Medicina Intensiva最新文献

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Intravenous beta-blockers versus amiodarone on in-hospital mortality and safety profile in adult septic patients 静脉注射受体阻滞剂与胺碘酮对成人脓毒症患者住院死亡率和安全性的影响

IF 2.7 4区医学 Q2 CRITICAL CARE MEDICINE

Medicina Intensiva

Pub Date : 2025-07-01 DOI: 10.1016/j.medin.2025.502143

Guoge Huang , Haizhong Li , Feier Song , Chunmei Zhang , Mengling Jian , Chunyang Huang , Yingqin Zhang , Bei Hu , Wenqiang Jiang

Objective

In the present study, we aimed to compare in-hospital mortality and safety of intravenous beta-blockers and amiodarone in septic patients with new-onset atrial fibrillation (NOAF). The null hypothesis is that there is no significant difference in in-hospital mortality and safety of Beta-blocker (BBs) and amiodarone in treating NOAF in patients with sepsis.

Design

We conducted a retrospective analysis based on the MIMIC-IV database. Septic patients with NOAF were screened.

Setting

Patients admitted to adult mixed ICU for septic patients with NOAF.

Patients

A total of 34,789 patients were screened of whom 1394 patients were included for the analysis: 286 in the amiodarone group and 1108 in the BBs group.

Interventions

None.

Main variables of interest

Cox proportional hazard model was used to examine the in-hospital mortality, ventilator-free days and duration of atrial fibrillation in patients receiving either amiodarone or intravenous BBs. Propensity score matching was applied to determine any association.

Results

After Propensity Score (PS) matching, a total of 244 patients were included in both the BB and amiodarone groups. In this cohort, BBs was significantly associated with lower in-hospital mortality [adjusted hazard ratio (HR) of 0.70 (95% CI 0,54–0,91; P = 0.008)]. On the other hand, patients who received amiodarone had a shorter duration of atrial fibrillation (54.17 h vs 72.81 h; P = 0.003). There was no significant difference in ventilator-free days between the BB group and the amiodarone group.

Conclusion

In septic patients with NOAF, patients receiving BBs had lower in-hospital mortality than those who received amiodarone. On the other hand, amiodarone group had a shorter duration of atrial fibrillation. There was no significant difference in ventilator-free days between the BB group and the amiodarone group.

目的比较乙型受体阻滞剂和胺碘酮在脓毒症合并新发心房颤动（NOAF）患者中的住院死亡率和安全性。原假设：β受体阻滞剂（BBs）与胺碘酮治疗脓毒症患者NOAF的住院死亡率和安全性无显著差异。我们基于MIMIC-IV数据库进行回顾性分析。对脓毒性NOAF患者进行筛查。背景：脓毒症合并NOAF患者入住成人混合ICU。患者共筛选34,789例患者，其中1394例纳入分析：胺碘酮组286例，BBs组1108例。干预措施：主要感兴趣的变量采用cox比例风险模型检查接受胺碘酮或静脉注射BBs的患者的住院死亡率、无呼吸机天数和房颤持续时间。使用倾向评分匹配来确定任何关联。结果倾向评分（PS）匹配后，BB组和胺碘酮组共纳入244例患者。在这个队列中，BBs与较低的住院死亡率显著相关[校正危险比（HR）为0.70](95% CI 0,54 - 0,91； = 0.008页)]。另一方面，接受胺碘酮治疗的患者房颤持续时间较短(54.17 h vs 72.81 h； = 0.003页)。BB组与胺碘酮组无呼吸机天数差异无统计学意义。结论在脓毒症NOAF患者中，服用BBs的患者住院死亡率低于服用胺碘酮的患者。胺碘酮组房颤持续时间较短。BB组与胺碘酮组无呼吸机天数差异无统计学意义。

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引用次数: 0

What should intensivists know about immune checkpoint inhibitors and their side effects? 关于免疫检查点抑制剂及其副作用，强化医师应该知道些什么？

IF 2.7 4区医学 Q2 CRITICAL CARE MEDICINE

Medicina Intensiva

Pub Date : 2025-07-01 DOI: 10.1016/j.medin.2024.502135

Viktor Yordanov Zlatkov Aleksandrov, Fernando Martínez Sagasti, Juncal Pérez-Somarriba Moreno, Helena Huertas Mondéjar

The pharmacological group of immune checkpoint-inhibitors (ICI) has revolutionized the field of oncology in the last ten years. The improvements in the survival of certain cancers thanks to these treatments comes at the cost of an increased morbidity and mortality due to certain immune related adverse events (irAE). This review will concentrate on the irAE that more frequently require intensive care unit (ICU) admission. The infectious burden of patients treated with ICI is also explored, shining light not only on the infections caused by the immunosuppression needed to manage the different irAE, but also on the specific infections arising from a unique immune dysregulation only seen in ICI treated patients.

在过去的十年中，免疫检查点抑制剂（ICI）的药理学组已经彻底改变了肿瘤学领域。由于这些治疗，某些癌症的生存率有所提高，但代价是某些免疫相关不良事件（irAE）导致的发病率和死亡率增加。本综述将集中在更频繁需要重症监护病房（ICU）入院的irAE。研究还探讨了ICI治疗患者的感染负担，不仅揭示了由控制不同irAE所需的免疫抑制引起的感染，还揭示了仅在ICI治疗患者中可见的独特免疫失调引起的特定感染。

引用次数: 0

Seguridad y eficacia de betabloqueantes y amiodarona en el manejo de la fibrilación auricular de nueva aparición en el paciente crítico con sepsis β受体阻滞剂和amiodarone在治疗严重败血症患者耳部新发纤颤方面的安全性和有效性

IF 2.7 4区医学 Q2 CRITICAL CARE MEDICINE

Medicina Intensiva

Pub Date : 2025-07-01 DOI: 10.1016/j.medin.2025.502159

Alfonso Canabal Berlanga

引用次数: 0

Niveles óptimos de hemoglobina en el paciente neurocrítico: ¿hemos llegado ya? 神经危急患者的最佳血红蛋白水平：我们已经达到了吗？

IF 2.7 4区医学 Q2 CRITICAL CARE MEDICINE

Medicina Intensiva

Pub Date : 2025-07-01 DOI: 10.1016/j.medin.2025.502162

Manuel Quintana-Diaz , Daniel Agustin Godoy

引用次数: 0

Respuesta a: «Vasopresina: ¿por qué no en la enfermedad traumática grave?» 对：“后叶加压素：为什么不用于严重的创伤性疾病？”»

IF 2.7 4区医学 Q2 CRITICAL CARE MEDICINE

Medicina Intensiva

Pub Date : 2025-07-01 DOI: 10.1016/j.medin.2025.502220

Juan Carlos Ruíz-Rodríguez , Ana Ochagavia , Lluís Zapata , Ricard Ferrer

引用次数: 0

Electrical impedance tomography for the detection and management optimization of pulmonary embolism 电阻抗断层扫描对肺栓塞的检测和优化处理

IF 2.7 4区医学 Q2 CRITICAL CARE MEDICINE

Medicina Intensiva

Pub Date : 2025-07-01 DOI: 10.1016/j.medin.2024.502134

Isabel Magaña Bru, Alicia Delgado Arroyo, Fernando Suarez Sipmann

引用次数: 0

Ausencia congénita de la arteria coronaria circunfleja 先天性缺环冠状动脉

IF 2.7 4区医学 Q2 CRITICAL CARE MEDICINE

Medicina Intensiva

Pub Date : 2025-07-01 DOI: 10.1016/j.medin.2025.502152

Antonio Padilla-Serrano , Carmen de la Cueva Coca , Antonio Cárdenas Cruz

引用次数: 0

Neuroaspergilosis: un desafío diagnóstico en los pacientes inmunosuprimidos ilustrado en una imagen de resonancia magnética 神经曲霉病：免疫抑制患者的诊断挑战，如磁共振成像所示

IF 2.7 4区医学 Q2 CRITICAL CARE MEDICINE

Medicina Intensiva

Pub Date : 2025-07-01 DOI: 10.1016/j.medin.2025.502151

Almudena Domínguez González, Nuria Medina Cabrera, Alejandro Hueso Mor

引用次数: 0

Fiabilidad intraobservador e interobservador de las escalas de fragilidad Clinical Frailty Scale-España y FRAIL-España en pacientes críticos 重症患者临床虚弱量表（西班牙）和FRAIL（西班牙）的观察内和观察间可靠性

IF 2.7 4区医学 Q2 CRITICAL CARE MEDICINE

Medicina Intensiva

Pub Date : 2025-07-01 DOI: 10.1016/j.medin.2024.502131

Susana Arias-Rivera , María Mar Sánchez-Sánchez , Raquel Jareño-Collado , Marta Raurell-Torredà , Lorena Oteiza-López , Sonia López-Cuenca , Israel John Thuissard-Vasallo , Fernando Frutos-Vivar

Objective

To evaluate the intrarater and interrater reliability of the Clinical Frailty Scale-Spain (CFS-España) and FRAIL-España and the internal consistency of the FRAIL-España when implemented in critically ill patients by intensive care nurses and physicians.

Design

Descriptive, observational and metric study.

Setting

Intensive care unit (ICU) of Spain.

Patients

Patients > 18 years, with > 48 UCI hours.

Intervention

None.

Main variables of interest

On admission, frailty with CFS-España and FRAIL-España (by 3 nurses and 2 intensive care physicians), sex, age, comorbidities and severity.

Results

1,045 assessments were performed in 206 patients. Not frail patients on admission: 53% according to the CFS-Spain and 34% according to the FRAIL-Spain.

The intraclass correlation coefficient (ICC) shows almost perfect intrarater concordance (> 0.80 for CFS-España and > 0.90 for FRAIL-España). Agreement by frailty strata (non-fragile, pre-fragile and fragile patients) was substantial or almost perfect, with no major differences in ratings between nurses and physicians.

Interprofessional concordance shows an almost perfect ICC for both scales. The lowest agreement was obtained for the FRAIL-España ratings among physicians. In the frailty strata analysis, agreement was moderate. The highest agreement for the CFS-España was considering level 4 patients as frail.

High reliability of the FRAIL-España and strong correlation of all dimensions with the global assessment were obtained, except for the comorbidities dimension, with a weak correlation.

Conclusion

The CFS-España and FRAIL-España scales are reliable for assessing frailty in critically ill patients by nurses and/or intensive care physicians.

目的评价西班牙临床虚弱量表（CFS-España）和FRAIL-España在重症监护护士和内科医生实施时的内部信度和内部信度，以及FRAIL-España的内部一致性。设计描述性、观察性和度量性研究。西班牙重症监护病房（ICU）。PatientsPatients祝辞18年，与>；入院时，虚弱（CFS-España和FRAIL-España）（3名护士和2名重症监护医生），性别，年龄，合并症和严重程度。结果206例患者共进行1045次评估。入院时身体不虚弱的患者：根据CFS-Spain的数据为53%，根据fail - spain的数据为34%。类内相关系数（ICC）显示出几乎完美的类内一致性(>；0.80 CFS-España和>；0.90 （FRAIL-España）。脆弱阶层（非脆弱、预脆弱和脆弱患者）的同意是实质性的或几乎完美的，护士和医生之间的评分没有重大差异。专业间的一致性表明，这两个尺度的ICC几乎是完美的。在医生中，FRAIL-España评分的一致性最低。在脆弱层分析中，一致性是中等的。CFS-España的最高协议是将4级患者视为虚弱。除了合并症维度外，FRAIL-España的可靠性高，所有维度与整体评估的相关性强，相关性弱。结论CFS-España和FRAIL-España量表是护士和（或）重症监护医师评估危重病人虚弱程度的可靠量表。

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引用次数: 0

Vasopresina: ¿por qué no en la enfermedad traumática grave? 后叶加压素：为什么不能用于严重的创伤性疾病？

IF 2.7 4区医学 Q2 CRITICAL CARE MEDICINE

Medicina Intensiva

Pub Date : 2025-07-01 DOI: 10.1016/j.medin.2025.502173

Jesús Abelardo Barea-Mendoza , Juan Antonio Llompart-Pou , Adrian Marcos-Morales , Mario Chico-Fernández

引用次数: 0

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