Medicina Intensiva最新文献

{"title":"Situación actual y características de los centros especializados en el manejo de la hemorragia subaracnoidea aneurismática en España","authors":"Marta Bueso Navarro , Arturo Zabalegui Pérez , Aaron Blandino Ortiz , Bárbara Vidal Tegedor , Laura Galarza Barrachina , en representación de los investigadores del estudio REMOS","doi":"10.1016/j.medin.2024.01.008","DOIUrl":"10.1016/j.medin.2024.01.008","url":null,"abstract":"","PeriodicalId":49268,"journal":{"name":"Medicina Intensiva","volume":"48 7","pages":"Pages 426-428"},"PeriodicalIF":2.7,"publicationDate":"2024-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140092675","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":"Embarazo crítico en la altitud: una mirada en América Latina","authors":"Adrián Avila-Hilari ,&nbsp;Amilcar Tinoco-Solórzano ,&nbsp;Jorge Vélez-Páez ,&nbsp;Manuel Luis Avellanas-Chavala ,&nbsp;en representación del Comité de Expertos de Medicina Crítica en la Altitud de la Federación Panamericana e Ibérica de Medicina Crítica y Terapia Intensiva (FEPIMCTI)","doi":"10.1016/j.medin.2024.03.019","DOIUrl":"10.1016/j.medin.2024.03.019","url":null,"abstract":"<div><p>Critical pregnancy at high altitudes increases morbidity and mortality from 2,500 meters above sea level. In addition to altitude, there are other influential factors such as social inequalities, cultural, prehospital barriers, and lack the appropriate development of healthcare infrastructure. The most frequent causes of critical pregnancy leading to admission to Intensive Care Units are pregnancy hypertensive disorders (native residents seem to be more protected), hemorrhages and infection/sepsis. In Latin America, there are 32 Intensive Care Units above 2,500 meters above sea level. Arterial blood gases at altitude are affected by changes in barometric pressure. The analysis of their values provides very useful information for the management of obstetric emergencies at very high altitude, especially respiratory and metabolic pathologies.</p></div>","PeriodicalId":49268,"journal":{"name":"Medicina Intensiva","volume":"48 7","pages":"Pages 411-420"},"PeriodicalIF":2.7,"publicationDate":"2024-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141052748","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":"Changes in pulmonary mechanics from supine to prone position measured through esophageal manometry in critically ill patients with COVID-19 severe acute respiratory distress syndrome","authors":"Ismael Maldonado-Beltrán ,&nbsp;Martín Armando Ríos-Ayala ,&nbsp;Iván Armando Osuna-Padilla ,&nbsp;Nadia Carolina Rodríguez-Moguel ,&nbsp;Gustavo Lugo-Goytia ,&nbsp;Carmen Margarita Hernández-Cárdenas","doi":"10.1016/j.medin.2023.07.003","DOIUrl":"https://doi.org/10.1016/j.medin.2023.07.003","url":null,"abstract":"<div><h3>Objective</h3><p>To describe changes in pulmonary mechanics when changing from supine position (SP) to prone position (PP) in mechanically ventilated (MV) patients with Acute Respiratory Distress Syndrome (ARDS) due to severe COVID-19.</p></div><div><h3>Design</h3><p>Retrospective cohort.</p></div><div><h3>Setting</h3><p>Intensive Care Unit of the National Institute of Respiratory Diseases (Mexico City).</p></div><div><h3>Patients</h3><p>COVID-19 patients on MV due to ARDS, with criteria for PP.</p></div><div><h3>Intervention</h3><p>Measurement of pulmonary mechanics in patients on SP to PP, using esophageal manometry.</p></div><div><h3>Main variables of interest</h3><p>Changes in lung and thoracic wall mechanics in SP and PP</p></div><div><h3>Results</h3><p>Nineteen patients were included. Changes during first prone positioning were reported. Reductions in lung stress (10.6 vs 7.7, p<!--> <!-->=<!--> <!-->0.02), lung strain (0.74 vs 0.57, p<!--> <!-->=<!--> <!-->0.02), lung elastance (p<!--> <!-->=<!--> <!-->0.01), chest wall elastance (p<!--> <!-->=<!--> <!-->0.003) and relation of respiratory system elastances (p<!--> <!-->=<!--> <!-->0.001) were observed between patients when changing from SP to PP. No differences were observed in driving pressure (p<!--> <!-->=<!--> <!-->0.19) and transpulmonary pressure during inspiration (p<!--> <!-->=<!--> <!-->0.70).</p></div><div><h3>Conclusions</h3><p>Changes in pulmonary mechanics were observed when patients were comparing values of supine position with measurements obtained 24<!--> <!-->h after prone positioning. Esophageal pressure monitoring may facilitate ventilator management despite patient positioning.</p></div>","PeriodicalId":49268,"journal":{"name":"Medicina Intensiva","volume":"48 7","pages":"Pages 386-391"},"PeriodicalIF":2.7,"publicationDate":"2024-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141481287","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":"Hydrocephalus treatment monitoring on transcranial and abdominal ultrasound","authors":"Pablo Blanco ,&nbsp;Liliana Figueroa ,&nbsp;Gustavo Ottaviano","doi":"10.1016/j.medin.2023.12.008","DOIUrl":"https://doi.org/10.1016/j.medin.2023.12.008","url":null,"abstract":"","PeriodicalId":49268,"journal":{"name":"Medicina Intensiva","volume":"48 7","pages":"Pages 433-434"},"PeriodicalIF":2.7,"publicationDate":"2024-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141481289","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":"The open data revolution: Enhancing healthcare in intensive care units","authors":"Sergio Muñoz-Lezcano ,&nbsp;Carmen de la Fuente ,&nbsp;Ángel Estella ,&nbsp;Rosario Amaya-Villar ,&nbsp;Antonio M. Puppo-Moreno ,&nbsp;Miguel Ángel Armengol-de la Hoz ,&nbsp;José Garnacho-Montero","doi":"10.1016/j.medin.2024.03.006","DOIUrl":"https://doi.org/10.1016/j.medin.2024.03.006","url":null,"abstract":"","PeriodicalId":49268,"journal":{"name":"Medicina Intensiva","volume":"48 7","pages":"Pages 421-423"},"PeriodicalIF":2.7,"publicationDate":"2024-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141481288","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":"Factores asociados a shock vasopléjico en el postoperatorio de cirugía cardiaca e influencia en la morbimortalidad del uso de arginina vasopresina como terapia de rescate","authors":"María Barrera Sánchez,&nbsp;Cristina Royo Villa,&nbsp;Pablo Ruiz de Gopegui Miguelena,&nbsp;Pablo Gutiérrez Ibañes,&nbsp;Andrés Carrillo López","doi":"10.1016/j.medin.2024.03.005","DOIUrl":"10.1016/j.medin.2024.03.005","url":null,"abstract":"<div><h3>Objectives</h3><p>Analizing associated factors with vasoplegic shock in the postoperative period of cardiac surgery. Analizing the influence of vasopressin as rescue therapy to first-line treatment with norepinephrine.</p></div><div><h3>Design</h3><p>Cohort, prospective and observational study.</p></div><div><h3>Setting</h3><p>Main hospital postoperative cardiac ICU.</p></div><div><h3>Patients</h3><p>Patients undergoing cardiac surgery with subsequent ICU admission from January 2021 to December 2022.</p></div><div><h3>Interventions</h3><p>Record of presurgical, perioperative and ICU discharge clinical variables.</p></div><div><h3>Main variables of interest</h3><p>Chronic treatment, presence of vasoplegic shock, need for vasopressin, cardiopulmonary bypass time, mortality.</p></div><div><h3>Results</h3><p>773 patients met the inclusion criteria. The average age was 67.3, with predominance of males (65.7%). Post-CPB vasoplegia was documented in 94 patients (12.2%). In multivariate analysis, vasoplegia was associated with age, female sex, presurgical creatinine levels, cardiopulmonary bypass time, lactate level upon admission to the ICU, and need for prothrombin complex transfusion. Of the patients who developed vasoplegia, 18 (19%) required rescue vasopressin, associated with pre-surgical intake of ACEIs/ARBs, worse EuroScore score and longer cardiopulmonary bypass time. Refractory vasoplegia with vasopressin requirement was associated with increased morbidity and mortality.</p></div><div><h3>Conclusions</h3><p>Postcardiopulmonary bypass vasoplegia is associated with increased mortality and morbidity. Shortening cardiopulmonary bypass times and minimizing products blood transfusion could reduce its development. Removing ACEIs and ARBs prior to surgery could reduce the incidence of refractory vasoplegia requiring rescue with vasopressin. The first-line treatment is norepinephrine and rescue treatment with vasopressin is a good choice in refractory situations. The first-line treatment of this syndrome is norepinephrine, although rescue with vasopressin is a good complement in refractory situations.</p></div>","PeriodicalId":49268,"journal":{"name":"Medicina Intensiva","volume":"48 7","pages":"Pages 392-402"},"PeriodicalIF":2.7,"publicationDate":"2024-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140771915","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":"Disfunción del ventrículo derecho en el paciente crítico. Evaluación ecocardiográfica","authors":"Virginia Fraile Gutiérrez ,&nbsp;Luis Zapata Fenor ,&nbsp;Aaron Blandino Ortiz ,&nbsp;Manuel Guerrero Mier ,&nbsp;Ana Ochagavia Calvo","doi":"10.1016/j.medin.2024.05.008","DOIUrl":"10.1016/j.medin.2024.05.008","url":null,"abstract":"<div><p>The impairment of the right ventricle is a common condition in critically ill patients. Right ventricular dysfunction is associated with increased mortality, and its diagnosis remains challenging. In this review, we aim to outline the potential mechanisms underlying abnormal biomechanics of the right ventricle and different phenotypes of injury. A comprehensive understanding of the pathophysiology and natural history of right ventricular injury may be informative for the intensivist in the diagnosis and management of this condition, as well as contributing to the guidance of individualized treatment strategies.</p><p>We describe the main recommended parameters to assess right ventricular systolic and diastolic function. We also define how to evaluate cardiac output and pressures of the pulmonary circulation with echocardiography, with a focus on the diagnosis of acute cor pulmonale and relevant applications in critical illnesses such as distress, septic shock, and right ventricular infarction.</p></div>","PeriodicalId":49268,"journal":{"name":"Medicina Intensiva","volume":"48 9","pages":"Pages 528-542"},"PeriodicalIF":2.7,"publicationDate":"2024-06-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142087907","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":"Impacto de la oxigenoterapia a alto flujo a través de la insuflación de gas a alta velocidad sobre la fracción de engrosamiento diafragmático en sujetos sanos","authors":"Gustavo Adrián Plotnikow ,&nbsp;Facundo José Federico Bianchini ,&nbsp;Roque Moracci ,&nbsp;Jaime Andrés Santana Mackinlay ,&nbsp;Federico Melgarejo ,&nbsp;Malena Paula Loustau ,&nbsp;Valeria Silvina Acevedo ,&nbsp;Emanuel Di Salvo ,&nbsp;Facundo Javier Gutierrez ,&nbsp;Matias Madorno ,&nbsp;Javier Mariani","doi":"10.1016/j.medin.2024.05.010","DOIUrl":"10.1016/j.medin.2024.05.010","url":null,"abstract":"<div><h3>Objective</h3><div>The primary objective of this study was to evaluate the impact of high-flow nasal cannula oxygen therapy [HFNC] on the diaphragm thickening fraction.</div></div><div><h3>Design</h3><div>Prospective, descriptive, cohort study</div></div><div><h3>Setting</h3><div>The study was conducted in the Physiology and Respiratory Care Laboratory, Intensive Care Unit, Hospital Británico de Buenos Aires.</div></div><div><h3>Participants</h3><div>Thirteen healthy subjects &gt;18 years old</div></div><div><h3>Interventions</h3><div>High-flow nasal cannula oxygen therapy</div></div><div><h3>Main variables of interest</h3><div>Demographic data (age and gender), anthropometric data (weight, height, and body mass index), and clinical and respiratory variables (Diaphragm thickening fraction [DTf], esophageal pressure swing, respiratory rate [RR], esophageal pressure-time product per minute [PTPes/min]).</div></div><div><h3>Results</h3><div>Median DTf decreased significantly as flow increased (<em>P</em> <!-->&lt;<!--> <!-->.05). The baseline DTf measurement was 21.4%, 18.3% with 20 l/m, and 16.4% with 40 l/m. We also observed a significant decrease in RR as flow increased in HFNC (<em>P</em> <!-->&lt;<!--> <!-->.05). In the 8 subjects with recordings, the PTPes/min was 81.3 cmH₂O/sec/min (±30.8) and 64.4 cmH₂O/sec/min (±25.3) at baseline and 40 l/m respectively (<em>P</em> <!-->=<!--> <!-->.044).</div></div><div><h3>Conclusions</h3><div>The use of high-flow oxygen therapy through nasal cannula of HFNC in healthy subjects decreases the DTf and RR in association with increased flow. In addition, the use of 40 l/m flow may reduce the muscular work associated with respiration.</div></div>","PeriodicalId":49268,"journal":{"name":"Medicina Intensiva","volume":"48 12","pages":"Pages 686-692"},"PeriodicalIF":2.7,"publicationDate":"2024-06-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142721574","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":"Monitorización hemodinámica y evaluación ecocardiográfica en el shock cardiogénico","authors":"Ana Ochagavía ,&nbsp;Nora Palomo-López ,&nbsp;Virginia Fraile ,&nbsp;Luis Zapata","doi":"10.1016/j.medin.2024.05.011","DOIUrl":"10.1016/j.medin.2024.05.011","url":null,"abstract":"<div><div>Cardiogenic shock (CS) is characterized by the presence of a state of tissue hypoperfusion secondary to ventricular dysfunction. Hemodynamic monitoring allows us to obtain information about cardiovascular pathophysiology that will help us make the diagnosis and guide therapy in CS situations. The most used monitoring system in CS is the pulmonary artery catheter since it provides key hemodynamic variables in CS, such as cardiac output, pulmonary artery pressure, and pulmonary artery occlusion pressure. On the other hand, echocardiography makes it possible to obtain, at the bedside, anatomical and hemodynamic data that complement the information obtained through continuous monitoring devices.</div><div>CS monitoring can be considered multimodal and integrative by including hemodynamic, metabolic, and echocardiographic parameters that allow describing the characteristics of CS and guiding therapeutic interventions during hemodynamic resuscitation.</div></div>","PeriodicalId":49268,"journal":{"name":"Medicina Intensiva","volume":"48 10","pages":"Pages 602-613"},"PeriodicalIF":2.7,"publicationDate":"2024-06-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142322287","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 los diferentes accesos vasculares en Unidad de Cuidados Intensivos Neonatales. ¿Es el catéter midline una alternativa útil para terapias prolongadas?","authors":"Alba de Tíscar Sánchez García ,&nbsp;Judith Lozano González ,&nbsp;Francisco José Canals Candela","doi":"10.1016/j.medin.2024.05.022","DOIUrl":"10.1016/j.medin.2024.05.022","url":null,"abstract":"<div><h3>Objective</h3><div>Analyze the usefulness of the midline catheter in terms of efficacy and safety for treatments lasting more than 3 days in the neonatal population requiring admission to the NICU.</div></div><div><h3>Design</h3><div>Analytical and observational of a prospective cohort (December 2021-November 2023) compared to a historical cohort (January 2020-November 2021).</div></div><div><h3>Setting</h3><div>9-bed Neonatal Intensive Care Unit (NICU, level III hospital.</div></div><div><h3>Patients or participants</h3><div>288, 66 midline group and 222 control group. Inclusion criteria: newborns from 24 to 42 weeks of gestation who required short peripheral or midline cannulation and treatment longer than 3 days.</div></div><div><h3>Interventions</h3><div>Follow-up during NICU stay and comparison with retrospective data from a historical cohort.</div></div><div><h3>Main variables of interest</h3><div>Sociodemographics, success rate (permanence of the same vascular catheter without complications until finish the prescribed treatment), number of catheters, cannulation rate per patient, indwell time, complications.</div></div><div><h3>Results</h3><div>The midline group showed a higher success rate (54.2% vs. 5.6%, <em>P</em>&lt;.001), a lower number of canalizations per patient <em>(P</em> &lt;.001), a longer indwell time <em>(P</em>&lt;.001) and a lower number of extravasations <em>(P</em>&lt;.001).</div></div><div><h3>Conclusions</h3><div>The midline catheter has advantages over short peripheral catheters, being a useful alternative in terms of efficacy and safety for treatments lasting more than 3 days in the neonatal population that requires admission to the NICU.</div></div>","PeriodicalId":49268,"journal":{"name":"Medicina Intensiva","volume":"48 12","pages":"Pages e23-e29"},"PeriodicalIF":2.7,"publicationDate":"2024-06-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142721576","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}