Your browser doesn't support javascript.
loading
Mostrar: 20 | 50 | 100
Resultados 1 - 3 de 3
Filtrar
1.
N Engl J Med ; 384(14): 1301-1311, 2021 04 08.
Artículo en Inglés | MEDLINE | ID: mdl-33471452

RESUMEN

BACKGROUND: Patients with acute hypoxemic respiratory failure in the intensive care unit (ICU) are treated with supplemental oxygen, but the benefits and harms of different oxygenation targets are unclear. We hypothesized that using a lower target for partial pressure of arterial oxygen (Pao2) would result in lower mortality than using a higher target. METHODS: In this multicenter trial, we randomly assigned 2928 adult patients who had recently been admitted to the ICU (≤12 hours before randomization) and who were receiving at least 10 liters of oxygen per minute in an open system or had a fraction of inspired oxygen of at least 0.50 in a closed system to receive oxygen therapy targeting a Pao2 of either 60 mm Hg (lower-oxygenation group) or 90 mm Hg (higher-oxygenation group) for a maximum of 90 days. The primary outcome was death within 90 days. RESULTS: At 90 days, 618 of 1441 patients (42.9%) in the lower-oxygenation group and 613 of 1447 patients (42.4%) in the higher-oxygenation group had died (adjusted risk ratio, 1.02; 95% confidence interval, 0.94 to 1.11; P = 0.64). At 90 days, there was no significant between-group difference in the percentage of days that patients were alive without life support or in the percentage of days they were alive after hospital discharge. The percentages of patients who had new episodes of shock, myocardial ischemia, ischemic stroke, or intestinal ischemia were similar in the two groups (P = 0.24). CONCLUSIONS: Among adult patients with acute hypoxemic respiratory failure in the ICU, a lower oxygenation target did not result in lower mortality than a higher target at 90 days. (Funded by the Innovation Fund Denmark and others; HOT-ICU ClinicalTrials.gov number, NCT03174002.).


Asunto(s)
Terapia por Inhalación de Oxígeno/métodos , Oxígeno/administración & dosificación , Oxígeno/sangre , Insuficiencia Respiratoria/terapia , Anciano , Femenino , Humanos , Hipoxia/sangre , Hipoxia/etiología , Hipoxia/terapia , Unidades de Cuidados Intensivos , Estimación de Kaplan-Meier , Masculino , Persona de Mediana Edad , Respiración Artificial/métodos , Síndrome de Dificultad Respiratoria/sangre , Síndrome de Dificultad Respiratoria/mortalidad , Síndrome de Dificultad Respiratoria/terapia , Insuficiencia Respiratoria/sangre , Insuficiencia Respiratoria/complicaciones , Insuficiencia Respiratoria/mortalidad
2.
Acta Anaesthesiol Scand ; 64(6): 774-780, 2020 07.
Artículo en Inglés | MEDLINE | ID: mdl-32020586

RESUMEN

BACKGROUND: Frailty is associated with increased morbidity and mortality and frail patients may have reduced ability to tolerate severe vital sign derangement such as estimated by a high National Early Warning Score (NEWS). The clinical impact of frailty among patients that develop high NEWS during hospital admissions is sparsely studied. The aim of this study was to investigate the association between clinical frailty and admission to intensive care unit (ICU) among these patients. METHODS: We conducted a prospective observational study from November 2017 to January 2018. We included adult patients admitted to general wards that during hospitalization developed severe vital sign derangement defined as NEWS ≥7. Patients were without treatment restrictions at inclusion. Primary exposure was frailty as assessed by the Clinical Frailty Scale. Primary outcome was ICU admission within 90 days, which was analyzed using multivariate logistic regression. RESULTS: We included 109 patients with NEWS ≥7, of which 61 patients (56%) were frail. Ten of the 61 frail patients (16%) were admitted to ICU compared to 9 of the 48 non-frail patients (19%), adjusted odds ratio (aOR) 0.92 (95% CI 0.32-2.62). Frail patients were more likely to have new treatment restrictions (aOR 2.91; 95% CI 1.26-6.71). Their aOR for mortality was 1.95 (95% CI 0.84-4.55). CONCLUSION: Frail patients with severe vital sign derangement during acute hospital admissions were not more likely to be admitted to ICU nor was mortality higher. Treatment restrictions were more frequent among frail patients after vital sign derangements developed.


Asunto(s)
Puntuación de Alerta Temprana , Fragilidad/epidemiología , Evaluación Geriátrica/métodos , Anciano , Anciano de 80 o más Años , Estudios de Cohortes , Dinamarca/epidemiología , Femenino , Evaluación Geriátrica/estadística & datos numéricos , Humanos , Masculino , Persona de Mediana Edad , Estudios Prospectivos , Índice de Severidad de la Enfermedad , Signos Vitales
3.
J Clin Nurs ; 28(9-10): 1889-1898, 2019 May.
Artículo en Inglés | MEDLINE | ID: mdl-30667563

RESUMEN

AIMS AND OBJECTIVES: To explore the perspectives of hardly reached people with type 2 diabetes on social support for diabetes management from their formal and informal networks. BACKGROUND: People with low socioeconomic status and poorly controlled type 2 diabetes may be categorised as hardly reached. Social support is increasingly perceived to be a cornerstone in the management of type 2 diabetes. Few studies have, however, explored social support for diabetes management from the perspective of hardly reached people. METHODS: A qualitative design with individual semi-structured interviews captured the unique perspectives of hardly reached people. Data from 14 participants were analysed using conventional content analysis. The article adheres to the COREQ guidelines for reporting qualitative research. RESULTS: Participants preferred not to involve family and friends (the informal network) in diabetes management due to dysfunctional or lacking networks, existing norms and not wanting to burden vulnerable relationships. Others simply did not perceive themselves as sick and therefore saw no need for support. Opposed to this, participants wished for continuity and a personalised relationship with health professionals (the formal network). This entailed consultations that facilitated discussion of issues of importance to the participants. CONCLUSIONS: Hardly reached people with type 2 diabetes preferred to spare their informal networks from diabetes management. Instead, they wished for more presence and individualised support from health professionals. RELEVANCE TO CLINICAL PRACTICE: It appears timely to rethink the current "one-size-fits-all" approach for people with type 2 diabetes in order to allocate resources to those most in need. It is important that health professionals elicit perceptions of support needs and potential sources of support in hardly reached people with type 2 diabetes both from the formal and from informal networks in regard to managing their diabetes. To better reach hardly reached people with type 2 diabetes, specialised education of health professionals may be necessary to capture the complex underlying dynamics influencing disease management.


Asunto(s)
Actitud Frente a la Salud , Diabetes Mellitus Tipo 2/psicología , Automanejo/psicología , Apoyo Social , Adulto , Diabetes Mellitus Tipo 2/terapia , Femenino , Humanos , Persona de Mediana Edad , Relaciones Profesional-Paciente , Investigación Cualitativa , Factores Socioeconómicos
SELECCIÓN DE REFERENCIAS
DETALLE DE LA BÚSQUEDA