Medicina Intensiva最新文献

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ECPR … Ready for it? ECPR ... 准备好了吗？

IF 2.7 4区医学 Q2 CRITICAL CARE MEDICINE

Medicina Intensiva

Pub Date : 2024-09-26 DOI: 10.1016/j.medin.2024.07.001

Sara Alcántara Carmona, Héctor Villanueva Fernández

引用次数: 0

Sepsis mortality prediction with Machine Learning Tecniques 利用机器学习技术预测败血症死亡率

IF 2.7 4区医学 Q2 CRITICAL CARE MEDICINE

Medicina Intensiva

Pub Date : 2024-09-26 DOI: 10.1016/j.medin.2024.04.010

Javier Carrillo Pérez-Tome , Tesifón Parrón-Carreño , Ana Belen Castaño-Fernández , Bruno José Nievas-Soriano , Gracia Castro-Luna

Objective

To develop a sepsis death classification model based on machine learning techniques for patients admitted to the Intensive Care Unit (ICU).

Design

Cross-sectional descriptive study.

Setting

The Intensive Care Units (ICUs) of three Hospitals from Murcia (Spain) and patients from the MIMIC III open-access database.

Patients

180 patients diagnosed with sepsis in the ICUs of three hospitals and a total of 4559 patients from the MIMIC III database.

Main variables of interest

Age, weight, heart rate, respiratory rate, temperature, lactate levels, partial oxygen saturation, systolic and diastolic blood pressure, pH, urine, and potassium levels.

Results

A random forest classification model was calculated using the local and MIMIC III databases. The sensitivity of the model of our database, considering all the variables classified as important by the random forest, was 95.45%, the specificity was 100%, the accuracy was 96.77%, and an AUC of 95%. . In the case of the model based on the MIMIC III database, the sensitivity was 97.55%, the specificity was 100%, and the precision was 98.28%, with an AUC of 97.3%.

Conclusions

According to random forest classification in both databases, lactate levels, urine output and variables related to acid.base equilibrium were the most important variable in mortality due to sepsis in the ICU. The potassium levels were more critical in the MIMIC III database than the local database.

西班牙穆尔西亚三家医院的重症监护病房（ICU）和 MIMIC III 开放式数据库中的患者。主要关注变量年龄、体重、心率、呼吸频率、体温、乳酸水平、氧饱和度、收缩压和舒张压、pH值、尿液和血钾水平。结果利用本地数据库和MIMIC III数据库计算出随机森林分类模型。考虑到所有被随机森林分类为重要的变量，我们数据库的模型灵敏度为 95.45%，特异度为 100%，准确度为 96.77%，AUC 为 95%。.结论根据两个数据库的随机森林分类，乳酸水平、尿量和酸碱平衡相关变量是影响重症监护室败血症死亡率的最重要变量。与本地数据库相比，MIMIC III 数据库中的钾水平更为重要。

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引用次数: 0

High flow Tracheal oxygen: assessment of diaphragmatic functionality by ultrasonography in adults during weaning from mechanical ventilation 高流量气管供氧：在成人机械通气断奶期间通过超声波评估膈肌功能

IF 2.7 4区医学 Q2 CRITICAL CARE MEDICINE

Medicina Intensiva

Pub Date : 2024-09-26 DOI: 10.1016/j.medin.2024.05.017

Ignacio Fernández Ceballos , Ivan Alfredo Huespe , María Sofía Venuti , Bruno Leonel Ferreyro , José María Dianti , Romina Famiglietti , Ana Montserrat Rivera , Indalecio Carboni Bisso , Marcos Jose Las Heras

引用次数: 0

Comparing lung aeration and respiratory effort using two different spontaneous breathing trial: T-piece vs pressure support ventilation 使用两种不同的自主呼吸试验比较肺通气和呼吸强度：T形通气与压力支持通气

IF 2.7 4区医学 Q2 CRITICAL CARE MEDICINE

Medicina Intensiva

Pub Date : 2024-08-28 DOI: 10.1016/j.medin.2023.06.015

Raquel Bosch-Compte , Francisco José Parrilla , Rosana Muñoz-Bermúdez , Irene Dot , Cristina Climent , Joan Ramon Masclans , Judith Marin-Corral , Purificación Pérez-Terán

Objective

To assess the changes in lung aeration and respiratory effort generated by two different spontaneous breathing trial (SBT): T-piece (T-T) vs pressure support ventilation (PSV).

Design

Prospective, interventionist and randomized study.

Setting

Intensive Care Unit (ICU) of Hospital del Mar.

Participants

Forty-three ventilated patients for at least 24 h and considered eligible for an SBT were included in the study between October 2017 and March 2020.

Interventions

30-min SBT with T-piece (T-T group, 20 patients) or 8-cmH₂O PSV and 5-cmH₂O positive end expiratory pressure (PSV group, 23 patients).

Main variables of interest

Demographics, clinical data, physiological variables, lung aeration evaluated with electrical impedance tomography (EIT) and lung ultrasound (LUS), and respiratory effort using diaphragmatic ultrasonography (DU) were collected at different timepoints: basal (BSL), end of SBT (EoSBT) and one hour after extubation (OTE).

Results

There were a loss of aeration measured with EIT and LUS in the different study timepoints, without statistical differences from BSL to OTE, between T-T and PSV [LUS: 3 (1, 5.5) AU vs 2 (1, 3) AU; p = 0.088; EELI: −2516.41 (−5871.88, 1090.46) AU vs −1992.4 (−3458.76, −5.07) AU; p = 0.918]. Percentage of variation between BSL and OTE, was greater when LUS was used compared to EIT (68.1% vs 4.9%, p ≤ 0.001). Diaphragmatic excursion trend to decrease coinciding with a loss of aeration during extubation.

Conclusion

T-T and PSV as different SBT strategies in ventilated patients do not show differences in aeration loss, nor estimated respiratory effort or tidal volume measured by EIT, LUS and DU.

目的评估两种不同的自主呼吸试验（SBT）所产生的肺通气量和呼吸强度的变化：干预使用T-piece（T-T组，20名患者）或8-cmH2O PSV和5-cmH2O呼气末正压（PSV组，23名患者）进行30分钟SBT。主要关注变量在不同的时间点（基础（BSL）、SBT 结束（EoSBT）和拔管后一小时（OTE））收集人口统计学、临床数据、生理变量、电阻抗断层扫描（EIT）和肺部超声波（LUS）评估的肺通气情况以及膈肌超声波（DU）评估的呼吸强度。结果在不同的研究时间点，用 EIT 和 LUS 测量到的通气量减少，从 BSL 到 OTE，T-T 和 PSV 之间没有统计学差异[LUS：3 (1, 5.5) AU vs 2 (1, 3) AU; p = 0.088; EELI：-2516.41 (-5871.88, 1090.46) AU vs -1992.4 (-3458.76, -5.07) AU; p = 0.918]。与 EIT 相比，使用 LUS 时 BSL 和 OTE 之间的变化百分比更大（68.1% vs 4.9%，p ≤ 0.001）。结论T-T和PSV作为通气患者的不同SBT策略，在通气损失、EIT、LUS和DU测量的估计呼吸努力或潮气量方面并无差异。

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引用次数: 0

Subcutaneous emphysema everywhere! 皮下气肿无处不在！

IF 2.7 4区医学 Q2 CRITICAL CARE MEDICINE

Medicina Intensiva

Pub Date : 2024-08-28 DOI: 10.1016/j.medin.2024.01.007

Francisca Silva Cardoso, Rita Morais Passos

引用次数: 0

Harlequin syndrome: a picture speaks a thousand words 哈莱金综合征：一图胜千言

IF 2.7 4区医学 Q2 CRITICAL CARE MEDICINE

Medicina Intensiva

Pub Date : 2024-08-28 DOI: 10.1016/j.medin.2024.01.006

Jorge Martínez-Solano , Nerea Alava-Echevarría , Iago Sousa-Casasnovas

引用次数: 0

Can end-tidal CO2 measurement replace arterial partial CO2 in emergency department respiratory distress management? 在急诊科呼吸窘迫管理中，潮气末二氧化碳测量能否取代动脉部分二氧化碳测量？

IF 2.7 4区医学 Q2 CRITICAL CARE MEDICINE

Medicina Intensiva

Pub Date : 2024-08-28 DOI: 10.1016/j.medin.2024.03.021

Kudret Selki, Mehmet Cihat Demir, Erdinç Şengüldür, Emre Erdem, Hatice Güldal, Murat Taşdemir, Alp Kaan Furkan Kıcıroğlu, Mustafa Boğan

Objective

To assess the feasibility of using end-tidal carbon dioxide (EtCO₂) as a non-invasive substitute for partial pressure of arterial carbon dioxide (PaCO₂) in emergency department (ED) triage and follow-up, and to explore the potential of partial pressure of venous carbon dioxide (PvCO₂) as an alternative to PaCO₂.

Design

Prospective cross-sectional study.

Setting

Tertiary university hospital.

Patients or participants

97 patients presenting with acute respiratory distress to the ED.

Interventions

EtCO₂, arterial blood gases, and venous blood gases measured at admission (0 min), 60 min, and 120 min.

Main variables of interest

CO₂ levels.

Results

Among 97 patients (mean age: 70.93 ± 9.6 years; 60.8% male), EtCO₂ > 45 mmHg at admission showed strong positive correlations with PaCO₂ and PvCO₂ (r = 0.844, r = 0.803; p < 0.001, respectively). Significant positive correlation was observed between 60-min EtCO₂ and PaCO₂ (r = 0.729; p < 0.001). Strong correlation between PaCO₂ and PvCO₂ at 120 min when EtCO₂ > 45 mmHg (r = 0.870; p < 0.001). EtCO₂ was higher in hospitalized patients compared to discharged ones.

Conclusions

EtCO₂ appears promising as a substitute for PaCO₂ in ED patients with acute respiratory distress within the initial two hours of treatment. Venous blood gas sampling offers a less invasive alternative to arterial sampling, facilitating simultaneous blood tests.

目的评估在急诊科（ED）分诊和随访中使用潮气末二氧化碳（EtCO2）作为动脉二氧化碳分压（PaCO2）无创替代品的可行性，并探索静脉二氧化碳分压（PvCO2）作为 PaCO2 替代品的潜力。患者或参与者97名急性呼吸窘迫急诊患者。干预措施入院（0 分钟）、60 分钟和 120 分钟时测量 EtCO2、动脉血气和静脉血气。结果在 97 名患者（平均年龄：70.93 ± 9.6 岁；60.8% 为男性）中，入院时的 EtCO2 > 45 mmHg 与 PaCO2 和 PvCO2 呈强正相关（分别为 r = 0.844、r = 0.803；p <0.001）。60 分钟 EtCO2 与 PaCO2 之间呈显著正相关（r = 0.729；p <；0.001）。当 EtCO2 为 45 mmHg 时，120 分钟内 PaCO2 与 PvCO2 之间存在很强的相关性（r = 0.870；p <；0.001）。住院患者的 EtCO2 高于出院患者。静脉血气采样可替代动脉采样，创伤更小，便于同时进行血液检测。

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引用次数: 0

Intrahospital transportation of mechanically-ventilated COVID-19 patients: a cohort study 机械通气的 COVID-19 患者的院内转运：一项队列研究

IF 2.7 4区医学 Q2 CRITICAL CARE MEDICINE

Medicina Intensiva

Pub Date : 2024-08-28 DOI: 10.1016/j.medin.2024.05.001

Sara Ferreira Pagliarini , Pedro Henrique Rigotti Soares , Matheus Golenia dos Passos , Leonardo da Silva Marques , Wagner Nedel

引用次数: 0

Nitric oxide as the third respiratory gas. A new opportunity to revisit the use of oxygen therapy in clinical practice 一氧化氮作为第三种呼吸气体。在临床实践中重新审视氧气疗法的新机遇

IF 2.7 4区医学 Q2 CRITICAL CARE MEDICINE

Medicina Intensiva

Pub Date : 2024-08-28 DOI: 10.1016/j.medin.2024.06.006

José Manuel Valencia-Gallardo , Felipe Rodríguez de Castro , Jordi Solé-Violán , José Carlos Rodríguez-Gallego

引用次数: 0

High-flow nasal cannula in Spanish Pediatric Intensive Care Services: A national web survey about its use and indications 西班牙儿科重症监护服务中的高流量鼻插管：关于其使用和适应症的全国性网络调查

IF 2.7 4区医学 Q2 CRITICAL CARE MEDICINE

Medicina Intensiva

Pub Date : 2024-08-28 DOI: 10.1016/j.medin.2024.03.009

Alberto García-Salido , Vicente Modesto I Alapont , Alberto Medina-Villanueva , Spanish respiratory group of the Spanish Society of Pediatric Intensive Care

Objective

To describe the high-flow nasal cannula (HFNC) indications in the Spanish pediatric critical care units (PICUs).

Design

Descriptive cross-sectional observational study.

Setting

Electronic survey among members of the Spanish Society of Pediatric Intensive Care (SECIP). It was sent weekly from April 10, 2023, to May 21, 2023.

Participants

All SECIP members.

Interventions

None.

Main variables of interest

The questions focused on workplace, years of experience, use or non-use of HFNC, justification and expectations regarding its application, starting point within each center, clinical criteria for indication, existence of clinical guidelines, evaluation during its use, and criteria and mode of withdrawal.

Results

Two hundred and two participants, 176 were from Spain. Of these, 87/176 had over ten years of experience. One hundred sixty two use HFNC and 66/162 have HFNC clinical guidelines. Acute bronchiolitis (138/162) and respiratory assistance after extubation (106/56) are the two main indications. For 62/162 HFNC may reduce therapeutic escalation. Neuromuscular diseases (105/162) and anatomical airway diseases (135/162) are the two main contraindications. The reasons to do not use HFNC were the absence of evidence about it effectiveness (8/14) and its inadequate cost/effectiveness balance (8/14).

Conclusions

A majority of Spanish pediatric intensivists use HFNC. Its application and withdrawal appears to be primarily based on clinical experience. Besides, those who use HFNC are aware of its limitations and the lack of evidence in some cases. It is necessary to develop single-center and multicenter studies to elucidate the effectiveness of this therapy in the context of critically ill children.

目标描述西班牙儿科重症监护病房（PICU）中高流量鼻插管（HFNC）的适应症.设计描述性横断面观察研究.设置对西班牙儿科重症监护协会（SECIP）成员进行电子调查.从 2023 年 4 月 10 日至 2023 年 5 月 21 日，每周发送一次调查问卷.参与者所有 SECIP 成员.干预措施无.主要关注变量问题集中在工作场所、经验年限、使用情况等方面.主要关注变量问题主要涉及工作场所、工作年限、是否使用 HFNC、使用 HFNC 的理由和期望、每个中心的起始点、适应症的临床标准、是否存在临床指南、使用期间的评估以及停用的标准和方式。结果222 名参与者中有 176 名来自西班牙。其中 87/176 人有十年以上的使用经验。162 人使用 HFNC，66/162 人有 HFNC 临床指南。急性支气管炎（138/162）和拔管后呼吸辅助（106/56）是两个主要适应症。62/162 例 HFNC 可减少治疗升级。神经肌肉疾病（105/162）和气道解剖疾病（135/162）是两个主要禁忌症。不使用 HFNC 的原因是缺乏有关其有效性的证据（8/14）以及其成本/效益平衡不足（8/14）。大多数西班牙儿科重症监护医师都使用 HFNC，其使用和停用似乎主要基于临床经验。此外，使用 HFNC 的医生也意识到其局限性以及在某些情况下缺乏证据。有必要开展单中心和多中心研究，以阐明这种疗法在重症儿童中的有效性。

{"title":"High-flow nasal cannula in Spanish Pediatric Intensive Care Services: A national web survey about its use and indications","authors":"Alberto García-Salido , Vicente Modesto I Alapont , Alberto Medina-Villanueva , Spanish respiratory group of the Spanish Society of Pediatric Intensive Care","doi":"10.1016/j.medin.2024.03.009","DOIUrl":"10.1016/j.medin.2024.03.009","url":null,"abstract":"<div><h3>Objective</h3><p>To describe the high-flow nasal cannula (HFNC) indications in the Spanish pediatric critical care units (PICUs).</p></div><div><h3>Design</h3><p>Descriptive cross-sectional observational study.</p></div><div><h3>Setting</h3><p>Electronic survey among members of the Spanish Society of Pediatric Intensive Care (SECIP). It was sent weekly from April 10, 2023, to May 21, 2023.</p></div><div><h3>Participants</h3><p>All SECIP members.</p></div><div><h3>Interventions</h3><p>None.</p></div><div><h3>Main variables of interest</h3><p>The questions focused on workplace, years of experience, use or non-use of HFNC, justification and expectations regarding its application, starting point within each center, clinical criteria for indication, existence of clinical guidelines, evaluation during its use, and criteria and mode of withdrawal.</p></div><div><h3>Results</h3><p>Two hundred and two participants, 176 were from Spain. Of these, 87/176 had over ten years of experience. One hundred sixty two use HFNC and 66/162 have HFNC clinical guidelines. Acute bronchiolitis (138/162) and respiratory assistance after extubation (106/56) are the two main indications. For 62/162 HFNC may reduce therapeutic escalation. Neuromuscular diseases (105/162) and anatomical airway diseases (135/162) are the two main contraindications. The reasons to do not use HFNC were the absence of evidence about it effectiveness (8/14) and its inadequate cost/effectiveness balance (8/14).</p></div><div><h3>Conclusions</h3><p>A majority of Spanish pediatric intensivists use HFNC. Its application and withdrawal appears to be primarily based on clinical experience. Besides, those who use HFNC are aware of its limitations and the lack of evidence in some cases. It is necessary to develop single-center and multicenter studies to elucidate the effectiveness of this therapy in the context of critically ill children.</p></div>","PeriodicalId":49268,"journal":{"name":"Medicina Intensiva","volume":"48 9","pages":"Pages 520-527"},"PeriodicalIF":2.7,"publicationDate":"2024-08-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142087906","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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