Pub Date : 2025-10-01DOI: 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
{"title":"Utility of airway occlusion pressure in traumatic diaphragmatic rupture","authors":"Noemi Merino Pizarro , Manuel Valdivia Marchal , Carmen Bermudez Ruiz , Juan Francisco Martinez Carmona , Ashlen Rodriguez Carmona , Jose Manuel Serrano Simon","doi":"10.1016/j.medin.2025.502214","DOIUrl":"10.1016/j.medin.2025.502214","url":null,"abstract":"","PeriodicalId":49268,"journal":{"name":"Medicina Intensiva","volume":"49 10","pages":"Article 502214"},"PeriodicalIF":3.1,"publicationDate":"2025-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145189705","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 : 2025-10-01DOI: 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.
{"title":"Actualización de la taxonomía de los modos de ventilación mecánica","authors":"Aurio Fajardo-Campoverdi , Eduardo Mireles-Cabodevila , Alberto Medina , Miguel Ibarra-Estrada , José Baltazar-Torres , Robert Chatburn","doi":"10.1016/j.medin.2025.502211","DOIUrl":"10.1016/j.medin.2025.502211","url":null,"abstract":"<div><div>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.</div></div>","PeriodicalId":49268,"journal":{"name":"Medicina Intensiva","volume":"49 10","pages":"Article 502211"},"PeriodicalIF":3.1,"publicationDate":"2025-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145189702","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 : 2025-09-01DOI: 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 1st, 1997, and December 31st, 2022, who were treated with NIV.
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。
{"title":"Effectiveness of non-invasive ventilation in critical patients with acute respiratory failure and do not intubate order","authors":"Andres Carrillo-Alcaraz , Miguel Guia , Pilar Tornero-Yepez , Laura López-Gomez , Nuria Alonso-Fernandez , Juan Gervasio Martin Lorenzo , Juan Miguel Sanchez Nieto","doi":"10.1016/j.medin.2025.502169","DOIUrl":"10.1016/j.medin.2025.502169","url":null,"abstract":"<div><h3>Objective</h3><div>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.</div></div><div><h3>Design</h3><div>Retrospective observational study.</div></div><div><h3>Setting</h3><div>Polyvalent ICU.</div></div><div><h3>Patients</h3><div>All consecutively admitted ICU patients for ARF between January 1<sup>st</sup>, 1997, and December 31<sup>st</sup>, 2022, who were treated with NIV.</div></div><div><h3>Main variables of interest</h3><div>Initial clinical variables, NIV failure rate, complications, in-hospital and one-year mortality.</div></div><div><h3>Results</h3><div>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%<em>)</em>. 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).</div></div><div><h3>Conclusions</h3><div>DNI orders are common in patients with ARF treated with NIV and they related to worse short and long-term prognosis.</div></div>","PeriodicalId":49268,"journal":{"name":"Medicina Intensiva","volume":"49 9","pages":"Article 502169"},"PeriodicalIF":3.1,"publicationDate":"2025-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144921203","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 : 2025-09-01DOI: 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.
{"title":"Reformulación de los análisis aleatorios de seguridad en tiempo real durante la pandemia SARS-CoV-2","authors":"Gonzalo Sirgo , Manuel A. Samper , Julen Berrueta , Joana Cañellas , Alejandro Rodríguez , María Bodí","doi":"10.1016/j.medin.2024.502117","DOIUrl":"10.1016/j.medin.2024.502117","url":null,"abstract":"<div><h3>Introduction</h3><div>From a safety perspective, the pandemic imposed atypical work dynamics that led to noticeable gaps in clinical safety across all levels of health care.</div></div><div><h3>Objectives</h3><div>To verify that Real-Time Random Safety Analyses (AASTRE) are feasible and useful in a high-pressure care setting.</div></div><div><h3>Design</h3><div>Prospective study (January to September 2022).</div></div><div><h3>Setting</h3><div>University hospital with 350 beds. Two mixed ICUs (12 and 14 beds).</div></div><div><h3>Interventions</h3><div>Two safety audits per week were planned to determine the feasibility and usefulness of the 32 safety measures (grouped into 8 blocks).</div></div><div><h3>Main variables of interest</h3><div>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.</div></div><div><h3>Results</h3><div>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.</div></div><div><h3>Conclusions</h3><div>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.</div></div>","PeriodicalId":49268,"journal":{"name":"Medicina Intensiva","volume":"49 9","pages":"Article 502117"},"PeriodicalIF":3.1,"publicationDate":"2025-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144921201","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 : 2025-09-01DOI: 10.1016/j.medin.2025.502213
Rafael Fernández Fernández
{"title":"Usamos ventilación no invasiva cada día, pero ¿conocemos su eficacia real en nuestro centro?","authors":"Rafael Fernández Fernández","doi":"10.1016/j.medin.2025.502213","DOIUrl":"10.1016/j.medin.2025.502213","url":null,"abstract":"","PeriodicalId":49268,"journal":{"name":"Medicina Intensiva","volume":"49 9","pages":"Article 502213"},"PeriodicalIF":3.1,"publicationDate":"2025-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144922099","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 : 2025-09-01DOI: 10.1016/j.medin.2025.502175
Pablo Carrión Montaner , Mario Sutil-Vega , Jordi Sans-Roselló
{"title":"Susurros del corazón: la travesía de una disección aórtica","authors":"Pablo Carrión Montaner , Mario Sutil-Vega , Jordi Sans-Roselló","doi":"10.1016/j.medin.2025.502175","DOIUrl":"10.1016/j.medin.2025.502175","url":null,"abstract":"","PeriodicalId":49268,"journal":{"name":"Medicina Intensiva","volume":"49 9","pages":"Article 502175"},"PeriodicalIF":3.1,"publicationDate":"2025-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144921130","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}
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.
{"title":"Analysis of frailty as a prognostic factor independent of age: A prospective observational study","authors":"Rosario Molina Lobo , Federico Gordo Vidal , Lola Prieto López , Inés Torrejón Pérez , Antonio Naharro Abellán , Irene Salinas Gabiña , Beatriz Lobo Valbuena","doi":"10.1016/j.medin.2025.502144","DOIUrl":"10.1016/j.medin.2025.502144","url":null,"abstract":"<div><h3>Objective</h3><div>Analyze the effects of frailty and prefrailty in patients admitted to the ICU without age limits and to determine the factors associated with mortality.</div></div><div><h3>Design</h3><div>Prospective cohort.</div></div><div><h3>Setting</h3><div>Intensive Care Unit, Spain.</div></div><div><h3>Patients</h3><div>1462 critically ill patients without age limits.</div></div><div><h3>Intervention</h3><div>None.</div></div><div><h3>Main variables of interest</h3><div>Hospital mortality and health outcomes.</div></div><div><h3>Results</h3><div>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 <em>delirium</em>. The risk of hospital mortality was RR 4.04 (2.11–7.74; <em>P</em> <!--><<!--> <!-->.001) for prefail and 5.88 (2.45–14.10; <em>P</em> <!--><<!--> <!-->.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]; <em>P</em> .022) and thrombocytopenia (OR 11.46 [2.21–59.42]; <em>P</em> .004).</div></div><div><h3>Conclusions</h3><div>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.</div></div>","PeriodicalId":49268,"journal":{"name":"Medicina Intensiva","volume":"49 9","pages":"Article 502144"},"PeriodicalIF":3.1,"publicationDate":"2025-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144921202","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 : 2025-09-01DOI: 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.
{"title":"Reexplicarnos la seguridad del paciente en Medicina Intensiva: necesidad de entender y actuar","authors":"María Cruz Martín Delgado , Mario Chico Fernández , Gonzalo Sirgo Rodríguez , María Bodí","doi":"10.1016/j.medin.2025.502219","DOIUrl":"10.1016/j.medin.2025.502219","url":null,"abstract":"<div><div>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.</div></div>","PeriodicalId":49268,"journal":{"name":"Medicina Intensiva","volume":"49 9","pages":"Article 502219"},"PeriodicalIF":3.1,"publicationDate":"2025-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144921126","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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