SUMMARY Experimental subarachnoid hemorrhage (SAH) in dogs was produced by introducing blood into the subarachnoid space through a catheter connected to an artery of the animal. The intact animals and those with preserved vagi and heart sympathetic innervation, developed arrhythmias with short latencies which correlated with the sudden increase in the intracranial pressure. The animals with sections of both vagi and heart sympathetic innervation, but with an intact spinal cord, developed arrhythmias that were delayed and did not correlate with the changes in intracranial pressure. These arrhythmias were preceded by changes in the QT interval, T wave and ST segment. It was concluded that the arrhythmias could be produced either by direct autonomic discharges to the heart or by increased circulating and tissue catecholamines. The clinical implications of these findings are discussed.

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Current medicine, highly technified, and capable of amazing achievements, is not possible without the support of antibiotics. The problem of antibiotic resistance is almost as old as the antibiotics themselves. But at present, it is a serious threat to public health. We have to fight against antibiotic resistance in the hospital and in the out-of-hospital environment. The Resistance Zero program, promoted by the Spanish Society of Intensive Medicine, has achieved through a multidisciplinary approach with collaboration between doctors, nurses, cleaning staff and microbiologists, to control the colonization and infection by multiresistant germs in the environment of the Intensive Care Unit.

AimTo assess the effectiveness of cardiac resynchronisation therapy (CRT), implantable cardioverter defibrillator (ICD) therapy, and the combination of these devices (CRT+ICD) in adult patients with left ventricular dysfunction and symptomatic heart failure. Methods A comprehensive systematic review of randomised clinical trials was conducted. Several electronic databases (PubMed, Embase, Ovid, Cochrane, ClinicalTrials.gov) were reviewed. The mortality rates between treatments were compared. A network was established comparing the various options, and direct, indirect and mixed comparisons were made using multivariate meta-regression. The degree of clinical and statistical homogeneity was assessed. Results 43 trials involving 13 017 patients were reviewed. Resynchronisation therapy, defibrillators, and combined devices (CRT+ICD) are clearly beneficial compared to optimal medical treatment, showing clear benefit in all of these cases. In a theoretical order of efficiency, the first option is combined therapy (CRT +ICD), the second is CRT, and the third is defibrillator implantation (ICD). Given the observational nature of these comparisons, and the importance of the overlapping CIs, we cannot state that the combined option (CRT+ICD) offers superior survival benefit compared to the other two options. Conclusions The combined option of CRT+ICD seems to be better than the option of CRT alone, although no clear improvement in survival was found for the combined option. It would be advisable to perform a direct comparative study of these two options.

Intensive care unit is a special medial environment for many reasons (the severity of the patients, the important technological advances). In recent years, the medicine has changed to a more focused practice on the patient, leaving behind the paternalistic medical approach, with a transparent new relationship with the patient and his family. The ethical principles-autonomy, beneficence, non-maleficence and justice-and the possibility of conflicts between them make decision-making very complex. The admission of these patients in our unit is justified based on a triangle-acute, severe, and recoverable disease-trying to optimize their treatment. Unfavorable later evolution is possible; a palliative management can often be considered, changing the patient's approach from the cure of his illness to the relief of his symptoms. Decisions about patient's future must be jointly made by the health care team, the patient and his family. We must look for documents about previous instructions and/or opinion of a substitute decision-maker. We must humanize our units, thinking about the best care for the sick person and his family, and improve the support to the family after his death. Therefore, the development of practice guidelines on palliative care should be promoted by the hospitals.