Medicina Intensiva最新文献

{"title":"High-flow nasal cannula in Spanish Pediatric Intensive Care Services: A national web survey about its use and indications","authors":"Alberto García-Salido ,&nbsp;Vicente Modesto I Alapont ,&nbsp;Alberto Medina-Villanueva ,&nbsp;Spanish respiratory group of the Spanish Society of Pediatric Intensive Care","doi":"10.1016/j.medin.2024.03.009","DOIUrl":"10.1016/j.medin.2024.03.009","url":null,"abstract":"<div><h3>Objective</h3><p>To describe the high-flow nasal cannula (HFNC) indications in the Spanish pediatric critical care units (PICUs).</p></div><div><h3>Design</h3><p>Descriptive cross-sectional observational study.</p></div><div><h3>Setting</h3><p>Electronic survey among members of the Spanish Society of Pediatric Intensive Care (SECIP). It was sent weekly from April 10, 2023, to May 21, 2023.</p></div><div><h3>Participants</h3><p>All SECIP members.</p></div><div><h3>Interventions</h3><p>None.</p></div><div><h3>Main variables of interest</h3><p>The questions focused on workplace, years of experience, use or non-use of HFNC, justification and expectations regarding its application, starting point within each center, clinical criteria for indication, existence of clinical guidelines, evaluation during its use, and criteria and mode of withdrawal.</p></div><div><h3>Results</h3><p>Two hundred and two participants, 176 were from Spain. Of these, 87/176 had over ten years of experience. One hundred sixty two use HFNC and 66/162 have HFNC clinical guidelines. Acute bronchiolitis (138/162) and respiratory assistance after extubation (106/56) are the two main indications. For 62/162 HFNC may reduce therapeutic escalation. Neuromuscular diseases (105/162) and anatomical airway diseases (135/162) are the two main contraindications. The reasons to do not use HFNC were the absence of evidence about it effectiveness (8/14) and its inadequate cost/effectiveness balance (8/14).</p></div><div><h3>Conclusions</h3><p>A majority of Spanish pediatric intensivists use HFNC. Its application and withdrawal appears to be primarily based on clinical experience. Besides, those who use HFNC are aware of its limitations and the lack of evidence in some cases. It is necessary to develop single-center and multicenter studies to elucidate the effectiveness of this therapy in the context of critically ill children.</p></div>","PeriodicalId":49268,"journal":{"name":"Medicina Intensiva","volume":"48 9","pages":"Pages 520-527"},"PeriodicalIF":2.7,"publicationDate":"2024-08-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142087906","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":"Muscle wasting in ICU-patients with COVID-19 - Descriptive analysis and risk factors identification","authors":"Alan Garcia-Grimaldo ,&nbsp;Nadia Carolina Rodríguez-Moguel ,&nbsp;Martín Armando Ríos-Ayala ,&nbsp;Carmen Margarita Hernández-Cárdenas ,&nbsp;Lya Pensado-Piedra ,&nbsp;Iván Armando Osuna-Padilla","doi":"10.1016/j.medin.2024.03.018","DOIUrl":"10.1016/j.medin.2024.03.018","url":null,"abstract":"","PeriodicalId":49268,"journal":{"name":"Medicina Intensiva","volume":"48 8","pages":"Pages 487-490"},"PeriodicalIF":2.7,"publicationDate":"2024-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141954524","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":"Síndrome postcuidados intensivos en pacientes y familiares. Análisis de cohortes COVID-19 y no COVID-19, con seguimiento presencial a los tres meses y al año","authors":"","doi":"10.1016/j.medin.2024.03.008","DOIUrl":"10.1016/j.medin.2024.03.008","url":null,"abstract":"<div><h3>Objective</h3><p>Compare prevalence and profile of post-intensive care patient (P-PICS) and family/caregiver (F-PICS) syndrome in two cohorts (COVID and non-COVID) and analyse risk factors for P-PICS.</p></div><div><h3>Design</h3><p>Prospective, observational cohort (March 2018- 2023), follow-up at three months and one year.</p></div><div><h3>Setting</h3><p>14-bed polyvalent Intensive Care Unit (ICU), Level II Hospital.</p></div><div><h3>Patients or participants</h3><p>265 patients and 209 relatives. Inclusion criteria patients: age<!--> <!-->&gt; 18 years, mechanical ventilation<!--> <!-->&gt; 48<!--> <!-->hours, ICU stay<!--> <!-->&gt; 5 days, delirium, septic shock, acute respiratory distress syndrome, cardiac arrest. Inclusion criteria family: those who attended.</p></div><div><h3>Interventions</h3><p>Follow-up 3 months and 1 year after hospital discharge.</p></div><div><h3>Main variables of interest</h3><p>Patients; sociodemographic, clinical, evolutive, physical, psychological and cognitive alterations, dependency degree and quality of life. Main caregivers: mental state and physical overload.</p></div><div><h3>Results</h3><p>64.9% PICS-P, no differences between groups. COVID patients more physical alterations than non-COVID (p<!--> <!-->=<!--> <!-->0.028). These more functional deterioration (p<!--> <!-->=<!--> <!-->0.005), poorer quality of life (p<!--> <!-->=<!--> <!-->0.003), higher nutritional alterations (p<!--> <!-->=<!--> <!-->0.004) and cognitive deterioration (p&lt;<!--> <!-->0.001). 19.1% PICS-F, more frequent in relatives of non-COVID patients (17.6% vs. 5.5%; p<!--> <!-->=<!--> <!-->0.013). Independent predictors of PICS-P: first years of the study (OR: 0.484), higher comorbidity (OR: 1.158), delirium (OR: 2.935), several reasons for being included (OR: 3.171) and midazolam (OR: 4.265).</p></div><div><h3>Conclusions</h3><p>Prevalence PICS-P and PICS-F between both cohorts was similar. Main factors associated with the development of SPCI-P were: higher comorbidity, delirium, midazolam, inclusion for more than one reason and during the first years.</p></div>","PeriodicalId":49268,"journal":{"name":"Medicina Intensiva","volume":"48 8","pages":"Pages 445-456"},"PeriodicalIF":2.7,"publicationDate":"2024-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140780870","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":"«INTUPROS»: una oportunidad para reflexionar y mejorar","authors":"Andrea Viviani ,&nbsp;Carlos Vicent ,&nbsp;Álvaro Castellanos-Ortega","doi":"10.1016/j.medin.2024.03.014","DOIUrl":"10.1016/j.medin.2024.03.014","url":null,"abstract":"","PeriodicalId":49268,"journal":{"name":"Medicina Intensiva","volume":"48 8","pages":"Pages 493-494"},"PeriodicalIF":2.7,"publicationDate":"2024-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141954523","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":"Evaluación de la respuesta a la posición prona a través de tomografía por impedancia eléctrica","authors":"","doi":"10.1016/j.medin.2024.01.010","DOIUrl":"10.1016/j.medin.2024.01.010","url":null,"abstract":"","PeriodicalId":49268,"journal":{"name":"Medicina Intensiva","volume":"48 8","pages":"Pages 495-496"},"PeriodicalIF":2.7,"publicationDate":"2024-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140468905","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":"Duración de la primera maniobra de decúbito prono y su asociación con la mortalidad a 90 días en pacientes con insuficiencia respiratoria aguda por COVID-19: un estudio retrospectivo de terciles de tiempo","authors":"","doi":"10.1016/j.medin.2024.03.003","DOIUrl":"10.1016/j.medin.2024.03.003","url":null,"abstract":"<div><h3>Objective</h3><p>To investigate the association between the duration of the first prone positioning maneuver (PPM) and 90-day mortality in patients with C-ARDS.</p></div><div><h3>Design</h3><p>Retrospective, observational, and analytical study.</p></div><div><h3>Setting</h3><p>COVID-19 ICU of a tertiary hospital.</p></div><div><h3>Patients</h3><p>Adults over 18<!--> <!-->years old, with a confirmed diagnosis of SARS-CoV-2 disease requiring PPM.</p></div><div><h3>Interventions</h3><p>Multivariable analysis of 90-day survival.</p></div><div><h3>Main variables of interest</h3><p>Duration of the first PPM, number of PPM sessions, 90-day mortality.</p></div><div><h3>Results</h3><p>271 patients undergoing PPM were analyzed: first tertile (n<!--> <!-->=<!--> <!-->111), second tertile (n<!--> <!-->=<!--> <!-->95) and third tertile (n<!--> <!-->=<!--> <!-->65). The results indicated that the median duration of PDP was 14<!--> <!-->hours (95%<!--> <!-->CI: 10-16<!--> <!-->hours) in the first tertile, 19<!--> <!-->hours (95%<!--> <!-->CI: 18-20<!--> <!-->hours) in the second tertile and 22<!--> <!-->hours (95%<!--> <!-->CI: 21-24<!--> <!-->hours) in the third tertile. Comparison of survival curves using the Logrank test did not reach statistical significance (<em>P</em> <!-->=<!--> <!-->.11). Cox Regression analysis showed an association between the number of pronation sessions — patients receiving between 2 and 5 sessions (HR: 2.19; 95%<!--> <!-->CI: 1.07-4.49) and those receiving more than 5 sessions (HR: 6.05; 95%<!--> <!-->CI: 2.78-13.16 — and 90-day mortality.</p></div><div><h3>Conclusions</h3><p>While the duration of PDP does not appear to significantly influence 90-day mortality, the number of pronation sessions is identified as a significant factor associated with an increased risk of mortality.</p></div>","PeriodicalId":49268,"journal":{"name":"Medicina Intensiva","volume":"48 8","pages":"Pages 457-466"},"PeriodicalIF":2.7,"publicationDate":"2024-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140767165","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":"Ventricular tachycardia in a young female","authors":"Huyun Wan ,&nbsp;Gongli Liu ,&nbsp;Min Tang","doi":"10.1016/j.medin.2024.01.005","DOIUrl":"10.1016/j.medin.2024.01.005","url":null,"abstract":"","PeriodicalId":49268,"journal":{"name":"Medicina Intensiva","volume":"48 8","pages":"Pages 497-498"},"PeriodicalIF":2.7,"publicationDate":"2024-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141954525","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":"Effectiveness of Helmet-CPAP in mild to moderate coronavirus type 2 hypoxemia: An observational study","authors":"Aurio Fajardo-Campoverdi ,&nbsp;Juan José Orellana-Cáceres ,&nbsp;Vicente Fernández ,&nbsp;Felipe Poblete ,&nbsp;Priscila Reyes ,&nbsp;Kevin Rebolledo","doi":"10.1016/j.medin.2024.02.013","DOIUrl":"10.1016/j.medin.2024.02.013","url":null,"abstract":"<div><h3>Objective</h3><p>To determine the relative effectiveness of Helmet-CPAP (H_CPAP) with respect to high-flow nasal cannula oxygen therapy (HFNO) in avoiding greater need for intubation or mortality in a medium complexity hospital in Chile during the year 2021.</p></div><div><h3>Design</h3><p>Cohort analytical study, single center.</p></div><div><h3>Setting</h3><p>Units other than intensive care units.</p></div><div><h3>Patients</h3><p>Records of adults with mild to moderate hypoxemia due to coronavirus type 2.</p></div><div><h3>Interventions</h3><p>None.</p></div><div><h3>Main variables of interest</h3><p>Need for intubation or mortality.</p></div><div><h3>Results</h3><p>159 patients were included in the study, with a ratio by support of 2:10 (H_CPAP:HFNO). The 46.5% were women, with no significant differences by sex according to support (<em>p</em> = 0.99, Fisher test). The APACHE II score, for HFNO, had a median of 10.5, 3.5 units higher than H_CPAP (<em>p</em> &lt; 0.01, Wilcoxon rank sum). The risk of intubation in HFNO was 42.1% and in H_CPAP 3.8%, with a significant risk reduction of 91% (95% CI: 36.9%–98.7%; <em>p</em> &lt; 0.01). APACHE II does not modify or confound the support and intubation relationship (<em>p</em> &gt; 0.2, binomial regression); however, it does confound the support and mortality relationship (<em>p</em> = 0.82, RR homogeneity test). Despite a 79.1% reduction in mortality risk with H_CPAP, this reduction was not statistically significant (<em>p</em> = 0.11, binomial regression).</p></div><div><h3>Conclusions</h3><p>The use of Helmet CPAP, when compared to HFNO, was an effective therapeutic ventilatory support strategy to reduce the risk of intubation in patients with mild to moderate hypoxemia caused by coronavirus type 2 in inpatient units other than intensive care. The limitations associated with the difference in size, age and severity between the arms could generate bias.</p></div>","PeriodicalId":49268,"journal":{"name":"Medicina Intensiva","volume":"48 8","pages":"Pages 437-444"},"PeriodicalIF":2.7,"publicationDate":"2024-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141954527","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":"Abordaje práctico de la sedación inhalada en el paciente crítico","authors":"","doi":"10.1016/j.medin.2024.04.007","DOIUrl":"10.1016/j.medin.2024.04.007","url":null,"abstract":"<div><p>The use of sedatives in intensive care units (ICU) is essential for relieving anxiety and stress in mechanically ventilated patients, and it is related to clinical outcomes, duration of mechanical ventilation, and length of stay in the ICU. Inhaled sedatives offer benefits such as faster awakening and extubation, decreased total opioid and neuromuscular blocking agents (NMB) doses, as well as bronchodilator, anticonvulsant, and cardiopulmonary and neurological protective effects. Inhaled sedation is administered using a specific vaporizer. Isoflurane is the recommended agent due to its efficacy and safety profile. Inhaled sedation is recommended for moderate and deep sedation, prolonged sedation, difficult sedation, patients with acute respiratory distress syndrome (ARDS), status asthmaticus, and super-refractory status epilepticus. By offering these significant advantages, the use of inhaled sedatives allows for a personalized and controlled approach to optimize sedation in the ICU.</p></div>","PeriodicalId":49268,"journal":{"name":"Medicina Intensiva","volume":"48 8","pages":"Pages 467-476"},"PeriodicalIF":2.7,"publicationDate":"2024-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141278310","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":"McConnell’s sign in fat embolism syndrome","authors":"Ripenmeet Salhotra","doi":"10.1016/j.medin.2024.01.003","DOIUrl":"10.1016/j.medin.2024.01.003","url":null,"abstract":"","PeriodicalId":49268,"journal":{"name":"Medicina Intensiva","volume":"48 8","pages":"Pages 499-500"},"PeriodicalIF":2.7,"publicationDate":"2024-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141954526","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}