Pub Date : 2026-03-01DOI: 10.1016/j.medin.2025.502167
M. Ángeles Alonso Fernández , Carola Bledig , Madian Manso Álvarez , Raquel Gómez Guardiola , Marina Blancas García , Irene Bartolomé , Manuel Quintana Díaz , Pilar Marcos Neira , Jose Alberto Silva Obregón , Ainhoa Serrano Lázaro , Salvador Campillo Morales , Blanca López Matamala , Carmen Martín Parra , Ángela Algaba Calderón , Rafael Blancas Gómez-Casero , Óscar Martínez González
Objectives
The aim of this study was to evaluate the association between SARS-CoV-2 vaccination and the occurrence of thrombotic complications in patients admitted to intensive care for severe COVID-19 pneumonia.
Intensive care units of five university hospitals.
Patients
A total of 255 patients admitted to the intensive care unit (ICU) with SARS-CoV-2 pneumonia, confirmed by RT-PCR in throat swab or tracheal aspirate, starting the date the first vaccinated patient against SARS-CoV-2 was admitted in one of the participating ICUs, were included in the analysis.
Main variables of interest
Vaccination status against SARS-CoV-2 and thrombotic events.
Results
18.8% of patients had received some form of vaccination. Thrombotic events occurred in 21.2% of patients. Lack of vaccination was associated with thrombotic events (OR 5.024; 95% CI: 1.104−23.123; p = 0.0037) and death (OR 5.161; 95% CI: 1.075–24.787; p = 0.04). ICU mortality was not associated with the occurrence of thrombotic complications.
Conclusions
In this series of patients, vaccination against SARS-CoV-2 reduced the risk of thrombotic events and mortality in patients with severe COVID-19 admitted to the ICU. Thrombotic complications did not alter ICU mortality.
目的本研究旨在评估重症监护重症COVID-19肺炎患者接种SARS-CoV-2疫苗与血栓性并发症发生的关系。设计观察性、描述性、前瞻性、多中心研究。设置五所大学附属医院的重症监护病房。患者从首名接种SARS-CoV-2疫苗的患者入住重症监护病房（ICU）之日起，经咽拭子或气管吸入RT-PCR确诊的共255例SARS-CoV-2肺炎患者被纳入分析。结果18.8%的患者接受过某种形式的疫苗接种。21.2%的患者发生血栓性事件。缺乏疫苗接种与血栓事件（OR 5.024; 95% CI: 1.104 - 23.123; p = 0.0037）和死亡（OR 5.161; 95% CI: 1.075-24.787; p = 0.04）相关。ICU死亡率与血栓性并发症的发生无关。结论在这组患者中，接种SARS-CoV-2疫苗可降低ICU重症COVID-19患者血栓形成事件和死亡率的风险。血栓性并发症没有改变ICU死亡率。
{"title":"SARS-CoV-2 vaccination reduces the risk of thrombotic complications in severe COVID-19","authors":"M. Ángeles Alonso Fernández , Carola Bledig , Madian Manso Álvarez , Raquel Gómez Guardiola , Marina Blancas García , Irene Bartolomé , Manuel Quintana Díaz , Pilar Marcos Neira , Jose Alberto Silva Obregón , Ainhoa Serrano Lázaro , Salvador Campillo Morales , Blanca López Matamala , Carmen Martín Parra , Ángela Algaba Calderón , Rafael Blancas Gómez-Casero , Óscar Martínez González","doi":"10.1016/j.medin.2025.502167","DOIUrl":"10.1016/j.medin.2025.502167","url":null,"abstract":"<div><h3>Objectives</h3><div>The aim of this study was to evaluate the association between SARS-CoV-2 vaccination and the occurrence of thrombotic complications in patients admitted to intensive care for severe COVID-19 pneumonia.</div></div><div><h3>Design</h3><div>Observational, descriptive, prospective, multicentre study.</div></div><div><h3>Setting</h3><div>Intensive care units of five university hospitals.</div></div><div><h3>Patients</h3><div>A total of 255 patients admitted to the intensive care unit (ICU) with SARS-CoV-2 pneumonia, confirmed by RT-PCR in throat swab or tracheal aspirate, starting the date the first vaccinated patient against SARS-CoV-2 was admitted in one of the participating ICUs, were included in the analysis.</div></div><div><h3>Main variables of interest</h3><div>Vaccination status against SARS-CoV-2 and thrombotic events.</div></div><div><h3>Results</h3><div>18.8% of patients had received some form of vaccination. Thrombotic events occurred in 21.2% of patients. Lack of vaccination was associated with thrombotic events (OR 5.024; 95% CI: 1.104−23.123; <em>p</em> = 0.0037) and death (OR 5.161; 95% CI: 1.075–24.787; <em>p</em> = 0.04). ICU mortality was not associated with the occurrence of thrombotic complications.</div></div><div><h3>Conclusions</h3><div>In this series of patients, vaccination against SARS-CoV-2 reduced the risk of thrombotic events and mortality in patients with severe COVID-19 admitted to the ICU. Thrombotic complications did not alter ICU mortality.</div></div>","PeriodicalId":49268,"journal":{"name":"Medicina Intensiva","volume":"50 3","pages":"Article 502167"},"PeriodicalIF":3.1,"publicationDate":"2026-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147414363","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
{"title":"De lo que no hablan las escalas predictivas","authors":"Marcos Valiente Fernández , Cristina Serrano Gómez , Amanda Lesmes González de Aledo , Isaías Martín Badía","doi":"10.1016/j.medin.2025.502158","DOIUrl":"10.1016/j.medin.2025.502158","url":null,"abstract":"","PeriodicalId":49268,"journal":{"name":"Medicina Intensiva","volume":"50 3","pages":"Article 502158"},"PeriodicalIF":3.1,"publicationDate":"2026-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147414373","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2026-03-01Epub Date: 2025-10-15DOI: 10.1016/j.medin.2025.502316
Alicia Ogando Martínez , Amelia Martínez de Azagra , Vianor Pablo Silvero Enríquez , Santiago Mencía Bartolomé
David Gaba was one of the first to use simulation in medicine. He defined it as a learning method used to replace or amplify real experiences by guided experiences that evoke or reproduce aspects of the real world in a completely interactive way.
In the past, learning process and professional improvement in the healthcare were carried out progressively with the patient himself, so the management of infrequent situations was conditioned to a prolonged training period. Tools such as simulation allow us to carry out this training prior to patient care, providing an experience that was not available before.
In the last decade, this methodology has experienced exponential growth, gaining more and more prominence in the field of paediatric intensive care. It has not only been consolidated as a pedagogical method, but also as an essential tool for the acquisition and improvement of technical and non-technical skills in healthcare practice. Nowadays, it's considered a fundamental part of patient safety improvement strategies, allowing to examine care environments and processes, train multidisciplinary teams and practice work algorithms.
In this review, we will focus on the usefulness of clinical simulation for the training of Pediatric Critical Care Unit (PICU) staff, especially in non-technical skills such as effective communication and teamwork in critical situations.
David Gaba是最早在医学上使用模拟的人之一。他将其定义为一种学习方法，通过引导体验以一种完全互动的方式唤起或再现现实世界的各个方面，从而取代或放大真实体验。在过去，医疗保健的学习过程和专业改进是与患者自己逐步进行的，因此对不常见情况的管理需要长时间的培训。模拟等工具使我们能够在患者护理之前进行这种培训，提供以前无法获得的经验。在过去的十年中，这种方法经历了指数增长，在儿科重症监护领域获得越来越多的突出。它不仅被巩固为一种教学方法，而且还作为获得和改进医疗保健实践中的技术和非技术技能的基本工具。如今，它被认为是改善患者安全策略的基本组成部分，允许检查护理环境和流程，培训多学科团队和实践工作算法。在这篇综述中，我们将重点关注临床模拟对儿科重症监护病房（PICU）工作人员培训的有用性，特别是在非技术技能方面，如在危急情况下的有效沟通和团队合作。
{"title":"Simulación en la UCIP: formación en situaciones críticas","authors":"Alicia Ogando Martínez , Amelia Martínez de Azagra , Vianor Pablo Silvero Enríquez , Santiago Mencía Bartolomé","doi":"10.1016/j.medin.2025.502316","DOIUrl":"10.1016/j.medin.2025.502316","url":null,"abstract":"<div><div>David Gaba was one of the first to use simulation in medicine. He defined it as a learning method used to replace or amplify real experiences by guided experiences that evoke or reproduce aspects of the real world in a completely interactive way.</div><div>In the past, learning process and professional improvement in the healthcare were carried out progressively with the patient himself, so the management of infrequent situations was conditioned to a prolonged training period. Tools such as simulation allow us to carry out this training prior to patient care, providing an experience that was not available before.</div><div>In the last decade, this methodology has experienced exponential growth, gaining more and more prominence in the field of paediatric intensive care. It has not only been consolidated as a pedagogical method, but also as an essential tool for the acquisition and improvement of technical and non-technical skills in healthcare practice. Nowadays, it's considered a fundamental part of patient safety improvement strategies, allowing to examine care environments and processes, train multidisciplinary teams and practice work algorithms.</div><div>In this review, we will focus on the usefulness of clinical simulation for the training of Pediatric Critical Care Unit (PICU) staff, especially in non-technical skills such as effective communication and teamwork in critical situations.</div></div>","PeriodicalId":49268,"journal":{"name":"Medicina Intensiva","volume":"50 3","pages":"Article 502316"},"PeriodicalIF":3.1,"publicationDate":"2026-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147414362","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2026-03-01Epub Date: 2025-09-01DOI: 10.1016/j.medin.2025.502295
Javier Puerma Jiménez , Ana Carrasco Cáliz , José Miguel Pérez Villares , Antonio Cárdenas Cruz
Neurological prognosis of patients recovered from a cardiac arrest remains a challenge for intensive medicine specialists. Given the complexity of this scenario and the ensuing ethical dilemmas, current guidelines from the major scientific societies recommend a multimodal prognostic model for patients recovered from cardiac arrest. This model combines several clinical parameters, neurophysiological studies, such as electroencephalogram and somatosensory evoked potentials, and neuroimaging studies such as computed tomography scan and magnetic resonance imaging, as well as biomarkers for brain injury. More recently, several biomarkers associated with brain injury, originating from different regions of the brain, have been identified as potential prognostication tools within a multimodal approach. Based on the preliminary evidence gathered around them, several novel and promising biomarkers have been put forward. This literature review aims to examine four of them: ubiquitin carboxy-terminal hydrolase L1, glial fibrillary acidic protein, neurofilament light and tau protein.
{"title":"Valor pronóstico de los nuevos biomarcadores neuroespecíficos en el paciente recuperado de una parada cardiorrespiratoria","authors":"Javier Puerma Jiménez , Ana Carrasco Cáliz , José Miguel Pérez Villares , Antonio Cárdenas Cruz","doi":"10.1016/j.medin.2025.502295","DOIUrl":"10.1016/j.medin.2025.502295","url":null,"abstract":"<div><div>Neurological prognosis of patients recovered from a cardiac arrest remains a challenge for intensive medicine specialists. Given the complexity of this scenario and the ensuing ethical dilemmas, current guidelines from the major scientific societies recommend a multimodal prognostic model for patients recovered from cardiac arrest. This model combines several clinical parameters, neurophysiological studies, such as electroencephalogram and somatosensory evoked potentials, and neuroimaging studies such as computed tomography scan and magnetic resonance imaging, as well as biomarkers for brain injury. More recently, several biomarkers associated with brain injury, originating from different regions of the brain, have been identified as potential prognostication tools within a multimodal approach. Based on the preliminary evidence gathered around them, several novel and promising biomarkers have been put forward. This literature review aims to examine four of them: ubiquitin carboxy-terminal hydrolase L1, glial fibrillary acidic protein, neurofilament light and tau protein.</div></div>","PeriodicalId":49268,"journal":{"name":"Medicina Intensiva","volume":"50 3","pages":"Article 502295"},"PeriodicalIF":3.1,"publicationDate":"2026-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147414365","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2026-03-01DOI: 10.1016/j.medin.2025.502363
Yinghui Hong , Mingliang Ye , Junshi Wang , Yuhang Chen , Bin Huang , Xi Li , Lei Huang
Objective
To evaluate the impact of early empirical anti-Methicillin-resistant Staphylococcus aureus (MRSA) therapy on the survival outcomes of patients with severe acute pancreatitis (SAP) in the intensive care units (ICUs).
Design
Secondary Analysis of the the Medical Information Mart for Intensive Care-IV (MIMIC-IV v3.1) on MRSA therapy in Intensive Care Units (ICUs).
Setting
94,458 ICU hospitalization records from 65,366 unique patients between 2008 and 2019.
Patients
494 patients diagnosed with acute pancreatitis first admitted to the ICU.
Interventions
Anti-MRSA (vancomycin or linezolid) agents.
Main variables of interest
28-day and 90-day mortality rates, incidence of renal impairment, and total hospitalization costs.
Results
A total of 494 patients were included, 302 (61.1%) patients received anti-MRSA therapy. After PSM, no significant differences were observed in ICU mortality (adjusted relative risk [aRR], 0.39; 95% CI, 0.11–1.38, p = 0.14) or hospital mortality (aRR, 0.53; 95% CI, 0.21–1.33, p = 0.18) between the two groups. Similarly, 28-day mortality and 90-day mortality did not significantly differ (p > 0.05). Empirical anti-MRSA therapy was associated with significantly longer ICU and hospital LOS (p < 0.001). Subgroup analysis revealed that anti-MRSA therapy significantly increased acute kidney injury incidence (p = 0.002), particularly in patients without pre-existing kidney disease (p < 0.001).
Conclusions
Empirical anti-MRSA therapy was not associated with improved short- or long-term survival in SAP patients, and may lead to prolonged ICU and hospital stays. These findings highlight the importance of integrating local MRSA epidemiology into antimicrobial stewardship decisions.
目的探讨重症监护病房（icu）早期经年性抗甲氧西林耐药金黄色葡萄球菌（MRSA）治疗对重症急性胰腺炎（SAP）患者生存结局的影响。重症监护医学信息集市- iv （MIMIC-IV v3.1）对重症监护病房（icu） MRSA治疗的设计二次分析。在2008年至2019年期间，从65,366名独特患者中收集了94,458例ICU住院记录。患者494例诊断为急性胰腺炎的患者首次入住ICU。抗mrsa（万古霉素或利奈唑胺）药物。主要研究变量：28天和90天死亡率、肾功能损害发生率和总住院费用。结果共纳入494例患者，其中302例（61.1%）患者接受了抗mrsa治疗。经PSM治疗后，两组ICU死亡率（校正相对危险度[aRR]， 0.39; 95% CI, 0.11-1.38, p = 0.14）和住院死亡率（aRR, 0.53; 95% CI, 0.21-1.33, p = 0.18）无显著差异。同样，28天死亡率和90天死亡率无显著差异（p >； 0.05）。经验性抗mrsa治疗与ICU和医院LOS显著延长相关（p <； 0.001）。亚组分析显示，抗mrsa治疗显著增加急性肾损伤发生率（p = 0.002），特别是在没有肾脏疾病的患者中（p <； 0.001）。结论临床抗mrsa治疗与SAP患者短期或长期生存率无相关性，且可能导致ICU和住院时间延长。这些发现强调了将当地MRSA流行病学纳入抗菌药物管理决策的重要性。
{"title":"Impact of empiric anti-MRSA therapy on survival outcome in severe acute pancreatitis: a MIMIC-IV cohort study","authors":"Yinghui Hong , Mingliang Ye , Junshi Wang , Yuhang Chen , Bin Huang , Xi Li , Lei Huang","doi":"10.1016/j.medin.2025.502363","DOIUrl":"10.1016/j.medin.2025.502363","url":null,"abstract":"<div><h3>Objective</h3><div>To evaluate the impact of early empirical anti-Methicillin-resistant <em>Staphylococcus aureus</em> (MRSA) therapy on the survival outcomes of patients with severe acute pancreatitis (SAP) in the intensive care units (ICUs).</div></div><div><h3>Design</h3><div>Secondary Analysis of the the Medical Information Mart for Intensive Care-IV (MIMIC-IV v3.1) on MRSA therapy in Intensive Care Units (ICUs).</div></div><div><h3>Setting</h3><div>94,458 ICU hospitalization records from 65,366 unique patients between 2008 and 2019.</div></div><div><h3>Patients</h3><div>494 patients diagnosed with acute pancreatitis first admitted to the ICU.</div></div><div><h3>Interventions</h3><div>Anti-MRSA (vancomycin or linezolid) agents.</div></div><div><h3>Main variables of interest</h3><div>28-day and 90-day mortality rates, incidence of renal impairment, and total hospitalization costs.</div></div><div><h3>Results</h3><div>A total of 494 patients were included, 302 (61.1%) patients received anti-MRSA therapy. After PSM, no significant differences were observed in ICU mortality (adjusted relative risk [aRR], 0.39; 95% CI, 0.11–1.38, <em>p</em> = 0.14) or hospital mortality (aRR, 0.53; 95% CI, 0.21–1.33, <em>p</em> = 0.18) between the two groups. Similarly, 28-day mortality and 90-day mortality did not significantly differ (<em>p</em> > 0.05). Empirical anti-MRSA therapy was associated with significantly longer ICU and hospital LOS (<em>p</em> < 0.001). Subgroup analysis revealed that anti-MRSA therapy significantly increased acute kidney injury incidence (<em>p</em> = 0.002), particularly in patients without pre-existing kidney disease (<em>p</em> < 0.001).</div></div><div><h3>Conclusions</h3><div>Empirical anti-MRSA therapy was not associated with improved short- or long-term survival in SAP patients, and may lead to prolonged ICU and hospital stays. These findings highlight the importance of integrating local MRSA epidemiology into antimicrobial stewardship decisions.</div></div>","PeriodicalId":49268,"journal":{"name":"Medicina Intensiva","volume":"50 3","pages":"Article 502363"},"PeriodicalIF":3.1,"publicationDate":"2026-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147414366","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
To construct a risk prediction model and systematically analyze factors contributing to unplanned weaning during continuous renal replacement therapy (CRRT) in critically ill adult patients.
Design
Cross-sectional, single center study.
Setting
Dialysis Center of Third-level hospital in China.
Patients
Eight hundred and thirteen critically ill adults receiving CRRT after exclusions during May 2023 to Dec 2024.
Interventions
Prospective collection of variables during hospital admission and follow-up.
Independent predictors of unplanned weaning included anticoagulant type (nemastat mesylate, OR = 10.20, 95%CI 3.15–33.02), scheduled treatment time > 24 h (OR = 6.66, 95%CI 3.22–13.79), agitation status (OR = 2.76, 95%CI 1.27–6.02), peak venous pressure > 114 mmHg (OR = 3.58, 95%CI 1.84–6.93), peak transmembrane pressure > 172 mmHg (OR = 2.19, 95%CI 1.11–4.33), weight > 70 kg (OR = 2.13, 95%CI 1.13–4.01). The model demonstrated AUCs of 0.874 (training) and 0.730 (validation).
Conclusions
This nomogram-based model integrates multidimensional risk factors and provides actionable insights for preventing unplanned CRRT weaning. Key clinical strategies include optimizing anticoagulation protocols and monitoring hemodynamic parameters. Further multicenter validation is warranted to improve generalizability.
{"title":"Risk prediction model for unplanned weaning during continuous renal replacement therapy: A cross-sectional study","authors":"Xiaomin Liu, Minling Li, Rui Wu, Jiajia Ma, Cunyi Shen, Xiaohong Yang, Meng Wei, Limin Wei, Lei Chen, Qiaoning Wei, Hao He, Julin Gao","doi":"10.1016/j.medin.2025.502361","DOIUrl":"10.1016/j.medin.2025.502361","url":null,"abstract":"<div><h3>Objective</h3><div>To construct a risk prediction model and systematically analyze factors contributing to unplanned weaning during continuous renal replacement therapy (CRRT) in critically ill adult patients.</div></div><div><h3>Design</h3><div>Cross-sectional, single center study.</div></div><div><h3>Setting</h3><div>Dialysis Center of Third-level hospital in China.</div></div><div><h3>Patients</h3><div>Eight hundred and thirteen critically ill adults receiving CRRT after exclusions during May 2023 to Dec 2024.</div></div><div><h3>Interventions</h3><div>Prospective collection of variables during hospital admission and follow-up.</div></div><div><h3>Main variables of interest</h3><div>Demographics, clinical conditions, nursing parameters, vascular access, consumables, laboratory profiles, treatment prescriptions, and hemodynamic data.</div></div><div><h3>Results</h3><div>Independent predictors of unplanned weaning included anticoagulant type (nemastat mesylate, OR = 10.20, 95%CI 3.15–33.02), scheduled treatment time > 24 h (OR = 6.66, 95%CI 3.22–13.79), agitation status (OR = 2.76, 95%CI 1.27–6.02), peak venous pressure > 114 mmHg (OR = 3.58, 95%CI 1.84–6.93), peak transmembrane pressure > 172 mmHg (OR = 2.19, 95%CI 1.11–4.33), weight > 70 kg (OR = 2.13, 95%CI 1.13–4.01). The model demonstrated AUCs of 0.874 (training) and 0.730 (validation).</div></div><div><h3>Conclusions</h3><div>This nomogram-based model integrates multidimensional risk factors and provides actionable insights for preventing unplanned CRRT weaning. Key clinical strategies include optimizing anticoagulation protocols and monitoring hemodynamic parameters. Further multicenter validation is warranted to improve generalizability.</div></div>","PeriodicalId":49268,"journal":{"name":"Medicina Intensiva","volume":"50 3","pages":"Article 502361"},"PeriodicalIF":3.1,"publicationDate":"2026-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147414372","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2026-03-01DOI: 10.1016/j.medin.2025.502209
Marco Tomasino , Sofía Vila-Sanjuán , Ravi Vazirani , Jorge Salamanca , Manuel Martínez-Sellés , Julio Ruiz-Ruiz , Agustín Martín , Emilia Blanco-Ponce , Manuel Almendro-Delia , Miguel Corbí-Pascual , Aitor Uribarri , Iván J. Núñez-Gil
Objective
To determine the prognostic value of the Vasoactive-Inotropic Score (VIS) in patients with Takotsubo syndrome (TTS) complicated by cardiogenic shock (CS).
Design
Retrospective cohort analysis.
Setting
Multicenter registry (RETAKO) of patients diagnosed with TTS between 2003 and 2022.
Patients or participants
A total of 1591 patients with TTS, of which 412 (26%) developed CS.
Interventions
Patients were managed according to clinical criteria, with VIS calculated based on the maximum doses of inotropic and vasoactive drugs administered within the first 24 h of CS diagnosis.
Main variables of interest
30-day and 1-year mortality rates, VIS tertile classifications.
Results
Of the patients who developed CS, 208 received inotropic support. Patients in the highest VIS tertile had significantly higher 30-day (HR 8.80, 95% CI 1.96−39.48; p = 0.005) and 1-year (HR 4.55, 95% CI 1.11−18.63; p < 0.035) mortality compared to the lowest tertile. High VIS was also linked to increased complications, including acute kidney injury, major bleeding, and the need for mechanical circulatory support. In-hospital mortality rates were 4% for the low tertile, 14% for the middle tertile, and 47% for the high tertile (p < 0.001).
Conclusions
VIS is associated with worse short- and long-term outcomes in TTS complicated by CS. Further research is needed to explore potential causal pathways, if any, and to optimize therapeutic strategies for these patients.
目的探讨血管活性-肌力评分（VIS）对Takotsubo综合征（TTS）合并心源性休克（CS）患者的预后价值。设计回顾性队列分析。2003年至2022年间诊断为TTS的患者的多中心注册（RETAKO）。患者或参与者共1591例TTS患者，其中412例（26%）发展为CS。根据临床标准对患者进行管理，VIS根据CS诊断前24小时内给予的肌力药物和血管活性药物的最大剂量计算。感兴趣的主要变量：30天死亡率和1年死亡率，VIS分蘖分类。结果在发生CS的患者中，208例接受了肌力支持。与最低水平的患者相比，VIS水平最高的患者30天死亡率（HR 8.80, 95% CI 1.96 - 39.48; p = 0.005）和1年死亡率（HR 4.55, 95% CI 1.11 - 18.63; p < 0.035）显著高于最低水平的患者。高VIS还与并发症增加有关，包括急性肾损伤、大出血和需要机械循环支持。低四分之一组的住院死亡率为4%，中等四分之一组为14%，高四分之一组为47% （p < 0.001）。结论svis与TTS合并CS的短期和长期预后差相关。需要进一步的研究来探索潜在的因果途径，如果有的话，并优化这些患者的治疗策略。
{"title":"Vasoactive-Inotropic Score in Takotsubo syndrome induced cardiogenic shock","authors":"Marco Tomasino , Sofía Vila-Sanjuán , Ravi Vazirani , Jorge Salamanca , Manuel Martínez-Sellés , Julio Ruiz-Ruiz , Agustín Martín , Emilia Blanco-Ponce , Manuel Almendro-Delia , Miguel Corbí-Pascual , Aitor Uribarri , Iván J. Núñez-Gil","doi":"10.1016/j.medin.2025.502209","DOIUrl":"10.1016/j.medin.2025.502209","url":null,"abstract":"<div><h3>Objective</h3><div>To determine the prognostic value of the Vasoactive-Inotropic Score (VIS) in patients with Takotsubo syndrome (TTS) complicated by cardiogenic shock (CS).</div></div><div><h3>Design</h3><div>Retrospective cohort analysis.</div></div><div><h3>Setting</h3><div>Multicenter registry (RETAKO) of patients diagnosed with TTS between 2003 and 2022.</div></div><div><h3>Patients or participants</h3><div>A total of 1591 patients with TTS, of which 412 (26%) developed CS.</div></div><div><h3>Interventions</h3><div>Patients were managed according to clinical criteria, with VIS calculated based on the maximum doses of inotropic and vasoactive drugs administered within the first 24 h of CS diagnosis.</div></div><div><h3>Main variables of interest</h3><div>30-day and 1-year mortality rates, VIS tertile classifications.</div></div><div><h3>Results</h3><div>Of the patients who developed CS, 208 received inotropic support. Patients in the highest VIS tertile had significantly higher 30-day (HR 8.80, 95% CI 1.96−39.48; p = 0.005) and 1-year (HR 4.55, 95% CI 1.11−18.63; p < 0.035) mortality compared to the lowest tertile. High VIS was also linked to increased complications, including acute kidney injury, major bleeding, and the need for mechanical circulatory support. In-hospital mortality rates were 4% for the low tertile, 14% for the middle tertile, and 47% for the high tertile (p < 0.001).</div></div><div><h3>Conclusions</h3><div>VIS is associated with worse short- and long-term outcomes in TTS complicated by CS. Further research is needed to explore potential causal pathways, if any, and to optimize therapeutic strategies for these patients.</div></div>","PeriodicalId":49268,"journal":{"name":"Medicina Intensiva","volume":"50 3","pages":"Article 502209"},"PeriodicalIF":3.1,"publicationDate":"2026-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147414364","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2026-03-01Epub Date: 2025-12-31DOI: 10.1016/j.medin.2025.502389
Irene Cavada Carranza , Eva Esther Tejerina Álvarez , Teresa Molina García , José Ángel Lorente Balanza
{"title":"Milrinona en el vasoespasmo cerebral secundario a hemorragia subaracnoidea aneurismática: ¿alternativa terapéutica real o recurso de rescate?","authors":"Irene Cavada Carranza , Eva Esther Tejerina Álvarez , Teresa Molina García , José Ángel Lorente Balanza","doi":"10.1016/j.medin.2025.502389","DOIUrl":"10.1016/j.medin.2025.502389","url":null,"abstract":"","PeriodicalId":49268,"journal":{"name":"Medicina Intensiva","volume":"50 3","pages":"Article 502389"},"PeriodicalIF":3.1,"publicationDate":"2026-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147414361","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2026-03-01Epub Date: 2025-06-18DOI: 10.1016/j.medin.2025.502229
Alejandro González-Castro , Arturo Ávila
{"title":"El efecto trinquete: entre el enfoque del «pulmón abierto» y la estrategia de «pulmón estable»","authors":"Alejandro González-Castro , Arturo Ávila","doi":"10.1016/j.medin.2025.502229","DOIUrl":"10.1016/j.medin.2025.502229","url":null,"abstract":"","PeriodicalId":49268,"journal":{"name":"Medicina Intensiva","volume":"50 3","pages":"Article 502229"},"PeriodicalIF":3.1,"publicationDate":"2026-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147414374","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
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