Medicina Intensiva最新文献

{"title":"Relationship between fluid overload and mortality and morbidity in pediatric intensive care unit","authors":"Hilmi Bayirli ,&nbsp;Nazan Ulgen Tekerek ,&nbsp;Alper Koker ,&nbsp;Oguz Dursun","doi":"10.1016/j.medin.2024.06.017","DOIUrl":"10.1016/j.medin.2024.06.017","url":null,"abstract":"<div><h3>Objective</h3><div>The relationship between fluid overload and clinical outcomes was investigated.</div></div><div><h3>Design</h3><div>This study is an observational and analytic study of a retrospective cohort.</div></div><div><h3>Settings</h3><div>Pediatric intensive care units.</div></div><div><h3>Patients or participants</h3><div>Between 2019 and 2021 children who needed intensive care were included in the study.</div></div><div><h3>Interventions</h3><div>No intervention.</div></div><div><h3>Main variable of interest</h3><div>Early, peak and cumulative fluid overload were evaluated.</div></div><div><h3>Results</h3><div>The mortality rate was 11.7% (68/513). When fluid overloads were examined in terms of mortality, the percentage of early fluid overload was 1.86 and 3.35, the percent of peak fluid overload was 2.87 and 5.54, and the percent of cumulative fluid overload was 3.40 and 8.16, respectively, in the survivor and the non-survivor groups. After adjustment for age, severity of illness, and other potential confounders, peak (aOR = 1.15; 95%CI 1.05−1.26; p: 0.002) and cumulative (aOR = 1.10; 95%CI 1.04−1.16; p &lt; 0.001) fluid overloads were determined as independent risk factors associated with mortality. When the cumulative fluid overload is 10% or more, a 3.9-fold increase mortality rate was calculated. It is found that the peak and cumulative fluid overload, had significant negative correlation with intensive care unit free days and ventilator free days.</div></div><div><h3>Conclusions</h3><div>It is found that peak and cumulative fluid overload in critically ill children were independently associated with intensive care unit mortality and morbidity.</div></div>","PeriodicalId":49268,"journal":{"name":"Medicina Intensiva","volume":"49 3","pages":"Pages 125-134"},"PeriodicalIF":2.7,"publicationDate":"2025-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143527418","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":"Perspectivas actuales sobre el uso de la inteligencia artificial en la seguridad del paciente crítico","authors":"Jesús Abelardo Barea Mendoza ,&nbsp;Marcos Valiente Fernandez ,&nbsp;Alex Pardo Fernandez ,&nbsp;Josep Gómez Álvarez","doi":"10.1016/j.medin.2024.03.007","DOIUrl":"10.1016/j.medin.2024.03.007","url":null,"abstract":"<div><div>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.</div></div>","PeriodicalId":49268,"journal":{"name":"Medicina Intensiva","volume":"49 3","pages":"Pages 154-164"},"PeriodicalIF":2.7,"publicationDate":"2025-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140757190","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":"Dual therapy with remdesivir plus extended nirmatrelvir/ritonavir in immunocompromised and critically ill patient with suspected persistent COVID-19 infection: Case report","authors":"Arturo Gámiz Rejano ,&nbsp;Teresa López-Viñau ,&nbsp;Cristina López Martín ,&nbsp;Samira Marín Moreno ,&nbsp;Isabel Machuca ,&nbsp;Jorge Rodríguez-Gómez","doi":"10.1016/j.medin.2024.10.001","DOIUrl":"10.1016/j.medin.2024.10.001","url":null,"abstract":"","PeriodicalId":49268,"journal":{"name":"Medicina Intensiva","volume":"49 3","pages":"Pages 174-177"},"PeriodicalIF":2.7,"publicationDate":"2025-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143527422","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":"Early blood pressure drop predicts renal function deterioration and mortality in ICU patients with liver failure: a retrospective cohort study","authors":"Rubing Guo ,&nbsp;Jingjing Tong ,&nbsp;Li Wang ,&nbsp;Bo Yang ,&nbsp;Liang Ma ,&nbsp;Yongtong Cao ,&nbsp;Wei Zhao","doi":"10.1016/j.medin.2024.08.010","DOIUrl":"10.1016/j.medin.2024.08.010","url":null,"abstract":"<div><h3>Objective</h3><div>To investigate the association between early blood pressure drop and worsening renal function (WRF) in ICU patients with liver failure and to evaluate their clinical outcomes.</div></div><div><h3>Design</h3><div>Retrospective observational study.</div></div><div><h3>Setting</h3><div>Intensive Care Medicine.</div></div><div><h3>Patients</h3><div>Patients admitted to the ICU for the first time during their first hospitalization; diagnosed with liver failure according to the International Classification of Diseases, Ninth and Tenth Revision codes; and aged ≥18 years were included. Patients with a peak systolic blood pressure (SBP) drop of &lt;0 mmHg were excluded.</div></div><div><h3>Intervention</h3><div>We analyzed data of ICU patients with liver failure from the Medical Information Mart for Intensive Care IV version 2.2 database. Descriptive statistics, analysis of variance, Kruskal–Wallis test, and chi-square test were employed for analysis. Multivariate linear regression models were used to assess the determinants of blood pressure decline. Cox proportional hazards and generalized additive models were used to evaluate</div></div><div><h3>Main variables of interest</h3><div>The relationship between blood pressure decline, WRF, and 60-day in-hospital mortality were evaluated, along with subgroup analyses.</div></div><div><h3>Results</h3><div>Peak SBP drop was independently associated with higher risks of WRF (P &lt; 0.001) and 60-day in-hospital mortality (P &lt; 0.001), even after adjusting for potential confounders, including baseline SBP. The independent risk relationship observed between peak diastolic blood pressure, mean arterial pressure drop, and the occurrence of WRF and 60-day in-hospital mortality was similar.</div></div><div><h3>Conclusions</h3><div>In ICU patients with liver failure, a significant early drop in blood pressure was associated with a higher incidence of WRF, increased risk of 60-day in-hospital mortality, and poorer prognoses.</div></div>","PeriodicalId":49268,"journal":{"name":"Medicina Intensiva","volume":"49 3","pages":"Pages 145-153"},"PeriodicalIF":2.7,"publicationDate":"2025-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143527420","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":"Sedación inhalada en la unidad de cuidados intensivos. Un largo camino aún por recorrer","authors":"Hernán Aguirre-Bermeo ,&nbsp;Pedro D. Wendel-García ,&nbsp;Óscar Peñuelas ,&nbsp;Ferran Roche-Campo","doi":"10.1016/j.medin.2024.09.007","DOIUrl":"10.1016/j.medin.2024.09.007","url":null,"abstract":"","PeriodicalId":49268,"journal":{"name":"Medicina Intensiva","volume":"49 3","pages":"Pages 184-185"},"PeriodicalIF":2.7,"publicationDate":"2025-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143527426","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":"Reversión guiada de dabigatrán en un caso de shock hemorrágico masivo","authors":"Manuel Fernández Caro ,&nbsp;Manuel Casado_Méndez ,&nbsp;Francisco Javier Rodríguez Martorell ,&nbsp;Antonio Manuel Puppo Moreno","doi":"10.1016/j.medin.2024.08.005","DOIUrl":"10.1016/j.medin.2024.08.005","url":null,"abstract":"","PeriodicalId":49268,"journal":{"name":"Medicina Intensiva","volume":"49 3","pages":"Pages 181-182"},"PeriodicalIF":2.7,"publicationDate":"2025-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143527424","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":"Clinical efficacy of oXiris-continuous hemofiltration adsorption in septic shock patients: A retrospective analysis","authors":"Yuxin Yang,&nbsp;Qionglan Dong,&nbsp;Jianpeng Su,&nbsp;Hongjun Xiao,&nbsp;Dan Zan,&nbsp;Jinfeng Chen,&nbsp;Xue Chen,&nbsp;Fan Wei,&nbsp;Cheng Zeng,&nbsp;Yanyan Yong","doi":"10.1016/j.medin.2024.09.001","DOIUrl":"10.1016/j.medin.2024.09.001","url":null,"abstract":"<div><h3>Objective</h3><div>This study aimed to assess the clinical impact of oXiris-continuous hemofiltration adsorption on patients with septic shock and their prognosis.</div></div><div><h3>Design</h3><div>A retrospective study.</div></div><div><h3>Participants</h3><div>Septic shock patients.</div></div><div><h3>Interventions</h3><div>The oXiris group underwent hemofiltration adsorption using oXiris hemofilters and septic shock standard treatment, while the control group received septic shock standard treatment.</div></div><div><h3>Main variables of interest</h3><div>The changes in inflammatory indicators and short-term mortality rate were evaluated. Propensity score matching (PSM) was conducted based on the 1:2 ratio between the oXiris and control groups to account for any baseline data differences.</div></div><div><h3>Results</h3><div>Results showed that after 24 h, 48 h, and 72 h of treatment, PCT, IL-6, and hs-CRP levels in the oXiris group were significantly lower than those in the control group (P &lt; 0.05). However, there were no significant differences in norepinephrine equivalents and organ function status (APACHE II score, SOFA score, Lac) between the two groups at the same time points. The 72-h mortality rate (21.88% vs. 34.04%) and the 7-day mortality rate (28.12% vs. 44.68%) were lower in the oXiris group compared to the control group, but not statistically significant. The 28-day mortality rate did not show a significant difference between the two groups (53.19% vs. 56.25%).</div></div><div><h3>Conclusions</h3><div>oXiris continuous hemofiltration adsorption technology may reduce the levels of inflammatory factors in patients with septic shock; however, it does not appear to enhance organ function or improve the 28-day mortality rate in these patients.</div></div>","PeriodicalId":49268,"journal":{"name":"Medicina Intensiva","volume":"49 3","pages":"Pages 135-144"},"PeriodicalIF":2.7,"publicationDate":"2025-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143527419","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}

{"title":"Correlación y concordancia de las escalas HACOR e IROX en pacientes con neumonía por COVID-19 que recibieron soporte ventilatorio no invasivo en dos unidades de cuidados intensivos","authors":"Alberto Belenguer-Muncharaz ,&nbsp;Irina Hermosilla-Semikina ,&nbsp;Francisco Bernal-Julián ,&nbsp;Héctor Hernández-Garcés ,&nbsp;Lluís Tormo-Rodriguez ,&nbsp;Estefanía Granero-Gasamans","doi":"10.1016/j.medin.2024.09.005","DOIUrl":"10.1016/j.medin.2024.09.005","url":null,"abstract":"","PeriodicalId":49268,"journal":{"name":"Medicina Intensiva","volume":"49 3","pages":"Pages 177-180"},"PeriodicalIF":2.7,"publicationDate":"2025-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143527423","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":"Fístula de arteria subclavia a vena yugular interna derecha secundaria a lesión por arma de fuego","authors":"Antonio Padilla-Serrano ,&nbsp;Ala Eddine Daoudi El Boukhrissi ,&nbsp;Genaro López Milena","doi":"10.1016/j.medin.2024.06.018","DOIUrl":"10.1016/j.medin.2024.06.018","url":null,"abstract":"","PeriodicalId":49268,"journal":{"name":"Medicina Intensiva","volume":"49 3","pages":"Pages 187-188"},"PeriodicalIF":2.7,"publicationDate":"2025-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143527427","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":"Seguridad del paciente, ¿qué aportan la simulación clínica y la innovación docente?","authors":"María Jesús Broch Porcar,&nbsp;Álvaro Castellanos-Ortega","doi":"10.1016/j.medin.2024.03.017","DOIUrl":"10.1016/j.medin.2024.03.017","url":null,"abstract":"<div><div>Clinical simulation in Intensive Care Medicine is a crucial tool to strengthen patient safety. It focuses on the complexity of the Intensive Care Unit, where challenging clinical situations require rapid decision making and the use of invasive techniques that can increase the risk of errors and compromise safety. Clinical simulation, by mimicking clinical contexts, is presented as essential for developing technical and non-technical skills and enhancing teamwork in a safe environment, without harm to the patient. <em>In situ</em> simulation is a valuable approach to practice in realistic environments and to address latent security threats. Other simulation methods as virtual reality and tele-simulation are gaining more and more acceptance. Herein, we provide current data on the clinical utility of clinical simulation related to improved safety in the practice of techniques and procedures, as well as improvements of teamwork performance and outcomes. Finally, we propose the needs for future research.</div></div>","PeriodicalId":49268,"journal":{"name":"Medicina Intensiva","volume":"49 3","pages":"Pages 165-173"},"PeriodicalIF":2.7,"publicationDate":"2025-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143527421","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}