Medicina Intensiva最新文献

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Hypernatremia and renal dysfunction after sevoflurane sedation in the intensive care unit: Three case reports 重症监护病房七氟醚镇静后的高钠血症和肾功能障碍：3例报告

IF 3.1 4区医学 Q2 CRITICAL CARE MEDICINE

Medicina Intensiva

Pub Date : 2025-10-01 DOI: 10.1016/j.medin.2025.502215

Marta Bauça Socias , Dolly Andrea Caicedo , Eva Benveniste-Pérez , Georgina de la Rosa Loppacher , Eva Montané

引用次数: 0

Ventilación con liberación de presión en la vía aérea y membrana de oxigenación extracorpórea (ECMO) con configuración veno-venosa 气道减压通风和体外氧合膜（ECMO），静脉对静脉配置

IF 3.1 4区医学 Q2 CRITICAL CARE MEDICINE

Medicina Intensiva

Pub Date : 2025-10-01 DOI: 10.1016/j.medin.2025.502177

Ruben Martín-Latorre, Laura de Rivas-Alcover, Àngela Poquet-Poquet

引用次数: 0

Comparison of non-invasive ventilation on bilevel pressure mode and CPAP in the treatment of COVID-19 related acute respiratory failure. A propensity score–matched analysis 双水平压力模式无创通气与CPAP治疗COVID-19相关急性呼吸衰竭的比较倾向评分匹配分析

IF 3.1 4区医学 Q2 CRITICAL CARE MEDICINE

Medicina Intensiva

Pub Date : 2025-10-01 DOI: 10.1016/j.medin.2025.502146

Andrés Carrillo-Alcaraz , Miguel Guia , Laura Lopez-Gomez , Pablo Bayoumy , Aurea Higon-Cañigral , Elena Carrasco González , Pilar Tornero Yepez , Juan Miguel Sánchez-Nieto

Objective

The purpose of this study was to analyze the differences in the effectiveness and complications of CPAP versus non-invasive ventilation on bilevel positive airway pressure (BiPAP) in the treatment of COVID-19 associated acute respiratory failure (ARF).

Design

Retrospective observational study.

Setting

ICU.

Patients

All COVID-19 patients, admitted to an ICU between March 2020 and February 2023, who required CPAP or BiPAP were analyzed.

Interventions

Use of CPAP or BiPAP in COVID-19 associated ARF.

Main variables of interest

Initial clinical variables, CPAP and BiPAP failure rate, complications, in-hospital mortality.

Results

429 patients were analyzed, of whom 328 (76.5%) initially received CPAP and 101 (23.5%) BiPAP. Initial respiratory rate was 30 ± 8 in the CPAP group and 34 ± 9 in BiPAP (p < 0.001), while PaO₂/FiO₂ was 120 ± 26 and 111 ± 24 mmHg (p = 0.001), respectively. The most frequent complication related to the device was claustrophobia/discomfort, 23.2% in CPAP and 25.7% in BiPAP (p = 0.596), while the most frequent complications not related to the device were severe ARDS, 58.6% and 70.1% (p = 0.044), and hyperglycemia, 44.5% and 37.6%, respectively (p = 0.221). After adjusting by propensity score matched analysis, neither failure of the device (OR 1.37, CI 95% 0.72–2.62) nor in-hospital mortality (OR 1.57, CI 95% 0.73–3.42) differed between both groups.

Conclusions

Either non-invasive ventilatory device failure or mortality rate differed in patients initially treated with CPAP versus BiPAP.

目的分析双水平气道正压通气（BiPAP）与无创通气治疗COVID-19相关急性呼吸衰竭（ARF）的疗效及并发症的差异。设计：回顾性观察性研究设置：ICU患者分析2020年3月至2023年2月期间入住ICU的所有需要CPAP或BiPAP的COVID-19患者。CPAP或BiPAP在COVID-19相关ARF中的干预作用主要感兴趣的变量初始临床变量，CPAP和BiPAP失败率，并发症，住院死亡率。结果共分析429例患者，其中328例（76.5%）首次接受CPAP， 101例（23.5%）首次接受BiPAP。最初的呼吸速率是30 ±8 CPAP组和34 ± 9 BiPAP (p & lt; 0.001),而PaO2 /供给120 ± 26日和111年 ± 24 毫米汞柱(p = 0.001),分别。与设备相关的最常见并发症为幽闭恐惧症/不适，CPAP为23.2%，BiPAP为25.7% (p = 0.596)，与设备无关的最常见并发症为严重ARDS，分别为58.6%和70.1% (p = 0.044)，高血糖症，分别为44.5%和37.6% （p = 0.221）。经倾向评分匹配分析调整后，两组间装置失效（OR 1.37, CI 95% 0.72-2.62）和住院死亡率（OR 1.57, CI 95% 0.73-3.42）均无差异。结论初始采用CPAP与BiPAP治疗的患者无创通气装置失效或死亡率存在差异。

{"title":"Comparison of non-invasive ventilation on bilevel pressure mode and CPAP in the treatment of COVID-19 related acute respiratory failure. A propensity score–matched analysis","authors":"Andrés Carrillo-Alcaraz , Miguel Guia , Laura Lopez-Gomez , Pablo Bayoumy , Aurea Higon-Cañigral , Elena Carrasco González , Pilar Tornero Yepez , Juan Miguel Sánchez-Nieto","doi":"10.1016/j.medin.2025.502146","DOIUrl":"10.1016/j.medin.2025.502146","url":null,"abstract":"<div><h3>Objective</h3><div>The purpose of this study was to analyze the differences in the effectiveness and complications of CPAP versus non-invasive ventilation on bilevel positive airway pressure (BiPAP) in the treatment of COVID-19 associated acute respiratory failure (ARF).</div></div><div><h3>Design</h3><div>Retrospective observational study.</div></div><div><h3>Setting</h3><div>ICU.</div></div><div><h3>Patients</h3><div>All COVID-19 patients, admitted to an ICU between March 2020 and February 2023, who required CPAP or BiPAP were analyzed.</div></div><div><h3>Interventions</h3><div>Use of CPAP or BiPAP in COVID-19 associated ARF.</div></div><div><h3>Main variables of interest</h3><div>Initial clinical variables, CPAP and BiPAP failure rate, complications, in-hospital mortality.</div></div><div><h3>Results</h3><div>429 patients were analyzed, of whom 328 (76.5%) initially received CPAP and 101 (23.5%) BiPAP. Initial respiratory rate was 30 ± 8 in the CPAP group and 34 ± 9 in BiPAP (p < 0.001), while PaO<sub>2</sub>/FiO<sub>2</sub> was 120 ± 26 and 111 ± 24 mmHg (p = 0.001), respectively. The most frequent complication related to the device was claustrophobia/discomfort, 23.2% in CPAP and 25.7% in BiPAP (p = 0.596), while the most frequent complications not related to the device were severe ARDS, 58.6% and 70.1% (p = 0.044), and hyperglycemia, 44.5% and 37.6%, respectively (p = 0.221). After adjusting by propensity score matched analysis, neither failure of the device (OR 1.37, CI 95% 0.72–2.62) nor in-hospital mortality (OR 1.57, CI 95% 0.73–3.42) differed between both groups.</div></div><div><h3>Conclusions</h3><div>Either non-invasive ventilatory device failure or mortality rate differed in patients initially treated with CPAP versus BiPAP.</div></div>","PeriodicalId":49268,"journal":{"name":"Medicina Intensiva","volume":"49 10","pages":"Article 502146"},"PeriodicalIF":3.1,"publicationDate":"2025-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145189700","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

¿Es la inestabilidad hemodinámica una contraindicación absoluta para la posición prono? 血流动力学不稳定性是前位的绝对禁忌吗？

IF 3.1 4区医学 Q2 CRITICAL CARE MEDICINE

Medicina Intensiva

Pub Date : 2025-10-01 DOI: 10.1016/j.medin.2025.502201

Marina Busico, Fernando Villarejo

引用次数: 0

Utility of airway occlusion pressure in traumatic diaphragmatic rupture 气道闭塞压在外伤性膈破裂中的应用

IF 3.1 4区医学 Q2 CRITICAL CARE MEDICINE

Medicina Intensiva

Pub Date : 2025-10-01 DOI: 10.1016/j.medin.2025.502214

Noemi Merino Pizarro , Manuel Valdivia Marchal , Carmen Bermudez Ruiz , Juan Francisco Martinez Carmona , Ashlen Rodriguez Carmona , Jose Manuel Serrano Simon

引用次数: 0

Actualización de la taxonomía de los modos de ventilación mecánica 更新机械通风模式分类法

IF 3.1 4区医学 Q2 CRITICAL CARE MEDICINE

Medicina Intensiva

Pub Date : 2025-10-01 DOI: 10.1016/j.medin.2025.502211

Aurio Fajardo-Campoverdi , Eduardo Mireles-Cabodevila , Alberto Medina , Miguel Ibarra-Estrada , José Baltazar-Torres , Robert Chatburn

The rapid technological development of mechanical ventilation has resulted in increasingly complex modes, advanced monitoring capabilities and the incorporation of artificial intelligence. However, manufacturers have created a multitude of trade names, which has generated a great deal of confusion in their understanding, handling and application. This problem is exacerbated in Spanish-speaking countries due to inconsistencies in translations and variability in nomenclature between regions. This manuscript aims to provide an updated review of the taxonomic classification of ventilatory modes in order to promote standardization of terminology, especially in the Spanish-speaking clinical context, and includes changes in the taxonomy and manner of labeling modes of mechanical ventilation. This review focuses on invasive mechanical ventilation of the adult critically ill patient, although the taxonomy is also applicable to all ventilation modalities, including noninvasive, high-frequency, pediatric, and even home ventilation.

机械通气技术的快速发展使其模式日益复杂，监测能力日益先进，人工智能技术的应用也越来越广泛。然而，制造商创造了大量的商品名称，这在他们的理解、处理和应用中产生了很大的混乱。这一问题在西班牙语国家由于翻译的不一致和地区之间命名的变化而加剧。该手稿旨在提供通气模式分类分类的最新综述，以促进术语的标准化，特别是在西班牙语临床环境中，并包括机械通气的分类和标签模式的变化。尽管该分类也适用于所有的通气方式，包括无创、高频、儿科甚至家庭通气，但本文的综述主要集中在成人危重患者的有创机械通气上。

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引用次数: 0

Endobronchial actinomycosis Endobronchial actinomycosis

IF 3.1 4区医学 Q2 CRITICAL CARE MEDICINE

Medicina Intensiva

Pub Date : 2025-10-01 DOI: 10.1016/j.medin.2025.502228

Chih-Jung Chang , Yi-Han Hsiao

引用次数: 0

La inteligencia artificial en medicina intensiva, la revolución gradual 人工智能在重症监护中的渐进式革命

IF 3.1 4区医学 Q2 CRITICAL CARE MEDICINE

Medicina Intensiva

Pub Date : 2025-09-01 DOI: 10.1016/j.medin.2025.502164

Alejandro González-Castro

引用次数: 0

Effectiveness of non-invasive ventilation in critical patients with acute respiratory failure and do not intubate order 无创通气在急性呼吸衰竭危重患者无插管顺序中的有效性

IF 3.1 4区医学 Q2 CRITICAL CARE MEDICINE

Medicina Intensiva

Pub Date : 2025-09-01 DOI: 10.1016/j.medin.2025.502169

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

Objective

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 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.

Design

Retrospective observational study.

Setting

Polyvalent ICU.

Patients

All consecutively admitted ICU patients for ARF between January 1^st, 1997, and December 31^st, 2022, who were treated with NIV.

Main variables of interest

Initial clinical variables, NIV failure rate, complications, in-hospital and one-year mortality.

Results

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%). Patients with DNI order were older, had higher Charlson comorbidity index 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).

Conclusions

DNI orders are common in patients with ARF treated with NIV and they related to worse short and long-term prognosis.

目的本研究的主要目的是分析重症监护病房（ICU）因急性呼吸衰竭（ARF）而接受无创通气（NIV）治疗的患者中不插管（DNI）订单的患病率。次要目的是将DNI命令的存在与患者的预后联系起来。设计回顾性观察性研究。SettingPolyvalent ICU。患者均为1997年1月1日至2022年12月31日连续入住ICU的ARF患者，均采用NIV治疗。主要感兴趣的变量初步临床变量，NIV失败率，并发症，住院和一年死亡率。结果共分析5972例患者，1275例（21.3%）出现DNI顺序。平均年龄68.2 ± 14.9；60.2%为男性。DNI顺序的最常见原因是慢性呼吸道疾病（452例，占35.5%）。DNI顺序患者年龄较大，Charlson合并症指数较高，体弱多病。DNI组536例（42.0%）患者发生NIV失败，非DNI组1118例（23.8%）（p <； 0.001）。DNI患者的住院死亡率更高（57.9% vs 16.4%; p <； 0.001）。住院死亡率的调整OR为2.14 （95% CI 1.98 - 2.31）。结论经NIV治疗的ARF患者普遍存在sni顺序，且与较差的短期和长期预后相关。

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引用次数: 0

Reformulación de los análisis aleatorios de seguridad en tiempo real durante la pandemia SARS-CoV-2 在SARS-CoV-2大流行期间重新设计实时随机安全分析

IF 3.1 4区医学 Q2 CRITICAL CARE MEDICINE

Medicina Intensiva

Pub Date : 2025-09-01 DOI: 10.1016/j.medin.2024.502117

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

Introduction

From a safety perspective, the pandemic imposed atypical work dynamics that led to noticeable gaps in clinical safety across all levels of health care.

Objectives

To verify that Real-Time Random Safety Analyses (AASTRE) are feasible and useful in a high-pressure care setting.

Design

Prospective study (January to September 2022).

Setting

University hospital with 350 beds. Two mixed ICUs (12 and 14 beds).

Interventions

Two safety audits per week were planned to determine the feasibility and usefulness of the 32 safety measures (grouped into 8 blocks).

Main variables of interest

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.

Results

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 minutes. Overall, changes in the care process were made in 11.8% of the measures analyzed.

Conclusions

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 minutes. Overall, AASTRE allowed unsafe situations to be turned safe in more than 10% of the evaluations.

从安全角度来看，大流行带来了非典型的工作动态，导致各级卫生保健在临床安全方面存在明显差距。目的验证实时随机安全性分析（AASTRE）在高压护理环境中的可行性和实用性。前瞻性研究（2022年1月至9月）。大学附属医院，拥有350张床位。2个混合icu（12床和14床）。干预措施每周计划进行两次安全审核，以确定32项安全措施（分为8个区块）的可行性和有效性。主要感兴趣的变量1)可行性：完成审核与计划审核的比例和花费的时间。2)效用：由于AASTRE的实施，护理过程发生了变化。结果共分析390个患者日（其中非COVID患者179例，COVID患者49例）。在COVID患者亚组中，年龄、ICU住院时间、SAPS-3和ICU死亡率均显著高于非COVID患者亚组。在可行性方面，93.8%的计划轮次被执行，平均审计时间为25±8分钟。总体而言，11.8%的分析措施改变了护理过程。结论在高度复杂的护理环境中，AASTRE被证明是一种可行和有用的工具，每周只需两次干预，持续时间不超过30分钟。总的来说，AASTRE在超过10%的评估中允许不安全的情况变成安全的。

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引用次数: 0

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