration paradigms used to manage critically ill patients with a dysregulated inflammatory response (DIR) assess kidney function to monitor its onset, adaptation, and completion. A Continuous Venous Hyperfiltration (CONVEHY) protocol is presented, in which a non-specific adsorption membrane (AN69-ST-Heparin Grafted) is used with citrate as an anticoagulant and substitution fluid. CONVEHY uses tools readily available to achieve kidney related and non-related objectives, and it is guided by the monitoring of pathophysiological responses. Objectives: To compare the response to an AN69-ST-HG membrane when heparin (He, n=5: Standard protocol) or citrate (Ci, n=6: CONVEHY protocol) was used to evaluate whether a larger study into the benefits of this protocol would be feasible. Materials and methods: In a retrospective pilot study, the benefits of the CONVEHY protocol to manage patients with a DIR in a surgical critical care unit (CCUs) were assessed by evaluating the SOFA (Sequential Organ Failure Assessment) (He 11 +/- 2.35; Ci 11 +/- 3.63: p=0.54) and APACHE II (He 28.60 +/- 9.40; Ci 24 +/- 8.46: p=0.93) scores. Results: Nights in hospital (He 35.2 +/- 16.3 nights; Ci 9 +/- 2.53: p=0.004), hospital admission after discharge from the CCUs (He 40.25 +/- 21.82; Ci 13.2 +/- 4.09: p=0.063), patients hospitalised >20 days (He 80%; Ci 0%: p=0.048), days requiring mechanical ventilation (He 16 +/- 5.66; Ci 4 +/- 1.72: p=0.004), and the predicted (55.39 +/- 26.13%) versus real mortality in both groups (9.1%: p=0.004). Conclusions: The CONVEHY protocol improves the clinical responses of patients with DIR, highlighting the potential value of performing larger and confirmatory studies
Subject(s)
Humans , Systemic Inflammatory Response Syndrome/therapy , Hemofiltration/methods , Heparin/therapeutic use , Citric Acid/therapeutic use , Membrane Filters/methods , Anticoagulants/therapeutic use , Reperfusion Injury/complications , Prefiltration/methodsABSTRACT
INTRODUCTION: Haemofiltration paradigms used to manage critically ill patients with a dysregulated inflammatory response (DIR) assess kidney function to monitor its onset, adaptation, and completion. A Continuous Venous Hyperfiltration (CONVEHY) protocol is presented, in which a non-specific adsorption membrane (AN69-ST-Heparin Grafted) is used with citrate as an anticoagulant and substitution fluid. CONVEHY uses tools readily available to achieve kidney related and non-related objectives, and it is guided by the monitoring of pathophysiological responses. OBJECTIVES: To compare the response to an AN69-ST-HG membrane when heparin (He, n=5: Standard protocol) or citrate (Ci, n=6: CONVEHY protocol) was used to evaluate whether a larger study into the benefits of this protocol would be feasible. MATERIALS AND METHODS: In a retrospective pilot study, the benefits of the CONVEHY protocol to manage patients with a DIR in a surgical critical care unit (CCUs) were assessed by evaluating the SOFA (Sequential Organ Failure Assessment) (He 11 ± 2.35; Ci 11 ± 3.63: p=0.54) and APACHE II (He 28.60 ± 9.40; Ci 24 ± 8.46: p=0.93) scores. RESULTS: Nights in hospital (He 35.2 ± 16.3 nights; Ci 9 ± 2.53: p=0.004), hospital admission after discharge from the CCUs (He 40.25 ± 21.82; Ci 13.2 ± 4.09: p=0.063), patients hospitalised >20 days (He 80%; Ci 0%: p=0.048), days requiring mechanical ventilation (He 16 ± 5.66; Ci 4 ± 1.72: p=0.004), and the predicted (55.39 ± 26.13%) versus real mortality in both groups (9.1%: p=0.004). CONCLUSIONS: The CONVEHY protocol improves the clinical responses of patients with DIR, highlighting the potential value of performing larger and confirmatory studies.
Subject(s)
Anticoagulants/therapeutic use , Citrates/therapeutic use , Continuous Renal Replacement Therapy/methods , Inflammation/therapy , Membranes, Artificial , Postoperative Complications/therapy , APACHE , Adult , Case-Control Studies , Clinical Protocols , Continuous Renal Replacement Therapy/instrumentation , Critical Illness , Feasibility Studies , Fluid Therapy , Heparin/therapeutic use , Hospitalization/statistics & numerical data , Humans , Inflammation/etiology , Organ Dysfunction Scores , Pilot Projects , Postoperative Complications/etiology , Retrospective Studies , Sample Size , Surgical Procedures, Operative/adverse effectsABSTRACT
La fístula arteriovenosa pial es una malformación congénita intracraneal infrecuente (0,1-1:100.000 habitantes). Presenta un alto flujo sanguíneo entre una o más arterias piales y un drenaje en la circulación venosa. Suele diagnosticarse durante la edad pediátrica al desencadenar un cuadro de hipertensión intracraneal y/o una insuficiencia cardiaca congestiva por shunt sistémico izquierda-derecha. Al ser poco frecuente y tener una fisiopatología compleja, su manejo perioperatorio anestésico no está bien establecido. Presentamos el caso de un lactante de 6 meses con fístula arteriovenosa pial con hipertensión intracraneal e insuficiencia cardiaca congestiva por shunt izquierda-derecha, que se sometió a craneotomía y pinzamiento de la malformación vascular. Las consideraciones anestésicas en pacientes con esta afección suponen un importante reto y deben realizarse por equipos multidisciplinares con experiencia en pediatría. Especial interés ocupa el manejo de la volemia durante el curso intraoperatorio, por exceso, para no precipitar una insuficiencia cardiaca congestiva o una hipertensión intracraneal, y por defecto, una hipoxia tisular por el sangrado (AU)
Pial arteriovenous fistula is a rare intracranial congenital malformation (0.1-1: 100,000). It has a high blood flow between one or more pial arteries and drains into the venous circulation. It is usually diagnosed during the childhood by triggering an intracranial hypertension and/or congestive heart failure due to left-right systemic shunt. It is a rare malformation with a complex pathophysiology. The perioperative anaesthetic management is not well established. We present a 6-month-old infant diagnosed with pial arteriovenous fistula with hypertension and congestive heart failure due to left-right shunt. He required a craniotomy and clipping of vascular malformation. Anaesthetic considerations in patients with this condition are a great challenge. It must be performed by multidisciplinary teams with experience in paediatrics. The maintenance of blood volume during the intraoperative course is very important. Excessive fluid therapy can precipitate a congestive heart failure or intracranial hypertension, and a lower fluid therapy may cause a tissue hypoxia due to the bleeding (AU)
Subject(s)
Humans , Male , Infant , Arteriovenous Fistula/drug therapy , Arteriovenous Fistula/surgery , Arteriovenous Fistula , Fluid Therapy/instrumentation , Fluid Therapy/methods , Heart Failure/complications , Heart Failure/therapy , Angiography/instrumentation , Angiography/methods , Fentanyl/therapeutic use , Monitoring, Intraoperative/methods , Monitoring, Intraoperative , Cerebrum/pathology , Enalapril/therapeutic use , Fluid Therapy , CerebrumABSTRACT
Pial arteriovenous fistula is a rare intracranial congenital malformation (0.1-1: 100,000). It has a high blood flow between one or more pial arteries and drains into the venous circulation. It is usually diagnosed during the childhood by triggering an intracranial hypertension and/or congestive heart failure due to left-right systemic shunt. It is a rare malformation with a complex pathophysiology. The perioperative anaesthetic management is not well established. We present a 6-month-old infant diagnosed with pial arteriovenous fistula with hypertension and congestive heart failure due to left-right shunt. He required a craniotomy and clipping of vascular malformation. Anaesthetic considerations in patients with this condition are a great challenge. It must be performed by multidisciplinary teams with experience in paediatrics. The maintenance of blood volume during the intraoperative course is very important. Excessive fluid therapy can precipitate a congestive heart failure or intracranial hypertension, and a lower fluid therapy may cause a tissue hypoxia due to the bleeding.
Subject(s)
Arteriovenous Fistula/surgery , Fluid Therapy , Heart Failure/surgery , Arteriovenous Fistula/diagnosis , Cerebral Angiography , Craniotomy , Humans , Infant , MaleABSTRACT
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Subject(s)
Humans , Male , Female , Pain Clinics , Pain Clinics/organization & administration , Nursing Assessment/ethics , Nursing Assessment/methods , Physician Assistants/education , Physician Assistants/standards , Patient Care Team/standards , Public Health/ethics , Public Health/methods , Pain Clinics/standards , Pain Clinics , Nursing Assessment/standards , Nursing Assessment , Physician Assistants/psychology , Physician Assistants , Patient Care Team/classification , Public Health , Public Health/standardsSubject(s)
Humans , Female , Pregnancy , Fentanyl/therapeutic use , Parturition , Anesthesia, Caudal/methods , Anesthesia, Caudal , Anesthesia, Epidural/instrumentation , Anesthesia, Epidural/methods , Epidural Space , Anesthesia, Epidural/standards , Anesthesia, Epidural , Labor, Obstetric , Anesthesiology/methodsABSTRACT
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Subject(s)
Humans , Acupuncture Analgesia/history , Acupuncture Analgesia/methods , Acupuncture Analgesia/trends , Acupuncture/trends , Migraine Disorders/epidemiology , Pain/epidemiology , Socioeconomic Factors , 24436Subject(s)
Anesthesia, Local , Hemangioma, Cavernous/complications , Neoplasms, Multiple Primary/complications , Neoplastic Syndromes, Hereditary/complications , Nevus, Blue/complications , Rectal Fistula/surgery , Adult , Anesthesia, Spinal , Anesthetics, Local/administration & dosage , Blood Coagulation Disorders/genetics , Case Management , Contraindications , Genetic Predisposition to Disease , Hemangioma, Cavernous/genetics , Humans , Male , Mepivacaine/administration & dosage , Neoplasms, Multiple Primary/genetics , Neoplastic Syndromes, Hereditary/genetics , Nevus, Blue/genetics , Preanesthetic Medication , Preoperative Care , Rectal Fistula/complications , Subarachnoid SpaceABSTRACT
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