Dr. Javier Velastegui Especialista en Medicina Crítica y Terapia Intensiva

27/08/2024

Debido a la demanda de pacientes abro mi agenda de atención para el 3 de septiembre. Será un gusto atender a los más pequeños del hogar.
Si tienes alguna duda consultamelo.

09/08/2024

20/05/2024

🩺💊💉 Dosificación de antimicrobianos para pacientes obesos⚫️Recomendaciones actualizadas.
👇🏽👇🏽👇🏽
https://journals.asm.org/doi/10.1128/aac.01719-23
🗝🔓
https://acrobat.adobe.com/link/review?uri=urn:aaid:scds:US:ce089d2f-0521-3314-9606-31e7a50ffc3c
📬Link Telegram
https://t.me/+UP_-QBaszOoc2X5p

20/05/2024

🕯️ Caring for dying critically ill patient in ? One-size-fits all recipe for good death unachievable, but some common ground can be identified. Here, framework to prevent poor quality of dying and moral distress among staff/families:
1️⃣ what most important for patient/family?
2️⃣ invasive monitoring need to continue?
3️⃣ investigations need to continue?
4️⃣ can interventions/treatment be discontinued?
5️⃣ plan clearly communicated to stop treatment?
6️⃣ EOL symptoms anticipated/planned?
7️⃣ preferred/allowed anticipatory medication?
8️⃣ enough time to talk to the family?
9️⃣ patient’s death particularly challenging?
🔟 post-death considerations?
Once shared (patient, family/surrogates, clinicians) decision to limit life-sustaining treatment reached, and approaching end-of-life recognised/accepted, pivotal caring for patient consistently with their values & preferences, ideally, as documented before mental capacity loss.
Free to read on Intensive Care Medicine
🔓 https://rdcu.be/dHGQV

20/05/2024

💥🧠Hidrocefalia y el neurointensivista: hidrodinámica del LCR a la cabecera del paciente 🛌
👇🏽👇🏽👇🏽👇🏽
https://icm-experimental.springeropen.com/articles/10.1186/s40635-022-00452-9?s=09
🔑🔓
https://acrobat.adobe.com/link/review?uri=urn:aaid:scds:US:6506afab-3f6a-366f-abff-5049ee742bca
📬 Telegram RECAT
https://t.me/+UP_-QBaszOoc2X5p

20/05/2024

Finding optimal tidal volume in
🫁 is ΔP indicator of unsafe VT & does it directly impact on outcome?
🫁 what factors can influence CRS + interplay between VT & ΔP?
We should continue using protective mechanical ventilation but, rather than fixed cut-of (6 ml/kg PBW) it may be more advantageous individualize VT considering multifactorial contribution of ∆P, CRS, ECW, PEEP + regional lung mechanics.
Free to read on Intensive Care Medicine
🔓 https://rdcu.be/dHUzd

23/03/2024

23/03/2024

Caring for frail patients in : complex, multidimensional approach:
➡️ what is frailty?
➡️ comorbidities vs frailty
➡️ concept of physiological reserve, frailty, clinical trajectory in ICU
➡️ frailty & admission criteria
➡️ different patient groups: medical vs surgical, multidimensional frailty data
➡️ informing/explaining frailty to patients & families
Free to read on Intensive Care Medicine
🔓 https://rdcu.be/dCeKy

27/02/2024

Impact of early systemic insults (hypoxemia & hypotension) on brain injury biomarker profiles, acute care requirements during stay, and neurological outcomes in patients with traumatic brain injury, analysis of CENTER-TBI data. Systemic insults:
📉 less common than previously described
⚡️ occurrence closely tied to severity of trauma & extracranial injuries
🧠 given current criteria for defining hypoxic/hypotensive insult, low blood pressure, rather than O2 deficiency, exerts a more pronounced impact on neuronal injury biomarkers, and on unfavourable neurological outcomes: need to revisit pressure targets in the prehospital settings? If both hypoxemia & hypotension occur concurrently, this produces higher biomarkers release and is associated with a worse clinical outcome & mortality.
Free to read on Intensive Care Medicine
🔓 https://rdcu.be/dziCL

27/02/2024

Dyspnea in acutely ill mechanically ventilated adults, ERS/ESICM
statement outlining a review of literature & current practice concerning prevalence, clinical significance, diagnosis and management:
🫁 conceptual, semantic & operational challenges
🫁 pathophysiology & factors associated with mechanical ventilation that may affect dyspnea
🫁 prevalence & (under)estimation of dyspnea
🫁 tools to detect dyspnea in communicative/noncommunicative patients
🫁 interventions to relieve dyspnea

Dyspnea, reported by 40% of patients undergoing IMV, ranks among most distressing experiences. Although it shares many similarities with pain, can be far worse as summons a primal fear response. It must be identifed, prevented, relieved in every patient.
Free to read on Intensive Care Medicine
🔓 https://rdcu.be/dzq9F

European Society of Intensive Care Medicine (ESICM)
European Respiratory Society