Medicina intensiva最新文献_第4页

Analysis of frailty as a prognostic factor independent of age: A prospective observational study 衰弱作为独立于年龄的预后因素的分析：一项前瞻性观察研究。

Medicina intensiva Pub Date : 2025-09-01 DOI: 10.1016/j.medine.2025.502144

Rosario Molina Lobo , Federico Gordo Vidal , Lola Prieto López , Inés Torrejón Pérez , Antonio Naharro Abellán , Irene Salinas Gabiña , Beatriz Lobo Valbuena

{"title":"Analysis of frailty as a prognostic factor independent of age: A prospective observational study","authors":"Rosario Molina Lobo , Federico Gordo Vidal , Lola Prieto López , Inés Torrejón Pérez , Antonio Naharro Abellán , Irene Salinas Gabiña , Beatriz Lobo Valbuena","doi":"10.1016/j.medine.2025.502144","DOIUrl":"10.1016/j.medine.2025.502144","url":null,"abstract":"<div><h3>Objective</h3><div>Analyze the effects of frailty and prefrailty in patients admitted to the ICU without age limits and to determine the factors associated with mortality.</div></div><div><h3>Design</h3><div>Prospective cohort.</div></div><div><h3>Setting</h3><div>Intensive Care Unit, Spain.</div></div><div><h3>Patients</h3><div>1462 critically ill patients without age limits.</div></div><div><h3>Intervention</h3><div>None.</div></div><div><h3>Main variables of interest</h3><div>Hospital mortality and health outcomes.</div></div><div><h3>Results</h3><div><span>Patients’ ages ranged from 15 to 93 years, median of 66 years. Predisposing factors independently associated with frailty and prefrailty were age older than 65 years, female sex, respiratory and renal comorbidities, longer pre-ICU stays, and weekend admission. There is a greater use of noninvasive mechanical ventilation, greater colonization by multidrug-resistant bacteria, and the development of </span><em>delirium</em>. The risk of hospital mortality was RR 4.04 (2.11–7.74; <em>P</em>  <<!--> <span>.001) for frail. Factors associated with in-hospital mortality in prefrail and frail were pre-ICU hospital length of stay (cutpoint 4.5 days [1.6–7.4]), greater severity on admission (SAPS3) (cutpoint 64.5 [63.6–65.4]), Glasgow Coma Scale deterioration (OR 4.14 [1.23–13.98]; </span><em>P</em><span> .022) and thrombocytopenia (OR 11.46 [2.21–59.42]; </span><em>P</em> .004).</div></div><div><h3>Conclusions</h3><div>Lower levels of frailty are most common in ICU patients and are associated with worse health outcomes. Our data suggest that frailty and pre frailty should be determined in all patients admitted to the ICU, regardless of their age.</div></div>","PeriodicalId":94139,"journal":{"name":"Medicina intensiva","volume":"49 9","pages":"Article 502144"},"PeriodicalIF":0.0,"publicationDate":"2025-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143517775","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}

引用次数: 0

Intensivist should lead artificial intelligence implementation in the ICU 重症监护医师应领导人工智能在ICU的实施。

Medicina intensiva Pub Date : 2025-09-01 DOI: 10.1016/j.medine.2025.502253

Juan-Jose Beunza

引用次数: 0

Artificial intelligence in intensive care medicine, the gradual revolution 人工智能在重症监护医学中，逐渐发生革命。

Medicina intensiva Pub Date : 2025-09-01 DOI: 10.1016/j.medine.2025.502164

Alejandro González-Castro

引用次数: 0

Re-explaining patient safety in Intensive Care Medicine: In need of understanding and action 重新解释重症监护医学中的患者安全：需要理解和行动。

Medicina intensiva Pub Date : 2025-09-01 DOI: 10.1016/j.medine.2025.502219

María Cruz Martín Delgado , Mario Chico Fernández , Gonzalo Sirgo Rodríguez , María Bodí

引用次数: 0

Reformulating real-time random safety analysis during the SARS-CoV-2 pandemic 重新制定SARS-CoV-2大流行期间的实时随机安全性分析。

Medicina intensiva Pub Date : 2025-09-01 DOI: 10.1016/j.medine.2024.502117

Gonzalo Sirgo , Manuel A. Samper , Julen Berrueta , Joana Cañellas , Alejandro Rodríguez , María Bodí

{"title":"Reformulating real-time random safety analysis during the SARS-CoV-2 pandemic","authors":"Gonzalo Sirgo , Manuel A. Samper , Julen Berrueta , Joana Cañellas , Alejandro Rodríguez , María Bodí","doi":"10.1016/j.medine.2024.502117","DOIUrl":"10.1016/j.medine.2024.502117","url":null,"abstract":"<div><h3>Introduction</h3><div>From a safety perspective, the pandemic imposed atypical work dynamics that led to noticeable gaps in clinical safety across all levels of health care.</div></div><div><h3>Objectives</h3><div>To verify that Real-Time Random Safety Analyses (AASTRE) are feasible and useful in a high-pressure care setting.</div></div><div><h3>Design</h3><div>Prospective study (January–September 2022).</div></div><div><h3>Setting</h3><div>University Hospital with 350 beds. Two mixed ICUs (12 and 14 beds).</div><div>Interventions: Two safety audits per week were planned to determine the feasibility and usefulness of the 32 safety measures (grouped into 8 blocks).</div></div><div><h3>Main variables of interest</h3><div>1) Feasibility: Proportion of completed audits compared to scheduled audits and time spent. 2) Utility: Changes in the care process made as a result of implementing AASTRE.</div></div><div><h3>Results</h3><div>A total of 390 patient-days were analyzed (179 were Non-COVID patients and 49 were COVID patients). In the COVID patient subgroup, age, ICU stay, SAPS 3, and ICU mortality were significantly higher compared to the Non-COVID patient subgroup. Regarding feasibility, 93.8% of planned rounds were carried out with an average audit time of 25 ± 8 min. Overall, changes in the care process were made in 11.8% of the measures analyzed.</div></div><div><h3>Conclusions</h3><div>In a high-complexity care environment, AASTRE proved to be a feasible and useful tool with only two interventions per week lasting less than 30 min. Overall, AASTRE allowed unsafe situations to be turned safe in more than 10% of the evaluations.</div></div>","PeriodicalId":94139,"journal":{"name":"Medicina intensiva","volume":"49 9","pages":"Article 502117"},"PeriodicalIF":0.0,"publicationDate":"2025-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142904624","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}

引用次数: 0

Quality of causality assessment among observational studies in intensive care: A methodological review 重症监护观察性研究因果关系评价的质量：方法学回顾。

Medicina intensiva Pub Date : 2025-09-01 DOI: 10.1016/j.medine.2025.502142

Laura Del Campo-Albendea , Ana García De La Santa Viñuela , Óscar Peñuelas , José Ignacio Pijoan Zubizarreta , Khalid Saeed Khan , Alfonso Muriel , Javier Zamora

{"title":"Quality of causality assessment among observational studies in intensive care: A methodological review","authors":"Laura Del Campo-Albendea , Ana García De La Santa Viñuela , Óscar Peñuelas , José Ignacio Pijoan Zubizarreta , Khalid Saeed Khan , Alfonso Muriel , Javier Zamora","doi":"10.1016/j.medine.2025.502142","DOIUrl":"10.1016/j.medine.2025.502142","url":null,"abstract":"<div><div>Intensive care units<span> (ICUs) rely in many instances on observational research and often encounter difficulties in establishing cause-and-effect relationships. After conducting a thorough search focused on ICU observational studies, this review analysed the causal language and evaluated the quality of reporting of the methodologies employed. The causal was assessed by analysing the words linking exposure to outcomes in the title and main objective. The quality of the reporting of the key methodological aspects related to causal inference was based on STROBE and ROBINS-I tools. We identified 139 articles, with 87 (63%) and 82 (59%) studies having non-causal language in their title and main objective, respectively. Among the total, 49 (35%) articles directly addressed causality. The review found vague causal language in observational ICU research and highlighted the need for better adherence to reporting guidelines for improved causal analysis and inference.</span></div></div>","PeriodicalId":94139,"journal":{"name":"Medicina intensiva","volume":"49 9","pages":"Article 502142"},"PeriodicalIF":0.0,"publicationDate":"2025-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143367171","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}

引用次数: 0

Effectiveness of non-invasive ventilation in critical patients with acute respiratory failure and do not intubate order 对急性呼吸衰竭且未下达插管指令的危重病人进行无创通气的效果。

Medicina intensiva Pub Date : 2025-09-01 DOI: 10.1016/j.medine.2025.502169

Andres Carrillo-Alcaraz , Miguel Guia , Pilar Tornero-Yepez , Laura López-Gomez , Nuria Alonso-Fernandez , Juan Gervasio Martin Lorenzo , Juan Miguel Sanchez Nieto

{"title":"Effectiveness of non-invasive ventilation in critical patients with acute respiratory failure and do not intubate order","authors":"Andres Carrillo-Alcaraz , Miguel Guia , Pilar Tornero-Yepez , Laura López-Gomez , Nuria Alonso-Fernandez , Juan Gervasio Martin Lorenzo , Juan Miguel Sanchez Nieto","doi":"10.1016/j.medine.2025.502169","DOIUrl":"10.1016/j.medine.2025.502169","url":null,"abstract":"<div><h3>Objective</h3><div><span>The main purpose of this study was to analyze the prevalence of do-not-intubate (DNI) orders in patients admitted to an Intensive Care Unit (ICU) due to </span>acute respiratory failure (ARF) and who were treated with non-invasive ventilation (NIV). The secondary objective was to correlate the presence of a DNI order with the patient’s prognosis.</div></div><div><h3>Design</h3><div>Retrospective observational study.</div></div><div><h3>Setting</h3><div>Polyvalent ICU.</div></div><div><h3>Patients</h3><div>All consecutively admitted ICU patients for ARF between January 1<sup>st</sup>, 1997, and December 31<sup>st</sup>, 2022, who were treated with NIV.</div></div><div><h3>Main variables of interest</h3><div>Initial clinical variables, NIV failure rate, complications, in-hospital and one-year mortality.</div></div><div><h3>Results</h3><div><span>5972 patients were analyzed, 1275 (21.3%) presenting a DNI order. The mean age was 68.2 ± 14.9; 60.2% were male. The most frequent cause of DNI order was chronic respiratory disease (452 patients; 35.5%</span><em>)</em><span>. Patients with DNI order were older, had higher Charlson comorbidity index<span> and higher frailty. NIV failure occurred in 536 (42.0%) patients in the DNI order group vs. 1118 (23.8%) in the non-DNI order group (p < 0.001). In-hospital mortality was higher in patients with DNI order (57.9% vs 16.4%; p < 0.001). The adjusted OR for inhospital mortality was 2.14 (95% CI 1.98 to 2.31).</span></span></div></div><div><h3>Conclusions</h3><div>DNI orders are common in patients with ARF treated with NIV and they related to worse short and long-term prognosis.</div></div>","PeriodicalId":94139,"journal":{"name":"Medicina intensiva","volume":"49 9","pages":"Article 502169"},"PeriodicalIF":0.0,"publicationDate":"2025-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143607495","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}

引用次数: 0

Whispers of the heart: The journey of an aortic dissection 心脏的低语：主动脉夹层的旅程。

Medicina intensiva Pub Date : 2025-09-01 DOI: 10.1016/j.medine.2025.502175

Pablo Carrión Montaner , Mario Sutil-Vega , Jordi Sans-Roselló

引用次数: 0

We use non-invasive ventilation every day, but are we aware, in our center, of its real effectiveness? 我们每天都在使用无创呼吸机，但我们是否意识到，在我们的中心，它的真正有效性？

Medicina intensiva Pub Date : 2025-09-01 DOI: 10.1016/j.medine.2025.502213

Rafael Fernández Fernández

引用次数: 0

Clinical Frailty Scale and Comorbidity-Polypharmacy Score for prediction of 30-day mortality in a mixed ICU population. 临床虚弱量表和合并症-多重用药评分用于预测混合ICU人群30天死亡率。

Medicina intensiva Pub Date : 2025-08-27 DOI: 10.1016/j.medine.2025.502292

Sarah Weihe, Lone Musaeus Poulsen, Mathias Maagaard, Anders Fournaise, Søren Kabell Nissen, Camilla Bekker Mortensen, Ole Mathiesen

{"title":"Clinical Frailty Scale and Comorbidity-Polypharmacy Score for prediction of 30-day mortality in a mixed ICU population.","authors":"Sarah Weihe, Lone Musaeus Poulsen, Mathias Maagaard, Anders Fournaise, Søren Kabell Nissen, Camilla Bekker Mortensen, Ole Mathiesen","doi":"10.1016/j.medine.2025.502292","DOIUrl":"https://doi.org/10.1016/j.medine.2025.502292","url":null,"abstract":"<p><strong>Objective: </strong>To investigate the prediction of 30-day mortality by frailty and comorbidity in a mixed ICU population and monitor the implementation of the Clinical Frailty Scale as daily practice in the ICU.</p><p><strong>Design: </strong>A prospective observational single-center cohort study.</p><p><strong>Setting: </strong>Mixed ICU at Zealand University Hospital.</p><p><strong>Patients: </strong>All patients >40 years of age acutely admitted to the ICU from April 1st 2021 to March 31st 2022.</p><p><strong>Main variables of interest: </strong>Frailty assessed by the Clinical Frailty Scale (CFS), Comorbidity-Polypharmacy-Score (CPS), and 30-day mortality.</p><p><strong>Results: </strong>A total of 319 patients were included in the study. Of these, 118 (37%) were categorized as frail, defined by a CFS ≥ 5. The CPS score was median (IQR) 13 (7-18), rated as moderate. Patients with increasing frailty demonstrated higher CPS scores. The overall 30-day mortality was 34.5%. Patients categorised as frail had a higher 30-day mortality compared to non-frail patients (47% vs 27%). The AUROC of CFS and CPS of 30-day mortality was 0.77 (95% CI 0.72 to 0.83) and 0.75 (95% CI 0.69 to 0.81), respectively. Combining CFS and CPS did not strengthen the ability to predict 30-day mortality compared to CFS alone. ICU clinicians assessed CFS in 79% of patients.</p><p><strong>Conclusion: </strong>Frailty assessed by CFS had a fair prediction of 30-day mortality after ICU admission in a mixed ICU population. The discriminatory ability for predicting 30-day mortality was not improved by combining CFS and CPS compared to CFS alone. The clinical implementation of the CFS was performed effectively.</p>","PeriodicalId":94139,"journal":{"name":"Medicina intensiva","volume":" ","pages":"502292"},"PeriodicalIF":0.0,"publicationDate":"2025-08-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144984376","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}

引用次数: 0