Medicina Intensiva最新文献

英文中文

Giant lung abscess complicating pneumonia managed with veno venous extracorporeal membrane oxygenation 静脉体外膜肺氧合治疗肺炎并发的巨大肺脓肿

IF 2.7 4区医学 Q2 CRITICAL CARE MEDICINE

Medicina Intensiva

Pub Date : 2024-11-01 DOI: 10.1016/j.medin.2024.04.008

引用次数: 0

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 通过 COVID-19 分析死腔分数与急性呼吸窘迫综合征患者死亡率的关系：一项历史队列观察研究。

IF 2.7 4区医学 Q2 CRITICAL CARE MEDICINE

Medicina Intensiva

Pub Date : 2024-11-01 DOI: 10.1016/j.medin.2024.05.007

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.

目的评估通过时间式毛细血管通气图测量的死腔分数（VD/VT）、校正分钟容量（CMV）和通气比（VR）与需要进行有创机械通气的 COVID-19 患者的临床预后之间的关系。主要关注变量VD/VT、CMV、VR、人口统计学数据、氧合作用指数和通气参数。结果在研究期间，分析了 1047 名接受机械通气的 COVID-19 患者，其中 446 人（42%）死亡。死亡患者的高龄和肥胖比例较高，Charlson 指数升高，APACHE II 和 SOFA 评分较高，机械通气第一天的 VD/VT 比值（存活者为 0.27，死亡者为 0.31）和分钟通气量也有所增加。多变量分析显示，与院内死亡率、较高的VD/VT（HR：1.24；95% CI：1.003-1.525；P = 0.046）、年龄（HR：1.024；95% CI：1.014-1.034；P<；0.001）和发病时的 SOFA 评分（HR：1.036；95% CI：1.001-1.07；P = 0.017）。结论VD/VT 显示与 COVID-19 ARDS 机械通气患者的死亡率有关。这些研究结果表明，VD/VT 测量可作为疾病严重程度的标志。

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引用次数: 0

Análisis de los errores de medicación en Cuidados Intensivos Neonatales: una revisión sistemática 新生儿重症监护中的用药错误分析：系统性综述

IF 2.7 4区医学 Q2 CRITICAL CARE MEDICINE

Medicina Intensiva

Pub Date : 2024-11-01 DOI: 10.1016/j.medin.2024.06.012

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.

在重症监护环境下护理的新生儿中，可能造成伤害和潜在伤害的用药错误显著增加。从这个意义上说，本研究对新生儿重症监护中用药错误的最新证据进行了系统性回顾分析，讨论的主题涉及智能泵等医疗技术、药物的成本效益、护理专业人员在用药过程中的实践以及质量改进模式。因此，它可被视为促进新生儿重症监护质量和安全的有用工具。

引用次数: 0

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 根据脓毒症重症患者的乳酸、降钙素原和钙黏蛋白联合序列水平建立死亡率预测模型：根据败血症-3 定义进行的回顾性研究

IF 2.7 4区医学 Q2 CRITICAL CARE MEDICINE

Medicina Intensiva

Pub Date : 2024-11-01 DOI: 10.1016/j.medin.2024.05.004

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.

目标1）评估基线和24小时血清钙蛋白与典型生物标志物（乳酸和降钙素原）相比，对重症脓毒症患者28天死亡率的预后能力；以及2）建立一个结合三种生物标志物的预测模型。干预措施测量基线乳酸、降钙素原和钙黏蛋白水平，以及24小时的降钙素原和钙黏蛋白水平。主要关注变量人口统计学和合并症，入ICU时的SOFA评分，入院时和24小时的基线乳酸、降钙素原和钙黏蛋白水平，以及28天的死亡率。结果1）在重症监护室入院时，乳酸盐是唯一一个具有显著准确性的生物标志物（AUC：0.698）；2）在 24 小时内，降钙素原和钙蛋白水平没有发现差异。非幸存者的降钙素原和钙黏蛋白清除率明显较低，两者均达到中等水平（AUC：分别为 0.668 和 0.664）；3）基于生物标记物的模型具有显著的准确性（AUC：0.766），与单独的 SOFA 评分相比呈上升趋势（AUC：0.829）；4）基线乳酸水平、降钙素原和钙黏蛋白清除率是预测结果的独立指标。结论1）基线和 24 小时钙蛋白和降钙素水平缺乏预测 28 天死亡率的能力；2）两种生物标记物清除率的准确性一般；3）SOFA 评分与基于生物标记物的预测模型相结合显示出较高的预后准确性。

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引用次数: 0

Aneurisma de aorta abdominal complicado con fístula aortocava 腹主动脉瘤并发主动脉腔瘘

IF 2.7 4区医学 Q2 CRITICAL CARE MEDICINE

Medicina Intensiva

Pub Date : 2024-11-01 DOI: 10.1016/j.medin.2024.02.011

引用次数: 0

Seguridad del paciente, ¿qué aportan la simulación clínica y la innovación docente? 患者安全，临床模拟和教学创新的贡献是什么？

IF 2.7 4区医学 Q2 CRITICAL CARE MEDICINE

Medicina Intensiva

Pub Date : 2024-11-01 DOI: 10.1016/j.medin.2024.06.016

引用次数: 0

Early identification of a knotted peripherally inserted central venous catheter 外周插入式中心静脉导管打结的早期识别

IF 2.7 4区医学 Q2 CRITICAL CARE MEDICINE

Medicina Intensiva

Pub Date : 2024-11-01 DOI: 10.1016/j.medin.2024.03.001

引用次数: 0

Endoftalmitis endógena en un caso de meningitis meningocócica 一例脑膜炎球菌性脑膜炎患者的内源性眼内炎

IF 2.7 4区医学 Q2 CRITICAL CARE MEDICINE

Medicina Intensiva

Pub Date : 2024-11-01 DOI: 10.1016/j.medin.2024.03.010

引用次数: 0

The effect of different definitions of hepatic injury on incidence and mortality rates in the ICU patient population with secondary hepatic injury 肝损伤的不同定义对重症监护病房继发性肝损伤患者发病率和死亡率的影响

IF 2.7 4区医学 Q2 CRITICAL CARE MEDICINE

Medicina Intensiva

Pub Date : 2024-11-01 DOI: 10.1016/j.medin.2024.05.013

Objective

The aim was to investigate how different hepatic injury (HI) definitions used in the same study population change incidence and mortality rates and which would best diagnose secondary HI.

Design

Single-centre retrospective observational cohort study.

Setting

Tertiary hospital ICU, ANKARA, Turkey.

Patients

Four hundred seventy-eight adult patients were included in the study.

Interventions

None.

Main variables of interest

Three definitions of HI were compared. Taking the SOFA hepatic criteria (SOFA: Total bilirubin (TBL) > 1.2 mg/dl) as the gold standard, sensitivity, specificity, positive and negative predictive values, and accuracy of the modified 2017 definition by the American College of Gastroenterology (ACG) and the 2019 European Association for the Study of the Liver (EASL) were calculated.

Results

Incidence rates ranged from 10% to 45% according to the definition (p < 0.005), while mortality rates ranged from 38% to 57%. When the SOFA1.2 (TBL > 1.2 definition was taken as the gold standard, the diagnostic value of the ACG definition was high, and HI was found to be an independent risk factor that increased mortality four times.

Conclusions

According to this study’s results, the incidence and mortality rates of secondary HI vary greatly depending on the definition used. A definition that includes minimal increases in ALT, AST, and TBL predicts mortality with reasonable incidence rates.

目的研究在同一研究人群中使用不同的肝损伤（HI）定义会如何改变发病率和死亡率，以及哪种定义能最好地诊断继发性肝损伤。以SOFA肝脏标准（SOFA：总胆红素（TBL）> 1.2 mg/dl）为金标准，计算了美国胃肠病学院（ACG）和2019年欧洲肝脏研究协会（EASL）修改后的2017年定义的敏感性、特异性、阳性和阴性预测值以及准确性。结果根据定义的不同，发病率从10%到45%不等（P< 0.005），而死亡率从38%到57%不等。当把 SOFA1.2 (TBL > 1.2 定义作为金标准时，ACG 定义的诊断价值很高，而且发现 HI 是一个独立的危险因素，会使死亡率增加四倍。包括谷丙转氨酶（ALT）、谷草转氨酶（AST）和总胆碱酯酶（TBL）微小升高的定义可预测死亡率，且发病率合理。

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引用次数: 0

Incidence of venous thromboembolic disease and risk of bleeding in critically ill patients with hematologic malignancies: A retrospective study 血液恶性肿瘤重症患者的静脉血栓栓塞性疾病发病率和出血风险：回顾性研究

IF 2.7 4区医学 Q2 CRITICAL CARE MEDICINE

Medicina Intensiva

Pub Date : 2024-11-01 DOI: 10.1016/j.medin.2024.05.014

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/).

目标我们的目标是描述血液恶性肿瘤（HM）重症患者血栓预防措施的使用情况和 VTE/出血的发生率。主要关注变量我们分析了人口统计学数据、血栓预防措施的使用情况以及次要结果，包括 VTE（静脉血栓栓塞症）发生率、出血、死亡率、严重程度评分和器官支持。我们采用多变量逻辑回归模型来研究重症监护病房血栓形成的风险。65%的入院患者接受了血栓预防治疗（LMWH 14%、UFH 8%、SCDs 43%）；21%的患者因血小板减少而禁用；14%的病例缺乏预防记录。VTE病例共有38例（深静脉血栓27例、聚乙烯醇11例），占重症监护病房病例的4.4%。大多数 VTE 病例发生在不同程度血小板减少的患者身上。在多变量分析中，ICU 第一天的 SOFA 评分与 VTE 风险独立相关（OR 0.85，95% CI 0.76-0.96）。出血发生率为7.2%（轻微）和14.4%（严重）；最常见的部位是中枢神经系统、腹部/消化道和肺部。VTE发生率为4.4%，大出血发生率为14%。血液恶性肿瘤和造血细胞移植患者的静脉血栓栓塞症：一项回顾性研究》(https://clinicaltrials.gov/)。

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