Medicina intensiva最新文献

{"title":"Moral complexity in the organ donation process: A prudential act","authors":"","doi":"10.1016/j.medine.2024.05.007","DOIUrl":"10.1016/j.medine.2024.05.007","url":null,"abstract":"","PeriodicalId":94139,"journal":{"name":"Medicina intensiva","volume":"48 9","pages":"Pages 555-556"},"PeriodicalIF":0.0,"publicationDate":"2024-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141066237","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","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":"","doi":"10.1016/j.medine.2024.04.011","DOIUrl":"10.1016/j.medine.2024.04.011","url":null,"abstract":"<div><h3>Objective</h3><p>To assess the feasibility of using end-tidal carbon dioxide (EtCO₂<span>) as a non-invasive substitute for partial pressure<span> of arterial carbon dioxide (PaCO</span></span>₂<span>) in emergency department (ED) triage and follow-up, and to explore the potential of partial pressure of venous carbon dioxide (PvCO</span>₂) 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<span><span>, arterial blood gases, and </span>venous blood gases measured at admission (0 min), 60 min, and 120 min.</span></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":94139,"journal":{"name":"Medicina intensiva","volume":"48 9","pages":"Pages 511-519"},"PeriodicalIF":0.0,"publicationDate":"2024-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140870712","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Acute respiratory distress syndrome at high altitude: Considerations for diagnosis and treatment","authors":"Adrián Avila-Hilari ,&nbsp;Amilcar Tinoco-Solórzano ,&nbsp;Jorge Vélez-Páez ,&nbsp;Daniel Molano Franco ,&nbsp;Felipe de Jesús Montelongo ,&nbsp;Manuel Luis Avellanas-Chavala","doi":"10.1016/j.medine.2024.04.018","DOIUrl":"10.1016/j.medine.2024.04.018","url":null,"abstract":"","PeriodicalId":94139,"journal":{"name":"Medicina intensiva","volume":"48 9","pages":"Pages 546-548"},"PeriodicalIF":0.0,"publicationDate":"2024-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141763659","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","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":"","doi":"10.1016/j.medine.2024.02.002","DOIUrl":"10.1016/j.medine.2024.02.002","url":null,"abstract":"","PeriodicalId":94139,"journal":{"name":"Medicina intensiva","volume":"48 9","pages":"Pages 561-562"},"PeriodicalIF":0.0,"publicationDate":"2024-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139992297","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Right ventricular dysfunction in the critically ill. Echocardiographic evaluation","authors":"Virginia Fraile-Gutiérrez ,&nbsp;Lluis Zapata-Fenor ,&nbsp;Aaron Blandino-Ortiz ,&nbsp;Manuel Guerrero-Mier ,&nbsp;Ana Ochagavia-Calvo","doi":"10.1016/j.medine.2024.06.019","DOIUrl":"10.1016/j.medine.2024.06.019","url":null,"abstract":"<div><p>Right ventricular dysfunction is common in critically ill patients, and is associated with increased mortality. Its diagnosis moreover remains challenging. In this review, we aim to outline the potential mechanisms underlying abnormal biomechanics of the right ventricle and the different injury phenotypes. A comprehensive understanding of the pathophysiology and natural history of right ventricular injury can be informative for the intensivist in the diagnosis and management of this condition, and may serve to guide individualized treatment strategies.</p><p>We describe the main recommended parameters for assessing right ventricular systolic and diastolic function. We also define how to evaluate cardiac output and pulmonary circulation pressures with echocardiography, with a focus on the diagnosis of acute cor pulmonale and relevant applications in critical disorders such as distress, septic shock, and right ventricular infarction.</p></div>","PeriodicalId":94139,"journal":{"name":"Medicina intensiva","volume":"48 9","pages":"Pages 528-542"},"PeriodicalIF":0.0,"publicationDate":"2024-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141857473","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"A shattered heart: Discovery of two lethal mechanical complications.","authors":"Alberto Garrido Callén, Irene Fernández Muñoz, Marta Martín Muñoz","doi":"10.1016/j.medine.2024.08.001","DOIUrl":"https://doi.org/10.1016/j.medine.2024.08.001","url":null,"abstract":"","PeriodicalId":94139,"journal":{"name":"Medicina intensiva","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2024-08-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142116532","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Incorporating the perspective of the critically ill patient: A matter of fashion or necessity?","authors":"Olga Rubio Sanchiz ,&nbsp;Joan Escarrabill","doi":"10.1016/j.medine.2024.07.005","DOIUrl":"10.1016/j.medine.2024.07.005","url":null,"abstract":"","PeriodicalId":94139,"journal":{"name":"Medicina intensiva","volume":"48 12","pages":"Pages 737-739"},"PeriodicalIF":0.0,"publicationDate":"2024-08-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142116534","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Removal of giant bronchial clot with cryoadhesion probe.","authors":"Mónica García Simón, Cristina Sanchís Piqueras, Georgia García Fernández","doi":"10.1016/j.medine.2024.07.012","DOIUrl":"https://doi.org/10.1016/j.medine.2024.07.012","url":null,"abstract":"","PeriodicalId":94139,"journal":{"name":"Medicina intensiva","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2024-08-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142019978","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Outcomes of an extracorporeal cardiopulmonary resuscitation (ECPR) program for in- and out-of-hospital cardiac arrest in a tertiary hospital in Spain","authors":"María Martínez-Martínez ,&nbsp;María Vidal-Burdeus ,&nbsp;Jordi Riera ,&nbsp;Aitor Uribarri ,&nbsp;Elisabet Gallart ,&nbsp;Laia Milà ,&nbsp;Pau Torrella ,&nbsp;Irene Buera ,&nbsp;Luis Chiscano-Camon ,&nbsp;Bruno García del Blanco ,&nbsp;Carlota Vigil-Escalera ,&nbsp;José A. Barrabés ,&nbsp;Jordi Llaneras ,&nbsp;Juan Carlos Ruiz-Rodríguez ,&nbsp;Cristopher Mazo ,&nbsp;Jorge Morales ,&nbsp;Ricard Ferrer ,&nbsp;Ignacio Ferreira-Gonzalez ,&nbsp;Eduard Argudo","doi":"10.1016/j.medine.2024.06.021","DOIUrl":"10.1016/j.medine.2024.06.021","url":null,"abstract":"<div><h3>Objective</h3><div>To analyze if the implementation of a multidisciplinary extracorporeal cardiopulmonary resuscitation (ECPR) program in a tertiary hospital in Spain is feasible and could yield survival outcomes similar to international published experiences.</div></div><div><h3>Design</h3><div>Retrospective observational cohort study.</div></div><div><h3>Setting</h3><div>One tertiary referral university hospital in Spain.</div></div><div><h3>Patients</h3><div>All adult patients receiving ECPR between January 2019 and April 2023.</div></div><div><h3>Interventions</h3><div>Prospective collection of variables and follow-up for up to 180 days.</div></div><div><h3>Main variables of interest</h3><div>To assess outcomes, survival with good neurological outcome defined as a Cerebral Performance Categories scale 1–2 at 180 days was used. Secondary variables were collected including demographics and comorbidities, cardiac arrest and cannulation characteristics, ROSC, ECMO-related complications, survival to ECMO decannulation, survival at Intensive Care Unit (ICU) discharge, survival at 180 days, neurological outcome, cause of death and eligibility for organ donation.</div></div><div><h3>Results</h3><div>Fifty-four patients received ECPR, 29 for OHCA and 25 for IHCA. Initial shockable rhythm was identified in 27 (50%) patients. The most common cause for cardiac arrest was acute coronary syndrome [29 (53.7%)] followed by pulmonary embolism [7 (13%)] and accidental hypothermia [5 (9.3%)]. Sixteen (29.6%) patients were alive at 180 days, 15 with good neurological outcome. Ten deceased patients (30.3%) became organ donors after neuroprognostication.</div></div><div><h3>Conclusions</h3><div>The implementation of a multidisciplinary ECPR program in an experienced Extracorporeal Membrane Oxygenation center in Spain is feasible and can lead to good survival outcomes and valid organ donors.</div></div>","PeriodicalId":94139,"journal":{"name":"Medicina intensiva","volume":"48 10","pages":"Pages 565-574"},"PeriodicalIF":0.0,"publicationDate":"2024-08-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141891449","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Hemodynamic monitoring and echocardiographic evaluation in cardiogenic shock","authors":"Ana Ochagavía ,&nbsp;Nora Palomo-López ,&nbsp;Virginia Fraile ,&nbsp;Luis Zapata","doi":"10.1016/j.medine.2024.07.001","DOIUrl":"10.1016/j.medine.2024.07.001","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":94139,"journal":{"name":"Medicina intensiva","volume":"48 10","pages":"Pages 602-613"},"PeriodicalIF":0.0,"publicationDate":"2024-08-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141891448","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}