Medicina Intensiva最新文献

{"title":"«INTUPROS»: una oportunidad para reflexionar y mejorar","authors":"Andrea Viviani , Carlos Vicent , 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}

{"title":"Tratamiento médico del shock cardiogénico","authors":"Manuel García-Delgado ,&nbsp;Raquel Rodríguez-García ,&nbsp;Ana Ochagavía ,&nbsp;M. Ángeles Rodríguez-Esteban","doi":"10.1016/j.medin.2024.05.002","DOIUrl":"10.1016/j.medin.2024.05.002","url":null,"abstract":"<div><p>Cardiogenic shock is characterized by tissue hypoperfusion due to the inadequate cardiac output to maintain the tissue oxygen demand. Despite some advances in cardiogenic shock management, extremely high mortality is still associated with this clinical syndrome. Its management is based on the immediate stabilization of hemodynamic parameters through medical care and the use of mechanical circulatory supports in specialized centers. This review aims to understand the cardiogenic shock current medical treatment, consisting mainly of inotropic drugs, vasopressors and coronary revascularization. In addition, we highlight the relevance of applying measures to other organ levels based on the optimization of mechanical ventilation and the appropriate initiation of renal replacement therapy.</p></div>","PeriodicalId":49268,"journal":{"name":"Medicina Intensiva","volume":"48 8","pages":"Pages 477-486"},"PeriodicalIF":2.7,"publicationDate":"2024-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141954521","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 rate-trauma: the new world order?","authors":"Aurio Fajardo-Campoverdi ,&nbsp;Miguel Ibarra-Estrada ,&nbsp;Alejandro González-Castro ,&nbsp;Alejandra Cortés ,&nbsp;Juan Núñez-Silveira","doi":"10.1016/j.medin.2024.03.002","DOIUrl":"10.1016/j.medin.2024.03.002","url":null,"abstract":"","PeriodicalId":49268,"journal":{"name":"Medicina Intensiva","volume":"48 8","pages":"Pages 490-492"},"PeriodicalIF":2.7,"publicationDate":"2024-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141954522","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":"Hacia una mejor predicción de la mortalidad en pacientes oncológicos en UCI: análisis comparativo de escalas pronósticas: revisión sistemática de la literatura","authors":"Andrea Cabrera Losada ,&nbsp;Maria Alejandra Correa Oviedo ,&nbsp;Vanessa Carolina Herrera Villazón ,&nbsp;Sebastián Gil-Tamayo ,&nbsp;Carlos Federico Molina ,&nbsp;Carola Gimenez-Esparza Vich ,&nbsp;Víctor Hugo Nieto Estrada","doi":"10.1016/j.medin.2024.06.008","DOIUrl":"10.1016/j.medin.2024.06.008","url":null,"abstract":"<div><h3>Objective</h3><div>To evaluate the predictive ability of mortality prediction scales in cancer patients admitted to intensive care units.</div></div><div><h3>Design</h3><div>A systematic review of the literature was conducted using a search algorithm in October 2022. The following databases were searched: PubMed, Scopus, Virtual Health Library (BVS), and Medrxiv. The risk of bias was assessed using the QUADAS-2 scale.</div></div><div><h3>Setting</h3><div>Intensive care units admitting cancer patients.</div></div><div><h3>Participants</h3><div>Studies that included adult patients with an active cancer diagnosis who were admitted to the intensive care unit.</div></div><div><h3>Interventions</h3><div>Integrative study without interventions.</div></div><div><h3>Main variables of interest</h3><div>Mortality prediction, standardized mortality, discrimination, and calibration.</div></div><div><h3>Results</h3><div>Seven mortality risk prediction models were analyzed in cancer patients in the ICU. Most models (APACHE II, APACHE IV, SOFA, SAPS-II, SAPS-III, and MPM II) underestimated mortality, while the ICMM overestimated it. The APACHE II had the SMR (Standardized Mortality Ratio) value closest to 1, suggesting a better prognostic ability compared to the other models.</div></div><div><h3>Conclusions</h3><div>Predicting mortality in intensive care unit cancer patients remains an intricate challenge due to the lack of a definitive superior model and the inherent limitations of available prediction tools. For evidence-based informed clinical decision-making, it is crucial to consider the healthcare team's familiarity with each tool and its inherent limitations. Developing novel instruments or conducting large-scale validation studies is essential to enhance prediction accuracy and optimize patient care in this population.</div></div>","PeriodicalId":49268,"journal":{"name":"Medicina Intensiva","volume":"48 12","pages":"Pages e30-e40"},"PeriodicalIF":2.7,"publicationDate":"2024-07-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141840890","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}