Medicina Intensiva最新文献_第3页

Short- and long-term mortality in critically ill patients with solid cancer. The Vall d’Hebron Intensive Care Unit-Vall d’Hebron Institute of Oncology Cohort: a retrospective study 实体癌危重病人的短期和长期死亡率。Vall d 'Hebron重症监护病房-Vall d 'Hebron肿瘤研究所队列：回顾性研究

IF 3.1 4区医学 Q2 CRITICAL CARE MEDICINE

Medicina Intensiva

Pub Date : 2025-11-01 DOI: 10.1016/j.medin.2025.502176

Cándido Díaz-Lagares , Alejandra García-Roche , Andrés Pacheco , Javier Ros , Erika P. Plata-Menchaca , Adaia Albasanz , David Pérez , Nadia Saoudi , Isabel Ruiz-Camps , Elena Élez , Ricard Ferrer

Objective

To describe in-hospital and one-year mortality and to identify prognostic variables associated with mortality.

Design

Retrospective cohort study.

Setting

Tertiary referral hospital in Barcelona (Spain).

Patients

Consecutive patients with solid cancer and unplanned admission to the ICU over a ten year period (2010–2019).

Main variables of interest

In-hospital mortality, one-year mortality, type of cancer, metastatic disease, ECOG, APACHE, SOFA, invasive mechanical ventilation, vasoactive drugs, renal replacement therapy.

Results

Three hundred and ninety-five patients were admitted to the ICU; 193 (48.8%) had metastatic disease, and 22 (5.9%) presented neutropenia. The median SOFA score on day 1 of ICU admission was 6 (3−9). ICU, in-hospital, and one-year mortality were 27.9% (110 patients), 39% (139 patients), and 61.1% (236 patients), respectively. A non-surgical admission, a higher ECOG, a SOFA score > 9 on day 1, a non-decreasing SOFA score on day 5, and requiring invasive mechanical ventilation were factors associated with in-hospital mortality. ECOG, inability to resume anticancer therapy, and ICU admission due to respiratory failure were associated with one-year mortality in hospital survivors.

Conclusion

Survival in critically ill solid cancer patients is substantial, even when metastatic disease exists. Short-term outcomes were associated with ECOG and organ dysfunction, not cancer per se. The prognosis of patients with a non-decreasing SOFA score on day 5 is poor, especially when the SOFA score on day 1 was >9. Long-term mortality was associated with functional status and inability to resume anticancer therapy.

目的描述住院和一年内的死亡率，并确定与死亡率相关的预后变量。设计回顾性队列研究。巴塞罗那三级转诊医院（西班牙）。患者：在10年期间（2010-2019年），连续罹患实体癌且计划外入住ICU的患者。感兴趣的主要变量：医院死亡率、一年死亡率、癌症类型、转移性疾病、ECOG、APACHE、SOFA、有创机械通气、血管活性药物、肾脏替代治疗。结果395例患者入住ICU；193例（48.8%）有转移性疾病，22例（5.9%）出现中性粒细胞减少。ICU入院第1天SOFA评分中位数为6（3 - 9）。ICU、住院和1年死亡率分别为27.9%（110例）、39%（139例）和61.1%（236例）。非手术入院、较高的ECOG、第1天SOFA评分[gt； 9]、第5天SOFA评分不下降以及需要有创机械通气是院内死亡率相关的因素。ECOG、无法恢复抗癌治疗和因呼吸衰竭而入住ICU与住院幸存者的1年死亡率相关。结论危重期实体癌患者的生存率很高，即使存在转移性肿瘤。短期预后与ECOG和器官功能障碍有关，而与癌症本身无关。第5天SOFA评分不下降的患者预后较差，特别是第1天SOFA评分为>；9时。长期死亡率与功能状态和无法恢复抗癌治疗有关。

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引用次数: 0

Implementación de la tomografía por impedancia eléctrica en la enfermedad pleuropulmonar del paciente adulto 在成人患者胸膜肺病中实施电阻抗断层扫描

IF 3.1 4区医学 Q2 CRITICAL CARE MEDICINE

Medicina Intensiva

Pub Date : 2025-11-01 DOI: 10.1016/j.medin.2025.502262

Gabriel Appendino, Celeste Gomez, Carlos Lovesio

引用次数: 0

Calidad de vida en pacientes post-COVID-19 tras el alta de un centro de desvinculación de ventilación mecánica y rehabilitación: estudio de cohorte retrospectivo 2019冠状病毒病患者出院后的生活质量：回顾性队列研究

IF 3.1 4区医学 Q2 CRITICAL CARE MEDICINE

Medicina Intensiva

Pub Date : 2025-11-01 DOI: 10.1016/j.medin.2025.502257

Emilio Sebastián Rositi , Emiliano Navarro , Mirian Lorena Delvalle , Agustín García , Miguel Antonio Escobar , Javier Eugenio Cromberg , Gastón Germán Morel Vulliez , Melina Calvo Delfino , Eduardo Luis de Vito

引用次数: 0

Analgesia, sedation, and neuromuscular blocking agents: A standardized protocol of analgosedation in COVID-19 镇痛、镇静和神经肌肉阻滞剂：新冠肺炎患者镇痛镇静的标准化方案

IF 3.1 4区医学 Q2 CRITICAL CARE MEDICINE

Medicina Intensiva

Pub Date : 2025-11-01 DOI: 10.1016/j.medin.2025.502223

Cecilia Inés Loudet , Marisol García Sarubbio , María Julia Meschini , Jacqueline Vilca Becerra , María Agustina Mazzoleni , Vanesa Aramendi , Agustina Barbieri , Carolina Colavita , Gustavo Cerri , Sofía Pacho , Eliseo Hernán Ferrari , Rosa Reina

Objectives

Primary: To evaluate the level of sedation, use, daily doses, and duration of analgosedative drugs in COVID-19 patients on mechanical ventilation (MV) using a standardized protocol, comparing survivors and non-survivors. Secondary: To identify independent predictors of hospital mortality.

Design

Retrospective cohort study.

Setting

Medical-surgical ICU.

Patients

Adults with SARS-CoV-2 infection requiring invasive MV and continuous infusion of analgosedation and/or neuromuscular blocking agents (NMBAs) for at least 48 h.

Interventions

None.

Main variables of interest

Level of sedation, use, daily doses, and duration of analgosedative drugs; hospital mortality and associated factors.

Results

Among 198 patients (nurse-to-patient ratio 1:2.4; 65% staff turnover), median global RASS was –4.5. Kaplan–Meier analysis showed lower survival with deeper sedation. Fentanyl (99%) and midazolam (97%) were the most used, followed by NMBAs (81%), propofol and dexmedetomidine (48%). Non-benzodiazepine sedatives were precribed more in survivors (88%) than non-survivors (53%) (p < 0.01). Survivors had more days of fentanyl, midazolam, and dexmedetomidine; no differences in NMBA use or drug doses were observed. Mortality was 63%. Independent predictors of mortality included APACHE II, SOFA₂₄, Charlson score, median RASS, and non-benzodiazepine sedative use.

Conclusions

Standardized protocols emphasizing the ACD components of the ABCDEF bundle, along with appropriate use of analgosedation and NMBAs despite limited staffing, effectively supported the management of sedation without significant dose differences between survivors and non-survivors. Sedation level and the use of non-benzodiazepine sedatives were independently associated with better outcomes, highlighting the importance of the light sedation and the ABCDEF bundle.

目的：评价采用标准化方案机械通气（MV）的COVID-19患者镇静水平、使用、日剂量和持续时间，比较存活患者和非存活患者。次要目的：确定医院死亡率的独立预测因子。设计回顾性队列研究。SettingMedical-surgical ICU。SARS-CoV-2感染的成人患者需要侵入性MV和连续输注镇痛镇静和/或神经肌肉阻断剂（nmba）至少48次 。感兴趣的主要变量：镇静水平、使用方法、日剂量、持续时间；医院死亡率及其相关因素。结果198例患者（护患比1:24 .4，人员流失率65%），总体RASS中位数为-4.5。Kaplan-Meier分析显示，镇静程度越深，生存率越低。使用最多的是芬太尼（99%）和咪达唑仑（97%），其次是nmba（81%）、异丙酚和右美托咪定（48%）。幸存者使用非苯二氮卓类镇静剂的比例（88%）高于非幸存者（53%）（p <； 0.01）。幸存者使用芬太尼、咪达唑仑和右美托咪定的天数更长；在NMBA的使用或药物剂量方面没有观察到差异。死亡率为63%。死亡率的独立预测因子包括APACHE II、SOFA24、Charlson评分、中位RASS和非苯二氮卓类镇静剂的使用。结论强调ABCDEF束ACD成分的标准化方案，以及在人员有限的情况下适当使用镇静和NMBAs，有效地支持镇静管理，在幸存者和非幸存者之间没有显着的剂量差异。镇静水平和非苯二氮卓类镇静剂的使用与更好的结果独立相关，突出了轻度镇静和ABCDEF束的重要性。

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引用次数: 0

Organización de los Servicios de Medicina Intensiva para una asistencia de calidad. Recomendaciones de la SOGAMIUC utilizando una metodología Delphi (con el respaldo de SEMICYUC, SAMI, SBMICIUC, SOCAMICYUC, SNMIUC, SCLMICYUC, SOCMIC, SEXMICYUC, SOMIUC) 组织重症监护服务，提供高质量的护理。SOGAMIUC使用Delphi方法的建议（由SEMICYUC、SAMI、SBMICIUC、SOCAMICYUC、SNMIUC、SCLMICYUC、SOCMIC、SEXMICYUC、SOMIUC支持）

IF 3.1 4区医学 Q2 CRITICAL CARE MEDICINE

Medicina Intensiva

Pub Date : 2025-11-01 DOI: 10.1016/j.medin.2025.502267

Pablo Vidal-Cortés , Rocío Gómez-López , Emilio Rodríguez-Ruiz , Paula Fernández-Ugidos , Fernando Eiras Abalde , Lorena del Río-Carbajo , Jorge Nieto-del Olmo , Daniel Ernesto Suárez Fernández , Ana María Ferreiro González , Mónica Mourelo Fariña , Pedro Rascado Sedes , María José de la Torre Fernández , José Luis Martínez Melgar , Miguel Ángel Fernández López , María José Castro Orjales , Patricia Barral Segade , Víctor José López Ciudad , María Isabel Álvarez Diéguez , Salvador Fojón Polanco

The proper organization of Intensive Care Medicine Departments is a key element in order to ensure high-quality care of critically ill patients and to preserve the well-being of healthcare professionals. Using a Delphi methodology, the Galician Society of Intensive Care Medicine and Coronary Units (SOGAMIUC) has reached a consensus on a set of recommendations covering structure, clinical organization, continuous care, specialized programs, and staffing requirements in ICUs. These recommendations aim to optimize continuity of care and patient safety, promote a healthy work environment, and encourage the development of advanced clinical programs. Implementation of these measures is proposed as an essential step toward improving clinical outcomes and the well-being of healthcare professionals in Intensive Care Departments.

重症监护室的适当组织是确保重症患者高质量护理和维护医疗保健专业人员健康的关键因素。加利西亚重症监护医学和冠状动脉病房协会（SOGAMIUC）采用德尔菲方法，就icu的结构、临床组织、持续护理、专业项目和人员配备要求等一系列建议达成了共识。这些建议旨在优化护理的连续性和患者安全，促进健康的工作环境，并鼓励发展先进的临床方案。这些措施的实施被认为是改善临床结果和重症监护室医护人员福祉的重要一步。

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引用次数: 0

Contrast media extravasation mimicking subarachnoid hemorrhage due to hypertensive encephalopathy 高血压脑病引起的类似蛛网膜下腔出血的造影剂外渗

IF 3.1 4区医学 Q2 CRITICAL CARE MEDICINE

Medicina Intensiva

Pub Date : 2025-10-01 DOI: 10.1016/j.medin.2025.502208

Gökhan Tonkaz, Merve Nur Taşdemir, Mehmet Tonkaz

引用次数: 0

Reduction of norepinephrine versus vasopressin in the stabilization phase of septic shock: RENOVA clinical trial 去甲肾上腺素与加压素在脓毒性休克稳定期的对照：RENOVA临床试验

IF 3.1 4区医学 Q2 CRITICAL CARE MEDICINE

Medicina Intensiva

Pub Date : 2025-10-01 DOI: 10.1016/j.medin.2025.502147

Cássio Mallmann , Thizá Maria Bianchi Galiotto , Michele Salibe de Oliveira , Rafael Barberena Moraes

Objective

Evaluate the incidence of hypotension during the weaning phase of vasopressors.

Design

A single-center, open-label randomized clinical trial between May and December 2022.

Setting

a tertiary care academic medical center.

Patients

91 adult patients over 18 years of age with septic shock (according to Sepsis-3).

Intervention

Patients were divided into two groups: initial reduction of norepinephrine or initial reduction of vasopressin.

Main variables of interest

The primary outcome was the incidence of hypotension within the first 24 h after reducing vasopressors. Additionally, the clinical impact of this hypotension was assessed through mortality, length of hospital stay, duration of vasopressor use, incidence of arrhythmias, and prevalence of hemodialysis.

Results

Out of a total of 91 patients, 78 were included in the analysis: 39 in the norepinephrine group and 39 in the vasopressin group. Despite a numerically significant difference in the incidence of hypotension between the groups (norepinephrine 43.6%, vasopressin 25.6%), there was no statistical difference (p =  0.153, relative risk = 1.7, 95% confidence interval: 0.9–3.2). In this sample, vasopressin withdrawal was predominantly titrated. There were no differences between the groups in terms of the evaluated clinical outcomes.

Conclusion

No differences were detected in the incidence of hypotension when weaning was initiated with norepinephrine or vasopressin, although it was non significantly higher in norepinephrine group. In our sample, vasopressin withdrawal was titrated, which differs from North American practice. Brazilian Clinical Trials Registry (REBEC: RBR-10smbw65). ClinicalTrials.gov platform (NCT 05506319).

目的探讨降压药脱机期低血压的发生率。在2022年5月至12月期间进行一项单中心、开放标签随机临床试验。建立三级保健学术医疗中心。患者：91例18岁以上感染性休克的成人患者（根据《败血症-3》）。患者被分为两组：初始降低去甲肾上腺素或初始降低抗利尿激素。主要观察指标为降低血管降压药后24小时内的低血压发生率 h。此外，通过死亡率、住院时间、血管加压药使用时间、心律失常发生率和血液透析患病率来评估这种低血压的临床影响。结果91例患者中，78例纳入分析：去甲肾上腺素组39例，加压素组39例。尽管两组间低血压的发生率在数值上有显著差异（去甲肾上腺素43.6%，加压素25.6%），但没有统计学差异（p = 0.153，相对风险= 1.7,95%可信区间：0.9-3.2）。在这个样本中，抗利尿激素的戒断主要是滴定的。在评估的临床结果方面，两组之间没有差异。结论去甲肾上腺素组与加压素组的低血压发生率无显著性差异，去甲肾上腺素组与加压素组的低血压发生率无显著性差异。在我们的样本中，抗利尿激素的戒断是滴定的，这与北美的做法不同。巴西临床试验注册中心（REBEC: RBR-10smbw65）。ClinicalTrials.gov平台（NCT 05506319）。

{"title":"Reduction of norepinephrine versus vasopressin in the stabilization phase of septic shock: RENOVA clinical trial","authors":"Cássio Mallmann , Thizá Maria Bianchi Galiotto , Michele Salibe de Oliveira , Rafael Barberena Moraes","doi":"10.1016/j.medin.2025.502147","DOIUrl":"10.1016/j.medin.2025.502147","url":null,"abstract":"<div><h3>Objective</h3><div>Evaluate the incidence of hypotension during the weaning phase of vasopressors.</div></div><div><h3>Design</h3><div>A single-center, open-label randomized clinical trial between May and December 2022.</div></div><div><h3>Setting</h3><div>a tertiary care academic medical center.</div></div><div><h3>Patients</h3><div>91 adult patients over 18 years of age with septic shock (according to Sepsis-3).</div></div><div><h3>Intervention</h3><div>Patients were divided into two groups: initial reduction of norepinephrine or initial reduction of vasopressin.</div></div><div><h3>Main variables of interest</h3><div>The primary outcome was the incidence of hypotension within the first 24 h after reducing vasopressors. Additionally, the clinical impact of this hypotension was assessed through mortality, length of hospital stay, duration of vasopressor use, incidence of arrhythmias, and prevalence of hemodialysis.</div></div><div><h3>Results</h3><div>Out of a total of 91 patients, 78 were included in the analysis: 39 in the norepinephrine group and 39 in the vasopressin group. Despite a numerically significant difference in the incidence of hypotension between the groups (norepinephrine 43.6%, vasopressin 25.6%), there was no statistical difference (<em>p</em> =  0.153, relative risk = 1.7, 95% confidence interval: 0.9–3.2). In this sample, vasopressin withdrawal was predominantly titrated. There were no differences between the groups in terms of the evaluated clinical outcomes.</div></div><div><h3>Conclusion</h3><div>No differences were detected in the incidence of hypotension when weaning was initiated with norepinephrine or vasopressin, although it was non significantly higher in norepinephrine group. In our sample, vasopressin withdrawal was titrated, which differs from North American practice. Brazilian Clinical Trials Registry (REBEC: RBR-10smbw65). ClinicalTrials.gov platform (NCT 05506319).</div></div>","PeriodicalId":49268,"journal":{"name":"Medicina Intensiva","volume":"49 10","pages":"Article 502147"},"PeriodicalIF":3.1,"publicationDate":"2025-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145189701","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}

引用次数: 0

Impacto de la COVID-19 en las activaciones del equipo de parada cardiorrespiratoria intrahospitalaria: estudio retrospectivo 2019冠状病毒病对医院内心肺停止设备激活的影响：一项回顾性研究

IF 3.1 4区医学 Q2 CRITICAL CARE MEDICINE

Medicina Intensiva

Pub Date : 2025-10-01 DOI: 10.1016/j.medin.2024.502137

Ghali Ballout , Marta Magaldi Mendaña , Bartomeu Ramis Bou , Cristian Torres Quevedo , Adriana Capdevila Freixas , Silvia Moreno-Jurico , Enrique Jesús Carrero Cardenal , Jaime Fontanals Dotras , Comisión a la Atención a la Parada Cardiorrespiratoria del Hospital Clínic de Barcelona

Objective

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.

Design

Observational and retrospective study from January 1st, 2018, to December 31st, 2021.

Setting

Tertiary hospital.

Patients

All adult patients over 18 years old requiring attention from the IHCA response team.

Interventions

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).

Main variables

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.

Results

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.

Conclusions

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.

目的分析新型冠状病毒肺炎疫情前与疫情大流行期相比，院内心肺骤停团队、IHCA和心肺复苏术（CPR）治疗的患者特征是否存在差异；并分析COVID+和COVID -患者的差异。设计：2018年1月1日至2021年12月31日进行观察性和回顾性研究。SettingTertiary医院。患者：所有18岁以上需要IHCA反应小组关注的成年患者。根据2015年欧洲复苏委员会发布的先进生命支持指南以及新冠肺炎时代（2020年）所做的修改进行干预和scpr操作。主要变量：人口统计和流行病学数据、IHCA反应小组的激活情况、CA数据、医院和重症监护病房（ICU）的住院时间、生存和出院时的神经预后。结果共分析368例患者：大流行前组173例，大流行组195例。大流行前组神经系统预后较好，COVID+患者的ICU住院时间较长。然而，在两组之间或在COVID+和COVID -患者之间，在心肺复苏术小组的反应时间或心肺复苏术持续时间、即时生存或出院时均未发现差异。结论：COVID-19大流行导致的心肺复苏术护理方案的变化似乎并未影响IHCA团队的反应时间，无论是即时生存还是出院生存。

{"title":"Impacto de la COVID-19 en las activaciones del equipo de parada cardiorrespiratoria intrahospitalaria: estudio retrospectivo","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 , Comisión a la Atención a la Parada Cardiorrespiratoria del Hospital Clínic de Barcelona","doi":"10.1016/j.medin.2024.502137","DOIUrl":"10.1016/j.medin.2024.502137","url":null,"abstract":"<div><h3>Objective</h3><div>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.</div></div><div><h3>Design</h3><div>Observational and retrospective study from January 1st, 2018, to December 31st, 2021.</div></div><div><h3>Setting</h3><div>Tertiary hospital.</div></div><div><h3>Patients</h3><div>All adult patients over 18years old requiring attention from the IHCA response team.</div></div><div><h3>Interventions</h3><div>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).</div></div><div><h3>Main variables</h3><div>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.</div></div><div><h3>Results</h3><div>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.</div></div><div><h3>Conclusions</h3><div>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.</div></div>","PeriodicalId":49268,"journal":{"name":"Medicina Intensiva","volume":"49 10","pages":"Article 502137"},"PeriodicalIF":3.1,"publicationDate":"2025-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145189642","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}

引用次数: 0

Association between lactate-to-albumin ratio and all-cause mortality in cirrhosis patients: Analysis of the MIMIC-IV database 肝硬化患者乳酸-白蛋白比与全因死亡率的关系：MIMIC-IV数据库分析

IF 3.1 4区医学 Q2 CRITICAL CARE MEDICINE

Medicina Intensiva

Pub Date : 2025-10-01 DOI: 10.1016/j.medin.2025.502145

Yusong Ye , Shu Huang , Xiaohong Wang , Wensen Ren , Xiaomin Shi , Sha Liu , Wei Zhang , Lei Shi , Muhan Lü , Xiaowei Tang

Objective

This study evaluates the predictive value of the lactate/albumin ratio (LAR) for all-cause mortality in cirrhosis patients.

Design

Retrospective observational study.

Setting

Intensive care unit (ICU).

Patients or participants

626 first-time ICU-admitted cirrhosis patients in the USA (MIMIC-IV v2.2).

Interventions

None.

Main variables of interest

LAR index, 28-day, and 90-day all-cause mortality.

Results

Of 626 patients (60.86% male), 27.80% and 39.14% died within 28 and 90 days, respectively. Multivariate Cox analysis showed a significant association between higher LAR and mortality. Adjusted for confounders, elevated LAR increased the 28-day mortality risk [HR: 1.31 (1.21–1.42), P < 0.001]. A restricted cubic spline analysis revealed non-linear relationships between LAR and mortality. For 28-day mortality, the inflection point was 1.583: below this, HR was 2.29 (95% CI: 1.61–3.27, P < 0.001); above, HR was 1.16 (95% CI: 1.02–1.31, P = 0.021; P = 0.002). For 90-day mortality, the inflection point was 1.423: below, HR was 1.60 (95% CI: 1.04–2.47, P = 0.033); above, HR was 0.94 (95% CI: 0.75–1.16, P = 0.542; P = 0.012).

Conclusions

LAR predicts 28-day and 90-day mortality with a segmented effect. An LAR ≥1.583 signals high 28-day mortality risk, necessitating intensified monitoring and potential ICU admission. For 90-day mortality, LAR near 1.423 serves as an early warning for high-risk patients and guides interventions. Continuous LAR monitoring aids management, but prospective studies are needed to confirm clinical utility.

目的探讨乳酸/白蛋白比值（LAR）对肝硬化患者全因死亡率的预测价值。设计回顾性观察性研究。重症监护病房（ICU）。患者或参与者：美国626例首次入住icu的肝硬化患者（MIMIC-IV v2.2）。主要变量为interestLAR指数、28天全因死亡率、90天全因死亡率。结果626例患者（男性60.86%）中，28天内死亡占27.80%，90天内死亡占39.14%。多变量Cox分析显示，较高的LAR与死亡率之间存在显著关联。调整混杂因素后，LAR升高增加了28天死亡风险[HR: 1.31 (1.21-1.42), P <； 0.001]。限制三次样条分析显示LAR与死亡率之间存在非线性关系。28天死亡率的拐点为1.583，低于该拐点的死亡率为2.29 (95% CI: 1.61-3.27, P <； 0.001)；以上,人力资源是1.16(95%置信区间:1.02—-1.31,P = 0.021;P = 0.002)。90天死亡率的拐点为1.423，小于90天的死亡率为1.60 (95% CI: 1.04 ~ 2.47, P = 0.033)；以上,人力资源是0.94(95%置信区间:0.75—-1.16,P = 0.542;P = 0.012)。结论slar预测28天和90天死亡率具有分段效应。LAR≥1.583表明28天死亡风险高，需要加强监测并可能进入ICU。对于90天死亡率，接近1.423的LAR可作为高危患者的早期预警并指导干预措施。持续的LAR监测有助于管理，但需要前瞻性研究来证实临床应用。

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引用次数: 0

Definiciones y recomendaciones de consenso sobre la medicina crítica en la altitud del Comité de Expertos de Medicina Crítica en la altitud de la Federación Panamericana e Ibérica de Medicina Crítica y Terapia Intensiva 泛美和伊比利亚关键海拔医学和强化治疗联合会关键海拔医学专家委员会关于关键海拔医学的共识定义和建议

IF 3.1 4区医学 Q2 CRITICAL CARE MEDICINE

Medicina Intensiva

Pub Date : 2025-10-01 DOI: 10.1016/j.medin.2025.502256

Amilcar Tinoco-Solórzano , Adrian Avila-Hilari , Manuel Luis Avellanas-Chavala , Felipe de Jesús Montelongo , Jorge Vélez-Páez , Víctor Nieto Estrada , Antonio Viruez Soto , Daniel Molano Franco , Eduardo Castelo Tamayo , Ignacio Granda Luna , Alfonso Salazar Mendoza , Luis Mamani Cruz , Jonathan Galindo Ayala , Pablo Vásquez-Hoyos , Fausto Maldonado Coronel , Roger Huanca Payehuanca , Jorge Rosendo Sánchez Medina

The Expert Committee on Critical Care Medicine at altitude of the Pan American and Iberian Federation of Critical Care Medicine and Intensive Care detected a lack of terms defining this critical care medicine, as well as a lack of standardization in the approach to these patients. These shortcomings can lead to errors in management, for example, in critically ill patients at risk of death who require oxygen therapy, whether invasive or non-invasively.

The objective of the expert committee was to develop an international consensus that would standardize terminology and establish key definitions and recommendations for the care of critically ill patients at altitude. This document includes five important definitions, four recommendations related to the management of acute respiratory failure at altitude, and a series of considerations for future research. It also establishes specific criteria that differentiate it from the traditional approach used at sea level.

泛美和伊比利亚重症监护医学和重症监护联合会的重症监护医学专家委员会发现，缺乏定义这种重症监护医学的术语，而且在治疗这些患者的方法中缺乏标准化。这些缺点可能导致管理上的错误，例如，在有死亡危险的危重病人中，需要进行有创或无创氧疗。专家委员会的目标是形成一种国际共识，使术语标准化，并为高原重病患者的护理确立关键定义和建议。本文件包括5个重要定义，4个与高原急性呼吸衰竭管理相关的建议，以及未来研究的一系列考虑。它还建立了具体的标准，将其与在海平面上使用的传统方法区分开来。

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引用次数: 0