Medicina intensiva最新文献

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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。

Medicina intensiva

Pub Date : 2024-09-01 DOI: 10.1016/j.medine.2024.02.011

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。

Medicina intensiva

Pub Date : 2024-09-01 DOI: 10.1016/j.medine.2024.05.008

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

Medicina intensiva

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。

Medicina intensiva

Pub Date : 2024-09-01 DOI: 10.1016/j.medine.2024.06.016

引用次数: 0

Subcutaneous emphysema everywhere! 皮下气肿无处不在！

Medicina intensiva

Pub Date : 2024-09-01 DOI: 10.1016/j.medine.2024.02.005

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。

Medicina intensiva

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。

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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。

Medicina intensiva

Pub Date : 2024-09-01 DOI: 10.1016/j.medine.2024.06.013

引用次数: 0

Moral complexity in the organ donation process: A prudential act 器官捐献过程中的道德复杂性：一种审慎的行为。

Medicina intensiva

Pub Date : 2024-09-01 DOI: 10.1016/j.medine.2024.05.007

引用次数: 0

Can end-tidal CO2 measurement replace arterial partial CO2 in emergency department respiratory distress management? 在急诊科呼吸窘迫管理中，潮气末二氧化碳测量能否取代动脉部分二氧化碳测量？

Medicina intensiva

Pub Date : 2024-09-01 DOI: 10.1016/j.medine.2024.04.011

Objective

To assess the feasibility of using end-tidal carbon dioxide (EtCO₂) as a non-invasive substitute for partial pressure of arterial carbon dioxide (PaCO₂) in emergency department (ED) triage and follow-up, and to explore the potential of partial pressure of venous carbon dioxide (PvCO₂) as an alternative to PaCO₂.

Design

Prospective cross-sectional study.

Setting

Tertiary university hospital.

Patients or participants

97 patients presenting with acute respiratory distress to the ED.

Interventions

EtCO₂, arterial blood gases, and venous blood gases measured at admission (0 min), 60 min, and 120 min.

Main variables of interest

CO₂ levels.

Results

Among 97 patients (mean age: 70.93 ± 9.6 years; 60.8% male), EtCO₂ > 45 mmHg at admission showed strong positive correlations with PaCO₂ and PvCO₂ (r = 0.844, r = 0.803; p < 0.001, respectively). Significant positive correlation was observed between 60-min EtCO₂ and PaCO₂ (r = 0.729; p < 0.001). Strong correlation between PaCO₂ and PvCO₂ at 120 min when EtCO₂ > 45 mmHg (r = 0.870; p < 0.001). EtCO₂ was higher in hospitalized patients compared to discharged ones.

Conclusions

EtCO₂ appears promising as a substitute for PaCO₂ in ED patients with acute respiratory distress within the initial two hours of treatment. Venous blood gas sampling offers a less invasive alternative to arterial sampling, facilitating simultaneous blood tests.

目的评估在急诊科（ED）分诊和随访中使用潮气末二氧化碳（EtCO2）无创替代动脉二氧化碳分压（PaCO2）的可行性，并探索静脉二氧化碳分压（PvCO2）替代PaCO2的潜力：设计：前瞻性横断面研究：患者或参与者：97 名急性呼吸窘迫急诊患者：干预措施：入院（0 分钟）、60 分钟和 120 分钟时测量 EtCO2、动脉血气和静脉血气：主要关注变量：二氧化碳水平：97 名患者（平均年龄：70.93 ± 9.6 岁；60.8% 为男性）中，入院时 EtCO2 > 45 mmHg 与 PaCO2 和 PvCO2 呈强正相关（r = 0.844，r = 0.803；p 2），120 分钟时 EtCO2 > 45 mmHg 与 PaCO2 呈强正相关（r = 0.729；p 2），住院患者的 PvCO2 比出院患者更高（r = 0.870；p 2）：结论：EtCO2 似乎有望替代 PaCO2，用于治疗最初两小时内急性呼吸窘迫的急诊室患者。静脉血气采样可替代动脉采样，创伤更小，便于同时进行血液检测。

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引用次数: 0

Acute respiratory distress syndrome at high altitude: Considerations for diagnosis and treatment 高海拔地区急性呼吸窘迫综合征：诊断和治疗注意事项。

Medicina intensiva

Pub Date : 2024-09-01 DOI: 10.1016/j.medine.2024.04.018

Adrián Avila-Hilari , Amilcar Tinoco-Solórzano , Jorge Vélez-Páez , Daniel Molano Franco , Felipe de Jesús Montelongo , Manuel Luis Avellanas-Chavala

引用次数: 0

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