Medicina intensiva最新文献

英文中文

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。

Medicina intensiva

Pub Date : 2025-02-01 DOI: 10.1016/j.medine.2024.05.014

Arthur Orieux , Raphaël Birot , Didier Gruson , Renaud Prevel

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。

Medicina intensiva

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

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。

Medicina intensiva

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。

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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.

Medicina intensiva

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

The organ donation process: An ethical commitment 器官捐献程序：道德承诺。

Medicina intensiva

Pub Date : 2025-02-01 DOI: 10.1016/j.medine.2024.09.008

Francisco del Rio Gallegos, Almudena Escribá Bárcena, Teodoro Grau Carmona, Alonso Mateos Rodriguez

引用次数: 0

Safe practices in Intensive Care Medicine, is zero risk possible? 重症监护医学的安全实践，零风险可能吗？

Medicina intensiva

Pub Date : 2025-02-01 DOI: 10.1016/j.medine.2024.05.005

Xavier Nuvials Casals , Marta García García

Incidents related to patient safety are a problem of great impact in Intensive Care Medicine (ICM). Multiple strategies have been developed to identify them, analyze, and develop policies aim at reducing their incidence and minimizing their effects and consequences. The development of a safety culture, an adequate organizational and structural design of the ICM, which contemplates the implementation of effective safe practices, with a provision of human resources adjusted to the care activity carried out and the periodic analysis of the different events and their factors, will allow us to bring the risk of critical patient care closer to zero, as would be desirable.

与患者安全相关的事故是重症监护医学（ICM）中一个具有重大影响的问题。已经制定了多种策略来识别、分析和制定政策，旨在降低事故发生率，并将其影响和后果降至最低。发展安全文化，对重症医学进行适当的组织和结构设计，考虑实施有效的安全措施，提供与所开展的护理活动相适应的人力资源，定期分析各种事件及其因素，将使我们能够如愿以偿地使危重病人护理风险趋近于零。

引用次数: 0

Cytoreductive surgery for cardiac sarcoma.

Medicina intensiva

Pub Date : 2025-01-30 DOI: 10.1016/j.medine.2025.502132

Bárbara Segura-Méndez, Ana Revilla, Yolanda Carrascal

引用次数: 0

Tranexamic acid applications in neurocritical patients: A narrative review.

Medicina intensiva

Pub Date : 2025-01-30 DOI: 10.1016/j.medine.2025.502139

Eva Esther Tejerina Álvarez, Irene Cavada Carranza, Marcos González Bermejo, Teresa Molina García, José Ángel Lorente Balanza

In patients with spontaneous or traumatic intracranial hemorrhage, hematoma expansion is associated with poorer neurological outcomes and increased mortality. The administration of an antifibrinolytic agent like tranexamic acid (TXA) may potentially improve clinical outcomes in patients with acute brain injury by preventing such intracranial expansion. However, studies on the impact of TXA in these patients have yielded variable results, and its efficacy, appropriate dosing and optimal timing of administration remain unclear. The present review summarizes the clinical evidence regarding the proper use of tranexamic acid in the treatment of intracranial traumatic and non-traumatic hemorrhage, and its implications for clinical practice.

引用次数: 0

Reduction of norepinephrine versus vasopressin in the stabilization phase of septic shock: RENOVA clinical trial.

Medicina intensiva

Pub Date : 2025-01-29 DOI: 10.1016/j.medine.2025.502147

Cássio Mallmann, Thizá Maria Bianchi Galiotto, Michele Salibe de Oliveira, Rafael Barberena Moraes

Objective: Evaluate the incidence of hypotension during the weaning phase of vasopressors.

Design: A single-center, open-label randomized clinical trial between May and December 2022.

Setting: a tertiary care academic medical center.

Patients: 91 adult patients over 18 years of age with septic shock (according to Sepsis-3).

Intervention: Patients were divided into two groups: initial reduction of norepinephrine or initial reduction of vasopressin.

Main variables of interest: The primary outcome was the incidence of hypotension within the first 24 h after reducing vasopressors. Additionally, the clinical impact of this hypotension was assessed through mortality, length of hospital stay, duration of vasopressor use, incidence of arrhythmias, and prevalence of hemodialysis.

Results: Out of a total of 91 patients, 78 were included in the analysis: 39 in the norepinephrine group and 39 in the vasopressin group. Despite a numerically significant difference in the incidence of hypotension between the groups (norepinephrine 43.6%, vasopressin 25.6%), there was no statistical difference (p =  0.153, relative risk = 1.7, 95% confidence interval: 0.9-3.2). In this sample, vasopressin withdrawal was predominantly titrated. There were no differences between the groups in terms of the evaluated clinical outcomes.

Conclusion: No differences were detected in the incidence of hypotension when weaning was initiated with norepinephrine or vasopressin, although it was non significantly higher in norepinephrine group. In our sample, vasopressin withdrawal was titrated, which differs from North American practice. Brazilian Clinical Trials Registry (REBEC: RBR-10smbw65).

Clinicaltrials: gov platform (NCT05506319).

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引用次数: 0

Airway management in critically ill patients. In need of a new approach.

Medicina intensiva

Pub Date : 2025-01-27 DOI: 10.1016/j.medine.2025.502138

R Albillos-Almaraz, S Balboa-Palomino, E Pérez-Cabo

引用次数: 0

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