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.
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.
{"title":"The effect of different definitions of hepatic injury on incidence and mortality rates in the ICU patient population with secondary hepatic injury","authors":"Gül Gürsel , Ayshan Mammadova , Eda Macit Aydın , Zeynep Çınar , Nurgül Navruzvai , Sümeyye Kodalak","doi":"10.1016/j.medin.2024.05.013","DOIUrl":"10.1016/j.medin.2024.05.013","url":null,"abstract":"<div><h3>Objective</h3><div>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.</div></div><div><h3>Design</h3><div>Single-centre retrospective observational cohort study.</div></div><div><h3>Setting</h3><div>Tertiary hospital ICU, ANKARA, Turkey.</div></div><div><h3>Patients</h3><div>Four hundred seventy-eight adult patients were included in the study.</div></div><div><h3>Interventions</h3><div>None.</div></div><div><h3>Main variables of interest</h3><div>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.</div></div><div><h3>Results</h3><div>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.</div></div><div><h3>Conclusions</h3><div>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.</div></div>","PeriodicalId":49268,"journal":{"name":"Medicina Intensiva","volume":"48 11","pages":"Pages 646-653"},"PeriodicalIF":2.7,"publicationDate":"2024-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142592598","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.2024.06.011
Juan José Diaztagle Fernández , Juan Pablo Castañeda-González , José Ignacio Trujillo Zambrano , Francy Esmith Duarte Martínez , Miguel Ángel Saavedra Ortiz
Objective
To identify published research on the Shock Index (SI) in patients with septic shock or severe sepsis and to describe its main findings and conclusions.
Design
Systematic review of the literature following the recommendations of the PRISMA protocol (Preferred Reporting Items for Systematic Reviews and Meta-Analyses).
Settings
The following databases were consulted: Pubmed, Embase, Library Cochrane and Lilacs.
Patients
Patients older than 14 years with septic shock. Pregnant women and population with COVID-19 were excluded.
Interventions
Studies reporting measurement of the shock index or its modified variants.
Main variables of interest
Absolute frequencies and relative frequencies were assessed with measures of central tendency and dispersion. Effect estimators (OR, RR and HR) were extracted according to the context of each study.
Results
Seventeen articles were included, of which 11 investigated the SI as a predictor of mortality. Seven of them found significant differences in the SI when comparing survivors to non-survivors and observed a relationship between the SI evolution and clinical outcomes. Additional research evidenced a relation between the Modified Shock Index and myocardial depression, as well as mortality. Furthermore, they identified a relationship between the Diastolic Shock Index, the dose of administered dobutamine, and mortality.
Conclusions
The results suggest that both the SI and its modified versions, particularly in serial assessments, can be considered for evaluating patient prognosis. The SI can also aid in determining fluid management for patients.
目的 确定已发表的有关脓毒性休克或严重脓毒症患者休克指数（SI）的研究，并描述其主要发现和结论。设计 按照 PRISMA 协议（系统综述和 Meta 分析首选报告项目）的建议对文献进行系统综述：患者14岁以上的脓毒性休克患者。干预措施报告休克指数或其修正变体测量结果的研究。主要关注变量用中心倾向和离散度评估绝对频率和相对频率。结果共纳入 17 篇文章，其中 11 篇研究了作为死亡率预测指标的休克指数。其中 7 篇文章发现，幸存者与非幸存者的 SI 存在明显差异，并观察到 SI 变化与临床结果之间的关系。其他研究证明了修正冲击指数与心肌抑制和死亡率之间的关系。此外，他们还确定了舒张性休克指数、多巴酚丁胺给药剂量与死亡率之间的关系。SI 还有助于确定患者的输液管理。
{"title":"Evaluación del índice de shock en choque séptico: una revisión sistemática","authors":"Juan José Diaztagle Fernández , Juan Pablo Castañeda-González , José Ignacio Trujillo Zambrano , Francy Esmith Duarte Martínez , Miguel Ángel Saavedra Ortiz","doi":"10.1016/j.medin.2024.06.011","DOIUrl":"10.1016/j.medin.2024.06.011","url":null,"abstract":"<div><h3>Objective</h3><div>To identify published research on the Shock Index (SI) in patients with septic shock or severe sepsis and to describe its main findings and conclusions.</div></div><div><h3>Design</h3><div>Systematic review of the literature following the recommendations of the PRISMA protocol (Preferred Reporting Items for Systematic Reviews and Meta-Analyses).</div></div><div><h3>Settings</h3><div>The following databases were consulted: Pubmed, Embase, Library Cochrane and Lilacs.</div></div><div><h3>Patients</h3><div>Patients older than 14 years with septic shock. Pregnant women and population with COVID-19 were excluded.</div></div><div><h3>Interventions</h3><div>Studies reporting measurement of the shock index or its modified variants.</div></div><div><h3>Main variables of interest</h3><div>Absolute frequencies and relative frequencies were assessed with measures of central tendency and dispersion. Effect estimators (OR, RR and HR) were extracted according to the context of each study.</div></div><div><h3>Results</h3><div>Seventeen articles were included, of which 11 investigated the SI as a predictor of mortality. Seven of them found significant differences in the SI when comparing survivors to non-survivors and observed a relationship between the SI evolution and clinical outcomes. Additional research evidenced a relation between the Modified Shock Index and myocardial depression, as well as mortality. Furthermore, they identified a relationship between the Diastolic Shock Index, the dose of administered dobutamine, and mortality.</div></div><div><h3>Conclusions</h3><div>The results suggest that both the SI and its modified versions, particularly in serial assessments, can be considered for evaluating patient prognosis. The SI can also aid in determining fluid management for patients.</div></div>","PeriodicalId":49268,"journal":{"name":"Medicina Intensiva","volume":"48 11","pages":"Pages e10-e19"},"PeriodicalIF":2.7,"publicationDate":"2024-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142592602","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.2024.07.005
María Jesús Broch Porcar, Álvaro Castellanos-Ortega
{"title":"Respuesta a «Seguridad del paciente, ¿qué aportan la simulación clínica y la innovación docente?»","authors":"María Jesús Broch Porcar, Álvaro Castellanos-Ortega","doi":"10.1016/j.medin.2024.07.005","DOIUrl":"10.1016/j.medin.2024.07.005","url":null,"abstract":"","PeriodicalId":49268,"journal":{"name":"Medicina Intensiva","volume":"48 11","pages":"Pages 670-671"},"PeriodicalIF":2.7,"publicationDate":"2024-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142592698","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.2024.06.004
Alejandro González-Castro , Elena Cuenca Fito , Carmen Huertas Martín , Yhivian Peñasco , Aurio Fajardo Campoverdi
{"title":"Análisis de los valores de carga de energía en ventilación mecánica en pacientes obesos con insuficiencia respiratoria hipoxémica secundaria a SARS-CoV-2","authors":"Alejandro González-Castro , Elena Cuenca Fito , Carmen Huertas Martín , Yhivian Peñasco , Aurio Fajardo Campoverdi","doi":"10.1016/j.medin.2024.06.004","DOIUrl":"10.1016/j.medin.2024.06.004","url":null,"abstract":"","PeriodicalId":49268,"journal":{"name":"Medicina Intensiva","volume":"48 11","pages":"Pages 663-666"},"PeriodicalIF":2.7,"publicationDate":"2024-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141847730","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 : 2024-09-26DOI: 10.1016/j.medin.2024.04.011
Jesús Abelardo Barea-Mendoza, Zaira Molina-Collado, María Ángeles Ballesteros-Sanz, Luisa Corral-Ansa, Maite Misis del Campo, Cándido Pardo-Rey, Juan Angel Tihista-Jiménez, Carmen Corcobado-Márquez, Juan Pedro Martín del Rincón, Juan Antonio Llompart-Pou, Luis Alfonso Marcos-Prieto, Ander Olazabal-Martínez, Rubén Herrán-Monge, Ana María Díaz-Lamas, Mario Chico-Fernández
Objective
To analyze the impact of positive end-expiratory pressure (PEEP) changes on intracranial pressure (ICP) dynamics in patients with acute brain injury (ABI).
Design
Observational, prospective and multicenter study (PEEP-PIC study).
Setting
Seventeen intensive care units in Spain.
Patients
Neurocritically ill patients who underwent invasive neuromonitorization from November 2017 to June 2018.
Interventions
Baseline ventilatory, hemodynamic and neuromonitoring variables were collected immediately before PEEP changes and during the following 30 min.
Main variables of interest
PEEP and ICP changes.
Results
One-hundred and nine patients were included. Mean age was 52.68 (15.34) years, male 71 (65.13%). Traumatic brain injury was the cause of ABI in 54 (49.54%) patients. Length of mechanical ventilation was 16.52 (9.23) days. In-hospital mortality was 21.1%. PEEP increases (mean 6.24–9.10 cmH2O) resulted in ICP increase from 10.4 to 11.39 mmHg, P < .001, without changes in cerebral perfusion pressure (CPP) (P = .548). PEEP decreases (mean 8.96 to 6.53 cmH2O) resulted in ICP decrease from 10.5 to 9.62 mmHg (P = .052), without changes in CPP (P = .762). Significant correlations were established between the increase of ICP and the delta PEEP (R = 0.28, P < .001), delta driving pressure (R = 0.15, P = .038) and delta compliance (R = −0.14, P = .052). ICP increment was higher in patients with lower baseline ICP.
Conclusions
PEEP changes were not associated with clinically relevant modifications in ICP values in ABI patients. The magnitude of the change in ICP after PEEP increase was correlated with the delta of PEEP, the delta driving pressure and the delta compliance.
{"title":"Effects of PEEP on intracranial pressure in patients with acute brain injury: An observational, prospective and multicenter study","authors":"Jesús Abelardo Barea-Mendoza, Zaira Molina-Collado, María Ángeles Ballesteros-Sanz, Luisa Corral-Ansa, Maite Misis del Campo, Cándido Pardo-Rey, Juan Angel Tihista-Jiménez, Carmen Corcobado-Márquez, Juan Pedro Martín del Rincón, Juan Antonio Llompart-Pou, Luis Alfonso Marcos-Prieto, Ander Olazabal-Martínez, Rubén Herrán-Monge, Ana María Díaz-Lamas, Mario Chico-Fernández","doi":"10.1016/j.medin.2024.04.011","DOIUrl":"10.1016/j.medin.2024.04.011","url":null,"abstract":"<div><h3>Objective</h3><div>To analyze the impact of positive end-expiratory pressure (PEEP) changes on intracranial pressure (ICP) dynamics in patients with acute brain injury (ABI).</div></div><div><h3>Design</h3><div>Observational, prospective and multicenter study (PEEP-PIC study).</div></div><div><h3>Setting</h3><div>Seventeen intensive care units in Spain.</div></div><div><h3>Patients</h3><div>Neurocritically ill patients who underwent invasive neuromonitorization from November 2017 to June 2018.</div></div><div><h3>Interventions</h3><div>Baseline ventilatory, hemodynamic and neuromonitoring variables were collected immediately before PEEP changes and during the following 30 min.</div></div><div><h3>Main variables of interest</h3><div>PEEP and ICP changes.</div></div><div><h3>Results</h3><div>One-hundred and nine patients were included. Mean age was 52.68 (15.34) years, male 71 (65.13%). Traumatic brain injury was the cause of ABI in 54 (49.54%) patients. Length of mechanical ventilation was 16.52 (9.23) days. In-hospital mortality was 21.1%. PEEP increases (mean 6.24–9.10 cmH2O) resulted in ICP increase from 10.4 to 11.39 mmHg, <em>P</em> < .001, without changes in cerebral perfusion pressure (CPP) (<em>P</em> = .548). PEEP decreases (mean 8.96 to 6.53 cmH2O) resulted in ICP decrease from 10.5 to 9.62 mmHg (<em>P</em> = .052), without changes in CPP (<em>P</em> = .762). Significant correlations were established between the increase of ICP and the delta PEEP (R = 0.28, <em>P</em> < .001), delta driving pressure (R = 0.15, <em>P</em> = .038) and delta compliance (R = −0.14, <em>P</em> = .052). ICP increment was higher in patients with lower baseline ICP.</div></div><div><h3>Conclusions</h3><div>PEEP changes were not associated with clinically relevant modifications in ICP values in ABI patients. The magnitude of the change in ICP after PEEP increase was correlated with the delta of PEEP, the delta driving pressure and the delta compliance.</div></div>","PeriodicalId":49268,"journal":{"name":"Medicina Intensiva","volume":"48 10","pages":"Pages 594-601"},"PeriodicalIF":2.7,"publicationDate":"2024-09-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142322286","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 : 2024-09-26DOI: 10.1016/j.medin.2024.05.023
María Romero Carratala , Luis Pérez de Amezaga Tomás , María Sala Carazo , Gemma Rialp Cervera
{"title":"Meropenem for the management of valproic acid intoxication: a case report and a review of the literature","authors":"María Romero Carratala , Luis Pérez de Amezaga Tomás , María Sala Carazo , Gemma Rialp Cervera","doi":"10.1016/j.medin.2024.05.023","DOIUrl":"10.1016/j.medin.2024.05.023","url":null,"abstract":"","PeriodicalId":49268,"journal":{"name":"Medicina Intensiva","volume":"48 10","pages":"Pages 620-622"},"PeriodicalIF":2.7,"publicationDate":"2024-09-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142322347","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 : 2024-09-26DOI: 10.1016/j.medin.2024.06.007
María Martínez-Martínez , María Vidal-Burdeus , Jordi Riera , Aitor Uribarri , Elisabet Gallart , Laia Milà , Pau Torrella , Irene Buera , Luis Chiscano-Camon , Bruno García del Blanco , Carlota Vigil-Escalera , José A. Barrabés , Jordi Llaneras , Juan Carlos Ruiz-Rodríguez , Cristopher Mazo , Jorge Morales , Ricard Ferrer , Ignacio Ferreira-Gonzalez , Eduard Argudo
Objective
To analyze if the implementation of a multidisciplinary extracorporeal cardiopulmonary resuscitation (ECPR) program in a tertiary hospital in Spain is feasible and could yield survival outcomes similar to international published experiences.
Design
Retrospective observational cohort study.
Setting
One tertiary referral university hospital in Spain.
Patients
All adult patients receiving ECPR between January 2019 and April 2023.
Interventions
Prospective collection of variables and follow-up for up to 180 days.
Main variables of interest
To assess outcomes, survival with good neurological outcome defined as a Cerebral Performance Categories scale 1–2 at 180 days was used. Secondary variables were collected including demographics and comorbidities, cardiac arrest and cannulation characteristics, ROSC, ECMO-related complications, survival to ECMO decannulation, survival at Intensive Care Unit (ICU) discharge, survival at 180 days, neurological outcome, cause of death and eligibility for organ donation.
Results
Fifty-four patients received ECPR, 29 for OHCA and 25 for IHCA. Initial shockable rhythm was identified in 27 (50%) patients. The most common cause for cardiac arrest was acute coronary syndrome [29 (53.7%)] followed by pulmonary embolism [7 (13%)] and accidental hypothermia [5 (9.3%)]. Sixteen (29.6%) patients were alive at 180 days, 15 with good neurological outcome. Ten deceased patients (30.3%) became organ donors after neuroprognostication.
Conclusions
The implementation of a multidisciplinary ECPR program in an experienced Extracorporeal Membrane Oxygenation center in Spain is feasible and can lead to good survival outcomes and valid organ donors.
{"title":"Outcomes of an extracorporeal cardiopulmonary resuscitation (ECPR) program for in- and out-of-hospital cardiac arrest in a tertiary hospital in Spain","authors":"María Martínez-Martínez , María Vidal-Burdeus , Jordi Riera , Aitor Uribarri , Elisabet Gallart , Laia Milà , Pau Torrella , Irene Buera , Luis Chiscano-Camon , Bruno García del Blanco , Carlota Vigil-Escalera , José A. Barrabés , Jordi Llaneras , Juan Carlos Ruiz-Rodríguez , Cristopher Mazo , Jorge Morales , Ricard Ferrer , Ignacio Ferreira-Gonzalez , Eduard Argudo","doi":"10.1016/j.medin.2024.06.007","DOIUrl":"10.1016/j.medin.2024.06.007","url":null,"abstract":"<div><h3>Objective</h3><div>To analyze if the implementation of a multidisciplinary extracorporeal cardiopulmonary resuscitation (ECPR) program in a tertiary hospital in Spain is feasible and could yield survival outcomes similar to international published experiences.</div></div><div><h3>Design</h3><div>Retrospective observational cohort study.</div></div><div><h3>Setting</h3><div>One tertiary referral university hospital in Spain.</div></div><div><h3>Patients</h3><div>All adult patients receiving ECPR between January 2019 and April 2023.</div></div><div><h3>Interventions</h3><div>Prospective collection of variables and follow-up for up to 180 days.</div></div><div><h3>Main variables of interest</h3><div>To assess outcomes, survival with good neurological outcome defined as a Cerebral Performance Categories scale 1–2 at 180 days was used. Secondary variables were collected including demographics and comorbidities, cardiac arrest and cannulation characteristics, ROSC, ECMO-related complications, survival to ECMO decannulation, survival at Intensive Care Unit (ICU) discharge, survival at 180 days, neurological outcome, cause of death and eligibility for organ donation.</div></div><div><h3>Results</h3><div>Fifty-four patients received ECPR, 29 for OHCA and 25 for IHCA. Initial shockable rhythm was identified in 27 (50%) patients. The most common cause for cardiac arrest was acute coronary syndrome [29 (53.7%)] followed by pulmonary embolism [7 (13%)] and accidental hypothermia [5 (9.3%)]. Sixteen (29.6%) patients were alive at 180 days, 15 with good neurological outcome. Ten deceased patients (30.3%) became organ donors after neuroprognostication.</div></div><div><h3>Conclusions</h3><div>The implementation of a multidisciplinary ECPR program in an experienced Extracorporeal Membrane Oxygenation center in Spain is feasible and can lead to good survival outcomes and valid organ donors.</div></div>","PeriodicalId":49268,"journal":{"name":"Medicina Intensiva","volume":"48 10","pages":"Pages 565-574"},"PeriodicalIF":2.7,"publicationDate":"2024-09-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142322059","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 : 2024-09-26DOI: 10.1016/j.medin.2024.04.002
Lubov Stroh , Dennis Nurjadi , Florian Uhle , Thomas Bruckner , Armin Kalenka , Markus Alexander Weigand , Mascha Onida Fiedler-Kalenka
Objective
Oxygen has been used liberally in ICUs for a long time to prevent hypoxia in ICU- patients. Current evidence suggests that paO2 >300 mmHg should be avoided, it remains uncertain whether an “optimal level” exists. We investigated how “mild” hyperoxia influences diseases and in-hospital mortality.
Design
This is a retrospective study.
Setting
112 mechanically ventilated ICU-patients were enrolled.
Patients or participants
112 ventilated patients were included and categorized into two groups based on the median paO2 values measured in initial 24 h of mechanical ventilation: normoxia group (paO2 ≤ 100 mmHg, n = 43) and hyperoxia group patients (paO2 > 100 mmHg, n = 69).
Interventions
No interventions were performed.
Main variables of interest
The primary outcome was the incidence of pulmonary events, the secondary outcomes included the incidence of other new organ dysfunctions and in-hospital mortality.
Results
The baseline characteristics, such as age, body mass index, lactate levels, and severity of disease scores, were similar in both groups. There were no statistically significant differences in the incidence of pulmonary events, infections, and new organ dysfunctions between the groups. 27 out of 69 patients (39.1%) in the “mild” hyperoxia group and 12 out of 43 patients (27.9%) in the normoxia group died during their ICU or hospital stay (p = 0.54). The mean APACHE Score was 29.4 (SD 7.9) in the normoxia group and 30.0 (SD 6.7) in the hyperoxia group (p = 0.62).
Conclusions
We found no differences in pulmonary events, other coded diseases, and in-hospital mortality between both groups. It remains still unclear what the "best oxygen regime" is for intensive care patients.
{"title":"Pulmonary Events in ICU patients with hyperoxia: is it possible to relate arterial partial pressure of oxygen to coded diseases? A retrospective analysis","authors":"Lubov Stroh , Dennis Nurjadi , Florian Uhle , Thomas Bruckner , Armin Kalenka , Markus Alexander Weigand , Mascha Onida Fiedler-Kalenka","doi":"10.1016/j.medin.2024.04.002","DOIUrl":"10.1016/j.medin.2024.04.002","url":null,"abstract":"<div><h3>Objective</h3><div>Oxygen has been used liberally in ICUs for a long time to prevent hypoxia in ICU- patients. Current evidence suggests that paO<sub>2</sub> >300 mmHg should be avoided, it remains uncertain whether an “optimal level” exists. We investigated how “mild” hyperoxia influences diseases and in-hospital mortality.</div></div><div><h3>Design</h3><div>This is a retrospective study.</div></div><div><h3>Setting</h3><div>112 mechanically ventilated ICU-patients were enrolled.</div></div><div><h3>Patients or participants</h3><div>112 ventilated patients were included and categorized into two groups based on the median paO<sub>2</sub> values measured in initial 24 h of mechanical ventilation: normoxia group (paO<sub>2</sub> ≤ 100 mmHg, n = 43) and hyperoxia group patients (paO<sub>2</sub> > 100 mmHg, n = 69).</div></div><div><h3>Interventions</h3><div>No interventions were performed.</div></div><div><h3>Main variables of interest</h3><div>The primary outcome was the incidence of pulmonary events, the secondary outcomes included the incidence of other new organ dysfunctions and in-hospital mortality.</div></div><div><h3>Results</h3><div>The baseline characteristics, such as age, body mass index, lactate levels, and severity of disease scores, were similar in both groups. There were no statistically significant differences in the incidence of pulmonary events, infections, and new organ dysfunctions between the groups. 27 out of 69 patients (39.1%) in the “mild” hyperoxia group and 12 out of 43 patients (27.9%) in the normoxia group died during their ICU or hospital stay (p = 0.54). The mean APACHE Score was 29.4 (SD 7.9) in the normoxia group and 30.0 (SD 6.7) in the hyperoxia group (p = 0.62).</div></div><div><h3>Conclusions</h3><div>We found no differences in pulmonary events, other coded diseases, and in-hospital mortality between both groups. It remains still unclear what the \"best oxygen regime\" is for intensive care patients.</div></div>","PeriodicalId":49268,"journal":{"name":"Medicina Intensiva","volume":"48 10","pages":"Pages 575-583"},"PeriodicalIF":2.7,"publicationDate":"2024-09-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142322060","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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