Medicina intensiva最新文献

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On frailty, quality of life and post-ICU syndrome 关于虚弱、生活质量和重症监护室术后综合症。

Medicina intensiva

Pub Date : 2024-07-01 DOI: 10.1016/j.medine.2024.04.015

Arantxa Mas Serra

引用次数: 0

Hydrocephalus treatment monitoring on transcranial and abdominal ultrasound 经颅和腹部超声监测脑积水治疗。

Medicina intensiva

Pub Date : 2024-07-01 DOI: 10.1016/j.medine.2023.12.008

Pablo Blanco , Liliana Figueroa , Gustavo Ottaviano

引用次数: 0

Spontaneous air cerebral embolism secondary to pulmonary vulnerability 继发于肺损伤的自发性空气脑栓塞。

Medicina intensiva

Pub Date : 2024-07-01 DOI: 10.1016/j.medine.2024.01.006

Alejandra Carmen Nasarre Puyuelo , Daniel Saénz Abad , José María Ferreras Amez

引用次数: 0

Cistitis enfisematosa en el postoperatorio de reemplazo de válvula aórtica 主动脉瓣置换术后气肿性膀胱炎

Medicina intensiva

Pub Date : 2024-07-01 DOI: 10.1016/j.medin.2024.06.015

Iratxe Iriondo Irigoras, M. Á. Rodríguez Esteban

引用次数: 0

Assessment of early traumatic mortality using post-mortem computed tomography 利用死后计算机断层扫描评估早期创伤死亡率。

Medicina intensiva

Pub Date : 2024-07-01 DOI: 10.1016/j.medine.2024.01.005

Lidia Orejón García , Laín Ibáñez Sanz , Marcos Valiente Fernández , Francisco de Paula Delgado Moya , Elena Martinez Chamorro , Mario Chico Fernández

引用次数: 0

Factors associated with vasoplegic shock in the postoperative period of cardiac surgery and influence on morbidity and mortality of the use of arginine vasopressin as rescue therapy 心脏手术术后出现血管性休克的相关因素，以及使用精氨酸血管加压素作为抢救疗法对发病率和死亡率的影响。

Medicina intensiva

Pub Date : 2024-07-01 DOI: 10.1016/j.medine.2024.04.003

María Barrera Sánchez, Cristina Royo Villa, Pablo Ruiz de Gopegui Miguelena, Pablo Gutiérrez Ibañes, Andrés Carrillo López

Objectives

Analyzing associated factors with vasoplegic shock in the postoperative period of Cardiac Surgery. Analyzing the influence of vasopressin as rescue therapy to first-line treatment with norepinephrine.

Design

Cohort, prospective and observational study.

Setting

Main hospital Postoperative Cardiac ICU.

Patients

Patients undergoing cardiac surgery with subsequent ICU admission from January 2021 to December 2022.

Interventions

Record of presurgical, perioperative and ICU discharge clinical variables.

Main variables of interest

chronic treatment, presence of vasoplegic shock, need for vasopressin, cardiopulmonary bypass time, mortality.

Results

773 patients met the inclusion criteria. The average age was 67.3, with predominance of males (65.7%). Post-CPB vasoplegia was documented in 94 patients (12.2%). In multivariate analysis, vasoplegia was associated with age, female sex, presurgical creatinine levels, cardiopulmonary bypass time, lactate level upon admission to the ICU, and need for prothrombin complex transfusion. Of the patients who developed vasoplegia, 18 (19%) required rescue vasopressin, associated with pre-surgical intake of ACEIs/ARBs, worse Euroscore score and longer cardiopulmonary bypass time. Refractory vasoplegia with vasopressin requirement was associated with increased morbidity and mortality.

Conclusions

Postcardiopulmonary bypass vasoplegia is associated with increased mortality and morbidity. Shortening cardiopulmonary bypass times and minimizing products blood transfusion could reduce its development. Removing ACEIs and ARBs prior to surgery could reduce the incidence of refractory vasoplegia requiring rescue with vasopressin. The first-line treatment is norepinephrine and rescue treatment with VSP is a good choice in refractory situations. The first-line treatment of this syndrome is norepinephrine, although rescue with vasopressin is a good complement in refractory situations.

目的分析心脏手术术后血管性休克的相关因素。分析血管加压素作为去甲肾上腺素一线治疗的救援疗法的影响：队列、前瞻性和观察性研究：主要医院心脏手术后重症监护室：患者：2021 年 1 月至 2022 年 12 月期间接受心脏手术并随后入住 ICU 的患者：主要关注变量：慢性治疗、血管性休克、血管加压素需求、心肺旁路时间、死亡率：结果：773 名患者符合纳入标准。平均年龄为 67.3 岁，男性居多（65.7%）。有 94 名患者（12.2%）在 CPB 后出现血管瘫痪。在多变量分析中，血管痉挛与年龄、女性性别、手术前肌酐水平、心肺旁路时间、进入重症监护室时的乳酸水平以及凝血酶原复合物输血需求有关。在出现血管痉挛的患者中，有18人（19%）需要使用血管加压素进行抢救，这与手术前服用 ACEIs/ARBs、Euroscore 评分较差和心肺旁路时间较长有关。需要使用血管加压素的难治性血管痉挛与发病率和死亡率增加有关：结论：心肺旁路术后血管痉挛与死亡率和发病率增加有关。结论：心肺搭桥术后血管痉挛与死亡率和发病率的增加有关。缩短心肺搭桥时间并尽量减少输血产品可减少血管痉挛的发生。手术前停用 ACEIs 和 ARBs 可减少需要使用血管加压素抢救的难治性血管痉挛的发生率。去甲肾上腺素是一线治疗药物，在难治性情况下，使用血管加压素进行抢救治疗是一个不错的选择。该综合征的一线治疗是去甲肾上腺素，但在难治性情况下，使用血管加压素进行抢救是一种很好的补充治疗。

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引用次数: 0

Current situation and characteristics of centers specialized in management of aneurysmal subarachnoid hemorrhage in Spain 西班牙动脉瘤性蛛网膜下腔出血专业治疗中心的现状和特点。

Medicina intensiva

Pub Date : 2024-07-01 DOI: 10.1016/j.medine.2024.02.016

Marta Bueso Navarro , Arturo Zabalegui Pérez , Aaron Blandino Ortiz , Bárbara Vidal Tegedor , Laura Galarza Barrachina , representing the REMOS study investigators

引用次数: 0

Changes in pulmonary mechanics from supine to prone position measured through esophageal manometry in critically ill patients with COVID-19 severe acute respiratory distress syndrome 通过食管测压法测量 COVID-19 严重急性呼吸窘迫综合征重症患者从仰卧位到俯卧位的肺力学变化

Medicina intensiva

Pub Date : 2024-07-01 DOI: 10.1016/j.medine.2023.07.013

Ismael Maldonado-Beltrán , Martín Armando Ríos-Ayala , Iván Armando Osuna-Padilla , Nadia Carolina Rodríguez-Moguel , Gustavo Lugo-Goytia , Carmen Margarita Hernández-Cárdenas

Objective

To describe changes in pulmonary mechanics when changing from supine position (SP) to prone position (PP) in mechanically ventilated (MV) patients with Acute Respiratory Distress Syndrome (ARDS) due to severe COVID-19.

Design

Retrospective cohort.

Setting

Intensive Care Unit of the National Institute of Respiratory Diseases (Mexico City).

Patients

COVID-19 patients on MV due to ARDS, with criteria for PP.

Intervention

Measurement of pulmonary mechanics in patients on SP to PP, using esophageal manometry.

Main variables of interest

Changes in lung and thoracic wall mechanics in SP and PP

Results

Nineteen patients were included. Changes during first prone positioning were reported. Reductions in lung stress (10.6 vs 7.7, p = 0.02), lung strain (0.74 vs 0.57, p = 0.02), lung elastance (p = 0.01), chest wall elastance (p = 0.003) and relation of respiratory system elastances (p = 0.001) were observed between patients when changing from SP to PP. No differences were observed in driving pressure (p = 0.19) and transpulmonary pressure during inspiration (p = 0.70).

Conclusions

Changes in pulmonary mechanics were observed when patients were comparing values of supine position with measurements obtained 24 h after prone positioning. Esophageal pressure monitoring may facilitate ventilator management despite patient positioning.

目的描述因严重 COVID-19 而接受机械通气的急性呼吸窘迫综合征（ARDS）患者从仰卧位（SP）转变为俯卧位（PP）时肺力学的变化。患者COVID-19患者因ARDS接受MV治疗，符合PP标准。干预措施使用食管测压法测量SP到PP患者的肺力学。主要关注变量SP和PP患者肺和胸壁力学的变化。报告了首次俯卧位时的变化。从 SP 到 PP 时，观察到不同患者的肺压力（10.6 vs 7.7，p = 0.02）、肺应变（0.74 vs 0.57，p = 0.02）、肺弹性（p = 0.01）、胸壁弹性（p = 0.003）和呼吸系统弹性关系（p = 0.001）均有所降低。结论当患者比较仰卧位和俯卧位 24 小时后的测量值时，可观察到肺力学的变化。食管压力监测可在患者摆放体位时促进呼吸机管理。

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引用次数: 0

The open data revolution: Enhancing healthcare in intensive care units 开放数据革命：加强重症监护室的医疗保健。

Medicina intensiva

Pub Date : 2024-07-01 DOI: 10.1016/j.medine.2024.03.011

Sergio Muñoz-Lezcano , Carmen de la Fuente , Ángel Estella , Rosario Amaya-Villar , Antonio M. Puppo-Moreno , Miguel Ángel Armengol-de la Hoz , José Garnacho-Montero

引用次数: 0

Intramyocardial edema as an atypical manifestation of capillary leak syndrome. 心肌内水肿是毛细血管渗漏综合征的一种非典型表现。

Medicina intensiva

Pub Date : 2024-06-27 DOI: 10.1016/j.medine.2024.06.010

Montserrat Rodríguez Gómez, María Calle Romero, Sara Domingo Marín

引用次数: 0

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