Pub Date : 2026-01-01DOI: 10.1016/j.medin.2025.502294
Rafael González Cortés , Martí Pons Òdena , Mirella Gaboli , María Angeles García-Teresa
Prolonged mechanical ventilation (PMV) in paediatric intensive care (PICU) is increasing due to health advances and ethical criteria favouring the survival of chronically ill children. These patients require resources, generate high family demand and present a high risk of complications and mortality. Among the most frequent underlying pathologies are chronic respiratory diseases, neuromuscular diseases, prematurity, bronchopulmonary dysplasia and heart disease, with oncological pathology emerging in recent years.
In PICU, PMV is mainly performed by invasive MV with an endotracheal or tracheostomy tube (TQ), with non-invasive ventilation (NIV) being less frequent. Successful weaning from MV requires strategies aimed at identifying and correcting factors that alter the balance between respiratory system load and respiratory work capacity. Both TQ and NIV can facilitate ventilatory weaning or be solutions for long-term ventilation. There is no defined optimal time to perform TQ in children; this decision should be individualised on a risk-benefit basis. TQ tends to be delayed in children much longer than in adults. One-piece cannulae are used in paediatrics; in addition, if there is clinical stability and the possibility of connection to a home ventilator, uncuffed cannulae should be prioritised because of their better tolerance and safety. Home ventilation allows for a return to the home environment, improving quality of life and favouring neurodevelopment. However, institutional support can be insufficient to cope with the high responsibility and burden assumed by families.
{"title":"Ventilación mecánica prolongada y paciente traqueostomizado en cuidados intensivos pediátricos","authors":"Rafael González Cortés , Martí Pons Òdena , Mirella Gaboli , María Angeles García-Teresa","doi":"10.1016/j.medin.2025.502294","DOIUrl":"10.1016/j.medin.2025.502294","url":null,"abstract":"<div><div>Prolonged mechanical ventilation (PMV) in paediatric intensive care (PICU) is increasing due to health advances and ethical criteria favouring the survival of chronically ill children. These patients require resources, generate high family demand and present a high risk of complications and mortality. Among the most frequent underlying pathologies are chronic respiratory diseases, neuromuscular diseases, prematurity, bronchopulmonary dysplasia and heart disease, with oncological pathology emerging in recent years.</div><div>In PICU, PMV is mainly performed by invasive MV with an endotracheal or tracheostomy tube (TQ), with non-invasive ventilation (NIV) being less frequent. Successful weaning from MV requires strategies aimed at identifying and correcting factors that alter the balance between respiratory system load and respiratory work capacity. Both TQ and NIV can facilitate ventilatory weaning or be solutions for long-term ventilation. There is no defined optimal time to perform TQ in children; this decision should be individualised on a risk-benefit basis. TQ tends to be delayed in children much longer than in adults. One-piece cannulae are used in paediatrics; in addition, if there is clinical stability and the possibility of connection to a home ventilator, uncuffed cannulae should be prioritised because of their better tolerance and safety. Home ventilation allows for a return to the home environment, improving quality of life and favouring neurodevelopment. However, institutional support can be insufficient to cope with the high responsibility and burden assumed by families.</div></div>","PeriodicalId":49268,"journal":{"name":"Medicina Intensiva","volume":"50 1","pages":"Article 502294"},"PeriodicalIF":3.1,"publicationDate":"2026-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145886211","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2026-01-01DOI: 10.1016/j.medin.2025.502259
Susana Arias-Rivera , Fernando Frutos-Vivar , María Nieves Moro-Tejedor , María Mar Sánchez-Sánchez , Emilia Romero-de San Pío , Yeray Gabriel Santana-Padilla , Gemma Via-Clavero , María del Rosario Villar-Redondo , María Jesús Frade-Mera , Mónica Juncos Gozalo , Elisabet Gallart-Vivé , Marta Raurell-Torredà , Grupo FRAIL-Es-UCI
Objective
To evaluate the validity and sensitivity to change of the FRAIL-Spain scale in critically ill adult patients admitted to intensive care units (ICUs) in Spain.
Design
Descriptive, observational, prospective, multicenter, metric in nature.
The prevalence of frailty at ICU admission, among the 493 patients in the cohort, was 23.9%. Multivariate risk factors for frailty were age and hospital admissions in the year prior to the current admission. Being independent, having a stable partner, and good physical quality of life are protective factors for frailty. Frailty is associated with greater resource utilization, increased mortality, and a higher likelihood of discharge to a long-stay facility. The effect size of the observed change was moderate-large (d = .850).
Conclusions
The FRAIL-Spain model shows good convergent validity with age, dependency, marital status, comorbidities, perceived physical quality of life, and hospitalization in an acute care facility in the previous year. It has good predictive validity for ICU-acquired weakness, alterations in glycemic control and resource use, hospital discharge, and mortality. It is sensitive for detecting changes in frailty.
{"title":"Validez de la escala FRAIL-España en pacientes críticos","authors":"Susana Arias-Rivera , Fernando Frutos-Vivar , María Nieves Moro-Tejedor , María Mar Sánchez-Sánchez , Emilia Romero-de San Pío , Yeray Gabriel Santana-Padilla , Gemma Via-Clavero , María del Rosario Villar-Redondo , María Jesús Frade-Mera , Mónica Juncos Gozalo , Elisabet Gallart-Vivé , Marta Raurell-Torredà , Grupo FRAIL-Es-UCI","doi":"10.1016/j.medin.2025.502259","DOIUrl":"10.1016/j.medin.2025.502259","url":null,"abstract":"<div><h3>Objective</h3><div>To evaluate the validity and sensitivity to change of the FRAIL-Spain scale in critically ill adult patients admitted to intensive care units (ICUs) in Spain.</div></div><div><h3>Design</h3><div>Descriptive, observational, prospective, multicenter, metric in nature.</div></div><div><h3>Setting</h3><div>ICUs in Spain.</div></div><div><h3>Patients</h3><div>Patients ><!--> <!-->18<!--> <!-->years old with ICU stay ><!--> <!-->48<!--> <!-->hours.</div></div><div><h3>Interventions</h3><div>None.</div></div><div><h3>Main variables of interest</h3><div>Frailty (FRAIL-Spain), sociodemographic characteristics, dependency, ICU stay clinical variables, stay, mortality, destination at discharge.</div></div><div><h3>Results</h3><div>The prevalence of frailty at ICU admission, among the 493 patients in the cohort, was 23.9%. Multivariate risk factors for frailty were age and hospital admissions in the year prior to the current admission. Being independent, having a stable partner, and good physical quality of life are protective factors for frailty. Frailty is associated with greater resource utilization, increased mortality, and a higher likelihood of discharge to a long-stay facility. The effect size of the observed change was moderate-large (d<!--> <!-->=<!--> <!-->.850).</div></div><div><h3>Conclusions</h3><div>The FRAIL-Spain model shows good convergent validity with age, dependency, marital status, comorbidities, perceived physical quality of life, and hospitalization in an acute care facility in the previous year. It has good predictive validity for ICU-acquired weakness, alterations in glycemic control and resource use, hospital discharge, and mortality. It is sensitive for detecting changes in frailty.</div></div>","PeriodicalId":49268,"journal":{"name":"Medicina Intensiva","volume":"50 1","pages":"Article 502259"},"PeriodicalIF":3.1,"publicationDate":"2026-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145886157","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2026-01-01DOI: 10.1016/j.medin.2025.502254
Eric Mayor-Vázquez , Elena Cuenca Fito , Pilar Marcos-Neira , Cándido Díaz-Lagares , Carme Gomila-Sintes , Noelia Albalá , Alejandra García-Roche , Pedro Castro
In recent years, there has been an increase in the number of patients affected by oncohematologic diseases in developed countries due to the improved survival rates and quality of life. This increase has generated a greater need for care in intensive care units (ICU), mainly due to complications related to immunosuppression, treatment toxicity or complications derived from cancer itself. Immunotherapy has transformed cancer treatment, but it can cause serious side effects such as cytokine release syndrome and hemophagocytic syndrome, which often require ICU admission. This review seeks to expand knowledge and management strategies for these complications in the ICU.
{"title":"Síndrome de liberación de citocinas y síndrome hemofagocítico asociados a inmunoterapia: una revisión narrativa","authors":"Eric Mayor-Vázquez , Elena Cuenca Fito , Pilar Marcos-Neira , Cándido Díaz-Lagares , Carme Gomila-Sintes , Noelia Albalá , Alejandra García-Roche , Pedro Castro","doi":"10.1016/j.medin.2025.502254","DOIUrl":"10.1016/j.medin.2025.502254","url":null,"abstract":"<div><div>In recent years, there has been an increase in the number of patients affected by oncohematologic diseases in developed countries due to the improved survival rates and quality of life. This increase has generated a greater need for care in intensive care units (ICU), mainly due to complications related to immunosuppression, treatment toxicity or complications derived from cancer itself. Immunotherapy has transformed cancer treatment, but it can cause serious side effects such as cytokine release syndrome and hemophagocytic syndrome, which often require ICU admission. This review seeks to expand knowledge and management strategies for these complications in the ICU.</div></div>","PeriodicalId":49268,"journal":{"name":"Medicina Intensiva","volume":"50 1","pages":"Article 502254"},"PeriodicalIF":3.1,"publicationDate":"2026-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145886161","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2026-01-01DOI: 10.1016/j.medin.2025.502232
Eugenia Anabel Liger Borja, Jose Joaquín Cortina Gomez, Gabriela Carolina El Ashkar Palacios
{"title":"Hallazgo de vena cava superior izquierda persistente durante el implante de marcapasos","authors":"Eugenia Anabel Liger Borja, Jose Joaquín Cortina Gomez, Gabriela Carolina El Ashkar Palacios","doi":"10.1016/j.medin.2025.502232","DOIUrl":"10.1016/j.medin.2025.502232","url":null,"abstract":"","PeriodicalId":49268,"journal":{"name":"Medicina Intensiva","volume":"50 1","pages":"Article 502232"},"PeriodicalIF":3.1,"publicationDate":"2026-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145886167","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2026-01-01DOI: 10.1016/j.medin.2025.502290
Yueqi Wang , Yan Cui , Moxuan Han , Donghui Yue
{"title":"Enhancing methodological rigor in mechanical insufflation-exsufflation weaning studies: Commentary on patient selection, long-term outcomes, and psychological assessment","authors":"Yueqi Wang , Yan Cui , Moxuan Han , Donghui Yue","doi":"10.1016/j.medin.2025.502290","DOIUrl":"10.1016/j.medin.2025.502290","url":null,"abstract":"","PeriodicalId":49268,"journal":{"name":"Medicina Intensiva","volume":"50 1","pages":"Article 502290"},"PeriodicalIF":3.1,"publicationDate":"2026-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145886165","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2026-01-01DOI: 10.1016/j.medin.2025.502258
Yukang Dong , Guiyun Li , Jiangquan Fu , Rui Huang , Huan Yao , Jingni Wang , Ying Wang , Feng Shen
Objective
This study aims to evaluate the association of time‑weighted average mechanical power normalized to compliance (TWA-MPCRS) with all-cause mortality to determine its value as a prognostic tool in intensive care patients.
Design
Retrospective observational study.
Setting
Intensive care unit (ICU).
Patients or participants
4387 first-time ICU-admitted patients in the Medical Information Mart for Intensive Care (MIMIC) IV.
Interventions
None.
Main variables of interest
TWA-MPCRS, ICU mortality and in-hospital mortality.
Results
Participants' mean age was 61.4 ± 16.9 years and the median [IQR] baseline TWA-MPCRS was 0.3 (0.2, 0.6) J/min/mL/cmH2O. When TWA-MPCRS was divided into quintiles (with quintile 1 representing the lowest values), after adjusting for covariates, the odds ratios [95% confidence intervals (CIs)] for ICU mortality were 1.49 (95% CI: 1.15–1.94), 1.67 (95% CI: 1.29–2.16), 1.79 (95% CI: 1.37–2.33), and 3.96 (95% CI: 3.01–5.21) for quintiles 2, 3, 4, and 5 respectively, with quintile 1 as reference. Similar results were found for hospital mortality.
Conclusion
Higher TWA-MPCRS is associated with poor clinical outcomes in critically ill patients. Higher TWA-MPCRS can lead to a higher mortality among ICU and in-hospital patients.
{"title":"Association between time weighted average mechanical power normalized to compliance and prognosis of critically ill patients: A retrospective cohort study based on the MIMIC-IV database","authors":"Yukang Dong , Guiyun Li , Jiangquan Fu , Rui Huang , Huan Yao , Jingni Wang , Ying Wang , Feng Shen","doi":"10.1016/j.medin.2025.502258","DOIUrl":"10.1016/j.medin.2025.502258","url":null,"abstract":"<div><h3>Objective</h3><div>This study aims to evaluate the association of time‑weighted average mechanical power normalized to compliance (TWA-MP<sub>CRS</sub>) with all-cause mortality to determine its value as a prognostic tool in intensive care patients.</div></div><div><h3>Design</h3><div>Retrospective observational study.</div></div><div><h3>Setting</h3><div>Intensive care unit (ICU).</div></div><div><h3>Patients or participants</h3><div>4387 first-time ICU-admitted patients in the Medical Information Mart for Intensive Care (MIMIC) IV.</div></div><div><h3>Interventions</h3><div>None.</div></div><div><h3>Main variables of interest</h3><div>TWA-MP<sub>CRS</sub>, ICU mortality and in-hospital mortality.</div></div><div><h3>Results</h3><div>Participants' mean age was 61.4 ± 16.9 years and the median [IQR] baseline TWA-MP<sub>CRS</sub> was 0.3 (0.2, 0.6) J/min/mL/cmH<sub>2</sub>O. When TWA-MP<sub>CRS</sub> was divided into quintiles (with quintile 1 representing the lowest values), after adjusting for covariates, the odds ratios [95% confidence intervals (CIs)] for ICU mortality were 1.49 (95% CI: 1.15–1.94), 1.67 (95% CI: 1.29–2.16), 1.79 (95% CI: 1.37–2.33), and 3.96 (95% CI: 3.01–5.21) for quintiles 2, 3, 4, and 5 respectively, with quintile 1 as reference. Similar results were found for hospital mortality.</div></div><div><h3>Conclusion</h3><div>Higher TWA-MP<sub>CRS</sub> is associated with poor clinical outcomes in critically ill patients. Higher TWA-MP<sub>CRS</sub> can lead to a higher mortality among ICU and in-hospital patients.</div></div>","PeriodicalId":49268,"journal":{"name":"Medicina Intensiva","volume":"50 1","pages":"Article 502258"},"PeriodicalIF":3.1,"publicationDate":"2026-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145886159","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2026-01-01DOI: 10.1016/j.medin.2025.502297
Diego Maqueda Lluva, Alberto Garrido Callén, Manuel Pérez Torres
{"title":"Cuando la resonancia ve lo que el sodio no muestra: más allá del desequilibrio osmótico en la mielinólisis central pontina","authors":"Diego Maqueda Lluva, Alberto Garrido Callén, Manuel Pérez Torres","doi":"10.1016/j.medin.2025.502297","DOIUrl":"10.1016/j.medin.2025.502297","url":null,"abstract":"","PeriodicalId":49268,"journal":{"name":"Medicina Intensiva","volume":"50 1","pages":"Article 502297"},"PeriodicalIF":3.1,"publicationDate":"2026-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145886168","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2026-01-01DOI: 10.1016/j.medin.2025.502344
Elena Cuenca Fito , Eric Mayor-Vázquez , Cándido Díaz Lagares , Bárbara Vidal Tegedor , Noelia Isabel Lázaro Martín , Alba López Fernández , Laura Sanchez Montori , Íñigo Isern , Amparo Cabanillas Carrillo , Jorge Sánchez Gómez , Maria Luisa Gómez Grande , Alba Fernández Rodríguez , Anastasio Espejo , Domingo Díaz Díaz , Alejandra García Roche , Margarita Márquez , Mireya Molina Cortés , Natalia Valero , Manuel Gracia Romero , Fernando Eiras Abalde , Inés Gómez-Acebo
Objective
This study compares the clinical, functional, and oncological characteristics of patients with cancer assessed for ICU admission, with the aim of identifying factors associated with admission and of developing specific predictive models.
Design
A prospective, observational, multicentre study.
Setting
Thirty-three Intensive Care Units (ICUs) across Spain.
Patients or participants
Patients aged 18 years or older with solid tumors or haematological malignancies assessed for ICU admission between January and June 2024 were included.
Interventions
None.
Main variables of interest
Demographic, clinical, functional, oncological, and severity variables were collected. Differences between admitted and non-admitted patients were analyzed using multivariate logistic regression and LASSO-type predictive models.
Results
One thousand three hundred forty-one patients were included, with 1,177 (87.8%) admitted to ICU. Neutropenia, younger age, and recent oncologic treatment, among other factors, were associated with a higher likelihood of ICU admission. Patients with metastasis or progression of the haematological disease had a lower probability of admission. The predictive models demonstrated high discriminative ability for both solid tumors (AUC 0.79) and haematological malignancies (AUC 0.82).
Conclusions
We developed prognostic models for ICU admission by applying a multivariable approach, whereby variables were selected based on their joint contribution to the overall predictive accuracy rather than in isolation. The full model (Model 1) showed the best predictive capacity, with an area under the curve (AUC) of 0.79 (95% CI: 0.75-0.84) for solid and 0.82 (95% CI: 0.76-0.88) for haematological tumors.
{"title":"Factores determinantes en la decisión de ingreso de pacientes oncológicos en la unidad de cuidados intensivos: estudio español prospectivo multicéntrico","authors":"Elena Cuenca Fito , Eric Mayor-Vázquez , Cándido Díaz Lagares , Bárbara Vidal Tegedor , Noelia Isabel Lázaro Martín , Alba López Fernández , Laura Sanchez Montori , Íñigo Isern , Amparo Cabanillas Carrillo , Jorge Sánchez Gómez , Maria Luisa Gómez Grande , Alba Fernández Rodríguez , Anastasio Espejo , Domingo Díaz Díaz , Alejandra García Roche , Margarita Márquez , Mireya Molina Cortés , Natalia Valero , Manuel Gracia Romero , Fernando Eiras Abalde , Inés Gómez-Acebo","doi":"10.1016/j.medin.2025.502344","DOIUrl":"10.1016/j.medin.2025.502344","url":null,"abstract":"<div><h3>Objective</h3><div>This study compares the clinical, functional, and oncological characteristics of patients with cancer assessed for ICU admission, with the aim of identifying factors associated with admission and of developing specific predictive models.</div></div><div><h3>Design</h3><div>A prospective, observational, multicentre study.</div></div><div><h3>Setting</h3><div>Thirty-three Intensive Care Units (ICUs) across Spain.</div></div><div><h3>Patients or participants</h3><div>Patients aged 18 years or older with solid tumors or haematological malignancies assessed for ICU admission between January and June 2024 were included.</div></div><div><h3>Interventions</h3><div>None.</div></div><div><h3>Main variables of interest</h3><div>Demographic, clinical, functional, oncological, and severity variables were collected. Differences between admitted and non-admitted patients were analyzed using multivariate logistic regression and LASSO-type predictive models.</div></div><div><h3>Results</h3><div>One thousand three hundred forty-one patients were included, with 1,177 (87.8%) admitted to ICU. Neutropenia, younger age, and recent oncologic treatment, among other factors, were associated with a higher likelihood of ICU admission. Patients with metastasis or progression of the haematological disease had a lower probability of admission. The predictive models demonstrated high discriminative ability for both solid tumors (AUC 0.79) and haematological malignancies (AUC 0.82).</div></div><div><h3>Conclusions</h3><div>We developed prognostic models for ICU admission by applying a multivariable approach, whereby variables were selected based on their joint contribution to the overall predictive accuracy rather than in isolation. The full model (Model 1) showed the best predictive capacity, with an area under the curve (AUC) of 0.79 (95% CI: 0.75-0.84) for solid and 0.82 (95% CI: 0.76-0.88) for haematological tumors.</div></div>","PeriodicalId":49268,"journal":{"name":"Medicina Intensiva","volume":"50 1","pages":"Article 502344"},"PeriodicalIF":3.1,"publicationDate":"2026-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145886158","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
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