Medicina intensiva最新文献_第5页

High flow in tracheostomized patients on their first attempt to wean from mechanical ventilation: more questions on the table. 首次尝试脱离机械通气的气管插管患者中的高流量：桌面上的更多问题。

Medicina intensiva Pub Date : 2024-09-14 DOI: 10.1016/j.medine.2024.09.002

Adrián Gallardo, Aldana Silvero, Santiago Saavedra

引用次数: 0

How to involve the patient and family in improving safety in intensive medicine services (SMI)? 如何让患者和家属参与改善重症医学服务（SMI）的安全性？

Medicina intensiva Pub Date : 2024-09-14 DOI: 10.1016/j.medine.2024.06.012

Olga Rubio Sanchiz, Joan Escarrabill, Joan Fernando Peidró, Anne Sophie Gresle

{"title":"How to involve the patient and family in improving safety in intensive medicine services (SMI)?","authors":"Olga Rubio Sanchiz, Joan Escarrabill, Joan Fernando Peidró, Anne Sophie Gresle","doi":"10.1016/j.medine.2024.06.012","DOIUrl":"https://doi.org/10.1016/j.medine.2024.06.012","url":null,"abstract":"<p><p>Patient safety is a priority for health systems and is especially relevant for critically ill patients. Despite its relevance in recent years, many patients suffer adverse events with harm and negative repercussions for professionals and institutions. Numerous safe practices have been promoted and strategies have been developed that have been incorporated into institutional policies and thereby improving the safety culture. But there are still underdeveloped strategies, such as incorporating the participation of patients and family members in their safety. Until recently, the patient and family have been considered as a passive part in the reception of health services, not as an active part, much less as a possible opportunity to improve safety against errors that occur during care. The critically ill patient and/or family members must be informed and, ideally, trained to facilitate active participation in their safety. It is not about transferring responsibility, but about facilitating and promoting their participation by reinforcing their safety. And professionals must be committed to their safety and facilitate the conditions to encourage their participation. We provide tools and reflections to help professionals implement the participation of patients and family members in safety as they pass through intensive medicine services.</p>","PeriodicalId":94139,"journal":{"name":"Medicina intensiva","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2024-09-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142305042","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}

引用次数: 0

Relationship between fluid overload and mortality and morbidity in pediatric intensive care unit. 儿科重症监护室液体超负荷与死亡率和发病率之间的关系。

Medicina intensiva Pub Date : 2024-09-14 DOI: 10.1016/j.medine.2024.09.001

Hilmi Bayirli, Nazan Ulgen Tekerek, Alper Koker, Oguz Dursun

{"title":"Relationship between fluid overload and mortality and morbidity in pediatric intensive care unit.","authors":"Hilmi Bayirli, Nazan Ulgen Tekerek, Alper Koker, Oguz Dursun","doi":"10.1016/j.medine.2024.09.001","DOIUrl":"https://doi.org/10.1016/j.medine.2024.09.001","url":null,"abstract":"<p><strong>Objective: </strong>The relationship between fluid overload and clinical outcomes was investigated.</p><p><strong>Design: </strong>This study is an observational and analytic study of a retrospective cohort.</p><p><strong>Settings: </strong>Pediatric intensive care units.</p><p><strong>Patients or participants: </strong>Between 2019 and 2021 children who needed intensive care were included in the study.</p><p><strong>Interventions: </strong>No intervention.</p><p><strong>Main variable of interest: </strong>Early, peak and cumulative fluid overload were evaluated.</p><p><strong>Results: </strong>The mortality rate was 11.7% (68/513). When fluid overloads were examined in terms of mortality, the percentage of early fluid overload was 1.86 and 3.35, the percent of peak fluid overload was 2.87 and 5.54, and the percent of cumulative fluid overload was 3.40 and 8.16, respectively, in the survivor and the non-survivor groups. After adjustment for age, severity of illness, and other potential confounders, peak (aOR = 1.15; 95%CI 1.05-1.26; p: 0.002) and cumulative (aOR = 1.10; 95%CI 1.04-1.16; p < 0.001) fluid overloads were determined as independent risk factors associated with mortality. When the cumulative fluid overload is 10% or more, a 3.9-fold increase mortality rate was calculated. It is found that the peak and cumulative fluid overload, had significant negative correlation with intensive care unit free days and ventilator free days.</p><p><strong>Conclusions: </strong>It is found that peak and cumulative fluid overload in critically ill children were independently associated with intensive care unit mortality and morbidity.</p>","PeriodicalId":94139,"journal":{"name":"Medicina intensiva","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2024-09-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142305043","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}

引用次数: 0

Strongyloides stercoralis hyperinfection syndrome: A rare but fatal challenge in the ICU 盘尾丝虫高感染综合征：重症监护室中罕见但致命的挑战。

Medicina intensiva Pub Date : 2024-09-01 DOI: 10.1016/j.medine.2024.02.011

引用次数: 0

Intrahospital transportation of mechanically-ventilated COVID-19 patients: a cohort study 机械通气的 COVID-19 患者的院内转运：一项队列研究。

Medicina intensiva Pub Date : 2024-09-01 DOI: 10.1016/j.medine.2024.05.008

引用次数: 0

High-flow nasal cannula in Spanish Pediatric Intensive Care Services: A national web survey about its use and indications 西班牙儿科重症监护服务中的高流量鼻插管：关于其使用和适应症的全国性网络调查

Medicina intensiva Pub Date : 2024-09-01 DOI: 10.1016/j.medine.2024.03.012

{"title":"High-flow nasal cannula in Spanish Pediatric Intensive Care Services: A national web survey about its use and indications","authors":"","doi":"10.1016/j.medine.2024.03.012","DOIUrl":"10.1016/j.medine.2024.03.012","url":null,"abstract":"<div><h3>Objective</h3><p>To describe the high-flow nasal cannula<span><span> (HFNC) indications in the Spanish pediatric </span>critical care units (PICUs).</span></p></div><div><h3>Design</h3><p>Descriptive cross-sectional observational study.</p></div><div><h3>Setting</h3><p>Electronic survey among members of the Spanish Society of Pediatric Intensive Care (SECIP). It was sent weekly from April 10, 2023, to May 21, 2023.</p></div><div><h3>Participants</h3><p>All SECIP members.</p></div><div><h3>Interventions</h3><p>None.</p></div><div><h3>Main variables of interest</h3><p>The questions focused on workplace, years of experience, use or non-use of HFNC, justification and expectations regarding its application, starting point within each center, clinical criteria for indication, existence of clinical guidelines, evaluation during its use, and criteria and mode of withdrawal.</p></div><div><h3>Results</h3><p><span><span><span>Two hundred and two participants, 176 were from Spain. Of these, 87/176 had over ten years of experience. One hundred sixty two use HFNC and 66/162 have HFNC clinical guidelines. Acute bronchiolitis (138/162) and respiratory assistance after </span>extubation (106/56) are the two main indications. For 62/162 HFNC may reduce therapeutic escalation. </span>Neuromuscular diseases<span> (105/162) and anatomical airway diseases (135/162) are the two main contraindications. The reasons to do not use HFNC were the </span></span>absence of evidence about it effectiveness (8/14) and its inadequate cost/effectiveness balance (8/14).</p></div><div><h3>Conclusions</h3><p>A majority of Spanish pediatric intensivists use HFNC. Its application and withdrawal appears to be primarily based on clinical experience. Besides, those who use HFNC are aware of its limitations and the lack of evidence in some cases. It is necessary to develop single-center and multicenter studies to elucidate the effectiveness of this therapy in the context of critically ill children.</p></div>","PeriodicalId":94139,"journal":{"name":"Medicina intensiva","volume":"48 9","pages":"Pages 520-527"},"PeriodicalIF":0.0,"publicationDate":"2024-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140766092","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}

引用次数: 0

Nitric oxide as the third respiratory gas. A new opportunity to revisit the use of oxygen therapy in clinical practice 一氧化氮作为第三种呼吸气体。重新审视氧疗在临床实践中的应用的新机遇。

Medicina intensiva Pub Date : 2024-09-01 DOI: 10.1016/j.medine.2024.06.016

引用次数: 0

Subcutaneous emphysema everywhere! 皮下气肿无处不在！

Medicina intensiva Pub Date : 2024-09-01 DOI: 10.1016/j.medine.2024.02.005

引用次数: 0

Comparing lung aeration and respiratory effort using two different spontaneous breathing trial: T-piece vs pressure support ventilation 使用两种不同的自主呼吸试验比较肺通气和呼吸努力：T型通气与压力支持通气。

Medicina intensiva Pub Date : 2024-09-01 DOI: 10.1016/j.medine.2023.07.010

{"title":"Comparing lung aeration and respiratory effort using two different spontaneous breathing trial: T-piece vs pressure support ventilation","authors":"","doi":"10.1016/j.medine.2023.07.010","DOIUrl":"10.1016/j.medine.2023.07.010","url":null,"abstract":"<div><h3>Objective</h3><p><span>To assess the changes in lung aeration<span> and respiratory effort generated by two different spontaneous breathing trial (SBT): T-piece (T-T) vs </span></span>pressure support ventilation (PSV).</p></div><div><h3>Design</h3><p>Prospective, interventionist and randomized study.</p></div><div><h3>Setting</h3><p>Intensive Care Unit (ICU) of Hospital del Mar.</p></div><div><h3>Participants</h3><p>Forty-three ventilated patients for at least 24 h and considered eligible for an SBT were included in the study between October 2017 and March 2020.</p></div><div><h3>Interventions</h3><p>30-min SBT with T-piece (T-T group, 20 patients) or 8-cmH<sub>2</sub>O PSV and 5-cmH<sub>2</sub><span>O positive end expiratory pressure (PSV group, 23 patients).</span></p></div><div><h3>Main variables of interest</h3><p><span>Demographics, clinical data, physiological variables, lung aeration evaluated with electrical impedance tomography<span> (EIT) and lung ultrasound (LUS), and respiratory effort using diaphragmatic ultrasonography (DU) were collected at different timepoints: basal (BSL), end of SBT (EoSBT) and one hour after </span></span>extubation (OTE).</p></div><div><h3>Results</h3><p>There were a loss of aeration measured with EIT and LUS in the different study timepoints, without statistical differences from BSL to OTE, between T-T and PSV [LUS: 3 (1, 5.5) AU vs 2 (1, 3) AU; p = 0.088; EELI: −2516.41 (−5871.88, 1090.46) AU vs −1992.4 (−3458.76, −5.07) AU; p = 0.918]. Percentage of variation between BSL and OTE, was greater when LUS was used compared to EIT (68.1% vs 4.9%, p ≤ 0.001). Diaphragmatic excursion trend to decrease coinciding with a loss of aeration during extubation.</p></div><div><h3>Conclusion</h3><p>T-T and PSV as different SBT strategies in ventilated patients do not show differences in aeration loss, nor estimated respiratory effort or tidal volume measured by EIT, LUS and DU.</p></div>","PeriodicalId":94139,"journal":{"name":"Medicina intensiva","volume":"48 9","pages":"Pages 501-510"},"PeriodicalIF":0.0,"publicationDate":"2024-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"41144202","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}

引用次数: 0

Before and after the first extracorporeal cardiopulmonary resuscitation due to accidental hypothermia in Spain 西班牙首例意外低体温导致的体外心肺复苏术前后。

Medicina intensiva Pub Date : 2024-09-01 DOI: 10.1016/j.medine.2024.06.013

引用次数: 0