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<mods:namePart>Gómez Herreras, José Ignacio</mods:namePart>
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<mods:identifier type="citation">Anales de la Real Academia de Medicina y Cirugía de Valladolid, 2013, N.50, pags.133-144</mods:identifier>
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<mods:abstract>Critical care patients are defined by two main characteristics: the severity of injury of their organ systems and their increased need of resources in the so-called Intensive Care Units.Nowadays there are objective scales capable of punctuating both the need for medical resources and the severity of the patient illness, allowing a follow up of clinical evolution, response to treatment and odds of survival.In the physiopathology of critical illness it is important to highlight the cellular inability to maintain an aerobic metabolism due to the mitochondrial respiratory system failure, which translates into a derivation of energy sources metabolism, especially glucose, to lactic acid. This failure is conditioned by primary mitochondrial failure or, more frequently, by lack of oxygen supply. Because of this, measurement of lactic acid and venous oxygen saturation, as result of circulatory sufficiency and thus, of oxygen tissue supply, are fundamental not just to establish diagnosis but to monitor clinical evolution.Treatment must contemplate both the etiology of disease resulting in critical illness and the reestablishment of aerobic metabolism by so called resuscitation techniques. These tech- niques must be based on Early Goal-Directed Therapy, which consists in the consecution of hemodynamic, tissue perfusion, ventilator and metabolic goals, procuring their completion in the first six hours after the established need for resuscitation.</mods:abstract>
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<mods:title>Tratamiento del enfermo en situación crítica</mods:title>
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