Pub Date : 2024-11-26DOI: 10.1016/j.medin.2024.04.003
Alexandra Paula, David Mestre, Denise Pinto
{"title":"Echo-guided left internal jugular vein central venous catheter insertion, with its tip in the left internal thoracic vein","authors":"Alexandra Paula, David Mestre, Denise Pinto","doi":"10.1016/j.medin.2024.04.003","DOIUrl":"10.1016/j.medin.2024.04.003","url":null,"abstract":"","PeriodicalId":49268,"journal":{"name":"Medicina Intensiva","volume":"48 12","pages":"Pages e41-e42"},"PeriodicalIF":2.7,"publicationDate":"2024-11-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142721584","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}
Pub Date : 2024-11-26DOI: 10.1016/j.medin.2024.06.001
Gabriella Gambadoro , Brian J. Kopp , Brian L. Erstad
Objective
The purpose of this scoping review was to evaluate literature involving opioid-sparing medications in critically ill patients with a focus on clinically meaningful outcomes.
Design
Scoping review using the Preferred Reporting Items for Systematic Reviews and Meta-Analyses extension for Scoping Reviews.
Setting
Intensive care unit.
Patients or participants
Adult patients in an intensive care unit setting.
Interventions
None.
Main variables of interest
PubMed and Cochrane Library were searched from October 1, 2019 to June 1, 2023. Inclusion criteria consisted of randomized controlled trials evaluating adjunctive analgesic use in adult patients in an intensive care unit setting.
Results
There were 343 citations and titles identified in the initial search, with 328 remaining after removal of duplicates, 294 excluded at title and abstract screening, 34 available for full text review, and six included in the scoping review. Most studies reported modest reductions in opioid use as a secondary endpoint. Improvement in clinical outcomes such as reduction in duration of mechanical ventilation or delirium were reported in two trials with dexmedetomidine.
Conclusions
In recently published trials of adjunctive agents in critically ill patients, opioid-sparing effects were small. Data to support improvements in clinical outcomes remains limited.
{"title":"Implications of opioid-sparing medications in critically ill patients: A scoping review","authors":"Gabriella Gambadoro , Brian J. Kopp , Brian L. Erstad","doi":"10.1016/j.medin.2024.06.001","DOIUrl":"10.1016/j.medin.2024.06.001","url":null,"abstract":"<div><h3>Objective</h3><div>The purpose of this scoping review was to evaluate literature involving opioid-sparing medications in critically ill patients with a focus on clinically meaningful outcomes.</div></div><div><h3>Design</h3><div>Scoping review using the Preferred Reporting Items for Systematic Reviews and Meta-Analyses extension for Scoping Reviews.</div></div><div><h3>Setting</h3><div>Intensive care unit.</div></div><div><h3>Patients or participants</h3><div>Adult patients in an intensive care unit setting.</div></div><div><h3>Interventions</h3><div>None.</div></div><div><h3>Main variables of interest</h3><div>PubMed and Cochrane Library were searched from October 1, 2019 to June 1, 2023. Inclusion criteria consisted of randomized controlled trials evaluating adjunctive analgesic use in adult patients in an intensive care unit setting.</div></div><div><h3>Results</h3><div>There were 343 citations and titles identified in the initial search, with 328 remaining after removal of duplicates, 294 excluded at title and abstract screening, 34 available for full text review, and six included in the scoping review. Most studies reported modest reductions in opioid use as a secondary endpoint. Improvement in clinical outcomes such as reduction in duration of mechanical ventilation or delirium were reported in two trials with dexmedetomidine.</div></div><div><h3>Conclusions</h3><div>In recently published trials of adjunctive agents in critically ill patients, opioid-sparing effects were small. Data to support improvements in clinical outcomes remains limited.</div></div>","PeriodicalId":49268,"journal":{"name":"Medicina Intensiva","volume":"48 12","pages":"Pages 693-703"},"PeriodicalIF":2.7,"publicationDate":"2024-11-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142721575","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}
Pub Date : 2024-11-26DOI: 10.1016/j.medin.2024.08.007
Francesco Sbrana, Umberto Startari, Alessia Gimelli, Beatrice Dal Pino
{"title":"In-hospital cardiac arrest simulation program in a cardiopulmonary critical care unit: A pilot experience","authors":"Francesco Sbrana, Umberto Startari, Alessia Gimelli, Beatrice Dal Pino","doi":"10.1016/j.medin.2024.08.007","DOIUrl":"10.1016/j.medin.2024.08.007","url":null,"abstract":"","PeriodicalId":49268,"journal":{"name":"Medicina Intensiva","volume":"48 12","pages":"Pages 734-736"},"PeriodicalIF":2.7,"publicationDate":"2024-11-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142721581","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}
Pub Date : 2024-11-26DOI: 10.1016/j.medin.2024.03.013
Xiaoyang Zhou, Yuyi Sha, Bixin Chen
{"title":"Ultrasound artifacts “shred sign” and “pseudo-B lines” in the liver: What is the culprit?","authors":"Xiaoyang Zhou, Yuyi Sha, Bixin Chen","doi":"10.1016/j.medin.2024.03.013","DOIUrl":"10.1016/j.medin.2024.03.013","url":null,"abstract":"","PeriodicalId":49268,"journal":{"name":"Medicina Intensiva","volume":"48 12","pages":"Pages 740-741"},"PeriodicalIF":2.7,"publicationDate":"2024-11-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142721583","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}
Pub Date : 2024-11-26DOI: 10.1016/j.medin.2024.06.009
Manuel Valdivia Marchal , María Carmen Bermúdez Ruiz , José Ricardo Naranjo Izurieta , Ashlen Rodríguez Carmona , Juan Francisco Martínez Carmona , José Manuel Serrano Simón
{"title":"Stress relaxation, another cause of “Pseudo auto-PEEP”?","authors":"Manuel Valdivia Marchal , María Carmen Bermúdez Ruiz , José Ricardo Naranjo Izurieta , Ashlen Rodríguez Carmona , Juan Francisco Martínez Carmona , José Manuel Serrano Simón","doi":"10.1016/j.medin.2024.06.009","DOIUrl":"10.1016/j.medin.2024.06.009","url":null,"abstract":"","PeriodicalId":49268,"journal":{"name":"Medicina Intensiva","volume":"48 12","pages":"Pages 731-734"},"PeriodicalIF":2.7,"publicationDate":"2024-11-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142721580","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}
Pub Date : 2024-11-26DOI: 10.1016/j.medin.2024.05.006
David Pérez-Torres , Ana Isabel Martín-Luengo , Cristina Cuenca-Rubio , José Ángel Berezo-García , Cristina Díaz-Rodríguez , Isabel Canas-Pérez , María Lorena Fernández-Rodríguez , Cristina Colmenero-Calleja , Jesús Sánchez-Ballesteros , Pablo Blanco-Schweizer , Thalia Gloria Ticona-Espinoza , José María Piqueras-Pérez
Objective
To evaluate the effect of selective decontamination of the digestive tract (SDD) on hospital-acquired infections (HAIs) in patients with acute burn injury requiring admission to a Burns Unit (BU).
Design
Retrospective before-and-after cohort study, between January 2017 and June 2023. SDD was implemented in March 2019, dividing patients into two groups.
Setting
Four-bed BU, in a referral University Hospital in Spain.
Patients
All the patients admitted during the study period were eligible for analysis. Patients who died or were discharged within 48 hours of admission, and patients with an estimated survival less than 10% not considered for full escalation of therapy were excluded.
Intervention
SDD comprised the administration of a 4-day course of an intravenous antibiotic, and an oral suspension and oral topical paste of non-absorbable antibiotics during the stay in the BU.
Main variable of interest
Incidence of HAIs during the stay in the BU. Secondary outcomes: incidence of specific types of infections by site (bacteremia, pneumonia, skin and soft tissue infection) and microorganism (Gram-positive, Gram-negative, fungi), and safety endpoints.
Results
We analyzed 72 patients: 27 did not receive SDD, and 45 received SDD. The number of patients who developed HAIs were 21 (77.8%) and 21 (46.7%) in the non-SDD and the SDD groups, respectively (p = 0.009). The number of hospital-acquired infectious episodes were 2.52 (1.21–3.82) and 1.13 (0.54–1.73), respectively (p = 0.029).
Conclusions
SDD was associated with a reduced incidence of bacterial HAIs and a decrease in the number of infectious episodes per patient.
{"title":"Selective decontamination of the digestive tract in a burns unit reduces the incidence of hospital-acquired infections: A retrospective before-and-after cohort study","authors":"David Pérez-Torres , Ana Isabel Martín-Luengo , Cristina Cuenca-Rubio , José Ángel Berezo-García , Cristina Díaz-Rodríguez , Isabel Canas-Pérez , María Lorena Fernández-Rodríguez , Cristina Colmenero-Calleja , Jesús Sánchez-Ballesteros , Pablo Blanco-Schweizer , Thalia Gloria Ticona-Espinoza , José María Piqueras-Pérez","doi":"10.1016/j.medin.2024.05.006","DOIUrl":"10.1016/j.medin.2024.05.006","url":null,"abstract":"<div><h3>Objective</h3><div>To evaluate the effect of selective decontamination of the digestive tract (SDD) on hospital-acquired infections (HAIs) in patients with acute burn injury requiring admission to a Burns Unit (BU).</div></div><div><h3>Design</h3><div>Retrospective before-and-after cohort study, between January 2017 and June 2023. SDD was implemented in March 2019, dividing patients into two groups.</div></div><div><h3>Setting</h3><div>Four-bed BU, in a referral University Hospital in Spain.</div></div><div><h3>Patients</h3><div>All the patients admitted during the study period were eligible for analysis. Patients who died or were discharged within 48<!--> <!-->hours of admission, and patients with an estimated survival less than 10% not considered for full escalation of therapy were excluded.</div></div><div><h3>Intervention</h3><div>SDD comprised the administration of a 4-day course of an intravenous antibiotic, and an oral suspension and oral topical paste of non-absorbable antibiotics during the stay in the BU.</div></div><div><h3>Main variable of interest</h3><div>Incidence of HAIs during the stay in the BU. Secondary outcomes: incidence of specific types of infections by site (bacteremia, pneumonia, skin and soft tissue infection) and microorganism (Gram-positive, Gram-negative, fungi), and safety endpoints.</div></div><div><h3>Results</h3><div>We analyzed 72 patients: 27 did not receive SDD, and 45 received SDD. The number of patients who developed HAIs were 21 (77.8%) and 21 (46.7%) in the non-SDD and the SDD groups, respectively (p<!--> <!-->=<!--> <!-->0.009). The number of hospital-acquired infectious episodes were 2.52 (1.21–3.82) and 1.13 (0.54–1.73), respectively (p<!--> <!-->=<!--> <!-->0.029).</div></div><div><h3>Conclusions</h3><div>SDD was associated with a reduced incidence of bacterial HAIs and a decrease in the number of infectious episodes per patient.</div></div>","PeriodicalId":49268,"journal":{"name":"Medicina Intensiva","volume":"48 12","pages":"Pages 677-685"},"PeriodicalIF":2.7,"publicationDate":"2024-11-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142721573","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}
Pub Date : 2024-11-01DOI: 10.1016/j.medin.2024.05.007
Carlos Carvajal , Nelson Darío Giraldo Ramirez , Andrés David de la Hoz Castro , Carlos Guillermo Vidal Vargas , Hemel Antonio Pacheco , David Fernández Sánchez , Laura Vannesa González Salazar , Silvia Stella Romero Otta , Silvia Vergara Jaimes , Juan Fernando Bolívar Ospina , Juliana Correa Céspedes , Alejandro Narváez Orozco , Jorge Hernando Donado , Carlos Alberto Cadavid , Gisela de la Rosa
Objective
To assess the association between dead space fraction (VD/VT) measured through time capnography, corrected minute volume (CMV), and ventilation ratio (VR) with clinical outcomes in COVID-19 patients requiring invasive mechanical ventilation.
Design
Observational study of a historical cohort in an university hospital in Medellin, Colombia.
Participants
Patients aged 15 and above with confirmed COVID-19 diagnosis admitted to the ICU requiring mechanical ventilation; interventions: measurement of VD/VT, CMV, and VR in COVID-19 patients.
Main variables of interest
VD/VT, CMV, VR, demographic data, oxygenation index, and ventilatory parameters.
Results
During the study period, 1,047 COVID-19 patients on mechanical ventilation were analyzed, of whom 446 (42%) died. Deceased patients exhibited a higher prevalence of advanced age and obesity, elevated Charlson index, higher APACHE II and SOFA scores, as well as an increase in VD/VT ratio (0.27 in survivors and 0.31 in deceased) and minute ventilation volume on the first day of mechanical ventilation. Multivariate analysis revealed independent associations with in-hospital mortality, higher VD/VT (HR: 1.24; 95% CI: 1.003-1.525; P = 0.046), age (HR: 1.024; 95% CI: 1.014-1.034; P< 0.001), and SOFA score at onset (HR: 1.036; 95% CI: 1.001-1.07; P = 0.017).
Conclusions
VD/VT demonstrated an association with mortality in COVID-19 ARDS patients on mechanical ventilation. These findings suggest that VD/VT measurement may serve as a severity marker for the disease.
{"title":"Asociación de fracción de espacio muerto con la mortalidad en pacientes con síndrome de dificultad respiratoria aguda por COVID-19: Un estudio observacional de una cohorte histórica","authors":"Carlos Carvajal , Nelson Darío Giraldo Ramirez , Andrés David de la Hoz Castro , Carlos Guillermo Vidal Vargas , Hemel Antonio Pacheco , David Fernández Sánchez , Laura Vannesa González Salazar , Silvia Stella Romero Otta , Silvia Vergara Jaimes , Juan Fernando Bolívar Ospina , Juliana Correa Céspedes , Alejandro Narváez Orozco , Jorge Hernando Donado , Carlos Alberto Cadavid , Gisela de la Rosa","doi":"10.1016/j.medin.2024.05.007","DOIUrl":"10.1016/j.medin.2024.05.007","url":null,"abstract":"<div><h3>Objective</h3><div>To assess the association between dead space fraction (VD/VT) measured through time capnography, corrected minute volume (CMV), and ventilation ratio (VR) with clinical outcomes in COVID-19 patients requiring invasive mechanical ventilation.</div></div><div><h3>Design</h3><div>Observational study of a historical cohort in an university hospital in Medellin, Colombia.</div></div><div><h3>Participants</h3><div>Patients aged 15 and above with confirmed COVID-19 diagnosis admitted to the ICU requiring mechanical ventilation; interventions: measurement of VD/VT, CMV, and VR in COVID-19 patients.</div></div><div><h3>Main variables of interest</h3><div>VD/VT, CMV, VR, demographic data, oxygenation index, and ventilatory parameters.</div></div><div><h3>Results</h3><div>During the study period, 1,047 COVID-19 patients on mechanical ventilation were analyzed, of whom 446 (42%) died. Deceased patients exhibited a higher prevalence of advanced age and obesity, elevated Charlson index, higher APACHE II and SOFA scores, as well as an increase in VD/VT ratio (0.27 in survivors and 0.31 in deceased) and minute ventilation volume on the first day of mechanical ventilation. Multivariate analysis revealed independent associations with in-hospital mortality, higher VD/VT (HR: 1.24; 95% CI: 1.003-1.525; <em>P</em> <!-->=<!--> <!-->0.046), age (HR: 1.024; 95% CI: 1.014-1.034; <em>P</em><<!--> <!-->0.001), and SOFA score at onset (HR: 1.036; 95% CI: 1.001-1.07; <em>P</em> <!-->=<!--> <!-->0.017).</div></div><div><h3>Conclusions</h3><div>VD/VT demonstrated an association with mortality in COVID-19 ARDS patients on mechanical ventilation. These findings suggest that VD/VT measurement may serve as a severity marker for the disease.</div></div>","PeriodicalId":49268,"journal":{"name":"Medicina Intensiva","volume":"48 11","pages":"Pages 639-645"},"PeriodicalIF":2.7,"publicationDate":"2024-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142592597","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}
Pub Date : 2024-11-01DOI: 10.1016/j.medin.2024.06.012
Francisco Miguel Escandell-Rico , Lucia Pérez-Fernández
Medication errors, potentially causing harm and causing harm, increase significantly in newborns cared for in intensive care settings. In this sense, this work carries out a systematic review to analyze the most current evidence in relation to medication errors in neonatal intensive care, discussing the topics that refer to health technology from smart pumps, cost-effectiveness of medications, the practice of nursing professionals on the medication administration process and quality improvement models. In this way, it could be considered a useful tool to promote quality and safety in neonatal intensive care.
{"title":"Análisis de los errores de medicación en Cuidados Intensivos Neonatales: una revisión sistemática","authors":"Francisco Miguel Escandell-Rico , Lucia Pérez-Fernández","doi":"10.1016/j.medin.2024.06.012","DOIUrl":"10.1016/j.medin.2024.06.012","url":null,"abstract":"<div><div>Medication errors, potentially causing harm and causing harm, increase significantly in newborns cared for in intensive care settings. In this sense, this work carries out a systematic review to analyze the most current evidence in relation to medication errors in neonatal intensive care, discussing the topics that refer to health technology from smart pumps, cost-effectiveness of medications, the practice of nursing professionals on the medication administration process and quality improvement models. In this way, it could be considered a useful tool to promote quality and safety in neonatal intensive care.</div></div>","PeriodicalId":49268,"journal":{"name":"Medicina Intensiva","volume":"48 11","pages":"Pages 654-662"},"PeriodicalIF":2.7,"publicationDate":"2024-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141839311","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}
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