Medicina Intensiva最新文献

{"title":"Pósteres Pantalla. Cirugía Cardiaca II. Respiratorio I. Síndrome Coronario Agudo/Monitorización Hemodinámica/Cirugía Cardiaca. Neurointensivismo II. Infección/Antibióticos II. Organización/Gestión/Calidad II. Hematología I. Urgencias/Emergencias I.","authors":"","doi":"10.1016/S0210-5691(24)00198-0","DOIUrl":"https://doi.org/10.1016/S0210-5691(24)00198-0","url":null,"abstract":"","PeriodicalId":49268,"journal":{"name":"Medicina Intensiva","volume":"48 ","pages":"Pages S55-S78"},"PeriodicalIF":3.0,"publicationDate":"2024-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141097252","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":"Pósteres Pantalla. Marcapasos/Arritmias I. Infección/Antibióticos VI. Síndrome Coronario Agudo II. Infección/Antibióticos VII. Organización/Gestión/Calidad IV. Sedación/Analgesia II. Urgencias/Emergencias. Cardiovascular II. Trasplantes I. Ventilación","authors":"","doi":"10.1016/S0210-5691(24)00203-1","DOIUrl":"https://doi.org/10.1016/S0210-5691(24)00203-1","url":null,"abstract":"","PeriodicalId":49268,"journal":{"name":"Medicina Intensiva","volume":"48 ","pages":"Pages S184-S207"},"PeriodicalIF":3.0,"publicationDate":"2024-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141097515","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":"Sepsis death risk factor score based on systemic inflammatory response syndrome, quick sequential organ failure assessment, and comorbidities","authors":"Vinicius Nakad Orsatti,&nbsp;Victoria Stadler Tasca Ribeiro,&nbsp;Carolina de Oliveira Montenegro,&nbsp;Clarice Juski Costa,&nbsp;Eduardo Albanske Raboni,&nbsp;Eduardo Ramos Sampaio,&nbsp;Fernando Michielin,&nbsp;Juliano Gasparetto,&nbsp;João Paulo Telles,&nbsp;Felipe Francisco Tuon","doi":"10.1016/j.medin.2024.02.010","DOIUrl":"https://doi.org/10.1016/j.medin.2024.02.010","url":null,"abstract":"<div><h3>Objective</h3><p>In this study, we aimed to evaluate the death risk factors of patients included in the sepsis protocol bundle, using clinical data from qSOFA, SIRS, and comorbidities, as well as development of a mortality risk score.</p></div><div><h3>Design</h3><p>This retrospective cohort study was conducted between 2016 and 2021.</p></div><div><h3>Setting</h3><p>Two university hospitals in Brazil.</p></div><div><h3>Participants</h3><p>Patients with sepsis.</p></div><div><h3>Interventions</h3><p>Several clinical and laboratory data were collected focused on SIRS, qSOFA, and comorbidities.</p></div><div><h3>Main variable of interest</h3><p>In-hospital mortality was the primary outcome variable. A mortality risk score was developed after logistic regression analysis.</p></div><div><h3>Results</h3><p>A total of 1,808 patients were included with a death rate of 36%. Ten variables remained independent factors related to death in multivariate analysis: temperature ≥38 °C (odds ratio [OR] = 0.65), previous sepsis (OR = 1.42), qSOFA ≥ 2 (OR = 1.43), leukocytes &gt;12,000 or &lt;4,000 cells/mm³ (OR = 1.61), encephalic vascular accident (OR = 1.88), age &gt;60 years (OR = 1.93), cancer (OR = 2.2), length of hospital stay before sepsis &gt;7 days (OR = 2.22,), dialysis (OR = 2.51), and cirrhosis (OR = 3.97). Considering the equation of the binary regression logistic analysis, the score presented an area under curve of 0.668, is not a potential model for death prediction.</p></div><div><h3>Conclusions</h3><p>Several risk factors are independently associated with mortality, allowing the development of a prediction score based on qSOFA, SIRS, and comorbidities data, however, the performance of this score is low.</p></div>","PeriodicalId":49268,"journal":{"name":"Medicina Intensiva","volume":"48 5","pages":"Pages 263-271"},"PeriodicalIF":3.0,"publicationDate":"2024-04-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140649801","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":"Current perspectives on the use of artificial intelligence in critical patient safety.","authors":"Jesús Abelardo Barea Mendoza, Marcos Valiente Fernandez, Alex Pardo Fernandez, Josep Gómez Álvarez","doi":"10.1016/j.medine.2024.04.002","DOIUrl":"https://doi.org/10.1016/j.medine.2024.04.002","url":null,"abstract":"<p><p>Intensive Care Units (ICUs) have undergone enhancements in patient safety, and artificial intelligence (AI) emerges as a disruptive technology offering novel opportunities. While the published evidence is limited and presents methodological issues, certain areas show promise, such as decision support systems, detection of adverse events, and prescription error identification. The application of AI in safety may pursue predictive or diagnostic objectives. Implementing AI-based systems necessitates procedures to ensure secure assistance, addressing challenges including trust in such systems, biases, data quality, scalability, and ethical and confidentiality considerations. The development and application of AI demand thorough testing, encompassing retrospective data assessments, real-time validation with prospective cohorts, and efficacy demonstration in clinical trials. Algorithmic transparency and explainability are essential, with active involvement of clinical professionals being crucial in the implementation process.</p>","PeriodicalId":49268,"journal":{"name":"Medicina Intensiva","volume":" ","pages":""},"PeriodicalIF":3.0,"publicationDate":"2024-04-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140873238","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":"High-flow oxygen therapy in single lung transplant for COPD","authors":"Ignacio Fernández Ceballos,&nbsp;Indalecio Carboni Bisso,&nbsp;Marcos J. Las Heras","doi":"10.1016/j.medin.2023.09.005","DOIUrl":"https://doi.org/10.1016/j.medin.2023.09.005","url":null,"abstract":"","PeriodicalId":49268,"journal":{"name":"Medicina Intensiva","volume":"48 5","pages":"Pages 303-304"},"PeriodicalIF":3.0,"publicationDate":"2024-04-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140649802","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":"Point of care lung ultrasound diagnosis of concomitant lung abscess and pleural empyema due to a bronchopleural fistula","authors":"Adrien Rivory,&nbsp;Gary Duclos,&nbsp;Laurent Zieleskiewicz","doi":"10.1016/j.medin.2023.12.003","DOIUrl":"https://doi.org/10.1016/j.medin.2023.12.003","url":null,"abstract":"","PeriodicalId":49268,"journal":{"name":"Medicina Intensiva","volume":"48 5","pages":"Pages 305-306"},"PeriodicalIF":3.0,"publicationDate":"2024-04-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140649803","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":"Complicación tras tumorectomía renal: un caso inusual","authors":"Montserrat Rodríguez Gómez,&nbsp;Sara Domingo Marín,&nbsp;María Paloma González Arenas","doi":"10.1016/j.medin.2024.03.012","DOIUrl":"10.1016/j.medin.2024.03.012","url":null,"abstract":"","PeriodicalId":49268,"journal":{"name":"Medicina Intensiva","volume":"48 12","pages":"Page 743"},"PeriodicalIF":2.7,"publicationDate":"2024-04-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140797302","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":"La coordinación de los equipos médicos en una zona en conflicto","authors":"Alberto Hernández-Tejedor,&nbsp;Víctor Sainz Ruiz de León","doi":"10.1016/j.medin.2024.03.011","DOIUrl":"10.1016/j.medin.2024.03.011","url":null,"abstract":"","PeriodicalId":49268,"journal":{"name":"Medicina Intensiva","volume":"48 6","pages":"Pages 365-366"},"PeriodicalIF":3.0,"publicationDate":"2024-04-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140790405","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":"Switches in non-invasive respiratory support strategies during acute hypoxemic respiratory failure: Need to monitoring from a retrospective observational study","authors":"Francisco José Parrilla-Gómez ,&nbsp;Judith Marin-Corral ,&nbsp;Andrea Castellví-Font ,&nbsp;Purificación Pérez-Terán ,&nbsp;Lucía Picazo ,&nbsp;Jorge Ravelo-Barba ,&nbsp;Marta Campano-García ,&nbsp;Olimpia Festa ,&nbsp;Marcos Restrepo ,&nbsp;Joan Ramón Masclans","doi":"10.1016/j.medin.2023.10.010","DOIUrl":"https://doi.org/10.1016/j.medin.2023.10.010","url":null,"abstract":"<div><h3>Objective</h3><p>To explore combined non-invasive-respiratory-support (NIRS) patterns, reasons for NIRS switching, and their potential impact on clinical outcomes in acute-hypoxemic-respiratory-failure (AHRF) patients.</p></div><div><h3>Design</h3><p>Retrospective, single-center observational study.</p></div><div><h3>Setting</h3><p>Intensive Care Medicine.</p></div><div><h3>Patients</h3><p>AHRF patients (cardiac origin and respiratory acidosis excluded) underwent combined NIRS therapies such as non-invasive-ventilation (NIV) and High-Flow-Nasal-Cannula (HFNC).</p></div><div><h3>Interventions</h3><p>Patients were classified based on the first NIRS switch performed (HFNC-to-NIV or NIV-to-HFNC), and further specific NIRS switching strategies (NIV trial-like vs. Non-NIV trial-like and single vs. multiples switches) were independently evaluated.</p></div><div><h3>Main variables of interest</h3><p>Reasons for switching, NIRS failure and mortality rates.</p></div><div><h3>Results</h3><p>A total of 63 patients with AHRF were included, receiving combined NIRS, 58.7% classified in the HFNC-to-NIV group and 41.3% in the NIV-to-HFNC group. Reason for switching from HFNC to NIV was AHRF worsening (100%), while from NIV to HFNC was respiratory improvement (76.9%). NIRS failure rates were higher in the HFNC-to-NIV than in NIV-to-HFNC group (81% vs. 35%, <em>p</em> &lt; 0.001). Among HFNC-to-NIV patients, there was no difference in the failure rate between the NIV trial-like and non-NIV trial-like groups (86% vs. 78%, <em>p</em> = 0.575) but the mortality rate was significantly lower in NIV trial-like group (14% vs. 52%, <em>p</em> = 0.02). Among NIV to HFNC patients, NIV failure was lower in the single switch group compared to the multiple switches group (15% vs. 53%, <em>p</em> = 0.039), with a shorter length of stay (5 [2–8] vs. 12 [8–30] days, <em>p</em> = 0.001).</p></div><div><h3>Conclusions</h3><p>NIRS combination is used in real life and both switches’ strategies, HFNC to NIV and NIV to HFNC, are common in AHRF management. Transitioning from HFNC to NIV is suggested as a therapeutic escalation and in this context performance of a NIV-trial could be beneficial. Conversely, switching from NIV to HFNC is suggested as a de-escalation strategy that is deemed safe if there is no NIRS failure.</p></div>","PeriodicalId":49268,"journal":{"name":"Medicina Intensiva","volume":"48 4","pages":"Pages 200-210"},"PeriodicalIF":3.0,"publicationDate":"2024-03-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140297000","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":"How to use echocardiography to manage patients with shock?","authors":"Guillaume Théry ,&nbsp;Victor Gascon ,&nbsp;Virginia Fraile ,&nbsp;Ana Ochagavia ,&nbsp;Olfa Hamzaoui","doi":"10.1016/j.medin.2023.10.012","DOIUrl":"https://doi.org/10.1016/j.medin.2023.10.012","url":null,"abstract":"<div><p>Echocardiography enables the intensivist to assess the patient with circulatory failure. It allows the clinician to identify rapidly the type and the cause of shock in order to develop an effective management strategy. Important characteristics in the setting of shock are that it is non-invasive and can be rapidly applied. Early and repeated echocardiography is a valuable tool for the management of shock in the intensive care unit. Competency in basic critical care echocardiography is now regarded as a mandatory part of critical care training with clear guidelines available. The majority of pathologies found in shocked patients are readily identified using basic level 2D and M-mode echocardiography.</p><p>The four core types of shock (cardiogenic, hypovolemic, obstructive, and septic) can readily be identified by echocardiography. Echocardiography can differentiate the different pathologies that may be the cause of each type of shock. More importantly, as a result of more complex and elderly patients, the shock may be multifactorial, such as a combination of cardiogenic and septic shock, which emphasises on the added value of transthoracic echocardiography (TTE) in such population of patients.</p><p>In this review we aimed to provide to clinicians a bedside strategy of the use of TTE parameters to manage patients with shock. In the first part of this overview, we detailed the different TTE parameters and how to use them to identify the type of shock. And in the second part, we focused on the use of these parameters to evaluate the effect of treatments, in different types of shock.</p></div>","PeriodicalId":49268,"journal":{"name":"Medicina Intensiva","volume":"48 4","pages":"Pages 220-230"},"PeriodicalIF":3.0,"publicationDate":"2024-03-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140297061","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}