Pub Date : 2025-02-04DOI: 10.1016/j.medine.2025.502122
José Luis García-Garmendia, Josep Trenado-Álvarez, Federico Gordo-Vidal, Elena Gordillo-Escobar, Esther Martínez-Barrios, Fernando Onieva-Calero, Víctor Sagredo-Meneses, Emilio Rodríguez-Ruiz, Rafael Ángel Bohollo-de-Austria, José Moreno-Quintana, María Isabel Ruiz-García, José Garnacho-Montero
Objective: To determine the changes in intubation procedures of critically ill patients without SARS-CoV-2 infection induced during the COVID-19 pandemic.
Design: Secondary Analysis of the INTUPROS Prospective Multicenter Observational Study on Intubation in Intensive Care Units (ICUs).
Setting: 43 Spanish ICUs between April 2019 and October 2020.
Patients: 1515 Non-COVID-19 patients intubated before and during the pandemic.
Interventions: None.
Main variables of interest: Intubation procedures and medication, first-pass success rate, complications, and mortality.
Results: 1199 patients intubated before the pandemic and 316 during the pandemic were analyzed. During the pandemic, there were fewer days until intubation (OR 0.95 95% CI [0.92-0.98]), reduced resuscitation bag (OR 0.43 95% CI [0.29-0.63]) and non-invasive ventilation oxygenation (OR 0.51 95% CI [0.34-0.76]), reduced use of capnography (OR 0.55 95% CI [0.33-0.92]) and fentanyl (OR 0.47 95% CI [0.34-0.63]). On the other hand, there was an increase in oxygenation with non-HFNC devices (OR 2.21 95% CI [1.23-3.96]), in use of videolaryngoscopy on the first-pass (OR 2.74 95% CI [1.76-4.24]), and greater use of midazolam (OR 1.95 95% CI [1.39-2.72]), etomidate (OR 1.78 95% CI [1.28-2.47]) and succinylcholine (OR 2.55 95% CI [1.82-3.58]). The first-pass success was higher (68.5% vs. 74.7%; P=.033). There were no pre-post differences in major complications (34.7% vs. 34.8%; P=.970) and in-hospital mortality (42.7% vs. 38.6%; P=.137).
Conclusions: The COVID-19 pandemic modified intubation procedures in non-COVID-19 patients, changing the oxygenation strategy, the medication and the use of videolaryngoscopy, with no impact on complications or mortality.
{"title":"Did intubation procedures for critically ill patients without SARS-CoV-2 infection change during the pandemic? Secondary analysis of the INTUPROS multicenter study.","authors":"José Luis García-Garmendia, Josep Trenado-Álvarez, Federico Gordo-Vidal, Elena Gordillo-Escobar, Esther Martínez-Barrios, Fernando Onieva-Calero, Víctor Sagredo-Meneses, Emilio Rodríguez-Ruiz, Rafael Ángel Bohollo-de-Austria, José Moreno-Quintana, María Isabel Ruiz-García, José Garnacho-Montero","doi":"10.1016/j.medine.2025.502122","DOIUrl":"https://doi.org/10.1016/j.medine.2025.502122","url":null,"abstract":"<p><strong>Objective: </strong>To determine the changes in intubation procedures of critically ill patients without SARS-CoV-2 infection induced during the COVID-19 pandemic.</p><p><strong>Design: </strong>Secondary Analysis of the INTUPROS Prospective Multicenter Observational Study on Intubation in Intensive Care Units (ICUs).</p><p><strong>Setting: </strong>43 Spanish ICUs between April 2019 and October 2020.</p><p><strong>Patients: </strong>1515 Non-COVID-19 patients intubated before and during the pandemic.</p><p><strong>Interventions: </strong>None.</p><p><strong>Main variables of interest: </strong>Intubation procedures and medication, first-pass success rate, complications, and mortality.</p><p><strong>Results: </strong>1199 patients intubated before the pandemic and 316 during the pandemic were analyzed. During the pandemic, there were fewer days until intubation (OR 0.95 95% CI [0.92-0.98]), reduced resuscitation bag (OR 0.43 95% CI [0.29-0.63]) and non-invasive ventilation oxygenation (OR 0.51 95% CI [0.34-0.76]), reduced use of capnography (OR 0.55 95% CI [0.33-0.92]) and fentanyl (OR 0.47 95% CI [0.34-0.63]). On the other hand, there was an increase in oxygenation with non-HFNC devices (OR 2.21 95% CI [1.23-3.96]), in use of videolaryngoscopy on the first-pass (OR 2.74 95% CI [1.76-4.24]), and greater use of midazolam (OR 1.95 95% CI [1.39-2.72]), etomidate (OR 1.78 95% CI [1.28-2.47]) and succinylcholine (OR 2.55 95% CI [1.82-3.58]). The first-pass success was higher (68.5% vs. 74.7%; P=.033). There were no pre-post differences in major complications (34.7% vs. 34.8%; P=.970) and in-hospital mortality (42.7% vs. 38.6%; P=.137).</p><p><strong>Conclusions: </strong>The COVID-19 pandemic modified intubation procedures in non-COVID-19 patients, changing the oxygenation strategy, the medication and the use of videolaryngoscopy, with no impact on complications or mortality.</p>","PeriodicalId":94139,"journal":{"name":"Medicina intensiva","volume":" ","pages":"502122"},"PeriodicalIF":0.0,"publicationDate":"2025-02-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143257278","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}
Pub Date : 2025-02-04DOI: 10.1016/j.medine.2025.502159
Alfonso Canabal Berlanga
{"title":"Safety and efficacy of beta-blockers and amiodarone in the management of new-onset atrial fibrillation in critically ill patients with sepsis.","authors":"Alfonso Canabal Berlanga","doi":"10.1016/j.medine.2025.502159","DOIUrl":"https://doi.org/10.1016/j.medine.2025.502159","url":null,"abstract":"","PeriodicalId":94139,"journal":{"name":"Medicina intensiva","volume":" ","pages":"502159"},"PeriodicalIF":0.0,"publicationDate":"2025-02-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143257462","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}
Pub Date : 2025-02-01DOI: 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.
{"title":"Clinical utility of rapid shallow breathing index in predicting successful weaning: secondary analysis of the COBRE-US trial","authors":"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","doi":"10.1016/j.medine.2024.06.007","DOIUrl":"10.1016/j.medine.2024.06.007","url":null,"abstract":"<div><h3>Objective</h3><div><span><span>To assess the predictive capacity of the Rapid Shallow Breathing Index (RSBI) for success in </span>spontaneous breathing trials (SBT) and </span>extubation<span> in critically ill patients. We evaluated the association between RSBI, duration of mechanical ventilation, and ventilator-free time at 28 days.</span></div></div><div><h3>Design</h3><div>Prospective multicenter observational study. Secondary analysis of the COBRE-US study.</div></div><div><h3>Setting</h3><div>Intensive care unit (ICU).</div></div><div><h3>Patients or participants</h3><div>367 patients in the ICU receiving invasive mechanical ventilation.</div></div><div><h3>Interventions</h3><div>Assessment of RSBI at the end of SBT.</div></div><div><h3>Main variables of interest</h3><div>RSBI, SBT, duration of mechanical ventilation, and ventilator-free time at 28 days were evaluated.</div></div><div><h3>Results</h3><div>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).</div></div><div><h3>Conclusions</h3><div>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.</div></div>","PeriodicalId":94139,"journal":{"name":"Medicina intensiva","volume":"49 2","pages":"Pages 72-77"},"PeriodicalIF":0.0,"publicationDate":"2025-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141433674","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}
Pub Date : 2025-02-01DOI: 10.1016/j.medine.2024.10.003
Lorena Oteiza López , Óscar Elía Mañú
{"title":"Organ donation process: more than just guidelines and protocols","authors":"Lorena Oteiza López , Óscar Elía Mañú","doi":"10.1016/j.medine.2024.10.003","DOIUrl":"10.1016/j.medine.2024.10.003","url":null,"abstract":"","PeriodicalId":94139,"journal":{"name":"Medicina intensiva","volume":"49 2","pages":"Pages 116-117"},"PeriodicalIF":0.0,"publicationDate":"2025-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142484574","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}
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。
{"title":"Anti-Xa activity below range is related to thrombosis in patients with severe COVID-19","authors":"Pilar Marcos-Neira , Cristian Morales-Indiano , Mariana Fernández-Caballero , Teresa Tomasa-Irriguible , Luisa Bordejé-Laguna , Víctor Ruíz-Artola","doi":"10.1016/j.medine.2024.07.003","DOIUrl":"10.1016/j.medine.2024.07.003","url":null,"abstract":"<div><h3>Objective</h3><div>We aimed to anlayse the relationship between anti-Xa activity below range and thomboembolic events.</div></div><div><h3>Design</h3><div>Single center prospective observational longitudinal cohort study (February–November 2021).</div></div><div><h3>Setting</h3><div>Patients admitted to the ICU of a University Hospital.</div></div><div><h3>Participants</h3><div>Patients with severe COVID-19 pneumoniae.</div></div><div><h3>Interventions</h3><div>Enoxaparin was used for prophylactic and therapeutic anticoagulation. Enoxaparin dosing and dose adjustment were based on anti-Xa activity according to the hospital protocol.</div></div><div><h3>Main variables of interest</h3><div>Target: thomboembolic events.</div><div>Predictors: demographics, pharmacotherapy, anti-Xa measurements, clinical data, and laboratory results.</div><div>Logistic regression was used to identify independent risk factors for thomboembolic events.</div></div><div><h3>Results</h3><div>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.</div></div><div><h3>Conclusions</h3><div>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.</div></div>","PeriodicalId":94139,"journal":{"name":"Medicina intensiva","volume":"49 2","pages":"Pages 78-87"},"PeriodicalIF":0.0,"publicationDate":"2025-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141763660","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}
Pub Date : 2025-02-01DOI: 10.1016/j.medine.2024.07.014
José Miguel Pérez-Villares , Ramón Lara-Rosales , Alberto Fernández-Carmona , Alberto Iglesias-Santiago
{"title":"Moral complexity in the organ donation process: The satisfaction of a job well done","authors":"José Miguel Pérez-Villares , Ramón Lara-Rosales , Alberto Fernández-Carmona , Alberto Iglesias-Santiago","doi":"10.1016/j.medine.2024.07.014","DOIUrl":"10.1016/j.medine.2024.07.014","url":null,"abstract":"","PeriodicalId":94139,"journal":{"name":"Medicina intensiva","volume":"49 2","pages":"Pages 114-115"},"PeriodicalIF":0.0,"publicationDate":"2025-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142515541","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}
Pub Date : 2025-02-01DOI: 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.
{"title":"The human factor and ergonomics in Patient Safety","authors":"Miguel Valdivia de la Fuente, Diego José Palacios Castañeda, Nuria Martínez Sanz","doi":"10.1016/j.medine.2024.03.014","DOIUrl":"10.1016/j.medine.2024.03.014","url":null,"abstract":"<div><div>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.</div><div>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.</div></div>","PeriodicalId":94139,"journal":{"name":"Medicina intensiva","volume":"49 2","pages":"Pages 96-104"},"PeriodicalIF":0.0,"publicationDate":"2025-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141066239","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}
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