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}
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.2024.05.004
Luis García de Guadiana-Romualdo , Lourdes Albert Botella , Carlos Rodríguez Rojas , Angela Puche Candel , Roberto Jimenez Sánchez , Pablo Conesa Zamora , María Dolores Albaladejo-Otón , José Manuel Allegue-Gallego
Objective
1) To evaluate the ability of baseline and on 24 h serum calprotectin, in comparison to canonical biomarkers (lactate and procalcitonin), for prognosis of 28-day mortality in critically ill septic patients; and 2) To develop a predictive model combining the three biomarkers.
Design
A single-center, retrospective study.
Setting
Intensive Care Unit of a university hospital.
Patients or participants
One hundred and seventy three septic pacientes were included.
Interventions
Measurement of baseline lactate, procalcitonin and calprotectin level and procalcitonin and calprotectin levels on 24 h.
Main variables of interest
Demographics and comorbidities, SOFA score on ICU admission, baseline lactate, procalcitonin and calprotectin on admission and on 24 h and 28-day mortality.
Results
1) On ICU admission, lactate was the only biomarker achieving a significant accuracy (AUC: 0.698); 2) On 24 h, no differences were found on procalcitonin and calprotectin levels. Procalcitonin and calprotectin clearances were significantly lower in non-survivors and both achieved a moderate performance (AUCs: 0.668 and 0.664, respectively); 3) A biomarker based-model achieved a significant accuracy (AUC: 0.766), trending to increase (AUC: 0.829) to SOFA score alone; y 4) Baseline lactate levels and procalcitonin and calprotectin clearance were independent predictors for the outcome.
Conclusions
1) Baseline and on 24 h calprotectina and procalcitonin levels lacked ability in predicting 28-day mortality; 2) Accuracy of clearance of both biomarkers was moderate; and 3) Combination of SOFA score and the predictive biomarker based-model showed a high prognostic accuracy.
{"title":"Mortality prediction model from combined serial lactate, procalcitonin and calprotectin levels in critically ill patients with sepsis: A retrospective study according to Sepsis-3 definition","authors":"Luis García de Guadiana-Romualdo , Lourdes Albert Botella , Carlos Rodríguez Rojas , Angela Puche Candel , Roberto Jimenez Sánchez , Pablo Conesa Zamora , María Dolores Albaladejo-Otón , José Manuel Allegue-Gallego","doi":"10.1016/j.medin.2024.05.004","DOIUrl":"10.1016/j.medin.2024.05.004","url":null,"abstract":"<div><h3>Objective</h3><div>1) To evaluate the ability of baseline and on 24 h serum calprotectin, in comparison to canonical biomarkers (lactate and procalcitonin), for prognosis of 28-day mortality in critically ill septic patients; and 2) To develop a predictive model combining the three biomarkers.</div></div><div><h3>Design</h3><div>A single-center, retrospective study.</div></div><div><h3>Setting</h3><div>Intensive Care Unit of a university hospital.</div></div><div><h3>Patients or participants</h3><div>One hundred and seventy three septic pacientes were included.</div></div><div><h3>Interventions</h3><div>Measurement of baseline lactate, procalcitonin and calprotectin level and procalcitonin and calprotectin levels on 24 h.</div></div><div><h3>Main variables of interest</h3><div>Demographics and comorbidities, SOFA score on ICU admission, baseline lactate, procalcitonin and calprotectin on admission and on 24 h and 28-day mortality.</div></div><div><h3>Results</h3><div>1) On ICU admission, lactate was the only biomarker achieving a significant accuracy (AUC: 0.698); 2) On 24 h, no differences were found on procalcitonin and calprotectin levels. Procalcitonin and calprotectin clearances were significantly lower in non-survivors and both achieved a moderate performance (AUCs: 0.668 and 0.664, respectively); 3) A biomarker based-model achieved a significant accuracy (AUC: 0.766), trending to increase (AUC: 0.829) to SOFA score alone; y 4) Baseline lactate levels and procalcitonin and calprotectin clearance were independent predictors for the outcome.</div></div><div><h3>Conclusions</h3><div>1) Baseline and on 24 h calprotectina and procalcitonin levels lacked ability in predicting 28-day mortality; 2) Accuracy of clearance of both biomarkers was moderate; and 3) Combination of SOFA score and the predictive biomarker based-model showed a high prognostic accuracy.</div></div>","PeriodicalId":49268,"journal":{"name":"Medicina Intensiva","volume":"48 11","pages":"Pages 629-638"},"PeriodicalIF":2.7,"publicationDate":"2024-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142592596","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.2024.06.016
Antonio Dueñas-Ruiz , Luis M. Tamayo Lomas , Miguel A. Castro Villamor , Francisco Martín-Rodríguez
{"title":"Seguridad del paciente, ¿qué aportan la simulación clínica y la innovación docente?","authors":"Antonio Dueñas-Ruiz , Luis M. Tamayo Lomas , Miguel A. Castro Villamor , Francisco Martín-Rodríguez","doi":"10.1016/j.medin.2024.06.016","DOIUrl":"10.1016/j.medin.2024.06.016","url":null,"abstract":"","PeriodicalId":49268,"journal":{"name":"Medicina Intensiva","volume":"48 11","pages":"Pages 669-670"},"PeriodicalIF":2.7,"publicationDate":"2024-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141839078","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.2024.03.010
José Ginestal, Elena Álvaro, Zaira Molina
{"title":"Endoftalmitis endógena en un caso de meningitis meningocócica","authors":"José Ginestal, Elena Álvaro, Zaira Molina","doi":"10.1016/j.medin.2024.03.010","DOIUrl":"10.1016/j.medin.2024.03.010","url":null,"abstract":"","PeriodicalId":49268,"journal":{"name":"Medicina Intensiva","volume":"48 11","pages":"Page e20"},"PeriodicalIF":2.7,"publicationDate":"2024-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142592537","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.2024.01.012
{"title":"Perforación esofágica secundaria a una acalasia","authors":"","doi":"10.1016/j.medin.2024.01.012","DOIUrl":"10.1016/j.medin.2024.01.012","url":null,"abstract":"","PeriodicalId":49268,"journal":{"name":"Medicina Intensiva","volume":"48 11","pages":"Page 674"},"PeriodicalIF":2.7,"publicationDate":"2024-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140469450","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.2024.05.014
Federico C. Carini , Laveena Munshi , Igor Novitzky-Basso , Graham Dozois , Camila Heredia , Sotirios Damouras , Bruno L. Ferreyro , Sangeeta Mehta
Objective
Our objectives were to describe the use of thromboprophylaxis and the incidence of VTE/bleeding in critically ill patients with hematologic malignancies (HM).
Design
Retrospective cohort study (2014–2022).
Setting
Medic-Surgical Intensive Care Unit (ICU) in a tertiary care academic center.
Patients
Adult patients admitted to ICU with a concomitant diagnosis of a hematological malignancy.
Interventions
None.
Main variables of interest
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.
Results
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.
Conclusions
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%.
Clinical Trial Registration
NCT05396157. Venous Thromboembolism in Hematologic Malignancy and Hematopoietic Cell Transplant Patients: a Retrospective Study (https://clinicaltrials.gov/).
{"title":"Incidence of venous thromboembolic disease and risk of bleeding in critically ill patients with hematologic malignancies: A retrospective study","authors":"Federico C. Carini , Laveena Munshi , Igor Novitzky-Basso , Graham Dozois , Camila Heredia , Sotirios Damouras , Bruno L. Ferreyro , Sangeeta Mehta","doi":"10.1016/j.medin.2024.05.014","DOIUrl":"10.1016/j.medin.2024.05.014","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":49268,"journal":{"name":"Medicina Intensiva","volume":"48 11","pages":"Pages e1-e9"},"PeriodicalIF":2.7,"publicationDate":"2024-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142592601","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
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