Pub Date : 2025-01-01DOI: 10.1016/j.medine.2024.06.005
Facundo J. Gutierrez , Mario O. Pozo , Matías Mugno , Sebastián P. Chapela , Natalia Llobera , María J. Reberendo , Gastón E. Murias , Paolo N. Rubatto Birri , Vanina S. Kanoore Edul , Arnaldo Dubin
Objective
Central venous-arterial PCO2 to arterial-central venous O2 content ratio (Pcv-aCO2/Ca-cvO2) is commonly used as a surrogate for respiratory quotient (RQ) and tissue oxygenation. Although Pcv-aCO2/Ca-cvO2 might be associated with hyperlactatemia and outcome, neither the interchangeability with RQ nor the correlation with conclusive variables of anaerobic metabolism has never been demonstrated in septic shock. Our goal was to compare Pcv-aCO2/Ca-cvO2 and RQ in patients with septic shock.
Design
Prospective, observational study.
Setting
Two adult ICUs.
Patients
Forty-seven patients with septic shock on mechanical ventilation with stable respiratory settings and vasopressor dose after initial resuscitation.
Interventions
None.
Main variables of interest
We measured arterial and central venous gases, Hb, and O2Hb. Pcv-aCO2/Ca-cvO2 and the ratio of central venous-arterial CO2 content to arterial-central venous O2 content (Ccv-aCO2/Ca-cvO2) were calculated. RQ was determined by indirect calorimetry.
Results
Pcv-aCO2/Ca-cvO2 and Ccv-aCO2/Ca-cvO2 were not correlated with RQ (R2 = 0.01, P = 0.50 and R2 = 0.01, P = 0.58, respectively), showing large bias and wide 95 % limits of agreement with RQ (1.09, -1.10−3.27 and 0.42, -1.53−2.37). A multiple linear regression model showed Hb, and central venous PCO2 and O2Hb, but not RQ, as Pcv-aCO2/Ca-cvO2 determinants (R2 = 0.36, P = 0.0007).
Conclusions
In patients with septic shock, Pcv-aCO2/Ca-cvO2 did not correlate with RQ and was mainly determined by factors that modify the dissociation of CO2 from Hb. Pcv-aCO2/Ca-cvO2 seems to be a poor surrogate for RQ; therefore, its values should be interpreted with caution.
{"title":"Lack of correlation between central venous minus arterial PCO2 to arterial minus central venous O2 content ratio and respiratory quotient in patients with septic shock: A prospective observational study","authors":"Facundo J. Gutierrez , Mario O. Pozo , Matías Mugno , Sebastián P. Chapela , Natalia Llobera , María J. Reberendo , Gastón E. Murias , Paolo N. Rubatto Birri , Vanina S. Kanoore Edul , Arnaldo Dubin","doi":"10.1016/j.medine.2024.06.005","DOIUrl":"10.1016/j.medine.2024.06.005","url":null,"abstract":"<div><h3>Objective</h3><div>Central venous-arterial PCO<sub>2</sub> to arterial-central venous O<sub>2</sub> content ratio (P<sub>cv-a</sub>CO<sub>2</sub>/C<sub>a-cv</sub>O<sub>2</sub><span>) is commonly used as a surrogate for respiratory quotient (RQ) and tissue oxygenation. Although P</span><sub>cv-a</sub>CO<sub>2</sub>/C<sub>a-cv</sub>O<sub>2</sub><span> might be associated with hyperlactatemia<span> and outcome, neither the interchangeability with RQ nor the correlation with conclusive variables of anaerobic metabolism<span> has never been demonstrated in septic shock. Our goal was to compare P</span></span></span><sub>cv-a</sub>CO<sub>2</sub>/C<sub>a-cv</sub>O<sub>2</sub> and RQ in patients with septic shock.</div></div><div><h3>Design</h3><div>Prospective, observational study.</div></div><div><h3>Setting</h3><div>Two adult ICUs.</div></div><div><h3>Patients</h3><div>Forty-seven patients with septic shock on mechanical ventilation with stable respiratory settings and vasopressor dose after initial resuscitation.</div></div><div><h3>Interventions</h3><div>None.</div></div><div><h3>Main variables of interest</h3><div><span>We measured arterial and central venous gases, Hb, and O</span><sub>2</sub>Hb. P<sub>cv-a</sub>CO<sub>2</sub>/C<sub>a-cv</sub>O<sub>2</sub> and the ratio of central venous-arterial CO<sub>2</sub> content to arterial-central venous O<sub>2</sub> content (C<sub>cv-a</sub>CO<sub>2</sub>/C<sub>a-cv</sub>O<sub>2</sub><span>) were calculated. RQ was determined by indirect calorimetry.</span></div></div><div><h3>Results</h3><div>P<sub>cv-a</sub>CO<sub>2</sub>/C<sub>a-cv</sub>O<sub>2</sub> and C<sub>cv-a</sub>CO<sub>2</sub>/C<sub>a-cv</sub>O<sub>2</sub> were not correlated with RQ (R<sup>2</sup> = 0.01, <em>P</em> = 0.50 and R<sup>2</sup> = 0.01, <em>P</em><span> = 0.58, respectively), showing large bias and wide 95 % limits of agreement with RQ (1.09, -1.10−3.27 and 0.42, -1.53−2.37). A multiple linear regression model showed Hb, and central venous PCO</span><sub>2</sub> and O<sub>2</sub>Hb, but not RQ, as P<sub>cv-a</sub>CO<sub>2</sub>/C<sub>a-cv</sub>O<sub>2</sub> determinants (R<sup>2</sup> = 0.36, <em>P</em> = 0.0007).</div></div><div><h3>Conclusions</h3><div>In patients with septic shock, P<sub>cv-a</sub>CO<sub>2</sub>/C<sub>a-cv</sub>O<sub>2</sub> did not correlate with RQ and was mainly determined by factors that modify the dissociation of CO<sub>2</sub> from Hb. P<sub>cv-a</sub>CO<sub>2</sub>/C<sub>a-cv</sub>O<sub>2</sub> seems to be a poor surrogate for RQ; therefore, its values should be interpreted with caution.</div></div>","PeriodicalId":94139,"journal":{"name":"Medicina intensiva","volume":"49 1","pages":"Pages 8-14"},"PeriodicalIF":0.0,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141441189","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}
{"title":"From geometric equations to dynamic strategies: advances in the personalization of mechanical ventilation through mechanical power","authors":"Alejandro González-Castro , Aurio Fajardo Campoverdi","doi":"10.1016/j.medine.2024.11.004","DOIUrl":"10.1016/j.medine.2024.11.004","url":null,"abstract":"","PeriodicalId":94139,"journal":{"name":"Medicina intensiva","volume":"49 1","pages":"Pages 59-60"},"PeriodicalIF":0.0,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142684067","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}
Pub Date : 2025-01-01DOI: 10.1016/j.medine.2024.02.003
Nicolás Contrera Rolón , Joaquín Cantos , Iván Huespe , Eduardo Prado , Griselda I. Bratti , Carlos Schreck , Sergio Giannasi , Guillermo Rosa Diez , Carlos F. Varela
Objective
To evaluate the diagnostic performance of FENa (Fractional excretion of sodium), FEK (fractional excretion of potassium) and uSID (urinary strong ion difference) in predicting pAKI in sepsis and septic shock.
Design
Retrospective cohort study.
Setting
Two intensive care units in Argentina.
Patients
Adult patients with a confirmed diagnosis of sepsis or septic shock and AKI, and had a urinary biochemistry within 24h of the AKI diagnosis.
Interventions
None.
Main variables of interest
We evaluated the diagnostic accuracy of FENa, FEK and uSID through a ROC (Receiver Operating Characteristic) curve analysis.
Results
80 patients were included. 40 patients presented pAKI. pAKI group had higher APACHE, SOFA score, and mortality rate. In the ROC curve analysis, uSID had no diagnostic utility (AUC = 0.52, p = 0.69). FENa presented moderate accuracy showing an AUC of 0.71 (95% CI 0.60−0.83; p = 0.001), while FEK presented low accuracy with an AUC of 0.69 (95% CI 0.57−0.80; p = 0.04). The optimal Youden point for identifying pAKI was at a FENa higher than 0.51 % with a specificity of 72.5% and a sensitivity of 65.0%. In the case of FEK, a value higher than 21.9 % presented the best relation, with a specificity of 67.5% and a sensitivity of 65.0%.
Conclusions
urine biochemistry interpretation in septic patients must be revised. FENa and FEK are related to the severity of AKI and could be helpful complementary tools for diagnosing pAKI.
目的评估FENa（钠的分量排泄）、FEK（钾的分量排泄）和uSID（尿强离子差）在预测脓毒症和脓毒性休克中pAKI方面的诊断性能：设计：回顾性队列研究：患者：确诊为败血症和脓毒性休克的成人患者：患者：确诊为脓毒症或脓毒性休克并出现 AKI 的成人患者，且在确诊 AKI 后 24 小时内进行过尿液生化检查：无：我们通过ROC（Receiver Operating Characteristic）曲线分析评估了FENa、FEK和uSID的诊断准确性：共纳入 80 名患者。pAKI组的APACHE、SOFA评分和死亡率均较高。在 ROC 曲线分析中，uSID 没有诊断效用（AUC=0.52，P=0.69）。FENa 的 AUC 为 0.71（95% CI 0.60-0.83；p=0.001），准确度适中；而 FEK 的 AUC 为 0.69（95% CI 0.57-0.80；p=0.04），准确度较低。鉴别 pAKI 的最佳尤登点是 FENa 高于 0.51%，特异性为 72.5%，灵敏度为 65.0%。结论：必须对脓毒症患者的尿液生化解释进行修正。FENa和FEK与AKI的严重程度有关，可作为诊断pAKI的辅助工具。
{"title":"Fractional excretion of sodium and potassium and urinary strong ion difference in the evaluation of persistent AKI in sepsis","authors":"Nicolás Contrera Rolón , Joaquín Cantos , Iván Huespe , Eduardo Prado , Griselda I. Bratti , Carlos Schreck , Sergio Giannasi , Guillermo Rosa Diez , Carlos F. Varela","doi":"10.1016/j.medine.2024.02.003","DOIUrl":"10.1016/j.medine.2024.02.003","url":null,"abstract":"<div><h3>Objective</h3><div><span><span>To evaluate the diagnostic performance of FENa (Fractional excretion of sodium), FEK (fractional excretion of potassium) and uSID (urinary strong ion difference) in predicting pAKI in </span>sepsis and </span>septic shock.</div></div><div><h3>Design</h3><div>Retrospective cohort study.</div></div><div><h3>Setting</h3><div>Two intensive care units in Argentina.</div></div><div><h3>Patients</h3><div><span><span>Adult patients with a confirmed diagnosis of sepsis or septic shock<span> and AKI, and had a </span></span>urinary biochemistry within 24</span> <span>h of the AKI diagnosis.</span></div></div><div><h3>Interventions</h3><div>None.</div></div><div><h3>Main variables of interest</h3><div>We evaluated the diagnostic accuracy of FENa, FEK and uSID through a ROC (Receiver Operating Characteristic) curve analysis.</div></div><div><h3>Results</h3><div><span>80 patients were included. 40 patients presented pAKI. pAKI group had higher APACHE, SOFA score<span>, and mortality rate. In the ROC curve analysis, uSID had no diagnostic utility (AUC</span></span> <!-->=<!--> <!-->0.52, <em>p</em> <!-->=<!--> <!-->0.69). FENa presented moderate accuracy showing an AUC of 0.71 (95% CI 0.60−0.83; <em>p</em> <!-->=<!--> <!-->0.001), while FEK presented low accuracy with an AUC of 0.69 (95% CI 0.57−0.80; <em>p</em> <!-->=<!--> <!-->0.04). The optimal Youden point for identifying pAKI was at a FENa higher than 0.51 % with a specificity of 72.5% and a sensitivity of 65.0%. In the case of FEK, a value higher than 21.9 % presented the best relation, with a specificity of 67.5% and a sensitivity of 65.0%.</div></div><div><h3>Conclusions</h3><div>urine biochemistry interpretation in septic patients must be revised. FENa and FEK are related to the severity of AKI and could be helpful complementary tools for diagnosing pAKI.</div></div>","PeriodicalId":94139,"journal":{"name":"Medicina intensiva","volume":"49 1","pages":"Pages 1-7"},"PeriodicalIF":0.0,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139975241","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}
Pub Date : 2025-01-01DOI: 10.1016/j.medine.2024.06.011
Johanna Marcela Abril-Victorino, Mirian Ruiz de la Cuesta-López, Sergio Gómez-Camino
{"title":"Severe community-acquired pneumonia due to Streptococcus pyogenes","authors":"Johanna Marcela Abril-Victorino, Mirian Ruiz de la Cuesta-López, Sergio Gómez-Camino","doi":"10.1016/j.medine.2024.06.011","DOIUrl":"10.1016/j.medine.2024.06.011","url":null,"abstract":"","PeriodicalId":94139,"journal":{"name":"Medicina intensiva","volume":"49 1","pages":"Pages 66-67"},"PeriodicalIF":0.0,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141474091","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}
Pub Date : 2025-01-01DOI: 10.1016/j.medine.2024.09.010
Fernando Clau Terré , Raul Vicho Pereira , Jose Maria Ayuela Azcárate , Manuel Ruiz Bailén
The present study highlights the advances in ultrasound, especially regarding its clinical applications to critically ill patients.
Artificial intelligence (AI) is crucial in automating image interpretation, improving accuracy and efficiency. Software has been developed to make it easier to perform accurate bedside ultrasound examinations, even by professionals lacking prior experience, with automatic image optimization. In addition, some applications identify cardiac structures, perform planimetry of the Doppler wave, and measure the size of vessels, which is especially useful in hemodynamic monitoring and continuous recording. The "strain" and "strain rate" parameters evaluate ventricular function, while "auto strain" automates its calculation from bedside images. These advances, and the automatic determination of ventricular volume, make ultrasound monitoring more precise and faster. The next step is continuous monitoring using gel devices attached to the skin.
{"title":"New ultrasound techniques. Present and future","authors":"Fernando Clau Terré , Raul Vicho Pereira , Jose Maria Ayuela Azcárate , Manuel Ruiz Bailén","doi":"10.1016/j.medine.2024.09.010","DOIUrl":"10.1016/j.medine.2024.09.010","url":null,"abstract":"<div><div>The present study highlights the advances in ultrasound, especially regarding its clinical applications to critically ill patients.</div><div>Artificial intelligence (AI) is crucial in automating image interpretation, improving accuracy and efficiency. Software has been developed to make it easier to perform accurate bedside ultrasound examinations, even by professionals lacking prior experience, with automatic image optimization. In addition, some applications identify cardiac structures, perform planimetry of the Doppler wave, and measure the size of vessels, which is especially useful in hemodynamic monitoring and continuous recording. The \"strain\" and \"strain rate\" parameters evaluate ventricular function, while \"auto strain\" automates its calculation from bedside images. These advances, and the automatic determination of ventricular volume, make ultrasound monitoring more precise and faster. The next step is continuous monitoring using gel devices attached to the skin.</div></div>","PeriodicalId":94139,"journal":{"name":"Medicina intensiva","volume":"49 1","pages":"Pages 40-49"},"PeriodicalIF":0.0,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142378684","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}
Pub Date : 2025-01-01DOI: 10.1016/j.medine.2024.10.007
Ignacio Fernández Ceballos , Ivan A. Huespe , Indalecio Carboni Bisso , Marcos J. Las Heras
{"title":"Respuesta a “High flow in tracheostomized patients on their first attempt to wean from mechanical ventilation: More questions on the table”","authors":"Ignacio Fernández Ceballos , Ivan A. Huespe , Indalecio Carboni Bisso , Marcos J. Las Heras","doi":"10.1016/j.medine.2024.10.007","DOIUrl":"10.1016/j.medine.2024.10.007","url":null,"abstract":"","PeriodicalId":94139,"journal":{"name":"Medicina intensiva","volume":"49 1","pages":"Pages 58-59"},"PeriodicalIF":0.0,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142684070","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}
Pub Date : 2025-01-01DOI: 10.1016/j.medine.2024.05.006
Paz Merino
The severity of the critically ill patient, the practice of diagnostic procedures and invasive treatments, the high number of drugs administered, a high volume of data generated during the care of the critically ill patient along with a technical work environment, the stress and workload of work of professionals, are circumstances that favor the appearance of errors, turning Intensive Medicine Services into risk areas for adverse events to occur. Knowing their epidemiology is the first step to improve the safety of the care we provide to our patients, because it allows us to identify risk areas, analyze them and develop strategies to prevent the adverse events, or if this is not possible, be able to manage them.
This article analyzes the main studies published to date on incidents related to safety in the field of critically ill patients.
{"title":"Epidemiology of adverse events in Intensive Medicine units","authors":"Paz Merino","doi":"10.1016/j.medine.2024.05.006","DOIUrl":"10.1016/j.medine.2024.05.006","url":null,"abstract":"<div><div><span><span>The severity of the critically ill patient, the practice of diagnostic procedures and invasive treatments, the high number of drugs administered, a high volume of data generated during the care of the critically ill patient along with a technical </span>work environment, the stress and workload of work of professionals, are circumstances that favor the appearance of errors, turning Intensive Medicine Services into risk areas for </span>adverse events<span><span> to occur. Knowing their epidemiology is the first step to improve the safety of the care we provide to our patients, because it allows us to identify risk areas, analyze them and develop strategies to prevent the </span>adverse events, or if this is not possible, be able to manage them.</span></div><div>This article analyzes the main studies published to date on incidents related to safety in the field of critically ill patients.</div></div>","PeriodicalId":94139,"journal":{"name":"Medicina intensiva","volume":"49 1","pages":"Pages 32-39"},"PeriodicalIF":0.0,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141066234","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}
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