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High flow in tracheostomized patients on their first attempt to wean from mechanical ventilation: more questions on the table. 首次尝试脱离机械通气的气管插管患者中的高流量:桌面上的更多问题。
Pub Date : 2024-09-14 DOI: 10.1016/j.medine.2024.09.002
Adrián Gallardo, Aldana Silvero, Santiago Saavedra
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引用次数: 0
How to involve the patient and family in improving safety in intensive medicine services (SMI)? 如何让患者和家属参与改善重症医学服务(SMI)的安全性?
Pub Date : 2024-09-14 DOI: 10.1016/j.medine.2024.06.012
Olga Rubio Sanchiz, Joan Escarrabill, Joan Fernando Peidró, Anne Sophie Gresle

Patient safety is a priority for health systems and is especially relevant for critically ill patients. Despite its relevance in recent years, many patients suffer adverse events with harm and negative repercussions for professionals and institutions. Numerous safe practices have been promoted and strategies have been developed that have been incorporated into institutional policies and thereby improving the safety culture. But there are still underdeveloped strategies, such as incorporating the participation of patients and family members in their safety. Until recently, the patient and family have been considered as a passive part in the reception of health services, not as an active part, much less as a possible opportunity to improve safety against errors that occur during care. The critically ill patient and/or family members must be informed and, ideally, trained to facilitate active participation in their safety. It is not about transferring responsibility, but about facilitating and promoting their participation by reinforcing their safety. And professionals must be committed to their safety and facilitate the conditions to encourage their participation. We provide tools and reflections to help professionals implement the participation of patients and family members in safety as they pass through intensive medicine services.

患者安全是医疗系统的首要任务,尤其与危重病人息息相关。尽管近年来患者安全问题受到重视,但仍有许多患者遭受不良事件的伤害,对专业人员和医疗机构造成负面影响。许多安全措施得到了推广,制定的战略也被纳入了机构政策,从而改善了安全文化。但仍有一些战略发展不足,例如让病人和家属参与到他们的安全工作中来。直到最近,病人和家属一直被认为是接受医疗服务的被动部分,而不是主动部分,更不可能成为改善护理过程中发生的错误的安全机会。必须让危重病人和/或家属了解情况,最好还能对他们进行培训,以促进他们积极参与保障自身安全。这并不是要转嫁责任,而是要通过加强他们的安全来促进和推动他们的参与。专业人员必须致力于保障他们的安全,并创造条件鼓励他们参与。我们提供了各种工具和思考方法,帮助专业人员在患者和家属通过重症医学服务时实施安全参与。
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引用次数: 0
Relationship between fluid overload and mortality and morbidity in pediatric intensive care unit. 儿科重症监护室液体超负荷与死亡率和发病率之间的关系。
Pub Date : 2024-09-14 DOI: 10.1016/j.medine.2024.09.001
Hilmi Bayirli, Nazan Ulgen Tekerek, Alper Koker, Oguz Dursun

Objective: The relationship between fluid overload and clinical outcomes was investigated.

Design: This study is an observational and analytic study of a retrospective cohort.

Settings: Pediatric intensive care units.

Patients or participants: Between 2019 and 2021 children who needed intensive care were included in the study.

Interventions: No intervention.

Main variable of interest: Early, peak and cumulative fluid overload were evaluated.

Results: The mortality rate was 11.7% (68/513). When fluid overloads were examined in terms of mortality, the percentage of early fluid overload was 1.86 and 3.35, the percent of peak fluid overload was 2.87 and 5.54, and the percent of cumulative fluid overload was 3.40 and 8.16, respectively, in the survivor and the non-survivor groups. After adjustment for age, severity of illness, and other potential confounders, peak (aOR = 1.15; 95%CI 1.05-1.26; p: 0.002) and cumulative (aOR = 1.10; 95%CI 1.04-1.16; p < 0.001) fluid overloads were determined as independent risk factors associated with mortality. When the cumulative fluid overload is 10% or more, a 3.9-fold increase mortality rate was calculated. It is found that the peak and cumulative fluid overload, had significant negative correlation with intensive care unit free days and ventilator free days.

Conclusions: It is found that peak and cumulative fluid overload in critically ill children were independently associated with intensive care unit mortality and morbidity.

目的研究液体超负荷与临床结果之间的关系:本研究是一项回顾性队列观察和分析研究:儿科重症监护病房:研究纳入了2019年至2021年间需要重症监护的儿童:主要关注变量评估早期、高峰期和累积性液体超负荷:死亡率为11.7%(68/513)。结果:死亡率为 11.7%(68/513),根据死亡率对体液超负荷进行评估,幸存者组和非幸存者组的早期体液超负荷百分比分别为 1.86 和 3.35,高峰期体液超负荷百分比分别为 2.87 和 5.54,累积性体液超负荷百分比分别为 3.40 和 8.16。在对年龄、病情严重程度和其他潜在混杂因素进行调整后,峰值(aOR = 1.15;95%CI 1.05-1.26;P:0.002)和累积(aOR = 1.10;95%CI 1.04-1.16;P:0.002)和峰值(aOR = 1.15;95%CI 1.05-1.26;P:0.002)均高于非幸存者组:研究发现,危重症儿童的峰值和累积性液体超负荷与重症监护室的死亡率和发病率有独立关联。
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引用次数: 0
Strongyloides stercoralis hyperinfection syndrome: A rare but fatal challenge in the ICU 盘尾丝虫高感染综合征:重症监护室中罕见但致命的挑战。
Pub Date : 2024-09-01 DOI: 10.1016/j.medine.2024.02.011
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引用次数: 0
Intrahospital transportation of mechanically-ventilated COVID-19 patients: a cohort study 机械通气的 COVID-19 患者的院内转运:一项队列研究。
Pub Date : 2024-09-01 DOI: 10.1016/j.medine.2024.05.008
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引用次数: 0
High-flow nasal cannula in Spanish Pediatric Intensive Care Services: A national web survey about its use and indications 西班牙儿科重症监护服务中的高流量鼻插管:关于其使用和适应症的全国性网络调查
Pub Date : 2024-09-01 DOI: 10.1016/j.medine.2024.03.012

Objective

To describe the high-flow nasal cannula (HFNC) indications in the Spanish pediatric critical care units (PICUs).

Design

Descriptive cross-sectional observational study.

Setting

Electronic survey among members of the Spanish Society of Pediatric Intensive Care (SECIP). It was sent weekly from April 10, 2023, to May 21, 2023.

Participants

All SECIP members.

Interventions

None.

Main variables of interest

The questions focused on workplace, years of experience, use or non-use of HFNC, justification and expectations regarding its application, starting point within each center, clinical criteria for indication, existence of clinical guidelines, evaluation during its use, and criteria and mode of withdrawal.

Results

Two hundred and two participants, 176 were from Spain. Of these, 87/176 had over ten years of experience. One hundred sixty two use HFNC and 66/162 have HFNC clinical guidelines. Acute bronchiolitis (138/162) and respiratory assistance after extubation (106/56) are the two main indications. For 62/162 HFNC may reduce therapeutic escalation. Neuromuscular diseases (105/162) and anatomical airway diseases (135/162) are the two main contraindications. The reasons to do not use HFNC were the absence of evidence about it effectiveness (8/14) and its inadequate cost/effectiveness balance (8/14).

Conclusions

A majority of Spanish pediatric intensivists use HFNC. Its application and withdrawal appears to be primarily based on clinical experience. Besides, those who use HFNC are aware of its limitations and the lack of evidence in some cases. It is necessary to develop single-center and multicenter studies to elucidate the effectiveness of this therapy in the context of critically ill children.

目标描述西班牙儿科重症监护病房(PICU)中高流量鼻插管(HFNC)的适应症.设计描述性横断面观察研究.设置对西班牙儿科重症监护协会(SECIP)成员进行电子调查.从 2023 年 4 月 10 日至 2023 年 5 月 21 日,每周发送一次调查问卷.参与者所有 SECIP 成员.干预措施无.主要关注变量问题集中在工作场所、经验年限、使用情况等方面.主要关注变量问题主要涉及工作场所、工作年限、是否使用 HFNC、使用 HFNC 的理由和期望、每个中心的起始点、适应症的临床标准、是否存在临床指南、使用期间的评估以及停用的标准和方式。结果222 名参与者中有 176 名来自西班牙。其中 87/176 人有十年以上的使用经验。162 人使用 HFNC,66/162 人有 HFNC 临床指南。急性支气管炎(138/162)和拔管后呼吸辅助(106/56)是两个主要适应症。62/162 例 HFNC 可减少治疗升级。神经肌肉疾病(105/162)和气道解剖疾病(135/162)是两个主要禁忌症。不使用 HFNC 的原因是缺乏有关其有效性的证据(8/14)以及其成本/效益平衡不足(8/14)。大多数西班牙儿科重症监护医师都使用 HFNC,其使用和停用似乎主要基于临床经验。此外,使用 HFNC 的医生也意识到其局限性以及在某些情况下缺乏证据。有必要开展单中心和多中心研究,以阐明这种疗法在重症儿童中的有效性。
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引用次数: 0
Nitric oxide as the third respiratory gas. A new opportunity to revisit the use of oxygen therapy in clinical practice 一氧化氮作为第三种呼吸气体。重新审视氧疗在临床实践中的应用的新机遇。
Pub Date : 2024-09-01 DOI: 10.1016/j.medine.2024.06.016
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引用次数: 0
Subcutaneous emphysema everywhere! 皮下气肿无处不在!
Pub Date : 2024-09-01 DOI: 10.1016/j.medine.2024.02.005
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引用次数: 0
Comparing lung aeration and respiratory effort using two different spontaneous breathing trial: T-piece vs pressure support ventilation 使用两种不同的自主呼吸试验比较肺通气和呼吸努力:T型通气与压力支持通气。
Pub Date : 2024-09-01 DOI: 10.1016/j.medine.2023.07.010

Objective

To assess the changes in lung aeration and respiratory effort generated by two different spontaneous breathing trial (SBT): T-piece (T-T) vs pressure support ventilation (PSV).

Design

Prospective, interventionist and randomized study.

Setting

Intensive Care Unit (ICU) of Hospital del Mar.

Participants

Forty-three ventilated patients for at least 24 h and considered eligible for an SBT were included in the study between October 2017 and March 2020.

Interventions

30-min SBT with T-piece (T-T group, 20 patients) or 8-cmH2O PSV and 5-cmH2O positive end expiratory pressure (PSV group, 23 patients).

Main variables of interest

Demographics, clinical data, physiological variables, lung aeration evaluated with electrical impedance tomography (EIT) and lung ultrasound (LUS), and respiratory effort using diaphragmatic ultrasonography (DU) were collected at different timepoints: basal (BSL), end of SBT (EoSBT) and one hour after extubation (OTE).

Results

There were a loss of aeration measured with EIT and LUS in the different study timepoints, without statistical differences from BSL to OTE, between T-T and PSV [LUS: 3 (1, 5.5) AU vs 2 (1, 3) AU; p = 0.088; EELI: −2516.41 (−5871.88, 1090.46) AU vs −1992.4 (−3458.76, −5.07) AU; p = 0.918]. Percentage of variation between BSL and OTE, was greater when LUS was used compared to EIT (68.1% vs 4.9%, p ≤ 0.001). Diaphragmatic excursion trend to decrease coinciding with a loss of aeration during extubation.

Conclusion

T-T and PSV as different SBT strategies in ventilated patients do not show differences in aeration loss, nor estimated respiratory effort or tidal volume measured by EIT, LUS and DU.

目的:评估两种不同的自主呼吸试验(SBT)引起的肺通气和呼吸努力的变化:T型片(T-T)与压力支持通气(PSV)。设计:前瞻性、干预性和随机研究。设置:德尔马医院重症监护室(ICU)参与者:43名通气患者,至少24小时 在2017年10月至2020年3月期间,研究纳入了h和被认为有资格进行SBT的患者。干预措施:30分钟SBT,带T片(T-T组,20名患者)或8cmH2O PSV和5cm H2O呼气末正压(PSV组,23名患者)。感兴趣的主要变量:人口学、临床数据、生理变量,在不同的时间点:基础(BSL)、SBT结束(EoSBT)和拔管后1小时(OTE)收集用电阻抗断层扫描(EIT)和肺超声(LUS)评估的肺通气量以及用膈超声(DU)测量的呼吸力,从BSL到OTE,T-T和PSV之间没有统计学差异[LUS:3(1,5.5) AU与2(1,3) AU;p = 0.088;伊利:-2516.41(-5871.881090.46) AU与-1992.4(-3458.76,-5.07) AU;p = 0.918]。当使用LUS时,BSL和OTE之间的变化百分比比EIT更大(68.1%vs 4.9%,p ≤ 0.001)。膈肌偏移有减少的趋势,同时在拔管过程中失去通气。结论:T-T和PSV作为通气患者的不同SBT策略,在通气损失、EIT、LUS和DU测量的呼吸功或潮气量方面没有差异。
{"title":"Comparing lung aeration and respiratory effort using two different spontaneous breathing trial: T-piece vs pressure support ventilation","authors":"","doi":"10.1016/j.medine.2023.07.010","DOIUrl":"10.1016/j.medine.2023.07.010","url":null,"abstract":"<div><h3>Objective</h3><p><span>To assess the changes in lung aeration<span> and respiratory effort generated by two different spontaneous breathing trial (SBT): T-piece (T-T) vs </span></span>pressure support ventilation (PSV).</p></div><div><h3>Design</h3><p>Prospective, interventionist and randomized study.</p></div><div><h3>Setting</h3><p>Intensive Care Unit (ICU) of Hospital del Mar.</p></div><div><h3>Participants</h3><p>Forty-three ventilated patients for at least 24 h and considered eligible for an SBT were included in the study between October 2017 and March 2020.</p></div><div><h3>Interventions</h3><p>30-min SBT with T-piece (T-T group, 20 patients) or 8-cmH<sub>2</sub>O PSV and 5-cmH<sub>2</sub><span>O positive end expiratory pressure (PSV group, 23 patients).</span></p></div><div><h3>Main variables of interest</h3><p><span>Demographics, clinical data, physiological variables, lung aeration evaluated with electrical impedance tomography<span> (EIT) and lung ultrasound (LUS), and respiratory effort using diaphragmatic ultrasonography (DU) were collected at different timepoints: basal (BSL), end of SBT (EoSBT) and one hour after </span></span>extubation (OTE).</p></div><div><h3>Results</h3><p>There were a loss of aeration measured with EIT and LUS in the different study timepoints, without statistical differences from BSL to OTE, between T-T and PSV [LUS: 3 (1, 5.5) AU vs 2 (1, 3) AU; p = 0.088; EELI: −2516.41 (−5871.88, 1090.46) AU vs −1992.4 (−3458.76, −5.07) AU; p = 0.918]. Percentage of variation between BSL and OTE, was greater when LUS was used compared to EIT (68.1% vs 4.9%, p ≤ 0.001). Diaphragmatic excursion trend to decrease coinciding with a loss of aeration during extubation.</p></div><div><h3>Conclusion</h3><p>T-T and PSV as different SBT strategies in ventilated patients do not show differences in aeration loss, nor estimated respiratory effort or tidal volume measured by EIT, LUS and DU.</p></div>","PeriodicalId":94139,"journal":{"name":"Medicina intensiva","volume":"48 9","pages":"Pages 501-510"},"PeriodicalIF":0.0,"publicationDate":"2024-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"41144202","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
引用次数: 0
Before and after the first extracorporeal cardiopulmonary resuscitation due to accidental hypothermia in Spain 西班牙首例意外低体温导致的体外心肺复苏术前后。
Pub Date : 2024-09-01 DOI: 10.1016/j.medine.2024.06.013
{"title":"Before and after the first extracorporeal cardiopulmonary resuscitation due to accidental hypothermia in Spain","authors":"","doi":"10.1016/j.medine.2024.06.013","DOIUrl":"10.1016/j.medine.2024.06.013","url":null,"abstract":"","PeriodicalId":94139,"journal":{"name":"Medicina intensiva","volume":"48 9","pages":"Pages 551-554"},"PeriodicalIF":0.0,"publicationDate":"2024-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141437972","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
引用次数: 0
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Medicina intensiva
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