Medicina Intensiva最新文献

英文中文

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

Short- and long-term mortality in critically ill patients with solid cancer. The Vall d’Hebron Intensive Care Unit-Vall d’Hebron Institute of Oncology Cohort: a retrospective study 实体癌危重病人的短期和长期死亡率。Vall d 'Hebron重症监护病房-Vall d 'Hebron肿瘤研究所队列：回顾性研究

IF 3.1 4区医学 Q2 CRITICAL CARE MEDICINE

Medicina Intensiva

Pub Date : 2025-11-01 DOI: 10.1016/j.medin.2025.502176

Cándido Díaz-Lagares , Alejandra García-Roche , Andrés Pacheco , Javier Ros , Erika P. Plata-Menchaca , Adaia Albasanz , David Pérez , Nadia Saoudi , Isabel Ruiz-Camps , Elena Élez , Ricard Ferrer

Objective

To describe in-hospital and one-year mortality and to identify prognostic variables associated with mortality.

Design

Retrospective cohort study.

Setting

Tertiary referral hospital in Barcelona (Spain).

Patients

Consecutive patients with solid cancer and unplanned admission to the ICU over a ten year period (2010–2019).

Main variables of interest

In-hospital mortality, one-year mortality, type of cancer, metastatic disease, ECOG, APACHE, SOFA, invasive mechanical ventilation, vasoactive drugs, renal replacement therapy.

Results

Three hundred and ninety-five patients were admitted to the ICU; 193 (48.8%) had metastatic disease, and 22 (5.9%) presented neutropenia. The median SOFA score on day 1 of ICU admission was 6 (3−9). ICU, in-hospital, and one-year mortality were 27.9% (110 patients), 39% (139 patients), and 61.1% (236 patients), respectively. A non-surgical admission, a higher ECOG, a SOFA score > 9 on day 1, a non-decreasing SOFA score on day 5, and requiring invasive mechanical ventilation were factors associated with in-hospital mortality. ECOG, inability to resume anticancer therapy, and ICU admission due to respiratory failure were associated with one-year mortality in hospital survivors.

Conclusion

Survival in critically ill solid cancer patients is substantial, even when metastatic disease exists. Short-term outcomes were associated with ECOG and organ dysfunction, not cancer per se. The prognosis of patients with a non-decreasing SOFA score on day 5 is poor, especially when the SOFA score on day 1 was >9. Long-term mortality was associated with functional status and inability to resume anticancer therapy.

目的描述住院和一年内的死亡率，并确定与死亡率相关的预后变量。设计回顾性队列研究。巴塞罗那三级转诊医院（西班牙）。患者：在10年期间（2010-2019年），连续罹患实体癌且计划外入住ICU的患者。感兴趣的主要变量：医院死亡率、一年死亡率、癌症类型、转移性疾病、ECOG、APACHE、SOFA、有创机械通气、血管活性药物、肾脏替代治疗。结果395例患者入住ICU；193例（48.8%）有转移性疾病，22例（5.9%）出现中性粒细胞减少。ICU入院第1天SOFA评分中位数为6（3 - 9）。ICU、住院和1年死亡率分别为27.9%（110例）、39%（139例）和61.1%（236例）。非手术入院、较高的ECOG、第1天SOFA评分[gt； 9]、第5天SOFA评分不下降以及需要有创机械通气是院内死亡率相关的因素。ECOG、无法恢复抗癌治疗和因呼吸衰竭而入住ICU与住院幸存者的1年死亡率相关。结论危重期实体癌患者的生存率很高，即使存在转移性肿瘤。短期预后与ECOG和器官功能障碍有关，而与癌症本身无关。第5天SOFA评分不下降的患者预后较差，特别是第1天SOFA评分为>；9时。长期死亡率与功能状态和无法恢复抗癌治疗有关。

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引用次数: 0

Implementación de la tomografía por impedancia eléctrica en la enfermedad pleuropulmonar del paciente adulto 在成人患者胸膜肺病中实施电阻抗断层扫描

IF 3.1 4区医学 Q2 CRITICAL CARE MEDICINE

Medicina Intensiva

Pub Date : 2025-11-01 DOI: 10.1016/j.medin.2025.502262

Gabriel Appendino, Celeste Gomez, Carlos Lovesio

引用次数: 0

Calidad de vida en pacientes post-COVID-19 tras el alta de un centro de desvinculación de ventilación mecánica y rehabilitación: estudio de cohorte retrospectivo 2019冠状病毒病患者出院后的生活质量：回顾性队列研究

IF 3.1 4区医学 Q2 CRITICAL CARE MEDICINE

Medicina Intensiva

Pub Date : 2025-11-01 DOI: 10.1016/j.medin.2025.502257

Emilio Sebastián Rositi , Emiliano Navarro , Mirian Lorena Delvalle , Agustín García , Miguel Antonio Escobar , Javier Eugenio Cromberg , Gastón Germán Morel Vulliez , Melina Calvo Delfino , Eduardo Luis de Vito

引用次数: 0

Analgesia, sedation, and neuromuscular blocking agents: A standardized protocol of analgosedation in COVID-19 镇痛、镇静和神经肌肉阻滞剂：新冠肺炎患者镇痛镇静的标准化方案

IF 3.1 4区医学 Q2 CRITICAL CARE MEDICINE

Medicina Intensiva

Pub Date : 2025-11-01 DOI: 10.1016/j.medin.2025.502223

Cecilia Inés Loudet , Marisol García Sarubbio , María Julia Meschini , Jacqueline Vilca Becerra , María Agustina Mazzoleni , Vanesa Aramendi , Agustina Barbieri , Carolina Colavita , Gustavo Cerri , Sofía Pacho , Eliseo Hernán Ferrari , Rosa Reina

Objectives

Primary: To evaluate the level of sedation, use, daily doses, and duration of analgosedative drugs in COVID-19 patients on mechanical ventilation (MV) using a standardized protocol, comparing survivors and non-survivors. Secondary: To identify independent predictors of hospital mortality.

Design

Retrospective cohort study.

Setting

Medical-surgical ICU.

Patients

Adults with SARS-CoV-2 infection requiring invasive MV and continuous infusion of analgosedation and/or neuromuscular blocking agents (NMBAs) for at least 48 h.

Interventions

None.

Main variables of interest

Level of sedation, use, daily doses, and duration of analgosedative drugs; hospital mortality and associated factors.

Results

Among 198 patients (nurse-to-patient ratio 1:2.4; 65% staff turnover), median global RASS was –4.5. Kaplan–Meier analysis showed lower survival with deeper sedation. Fentanyl (99%) and midazolam (97%) were the most used, followed by NMBAs (81%), propofol and dexmedetomidine (48%). Non-benzodiazepine sedatives were precribed more in survivors (88%) than non-survivors (53%) (p < 0.01). Survivors had more days of fentanyl, midazolam, and dexmedetomidine; no differences in NMBA use or drug doses were observed. Mortality was 63%. Independent predictors of mortality included APACHE II, SOFA₂₄, Charlson score, median RASS, and non-benzodiazepine sedative use.

Conclusions

Standardized protocols emphasizing the ACD components of the ABCDEF bundle, along with appropriate use of analgosedation and NMBAs despite limited staffing, effectively supported the management of sedation without significant dose differences between survivors and non-survivors. Sedation level and the use of non-benzodiazepine sedatives were independently associated with better outcomes, highlighting the importance of the light sedation and the ABCDEF bundle.

目的：评价采用标准化方案机械通气（MV）的COVID-19患者镇静水平、使用、日剂量和持续时间，比较存活患者和非存活患者。次要目的：确定医院死亡率的独立预测因子。设计回顾性队列研究。SettingMedical-surgical ICU。SARS-CoV-2感染的成人患者需要侵入性MV和连续输注镇痛镇静和/或神经肌肉阻断剂（nmba）至少48次 。感兴趣的主要变量：镇静水平、使用方法、日剂量、持续时间；医院死亡率及其相关因素。结果198例患者（护患比1:24 .4，人员流失率65%），总体RASS中位数为-4.5。Kaplan-Meier分析显示，镇静程度越深，生存率越低。使用最多的是芬太尼（99%）和咪达唑仑（97%），其次是nmba（81%）、异丙酚和右美托咪定（48%）。幸存者使用非苯二氮卓类镇静剂的比例（88%）高于非幸存者（53%）（p <； 0.01）。幸存者使用芬太尼、咪达唑仑和右美托咪定的天数更长；在NMBA的使用或药物剂量方面没有观察到差异。死亡率为63%。死亡率的独立预测因子包括APACHE II、SOFA24、Charlson评分、中位RASS和非苯二氮卓类镇静剂的使用。结论强调ABCDEF束ACD成分的标准化方案，以及在人员有限的情况下适当使用镇静和NMBAs，有效地支持镇静管理，在幸存者和非幸存者之间没有显着的剂量差异。镇静水平和非苯二氮卓类镇静剂的使用与更好的结果独立相关，突出了轻度镇静和ABCDEF束的重要性。

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引用次数: 0

Organización de los Servicios de Medicina Intensiva para una asistencia de calidad. Recomendaciones de la SOGAMIUC utilizando una metodología Delphi (con el respaldo de SEMICYUC, SAMI, SBMICIUC, SOCAMICYUC, SNMIUC, SCLMICYUC, SOCMIC, SEXMICYUC, SOMIUC) 组织重症监护服务，提供高质量的护理。SOGAMIUC使用Delphi方法的建议（由SEMICYUC、SAMI、SBMICIUC、SOCAMICYUC、SNMIUC、SCLMICYUC、SOCMIC、SEXMICYUC、SOMIUC支持）

IF 3.1 4区医学 Q2 CRITICAL CARE MEDICINE

Medicina Intensiva

Pub Date : 2025-11-01 DOI: 10.1016/j.medin.2025.502267

Pablo Vidal-Cortés , Rocío Gómez-López , Emilio Rodríguez-Ruiz , Paula Fernández-Ugidos , Fernando Eiras Abalde , Lorena del Río-Carbajo , Jorge Nieto-del Olmo , Daniel Ernesto Suárez Fernández , Ana María Ferreiro González , Mónica Mourelo Fariña , Pedro Rascado Sedes , María José de la Torre Fernández , José Luis Martínez Melgar , Miguel Ángel Fernández López , María José Castro Orjales , Patricia Barral Segade , Víctor José López Ciudad , María Isabel Álvarez Diéguez , Salvador Fojón Polanco

The proper organization of Intensive Care Medicine Departments is a key element in order to ensure high-quality care of critically ill patients and to preserve the well-being of healthcare professionals. Using a Delphi methodology, the Galician Society of Intensive Care Medicine and Coronary Units (SOGAMIUC) has reached a consensus on a set of recommendations covering structure, clinical organization, continuous care, specialized programs, and staffing requirements in ICUs. These recommendations aim to optimize continuity of care and patient safety, promote a healthy work environment, and encourage the development of advanced clinical programs. Implementation of these measures is proposed as an essential step toward improving clinical outcomes and the well-being of healthcare professionals in Intensive Care Departments.

重症监护室的适当组织是确保重症患者高质量护理和维护医疗保健专业人员健康的关键因素。加利西亚重症监护医学和冠状动脉病房协会（SOGAMIUC）采用德尔菲方法，就icu的结构、临床组织、持续护理、专业项目和人员配备要求等一系列建议达成了共识。这些建议旨在优化护理的连续性和患者安全，促进健康的工作环境，并鼓励发展先进的临床方案。这些措施的实施被认为是改善临床结果和重症监护室医护人员福祉的重要一步。

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引用次数: 0

Contrast media extravasation mimicking subarachnoid hemorrhage due to hypertensive encephalopathy 高血压脑病引起的类似蛛网膜下腔出血的造影剂外渗

IF 3.1 4区医学 Q2 CRITICAL CARE MEDICINE

Medicina Intensiva

Pub Date : 2025-10-01 DOI: 10.1016/j.medin.2025.502208

Gökhan Tonkaz, Merve Nur Taşdemir, Mehmet Tonkaz

引用次数: 0

Reduction of norepinephrine versus vasopressin in the stabilization phase of septic shock: RENOVA clinical trial 去甲肾上腺素与加压素在脓毒性休克稳定期的对照：RENOVA临床试验

IF 3.1 4区医学 Q2 CRITICAL CARE MEDICINE

Medicina Intensiva

Pub Date : 2025-10-01 DOI: 10.1016/j.medin.2025.502147

Cássio Mallmann , Thizá Maria Bianchi Galiotto , Michele Salibe de Oliveira , Rafael Barberena Moraes

Objective

Evaluate the incidence of hypotension during the weaning phase of vasopressors.

Design

A single-center, open-label randomized clinical trial between May and December 2022.

Setting

a tertiary care academic medical center.

Patients

91 adult patients over 18 years of age with septic shock (according to Sepsis-3).

Intervention

Patients were divided into two groups: initial reduction of norepinephrine or initial reduction of vasopressin.

Main variables of interest

The primary outcome was the incidence of hypotension within the first 24 h after reducing vasopressors. Additionally, the clinical impact of this hypotension was assessed through mortality, length of hospital stay, duration of vasopressor use, incidence of arrhythmias, and prevalence of hemodialysis.

Results

Out of a total of 91 patients, 78 were included in the analysis: 39 in the norepinephrine group and 39 in the vasopressin group. Despite a numerically significant difference in the incidence of hypotension between the groups (norepinephrine 43.6%, vasopressin 25.6%), there was no statistical difference (p =  0.153, relative risk = 1.7, 95% confidence interval: 0.9–3.2). In this sample, vasopressin withdrawal was predominantly titrated. There were no differences between the groups in terms of the evaluated clinical outcomes.

Conclusion

No differences were detected in the incidence of hypotension when weaning was initiated with norepinephrine or vasopressin, although it was non significantly higher in norepinephrine group. In our sample, vasopressin withdrawal was titrated, which differs from North American practice. Brazilian Clinical Trials Registry (REBEC: RBR-10smbw65). ClinicalTrials.gov platform (NCT 05506319).

目的探讨降压药脱机期低血压的发生率。在2022年5月至12月期间进行一项单中心、开放标签随机临床试验。建立三级保健学术医疗中心。患者：91例18岁以上感染性休克的成人患者（根据《败血症-3》）。患者被分为两组：初始降低去甲肾上腺素或初始降低抗利尿激素。主要观察指标为降低血管降压药后24小时内的低血压发生率 h。此外，通过死亡率、住院时间、血管加压药使用时间、心律失常发生率和血液透析患病率来评估这种低血压的临床影响。结果91例患者中，78例纳入分析：去甲肾上腺素组39例，加压素组39例。尽管两组间低血压的发生率在数值上有显著差异（去甲肾上腺素43.6%，加压素25.6%），但没有统计学差异（p = 0.153，相对风险= 1.7,95%可信区间：0.9-3.2）。在这个样本中，抗利尿激素的戒断主要是滴定的。在评估的临床结果方面，两组之间没有差异。结论去甲肾上腺素组与加压素组的低血压发生率无显著性差异，去甲肾上腺素组与加压素组的低血压发生率无显著性差异。在我们的样本中，抗利尿激素的戒断是滴定的，这与北美的做法不同。巴西临床试验注册中心（REBEC: RBR-10smbw65）。ClinicalTrials.gov平台（NCT 05506319）。

{"title":"Reduction of norepinephrine versus vasopressin in the stabilization phase of septic shock: RENOVA clinical trial","authors":"Cássio Mallmann , Thizá Maria Bianchi Galiotto , Michele Salibe de Oliveira , Rafael Barberena Moraes","doi":"10.1016/j.medin.2025.502147","DOIUrl":"10.1016/j.medin.2025.502147","url":null,"abstract":"<div><h3>Objective</h3><div>Evaluate the incidence of hypotension during the weaning phase of vasopressors.</div></div><div><h3>Design</h3><div>A single-center, open-label randomized clinical trial between May and December 2022.</div></div><div><h3>Setting</h3><div>a tertiary care academic medical center.</div></div><div><h3>Patients</h3><div>91 adult patients over 18 years of age with septic shock (according to Sepsis-3).</div></div><div><h3>Intervention</h3><div>Patients were divided into two groups: initial reduction of norepinephrine or initial reduction of vasopressin.</div></div><div><h3>Main variables of interest</h3><div>The primary outcome was the incidence of hypotension within the first 24 h after reducing vasopressors. Additionally, the clinical impact of this hypotension was assessed through mortality, length of hospital stay, duration of vasopressor use, incidence of arrhythmias, and prevalence of hemodialysis.</div></div><div><h3>Results</h3><div>Out of a total of 91 patients, 78 were included in the analysis: 39 in the norepinephrine group and 39 in the vasopressin group. Despite a numerically significant difference in the incidence of hypotension between the groups (norepinephrine 43.6%, vasopressin 25.6%), there was no statistical difference (<em>p</em> =  0.153, relative risk = 1.7, 95% confidence interval: 0.9–3.2). In this sample, vasopressin withdrawal was predominantly titrated. There were no differences between the groups in terms of the evaluated clinical outcomes.</div></div><div><h3>Conclusion</h3><div>No differences were detected in the incidence of hypotension when weaning was initiated with norepinephrine or vasopressin, although it was non significantly higher in norepinephrine group. In our sample, vasopressin withdrawal was titrated, which differs from North American practice. Brazilian Clinical Trials Registry (REBEC: RBR-10smbw65). ClinicalTrials.gov platform (NCT 05506319).</div></div>","PeriodicalId":49268,"journal":{"name":"Medicina Intensiva","volume":"49 10","pages":"Article 502147"},"PeriodicalIF":3.1,"publicationDate":"2025-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145189701","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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