Pub Date : 2025-11-01DOI: 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.
{"title":"Advances in extracorporeal liver support for acute and acute-on-chronic liver failure","authors":"David Toapanta-Gaibor , Jesús Sánchez-Ballesteros , María González-Fernández , María Jesús Broch-Porcar","doi":"10.1016/j.medin.2025.502291","DOIUrl":"10.1016/j.medin.2025.502291","url":null,"abstract":"<div><div>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.</div><div>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.</div><div>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.</div><div>Plasma exchange (PE) has promising detoxification and immunomodulatory effects, improving survival in ALF. In ACLF, PE may reduce systemic inflammation, though evidence remains limited.</div><div>Further studies are needed to optimize ECLS therapies, refine patient selection, and establish their role in ALF and ACLF management.</div></div>","PeriodicalId":49268,"journal":{"name":"Medicina Intensiva","volume":"49 11","pages":"Article 502291"},"PeriodicalIF":3.1,"publicationDate":"2025-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145425872","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 : 2025-11-01DOI: 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.
{"title":"The role of point-of-care ultrasonography in central venous catheter insertion: A randomized controlled trial of safety and cost-effectiveness","authors":"Ahmed Beniamen , Ahmed Mosallem , Hossam Tharwat Ali , Hanaa A. Nofal , Essamedin M. Negm","doi":"10.1016/j.medin.2025.502221","DOIUrl":"10.1016/j.medin.2025.502221","url":null,"abstract":"<div><h3>Objective</h3><div>The objective of the study was to compare landmark-based and ultrasound-guided techniques of central venous catheter insertion (CVC).</div></div><div><h3>Design</h3><div>Randomized controlled trial (2021–2023).</div></div><div><h3>Setting</h3><div>Zagazig University Hospitals (ZUH), a tertiary care center.</div></div><div><h3>Patients</h3><div>Adult patients in whom CVC insertion is indicated.</div></div><div><h3>Main variables of interest</h3><div>Demographic and clinical peri-procedural data, the safety of the technique, time of performance, and cost-effectiveness were compared.</div></div><div><h3>Results</h3><div>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).</div></div><div><h3>Conclusion</h3><div>Point-of-care ultrasonography bundle for CVC insertion is considered superior to, safer, and more cost-effective than the blind technique.</div></div>","PeriodicalId":49268,"journal":{"name":"Medicina Intensiva","volume":"49 11","pages":"Article 502221"},"PeriodicalIF":3.1,"publicationDate":"2025-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145425950","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 : 2025-11-01DOI: 10.1016/j.medin.2025.502264
Sara Alcántara Carmona, Miguel Ángel Romera Ortega
{"title":"Sedación y COVID-19. Tiempo de olvidar, tiempo de retornar","authors":"Sara Alcántara Carmona, Miguel Ángel Romera Ortega","doi":"10.1016/j.medin.2025.502264","DOIUrl":"10.1016/j.medin.2025.502264","url":null,"abstract":"","PeriodicalId":49268,"journal":{"name":"Medicina Intensiva","volume":"49 11","pages":"Article 502264"},"PeriodicalIF":3.1,"publicationDate":"2025-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145425946","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 : 2025-11-01DOI: 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
{"title":"Evaluation of functional brain damage using resting-state functional magnetic resonance imaging in patients with diffuse axonal injury admitted to the ICU","authors":"Patricia Serrats-López , Juan Antonio Llompart-Pou , Ana María González-Roldán , Juan Lorenzo Terrasa-Navarro , Apolonia Moll-Servera , Jon Pérez-Bárcena","doi":"10.1016/j.medin.2025.502260","DOIUrl":"10.1016/j.medin.2025.502260","url":null,"abstract":"","PeriodicalId":49268,"journal":{"name":"Medicina Intensiva","volume":"49 11","pages":"Article 502260"},"PeriodicalIF":3.1,"publicationDate":"2025-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145425909","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 : 2025-11-01DOI: 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.
{"title":"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","authors":"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","doi":"10.1016/j.medin.2025.502176","DOIUrl":"10.1016/j.medin.2025.502176","url":null,"abstract":"<div><h3>Objective</h3><div>To describe in-hospital and one-year mortality and to identify prognostic variables associated with mortality.</div></div><div><h3>Design</h3><div>Retrospective cohort study.</div></div><div><h3>Setting</h3><div>Tertiary referral hospital in Barcelona (Spain).</div></div><div><h3>Patients</h3><div>Consecutive patients with solid cancer and unplanned admission to the ICU over a ten year period (2010–2019).</div></div><div><h3>Main variables of interest</h3><div>In-hospital mortality, one-year mortality, type of cancer, metastatic disease, ECOG, APACHE, SOFA, invasive mechanical ventilation, vasoactive drugs, renal replacement therapy.</div></div><div><h3>Results</h3><div>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.</div></div><div><h3>Conclusion</h3><div>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 <em>per se</em>. 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.</div></div>","PeriodicalId":49268,"journal":{"name":"Medicina Intensiva","volume":"49 11","pages":"Article 502176"},"PeriodicalIF":3.1,"publicationDate":"2025-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145425948","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 : 2025-11-01DOI: 10.1016/j.medin.2025.502262
Gabriel Appendino, Celeste Gomez, Carlos Lovesio
{"title":"Implementación de la tomografía por impedancia eléctrica en la enfermedad pleuropulmonar del paciente adulto","authors":"Gabriel Appendino, Celeste Gomez, Carlos Lovesio","doi":"10.1016/j.medin.2025.502262","DOIUrl":"10.1016/j.medin.2025.502262","url":null,"abstract":"","PeriodicalId":49268,"journal":{"name":"Medicina Intensiva","volume":"49 11","pages":"Article 502262"},"PeriodicalIF":3.1,"publicationDate":"2025-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145425922","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 : 2025-11-01DOI: 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
{"title":"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","authors":"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","doi":"10.1016/j.medin.2025.502257","DOIUrl":"10.1016/j.medin.2025.502257","url":null,"abstract":"","PeriodicalId":49268,"journal":{"name":"Medicina Intensiva","volume":"49 11","pages":"Article 502257"},"PeriodicalIF":3.1,"publicationDate":"2025-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145424328","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 : 2025-11-01DOI: 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.
{"title":"Analgesia, sedation, and neuromuscular blocking agents: A standardized protocol of analgosedation in COVID-19","authors":"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","doi":"10.1016/j.medin.2025.502223","DOIUrl":"10.1016/j.medin.2025.502223","url":null,"abstract":"<div><h3>Objectives</h3><div>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.</div></div><div><h3>Design</h3><div>Retrospective cohort study.</div></div><div><h3>Setting</h3><div>Medical-surgical ICU.</div></div><div><h3>Patients</h3><div>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.</div></div><div><h3>Interventions</h3><div>None.</div></div><div><h3>Main variables of interest</h3><div>Level of sedation, use, daily doses, and duration of analgosedative drugs; hospital mortality and associated factors.</div></div><div><h3>Results</h3><div>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, SOFA<sub>24</sub>, Charlson score, median RASS, and non-benzodiazepine sedative use.</div></div><div><h3>Conclusions</h3><div>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.</div></div>","PeriodicalId":49268,"journal":{"name":"Medicina Intensiva","volume":"49 11","pages":"Article 502223"},"PeriodicalIF":3.1,"publicationDate":"2025-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145425947","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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