OBJECTIVE:To evaluate the association between beta-blocker therapy and major cardiovascular outcomes in patients with acute myocardial infarction (AMI) and preserved or mildly reduced left ventricular ejection fraction (LVEF). DESIGN:Systematic review and meta-analysis of randomized clinical trials. SETTING:A comprehensive search of five electronic databases was conducted using a predefined PICO strategy to identify published studies. Seven studies were selected and included in the meta-analysis. PARTICIPANTS:Patients with AMI and preserved or mildly reduced LVEF who received beta-blocker therapy. INTERVENTION:Use of beta-blockers. MAIN OUTCOME MEASURES:Primary composite outcome including mortality, reinfarction, cardiovascular-related hospitalization, and other cardiovascular events. RESULTS:This meta-analysis included four studies comprising a total of 18,504 patients with a history of AMI and an LVEF ≥ 40%. Among them, 2223 patients had mildly reduced LVEF, while 15,908 belonged to the preserved LVEF group. Beta-blocker therapy did not reduce the primary composite outcome (death, reinfarction, and hospitalization) in patients with LVEF ≥ 40% (hazard ratio [HR]: 0.90; 95% confidence interval [95% CI]: 0.81-1.01). Subsequent subgroup analyses showed that beta-blocker therapy did not reduce the primary composite outcome in patients with preserved LVEF (HR: 0.94; 95% CI: 0.87-1.03); however, in patients with mildly reduced LVEF, it was associated with a reduction in the same primary composite outcome (HR: 0.82; 95% CI: 0.70-0.97). CONCLUSIONS:In this meta-analysis, beta-blocker use was not associated with a significant reduction in the primary composite outcome or in mortality or reinfarction. The association observed in patients with mildly reduced ejection fraction derives from a subgroup and should be interpreted with caution in the context of an overall neutral result.
Objetivo Identificar factores de riesgo de reintubación en pacientes críticos tras una extubación planificada, utilizando datos clínicos extraídos automáticamente desde el sistema de información clínica. Diseño Estudio observacional retrospectivo. Ámbito Unidad de Cuidados Intensivos del Hospital Universitario JoanXXIII (2014-2024). Pacientes Adultos ingresados en la UCI que requirieron ventilación mecánica invasiva (VMI) más de 48horas. Intervenciones Extracción automatizada de datos (Centricity Critical Care®). Se calcularon medianas, máximos o mínimos en ventanas predefinidas de 6 y 24horas previas a la extubación. Variables de interés principales Tasa de reintubación, presión de soporte (PS), frecuencia cardíaca (FC), administración previa de antibióticos, estancia en la UCI, incidencia de neumonía asociada a ventilación (NAV) y mortalidad. Resultados La tasa global de reintubación fue del 11%. Mediante análisis multivariante, una PS más alta (OR: 1,36; IC95%: 1,10-1,67) y una mayor FC (OR: 1,22; IC95%: 1,00-1,49) en las 6horas previas predijeron de forma independiente la reintubación. Administrar antibióticos en las 24horas anteriores mostró un efecto protector (OR: 0,55; IC95%: 0,37-0,82). El modelo alcanzó 0,63 de AUC (IC95% bootstrap: 0,52-0,72). Los pacientes reintubados presentaron mayor estancia en la UCI, mayor incidencia de NAV y mayor mortalidad. Conclusiones Valores más elevados de FC y la PS previas a la extubación se asociaron con un mayor riesgo de reintubación, mientras que la antibioterapia las 24horas previas parece tener un efecto protector. El análisis automatizado de datos longitudinales obtenidos desde los registros electrónicos permitió identificar asociaciones clínicamente plausibles relacionadas con la reintubación.
OBJECTIVE:To evaluate post-traumatic stress symptoms, anxiety, depression, and health-related quality of life six months after intensive care unit (ICU) discharge, and to explore potential dyadic associations of psychological outcomes within ICU survivor-caregiver dyads. DESIGN:Prospective single-center pilot observational study. SETTING:Adult intensive care unit of a tertiary-care hospital. PATIENTS OR PARTICIPANTS:Adult ICU survivors with length of stay ≥72 h and their identified primary caregivers enrolled as dyads. INTERVENTIONS:No therapeutic interventions were performed. ICU-related stressors (ICUESS) and caregiver satisfaction (FS-ICU) were assessed at ICU discharge. At 6 months, post-traumatic stress symptoms (IES-R), anxiety and depression (HADS), and patient-reported quality of life (EQ-5D-5L and EQ-VAS) were evaluated. MAIN VARIABLES OF INTEREST:Prevalence of probable PTSD (IES-R ≥33), dyadic concordance of PTSD symptoms, and associations between PTSD and health-related quality of life deterioration. RESULTS:Thirty-nine dyads were enrolled; 31 patients and 36 caregivers completed follow-up. Probable PTSD occurred in 15.4% of patients and 23.1% of caregivers. Within-dyad concordance was high (82% overall agreement: φ = 0.44), suggesting non-random clustering of PTSD symptoms within dyads. Nearly half of survivors (≈48%) experienced clinically meaningful deterioration in EQ-VAS, which was associated with probable PTSD in both dyad members. Perceived ICU-related stressors showed high concordance across dyads. CONCLUSIONS:Post-ICU psychological distress may show relational patterns within ICU survivor-caregiver dyads. Functional decline and shared psychological vulnerability may contribute to post-traumatic stress symptom burden after ICU discharge. These preliminary findings should be considered exploratory and hypothesis-generating and require confirmation in larger, adequately powered dyadic studies.
OBJECTIVES:Environmental contamination plays a key role in the transmission of multidrug-resistant microorganisms (MDRMs) in intensive care units (ICUs). We evaluated the effectiveness of a silver ion-controlled release antimicrobial compound applied to ICU surfaces in reducing environmental contamination and patient colonization. DESIGN:Quasi-experimental study with a concurrent control group. SETTING:A 24-bed ICU divided into two identical subunits. PARTICIPANTS:All patients admitted to the ICU during the study period. INTERVENTIONS:One subunit followed standard disinfection procedures (control unit), while the other used standard disinfection plus monthly application of a silver ion-controlled release antimicrobial compound (NOB166®) to high-touch surfaces (intervention unit). VARIABLES OF INTEREST:Environmental surface cultures and patient surveillance cultures were obtained weekly over a 5-month period. RESULTS:A total of 506 environmental samples were collected. MDRMs were detected in 22/256 samples (8.5%) from the control unit compared with 8/250 samples (3.2%) from the intervention unit (P = .01). MDRM acquisition occurred in 19/127 patients (14.9%) in the control unit and 10/168 patients (5.9%) in the intervention unit (P < .01). Acinetobacter baumannii and Candida auris were the most frequently isolated organisms. Two MDRM outbreaks occurred in the control unit, whereas none were detected in the intervention unit. Rates of nosocomial infection did not differ significantly between groups. CONCLUSIONS:The use of a silver ion-controlled release antimicrobial surface coating was associated with a significant reduction in environmental MDRM contamination and patient colonization in ICU. These findings support the role of long-acting antimicrobial surface treatments as adjuncts to standard infection prevention strategies.
El pronóstico del paciente crítico con cáncer ha cambiado de manera significativa en la era de la oncología de precisión. Los avances en el soporte vital, el ingreso oportuno a la UCI y la disponibilidad de terapias dirigidas e inmunoterapia han permitido que la supervivencia aumente en muchos escenarios, con un número creciente de pacientes que logra retomar su tratamiento oncológico. Sin embargo, predecir la evolución individual sigue siendo un desafío, ya que los modelos tradicionales no capturan la complejidad biológica ni la heterogeneidad clínica del cáncer. Factores como el estado funcional, la reversibilidad del evento agudo, la presencia de fallas orgánicas y las características moleculares del tumor han emergido como determinantes pronósticos relevantes. Además, el microbioma se reconoce como un modulador de la respuesta inmunológica, determinando la susceptibilidad a infecciones y participando en la carcinogénesis. Integrar estos elementos es esencial para avanzar hacia un pronóstico más preciso en pacientes oncológicos críticos.
