Medicina Intensiva最新文献

英文中文

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

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

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