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The oxygenation indices are defined as the numerical expression of the relationship that exists between the gasometric values of the arterial oxygen pressure (PaO2) and the arterial pressure of carbon dioxide (PaCO2) at the level of the alveoli; they represent the function of the respiratory unit capillary alveolus membrane; at the pathophysiological level they represent hypoxemia. The utility of these numbers ranges from establishing a diagnostic impression of a lung disease to prognostic orientation thereof. It is an affordable and accessible tool to most medical units. The objective of this paper is to describe the usefulness of oxygenation indices in our daily medical practice. [ABSTRACT FROM AUTHOR]

SARS-CoV-2 has a predilection for cell groups that are rich in ACE2 and TMPRSS2 receptors, which are distributed throughout the human body, which means that, in addition to the primary site of contagion or primary infection, which is the respiratory system, the virus tends to spread by different mechanisms, affecting practically all the known organs, apparatuses and systems, with which its tropism becomes extensive, being able to condition diverse pictures together with the respiratory one. [ABSTRACT FROM AUTHOR]

In clinical practice, oxygen can save lives, although, wu ji bi fan: too much of something is not good and it can also cause toxicity; 14% of patients with coronavirus disease 2019 (COVID-19) will need non-invasive oxygen therapy and approximately 5% will require invasive mechanical ventilation (IMV). Noninvasive oxygen therapy is the first-line treatment for patients with hypoxemic acute respiratory failure secondary to COVID-19. The devices through which this therapy is administered can be classified into low flow and high flow. In the presence of acute hypoxemic respiratory failure, the necessary flow can be 30 to 120 L/min, a number that cannot be achieved with conventional systems (low flow), therefore, high-flow devices can be effective in well-selected patients, the aim is to improve oxygenation, avoid orotracheal intubation of the patient, but without delaying it. Noninvasive oxygen therapy does not increase the risk of aerosol infection. [ABSTRACT FROM AUTHOR]

Metabolic acidosis is the most complex acid-base disorder to study, originated as a consequence of the loss of bicarbonate; the gain of hydrogen ions or the lack of elimination of these makes its etiology a multifactorial nature, making its diagnostic and therapeutic approach very feared by most clinical doctors, so, through this narrative review it is intended to expose in a practical way the physiology, pathophysiology, etiology, diagnosis and therapeutic options so that the doctor, in a simple way, puts the "complex" into practice and understands this disorder from beginning to the end. [ABSTRACT FROM AUTHOR]

The word euboxia is a neologism of the Greek eu, good or normal, and the English word box, translated into Spanish as caja, it describes in the medical jargon the obsession we have trying to restore the physiological variables to a normal range; On the other hand, weaning describes a process or protocol for the removal of invasive mechanical ventilation. The euboxia during the course of weaning may delay extubation and beyond achieving reference ranges, it invites reflection and the particularized clinical judgment of the patient to achieve successful extubation. Neurological, respiratory, hemodynamic and metabolic factors must be analyzed during weaning, considering the practice of individualized dysboxia more than euboxia. [ABSTRACT FROM AUTHOR]

OBJECTIVE: To demonstrate if in patients with COVID-19 hypoxemia is a risk factor of acute kidney injury. MATERIALS AND METHODS: Cross-sectional, retrospective, descriptive, analytical study was done from May 1st to September 30th, 2020, including patients over 18 years of age admitted to the emergency service of a COVID-19 care medical center with the criteria of a suspected case of COVID-19 plus chest tomography with suggestive images. They were classified by the serum creatinine (SCr) value: Group 1 (G1) without acute kidney injury and group 2 (G2) with acute kidney injury. RESULTS: One hundred and five patients were recruited. G1 included 32 patients (30.5%) and G2 73 (69.5%). Median SCr at admission was 0.7 and 1.0 mg/dL for G1 and G2, respectively (p = 0.05). The median PaO2/FiO2 at admission for G1 was 90 mmHg and for G2 105 mmHg (p = 0.76) without finding association with admission acute kidney injury; arterial oxygen saturation (SatO2) equal or higher than 92% to the moment of admission to the emergency department presented a negative correlation for the development of acute kidney injury (Pearson: -0.537, p = 0.04). CONCLUSIONS: In the initial phase of COVID-19, hypoxemia is not a triggering factor for acute kidney injury; however, SatO2 can be a distracting marker of respiratory stability since persistent hypoxemia would be one more conditioning of acute kidney injury. [ABSTRACT FROM AUTHOR]

Copyright of Medicina Interna de Mexico is the property of Colegio de Medicina Interna de Mexico and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Copyright of Medicina Interna de Mexico is the property of Colegio de Medicina Interna de Mexico and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Copyright of Medicina Interna de Mexico is the property of Colegio de Medicina Interna de Mexico and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Fluid therapy is the first maneuver performed by the physician to be in contact with a patient who is intended to increase the volemia, the administration of parenteral solution type, the amount and duration in its application is the challenge of the intensivist. Currently the hemodynamic monitoring has undergone an important technological advance, being minimally invasive and with not only static but also dynamic constants, they have allowed to improve the medical decision making in the critically ill patient. The present non-systematic review aims to provide an update on measurements that are considered new tools before old paradigms in hemodynamic monitoring. [ABSTRACT FROM AUTHOR]

Copyright of Medicina Interna de Mexico is the property of Colegio de Medicina Interna de Mexico and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Long mechanical ventilation (MV) increases the risk of complications; moreover, early retirement of it exposes the patient to the risks presented before starting. The balance in speaking of prolonged mechanical ventilation and early retirement remains controversial, besides being an unresolved issue, even more so when speaking of neurological patients. Protection of the airway and prevention of further compromised brain compliance are the purposes of initiating invasive mechanical ventilation in patients with neurological impairment in addition to engaging the patient with particular fan under the presence of abnormal breathing patterns. Of patients requiring mechanical ventilation in the Intensive Care Unit (ICU), about 20% are due to neurological diseases. The appropriate time for extubation may be based on a clinical decision, which may be considered subjective, for this reason objective parameters have been proposed to make such a decision, they will identify candidates to perform test of spontaneous ventilation with great chance of success. The search for a parameter to evaluate the success or failure of extubation in neurological patient is a problem not solved so far, so it should be the subject of further studies, until today the Glasgow Coma Scale (SCG) is the variable associated with good or bad results. [ABSTRACT FROM AUTHOR]

BACKGROUND: Hyperchloremia is the most common cause of metabolic acidosis in critically ill patients. The sodium-chloride difference (Na+-Cl-) and chloride/sodium ratio (Cl-/Na+) may simply evaluate the role of hyperchloremia in acid-base disturbances. OBJECTIVE: To determine if sodium-chloride difference and chloride/ sodium ratio measured at 24 h of admission are mortality predictors at 30 days in patients with septic shock. MATERIAL AND METHOD: A prospective cohort, longitudinal, descriptive and analytic study was done including patients diagnosed with septic shock according to the guidelines of the Surviving Sepsis Campaign in 2012, admitted to the Intensive Care Unit in the period comprising from June 2015 to June 2016. RESULTS: The multivariate analysis showed that the Na+-Cl- difference less than 31 mEq/L increases the risk of death in patients with septic shock at 30 days, OR 15.26 (95% CI 1.56-148.49) p=0.019. CONCLUSION: The decrease in the Na+-Cl- difference below 31 mEq/L conditioned by hyperchloremia increases the risk of death at 30 days in the patient with septic shock. [ABSTRACT FROM AUTHOR]

Fever is a common sign in the intensive care unit, this involves the challenge of discovering its cause, usually reflects the presence of infection, but may have no infectious origin or be conditioned by hyperthermia syndromes. The Infectious Diseases Society of America (IDSA) and the American College of Critical Care Medicine define fever in critically ill patients as temperature equal or greater than 38.3°C. Fever is a complex physiological reaction to a disease mediated increase of cytokines and generation of acute phase reactants. There are different methods to measure temperature; physicians should know the degree of accuracy and limitations of each. In the intensive care unit body temperature can be measured using different techniques among which the catheter in the pulmonary artery is considered the gold standard. Fever in critically ill patients can be classified into three main categories: hyperthermia syndromes, infectious origin and noninfectious. An episode of greater than or equal to 38.3°C temperature should be evaluated. The clinical history, physical examination and characteristics of fever (magnitude, duration, frequency and its relation to diagnostic or therapeutic interventions) are essential. There is controversy regarding the treatment of fever, current evidence gives a dual and opposite, benefits and harms, role depending on the situation. [ABSTRACT FROM AUTHOR]

In the intensive care unit alterations in acid-base balance are common although the actual epidemiology remains uncertain. Conventionally Henderson-Hasselbalch equation is used to classify disorders of acid-base balance. The traditional method can be supplemented with base excess and anionic gap, described both in 1977. Keeping the hydrogen ion concentration of extracellular fluid within normal limits is the purpose of compensating mechanisms. Renal function dominates the maintenance of acid-base balance in the long term. Analysis and diagnosis of acid-base disorders should be based on the clinical picture of the patient and arterial blood gas analysis, the plasmatic value of sodium, chloride and potassium are essential. The diagnostic approach to acid-base disorders with the "traditional" Henderson-Hasselbalch method does not explain all acid-base disorders, this review is based on this method because it remains the most widely used in clinical practice. [ABSTRACT FROM AUTHOR]