José Ángel Baltazar-Torres

SUMMARY OBJECTIVE: The aim of this study was to describe the prescription of medical nutrition therapy for critically ill patients who were admitted to an intensive care unit during the first 5 days. METHODS: In an observational, longitudinal, retrospective study conducted at the intensive care unit of a tertiary hospital in Mexico City, adult patients admitted from January to December 2018 and from November 2024 to February 2025 were included. Indications for fasting, the route of medical nutrition therapy (enteral nutrition—parenteral nutrition), caloric and protein intakes, sequential organ failure assessment score and lactate levels, and vasopressor requirements during the 5 days were evaluated. Delay in initiating medical nutrition therapy was defined as initiated after 48 h of intensive care unit admission. RESULTS: 100 critically ill patients were included; aged 53±18.8, and with a median sequential organ failure assessment score of 10 (7–12). The most frequent diagnoses at admission were pulmonary disease and septic shock. On the first day, 98% of patients were fasting, and 25% received high-dose vasopressor therapy (if the norepinephrine equivalent dose >0.3 μg/kg/min). Over 5 days, medical nutrition therapy transitioned progressively, predominantly from fasting through enteral nutrition (45%) and parenteral nutrition (11%). medical nutrition therapy delay in 54 patients and in a multivariate analysis was associated with age (OR 1.04; 95%CI 1.01–1.07), sequential organ failure assessment score (OR 1.20; 95%CI 1.02–1.40), and lactate levels (OR 1.8; 95%CI 1.10–3.00). CONCLUSION: Prescription of medical nutrition therapy in critically ill patients admitted to a intensive care unit during 5 days is dynamic, and in all patients, it is not possible to initiate at 48 h, associated with higher age and illness severity.

It has been observed that sex hormones may play a role in inflammatory processes and mortality of critically ill patients. The aim was evaluated the relationship between serum estradiol level at Intensive Care Unit (ICU) admission and mortality of critically ill patients. This study was a prospective cohort conducted in one mixed ICU. In heterogeneous group of critically ill patients admitted to the ICU, we measured serum estradiol at admission time. The discrimination to predict mortality of serum estradiol level was assessed by the receiver-operating curve (ROC) curve and its association with mortality by logistic regression analysis. We included 131 patients, 57.3% of which were male. The serum estradiol level measured at ICU admission was significantly higher in nonsurvivors than in survivors: 116 versus 67.2 pg/mL, respectively (P < 0.0001). The area under the ROC of serum estradiol level to predict mortality was 0.74 (P < 0.0001). Serum estradiol level ≥97.9 pg/mL had sensitivity of 60%, specificity of 90%, positive predictive value of 64%, negative predictive value of 88%, positive likelihood ratio of 6, and negative likelihood ratio of 0.44, for predicting mortality. In multivariate analysis, it had relative risk of 6.47 (P = 0.002) for ICU mortality. The serum estradiol level is elevated in critically ill patients, regardless of gender, especially in those who die. It has good discriminative capacity to predict mortality, and it is an independent risk factor for death in this group of patients.

Objectives: The 2009–2010 influenza A (H1N1pdm09) pandemic caused substantial morbidity and mortality among young patients; however, mortality estimates have been confounded by regional differences in eligibility criteria and inclusion of selected populations. In 2013–2014, H1N1pdm09 became North America’s dominant seasonal influenza strain. Our objective was to compare the baseline characteristics, resources, and treatments with outcomes among critically ill patients with influenza A (H1N1pdm09) in Mexican and Canadian hospitals in 2014 using consistent eligibility criteria. Design: Observational study and a survey of available healthcare setting resources. Setting: Twenty-one hospitals, 13 in Mexico and eight in Canada. Patients: Critically ill patients with confirmed H1N1pdm09 during 2013–2014 influenza season. Interventions: None. Measurements and Main Results: The main outcome measures were 90-day mortality and independent predictors of mortality. Among 165 adult patients with H1N1pdm09-related critical illness between September 2013 and March 2014, mean age was 48.3 years, 64% were males, and nearly all influenza was community acquired. Patients were severely hypoxic (median Pao ₂-to-Fio ₂ ratio, 83 mm Hg), 97% received mechanical ventilation, with mean positive end-expiratory pressure of 14 cm H₂O at the onset of critical illness and 26.7% received rescue oxygenation therapy with prone ventilation, extracorporeal life support, high-frequency oscillatory ventilation, or inhaled nitric oxide. At 90 days, mortality was 34.6% (13.9% in Canada vs 50.5% in Mexico, p < 0.0001). Independent predictors of mortality included lower presenting Pao ₂-to-Fio ₂ ratio (odds ratio, 0.89 per 10-point increase [95% CI, 0.80–0.99]), age (odds ratio, 1.49 per 10 yr increment [95% CI, 1.10–2.02]), and requiring critical care in Mexico (odds ratio, 7.76 [95% CI, 2.02–27.35]). ICUs in Canada generally had more beds, ventilators, healthcare personnel, and rescue oxygenation therapies. Conclusions: Influenza A (H1N1pdm09)-related critical illness still predominantly affects relatively young to middle-aged patients and is associated with severe hypoxemic respiratory failure. The local critical care system and available resources may be influential determinants of patient outcome.

Our aims were to describe the prevalence of pulmonary hypertension in patients with acute respiratory distress syndrome (ARDS), to characterize their hemodynamic cardiopulmonary profiles, and to correlate these parameters with outcome. All consecutive patients over 16 years of age who were in the intensive care unit with a diagnosis of ARDS and an in situ pulmonary artery catheter for hemodynamic monitoring were studied. Pulmonary hypertension was diagnosed when the mean pulmonary artery pressure was >25 mmHg at rest with a pulmonary artery occlusion pressure or left atrial pressure 2 was higher in those who died. The level of airway pressure seemed to influence the onset of pulmonary hypertension. Survival was determined by the severity of organ failure at admission to the intensive care unit.

The purpose of the present study was to explore the usefulness of the Mexican sequential organ failure assessment (MEXSOFA) score for assessing the risk of mortality for critically ill patients in the ICU. A total of 232 consecutive patients admitted to an ICU were included in the study. The MEXSOFA was calculated using the original SOFA scoring system with two modifications: the PaO₂/FiO₂ ratio was replaced with the SpO₂/FiO₂ ratio, and the evaluation of neurologic dysfunction was excluded. The ICU mortality rate was 20.2%. Patients with an initial MEXSOFA score of 9 points or less calculated during the first 24 h after admission to the ICU had a mortality rate of 14.8%, while those with an initial MEXSOFA score of 10 points or more had a mortality rate of 40%. The MEXSOFA score at 48 h was also associated with mortality: patients with a score of 9 points or less had a mortality rate of 14.1%, while those with a score of 10 points or more had a mortality rate of 50%. In a multivariate analysis, only the MEXSOFA score at 48 h was an independent predictor for in-ICU death with an OR = 1.35 (95%CI = 1.14-1.59, P < 0.001). The SOFA and MEXSOFA scores calculated 24 h after admission to the ICU demonstrated a good level of discrimination for predicting the in-ICU mortality risk in critically ill patients. The MEXSOFA score at 48 h was an independent predictor of death; with each 1-point increase, the odds of death increased by 35%.

Research from JAMA — Critically Ill Patients With 2009 Influenza A(H1N1) in Mexico

The objectives of this study were to identify risk factors associated with mortality in patients with systemic lupus erythematosus (SLE) admitted to the intensive care unit (ICU) and to evaluate the usefulness of Acute Physiologic and Chronic Health Evaluation (APACHE) II score to predict outcomes in these patients, through the use of a retrospective patient record review from a multidisciplinary intensive care unit in a teaching hospital. One hundred and four patients with SLE admitted to the ICU were included in the study. The mean age of patients was 32.44 years, 96.2% were female and 61.5% were admitted with infection. The mean APACHE II score was 19.7, 46.2% had acute renal dysfunction, 67.3% received inotropics/ vasopressors, 27.9% pulmonary artery catheter and 74% invasive mechanical ventilation. The mean length of stay in ICU was 18.5 days and mortality rate was 32.7%. In the univariate logistic regression analysis, factors associated with mortality were high APACHE II score, use of inotropics/vasopressors, pulmonary artery catheter and invasive mechanical ventilation. High APACHE II score and use of inotropics/vasopressors remained significant in the multi-variate analysis. The area under the receiver operating characteristic curve of the APACHE II score to predict mortality was 0.689 (95% CI 0.586—0.791 p = 0.002) and the Hosmer— Lemeshow χ ² was 5.094 (p = 0.747). We conclude that the mortality rate in patients with SLE admitted to the ICU is high. The most common cause of admission was infection. The factors associated with mortality were high APACHE II score and the use of inotropics/vasopressors. APACHE II score was unable to accurately predict mortality. Lupus (2009) 18, 1252—1258.