Search

Jose-Luis Lafuente,1,2,* Samuel González,1,3 Vicente Gómez-Tello,1,4 Enrique Puertas,1,5 Eva Avilés,1,2 Juan-Jose Beunza1,6,* 1IASalud, Universidad Europea de Madrid, Villaviciosa de Odón, Madrid, Spain; 2Department of Engineering, Universidad Europea de Madrid, Villaviciosa de Odón, Madrid, Spain; 3Intensive Care Unit, University Hospital HLA Moncloa, Madrid, Spain; 4Hospital Emergency Department, University Hospital HLA Moncloa, Madrid, Spain; 5Department of Science, Computing and Technology, Universidad Europea de Madrid, Villaviciosa de Odón, Madrid, Spain; 6Research and Doctoral School, Universidad Europea de Madrid, Villaviciosa de Odón, Madrid, Spain*These authors contributed equally to this workCorrespondence: Juan-Jose Beunza, Research and Doctoral School, Universidad Europea de Madrid, Villaviciosa de Odón, Madrid, Spain, Tel +34633398636, Email juanjose.beunza@universidadeuropea.esAbstract: The measurement of urinary flow is a vital medical indicator for critically ill patients in intensive care units. However, there is a clinical need to automate the real-time measurement of diuresis using Internet of Medical Things devices, allowing continuous monitoring of urine flow. A systematic review of scientific literature, patents, and available commercial products was conducted, leading to the conclusion that there is no suitable device to fulfill this need. We identified six characteristics that such a device should possess: minimizing contact with urine, detecting changes in flow patterns, the ability to record minute-by-minute data, capable of sending early alerts, not relying on exclusive disposable components, and being user-friendly for clinical professionals. Additionally, cost-effectiveness is crucial, encompassing the device, infrastructure, maintenance, and usage. Plain Language Summary: Continuous monitoring of urinary output in intensive care patients provides vital insights, potentially revealing low cardiac output, renal hypoperfusion, or deteriorating renal function. Currently, these measurements are done manually, prompting a need for automated, real-time monitoring using Internet of Medical Things (IoMT) devices. Current automatic urinometers are not widely used due to high costs, maintenance requirements, and logistical complications. However, we propose developing an affordable, updated urinometer that meets clinician needs and can be widely used in hospitals.This innovation would enable early intervention strategies to reverse or improve renal perfusion and prevent potential toxic treatments. The shift from manual to automated monitoring is likely, facilitating real-time data integration such as blood pressure, heart rate, and temperature. This can lead to personalized medical approaches and predictive algorithms for renal function deterioration.As technology, IoMT, big data, and artificial intelligence (AI) evolve, these advancements will be indispensable for hospital medicine, supporting precision medicine and efficient clinical operation. While we cannot predict the definitive method for continuous diuresis measurement, we anticipate the adoption of these technologies in the near future, improving diagnostics and clinical practice. If successful, the application could extend beyond critical care into postoperative or home care, not only for diuresis but for any fluid flow, enabling early pathology identification and potentially revealing diagnostic patterns through AI.Keywords: clinical decision support systems, critical care, internet of things, renal insufficiency, urinometer

Objetivo: Evaluar, mediante revisión sistemática y metaanálisis, el efecto de una presión positiva al final de la espiración (PEEP) alta en comparación con una PEEP convencional sobre la mortalidad y el riesgo de barotrauma en los pacientes con síndrome de distrés respiratorio agudo (SDRA). Fuente de datos: Búsqueda mediante ordenador en Medline, Embase, CINAHL, CANCERLIT, Pascal-Biomed, ACP Journal Club, Biblioteca Cochrane (CDSR, DARE, CCTR), ISI Proceedings, Current Contents y Web of Science, así como búsqueda manual de referencias seleccionadas. Selección de estudios: Ensayos clínicos controlados aleatorizados publicados tras la NAECC (1994) donde se evaluara el efecto de dos niveles de PEEP y se informara sobre la mortalidad e incidencia de barotrauma. Extracción de datos: Realizada independientemente por dos investigadores, y resueltas las discrepancias por consenso del grupo. Se elaboraron las tablas de contingencia y se obtuvieron los riesgos relativos (RR) con los intervalos de confianza (IC) de cada estudio. Resultados: Se seleccionaron cuatro artículos para el metaanálisis de mortalidad y tres para el de barotrauma. No se encontró efecto de ninguno de los niveles de PEEP sobre la mortalidad (RR, 0,73; IC del 95%, 0,49-1,10) ni sobre la incidencia de barotrauma (RR, 0,59; IC del 95%, 0,14-1,73). Sin embargo, un análisis de los estudios en los que la PEEP se individualizó en función del punto de inflexión (Pflex), mostró una reducción significativa de la mortalidad (RR, 0,59; IC del 95%, 0,43-0,82) (p = 0,001). Conclusiones: El uso de PEEP alta o convencional en función de la oxigenación no afecta a la mortalidad o a la incidencia de barotrauma en los pacientes con SDRA. Sin embargo, podría existir una reducción de la mortalidad asociada al empleo de PEEP alta individualizada en función de la mecánica pulmonar de cada paciente. [ABSTRACT FROM AUTHOR]

Objectives: The main objective of this study was to evaluate whether the implementation of CoBaTrICE (Competency-Based Training in Intensive Care Medicine in Europe) provides higher levels of competency in comparison with the current official time-based program in Intensive Care Medicine in Spain. Secondary objectives were: 1) To determine the percentage of critical essential performance elements (CEPE) accomplished, 2) To determine compliance with workplace-based assessments (wba)., Design: Multicenter cluster randomized trial., Setting: Thirteen Spanish ICU Departments., Participants: Thirty-six residents INTERVENTION: The implementation of CoBaTrICE included: (1) Training the trainers; (2) Wba; (3) The use of an electronic portfolio. The level of competency achieved by each participant was determined by a simulation-based Objective Structured Clinical Exam (OSCE) performed at the end of the 5th year of training period., Main Variables of Interest: Total scoring in the five scenarios, CEPE completed, level of competency (1-5) achieved., Results: A total of 119 performances from 26 residents (17 from CoBaTrICE group and 9 from control group) were analyzed in the OSCE. CoBaTrICE residents´ achieved higher levels of competency [2 (1-5) vs. 2 (1-3), p = 0.07) and higher percentages of CEPE´s accomplishment than the control group (78% vs. 71%, p = 0.09)., Conclusions: The CoBaTrICE group showed a better performance trend in comparison to the control group, but the differences were not statistically significant. Since the number of Wba performed was low, additional research is needed to determine the potential superiority of CoBaTrICE., Competing Interests: Declaration of competing interest The authors declare that they have no competing interests., (Copyright © 2024. Published by Elsevier España, S.L.U.)

Urinary flow measurement and colorimetry are vital medical indicators for critically ill patients in intensive care units. However, there is a clinical need for low-cost, continuous urinary flow monitoring devices that can automatically and in real-time measure urine flow. This need led to the development of a non-invasive device that is easy to use and does not require proprietary disposables. The device operates by detecting urine flow using an infrared barrier that returns an unequivocal pattern, and it is capable of measuring the volume of liquid in real-time, storing the history with a precise date, and returning alarms to detect critical trends. The device also has the ability to detect the color of urine, allowing for extended data and detecting problems in catheterized patients such as hematuria. The device is proposed as an automated clinical decision support system that utilizes the concept of the Internet of Medical Things. It works by using a LoRa communication method with the LoRaWAN protocol to maximize the distance to access points, reducing infrastructure costs in massive deployments. The device can send data wirelessly for remote monitoring and allows for the collection of data on a dashboard in a pseudonymous way. Tests conducted on the device using a gold standard medical grade infusion pump and fluid densities within the 1.005 g/ml to 1.030 g/ml urine density range showed that droplets were satisfactorily captured in the range of flows from less than 1 ml/h to 500 ml/h, which are acceptable ranges for urinary flow. Errors ranged below 15%, when compared to the values obtained by the hospital infusion pump used as gold standard. Such values are clinically adequate to detect changes in diuresis patterns, specially at low urine output ranges, related to renal disfunction. Additionally, tests carried out with different color patterns indicate that it detects different colors of urine with a precision in detecting RGB values <5%. In conclusion, the results suggest that the device can be useful in automatically monitoring diuresis and colorimetry in real-time, which can facilitate the work of nursing and provide automatic decision-making support to intensive care physicians., Competing Interests: The authors have declared that no competing interests exist., (Copyright: © 2023 Lafuente et al. This is an open access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.)

Background and Objective: To assess the post-Intensive Care Unit (ICU) mortality (in-hospital and one year after hospital discharge) and the associated factors., Patients and Method: Cohort design in medical-surgical patients with multi-organ dysfunction syndrome (MODS) during the first 24h of admission to ICU. We recorded the following data: personal background, functional general situation, general information about admission to ICU, hospital stay and contact by phone after one year of hospital discharge. We registered mortality at the follow-up at anytime. Cox regression was performed to evaluate mortality factors., Results: Five hundred and forty five patients were recruited. During the study period 256 patients (52.9%) died; out of them 29.5% in ICU; 14.8% of 384 patients transferred to the ward died. Of 327 discharged patients, 266 (81.3%) were contacted; 14.3% of those had died. In-hospital death-related factors were age (odds ratio [OR] 1.04; 95% confidence interval [95% CI] 1.02-1.06; P<.01) and a decreased functional general status (OR 1.7; 95% CI 1.1-2.9; P<.05). Post-hospitalisation mortality-related variables were: diminished functional general status (OR 2.42; 95% CI 1.23-4.75; P<.01) and readmission after discharge from hospital (1.45 OR; 95% CI 1.19-1.76; P<.001)., Conclusions: Patients admitted for a medical-surgical MODS presented a mortality of 52.9% within one year. The factors influencing hospital mortality are age and a generally diminished functional status, both being not modifiable factors. After discharge, the decreased general functional status remained central along with the re-hospitalisation., (Copyright © 2012 Elsevier España, S.L. All rights reserved.)

Critically ill patients have important modifications in their energetic requirements, in which the clinical situation, treatment applied and the time course take part. Thus, the most appropriate method to calculate the caloric intake is indirect calorimetry. When this test is not available, calculations such as Harris-Benedict's may be used, although not using the so high correction factors as previously recommended in order to avoid hypercaloric intakes. The intake of a fixed caloric amount (comprised between 25-30 KcalKg/min) is adequate for most critically ill patients. Carbohydrates intake must be of 5 g/kg/day) maximum. Glucose plasma levels must be controlled in order to avoid hyperglycemia. With regards to fat intake, the maximum limit should be 1.5 g/kg/day. The recommended protein intake is 1.0-1.5 g/kg/day, according to the clinical situation characteristics. Special care must be taken with micronutrients intake, an issue that is many times undervalued. In this sense, there are data to consider some micronutrients such as Zn, CU, Mn, Cr, Se, Mo and some vitamins (A, B, C, and E) of great importance for patients in a critical condition, although specific requirements for each one of them have not been established.

There are different parameters aimed at assessing nutritional status. These parameters may be of some help to assess nutritional status prior to patients' admission. However, their application in the critically ill patient is troublesome since results interpretation is interfered by changes originated by the acute disease or treatment measures. This is particularly true in relation to anthropometrical variables that are severely affected by changes in water distribution in the critical patient. Biochemical markers (creatinine/height index, serum albumin, etc.) are also interfered as a result of the metabolic changes that modify the synthesis and degradation processes. Short half-life proteins (prealbumin, retinol-bound protein) are not indicative of the nutritional status although they do inform about an appropriate response to nutrients intake and concurrence of new conditions of metabolic stress. Functional assessment parameters, such as muscular function test, are also difficult to apply in a great number of patients. Subjective global assessment, although it requires some degree of expertise, may be an appropriate tool. Some theoretically more accurate methods, such as bioelectrical impedance, need further investigation in these patients before being recommended.

The object of this is to evaluate the influence of several micronutrients on the survival rate of septic patients following abdominal surgery. A retrospective assessment was done of sixty-one patients suffering from neoplastic or non-neoplastic pathology associated to septicemia. On admission the following parameters were determined: number of total lymphocytes, serum albumin, transferrin, zinc, copper, magnesium, iron, calcium, phosphorus, and copper/zinc levels. The differences obtained between surviving and non-surviving patients were analyzed. The most relevant findings revealed statistically significant lower serum albumin, zinc and transferrin values in the latter group. We conclude by stating that such parameters may be of prognostic value in this type of patients, and that supplemental micronutrients must be administered in order to improve prognosis.