Abstract:
OBJECTIVE:To design a probability model for prolonged mechanical ventilation (PMV) using variables obtained during the first 24 hours of the start of MV. DESIGN:An observational, prospective, multicenter cohort study. SCOPE:Thirteen Spanish medical-surgical intensive care units. PATIENTS:Adult patients requiring mechanical ventilation for more than 24 hours. INTERVENTIONS:None. STUDY VARIABLES:APACHE II, SOFA, demographic data, clinical data, reason for mechanical ventilation, comorbidity, and functional condition. A multivariate risk model was constructed. The model contemplated a dependent variable with three possible conditions: 1. Early mortality; 2. Early extubation; and 3. PMV. RESULTS:Of the 1661 included patients, 67.9% (n=1127) were men. Age: 62.1±16.2 years. APACHE II: 20.3±7.5. Total SOFA: 8.4±3.5. The APACHE II and SOFA scores were higher in patients ventilated for 7 or more days (p=0.04 and p=0.0001, respectively). Noninvasive ventilation failure was related to PMV (p=0.005). A multivariate model for the three above exposed outcomes was generated. The overall accuracy of the model in the training and validation sample was 0.763 (95%IC: 0.729-0.804) and 0.751 (95%IC: 0.672-0.816), respectively. The likelihood ratios (LRs) for early extubation, involving a cutoff point of 0.65, in the training sample were LR (+): 2.37 (95%CI: 1.77-3.19) and LR (-): 0.47 (95%CI: 0.41-0.55). The LRs for the early mortality model, for a cutoff point of 0.73, in the training sample, were LR (+): 2.64 (95%CI: 2.01-3.4) and LR (-): 0.39 (95%CI: 0.30-0.51). CONCLUSIONS:The proposed model could be a helpful tool in decision making. However, because of its moderate accuracy, it should be considered as a first approach, and the results should be corroborated by further studies involving larger samples and the use of standardized criteria.
journal_name
Med Intensivajournal_title
Medicina intensivaauthors
Añón JM,Gómez-Tello V,González-Higueras E,Oñoro JJ,Córcoles V,Quintana M,López-Martínez J,Marina L,Choperena G,García-Fernández AM,Martín-Delgado C,Gordo F,Díaz-Alersi R,Montejo JC,Lorenzo AG,Pérez-Arriaga M,Madero Rdoi
10.1016/j.medin.2012.01.003subject
Has Abstractpub_date
2012-10-01 00:00:00pages
488-95issue
7eissn
0210-5691issn
1578-6749pii
S0210-5691(12)00049-6journal_volume
36pub_type
杂志文章,多中心研究abstract::The use of neuromuscular blockers (NMB) is a frequent practice in Intensive Care Units. However most of the experience with the use of these agents come from the operating room used to deal with patients with different characteristics from those admitted in the ICU. Recent advances on neuromonitoring and the commercia...
journal_title:Medicina intensiva
pub_type: 杂志文章,评审
doi:
更新日期:2008-02-01 00:00:00
abstract::Coronavirus disease 2019 (COVID-19) is a respiratory tract infection caused by a newly emergent coronavirus, that was first recognized in Wuhan, China, in December 2019. Currently, the World Health Organization (WHO) has defined the infection as a global pandemic and there is a health and social emergency for the mana...
journal_title:Medicina intensiva
pub_type: 共识发展会议,杂志文章,实务指引
doi:10.1016/j.medin.2020.03.005
更新日期:2020-10-01 00:00:00
abstract:PURPOSE:Streptococcus pneumoniae and Neisseria meningitidis are major causes of severe invasive bacterial infections in some individuals. Apparently the genetic is a major susceptibility determinant to these infectious diseases. We study if the functional polymorphisms within genes of the innate immune system (TLR2-TLR...
journal_title:Medicina intensiva
pub_type: 杂志文章
doi:10.1016/j.medin.2013.08.006
更新日期:2014-08-01 00:00:00
abstract::The benefit of enteral nutrition in critically ill patients has been demonstrated by several studies, especially when it is started early, in the first 24-48h of stay in the Intensive Care Unit, and this practice is currently advised by the main clinical guidelines. The start of enteral nutrition is controversial in p...
journal_title:Medicina intensiva
pub_type: 杂志文章,评审
doi:10.1016/j.medin.2014.04.002
更新日期:2015-01-01 00:00:00
abstract::Severe acute pancreatitis (SAP) causes local and systemic complications leading to high catabolic, hypermetabolic and hyperdynamic stress states with marked morbidity and mortality. In the last decade, nutritional support has become a key element in the treatment of SAP. Thus, specialized nutrition is indicated from a...
journal_title:Medicina intensiva
pub_type: 共识发展会议,杂志文章,实务指引
doi:10.1016/S0210-5691(11)70007-9
更新日期:2011-11-01 00:00:00
abstract:OBJECTIVE:To analyze the efficacy of negative fluid balance in hypoxemic patients with an elevated extravascular lung water index (EVLWI). DESIGN:A retrospective observational study was made. SETTING:Intensive Care Unit of Virgen de las Nieves Hospital (Spain). PARTICIPANTS:Forty-four patients participated in the st...
journal_title:Medicina intensiva
pub_type: 杂志文章
doi:10.1016/j.medin.2014.07.008
更新日期:2015-08-01 00:00:00
abstract:INTRODUCTION:Real body weight and height are essential data to be obtained in all critically ill patients (CIP), due to their influence in the designing of therapies and monitoring. Visual estimation is a very inaccurate practice. No precise descriptions of anthropometric measurements among CIP are available in the cli...
journal_title:Medicina intensiva
pub_type: 杂志文章,多中心研究
doi:10.1016/j.medin.2017.09.008
更新日期:2018-01-01 00:00:00
abstract::Immunosuppression in transplantation has experienced changes in recent years as a result of the introduction of new drugs that act upon the different pathways of the host immune response with the purpose of securing more individualized immune suppression, with fewer side effects. Although following in the steps of oth...
journal_title:Medicina intensiva
pub_type: 杂志文章
doi:10.1016/j.medin.2012.05.011
更新日期:2013-01-01 00:00:00
abstract::Thoracic surgery has undergone significant advances in recent years related to anesthetic and surgical techniques and the prevention and management of complications related to the procedure. This has allowed improvements in patient clinical outcomes in surgeries of this kind. Despite the above, thoracic surgery, espec...
journal_title:Medicina intensiva
pub_type: 杂志文章
doi:10.1016/j.medin.2019.10.012
更新日期:2020-04-01 00:00:00
abstract:OBJECTIVE:To assess the impact of gender upon the prognosis and medical care in a regional acute ST-elevation myocardial infarction management network. DESIGN:An observational study was made of consecutive patients entered in a prospective database. SCOPE:The Catalan acute ST-elevation myocardial infarction managemen...
journal_title:Medicina intensiva
pub_type: 杂志文章,多中心研究
doi:10.1016/j.medin.2016.06.008
更新日期:2017-03-01 00:00:00
abstract:OBJECTIVE:To compare the results of quality monitoring after the implementation of improvement strategies in the respiratory intensive care unit (RICU). DESIGN:A prospective, comparative, longitudinal and interventional study was carried out. SETTING:The RICU of Hospital General de México (Mexico). PATIENTS:All pati...
journal_title:Medicina intensiva
pub_type: 杂志文章
doi:10.1016/j.medin.2014.01.006
更新日期:2015-04-01 00:00:00
abstract:PURPOSE:Chemokines are a large superfamily of small proteins that function not only in leukocyte trafficking, but are also necessary for linkage between innate and adaptive immunity. Little is known about their role in septic shock. We hypothesized that serum levels of the most important chemokines are related to organ...
journal_title:Medicina intensiva
pub_type: 杂志文章
doi:10.1016/j.medin.2012.09.008
更新日期:2013-11-01 00:00:00
abstract:OBJECTIVE:To describe the incidence and main clinical characteristics of barotrauma during open lung ventilation (OLV). DESIGN:A retrospective, observational, descriptive study was made of 100 patients with acute respiratory failure and bilateral pulmonary infiltrates. INTERVENTIONS:1) A lung recruitment maneuver (LR...
journal_title:Medicina intensiva
pub_type: 杂志文章
doi:10.1016/j.medin.2011.10.011
更新日期:2012-06-01 00:00:00
abstract::The utility of using quality indicators as a tool to measure the common practice and evaluate efficacy of measures established to improve quality has been demonstrated, making it possible to identify and make known the improvements carried out. The project "Quality indicators in the critical patient" has been conducte...
journal_title:Medicina intensiva
pub_type: 杂志文章
doi:10.1016/s0210-5691(08)70899-4
更新日期:2008-01-01 00:00:00
abstract::Most of transplanted organs are obtained from brain death (BD) donors. In neurocritical patients with catastrophic injuries and decompressive craniectomy (DC), which show a dreadful development in spite of this treatment, DC could be a futile tool to avoid natural progress to BD. We propose if cranial compressive band...
journal_title:Medicina intensiva
pub_type: 杂志文章
doi:10.1016/j.medin.2012.12.008
更新日期:2013-04-01 00:00:00
abstract::Maintaining organ viability from extraction to transplantation is crucial to ensure the function and survival of the graft. In recent years, maintaining organ viability has become more challenging because the shortage of donors has led to broader criteria for donor acceptability and consequently to organs with greater...
journal_title:Medicina intensiva
pub_type: 杂志文章
doi:10.1016/S0210-5691(09)72196-5
更新日期:2009-08-01 00:00:00
abstract:OBJECTIVE:To detect donor characteristics related to graft function after orthotopic liver transplantation (OLT). DESIGN:Retrospective cohort study. CONTEXT:Polyvalent intensive care unit. PATIENTS:145 liver transplant recipients and their respective donors. INTERVENTIONS:None. MAIN VARIABLES OF INTEREST:In donors...
journal_title:Medicina intensiva
pub_type: 杂志文章
doi:10.1016/s0210-5691(08)75708-5
更新日期:2008-11-01 00:00:00
abstract:OBJECTIVE:To analyze the current evidence on glycemic control with insulin therapy in the critically ill. RECENT FINDINGS:Stress hyperglycemia in critically ill patients has been associated with increased morbidity and mortality. Furthermore, current evidence suggests that glucose variability has a predictive value fo...
journal_title:Medicina intensiva
pub_type: 杂志文章,评审
doi:10.1016/j.medin.2009.10.003
更新日期:2010-05-01 00:00:00
abstract:OBJECTIVE:Apply a sedoanalgesic (SA) protocol for invasive procedures (PI) in pediatric patients and evaluate its effectiveness and safety. DESIGN:Prospective observational study. SCOPE:Pediatric Intensive Care Unit (PICU) of third level hospital. PATIENTS:A total of 110 children subjected to invasive procedures und...
journal_title:Medicina intensiva
pub_type: 杂志文章
doi:10.1016/s0210-5691(07)74851-9
更新日期:2007-11-01 00:00:00
abstract:OBJECTIVE:An evaluation is made of the hospital mortality predicting capacity of the main predictive scoring systems. DESIGN:A 2-year retrospective cohort study was carried out. SETTING:A third level ICU with surgical and medical patients. PATIENTS:All patients with multiorgan failure during the first day in the ICU...
journal_title:Medicina intensiva
pub_type: 杂志文章
doi:10.1016/j.medin.2015.03.005
更新日期:2016-04-01 00:00:00
abstract::The intensive care units must be prepared for a possible disaster, whether internal or external, in case it becomes necessary to evacuate the in-patients. They must have an Emergency and Self-protection Plan that includes the patient evacuation criteria and this must be known by all the personnel who work in the servi...
journal_title:Medicina intensiva
pub_type: 杂志文章
doi:10.1016/j.medin.2009.05.005
更新日期:2010-04-01 00:00:00
abstract::Posttraumatic carotid-cavernous fistula (PtCCF) is an uncommon complication after cranioencephalic trauma. It is usually diagnosed with a cerebral arteriography when the clinical symptoms have already appeared. The transcranial color-coded duplex sonography (TCDS) is a non-invasive technique at the patient's bedside t...
journal_title:Medicina intensiva
pub_type: 杂志文章
doi:10.1016/s0210-5691(07)74769-1
更新日期:2007-01-01 00:00:00
abstract::Second level therapeutic maneuvres for controlling intracranial hypertension (ICH) proposed by the European Brain Injury Consortium and the American Association of Neurological Surgeons include barbiturates, moderate hypothermia and more recently the decompressive craniectomy (DC).In most patients, ICP can be maintain...
journal_title:Medicina intensiva
pub_type: 杂志文章
doi:10.1016/j.medin.2010.09.011
更新日期:2011-04-01 00:00:00
abstract::Patients with cardiac disease can develop two types of malnutrition: cardiac cachexia, which appears in chronic congestive heart failure, and malnutrition due to the complications of cardiac surgery or any other type of surgery in patients with heart disease. Early enteral nutrition should be attempted if the oral rou...
journal_title:Medicina intensiva
pub_type: 共识发展会议,杂志文章,实务指引
doi:10.1016/S0210-5691(11)70017-1
更新日期:2011-11-01 00:00:00
abstract::Sepsis is a major public health problem and a leading cause of death in the world, where delay in the beginning of treatment, along with clinical guidelines non-adherence have been proved to be associated with higher mortality. Machine Learning is increasingly being adopted in developing innovative Clinical Decision S...
journal_title:Medicina intensiva
pub_type: 杂志文章,评审
doi:10.1016/j.medin.2020.04.003
更新日期:2020-05-29 00:00:00
abstract:AIM:To determine the risk of microbiological contamination with hospital use high- and low-flow bubbling humidifiers. METHODS:A systematic literature review was carried out in 6 databases. Observational or experimental studies published between 1990 and 2016 were selected, written in English or Spanish, and in which m...
journal_title:Medicina intensiva
pub_type: 杂志文章
doi:10.1016/j.medin.2017.11.003
更新日期:2019-01-01 00:00:00
abstract::With the aim of analyzing the current state of the educational objectives in the training of medical residents in solid organ transplantation (SOT), we conducted a review of the status of the official programs of the specialities involved in SOT, focusing particularly on lung transplantation. A survey of medical resid...
journal_title:Medicina intensiva
pub_type: 杂志文章
doi:10.1016/j.medin.2012.03.012
更新日期:2012-11-01 00:00:00
abstract::This syndrome was described in 1990. It is characterized by chest pain that simulates an acute coronary syndrome (ACS), with alterations in the ECG, but with normal coronary arteries. We present 16 patients admitted in our ICU, who met the criteria of transient left ventricular dysfunction syndrome (TLVDS). All but 1 ...
journal_title:Medicina intensiva
pub_type: 杂志文章
doi:10.1016/j.medin.2010.09.010
更新日期:2011-06-01 00:00:00
abstract::Electrical impedance tomography has been described as a new method of monitoring critically ill patients on mechanical ventilation. It has recently gained special interest because of its applicability for monitoring ventilation and pulmonary perfusion. Its bedside and continuous implementation, and the fact that it is...
journal_title:Medicina intensiva
pub_type: 杂志文章,评审
doi:10.1016/j.medin.2011.05.005
更新日期:2011-11-01 00:00:00
abstract:OBJECTIVE:To assess the incidence and prognostic value of acute renal function deterioration (ARFD) in patients with acute heart disease. SETTING:Coronary Care Unit in a tertiary university hospital. DESIGN:Retrospective study. PARTICIPANTS:One hundred consecutive patients admitted during 2004. INTERVENTIONS:No ran...
journal_title:Medicina intensiva
pub_type: 杂志文章
doi:10.1016/s0210-5691(08)70932-x
更新日期:2008-05-01 00:00:00