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Did intubation procedures for critically ill patients without SARS-CoV-2 infection change during the pandemic? Secondary analysis of the INTUPROS multicenter study.
Pub Date : 2025-02-04 DOI: 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.

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引用次数: 0
Safety and efficacy of beta-blockers and amiodarone in the management of new-onset atrial fibrillation in critically ill patients with sepsis.
Pub Date : 2025-02-04 DOI: 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}
引用次数: 0
Dynamic air bronchogram in pneumococcal community acquired pneumonia 肺炎球菌社区获得性肺炎的动态空气支气管造影。
Pub Date : 2025-02-01 DOI: 10.1016/j.medine.2024.06.004
Abdo Taché Sala, Sara Foradada Ubach, Meritxell Lladó Vilar
{"title":"Dynamic air bronchogram in pneumococcal community acquired pneumonia","authors":"Abdo Taché Sala,&nbsp;Sara Foradada Ubach,&nbsp;Meritxell Lladó Vilar","doi":"10.1016/j.medine.2024.06.004","DOIUrl":"10.1016/j.medine.2024.06.004","url":null,"abstract":"","PeriodicalId":94139,"journal":{"name":"Medicina intensiva","volume":"49 2","pages":"Pages 120-121"},"PeriodicalIF":0.0,"publicationDate":"2025-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141428547","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
Global definition of acute respiratory distress syndrome: An epidemiology perspective 急性呼吸窘迫综合征的全球定义:流行病学视角。
Pub Date : 2025-02-01 DOI: 10.1016/j.medine.2024.10.001
Pablo Cardinal-Fernández , Guillermo Ortiz , Luis Blanch
{"title":"Global definition of acute respiratory distress syndrome: An epidemiology perspective","authors":"Pablo Cardinal-Fernández ,&nbsp;Guillermo Ortiz ,&nbsp;Luis Blanch","doi":"10.1016/j.medine.2024.10.001","DOIUrl":"10.1016/j.medine.2024.10.001","url":null,"abstract":"","PeriodicalId":94139,"journal":{"name":"Medicina intensiva","volume":"49 2","pages":"Pages 69-71"},"PeriodicalIF":0.0,"publicationDate":"2025-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142484573","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
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
{"title":"Venous pulmonary embolism - A rare clinical case","authors":"Sérgio Pina ,&nbsp;Pedro Alves ,&nbsp;Andriy Krystopchuc","doi":"10.1016/j.medine.2024.06.008","DOIUrl":"10.1016/j.medine.2024.06.008","url":null,"abstract":"","PeriodicalId":94139,"journal":{"name":"Medicina intensiva","volume":"49 2","pages":"Pages 122-123"},"PeriodicalIF":0.0,"publicationDate":"2025-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141437975","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
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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Medicina intensiva
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