Medicina intensiva最新文献

Objective: To assess the impact of the October 29, 2024 DANA-related floods on Intensive Care Unit (ICU) operations and patient care in the Valencia region. This study aims to characterize the clinical profiles, logistical pathways, and outcomes of patients requiring intensive care during the month following the flood event DESIGN: Multicenter prospective observational study.

Setting: Nine intensive care units in the Valencia region from October 29 to November 30, 2024.

Patients or participants: All ICU admissions prospectively identified as being influenced by the DANA event using a predefined checklist INTERVENTIONS: None.

Main variables of interest: Demographic and clinical data, ICU management, length of stay, and outcomes.

Results: Twenty-six patients were included and classified as direct (15.4%) or indirect victims (84.6%). Median age was 60 years, and most had chronic comorbidities. ICU admission causes included acute cardiac events, trauma, infections, and worsening of chronic conditions due to treatment disruptions. Delays in diagnosis or transportation were reported in over 50% of cases. The median ICU stay was 3 days, with 15.4% mortality rate. ICU capacity remained sufficient throughout the event, and no surge-capacity plans were activated.

Conclusion: The ICU burden during the DANA event was predominantly due to indirect health effects, especially in vulnerable populations with chronic diseases. Disaster preparedness strategies must prioritize continuity of care and address logistical barriers to reduce avoidable critical care admissions and mortality.

Objective: To evaluate the impact of antibiotic therapy within the first 24 h of admission on the development of VAP occurring in the first week (VAPFW) in patients admitted with low level of consciousness.

Desing: Cohort retrospective observational study, from January 1, 2014, to December 1, 2024 SETTING: 24-bed general Intensive Care Unit of a secondary hospital.

Patients: Admitted with decreased level of consciousness or TBI with or without other trauma associated, who required mechanical ventilation for >48 h. A total of 449 patients were included. Median age was 57.2 years, and 67.4% were male.

Interventions: No interventions were performed.

Main variables of interest: Demographic variables, APACHE and SAPS II scores, reason for ICU admission, antibiotic administration in the first 24 h, development of VAPFW. Length of stay, days of mechanical ventilation and ICU mortality.

Results: Only 38 (8.5%) were diagnosed with VAP. A total of 242 patients (53.8%) received antibiotic treatment. There were no differences in the incidence of VAPFW between patients with and without antibiotic (8.2% vs 8.7%, p = 0.99). After Propensity Score matching, Cox proportional hazards model showed that antibiotic administration was associated with a 62% lower proportional daily risk of developing VAPFW (HR = 0.38; 95% CI 0.17-0.83). This protective effect was not confirmed in multiple logistic regression (OR 0.45, CI 95% 0.18-1.1, P = 0.08).

Conclusions: In ICUs with low incidence of VAPFW, administration of prophylactic antibiotics to patients intubated for low level of consciousness does not appear to confer a meaningful reduction in VAPFW risk.

Patients with cirrhosis present a highly vulnerable and rebalanced hemostasis state. Assessing the bleeding risk in these patients is complex. It is essential to recognize that conventional coagulation tests do not adequately reflect the true risk of bleeding or thrombosis. The detailed understanding of this balance and the application of more precise diagnostic tools, such as viscoelastic tests that can more accurately evaluate their coagulation status, facilitate clinical management and can improve the results in these patients. The haemorrhagic risk of this group of patients is conditioned by specific factors of liver disease, such as portal hypertension and altered haemostatic status, and by systemic factors like the presence of infections and kidney disease, which are independent predictors of bleeding during high-risk procedures. These concepts and the recommendations from the most recent clinical practice guidelines are reviewed in this article.

Objective: We sought to delineate the mortality outcome time frames reported in septic shock randomized control trials (RCTs).

Design: Systematic review of PubMed, EMBASE, and the Cochrane Database of Systematic Reviews.

Setting: Intensive care units.

Participants: Studies that included adult patients with septic shock.

Interventions: Any type of intervention.

Main variables of interest: Information about the study, specific patient population, type of study intervention, specific intervention, and number of patients. Mortality time frames were analyzed for geographical differences and changes over time.

Results: The search yielded 2660 unique citations. After screening, 132 eligible studies were identified. A total of 234 mortality time frames were collected from the included studies, of which 15 timeframes were unique. The most frequently reported time frame was 28-day mortality (n = 98, 74% of trials), followed by hospital mortality (n = 35, 27%), ICU mortality (n = 30, 23%), and 90-day mortality (n = 29, 22%). The most reported mortality time frame was 28 days in studies from every continent except Africa. The studies published between 2008 and 2013 (25%) more frequently reported hospital and ICU mortality combination than studies published between 2014 and 2019 (11.4%) (P = 0.043).

Conclusions: There was considerable variability in the mortality time frames reported in ICU-based septic shock trials. This variability may lead to under or overestimation of the problem, overlooking the effectiveness of the interventions studied, and further limiting the application of trials and their pooling in meta-analyses. A consensus regarding time frame reporting in septic shock trials is long overdue.

Objective: To analyse which variables associated with ICU admission for COVID-19 were linked to higher hospital costs according to the APR-DRG classification.

Design: Retrospective, observational, and analytical study.

Setting: COVID-19 ICU in a tertiary hospital.

Patients: Adults (>18 years) with a confirmed diagnosis of SARS-CoV-2 infection.

Interventions: Predictive models using multiple logistic regression.

Main variables of interest: Hospital cost, APR-DRG, mechanical ventilation.

Results: A total of 799 patients were analyzed and categorized into tertiles based on hospital stay costs, resulting in three groups: 266 patients with lower costs (median ;6160 [p25: 3962-p75: 6160]), 314 with intermediate costs (median ;16,446 [p25: 10,653-p75: 18,274]), and 219 with higher costs (median ;26,085 [p25: 26,085-p75: 51,523]). The best predictive model, with an AIC of 490.09 and an R² of 0.32, identified the following factors as significantly associated with higher hospital costs: ICU length of stay (OR: 1.05; 95% CI: 1.03-1.07; p < 0.01), development of VAT/VAP (OR: 4.72; 95% CI: 2.83-7.85; p < 0.01), OXA-48 infection (OR: 2.65; 95% CI: 1.25-5.61; p = 0.01), pulmonary embolism (OR: 6.42; 95% CI: 2.17-19.26; p < 0.01), smoking history (OR: 2.22; 95% CI: 1.49-3.74; p < 0.01), and vasopressor requirement (OR: 1.79; 95% CI: 1.22-2.86; p = 0.01). The area under the curve (AUC) was 0.866 (p < 0.01).

Conclusions: Prolonged ICU stay, infectious and thromboembolic complications, smoking history, and vasopressor requirement were significantly associated with higher hospital costs.