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1.
J Trauma ; 67(6): 1220-4, 2009 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-20009670

RESUMO

INTRODUCTION: Preload parameters in postresuscitation phase are not sufficiently sensitive to guide fluid therapy in critically ill patients. We analyzed modifications in the fluid therapy and vasoactive drugs of critically ill patients that were produced by inclusion of extravascular lung water (EVLW) data in the treatment protocol and evaluated the short-term response. METHODS: This observational and prospective study included consecutive patients with hypotension or hypoxemia, comparing the therapeutic plan for fluid and vasoactive drug treatment between before and after knowing the EVLW value. RESULTS: We studied 42 patients. After knowing the EVLW, 52.4% (n = 22) of initial therapeutic plans were changed, modifying fluid therapy in all of these cases and vasoactive therapy in 22% of them. EVLW value was 13.91 +/- 5.62 in patients with change of therapeutic plan versus 10 +/- 4.52 in those with no change (p < 0.05). No differences were found in preload parameters as a function of change/no change. The most frequent decision change (n = 13) was to fluid reduction plus diuretic administration, and patients with this modification had significantly (p < 0.05) higher EVLW values compared with the remaining patients with a change in fluid therapy. Out of the 22 patients with a modified therapeutic decision, the therapy proved effective in 18 patients CONCLUSION: Quantification of EVLW in patients who can be considered euvolemic induces important modifications in fluid and vasoactive therapy. These changes generally resulted in a lower volume loading and a positive outcome for the patient.


Assuntos
Estado Terminal/terapia , Água Extravascular Pulmonar/fisiologia , Hidratação/métodos , Hipotensão/terapia , Hipóxia/terapia , Síndrome do Desconforto Respiratório do Adulto/terapia , Sepse/terapia , Análise de Variância , Fármacos Cardiovasculares/uso terapêutico , Distribuição de Qui-Quadrado , Feminino , Hemodinâmica , Humanos , Hipotensão/mortalidade , Hipotensão/fisiopatologia , Hipóxia/mortalidade , Hipóxia/fisiopatologia , Técnicas de Diluição do Indicador , Masculino , Estudos Prospectivos , Respiração Artificial , Síndrome do Desconforto Respiratório do Adulto/fisiopatologia , Sepse/fisiopatologia
2.
Cir Esp ; 85 Suppl 1: 29-34, 2009 Jun.
Artigo em Espanhol | MEDLINE | ID: mdl-19589407

RESUMO

In patients with traumatic intraabdominal hemorrhage, urgent decisions must be made. Resuscitation measures must often be simultaneously combined with diagnostic actions and measures to control the source of the bleeding. Hemorrhages are usually complicated by coagulation disorders and the presence of acidosis and hypothermia. In these conditions, emergency measures are required that usually involve various specialists. However, given the paucity of the scientific evidence in this field, the intervention protocols differ from one center to another. The European Guidelines for the management of bleeding following major trauma has recently been published. These guidelines review aspects such as evaluation and initial management of bleeding, localization and control of the source of bleeding and replacement of blood products. In addition, recommendations based on the best available evidence to 2008 are made. This review describes the basic aspects of traumatic intraabdominal hemorrhage.


Assuntos
Traumatismos Abdominais/complicações , Hemorragia/terapia , Guias de Prática Clínica como Assunto , Hemorragia/etiologia , Humanos , Escala de Gravidade do Ferimento
3.
Cir. Esp. (Ed. impr.) ; 85(supl.1): 29-34, jun. 2009. tab
Artigo em Espanhol | IBECS | ID: ibc-108533

RESUMO

El paciente con hemorragia intraabdominal traumática requiere la toma de decisiones con carácter urgente. Con frecuencia habrá que combinar de forma simultánea las medidas de reanimación con acciones diagnósticas y de control de la fuente de la hemorragia. El cuadro hemorrágico suele verse complicado con trastornos de la coagulación y la presencia de acidosis e hipotermia. En estas condiciones son necesarias actuaciones urgentes que generalmente implican a varios especialistas, pero dada la debilidad de la evidencia científica en este campo, las pautas de actuación difieren de un centro a otro. Recientemente se han publicado las Guías Europeas para el manejo del paciente traumatizado sangrante en las que se revisan aspectos como la valoración y el manejo inicial de la hemorragia, la localización y control de la fuente del sangrado y la reposición de hemoderivados. Se elaboran, asimismo, unas recomendaciones basadas en la mejor evidencia disponible hasta 2008. En la presente revisión expondremos los aspectos fundamentales referidos a la hemorragia intraabdominal traumática (AU)


In patients with traumatic intraabdominal hemorrhage, urgent decisions must be made. Resuscitation measures must often be simultaneously combined with diagnostic actions and measures to control the source of the bleeding. Hemorrhages are usually complicated by coagulation disorders and the presence of acidosis and hypothermia. In these conditions, emergency measures are required that usually involve various specialists. However, given the paucity of the scientific evidence in this field, the intervention protocols differ from one center to another. The European Guidelines for the management of bleeding following major trauma has recently been published. These guidelines review aspects such as evaluation and initial management of bleeding, localization and control of the source of bleeding and replacement of blood products. In addition, recommendations based on the best available evidence to 2008 are made. This review describes the basic aspects of traumatic intraabdominal hemorrhage (AU)


Assuntos
Humanos , Traumatismos Abdominais/cirurgia , Perda Sanguínea Cirúrgica/prevenção & controle , Padrões de Prática Médica , Acidose/complicações , Hipotermia/complicações , Fatores de Risco , Medicina Baseada em Evidências
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