Sujet(s)
Soins de réanimation , Maladie grave , Maladie chronique , Maladie grave/thérapie , HumainsRÉSUMÉ
No disponible
Sujet(s)
Humains , Soins de réanimation/tendances , Infections à coronavirus/épidémiologie , Pandémies/prévention et contrôle , Unités de soins intensifs , Systèmes de Santé/tendances , Épuisement psychologique , Troubles de stress post-traumatique/psychologie , Efficacité au travail , Temps de Réaction Si Désastre , Ressources en santé/tendances , Dépression/psychologie , Aidants/psychologie , Espagne/épidémiologieRÉSUMÉ
El 31 de diciembre de 2019, la Comisión de Salud de la provincia China de Hubei, dio a conocer por primera vez un grupo de casos inexplicables de neumonía, que posteriormente la OMS definió como el nuevo coronavirus de 2019 (SARS-CoV-2). El SARS-CoV-2 ha presentado una transmisión rápida de persona a persona y actualmente es una pandemia mundial. En la mayor serie de casos descrita hasta la fecha de pacientes hospitalizados con enfermedad por SARS-CoV-2 (2019-nCoViD), el 26% requirió atención en una unidad de cuidados intensivos (UCI). Esta pandemia está provocando una movilización de la comunidad científica sin precedentes, lo que lleva asociado un numero exponencialmente creciente de publicaciones en relación con la misma. La presente revisión bibliográfica narrativa, tiene como objetivo reunir las principales aportaciones en el área de los cuidados intensivos hasta la fecha en relación con la epidemiología, clínica, diagnóstico y manejo de 2019-nCoViD
On 31 December 2019, the Health Commission of Hubei Province of China first unveiled a group of unexplained cases of pneumonia, which WHO subsequently defined as the new coronavirus of 2019 (SARS-CoV-2). SARS-CoV-2 has presented rapid person-to-person transmission and is currently a global pandemic. In the largest number of cases described to date of hospitalized patients with SARS-CoV-2 disease (2019-nCoViD), 26% required care in an intensive care unit (ICU). This pandemic is causing an unprecedented mobilization of the scientific community, which has been associated with an exponentially growing number of publications in relation to it. This narrative literature review aims to gather the main contributions in the area of intensive care to date in relation to the epidemiology, clinic, diagnosis and management of 2019-nCoViD
Sujet(s)
Humains , Infections à coronavirus/épidémiologie , Soins de réanimation/méthodes , Triage , Betacoronavirus , Pneumopathie virale/épidémiologie , Infections à coronavirus/imagerie diagnostique , Espagne/épidémiologie , Unités de soins intensifs/statistiques et données numériques , Pandémies , Facteurs de risqueSujet(s)
Candidémie , Infections à coronavirus , Maladie grave , Pandémies , Pneumopathie virale , Betacoronavirus , COVID-19 , Candidémie/épidémiologie , Humains , SARS-CoV-2RÉSUMÉ
On 31 December 2019, the Health Commission of Hubei Province of China first unveiled a group of unexplained cases of pneumonia, which WHO subsequently defined as the new coronavirus of 2019 (SARS-CoV-2). SARS-CoV-2 has presented rapid person-to-person transmission and is currently a global pandemic. In the largest number of cases described to date of hospitalized patients with SARS-CoV-2 disease (2019-nCoViD), 26% required care in an intensive care unit (ICU). This pandemic is causing an unprecedented mobilization of the scientific community, which has been associated with an exponentially growing number of publications in relation to it. This narrative literature review aims to gather the main contributions in the area of intensive care to date in relation to the epidemiology, clinic, diagnosis and management of 2019-nCoViD.
Sujet(s)
Betacoronavirus , Infections à coronavirus , Soins de réanimation/statistiques et données numériques , Pandémies , Pneumopathie virale , Facteurs âges , Angiotensin-converting enzyme 2 , Antiviraux/usage thérapeutique , Infections asymptomatiques/épidémiologie , Betacoronavirus/génétique , Betacoronavirus/isolement et purification , COVID-19 , Infections à coronavirus/diagnostic , Infections à coronavirus/traitement médicamenteux , Infections à coronavirus/épidémiologie , Infections à coronavirus/transmission , Maladie grave/épidémiologie , Humains , Peptidyl-Dipeptidase A , Équipement de protection individuelle/normes , Pneumopathie virale/diagnostic , Pneumopathie virale/traitement médicamenteux , Pneumopathie virale/épidémiologie , Pneumopathie virale/transmission , SARS-CoV-2 , Norme de soins , Évaluation des symptômes/méthodes , Triage/méthodesSujet(s)
Betacoronavirus , Infections à coronavirus/épidémiologie , Soins de réanimation/psychologie , Pneumopathie virale/épidémiologie , Épuisement professionnel/étiologie , COVID-19 , Maladie chronique/thérapie , Infections à coronavirus/psychologie , Dépression/épidémiologie , Humains , Unités de soins intensifs , Pandémies , Pneumopathie virale/psychologie , Qualité des soins de santé , SARS-CoV-2 , SyndromeRÉSUMÉ
On 31 December 2019, the Health Commission of Hubei Province of China first unveiled a group of unexplained cases of pneumonia, which WHO subsequently defined as the new coronavirus of 2019 (SARS-CoV-2). SARS-CoV-2 has presented rapid person-to-person transmission and is currently a global pandemic. In the largest number of cases described to date of hospitalized patients with SARS-CoV-2 disease (2019-nCoViD), 26% required care in an intensive care unit (ICU). This pandemic is causing an unprecedented mobilization of the scientific community, which has been associated with an exponentially growing number of publications in relation to it. This narrative literature review aims to gather the main contributions in the area of intensive care to date in relation to the epidemiology, clinic, diagnosis and management of 2019-nCoViD.
RÉSUMÉ
OBJETIVO: Analizar las complicaciones a largo plazo de los pacientes críticos que requirieron traqueotomía percutánea (TP) con el método de dilatación con balón. DISEÑO: Estudio observacional, prospectivo, de cohorte. Ámbito: Dos unidades de cuidados intensivos (UCI) polivalentes. PACIENTES: Adultos ventilados mecánicamente ingresados en UCI con indicación de TP. Intervención: En todos los pacientes se realizó TP mediante Ciaglia Blue Dolphin® con guía endoscópica. Los pacientes decanulados vivos fueron evaluados clínicamente, así como mediante laringotraqueoscopia y tomografía axial computarizada cervical al cabo de al menos 6 meses tras la decanulación. VARIABLES: Complicaciones intraoperatorias, postoperatorias y tardías. Mortalidad intra-UCI y hospitalaria. RESULTADOS: Se incluyeron 114 pacientes. Las complicaciones intraoperatorias más frecuentes fueron la hemorragia leve (n=20) y la dificultad para insertar la cánula (n=19). Dos pacientes tuvieron complicaciones intraoperatorias graves (1,7%) (hemorragia e imposibilidad de finalización de la técnica, en un caso, y falsa vía y desaturación, en otro). Todos los pacientes decanulados vivos (n=52) fueron revisados a los 221±28 días tras la decanulación. Ningún paciente presentaba síntomas. La tomografía axial computarizada y la laringotraqueoscopia mostraron estenosis traqueal severa (>50%) en 2 pacientes (3,7%), ambos con periodos de canulación superiores a 100 días. CONCLUSIONES: La TP usando la técnica Ciaglia Blue Dolphin® con guía endoscópica es un procedimiento seguro. La estenosis traqueal grave es una complicación tardía que, aunque infrecuente, debe ser tenida en cuenta por su falta de expresividad clínica. Debería considerarse la evaluación de aquellos pacientes críticos que han sido traqueotomizados y han permanecido canulados durante periodos prolongados de tiempo
OBJECTIVE: The purpose of this study was to determine the late complications in critically ill patients requiring percutaneous tracheostomy (PT) using the balloon dilation technique. DESIGN: A prospective, observational cohort study was carried out. Scope: Two medical-surgical intensive care units (ICU). PATIENTS: All mechanically ventilated adult patients consecutively admitted to the ICU with an indication of tracheostomy. INTERVENTIONS: All patients underwent PT according to the Ciaglia Blue Dolphin® method, with endoscopic guidance. Survivors were interviewed and evaluated by fiberoptic laryngotracheoscopy and tracheal computed tomography at least 6 months after decannulation. VARIABLES: Intraoperative, postoperative and long-term complications and mortality (in-ICU, in-hospital) were recorded. RESULTS: A total of 114 patients were included. The most frequent perioperative complication was minor bleeding (n=20) and difficult cannula insertion (n=19). Two patients had severe perioperative complications (1.7%) (major bleeding and inability to complete de procedure in one case and false passage and desaturation in the other). All survivors (n=52) were evaluated 211±28 days after decannulation. None of the patients had symptoms. Fiberoptic laryngotracheoscopy and computed tomography showed severe tracheal stenosis (>50%) in 2patients (3.7%), both with a cannulation period of over 100 days. CONCLUSIONS: Percutaneous tracheostomy using the Ciaglia Blue Dolphin® technique with an endoscopic guide is a safe procedure. Severe tracheal stenosis is a late complication which although infrequent, must be taken into account due to its lack of clinical expressiveness. Evaluation should be considered in those tracheostomized critical patients who have been cannulated for a long time
Sujet(s)
Humains , Trachéotomie/effets indésirables , Ventilation artificielle/méthodes , Insuffisance respiratoire/chirurgie , Sténose trachéale/épidémiologie , Complications postopératoires/épidémiologie , Dilatation/méthodes , Temps , Études prospectives , Soins de réanimation/méthodes , Sécurité des patients/statistiques et données numériquesRÉSUMÉ
No disponible
Sujet(s)
Humains , Mâle , Femelle , Services de consultations externes des hôpitaux/tendances , Unités de soins intensifs/organisation et administration , Unités de soins intensifs/normes , Facteurs de risque , Histoire naturelle/méthodes , Soins de réanimation/organisation et administration , Soins de réanimation/normesSujet(s)
Post-cure/organisation et administration , Soins de réanimation/organisation et administration , Services de consultations externes des hôpitaux/organisation et administration , Troubles de stress post-traumatique/prévention et contrôle , Survivants , Activités de la vie quotidienne , Troubles de la cognition/étiologie , Troubles de la cognition/prévention et contrôle , Soins de réanimation/psychologie , Humains , Troubles mentaux/étiologie , Troubles mentaux/prévention et contrôle , Faiblesse musculaire/étiologie , Faiblesse musculaire/rééducation et réadaptation , Facteurs de risque , Troubles de stress post-traumatique/étiologie , Troubles de stress post-traumatique/rééducation et réadaptation , Survivants/psychologieRÉSUMÉ
PURPOSE: Our purpose was to assess the amino acids' (AAs) profile in trauma patients and to assess the effect of the route of nutrition and the exogenous ALA-GLN dipeptide supplementation on plasma AAs' concentration. METHODS: This is a secondary analysis of a previous randomized controlled trial. On day 1 and day 6 after trauma, plasma concentration of 25 AAs was measured using reverse phase high-performance liquid chromatography. Results were analyzed in relation to the route of nutrition and supplementation of ALA-GLN dipeptide. Differences between plasma AAs' concentrations at day 1 and day 6 were evaluated using the Student's t test or Mann-Whitney-Wilcoxon test. One-way ANOVA and the Kruskal-Wallis test were used to compare groups. A two-sided p value less than 0.05 was considered statistically significant. RESULTS: Ninety-eight patients were analyzed. Mean plasma concentrations at day 1 were close to the lower normal level for most AAs. At day 6 we found an increase in the eight essential AAs' concentrations and in 9 out of 17 measured non-essential AAs. At day 6 we found no differences in plasma concentrations for the sum of all AAs (p = .72), glutamine (p = .31) and arginine (p = .23) distributed by the route of nutrition. Administration of ALA-GLN dipeptide increased the plasma concentration of alanine (p = .004), glutamine (p < .001) and citrulline (p = .006). CONCLUSIONS: We found an early depletion of plasma AAs' concentration which partially recovered at day 6, which was unaffected by the route of nutrition. ALA-GLN dipeptide supplementation produced a small increase in plasma levels of glutamine and citrulline.
Sujet(s)
Acides aminés/métabolisme , Compléments alimentaires , Dipeptides/administration et posologie , Plaies et blessures/métabolisme , Adolescent , Adulte , Sujet âgé , Acides aminés/sang , Dipeptides/pharmacocinétique , Nutrition entérale , Femelle , Humains , Score de gravité des lésions traumatiques , Mâle , Adulte d'âge moyen , État nutritionnel , Nutrition parentérale , Résultat thérapeutique , Plaies et blessures/sang , Jeune adulteRÉSUMÉ
OBJECTIVE: The purpose of this study was to determine the late complications in critically ill patients requiring percutaneous tracheostomy (PT) using the balloon dilation technique. DESIGN: A prospective, observational cohort study was carried out. SCOPE: Two medical-surgical intensive care units (ICU). PATIENTS: All mechanically ventilated adult patients consecutively admitted to the ICU with an indication of tracheostomy. INTERVENTIONS: All patients underwent PT according to the Ciaglia Blue Dolphin® method, with endoscopic guidance. Survivors were interviewed and evaluated by fiberoptic laryngotracheoscopy and tracheal computed tomography at least 6 months after decannulation. VARIABLES: Intraoperative, postoperative and long-term complications and mortality (in-ICU, in-hospital) were recorded. RESULTS: A total of 114 patients were included. The most frequent perioperative complication was minor bleeding (n=20) and difficult cannula insertion (n=19). Two patients had severe perioperative complications (1.7%) (major bleeding and inability to complete de procedure in one case and false passage and desaturation in the other). All survivors (n=52) were evaluated 211±28 days after decannulation. None of the patients had symptoms. Fiberoptic laryngotracheoscopy and computed tomography showed severe tracheal stenosis (>50%) in 2patients (3.7%), both with a cannulation period of over 100 days. CONCLUSIONS: Percutaneous tracheostomy using the Ciaglia Blue Dolphin® technique with an endoscopic guide is a safe procedure. Severe tracheal stenosis is a late complication which although infrequent, must be taken into account due to its lack of clinical expressiveness. Evaluation should be considered in those tracheostomized critical patients who have been cannulated for a long time.
Sujet(s)
Trachéostomie/effets indésirables , Sujet âgé , Sujet âgé de 80 ans ou plus , Soins de réanimation/méthodes , Dilatation/instrumentation , Dilatation/méthodes , Endoscopie , Femelle , Hémorragie/étiologie , Mortalité hospitalière , Humains , Complications peropératoires/imagerie diagnostique , Complications peropératoires/étiologie , Mâle , Adulte d'âge moyen , Complications postopératoires/imagerie diagnostique , Complications postopératoires/étiologie , Études prospectives , Facteurs temps , Tomodensitométrie , Trachée/imagerie diagnostique , Trachée/traumatismes , Sténose trachéale/imagerie diagnostique , Sténose trachéale/étiologie , Trachéostomie/méthodesRÉSUMÉ
Severely burned patients have altered drug pharmacokinetics (PKs), but it is unclear how different they are from those in other critically ill patient groups. The aim of the present study was to compare the population pharmacokinetics of micafungin in the plasma and burn eschar of severely burned patients with those of micafungin in the plasma and peritoneal fluid of postsurgical critically ill patients with intra-abdominal infection. Fifteen burn patients were compared with 10 patients with intra-abdominal infection; all patients were treated with 100 to 150 mg/day of micafungin. Micafungin concentrations in serial blood, peritoneal fluid, and burn tissue samples were determined and were subjected to a population pharmacokinetic analysis. The probability of target attainment was calculated using area under the concentration-time curve from 0 to 24 h/MIC cutoffs of 285 for Candida parapsilosis and 3,000 for non-parapsilosis Candida spp. by Monte Carlo simulations. Twenty-five patients (18 males; median age, 50 years; age range, 38 to 67 years; median total body surface area burned, 50%; range of total body surface area burned, 35 to 65%) were included. A three-compartment model described the data, and only the rate constant for the drug distribution from the tissue fluid to the central compartment was statistically significantly different between the burn and intra-abdominal infection patients (0.47 ± 0.47 versus 0.15 ± 0.06 h(-1), respectively; P < 0.05). Most patients would achieve plasma PK/pharmacodynamic (PD) targets of 90% for non-parapsilosis Candida spp. and C. parapsilosis with MICs of 0.008 and 0.064 mg/liter, respectively, for doses of 100 mg daily and 150 mg daily. The PKs of micafungin were not significantly different between burn patients and intra-abdominal infection patients. After the first dose, micafungin at 100 mg/day achieved the PK/PD targets in plasma for MIC values of ≤0.008 mg/liter and ≤0.064 mg/liter for non-parapsilosis Candida spp. and Candida parapsilosis species, respectively.
Sujet(s)
Antifongiques/pharmacocinétique , Échinocandines/pharmacocinétique , Infections intra-abdominales/traitement médicamenteux , Lipopeptides/pharmacocinétique , Adulte , Sujet âgé , Antifongiques/sang , Liquide d'ascite/effets des médicaments et des substances chimiques , Brûlures/complications , Brûlures/microbiologie , Maladie grave , Échinocandines/sang , Femelle , Humains , Lipopeptides/sang , Mâle , Micafungine , Adulte d'âge moyen , Méthode de Monte Carlo , Études prospectives , Distribution tissulaireRÉSUMÉ
Currently, the aim of the resuscitation of burn patients is to maintain end-organ perfusion with fluid intake as minimal as possible. To avoid excess intake, we can improve the estimation using computer methods. Parkland and Brooke are the commonly used formulas, and recently, a new, an easy formula is been used, i.e. the Rule of TEN. Fluid resuscitation should be titrated to maintain the urine output of approximately 30-35 mL/h for an average-sized adult. The most commonly used fluids are crystalloid, but the phenomenon of creep flow has renewed interest in albumin. In severely burn patients, monitoring with transpulmonary thermodilution together with lactate, ScvO2 and intraabdominal pressures is a good option. Nurse-driven protocols or computer-based resuscitation algorithms reduce the dependence on clinical decision making and decrease fluid resuscitation intake. High-dose vitamin C, propranolol, the avoidance of excessive use of morphine and mechanical ventilation are other useful resources
El objetivo de la reanimación de los pacientes quemados es mantener la perfusión tisular con el menor aporte de fluidos posible. Para evitar un aporte excesivo podemos usar métodos de estimación computarizados. La fórmula de Parkland y la de Brooke son las más usadas y recientemente se ha propuesto una fórmula sencilla que es la «regla de los diez». Los fluidos de reanimación deben intentar mantener una diuresis de 30-35ml/h. Los fluidos más usados son los cristaloides, pero el fenómeno del «fluid creep» ha renovado el interés por el uso de la albúmina. En pacientes quemados críticos, la monitorización con termodilución transpulmonar junto con lactato, SvcO2 y presión intraabdominal es una buena opción. Protocolos de enfermería y algoritmos de reanimación informáticos reducen la dependencia de las decisiones de los clínicos y disminuyen el aporte requerido. Otras actuaciones útiles son: usar altas dosis de vitamina C, emplear propranolol y evitar el uso excesivo de morfina y de ventilación mecánica
Sujet(s)
Humains , Brûlures/thérapie , Maladie grave/thérapie , Réanimation/méthodes , Traitement par apport liquidien/méthodes , Premiers secours/méthodes , Colloïdes/usage thérapeutique , Agents mouillants/usage thérapeutiqueRÉSUMÉ
Currently, the aim of the resuscitation of burn patients is to maintain end-organ perfusion with fluid intake as minimal as possible. To avoid excess intake, we can improve the estimation using computer methods. Parkland and Brooke are the commonly used formulas, and recently, a new, an easy formula is been used, i.e. the 'Rule of TEN'. Fluid resuscitation should be titrated to maintain the urine output of approximately 30-35 mL/h for an average-sized adult. The most commonly used fluids are crystalloid, but the phenomenon of creep flow has renewed interest in albumin. In severely burn patients, monitoring with transpulmonary thermodilution together with lactate, ScvO2 and intraabdominal pressures is a good option. Nurse-driven protocols or computer-based resuscitation algorithms reduce the dependence on clinical decision making and decrease fluid resuscitation intake. High-dose vitamin C, propranolol, the avoidance of excessive use of morphine and mechanical ventilation are other useful resources.