Inicio » ARTÍCULOS DE INTERÉS

ARTÍCULOS DE INTERÉS

  1. Angiotensin–Neprilysin Inhibition in Acute Decompensated Heart Failure

    Eric J. Velazquez, M.D., David A. Morrow, M.D., M.P.H., Adam D. DeVore, M.D., M.H.S., Carol I. Duffy, D.O., Andrew P. Ambrosy, M.D., Kevin McCague, M.A., Ricardo Rocha, M.D., and Eugene Braunwald, M.D., for the PIONEER-HF Investigators. November 11, 2018, at NEJM.org. DOI: 10.1056/NEJMoa1812851

    Conclusions:Among patients with heart failure with reduced ejection fraction who were hospitalized for acute decompensated heart failure, the initiation of sacubitril–valsartantherapy led to a greater reduction in the NT-proBNP concentration than enalapriltherapy. Rates of worsening renal function, hyperkalemia, symptomatic hypotension, and angioedema did not differ significantly between the two groups.

  2. Vitamin C for Vasoplegia After Cardiopulmonary Bypass: A Case Series. Wieruszewski, Patrick M., Nei, Scott D., Maltais, Simon, Schaff, Hartzell V.,Wittwer, Erica D. Caso clínico

    CONCLUSIONS: In 3 cases of cardiac vasoplegia after CPB necessitating epinephrine, vasopressin, and escalating norepinephrine doses to maintain MAP >65 mm Hg, we found reduced vasopressor support after administration of high-dose ascorbic acid. In 2 cases, complete liberation of norepinephrine was achieved within just 24 hours of ascorbic acid initiation. Prospective, randomized studies are warranted to evaluate the efficacy and determine the appropriate dosage and duration of ascorbic acid in the treatment of cardiac vasoplegia after CPB.

  3. Wearable Cardioverter–Defibrillator after Myocardial Infarction. Jeffrey E. Olgin, Mark J. Pletcher, Eric Vittinghoff, et al. 

    Arrhythmic death occurred in 1.6% of the participants in the device group and in 2.4% of those in the control group (relative risk, 0.67; 95% confidence interval [CI], 0.37 to 1.21; P=0.18). Death from any cause occurred in 3.1% of the participants in the device group and in 4.9% of those in the control group (relative risk, 0.64; 95% CI, 0.43 to 0.98; uncorrected P=0.04). Conclusions: Among patients with a recent myocardial infarction and an ejection fraction of 35% or less, the wearable cardioverter–defibrillator did not lead to a significantly lower rate of the primary outcome of arrhythmic death than control. (Funded by the National Institutes of Health and Zoll Medical; VEST ClinicalTrials.gov number, NCT01446965. N Engl J Med 2018; 379:1205-1215 . DOI: 10.1056/NEJMoa1800781 Abstrac

  4. Ultra-protective mechanical ventilation without extra-corporeal carbon dioxide removal for acute respiratory distress syndrome. Hariharan Regunath, Nathanial Moulton, DanielWoolery, Mohammed Alnijoumi, Troy Whitacre, Jonathan Collins. Journal of the Intensive Care Society First Published May 10, 2018. Department of Medicine, Division of Pulmonary, Critical Care and Environmental Medicine, University of Missouri, Columbia, MO, USA.

    During-UPMV, VT ranged 2–5 mL/kg PBW(3.99 ± 0.73), the arterial partial pressure of carbon dioxide (PaCO2) was higher than pre-UPMV values (84.81 ± 18.95 cmH2O vs. 69.16 ± 33.09 cmH2O), but pH was comparable and none received extracorporeal carbon dioxide removal (ECCO2-R). The positive end-expiratory pressure (14.18 ± 7.56 vs. 12.31 ± 6.84 cmH2O), PIP (38.21 ± 12.89 vs. 32.59 ± 9.88), and mean airway pressures (19.98 ± 7.61 vs. 17.48 ± 6.7 cm H2O) were higher during UPMV, but Pplat and PaO2/FiO2 were comparable during- and pre-UPMV. Driving pressure was observed to be higher in those who died than who survived (24.18 ± 12.36 vs. 13.42 ± 3.25).Conclusion UPMV alone may be a safe alternative option for ARDS patients in centers without ECCO2-R.                                                                                                                             

  5. MITRA-FR: Patients with severe secondary mitral regurgitation were assigned to either percutaneous valve repair or medical therapy. At 12 months, there was no difference between groups in the rate of death or rehospitalization for HF.                                                                                             Conclusion: Among patients with severe secondary mitral regurgitation, the rate of death or unplanned hospitalization for heart failure at 1 year did not differ significantly between patients who underwent percutaneous mitral-valve repair in addition to receiving medical therapy and those who received medical therapy alone. (Funded by the French Ministry of Health and Research National Program and Abbott Vascular; MITRA-FR ClinicalTrials.gov number, NCT01920698)NEJM August 27, 2018 DOI: 10.1056/NEJMoa1805374

          Inclusion Criteria:

  • Severe secondary mitral regurgitation  volume>30 mL/beat or an effective regurgitant orifice>20 mm².
  • New York heart Association Class≥ II.
  • Left ventricular ejection fraction between 15% and 40%
  • Minimum of 1 hospitalization for heart failure within 12 months preceding randomization
  • Optimal standard of care therapy for heart failure according to investigator.
  • Not eligible for a mitral surgery intervention according to the Heart Team.

___________________OTROS ARTICULOS______________________

  1. Invasive aspergillosis in patients admitted to the intensive care unit with severe influenza: a retrospective cohort study. Lancet July 31, 2018 DOI:https://doi.org/10.1016/S2213-2600(18)30274-1 .

    Findings: Data were collected from patients admitted to the ICU between Jan 1, 2009, and June 30, 2016. Invasive pulmonary aspergillosis was diagnosed in 83 (19%) of 432 patients admitted with influenza (influenza cohort), a median of 3 days after admission to the ICU. The incidence was similar for influenza A and B. For patients with influenza who were immunocompromised, incidence of invasive pulmonary aspergillosis was as high as 32% (38 of 117 patients), whereas in the non-immunocompromised influenza case group, incidence was 14% (45 of 315 patients).  The 90-day mortality was 51% in patients in the influenza cohort with invasive pulmonary aspergillosis and 28% in the influenza cohort without invasive pulmonary aspergillosis (p=0·0001). In this study, influenza was found to be independently associated with invasive pulmonary aspergillosis (adjusted odds ratio 5·19; p<0·0001), along with a higher APACHE II score, male sex, and use of corticosteroids. Interpretation:  Influenza was identified as an independent risk factor for invasive pulmonary aspergillosis and is associated with high mortality.

  2. GUIDELINES ON THE MANAGEMENT OF ARDS ARDS Guideline of Intensive care Society 2018 FICM &amp; ICS ARDS GUIDELINE – July 2018 (CLICK HERE)   El propósito de esta guía es proporcionar un marco basado en la evidencia para el manejo de pacientes adultos con síndrome de dificultad respiratoria aguda (SDRA) Captura de pantalla -2018-07-08 11-43-39
  3. INSTAURACION ECMO EN URGENCIAS. Ver video, ECMO pre-cateterismo cardiaco

  4. Device-Related Thrombus After Left Atrial Appendage Closure: Incidence, Predictors, and Outcomes. Srinivas R. Dukkipati, Saibal Kar, David R. Holmes, Shephal K. Doshi, Vijendra Swarup, Douglas N. Gibson, Brijeshwar Maini, Nicole T. Gordon, Michael L. Main and Vivek Y. Reddy.Circulation. 2018;CIRCULATION AHA.118.035090, originally published May 11, 2018 Pulsa enlace art.

  5. Restrictive versus Liberal Fluid Therapy for Major Abdominal Surgery. The Australian and New Zealand College of Anaesthetists Clinical Trials Network and the Australian and New Zealand Intensive Care Society Clinical Trials Group. N Engl J Med 2018; 378:2263-2274. Pulsa enlace art. Resultados sorprendentes.

  6. Quality-of-Life Outcomes After Transcatheter Aortic Valve Replacement in an Unselected PopulationA Report From the STS/ACC Transcatheter Valve Therapy Registry. and Assessing the Utility of Transcatheter Aortic Valve Replacement.K P. Alexander JAMA Cardiol. 2017;2(4):409-416. and JAMA Cardiol. 2017;2(4):416-417.  Pulsa para art. » Aproximadamente 1 de cada 3 todavía tuvo un mal resultado 1 año después de la TAVR. Se necesitan esfuerzos continuados para mejorar la selección de pacientes y cuidados en el postoperatorio para mejorar los resultados.» Reiterando lo obvio, solo TAVR trata los síntomas debidos a la EAo.«

  7. Routine Postoperative Care of Patients Undergoing Coronary Artery Bypass Grafting on Cardiopulmonary Bypass.  Seminars in Cardiothoracic and Vascular Anesthesia 2015, Vol. 19(2) 78­–86.  Enlace Geoffrey K. Lighthall, and Megan Olejniczak.
    Abstract
    The postoperative course of a patient undergoing cardiac surgery (CS) is dictated by a largely predictable set of interactions between disease-specific and therapeutic factors. ICU personnel need to quickly develop a detailed understanding of the patient’s current status and how critical care resources can be used to promote further recovery and eventual independence from external support. The goal of this article is to describe a typical operative and postoperative course, with emphasis on the latter, and the diagnostic and therapeutic options necessary for the proper care of these patients.
    This paper will focus on coronary artery bypass grafting as a model for understanding the course of CS patients; however, many of the principles discussed are applicable to most cardiac surgery patients.