ABSTRACT
In this work, we introduce the numerous emerging areas and frontiers in the use of point-of-care ultrasonography. Of these, we review the following three: 1) the use of clinical ultrasonography in infectious and tropical diseases (we address its usefulness in the diagnosis and follow-up of the main syndromes, in tropical diseases, and in areas with scarce resources); 2) the usefulness of clinical ultrasonography in the assessment of response to volume infusion in severely ill patients (we review basic concepts and the main static and dynamic variables used for this evaluation); and 3) the use of clinical ultrasonography in the assessment of muscle mass in elderly patients with primary sarcopenia (we review the main muscles and measurements used for it).
Subject(s)
Point-of-Care Testing/trends , Ultrasonography/trends , Aged , Communicable Diseases, Imported/diagnostic imaging , Critical Illness , Fluid Therapy , Humans , Infections/diagnostic imaging , Muscle, Skeletal/diagnostic imaging , Pleural Effusion/diagnostic imaging , Pneumonia/diagnostic imaging , Poverty Areas , Sarcopenia/diagnostic imaging , Tropical MedicineABSTRACT
No disponible
Subject(s)
Humans , Ventricular Function, Left/physiology , Stroke Volume/physiology , Shock/physiopathology , Catheterization, Swan-Ganz/methods , Risk Factors , Hemodynamics/physiology , Echocardiography/methodsSubject(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
En el documento actual introduciremos las áreas más emergentes y frontera del uso de la ecografía clínica a la cabecera del paciente, que son numerosas. De entre todas ellas se revisarán 3: 1) la ecografía clínica en las enfermedades infecciosas y patología tropical (se abordará su utilidad en el diagnóstico y seguimiento de los principales síndromes, así como los usos para patología tropical y en áreas con escasos recursos); 2) la utilidad de la ecografía clínica para la evaluación de la respuesta a la infusión de volumen en pacientes graves (se revisarán conceptos básicos, así como las principales variables estáticas y dinámicas utilizadas para realizar esta evaluación); y por último, 3) se abordará la utilización de la ecografía clínica para la valoración de la masa muscular en la sarcopenia primaria de las personas ancianas (se repasarán los principales músculos y medidas que se utilizan para ello) (AU)
In this work, we introduce the numerous emerging areas and frontiers in the use of point-of-care ultrasonography. Of these, we review the following three: 1) the use of clinical ultrasonography in infectious and tropical diseases (we address its usefulness in the diagnosis and follow-up of the main syndromes, in tropical diseases, and in areas with scarce resources); 2) the usefulness of clinical ultrasonography in the assessment of response to volume infusion in severely ill patients (we review basic concepts and the main static and dynamic variables used for this evaluation); and 3) the use of clinical ultrasonography in the assessment of muscle mass in elderly patients with primary sarcopenia (we review the main muscles and measurements used for it) (AU)
Subject(s)
Humans , Ultrasonography/methods , Point-of-Care Testing , Point-of-Care Systems , Tropical Medicine , Communicable Diseases/diagnostic imaging , Sarcopenia/diagnostic imagingABSTRACT
No disponible
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
In the current document, we introduce the numerous emerging areas and frontiers in the use of point-of-care clinical ultrasonography. Of these, we review the following 3: 1) the use of clinical ultrasonography in infectious and tropical diseases (we address it's usefulness in the diagnosis and follow-up of the main syndromes, tropical diseases and in areas with scarce resources); 2) the usefulness of clinical ultrasonography in the assessment of response to volume infusion in severely ill patients (we review basic concepts and the main static and dynamic variables employed for this evaluation); and 3) the use of clinical ultrasonography in the assessment of muscle mass in elderly patients with primary sarcopenia (we review the main muscles and measurements employed for them it.
ABSTRACT
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
No disponible
