Medicina Intensiva最新文献

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Bridging the nutritional gap between the intensive care unit and the ward: A plea for action to ensure continuity of care 弥合重症监护室和病房之间的营养差距：呼吁采取行动确保护理的连续性

IF 3.1 4区医学 Q2 CRITICAL CARE MEDICINE

Medicina Intensiva

Pub Date : 2025-12-01 DOI: 10.1016/j.medin.2025.502222

David Pérez-Torres, Isabel Canas-Pérez, Cristina Díaz-Rodríguez, Ana Isabel Martín-Luengo

引用次数: 0

Massive left atrial appendage thrombus in a patient with paroxysmal atrial fibrillation 阵发性心房颤动患者的大块左心房附件血栓

IF 3.1 4区医学 Q2 CRITICAL CARE MEDICINE

Medicina Intensiva

Pub Date : 2025-12-01 DOI: 10.1016/j.medin.2025.502261

Dipesh Raniga, Bradley Hefford, Maria Gabriela Matta

引用次数: 0

β-lactam antibiotics to prevent ventilator-associated pneumonia (VAP) in coma patients: A systematic review and meta-analysis of randomized controlled trials β-内酰胺抗生素预防昏迷患者呼吸机相关性肺炎（VAP）：随机对照试验的系统回顾和荟萃分析

IF 3.1 4区医学 Q2 CRITICAL CARE MEDICINE

Medicina Intensiva

Pub Date : 2025-11-01 DOI: 10.1016/j.medin.2025.502199

Edinson Dante Meregildo-Rodriguez , Mariano Ortiz-Pizarro , Martha Genara Asmat-Rubio , Carlos Geraldo Fernandez-Narváez , Gustavo Adolfo Vásquez-Tirado

Objective

To evaluate the effect of parenteral β-lactam antibiotics on outcomes related to ventilator-associated pneumonia (VAP) in adult patients in coma due to acute brain injury (ABI).

Design

Systematic review and meta-analysis.

Setting

Randomized controlled trials (RCTs) published up toSeptember 30, 2024.

Patients or participants

Adult patients in coma due to ABI.

Interventions

Parenteral β-lactam antibiotics.

Main variables of interest

Incidence and outcomes related to VAP.

Results

Three RCTs involving 483 patients met inclusion criteria; 231 patients received β-lactam prophylaxis. Among these, there were 115 cases of early-onset VAP (EO-VAP), 49 of late-onset VAP (LO-VAP), and 102 deaths. All studies were conducted in Europe. Causes of coma included trauma, stroke, and CO poisoning. Intravenous β-lactams (ampicillin/sulbactam, cefuroxime, and ceftriaxone) reduced EO-VAP risk by 57% (RR 0.43; 95% CI 0.30–0.61), and all-VAP by 35% (RR 0.65; 95% CI 0.53–0.80).

No impact was observed on LO-VAP (RR 0.95; 95% CI 0.54–1.67), 28-day mortality (RR 0.76; 95% CI 0.53–1.09), intubation duration (SMD -0.13; 95% CI −0.46–0.21), or ICU length of stay (SMD −0.22; 95% CI −0.55–0.12). Heterogeneity and the risk of bias were low, with high overall evidence certainty.

Conclusions

In adult patients in coma due to ABI, intravenous β-lactam antibiotics reduce EO-VAP and all-VAP risk.

目的探讨β-内酰胺类抗生素对急性脑损伤（ABI）昏迷成人患者呼吸机相关性肺炎（VAP）预后的影响。设计系统回顾和荟萃分析。截止到2024年9月30日发表的随机对照试验（rct）。患者或参与者因ABI而昏迷的成人患者。干预：肠外β-内酰胺类抗生素。与VAP相关的发病率和转归的主要变量。结果3项rct共纳入483例患者，符合纳入标准；231例患者接受β-内酰胺预防治疗。早发型VAP 115例（EO-VAP），晚发型VAP 49例（LO-VAP），死亡102例。所有的研究都在欧洲进行。昏迷的原因包括外伤、中风和一氧化碳中毒。静脉注射β-内酰胺类药物（氨苄西林/舒巴坦、头孢呋辛和头孢曲松）可使EO-VAP风险降低57% (RR 0.43; 95% CI 0.30-0.61)，使全vap风险降低35% （RR 0.65; 95% CI 0.53-0.80）。对LO-VAP （RR 0.95; 95% CI 0.54-1.67）、28天死亡率（RR 0.76; 95% CI 0.53-1.09）、插管时间（SMD -0.13; 95% CI - 0.46-0.21）或ICU住院时间（SMD - 0.22; 95% CI - 0.55-0.12）均无影响。异质性和偏倚风险较低，总体证据确定性较高。结论在ABI昏迷的成人患者中，静脉注射β-内酰胺类抗生素可降低EO-VAP和all-VAP的风险。

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引用次数: 0

Shock séptico por Capnocytophaga canimorsus por mordedura sin celulitis 无蜂窝组织炎咬伤食虫角虫的化脓性休克

IF 3.1 4区医学 Q2 CRITICAL CARE MEDICINE

Medicina Intensiva

Pub Date : 2025-11-01 DOI: 10.1016/j.medin.2025.502233

Hugo Arrando Barbera , Ángel Orera Pérez , Juan Díaz Nohales

引用次数: 0

Advances in extracorporeal liver support for acute and acute-on-chronic liver failure 体外肝支持治疗急性和急性伴慢性肝衰竭的研究进展

IF 3.1 4区医学 Q2 CRITICAL CARE MEDICINE

Medicina Intensiva

Pub Date : 2025-11-01 DOI: 10.1016/j.medin.2025.502291

David Toapanta-Gaibor , Jesús Sánchez-Ballesteros , María González-Fernández , María Jesús Broch-Porcar

Liver failure, either acute (ALF) or acute-on-chronic (ACLF), is characterized by hepatocellular dysfunction, systemic inflammation, and multiorgan failure, leading to high mortality without liver transplantation (LT). However, LT is limited by organ shortages and medical contraindications, necessitating alternative therapeutic strategies.

Biological liver support systems, incorporate functional hepatocytes to partially restore hepatic metabolic functions, though clinical trials have not demonstrated a survival benefit. Artificial systems, such as albumin dialysis (MARS, Prometheus), facilitate toxin removal, though evidence remains limited.

Continuous renal replacement therapy, while not specific for liver failure, is essential in patients with severe hyperammonemia or acute kidney injury, aiding in ammonia clearance and fluid balance control.

Plasma exchange (PE) has promising detoxification and immunomodulatory effects, improving survival in ALF. In ACLF, PE may reduce systemic inflammation, though evidence remains limited.

Further studies are needed to optimize ECLS therapies, refine patient selection, and establish their role in ALF and ACLF management.

急性（ALF）或急性伴慢性（ACLF）肝衰竭的特点是肝细胞功能障碍、全身炎症和多器官功能衰竭，导致不进行肝移植（LT）的高死亡率。然而，肝移植受到器官短缺和医学禁忌症的限制，需要其他治疗策略。生物肝支持系统包含功能性肝细胞，可部分恢复肝脏代谢功能，但临床试验尚未证明其对生存有好处。人工系统，如白蛋白透析（MARS，普罗米修斯），有助于毒素的清除，尽管证据仍然有限。持续的肾脏替代治疗，虽然不是针对肝功能衰竭，但对于严重高氨血症或急性肾损伤的患者是必不可少的，有助于氨清除和液体平衡控制。血浆交换（PE）具有良好的解毒和免疫调节作用，可提高ALF患者的生存率。在ACLF中，PE可能减轻全身性炎症，尽管证据仍然有限。需要进一步的研究来优化ECLS疗法，优化患者选择，并确定其在ALF和ACLF管理中的作用。

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引用次数: 0

The role of point-of-care ultrasonography in central venous catheter insertion: A randomized controlled trial of safety and cost-effectiveness 即时超声检查在中心静脉置管中的作用：一项安全性和成本效益的随机对照试验

IF 3.1 4区医学 Q2 CRITICAL CARE MEDICINE

Medicina Intensiva

Pub Date : 2025-11-01 DOI: 10.1016/j.medin.2025.502221

Ahmed Beniamen , Ahmed Mosallem , Hossam Tharwat Ali , Hanaa A. Nofal , Essamedin M. Negm

Objective

The objective of the study was to compare landmark-based and ultrasound-guided techniques of central venous catheter insertion (CVC).

Design

Randomized controlled trial (2021–2023).

Setting

Zagazig University Hospitals (ZUH), a tertiary care center.

Patients

Adult patients in whom CVC insertion is indicated.

Main variables of interest

Demographic and clinical peri-procedural data, the safety of the technique, time of performance, and cost-effectiveness were compared.

Results

Patient ages ranged from 17 to 80 years with 56% being males. Urgent indications were found in around 22% without significant differences between groups. Regarding the time of performance, the ultrasound-guided method had slightly but significantly less time of performance (25.7 ± 4.3; range: 18−33) compared to the blind technique (26.9 ± 7.4; range: 15−45) (P-value < 0.001) with a higher but non-significant number of patients without complications (64% vs 52%; P-value = 0.2). Failure to insert the CVC into the IJV occurred in 12 patients (12%) with the blind technique and in eight patients (8%) with the ultrasound-guided technique (P-value = 0.04). Carotid artery puncture with neck hematoma occurred in only 8 (8%) patients with the blind technique (P-value = 0.04). Excess cost was consumed in only 36 patients (36%) in the blind technique group (P-value = 0.001).

Conclusion

Point-of-care ultrasonography bundle for CVC insertion is considered superior to, safer, and more cost-effective than the blind technique.

目的比较地标式和超声引导下中心静脉置管（CVC）技术。随机对照试验（2021-2023）。扎加齐格大学医院（ZUH），三级保健中心。患者指征CVC插入的成年患者。主要感兴趣的变量进行人口统计学和临床围手术期数据，技术的安全性，执行时间和成本-效果的比较。结果患者年龄17 ~ 80岁，男性占56%。紧急适应症发生率约为22%，组间无显著差异。在执行时间方面，超声引导法的执行时间（25.7 ± 4.3；范围：18−33）略低于盲法（26.9 ± 7.4；范围：15−45）（p值<； 0.001），无并发症患者数量较高但不显著（64% vs 52%； p值 = 0.2）。盲法和超声引导法分别有12例（12%）和8例（8%）CVC插入失败（p值 = 0.04）。采用盲法穿刺颈动脉导致颈部血肿的患者仅8例（8%）（p值 = 0.04）。在盲法组中，只有36例（36%）患者消耗了额外的费用（p值 = 0.001）。结论即时超声束在CVC插入中的应用优于盲法，安全性好，性价比高。

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引用次数: 0

Shock cardiogénico por gran pseudoaneurisma apical del ventrículo izquierdo: una complicación infrecuente 左心室大顶动脉瘤引起的心源性休克：罕见的并发症

IF 3.1 4区医学 Q2 CRITICAL CARE MEDICINE

Medicina Intensiva

Pub Date : 2025-11-01 DOI: 10.1016/j.medin.2025.502212

Jaime Andrés Romero León, Elena Morente García, Eva Peregrina Caño

引用次数: 0

Sedación y COVID-19. Tiempo de olvidar, tiempo de retornar 镇静和COVID-19。时间的遗忘，时间的回归

IF 3.1 4区医学 Q2 CRITICAL CARE MEDICINE

Medicina Intensiva

Pub Date : 2025-11-01 DOI: 10.1016/j.medin.2025.502264

Sara Alcántara Carmona, Miguel Ángel Romera Ortega

引用次数: 0

Thomas R. Martin, M.D. (1947–2025) 托马斯·马丁，医学博士（1947-2025）

IF 3.1 4区医学 Q2 CRITICAL CARE MEDICINE

Medicina Intensiva

Pub Date : 2025-11-01 DOI: 10.1016/j.medin.2025.502317

Raquel Herrero , Antonio Artigas , Gustavo Matute-Bello

引用次数: 0

Evaluation of functional brain damage using resting-state functional magnetic resonance imaging in patients with diffuse axonal injury admitted to the ICU 静息状态功能磁共振成像对ICU弥漫性轴索损伤患者功能性脑损伤的评价

IF 3.1 4区医学 Q2 CRITICAL CARE MEDICINE

Medicina Intensiva

Pub Date : 2025-11-01 DOI: 10.1016/j.medin.2025.502260

Patricia Serrats-López , Juan Antonio Llompart-Pou , Ana María González-Roldán , Juan Lorenzo Terrasa-Navarro , Apolonia Moll-Servera , Jon Pérez-Bárcena

引用次数: 0

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