Medicina Intensiva最新文献

{"title":"Effect of a competence based medical education program on training quality in Intensive Care Medicine. COBALIDATION TRIAL","authors":"Álvaro Castellanos-Ortega ,&nbsp;María Jesús Broch Porcar ,&nbsp;Diego Palacios-Castañeda ,&nbsp;Vicente Gómez-Tello ,&nbsp;Miguel Valdivia ,&nbsp;Carlos Vicent ,&nbsp;Isabel Madrid ,&nbsp;Nuria Martinez ,&nbsp;Manuel José Párraga ,&nbsp;Elena Sancho ,&nbsp;María del Castillo Fuentes-Dura ,&nbsp;Rafael García-Ros","doi":"10.1016/j.medin.2024.502126","DOIUrl":"10.1016/j.medin.2024.502126","url":null,"abstract":"<div><h3>Objectives</h3><div>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).</div></div><div><h3>Design</h3><div>Multicenter cluster randomized trial.</div></div><div><h3>Setting</h3><div>Thirteen Spanish ICU Departments.</div></div><div><h3>Participants</h3><div>Thirty-six residents</div></div><div><h3>Intervention</h3><div>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.</div></div><div><h3>Main variables of interest</h3><div>Total scoring in the five scenarios, CEPE completed, level of competency (1–5) achieved.</div></div><div><h3>Results</h3><div>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).</div></div><div><h3>Conclusions</h3><div>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.</div></div>","PeriodicalId":49268,"journal":{"name":"Medicina Intensiva","volume":"49 6","pages":"Article 502126"},"PeriodicalIF":2.7,"publicationDate":"2025-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144185279","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Calidad y seguridad del transporte en ECMO. Aspectos prácticos derivados de nuestra experiencia","authors":"Manuel García-Delgado ,&nbsp;Violeta Chica-Sáez ,&nbsp;Andrea Ferreiro-Marzal ,&nbsp;María Redondo-Orts ,&nbsp;María Esteban-Molina ,&nbsp;José Manuel Garrido-Jiménez ,&nbsp;en representación de la UAMC","doi":"10.1016/j.medin.2025.502156","DOIUrl":"10.1016/j.medin.2025.502156","url":null,"abstract":"","PeriodicalId":49268,"journal":{"name":"Medicina Intensiva","volume":"49 6","pages":"Article 502156"},"PeriodicalIF":2.7,"publicationDate":"2025-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144184703","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Evaluación de modelos de formación como método de mejora en la adquisición de competencias en Medicina Intensiva","authors":"Ana Rodríguez Alcaraz ,&nbsp;Federico Gordo Vidal","doi":"10.1016/j.medin.2025.502141","DOIUrl":"10.1016/j.medin.2025.502141","url":null,"abstract":"","PeriodicalId":49268,"journal":{"name":"Medicina Intensiva","volume":"49 6","pages":"Article 502141"},"PeriodicalIF":2.7,"publicationDate":"2025-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144185690","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Aplicaciones del ácido tranexámico en los pacientes neurocríticos: revisión narrativa","authors":"Eva Esther Tejerina Álvarez ,&nbsp;Irene Cavada Carranza ,&nbsp;Marcos Gómez Bermejo ,&nbsp;Teresa Molina García ,&nbsp;José Ángel Lorente Balanza","doi":"10.1016/j.medin.2025.502139","DOIUrl":"10.1016/j.medin.2025.502139","url":null,"abstract":"<div><div>In patients with spontaneous or traumatic intracranial hemorrhage, hematoma expansion is associated with poorer neurological outcomes and increased mortality. The administration of an antifibrinolytic agent like tranexamic acid (TXA) may potentially improve clinical outcomes in patients with acute brain injury by preventing such intracranial expansion. However, studies on the impact of TXA in these patients have yielded variable results, and its efficacy, appropriate dosing and optimal timing of administration remain unclear. The present review summarizes the clinical evidence regarding the proper use of tranexamic acid in the treatment of intracranial traumatic and non-traumatic hemorrhage, and its implications for clinical practice.</div></div>","PeriodicalId":49268,"journal":{"name":"Medicina Intensiva","volume":"49 6","pages":"Article 502139"},"PeriodicalIF":2.7,"publicationDate":"2025-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144185276","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Canalización supraclavicular ecoguiada de vena cefálica, una alternativa a los accesos centrales clásicos","authors":"Alejandro Gómez-Carranza ,&nbsp;Francisco Javier Vasserot-Vargas ,&nbsp;Beatriz Girela-Pérez","doi":"10.1016/j.medin.2024.502118","DOIUrl":"10.1016/j.medin.2024.502118","url":null,"abstract":"","PeriodicalId":49268,"journal":{"name":"Medicina Intensiva","volume":"49 5","pages":"Article 502118"},"PeriodicalIF":2.7,"publicationDate":"2025-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143891454","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Adenopatía metastásica abscesificada como origen de un shock séptico","authors":"Enrique Alfonso Aguilar Valero,&nbsp;Ana María Vela Colmenero,&nbsp;Rosa María Vela Colmenero","doi":"10.1016/j.medin.2024.502127","DOIUrl":"10.1016/j.medin.2024.502127","url":null,"abstract":"","PeriodicalId":49268,"journal":{"name":"Medicina Intensiva","volume":"49 5","pages":"Article 502127"},"PeriodicalIF":2.7,"publicationDate":"2025-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143891517","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"El manejo de la vía aérea en el paciente crítico. Necesidad de un nuevo enfoque","authors":"R. Albillos-Almaraz ,&nbsp;S. Balboa-Palomino ,&nbsp;E. Pérez-Cabo","doi":"10.1016/j.medin.2025.502138","DOIUrl":"10.1016/j.medin.2025.502138","url":null,"abstract":"","PeriodicalId":49268,"journal":{"name":"Medicina Intensiva","volume":"49 5","pages":"Article 502138"},"PeriodicalIF":2.7,"publicationDate":"2025-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143891452","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Experiencia con soporte de oxigenación con membrana extracorpórea en América Latina entre 2016 y 2020","authors":"Camilo Pizarro ,&nbsp;Anderson Bermon ,&nbsp;Silvia Plata Vanegas ,&nbsp;Claudia Colmenares-Mejia ,&nbsp;Claudia Marcela Poveda ,&nbsp;René D. Gómez Gutiérrez ,&nbsp;Jorge Arturo Ramírez Arce ,&nbsp;Sonia Villarroel ,&nbsp;Daniel Absi ,&nbsp;Marco Antonio Montes de Oca Sandoval ,&nbsp;Fernando Pálizas ,&nbsp;Leonardo Salazar","doi":"10.1016/j.medin.2024.502129","DOIUrl":"10.1016/j.medin.2024.502129","url":null,"abstract":"<div><h3>Objective</h3><div>To document the experience with ECMO therapy in healthcare institutions across Latin America between 2016 and 2020.</div></div><div><h3>Design</h3><div>Cross-sectional study.</div></div><div><h3>Setting</h3><div>Private and public health institutions from 7 countries.</div></div><div><h3>Participants</h3><div>ECMO intensive care units.</div></div><div><h3>Interventions</h3><div>None.</div></div><div><h3>Main variables of interest</h3><div>General characteristics of the center (country, ELSO center, year of first cannulation, public or private network, ECMO devices available, mobile ECMO), professional category (nurses, physicians, specialists and other professionals), nurse-to-patient ratio, interventions applied (support indications, scores, mechanical ventilation at ECMO commencement, anticoagulation and hemolysis, circuit monitoring and patient perfusion, antibiotic prophylaxis), and patient outcomes (complications and survival) in ECMO centers.</div></div><div><h3>Results</h3><div>Thirteen ECMO units were included. These units reported 133 consoles and 1,629 ECMO cannulations. Of these, 1,018 corresponded to adult patients, 468 to pediatric patients, and 143 to newborn infants. A total of 310 medical specialists were involved in ECMO care, of whom 70.3% had received ECMO training. The nurse-to-patient ratio was 1:1 in most centers (76.9%, <em>n</em> <!-->=<!--> <!-->10). Amongst adult patients, the most common indication for initiating ECMO support was refractory hypoxemia, whereas in pediatric patients, it was a post-cardiotomy shock. The mean overall survival rate of the patients at the time of decannulation was 55.7% (95%<span>C</span>I<span>:</span> 53.0-58.3).</div></div><div><h3>Conclusions</h3><div>The ICUs with ECMO in Latin America participating in this study have demonstrated operational capabilities enabling them to achieve outcomes comparable to those of other ECMO units across the world.</div></div>","PeriodicalId":49268,"journal":{"name":"Medicina Intensiva","volume":"49 5","pages":"Article 502129"},"PeriodicalIF":2.7,"publicationDate":"2025-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143891471","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Elastic static power, its correlation with acute respiratory distress syndrome severity: A Bayesian post-hoc analysis of the Mechanical Power Day cross-sectional trial","authors":"Aurio Fajardo-Campoverdi ,&nbsp;Alejandro González-Castro ,&nbsp;Vicent Modesto i Alapont ,&nbsp;Miguel Ibarra-Estrada ,&nbsp;Carmen Chica-Meza ,&nbsp;Alberto Medina ,&nbsp;Patricia Escudero-Acha ,&nbsp;Denise Battaglini ,&nbsp;Patricia R.M. Rocco ,&nbsp;Chiara Robba ,&nbsp;Paolo Pelosi","doi":"10.1016/j.medin.2024.502128","DOIUrl":"10.1016/j.medin.2024.502128","url":null,"abstract":"<div><h3>Objective</h3><div>The relationship between different power equations and the severity of acute respiratory distress syndrome (ARDS) remains unclear. This study aimed to evaluate various power equations: total mechanical power, total elastic power (comprising elastic static and elastic dynamic power), and resistive power, in a cohort of mechanically ventilated patients with and without ARDS. Bayesian analysis was employed to refine estimates and quantify uncertainty by incorporating <em>a priori</em> distributions.</div></div><div><h3>Design</h3><div>A Bayesian post-hoc analysis was conducted on data from the Mechanical Power Day study.</div></div><div><h3>Setting</h3><div>113 intensive care units across 15 countries and 4 continents.</div></div><div><h3>Patients</h3><div>Adults who received invasive mechanical ventilation in volume-controlled mode, with (mild and moderate/severe ARDS) and without ARDS.</div></div><div><h3>Interventions</h3><div>None.</div></div><div><h3>Main variables of interest</h3><div>ARDS, Elastic static power.</div></div><div><h3>Results</h3><div>Elastic static power was 5.8 J/min (BF: 0.3) in patients with mild ARDS and 7.4 J/min (BF: 0.9) in moderate/severe ARDS patients. Bayesian regression and modeling analysis revealed that elastic static power was independently correlated with mild (<em>a posteriori</em> Mean: 1.3; 95% Credible Interval [Cred. Interval]: 0.2–2.2) and moderate/severe ARDS (<em>a posteriori</em> Mean: 2.8; 95% Cred. Interval: 1.7–3.8) more strongly than other power equations.</div></div><div><h3>Conclusions</h3><div>Elastic static power was found to have the strongest correlation with ARDS severity among the power equations studied. Prospective studies are needed to further validate these findings.</div></div>","PeriodicalId":49268,"journal":{"name":"Medicina Intensiva","volume":"49 5","pages":"Article 502128"},"PeriodicalIF":2.7,"publicationDate":"2025-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143891470","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Ictus en cuidados intensivos pediátricos","authors":"Javier Zorrilla Abad ,&nbsp;Débora Sanz Álvarez ,&nbsp;Gema Manrique Martín ,&nbsp;Laura Herrera Castillo ,&nbsp;Jesús López-Herce Cid ,&nbsp;Grupo de Código Ictus Pediátrico","doi":"10.1016/j.medin.2025.502154","DOIUrl":"10.1016/j.medin.2025.502154","url":null,"abstract":"<div><h3>Objectives</h3><div>To analyze the frequency, causes, risk factors, mortality and sequelae of stroke in children admitted to the pediatric intensive care unit (PICU).</div></div><div><h3>Design</h3><div>Single-center retrospective observational study based on a prospective database.</div></div><div><h3>Setting</h3><div>Pediatric intensive care unit.</div></div><div><h3>Patients</h3><div>Children between one month and eighteen years of age admitted to the PICU and diagnosed with stroke were included.</div></div><div><h3>Main variables of interest</h3><div>Epidemiological, clinical, diagnostic and treatment data, sequelae and mortality were recorded.</div></div><div><h3>Interventions</h3><div>None.</div></div><div><h3>Results</h3><div>46 patients were studied, of whom 29 (63%) had an ischemic stroke, 14 (30.4%) a hemorrhagic stroke, 1 (2.2%) venous sinus thrombosis and 2 (4.3%) mixed stroke. 11 patients (23.9%) had heart disease and 7 (15.2%) were treated with extracorporeal membrane oxygenation (ECMO) or ventricular assist. 8.6% of patients were treated with fibrinolysis or thrombectomy. 9 patients (19.6%) died. Patients with heart disease and those treated with ECMO had a higher mortality rate. 23 children, 62.1% of survivors, suffered sequelae at discharge. The most frequent sequelae were hemiparesis. Sequelae were significantly more frequent in patients who presented with motor symptoms (76.2%) (<em>P</em> <!-->&lt;<!--> <!-->.001).</div></div><div><h3>Conclusions</h3><div>The frequency of ischemic stroke in pediatric patients is higher than that of hemorrhagic stroke. Pediatric patients who suffer a stroke have a high mortality rate and a high rate of sequelae. Patients with heart disease and those treated with ECMO are those who present stroke most frequently and have a higher mortality rate.</div></div>","PeriodicalId":49268,"journal":{"name":"Medicina Intensiva","volume":"49 5","pages":"Article 502154"},"PeriodicalIF":2.7,"publicationDate":"2025-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143891472","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}