Intensive Care Medicine最新文献_第7页

Benzodiazepine and z-drug prescribing in critical care survivors and the risk of rehospitalisation or death due to falls/trauma and due to any cause: a retrospective matched cohort study using the UK Clinical Practice Research Datalink 重症监护幸存者的苯二氮卓类药物和z-药物处方以及因跌倒/创伤和任何原因导致的再住院或死亡的风险：使用英国临床实践研究数据链的回顾性匹配队列研究

IF 38.9 1区医学

Intensive Care Medicine Pub Date : 2025-01-07 DOI: 10.1007/s00134-024-07762-4

Elizabeth T. Mansi, Christopher T. Rentsch, Richard S. Bourne, Annie Jeffery, Bruce Guthrie, Nazir I. Lone

{"title":"Benzodiazepine and z-drug prescribing in critical care survivors and the risk of rehospitalisation or death due to falls/trauma and due to any cause: a retrospective matched cohort study using the UK Clinical Practice Research Datalink","authors":"Elizabeth T. Mansi, Christopher T. Rentsch, Richard S. Bourne, Annie Jeffery, Bruce Guthrie, Nazir I. Lone","doi":"10.1007/s00134-024-07762-4","DOIUrl":"https://doi.org/10.1007/s00134-024-07762-4","url":null,"abstract":"<h3 data-test=\"abstract-sub-heading\">Purpose</h3><p>Benzodiazepines and z-drugs are often prescribed to critical care survivors due to high prevalence of mental health problems and insomnia. However, their safety has not been studied in this population.</p><h3 data-test=\"abstract-sub-heading\">Methods</h3><p>Retrospective cohort study of 28,678 adult critical care survivors hospitalised in 2010 and 2018: 4844 prescribed benzodiazepines or z-drugs, matched to 23,834 unexposed survivors using UK Clinical Practice Research Datalink linked datasets. Multivariable stratified Cox regression was used to estimate the adjusted hazards ratio (adjHR) with 95% confidence intervals (CI) of community benzodiazepine/z-drug prescribing and falls/trauma-related events, as well as all-cause 30-day rehospitalisation or death. We performed subgroup analyses on patients without pre-critical care admission prescription of benzodiazepines/z-drugs (‘treatment-naïve’), and sensitivity analyses excluding patients receiving palliative care after discharge.</p><h3 data-test=\"abstract-sub-heading\">Results</h3><p>Prescription of benzodiazepines or z-drugs showed no conclusive evidence of increased risk of falls/trauma-related events in the whole cohort (adjHR 1.27; 95%CI 0.76–2.14) or in treatment-naïve individuals (adjHR 1.79; 95%CI 0.61–5.26), because estimates lacked precision due to low event rates. For all-cause rehospitalisation or death, benzodiazepines/z-drugs were associated with increased risk (whole cohort adjHR 1.24, 95%CI 1.14–1.36; treatment-naïve adjHR 1.66, 95%CI 1.49–1.86). However, after excluding patients treated for palliative care, the association persisted only in treatment-naïve individuals (whole cohort adjHR 1.08, 95%CI 0.98–1.19; treatment-naïve adjHR 1.42, 95%CI1.25–1.62).</p><h3 data-test=\"abstract-sub-heading\">Conclusions</h3><p>Community benzodiazepine and z-drug prescribing was associated with increased risk of all-cause, but not falls/trauma-related, rehospitalisations and deaths in critical care survivors who had not been prescribed these before hospitalisation. Clinicians should balance the possible benefits with the likely harms of prescribing these drugs in this potentially vulnerable patient group.</p>","PeriodicalId":13665,"journal":{"name":"Intensive Care Medicine","volume":"15 1","pages":""},"PeriodicalIF":38.9,"publicationDate":"2025-01-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142934519","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

引用次数: 0

Best clinical model predicting extubation failure: a diagnostic accuracy post hoc analysis 预测拔管失败的最佳临床模型：诊断准确性事后分析

IF 38.9 1区医学

Intensive Care Medicine Pub Date : 2025-01-07 DOI: 10.1007/s00134-024-07758-0

Patricia Rodríguez Villamizar, Arnaud W. Thille, Margarita Márquez Doblas, Jean-Pierre Frat, Pilar Leal Sanz, Elena Alonso, Victoria País, Guillermo Morales, Laura Colinas, Alicia Propín, Aida Fernández Olivares, María Martínez Balaguer, Diego Alvaredo Rodrigo, Gonzalo Hernández

{"title":"Best clinical model predicting extubation failure: a diagnostic accuracy post hoc analysis","authors":"Patricia Rodríguez Villamizar, Arnaud W. Thille, Margarita Márquez Doblas, Jean-Pierre Frat, Pilar Leal Sanz, Elena Alonso, Victoria País, Guillermo Morales, Laura Colinas, Alicia Propín, Aida Fernández Olivares, María Martínez Balaguer, Diego Alvaredo Rodrigo, Gonzalo Hernández","doi":"10.1007/s00134-024-07758-0","DOIUrl":"https://doi.org/10.1007/s00134-024-07758-0","url":null,"abstract":"<h3 data-test=\"abstract-sub-heading\">Purpose</h3><p>Predicting extubation failure remains a clinical challenge. This study aimed to determine diagnostic accuracy of models used at the bed side.</p><h3 data-test=\"abstract-sub-heading\">Methods</h3><p>Post hoc analysis of 2341 patients at all risk included in five multicenter randomized trials. Diagnostic accuracy of three clinical prediction models was compared: 3-factors model including age > 65y, chronic heart or pulmonary disease; 4-factors model adding prolonged mechanical ventilation; and 11-factors model including age > 65 years, ≥ 2 comorbidities, prolonged mechanical ventilation, acute heart failure as the primary indication for mechanical ventilation, moderate-to-severe chronic obstructive pulmonary disease, APACHE II score > 12 on extubation day, airway patency problems, inability to deal with respiratory secretions, not simple weaning, obesity, or hypercapnia at the end of the spontaneous breathing trial. Crude and adjusted for spontaneous breathing trial (SBT) models were compared for all-cause reintubation at 7 days using Youden and Kappa indexes.</p><h3 data-test=\"abstract-sub-heading\">Results</h3><p>The 3-factors model had a very low global prediction capability (Youden index 0.08 and Kappa index 0.04); the 4-factors and 11-factors models had low global prediction capability (Youden index 0.12 and 0.16, and Kappa index 0.06 and 0.07, respectively). Aggressive SBT strategies (pressure support ≥ 7 cm H<sub>2</sub>O with or without positive end-expiratory pressure) were associated with extubation failure risk (<i>p</i> < 0.001). All adjusted models had low diagnostic capability (0.08/0.03, 0.07/0.03, and 0.06/0.02 respectively).</p><h3 data-test=\"abstract-sub-heading\">Conclusion</h3><p>Based on these results, the 3-factors model reported a very low diagnostic accuracy, and the 4 or 11-factors models showed similar low accuracy. No improvement was observed after adjusting for other aspects of weaning.</p>","PeriodicalId":13665,"journal":{"name":"Intensive Care Medicine","volume":"5 1","pages":""},"PeriodicalIF":38.9,"publicationDate":"2025-01-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142935021","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

引用次数: 0

How we use ultrasound in the management of weaning from mechanical ventilation 超声在机械通气脱机管理中的应用

IF 38.9 1区医学

Intensive Care Medicine Pub Date : 2025-01-07 DOI: 10.1007/s00134-024-07753-5

Pieter R. Tuinman, Zhonghua Shi, Leo Heunks

引用次数: 0

A video-based approach to decipher intubation decisions for the critically ill 一种基于视频的方法来解读危重病人的插管决定

IF 38.9 1区医学

Intensive Care Medicine Pub Date : 2025-01-07 DOI: 10.1007/s00134-024-07765-1

Guillaume Dumas, Jean-Rémi Lavillegrand, Elie Azoulay

引用次数: 0

What’s new: the Glasgow Coma Scale at 50—evolution and future directions 最新消息：格拉斯哥昏迷等级50 -进化和未来方向