Medicina intensiva最新文献

{"title":"Clinical utility of rapid shallow breathing index in predicting successful weaning: secondary analysis of the COBRE-US trial","authors":"Fabio Varón-Vega ,&nbsp;Eduardo Tuta-Quintero ,&nbsp;Henry Robayo-Amortegui ,&nbsp;Adriana Rincón ,&nbsp;Luis F. Giraldo-Cadavid ,&nbsp;Jonathan Palacios ,&nbsp;Stephanie Crevoisier ,&nbsp;Diana C. Duarte ,&nbsp;Marcela Poveda ,&nbsp;Laura Cucunubo ,&nbsp;Pablo Monedero","doi":"10.1016/j.medine.2024.06.007","DOIUrl":"10.1016/j.medine.2024.06.007","url":null,"abstract":"<div><h3>Objective</h3><div><span><span>To assess the predictive capacity of the Rapid Shallow Breathing Index (RSBI) for success in </span>spontaneous breathing trials (SBT) and </span>extubation<span> in critically ill patients. We evaluated the association between RSBI, duration of mechanical ventilation, and ventilator-free time at 28 days.</span></div></div><div><h3>Design</h3><div>Prospective multicenter observational study. Secondary analysis of the COBRE-US study.</div></div><div><h3>Setting</h3><div>Intensive care unit (ICU).</div></div><div><h3>Patients or participants</h3><div>367 patients in the ICU receiving invasive mechanical ventilation.</div></div><div><h3>Interventions</h3><div>Assessment of RSBI at the end of SBT.</div></div><div><h3>Main variables of interest</h3><div>RSBI, SBT, duration of mechanical ventilation, and ventilator-free time at 28 days were evaluated.</div></div><div><h3>Results</h3><div>367 patients in the ICU under invasive mechanical ventilation were evaluated, of whom 59.7% were male with a median age of 61 years (IQR: 49–72). A total of 456 SBT were conducted with a success rate of 76.5%. RSBI had a ROC-curve of 0.53 for SBT success and a ROC-curve of 0.48 for extubation. The Spearman correlation coefficient between RSBI and duration of ventilation was 0.117 (p = 0.026), while for ventilator-free time at 28 days, it was −0.116 (p = 0.028).</div></div><div><h3>Conclusions</h3><div>RSBI was not associated with success in SBT or extubation, regardless of the cutoff point used. Correlation analyses showed weak associations between RSBI and both the duration of ventilation and ventilator-free time at 28 days.</div></div>","PeriodicalId":94139,"journal":{"name":"Medicina intensiva","volume":"49 2","pages":"Pages 72-77"},"PeriodicalIF":0.0,"publicationDate":"2025-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141433674","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":"Organ donation process: more than just guidelines and protocols","authors":"Lorena Oteiza López ,&nbsp;Óscar Elía Mañú","doi":"10.1016/j.medine.2024.10.003","DOIUrl":"10.1016/j.medine.2024.10.003","url":null,"abstract":"","PeriodicalId":94139,"journal":{"name":"Medicina intensiva","volume":"49 2","pages":"Pages 116-117"},"PeriodicalIF":0.0,"publicationDate":"2025-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142484574","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":"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.medine.2024.07.003","DOIUrl":"10.1016/j.medine.2024.07.003","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":94139,"journal":{"name":"Medicina intensiva","volume":"49 2","pages":"Pages 78-87"},"PeriodicalIF":0.0,"publicationDate":"2025-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141763660","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":"Venous pulmonary embolism - A rare clinical case","authors":"Sérgio Pina ,&nbsp;Pedro Alves ,&nbsp;Andriy Krystopchuc","doi":"10.1016/j.medine.2024.06.008","DOIUrl":"10.1016/j.medine.2024.06.008","url":null,"abstract":"","PeriodicalId":94139,"journal":{"name":"Medicina intensiva","volume":"49 2","pages":"Pages 122-123"},"PeriodicalIF":0.0,"publicationDate":"2025-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141437975","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":"Moral complexity in the organ donation process: The satisfaction of a job well done","authors":"José Miguel Pérez-Villares ,&nbsp;Ramón Lara-Rosales ,&nbsp;Alberto Fernández-Carmona ,&nbsp;Alberto Iglesias-Santiago","doi":"10.1016/j.medine.2024.07.014","DOIUrl":"10.1016/j.medine.2024.07.014","url":null,"abstract":"","PeriodicalId":94139,"journal":{"name":"Medicina intensiva","volume":"49 2","pages":"Pages 114-115"},"PeriodicalIF":0.0,"publicationDate":"2025-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142515541","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 human factor and ergonomics in Patient Safety","authors":"Miguel Valdivia de la Fuente,&nbsp;Diego José Palacios Castañeda,&nbsp;Nuria Martínez Sanz","doi":"10.1016/j.medine.2024.03.014","DOIUrl":"10.1016/j.medine.2024.03.014","url":null,"abstract":"<div><div>The human condition is linked to error in any activity that is performed, and the healthcare world is no exception. The origin of human error does not lie within the perversity of human nature, instead, it has its origins in latent failures in the healthcare environment and is a consequence of the processes and procedures applied. The science of the Human Factor deals with the application of knowledge to people (capabilities, characteristics and limitations), with the design and the management of the equipment they use and with the environments in which they work and the activities they carry out.</div><div>Part of the Human Factor are the non-technical skills. These skills greatly influence people's behavior and, therefore, their performance and the quality of healthcare in a very complex socio-technical system.</div></div>","PeriodicalId":94139,"journal":{"name":"Medicina intensiva","volume":"49 2","pages":"Pages 96-104"},"PeriodicalIF":0.0,"publicationDate":"2025-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141066239","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":"Horner’s syndrome after chest drain insertion due to pneumothorax","authors":"Arthur Orieux ,&nbsp;Raphaël Birot ,&nbsp;Didier Gruson ,&nbsp;Renaud Prevel","doi":"10.1016/j.medine.2024.05.014","DOIUrl":"10.1016/j.medine.2024.05.014","url":null,"abstract":"","PeriodicalId":94139,"journal":{"name":"Medicina intensiva","volume":"49 2","pages":"Pages 118-119"},"PeriodicalIF":0.0,"publicationDate":"2025-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141332784","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":"Sepsis associated to contamination of propofol infusion by Pantoea agglomerans. A case series","authors":"Marlene Feo González,&nbsp;Maite Arlabán Carpintero,&nbsp;Lucía Corta Iriarte,&nbsp;Adolfo Íñiguez de Diego,&nbsp;Johanna Marcela Abril Victorino,&nbsp;Verónica Calleja Muñoz","doi":"10.1016/j.medine.2024.10.006","DOIUrl":"10.1016/j.medine.2024.10.006","url":null,"abstract":"","PeriodicalId":94139,"journal":{"name":"Medicina intensiva","volume":"49 2","pages":"Pages 112-113"},"PeriodicalIF":0.0,"publicationDate":"2025-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142634715","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":"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.medine.2024.07.004","DOIUrl":"10.1016/j.medine.2024.07.004","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":94139,"journal":{"name":"Medicina intensiva","volume":"49 2","pages":"Pages 88-95"},"PeriodicalIF":0.0,"publicationDate":"2025-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142116533","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":"Analgosedation and delirium practices in critically ill patients in the Pan-American and Iberian setting, and factors associated with oversedation after the COVID-19 pandemic: Results from the PANDEMIC study.","authors":"Carola Giménez-Esparza Vich, Felipe Martínez, Daniela Olmos Kutscherauer, Daniel Molano, Maria Del Carmen Gallardo, Enrique Mario Olivares-Durán, Jesús Caballero, Rosa Reina, Manuela García Sánchez, Federico C Carini","doi":"10.1016/j.medine.2025.502123","DOIUrl":"https://doi.org/10.1016/j.medine.2025.502123","url":null,"abstract":"<p><p>Oversedation has adverse effects on critically ill patients. The Analgosedation and Delirium Committee of the FEPIMCTI (Pan-American and Iberian Federation of Critical Care Medicine and Intensive Care) conducted a cross-sectional study through a survey addressed to ICU physicians: PANDEMIC (Pan-American and Iberian Study on the Management of Analgosedation and Delirium in Critical Care [fepImCti]). HYPOTHESIS: Worsening of these practices in the course of the pandemic and that continued afterwards, with further oversedation. OBJECTIVES: Perception of analgosedation and delirium practices in Pan-American and Iberian ICUs before, during and after the COVID-19 pandemic, and factors associated with persistent oversedation after the pandemic. Of the 1008 respondents, 25% perceived oversedation after the pandemic (95%CI 22.4-27.8). This perception was higher in South America (35.8%, P < .001). Main risk factor: habit acquired during the pandemic (adjusted OR [aOR] 3.16, 95%CI 2.24-4.45, P < .001). Main protective factor: delirium monitoring before the pandemic (aOR 0.70, 95%CI 0.50-0.98, P = .038). The factors identified in this study provide a basis for targeting future interventions.</p>","PeriodicalId":94139,"journal":{"name":"Medicina intensiva","volume":" ","pages":"502123"},"PeriodicalIF":0.0,"publicationDate":"2025-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143082886","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}