Medicina Intensiva最新文献

{"title":"Incorporar la perspectiva del paciente crítico… ¿Cuestión de moda o de necesidad?","authors":"Olga Rubio Sanchiz , Joan Escarrabill","doi":"10.1016/j.medin.2024.06.010","DOIUrl":"10.1016/j.medin.2024.06.010","url":null,"abstract":"","PeriodicalId":49268,"journal":{"name":"Medicina Intensiva","volume":"48 12","pages":"Pages 737-739"},"PeriodicalIF":2.7,"publicationDate":"2024-09-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142721582","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":"Comparing lung aeration and respiratory effort using two different spontaneous breathing trial: T-piece vs pressure support ventilation","authors":"Raquel Bosch-Compte ,&nbsp;Francisco José Parrilla ,&nbsp;Rosana Muñoz-Bermúdez ,&nbsp;Irene Dot ,&nbsp;Cristina Climent ,&nbsp;Joan Ramon Masclans ,&nbsp;Judith Marin-Corral ,&nbsp;Purificación Pérez-Terán","doi":"10.1016/j.medin.2023.06.015","DOIUrl":"10.1016/j.medin.2023.06.015","url":null,"abstract":"<div><h3>Objective</h3><p>To assess the changes in lung aeration and respiratory effort generated by two different spontaneous breathing trial (SBT): T-piece (T-T) vs pressure support ventilation (PSV).</p></div><div><h3>Design</h3><p>Prospective, interventionist and randomized study.</p></div><div><h3>Setting</h3><p>Intensive Care Unit (ICU) of Hospital del Mar.</p></div><div><h3>Participants</h3><p>Forty-three ventilated patients for at least 24 h and considered eligible for an SBT were included in the study between October 2017 and March 2020.</p></div><div><h3>Interventions</h3><p>30-min SBT with T-piece (T-T group, 20 patients) or 8-cmH₂O PSV and 5-cmH₂O positive end expiratory pressure (PSV group, 23 patients).</p></div><div><h3>Main variables of interest</h3><p>Demographics, clinical data, physiological variables, lung aeration evaluated with electrical impedance tomography (EIT) and lung ultrasound (LUS), and respiratory effort using diaphragmatic ultrasonography (DU) were collected at different timepoints: basal (BSL), end of SBT (EoSBT) and one hour after extubation (OTE).</p></div><div><h3>Results</h3><p>There were a loss of aeration measured with EIT and LUS in the different study timepoints, without statistical differences from BSL to OTE, between T-T and PSV [LUS: 3 (1, 5.5) AU vs 2 (1, 3) AU; p = 0.088; EELI: −2516.41 (−5871.88, 1090.46) AU vs −1992.4 (−3458.76, −5.07) AU; p = 0.918]. Percentage of variation between BSL and OTE, was greater when LUS was used compared to EIT (68.1% vs 4.9%, p ≤ 0.001). Diaphragmatic excursion trend to decrease coinciding with a loss of aeration during extubation.</p></div><div><h3>Conclusion</h3><p>T-T and PSV as different SBT strategies in ventilated patients do not show differences in aeration loss, nor estimated respiratory effort or tidal volume measured by EIT, LUS and DU.</p></div>","PeriodicalId":49268,"journal":{"name":"Medicina Intensiva","volume":"48 9","pages":"Pages 501-510"},"PeriodicalIF":2.7,"publicationDate":"2024-08-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142087900","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":"Subcutaneous emphysema everywhere!","authors":"Francisca Silva Cardoso,&nbsp;Rita Morais Passos","doi":"10.1016/j.medin.2024.01.007","DOIUrl":"10.1016/j.medin.2024.01.007","url":null,"abstract":"","PeriodicalId":49268,"journal":{"name":"Medicina Intensiva","volume":"48 9","pages":"Pages 557-558"},"PeriodicalIF":2.7,"publicationDate":"2024-08-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142087903","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":"Harlequin syndrome: a picture speaks a thousand words","authors":"Jorge Martínez-Solano ,&nbsp;Nerea Alava-Echevarría ,&nbsp;Iago Sousa-Casasnovas","doi":"10.1016/j.medin.2024.01.006","DOIUrl":"10.1016/j.medin.2024.01.006","url":null,"abstract":"","PeriodicalId":49268,"journal":{"name":"Medicina Intensiva","volume":"48 9","pages":"Pages 561-562"},"PeriodicalIF":2.7,"publicationDate":"2024-08-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142087904","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":"Can end-tidal CO2 measurement replace arterial partial CO2 in emergency department respiratory distress management?","authors":"Kudret Selki,&nbsp;Mehmet Cihat Demir,&nbsp;Erdinç Şengüldür,&nbsp;Emre Erdem,&nbsp;Hatice Güldal,&nbsp;Murat Taşdemir,&nbsp;Alp Kaan Furkan Kıcıroğlu,&nbsp;Mustafa Boğan","doi":"10.1016/j.medin.2024.03.021","DOIUrl":"10.1016/j.medin.2024.03.021","url":null,"abstract":"<div><h3>Objective</h3><p>To assess the feasibility of using end-tidal carbon dioxide (EtCO₂) as a non-invasive substitute for partial pressure of arterial carbon dioxide (PaCO₂) in emergency department (ED) triage and follow-up, and to explore the potential of partial pressure of venous carbon dioxide (PvCO₂) as an alternative to PaCO₂.</p></div><div><h3>Design</h3><p>Prospective cross-sectional study.</p></div><div><h3>Setting</h3><p>Tertiary university hospital.</p></div><div><h3>Patients or participants</h3><p>97 patients presenting with acute respiratory distress to the ED.</p></div><div><h3>Interventions</h3><p>EtCO₂, arterial blood gases, and venous blood gases measured at admission (0 min), 60 min, and 120 min.</p></div><div><h3>Main variables of interest</h3><p>CO₂ levels.</p></div><div><h3>Results</h3><p>Among 97 patients (mean age: 70.93 ± 9.6 years; 60.8% male), EtCO₂ &gt; 45 mmHg at admission showed strong positive correlations with PaCO₂ and PvCO₂ (<em>r</em> = 0.844, <em>r</em> = 0.803; <em>p</em> &lt; 0.001, respectively). Significant positive correlation was observed between 60-min EtCO₂ and PaCO₂ (<em>r</em> = 0.729; <em>p</em> &lt; 0.001). Strong correlation between PaCO₂ and PvCO₂ at 120 min when EtCO₂ &gt; 45 mmHg (<em>r</em> = 0.870; <em>p</em> &lt; 0.001). EtCO₂ was higher in hospitalized patients compared to discharged ones.</p></div><div><h3>Conclusions</h3><p>EtCO₂ appears promising as a substitute for PaCO₂ in ED patients with acute respiratory distress within the initial two hours of treatment. Venous blood gas sampling offers a less invasive alternative to arterial sampling, facilitating simultaneous blood tests.</p></div>","PeriodicalId":49268,"journal":{"name":"Medicina Intensiva","volume":"48 9","pages":"Pages 511-519"},"PeriodicalIF":2.7,"publicationDate":"2024-08-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142087905","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":"Intrahospital transportation of mechanically-ventilated COVID-19 patients: a cohort study","authors":"Sara Ferreira Pagliarini ,&nbsp;Pedro Henrique Rigotti Soares ,&nbsp;Matheus Golenia dos Passos ,&nbsp;Leonardo da Silva Marques ,&nbsp;Wagner Nedel","doi":"10.1016/j.medin.2024.05.001","DOIUrl":"10.1016/j.medin.2024.05.001","url":null,"abstract":"","PeriodicalId":49268,"journal":{"name":"Medicina Intensiva","volume":"48 9","pages":"Pages 549-551"},"PeriodicalIF":2.7,"publicationDate":"2024-08-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142087901","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":"Nitric oxide as the third respiratory gas. A new opportunity to revisit the use of oxygen therapy in clinical practice","authors":"José Manuel Valencia-Gallardo ,&nbsp;Felipe Rodríguez de Castro ,&nbsp;Jordi Solé-Violán ,&nbsp;José Carlos Rodríguez-Gallego","doi":"10.1016/j.medin.2024.06.006","DOIUrl":"10.1016/j.medin.2024.06.006","url":null,"abstract":"","PeriodicalId":49268,"journal":{"name":"Medicina Intensiva","volume":"48 9","pages":"Pages 543-545"},"PeriodicalIF":2.7,"publicationDate":"2024-08-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142087908","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 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}