Medicina Intensiva最新文献

{"title":"Electrical impedance tomography: Usefulness for respiratory physiotherapy in critical illnesses","authors":"Ricardo Arriagada ,&nbsp;María Consuelo Bachmann ,&nbsp;Constanza San Martin ,&nbsp;Michela Rauseo ,&nbsp;Denise Battaglini","doi":"10.1016/j.medin.2024.02.012","DOIUrl":"https://doi.org/10.1016/j.medin.2024.02.012","url":null,"abstract":"<div><p>Respiratory physiotherapy, including the management of invasive mechanical ventilation (MV) and noninvasive mechanical ventilation (NIV), is a key supportive intervention for critically ill patients. MV has potential for inducing ventilator-induced lung injury (VILI) as well as long-term complications related to prolonged bed rest, such as post-intensive care syndrome and intensive care unit acquired weakness. Physical and respiratory therapy, developed by the critical care team, in a timely manner, has been shown to prevent these complications. In this pathway, real-time bedside monitoring of changes in pulmonary aeration and alveolar gas distribution associated with postural positioning, respiratory physiotherapy techniques and changes in MV strategies can be crucial in guiding these procedures, providing safe therapy and prevention of potential harm to the patient. Along this path, electrical impedance tomography (EIT) has emerged as a new key non-invasive bedside strategy free of radiation, to allow visualization of lung recruitment. This review article presents the main and potential applications of EIT in relation to physiotherapy techniques in the ICU setting.</p></div>","PeriodicalId":49268,"journal":{"name":"Medicina Intensiva","volume":"48 7","pages":"Pages 403-410"},"PeriodicalIF":2.7,"publicationDate":"2024-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141484492","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":"De fragilidad, calidad de vida y síndrome post-UCI","authors":"Arantxa Mas Serra","doi":"10.1016/j.medin.2024.04.001","DOIUrl":"10.1016/j.medin.2024.04.001","url":null,"abstract":"","PeriodicalId":49268,"journal":{"name":"Medicina Intensiva","volume":"48 7","pages":"Pages 375-376"},"PeriodicalIF":2.7,"publicationDate":"2024-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141055678","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":"Desafíos en el uso de albúmina intravenosa en pacientes críticamente enfermos: Reflexiones y perspectivas futuras","authors":"Alejandro González-Castro ,&nbsp;Raquel Ferrero-Franco ,&nbsp;Carmen Blanco Huelga","doi":"10.1016/j.medin.2024.03.016","DOIUrl":"10.1016/j.medin.2024.03.016","url":null,"abstract":"","PeriodicalId":49268,"journal":{"name":"Medicina Intensiva","volume":"48 7","pages":"Pages 429-430"},"PeriodicalIF":2.7,"publicationDate":"2024-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141057803","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":"Mediastinitis necrosante descendente en paciente sin inmunodepresión","authors":"David Roa Alonso,&nbsp;Juan Pedro Martínez García-Rodrigo,&nbsp;Fernando Fong Ruiz","doi":"10.1016/j.medin.2023.12.007","DOIUrl":"10.1016/j.medin.2023.12.007","url":null,"abstract":"","PeriodicalId":49268,"journal":{"name":"Medicina Intensiva","volume":"48 7","pages":"Page 435"},"PeriodicalIF":2.7,"publicationDate":"2024-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139966807","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":"Frailty in severe COVID-19 survivors after ICU admission. A prospective and multicenter study in Mexico","authors":"Oscar Peñuelas ,&nbsp;Manuel Lomelí ,&nbsp;Laura del Campo-Albendea ,&nbsp;Sara I. Toledo ,&nbsp;Alfredo Arellano ,&nbsp;Uriel Chavarría ,&nbsp;Maria Carmen Marín ,&nbsp;Karina Rosas ,&nbsp;María Alacíen Galván Merlos ,&nbsp;Roberto Mercado ,&nbsp;Héctor R. García-Lerma ,&nbsp;Enrique Monares ,&nbsp;Daira González ,&nbsp;Juan Pérez ,&nbsp;Andrés Esteban-Fernández ,&nbsp;Alfonso Muriel ,&nbsp;Fernando Frutos-Vivar ,&nbsp;Andrés Esteban","doi":"10.1016/j.medin.2024.02.009","DOIUrl":"https://doi.org/10.1016/j.medin.2024.02.009","url":null,"abstract":"<div><h3>Objective</h3><p>To analyze the presence of frailty in survivors of severe COVID-19 admitted in the Intensive Care Unit (ICU) and followed six months after discharge.</p></div><div><h3>Design</h3><p>An observational, prospective and multicenter, nation-wide study.</p></div><div><h3>Setting</h3><p>Eight adult ICU across eight academic acute care hospitals in Mexico.</p></div><div><h3>Patients</h3><p>All consecutive adult COVID-19 patients admitted in the ICU with acute respiratory failure between March 8, 2020 to February 28, 2021 were included. Frailty was defined according to the FRAIL scale, and was obtained at ICU admission and 6-month after hospital discharge.</p></div><div><h3>Interventions</h3><p>None.</p></div><div><h3>Main variables of interest</h3><p>The primary endpoint was the frailty status 6-months after discharge. A regression model was used to evaluate the predictors during ICU stay associated with frailty.</p></div><div><h3>Results</h3><p>196 ICU survivors were evaluated for basal frailty at ICU admission and were included in this analysis. After 6-months from discharge, 164 patients were evaluated for frailty: 40 patients (20.4%) were classified as non-frail, 67 patients (34.2%) as pre-frail and 57 patients (29.1%) as frail. After adjustment, the need of invasive mechanical ventilation was the only factor independently associated with frailty at 6 month follow-up (Odds Ratio [OR] 3.70, 95% confidence interval 1.40–9.81, <em>P</em> = .008).</p></div><div><h3>Conclusions</h3><p>Deterioration of frailty was reported frequently among ICU survivors with severe COVID-19 at 6-months. The need of invasive mechanical ventilation in ICU survivors was the only predictor independently associated with frailty.</p></div>","PeriodicalId":49268,"journal":{"name":"Medicina Intensiva","volume":"48 7","pages":"Pages 377-385"},"PeriodicalIF":2.7,"publicationDate":"2024-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141481286","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":"Embolia cerebral aérea espontánea secundaria a vulnerabilidad pulmonar","authors":"Alejandra Carmen Nasarre Puyuelo ,&nbsp;Daniel Sáenz Abad ,&nbsp;José María Ferreras Amez","doi":"10.1016/j.medin.2023.12.009","DOIUrl":"10.1016/j.medin.2023.12.009","url":null,"abstract":"","PeriodicalId":49268,"journal":{"name":"Medicina Intensiva","volume":"48 7","pages":"Pages 431-432"},"PeriodicalIF":2.7,"publicationDate":"2024-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139814481","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":"Valoración de la mortalidad traumática precoz mediante tomografía computarizada post mortem","authors":"Lidia Orejón García ,&nbsp;Laín Ibáñez Sanz ,&nbsp;Marcos Valiente Fernández ,&nbsp;Francisco de Paula Delgado Moya ,&nbsp;Elena Martinez Chamorro ,&nbsp;Mario Chico Fernández","doi":"10.1016/j.medin.2023.12.010","DOIUrl":"10.1016/j.medin.2023.12.010","url":null,"abstract":"","PeriodicalId":49268,"journal":{"name":"Medicina Intensiva","volume":"48 7","pages":"Pages 424-426"},"PeriodicalIF":2.7,"publicationDate":"2024-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139826047","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":"Situación actual y características de los centros especializados en el manejo de la hemorragia subaracnoidea aneurismática en España","authors":"Marta Bueso Navarro ,&nbsp;Arturo Zabalegui Pérez ,&nbsp;Aaron Blandino Ortiz ,&nbsp;Bárbara Vidal Tegedor ,&nbsp;Laura Galarza Barrachina ,&nbsp;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}