搜索到75212篇“ INTENSIVE“的相关文章
Severe dengue in the intensive care unit
2024年
Dengue fever is considered the most prolific vector-borne disease in the world,with its transmission rate increasing more than eight times in the last two decades.While most cases present mild to moderate symptoms,5%of patients can develop severe disease.Although the mechanisms are yet not fully comprehended,immune-mediated activation leading to excessive cytokine expression is suggested as a cause of the two main findings in critical patients:increased vascular permeability that may shock and thrombocytopenia,and coagulopathy that can induce hemorrhage.The risk factors of severe disease include previous infection by a different serotype,specific genotypes associated with more efficient replication,certain genetic polymorphisms,and comorbidities such as diabetes,obesity,and cardiovascular disease.The World Health Organization recommends careful monitoring and prompt hospitalization of patients with warning signs or propensity for severe disease to reduce mortality.This review aims to update the diagnosis and management of patients with severe dengue in the intensive care unit.
Alexandre Mestre TejoDebora Toshie HamasakiLetícia Mattos MenezesYeh-Li Ho
关键词:PATHOGENESISDIAGNOSISMANAGEMENT
Diagnosis and management of malaria in the intensive care unit
2024年
Malaria is responsible for approximately three-quarters of a million deaths in humans globally each year.Most of the morbidity and mortality reported are from Sub-Saharan Africa and Asia,where the disease is endemic.In non-endemic areas,malaria is the most common cause of imported infection and is associated with significant mortality despite recent advancements and investments in elimination programs.Severe malaria often requires intensive care unit admission and can be complicated by cerebral malaria,respiratory distress,acute kidney injury,bleeding complications,and co-infection.Intensive care management includes prompt diagnosis and early initiation of effective antimalarial therapy,recognition of complications,and appropriate supportive care.However,the lack of diagnostic capacities due to limited advances in equipment,personnel,and infrastructure presents a challenge to the effective diagnosis and management of malaria.This article reviews the clinical classification,diagnosis,and management of malaria as relevant to critical care clinicians,highlighting the role of diagnostic capacity,treatment options,and supportive care.
George AkafityNicholas KumiJoyce Ashong
关键词:MALARIAANTIMALARIALS
Intensive care unit-acquired weakness: Recent insights被引量:5
2024年
Intensive care unit-acquired weakness(ICU-AW)is a common complication in critically ill patients and is associated with a variety of adverse outcomes.These include the need for prolonged mechanical ventilation and ICU stay;higher ICU,in-hospital,and 1-year mortality;and increased in-hospital costs.ICU-AW is associated with multiple risk factors including age,underlying disease,severity of illness,organ failure,sepsis,immobilization,receipt of mechanical ventilation,and other factors related to critical care.The pathological mechanism of ICUAW remains unclear and may be considerably varied.This review aimed to evaluate recent insights into ICU-AW from several aspects including risk factors,pathophysiology,diagnosis,and treatment strategies;this provides new perspectives for future research.
Juan ChenMan Huang
关键词:MECHANISM
儿童重症监护病房可弯曲支气管镜下形态学诊断分析
2024年
目的通过形态学诊断分析可弯曲支气管镜术在诊断儿童重症监护病房(PICU)呼吸道疾病患儿中的临床应用价值。方法回顾性分析2017年7月至2022年12月兰州大学第二医院PICU收治的124例呼吸系统危重症行床旁电子支气管镜术后形态学异常患儿的临床资料,其中96例行支气管肺泡灌洗液(BALF)病原学检查,3例进行引导经鼻气管插管术。比较电子支气管镜和胸部CT诊断肺部病变准确性的差异,并观察电子支气管镜下肺部病变的形态学变化。结果电子支气管镜检查对于气管食管瘘、气管断裂、支气管异物诊断的准确性明显高于胸部CT(气管食管瘘:4例比0例,气管断裂:4例比0例,支气管异物:4例比6例,均P<0.05),电子支气管镜检查和胸部CT对于肺挫伤、支气管扩张诊断的准确性比较差异无统计学意义。镜下确诊典型病例:气管食管瘘4例(3.23%);支气管断裂伤4例(3.23%);支气管赞生物并黏膜附着白色干酪样物1例(0.81%),镜下诊断为支气管内膜结核。病原学检出阳性细菌23例(23.96%)。因患儿颌骨或颈椎骨折行引导经鼻气管插管术3例;机械通气下经气管导管进镜操作13例。术中和术后无严重并发症及死亡病例结论PICU开展儿科可弯曲支气管镜术安全可靠,可提高PICU呼吸系统疾病的确诊率,有较高的临床应用价值。
王海东杜转环裴炜娜曹娥英吴静
关键词:支气管镜术儿童重症监护病房儿童
重症监护病房267株病原菌的分布特点及耐药性
2024年
目的 探讨重症监护病房267株病原菌的分布特点及耐药性。方法 收集2021年1月—2023年11月义乌市中心医院重症监护病房收治的180例发生医院获得性感染患者送检的180份标本,统计医院获得性感染患者感染部位、标本来源。分析患者:病原菌的分布特点,结合药敏评估结果对主要革兰氏阳性菌(金黄色葡萄球菌、表皮葡萄球菌)、革兰氏阴性菌(大肠埃希菌、铜绿假单胞菌、肺炎克雷伯菌)的耐药性进行分析。结果 180例发生医院获得性感染患者肺部感染、泌尿系统感染占比较高,送检标本中痰液、尿液标本占比较高。180份标本经病原菌培养后共检出267株病原菌,其中革兰氏阳性菌占比29.59%,革兰氏阴性菌占比67.04%,真菌占比3.37%。2021—2023年间革兰氏阳性菌、真菌检出率呈上升趋势,革兰氏阴性菌检出率呈降低趋势。金黄色葡萄球菌对利奈唑胺具有较高的敏感性,表皮葡萄球菌对莫西沙星和利奈唑胺具有较高的敏感性。大肠埃希菌、铜绿假单胞菌均对哌拉西林/他唑巴坦具有较高的敏感性,肺炎克雷伯菌对复方新诺明、亚胺培南、哌拉西林/他唑巴坦具有较高的敏感性。结论 重症监护病房收治的医院获得性感染患者中病原菌分布主要为金黄色葡萄球菌、表皮葡萄球菌、大肠埃希菌、铜绿假单胞菌及肺炎克雷伯菌,且对抗菌药物存在不同程度耐药,后续在临床用药选择中应当慎重,应优先考虑敏感性高的抗菌药物。
谢其洋王逸楼彦明楼翰健何俊洪
关键词:重症监护病房医院获得性感染病原菌分布抗菌药物耐药性药敏试验
重症监护室马尔尼菲篮状菌感染儿童的临床特征
2024年
目的探讨儿童重症监护室(pediatric intensive care unit,PICU)收治的马尔尼菲篮状菌(Talaromyces marneffei,TM)感染患儿的临床资料,以期提高儿童TM感染的诊疗水平。方法回顾性分析2013年1月—2022年12月中国南方4家医院PICU诊治的23例TM感染患儿的临床资料,包括临床特征、实验室检查、治疗方案及转归。结果23例患儿中,男14例,女9例,中位年龄24个月,起病至入室时间15(10~30)d,1例存在免疫缺陷病。常见症状为发热(91.3%,21例)、咳嗽(78.3%,18例)和肝脾肿大(78.3%,18例)。严重临床并发症包括多器官功能障碍(69.6%,16例),脓毒性休克(65.2%,15例)及急性呼吸窘迫综合征(65.2%,15例)。所有患者C-反应蛋白(C-reactive protein,CRP)升高,69.2%(9/13)G试验阳性,53.3%(8/15)免疫球蛋白E升高,17.6%(3/17)CD4/CD8倒置,84.2%(16/19)自然杀伤细胞细胞减少。HIV检测均阴性。TM最常通过血液及骨髓培养检出。7例通过基因检测诊断免疫缺陷。采用两性霉素B或伏立康唑单药,或联合用药改口服续贯治疗,最终13例(56.5%)患儿死亡。结论HIV阴性儿童TM感染临床表现不典型,入住重症监护室者病情进展快,严重并发症多,死亡率高。多途径、多手段检测TM,结合免疫功能及基因检测,有助于早诊断。抗真菌治疗策略有待深入研究。
李甜樊慧峰杨志勇卢秀兰武宇辉李木胜张剑珲黄莉
关键词:多器官功能障碍儿童重症监护
Risk Factors for Mortality in Acute Kidney Injury in Intensive Care Units in Togo
2024年
Context: Acute kidney injury (AKI) in intensive care unit (ICU) is common and associated with very high mortality. In Togo, a tropical country with limited resources and only one nephrology department in the north, acute kidney injury seems to be a real tragedy with high mortality. Aims: to determine risk factors for mortality in acute kidney injury in the intensive care units. Methods and Material: We made a multicentric cross sectional study during 6 months in the four referral centers in northern Togo. Univariate and multivariate logistic regression was used to identify factors associated with mortality. Data were analyzed using RStudio 2023.04.1. Results: A total of 12.6% of patients admitted to intensive care had presented with AKI. The mean age was 49.6 ± 17.9. The sex ratio (M/F) was 2.1. Community-acquired AKI was in the majority (67.7%). Oligo anuria was the most frequent functional sign (38.4%). In our series, 81.6% of patients were in KDIGO stages 2 to 3. AKI was organic in 56.2% of cases. Mortality was 44.3%. In multivariate analysis, the main factors predictive of death were: respiratory distress (OR = 2.36;p Conclusions: Acute kidney injury in intensive care is common in northern Togo, and mortality is high. Identification of associated factors should help anticipate prognosis.
Eyram Makafui Yoan Yawo AmekoudiKossi Akomola SabiMarcel David KeoulaBadomta DolaamaSarakawabalo AssenouweTabana Mouzou
关键词:AKIDIALYSISEPIDEMIOLOGYTOGO
重症监护室强化细节管理对护理管理质量的影响
2024年
目的研究重症监护室强化细节管理对护理管理质量的影响。方法选取2021年4月—2022年5月山东省烟台市烟台山医院东院收治的重症患者50例为研究对象,同时期选取12名护理人员对患者进行相关性管理措施。以随机数字表法将50例患者及护理人员随机分为对照组与研究组(重症患者各25例,护理人员各6例)。对照组予以常规护理,而研究组在此基础上添加强化细节管理。对比2组患者的护理质量、护理满意度评分以及护患纠纷事件发生率。结果采取强化细节管理后,研究组的护理质量评分明显高于对照组,护患纠纷发生率(0)少于对照组(36.00%),差异有统计学意义(P<0.05)。研究组护理满意度(96.0%)高于对照组(68.0%),差异有统计学意义(P<0.05)。结论强化细节管理可有效改善护理质量,降低护患纠纷发生率,提高护理满意度,临床运用价值显著。
李宏曲姿锟刘贝贝
关键词:细节管理重症监护室护理质量满意度
Adverse events related to physical restraint use in intensive care units: A review of the literature
2024年
Physical restraints are widely used and accepted as protective measures during treatment in intensive care unit (ICU). This review of the literature summarizes the adverse events and outcomes associated with physical restraint use, and the risk factors associated with their use during treatment in the ICU. The PubMed, Scopus, and Google Scholar databases were screened using predefined search terms to identify studies pertaining to adverse events and/or outcomes associated with physical restraint use, and the factors associated with their use in adult patients admitted to the ICU. A total of 24 articles (including 6126 patients) that were published between 2006 and 2022 were identified. The described adverse events associated with physical restraint use included skin injuries, subsequent delirium, neurofunctional impairment, and a higher rate of post-traumatic stress disorder. Subsequent delirium was the most frequent adverse event to be reported. No alternative measures to physical restraints were discussed, and only one study reported a standardized protocol for their use. Although physical restraint use has been reported to be associated with adverse events (including neurofunctional impairment) in the literature, the available evidence is limited. Although causality cannot be confirmed, a definite association appears to exist. Our findings suggest that it is essential to improve awareness regarding their adverse impact and optimize approaches for their detection, management, and prevention using protocols or checklists.
Sebastian BergerPascale GrzonkaSimon A.AmacherSabina HunzikerAnja I.FreiRaoul Sutter
关键词:DELIRIUMCOMPLICATION
基于云教学查房对西藏地区重症医学人才培养的实践研究
2024年
针对西藏地区重症医学发展缓慢的难题,研究团队充分借力国家对口援藏力量,网聚西藏各地市资源,形成国家级高原重症学术平台。该平台坚持以血流动力学为主线,以重症超声为床旁动态监测评估方法,并以血流-氧流复苏作为核心内涵的学术导向。通过这些努力,实现了西藏地区重症人才梯队日臻完善、西藏整体重症医学日益进步并在国内崭露头角、拔尖人才重点培养的目标。
杜微蔺国英桂喜盈程莉蔡鑫付建垒李茜玮普布卓玛次央旦增曲珍吉律次仁桑珠达瓦郭娟邱成
关键词:重症医学教学查房

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