Medicina Intensiva最新文献_第2页

Perforación esofágica secundaria a una acalasia 贲门失弛缓症继发食管穿孔

IF 2.7 4区医学

Medicina Intensiva Pub Date : 2024-11-01 DOI: 10.1016/j.medin.2024.01.012

引用次数: 0

Evaluación del índice de shock en choque séptico: una revisión sistemática 脓毒性休克的休克指数评估：系统综述

IF 2.7 4区医学

Medicina Intensiva Pub Date : 2024-11-01 DOI: 10.1016/j.medin.2024.06.011

{"title":"Evaluación del índice de shock en choque séptico: una revisión sistemática","authors":"","doi":"10.1016/j.medin.2024.06.011","DOIUrl":"10.1016/j.medin.2024.06.011","url":null,"abstract":"<div><h3>Objective</h3><div>To identify published research on the Shock Index (SI) in patients with septic shock or severe sepsis and to describe its main findings and conclusions.</div></div><div><h3>Design</h3><div>Systematic review of the literature following the recommendations of the PRISMA protocol (Preferred Reporting Items for Systematic Reviews and Meta-Analyses).</div></div><div><h3>Settings</h3><div>The following databases were consulted: Pubmed, Embase, Library Cochrane and Lilacs.</div></div><div><h3>Patients</h3><div>Patients older than 14 years with septic shock. Pregnant women and population with COVID-19 were excluded.</div></div><div><h3>Interventions</h3><div>Studies reporting measurement of the shock index or its modified variants.</div></div><div><h3>Main variables of interest</h3><div>Absolute frequencies and relative frequencies were assessed with measures of central tendency and dispersion. Effect estimators (OR, RR and HR) were extracted according to the context of each study.</div></div><div><h3>Results</h3><div>Seventeen articles were included, of which 11 investigated the SI as a predictor of mortality. Seven of them found significant differences in the SI when comparing survivors to non-survivors and observed a relationship between the SI evolution and clinical outcomes. Additional research evidenced a relation between the Modified Shock Index and myocardial depression, as well as mortality. Furthermore, they identified a relationship between the Diastolic Shock Index, the dose of administered dobutamine, and mortality.</div></div><div><h3>Conclusions</h3><div>The results suggest that both the SI and its modified versions, particularly in serial assessments, can be considered for evaluating patient prognosis. The SI can also aid in determining fluid management for patients.</div></div>","PeriodicalId":49268,"journal":{"name":"Medicina Intensiva","volume":null,"pages":null},"PeriodicalIF":2.7,"publicationDate":"2024-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142592602","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}

引用次数: 0

Respuesta a «Seguridad del paciente, ¿qué aportan la simulación clínica y la innovación docente?» 回应 "患者安全，临床模拟和教学创新的贡献是什么？

IF 2.7 4区医学

Medicina Intensiva Pub Date : 2024-11-01 DOI: 10.1016/j.medin.2024.07.005

引用次数: 0

Fragilidad, prevalencia en nuestras unidades de cuidados intensivos y características diferenciales de los pacientes frágiles 虚弱、重症监护室的发病率和虚弱患者的不同特征

IF 2.7 4区医学

Medicina Intensiva Pub Date : 2024-11-01 DOI: 10.1016/j.medin.2024.06.003

引用次数: 0

Análisis de los valores de carga de energía en ventilación mecánica en pacientes obesos con insuficiencia respiratoria hipoxémica secundaria a SARS-CoV-2 继发于 SARS-CoV-2 的低氧血症呼吸衰竭肥胖患者机械通气的能量负荷值分析。

IF 2.7 4区医学

Medicina Intensiva Pub Date : 2024-11-01 DOI: 10.1016/j.medin.2024.06.004

引用次数: 0

Effects of PEEP on intracranial pressure in patients with acute brain injury: An observational, prospective and multicenter study PEEP 对急性脑损伤患者颅内压的影响：一项前瞻性多中心观察研究

IF 2.7 4区医学

Medicina Intensiva Pub Date : 2024-09-26 DOI: 10.1016/j.medin.2024.04.011

{"title":"Effects of PEEP on intracranial pressure in patients with acute brain injury: An observational, prospective and multicenter study","authors":"","doi":"10.1016/j.medin.2024.04.011","DOIUrl":"10.1016/j.medin.2024.04.011","url":null,"abstract":"<div><h3>Objective</h3><div>To analyze the impact of positive end-expiratory pressure (PEEP) changes on intracranial pressure (ICP) dynamics in patients with acute brain injury (ABI).</div></div><div><h3>Design</h3><div>Observational, prospective and multicenter study (PEEP-PIC study).</div></div><div><h3>Setting</h3><div>Seventeen intensive care units in Spain.</div></div><div><h3>Patients</h3><div>Neurocritically ill patients who underwent invasive neuromonitorization from November 2017 to June 2018.</div></div><div><h3>Interventions</h3><div>Baseline ventilatory, hemodynamic and neuromonitoring variables were collected immediately before PEEP changes and during the following 30 min.</div></div><div><h3>Main variables of interest</h3><div>PEEP and ICP changes.</div></div><div><h3>Results</h3><div>One-hundred and nine patients were included. Mean age was 52.68 (15.34) years, male 71 (65.13%). Traumatic brain injury was the cause of ABI in 54 (49.54%) patients. Length of mechanical ventilation was 16.52 (9.23) days. In-hospital mortality was 21.1%. PEEP increases (mean 6.24–9.10 cmH2O) resulted in ICP increase from 10.4 to 11.39 mmHg, <em>P</em> < .001, without changes in cerebral perfusion pressure (CPP) (<em>P</em> = .548). PEEP decreases (mean 8.96 to 6.53 cmH2O) resulted in ICP decrease from 10.5 to 9.62 mmHg (<em>P</em> = .052), without changes in CPP (<em>P</em> = .762). Significant correlations were established between the increase of ICP and the delta PEEP (R = 0.28, <em>P</em> < .001), delta driving pressure (R = 0.15, <em>P</em> = .038) and delta compliance (R = −0.14, <em>P</em> = .052). ICP increment was higher in patients with lower baseline ICP.</div></div><div><h3>Conclusions</h3><div>PEEP changes were not associated with clinically relevant modifications in ICP values in ABI patients. The magnitude of the change in ICP after PEEP increase was correlated with the delta of PEEP, the delta driving pressure and the delta compliance.</div></div>","PeriodicalId":49268,"journal":{"name":"Medicina Intensiva","volume":null,"pages":null},"PeriodicalIF":2.7,"publicationDate":"2024-09-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142322286","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}

引用次数: 0

Eczema herpeticum in a burned patient: Skin grafting failure and tracheobronchitis 烧伤患者的疱疹性湿疹：植皮失败和气管支气管炎

IF 2.7 4区医学

Medicina Intensiva Pub Date : 2024-09-26 DOI: 10.1016/j.medin.2024.02.002

引用次数: 0

Meropenem for the management of valproic acid intoxication: a case report and a review of the literature 美罗培南治疗丙戊酸中毒：病例报告和文献综述

IF 2.7 4区医学

Medicina Intensiva Pub Date : 2024-09-26 DOI: 10.1016/j.medin.2024.05.023

引用次数: 0

Outcomes of an extracorporeal cardiopulmonary resuscitation (ECPR) program for in- and out-of-hospital cardiac arrest in a tertiary hospital in Spain 西班牙一家三级医院针对院内和院外心脏骤停实施的体外心肺复苏（ECPR）计划的成果

IF 2.7 4区医学

Medicina Intensiva Pub Date : 2024-09-26 DOI: 10.1016/j.medin.2024.06.007

{"title":"Outcomes of an extracorporeal cardiopulmonary resuscitation (ECPR) program for in- and out-of-hospital cardiac arrest in a tertiary hospital in Spain","authors":"","doi":"10.1016/j.medin.2024.06.007","DOIUrl":"10.1016/j.medin.2024.06.007","url":null,"abstract":"<div><h3>Objective</h3><div>To analyze if the implementation of a multidisciplinary extracorporeal cardiopulmonary resuscitation (ECPR) program in a tertiary hospital in Spain is feasible and could yield survival outcomes similar to international published experiences.</div></div><div><h3>Design</h3><div>Retrospective observational cohort study.</div></div><div><h3>Setting</h3><div>One tertiary referral university hospital in Spain.</div></div><div><h3>Patients</h3><div>All adult patients receiving ECPR between January 2019 and April 2023.</div></div><div><h3>Interventions</h3><div>Prospective collection of variables and follow-up for up to 180 days.</div></div><div><h3>Main variables of interest</h3><div>To assess outcomes, survival with good neurological outcome defined as a Cerebral Performance Categories scale 1–2 at 180 days was used. Secondary variables were collected including demographics and comorbidities, cardiac arrest and cannulation characteristics, ROSC, ECMO-related complications, survival to ECMO decannulation, survival at Intensive Care Unit (ICU) discharge, survival at 180 days, neurological outcome, cause of death and eligibility for organ donation.</div></div><div><h3>Results</h3><div>Fifty-four patients received ECPR, 29 for OHCA and 25 for IHCA. Initial shockable rhythm was identified in 27 (50%) patients. The most common cause for cardiac arrest was acute coronary syndrome [29 (53.7%)] followed by pulmonary embolism [7 (13%)] and accidental hypothermia [5 (9.3%)]. Sixteen (29.6%) patients were alive at 180 days, 15 with good neurological outcome. Ten deceased patients (30.3%) became organ donors after neuroprognostication.</div></div><div><h3>Conclusions</h3><div>The implementation of a multidisciplinary ECPR program in an experienced Extracorporeal Membrane Oxygenation center in Spain is feasible and can lead to good survival outcomes and valid organ donors.</div></div>","PeriodicalId":49268,"journal":{"name":"Medicina Intensiva","volume":null,"pages":null},"PeriodicalIF":2.7,"publicationDate":"2024-09-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142322059","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}

引用次数: 0

Pulmonary Events in ICU patients with hyperoxia: is it possible to relate arterial partial pressure of oxygen to coded diseases? A retrospective analysis 高氧重症监护病房患者的肺部事件：动脉血氧分压与编码疾病有关联吗？回顾性分析

IF 2.7 4区医学

Medicina Intensiva Pub Date : 2024-09-26 DOI: 10.1016/j.medin.2024.04.002

{"title":"Pulmonary Events in ICU patients with hyperoxia: is it possible to relate arterial partial pressure of oxygen to coded diseases? A retrospective analysis","authors":"","doi":"10.1016/j.medin.2024.04.002","DOIUrl":"10.1016/j.medin.2024.04.002","url":null,"abstract":"<div><h3>Objective</h3><div>Oxygen has been used liberally in ICUs for a long time to prevent hypoxia in ICU- patients. Current evidence suggests that paO<sub>2</sub> >300 mmHg should be avoided, it remains uncertain whether an “optimal level” exists. We investigated how “mild” hyperoxia influences diseases and in-hospital mortality.</div></div><div><h3>Design</h3><div>This is a retrospective study.</div></div><div><h3>Setting</h3><div>112 mechanically ventilated ICU-patients were enrolled.</div></div><div><h3>Patients or participants</h3><div>112 ventilated patients were included and categorized into two groups based on the median paO<sub>2</sub> values measured in initial 24 h of mechanical ventilation: normoxia group (paO<sub>2</sub> ≤ 100 mmHg, n = 43) and hyperoxia group patients (paO<sub>2</sub> > 100 mmHg, n = 69).</div></div><div><h3>Interventions</h3><div>No interventions were performed.</div></div><div><h3>Main variables of interest</h3><div>The primary outcome was the incidence of pulmonary events, the secondary outcomes included the incidence of other new organ dysfunctions and in-hospital mortality.</div></div><div><h3>Results</h3><div>The baseline characteristics, such as age, body mass index, lactate levels, and severity of disease scores, were similar in both groups. There were no statistically significant differences in the incidence of pulmonary events, infections, and new organ dysfunctions between the groups. 27 out of 69 patients (39.1%) in the “mild” hyperoxia group and 12 out of 43 patients (27.9%) in the normoxia group died during their ICU or hospital stay (p = 0.54). The mean APACHE Score was 29.4 (SD 7.9) in the normoxia group and 30.0 (SD 6.7) in the hyperoxia group (p = 0.62).</div></div><div><h3>Conclusions</h3><div>We found no differences in pulmonary events, other coded diseases, and in-hospital mortality between both groups. It remains still unclear what the \"best oxygen regime\" is for intensive care patients.</div></div>","PeriodicalId":49268,"journal":{"name":"Medicina Intensiva","volume":null,"pages":null},"PeriodicalIF":2.7,"publicationDate":"2024-09-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142322060","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

引用次数: 0