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Clinical utility of rapid shallow breathing index in predicting successful weaning: secondary analysis of the COBRE-US trial 快速浅呼吸指数在预测成功断奶方面的临床实用性:COBRE-US 试验的二次分析。
Pub Date : 2025-02-01 DOI: 10.1016/j.medine.2024.06.007
Fabio Varón-Vega , Eduardo Tuta-Quintero , Henry Robayo-Amortegui , Adriana Rincón , Luis F. Giraldo-Cadavid , Jonathan Palacios , Stephanie Crevoisier , Diana C. Duarte , Marcela Poveda , Laura Cucunubo , Pablo Monedero

Objective

To assess the predictive capacity of the Rapid Shallow Breathing Index (RSBI) for success in spontaneous breathing trials (SBT) and extubation in critically ill patients. We evaluated the association between RSBI, duration of mechanical ventilation, and ventilator-free time at 28 days.

Design

Prospective multicenter observational study. Secondary analysis of the COBRE-US study.

Setting

Intensive care unit (ICU).

Patients or participants

367 patients in the ICU receiving invasive mechanical ventilation.

Interventions

Assessment of RSBI at the end of SBT.

Main variables of interest

RSBI, SBT, duration of mechanical ventilation, and ventilator-free time at 28 days were evaluated.

Results

367 patients in the ICU under invasive mechanical ventilation were evaluated, of whom 59.7% were male with a median age of 61 years (IQR: 49–72). A total of 456 SBT were conducted with a success rate of 76.5%. RSBI had a ROC-curve of 0.53 for SBT success and a ROC-curve of 0.48 for extubation. The Spearman correlation coefficient between RSBI and duration of ventilation was 0.117 (p = 0.026), while for ventilator-free time at 28 days, it was −0.116 (p = 0.028).

Conclusions

RSBI was not associated with success in SBT or extubation, regardless of the cutoff point used. Correlation analyses showed weak associations between RSBI and both the duration of ventilation and ventilator-free time at 28 days.
目的评估快速浅呼吸指数(RSBI)对重症患者自主呼吸试验(SBT)和拔管成功的预测能力。我们评估了 RSBI、机械通气持续时间和 28 天无呼吸机时间之间的关联:设计:前瞻性多中心观察研究。COBRE-US研究的二次分析:重症监护病房(ICU):367名接受有创机械通气的重症监护病房患者:主要关注变量:RSBI、SBT、持续时间:评估RSBI、SBT、机械通气持续时间和28天无呼吸机时间:结果:共评估了367名在重症监护室接受有创机械通气的患者,其中59.7%为男性,中位年龄为61岁(IQR:49-72)。共进行了 456 次 SBT,成功率为 76.5%。RSBI 对 SBT 成功率的 ROC 曲线为 0.53,对拔管率的 ROC 曲线为 0.48。RSBI与通气时间的斯皮尔曼相关系数为0.117(p = 0.026),而28天无呼吸机时间的斯皮尔曼相关系数为-0.116(p = 0.028):无论采用哪种截断点,RSBI 都与 SBT 或拔管成功率无关。相关分析表明,RSBI 与通气持续时间和 28 天无呼吸机时间之间的相关性较弱。
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引用次数: 0
Organ donation process: more than just guidelines and protocols 器官捐献程序:不仅仅是指导方针和协议。
Pub Date : 2025-02-01 DOI: 10.1016/j.medine.2024.10.003
Lorena Oteiza López , Óscar Elía Mañú
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引用次数: 0
Anti-Xa activity below range is related to thrombosis in patients with severe COVID-19 抗 Xa 活性低于范围与严重 COVID-19 患者的血栓形成有关。
Pub Date : 2025-02-01 DOI: 10.1016/j.medine.2024.07.003
Pilar Marcos-Neira , Cristian Morales-Indiano , Mariana Fernández-Caballero , Teresa Tomasa-Irriguible , Luisa Bordejé-Laguna , Víctor Ruíz-Artola

Objective

We aimed to anlayse the relationship between anti-Xa activity below range and thomboembolic events.

Design

Single center prospective observational longitudinal cohort study (February–November 2021).

Setting

Patients admitted to the ICU of a University Hospital.

Participants

Patients with severe COVID-19 pneumoniae.

Interventions

Enoxaparin was used for prophylactic and therapeutic anticoagulation. Enoxaparin dosing and dose adjustment were based on anti-Xa activity according to the hospital protocol.

Main variables of interest

Target: thomboembolic events.
Predictors: demographics, pharmacotherapy, anti-Xa measurements, clinical data, and laboratory results.
Logistic regression was used to identify independent risk factors for thomboembolic events.

Results

Data were available for 896 serum anti-Xa measurements from 228 subjects. Overall, 71.9% were male, with a median age of 62. Most patients needed invasive mechanical ventilation (87.7%) and mortality was 24.1%. A total of 28.9% new thomboembolic events were diagnosed. There were 27.1% anti-Xa measesurements below range. When multivariable logistic regression analysis was performed anti-Xa activity below range (RR, 4.2; p = 0.000), C-reactive protein (25 mg/L increase) (RR, 1.14; p = 0.005) and D-dimer (1000 ng/L increase) (RR, 1.06; p = 0.002) were the independent factors related to new thomboembolic events in patients with severe COVID-19.

Conclusions

Anti-Xa activity below range, C-reactive protein and D-dimer were the independent factors related to thomboembolic events in patients with severe COVID-19. Purposely designed clinical trials should be carried out to confirm the benefit of an anti-Xa monitoring.
目的我们旨在分析抗 Xa 活性低于范围与血栓栓塞事件之间的关系:单中心前瞻性纵向队列研究(2021 年 2 月至 11 月):地点:某大学附属医院重症监护室收治的患者:重症COVID-19肺炎患者:干预措施:依诺肝素用于预防性和治疗性抗凝。干预措施:使用依诺肝素进行预防性和治疗性抗凝,并根据医院的方案,根据抗 Xa 活性对依诺肝素的剂量和剂量进行调整:目标:血栓栓塞事件。预测因素:人口统计学、药物治疗、抗 Xa 测量、临床数据和实验室结果。采用逻辑回归法确定血栓栓塞事件的独立风险因素:228名受试者的896次血清抗Xa测量数据可用。总体而言,71.9%为男性,中位年龄为62岁。大多数患者需要有创机械通气(87.7%),死亡率为 24.1%。共诊断出 28.9% 的新血栓栓塞事件。27.1%的患者抗Xa测定值低于范围。在进行多变量逻辑回归分析时,抗 Xa 活性低于范围(RR,4.2;P = 0.000)、C 反应蛋白(增加 25 毫克/升)(RR,1.14;P = 0.005)和 D-二聚体(增加 1000 纳克/升)(RR,1.06;P = 0.002)是严重 COVID-19 患者新发血栓栓塞事件的独立相关因素:结论:抗-Xa活性低于范围、C反应蛋白和D-二聚体是严重COVID-19患者发生血栓栓塞事件的独立相关因素。应开展专门设计的临床试验,以确认抗 Xa 监测的益处。
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引用次数: 0
Venous pulmonary embolism - A rare clinical case 静脉肺栓塞--一个罕见的临床病例。
Pub Date : 2025-02-01 DOI: 10.1016/j.medine.2024.06.008
Sérgio Pina , Pedro Alves , Andriy Krystopchuc
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引用次数: 0
Moral complexity in the organ donation process: The satisfaction of a job well done 器官捐献过程中的道德复杂性:完成工作的满足感。
Pub Date : 2025-02-01 DOI: 10.1016/j.medine.2024.07.014
José Miguel Pérez-Villares , Ramón Lara-Rosales , Alberto Fernández-Carmona , Alberto Iglesias-Santiago
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引用次数: 0
The human factor and ergonomics in Patient Safety 病人安全中的人为因素和人体工程学。
Pub Date : 2025-02-01 DOI: 10.1016/j.medine.2024.03.014
Miguel Valdivia de la Fuente, Diego José Palacios Castañeda, Nuria Martínez Sanz
The human condition is linked to error in any activity that is performed, and the healthcare world is no exception. The origin of human error does not lie within the perversity of human nature, instead, it has its origins in latent failures in the healthcare environment and is a consequence of the processes and procedures applied. The science of the Human Factor deals with the application of knowledge to people (capabilities, characteristics and limitations), with the design and the management of the equipment they use and with the environments in which they work and the activities they carry out.
Part of the Human Factor are the non-technical skills. These skills greatly influence people's behavior and, therefore, their performance and the quality of healthcare in a very complex socio-technical system.
在任何活动中,人为因素都会导致错误,医疗保健领域也不例外。人为错误的根源并不在于人性的变态,相反,它起源于医疗环境中潜在的失误,是所应用的流程和程序造成的后果。人为因素科学涉及到人的知识应用(能力、特点和局限性)、人所使用设备的设计和管理、人的工作环境以及人所开展的活动。人的因素的一部分是非技术性技能。这些技能在很大程度上影响着人们的行为,进而影响着他们在一个非常复杂的社会技术系统中的表现和医疗质量。
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引用次数: 0
Horner’s syndrome after chest drain insertion due to pneumothorax 因气胸插入胸腔引流管后出现霍纳氏综合征。
Pub Date : 2025-02-01 DOI: 10.1016/j.medine.2024.05.014
Arthur Orieux , Raphaël Birot , Didier Gruson , Renaud Prevel
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引用次数: 0
Sepsis associated to contamination of propofol infusion by Pantoea agglomerans. A case series 与异丙酚输液受到泛变形杆菌污染有关的败血症。病例系列。
Pub Date : 2025-02-01 DOI: 10.1016/j.medine.2024.10.006
Marlene Feo González, Maite Arlabán Carpintero, Lucía Corta Iriarte, Adolfo Íñiguez de Diego, Johanna Marcela Abril Victorino, Verónica Calleja Muñoz
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引用次数: 0
Application of a machine learning model for early prediction of in-hospital cardiac arrests: Retrospective observational cohort study 应用机器学习模型对院内心脏骤停进行早期预测:回顾性观察队列研究。
Pub Date : 2025-02-01 DOI: 10.1016/j.medine.2024.07.004
L. Socias Crespí , L. Gutiérrez Madroñal , M. Fiorella Sarubbo , M. Borges-Sa , A. Serrano García , D. López Ramos , C. Pruenza Garcia-Hinojosa , E. Martin Garijo

Objective

To describe the results of the application of a Machine Learning (ML) model to predict in-hospital cardiac arrests (ICA) 24 hours in advance in the hospital wards.

Design

Retrospective observational cohort study.

Setting

Hospital Wards.

Patients

Data were extracted from the hospital's Electronic Health Record (EHR). The resulting database contained a total of 750 records corresponding to 620 different patients (370 patients with ICA and 250 control), between may 2009 and december 2021.

Interventions

No.

Main variables of interest

As predictors of ICA, a set of 28 variables including personal history, vital signs and laboratory data was employed.

Models

For the early prediction of ICA, predictive models based on the following ML algorithms and using the mentioned variables, were developed and compared: K Nearest Neighbours, Support Vector Machine, Multilayer Perceptron, Random Forest, Gradient Boosting and Custom Ensemble of Gradient Boosting estimators (CEGB).

Experiments

Model training and evaluation was carried out using cross validation. Among metrics of performance, accuracy, specificity, sensitivity and AUC were estimated.

Results

The best performance was provided by the CEGB model, which obtained an AUC = 0.90, a specificity = 0.84 and a sensitivity = 0.81. The main variables with influence to predict ICA were level of consciousness, haemoglobin, glucose, urea, blood pressure, heart rate, creatinine, age and hypertension, among others.

Conclusions

The use of ML models could be of great support in the early detection of ICA, as the case of the CEGB model endorsed, which enabled good predictions of ICA.
目的:描述应用机器学习(ML)模型预测院内心脏骤停(ICA)的结果:描述应用机器学习(ML)模型提前 24 小时预测医院病房内心脏骤停(ICA)的结果:设计:回顾性观察队列研究:环境:医院病房:数据来自医院的电子健康记录(EHR)。由此产生的数据库包含 2009 年 5 月至 2021 年 12 月期间 620 名不同患者(370 名 ICA 患者和 250 名对照组患者)的 750 条记录:无:主要研究变量:采用一组包括个人病史、生命体征和实验室数据在内的 28 个变量作为 ICA 的预测因子:模型:为早期预测 ICA,基于以下 ML 算法并使用上述变量开发了预测模型,并进行了比较:K 近邻、支持向量机、多层感知器、随机森林、梯度提升和梯度提升估计器自定义组合(CEGB):实验:采用交叉验证法进行模型训练和评估。在性能指标中,对准确率、特异性、灵敏度和 AUC 进行了估算:结果:CEGB 模型的性能最佳,其 AUC = 0.90,特异性 = 0.84,灵敏度 = 0.81。对预测 ICA 有影响的主要变量是意识水平、血红蛋白、葡萄糖、尿素、血压、心率、肌酐、年龄和高血压等:正如 CEGB 模型所认可的那样,使用 ML 模型对早期发现 ICA 有很大帮助,它能很好地预测 ICA。
{"title":"Application of a machine learning model for early prediction of in-hospital cardiac arrests: Retrospective observational cohort study","authors":"L. Socias Crespí ,&nbsp;L. Gutiérrez Madroñal ,&nbsp;M. Fiorella Sarubbo ,&nbsp;M. Borges-Sa ,&nbsp;A. Serrano García ,&nbsp;D. López Ramos ,&nbsp;C. Pruenza Garcia-Hinojosa ,&nbsp;E. Martin Garijo","doi":"10.1016/j.medine.2024.07.004","DOIUrl":"10.1016/j.medine.2024.07.004","url":null,"abstract":"<div><h3>Objective</h3><div>To describe the results of the application of a Machine Learning (ML) model to predict in-hospital cardiac arrests (ICA) 24 hours in advance in the hospital wards.</div></div><div><h3>Design</h3><div>Retrospective observational cohort study.</div></div><div><h3>Setting</h3><div>Hospital Wards.</div></div><div><h3>Patients</h3><div>Data were extracted from the hospital's Electronic Health Record (EHR). The resulting database contained a total of 750 records corresponding to 620 different patients (370 patients with ICA and 250 control), between may 2009 and december 2021.</div></div><div><h3>Interventions</h3><div>No.</div></div><div><h3>Main variables of interest</h3><div>As predictors of ICA, a set of 28 variables including personal history, vital signs and laboratory data was employed.</div></div><div><h3>Models</h3><div>For the early prediction of ICA, predictive models based on the following ML algorithms and using the mentioned variables, were developed and compared: K Nearest Neighbours, Support Vector Machine, Multilayer Perceptron, Random Forest, Gradient Boosting and Custom Ensemble of Gradient Boosting estimators (CEGB).</div></div><div><h3>Experiments</h3><div>Model training and evaluation was carried out using cross validation. Among metrics of performance, accuracy, specificity, sensitivity and AUC were estimated.</div></div><div><h3>Results</h3><div>The best performance was provided by the CEGB model, which obtained an AUC = 0.90, a specificity = 0.84 and a sensitivity = 0.81. The main variables with influence to predict ICA were level of consciousness, haemoglobin, glucose, urea, blood pressure, heart rate, creatinine, age and hypertension, among others.</div></div><div><h3>Conclusions</h3><div>The use of ML models could be of great support in the early detection of ICA, as the case of the CEGB model endorsed, which enabled good predictions of ICA.</div></div>","PeriodicalId":94139,"journal":{"name":"Medicina intensiva","volume":"49 2","pages":"Pages 88-95"},"PeriodicalIF":0.0,"publicationDate":"2025-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142116533","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
引用次数: 0
Analgosedation and delirium practices in critically ill patients in the Pan-American and Iberian setting, and factors associated with oversedation after the COVID-19 pandemic: Results from the PANDEMIC study.
Pub Date : 2025-02-01 DOI: 10.1016/j.medine.2025.502123
Carola Giménez-Esparza Vich, Felipe Martínez, Daniela Olmos Kutscherauer, Daniel Molano, Maria Del Carmen Gallardo, Enrique Mario Olivares-Durán, Jesús Caballero, Rosa Reina, Manuela García Sánchez, Federico C Carini

Oversedation has adverse effects on critically ill patients. The Analgosedation and Delirium Committee of the FEPIMCTI (Pan-American and Iberian Federation of Critical Care Medicine and Intensive Care) conducted a cross-sectional study through a survey addressed to ICU physicians: PANDEMIC (Pan-American and Iberian Study on the Management of Analgosedation and Delirium in Critical Care [fepImCti]). HYPOTHESIS: Worsening of these practices in the course of the pandemic and that continued afterwards, with further oversedation. OBJECTIVES: Perception of analgosedation and delirium practices in Pan-American and Iberian ICUs before, during and after the COVID-19 pandemic, and factors associated with persistent oversedation after the pandemic. Of the 1008 respondents, 25% perceived oversedation after the pandemic (95%CI 22.4-27.8). This perception was higher in South America (35.8%, P < .001). Main risk factor: habit acquired during the pandemic (adjusted OR [aOR] 3.16, 95%CI 2.24-4.45, P < .001). Main protective factor: delirium monitoring before the pandemic (aOR 0.70, 95%CI 0.50-0.98, P = .038). The factors identified in this study provide a basis for targeting future interventions.

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引用次数: 0
期刊
Medicina intensiva
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