Medicina Intensiva最新文献

{"title":"Canalización supraclavicular ecoguiada de vena cefálica, una alternativa a los accesos centrales clásicos","authors":"Alejandro Gómez-Carranza , Francisco Javier Vasserot-Vargas , Beatriz Girela-Pérez","doi":"10.1016/j.medin.2024.502118","DOIUrl":"10.1016/j.medin.2024.502118","url":null,"abstract":"","PeriodicalId":49268,"journal":{"name":"Medicina Intensiva","volume":"49 5","pages":"Article 502118"},"PeriodicalIF":2.7,"publicationDate":"2025-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143891454","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Adenopatía metastásica abscesificada como origen de un shock séptico","authors":"Enrique Alfonso Aguilar Valero, Ana María Vela Colmenero, Rosa María Vela Colmenero","doi":"10.1016/j.medin.2024.502127","DOIUrl":"10.1016/j.medin.2024.502127","url":null,"abstract":"","PeriodicalId":49268,"journal":{"name":"Medicina Intensiva","volume":"49 5","pages":"Article 502127"},"PeriodicalIF":2.7,"publicationDate":"2025-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143891517","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"El manejo de la vía aérea en el paciente crítico. Necesidad de un nuevo enfoque","authors":"R. Albillos-Almaraz , S. Balboa-Palomino , E. Pérez-Cabo","doi":"10.1016/j.medin.2025.502138","DOIUrl":"10.1016/j.medin.2025.502138","url":null,"abstract":"","PeriodicalId":49268,"journal":{"name":"Medicina Intensiva","volume":"49 5","pages":"Article 502138"},"PeriodicalIF":2.7,"publicationDate":"2025-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143891452","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Experiencia con soporte de oxigenación con membrana extracorpórea en América Latina entre 2016 y 2020","authors":"Camilo Pizarro ,&nbsp;Anderson Bermon ,&nbsp;Silvia Plata Vanegas ,&nbsp;Claudia Colmenares-Mejia ,&nbsp;Claudia Marcela Poveda ,&nbsp;René D. Gómez Gutiérrez ,&nbsp;Jorge Arturo Ramírez Arce ,&nbsp;Sonia Villarroel ,&nbsp;Daniel Absi ,&nbsp;Marco Antonio Montes de Oca Sandoval ,&nbsp;Fernando Pálizas ,&nbsp;Leonardo Salazar","doi":"10.1016/j.medin.2024.502129","DOIUrl":"10.1016/j.medin.2024.502129","url":null,"abstract":"<div><h3>Objective</h3><div>To document the experience with ECMO therapy in healthcare institutions across Latin America between 2016 and 2020.</div></div><div><h3>Design</h3><div>Cross-sectional study.</div></div><div><h3>Setting</h3><div>Private and public health institutions from 7 countries.</div></div><div><h3>Participants</h3><div>ECMO intensive care units.</div></div><div><h3>Interventions</h3><div>None.</div></div><div><h3>Main variables of interest</h3><div>General characteristics of the center (country, ELSO center, year of first cannulation, public or private network, ECMO devices available, mobile ECMO), professional category (nurses, physicians, specialists and other professionals), nurse-to-patient ratio, interventions applied (support indications, scores, mechanical ventilation at ECMO commencement, anticoagulation and hemolysis, circuit monitoring and patient perfusion, antibiotic prophylaxis), and patient outcomes (complications and survival) in ECMO centers.</div></div><div><h3>Results</h3><div>Thirteen ECMO units were included. These units reported 133 consoles and 1,629 ECMO cannulations. Of these, 1,018 corresponded to adult patients, 468 to pediatric patients, and 143 to newborn infants. A total of 310 medical specialists were involved in ECMO care, of whom 70.3% had received ECMO training. The nurse-to-patient ratio was 1:1 in most centers (76.9%, <em>n</em> <!-->=<!--> <!-->10). Amongst adult patients, the most common indication for initiating ECMO support was refractory hypoxemia, whereas in pediatric patients, it was a post-cardiotomy shock. The mean overall survival rate of the patients at the time of decannulation was 55.7% (95%<span>C</span>I<span>:</span> 53.0-58.3).</div></div><div><h3>Conclusions</h3><div>The ICUs with ECMO in Latin America participating in this study have demonstrated operational capabilities enabling them to achieve outcomes comparable to those of other ECMO units across the world.</div></div>","PeriodicalId":49268,"journal":{"name":"Medicina Intensiva","volume":"49 5","pages":"Article 502129"},"PeriodicalIF":2.7,"publicationDate":"2025-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143891471","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Elastic static power, its correlation with acute respiratory distress syndrome severity: A Bayesian post-hoc analysis of the Mechanical Power Day cross-sectional trial","authors":"Aurio Fajardo-Campoverdi ,&nbsp;Alejandro González-Castro ,&nbsp;Vicent Modesto i Alapont ,&nbsp;Miguel Ibarra-Estrada ,&nbsp;Carmen Chica-Meza ,&nbsp;Alberto Medina ,&nbsp;Patricia Escudero-Acha ,&nbsp;Denise Battaglini ,&nbsp;Patricia R.M. Rocco ,&nbsp;Chiara Robba ,&nbsp;Paolo Pelosi","doi":"10.1016/j.medin.2024.502128","DOIUrl":"10.1016/j.medin.2024.502128","url":null,"abstract":"<div><h3>Objective</h3><div>The relationship between different power equations and the severity of acute respiratory distress syndrome (ARDS) remains unclear. This study aimed to evaluate various power equations: total mechanical power, total elastic power (comprising elastic static and elastic dynamic power), and resistive power, in a cohort of mechanically ventilated patients with and without ARDS. Bayesian analysis was employed to refine estimates and quantify uncertainty by incorporating <em>a priori</em> distributions.</div></div><div><h3>Design</h3><div>A Bayesian post-hoc analysis was conducted on data from the Mechanical Power Day study.</div></div><div><h3>Setting</h3><div>113 intensive care units across 15 countries and 4 continents.</div></div><div><h3>Patients</h3><div>Adults who received invasive mechanical ventilation in volume-controlled mode, with (mild and moderate/severe ARDS) and without ARDS.</div></div><div><h3>Interventions</h3><div>None.</div></div><div><h3>Main variables of interest</h3><div>ARDS, Elastic static power.</div></div><div><h3>Results</h3><div>Elastic static power was 5.8 J/min (BF: 0.3) in patients with mild ARDS and 7.4 J/min (BF: 0.9) in moderate/severe ARDS patients. Bayesian regression and modeling analysis revealed that elastic static power was independently correlated with mild (<em>a posteriori</em> Mean: 1.3; 95% Credible Interval [Cred. Interval]: 0.2–2.2) and moderate/severe ARDS (<em>a posteriori</em> Mean: 2.8; 95% Cred. Interval: 1.7–3.8) more strongly than other power equations.</div></div><div><h3>Conclusions</h3><div>Elastic static power was found to have the strongest correlation with ARDS severity among the power equations studied. Prospective studies are needed to further validate these findings.</div></div>","PeriodicalId":49268,"journal":{"name":"Medicina Intensiva","volume":"49 5","pages":"Article 502128"},"PeriodicalIF":2.7,"publicationDate":"2025-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143891470","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Ictus en cuidados intensivos pediátricos","authors":"Javier Zorrilla Abad ,&nbsp;Débora Sanz Álvarez ,&nbsp;Gema Manrique Martín ,&nbsp;Laura Herrera Castillo ,&nbsp;Jesús López-Herce Cid ,&nbsp;Grupo de Código Ictus Pediátrico","doi":"10.1016/j.medin.2025.502154","DOIUrl":"10.1016/j.medin.2025.502154","url":null,"abstract":"<div><h3>Objectives</h3><div>To analyze the frequency, causes, risk factors, mortality and sequelae of stroke in children admitted to the pediatric intensive care unit (PICU).</div></div><div><h3>Design</h3><div>Single-center retrospective observational study based on a prospective database.</div></div><div><h3>Setting</h3><div>Pediatric intensive care unit.</div></div><div><h3>Patients</h3><div>Children between one month and eighteen years of age admitted to the PICU and diagnosed with stroke were included.</div></div><div><h3>Main variables of interest</h3><div>Epidemiological, clinical, diagnostic and treatment data, sequelae and mortality were recorded.</div></div><div><h3>Interventions</h3><div>None.</div></div><div><h3>Results</h3><div>46 patients were studied, of whom 29 (63%) had an ischemic stroke, 14 (30.4%) a hemorrhagic stroke, 1 (2.2%) venous sinus thrombosis and 2 (4.3%) mixed stroke. 11 patients (23.9%) had heart disease and 7 (15.2%) were treated with extracorporeal membrane oxygenation (ECMO) or ventricular assist. 8.6% of patients were treated with fibrinolysis or thrombectomy. 9 patients (19.6%) died. Patients with heart disease and those treated with ECMO had a higher mortality rate. 23 children, 62.1% of survivors, suffered sequelae at discharge. The most frequent sequelae were hemiparesis. Sequelae were significantly more frequent in patients who presented with motor symptoms (76.2%) (<em>P</em> <!-->&lt;<!--> <!-->.001).</div></div><div><h3>Conclusions</h3><div>The frequency of ischemic stroke in pediatric patients is higher than that of hemorrhagic stroke. Pediatric patients who suffer a stroke have a high mortality rate and a high rate of sequelae. Patients with heart disease and those treated with ECMO are those who present stroke most frequently and have a higher mortality rate.</div></div>","PeriodicalId":49268,"journal":{"name":"Medicina Intensiva","volume":"49 5","pages":"Article 502154"},"PeriodicalIF":2.7,"publicationDate":"2025-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143891472","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Prácticas de analgosedación y delirium en pacientes críticos de la región Panamericana e Ibérica y factores asociados a la sobresedación tras la pandemia COVID-19: resultados del estudio PANDEMIC","authors":"Carola Giménez-Esparza Vich ,&nbsp;Felipe Martínez ,&nbsp;Daniela Olmos Kutscherauer ,&nbsp;Daniel Molano ,&nbsp;Maria del Carmen Gallardo ,&nbsp;Enrique Mario Olivares-Durán ,&nbsp;Jesús Caballero ,&nbsp;Rosa Reina ,&nbsp;Manuela García Sánchez ,&nbsp;Federico C. Carini ,&nbsp;Comité de Analgesia, Sedación y Delirium de la Federación Panamericana e Ibérica de Cuidados Críticos y Terapia Intensiva (FEPIMCTI)","doi":"10.1016/j.medin.2024.502123","DOIUrl":"10.1016/j.medin.2024.502123","url":null,"abstract":"<div><div>Oversedation has adverse effects on critically ill patients. The Analgosedation and Delirium Committee of the FEPIMCTI (Pan-American and Iberian Federation of Critical Care Medicine and Intensive Care) conducted a cross-sectional study through a survey addressed to ICU physicians: PANDEMIC (Pan-American and Iberian Study on the Management of Analgosedation and Delirium in Critical Care [fepImCti]).</div><div>Hypothesis Worsening of these practices in the course of the pandemic and that continued afterwards, with further oversedation.</div></div><div><h3>Objectives</h3><div>Perception of analgosedation and delirium practices in Pan-American and Iberian ICUs before, during and after the COVID-19 pandemic, and factors associated with persistent oversedation after the pandemic.</div><div>Of the 1008 respondents, 25% perceived oversedation after the pandemic (95%<!--> <!-->CI: 22.4-27.8). This perception was higher in South America (35.8%; <em>P</em> <!-->&lt;<!--> <!-->.001). Main risk factor: habit acquired during the pandemic (adjusted OR [aOR]: 3.16; 95%<!--> <!-->CI: 2.24-4.45; <em>P</em> <!-->&lt;<!--> <!-->.001). Main protective factor: delirium monitoring before the pandemic (aOR: 0.70; 95%<!--> <!-->CI: 0.50-0.98; <em>P</em> <!-->=<!--> <!-->.038).</div><div>The factors identified in this study provide a basis for targeting future interventions.</div></div>","PeriodicalId":49268,"journal":{"name":"Medicina Intensiva","volume":"49 5","pages":"Article 502123"},"PeriodicalIF":2.7,"publicationDate":"2025-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143891451","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"¿Es hora de medir la supervivencia libre de enfermedad en población oncológica crítica?","authors":"Elena Cuenca-Fito ,&nbsp;Eric Mayor-Vázquez","doi":"10.1016/j.medin.2025.502157","DOIUrl":"10.1016/j.medin.2025.502157","url":null,"abstract":"","PeriodicalId":49268,"journal":{"name":"Medicina Intensiva","volume":"49 5","pages":"Article 502157"},"PeriodicalIF":2.7,"publicationDate":"2025-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143891453","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"El rol de la potencia elástica estática en la gravedad y en el pronóstico del síndrome de distrés respiratorio agudo","authors":"Sara Manrique ,&nbsp;Federico Gordo","doi":"10.1016/j.medin.2025.502160","DOIUrl":"10.1016/j.medin.2025.502160","url":null,"abstract":"","PeriodicalId":49268,"journal":{"name":"Medicina Intensiva","volume":"49 5","pages":"Article 502160"},"PeriodicalIF":2.7,"publicationDate":"2025-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143891518","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Esfuerzos respiratorios inefectivos y sus potenciales consecuencias durante la ventilación mecánica","authors":"Mauro Robertino Del Bono ,&nbsp;Luis Felipe Damiani ,&nbsp;Gustavo Adrián Plotnikow ,&nbsp;Sebastián Consalvo ,&nbsp;Emanuel Di Salvo ,&nbsp;Gastón Murias","doi":"10.1016/j.medin.2024.502133","DOIUrl":"10.1016/j.medin.2024.502133","url":null,"abstract":"<div><div>The implementation of invasive mechanical ventilation (IMV) in critically ill patients involves two crucial moments: the total control phase, affected among other things by the use of analgesics and sedatives, and the transition phase to spontaneous ventilation, which seeks to shorten IMV times and where optimizing patient-ventilator interaction is one of the main challenges. Ineffective inspiratory efforts (IEE) arise when there is no coordination between patient effort and ventilator support. IIE are common in different ventilatory modes and are associated with worse clinical outcomes: dyspnea, increased sedation requirements, increased IMV days and longer intensive care unit (ICU) and hospital stay. These are manifested graphically as an abrupt decrease in expiratory flow, being more frequent during expiration. However, and taking into consideration that it is still unknown whether this association is causal or rather a marker of disease severity, recognizing the potential physiological consequences, reviewing diagnostic methods and implementing detection and treatment strategies that can limit them, seems reasonable.</div></div>","PeriodicalId":49268,"journal":{"name":"Medicina Intensiva","volume":"49 5","pages":"Article 502133"},"PeriodicalIF":2.7,"publicationDate":"2025-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143891473","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}