Saturday, November 20, 2010


Para recordad Enfermedad Intersticial Pulmonar
Causas :
The mnemonic Fasten -  Bad Rash, here it is
(it refers to upper vs lower lobe predominance of the ILDs=  Interstitial Lung Dz):

Upper Lobe Predominant

F  armer's lung
A  nkylosing spondylitis
S  ilicosis/sarcoidosis
T   uberculosis
E  eosinophic granuloma
N  eoplastic/neurofibromatosis

Lower Lobe Predominant

B  ronchiectasis
A  sbestosis
D  ermatomyositis/drugs
R  heumatoid arthritis
A  spiration
S  cleroderma
H  amman Rich (acute interstitial pneumonia)

Given that clinicians each day face the decision whether or not to transfuse, how should we measure the totality of the evidence? 
It appears that transfusion must be viewed as any other intervention in the ICU. It is associated with clear risks. Therefore, the expected benefits and risks must be expressly weighed in light of the goal of transfusion. The traditional approach of failing to view transfusion as a risk/benefit tradeoff is both naı¨ve and inappropriate. A more conservative policy to transfusion is justified, and we must accept lower hemoglobin levels (eg, 7 mg/dL) in hemodynamically stable, nonbleeding patients.

Where do we go from here? Many important questions still await answers, such as: What is the
mechanism for immunomodulation? Is the age of blood important? What is the role of leukoreduction?
What is optimal hemoglobin in cardiac patients or in early resuscitation? Observational trials
have clearly played a crucial role in advancing our understanding of RBC transfusion in the critically ill patient and shaped the current approach to RBC transfusion. This approach, though, can take us no further. We have now reached the point where the questions that need to be answered can only be answered with randomized controlled trials. If the field of transfusion in the critically ill is to move forward, it is only going to be by
concentrating efforts on well-designed prospective, randomized, clinical trials.
Andrew F. Shorr, MD, MPH, FCCP
Washington, DC
Howard L. Corwin, MD, FCCP
Lebanon, NH
CHEST Editorials
CHEST | Volume 132 | Number 4 | October 2007

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