Integridad renal y hepática tras la sedación prolongada con sevoflurano administrado a través del dispositivo AnaConDa®: comparación con la sedación intravenosa con propofol en modelo animal

Resumen Introduccion En la actualidad la sedacion de los pacientes criticos se realiza mediante agentes intravenosos. La utilizacion de agentes inhalatorios, como alternativa a la sedacion intravenosa, se encuentra limitada por su potencial riesgo de toxicidad. El incremento de los niveles de fluoruros inorganicos, tras su metabolizacion, ha sido considerado potencialmente nefrotoxico. Por otro lado, la afectacion hepatica despues de la administracion prolongada de sevoflurano no ha sido estudiada. Se evaluo la potencial toxicidad renal y hepatica causada por la administracion prolongada (72 h) de sevoflurano. Metodos Estudio experimental, prospectivo, aleatorizado y controlado. Veintidos a…

Ventilación mecánica no invasiva en el postoperatorio. Revisión clínica

Non-invasive ventilation (NIV) is a method of ventilatory support that is increasing in importance day by day in the management of postoperative respiratory failure. Its role in the prevention and treatment of atelectasis is particularly important in the in the period after thoracic and abdominal surgeries. Similarly, in the transplanted patient, NIV can shorten the time of invasive mechanical ventilation, reducing the risk of infectious complications in these high-risk patients. It has been performed A systematic review of the literature has been performed, including examining the technical, clinical experiences and recommendations concerning the application of NIV in the postoperative per…

Ventilación mecánica no invasiva en pre e intraoperatorio y vía aérea difícil

Non-invasive mechanical ventilation is a method of ventilatory assistance aimed at increasing alveolar ventilation, thus achieving, in selected subjects, the avoidance of endotracheal intubation and invasive mechanical ventilation, with the consequent improvement in survival. There has been a systematic review and study of the technical, clinical experiences, and recommendations concerning the application of non-invasive mechanical ventilation in the pre- and intraoperative period. The use of prophylactic non-invasive mechanical ventilation before surgery that involves significant alterations in the ventilatory function may decrease the incidence of postoperative respiratory complications. …

Increased Expression of AQP 1 and AQP 5 in Rat Lungs Ventilated with Low Tidal Volume is Time Dependent

BACKGROUND AND GOALS: Mechanical ventilation (MV) can induce or worsen pulmonary oedema. Aquaporins (AQPs) facilitate the selective and rapid bi-directional movement of water. Their role in the development and resolution of pulmonary oedema is controversial. Our objectives are to determine if prolonged MV causes lung oedema and changes in the expression of AQP 1 and AQP 5 in rats. METHODS: 25 male Wistar rats were subjected to MV with a tidal volume of 10 ml/kg, during 2 hours (n = 12) and 4 hours (n = 13). Degree of oedema was compared with a group of non-ventilated rats (n = 5). The expression of AQP 1 and AQP 5 were determined by western immunoblotting, measuring the amount of mRNA (prev…

The Effects of Flow Waveform on Oxygenation in Pediatric Patients

PiCCO plus: monitorización cardiopulmonar mínimamente invasiva

Insertion of a central venous catheter and an arterial catheter would be indicated in hemodynamically unstable or severely hypoxic patients in critical care units. In this setting, cardiorespiratory monitoring by transpulmonary thermodilution (TPTD) can be considered minimally invasive given that only a single arterial thermodilution catheter and a single central venous catheter are required to be connected to a specific monitor (the PiCCO Plus, Pulsion Medical Systems, Munich, Germany). TDTP simultaneously measures cardiac output, preloading, and cardiac function in hemodynamically unstable patients and predicts the response to volume. The technique can be managed by any health care profes…

Remote Ischemic Preconditioning Decreases Oxidative Lung Damage After Pulmonary Lobectomy

BACKGROUND:During lobectomy in patients with lung cancer, the operated lung is often collapsed and hypoperfused. Ischemia/reperfusion injury may then occur when the lung is re-expanded. We hypothesized that remote ischemic preconditioning (RIPC) would decrease oxidative lung damage and improve gas e

New frontiers: art and innovation for intraoperative ventilatory management.

Pathophysiology of respiratory failure

Summary Respiratory failure (RF) is defined as a disturbance in gas exchange in the respiratory system which produces in arterial BGA a PaO 2 2  > 50 mmHg (hypercapnia). However hypoxaemic normocapnic (or hypocapnic) RF due to the failure in gas exchange is very common and should be separated from mechanical RF. Respiratory failure (hypercapnic) with or without hypoxaemia related to a failure in the respiratory pump. This review is focused on the pathophysiology of the mechanical RF less well known amongst anaesthesiologists.

Tratamiento con equinocandinas en un paciente crítico sometido a técnica continua de reemplazo renal

Resumen Antecedentes Los pacientes criticos con candidiasis invasiva (CI) suelen presentar con frecuencia insuficiencia renal, por lo que en ocasiones requieren tecnicas continuas de reemplazo renal (TCRR). Las equinocandinas son la primera opcion en el tratamiento de la CI en el paciente critico con enfermedad moderada o grave. Debido a su perfil farmacocinetico y farmacodinamico (FC/FD), su eliminacion durante las TCRR debe ser despreciable, sin que sea necesario ajustar sus dosis, como asi lo indican los escasos estudios clinicos que hay al respecto. Caso clinico Varon de 66 anos intervenido por peritonitis secundaria a dehiscencia de sutura intestinal, que ingresa en la unidad de cuidad…

Expression of aquaporins 1 and 5 in a model of ventilator-induced lung injury and its relation to tidal volume

New Findings What is the central question of this study? Although different studies have attempted to find factors that influence the expression of aquaporins (AQPs) in the lung in different situations, to date no research group has explored the expression of AQP1 and AQP5 jointly in rats mechanically ventilated with different tidal volumes in a model of ventilator-induced lung injury. What is the main finding? Mechanical ventilation with a high tidal volume causes lung injury and oedema, increasing lung permeability. In rats ventilated with a high tidal volume, the pulmonary expression of AQP1 decreases. We analysed the expression of aquaporins 1 and 5 and its relation with tidal volume in…

Renal and hepatic integrity in long-term sevoflurane sedation using the anesthetic conserving device: A comparison with intravenous propofol sedation in an animal model

Abstract Introduction Critically ill patients are sedated with intravenous agents because the use of inhaled agents is limited by their potential risk of toxicity. Increasing levels of inorganic fluorides after the metabolism of these agents have been considered potentially nephrotoxic. However, hepatic involvement after prolonged administration of sevoflurane has not yet been studied. The present study evaluated the potential renal and hepatic toxicity caused by prolonged administration (72 h) of sevoflurane. Methods For this experimental, prospective, randomized, controlled trial, 22 Landrace × Large-White female pigs were randomly assigned to two groups: intravenous propofol (P) or inhal…

The quest for the perfect Weaning Index.

Personalized intraoperative positive end-expiratory pressure: a further step in protective ventilation

Hipertensión endocraneal asociada a la sedación con sevoflurano mediante el dispositivo AnaConDa®en un paciente con traumatismo craneoencefálico severo

Sedation in neurocritical patients remains a challenge as there is no drug that meets all the requirements. Since the appearance of the AnaConDa® device, and according to the latest recommendations, sevoflurane has become an alternative for patients with brain injury. The use of AnaConDa® produces an increase in the anatomical dead space that leads to a decrease in alveolar ventilation. If the decrease in the alveolar ventilation is not offset by an increase in minute volume, there will be an increase in PaCO2. We report the case of a patient with severe traumatic brain injury who suffered an increase in intracranial pressure as a result of increased PaCO2 after starting sedation with the A…