Medicina intensiva最新文献

{"title":"Electrical impedance tomography for the detection and management optimization of pulmonary embolism.","authors":"Isabel Magaña Bru, Alicia Delgado Arroyo, Fernando Suarez Sipmann","doi":"10.1016/j.medine.2025.502134","DOIUrl":"https://doi.org/10.1016/j.medine.2025.502134","url":null,"abstract":"","PeriodicalId":94139,"journal":{"name":"Medicina intensiva","volume":" ","pages":"502134"},"PeriodicalIF":0.0,"publicationDate":"2025-01-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143019112","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Predictive performance of ROX index and its variations for NIV failure.","authors":"Lada Lijović, Tomislav Radočaj, Nataša Kovač, Marinko Vučić, Paul Elbers","doi":"10.1016/j.medine.2025.502136","DOIUrl":"https://doi.org/10.1016/j.medine.2025.502136","url":null,"abstract":"<p><strong>Objective: </strong>To determine whether the ROX index and its variations can predict the risk of intubation in ICU patients receiving NIV ventilation using large public ICU databases.</p><p><strong>Design: </strong>Retrospective observational cohort study.</p><p><strong>Setting: </strong>Patient data was extracted from both the AmsterdamUMCdb and the MIMIC-IV ICU databases, which contained data related to 20,109 and 50,920 unique patients.</p><p><strong>Patients: </strong>Non-invasively mechanically ventilated.</p><p><strong>Interventions: </strong>Retrospective review of variables.</p><p><strong>Main variables of interest: </strong>To assess the predictive values of models for each index, the ROX and its variations mROX, ROX-HR and mROX-HR were calculated based on mean values of SpO₂, respiratory rate, FiO₂ and PaO₂ from 2-h windows within the first 12 h of NIV.</p><p><strong>Results: </strong>3344 patients were eligible for analysis of which 1344 were intubated, died or returned to NIV within 24 h of ending NIV. NIV failure group had higher SOFA scores and higher CRP levels at admission. There was no difference in duration of NIV therapy or 28-day mortality, but patients who failed NIV had longer length of stay. The best performing index was ROX with an AUROC of 0.626 at 10-12 h. All other indices for all other time windows were less discriminating.</p><p><strong>Conclusions: </strong>The performance of ROX index and its variations to predict NIV failure in ICU patients across large public ICU databases was moderate at best and cannot currently be recommended for clinical decision support.</p>","PeriodicalId":94139,"journal":{"name":"Medicina intensiva","volume":" ","pages":"502136"},"PeriodicalIF":0.0,"publicationDate":"2025-01-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142985899","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Intrarater and interrater reliability of the Clinical Frailty Scale-Es and FRAIL-Es in critically ill patients.","authors":"Susana Arias-Rivera, María Mar Sánchez-Sánchez, Raquel Jareño-Collado, Marta Raurell-Torredà, Lorena Oteiza-López, Sonia López-Cuenca, Israel John Thuissard-Vasallo, Fernando Frutos-Vivar","doi":"10.1016/j.medine.2025.502131","DOIUrl":"https://doi.org/10.1016/j.medine.2025.502131","url":null,"abstract":"<p><strong>Objective: </strong>To evaluate the intrarater and interrater reliability of the Clinical Frailty Scale-Spain (CFS-España) and FRAIL-España and the internal consistency of the FRAIL-España when implemented in critically ill patients by intensive care nurses and physicians.</p><p><strong>Design: </strong>Descriptive, observational and metric study.</p><p><strong>Setting: </strong>intensive care unit (ICU) of Spain.</p><p><strong>Patients: </strong>Patients >18 years, with >48 UCI hours.</p><p><strong>Intervention: </strong>None.</p><p><strong>Main variables of interest: </strong>On admission, frailty with CFS-España and FRAIL-España (by 3 nurses and 2 intensive care physicians), sex, age, comorbidities and severity.</p><p><strong>Results: </strong>1045 assessments were performed in 206 patients. Not frail patients on admission: 53% according to the CFS-Spain and 34% according to the FRAIL-Spain. The intraclass correlation coefficient (ICC) shows almost perfect intrarater concordance (>0.80 for CFS-España and >0.90 for FRAIL-España). Agreement by frailty strata (non-fragile, pre-fragile and fragile patients) was substantial or almost perfect, with no major differences in ratings between nurses and physicians. Interprofessional concordance shows an almost perfect ICC for both scales. The lowest agreement was obtained for the FRAIL-España ratings among physicians. In the frailty strata analysis, agreement was moderate. The highest agreement for the CFS-España was considering level 4 patients as frail. High reliability of the FRAIL-España and strong correlation of all dimensions with the global assessment were obtained, except for the comorbidities dimension, with a weak correlation.</p><p><strong>Conclusion: </strong>The CFS-España and FRAIL-España scales are reliable for assessing frailty in critically ill patients by nurses and/or intensive care physicians.</p>","PeriodicalId":94139,"journal":{"name":"Medicina intensiva","volume":" ","pages":"502131"},"PeriodicalIF":0.0,"publicationDate":"2025-01-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142974098","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Experience with extracorporeal membrane oxygenation support in Latin America between 2016 and 2020.","authors":"Camilo Pizarro, Anderson Bermon, Silvia Plata Vanegas, Claudia Colmenares-Mejia, Claudia Marcela Poveda, René D Gómez Gutiérrez, Jorge Arturo Ramírez Arce, Sonia Villarroe, Daniel Absi, Marco Antonio Montes de Oca Sandoval, Fernando Pálizas, Leonardo Salazar","doi":"10.1016/j.medine.2025.502129","DOIUrl":"https://doi.org/10.1016/j.medine.2025.502129","url":null,"abstract":"<p><strong>Objective: </strong>To document the experience with ECMO therapy in healthcare institutions across Latin America between 2016 and 2020.</p><p><strong>Design: </strong>Cross-sectional study.</p><p><strong>Setting: </strong>Private and public health institutions from 7 countries.</p><p><strong>Participants: </strong>ECMO Intensive Care Units.</p><p><strong>Interventions: </strong>None.</p><p><strong>Main variables of interest: </strong>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.</p><p><strong>Results: </strong>Thirteen ECMO units were included. These units reported 133 consoles and 1629 ECMO cannulations. Of these, 1018 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%, n = 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%CI 53.0-58.3).</p><p><strong>Conclusions: </strong>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.</p>","PeriodicalId":94139,"journal":{"name":"Medicina intensiva","volume":" ","pages":"502129"},"PeriodicalIF":0.0,"publicationDate":"2025-01-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142974097","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"The endothelium or mitochondrial level therapy: new frontiers in sepsis?","authors":"Rashmi Datta, Shalendra Singh","doi":"10.1016/j.medine.2024.502130","DOIUrl":"https://doi.org/10.1016/j.medine.2024.502130","url":null,"abstract":"<p><p>The host and microbes play complex roles in balancing the pro- and anti-inflammatory pathways that cause sepsis. It is now increasingly recognized as a disorder of the mitochondrial system intrinsically or as a consequence of microcirculatory abnormalities leading to hypoperfusion/hypoxia (\"microcirculatory and mitochondrial distress syndrome\"). It is expected that improvements in endothelium or mitochondrial level therapy will lower sepsis-related morbidity and mortality. This article aimed to clarify the mitochondrial and microcirculation abnormalities in patients with sepsis and the futuristic research agenda for the management of sepsis.</p>","PeriodicalId":94139,"journal":{"name":"Medicina intensiva","volume":" ","pages":"502130"},"PeriodicalIF":0.0,"publicationDate":"2025-01-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142974099","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Effect of a competence based medical education program on training quality in Intensive Care Medicine. COBALIDATION TRIAL.","authors":"Álvaro Castellanos-Ortega, María Jesús Broch Porcar, Diego Palacios-Castañeda, Vicente Gómez-Tello, Miguel Valdivia, Carlos Vicent, Isabel Madrid, Nuria Martinez, Manuel José Párraga, Elena Sancho, María Del Castillo Fuentes-Dura, Rafael García-Ros","doi":"10.1016/j.medine.2024.502126","DOIUrl":"https://doi.org/10.1016/j.medine.2024.502126","url":null,"abstract":"<p><strong>Objectives: </strong>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).</p><p><strong>Design: </strong>Multicenter cluster randomized trial.</p><p><strong>Setting: </strong>Thirteen Spanish ICU Departments.</p><p><strong>Participants: </strong>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.</p><p><strong>Main variables of interest: </strong>Total scoring in the five scenarios, CEPE completed, level of competency (1-5) achieved.</p><p><strong>Results: </strong>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).</p><p><strong>Conclusions: </strong>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.</p>","PeriodicalId":94139,"journal":{"name":"Medicina intensiva","volume":" ","pages":"502126"},"PeriodicalIF":0.0,"publicationDate":"2025-01-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142928607","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Risk factors and outcome of acute kidney injury in critically ill patients with SARS-CoV-2 pneumonia: a multicenter study","authors":"Iban Oliva ,&nbsp;Cristina Ferré ,&nbsp;Xavier Daniel ,&nbsp;Marc Cartanyà ,&nbsp;Christian Villavicencio ,&nbsp;Melina Salgado ,&nbsp;Loreto Vidaur ,&nbsp;Elisabeth Papiol ,&nbsp;FJ González de Molina ,&nbsp;María Bodí ,&nbsp;Manuel Herrera ,&nbsp;Alejandro Rodríguez ,&nbsp;on behalf of the COVID-19 SEMICYUC Working Group","doi":"10.1016/j.medine.2024.06.022","DOIUrl":"10.1016/j.medine.2024.06.022","url":null,"abstract":"<div><h3>Objective</h3><div>To assess incidence, risk factors and impact of acute kidney injury(AKI) within 48 h of intensive care unit(ICU) admission on ICU mortality in patients with SARS-CoV-2 pneumonia. To assess ICU mortality and risk factors for continuous renal replacement therapy (CRRT) in AKI I and II patients.</div></div><div><h3>Design</h3><div>Retrospective observational study.</div></div><div><h3>Setting</h3><div>Sixty-seven ICU from Spain, Andorra, Ireland.</div></div><div><h3>Patients</h3><div>5399 patients March 2020 to April 2022.</div></div><div><h3>Main variables of interest</h3><div>Demographic variables, comorbidities, laboratory data (worst values) during the first two days of ICU admission to generate a logistic regression model describing independent risk factors for AKI and ICU mortality. AKI was defined according to current international guidelines (kidney disease improving global outcomes, KDIGO).</div></div><div><h3>Results</h3><div>Of 5399 patients included 1879 (34.8%) developed AKI. These patients had higher ICU mortality and AKI was independently associated with a higher ICU mortality (HR 1.32 CI 1.17–1.48; p &lt; 0.001).</div><div>Male gender, hypertension, diabetes, obesity, chronic heart failure, myocardial dysfunction, higher severity scores, and procalcitonine were independently associated with the development of AKI.</div><div>In AKI I and II patients the need for CRRT was 12.6% (217/1710). In these patients, APACHE II, need for mechanical ventilation in the first 24 h after ICU admission and myocardial dysfunction were associated with risk of needing CRRT. AKI I and II patients had a high ICU mortality (38.5%), especially if CRRT were required (64.1% vs. 34,8%; p &lt; 0.001).</div></div><div><h3>Conclusions</h3><div>Critically ill patients with SARS-CoV-2 pneumonia and AKI have a high ICU mortality. Even AKI I and II stages are associated with high risk of needing CRRT and ICU mortality.</div></div>","PeriodicalId":94139,"journal":{"name":"Medicina intensiva","volume":"49 1","pages":"Pages 15-24"},"PeriodicalIF":0.0,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141604700","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","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.medine.2024.09.005","DOIUrl":"10.1016/j.medine.2024.09.005","url":null,"abstract":"","PeriodicalId":94139,"journal":{"name":"Medicina intensiva","volume":"49 1","pages":"Pages 50-53"},"PeriodicalIF":0.0,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142484572","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","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.medine.2024.09.002","DOIUrl":"10.1016/j.medine.2024.09.002","url":null,"abstract":"","PeriodicalId":94139,"journal":{"name":"Medicina intensiva","volume":"49 1","pages":"Pages 57-58"},"PeriodicalIF":0.0,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142305041","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Effect of metamizole on plasma levels of voriconazole","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.medine.2024.10.009","DOIUrl":"10.1016/j.medine.2024.10.009","url":null,"abstract":"","PeriodicalId":94139,"journal":{"name":"Medicina intensiva","volume":"49 1","pages":"Pages 54-56"},"PeriodicalIF":0.0,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142788256","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}