ABSTRACT
La hiponatremia es el trastorno electrolítico más prevalente en las Unidades de Cuidados Intensivos. Se asocia a un aumento de la morbilidad, mortalidad y estancia hospitalaria. La mayoría de los estudios publicados hasta el momento son observacionales, retrospectivos y no incluyen pacientes críticos, lo que dificulta la extracción de conclusiones sólidas. Además, debido a la escasa evidencia científica de calidad, incluso las recomendaciones realizadas por distintas sociedades científicas recientemente publicadas difieren en aspectos importantes como son el diagnóstico o el tratamiento de la hiponatremia. Los mecanismos etiopatogénicos en los pacientes críticos suelen ser complejos. Sin embargo, hay que profundizar en ellos para llegar al diagnóstico más probable y a la pauta de tratamiento más adecuada. Todo ello, ha motivado la realización de esta revisión práctica sobre aspectos útiles en el abordaje de la hiponatremia en las Unidades de Cuidados intensivos, con el objetivo de homogeneizar el manejo de esta entidad y disponer de un algoritmo diagnóstico a nivel nacional
Hyponatremia is the most prevalent electrolyte disorder in Intensive Care Units. It is associated with an increase in morbidity, mortality and hospital stay. The majority of the published studies are observational, retrospective and do not include critical patients; hence it is difficult to draw definitive conclusions. Moreover, the lack of clinical evidence has led to important dissimilarities in the recommendations coming from different scientific societies. Finally, etiopathogenic mechanisms leading to hyponatremia in the critical care patient are complex and often combined, and an intensive analysis is clearly needed. A study was therefore made to review all clinical aspects about hyponatremia management in the critical care setting. The aim was to develop a Spanish nationwide algorithm to standardize hyponatremia diagnosis and treatment in the critical care patient
Subject(s)
Humans , Consensus , Hyponatremia/diagnosis , Critical Care , Intensive Care Units , Hyponatremia/etiology , Diagnosis, Differential , Societies, Medical/standards , Hyponatremia/physiopathology , AlgorithmsABSTRACT
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Subject(s)
Humans , Hypoxia, Brain/physiopathology , Craniocerebral Trauma/physiopathology , Blood Pressure Determination/methods , Monitoring, Physiologic/methods , Oxygen Consumption/physiologyABSTRACT
Since cadaveric donation is the main source of organs for transplantation in many countries, the diagnosis of brain death is an important issue. The cessation of cerebral circulation is one phenomenon closely related to brain death. Transcranial Doppler sonography is one of the accepted techniques to establish cessation of cerebral circulation. One of the limitations attributed to Doppler is the lack of sensitivity for this diagnosis. The objective of this research was to establish whether transcranial Doppler sonography showed acceptable sensitivity and whether this was affected by the location of the intracranial mass effect. Twenty-four patients underwent transcranial Doppler sonography to establish the incidence of the three sonographic patterns associated with brain death: separation diastole-systole, reverberating flow, and systolic spikes. In all the cases the insonation of the arteries of the base of the skull was performed. In supratentorial lesions, the predominant pattern was a reverberating flow, while in infratentorial lesions systolic spikes pattern was most frequent. Our study showed a high sensitivity of transcranial Doppler sonography for the diagnosis of brain death and the existence of different mechanisms of cerebral circulatory arrest depending on the location of the intracranial pressure wedge.
Subject(s)
Brain Death/diagnostic imaging , Brain Death/diagnosis , Supratentorial Neoplasms/diagnostic imaging , Ultrasonography, Doppler, Transcranial/methods , Adult , Cadaver , Cerebrovascular Circulation , Diastole , Humans , Middle Aged , Sensitivity and Specificity , Systole , Tissue DonorsABSTRACT
En la presente revisión se analizan inicialmente las distintas concepciones de muerte encefálica (muerte encefálica global, muerte troncoencefálica y muerte neocortical), y las implicaciones diagnósticas que cada una de ellas conlleva. Se revisan la implicación que el paro circulatorio cerebral tiene en los casos de muerte encefálica global, y los mecanismos implicados en el mismo. Se describen aspectos técnicos báscios de la sonografía Doppler transcraneal y, por último, se revisan diversos estudios que emplean la sonografía Doppler transcraneal en el diagnóstico de muerte encefálica (AU)
