Medicina Intensiva最新文献

{"title":"Anti-Xa activity below range is related to thrombosis in patients with severe COVID-19","authors":"Pilar Marcos-Neira ,&nbsp;Cristian Morales-Indiano ,&nbsp;Mariana Fernández-Caballero ,&nbsp;Teresa Tomasa-Irriguible ,&nbsp;Luisa Bordejé-Laguna ,&nbsp;Víctor Ruíz-Artola","doi":"10.1016/j.medin.2024.06.013","DOIUrl":"10.1016/j.medin.2024.06.013","url":null,"abstract":"<div><h3>Objective</h3><div>We aimed to anlayse the relationship between anti-Xa activity below range and thomboembolic events.</div></div><div><h3>Design</h3><div>Single center prospective observational longitudinal cohort study (February–November 2021).</div></div><div><h3>Setting</h3><div>Patients admitted to the ICU of a University Hospital.</div></div><div><h3>Participants</h3><div>Patients with severe COVID-19 pneumoniae.</div></div><div><h3>Interventions</h3><div>Enoxaparin was used for prophylactic and therapeutic anticoagulation. Enoxaparin dosing and dose adjustment were based on anti-Xa activity according to the hospital protocol.</div></div><div><h3>Main variables of interest</h3><div>Target: thomboembolic events.</div><div>Predictors: demographics, pharmacotherapy, anti-Xa measurements, clinical data, and laboratory results.</div><div>Logistic regression was used to identify independent risk factors for thomboembolic events.</div></div><div><h3>Results</h3><div>Data were available for 896 serum anti-Xa measurements from 228 subjects. Overall, 71.9% were male, with a median age of 62. Most patients needed invasive mechanical ventilation (87.7%) and mortality was 24.1%. A total of 28.9% new thomboembolic events were diagnosed. There were 27.1% anti-Xa measesurements below range. When multivariable logistic regression analysis was performed anti-Xa activity below range (RR, 4.2; p = 0.000), C-reactive protein (25 mg/L increase) (RR, 1.14; p = 0.005) and D-dimer (1000 ng/L increase) (RR, 1.06; p = 0.002) were the independent factors related to new thomboembolic events in patients with severe COVID-19.</div></div><div><h3>Conclusions</h3><div>Anti-Xa activity below range, C-reactive protein and D-dimer were the independent factors related to thomboembolic events in patients with severe COVID-19. Purposely designed clinical trials should be carried out to confirm the benefit of an anti-Xa monitoring.</div></div>","PeriodicalId":49268,"journal":{"name":"Medicina Intensiva","volume":"49 2","pages":"Pages 78-87"},"PeriodicalIF":2.7,"publicationDate":"2025-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143097579","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":"Dynamic air bronchogram in pneumococcal community acquired pneumonia","authors":"Abdo Taché Sala,&nbsp;Sara Foradada Ubach,&nbsp;Meritxell Lladó Vilar","doi":"10.1016/j.medin.2024.05.015","DOIUrl":"10.1016/j.medin.2024.05.015","url":null,"abstract":"","PeriodicalId":49268,"journal":{"name":"Medicina Intensiva","volume":"49 2","pages":"Pages 120-121"},"PeriodicalIF":2.7,"publicationDate":"2025-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143097575","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":"Application of a machine learning model for early prediction of in-hospital cardiac arrests: Retrospective observational cohort study","authors":"L. Socias Crespí ,&nbsp;L. Gutiérrez Madroñal ,&nbsp;M. Fiorella Sarubbo ,&nbsp;M. Borges-Sa ,&nbsp;A. Serrano García ,&nbsp;D. López Ramos ,&nbsp;C. Pruenza Garcia-Hinojosa ,&nbsp;E. Martin Garijo","doi":"10.1016/j.medin.2024.06.014","DOIUrl":"10.1016/j.medin.2024.06.014","url":null,"abstract":"<div><h3>Objective</h3><div>To describe the results of the application of a Machine Learning (ML) model to predict in-hospital cardiac arrests (ICA) 24 hours in advance in the hospital wards.</div></div><div><h3>Design</h3><div>Retrospective observational cohort study.</div></div><div><h3>Setting</h3><div>Hospital Wards.</div></div><div><h3>Patients</h3><div>Data were extracted from the hospital's Electronic Health Record (EHR). The resulting database contained a total of 750 records corresponding to 620 different patients (370 patients with ICA and 250 control), between may 2009 and december 2021.</div></div><div><h3>Interventions</h3><div>No.</div></div><div><h3>Main variables of interest</h3><div>As predictors of ICA, a set of 28 variables including personal history, vital signs and laboratory data was employed.</div></div><div><h3>Models</h3><div>For the early prediction of ICA, predictive models based on the following ML algorithms and using the mentioned variables, were developed and compared: K Nearest Neighbours, Support Vector Machine, Multilayer Perceptron, Random Forest, Gradient Boosting and Custom Ensemble of Gradient Boosting estimators (CEGB).</div></div><div><h3>Experiments</h3><div>Model training and evaluation was carried out using cross validation. Among metrics of performance, accuracy, specificity, sensitivity and AUC were estimated.</div></div><div><h3>Results</h3><div>The best performance was provided by the CEGB model, which obtained an AUC = 0.90, a specificity = 0.84 and a sensitivity = 0.81. The main variables with influence to predict ICA were level of consciousness, haemoglobin, glucose, urea, blood pressure, heart rate, creatinine, age and hypertension, among others.</div></div><div><h3>Conclusions</h3><div>The use of ML models could be of great support in the early detection of ICA, as the case of the CEGB model endorsed, which enabled good predictions of ICA.</div></div>","PeriodicalId":49268,"journal":{"name":"Medicina Intensiva","volume":"49 2","pages":"Pages 88-95"},"PeriodicalIF":2.7,"publicationDate":"2025-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143149418","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":"Definición global del síndrome de distrés respiratorio agudo: una visión epidemiológica","authors":"Pablo Cardinal-Fernández ,&nbsp;Guillermo Ortiz ,&nbsp;Luis Blanch","doi":"10.1016/j.medin.2024.08.002","DOIUrl":"10.1016/j.medin.2024.08.002","url":null,"abstract":"","PeriodicalId":49268,"journal":{"name":"Medicina Intensiva","volume":"49 2","pages":"Pages 69-71"},"PeriodicalIF":2.7,"publicationDate":"2025-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143149419","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":"Prácticas seguras en los servicios de medicina intensiva. ¿Es posible el riesgo Zero?","authors":"Xavier Nuvials Casals ,&nbsp;Marta García García","doi":"10.1016/j.medin.2024.04.004","DOIUrl":"10.1016/j.medin.2024.04.004","url":null,"abstract":"<div><div>Incidents related to patient safety are a problem of great impact in intensive care medicine (ICM). Multiple strategies have been developed to identify them, analyze, and develop policies aim at reducing their incidence and minimizing their effects and consequences. The development of a safety culture, an adequate organizational and structural design of the ICM, which contemplates the implementation of effective safe practices, with a provision of human resources adjusted to the care activity carried out and the periodic analysis of the different events and their factors, will allow us to bring the risk of critical patient care closer to zero, as would be desirable.</div></div>","PeriodicalId":49268,"journal":{"name":"Medicina Intensiva","volume":"49 2","pages":"Pages 105-111"},"PeriodicalIF":2.7,"publicationDate":"2025-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143097580","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":"De ecuaciones geométricas a estrategias dinámicas: avances en la personalización de la ventilación mecánica mediante la potencia mecánica","authors":"Alejandro González-Castro ,&nbsp;Aurio Fajardo Campoverdi","doi":"10.1016/j.medin.2024.10.003","DOIUrl":"10.1016/j.medin.2024.10.003","url":null,"abstract":"","PeriodicalId":49268,"journal":{"name":"Medicina Intensiva","volume":"49 1","pages":"Pages 59-60"},"PeriodicalIF":2.7,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143160858","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":"Clinical experience on the use of liposomal amphotericin B in the ICU","authors":"Silvia Ramos,&nbsp;Isabel Solchaga-Sánchez,&nbsp;Alberto Calvo,&nbsp;Mercedes Power,&nbsp;Sergio García-Ramos,&nbsp;Patricia Piñeiro","doi":"10.1016/j.medin.2024.08.006","DOIUrl":"10.1016/j.medin.2024.08.006","url":null,"abstract":"","PeriodicalId":49268,"journal":{"name":"Medicina Intensiva","volume":"49 1","pages":"Pages 50-53"},"PeriodicalIF":2.7,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143128508","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":"High flow in tracheostomized patients on their first attempt to wean from mechanical ventilation: more questions on the table","authors":"Adrián Gallardo ,&nbsp;Aldana Silvero ,&nbsp;Santiago Saavedra","doi":"10.1016/j.medin.2024.07.003","DOIUrl":"10.1016/j.medin.2024.07.003","url":null,"abstract":"","PeriodicalId":49268,"journal":{"name":"Medicina Intensiva","volume":"49 1","pages":"Pages 57-58"},"PeriodicalIF":2.7,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143160853","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":"Edema intramiocárdico como manifestación atípica del síndrome de fuga capilar","authors":"Montserrat Rodríguez Gómez,&nbsp;María Calle Romero,&nbsp;Sara Domingo Marín","doi":"10.1016/j.medin.2024.05.009","DOIUrl":"10.1016/j.medin.2024.05.009","url":null,"abstract":"","PeriodicalId":49268,"journal":{"name":"Medicina Intensiva","volume":"49 1","pages":"Pages 64-65"},"PeriodicalIF":2.7,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143160862","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":"Efecto del metamizol en los niveles plasmáticos de voriconazol","authors":"Carlos Ignacio Díaz-Calderón Horcada ,&nbsp;Marta Mejías Trueba ,&nbsp;Mónica Izuel Rami ,&nbsp;Ana Belén Guisado Gil ,&nbsp;Elena Herranz Bayo ,&nbsp;Laura Herrera Hidalgo","doi":"10.1016/j.medin.2024.10.002","DOIUrl":"10.1016/j.medin.2024.10.002","url":null,"abstract":"","PeriodicalId":49268,"journal":{"name":"Medicina Intensiva","volume":"49 1","pages":"Pages 54-56"},"PeriodicalIF":2.7,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143160852","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}