Medicina Intensiva最新文献

英文中文

Análisis de la experiencia clínica con angiotensina II: un metaanálisis y 4 inteligencias artificiales 血管紧张素II的临床经验分析：荟萃分析和4个人工智能

IF 3.1 4区医学 Q2 CRITICAL CARE MEDICINE

Medicina Intensiva

Pub Date : 2025-12-01 DOI: 10.1016/j.medin.2025.502269

Íñigo Isern-de-Val , Saray Antón Juarros , Marta Malingre Gajino , Héctor Mercado Castillo , Irene Orduna Casla , Raquel Lorenzo Álvarez , Lidia Serrano Martínez , Juan José Araiz Burdio

Objective

Angiotensin II (ATII) was approved for distributive shock in Spain (2023). The objective is to assess the experience with ATII by comparing a meta-analysis (MTA) and 4 Artificial Intelligence (AI) tools.

Design

A search was conducted in Pubmed®, Central®, Embase®, and Scopus®. Randomized clinical trials, non-randomized trials, and observational studies were included. The primary outcome was all-cause mortality. Odds ratios (OR) with 95% confidence intervals (CI) were pooled. Four AI tools were used: Consensus, Perplexity, Elicit, and Scite.

Setting

Intensive care medicine.

Patients or participants

One thousand six hundred and thirty-six studies were identified, with 10 studies included in the MTA.

Interventions

No interventions.

Main variables of interest

Mortality, efficacy, and safety.

Results

ATII shows a trend towards mortality reduction when compared with controls, OR: 0.86 (95% CI: 0.60-1.23); this reduction reaches significance in patient subgroups: High Renin Levels, OR: 0.45 (95% CI: 0.22-0.93); shock with renal replacement therapy, OR: 0.38 (95% CI: 0.17-0.84). ATII is very effective in increasing mean arterial pressure, OR: 3.25 (95% CI: 2.24-4.73), without increasing events, OR: 0.77 (95% CI: 0.51-1.14). The AI reached the same conclusions, but only 25-30% of the studies were included in the MTA.

Conclusions

ATII effectively increases blood pressure without side effects and without altering mortality. AI can assist in evaluating clinical evidence.

目的血管紧张素II （ATII）于2023年在西班牙被批准用于治疗缺血性休克。目的是通过比较荟萃分析（MTA）和4种人工智能（AI）工具来评估ATII的经验。在Pubmed®、Central®、Embase®和Scopus®中进行了DesignA检索。包括随机临床试验、非随机试验和观察性研究。主要结局为全因死亡率。合并优势比（OR）和95%置信区间（CI）。使用了四种人工智能工具：Consensus， Perplexity， Elicit和Scite。重症监护医学。患者或参与者共确定了1636项研究，其中10项研究被纳入了MTA。InterventionsNo干预措施。主要感兴趣的变量死亡率，疗效和安全性。结果与对照组相比，atii显示死亡率降低的趋势，OR: 0.86 (95% CI: 0.60-1.23)；这种降低在患者亚组中达到显著性：高肾素水平，OR: 0.45 (95% CI: 0.22-0.93)；休克合并肾脏替代治疗，OR: 0.38 （95% CI: 0.17-0.84）。ATII在增加平均动脉压方面非常有效，OR: 3.25 (95% CI: 2.24-4.73)，而不增加事件，OR: 0.77 （95% CI: 0.51-1.14）。人工智能也得出了同样的结论，但只有25-30%的研究被纳入了MTA。结论satii能有效提高血压，无副作用，不影响死亡率。人工智能可以协助评估临床证据。

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引用次数: 0

Reanimación cardiopulmonar extracorpórea prehospitalaria en eventos multitudinarios: hacia un nuevo paradigma en la atención a la parada cardíaca 群集性事件中的院前体外心肺复苏：迈向心脏骤停护理的新范式

IF 3.1 4区医学 Q2 CRITICAL CARE MEDICINE

Medicina Intensiva

Pub Date : 2025-12-01 DOI: 10.1016/j.medin.2025.502266

Eduard Argudo , Maria Vidal-Burdeus , Jorge Morales-Álvarez , Jordi Riera

引用次数: 0

Videolaryngoscopy vs. direct laryngoscopy in orotracheal intubation in obese critical patients: Systematic review and meta-analysis 视频喉镜与直接喉镜在肥胖危重患者经气管插管中的应用：系统回顾和荟萃分析

IF 3.1 4区医学 Q2 CRITICAL CARE MEDICINE

Medicina Intensiva

Pub Date : 2025-12-01 DOI: 10.1016/j.medin.2025.502168

Samuel David Gil-Bazán , Gustavo Adolfo Vásquez-Tirado , Edward Chávez-Cruzado , Edinson Dante Meregildo-Rodríguez , Claudia Vanessa Quispe-Castañeda , Wilson Marcial Guzmán-Aguilar , Leslie Jacqueline Liñán-Díaz

Objective

To determine whether the use of videolaryngoscopy (VL) is more effective than direct laryngoscopy (DL) for orotracheal intubation in obese patients.

Design

This is a systematic review and meta-analysis.

Setting

A comprehensive search was conducted in five databases for studies published up to December 26, 2023, using a PICO strategy. Fifteen studies were identified for quantitative analysis and included in our meta-analysis.

Participants

The participants of the included primary studies (obese patients).

Interventions

Orotracheal intubation with videolaryngoscopy or direct laryngoscopy.

Main variables of interest

Videolaryngoscopy, direct laryngoscopy, intubation time, first--pass success rate, minor complications.

Results

No significant differences were found in intubation time between VL and DL in obese patients (MD: −4.84; 95% CI: −13.49 to 3.80; I²: 90%). In the subgroup analysis, the Airtaq technique showed a significant difference in intubation time compared to the Macintosh technique (MD: −25.29; 95% CI: −49.17 to −1.38; I²: 95%). However, no significant differences were observed in the first--pass success rate (OR: 1.58; 95% CI: 0.77–3.23; I²: 33%) or in complications such as pain (OR: 1.15; 95% CI: 0.75–1.75; I²: 0%) and voice changes (OR: 0.76; 95% CI: 0.46–1.26; I²: 0%) between the two methods.

Conclusion

There are no significant differences in intubation time, first--pass success rate, or complications between VL and DL in obese critical patients.

目的探讨视频喉镜（VL）是否比直接喉镜（DL）更有效地用于肥胖患者的气管插管。这是一项系统回顾和荟萃分析。使用PICO策略，在5个数据库中对截至2023年12月26日发表的研究进行了全面检索。15项研究被确定用于定量分析，并纳入我们的荟萃分析。参与者纳入的主要研究的参与者（肥胖患者）。介入：经气管插管配合视频喉镜或直接喉镜检查。感兴趣的主要因素有：视频喉镜检查、直接喉镜检查、插管时间、一次通过率、轻微并发症。结果肥胖患者VL和DL插管时间无显著差异（MD: - 4.84; 95% CI: - 13.49 ~ 3.80; I2: 90%）。在亚组分析中，与Macintosh技术相比，Airtaq技术在插管时间上有显著差异（MD: - 25.29; 95% CI: - 49.17至- 1.38;I2: 95%）。然而，两种方法在一次通过成功率（OR: 1.58; 95% CI: 0.77-3.23; I2: 33%）或并发症(如疼痛（OR: 1.15; 95% CI: 0.75-1.75; I2: 0%）和声音变化（OR: 0.76; 95% CI: 0.46-1.26; I2: 0%）方面没有观察到显著差异。结论肥胖危重患者VL与DL在插管时间、一次通过成功率、并发症等方面无显著差异。

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引用次数: 0

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

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