Medicina intensiva最新文献

Objective: The relationship between different power equations and the severity of acute respiratory distress syndrome (ARDS) remains unclear. This study aimed to evaluate various power equations: total mechanical power, total elastic power (comprising elastic static and elastic dynamic power), and resistive power, in a cohort of mechanically ventilated patients with and without ARDS. Bayesian analysis was employed to refine estimates and quantify uncertainty by incorporating a priori distributions.

Design: A Bayesian post-hoc analysis was conducted on data from the Mechanical Power Day study.

Setting: 113 intensive care units across 15 countries and 4 continents.

Patients: Adults who received invasive mechanical ventilation in volume-controlled mode, with (mild and moderate/severe ARDS) and without ARDS.

Interventions: None.

Main variables of interest: ARDS, Elastic static power.

Results: Elastic static power was 5.8 J/min (BF: 0.3) in patients with mild ARDS and 7.4 J/min (BF: 0.9) in moderate/severe ARDS patients. Bayesian regression and modeling analysis revealed that elastic static power was independently correlated with mild (a posteriori Mean: 1.3; 95% Credible Interval [Cred. Interval]: 0.2-2.2) and moderate/severe ARDS (a posteriori Mean: 2.8; 95% Cred. Interval: 1.7-3.8) more strongly than other power equations.

Conclusions: Elastic static power was found to have the strongest correlation with ARDS severity among the power equations studied. Prospective studies are needed to further validate these findings.

Introduction: From a safety perspective, the pandemic imposed atypical work dynamics that led to noticeable gaps in clinical safety across all levels of health care.

Objectives: To verify that Real-Time Random Safety Analyses (AASTRE) are feasible and useful in a high-pressure care setting.

Design: Prospective study (January-September 2022).

Setting: University Hospital with 350 beds. Two mixed ICUs (12 and 14 beds).

Interventions: Two safety audits per week were planned to determine the feasibility and usefulness of the 32 safety measures (grouped into 8 blocks).

Main variables of interest: 1) Feasibility: Proportion of completed audits compared to scheduled audits and time spent. 2) Utility: Changes in the care process made as a result of implementing AASTRE.

Results: A total of 390 patient-days were analyzed (179 were Non-COVID patients and 49 were COVID patients). In the COVID patient subgroup, age, ICU stay, SAPS 3, and ICU mortality were significantly higher compared to the Non-COVID patient subgroup. Regarding feasibility, 93.8% of planned rounds were carried out with an average audit time of 25 ± 8 min. Overall, changes in the care process were made in 11.8% of the measures analyzed.

Conclusions: In a high-complexity care environment, AASTRE proved to be a feasible and useful tool with only two interventions per week lasting less than 30 min. Overall, AASTRE allowed unsafe situations to be turned safe in more than 10% of the evaluations.

Objective: The aim of the study was to assess the feasibility and safety of early mobilisation in patients with shock requiring vasoactive drugs in the intensive care unit (ICU).

Design: Systematic review and meta-analysis.

Setting: Intensive care unit (ICU).

Patients or participants: Adult patients requiring vasoactive drugs who received early mobilisation in the intensive care unit.

Interventions: A systematic search was conducted using the databases PubMed, Cochrane Library, Scopus, Medline Ovid, Science Direct, and CINAHL, including observational studies involving adult patients requiring vasoactive drugs who received early mobilisation. A meta-analysis was performed on the proportion of safety events and the proportion of early mobilisation in patients with high, moderate, and low doses of vasoactive drugs.

Main variables of interest: Feasibility, safety events, and the maximum level of activity achieved during early mobilisation.

Results: The search yielded 1875 studies, of which 8 were included in the systematic review and 5 in the meta-analysis. The results showed that 64% (95% CI: 34%-95%, p<0.05) of patients were mobilised with low doses of vasoactive drugs, 30% (95% CI: 7%-53%, p<0.05) with moderate doses, and 7% (95% CI: 3%-16%, p 0.17) with high doses. The proportion of adverse events was low, at 2% (95% CI: 1%-4%, p<0.05).

Conclusions: Early mobilisation in patients with shock and the need for vasoactive drugs is feasible and generally safe. However, there is an emphasis on the need for further high-quality research to confirm these findings.

Objective: This study explored the association between body temperature and 28-day septic ICU hospital mortality.

Design: Retrospective cohort analysis.

Setting: 208 ICUs in the United States.

Patients or participants: Sepsis patients from 2014-2015 eICU Collaborative Research Database.

Interventions: Binary logistic regression models, Generalized Additive Model (GAM), Two-Piece Binary Logistic Regression Model.

Main variables of interest: Body temperature, 28-day inpatient mortality.

Results: Nonlinear relationship observed; hypothermia (≤36.67 ℃) associated with increased mortality (adjusted OR = 0.74, 95% CI: 0.70-0.80, p < 0.0001).

Conclusions: Hypothermia in sepsis correlates with higher mortality; rewarming's potential benefit warrants further exploration.