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Muscle wasting in ICU-patients with COVID-19 - Descriptive analysis and risk factors identification 患有 COVID-19 的重症监护病房患者的肌肉萎缩--描述性分析和风险因素识别
IF 2.7 4区 医学 Q2 CRITICAL CARE MEDICINE Pub Date : 2024-08-01 DOI: 10.1016/j.medin.2024.03.018
Alan Garcia-Grimaldo , Nadia Carolina Rodríguez-Moguel , Martín Armando Ríos-Ayala , Carmen Margarita Hernández-Cárdenas , Lya Pensado-Piedra , Iván Armando Osuna-Padilla
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引用次数: 0
Síndrome postcuidados intensivos en pacientes y familiares. Análisis de cohortes COVID-19 y no COVID-19, con seguimiento presencial a los tres meses y al año 患者和亲属的重症监护后综合征。对 COVID-19 和非 COVID-19 组群进行分析,并在三个月和一年后进行面对面随访。
IF 2.7 4区 医学 Q2 CRITICAL CARE MEDICINE Pub Date : 2024-08-01 DOI: 10.1016/j.medin.2024.03.008

Objective

Compare prevalence and profile of post-intensive care patient (P-PICS) and family/caregiver (F-PICS) syndrome in two cohorts (COVID and non-COVID) and analyse risk factors for P-PICS.

Design

Prospective, observational cohort (March 2018- 2023), follow-up at three months and one year.

Setting

14-bed polyvalent Intensive Care Unit (ICU), Level II Hospital.

Patients or participants

265 patients and 209 relatives. Inclusion criteria patients: age > 18 years, mechanical ventilation > 48 hours, ICU stay > 5 days, delirium, septic shock, acute respiratory distress syndrome, cardiac arrest. Inclusion criteria family: those who attended.

Interventions

Follow-up 3 months and 1 year after hospital discharge.

Main variables of interest

Patients; sociodemographic, clinical, evolutive, physical, psychological and cognitive alterations, dependency degree and quality of life. Main caregivers: mental state and physical overload.

Results

64.9% PICS-P, no differences between groups. COVID patients more physical alterations than non-COVID (p = 0.028). These more functional deterioration (p = 0.005), poorer quality of life (p = 0.003), higher nutritional alterations (p = 0.004) and cognitive deterioration (p< 0.001). 19.1% PICS-F, more frequent in relatives of non-COVID patients (17.6% vs. 5.5%; p = 0.013). Independent predictors of PICS-P: first years of the study (OR: 0.484), higher comorbidity (OR: 1.158), delirium (OR: 2.935), several reasons for being included (OR: 3.171) and midazolam (OR: 4.265).

Conclusions

Prevalence PICS-P and PICS-F between both cohorts was similar. Main factors associated with the development of SPCI-P were: higher comorbidity, delirium, midazolam, inclusion for more than one reason and during the first years.

目的比较两个队列(COVID和非COVID)中重症监护后患者(P-PICS)和家属/护理人员(F-PICS)综合征的患病率和概况,并分析P-PICS的风险因素.设计前瞻性、观察性队列(2018年3月至2023年),随访3个月和1年.设置14张病床的多价重症监护病房(ICU),二级医院.患者或参与者265名患者和209名亲属.患者纳入标准:年龄 18 岁,机械通气 48 小时,重症监护室住院 5 天,谵妄、脓毒性休克、急性呼吸窘迫综合征、心脏骤停。主要关注变量患者:社会人口学、临床、演变、身体、心理和认知改变、依赖程度和生活质量。主要护理人员:精神状态和身体超负荷。COVID 患者比非 COVID 患者有更多的身体改变(p = 0.028)。这些患者的功能退化更严重(p = 0.005),生活质量更差(p = 0.003),营养状况变化更大(p = 0.004),认知能力更差(p< 0.001)。19.1%的PICS-F,在非COVID患者的亲属中更为常见(17.6% vs. 5.5%;p = 0.013)。PICS-P的独立预测因素:研究的最初几年(OR:0.484)、较高的合并症(OR:1.158)、谵妄(OR:2.935)、纳入的几个原因(OR:3.171)和咪达唑仑(OR:4.265)。与出现 SPCI-P 相关的主要因素有:合并症较多、谵妄、咪达唑仑、入院原因不止一个以及入院最初几年。
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引用次数: 0
«INTUPROS»: una oportunidad para reflexionar y mejorar "INTUPROS":反思和改进的机会
IF 2.7 4区 医学 Q2 CRITICAL CARE MEDICINE Pub Date : 2024-08-01 DOI: 10.1016/j.medin.2024.03.014
Andrea Viviani , Carlos Vicent , Álvaro Castellanos-Ortega
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引用次数: 0
Evaluación de la respuesta a la posición prona a través de tomografía por impedancia eléctrica 使用电阻抗断层扫描评估俯卧位的反应
IF 2.7 4区 医学 Q2 CRITICAL CARE MEDICINE Pub Date : 2024-08-01 DOI: 10.1016/j.medin.2024.01.010
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引用次数: 0
Duración de la primera maniobra de decúbito prono y su asociación con la mortalidad a 90 días en pacientes con insuficiencia respiratoria aguda por COVID-19: un estudio retrospectivo de terciles de tiempo 通过 COVID-19 对急性呼吸衰竭患者进行首次俯卧位操作的持续时间及其与 90 天死亡率的关系:时间分层回顾性研究。
IF 2.7 4区 医学 Q2 CRITICAL CARE MEDICINE Pub Date : 2024-08-01 DOI: 10.1016/j.medin.2024.03.003

Objective

To investigate the association between the duration of the first prone positioning maneuver (PPM) and 90-day mortality in patients with C-ARDS.

Design

Retrospective, observational, and analytical study.

Setting

COVID-19 ICU of a tertiary hospital.

Patients

Adults over 18 years old, with a confirmed diagnosis of SARS-CoV-2 disease requiring PPM.

Interventions

Multivariable analysis of 90-day survival.

Main variables of interest

Duration of the first PPM, number of PPM sessions, 90-day mortality.

Results

271 patients undergoing PPM were analyzed: first tertile (n = 111), second tertile (n = 95) and third tertile (n = 65). The results indicated that the median duration of PDP was 14 hours (95% CI: 10-16 hours) in the first tertile, 19 hours (95% CI: 18-20 hours) in the second tertile and 22 hours (95% CI: 21-24 hours) in the third tertile. Comparison of survival curves using the Logrank test did not reach statistical significance (P = .11). Cox Regression analysis showed an association between the number of pronation sessions — patients receiving between 2 and 5 sessions (HR: 2.19; 95% CI: 1.07-4.49) and those receiving more than 5 sessions (HR: 6.05; 95% CI: 2.78-13.16 — and 90-day mortality.

Conclusions

While the duration of PDP does not appear to significantly influence 90-day mortality, the number of pronation sessions is identified as a significant factor associated with an increased risk of mortality.

目的研究C-ARDS患者首次俯卧位操作(PPM)持续时间与90天死亡率之间的关系。干预措施90天生存率的多变量分析。主要关注变量首次PPM持续时间、PPM疗程次数、90天死亡率。结果表明,PDP 的中位持续时间在第一梯度为 14 小时(95% CI:10-16 小时),第二梯度为 19 小时(95% CI:18-20 小时),第三梯度为 22 小时(95% CI:21-24 小时)。使用 Logrank 检验比较生存曲线没有统计学意义(P = .11)。Cox回归分析表明,代偿治疗次数(接受2-5次治疗的患者(HR:2.19;95% CI:1.07-4.49)和接受5次以上治疗的患者(HR:6.05;95% CI:2.78-13.16))与90天死亡率之间存在关联。
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引用次数: 0
Ventricular tachycardia in a young female 一名年轻女性的室性心动过速
IF 2.7 4区 医学 Q2 CRITICAL CARE MEDICINE Pub Date : 2024-08-01 DOI: 10.1016/j.medin.2024.01.005
Huyun Wan , Gongli Liu , Min Tang
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引用次数: 0
Effectiveness of Helmet-CPAP in mild to moderate coronavirus type 2 hypoxemia: An observational study 头盔-CPAP 对轻中度冠状病毒 2 型低氧血症的疗效:观察性研究
IF 2.7 4区 医学 Q2 CRITICAL CARE MEDICINE Pub Date : 2024-08-01 DOI: 10.1016/j.medin.2024.02.013
Aurio Fajardo-Campoverdi , Juan José Orellana-Cáceres , Vicente Fernández , Felipe Poblete , Priscila Reyes , Kevin Rebolledo

Objective

To determine the relative effectiveness of Helmet-CPAP (H_CPAP) with respect to high-flow nasal cannula oxygen therapy (HFNO) in avoiding greater need for intubation or mortality in a medium complexity hospital in Chile during the year 2021.

Design

Cohort analytical study, single center.

Setting

Units other than intensive care units.

Patients

Records of adults with mild to moderate hypoxemia due to coronavirus type 2.

Interventions

None.

Main variables of interest

Need for intubation or mortality.

Results

159 patients were included in the study, with a ratio by support of 2:10 (H_CPAP:HFNO). The 46.5% were women, with no significant differences by sex according to support (p = 0.99, Fisher test). The APACHE II score, for HFNO, had a median of 10.5, 3.5 units higher than H_CPAP (p < 0.01, Wilcoxon rank sum). The risk of intubation in HFNO was 42.1% and in H_CPAP 3.8%, with a significant risk reduction of 91% (95% CI: 36.9%–98.7%; p < 0.01). APACHE II does not modify or confound the support and intubation relationship (p > 0.2, binomial regression); however, it does confound the support and mortality relationship (p = 0.82, RR homogeneity test). Despite a 79.1% reduction in mortality risk with H_CPAP, this reduction was not statistically significant (p = 0.11, binomial regression).

Conclusions

The use of Helmet CPAP, when compared to HFNO, was an effective therapeutic ventilatory support strategy to reduce the risk of intubation in patients with mild to moderate hypoxemia caused by coronavirus type 2 in inpatient units other than intensive care. The limitations associated with the difference in size, age and severity between the arms could generate bias.

目标确定在 2021 年期间,在智利的一家中型综合医院中,头盔-CPAP(H_CPAP)与高流量鼻插管供氧疗法(HFNO)在避免更多插管需求或死亡率方面的相对有效性.设计队列分析研究,单个中心.设置除重症监护室以外的其他单位.患者因冠状病毒 2 型导致轻度和中度低氧血症的成人记录.干预措施无.主要关注变量插管需求或死亡率.患者因冠状病毒 2 型导致轻度至中度低氧血症的成人患者记录。46.5%的患者为女性,不同支持方式的性别差异不大(费雪检验,P = 0.99)。HFNO 的 APACHE II 评分中位数为 10.5,比 H_CPAP 高 3.5 个单位(p < 0.01,Wilcoxon 秩和检验)。HFNO 的插管风险为 42.1%,H_CPAP 为 3.8%,风险显著降低 91% (95% CI: 36.9%-98.7%; p <0.01)。APACHE II 不会改变或混淆支持与插管的关系(p > 0.2,二项回归);但它会混淆支持与死亡率的关系(p = 0.82,RR 同质性检验)。结论与高频硝酸甘油相比,使用头盔式 CPAP 是一种有效的治疗性通气支持策略,可降低重症监护室以外的住院病房中由 2 型冠状病毒引起的轻度至中度低氧血症患者的插管风险。由于两组患者的大小、年龄和严重程度不同,可能会产生偏差。
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引用次数: 0
Abordaje práctico de la sedación inhalada en el paciente crítico 重症患者吸入镇静的实用方法。西班牙重症和危重症医学及冠心病病房学会镇静、镇痛和谵妄工作组(GTSAD)。
IF 2.7 4区 医学 Q2 CRITICAL CARE MEDICINE Pub Date : 2024-08-01 DOI: 10.1016/j.medin.2024.04.007

The use of sedatives in intensive care units (ICU) is essential for relieving anxiety and stress in mechanically ventilated patients, and it is related to clinical outcomes, duration of mechanical ventilation, and length of stay in the ICU. Inhaled sedatives offer benefits such as faster awakening and extubation, decreased total opioid and neuromuscular blocking agents (NMB) doses, as well as bronchodilator, anticonvulsant, and cardiopulmonary and neurological protective effects. Inhaled sedation is administered using a specific vaporizer. Isoflurane is the recommended agent due to its efficacy and safety profile. Inhaled sedation is recommended for moderate and deep sedation, prolonged sedation, difficult sedation, patients with acute respiratory distress syndrome (ARDS), status asthmaticus, and super-refractory status epilepticus. By offering these significant advantages, the use of inhaled sedatives allows for a personalized and controlled approach to optimize sedation in the ICU.

在重症监护病房(ICU)中使用镇静剂对于缓解机械通气患者的焦虑和压力至关重要,它与临床效果、机械通气持续时间和重症监护病房的住院时间有关。吸入镇静剂的好处包括:更快苏醒和拔管、减少阿片类药物和神经肌肉阻滞剂(NMB)的总剂量,以及支气管扩张、抗惊厥、心肺和神经保护作用。吸入镇静剂使用特定的蒸发器。异氟醚因其有效性和安全性而被推荐使用。中度和深度镇静、长期镇静、困难镇静、急性呼吸窘迫综合征(ARDS)患者、哮喘状态和超难治性癫痫状态患者建议使用吸入镇静剂。吸入式镇静剂具有这些显著优势,因此可以采用个性化的控制方法来优化重症监护病房的镇静效果。
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引用次数: 0
McConnell’s sign in fat embolism syndrome 脂肪栓塞综合征中的麦康奈尔征象
IF 2.7 4区 医学 Q2 CRITICAL CARE MEDICINE Pub Date : 2024-08-01 DOI: 10.1016/j.medin.2024.01.003
Ripenmeet Salhotra
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引用次数: 0
Tratamiento médico del shock cardiogénico 心源性休克的医学治疗
IF 2.7 4区 医学 Q2 CRITICAL CARE MEDICINE Pub Date : 2024-08-01 DOI: 10.1016/j.medin.2024.05.002
Manuel García-Delgado , Raquel Rodríguez-García , Ana Ochagavía , M. Ángeles Rodríguez-Esteban

Cardiogenic shock is characterized by tissue hypoperfusion due to the inadequate cardiac output to maintain the tissue oxygen demand. Despite some advances in cardiogenic shock management, extremely high mortality is still associated with this clinical syndrome. Its management is based on the immediate stabilization of hemodynamic parameters through medical care and the use of mechanical circulatory supports in specialized centers. This review aims to understand the cardiogenic shock current medical treatment, consisting mainly of inotropic drugs, vasopressors and coronary revascularization. In addition, we highlight the relevance of applying measures to other organ levels based on the optimization of mechanical ventilation and the appropriate initiation of renal replacement therapy.

心源性休克的特点是由于心输出量不足以维持组织的氧需求,导致组织灌注不足。尽管心源性休克的治疗取得了一些进展,但这种临床综合征的死亡率仍然极高。其治疗的基础是通过医疗护理和在专业中心使用机械循环支持来立即稳定血流动力学参数。本综述旨在了解心源性休克目前的医学治疗方法,主要包括肌力药物、血管加压药和冠状动脉再通术。此外,我们还强调了在优化机械通气和适当启动肾脏替代疗法的基础上对其他器官采取相应措施的意义。
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引用次数: 0
期刊
Medicina Intensiva
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