Medicina intensiva最新文献

{"title":"Assessment of the shock index in septic shock: A systematic review","authors":"Juan José Diaztagle Fernández ,&nbsp;Juan Pablo Castañeda-González ,&nbsp;José Ignacio Trujillo Zambrano ,&nbsp;Francy Esmith Duarte Martínez ,&nbsp;Miguel Ángel Saavedra Ortiz","doi":"10.1016/j.medine.2024.07.006","DOIUrl":"10.1016/j.medine.2024.07.006","url":null,"abstract":"<div><h3>Objective</h3><div>To identify published research on the Shock Index (SI) in patients with septic shock or severe sepsis and to describe its main findings and conclusions.</div></div><div><h3>Design</h3><div>Systematic review of the literature following the recommendations of the PRISMA protocol (Preferred Reporting Items for Systematic Reviews and Meta-Analyses).</div></div><div><h3>Settings</h3><div>The following databases were consulted: Pubmed, Embase, Library Cochrane and Lilacs.</div></div><div><h3>Patients</h3><div>Patients older than 14 years with septic shock. Pregnant women and population with COVID-19 were excluded.</div></div><div><h3>Interventions</h3><div>Studies reporting measurement of the shock index or its modified variants.</div></div><div><h3>Main variables of interest</h3><div>Absolute frequencies and relative frequencies were assessed with measures of central tendency and dispersion. Effect estimators (OR, RR and HR) were extracted according to the context of each study.</div></div><div><h3>Results</h3><div>Seventeen articles were included, of which 11 investigated the SI as a predictor of mortality. Seven of them found significant differences in the SI when comparing survivors to non-survivors and observed a relationship between the SI evolution and clinical outcomes. Additional research evidenced a relation between the Modified Shock Index and myocardial depression, as well as mortality. Furthermore, they identified a relationship between the Diastolic Shock Index, the dose of administered dobutamine, and mortality.</div></div><div><h3>Conclusions</h3><div>The results suggest that both the SI and its modified versions, particularly in serial assessments, can be considered for evaluating patient prognosis. The SI can also aid in determining fluid management for patients.</div></div>","PeriodicalId":94139,"journal":{"name":"Medicina intensiva","volume":"48 11","pages":"Pages e10-e19"},"PeriodicalIF":0.0,"publicationDate":"2024-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141763661","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":"Esophageal perforation secondary to achalasia","authors":"","doi":"10.1016/j.medine.2024.02.012","DOIUrl":"10.1016/j.medine.2024.02.012","url":null,"abstract":"","PeriodicalId":94139,"journal":{"name":"Medicina intensiva","volume":"48 11","pages":"Page 674"},"PeriodicalIF":0.0,"publicationDate":"2024-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140208747","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":"Incidence of venous thromboembolic disease and risk of bleeding in critically ill patients with hematologic malignancies: A retrospective study","authors":"","doi":"10.1016/j.medine.2024.06.003","DOIUrl":"10.1016/j.medine.2024.06.003","url":null,"abstract":"<div><h3>Objective</h3><div>Our objectives were to describe the use of thromboprophylaxis and the incidence of VTE/bleeding in critically ill patients with hematologic malignancies (HM).</div></div><div><h3>Design</h3><div>Retrospective cohort study (2014–2022).</div></div><div><h3>Setting</h3><div>Medic-Surgical Intensive Care Unit (ICU) in a tertiary care academic center.</div></div><div><h3>Patients</h3><div>Adult patients admitted to ICU with a concomitant diagnosis of a hematological malignancy.</div></div><div><h3>Interventions</h3><div>None.</div></div><div><h3>Main variables of interest</h3><div>We analyzed demographic data, use of thromboprophylaxis and secondary outcomes that included incidence of VTE (venous thromboembolism), bleeding, mortality, severity scores and organ support. We applied a multivariable logistic regression model to examine the risk of thrombosis in the ICU.</div></div><div><h3>Results</h3><div>We included 862 ICU admissions (813 unique patients). Thromboprophylaxis was given during 65% of admissions (LMWH 14%, UFH 8%, and SCDs 43%); in 21% it was contraindicated due to thrombocytopenia; 14% of cases lacked documentation on prophylaxis. There were 38 unique incident cases of VTE (27 DVT, 11 PE), constituting 4.4% of ICU episodes. Most of VTE cases happened in patients with various degrees of thrombocytopenia. In the multivariable analysis, SOFA score on the first ICU day was independently associated (OR 0.85, 95% CI 0.76−0.96) with the risk of VTE. Bleeding occurred in 7.2% (minor) and 14.4% (major) of episodes; most frequent sites being CNS, abdomen/GI and pulmonary.</div></div><div><h3>Conclusions</h3><div>In this cohort of critically ill patients with HM, there was considerable variability in the utilization of DVT prophylaxis, with predominant use of SCDs. The incidence of VTE was 4.4% and major bleeding 14%.</div></div><div><h3>Clinical Trial Registration</h3><div>NCT05396157. Venous Thromboembolism in Hematologic Malignancy and Hematopoietic Cell Transplant Patients: a Retrospective Study (<span><span>https://clinicaltrials.gov/</span><svg><path></path></svg></span>).</div></div>","PeriodicalId":94139,"journal":{"name":"Medicina intensiva","volume":"48 11","pages":"Pages e1-e9"},"PeriodicalIF":0.0,"publicationDate":"2024-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141437974","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Guided reversal of dabigatran in massive hemorrhagic shock: A case report.","authors":"Manuel Fernández Caro, Manuel Casado Méndez, Francisco Javier Rodríguez Martorell, Antonio Manuel Puppo Moreno","doi":"10.1016/j.medine.2024.10.002","DOIUrl":"https://doi.org/10.1016/j.medine.2024.10.002","url":null,"abstract":"","PeriodicalId":94139,"journal":{"name":"Medicina intensiva","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2024-10-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142515540","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":"Moral complexity in the organ donation process: The satisfaction of a job well done.","authors":"José Miguel Pérez-Villares, Ramón Lara-Rosales, Alberto Fernández-Carmona, Alberto Iglesias-Santiago","doi":"10.1016/j.medine.2024.07.014","DOIUrl":"https://doi.org/10.1016/j.medine.2024.07.014","url":null,"abstract":"","PeriodicalId":94139,"journal":{"name":"Medicina intensiva","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2024-10-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142515541","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":"The future of nursing in the intensive care unit: Specialization and advanced clinical practice - rivalry or synergy?","authors":"Mónica Vázquez-Calatayud","doi":"10.1016/j.medine.2024.08.003","DOIUrl":"10.1016/j.medine.2024.08.003","url":null,"abstract":"","PeriodicalId":94139,"journal":{"name":"Medicina intensiva","volume":"48 12","pages":"Pages 728-730"},"PeriodicalIF":0.0,"publicationDate":"2024-10-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142515543","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":"Early blood pressure drop predicts renal function deterioration and mortality in ICU patients with liver failure: a retrospective cohort study.","authors":"Rubing Guo, Jingjing Tong, Li Wang, Bo Yang, Liang Ma, Yongtong Cao, Wei Zhao","doi":"10.1016/j.medine.2024.10.005","DOIUrl":"https://doi.org/10.1016/j.medine.2024.10.005","url":null,"abstract":"<p><strong>Objective: </strong>To investigate the association between early blood pressure drop and worsening renal function (WRF) in ICU patients with liver failure and to evaluate their clinical outcomes.</p><p><strong>Design: </strong>Retrospective observational study.</p><p><strong>Setting: </strong>Intensive Care Medicine.</p><p><strong>Patients: </strong>Patients admitted to the ICU for the first time during their first hospitalization; diagnosed with liver failure according to the International Classification of Diseases, Ninth and Tenth Revision codes; and aged ≥18 years were included. Patients with a peak systolic blood pressure (SBP) drop of <0 mmHg were excluded.</p><p><strong>Intervention: </strong>We analyzed data of ICU patients with liver failure from the Medical Information Mart for Intensive Care IV version 2.2 database. Descriptive statistics, analysis of variance, Kruskal-Wallis test, and chi-square test were employed for analysis. Multivariate linear regression models were used to assess the determinants of blood pressure decline. Cox proportional hazards and generalized additive models were used to evaluate MAIN VARIABLES OF INTEREST: The relationship between blood pressure decline, WRF, and 60-day in-hospital mortality were evaluated, along with subgroup analyses.</p><p><strong>Results: </strong>Peak SBP drop was independently associated with higher risks of WRF (P < 0.001) and 60-day in-hospital mortality (P < 0.001), even after adjusting for potential confounders, including baseline SBP. The independent risk relationship observed between peak diastolic blood pressure, mean arterial pressure drop, and the occurrence of WRF and 60-day in-hospital mortality was similar.</p><p><strong>Conclusions: </strong>In ICU patients with liver failure, a significant early drop in blood pressure was associated with a higher incidence of WRF, increased risk of 60-day in-hospital mortality, and poorer prognoses.</p>","PeriodicalId":94139,"journal":{"name":"Medicina intensiva","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2024-10-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142515539","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":"Ten take-home messages on vasopressin use in critically ill patients","authors":"Ricard Ferrer ,&nbsp;Pedro Castro ,&nbsp;Carol Lorencio ,&nbsp;Josman Monclou ,&nbsp;Pilar Marcos ,&nbsp;Ana Ochagavia ,&nbsp;Juan Carlos Ruíz-Rodríguez ,&nbsp;Josep Trenado ,&nbsp;Christian Villavicencio ,&nbsp;Juan Carlos Yébenes ,&nbsp;Lluís Zapata ,&nbsp;on behalf of the SOCMIC Sepsis Working Group","doi":"10.1016/j.medine.2024.09.009","DOIUrl":"10.1016/j.medine.2024.09.009","url":null,"abstract":"<div><div>The most used vasopressors in critically ill patients are exogenous catecholamines, mainly norepinephrine. Their use can be associated with serious adverse events and even increased mortality, especially if administered at high doses. In recent years, the addition of vasopressin has been proposed to counteract the deleterious effects of high doses of catecholamines (decatecholaminization) with the intention of improving the prognosis of these patients. Currently, vasopressin has two main indications: septic shock and vasoplegic shock in the postoperative period of cardiac surgery. In septic shock, current evidence favors its early initiation before reaching high doses of norepinephrine. In the postoperative period of cardiac surgery, the different benefits of the use of vasopressin have been studied, especially in patients with atrial fibrillation and pulmonary hypertension. When used properly, vasopressin is a safe an effective drug for the indications described above.</div></div>","PeriodicalId":94139,"journal":{"name":"Medicina intensiva","volume":"48 12","pages":"Pages 704-713"},"PeriodicalIF":0.0,"publicationDate":"2024-10-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142515542","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":"Global definition of acute respiratory distress syndrome: An epidemiology perspective.","authors":"Pablo Cardinal-Fernández, Guillermo Ortiz, Luis Blanch","doi":"10.1016/j.medine.2024.10.001","DOIUrl":"https://doi.org/10.1016/j.medine.2024.10.001","url":null,"abstract":"","PeriodicalId":94139,"journal":{"name":"Medicina intensiva","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2024-10-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142484573","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 rare echocardiographic imaging of a giant atrial mass.","authors":"Pingping Dong, Jianneng Pan, Xiaoyang Zhou","doi":"10.1016/j.medine.2024.10.004","DOIUrl":"https://doi.org/10.1016/j.medine.2024.10.004","url":null,"abstract":"","PeriodicalId":94139,"journal":{"name":"Medicina intensiva","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2024-10-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142484571","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}