Medicina Intensiva最新文献

{"title":"Lack of correlation between central venous minus arterial PCO2 to arterial minus central venous O2 content ratio and respiratory quotient in patients with septic shock: A prospective observational study","authors":"Facundo J. Gutierrez ,&nbsp;Mario O. Pozo ,&nbsp;Matías Mugno ,&nbsp;Sebastián P. Chapela ,&nbsp;Natalia Llobera ,&nbsp;María J. Reberendo ,&nbsp;Gastón E. Murias ,&nbsp;Paolo N. Rubatto Birri ,&nbsp;Vanina S. Kanoore Edul ,&nbsp;Arnaldo Dubin","doi":"10.1016/j.medin.2024.05.016","DOIUrl":"10.1016/j.medin.2024.05.016","url":null,"abstract":"<div><h3>Objective</h3><div>Central venous-arterial PCO₂ to arterial-central venous O₂ content ratio (P_cv-aCO₂/C_a-cvO₂) is commonly used as a surrogate for respiratory quotient (RQ) and tissue oxygenation. Although P_cv-aCO₂/C_a-cvO₂ might be associated with hyperlactatemia and outcome, neither the interchangeability with RQ nor the correlation with conclusive variables of anaerobic metabolism has never been demonstrated in septic shock. Our goal was to compare P_cv-aCO₂/C_a-cvO₂ and RQ in patients with septic shock.</div></div><div><h3>Design</h3><div>Prospective, observational study.</div></div><div><h3>Setting</h3><div>Two adult ICUs.</div></div><div><h3>Patients</h3><div>Forty-seven patients with septic shock on mechanical ventilation with stable respiratory settings and vasopressor dose after initial resuscitation.</div></div><div><h3>Interventions</h3><div>None.</div></div><div><h3>Main variables of interest</h3><div>We measured arterial and central venous gases, Hb, and O₂Hb. P_cv-aCO₂/C_a-cvO₂ and the ratio of central venous-arterial CO₂ content to arterial-central venous O₂ content (C_cv-aCO₂/C_a-cvO₂) were calculated. RQ was determined by indirect calorimetry.</div></div><div><h3>Results</h3><div>P_cv-aCO₂/C_a-cvO₂ and C_cv-aCO₂/C_a-cvO₂ were not correlated with RQ (R² = 0.01, <em>P</em> = 0.50 and R² = 0.01, <em>P</em> = 0.58, respectively), showing large bias and wide 95 % limits of agreement with RQ (1.09, -1.10−3.27 and 0.42, -1.53−2.37). A multiple linear regression model showed Hb, and central venous PCO₂ and O₂Hb, but not RQ, as P_cv-aCO₂/C_a-cvO₂ determinants (R² = 0.36, <em>P</em> = 0.0007).</div></div><div><h3>Conclusions</h3><div>In patients with septic shock, P_cv-aCO₂/C_a-cvO₂ did not correlate with RQ and was mainly determined by factors that modify the dissociation of CO₂ from Hb. P_cv-aCO₂/C_a-cvO₂ seems to be a poor surrogate for RQ; therefore, its values should be interpreted with caution.</div></div>","PeriodicalId":49268,"journal":{"name":"Medicina Intensiva","volume":"49 1","pages":"Pages 8-14"},"PeriodicalIF":2.7,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143160528","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":"Echo-guided left internal jugular vein central venous catheter insertion, with its tip in the left internal thoracic vein","authors":"Alexandra Paula,&nbsp;David Mestre,&nbsp;Denise Pinto","doi":"10.1016/j.medin.2024.04.003","DOIUrl":"10.1016/j.medin.2024.04.003","url":null,"abstract":"","PeriodicalId":49268,"journal":{"name":"Medicina Intensiva","volume":"48 12","pages":"Pages e41-e42"},"PeriodicalIF":2.7,"publicationDate":"2024-11-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142721584","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":"Implications of opioid-sparing medications in critically ill patients: A scoping review","authors":"Gabriella Gambadoro ,&nbsp;Brian J. Kopp ,&nbsp;Brian L. Erstad","doi":"10.1016/j.medin.2024.06.001","DOIUrl":"10.1016/j.medin.2024.06.001","url":null,"abstract":"<div><h3>Objective</h3><div>The purpose of this scoping review was to evaluate literature involving opioid-sparing medications in critically ill patients with a focus on clinically meaningful outcomes.</div></div><div><h3>Design</h3><div>Scoping review using the Preferred Reporting Items for Systematic Reviews and Meta-Analyses extension for Scoping Reviews.</div></div><div><h3>Setting</h3><div>Intensive care unit.</div></div><div><h3>Patients or participants</h3><div>Adult patients in an intensive care unit setting.</div></div><div><h3>Interventions</h3><div>None.</div></div><div><h3>Main variables of interest</h3><div>PubMed and Cochrane Library were searched from October 1, 2019 to June 1, 2023. Inclusion criteria consisted of randomized controlled trials evaluating adjunctive analgesic use in adult patients in an intensive care unit setting.</div></div><div><h3>Results</h3><div>There were 343 citations and titles identified in the initial search, with 328 remaining after removal of duplicates, 294 excluded at title and abstract screening, 34 available for full text review, and six included in the scoping review. Most studies reported modest reductions in opioid use as a secondary endpoint. Improvement in clinical outcomes such as reduction in duration of mechanical ventilation or delirium were reported in two trials with dexmedetomidine.</div></div><div><h3>Conclusions</h3><div>In recently published trials of adjunctive agents in critically ill patients, opioid-sparing effects were small. Data to support improvements in clinical outcomes remains limited.</div></div>","PeriodicalId":49268,"journal":{"name":"Medicina Intensiva","volume":"48 12","pages":"Pages 693-703"},"PeriodicalIF":2.7,"publicationDate":"2024-11-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142721575","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":"In-hospital cardiac arrest simulation program in a cardiopulmonary critical care unit: A pilot experience","authors":"Francesco Sbrana,&nbsp;Umberto Startari,&nbsp;Alessia Gimelli,&nbsp;Beatrice Dal Pino","doi":"10.1016/j.medin.2024.08.007","DOIUrl":"10.1016/j.medin.2024.08.007","url":null,"abstract":"","PeriodicalId":49268,"journal":{"name":"Medicina Intensiva","volume":"48 12","pages":"Pages 734-736"},"PeriodicalIF":2.7,"publicationDate":"2024-11-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142721581","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":"Ultrasound artifacts “shred sign” and “pseudo-B lines” in the liver: What is the culprit?","authors":"Xiaoyang Zhou,&nbsp;Yuyi Sha,&nbsp;Bixin Chen","doi":"10.1016/j.medin.2024.03.013","DOIUrl":"10.1016/j.medin.2024.03.013","url":null,"abstract":"","PeriodicalId":49268,"journal":{"name":"Medicina Intensiva","volume":"48 12","pages":"Pages 740-741"},"PeriodicalIF":2.7,"publicationDate":"2024-11-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142721583","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":"Stress relaxation, another cause of “Pseudo auto-PEEP”?","authors":"Manuel Valdivia Marchal ,&nbsp;María Carmen Bermúdez Ruiz ,&nbsp;José Ricardo Naranjo Izurieta ,&nbsp;Ashlen Rodríguez Carmona ,&nbsp;Juan Francisco Martínez Carmona ,&nbsp;José Manuel Serrano Simón","doi":"10.1016/j.medin.2024.06.009","DOIUrl":"10.1016/j.medin.2024.06.009","url":null,"abstract":"","PeriodicalId":49268,"journal":{"name":"Medicina Intensiva","volume":"48 12","pages":"Pages 731-734"},"PeriodicalIF":2.7,"publicationDate":"2024-11-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142721580","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":"Selective decontamination of the digestive tract in a burns unit reduces the incidence of hospital-acquired infections: A retrospective before-and-after cohort study","authors":"David Pérez-Torres ,&nbsp;Ana Isabel Martín-Luengo ,&nbsp;Cristina Cuenca-Rubio ,&nbsp;José Ángel Berezo-García ,&nbsp;Cristina Díaz-Rodríguez ,&nbsp;Isabel Canas-Pérez ,&nbsp;María Lorena Fernández-Rodríguez ,&nbsp;Cristina Colmenero-Calleja ,&nbsp;Jesús Sánchez-Ballesteros ,&nbsp;Pablo Blanco-Schweizer ,&nbsp;Thalia Gloria Ticona-Espinoza ,&nbsp;José María Piqueras-Pérez","doi":"10.1016/j.medin.2024.05.006","DOIUrl":"10.1016/j.medin.2024.05.006","url":null,"abstract":"<div><h3>Objective</h3><div>To evaluate the effect of selective decontamination of the digestive tract (SDD) on hospital-acquired infections (HAIs) in patients with acute burn injury requiring admission to a Burns Unit (BU).</div></div><div><h3>Design</h3><div>Retrospective before-and-after cohort study, between January 2017 and June 2023. SDD was implemented in March 2019, dividing patients into two groups.</div></div><div><h3>Setting</h3><div>Four-bed BU, in a referral University Hospital in Spain.</div></div><div><h3>Patients</h3><div>All the patients admitted during the study period were eligible for analysis. Patients who died or were discharged within 48<!--> <!-->hours of admission, and patients with an estimated survival less than 10% not considered for full escalation of therapy were excluded.</div></div><div><h3>Intervention</h3><div>SDD comprised the administration of a 4-day course of an intravenous antibiotic, and an oral suspension and oral topical paste of non-absorbable antibiotics during the stay in the BU.</div></div><div><h3>Main variable of interest</h3><div>Incidence of HAIs during the stay in the BU. Secondary outcomes: incidence of specific types of infections by site (bacteremia, pneumonia, skin and soft tissue infection) and microorganism (Gram-positive, Gram-negative, fungi), and safety endpoints.</div></div><div><h3>Results</h3><div>We analyzed 72 patients: 27 did not receive SDD, and 45 received SDD. The number of patients who developed HAIs were 21 (77.8%) and 21 (46.7%) in the non-SDD and the SDD groups, respectively (p<!--> <!-->=<!--> <!-->0.009). The number of hospital-acquired infectious episodes were 2.52 (1.21–3.82) and 1.13 (0.54–1.73), respectively (p<!--> <!-->=<!--> <!-->0.029).</div></div><div><h3>Conclusions</h3><div>SDD was associated with a reduced incidence of bacterial HAIs and a decrease in the number of infectious episodes per patient.</div></div>","PeriodicalId":49268,"journal":{"name":"Medicina Intensiva","volume":"48 12","pages":"Pages 677-685"},"PeriodicalIF":2.7,"publicationDate":"2024-11-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142721573","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":"Nutrithorax: an uncommon differential diagnosis of the plankton sign","authors":"Isabel Canas-Pérez,&nbsp;David Pérez-Torres,&nbsp;Cristina Cuenca-Rubio","doi":"10.1016/j.medin.2024.04.009","DOIUrl":"10.1016/j.medin.2024.04.009","url":null,"abstract":"","PeriodicalId":49268,"journal":{"name":"Medicina Intensiva","volume":"48 12","pages":"Pages e43-e45"},"PeriodicalIF":2.7,"publicationDate":"2024-11-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142720110","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":"Giant lung abscess complicating pneumonia managed with veno venous extracorporeal membrane oxygenation","authors":"Marina López Olivencia,&nbsp;Luis Jaramillo Valarezo,&nbsp;Aaron Blandino Ortiz","doi":"10.1016/j.medin.2024.04.008","DOIUrl":"10.1016/j.medin.2024.04.008","url":null,"abstract":"","PeriodicalId":49268,"journal":{"name":"Medicina Intensiva","volume":"48 11","pages":"Pages e21-e22"},"PeriodicalIF":2.7,"publicationDate":"2024-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142592538","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":"Asociación de fracción de espacio muerto con la mortalidad en pacientes con síndrome de dificultad respiratoria aguda por COVID-19: Un estudio observacional de una cohorte histórica","authors":"Carlos Carvajal ,&nbsp;Nelson Darío Giraldo Ramirez ,&nbsp;Andrés David de la Hoz Castro ,&nbsp;Carlos Guillermo Vidal Vargas ,&nbsp;Hemel Antonio Pacheco ,&nbsp;David Fernández Sánchez ,&nbsp;Laura Vannesa González Salazar ,&nbsp;Silvia Stella Romero Otta ,&nbsp;Silvia Vergara Jaimes ,&nbsp;Juan Fernando Bolívar Ospina ,&nbsp;Juliana Correa Céspedes ,&nbsp;Alejandro Narváez Orozco ,&nbsp;Jorge Hernando Donado ,&nbsp;Carlos Alberto Cadavid ,&nbsp;Gisela de la Rosa","doi":"10.1016/j.medin.2024.05.007","DOIUrl":"10.1016/j.medin.2024.05.007","url":null,"abstract":"<div><h3>Objective</h3><div>To assess the association between dead space fraction (VD/VT) measured through time capnography, corrected minute volume (CMV), and ventilation ratio (VR) with clinical outcomes in COVID-19 patients requiring invasive mechanical ventilation.</div></div><div><h3>Design</h3><div>Observational study of a historical cohort in an university hospital in Medellin, Colombia.</div></div><div><h3>Participants</h3><div>Patients aged 15 and above with confirmed COVID-19 diagnosis admitted to the ICU requiring mechanical ventilation; interventions: measurement of VD/VT, CMV, and VR in COVID-19 patients.</div></div><div><h3>Main variables of interest</h3><div>VD/VT, CMV, VR, demographic data, oxygenation index, and ventilatory parameters.</div></div><div><h3>Results</h3><div>During the study period, 1,047 COVID-19 patients on mechanical ventilation were analyzed, of whom 446 (42%) died. Deceased patients exhibited a higher prevalence of advanced age and obesity, elevated Charlson index, higher APACHE II and SOFA scores, as well as an increase in VD/VT ratio (0.27 in survivors and 0.31 in deceased) and minute ventilation volume on the first day of mechanical ventilation. Multivariate analysis revealed independent associations with in-hospital mortality, higher VD/VT (HR: 1.24; 95% CI: 1.003-1.525; <em>P</em> <!-->=<!--> <!-->0.046), age (HR: 1.024; 95% CI: 1.014-1.034; <em>P</em>&lt;<!--> <!-->0.001), and SOFA score at onset (HR: 1.036; 95% CI: 1.001-1.07; <em>P</em> <!-->=<!--> <!-->0.017).</div></div><div><h3>Conclusions</h3><div>VD/VT demonstrated an association with mortality in COVID-19 ARDS patients on mechanical ventilation. These findings suggest that VD/VT measurement may serve as a severity marker for the disease.</div></div>","PeriodicalId":49268,"journal":{"name":"Medicina Intensiva","volume":"48 11","pages":"Pages 639-645"},"PeriodicalIF":2.7,"publicationDate":"2024-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142592597","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}