The majority of ICU deaths are preceded by a decision to limit treatment in some way. Decisions to withhold or withdraw treatment vary considerably depending on many factors including local practice, cultural and religious background, family and peer pressure. Here we will discuss the current situation across Europe, based on the findings from three large international studies.
info:eu-repo/semantics/published
info:eu-repo/semantics/published
Anaemia is a common problem in critically ill patients admitted to intensive care units. Many factors can be involved in its development, including rapid alterations in iron metabolism. Maintenance of iron homeostasis is a prerequisite for many essential biological processes and is a central element for the development of erythroid precursors and mature red blood cells. With the inflammatory process, iron distribution is disturbed, with decreased serum iron levels and increased iron stores. Little information is available on the precise role of alterations in iron metabolism in the development of iron anaemia in critically ill patients.
info:eu-repo/semantics/published
La importancia real de un insecto nocivo no es en efecto siempre fácil de determinar. Si no hay ninguna duda sobre los daños provocados por Anthonomus grandis en el algodón o por Idiarthron subquadratum en el café, es mucho la fecundidad del insecto y la frecuencia de sus generaciones, son evidentemente muy importantes, lo mismo que el número y la importancia de sus parásito Las condiciones del cultivo tiene también su papel: es así como el chacuatete parece desarrollarse sobre todo en las fincas invadidas por malas hierbas (monte), y se abriga en las cercas de izote y en los montones de madera proveniente de la poda de árboles de sombra. El estudio de un insecto nocivo se concentra en total, al estudio de la ruptura del equilibrio biológico que provoca. Los insectos que nos parecen más importantes para el salvador son el chacuatete, contra el cual sería oportuno crear una organización de lucha parecida a la establecida para combatir los acridios. El picudo, contra el cual los métodos actuales de lucha son técnicamente satisfactorios, pero plantean un problema al precio del costo del algodón. Rhyncophorus palmarum, o más exactamente las enfermedades del cocotero que producen su auge. Los Diabroticas, muy peligrosos por el número de sus plantas-huéspedes y por su dispersión, como también porque constituyen un peligro particularmente para el frijol. Los Cercospídeos, muy peligrosos también por el número elevado de sus plantas-huéspedes y su expansión, como por el peligro que pueden representar para el maíz y la caña de azúcar.
In this endotoxic shock model, both norepinephrine and dobutamine can increase DO2 and VO2 but dobutamine caused a more consistent increase in these parameters. The decrease in oxygen extraction was relatively similar with dobutamine and norepinephrine. The present study does not support a significant beneficial effect of norepinephrine on the tissue extraction capabilities in endotoxic shock.
The transfusion rate in ICU patients decreased during the 13-year period, despite patients being more severely ill in the more recent study; ICU mortality rates remained relatively stable. In patients who received more than 4 units of blood, the mortality rate was significantly lower in the more recent database.
Introduction: Fenoldopam is a selective dopamine-1 receptor agonist, which has mainly been studied as a possible prophylactic agent against contrast-induced nephropathy. Despite some promising clinical data, there is a lack of knowledge regarding fenoldopam's mechanism of action in septic shock. Methods: Sepsis was established in sheep by injecting 1.5 g/kg of autologous feces into the abdominal cavity; 2 hours later, the animals were randomized to receive either placebo or fenoldopam intravenously at a rate of 1.0 µg/kg/min for 16 hours. The two groups were assessed for differences in general hemodynamics, kidney oxygen-derived variables (oxygen delivery (K-DO2), oxygen consumption (K-VO2) and oxygen extraction ratio (K-O2ER)) and the metabolic response (L/P ratio) of both renal cortex and medulla using microdialysis (CMA20, CMA, Sweden). Results: Throughout the course of the experiment, animals treated with the vasodilator fenoldopam had a significantly lower mean arterial pressure (p < 0.05) and higher blood lactate levels (p <0.05) compared to controls. After an initial increase, K-DO2 decreased in fenoldopam-treated animals when shock developed, to the same level as that of control animals. In the face of a reduction in perfusion pressure, K-O2ER doubled as K-VO2 remained constant. Metabolic stress was apparent with lactate/pyruvate ratios and lactate levels increasing early in cortex and medulla. Conclusions: In this sheep model of septic shock, fenoldopam-administration was associated with a worsening of general hemodynamic and renal metabolic parameters.
