Critical care science最新文献

英文中文

To: Death by community-based methicillin-resistant Staphylococcus aureus: case report. 致：死于社区耐甲氧西林金黄色葡萄球菌：病例报告。

Critical care science

Pub Date : 2024-07-01 eCollection Date: 2024-01-01 DOI: 10.62675/2965-2774.20240040-en

Fulvio Alexandre Scorza, Carla Alessandra Scorza, Josef Finsterer

引用次数: 0

New Phoenix criteria for pediatric sepsis and septic shock: the strengths and the future of a comprehensive perspective 凤凰城小儿败血症和脓毒性休克新标准：全面视角的优势与未来

Critical care science

Pub Date : 2024-07-01 DOI: 10.62675/2965-2774.20240058-en

Vanessa Soares Lanziotti, Andrea Ventura, S. Kache, Jaime Fernández-Sarmiento

In Greek mythology, the phoenix bird symbolizes life that overcomes death and the strength that accompanies transformation. Therefore, Phoenix is an appropriate name for the new Pediatric Sepsis Score owing to both the mythological reference and the location where it was first presented (Society of Critical Care Medicine – SCCM - Conference in Phoenix, Arizona). (1) The Phoenix Pediatric Sepsis (PPS) criteria for sepsis and septic shock are intended to identify children (1 month to <18 years) with life-threatening organ dysfunction due to infection, and the score was developed based on more than three million pediatric electronic health encounters, (2) which is a remarkable achievement considering pediatric and adult sepsis studies. The previous pediatric sepsis criteria were published in 2005 by the International Pediatric Sepsis Consensus Conference (IPSCC), and sepsis was defined as a suspected or confirmed infection in the presence of systemic inflammatory response syndrome (SIRS) (Figure 1). (3) Although these criteria are broadly used in daily practice, limitations to this definition have been identified since its inception. (4) Specific limitations of concern include a lack of consideration of a global context, leading to challenges in the applicabiblity of these criteria in limited-resource settings where the highest sepsis burden lies; variability in application at the bedside, which leads to delay in patient diagnosis; and the inability to

在希腊神话中，凤凰鸟象征着战胜死亡的生命和伴随转变的力量。因此，凤凰城是新的儿科脓毒症评分标准的恰当名称，这既与神话有关，也与该评分标准首次发布的地点有关（美国亚利桑那州凤凰城召开的重症医学会（Society of Critical Care Medicine - SCCM））。(1）凤凰城儿科败血症（PPS）败血症和脓毒性休克标准旨在识别因感染导致器官功能障碍而危及生命的儿童（1 个月至小于 18 岁），该评分是基于 300 多万次儿科电子健康会诊制定的，（2）考虑到儿科和成人败血症研究，这是一项了不起的成就。之前的儿科败血症标准由国际儿科败血症共识会议（IPSCC）于 2005 年发布，败血症被定义为存在全身炎症反应综合征（SIRS）的疑似或确诊感染（图 1）。(3）尽管这些标准在日常实践中得到了广泛应用，但自该定义提出以来，已发现了其局限性。(4)值得关注的具体局限性包括：缺乏对全球背景的考虑，导致这些标准在资源有限的环境中的适用性面临挑战，而这些环境正是败血症负担最重的地方；床旁应用的可变性，导致患者诊断的延迟；以及无法在全球范围内使用这些标准。

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引用次数: 0

Analysis of factors associated with admission to the intensive care unit of children and adolescents with COVID-19: application of a multilevel model 分析儿童和青少年因 COVID-19 而入住重症监护室的相关因素：多层次模型的应用

Critical care science

Pub Date : 2024-07-01 DOI: 10.62675/2965-2774.20240068-en

L. C. L. Damascena, Aline Roseane Queiroz de Paiva Faria, Nyellisonn Nando Nóbrega de Lucena, Ana Hermínia Andrade e Silva, Talita Tavares Alves de Almeida, Diana de Fátima Alves Pinto, H. F. Coêlho, Ana Maria Gondim Valença

ABSTRACT Objective To identify factors associated with hospitalization in the intensive care unit in children and adolescents with COVID-19. Methods This was a retrospective cohort study using secondary data of hospitalized children and adolescents (zero to 18 years old) with COVID-19 reported in Paraíba from April 2020 to July 2021, totaling 486 records. Descriptive analysis, logistic regression and multilevel regression were performed, utilizing a significance level of 5%. Results According to logistic regression without hierarchical levels, there was an increased chance of admission to the intensive care unit for male patients (OR = 1.98; 95%CI 1.18 - 3.32), patients with respiratory distress (OR = 2.43; 95%CI 1.29 - 4.56), patients with dyspnea (OR = 3.57; 95%CI 1.77 - 7.18) and patients living in large cities (OR = 2.70; 95%CI 1.07 - 6.77). The likelihood of requiring intensive care was observed to decrease with increasing age (OR = 0.94; 95%CI = 0.90 - 0.97), the presence of cough (OR = 0.32; 95%CI 0.18 - 0.59) or fever (OR = 0.42; 95%CI 0.23 - 0.74) and increasing Gini index (OR = 0.003; 95%CI 0.000 - 0.243). According to the multilevel analysis, the odds of admission to the intensive care unit increased in male patients (OR = 1.70; 95%CI = 1.68-1.71) and with increasing population size of the municipality per 100,000 inhabitants (OR = 1.01; 95%CI 1.01-1.03); additionally, the odds of admission to the intensive care unit decreased for mixed-race versus non-brown-skinned patients (OR = 0.981; 95%CI 0.97 - 0.99) and increasing Gini index (OR = 0.02; 95%CI 0.02 - 0.02). Conclusion The effects of patient characteristics and social context on the need for intensive care in children and adolescents with SARS-CoV-2 infection were better estimated with the inclusion of a multilevel regression model.

ABSTRACT Objective To identify factors associated with hospitalization in the intensive care unit in children and adolescents with COVID-19。方法这是一项回顾性队列研究，使用的是 2020 年 4 月至 2021 年 7 月期间帕拉伊巴州报告的 COVID-19 住院儿童和青少年（0 至 18 岁）的二手数据，共计 486 条记录。研究采用描述性分析、逻辑回归和多层次回归，显著性水平为 5%。结果根据无层次的逻辑回归，男性患者（OR = 1.98；95%CI 1.18 - 3.32）、呼吸困难患者（OR = 2.43；95%CI 1.29 - 4.56）、呼吸困难患者（OR = 3.57；95%CI 1.77 - 7.18）和居住在大城市的患者（OR = 2.70；95%CI 1.07 - 6.77）入住重症监护室的几率增加。据观察，随着年龄的增加（OR = 0.94；95%CI = 0.90 - 0.97）、出现咳嗽（OR = 0.32；95%CI 0.18 - 0.59）或发烧（OR = 0.42；95%CI 0.23 - 0.74）以及基尼指数的增加（OR = 0.003；95%CI 0.000 - 0.243），需要重症监护的可能性降低。根据多层次分析，男性患者入住重症监护室的几率增加（OR = 1.70；95%CI = 1.68-1.71），且随着每 10 万居民中城市人口数量的增加而增加（OR = 1.01；95%CI=1.01-1.03）；此外，混血儿相对于非棕色皮肤患者（OR=0.981；95%CI=0.97-0.99）和基尼指数增加（OR=0.02；95%CI=0.02-0.02）时，入住重症监护室的几率降低。结论采用多层次回归模型可以更好地估计患者特征和社会环境对感染 SARS-CoV-2 的儿童和青少年重症监护需求的影响。

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引用次数: 0

A decade of the ORCHESTRA study: organizational characteristics, patient outcomes, performance and efficiency in critical care ORCHESTRA 研究十年：重症监护的组织特征、患者疗效、绩效和效率

Critical care science

Pub Date : 2024-07-01 DOI: 10.62675/2965-2774.20240118-en

Marcio Soares, J. Salluh, Fernando G Zampieri, F. A. Bozza, Pedro Martins Pereira Kurtz

引用次数: 0

The respiratory oxygenation index for identifying the risk of orotracheal intubation in COVID-19 patients receiving high-flow nasal cannula oxygen. 用于识别接受高流量鼻导管供氧的 COVID-19 患者气管插管风险的呼吸氧合指数。

Critical care science

Pub Date : 2024-07-01 eCollection Date: 2024-01-01 DOI: 10.62675/2965-2774.20240203-en

Aline Braz Pereira, Felipe Dal Pizzol, Viviane Cordeiro Veiga, Leandro Utino Taniguchi, Aline Finoti Misquita, Gustavo Augusto Couto Carvalho, Ligia Maria Coscrato Junqueira Silva, Michelli Marcela Dadam, Ruthy Perotto Fernandes, Israel Silva Maia, Cassio Luis Zandonai, Alexandre Biasi Cavalcanti, Marcelo Luz Pereira Romano, Glauco Adrieno Westphal

Objective: To assess whether the respiratory oxygenation index (ROX index) measured after the start of high-flow nasal cannula oxygen therapy can help identify the need for intubation in patients with acute respiratory failure due to coronavirus disease 2019.

Methods: This retrospective, observational, multicenter study was conducted at the intensive care units of six Brazilian hospitals from March to December 2020. The primary outcome was the need for intubation up to 7 days after starting the high-flow nasal cannula.

Results: A total of 444 patients were included in the study, and 261 (58.7%) were subjected to intubation. An analysis of the area under the receiver operating characteristic curve (AUROC) showed that the ability to discriminate between successful and failed high-flow nasal cannula oxygen therapy within 7 days was greater for the ROX index measured at 24 hours (AUROC 0.80; 95%CI 0.76 - 0.84). The median interval between high-flow nasal cannula initiation and intubation was 24 hours (24 - 72), and the most accurate predictor of intubation obtained before 24 hours was the ROX index measured at 12 hours (AUROC 0.75; 95%CI 0.70 - 0.79). Kaplan-Meier curves revealed a greater probability of intubation within 7 days in patients with a ROX index ≤ 5.54 at 12 hours (hazard ratio 3.07; 95%CI 2.24 - 4.20) and ≤ 5.96 at 24 hours (hazard ratio 5.15; 95%CI 3.65 - 7.27).

Conclusion: The ROX index can aid in the early identification of patients with acute respiratory failure due to COVID-19 who will progress to the failure of high-flow nasal cannula supportive therapy and the need for intubation.

目的评估在开始高流量鼻插管氧疗后测量的呼吸氧合指数（ROX指数）是否有助于确定2019年冠状病毒病导致的急性呼吸衰竭患者是否需要插管：这项回顾性、观察性、多中心研究于 2020 年 3 月至 12 月在巴西六家医院的重症监护室进行。主要结果是开始使用高流量鼻插管后 7 天内的插管需求：研究共纳入了 444 名患者，其中 261 人（58.7%）需要插管。对接收器操作特征曲线下面积（AUROC）的分析表明，24 小时内测量的 ROX 指数在 7 天内区分高流量鼻插管氧疗成功与失败的能力更强（AUROC 0.80；95%CI 0.76 - 0.84）。开始使用高流量鼻插管与插管之间的中位间隔为 24 小时（24 - 72），24 小时前插管的最准确预测指标是 12 小时时测量的 ROX 指数（AUROC 0.75；95%CI 0.70 - 0.79）。卡普兰-梅耶曲线显示，12小时时ROX指数≤5.54（危险比3.07；95%CI 2.24 - 4.20）和24小时时ROX指数≤5.96（危险比5.15；95%CI 3.65 - 7.27）的患者在7天内插管的可能性更大：ROX指数有助于早期识别因COVID-19导致的急性呼吸衰竭患者，这些患者将发展为高流量鼻插管支持疗法失败并需要插管治疗。

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引用次数: 0

Boswellia serrata intoxication manifesting with syndrome of inappropriate antidiuretic hormone secretion, hyponatremia, seizure, and rhabdomyolysis. Boswellia serrata中毒表现为抗利尿激素分泌失调综合征、低钠血症、癫痫发作和横纹肌溶解症。

Critical care science

Pub Date : 2024-06-24 eCollection Date: 2024-01-01 DOI: 10.62675/2965-2774.20240049-en

Josef Finsterer

Boswellia serrata is an herbal extract from the Boswellia serrata tree that has anti-inflammatory and analgesic properties and alleviates pain caused by rheumatoid arthritis, gout, osteoarthritis, and sciatica. Syndrome of inappropriate antidiuretic hormone secretion accompanied by hyponatremia, seizures, and rhabdomyolysis as a manifestation of Boswellia serrata intoxication has not been reported previously. A 38-year-old female suffered clinically isolated syndrome and has since been regularly taking B. serrata capsules (200mg/d) to strengthen her immune system. She experienced hypersensitivity to light, ocular pain, nausea, dizziness, and lower limb weakness four days after receiving her first BNT162b2 vaccine dose, and she increased the dosage of B. serrata to five capsules (1000mg/d) one week after vaccination. After taking B. serrata at a dosage of 1000mg/d for 3 weeks, she was admitted to the intensive care unit because of a first, unprovoked generalized tonic-clonic seizure. The patient's workup revealed syndrome of inappropriate antidiuretic hormone secretion, which resolved completely upon treatment and discontinuation of B. serrata. In summary, B. serrata potentially causes syndrome of inappropriate antidiuretic hormone secretion when it is taken at high doses. Patients should not self-medicate.

血清乳香是从血清乳香树中提取的一种草药提取物，具有消炎和镇痛特性，可减轻类风湿性关节炎、痛风、骨关节炎和坐骨神经痛引起的疼痛。作为乳香中毒的一种表现形式，抗利尿激素分泌失调综合征伴有低钠血症、癫痫发作和横纹肌溶解症，此前尚未见报道。一名 38 岁的女性患有临床孤立综合征，此后一直定期服用蛇床子乳香胶囊（200 毫克/天）以增强免疫系统。在接种第一剂 BNT162b2 疫苗四天后，她出现了对光过敏、眼痛、恶心、头晕和下肢无力等症状，接种疫苗一周后，她将血清 B. 的剂量增加到五粒（1000 毫克/天）。在以 1000 毫克/天的剂量服用血清乙型肝炎片 3 周后，她因首次无诱因全身强直-阵挛发作而被送入重症监护室。患者的检查结果显示其患有抗利尿激素分泌失调综合征，经治疗并停用血清双氢萘后，该综合征完全消失。总之，大剂量服用 B. serrata 有可能导致抗利尿激素分泌失调综合征。患者不应自行用药。

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引用次数: 0

To: Critical COVID-19 and neurological dysfunction - a direct comparative analysis between SARS-CoV-2 and other infectious pathogens. 致：临界 COVID-19 和神经功能障碍--SARS-CoV-2 与其他传染病病原体的直接比较分析。

Critical care science

Pub Date : 2024-06-17 eCollection Date: 2024-01-01 DOI: 10.62675/2965-2774.20240291-en

Roberto A Villa

引用次数: 0

To: Factors associated with mortality in mechanically ventilated patients with severe acute respiratory syndrome due to COVID-19 evolution. 要：与 COVID-19 演变导致的严重急性呼吸系统综合征机械通气患者死亡率相关的因素。

Critical care science

Pub Date : 2024-06-17 eCollection Date: 2024-01-01 DOI: 10.62675/2965-2774.20240192-en

Abel Arroyo-Sánchez, Rosa Aguirre-Mejía

引用次数: 0

Impact on pulmonary, cardiac, and renal function and long-term quality of life after hospitalization for acute respiratory distress syndrome due to COVID-19: Protocol of the Post-COVID Brazil 3 study COVID-19 对急性呼吸窘迫综合征患者住院后肺功能、心功能和肾功能以及长期生活质量的影响：后 COVID 巴西 3 研究方案

Critical care science

Pub Date : 2024-06-05 DOI: 10.62675/2965-2774.20240258-en

Fernando Luís Scolari, M. Rover, Geraldine Trott, Mariana Motta Dias da Silva, Denise de Souza, Raine Fogliati de Carli Schardosim, Rosa da Rosa Minho dos Santos, Emelyn de Souza Roldão, Duane Mocellin, Jennifer Menna Barreto de Souza, A. Miozzo, G. Rech, Carolina Rothmann Itaqui, Juliana de Mesquita, Gabriel Pozza Muller Estivalete, Hellen Jordan Martins Freitas, Catherine Vitória Pereira dos Santos, L. G. da Luz, Marcelo Kern, M. S. Marcolino, Bruna Brandão Barreto, Paulo R. Schwartzman, A. C. P. Antonio, Maicon Falavigna, C. Robinson, Carisi Anne Polanczy, R. G. Rosa

ABSTRACT Rationale: Evidence about long-term sequelae after hospitalization for acute respiratory distress syndrome due to COVID-19 is still scarce. Purpose: To evaluate changes in pulmonary, cardiac, and renal function and in quality of life after hospitalization for acute respiratory distress syndrome secondary to COVID-19. Methods: This will be a multicenter case–control study of 220 participants. Eligible are patients who are hospitalized for acute respiratory distress syndrome due to COVID-19. In the control group, individuals with no history of hospitalization in the last 12 months or long-term symptoms of COVID-19 will be selected. All individuals will be subjected to pulmonary spirometry with a carbon monoxide diffusion test, chest tomography, cardiac and renal magnetic resonance imaging with gadolinium, ergospirometry, serum and urinary creatinine, total protein, and urinary microalbuminuria, in addition to quality-of-life questionnaires. Patients will be evaluated 12 months after hospital discharge, and controls will be evaluated within 90 days of inclusion in the study. For all the statistical analyses, p < 0.05 is the threshold for significance. Results: The primary outcome of the study will be the pulmonary diffusing capacity for carbon monoxide measured after 12 months. The other parameters of pulmonary, cardiac, and renal function and quality of life are secondary outcomes. Conclusion: This study aims to determine the long-term sequelae of pulmonary, cardiac, and renal function and the quality of life of patients hospitalized for acute respiratory distress syndrome due to COVID-19 in the Brazilian population.

ABSTRACT 理由：有关 COVID-19 引起的急性呼吸窘迫综合征住院后长期后遗症的证据仍然很少。目的：评估 COVID-19 引起的急性呼吸窘迫综合征住院后肺功能、心功能和肾功能以及生活质量的变化。方法：这将是一项多中心病例研究：这是一项多中心病例对照研究，共有 220 人参加。研究对象为因 COVID-19 导致的急性呼吸窘迫综合征而住院的患者。在对照组中，将选择在过去 12 个月中没有住院史或没有 COVID-19 长期症状的患者。所有患者都将接受肺活量测定和一氧化碳扩散测试、胸部断层扫描、心脏和肾脏钆磁共振成像、肌力测定、血清和尿肌酐、总蛋白、尿微量白蛋白尿以及生活质量问卷调查。患者将在出院后 12 个月接受评估，对照组将在纳入研究后 90 天内接受评估。所有统计分析均以 P < 0.05 为显著性阈值。研究结果研究的主要结果是 12 个月后测量的一氧化碳肺弥散能力。肺、心、肾功能的其他参数和生活质量是次要结果。结论本研究旨在确定巴西人群中因 COVID-19 引起的急性呼吸窘迫综合征住院患者的肺、心、肾功能长期后遗症和生活质量。

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引用次数: 0

To: Biomarkers of neuropsychiatric dysfunction in intensive care unit survivors: a prospective cohort study 对重症监护室幸存者神经精神功能障碍的生物标志物：一项前瞻性队列研究

Critical care science

Pub Date : 2024-06-05 DOI: 10.62675/2965-2774.20240260-en

J. Finsterer, F. Scorza

引用次数: 0

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