Medicina Intensiva最新文献

{"title":"Early identification of a knotted peripherally inserted central venous catheter","authors":"Andrés Felipe Mora-Salamanca , John Álvaro Niño Aponte , Jorge Iván Alvarado-Sánchez","doi":"10.1016/j.medin.2024.03.001","DOIUrl":"10.1016/j.medin.2024.03.001","url":null,"abstract":"","PeriodicalId":49268,"journal":{"name":"Medicina Intensiva","volume":"48 11","pages":"Pages 675-676"},"PeriodicalIF":2.7,"publicationDate":"2024-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142592536","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":"Endoftalmitis endógena en un caso de meningitis meningocócica","authors":"José Ginestal, Elena Álvaro, Zaira Molina","doi":"10.1016/j.medin.2024.03.010","DOIUrl":"10.1016/j.medin.2024.03.010","url":null,"abstract":"","PeriodicalId":49268,"journal":{"name":"Medicina Intensiva","volume":"48 11","pages":"Page e20"},"PeriodicalIF":2.7,"publicationDate":"2024-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142592537","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":"Perforación esofágica secundaria a una acalasia","authors":"","doi":"10.1016/j.medin.2024.01.012","DOIUrl":"10.1016/j.medin.2024.01.012","url":null,"abstract":"","PeriodicalId":49268,"journal":{"name":"Medicina Intensiva","volume":"48 11","pages":"Page 674"},"PeriodicalIF":2.7,"publicationDate":"2024-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140469450","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":"Incidence of venous thromboembolic disease and risk of bleeding in critically ill patients with hematologic malignancies: A retrospective study","authors":"Federico C. Carini ,&nbsp;Laveena Munshi ,&nbsp;Igor Novitzky-Basso ,&nbsp;Graham Dozois ,&nbsp;Camila Heredia ,&nbsp;Sotirios Damouras ,&nbsp;Bruno L. Ferreyro ,&nbsp;Sangeeta Mehta","doi":"10.1016/j.medin.2024.05.014","DOIUrl":"10.1016/j.medin.2024.05.014","url":null,"abstract":"<div><h3>Objective</h3><div>Our objectives were to describe the use of thromboprophylaxis and the incidence of VTE/bleeding in critically ill patients with hematologic malignancies (HM).</div></div><div><h3>Design</h3><div>Retrospective cohort study (2014–2022).</div></div><div><h3>Setting</h3><div>Medic-Surgical Intensive Care Unit (ICU) in a tertiary care academic center.</div></div><div><h3>Patients</h3><div>Adult patients admitted to ICU with a concomitant diagnosis of a hematological malignancy.</div></div><div><h3>Interventions</h3><div>None.</div></div><div><h3>Main variables of interest</h3><div>We analyzed demographic data, use of thromboprophylaxis and secondary outcomes that included incidence of VTE (venous thromboembolism), bleeding, mortality, severity scores and organ support. We applied a multivariable logistic regression model to examine the risk of thrombosis in the ICU.</div></div><div><h3>Results</h3><div>We included 862 ICU admissions (813 unique patients). Thromboprophylaxis was given during 65% of admissions (LMWH 14%, UFH 8%, and SCDs 43%); in 21% it was contraindicated due to thrombocytopenia; 14% of cases lacked documentation on prophylaxis. There were 38 unique incident cases of VTE (27 DVT, 11 PE), constituting 4.4% of ICU episodes. Most of VTE cases happened in patients with various degrees of thrombocytopenia. In the multivariable analysis, SOFA score on the first ICU day was independently associated (OR 0.85, 95% CI 0.76−0.96) with the risk of VTE. Bleeding occurred in 7.2% (minor) and 14.4% (major) of episodes; most frequent sites being CNS, abdomen/GI and pulmonary.</div></div><div><h3>Conclusions</h3><div>In this cohort of critically ill patients with HM, there was considerable variability in the utilization of DVT prophylaxis, with predominant use of SCDs. The incidence of VTE was 4.4% and major bleeding 14%.</div></div><div><h3>Clinical Trial Registration</h3><div>NCT05396157. Venous Thromboembolism in Hematologic Malignancy and Hematopoietic Cell Transplant Patients: a Retrospective Study (<span><span>https://clinicaltrials.gov/</span><svg><path></path></svg></span>).</div></div>","PeriodicalId":49268,"journal":{"name":"Medicina Intensiva","volume":"48 11","pages":"Pages e1-e9"},"PeriodicalIF":2.7,"publicationDate":"2024-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142592601","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":"The effect of different definitions of hepatic injury on incidence and mortality rates in the ICU patient population with secondary hepatic injury","authors":"Gül Gürsel ,&nbsp;Ayshan Mammadova ,&nbsp;Eda Macit Aydın ,&nbsp;Zeynep Çınar ,&nbsp;Nurgül Navruzvai ,&nbsp;Sümeyye Kodalak","doi":"10.1016/j.medin.2024.05.013","DOIUrl":"10.1016/j.medin.2024.05.013","url":null,"abstract":"<div><h3>Objective</h3><div>The aim was to investigate how different hepatic injury (HI) definitions used in the same study population change incidence and mortality rates and which would best diagnose secondary HI.</div></div><div><h3>Design</h3><div>Single-centre retrospective observational cohort study.</div></div><div><h3>Setting</h3><div>Tertiary hospital ICU, ANKARA, Turkey.</div></div><div><h3>Patients</h3><div>Four hundred seventy-eight adult patients were included in the study.</div></div><div><h3>Interventions</h3><div>None.</div></div><div><h3>Main variables of interest</h3><div>Three definitions of HI were compared. Taking the SOFA hepatic criteria (SOFA: Total bilirubin (TBL) &gt; 1.2 mg/dl) as the gold standard, sensitivity, specificity, positive and negative predictive values, and accuracy of the modified 2017 definition by the American College of Gastroenterology (ACG) and the 2019 European Association for the Study of the Liver (EASL) were calculated.</div></div><div><h3>Results</h3><div>Incidence rates ranged from 10% to 45% according to the definition (p &lt; 0.005), while mortality rates ranged from 38% to 57%. When the SOFA1.2 (TBL &gt; 1.2 definition was taken as the gold standard, the diagnostic value of the ACG definition was high, and HI was found to be an independent risk factor that increased mortality four times.</div></div><div><h3>Conclusions</h3><div>According to this study’s results, the incidence and mortality rates of secondary HI vary greatly depending on the definition used. A definition that includes minimal increases in ALT, AST, and TBL predicts mortality with reasonable incidence rates.</div></div>","PeriodicalId":49268,"journal":{"name":"Medicina Intensiva","volume":"48 11","pages":"Pages 646-653"},"PeriodicalIF":2.7,"publicationDate":"2024-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142592598","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 del índice de shock en choque séptico: una revisión sistemática","authors":"Juan José Diaztagle Fernández ,&nbsp;Juan Pablo Castañeda-González ,&nbsp;José Ignacio Trujillo Zambrano ,&nbsp;Francy Esmith Duarte Martínez ,&nbsp;Miguel Ángel Saavedra Ortiz","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":"48 11","pages":"Pages e10-e19"},"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}

{"title":"Fragilidad, prevalencia en nuestras unidades de cuidados intensivos y características diferenciales de los pacientes frágiles","authors":"Cristina Dólera Moreno ,&nbsp;Francisco Colomina Climent ,&nbsp;Inés Torrejón Pérez ,&nbsp;Cristina Mollá Jiménez ,&nbsp;Adoración Alcalá López ,&nbsp;Francisco Ángel Jaime Sánchez ,&nbsp;Maria Luisa Navarrete Rebollo ,&nbsp;Salomé Sánchez Pino","doi":"10.1016/j.medin.2024.06.003","DOIUrl":"10.1016/j.medin.2024.06.003","url":null,"abstract":"","PeriodicalId":49268,"journal":{"name":"Medicina Intensiva","volume":"48 11","pages":"Pages 666-668"},"PeriodicalIF":2.7,"publicationDate":"2024-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141708477","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":"Respuesta a «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.2024.07.005","DOIUrl":"10.1016/j.medin.2024.07.005","url":null,"abstract":"","PeriodicalId":49268,"journal":{"name":"Medicina Intensiva","volume":"48 11","pages":"Pages 670-671"},"PeriodicalIF":2.7,"publicationDate":"2024-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142592698","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":"Análisis de los valores de carga de energía en ventilación mecánica en pacientes obesos con insuficiencia respiratoria hipoxémica secundaria a SARS-CoV-2","authors":"Alejandro González-Castro ,&nbsp;Elena Cuenca Fito ,&nbsp;Carmen Huertas Martín ,&nbsp;Yhivian Peñasco ,&nbsp;Aurio Fajardo Campoverdi","doi":"10.1016/j.medin.2024.06.004","DOIUrl":"10.1016/j.medin.2024.06.004","url":null,"abstract":"","PeriodicalId":49268,"journal":{"name":"Medicina Intensiva","volume":"48 11","pages":"Pages 663-666"},"PeriodicalIF":2.7,"publicationDate":"2024-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141847730","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":"Soporte circulatorio mecánico en el paciente en shock cardiogénico","authors":"Luis Martin-Villen ,&nbsp;Alejandro Adsuar Gomez ,&nbsp;José Manuel Garrido Jimenez ,&nbsp;Jose Luis Perez Vela ,&nbsp;María Paz Fuset Cabanes","doi":"10.1016/j.medin.2024.07.009","DOIUrl":"10.1016/j.medin.2024.07.009","url":null,"abstract":"<div><div>Cardiogenic shock (CS) is a highly complex clinical condition that requires a management strategy focused on early resolution of the underlying cause and the provision of circulatory support. In cases of refractory CS, mechanical circulatory support (MCS) is employed to replace the failed cardiocirculatory system, thereby preventing the development of multiorgan failure. There are various types of MCS, and patients with CS typically require devices that are either short-term (&lt; 15 days) or intermediate-term (15-30 days). When choosing the device the underlying cause of CS, as well as the presence or absence of concomitant conditions such as failed ventricle, respiratory failure, and the intended purpose of the support should be taken into consideration. Patients with MCS require the comprehensive care indicated in complex critically ill patients with multiorgan dysfunction, with an emphasis on device monitoring and control. Different complications may arise during support management, and its withdrawal must be protocolized.</div></div>","PeriodicalId":49268,"journal":{"name":"Medicina Intensiva","volume":"48 12","pages":"Pages 714-727"},"PeriodicalIF":2.7,"publicationDate":"2024-10-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142721578","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}