Medicina intensiva最新文献

The implementation of invasive mechanical ventilation (IMV) in critically ill patients involves two crucial moments: the total control phase, affected among other things by the use of analgesics and sedatives, and the transition phase to spontaneous ventilation, which seeks to shorten IMV times and where optimizing patient-ventilator interaction is one of the main challenges. Ineffective inspiratory efforts (IEE) arise when there is no coordination between patient effort and ventilator support. IIE are common in different ventilatory modes and are associated with worse clinical outcomes: dyspnea, increased sedation requirements, increased IMV days and longer intensive care unit (ICU) and hospital stay. These are manifested graphically as an abrupt decrease in expiratory flow, being more frequent during expiration. However, and taking into consideration that it is still unknown whether this association is causal or rather a marker of disease severity, recognizing the potential physiological consequences, reviewing diagnostic methods and implementing detection and treatment strategies that can limit them, seems reasonable.

Objective: To analyze whether the characteristics of the patients treated by the in-hospital cardiorespiratory arrest team, IHCA and cardiopulmonary resuscitation (CPR) were different in the period before the COVID-19 compared to the pandemic period; also analyzing the differences between COVID+ and COVID- patients.

Design: Observational and retrospective study from January 1st, 2018, to December 31st, 2021.

Setting: Tertiary hospital.

Patients: All adult patients over 18 years old requiring attention from the IHCA response team.

Interventions: CPR maneuvers according to the advanced life support guidelines of the European Resuscitation Council published in 2015, as well as the modifications made in the COVID era (2020).

Main variables: Demographic and epidemiological data, activations of the IHCA response team, CA data, hospital and intensive care unit (ICU) length of stay, survival and neurological outcome at hospital discharge.

Results: A total of 368 patients were analyzed: 173 in the pre-pandemic group and 195 in the pandemic group. The neurological outcome was better in the pre-pandemic group, and COVID+ patients had a longer ICU length of stay. However, no differences in the response time of the CPR team or in CPR duration were found, nor in immediate survival or at hospital discharge, between both groups or between COVID+ and COVID- patients.

Conclusions: Changes in CPR care protocols due to the COVID-19 pandemia did not seem to affect response times from IHCA team neither immediate nor discharge survival.

Intensive care units (ICUs) rely in many instances on observational research and often encounter difficulties in establishing cause-and-effect relationships. After conducting a thorough search focused on ICU observational studies, this review analysed the causal language and evaluated the quality of reporting of the methodologies employed. The causal was assessed by analysing the words linking exposure to outcomes in the title and main objective. The quality of the reporting of the key methodological aspects related to causal inference was based on STROBE and ROBINS-I tools. We identified 139 articles, with 87 (63%) and 82 (59%) studies having non-causal language in their title and main objective, respectively. Among the total, 49 (35%) articles directly addressed causality. The review found vague causal language in observational ICU research and highlighted the need for better adherence to reporting guidelines for improved causal analysis and inference.

Objective: To determine the changes in intubation procedures of critically ill patients without SARS-CoV-2 infection induced during the COVID-19 pandemic.

Design: Secondary Analysis of the INTUPROS Prospective Multicenter Observational Study on Intubation in Intensive Care Units (ICUs).

Setting: 43 Spanish ICUs between April 2019 and October 2020.

Patients: 1515 Non-COVID-19 patients intubated before and during the pandemic.

Interventions: None.

Main variables of interest: Intubation procedures and medication, first-pass success rate, complications, and mortality.

Results: 1199 patients intubated before the pandemic and 316 during the pandemic were analyzed. During the pandemic, there were fewer days until intubation (OR 0.95 95% CI [0.92-0.98]), reduced resuscitation bag (OR 0.43 95% CI [0.29-0.63]) and non-invasive ventilation oxygenation (OR 0.51 95% CI [0.34-0.76]), reduced use of capnography (OR 0.55 95% CI [0.33-0.92]) and fentanyl (OR 0.47 95% CI [0.34-0.63]). On the other hand, there was an increase in oxygenation with non-HFNC devices (OR 2.21 95% CI [1.23-3.96]), in use of videolaryngoscopy on the first-pass (OR 2.74 95% CI [1.76-4.24]), and greater use of midazolam (OR 1.95 95% CI [1.39-2.72]), etomidate (OR 1.78 95% CI [1.28-2.47]) and succinylcholine (OR 2.55 95% CI [1.82-3.58]). The first-pass success was higher (68.5% vs. 74.7%; P=.033). There were no pre-post differences in major complications (34.7% vs. 34.8%; P=.970) and in-hospital mortality (42.7% vs. 38.6%; P=.137).

Conclusions: The COVID-19 pandemic modified intubation procedures in non-COVID-19 patients, changing the oxygenation strategy, the medication and the use of videolaryngoscopy, with no impact on complications or mortality.