Medicina intensiva最新文献

英文中文

Assessment of the shock index in septic shock: A systematic review 脓毒性休克的休克指数评估：系统综述。

Medicina intensiva

Pub Date : 2024-11-01 DOI: 10.1016/j.medine.2024.07.006

Juan José Diaztagle Fernández , Juan Pablo Castañeda-González , José Ignacio Trujillo Zambrano , Francy Esmith Duarte Martínez , Miguel Ángel Saavedra Ortiz

Objective

To identify published research on the Shock Index (SI) in patients with septic shock or severe sepsis and to describe its main findings and conclusions.

Design

Systematic review of the literature following the recommendations of the PRISMA protocol (Preferred Reporting Items for Systematic Reviews and Meta-Analyses).

Settings

The following databases were consulted: Pubmed, Embase, Library Cochrane and Lilacs.

Patients

Patients older than 14 years with septic shock. Pregnant women and population with COVID-19 were excluded.

Interventions

Studies reporting measurement of the shock index or its modified variants.

Main variables of interest

Absolute frequencies and relative frequencies were assessed with measures of central tendency and dispersion. Effect estimators (OR, RR and HR) were extracted according to the context of each study.

Results

Seventeen articles were included, of which 11 investigated the SI as a predictor of mortality. Seven of them found significant differences in the SI when comparing survivors to non-survivors and observed a relationship between the SI evolution and clinical outcomes. Additional research evidenced a relation between the Modified Shock Index and myocardial depression, as well as mortality. Furthermore, they identified a relationship between the Diastolic Shock Index, the dose of administered dobutamine, and mortality.

Conclusions

The results suggest that both the SI and its modified versions, particularly in serial assessments, can be considered for evaluating patient prognosis. The SI can also aid in determining fluid management for patients.

目的确定已发表的有关脓毒性休克或严重脓毒症患者休克指数（SI）的研究，并描述其主要发现和结论：设计：按照 PRISMA 协议（系统综述和 Meta 分析首选报告项目）的建议对文献进行系统综述：查阅了以下数据库Pubmed、Embase、Library Cochrane 和 Lilacs：14岁以上脓毒性休克患者。不包括孕妇和患有 COVID-19 的人群：干预措施：报告休克指数或其修正变体测量结果的研究：绝对频率和相对频率通过中心倾向和离散度量进行评估。根据每项研究的背景提取效应估计值（OR、RR 和 HR）：结果：共收录了 17 篇文章，其中 11 篇研究了作为死亡率预测因素的 SI。其中 7 篇文章发现，幸存者与非幸存者的 SI 存在明显差异，并观察到 SI 变化与临床结果之间的关系。其他研究证明了修正冲击指数与心肌抑制和死亡率之间的关系。此外，他们还确定了舒张性休克指数、多巴酚丁胺给药剂量与死亡率之间的关系：结果表明，SI 及其修正版，尤其是在连续评估中，可用于评估患者的预后。SI 还有助于确定患者的输液管理。

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引用次数: 0

Esophageal perforation secondary to achalasia 继发于贲门失弛缓症的食管穿孔。

Medicina intensiva

Pub Date : 2024-11-01 DOI: 10.1016/j.medine.2024.02.012

引用次数: 0

Incidence of venous thromboembolic disease and risk of bleeding in critically ill patients with hematologic malignancies: A retrospective study 血液系统恶性肿瘤重症患者的静脉血栓栓塞性疾病发病率和出血风险：回顾性研究。

Medicina intensiva

Pub Date : 2024-11-01 DOI: 10.1016/j.medine.2024.06.003

Objective

Our objectives were to describe the use of thromboprophylaxis and the incidence of VTE/bleeding in critically ill patients with hematologic malignancies (HM).

Design

Retrospective cohort study (2014–2022).

Setting

Medic-Surgical Intensive Care Unit (ICU) in a tertiary care academic center.

Patients

Adult patients admitted to ICU with a concomitant diagnosis of a hematological malignancy.

Interventions

None.

Main variables of interest

We analyzed demographic data, use of thromboprophylaxis and secondary outcomes that included incidence of VTE (venous thromboembolism), bleeding, mortality, severity scores and organ support. We applied a multivariable logistic regression model to examine the risk of thrombosis in the ICU.

Results

We included 862 ICU admissions (813 unique patients). Thromboprophylaxis was given during 65% of admissions (LMWH 14%, UFH 8%, and SCDs 43%); in 21% it was contraindicated due to thrombocytopenia; 14% of cases lacked documentation on prophylaxis. There were 38 unique incident cases of VTE (27 DVT, 11 PE), constituting 4.4% of ICU episodes. Most of VTE cases happened in patients with various degrees of thrombocytopenia. In the multivariable analysis, SOFA score on the first ICU day was independently associated (OR 0.85, 95% CI 0.76−0.96) with the risk of VTE. Bleeding occurred in 7.2% (minor) and 14.4% (major) of episodes; most frequent sites being CNS, abdomen/GI and pulmonary.

Conclusions

In this cohort of critically ill patients with HM, there was considerable variability in the utilization of DVT prophylaxis, with predominant use of SCDs. The incidence of VTE was 4.4% and major bleeding 14%.

Clinical Trial Registration

NCT05396157. Venous Thromboembolism in Hematologic Malignancy and Hematopoietic Cell Transplant Patients: a Retrospective Study (https://clinicaltrials.gov/).

目的我们的目标是描述血液系统恶性肿瘤（HM）重症患者血栓预防措施的使用情况以及VTE/出血的发生率：回顾性队列研究（2014-2022年）：地点：一家三级医疗学术中心的内外科重症监护病房（ICU）：干预措施：无：干预措施：无：我们分析了人口统计学数据、血栓预防措施的使用情况以及次要结果，包括VTE（静脉血栓栓塞症）发生率、出血、死亡率、严重程度评分和器官支持。我们采用多变量逻辑回归模型来研究重症监护病房血栓形成的风险：我们纳入了 862 例重症监护病房入院患者（813 例患者）。65%的入院患者接受了血栓预防治疗（LMWH 14%、UFH 8%、SCDs 43%）；21%的患者因血小板减少而禁用血栓预防治疗；14%的病例缺乏预防治疗记录。VTE病例共有38例（深静脉血栓27例、聚乙烯醇11例），占重症监护病房病例的4.4%。大多数 VTE 病例发生在不同程度血小板减少的患者身上。在多变量分析中，ICU 第一天的 SOFA 评分与 VTE 风险独立相关（OR 0.85，95% CI 0.76-0.96）。7.2%（轻微）和14.4%（严重）的出血发生在中枢神经系统、腹部/消化道和肺部：结论：在这批 HM 重症患者中，深静脉血栓预防措施的使用存在很大差异，主要使用 SCD。VTE发生率为4.4%，大出血发生率为14%：临床试验注册：NCT05396157。血液恶性肿瘤和造血细胞移植患者静脉血栓栓塞症：一项回顾性研究》(https://clinicaltrials.gov/)。

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引用次数: 0

Guided reversal of dabigatran in massive hemorrhagic shock: A case report. 大面积失血性休克患者在达比加群引导下逆转治疗：病例报告。

Medicina intensiva

Pub Date : 2024-10-24 DOI: 10.1016/j.medine.2024.10.002

Manuel Fernández Caro, Manuel Casado Méndez, Francisco Javier Rodríguez Martorell, Antonio Manuel Puppo Moreno

引用次数: 0

Moral complexity in the organ donation process: The satisfaction of a job well done. 器官捐献过程中的道德复杂性：完成工作的满足感。

Medicina intensiva

Pub Date : 2024-10-24 DOI: 10.1016/j.medine.2024.07.014

José Miguel Pérez-Villares, Ramón Lara-Rosales, Alberto Fernández-Carmona, Alberto Iglesias-Santiago

引用次数: 0

Early blood pressure drop predicts renal function deterioration and mortality in ICU patients with liver failure: a retrospective cohort study. 早期血压下降可预测重症监护病房肝功能衰竭患者的肾功能恶化和死亡率：一项回顾性队列研究。

Medicina intensiva

Pub Date : 2024-10-24 DOI: 10.1016/j.medine.2024.10.005

Rubing Guo, Jingjing Tong, Li Wang, Bo Yang, Liang Ma, Yongtong Cao, Wei Zhao

Objective: To investigate the association between early blood pressure drop and worsening renal function (WRF) in ICU patients with liver failure and to evaluate their clinical outcomes.

Design: Retrospective observational study.

Setting: Intensive Care Medicine.

Patients: Patients admitted to the ICU for the first time during their first hospitalization; diagnosed with liver failure according to the International Classification of Diseases, Ninth and Tenth Revision codes; and aged ≥18 years were included. Patients with a peak systolic blood pressure (SBP) drop of <0 mmHg were excluded.

Intervention: We analyzed data of ICU patients with liver failure from the Medical Information Mart for Intensive Care IV version 2.2 database. Descriptive statistics, analysis of variance, Kruskal-Wallis test, and chi-square test were employed for analysis. Multivariate linear regression models were used to assess the determinants of blood pressure decline. Cox proportional hazards and generalized additive models were used to evaluate MAIN VARIABLES OF INTEREST: The relationship between blood pressure decline, WRF, and 60-day in-hospital mortality were evaluated, along with subgroup analyses.

Results: Peak SBP drop was independently associated with higher risks of WRF (P < 0.001) and 60-day in-hospital mortality (P < 0.001), even after adjusting for potential confounders, including baseline SBP. The independent risk relationship observed between peak diastolic blood pressure, mean arterial pressure drop, and the occurrence of WRF and 60-day in-hospital mortality was similar.

Conclusions: In ICU patients with liver failure, a significant early drop in blood pressure was associated with a higher incidence of WRF, increased risk of 60-day in-hospital mortality, and poorer prognoses.

目的研究ICU肝功能衰竭患者早期血压下降与肾功能恶化（WRF）之间的关系，并评估其临床结局：设计：回顾性观察研究：重症医学科：研究对象：首次住院期间入住重症监护病房的患者；根据《国际疾病分类》第九版和第十版诊断为肝功能衰竭；年龄≥18岁。收缩压（SBP）峰值下降的患者介入：我们分析了重症监护医学信息市场 IV 版 2.2 数据库中 ICU 肝衰患者的数据。分析采用了描述性统计、方差分析、Kruskal-Wallis 检验和卡方检验。多变量线性回归模型用于评估血压下降的决定因素。采用 Cox 比例危险模型和广义加性模型评估主要相关变量：评估血压下降、WRF 和 60 天院内死亡率之间的关系，并进行亚组分析：结果：SBP 峰值下降与 WRF 风险较高密切相关（P＜0.05）：在重症监护病房肝衰竭患者中，早期血压显著下降与较高的 WRF 发生率、较高的 60 天院内死亡风险和较差的预后有关。

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引用次数: 0

The future of nursing in the intensive care unit: Specialization and advanced clinical practice - rivalry or synergy? 重症监护室护理工作的未来：专业化和高级临床实践--竞争还是协同？

Medicina intensiva

Pub Date : 2024-10-23 DOI: 10.1016/j.medine.2024.08.003

Mónica Vázquez-Calatayud

引用次数: 0

Ten take-home messages on vasopressin use in critically ill patients. 关于危重病人使用血管加压素的十点启示。

Medicina intensiva

Pub Date : 2024-10-21 DOI: 10.1016/j.medine.2024.09.009

Ricard Ferrer, Pedro Castro, Carol Lorencio, Josman Monclou, Pilar Marcos, Ana Ochagavia, Juan Carlos Ruíz-Rodríguez, Josep Trenado, Christian Villavicencio, Juan Carlos Yébenes, Lluís Zapata

The most used vasopressors in critically ill patients are exogenous catecholamines, mainly norepinephrine. Their use can be associated with serious adverse events and even increased mortality, especially if administered at high doses. In recent years, the addition of vasopressin has been proposed to counteract the deleterious effects of high doses of catecholamines (decatecholaminization) with the intention of improving the prognosis of these patients. Currently, vasopressin has two main indications: septic shock and vasoplegic shock in the postoperative period of cardiac surgery. In septic shock, current evidence favors its early initiation before reaching high doses of norepinephrine. In the postoperative period of cardiac surgery, the different benefits of the use of vasopressin have been studied, especially in patients with atrial fibrillation and pulmonary hypertension. When used properly, vasopressin is a safe an effective drug for the indications described above.

重症患者最常用的血管加压药是外源性儿茶酚胺，主要是去甲肾上腺素。使用这些药物可能会导致严重的不良反应，甚至增加死亡率，尤其是在大剂量使用的情况下。近年来，有人提出添加血管加压素来抵消大剂量儿茶酚胺的有害影响（去甲肾上腺素化），以期改善这些患者的预后。目前，血管加压素有两个主要适应症：脓毒性休克和心脏手术术后的血管性休克。对于脓毒性休克，目前的证据支持在使用大剂量去甲肾上腺素之前尽早使用血管加压素。在心脏手术术后，使用血管加压素的不同益处已得到研究，尤其是在心房颤动和肺动脉高压患者中。如果使用得当，血管加压素在上述适应症中是一种安全有效的药物。

引用次数: 0

Global definition of acute respiratory distress syndrome: An epidemiology perspective. 急性呼吸窘迫综合征的全球定义：流行病学视角。

Medicina intensiva

Pub Date : 2024-10-19 DOI: 10.1016/j.medine.2024.10.001

Pablo Cardinal-Fernández, Guillermo Ortiz, Luis Blanch

引用次数: 0

A rare echocardiographic imaging of a giant atrial mass. 罕见的巨大心房肿块超声心动图成像。

Medicina intensiva

Pub Date : 2024-10-19 DOI: 10.1016/j.medine.2024.10.004

Pingping Dong, Jianneng Pan, Xiaoyang Zhou

引用次数: 0

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