Medicina intensivaPub Date : 2025-06-01DOI: 10.1016/j.medine.2024.502125
Cristiane Bastos Netto , Maycon Moura Reboredo , Rodrigo Souza Vieira , Lídia Maria Carneiro da Fonseca , Elivaldo Cyrillo Júnior , André Luís Dias de Souza , Erich Vidal Carvalho , Bruno Valle Pinheiro
{"title":"The impact of mechanical insufflation-exsufflation on the weaning success rate of tracheostomized patients on prolonged mechanical ventilation: a pilot and feasibility study of a randomized controlled trial","authors":"Cristiane Bastos Netto , Maycon Moura Reboredo , Rodrigo Souza Vieira , Lídia Maria Carneiro da Fonseca , Elivaldo Cyrillo Júnior , André Luís Dias de Souza , Erich Vidal Carvalho , Bruno Valle Pinheiro","doi":"10.1016/j.medine.2024.502125","DOIUrl":"10.1016/j.medine.2024.502125","url":null,"abstract":"<div><h3>Objective</h3><div>To evaluate the feasibility of adding mechanical insufflation-exsufflation (MI-E) to a weaning protocol for tracheostomized patients undergoing prolonged mechanical ventilation (MV).</div></div><div><h3>Design</h3><div>Single-center, open-label, randomized, controlled pilot and feasibility study.</div></div><div><h3>Setting</h3><div>Intensive care unit in Brazil.</div></div><div><h3>Patients</h3><div>Tracheostomized adults who were invasively ventilated for more than 14 days and who were weaned from MV.</div></div><div><h3>Interventions</h3><div>Patients were randomized into two groups: intervention group (IG) or a control group (CG). During weaning with a tracheostomy collar, the IG received two daily sessions of MI-E, each with 5 cycles (insufflation and exsufflation pressures of 45 cm H<sub>2</sub>O). The CG received conventional chest physiotherapy.</div></div><div><h3>Main variables of interest</h3><div>The primary outcomes were the feasibility of adding MI-E to the weaning protocol and the rate of successful weaning.</div></div><div><h3>Results</h3><div>A total of 47 patients were randomized, with 25 in the IG and 22 in the CG. All patients randomized to the MI-E group received the proposed protocol, completing all the scheduled MI-E sessions. Adverse events occurred in 14% of the MI-E sessions, but they did not lead to treatment interruption. Weaning success was observed in 76% of IG patients and 73% of CG patients (relative risk, 1.05; 95% CI, 0.75–1.46). No significant differences were observed between the IG and CG regarding ICU mortality (16% and 18%, respectively, p = 0.99) or hospital mortality (40% and 41%, respectively, p = 0.99).</div></div><div><h3>Conclusions</h3><div>The addition of MI-E to the standard weaning protocol is feasible, but not result in a greater rate of successful weaning in tracheostomized patients.</div></div><div><h3>Clinical trial registration number</h3><div>U1111-1302-9035.</div></div>","PeriodicalId":94139,"journal":{"name":"Medicina intensiva","volume":"49 6","pages":"Article 502125"},"PeriodicalIF":0.0,"publicationDate":"2025-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144184803","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}
Medicina intensivaPub Date : 2025-06-01DOI: 10.1016/j.medine.2025.502139
Eva Esther Tejerina Álvarez , Irene Cavada Carranza , Marcos González Bermejo , Teresa Molina García , José Ángel Lorente Balanza
{"title":"Tranexamic acid applications in neurocritical patients: A narrative review","authors":"Eva Esther Tejerina Álvarez , Irene Cavada Carranza , Marcos González Bermejo , Teresa Molina García , José Ángel Lorente Balanza","doi":"10.1016/j.medine.2025.502139","DOIUrl":"10.1016/j.medine.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":94139,"journal":{"name":"Medicina intensiva","volume":"49 6","pages":"Article 502139"},"PeriodicalIF":0.0,"publicationDate":"2025-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143076808","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}
Medicina intensivaPub Date : 2025-06-01DOI: 10.1016/j.medine.2025.502156
Manuel García-Delgado , Violeta Chica-Sáez , Andrea Ferreiro-Marzal , María Redondo-Orts , María Esteban-Molina , José Manuel Garrido-Jiménez , on behalf of the UAMC
{"title":"Quality and safety of ECMO transport. Practical aspects from our experience","authors":"Manuel García-Delgado , Violeta Chica-Sáez , Andrea Ferreiro-Marzal , María Redondo-Orts , María Esteban-Molina , José Manuel Garrido-Jiménez , on behalf of the UAMC","doi":"10.1016/j.medine.2025.502156","DOIUrl":"10.1016/j.medine.2025.502156","url":null,"abstract":"","PeriodicalId":94139,"journal":{"name":"Medicina intensiva","volume":"49 6","pages":"Article 502156"},"PeriodicalIF":0.0,"publicationDate":"2025-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143257447","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}
Medicina intensivaPub Date : 2025-06-01DOI: 10.1016/j.medine.2025.502140
Jorge Luis Vélez-Páez , Christian Castro-Bustamante , Manuel Luis Avellanas-Chavala
{"title":"Gasometry and altitude: investigation of normal ranges in Quito, Ecuador (2,850 m above sea level)","authors":"Jorge Luis Vélez-Páez , Christian Castro-Bustamante , Manuel Luis Avellanas-Chavala","doi":"10.1016/j.medine.2025.502140","DOIUrl":"10.1016/j.medine.2025.502140","url":null,"abstract":"","PeriodicalId":94139,"journal":{"name":"Medicina intensiva","volume":"49 6","pages":"Article 502140"},"PeriodicalIF":0.0,"publicationDate":"2025-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143672186","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}
Medicina intensivaPub Date : 2025-06-01DOI: 10.1016/j.medine.2025.502153
Esteban Fernández-Hinojosa , María Adriaensens Pérez , José Cayetano Naranjo Jarillo
{"title":"Technological innovation in critical care and limits of the life","authors":"Esteban Fernández-Hinojosa , María Adriaensens Pérez , José Cayetano Naranjo Jarillo","doi":"10.1016/j.medine.2025.502153","DOIUrl":"10.1016/j.medine.2025.502153","url":null,"abstract":"","PeriodicalId":94139,"journal":{"name":"Medicina intensiva","volume":"49 6","pages":"Article 502153"},"PeriodicalIF":0.0,"publicationDate":"2025-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143538272","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}
Medicina intensivaPub Date : 2025-06-01DOI: 10.1016/j.medine.2024.502126
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
{"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":"10.1016/j.medine.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":94139,"journal":{"name":"Medicina intensiva","volume":"49 6","pages":"Article 502126"},"PeriodicalIF":0.0,"publicationDate":"2025-06-01","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}