[Early determinants of acute kidney injury during experimental intra-abdominal sepsis].

Background: Sepsis-induced acute kidney injury (AKI) is an early and frequent organ dysfunction, associated with increased mortality.

Aim: To evaluate the impact of macrohemodynamic and microcirculatory changes on renal function and histology during an experimental model of intra-abdominal sepsis.

Material And Methods: In 18 anaesthetized pigs, catheters were installed to measure hemodynamic parameters in the carotid, right renal and pulmonary arteries.

[Controversies in massive pulmonary embolism].

Massive pulmonary embolism (PE) is associated with high mortality. There is still a broad assortment of severity classifications for patients with PE, which affects the choice of therapies to use. The main clinical criteria for defining a PE as massive is systemic arterial hypotension, which depends on the extent of vascular obstruction and the previous cardiopulmonary status.

[Risk stratification of pulmonary thromboembolism].

The prognosis of pulmonary thromboembolism (PE) is related to the cardiopulmonary reserve of the patient and the magnitude of the embolus that impacts pulmonary circulation. The presence of hemodynamic instability (shock) stratifies a group of patients with high mortality, which should be treated with thrombolysis. Patients without shock but with right ventricular dysfunction can have a dismal evolution and should be managed aggressively.

Catastrophic respiratory failure from tuberculosis pneumonia: Survival after prolonged extracorporeal membrane oxygenation support.

Tuberculosis (TB) is an uncommon cause of severe respiratory failure, even in highly endemic regions. Mortality in cases requiring mechanical ventilation (MV) varies between 60 and 90%. The use of extracorporeal membrane oxygenation (ECMO) is not frequently needed in TB.

[Mini bronchoalveolar lavage in patients with severe respiratory failure].

Background: To recognize the etiological agent responsible for severe acute respiratory failure (ARF) in patients in mechanical ventilation (MV) is important to determine their treatment and prognosis, and to avoid the excessive use of antibiotics. Mini bronchoalveolar lavage (mini BAL) is a blind, non bronchoscopic procedure, used to obtain samples from the lower respiratory tract from patients on mechanical ventilation (MV).

Aim: To assess the feasibility, complications and preliminary results of mini BAL among patients with severe ARF on MV.

Natriuretic peptide type-B can be a marker of reperfusion in patients with pulmonary thromboembolism subjected to invasive treatment.

This study was intended to investigate changes in cardiac biomarkers and pulmonary hemodynamic effects of invasive treatment in patients with intermediate-risk (hemodynamic stability with evidence of right ventricle dysfunction and/or myocardial injury) pulmonary embolism. Also, to also evaluate if natriuretic peptide type-B (NT-proBNP) plasma levels are associated with right ventricle function and pulmonary arterial pressures. Interventional study: Fourteen normotensive adult patients with acute and radiologically massive pulmonary embolism plus positive biomarkers and evidences of right ventricle dysfunction underwent invasive pulmonary angiography for invasive treatment consisting on mechanical thrombus fragmentation and catheter-directed intrathrombus thrombolysis.

[Prevalence of severe sepsis in intensive care units. A national multicentric study].

Background: Severe sepsis (SS) is the leading cause of death in the Intensive Care Units (ICU).

Aim: To study the prevalence of SS in Chilean ICUs.

Material And Methods: An observational, cross-sectional study using a predesigned written survey was done in all ICUs of Chile on April 21st, 2004.

[Thiazide induced acute pulmonary edema: report of one case].

Acute pulmonary edema caused by thiazides is uncommon and of difficult diagnosis. It is considered an idiosyncratic reaction and the physiopathology or cardiac function changes are not well known. We report a 60 year-old female with a thiazide induced acute pulmonary edema who was followed with serial measurements of type B n-terminal natriuretic peptide fraction as marker for cardiac dysfunction.

[Comparison of cardiac output measurement in critical patients using transesophageal Doppler or thermodilution: a preliminary report].

Background: Cardiac output can be measured non invasively by transesophageal Doppler. This is an alternative to measure it by thermodilution with a catheter in the pulmonary artery.

Aim: To compare both methods of cardiac output measurement.

[Hantavirus cardiopulmonary syndrome: utility of the PICCO(Pulse contour cardiac output) system for monitoring].

We report a 68 years old man, farmer from the metropolitan region, admitted with a Hantavirus Cardiopulmonary Syndrome. The diagnosis was made using serologic test and was later confirmed by the Public Health Institute. He evolved to an early multiple organ failure, requiring high concentrations of oxygen and invasive ventilatory assistance, vasopressor drugs and renal replacement therapy.

[Hemodynamic impact of positive end expiratory pressure (PEEP) during severe respiratory failure: present view].

Bedside evaluation of pulmonary mechanics and thoracic computed axial tomography have changed the ventilatory management of patients suffering an acute respiratory failure caused by adult respiratory distress syndrome (ARDS). Mortality has been reduced limiting tidal volumes, which avoids alveolar overdistention and by the use of positive end expiratory pressure (PEEP), that reduces the damage caused by cyclical alveolar collapse-reopening. Nowadays, it is well known that inappropriate mechanical ventilation enhances lung damage caused by the underlying disease.