Medicina intensiva最新文献

{"title":"ECPR … Ready for it?","authors":"Sara Alcántara Carmona, Héctor Villanueva Fernández","doi":"10.1016/j.medine.2024.07.010","DOIUrl":"10.1016/j.medine.2024.07.010","url":null,"abstract":"","PeriodicalId":94139,"journal":{"name":"Medicina intensiva","volume":"48 10","pages":"Pages 563-564"},"PeriodicalIF":0.0,"publicationDate":"2024-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141879991","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":"Effectiveness of Helmet-CPAP in mild to moderate coronavirus type 2 hypoxemia: An observational study","authors":"","doi":"10.1016/j.medine.2024.03.007","DOIUrl":"10.1016/j.medine.2024.03.007","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<span> oxygen therapy (HFNO) in avoiding greater need for intubation or mortality in a medium complexity hospital in Chile during the year 2021.</span></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<span> due to coronavirus type 2.</span></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><span>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 </span>hypoxemia<span> 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.</span></p></div>","PeriodicalId":94139,"journal":{"name":"Medicina intensiva","volume":"48 8","pages":"Pages 437-444"},"PeriodicalIF":0.0,"publicationDate":"2024-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140308451","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":"“INTUPROS”: an opportunity to reflect upon and improve","authors":"","doi":"10.1016/j.medine.2024.04.014","DOIUrl":"10.1016/j.medine.2024.04.014","url":null,"abstract":"","PeriodicalId":94139,"journal":{"name":"Medicina intensiva","volume":"48 8","pages":"Pages 493-494"},"PeriodicalIF":0.0,"publicationDate":"2024-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140878248","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":"Towards better mortality prediction in cancer patients in the ICU: a comparative analysis of prognostic scales: systematic literature review","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.medine.2024.07.009","DOIUrl":"10.1016/j.medine.2024.07.009","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 (ICUs).</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>ICUs 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 ICU.</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 ICU 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":94139,"journal":{"name":"Medicina intensiva","volume":"48 12","pages":"Pages e30-e40"},"PeriodicalIF":0.0,"publicationDate":"2024-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141879993","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":"Duration of the first prone positioning maneuver and its association with 90-day mortality in patients with acute respiratory failure due to COVID-19: A retrospective study of time terciles","authors":"","doi":"10.1016/j.medine.2024.04.009","DOIUrl":"10.1016/j.medine.2024.04.009","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 (<em>n</em> = 111), second tertile (<em>n</em> = 95) and third tertile (<em>n</em> = 65). The results indicated that the median duration of PDP was 14 h (95% CI: 10−16 h) in the first tertile, 19 h (95% CI: 18−20 h) in the second tertile and 22 h (95% CI: 21−24 h) in the third tertile. Comparison of survival curves using the Logrank test did not reach statistical significance (<em>p</em> = 0.11). 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":94139,"journal":{"name":"Medicina intensiva","volume":"48 8","pages":"Pages 457-466"},"PeriodicalIF":0.0,"publicationDate":"2024-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140865583","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":"Emphysematous cystitis in the postoperative period of aortic valve replacement.","authors":"Iratxe Iriondo Irigoras, M Ángeles Rodríguez Esteban","doi":"10.1016/j.medine.2024.07.007","DOIUrl":"https://doi.org/10.1016/j.medine.2024.07.007","url":null,"abstract":"","PeriodicalId":94139,"journal":{"name":"Medicina intensiva","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2024-07-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141857472","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":"Anti-Xa activity below range is related to thrombosis in patients with severe COVID-19.","authors":"Pilar Marcos-Neira, Cristian Morales-Indiano, Mariana Fernández-Caballero, Teresa Tomasa-Irriguible, Luisa Bordejé-Laguna, Víctor Ruíz-Artola","doi":"10.1016/j.medine.2024.07.003","DOIUrl":"https://doi.org/10.1016/j.medine.2024.07.003","url":null,"abstract":"<p><strong>Objective: </strong>We aimed to anlayse the relationship between anti-Xa activity below range and thomboembolic events.</p><p><strong>Design: </strong>Single center prospective observational longitudinal cohort study (February-November 2021).</p><p><strong>Setting: </strong>Patients admitted to the ICU of a University Hospital.</p><p><strong>Participants: </strong>Patients with severe COVID-19 pneumoniae.</p><p><strong>Interventions: </strong>Enoxaparin was used for prophylactic and therapeutic anticoagulation. Enoxaparin dosing and dose adjustment were based on anti-Xa activity according to the hospital protocol.</p><p><strong>Main variables of interest: </strong>Target: thomboembolic events.</p><p><strong>Predictors: </strong>demographics, pharmacotherapy, anti-Xa measurements, clinical data, and laboratory results. Logistic regression was used to identify independent risk factors for thomboembolic events.</p><p><strong>Results: </strong>Data were available for 896 serum anti-Xa measurements from 228 subjects. Overall, 71.9% were male, with a median age of 62. Most patients needed invasive mechanical ventilation (87.7%) and mortality was 24.1%. A total of 28.9% new thomboembolic events were diagnosed. There were 27.1% anti-Xa measesurements below range. When multivariable logistic regression analysis was performed anti-Xa activity below range (RR, 4.2; p = 0.000), C-reactive protein (25 mg/L increase) (RR, 1.14; p = 0.005) and D-dimer (1000 ng/L increase) (RR, 1.06; p = 0.002) were the independent factors related to new thomboembolic events in patients with severe COVID-19.</p><p><strong>Conclusions: </strong>Anti-Xa activity below range, C-reactive protein and D-dimer were the independent factors related to thomboembolic events in patients with severe COVID-19. Purposely designed clinical trials should be carried out to confirm the benefit of an anti-Xa monitoring.</p>","PeriodicalId":94139,"journal":{"name":"Medicina intensiva","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2024-07-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141763660","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":"Impact of high-flow oxygen therapy via high velocity nasal insufflation on diaphragmatic thickening fraction in healthy subjects","authors":"Gustavo Adrián Plotnikow ,&nbsp;Facundo José Federico Bianchini ,&nbsp;Roque Moracci ,&nbsp;Jaime Andrés Santana Mackinlay ,&nbsp;Federico Melgarejo ,&nbsp;Malena Paula Loustau ,&nbsp;Valeria Silvina Acevedo ,&nbsp;Emanuel Di Salvo ,&nbsp;Facundo Javier Gutierrez ,&nbsp;Matias Madorno ,&nbsp;Javier Mariani","doi":"10.1016/j.medine.2024.05.017","DOIUrl":"10.1016/j.medine.2024.05.017","url":null,"abstract":"<div><h3>Objective</h3><div>The primary objective of this study was to evaluate the impact of high-flow nasal cannula oxygen therapy [HFNC] on the diaphragm thickening fraction.</div></div><div><h3>Design</h3><div>Prospective, descriptive, cohort study</div></div><div><h3>Setting</h3><div>The study was conducted in the Physiology and Respiratory Care Laboratory, Intensive Care Unit, Hospital Británico de Buenos Aires.</div></div><div><h3>Participants</h3><div>Thirteen healthy subjects &gt;18 years old</div></div><div><h3>Interventions</h3><div>High-flow nasal cannula oxygen therapy</div></div><div><h3>Main variables of interest</h3><div>Demographic data (age and gender), anthropometric data (weight, height, and body mass index), and clinical and respiratory variables (Diaphragm thickening fraction [DTf], esophageal pressure swing, respiratory rate [RR], esophageal pressure-time product per minute [PTPes/min]).</div></div><div><h3>Results</h3><div>Median DTf decreased significantly as flow increased (p &lt; 0.05). The baseline DTf measurement was 21.4 %, 18.3 % with 20 L/m, and 16.4 % with 40 L/m. We also observed a significant decrease in RR as flow increased in HFNC (p &lt; 0.05). In the 8 subjects with recordings, the PTPes/min was 81.3 (±30.8) cmH2O/sec/min and 64.4 (±25.3) cmH₂O/sec/min at baseline and 40 L/m respectively (p = 0.044).</div></div><div><h3>Conclusions</h3><div>The use of high-flow oxygen therapy through nasal cannula of HFNC in healthy subjects decreases the DTf and RR in association with increased flow. In addition, the use of 40 L/m flow may reduce the muscular work associated with respiration.</div></div>","PeriodicalId":94139,"journal":{"name":"Medicina intensiva","volume":"48 12","pages":"Pages 686-692"},"PeriodicalIF":0.0,"publicationDate":"2024-07-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141763662","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":"Stress relaxation, another cause of “Pseudo auto-PEEP”?","authors":"Manuel Valdivia Marchal ,&nbsp;María Carmen Bermúdez Ruiz ,&nbsp;José Ricardo Naranjo Izurieta ,&nbsp;Ashlen Rodríguez Carmona ,&nbsp;Juan Francisco Martínez Carmona ,&nbsp;José Manuel Serrano Simón","doi":"10.1016/j.medine.2024.07.002","DOIUrl":"10.1016/j.medine.2024.07.002","url":null,"abstract":"","PeriodicalId":94139,"journal":{"name":"Medicina intensiva","volume":"48 12","pages":"Pages 731-734"},"PeriodicalIF":0.0,"publicationDate":"2024-07-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141728412","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":"Risk factors and outcome of acute kidney injury in critically ill patients with SARS-CoV-2 pneumonia: a multicenter study.","authors":"Iban Oliva, Cristina Ferré, Xavier Daniel, Marc Cartanyà, Christian Villavicencio, Melina Salgado, Loreto Vidaur, Elisabeth Papiol, Fj González de Molina, María Bodí, Manuel Herrera, Alejandro Rodríguez","doi":"10.1016/j.medine.2024.06.022","DOIUrl":"https://doi.org/10.1016/j.medine.2024.06.022","url":null,"abstract":"<p><strong>Objective: </strong>To assess incidence, risk factors and impact of acute kidney injury(AKI) within 48 h of intensive care unit(ICU) admission on ICU mortality in patients with SARS-CoV-2 pneumonia. To assess ICU mortality and risk factors for continuous renal replacement therapy (CRRT) in AKI I and II patients.</p><p><strong>Design: </strong>Retrospective observational study.</p><p><strong>Setting: </strong>Sixty-seven ICU from Spain, Andorra, Ireland.</p><p><strong>Patients: </strong>5399 patients March 2020 to April 2022.</p><p><strong>Main variables of interest: </strong>Demographic variables, comorbidities, laboratory data (worst values) during the first two days of ICU admission to generate a logistic regression model describing independent risk factors for AKI and ICU mortality. AKI was defined according to current international guidelines (kidney disease improving global outcomes, KDIGO).</p><p><strong>Results: </strong>Of 5399 patients included 1879 (34.8%) developed AKI. These patients had higher ICU mortality and AKI was independently associated with a higher ICU mortality (HR 1.32 CI 1.17-1.48; p < 0.001). Male gender, hypertension, diabetes, obesity, chronic heart failure, myocardial dysfunction, higher severity scores, and procalcitonine were independently associated with the development of AKI. In AKI I and II patients the need for CRRT was 12.6% (217/1710). In these patients, APACHE II, need for mechanical ventilation in the first 24 h after ICU admission and myocardial dysfunction were associated with risk of needing CRRT. AKI I and II patients had a high ICU mortality (38.5%), especially if CRRT were required (64.1% vs. 34,8%; p < 0.001).</p><p><strong>Conclusions: </strong>Critically ill patients with SARS-CoV-2 pneumonia and AKI have a high ICU mortality. Even AKI I and II stages are associated with high risk of needing CRRT and ICU mortality.</p>","PeriodicalId":94139,"journal":{"name":"Medicina intensiva","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2024-07-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141604700","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}