Medicina Intensiva最新文献

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Usamos ventilación no invasiva cada día, pero ¿conocemos su eficacia real en nuestro centro? 我们每天都使用非侵入性通风，但我们知道它在我们中心的真正效果吗？

IF 3.1 4区医学 Q2 CRITICAL CARE MEDICINE

Medicina Intensiva

Pub Date : 2025-09-01 DOI: 10.1016/j.medin.2025.502213

Rafael Fernández Fernández

引用次数: 0

Susurros del corazón: la travesía de una disección aórtica 心脏低语：主动脉切除术之旅

IF 3.1 4区医学 Q2 CRITICAL CARE MEDICINE

Medicina Intensiva

Pub Date : 2025-09-01 DOI: 10.1016/j.medin.2025.502175

Pablo Carrión Montaner , Mario Sutil-Vega , Jordi Sans-Roselló

引用次数: 0

Analysis of frailty as a prognostic factor independent of age: A prospective observational study 衰弱作为独立于年龄的预后因素的分析：一项前瞻性观察研究

IF 3.1 4区医学 Q2 CRITICAL CARE MEDICINE

Medicina Intensiva

Pub Date : 2025-09-01 DOI: 10.1016/j.medin.2025.502144

Rosario Molina Lobo , Federico Gordo Vidal , Lola Prieto López , Inés Torrejón Pérez , Antonio Naharro Abellán , Irene Salinas Gabiña , Beatriz Lobo Valbuena

Objective

Analyze the effects of frailty and prefrailty in patients admitted to the ICU without age limits and to determine the factors associated with mortality.

Design

Prospective cohort.

Setting

Intensive Care Unit, Spain.

Patients

1462 critically ill patients without age limits.

Intervention

None.

Main variables of interest

Hospital mortality and health outcomes.

Results

Patients’ ages ranged from 15 to 93 years, median of 66 years. Predisposing factors independently associated with frailty and prefrailty were age older than 65 years, female sex, respiratory and renal comorbidities, longer pre-ICU stays, and weekend admission. There is a greater use of noninvasive mechanical ventilation, greater colonization by multidrug-resistant bacteria, and the development of delirium. The risk of hospital mortality was RR 4.04 (2.11–7.74; P < .001) for prefail and 5.88 (2.45–14.10; P < .001) for frail. Factors associated with in-hospital mortality in prefrail and frail were pre-ICU hospital length of stay (cutpoint 4.5 days [1.6–7.4]), greater severity on admission (SAPS3) (cutpoint 64.5 [63.6–65.4]), Glasgow Coma Scale deterioration (OR 4.14 [1.23–13.98]; P .022) and thrombocytopenia (OR 11.46 [2.21–59.42]; P .004).

Conclusions

Lower levels of frailty are most common in ICU patients and are associated with worse health outcomes. Our data suggest that frailty and pre frailty should be determined in all patients admitted to the ICU, regardless of their age.

目的分析无年龄限制ICU住院患者虚弱和易患的影响，确定与死亡率相关的因素。DesignProspective队列。重症监护室，西班牙。患者：1462例无年龄限制的危重患者。干预措施无。主要感兴趣的变量：住院死亡率和健康结局。结果患者年龄15 ~ 93岁，中位66岁。与虚弱和易患性独立相关的易感因素为年龄大于65岁、女性、呼吸和肾脏合并症、icu前住院时间较长和周末入院。无创机械通气的使用增多，多药耐药菌定植增多，谵妄发展。未衰竭患者住院死亡风险RR为4.04 (2.11-7.74;P < 0.001)，体弱患者住院死亡风险RR为5.88 （2.45-14.10;P < 0.001）。与体弱和体弱患者住院死亡率相关的因素是icu前住院时间（临界值4.5天[1.6-7.4]）、入院时严重程度（SAPS3）（临界值64.5[63.6-65.4]）、格拉斯哥昏迷评分恶化(OR 4.14 [1.23-13.98]；022)和血小板减少症（OR 11.46 [2.21-59.42]; P .004）。结论虚弱程度较低在ICU患者中最为常见，且与较差的健康结局相关。我们的数据表明，无论年龄大小，所有入住ICU的患者都应确定虚弱和前虚弱。

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引用次数: 0

Reexplicarnos la seguridad del paciente en Medicina Intensiva: necesidad de entender y actuar 重新解释重症监护患者的安全：理解和行动的必要性

IF 3.1 4区医学 Q2 CRITICAL CARE MEDICINE

Medicina Intensiva

Pub Date : 2025-09-01 DOI: 10.1016/j.medin.2025.502219

María Cruz Martín Delgado , Mario Chico Fernández , Gonzalo Sirgo Rodríguez , María Bodí

Both patient safety and risk management in the healthcare field have adjusted to a diversity of conceptual models arising from different industries. Nowadays, patient safety should not be anchored to the most classical models but should be complemented by innovative advances that allow for a comprehensive view of all the key elements and the participation of the agents involved in this essential dimension of healthcare quality. This narrative review aims to analyze the approaches that have nurtured the science of safety over time and to offer a holistic and integrative vision that allows professionals, patients, and organizations to understand how we can move forward in achieving a risk-free healthcare system or at least, make it safer. Although there are experiences in the healthcare field of the application of the new paradigms of safety, there are still many pending questions to be solved before integrating and applying them in the real world.

医疗保健领域的患者安全和风险管理已经适应了来自不同行业的各种概念模型。如今，患者安全不应该被固定在最经典的模型上，而应该被创新的进步所补充，这些进步允许对所有关键要素进行全面的观察，并允许在医疗质量的这个基本维度中涉及的代理的参与。这篇叙述性回顾的目的是分析随着时间的推移，培养安全科学的方法，并提供一个整体和综合的愿景，让专业人员、患者和组织了解我们如何才能向前迈进，实现无风险的医疗保健系统，或者至少使其更安全。虽然在医疗保健领域已经有了应用安全新范式的经验，但在将其整合应用于现实世界之前，仍有许多悬而未决的问题需要解决。

引用次数: 0

El intensivista debe dirigir la implementación de la inteligencia artificial en la UCI 强化者应该领导UCI的人工智能部署

IF 3.1 4区医学 Q2 CRITICAL CARE MEDICINE

Medicina Intensiva

Pub Date : 2025-09-01 DOI: 10.1016/j.medin.2025.502253

Juan-Jose Beunza

引用次数: 0

Quality of causality assessment among observational studies in intensive care: A methodological review 重症监护观察性研究因果关系评价的质量：方法学回顾

IF 3.1 4区医学 Q2 CRITICAL CARE MEDICINE

Medicina Intensiva

Pub Date : 2025-09-01 DOI: 10.1016/j.medin.2025.502142

Laura Del Campo-Albendea , Ana García De La Santa Viñuela , Óscar Peñuelas , José Ignacio Pijoan Zubizarreta , Khalid Saeed Khan , Alfonso Muriel , Javier Zamora

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.

重症监护病房（icu）在许多情况下依赖于观察性研究，在建立因果关系方面经常遇到困难。在对ICU观察性研究进行全面检索后，本综述分析了因果语言并评估了所采用方法的报告质量。因果关系是通过分析标题和主要目标中将暴露与结果联系起来的单词来评估的。与因果推理相关的关键方法学方面的报告质量基于STROBE和ROBINS-I工具。我们确定了139篇文章，其中87篇（63%）和82篇（59%）的研究分别在标题和主要目的中使用了非因果语言。在总数中，有49篇（35%）文章直接涉及因果关系。本综述发现观察性ICU研究中存在模糊的因果语言，并强调需要更好地遵守报告指南，以改进因果分析和推断。

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引用次数: 0

Comunicación interventricular post infarto 梗死后心室通讯

IF 3.1 4区医学 Q2 CRITICAL CARE MEDICINE

Medicina Intensiva

Pub Date : 2025-09-01 DOI: 10.1016/j.medin.2025.502202

Emilio Curiel Balsera, Guillermo Gómez Gallego, Alejandro Navarro Cruz

引用次数: 0

Reverse shock index multiplied by Glasgow coma scale (rSIG) to predict mortality in traumatic brain injury: systematic review and meta-analysis 逆休克指数乘以格拉斯哥昏迷量表（rSIG）预测外伤性脑损伤死亡率：系统回顾和荟萃分析

IF 3.1 4区医学 Q2 CRITICAL CARE MEDICINE

Medicina Intensiva

Pub Date : 2025-09-01 DOI: 10.1016/j.medin.2025.502149

Gustavo Adolfo Vásquez-Tirado , Edinson Dante Meregildo-Rodríguez , Claudia Vanessa Quispe-Castañeda , María Cuadra-Campos , Wilson Marcial Guzmán-Aguilar , Percy Hernán Abanto-Montalván , Hugo Alva-Guarniz , Leslie Jacqueline Liñán-Díaz , Luis Ángel Rodríguez-Chávez

Objective

To determine whether the Reverse Shock Index multiplied by the Glasgow Coma Scale (rSIG) is a predictor of in-hospital mortality in patients with traumatic brain injury (TBI).

Design

This is a systematic review and meta-analysis.

Setting

A comprehensive search was conducted in five databases for studies published up to May 22, 2024, using a PECO strategy. Eight studies were identified for quantitative analysis and included in our meta-analysis.

Participants

The participants of the included primary studies.

Interventions

Patients with a low rSIG as a predictor of in-hospital mortality in TBI.

Main variables of interest

rSIG, in-hospital mortality, TBI.

Results

Our meta-analysis evaluated a total of eight observational studies encompassing 430,000 patients with TBI, observing 6,417 deaths (15%). After performing a sensitivity analysis, we found that patients with TBI and a low value of the reverse shock index multiplied by the Glasgow Coma Scale (rSIG) had a 24% higher risk of death (OR 1.24; 95% CI 1.12–1.38; I²: 96%). Furthermore, rSIG values were significantly higher in survivors compared to those who died (MD 7.72; 95% CI 1.86–13.58; I²: 99%).

目的探讨逆休克指数乘以格拉斯哥昏迷量表（rSIG）是否可以预测外伤性脑损伤（TBI）患者的住院死亡率。这是一项系统回顾和荟萃分析。使用PECO策略，在5个数据库中对截至2024年5月22日发表的研究进行了全面检索。8项研究被确定用于定量分析，并纳入我们的荟萃分析。参与者纳入的主要研究的参与者。干预措施：低rSIG患者作为TBI住院死亡率的预测因子。感兴趣的主要变量：sig，住院死亡率，TBI。我们的荟萃分析共评估了8项观察性研究，包括430,000例TBI患者，观察到6,417例死亡（15%）。在进行敏感性分析后，我们发现，与格拉斯哥昏迷量表（rSIG）相比，逆行休克指数较低的TBI患者的死亡风险高出24% （OR 1.24; 95% CI 1.12-1.38; I²：96%）。此外，幸存者的rSIG值明显高于死亡患者（MD 7.72; 95% CI 1.86-13.58; I²：99%）。

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引用次数: 0

Monitoreo a través de tomografía por impedancia eléctrica en ECMO pediátrico 通过电阻抗断层扫描监测儿科心电图

IF 3.1 4区医学 Q2 CRITICAL CARE MEDICINE

Medicina Intensiva

Pub Date : 2025-09-01 DOI: 10.1016/j.medin.2025.502155

Gabriel Appendino, Fernando Paziencia, Carlos Lovesio

引用次数: 0

Changes in the stress hormone cortisol during intensive care unit stay as a predictor of objective cognition at discharge 在重症监护病房期间应激激素皮质醇的变化作为出院时客观认知的预测因子

IF 3.1 4区医学 Q2 CRITICAL CARE MEDICINE

Medicina Intensiva

Pub Date : 2025-08-01 DOI: 10.1016/j.medin.2025.502166

Guillem Navarra-Ventura , Marta Godoy-González , Lluís Blanch , Josefina López-Aguilar , Sol Fernández-Gonzalo

引用次数: 0

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