Medicina intensiva最新文献

{"title":"Ineffective respiratory efforts and their potential consequences during mechanical ventilation.","authors":"Mauro Robertino Del Bono, Luis Felipe Damiani, Gustavo Adrián Plotnikow, Sebastián Consalvo, Emanuel Di Salvo, Gastón Murias","doi":"10.1016/j.medine.2025.502133","DOIUrl":"https://doi.org/10.1016/j.medine.2025.502133","url":null,"abstract":"<p><p>The implementation of invasive mechanical ventilation (IMV) in critically ill patients involves two crucial moments: the total control phase, affected among other things by the use of analgesics and sedatives, and the transition phase to spontaneous ventilation, which seeks to shorten IMV times and where optimizing patient-ventilator interaction is one of the main challenges. Ineffective inspiratory efforts (IEE) arise when there is no coordination between patient effort and ventilator support. IIE are common in different ventilatory modes and are associated with worse clinical outcomes: dyspnea, increased sedation requirements, increased IMV days and longer intensive care unit (ICU) and hospital stay. These are manifested graphically as an abrupt decrease in expiratory flow, being more frequent during expiration. However, and taking into consideration that it is still unknown whether this association is causal or rather a marker of disease severity, recognizing the potential physiological consequences, reviewing diagnostic methods and implementing detection and treatment strategies that can limit them, seems reasonable.</p>","PeriodicalId":94139,"journal":{"name":"Medicina intensiva","volume":" ","pages":"502133"},"PeriodicalIF":0.0,"publicationDate":"2025-02-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143371472","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":"Impact of COVID-19 in the in-hospital cardiac arrest activations: Retrospective study.","authors":"Ghali Ballout, Marta Magaldi Mendaña, Bartomeu Ramis Bou, Cristian Torres Quevedo, Adriana Capdevila Freixas, Silvia Moreno-Jurico, Enrique Jesús Carrero Cardenal, Jaime Fontanals Dotras","doi":"10.1016/j.medine.2025.502137","DOIUrl":"https://doi.org/10.1016/j.medine.2025.502137","url":null,"abstract":"<p><strong>Objective: </strong>To analyze whether the characteristics of the patients treated by the in-hospital cardiorespiratory arrest team, IHCA and cardiopulmonary resuscitation (CPR) were different in the period before the COVID-19 compared to the pandemic period; also analyzing the differences between COVID+ and COVID- patients.</p><p><strong>Design: </strong>Observational and retrospective study from January 1st, 2018, to December 31st, 2021.</p><p><strong>Setting: </strong>Tertiary hospital.</p><p><strong>Patients: </strong>All adult patients over 18 years old requiring attention from the IHCA response team.</p><p><strong>Interventions: </strong>CPR maneuvers according to the advanced life support guidelines of the European Resuscitation Council published in 2015, as well as the modifications made in the COVID era (2020).</p><p><strong>Main variables: </strong>Demographic and epidemiological data, activations of the IHCA response team, CA data, hospital and intensive care unit (ICU) length of stay, survival and neurological outcome at hospital discharge.</p><p><strong>Results: </strong>A total of 368 patients were analyzed: 173 in the pre-pandemic group and 195 in the pandemic group. The neurological outcome was better in the pre-pandemic group, and COVID+ patients had a longer ICU length of stay. However, no differences in the response time of the CPR team or in CPR duration were found, nor in immediate survival or at hospital discharge, between both groups or between COVID+ and COVID- patients.</p><p><strong>Conclusions: </strong>Changes in CPR care protocols due to the COVID-19 pandemia did not seem to affect response times from IHCA team neither immediate nor discharge survival.</p>","PeriodicalId":94139,"journal":{"name":"Medicina intensiva","volume":" ","pages":"502137"},"PeriodicalIF":0.0,"publicationDate":"2025-02-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143367169","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":"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":"https://doi.org/10.1016/j.medine.2025.502142","url":null,"abstract":"<p><p>Intensive care units (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.</p>","PeriodicalId":94139,"journal":{"name":"Medicina intensiva","volume":" ","pages":"502142"},"PeriodicalIF":0.0,"publicationDate":"2025-02-05","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}

{"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","doi":"10.1016/j.medine.2025.502156","DOIUrl":"https://doi.org/10.1016/j.medine.2025.502156","url":null,"abstract":"","PeriodicalId":94139,"journal":{"name":"Medicina intensiva","volume":" ","pages":"502156"},"PeriodicalIF":0.0,"publicationDate":"2025-02-04","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}

{"title":"ProtekDuo cannula through Melody transcatheter pulmonary valve prosthesis bridge to heart-lung transplantation.","authors":"Carlos Domínguez-Massa, Manuel Pérez-Guillén, Juan Bautista Martínez-León","doi":"10.1016/j.medine.2025.502119","DOIUrl":"https://doi.org/10.1016/j.medine.2025.502119","url":null,"abstract":"","PeriodicalId":94139,"journal":{"name":"Medicina intensiva","volume":" ","pages":"502119"},"PeriodicalIF":0.0,"publicationDate":"2025-02-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143257446","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":"Did intubation procedures for critically ill patients without SARS-CoV-2 infection change during the pandemic? Secondary analysis of the INTUPROS multicenter study.","authors":"José Luis García-Garmendia, Josep Trenado-Álvarez, Federico Gordo-Vidal, Elena Gordillo-Escobar, Esther Martínez-Barrios, Fernando Onieva-Calero, Víctor Sagredo-Meneses, Emilio Rodríguez-Ruiz, Rafael Ángel Bohollo-de-Austria, José Moreno-Quintana, María Isabel Ruiz-García, José Garnacho-Montero","doi":"10.1016/j.medine.2025.502122","DOIUrl":"https://doi.org/10.1016/j.medine.2025.502122","url":null,"abstract":"<p><strong>Objective: </strong>To determine the changes in intubation procedures of critically ill patients without SARS-CoV-2 infection induced during the COVID-19 pandemic.</p><p><strong>Design: </strong>Secondary Analysis of the INTUPROS Prospective Multicenter Observational Study on Intubation in Intensive Care Units (ICUs).</p><p><strong>Setting: </strong>43 Spanish ICUs between April 2019 and October 2020.</p><p><strong>Patients: </strong>1515 Non-COVID-19 patients intubated before and during the pandemic.</p><p><strong>Interventions: </strong>None.</p><p><strong>Main variables of interest: </strong>Intubation procedures and medication, first-pass success rate, complications, and mortality.</p><p><strong>Results: </strong>1199 patients intubated before the pandemic and 316 during the pandemic were analyzed. During the pandemic, there were fewer days until intubation (OR 0.95 95% CI [0.92-0.98]), reduced resuscitation bag (OR 0.43 95% CI [0.29-0.63]) and non-invasive ventilation oxygenation (OR 0.51 95% CI [0.34-0.76]), reduced use of capnography (OR 0.55 95% CI [0.33-0.92]) and fentanyl (OR 0.47 95% CI [0.34-0.63]). On the other hand, there was an increase in oxygenation with non-HFNC devices (OR 2.21 95% CI [1.23-3.96]), in use of videolaryngoscopy on the first-pass (OR 2.74 95% CI [1.76-4.24]), and greater use of midazolam (OR 1.95 95% CI [1.39-2.72]), etomidate (OR 1.78 95% CI [1.28-2.47]) and succinylcholine (OR 2.55 95% CI [1.82-3.58]). The first-pass success was higher (68.5% vs. 74.7%; P=.033). There were no pre-post differences in major complications (34.7% vs. 34.8%; P=.970) and in-hospital mortality (42.7% vs. 38.6%; P=.137).</p><p><strong>Conclusions: </strong>The COVID-19 pandemic modified intubation procedures in non-COVID-19 patients, changing the oxygenation strategy, the medication and the use of videolaryngoscopy, with no impact on complications or mortality.</p>","PeriodicalId":94139,"journal":{"name":"Medicina intensiva","volume":" ","pages":"502122"},"PeriodicalIF":0.0,"publicationDate":"2025-02-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143257278","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":"Safety and efficacy of beta-blockers and amiodarone in the management of new-onset atrial fibrillation in critically ill patients with sepsis.","authors":"Alfonso Canabal Berlanga","doi":"10.1016/j.medine.2025.502159","DOIUrl":"https://doi.org/10.1016/j.medine.2025.502159","url":null,"abstract":"","PeriodicalId":94139,"journal":{"name":"Medicina intensiva","volume":" ","pages":"502159"},"PeriodicalIF":0.0,"publicationDate":"2025-02-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143257462","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":"Dynamic air bronchogram in pneumococcal community acquired pneumonia","authors":"Abdo Taché Sala,&nbsp;Sara Foradada Ubach,&nbsp;Meritxell Lladó Vilar","doi":"10.1016/j.medine.2024.06.004","DOIUrl":"10.1016/j.medine.2024.06.004","url":null,"abstract":"","PeriodicalId":94139,"journal":{"name":"Medicina intensiva","volume":"49 2","pages":"Pages 120-121"},"PeriodicalIF":0.0,"publicationDate":"2025-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141428547","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":"Global definition of acute respiratory distress syndrome: An epidemiology perspective","authors":"Pablo Cardinal-Fernández ,&nbsp;Guillermo Ortiz ,&nbsp;Luis Blanch","doi":"10.1016/j.medine.2024.10.001","DOIUrl":"10.1016/j.medine.2024.10.001","url":null,"abstract":"","PeriodicalId":94139,"journal":{"name":"Medicina intensiva","volume":"49 2","pages":"Pages 69-71"},"PeriodicalIF":0.0,"publicationDate":"2025-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142484573","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 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}